{"id":3249,"date":"2010-08-02T12:03:35","date_gmt":"2010-08-02T11:03:35","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=3249"},"modified":"2010-08-02T12:03:35","modified_gmt":"2010-08-02T11:03:35","slug":"richard-lehmans-journal-blog-2-august-2010","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/","title":{"rendered":"Richard Lehman’s journal blog 2 August 2010"},"content":{"rendered":"

\"Richard JAMA 21 July 2010 Vol 235<\/strong> JAMA\u00a0 28 July 2010\u00a0 Vol 469<\/strong>
\n469<\/strong>\u00a0\u00a0\u00a0 It is a solemn sight to see the great medical journals gathering to pronounce that rosiglitazone is dead. Like the bird of loudest lay in Shakespeare’s The Phoenix and the Turtle<\/em>, JAMA leads the troop of mourners with this big observational comparison with pioglitazone which it published on its website a month ago. It is accompanied by a sensible editorial pointing out that since we now have observational studies and meta-analyses enough, all of them showing that pioglitazone is the safer of these two thiazolidinediones, why should we keep the worse drug in circulation? Not that pioglitazone is a particularly safe drug itself: it probably increases rates of myocardial infarction and certainly worsens heart failure, even while it decreases glycaemia. The fact is that glycaemia, however you measure it, is a very bad surrogate for real outcomes in treating diabetes: something we should have got wise to long ago.
\nhttp:\/\/jama.ama-assn.org\/cgi\/content\/abstract\/304\/4\/411<\/a><\/p>\n

419<\/strong>\u00a0\u00a0\u00a0 There is a time to be born, as the Preacher says in Ecclesiastes; and that time is at 40 weeks’ gestation. This big trawl of US databases shows that just three weeks earlier than that, the risk of respiratory distress at birth is three times higher; at 34 weeks, it is 40 times higher. A needful reminder that even in the modern age, obstetrics is a risky business and that babies are usually better off left in the womb for as long as possible.
\nhttp:\/\/jama.ama-assn.org\/cgi\/content\/abstract\/304\/4\/419<\/a><\/p>\n

435<\/strong>\u00a0\u00a0\u00a0 My English town is, alas, full of fat young people; more even than I saw on a visit to the USA a year ago. I worry for them, since getting rid of large amounts of fat is an impossible task for most human beings, and many will end up needing bariatric surgery. This just doesn’t seem right, but is the only effective intervention, and fortunately it is generally a safe one, at least in Michigan. This careful audit compares ordinary hospitals with “centers of excellence” and high volume surgeons with low volume surgeons. There is no difference between excellent and ordinary centres but there is a roughly twofold difference in the complication rates between low- and high-volume operators. In the brave new NHS, GPs will have to ensure that there is a high-volume bariatric surgery centre in every town.
\nhttp:\/\/jama.ama-assn.org\/cgi\/content\/abstract\/304\/4\/435<\/a><\/p>\n

304<\/strong>\u00a0\u00a0 Seasoned pedantic Journal Watchers – and I hope that includes most of you – will recollect that JAMA rarely uses the eponymous genitive whereas the NEJM always does. Hence the title of this JAMA review: Treatment of Primary Sj\u00f6gren Syndrome. It would have been ” Sj\u00f6gren’s” in the New England Journal. Never mind. Henrik Sj\u00f6gren (1899-1986) was a Swedish ophthalmologist whose name has become attached to the sicca syndrome of indequate tears and saliva, first described by Jan Mikulicz-Radecki (1850-1905). Polish pride urges me to call it by its original and proper name, Mikulicz’s syndrome, but Mikulicz-Radecki himself would not have cared a jot. When asked his nationality, he replied: “I am a surgeon.” The evidence-based treatment for this syndrome, however you label it, is quite old-fashioned: not rituximab or TNF blockers but pilocarpine or cevimeline for sicca features and topical cyclosporine for dry eyes.
\nhttp:\/\/jama.ama-assn.org\/cgi\/content\/abstract\/304\/4\/452<\/a><\/p>\n

