BMJ April 14 2007

This week's BMJ is almost like a reminder of first principles in science and medicine.

Firstly, Niell Adhikari and colleagues confirm that in critical care medicine, theoretical hypotheses dont always translate into clinical and practical results. They review the use of Nitric Oxide in acute ling injury and show that depsite the physiological improvements it does not decrease death and conversely causes renal injury,limiting its use for this indication.
So, not everything that is supposed to work - works!

The second article is an incredible, much required review discussing the effect of interventions to improve drinking water on diarrheal diseases. As if to reinforce a point the authors from the London School show that any intervention will reduce the incidence of diarrhea. This review simply goes to show that simple measures are always the best and sanitation the key to all our problems and the most important medical advance over the last 166 years!

Finally, science is complicated enough for us not to make it more complicated with sophisticated biostatistics and data difficult to interpret. This review suggests that use of composite end points in cardiovascular trial points used mainly to decrease sample size might be fraught with its own problems and may lead to data being interpreted the wrong way.

So, when you read an article be careful, be careful when trying to transfer physiological phenomenon to the clinic and stick to the simple interventions - Clean Water!