Family doctors ‘make 600 mistakes a day’

By: Jeremy Laurance, Health Editor, The Independent
11 December 2008

Family doctors are committing up to 600 errors a day, mainly in diagnosis and treatment, but are among the worst staff at reporting them, an NHS watchdog says today.

Family doctors are committing up to 600 errors a day, mainly in diagnosis and treatment, but are among the worst staff at reporting them, an NHS watchdog says today.

Many errors are minor, but up to one in five cause harm to patients and failure to report them means they are more likely to be repeated, the Healthcare Commission says.

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Mobile phone use ‘raises children’s risk of brain cancer fivefold’

By: Geoffrey Lean, Environment Editor, The Independent
Sunday, 21 September 2008

Alarming new research from Sweden on the effects of radiation raises fears that today’s youngsters face an epidemic of the disease in later life.

Children and teenagers are five times more likely to get brain cancer if they use mobile phones, startling new research indicates.

The study, experts say, raises fears that today’s young people may suffer an “epidemic” of the disease in later life. At least nine out of 10 British 16-year-olds have their own handset, as do more than 40 per cent of primary schoolchildren.

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Breakthrough in migraine therapy ???

By: Jeremy Laurance, Health Editor, The Independent
Wednesday, 11 June 2008

New anti-migraine drugs that have fewer side effects than existing treatments could be on the market within three years, scientists said yesterday.

They have been developed thanks to improved understanding of the mechanism that makes the brain over-react to stimuli and will usher in a new era in management of the condition, experts say.

Migraine is a hereditary illness which affects an estimated six million Britons – or 15 per cent of all adults. It is caused by an “oversensitive” brain.

One of the new drugs – a rescue treatment known only by its code MK0974 – interrupts the sequence of chemical reactions in the brain that cause a migraine at a different point from existing drugs.

Studies have shown that the brain releases the chemical calcitonin gene-related peptide (CGRP) during a migraine. Existing drugs, called triptans, block the release of the chemical. The new drug, known as a CGRP antagonist, blocks uptake of the chemical by neighbouring nerve cells.

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Prolapsed intervertebral disc

BMJ, published 27 May 2008.

Editorials.
By: Jeremy Fairbank, professor of spinal surgery, Nuffield Orthopaedic Centre, Oxford OX3 7L

• Prolapsed intervertebral disc is common.
• Disc prolapse is genetically driven—twin studies indicate that at least 60% of the variance can be explained on genetic grounds and not by the commonly assumed environmental factors (work, trauma, exposure to excessive driving, smoking, and so on).

Current guidelines indicate that radicular pain should improve within six to eight weeks with conservative management.

• Surgery should be performed before eight weeks only in patients with progressive neurological deficit, which can be detected by magnetic resonance imaging.

If symptoms persist, evidence supports surgery after eight weeks.

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Food additives and hyperactivity

BMJ 2008;336:1144 (24 May).

An increasing number of children are taking drugs for hyperactivity.

Removing colours and preservatives is a relatively harmless activity, so a properly supervised and evaluated trial period of eliminating them should be part of standard treatment, says an editorial by Andrew Kemp, professor of paediatric allergy and clinical immunology at the University of Sydney.

• Whether preservatives and colourings cause or exacerbate hyperactive behaviours is an important question for many paediatricians and parents.
•  A recent randomised placebo controlled trial in 297 children aged 3-9 years provides evidence of increased hyperactive behaviour after they ate a mixture of food colourings and a preservative (sodium benzoate).
• In contrast to many previous studies, the children were from the general population and did not have attention-deficit/hyperactivity disorder.

The trial found an adverse effect of the mixture on behaviour as measured by a global hyperactivity aggregate score. The daily dose approximated that found in two 56 g bags of sweets.

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Effect on smoking quit rate of telling patients their lung age

BMJ 2008;336:598-600 (published 6 March 2008)

Research
Gary Parkes, general practitioner, Trisha Greenhalgh, professor, Department of Primary Care and Population Sciences, University College London; Mark Griffin, lecturer in medical statistics, and Richard Dent, consultant chest physician department of chest medicine

Conclusion: Telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.

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Antidepressants an untold story?

