Minerva: May 2001
John Travolta, Leonardo DiCaprio, and
Sharon Stone have all played a string of
characters whose on.screen charisma
depends on smoking. US tobacco researchers single them out as the most likely stars
out of a group of 43 to encourage smoking
among school children (Tobacco Control
2001;10:16.22). Children who nominated
any of them as a favourite star were more at
risk of becoming smokers than others who
chose the image of non.smoking idols such
as Tom Cruise, Mel Gibson, or Sandra
Bullock.
Medical graduates in Australasia can train
to be ophthalmologists in about four years.
Medical graduates in the United Kingdom
usually take about eight years-why? Are
they overtrained? An ophthalmologist from
Britain's flagship eye hospital stops short of
admitting it, but suggests that if specialty
leaders want Britain to fall in line with the
rest of the world, basic surgical training
could be the first victim (British Journal of
Ophthalmology 2001;85:383.4). Most trainees spend three years as a senior house
officer in unrelated surgical specialties
before their ophthalmology training gets
under way.
Another paper on trainees in the United
Kingdom, this time in cardiothoracic surgery, looks at the effect of training on
patients' outcome and hospital costs (Heart
2001;85:454.7). At Papworth Hospital in
Cambridge, 44% of straightforward coronary artery surgery is done by trainees-
mostly senior ones. Surgeons who audited
their work over a couple of years could find
no difference in costs or clinical outcome
attributable to trainees, although consultants
were about nine minutes faster at coronary
artery bypass operations.
Recruiting patients into intensive care
research is ethically challenging because
informed consent is often impossible.
Surrogates appointed by potential participants can give consent, but they don't always
get it right (Chest 2001;119:603.12). In one
test of 100 surrogates, up to a fifth gave consent for entry into a hypothetical trial when
the real participant refused. Disagreement
was most marked for high risk trials.
Developing advance directives for participation in trials may help.
Minerva lives close to a golf links and often
observes players as they amble from green
to green chatting and enjoying the sun.
shine. She has never seen any of them
stretching, bending, or doing squat thrusts
before teeing off so was not surprised to
read that golfers rarely warm up properly
before a game (British Journal of Sports
Medicine 2001;35:125.7). Ritualistic air
swings are the most popular form of preparation, but they are unlikely to prevent
injury or improve performance, write
Australian researchers.
Ironically, this month's Western Journal of
Medicine (2001;174:282.3) reprints another
article from the British Journal of Sports
Medicine which concludes that stretching
doesn't prevent exercise induced injury
either. The author, from McGill University in
Canada, reviews the evidence on stretching,
which includes a large randomised trial and
a systematic review. Neither show any
benefit. In fact, the basic science literature
reports that even mild stretching can cause
muscle damage at the cellular level.
George Bush will be relieved to hear from a
leading Princeton economist that inflated
drug costs and manufacturers' profits are
not an economic burden on the US healthcare system (Washington Post 28 March). He
recently told a meeting of the Council on
the Economic Impact of Health System
Change that Americans spend less on
prescription drugs than they do on alcohol,
tobacco, and admission fees to entertainment. He ended: "You could just as easily say
football was the problem."
Medical students and junior doctors in the
United Arab Emirates, just like students and
juniors elsewhere, admire honest, open
teachers who respect their patients, teach
students enthusiastically, and know their
subject (Medical Education 2001;35:272.7). A
survey of students and graduates from one
medical school also found that good role
models can attract students and doctors into
a specialty: half of the 96 respondents said
that a good role model would influence their
choice of career.
When an Australian doctor asked his oncology patients whether doctors should wear
white coats, a clear majority thought they
should (Medical Journal of Australia 2001;
174:343.4). Patients were particularly keen
for junior doctors to wear white coats and
cited ease of identification as the main
reason. Australian doctors were among the
first to shed this emblem of the profession.
Perhaps they should reverse the trend or,
like the Americans, develop a white coat
robing ceremony for new graduates.
The rising incidence of atopy is often
blamed on insufficient exposure to microbes
in early life. Finnish scientists tested the
hygiene hypothesis by randomly administering the beneficial bacteria strain Lactobacillus
GG or placebo to pregnant women who had
a partner or first degree relative with
eczema. Their infants were given the same
treatment for the first six months. The
incidence of atopic eczema in infants in the
treated group was half that of infants in the
placebo group. One commentator suggests
that this could be an immunological
extension of the Barker hypothesis (Lancet
2001;357:1076.9).
A report in Pediatrics describes two toddlers
who became seriously ill after their well
meaning and well educated parents weaned
them off breast milk and on to popular
"healthy" alternatives to cows' milk (pediatrics.org/cgi/content/full/107/4/e46). One boy
of 22 months developed severe kwashiorkor
on a diet of rice milk and erratic solids.
Another presented with advanced rickets
because the soya drink he was given was not
fortified with vitamin D. Health food drinks
that are unsuitable for children should be
clearly labelled by manufacturers, say the
authors.
A 17 year old Asian girl presented to the
dermatology department with symmetrical, pigmented
horizontal lines on her back. Histological
examination showed only chronic eczema. The patient
remarked that she had scratched her back with a long
bathroom loofah to relieve intractable itching. This
had caused postinflammatory pigmentation of the
skin overlying her ribs and vertebral prominences,
sparing the intervening areas.
G A Johnston, specialist registrar,
T O Bleiker,specialist registrar,
RAC Graham Brown, consultant, department of dermatology, Leicester Royal
Infirmary, Leicester LE1 5WW
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studentBMJ 2001;09:129-170 May ISSN 0966-6494
