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White discusses efforts to widen participation in medical school to include those from disadvantaged backgrounds.1 To ensure buy-in from all major stakeholders we need to emphasise the benefits to the profession and the health service of improving social mobility in medicine. And we need to tackle the gap in applications to, not just attendance at, medical schools between students of the highest and …

We welcome Waldron and Doherty’s reply and are reassured by local efforts.1 2 We agree that for UK and Northern Ireland alone, the threat is low. However, our letter was aimed at an international readership, and Middle East respiratory syndrome coronavirus (MERS-CoV) infected travellers pose different threats to each receiving country because awareness and diagnosis are not uniform worldwide. The case …

Last month around two million international pilgrims travelled to Mecca in Saudi Arabia to join in the annual Islamic Hajj pilgrimage before returning home to their countries of origin. Crowded close human and animal contact has caused previous communicable disease outbreaks.1 Coronaviruses2 such as Middle East respiratory syndrome coronavirus (MERS-CoV), which causes Middle East respiratory syndrome (MERS), have resulted in nosocomial outbreaks characterised by early nosocomial super-spreading events and transmission patterns involving healthcare workers. This poses great clinical concern as a potential cause of epidemics and threat to global health. In Saudi Arabia, 1231 MERS-CoV infections have resulted in 521 deaths and onward transmission to 21 …

We need to ban the sale of long pointed kitchen knives > “Britain in the grip of knives terror—third of murder victims are now stabbed to death.” Daily Express, 31 January 2005 > “Stabbing rampage kills one, injures five—a large kitchen knife was found.” Independent , 24 December 2004 Violent crime in the United Kingdom is increasing; figures from London show a 17.9% increase from 2003 to 2004,1 and one easily accessible weapon used in many incidents is the kitchen knife. Unfortunately, no data seem to have been collected to indicate how often kitchen knives are used in stabbings, but our own experience and that of police officers and pathologists we have spoken to indicates that they are used in at least half of all cases. UK government statistics show that 24% of 16 year old boys report carrying knives or other weapons and 19% admitting attacking someone with the intent to harm.2 Although other weapons—such as baseball bats, screwdrivers, and chains—are also carried, by far the most common weapons are knives.3 …

Paper p 311 It is extraordinary that more than 100 years since the first description of the treatment of hypothyroidism and the current availability of refined diagnostic tests, debate is continuing about its diagnosis and management. Symptoms of thyroid failure are often non-specific, such as weight gain, low mood, and fatigue. Some patients seeking an explanation for feeling “below par” are disappointed when thyroid function tests are normal. Unable to accept that there may be psychosocial reasons for their symptoms, a vociferous minority believe that hypothyroidism may exist with normal serum concentrations of both thyroxine (T4) and thyroid stimulating hormone (TSH). Their hypothesis is that a doctor cannot know whether a concentration of free T4 or TSH within wide reference ranges is normal for that individual. Such an argument, supported by some misguided medical practitioners to justify prescribing various combinations of thyroid hormones, does not appreciate the sensitivity of the pituitary thyrotroph, which modifies the synthesis and secretion of TSH in response to minor changes in thyroid hormone concentrations within their reference ranges. For example, a reduction in free T4 from 20 pmol/l to 15 pmol/l is likely to cause …

EDITOR—It is surely a sign of the increased pressures on doctors' time that they now tend to read only the titles or abstracts of manuscripts (designed to have maximum impact) rather than the body of the text. The two papers common to the criticisms of our position on thyroxine replacement treatment by both Crilly and Vanderpump and Franklyn illustrate the problem. In the Framingham study a low serum thyroid stimulating hormone concentration was shown …

Editor—Collier is right that the border between nutritional and medical uses of vitamin B-6 is blurred and needs fresh examination.1 It is therefore disappointing to note that a number of members of the Committee on Toxicity of Chemicals in Food, Consumer Products, and the Environment, whose report on pyridoxine was so roundly rejected by the Commons Agriculture Select Committee, will now sit on the new expert group on vitamins and minerals.2 However, I disagree with Collier on two specific points. Firstly, submissions to the Commons committee clearly showed that there is no scientific evidence that neuropathy results from the prolonged use of pyridoxine in doses of less than 500 mg/day.3 Whatever Dalton and Dalton observed, it was clearly not pyridoxine neuropathy.4 Secondly, I believe that Collier’s “centralist and restrictive” approach to the control of pyridoxine runs contrary to the widely held view that individuals should be responsible for their own health and should be given the best available information on which to base their decisions. Few would argue that scientific proof of activity for high doses of pyridoxine is not available. However, it is clear that pyridoxine is safe at doses of 100-200 mg, which is the dose at which it has been used, and that this dose is mainly used for self medication in disorders for which there is no effective alternative treatment. The data submitted to the agriculture committee showed that there are tens of thousands of people who have found relief by using pyridoxine—relief which may, admittedly, be due in part or entirely to a placebo effect.