BMJ  2005;331:E393 (17 December), doi:10.1136/bmj.331.7530.E393

BMJ USA: Editor's choice

Small change

"Change is scientific, progress is ethical; change is indubitable, whereas progress is a matter of controversy." Bertrand Russell could have been speaking about medicine, where change happens constantly. Whether it is change for the better remains to be seen.

A case in point is our ever-expanding number of new drugs. Most of them are just more expensive versions of existing preparations. Steven Morgan and colleagues (p 511) calculate that 80% of increased prescription costs in Canada are attributable to new "me-too" drugs that don't offer significant improvements. Another change for the worse is a little-discussed outcome of the sportutility vehicle craze: dramatic increases in pedestrian injuries, especially in the elderly. Ciaran Simms and Desmond O'Neill point out (p 496) that the problem is not the SUVs' mass, it's the height of their bumpers and poor visibility.

One thing that has changed for the better is our ability to recognize and treat adult depression effectively. A problem with screening for depression in primary care is the large number of patients who "screen" false-positive. Bruce Arroll and coauthors (p 502) find that simply adding a question asking whether patients want help with their problem makes screening more specific.

Most American doctors would like to change the malpractice litigation system in the US, and Carlos Tena-Tamayo and Julio Sotelo (p 528) offer the Mexican Conamed arbitration system as a possible way out of our mess. Richard Roberts, who is both a physician and an attorney, doesn't think it would help much (p 495).

Mobile phones have changed our lives in many ways, but is it progress? Suzanne McEvoy et al find (p 514) that using a cell phone while driving, even a hands-free model, probably increases your risk of a serious crash fourfold. This is not to say that telephones can't be useful in health care. The latest of many studies of telephone interventions in chronic disease, this one from Argentina for chronic heart failure (p 521), finds that a simple, centralized program delivered by telephone reduced CHF hospital admissions about 20%.

Which brings me to a big change. This is the last issue of BMJ USA (p 494). It's been great fun working on it. Although BMJ USA will be disappearing, we're making changes in the BMJ and to bmj.com that should make them both more appealing to US doctors. You're invited to sign up for a free trial subscription to bmj.com and see for yourself. We hope that this change will be good for all of us. See you on the Web.

dkamerow{at}bmj.com

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