BMJ  2003;327:E17 (4 October), doi:10.1136/bmjusa.01030008 (published 5 September 2002)

BMJ USA: Minerva

Minerva

This article originally appeared in BMJ USA

There is now consistent evidence that weight loss reduces blood pressure in people who are heavier than they should be and have high or "high normal" blood pressure. In one American study, participants' diastolic blood pressure went down 1.4 mm Hg for every 2 pounds (4.4 kg) they lost ( Annals of Internal Medicine 2001 ;134:1-11[Abstract/Free Full Text]. Most of them, however, were back to square one by the end of three years' follow up. Despite prolonged and intensive counselling by dietitians or health educators, only 13% of participants maintained their weight loss.

It seems likely that children who were breast fed as babies have a small but detectable cognitive advantage over children who were bottle fed. The latest study in a long line of inquiry, which began in 1929, looks at the IQ of children age 7-8 years who were born very prematurely ( Archives of Diseases in Childhood Fetal and Neonatal Edition 2001;84:F23-27). Nearly three quarters of mothers provided expressed breast milk for feeding. Their children ended up with a verbal IQ score six points higher than the rest, independent of social class.

A letter to the Canadian Medical Association Journal suggests that hospital specialists should wear colour coded lab coats to help patients identify them (2000;163:1553). For example, hepatologists might wear yellow, haematologists could wear red, and obstetricians should wear pink (or blue depending). The idea is unlikely to appeal to gastroenterologists or infectious disease specialists, however, who the author imagines wearing brown and mouldy green respectively.

Thiazide diuretics are one of those really useful treatments that, like aspirin, cost next to nothing. In a comparative study of different antihypertensive agents they come out on top again, this time for reducing the incidence of stroke in people with treated hypertension ( Archives of Internal Medicine 2001;161:37-43[Abstract/Free Full Text]. Since stroke is more strongly linked to systolic than diastolic blood pressure, it is possible that thiazide diuretics are better at controlling systolic hypertension than other classes of drugs, say the authors.

When neonatal screening for cystic fibrosis began in Wisconsin, USA, the authorities had the foresight to launch the programme in the context of a randomised trial. The results, after five to 14 years of follow up, show that children who were diagnosed early through neonatal screening ended up taller and less malnourished than children who were diagnosed only after they developed symptoms ( Pediatrics 2001;107:1-13[Abstract/Free Full Text]. Few countries have screening programmes yet, partly because data on effectiveness have been so scarce.

Minerva is often sent pictures of people impaled on fish hooks, so she has a heightened awareness of the dangers of fishing. Orthopaedic surgeons in one hospital in Israel treated 33 such injuries in 1995-1997 ( British Journal of Sports Medicine 2000 ;34:459-462[Abstract/Free Full Text]. They warn that fish hooks are designed to stay put—or inflict tissue damage—when pulled, so a quick tug is unlikely to do the trick. Even if the hook looks superficial, always find out what shape it is and where it goes before attempting extraction. A plain radiograph is usually enough.

For 10 years researchers have been studying the link between gallbladder disease and drinking coffee. Some of them find that drinking coffee prevents gall stones, and some find that it doesn't. The latest study, which is large but cross sectional, is also negative ( American Journal of Epidemiology 2000;152:1034-1038[Abstract/Free Full Text] but contains a hint that coffee may reduce symptoms in women with gall stones. If true, this could explain why coffee seems to be protective in studies that look exclusively at symptomatic gall stones.

Minerva's hunch that children's diets would improve overnight if the Teletubbies ate broccoli instead of tubby custard is supported by research showing that meal time television may influence what children eat (pediatrics.org/cgi/content/full/107/1/e7). In a survey of 91 families, those who watched television at meal times ate more pizza and salty snacks and less fruit and vegetables than other families. They also drank more caffeine and fizzy drinks. The findings were independent of social class.

Teaching medical students and doctors to practice evidence based medicine may be popular, but ironically there is no evidence that such teaching works ( Academic Medicine 2000;75:1184-1185[ISI][Medline]. One review concludes that programmes teaching evidence based medicine are themselves poorly evaluated. Those that are evaluated rarely manage to change students' or doctors' behaviour or improve patient care. At least part of the problem must be that most teaching on evidence based medicine goes on in the journal club and not at the bedside.

View larger version (115K): [in this window] [in a new window]   A 67 year old man presented with poor vision, blurring, and glare 16 months after bilateral cataract operations. To describe his symptoms more clearly he took this picture, scanned it into his computer, and drew the cross lines to represent the glare in his right eye. His symptoms were caused by thickening of the lens capsule and they disappeared after YAG laser capsulotomy. His visual acuity also improved. M N A Khalek, consultant ophthalmologist, R F Refaat, staff grade, eye department, Pilgrim Hospital, Boston, Lincolnshire PE21 9QS, UK.

Minerva learned a little English history from the British Journal of Psychiatry, thanks to a paper on suicide in medieval England (2001;178:42-47). During the reigns of Henry III (1216-1272) and the first three Edwards (1272-1377), judicial inquiries record 190 cases of suicide, gamely translated from medieval legal Latin by one of the authors. Hanging and drowning were the most popular methods, followed by self stabbing with a sword. Suicide was a crime and was often concealed. The consequences included confiscation of all the victim's property by the Crown, not to mention eternal damnation of the soul.