And so, to my mail box this morning.

“Dear Doctor

We are writing to brief you about the British Heart Foundation’s forthcoming Atrial Fibrillation campaign [when the upper chambers of the heart beat in an unco-ordinated fashion].

The campaign aims to increase people’s awareness of asymptomatic AF and encourages them to check their pulse for an irregular rhythm…The campaign will be starting on 16th November 2009 and will run across the following weeks. We will be directing people to visit our website or call a bespoke telephone line which will provide information about AF, how to check their pulse, and the difference between a regular and an irregular pulse…We would value your assistance in communicating the above information with your own patients, colleagues and networks.”

The picture at the top of the BHF website is of someone checking his pulse and the ominous message “An irregular pulse can kill. Don’t leave it to chance.”

So, a nice little campaign that should see us clutching our wrists, taking our pulse, and saving our lives?

Continue reading "Underwhelming evidence for a heart screening programme"

It seems that people like enticements. Take the shimmering lures at make-up counters, where if you buy enough of one brand’s products, you’re promised a “gift”.

Of course, these deals rarely look so good on closer inspection. Buying one and getting one free, for example, often applies to goods where buying large quantities is impractical. And I don’t really want another make-up bag full of travel-sized cosmetics, even if not boosting my spending just a bit to get that freebie seems like a waste.

So what happens when you incentivise patients to do what is “best” for their health – lose weight, stop smoking, eat more vegetables? Over the past few years, the catalogue of research on health-related incentives has thickened.

The remainder of this article can be read here. Please post comments below.

Last Saturday, How To Spend It ran an interview with Professor Susan Greenfield, who is famous as a neuroscientist and a life peer. And she says that one of the “grooming staples I’m never without [is] Boots No 7 Protect and Perfect Intense Beauty Serum (£19.75) - it is, they tell us, clinically proven to reduce wrinkles. And I believe it.”

If Baroness Greenfield is having trouble sorting the science from the spin….oh dear. I wrote about this face cream earlier this year. Since the conclusions of the scientists studying this cream were that the improvement in appearances between the placebo cream and the No 7 cream were “not statistically significant”, I felt it wasn’t the breakthrough it was being touted as.

Continue reading "What’s wrong with wrinkles, anyway?"

I’m always perversely pleased when research comes out saying that an intervention we previously thought of as useful turns out not to be.

The reason I’m pleased is that is shows that the necessary critical evaluation of what we are doing in healthcare is ongoing: it also means that genuine improvements in care can be made.

I’m not convinced that these kinds of studies get the attention they deserve in either the medical or non-medical press, so here’s a summary of two recent such studies that caught my eye.

Continue reading "Applause for the publishing of negative trial results"

Thank goodness for the small but awfully potent Drugs and Therapeutics Bulletin (DTB). On its front page this month, it notes that new warnings about side effects of statins have still to be included in the patient information leaflets about them. These side effects include sexual dysfunction, memory loss and depression.

In February 2008, they say, the Medicines and Healthcare products Regulatory Agency  (MHRA) decided, following a review of clinical trials, reports of adverse drug reactions, and publications, they were to update the leaflet ” to reflect a number of different side effects as class effects of all statins”.

Continue reading "We must have full disclosure on statin side effects"

News from the US, I can scarcely believe it: The New York Times reports that the American Cancer Society now accepts that screening for breast and prostate cancer is not only inefficient, but frequently inaccurate and alarmist. It has realised that such programmes – designed to detect cancer early – can do damage too, because they often detect cancers or pseudocancers that were never going to maim or kill.

That is the bit I can believe. After all, these are evidence-based observations, and none is particularly new. A recent paper in the Journal of the American Medical Association (Jama) also highlighted the weaknesses of screening. What I have difficulty with is that paper’s conclusion: “To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both diseases should be considered.” The problem with screening and even early detection is that because these two elements sound useful, we have great difficulty in believing it when the evidence tells us they are not.

The Jama paper states that, after 25 years of screening, “conclusions are troubling: Overall cancer rates are higher, many more patients are being treated, and the absolute incidence of aggressive or later-stage disease has not been significantly decreased”. The authors also say that screening comes at significant cost, including overdiagnosis and overtreatment. The complications of therapy are likely to get worse as the population ages. Not only that, but treatments for relatively indolent disease may in themselves do harm.

The remainder of this article can be read here. Please post comments below.

By Rebecca Knight

Work invades my sleep. I lie in bed thinking about editors I should email, sources I need to call, and story ideas I ought to follow up on.

To be honest, sleep has never been my strong suit. I suffered terrible insomnia as a kid and into early adulthood. I’ve tried quiet yoga, warm milk, and long, languorous bubble baths before bed. I feel relaxed and cosy as I climb under the sheets, but once my head hits the pillow, it’s all over.

Apparently, the remedy to my restlessness is simple: I should stop working. According to a study by researchers at the University of Turku in Finland, retirement is followed by a sharp decrease in the prevalence of sleep disturbances.

Continue reading "To sleep better all you need to do is…retire"

The Scottish Exhibition and Conference Centre is currently alive with the sound of thousands of GPs discussing ‘Excellence in Practice.’

But just what is a working definition of excellence? The Right Hon Mike O’Brien, Minister of State for Health, made a rather brave speech. He seemed likeable and pleasant, and able to tell mildly risque jokes about bishops, which made his frequently contradictory references to “evidence” slightly disappointing.

Continue reading "The UK Royal College of GPs conference focuses on excellence and screening"