BMJ 2008;336:532-534 (8 March)(published 27 February 2008)
By: Jeanne Lenzer, medical investigative journalist, New York.

• New generation antidepressants aren’t all they’re cracked up to be.
• That seems to be the central message in the meta-analysis published this week by Irving Kirsch and colleagues in PLoS-Medicine, and it was this message that made the headlines.
• Kirsch’s conclusion follows on the heels of similar studies showing that statins are useful in only a small subset of patients taking the drugs and earlier studies showing that the safety and performance of cyclo-oxygenase-2 inhibitors seemed better than proved to be the case, further reinforcing previous criticisms that regulators in the United Kingdom and the United States are not doing their duty to protect the public from useless and dangerous drugs.
• But there’s another, deeper problem here—a problem that, ironically enough, was highlighted by GlaxoSmithKline’s news release stating that Kirsch’s conclusions are “incorrect” because he evaluated only a “small subset of the total data available.”
• How can regulators, the public, and doctors know how useful (or how potentially dangerous) drugs really are unless outside researchers have access to all the data?

But do we know the truth about antidepressants even now? Or statins? Or any one of many other drugs currently on the market?

• The answer to that isn’t as simple as it might seem.
• Firstly, there’s the problem of publication bias, the tendency for positive studies to get published and negative studies to be filed away in a drawer. In the case of antidepressants, a 2008 analysis by Erick Turner and colleagues published in the New England Journal of Medicine found that only 8% of antidepressant trials with negative findings were reported as negative, while positive trials were reported as such 97% of the time.
• The problem is not limited to antidepressants, says Turner. A former medical examiner for the FDA, Turner recently told the BMJ that it is critical for researchers to be able to obtain complete study protocols and full datasets to be able determine whether a study’s conclusions are valid.
• His concerns were highlighted by a 1999 study showing that in five top medical journals the authors’ conclusions as stated in journal abstracts either were not supported or were contradicted by data given in the body of the article in 18% to 68% of articles (depending on journal).

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Investigating perianal pain of uncertain cause

BMJ 2008; (16 February).
Practice by: Dr Rebecca Greenhalgh, radiology specialist registrar et al, University College Hospital, London.

• Imaging plays an important role in elucidating the cause of anal pain when the diagnosis is not clinically apparent.
• Endoanal ultrasound is an increasingly available, relatively inexpensive, quick and safe technique providing high resolution images of the anal sphincter complex, and intersphincteric space, but it is limited by a relatively small field of view
• Magnetic resonance imaging, although not universally available, affords much greater anatomical coverage than endoanal ultrasound and can also image the perirectal tissues and lumbar-sacral spine, facilitating diagnosis of conditions beyond the anal canal
• In the case of perianal sepsis, preoperative magnetic resonance imaging may be indicated in clinically suspected complex or recurrent disease to guide surgery, reducing the risk of future recurrence

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Rates of medication errors among depressed and burnt out residents: prospective cohort study

BMJ, published 7 February 2008
Research: by: Dr Amy M Fahrenkopf, instructor of paediatrics, Harvard Medical School, Department of Medicine, Children’s Hospital Boston et al.

What is already known on this topic:

• Depression and burnout are highly prevalent in doctors in training
• Burnout is associated with a higher rate of self reported errors among residents

What this study adds:

• Depressed residents in paediatrics were more than six times as likely to make errors in medication as their non-depressed colleagues
• Burnout did not seem to be associated with higher rates of medication errors

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Soft drinks, fructose consumption, and the risk of gout in men

BMJ, published 31 January 2008

Research, by: Hyon K Choi, associate professor of medicine (University of British Columbia, Vancouver) and Gary Curhan, associate professor of medicine (Harvard Medical School, Boston).

Objective To examine the relation between intake of sugar sweetened soft drinks and fructose and the risk of incident gout in men.
 

Design Prospective cohort over 12 years.

What is already known on this topic:

• Sugar sweetened soft drinks contain large amounts of fructose, which is known to increase serum uric acid levels

What this study adds:

• Consumption of sugar sweetened soft drinks or fructose is associated with an increased risk of gout in men
• Diet soft drinks are not associated with the risk of gout in men

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