This week in the BMJ
Volume 328, Number 7437, Issue of 21 Feb 2004Treatment to change sexual orientation did not benefit patients...
Treatment to change sexual orientation did not benefit patients...
Homosexuality was considered a disease until the 1970s, and gay people were often coerced to undergo medical treatment. This resulted in more social isolation and shame, and provided no benefit. Smith and colleagues interviewed 31 patients (p 427) who had had treatment for same sex attraction, or their relatives. The most common treatments were behavioural aversion therapy with electric shocks, oestrogen therapy, religious counselling, electroconvulsive therapy, and psychoanalysis, but these had no beneficial effect. When homosexuality gained wider acceptance, these patients were able to explore their sexuality, and several found fulfilling, same sex relationships.
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...and health professionals had doubts about efficacy and ethics
Treatments to make homosexuals into heterosexuals did not follow a national protocol or ethical guidelines, and in the early 1970s many health professionals were uneasy with common treatments for homosexuality. King and colleagues (p 429), interviewing 30 health professionals who administered treatment for homosexuality during the 1970s, found that many were concerned about the treatments available at the time. Most provided behavioural therapy and covert sensitisation; several had pure science backgrounds; and often they were inexperienced young clinicians. Social and moral attitudes can determine pathological behaviour, say the authors; we should beware of assumptions that could lead to the infringement of human rights.
Evidence of success of blinding in clinical trials is scant
The success of blinding in placebo controlled trials is not well reported, and when it is reported it is often poor. Fergusson and colleagues (p 432) evaluated 191 randomised placebo controlled double blind trials published between 1998 and 2001 in nine general medicine or psychiatry journals. They found that only 15 trials (8%) provided information on the success of blinding, and that it was successful in only five trials. The validity of double blinding was reported in only four of the 191 articles.
Aspirin induced asthma is more common than previously suggested
The prevalence of aspirin induced asthma is higher than previously suggested. In a systematic review, Jenkins and colleagues (p 434) found that the prevalence of aspirin induced asthma was higher when determined by oral provocation testing than verbal history (21% v 3% in adults, 5% v 2% in children). Most patients were sensitive to NSAIDs, but sensitivity to paracetamol (7% of patients) was more likely in patients highly sensitive to aspirin. Since aspirin and other anti-inflammatory drugs are often self prescribed, patients with asthma should be alerted to the possibility of cross reaction. Simple, standardised warnings on packs of aspirin and NSAIDs may be indicated.
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Activation leaflets may improve patients' satisfaction...
Encouraging patients to raise issues and discuss symptoms may improve their satisfaction and perception of communication. Little and colleagues (p 441), in an attempt to improve patient satisfaction and health outcomes, randomised 635 patients to receive a general leaflet, a depression leaflet, both, or neither, before consultation in primary care. Among patients who received a general leaflet, satisfaction was increased, particularly when consultation time was short; the number of investigations was higher; and there was a small increase in consultation time. The depression leaflet had no effect on the outcome.
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...but perceived pressure from patients affects doctors' behaviour
Doctors' behaviour in primary care consultations is strongly associated with perceived medical needs, but it is affected also by perceived patient pressure. Little and colleagues (p 444) invited 847 patients attending five general practices to fill in a questionnaire before consultation and asked doctors about their perception of patients' needs and perceived pressure. They provide data showing that a minority of examinations, prescriptions, and referrals, and almost half of investigations, are only slightly needed or not needed at all, and that perceived pressure from patients predicts whether doctors examine, prescribe, refer, or investigate.
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