When a new scientific discipline emerges, publishers are rarely far behind. They were particularly fast off the blocks with Cloning, the new quarterly specialist journal devoted to the science of cloning. It’s edited by one of Dolly’s creators and contains the usual mix of original research and reviews, as well as policy updates on cloning. You can see what it looks like on the website (www.catchword.com/titles/15204553.htm), but to read the content you have to subscribe.

Drug treatment for cocaine addiction took a step forward last week when scientists reported the discovery of an agent with the potential to reduce addicts’ cravings for cocaine (Nature 1999;100:371-5). BP897 is a partial agonist at the dopamine D₃ receptor, which is thought to be involved in the reinforcing effects of cocaine. If the rat experiments translate to humans (always a big if) this agent could launch a new generation of treatments for this increasingly desperate problem.

Buprenorphine works in a similar way—at a different receptor—to attenuate heroin craving, and is emerging as an alternative to methadone for heroin addicts. Prescrire International, a pharmacology review journal, gave buprenorphine a cautious welcome this month, concluding that it was a real advance in treatment (1999;19:102-6). The editors warn, however, that maintenance treatment with high dose buprenorphine will work in the long term only if pharmacists and doctors learn to cooperate better.

Football widows everywhere will sympathise with a Scottish woman who had to throw herself, twitching, in front of the television during Scotland’s world cup coverage last year to attract her husband’s attention (Scottish Medical Journal 1999;44:75-6). The faked fit worked and she ended up in Edinburgh’s only accident and emergency department, where doctors had already seen dozens of other patients—mostly men—with viewing related problems, including eight with chest pain, two with hyperventilation, and one who thought the players were talking to him through the television.

Ice packs can be just as damaging as hot water bottles if they are applied directly to the skin, warn two plastic surgeons from London (British Journal of Sports Medicine 1999;33:278-9). A 59 year old woman in their care sustained a partial thickness burn to the calf after a gym instructor told her to rest it on an icepack for 20 minutes. Freezing and compressing the skin at the same time is asking for trouble, they say, so always put something between the ice and the skin.

Patients with implanted cardioverter defibrillators will come to no harm walking through electronic surveillance systems, as long as they don’t dawdle, say a team of US cardiologists (Circulation 1999;100:387-92). A slow walk through three antitheft systems went undetected by the implantable devices in 169 volunteers, but seven showed evidence of clinically important interference when subjects stood close to a gate transmitter for two minutes. The take home message for retailers is that they must signpost their systems better to avoid accidents.

The Sydney Morning Herald published 155 articles commenting on the tobacco industry between 1993 and 1997, says the Australia and New Zealand Journal of Public Health (1999;23:233-9). Predictably, most of the articles were negative, probably because only 5% of the quotes were from industry sources. A content analysis leads the authors to conclude that tobacco executives are now officially the pariahs of the late 20thcentury, having overtaken even white supremists as the people we love to hate.

Clopidogrel may be an effective antiplatelet agent in patients with stroke or myocardial infarction, but it can’t compete with aspirin on price (Stroke 1999;30:1716-21). At about 6 cents a tablet, aspirin is 45 times as cheap as the newcomer, and it is just as good at preventing thromboembolic events, say reviewers. Doctors should stick to aspirin, unless it’s badly tolerated or contraindicated.

Despite a mountain of research, there is still debate about how to manage young people with dyspepsia. A randomised trial in Gut (1999;45:186-90) concludes that the most effective strategy for young people who have Helicobacter pylori is to eradicate the infection but leave out the endoscopy. Subjects in this group were better than controls who had endoscopy and were managed according to the findings. General practitioners should be cautious, however, until data from primary care are available. A study is in press.

Few of us would like to be the expedition doctor stranded at the South Pole with an undiagnosed breast lump, but at least the US government didn’t begrudge the thousands of dollars it must have cost to airlift the ultrasound scanner, videoconferencing equipment, and tamoxifen she needed to diagnose and treat herself (Times [London] 14 July:16). It’s a pity that it’s not as generous to the thousands of other American women with breast lumps who are not stuck at the South Pole—but who might as well be, for all the treatment they are likely to get without insurance.

It should be clear by now that walking is good for the cardiovascular system. It is also good for the brain (Nature 1999;400:418-9). After a six month trial of walking versus stretching and toning exercises in older adults, the walking group did better in cognitive tests than controls. Walking had the biggest impact on subjects’ executive control processes like planning, scheduling, and working memory, which are controlled by the frontal and prefrontal cortex.

Children who are abused or seriously neglected are four times as likely to develop a personality disorder in young adulthood than peers who are well cared for (Archives of General Psychiatry 1999;56:600-6). American psychiatrists who interviewed 639 families also found that particular forms of childhood mistreatment were associated with different types of personality disorder: physical abuse, for example, was linked to antisocial and depressive symptoms. Narcissistic and passive-aggressive disorders tended to occur after neglect.

Figure.

This 66 year old man presented to a surgical unit with weight loss, anaemia, and microscopic haematuria. The diagnosis was elusive despite multiple investigations including panendoscopy and cystoscopy. Careful physical examination, however, revealed multiple petechial haemorrhages hidden between his toes. Not even the patient had noticed them, but they led to the correct diagnosis: endocarditis. After confirmatory tests the patient had an aortic valve replacement. There is still no substitute for careful, repeated physical examination in the face of diagnostic difficulty.

Nigel I Jowett, consultant, department of cardiovascular medicine, Pembrokeshire and Derwen NHS Trust, Pembrokeshire SA61 2PZ