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Hope Springs - Editorial

A dusty Bandolier has returned from a surfeit of recent scientific and clinical meetings. There were some good talks and some not so good talks. Sometimes there seems to be a gulf between the scientific inquiry and the everyday needs of people. Patients hope to get better, and researchers hope their work will help (and hope it will help to further their careers, too). Too often hope is the only link between the patient and the researcher.

There are glorious exceptions, the times when research and clinical need come together to create hope when previously there was none. The best current examples are the exciting developments taking place in HIV infection and AIDS, where new treatments and tests combine to hold out hope for improvement and perhaps more. Bandolier is following these developments with interest, and hopes (that word again) to write about them shortly. Perhaps when these triumphs first emerged Bandolier would have failed to predict their triumphant future.

Many people, and their relatives and carers, have to cope with awful symptoms and disabilities. Hope is important for them, and a nursing review of hope ( story 5 ), while it provides no numbers-needed-to-treat, or indeed any numbers, at least provides a starting point for those interested in this special aspect of the relationship with our patients.

Patients and others find hope in the trumpeting of research findings in the media, and the uncritical appraisal of launches of new interventions. An example is that of donepezil (Aricept) in Alzheimer's disease. As Bandolier reported last month ( #39 ), professionals are placed in a real bind having to advise patients with less than adequate information. We frogs need clear help with all this stuff which keeps landing in our jam jar. Bandolier this month ( story 2 ) reaches up from the slime at the bottom of the jar and bites the bullet (acknowledging the mixed metaphor).

Squaring the circle

How should health services manage innovation? There are real problems with both the range of information - the innovation may be a drug, an operation, a new diagnostic test, or a management change - and the quantity - one new drug is licensed about every 10 days. Some new knowledge will itself challenge the way in which we do things, not just what we do. Perhaps this is the section of the circle which we need to square. We tend to focus on the scientific advance - sometimes not asking which scientific advance would be most helpful - and then blink in astonishment when the advance arrives and we can't afford it. Nothing new here, and these things - the very necessary advance and the slightly less necessary advance, shouldn't be exclusive - trouble is they are when we haven't got unlimited money.

Philosophical in the bath

Bandolier has a Celtic distrust of philosophers, believing that some activities are best restricted to bath time, but offers some wise words attributed to Bertand Russell, via David Grahame-Smith.

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