461<\/strong>\u00a0\u00a0 I’m told that some people find JAMA boring and old fashioned, but being that way myself, I like it. I used to look forward to the front covers and the essays about them until Therese Southgate finally retired. I occasionally have a laugh at the “poetry” – last week’s was a particular hoot. The papers are frequently good. A recent innovation – greatly daring – is the inclusion of brief commentaries on hot topics. These vary from dire to brilliant. I really like this one on colonoscopy vs sigmoidoscopy screening. If you want a an extreme example of how counterintuitive medicine can be, consider the fact that screening colonoscopy has never been shown to be superior to screening sigmoidoscopy, and that colonoscopy has been shown to reduce mortality from left sided bowel cancers but not right-sided ones. This is really difficult to get to the bottom of.
\nhttp:\/\/jama.ama-assn.org\/cgi\/content\/extract\/304\/4\/461<\/a><\/p>\n

NEJM\u00a0 29 July 2010\u00a0 Vol 363<\/strong><\/p>\n

411<\/strong>\u00a0\u00a0\u00a0 Metastatic prostate cancer usually responds well to castration by surgery (rare nowadays) or by androgen-deprivation therapy, but recurs within a couple of years or so. At that point median survival is between one and two years and there is no one standard treatment to resort to. I have a feeling that this trial of sipuleucel-T is not going to change that very much. It is an individualised immunotherapy technique rather than a drug: the patient’s own peripheral-blood mononuclear cells are harvested, primed to attack prostate specific antigens and then reintroduced in three injections. Weirdly, this produced no tumour shrinkage but an overall postponement of death by 4 months, observable in the remaining survivors compared with the placebo group for about 4 years. The editorial (p.479) queries the design of the trial and the plausibility of these findings, but on a more cheerful note lists a number of more promising drug trials for advanced prostate cancer.
\nhttp:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1001294<\/a><\/p>\n

423<\/strong>\u00a0\u00a0\u00a0 Every year I am supposed to undergo three hours of Completely Pointless Retraining, or CPR for short. Fortunately I have devised a cunning plan to avoid this, which I am not at liberty to share with you. I was incensed to learn that our Instructor was still insisting that we spend part of these 3 hours learning to perform rescue breathing when it has been abundantly clear for several years that chest compression alone will achieve the same result as chest compression interrupted by rescue breathing, i.e. death in nine out of ten cases. When I become local health supremo with a budget of \u00a31bn I will insist that everybody is allowed no more than 15 minutes every 5 years for out-of-hospital CPR training, consisting of a reminder of how to compress the chest. I will cite this US\/UK study and the very similar one from Sweden which follows it (p.434).
\nhttp:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa0908993<\/a><\/p>\n

454<\/strong>\u00a0\u00a0 Another tempting career to supplement my NHS pension is that of sham acupuncturist. There will be a huge market for this in the new GP-led NHS. It is a well-trialled treatment for low back pain, as this review reminds us: cheap, harmless and moderately effective, unlike practically all other interventions for back pain. There is absolutely no need to know your yaoyangguan from your huantiao; just buy some sterile needles and get going as soon as you like. It helps to have a plausible manner and to look Chinese, though I must say I rather fall down on the latter.
\nhttp:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMct0806114<\/a><\/p>\n

