BMJ2012;345:e5529doi: 10.1136/bmj.e5529 (Published 15 August 2012)                                                                                                                                                            Page1of1
                             Editor's Choice
                                                                                                                                                                                                                                                                                                  BMJ: first published as 10.1136/bmj.e5529 on 15 August 2012. Downloaded from 
                                                                                                                                                                    EDITOR'SCHOICE
                             Onestepforward,twostepsback?
                             Jane Smith deputy editor
                             Ideas that have promise but don’t quite deliver seem to be a                                                                 the vast expansion in the numbers of people being treated for
                             themeinthisweek’sissue.Firstcomesdetailedinformationon                                                                       HIVinfection, a renewed interest in the search for a cure, and
                             genetic risks. Gareth Hollands and colleagues did a cluster                                                                  hopefultalkoferadicationandearlyintervention(doi:10.1136/
                             randomisedtrialtoseeifprovidingaDNAbasedriskassessment                                                                       bmj.5265). Yet Doug Kamerowremainsdoubtfulabouttalkof
                             to people at risk of Crohn’s disease increased the likelihood of                                                             an AIDSfree world (doi:10.1136/bmj.e5479). Even if all HIV
                             themgivingupsmoking,whichcanaffectthisrisk(doi:10.1136/                                                                      positive peoplewereidentifiedandstartedontreatment,hesays
                             bmj.e4708). It didn’t. In their accompanying editorial, Liam                                                                 in his Observations article, “it still would not spell the end of
                             SmeethandTjeerdvanStaacommendthisattempttostudythe                                                                           the HIV story . . . We have no vaccine and the virus keeps
                             effect of genetic information in a randomised trial, but they                                                                mutating.”
                             point out that the increased risk of Crohn’s disease conferred
                                                                                                                                                          In the wake of the Olympics it’s perhaps appropriate that
                             bythe particular genetic variants is dwarfed by the effect of
                                                                                                                                                          somethingassimpleasexerciseshouldfeatureasanimportant
                             havingafirstdegreerelativewiththedisease(doi:10.1136/bmj.
                                                                                                                                                          intervention for two common conditions. A Clinical Review
                             e4651). Once again the extra information provided by genetic
                                                                                                                                                          (doi:10.1136/bmj.e5208) and a summary of NICE guidance
                             analyses of common diseases doesn’t seem to be quite enough
                                                                                                                                                          (doi:10.1136/bmj.e4947) on peripheral artery disease both
                             to make an important difference.                                                                                                                                                                                                                                     http://www.bmj.com/
                                                                                                                                                          emphasisethestrongevidenceforofferingsupervisedexercise
                             Thesecondideathatgetsshortshriftis“payforperformance.”                                                                       programmes to everyone with intermittent claudication. And
                             PaulGlasziouandcolleaguesreviewedevidenceonthepositive                                                                       LindyClemsonandcolleaguesshowthatsometypesofexercise
                             andnegativeeffectsoffinancialincentivesinchangingclinical                                                                    can prevent falls (doi:10.1136/bmj.e4547). They randomised
                             behaviour and devised a checklist of things to consider before                                                               peopleagedover70toacontrolprogrammeofgentleexercise,
                             deciding to implement a pay for performance scheme (doi:10.                                                                  to structured exercise three times a week, or to a programme of
                             1136/bmj.e5047).Interestingly,noneofthewellknownschemes                                                                      balanceandstrengthtrainingintegratedintoeverydayactivities.
                             fromAustralia,theUnitedKingdom,andtheUnitedStatestick                                                                        Thegroupthatexercisedaspartoftheireverydayactivitieshad                                                                                  on 5 January 2023 by guest. Protected by copyright.
                             all the boxes. In an editorial Steffie Woolhandler and colleagues                                                            significantly fewer falls, whereas the structured exercise group
                             discuss the evidence that such schemes undermine honesty and                                                                 had only a non-significant reduction. In her accompanying
                             motivation(doi:10.1136/bmj.5015).Notonlydothesesystems                                                                       editorial (doi:10.1136/bmj.e4919), Meg Morris suggests that
                             invite“gaming,”suchasover-investigationtofindunimportant                                                                     embedding exercise in everyday activities is likely to increase
                             comorbidities and “upcoding” of conditions, they may also                                                                    adherence and ensure that “enough dosage of the intervention
                             “undermine the intrinsic motivation crucial to maintaining                                                                   is delivered.”
                             quality when nobody is looking.”
                                                                                                                                                          Cite this as: BMJ 2012;345:e5529
                             But there are more positive findings elsewhere in the issue. In
                                                                                                                                                          ©BMJPublishingGroupLtd2012
                             his feature on the 19th international AIDS conference in
                             Washington, Bob Roehr describes the upbeat mood driven by
                             jsmith@bmj.com
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