This week in the BMJ
Volume 331, Number 7528, Issue of 3 Dec 2005Uncertainty of outcome removes ethical dilemma in trials of cancer drugs
Uncertainty of outcome removes ethical dilemma in trials of cancer drugs
In clinical trials of new child cancer drugs, the experimental treatments for childhood cancer are just as likely to be inferior to the standard comparator treatment as they are to be superior. Such uncertainty makes it easier for patients to decide whether to participate in such trials, and for researchers to justify the clinical trial system, which has led to advances in treatment of several childhood cancers. After analysing a consecutive series of 126 published and unpublished randomised phase III trials performed between 1955 and 2000 under the aegis of the Children's Oncology Group, Kumar and colleagues (p 1295) found no evidence of the value of new experimental treatments being confidently predictable in advance.
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Abortion of unwanted first pregnancy may not increase risk of depression
Women who terminate an unintended first pregnancy don't seem to get more depressed than those who decide to carry the pregnancy to term. Schmiege and Russo (p 1303) re-analysed the data from a 1970s longitudinal cohort study of more than 1200 women and found discrepancies with the previous report of the study, which concluded that termination of unwanted first pregnancy increased the risk of depression. The authors put the inconsistency of results down to differences in coding.
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COX 2 inhibitors may not be safer for the stomach
Cyclo-oxygenase-2 inhibitors seem no better than conventional non-selective non-steroidal anti-inflammatory drugs in terms of the risk of an adverse upper gastrointestinal event. In a nested case-control study of more than 9000 cases of first peptic ulcer or haematemesis and almost 90 000 controls from 367 general practices throughout Great Britain, Hippisley-Cox and colleagues (p 1310) found that the risk of adverse events was increased with all NSAIDs included, selective and non-selective. Use of ulcer healing drugs reduced the increased risk of adverse events for all NSAIDs except diclofenac.
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Twins have lower IQ in childhood
On average, twins have lower IQ scores at 7 and 9 years old than singleton children in the same family. In a cohort study, Ronalds and colleagues (p 1306) used data on 9832 singletons and 236 twins born in Aberdeen between 1950 and 1956. At age 7, the mean IQ score of twins was 5.3 points lower than that of singletons in the same family, and at age 9, the score was 6.0 points lower. The lower intelligence of twins in childhood may partly be a consequence of the reduced fetal growth and shorter gestations of twins, say the authors.
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Obesity and hunger: where is the global balance?
Phasing out of market support for agricultural producers in developed countries is necessary as a first step in the fight against obesity, poverty, and hunger worldwide, says Schäfer Elinder (p 1333). She argues that the subsidising of agricultural overproduction in Europe has led to overconsumption and obesity. Also, the overproduction of food in rich countries distorts world trade and undermines the agricultural sectors in developing countries, hindering the eradication of hunger and poverty.
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