bmj.com: Comment

Helping to stop doctors becoming complicit in torture

The world has witnessed many examples of healthcare professionals being complicit in acts of torture or inhumane treatment. A new UN resolution should help doctors to follow their consciences when confronted with torture say Peter Polatin, Jens Modvig, and Therese Rytter: "Increased awareness of the problem of medical complicity in torture should lead to more education and training in medical ethics for doctors with dual obligations ... Additional political pressure must also be brought to bear by "naming and shaming" states, national medical associations, healthcare professionals, and other perpetrators who facilitate or allow acts of torture in breach of this resolution. "

New drugs for old: disinvestment and NICE

Methods for identifying drugs that can be discontinued need to be as rigorous as those for assessing potential new treatments. Dyfrig Hughes and Robin Ferner suggest some strategies to ensure best use of NHS resources: "There is a danger that although medicines approved by NICE are adopted uniformly, the treatments, interventions, and services that are displaced will be selected haphazardly. An explicit framework for the identification and appraisal of medicines for disinvestment should provide better value for money while reducing this source of inequity."

Publishing information about ongoing clinical trials for patients

Patients who want to take part in clinical trials often have difficulties in finding the required information. Fiona Godlee and Iain Chalmers argue that their needs can and should be met and conclude: "If progress in meeting these needs cannot be achieved without legislation, then the latest revision of the Helsinki declaration should be used as a basis for changing the law."

More comment published on 25 February:

Use of full body scanners at airports

Since the attempted bombing of an aeroplane bound for the United States on Christmas Day 2009, several countries have made or are in the process of making a decision about mandatory use of full body scanners at airports. Editorialist Mahadevappa Mahesh says that current calculations indicate that the scanners are safe for general use, even in infants and children, pregnant woman, and people with genetically based hypersensitivity to radiation.

Is underdiagnosis the main pitfall when diagnosing bipolar disorder?

Bipolar disorder is a complex condition, and patients can present with the entire range of psychiatric symptoms. In this head to head debate, Daniel Smith and Nassir Ghaemi believe that many people with bipolar disorder remain undiagnosed. However Mark Zimmerman argues that overdiagnosis is the bigger problem.

Medical implications of the Taser

Reports in the medical literature of serious injuries associated with the deployment of Tasers are few, despite several hundred thousand estimated uses of the device. Lesser injuries may be under-reported. It is crucial, therefore, that governments and law enforcement organisations, assisted by healthcare professionals, establish mechanisms to improve understanding of the medical consequences surrounding the use of conducted energy devices such as Tasers. The systematic capture of medically relevant data from operational incidents is a vital step in this process, say the authors of this editorial.

Global health: Linking up for better health care

Health links - long term, mutually beneficial relationships between an NHS institution and an overseas partner - aim to strengthen health systems and improve health care by responding to the needs of the overseas partner. The UK centre to support such links with developing countries becomes fully operational in March. The centre and the funding scheme are positive movements by the government to support global health, but with a general election approaching and stretched national budgets there is some uncertainty about the future, says Sophie Cook in this feature.

Tiotropium and chronic obstructive pulmonary disease

Tiotropium is a once daily, inhaled, long acting anticholinergic drug that provides at least 24 hour improvement in airflow and hyperinflation in patients with chronic obstructive pulmonary disease (COPD). Clinical trials have consistently shown that these physiological effects translate into improvements in lung function, exercise tolerance, and health related quality of life, in addition to fewer exacerbations. Although tiotropium is not the "holy grail" of treatment for COPD, the fact that it improves patient centred outcomes supports its adoption as a safe and effective foundation treatment for all patients except those with mild COPD, says editorialist R Andrew McIvor.

Doctors on the front line

Images of dead soldiers returning from Afghanistan are frequently in the media, but there would be many more if it were not for the expert medical treatment that casualties receive, says Helen Macdonald in this feature. In a linked feature, she looks at the challenges of rehabilitation given that the UK government has recently announced proposals to improve care for seriously injured serving soldiers and veterans.

More comment published on 18 February:

Risk and equality

Time to turn the world upside down

In 2006 the NHS in England was left with many of its parts in deficit after the biggest ever increases in funding, and Nigel Crisp, then the service's chief executive, was kicked upstairs to the House of Lords and offered what many saw as a face saving job to see how the United Kingdom could help with health care in developing countries. In January he published a book on global health that is refreshingly radical, says Richard Smith in this review.