Map of life expectancy at birth from Global Education Project.

Monday, June 20, 2005

BMJ does it again

My job is too easy. All I have to do is refer y'all to the British Medical Journal.

  1. I believe somebody was asking about head lice. Burgess, Brown and Lee compared an insecticidal treatment -- phenothrin, related to resmethrin -- with a treatment based on a silicone compound that suffocates the bugs (dimeticone). Dimeticone was almost as effective and much less likely to cause irritation. Phenothrin is not very toxic to humans, supposedly, but actually we don't know. It's a suspected endocrine disrupter and its carcinogenicity is unknown. It is highly toxic to fish and other aquatic organisms, and of course resistant strains of lice are virtually certain to emerge. Dimethicone kills lice by a physical process, so resistance seems implausible.
  2. I wrote a while back about aspirin. It is protective against heart attacks and strokes, but carries some risk of gastrointestinal bleeding. There is a dialogue between Elwood and Baigent about whether everyone over 50 (or maybe 60) should take low dose aspirin, or just people with known vascular risk. The editorial conclusion is that it needs to be a personal decision. For me, the major importance of this debate is that it points up once again that the drug companies have invested billions of dollars in developing and marketing analgesics to replace aspirin, purely because they were patentable and hence highly profitable, while aspirin was actually better -- and safer -- for most people all along.
  3. Pregnancy is not a disease, so why do we treat it as a medical emergency? Johnson and Daviss find that home deliveries, supervised by midwives, result in less medical intervention (such as caesarians and episiotomy, etc.) than hospital deliveries, but are just as safe for mother and baby.
  4. The Drugs for Neglected Diseases Initiative has launched an international appeal for increased research and development to address diseases which are endemic only in poor countries, and therefore don't offer the drug companies the lure of huge profits. These include leishmaniasis, Chagas' disease, and sleeping sickness.
  5. The Proceedings of the National Academy of Sciences has withdrawn a paper from publication after the Assistant Secretary of HHS complained that the information in it could be useful to terrorists. (It concerned possible deliberate contamination of milk.) Of course, it could also be useful to citizens who were concerned about public safety and wanted to hold officials democratically accountable. Revere has devoted considerable space to this question of secrecy surrounding bioterrorism preparedness. I'm with him. What I don't know can hurt me.

So why can't the United States have a medical journal like that?

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