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....
A mixed article about the placebo effect. The effort to outline the physical basis for it is not merely pointless but deluded; it rather presupposes a particular pathway, or at least a small number of them. The reality is almost certainly that the mind influences the body via every part of our complex physiologies. Understanding how to get the most out of placebo effects, however, is absolutely essential, and forms a useful part of this piece. Placebo effects are a key part of our influence, whether they accompany sugar pills or treatments of proven infra-tentorial efficacy. We need to know how to manage them in order to deliver the most benefits. Raise expectations, help people to expect small and cumulative improvements, use red pills and big needles wherever possible. And be positive yourself - your optimism is infectious. You might know it isn't based on anything more than placebo, but you know they work pretty damn well. Read more...
How should we manage simple UTIs?
A question worth asking, but not one I was convinced this paper was capable of answering. It randomised women to one of five strategies:"empirical" antibiotics, "empirical" delayed antibiotics, or "targeted" antibiotics based on symptoms, dipstick results or mid-stream urines. I've put those two words in quotation marks because I'm not sure what the authors mean by them, and suspect they mean nothing at all - they're jargon that makes everything sound more scientific but can be removed with altering the meaning of the text in any way. For these five groups, the authors recruit a total of only 300 women. There's no placebo arm and no difference between any of the groups in terms of outcomes. The BMJ's "what this study adds" section attributes great meaning to these results; I can't see that they mean much at all. Read more...
Failing to reduce neonatal deaths
If you're looking for grounds for good cheer this week, I suppose you can find them in the very fact that this study was carried out. Almost all neonatal deaths occur in the Third World, and this bit of research looked at whether training birth attendants in the care and resuscitation of newborns could reduce mortality. It didn't. A study with good intentions and good technique that had an unfortunately negative result. Read more...
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