Lancet\u00a0 31 July 2010<\/strong><\/p>\n

333<\/strong>\u00a0\u00a0\u00a0 JUPITER took many forms in ancient Rome, and the trial named after him tries to do the same. This was the study that compared the effect of rosuvastatin with placebo in people with no history of cardiovascular disease or diabetes or raised LDL-cholesterol but with a CRP of 2mg\/L or above. The rosuvastatin-treated group had 44% fewer events and their LDL-cholesterol showed the expected fall. But so did their HDL-cholesterol, which should have cancelled out some of the benefit. The paper here points out that it did not: when LDL-cholesterol is low, they argue, HDL-cholesterol no longer matters. But actually all you can say is that it failed to matter in people who were given a certain dose of a drug called rosuvastatin: you can’t generalise from this into the overall effects of subfractions of cholesterol. I do find all this special pleading by lipidologists depressingly circular: the editorial on p.305 is even worse. For a mind-clearing antidote read the brilliant overview just posted on the BMJ website, “Shifting views on lipid-lowering therapy” by Harlan Krumholz and Rodney Hayward.
\nhttp:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(10)60713-1\/abstract<\/a>
\nhttp:\/\/www.bmj.com\/cgi\/content\/extract\/341\/jul28_3\/c3531<\/a><\/p>\n

BMJ\u00a0 31 July 2010\u00a0 Vol 341<\/strong><\/p>\n

233<\/strong>\u00a0\u00a0\u00a0 It is impossible to read a completely clear account of the breast screening controversy, because the issue is intrinsically murky. But Klim McPherson’s analysis of the data is the clearest you will ever get. It won’t change your mind on this subject if you already have a strong opinion, but then it doesn’t set out to do that. Instead it points out the huge range of uncertainty in the existing studies, making it almost impossible to give women meaningful figures on which to base a choice. It’s a real tragedy that cancer screening programmes are still being rolled out with the same inadequate amount of evidence, and with accompanying information which plays down the uncertainties. I have just thrown my bowel cancer screening kit in the bin.
\nhttp:\/\/www.bmj.com\/cgi\/content\/extract\/340\/jun24_1\/c3106<\/a><\/p>\n

237\u00a0<\/strong>\u00a0\u00a0 Lifestyle Over and Above Drugs in Diabetes (LOADD) is a principle we can all agree on, at least in the earlier stages of type 2. Every drug we use to lower HbA1c\u00a0 in this condition has its disadvantages and we simply don’t know long-term\u00a0 effects of some of the polypharmacy that has become popular recently, such as metformin plus a dipeptidyl-peptidase inhibitor. We know from the observational study of Currie et al earlier this year that overall, drug-based strategies used in the UK to reduce HbA1c below 7.5 tend to increase mortality. The LOADD study from Dunedin in New Zealand sought to get HbA1c\u00a0 even lower – below 7 – using diet and exercise alone. They succeeded, and may even have improved the long-term outlook of some of their patients by so doing. We shall never know, since the trial was both underpowered\u00a0 (n=93) and heterogeneous (the exact drug treatments are not specified).
\nhttp:\/\/www.bmj.com\/cgi\/content\/full\/341\/jul20_2\/c3337<\/a><\/p>\n

239\u00a0<\/strong>\u00a0\u00a0 Vaccines that work: there’s a nice cheery topic when most of the rest of medicine is a confusing and subject to the whims of lunatic politicians. Give them quadrivalent human papillomavirus vaccine and it does just what it says on the syringe: it provides 96% protection against low grade cervical, vulval, and vaginal intraepithelial neoplasia and anogenital warts.
\nhttp:\/\/www.bmj.com\/cgi\/content\/full\/341\/jul20_1\/c3493<\/a><\/p>\n

240\u00a0<\/strong>\u00a0 There is a time to be born, as the preacher says in Ecclesiastes (the second time I’ve said that in this blog); and that time is between 0900 and 1700 on a weekday. Babies delivered at term outside these hours in Scotland are 60-70% more likely to die from anoxia. This is quite a shocking figure, and I guess we may be in for more shocks when we at last get place-of-birth morbidity figures for England and Wales later this year.
\nhttp:\/\/www.bmj.com\/cgi\/content\/full\/341\/jul15_1\/c3498<\/a><\/p>\n

