Minerva

Death rates from asthma in Philadelphia fell in the early 1970s but then increased again so that by 1990 the rate was 50% higher than that in 1965 (New England Journal of Medicine 1994;331:1542-6). During the same 25 years the concentrations of major air pollutants declined substantially. In the public eye air pollution explains the current worldwide epidemic of asthma, but medical epidemiologists are still looking for the cause.

Minerva has watched with interest the progressive refinement of the acute physiology and chronic health evaluation score as a predictor of survival for patients in intensive care. Yet as a review in "Critical Care Medicine" (1994;22:1345-7) admits, even the APACHE III score is not being used to decide when to withdraw treatment from seriously ill patients. Account is taken instead of attitudes-especially the value judgments of the patient's family.

Laparoscopic surgery for abdominal cancers is feasible but may have its own special drawbacks. Fourteen cases have now been reported (Surgery 1994;116:842-6) of patients developing recurrences of their cancers in the abdominal wall owing to seeding from tumour cells during the laparoscopic procedure. This occurred in four patients treated for ovarian cancer, five with cancers of the gall bladder, four with cancers of the colon, and one with cancer of the stomach.

Three papers in a recent issue of "JAMA" (1994;272:1583-7, 1588-91, 1619-20) have shown that doctors who have repeated allegations of malpractice made against them do not treat their patients less competently; what they do is...