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The BMJ Today: Smoking outdoors, substandard drugs in trials, and managing lower gastrointestinal symptoms

Here is my personal selection of what is new on The BMJ today:

Head to Head
smoking_park• Is a smoking ban in UK parks and outdoor spaces a good idea? 

In this topical debate, Ara Darzi and Oliver P Keown call for a ban to help smokers quit and to protect children from seeing people lighting up.

However, Simon Chapman says that there is no scientific justification for such a draconian attack on basic freedoms.

Analysis
drugs_quality_control• Quality assurance of drugs used in clinical trials: proposal for adapting guidelines

Paul Newton and colleagues draw attention to the problem of including substandard and falsified drugs in clinical trials. They say that while such drugs are recognised as an enormous public health problem, particularly in the developing world, their inclusion in clinical trials has been neglected.

The authors cite as examples the degradation of vitamin A capsules, poor quality sulfadoxine-pyrimethamine for a study of malaria in pregnancy in Africa, and falsified clopidogrel in the US. They call for clinical trial guidelines (CONSORT, SPIRIT, STARD, TIDieR) and good clinical practice guidelines from WHO and ICH to include a requirement to determine and state the quality of drugs.

Practice
• Investigating young adults with chronic diarrhoea in primary care
• Irritable bowel syndrome in adults in primary care: summary of updated NICE guidance

These two education articles shine the spotlight on patients presenting with lower gastrointestinal symptoms. The first considers the tests that should be performed and the referral thresholds when young adults present chronic diarrhoea.

abdominal_painThe second is a summary of NICE guidance on managing adults with irritable bowel syndrome, which—the authors say—has an estimated prevalence of 10-20%, mostly affects people aged 20-30 years, and is twice as common in women as in men. They take readers through the latest recommendations for initial assessment, diagnostic tests, dietary and lifestyle advice, drug therapy, and complementary and alternative medicine approaches.

Trevor Jackson is deputy editor and head of news and views, The BMJ.