Arch Intern Med\u00a0 26 July 2010\u00a0<\/strong><\/p>\n

1191<\/strong>\u00a0\u00a0\u00a0 Rosiglitazone increases the risk of myocardial infarction. We’ve known that for about 3 years, but oddly nobody has yet proved that it increases cardiovascular mortality. This latest meta-analysis gives the overall figures with and without the infamous RECORD study, which I won’t go on about. Although there are many similarities, the data on this drug are not as damning as they were for another discredited drug, rofecoxib. But just as rofecoxib disappeared because there was celecoxib, so rosiglitazone will disappear because there is pioglitazone: and the debate will only continue in the law courts, between patient group lawyers and the manufacturers.
\nhttp:\/\/archinte.ama-assn.org\/cgi\/content\/abstract\/170\/14\/1191<\/a><\/p>\n

1256<\/strong>\u00a0\u00a0 I love the “Less\u00a0is More” series, and not just for its whacky title. As far as I’m concerned, the less PSA testing we do, the better, and that’s the moral of this paper – sort of. The fact is that we don’t really know how to use this test, except to monitor the progression of disseminated prostate cancer. We don’t really know how best to treat prostate cancer, full stop. We can’t reliably separate out cancers that will do harm and those that will stay dormant. So the American way is to treat them all aggressively as soon as possible, as illustrated by this stratification of prostate treatment by PSA level. The “cancers” detected with PSA levels below 4 get the most aggressive treatment of all. This and much else is chewed over in the Invited Commentary which follows the paper – good, but not as good as the BMJ commentary on breast screening.
\nhttp:\/\/archinte.ama-assn.org\/cgi\/content\/abstract\/170\/14\/1256<\/a><\/p>\n

Plant of the Week: Belamcanda chinensis<\/em><\/strong><\/p>\n

This slightly outrageous border plant sits out the earlier part of the season looking like an iris of moderate size. Then, just as most other border plants are looking seedy, it throws up a stalk from which emerge a series of star-shaped flowers of bright orange mottled with crimson.<\/p>\n

I am not sure whether this plant has any vices. It has survived a brutal winter and seems to like a dry summer. I expect it splits as easily as most of its cousins in the iris family. Plant it wherever your late summer garden threatens to look sedate and tasteful.<\/p>\n

Poem of the Week: The Phoenix and the Turtle<\/em> by W Shakespeare<\/strong><\/p>\n

Good luck with making sense of this poem. In a way, you don’t need to. Two tips: the “turtle” is a turtle dove, and “the bird of loudest lay \/ On the sole Arabian tree” should be a phoenix, but later in the poem it is clear that it can’t be, since the phoenix turns out to be dead. Now carry on.<\/p>\n

Let the bird of loudest lay,
\nOn the sole Arabian tree,
\nHerald sad and trumpet be,
\nTo whose sound chaste wings obey.
\nBut thou, shriking harbinger,
\nFoul pre-currer of the fiend,
\nAugur of the fever’s end,
\nTo this troop come thou not near.
\nFrom this session interdict
\nEvery fowl of tyrant wing,
\nSave the eagle, feather’d king:
\nKeep the obsequy so strict.
\nLet the priest in surplice white,
\nThat defunctive music can,
\nBe the death-divining swan,
\nLest the requiem lack his right.
\nAnd thou, treble-dated crow,
\nThat thy sable gender mak’st
\nWith the breath thou giv’st and tak’st,
\n‘Mongst our mourners shalt thou go.
\nHere the anthem doth commence:
\nLove and constancy is dead;
\nPhoenix and the turtle fled
\nIn a mutual flame from hence.
\nSo they lov’d, as love in twain
\nHad the essence but in one;
\nTwo distincts, division none:
\nNumber there in love was slain.
\nHearts remote, yet not asunder;
\nDistance, and no space was seen
\n‘Twixt the turtle and his queen;
\nBut in them it were a wonder.
\nSo between them love did shine,
\nThat the turtle saw his right
\nFlaming in the phoenix’ sight:
\nEither was the other’s mine.
\nProperty was thus appall’d,
\nThat the self was not the same;
\nSingle nature’s double name
\nNeither two nor one was call’d.
\nReason, in itself confounded,
\nSaw division grow together;
\nTo themselves yet either-neither,
\nSimple were so well compounded
\nThat it cried how true a twain
\nSeemeth this concordant one!
\nLove hath reason, reason none
\nIf what parts can so remain.
\nWhereupon it made this threne
\nTo the phoenix and the dove,
\nCo-supreme and stars of love;
\nAs chorus to their tragic scene.
\nTHRENOS.
\nBeauty, truth, and rarity.
\nGrace in all simplicity,
\nHere enclos’d in cinders lie.
\nDeath is now the phoenix’ nest;
\nAnd the turtle’s loyal breast
\nTo eternity doth rest,
\nLeaving no posterity:–
\n‘Twas not their infirmity,
\nIt was married chastity.
\nTruth may seem, but cannot be:
\nBeauty brag, but ’tis not she;
\nTruth and beauty buried be.
\nTo this urn let those repair
\nThat are either true or fair;
\nFor these dead birds sigh a prayer.<\/p>\n

