bmj.com: Comment

How long does it take to train a surgeon?

The time required to train a competent surgeon is a hotly debated topic as working hours for medical trainees are increasingly restricted worldwide. Surgical disciplines are unique in that surgeons must not only acquire medical knowledge but also develop the manual dexterity and, sometimes, the strength and endurance to perform procedures. Gretchen Purcell Jackson and John Tarpley examine the evidence from the United States on the effects of duty hour legislation on surgeons' training. In a linked editorial Roy Pounder writes that creating more flexibility around current working is the solution.

Dangers of listening to the fetal heart at home

An over the counter fetal heart monitor can be a fun purchase for expectant parents eager to hear their unborn child. But Abhijoy Chakladar and Hazel Adams warn that parents shouldn't rely on the devices to indicate fetal health. In an accompanying commentary, Rebecca Coombes warns that there are some monitors on the market that do not comply with UK and EU regulations.

Commercial solutions to malnutrition

Big business in Bangladesh is at the centre of a drive to reduce rates of malnutrition, but is this an appropriate public health measure, and will it make any more than a dent in the problem? Ben Bland asks. In a linked feature Tahmeed Ahmed and A M Shamsir Ahmed write about the interventions needed to reduce the burden of malnutrition in Bangladesh.

Also published on 5 November:

International Aid: Innovative financing of health care

Tessa Richards: Brave new world

Theodore Dalrymple: Sound sleep advice

Mary E Black: An interest in teeth

Des Spence: It's better to give

Medical Classic: De Rerum Natura (The Nature of Things)

The highs and lows of policy based evidence

Review of the week: On the concept of trauma

The chilling effect of English libel law

English libel law creates a "chill factor" that results in censorship, and it must be reformed, argues Richard Hurley. Reform is necessary, he says, to stop expensive and unfair UK law preventing open scientific discussion here - and around the world.

Also published on 28 October:

Diagnosis of diabetes using the oral glucose tolerance test

Control of hepatitis B and C worldwide

Theodore Dalrymple: Poet scorner

Medical classic: Alcoholics Anonymous - "The Big Book"

Review of the week: The life stories of disease

Personal view: The doctor is sick

Des Spence: The colour purple

I'm a celebrity, get me the best treatment here

An eye on profit

Moorfields Eye Hospital in London was one of the first foundation trusts to be created. In 2007 it opened an outpatient branch in Dubai, the first such overseas outpost and example of "an entrepreneurial spirit that, depending on viewpoint, could either rescue or ravage the NHS," writes Jonathan Gornall. The Moorfields venture has yet to make a profit but is ahead of its business plan and on target to do so. Under current legislation, the success of such schemes is limited by the cap on the percentage of total income foundation trusts can earn from private patients, but the British government has now committed to a rapid review of the law that could change the rules. If this happens others may be tempted to follow Moorfields' lead.

Whistleblowing: The price of silence

Despite government outlawing of gagging clauses in NHS contracts, Jonathan Gornall reports a new case that shows at least one trust has continued to use them. Jane Cassidy reports another case of one consultant currently working as a locum who has left two trusts with gagging clauses concealing the reasons for the departures. She hears how a concerned medical colleague who tried to report the consultant to the General Medical Council got into trouble for breaching the gagging clause. In an accompanying commentary, Mark Porter gives the BMA's view on whistleblowing.

Also new:

Review: A country doctor's slide into addiction

Should healthy volunteers in clinical trials be paid according to risk?

The severe reactions experienced by healthy volunteers in the TGN1412 trial have led to questions about payment for participation. Currently, the dominant view is that only time and expenses should be remunerated. Eleri Jones and Kathleen Liddell argue in this head to head article that objections to paying according to risk are paternalistic, but John Saunders thinks it would lead to people being exposed to unacceptable danger.

Podcast: Need and no less, want and no more

Political attention has been focused on providing universal health cover, but this can't happen without curbing rising costs. In this week's podcast Duncan Jarvies talks to Albert Mulley, from Massachusetts General Hospital and Harvard Medical School, about how practice variation is driving up the cost of health care. Zosia Kmietowicz takes us through the news.