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Something for the weekend (Editorial)

Bandolier has spent a lot of its life agonising over diagnosis. It remembers an ultrasound diagnosis of an early miscarriage, and an eminent and experienced gynaecologist who didn't believe the diagnosis because it "didn't feel right". The miscarriage is now off to University. Our experience is that we need more information about demonstrating effectiveness of diagnostic tests. Interesting things on diagnostics are like buses. You wait for ages and then lots come along at the same time. So we have focused on diagnostics this month.
In the past there was too little information. Now two systematic reviews of the highest quality have been published, and we examine one of them (on the use of foetal fibronectin to predict preterm delivery) in detail . We also examine how different the pathological diagnosis of gastric cancer is between Japan and North America and Europe, and how even experienced colonoscopists may miss quite a number of adenomas in a single examination.
But there is good news on the prostate cancer front, where preliminary studies of a new type of prostate specific antigen test, combined with low prostate volume, seems to be able reliably to distinguish between cancer and benign hyperplasia. Not only might this save some unnecessary biposies, but there is also a suggestion that this test is the one that might just distinguish agressive tumours - or tell the tigers from the pussycats.

Something for the weekend

One of the things that Bandolier set out to do was to give its readers early warning of the effectiveness of new interventions and treatments. That has been quite difficult, as much as anything because of the need to examine the vast amount of information on interventions we already use.
We were struck by the increasing literature on treatment of erectile dysfunction , because of two quality trials in the New England Journal of Medicine (page 5). So Bandolier did some mental NNT calculations, and was surprised at the effectiveness of these. According to some estimates, erectile dysfunction is a common (though probably not much discussed) problem. We also chased down some information from the Guardian which told us that an oral preparation was on the way.
Now while all this begs for some schoolboy hilarity, the combination of a common problem and effective treatment in an area where demand could be high poses real problems for the NHS. It seemed to Bandolier worthy of some early thought. Take five minutes to think about the combinations of problems that this will bring for prescribers and commissioners.

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