This week in the BMJ
Volume 328, Number 7444, Issue of 10 Apr 2004Should antidepressants be used in children?
Should antidepressants be used in children?
When used in children, antidepressants carry a high risk of side effects and limited benefits, and their use cannot be recommended. Jureidini and colleagues (p 879) reviewed the seven randomised controlled trials analysing newer antidepressants, and found that reporting of results was often misleading, downplaying serious adverse effects and overstating benefits; the studies' methods were questionable, and placebo effects may have played a significant part in the final findings. Pharmaceutical companies funded at least three of the four major trials, which may be failing to disclose increased suicidal activity related to the use of these drugs. Biased reporting and overconfident recommendations may be misleading doctors, patients, and families, say the authors.
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Patients want trustworthy and caring doctors
Patients with cancer prefer their relationship with their doctor to be based on trust, care and respect, rather than on empowerment and shared decision making. In a qualitative study with 39 women with breast cancer, Burkitt Wright and colleagues (p 864) found that patients valued confidence in the ability of their doctors, their honesty, the ability to build a unique relationship, and their respect. Patients were not concerned about traditional communication skills of doctors, but valued forms of communication that are neglected in teaching and research such as respect for the patient's autonomy and conveying their expertise; they did not think that information on prognosis and choice was so important.
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Eye catching gear may reduce motorcycle injuries
Fluorescent clothing, white or light coloured helmets, and daytime headlights may reduce motorcycle injuries and death. Wells and colleagues (p 857) analysed 463 motorcycle drivers admitted to hospital following a road traffic incident and 1233 other drivers (control group) to evaluate how wearing conspicuous attire affected the risk of having an accident. They found that with reflective or fluorescent clothing the risk of a crash injury was reduced by 37%, with a white helmet by 24%, and with headlights by 27%.
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We need safer roads
Road crashes account for a high proportion of injuries and deaths, and making roads safer still presents challenges. Breen (p 888) argues that important measures to improve road safety are often opposed by groups with minority interests, and health professionals can act as a powerful lobby for change. Lower speed limits in residential areas, car designs that are safer for pedestrians and cyclists, and random breath testing for alcohol all need stronger promotion, say the authors. Without solid action the forecast looks bleak, particularly in low income countries.
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Clustering of common risk factors does not explain risk of CHD
Clustering of the risk factors for ischaemic heart disease that are used in the Framingham risk score is similar among women of different social groups, and clustering does not explain the differing risk of coronary artery disease between social classes. Ebrahim and colleagues (p 861) analysed data on 2936 women from the British women's heart and health study. They found that women from a manual social class in childhood had more risk factors for coronary heart disease, and that more women had no risk factors, or three or four, risk factors than expected, irrespective of social class—but there was no difference in clustering among all social classes. Including childhood social class in risk scoring would identify women in whom risk is high and who may benefit more from prevention, say the authors.
Corticosteroid injection improves knee pain
Intra-articular corticosteroid injections improve symptoms of osteoarthritis of the knee in the short term, and may work even after six months. Arrol and Goodyear-Smith (p 869) reviewed 10 randomised trials and found that intra-articular steroid injections improved symptoms at one to two weeks (relative risk 1.66). Only one study of good quality had results at 16-24 weeks; it showed a benefit from treatment. No major harms were found, and the only study investigating potential loss of joint space found no harm after steroid injection. Higher doses of corticosteroids may be needed to obtain long term benefits, the authors say.
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