Beclometasone

Earlier this year Minerva mentioned two Israeli doctors who said chicken soup should be classed as a drug. Cynics who want hard evidence of benefit will be interested in an almost forgotten controlled trial of chicken soup published by Chest in 1978 (74:408-10). It shows that sipping hot chicken soup from a cup speeds up nasal mucus by 2.3 mm per minute--more than hot water, cold water, or chicken soup through a straw. And faster mucus, say the authors, means shorter colds.

Researchers from Reykjavik exploited Iceland's excellent cancer registry to look into commercial airline pilots' risk of cancer (Occupational and Environmental Medicine 2000;57:175-9). Pilots have a high incidence of malignant melanoma, caused either by cosmic radiation at work or ultraviolet radiation on the beach. Jet lag from regular flights across time zones seems to increase the risk even further.

The Whitehall study of British civil servants has been running since 1967 and continues to provide evidence for the strong link between social class, illness, and death. The latest analysis in the Journal of Epidemiology and Community Health (2000;54:178-84) shows once again the health benefits of better pay and a high status job. Civil servants from the lower ranks get sicker and die younger than their superiors, even after retirement.

Clinical Evidence, the BMJ Publishing Group's acclaimed compendium of best evidence, is looking for clinical editors. If you are medically qualified and have clinical experience and skills in evidence based medicine the editors would like to hear from you. For more information see the advertisement in this week's classified supplement, visit the compendium's website (www.evidence.org), or call Fiona Godlee on 020 7383 6597.

It will not surprise many surgeons that their clinical hunches are less accurate than imaging by ultrasound at judging the cause of peritonitis (Archives of Surgery 2000;135: 170-3). Surgeons got the cause right in half of a series of 102 patients with peritonitis admitted to a hospital in Taiwan. The ultrasound results increased their diagnostic accuracy to over 80%. Other studies will have to compare ultrasound imaging with more traditional tests such as plain radiography.

Intranasal steroids such as beclometasone dipropionate may stunt the growth of children receiving chronic treatment for allergic rhinitis, although the randomised trial reporting this finding was marred by baseline differences in age and height between the intervention and placebo arms (Pediatrics 2000;105:e23). This stroke of bad luck in the randomisation process means that the study will have to be repeated before parents and their family doctors are convinced.

Scientists have engineered a line of human liver cells that can support liver function in rats--a small step along the road to reliable metabolic support for patients waiting for a liver transplant operation (Science 2000;287: 1258). The new cells' key feature is a "designer" oncogene that immortalises the cells in culture but can be modified to prevent cancer once transplanted. Hepatologists remain philosophical about the research. They have already waited more than 20 years for hepatocyte transplantation to deliver on its promises.

The next time you test a patient's stool for steatorrhoea, ask them first about "fat free" crisps. The fat substitute olestra is not absorbed by the gut and appears in the stool, where it mimics steatorrhoea in standard tests (Annals of Internal Medicine 2000;132: 279-82). An experiment in healthy volunteers showed that eating 5 ounces (140 g) of fat free crisps a day was enough to produce the kind of stools usually associated with serious malabsorption.

Between 1 August and 30 November 1995, 43 002 people died in the Netherlands. Nearly a third of deaths were preceded by a decision to withhold or withdraw life prolonging treatment, usually food, fluid, or antibiotics (Archives of Internal Medicine 2000;160:357-63). According to a survey of attending doctors, only a quarter of patients were competent enough to make the decision themselves, and in 17% of cases it was taken by a third party without the knowledge of the patient or their relatives. An "unexceptional" figure, say the authors.

Breastfeeding women who need to lose weight can be reassured that eating less and exercising more will not interfere with their baby's weight gain. A randomised trial in the New England Journal of Medicine (2000;342: 449-53) shows that babies continue to put on weight when their mothers lose 5 kg or so during a 10 week programme of diet and exercise. Fine; the difficulty will be persuading exhausted women to devote their only 45 minutes of peace a day to a workout and a carrot.

Cognitive behaviour therapy improves symptoms in people with schizophrenia, but no more than the same number of sessions spent chatting to a nurse about sports, hobbies, or current affairs (Archives of General Psychiatry 2000;57:165-72). This surprise result came out of a high calibre randomised trial of the technique conducted in two centres in England. The control intervention, known as befriending, worked as well as cognitive behaviour therapy, but not for as long. As soon as the befriending stopped, the benefits disappeared.

Dieting is depressing at the best of times because it leads to a dip in plasma concentrations of tryptophan, precursor to the "happy" neurotransmitter serotonin (British Journal of Psychiatry 2000;176:72-5). In women with a history of major depression, dieting can dangerously impair the regulatory mechanisms controlling serotonin, warn researchers from Oxford. In a controlled experiment, three weeks of dieting was enough to reduce everyone's happiness scores, but women with a previous history of depression scored lowest of all.

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