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Trust me, I'm a ..... (Editorial)

If you ride a motorbike from London to Glasgow, your risk of dying is about 300 times greater than if you fly or take a coach. Bandolier has found some more detailed figures that many of you asked for (page 8). That is a voluntary risk you are taking. You put your trust in the pilot or coach driver. Much of medicine involves trust, and a theme of Bandolier's stories this month is the risk, the peril, of misplaced trust.

Put not your trust in princes

If you have a mole excised you trust a pathologist to make an accurate judgement as to whether it is benign or malignant. That judgement may be more difficult than we punters realise (page 2). Recognising that there is uncertainty at every stage of the diagnostic process is hard for professionals. It's good to see that recognition in print with a will to improve.

Trusting reviews

Systematic reviews do not always tell exactly the same story, or necessarily the whole truth. Examples of four reviews of TENS (page 3) make interesting reading because of the nuances in different methods and conclusions. Another example is the way that NNT calculations can extract more useful truth from studies of new anti-epileptic drugs [British Medical Journal 1997 314: 603].

Urge to purge

Decisions not to use prostate-specific-antigen (PSA) for prostate cancer screening (page 7) are based on the argument that why bother to screen if there is no effective diagnosis or treatment? That is a statement which those diagnosed with prostate cancer, and those looking after them, may not like to hear. The clash between the politics of screening and shop floor treatment resonates again. PSA can be used successfully as a marker in treatment, so a knee jerk response to the reports of `purging' all PSA tests would be inappropriate.

Delete as inappropriate

Going to the chemist with a prescription Bandolier was surprised to be given a form to fill in. The form asked for details of Bandolier's ailments and medications. Ostensibly there is a laudable safety motive here, a double-check that patients do not take medicines which clash or are inappropriate. This information could also be misused, as for marketing purposes, or confidential details could leak. Are there any safeguards? Bandolier did not fill in the form.

Table of risks of travel

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