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BMJ. 2007 June 23; 334(7607): 1328.
PMCID: PMC1895636

Minerva

There are three categories of complainants, according to the Medical Protection Society (Casebook 2007;15(2):8-9, www.MPS.org.uk). Vexatious ones (who are rare), those who have been harmed by a doctor's negligence and should be compensated, and, the largest group, those think they've been harmed by a doctor but who are usually just experiencing the natural course of their disease or who have recognised complications. It's the last group who could be kept out of the arms of lawyers if sufficient time is taken to explain things to them.

Members of the UK reserve armed forces who were sent to Iraq in 2003 experienced high rates of mental health problems compared with the regulars. An investigation into the reasons for this points to higher exposure to traumatic events, lower unit cohesion, more problems adjusting to coming home, and lower marital satisfaction. Interestingly, higher rates of post-traumatic stress disorder symptoms were most powerfully associated with problems at home rather than events in Iraq (British Journal of Psychiatry 2007;190:484-9, doi: 10.1192/bjp.bp.106.030544).

People under 55 who undergo knee replacement surgery for osteoarthritis apparently have increased long term mortality compared with the general population. For the first 12 years after surgery, this group enjoys a reduced overall mortality, but then the trend reverses and there's an inverse correlation between age and mortality. The specific causes of death were chiefly cardiovascular, gastrointestinal, and urogenital diseases. The authors say their observations call for increased awareness of potential health problems in these patients (Journal of Bone & Joint Surgery(Br) 2007;89-B:599-603, doi: 10.1302/0301-620X.89B5.18355).

Here's a controversial suggestion in a letter published in Medical Education (2007;41:618-20, doi: 10.1111/j.1365-2923.2007.02774.x). The term “learning style” is commonly bandied about, and some researchers have suggested that such styles not only influence how we learn but also our attitude to work. However, there are apparently 71 different and competing learning styles theories, many of them contradictory. And the controversial idea? Perhaps we don't have learning styles at all, just personalities.

Another controversial issue is raised by researchers in the Journal of Laryngology & Otology (2007;121:526-9, doi: 10.1017/S0022215106005147). Is rhinitis due to food allergies fact or fiction? The view of many parents, possibly informed by what they read on the internet, is that food allergies often cause rhinitis. In fact, the incidence of food allergy in children is 2-8% and usually presents with multi-system symptoms, which the vast majority outgrow. Isolated rhinitis due to food allergy is “extremely rare,” and treatment is rarely indicated.

Marketing costs are said to exceed 30% of revenues for the pharmaceutical industry, and more than 90% of the marketing effort is aimed at doctors (Journal of Surgical Research 2007;140:1-5, doi: 10.1016/j.jss.2006.10.010). Despite the “unprecedented numbers of regulatory activities focusing on relationships” between the medical profession and the industry, such legislation is often “unrecognised or flouted.” The bottom line is that a re-evaluation of responsibilities towards both patients and shareholders alike is critically needed.

One might hypothesise that there's a direct relationship between exposure to road noise at home and hypertension. But a careful analysis of noise exposure and self reported use of antihypertensive drugs shows that the strongest link between the two is in middle aged people (45-55 years) and specifically at the higher noise levels (Journal of Occupational and Environmental Medicine 2007;49:484-92, doi: 10.1097/JOM.0b013e318058a9ff). Minerva surmises that, as we get beyond middle age, we become more accepting of those irritations which are beyond our control.

Between 1993 and 2004, 175 patients in New Zealand died in hospital from meningitis (Journal of Infection 2007;54:551-7, doi: 10.1016/j.jinf.2006.10.050). Of the 140 deaths for which records remained, 70% occurred within 24 hours of admission. In 29% of the deaths, a delay of more than two hours was noted between arrival and antibiotics being administered. The chief cause of delay was a failure to include meningococcal disease in the original differential diagnosis.


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