ADHD

NICE Guidance on Attention Deficit Hyperactivity Disorder has recently been published. Follow on letters in the BMJ (BMJ 2008; 337:a2287 and BMJ 2008; 337:a2284) draw attention to the risk of diversion and abuse of methylphenidate and the flimsy nature of the evidence on which the guidance to prescribe stimulants as a first line treatment in those with "severe" ADHD.
Clearly the management of this condition remains controversial and prescribers need to bear in mind the risks involved.

Aspirin

BMJ 2008; 337 :a1806 and
This story got coverage in the popular press and clearly indicates that aspirin is a secondary prevention drug only. We should not be using it for primary prevention, even in patients with diabetes.
We certainly need to change our practice.

Osteoporosis

I'm back after a break - with news from the BMJ.
The latest guidance from the National Osteoporosis Guideline Group is now available. This is interim guidance as we wait for NICE to release its osteoporosis appraisal. The NICE appraisal is held up by a second appeal (BMJ 2008;337:a2204).
What is in the guidance? Well the news bit for me was in two parts. Firstly - postmenopausal women with prior fragility fractures don't need to wait for a Bone Mineral Density scan before starting treatment. Secondly there is the availability of a tool to estimate risk (the FRAX tool - see the website) which is recommended for opportunistic use in:

• Men aged 50 years or more (with or without fracture) but with a WHO risk factor or a BMI <>
• All postmenopausal women without fracture but with a WHO risk factor or a BMI <>

This results in categorisation of people into low, intermediate and high risk groups.

We could be working opportunistically to identify those at high risk and starting treatment where appropriate.