Neglected

Medicine is so complicated that it's perhaps not surprising that some issues should be neglected. But why should cancer related fatigue be “the most important untreated symptom in cancer today” (p 1560)? The problem is common but is rarely discussed and seldom treated. Gregory Curt discusses the causes including poor sleep hygiene, depression, centrally acting drugs, and anaemia. All can be treated.

Pain relief in children has long been neglected—partly because of the mistaken belief that neonates couldn't experience pain and partly because of anxieties about adverse effects from pain relief. A news report on a study in Archives of Disease in Childhood suggests that many invasive bone marrow procedures are still carried out in conscious children despite the availability of safe and effective modern anaesthetic techniques (p 1564). This neglect seems to be commoner in North America than Europe, although a commentary in Archives is sceptical about the study.

Injuries are a major cause of death and disability that medicine and governments have neglected, which is unfortunate as deaths are set to increase from 5 million a year worldwide now to 8.4 million in 2020 (p 1557). The neglect may stem, write three editorialists, from “ignorance of the scale of the problem, the mistaken perception that deaths are “accidental” and therefore unavoidable, the belief that prevention lies outwith the scope of health services, and an absence of political will.” Political will has now been generated in Sweden, the United States, Australasia, and some parts of Europe, but not in Britain. A report from the BMA calling for a national body on injury prevention should help (p 1561).

Neglect of research into complementary medicine rightly upsets practitioners who are accused of using treatments not based on evidence but then can't get funding for trials. Public pressure is bringing about change, and this week's BMJ has two randomised trials of complementary treatments. One suggests that acupuncture will produce short but not long term benefit in patients with chronic neck pain (p 1574), while another shows that drinking cranberry juice will reduce urinary tract infections in women (p 1574).

Britain's General Medical Council, which regulates doctors, probably wishes that it was neglected more. It's constantly in the limelight, and a BMJ editorial of four weeks ago suggested it was approaching the abyss. Today the abyss looks further away. A meeting last week produced something close to agreement on the council's governance, and the council agreed recently on proposals for validation. Now both prominent doctors and lay members of the council write in support of the council (p 1599).