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....
The Lancet:
Lowering blood pressure in acute stroke
The teaching has always been that hypertension should be left alone in the setting of acute stroke, and that lowering it might increase the area of anoxic brain tissue. This teaching is based on theory and animal experiments, and as such, isn't in the slightest bit trustworthy. That doesn't mean we should all have been using anti-hypertensives in this setting; our default position should be inaction until we've a warrant to act. This trial of 2,029 people with acute stroke shows that blood pressure lowering in the setting of acute stroke does indeed do no good, and probably causes harm. The old-fashioned teaching was right; conducting a trial to properly check on it, however, was thoroughly laudable. Two other big studies are underway, looking at the effect of intravenous and transdermal drugs in similar settings.
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BMJ:
The health impacts of alcohol
At the close of his life, Winston Churchill looked back at long decades of over-consumption. Despite its drawbacks, he concluded he had got more out of alcohol than it had gotten out of him. The same is almost certainly true of the overall relationship between humanity and this particular drug. Understanding the health impact of different doses is important, since it can be a factor (not necessarily the deciding one) in the choices we make. The first of these two BMJ studies looks at the observational evidence we've gathered so far in relation to cardiovascular outcomes; the second looks at the impact of drinking on particular biomarkers. Neither one is as useful as the pre-existing evidence looking at alcohol's overall effect on all outcomes, and neither one suggests anything novel. Teetotalism is bad for your health and the government, if it was morally consistent, should be pressurising people to avoid it.
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NEJM:
Farmyard bugs are good for you
The 'hygiene hypothesis' has been around for a while, and this study adds more useful weight to it without providing anything that's really novel. We know that asthma prevalence is rising massively in the First World, and we've observed repeatedly that being exposed to a range of bugs in youth is associated with a much reduced risk of asthma and other atopic diseases as you grow. The two studies that make up this paper look at those who are raised on a farm, finding their microbiological exposure is broader than others and their atopic tendencies diminished.
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