Self monitoring of blood glucose in type 2 diabetes

BMJ, doi:10.1136/bmj.39538.469421.80 (published 17 April 2008)

Editorials
By: Martin Gulliford, professor of public health, Department of Public Health Sciences, London

• Self monitoring – whether intensive or not – is unlikely to be cost effective if added to standardised usual care and initially reduces quality of life.
• Self monitoring also had no effect over one year on:
• HbA1c,
• body mass index,
• use of oral hypoglycaemic drugs,
• or reported hypoglycaemia
• but was associated with a 6% higher score for depression.
• Self monitoring of blood glucose in type 2 diabetes may not be clinically beneficial or cost effective, and may reduce quality of life.

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Complaints against doctors

BMJ 2008;336:841-842 (19 April).

Editorials
By: Paul Kinnersley, reader, Adrian Edwards, professor, Department of Primary Care and Public Health, Cardiff University.

Complaints against doctors:
Could be reduced by identifying and remedying poor communication skills early on.

Clinical communication skills are at the heart of medical practice, and poor performance is an important factor in the origins of complaints and litigation. A recent study from Canada shows that poorly performing doctors can be identified early in their careers and possibly given targeted support and appropriate further training.

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Doctors’ education: the invisible influence of drug company sponsorship

BMJ 2008;336:416-417 (23 February).

As calls to end drug companies’ direct sponsorship of doctors’ education echo round the world, an investigation in Australia reveals sponsor involvement in the education of thousands of general practitioners, writes Ray Moynihan, conjoint lecturer, University of Newcastle, New South Wales, and visiting editor, BMJ

• Harvard professor David Blumenthal, an internationally recognised authority on relationships between doctors and drug companies, says that the industry is certainly looking for a return on its investment in medical education.
• “Why would for-profit companies, in this country at least (the United States), pour more than a billion dollars a year into continuing medical education without the expectation of gaining anything from it?” he asks.
• The obvious problem with allowing sponsors to suggest speakers is that they will tend to select speakers who will at best, from the company’s viewpoint, favour their drug or, at least, not contradict the sponsor’s marketing messages.
• The problem is not that individual speakers will change their presentations according to sponsor’s wishes;
• the problem is that doctors attending these sponsored sessions may not be getting the full range of views, in an educational setting supposedly free of industry influence.
• In a landmark paper in 2006 Professor Blumenthal and colleagues called on academic medical centres in the US to end the direct drug company sponsorship of continuing medical education events (also known as continuing professional development).
• In its place they suggested the creation of some sort of blind trust to fund education at an institution level.
• Others, such as Peter Mansfield from HealthySkepticism, a group critical of pharmaceutical marketing, have called for medical education to be funded by the taxpayer through a system of competitive grants.

Perhaps the recent revelations from Australia—and confirmation from the industry itself that it is “not unusual” for sponsors to suggest speakers—will sharpen the lines of debate about how to achieve more independent education or at least greater transparency.

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