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:
NICE guidance on clots
A brief editorial approving the recently published NICE guidelines on prophylaxis for venous thromboembolism in hospital. All should be assessed and virtually all should get a drug; no further details are provided here beyond the headline story that venous clots kill twenty-five thousand people in Britain a year. We're not told how many of these deaths would be avoidable if we followed these guidelines, an omission which isn't far removed from the journalistic standard of always offering numerators without denominators.
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BMJ:
Etanercept for psoriasis
A half-blinded half-trial which ended up concluding "the choice of regimen should be determined by the clinical needs of the individual patient". There really isn't much in it to command to your attention - nothing at all, in fact - but it is, nevertheless, the highlight of this week's BMJ contribution to the world of medical research. Richard Smith may well have made the conscious decision to turn the journal more into Cosmopolitan than Brain but he seems to have helped create a magazine with none of the good bits of either.
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NEJM:
Cladribine for multiple sclerosis
Another immunomodulatory drug, this one is selectively knocking off the DNA synthesis required by lymphocytes. CD4 and CD8 cells decline as a result and inflammatory cytokines also. The net effect over almost two years was another significant reduction versus placebo of multiple sclerosis relapse rates, another demonstration of relative MRI benefits, and another rack of infection-related side-effects. A vast amount of work needs to be done to determine the actual risks of these new drugs - the risks of benefits as well of the risks of harms - but we seem to have the greatest possible reason for engaging in this work. We can be confident we're seeing the arrival of thoroughly promising new drugs for a previously grim disease.
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