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:
Drugs for atrial fibrillation
What's the most useful drug for AF? This review of recent drug development lauds the leadership of amiodarone, while looking fondly ahead to a world in which something better holds sway. Dronedarone has been disappointing, although hopes linger, while ranolazine, vernakalant and others stand in the wings, optimistically awaiting their turns upon this important stage. The authors fondly look forward to the day when novel agents prove the superiority of rhythm control. Until that day, however, the answer to my opening question has to remain, a drug whose proven utility is so commonplace as to be dull: aspirin.
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BMJ:
Helping back pain
Back pain is a serious problem for a large number of people and for the wider economy. An intervention reducing the amount of time people spent suffering and incapacitated with it would be extremely useful. This trial compares a luxuriously integrated campaign by various different therapists with what is euphemistically called 'usual care'. The number of days that people spent off work was more than halved. Were these therapists applying physical fixes to an organic problem? Or was their compassion and attention an effective placebo? Does it even matter? Drug and surgical treatments for back pain are mostly harmful fictions. Placebos are real and can work wonders; getting the most out of them is important.
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NEJM:
Trajectories in the final year of life
I suppose it's worth wondering whether decline might be predictable, and if the end of human lives follow specific patterns. It comes as no surprise to find nothing of the sort. Our decays and our conclusions are uncertain and unknowable. We must endure our going hence, even as our coming hither; ripeness is all.
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