This week's journal reviews on Doctors.net.uk
Journal Watch is a service provided to summarise some of the most popular medical journals.
Doctors.net.uk has a panel of specialist advisers responsible for reviewing a range of journals of general medical interest and some more specialised publications.
General Journal Watch is written by Dr Druin Burch, Consultant in Internal Medicine
This week's journals include....
Attack on anaesthetists by enraged orthopaedic surgeons
There's no new BMJ
but last week, while you were eating your goose and drinking your port, you'll doubtless have worked your way through the Christmas issue. The highlight was this superbly pungent and delightfully waspish attack on anaesthetists by a group of enraged orthopaedic surgeons
. The only other article of note to me appeared a repulsive attempt to whip-up a politically correct frenzy about something which didn't need it in the slightest. It's an article about the Irish Giant
, whose corpse was stolen against his wishes by John Hunter and which now stands in the Hunterian Museum at London's Royal College of Surgeons. Getting morally outraged about things that happened centuries ago has never seemed to me a healthy way to spend your life's energies. If you want to get angry about horrors committed in the name of human anatomy, the Visible Human Project is a far better target. Its images, used for everything from teaching to consumer advertisements, come from the corpse of an executed American who was neither informed nor consulted about having his body used in this way. Perhaps because he wasn't part of an ethnic minority or a historical grudge, it's an outrage that has attracted no fuss whatsoever.
Do medical patients need heparin thromboprophylaxis?
Physicians like myself have been convulsed by the political priority to ensure their patients get appropriate thromboprophylaxis. NICE guidelines are hard to fault since they're so vague - what we need to do, they say, is ensure we 'consider' our actions, though what they've led to is a huge increase in the amount of subcut heparin being given. This subcut heparin has been shown to reduce clots but not to reduce mortality; we don't really know whether it's worth the vast fuss currently being made of it. This international study of over eight thousand patients found that adding in enoxaparin to compression stockings made absolutely no difference whatsoever to mortality at 30 days. Good stuff and we need more of it with more patients and longer follow up.
JAMA's support for thought
The personal essay this week, in contrast to the poem, is absolutely superb. Please, read it. It's actually about - of all things - prostate cancer screening. And while it's admirably personal, it's not about having prostate cancer, or even undergoing screening. It's a brilliantly written piece about the pros and cons of screening as an example of difficult decision making in a complex world. It's brilliance comes from the fact that what shines through isn't burnished cliche and received wisdom, but a seriously thought out and idiosyncratic view of a difficult subject. Reading it makes the world seem a richer more interesting place.
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