Published 1601<\/p>\n","protected":false},"excerpt":{"rendered":"

JAMA 21 July 2010 Vol 235 JAMA\u00a0 28 July 2010\u00a0 Vol 469 469\u00a0\u00a0\u00a0 It is a solemn sight to see the great medical journals gathering to pronounce that rosiglitazone is […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":38363,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[],"class_list":["post-3249","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-lehmans-weekly-review-of-medical-journals"],"yoast_head":"\nRichard Lehman's journal blog 2 August 2010 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Lehman's journal blog 2 August 2010 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"JAMA 21 July 2010 Vol 235 JAMA\u00a0 28 July 2010\u00a0 Vol 469 469\u00a0\u00a0\u00a0 It is a solemn sight to see the great medical journals gathering to pronounce that rosiglitazone is [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2010-08-02T11:03:35+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"540\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"13 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Richard Lehman’s journal blog 2 August 2010\",\"datePublished\":\"2010-08-02T11:03:35+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/\"},\"wordCount\":2634,\"commentCount\":1,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/richard-lehman.jpg\",\"articleSection\":[\"Richard Lehman's weekly review of medical journals\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/\",\"name\":\"Richard Lehman's journal blog 2 August 2010 - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/richard-lehman.jpg\",\"datePublished\":\"2010-08-02T11:03:35+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/richard-lehman.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/richard-lehman.jpg\",\"width\":540,\"height\":350},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2010\\\/08\\\/02\\\/richard-lehmans-journal-blog-2-august-2010\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Richard Lehman’s journal blog 2 August 2010\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Richard Lehman's journal blog 2 August 2010 - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/","og_locale":"en_US","og_type":"article","og_title":"Richard Lehman's journal blog 2 August 2010 - The BMJ","og_description":"JAMA 21 July 2010 Vol 235 JAMA\u00a0 28 July 2010\u00a0 Vol 469 469\u00a0\u00a0\u00a0 It is a solemn sight to see the great medical journals gathering to pronounce that rosiglitazone is [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2010-08-02T11:03:35+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","type":"image\/jpeg"}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"13 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Richard Lehman’s journal blog 2 August 2010","datePublished":"2010-08-02T11:03:35+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/"},"wordCount":2634,"commentCount":1,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","articleSection":["Richard Lehman's weekly review of medical journals"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/","url":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/","name":"Richard Lehman's journal blog 2 August 2010 - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","datePublished":"2010-08-02T11:03:35+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","width":540,"height":350},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/02\/richard-lehmans-journal-blog-2-august-2010\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"Richard Lehman’s journal blog 2 August 2010"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/3249","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=3249"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/3249\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/38363"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=3249"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=3249"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=3249"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}