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BMJ. 2007 July 28; 335(7612): 216.
PMCID: PMC1934501

Minerva

A “sweet tooth” seems to be inherited, at least in part. A genome-wide linkage analysis in Finland indicates that the craving for sweet foods and their pleasantness and the frequency of choosing sweet foods shows significant heritability. The chromosome 16p11.2 is implicated for people who often choose to eat sweet foods. Minerva presumes that a similar genetic picture may be found in people with many dental caries (American Journal of Clinical Nutrition 2007;86:55-63 www.ajcn.org/cgi/content/abstract/86/1/55).

Critically ill newborn babies are often at the centre of debate about end of life care and quality of life. A Dutch study of 30 babies who died within two months of birth reports that most deaths were attributable to withholding or withdrawing treatment because prolonging treatment couldn't be clinically justified. In some babies the decision to stop treatment was made on the level of predicted suffering. Potentially life threatening drugs were rarely the cause of death (Pediatrics 2007;120:e20-8 doi: 10.1542/peds.2006-2555).

A technique being developed to knock out genes in human tissues grown from mesenchymal stem cells in the laboratory could replace the need for transgenic knockout mice. Much of the research is supported by the Dr Hadwen Trust, a UK medical research charity that promotes alternatives to experimentation on animals, which is targeting the area of greatest growth—animals used in genetic experiments. If the technique succeeds it could end the reliance on mouse models of human physiology (www.drhadwentrust.org.uk).

The quality of chest compressions is more important than the timing of defibrillation, according to research on pigs (Chest 2007;132:70-5 doi: 10.1378/chest.06-3065). Optimal chest compressions, either as an initial intervention or after defibrillation, brought about successful resuscitation, with fewer shocks needed. Suboptimal compressions before delivering a shock failed to achieve successful resuscitation.

The “left handers life choices survey” aims to be the most widespread survey of the careers and interests of left handed people. Economic research shows that the earning power of left handed men is 15% more than for right handed men, and certain professions are particularly suited to the traits of left handed people, especially those requiring a high degree of creativity or artistic flair. Surgeons might be more likely to be right handed because of the traditional layout of operating theatres and the design of surgical tools. To participate go to www.lefthandersday.com.

Fear is delaying men from consulting general practitioners, says a study in the BritishJournal of Health Psychology (2007;12:403-20 doi: 10.1348/135910706X118413). Interviews with 20 men with prostate disease found that fear about what their symptoms might mean and perceived pressure to live up to a macho image in front of male doctors were common reasons for avoiding the doctor. Male general practitioners were often thought of as having negative attitudes towards male patients. Male patients also had poor knowledge about their own physiology.

Drawing on evidence in Dame Janet Smith's third Shipman inquiry report, the Ministry of Justice is proposing new changes to the existing cremation regulations, which date from 1930. Under the proposals bereaved families will have the right to inspect the medical forms of a relative who has died and will be able to alert the medical referee to any concerns they have about unexpected symptoms or features relating to the case. The aim is to “prevent another Shipman” (www.justice.gov.uk).

Exclusive breastfeeding is the best way for HIV positive mothers to feed their babies. For women who don't know their HIV status, promoting exclusive breastfeeding has the potential to reduce postnatal HIV transmission. These findings from a Zimbabwean study indicate that patterns of breast feeding may be more amenable to change through education than adoption of safer sexual practices (American Journal of Public Health 2007;97:1249-54 doi: 10.2105/AJPH.2006.085704).

“Pharmageddon” is the prospect of a world in which medicine and drugs produce more ill health than health, and when medical progress does more harm than good. Both Social Audit (www.socialaudit.org.uk) and Health Action International (www.haiweb.org) have raised the concept, and Social Audit is offering a number of prizes of money for thoughtful responses of fewer than 350 words published on their website, which will be fed into next year's conference on the topic.

After the somewhat simplistic report on hand washing from the chief medical officer, BMJ readers may prefer to get a copy of the winter 2006 issue of Emerging, the newsletter of the Plexus Institute, on methicillin resistant Staphylococcus aureus (MRSA). It contests that the core problem about MRSA is that it requires a complex human response, and the solution has to involve the entire community. One promising approach is “positive deviance,” which is a process of social change based on the recognition that every community has people who solve problems better than others who have exactly the same resources (www.positivedeviance.org).

Medical tourism thrives partly as a result of consumers (patients) who are dissatisfied with care in their home countries. The expansion in international medical travel has spawned a whole industry of service providers, providers of medical care, and medical travel agents, and now there's even a specialty journal. The first issue of the International Medical Travel Journal has hit the shelves and is also available on line at www.imtjonline.com.

Some women waiting for embryo transfer after in vitro fertilisation say that they are more worried about having no pregnancy at all than about the risks of giving birth to a child with a disability as a result of a multiple pregnancy. A gambling methodology was used to elicit women's preferences for giving birth to a child with physical impairments, cognitive impairments, or visual impairments; for perinatal death without a subsequent pregnancy; for premature delivery; and for no pregnancy. Women still need to be convinced that elective transfer of a single embryo is not going to significantly reduce the success of treatment (BJOG 2007;114:977-83 doi: 10.1111/j.1471-0528.2007.01396.x).

Headaches induced by overuse of drugs can be stopped by abruptly withdrawing the drugs, although many people don't get through the difficult first few days because of the headaches that they experience in this time. Some doctors encourage the empirical use of oral prednisolone in the first six days to help patients through, but it seems from a randomised, double blind trial, that this strategy doesn't help (Neurology 2007;69:26-31 doi: 10.1212/01.wnl.0000263652.46222.e8). Prednisolone had no effect on headaches associated with withdrawal in patients with chronic daily headache and overuse of drugs.


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