A group of wise and experienced academics got together in a Cambridge college last year to agree basic principles for designing and evaluating complex interventions to improve health care. But no-one has yet designed an intervention to make politicians listen. The most striking complex interventions in British health care over recent years have been NHS Direct, community matrons, walk-in primary care centres, referral management systems, and midwife-led birth centres without paediatric or obstetric cover. If the methods laid out here had been adopted, few of these would even have got a pilot study. As it is, billions of pounds have been spent and the (mostly dire) evaluations are barely trickling in.
The islands of New Zealand have a wide range of climates, but everywhere houses are still mostly wooden and about a third of them lack insulation. Families living in uninsulated houses get more illness than those in warmer dwellings. Warm housing is a medical issue: keep writing those letters for your patients.
A national study in Norway finds a protective effect from folic acid supplementation in early pregnancy on the rate of facial clefts in the newborn. I’m all for putting folate into European bread flour, as suggested in the editorial on p.433.
I take a keen personal interest in the management of kidney stones, and I can recommend this clinical review despite a few retained Americanisms, such as “narcotic