Evidence based medicine (EBM) was undoubtedly one of the major medical advances of the last century. EBM is at its best when it changes daily clinical practice and challenges well-established norms, but this only really happens every now and then. Two recent New England Journal papers about management of critically unwell patients have done just that.

Since medical school, doctors learn that the optimal treatment of patients with severe infection (sepsis) and low blood pressure (shock) is to pour in intravenous fluids. Not something that is up for debate, you would think. There are much more pressing things like drug-eluting stents to take to clinical trials. Well, think again. A paper by Maitland and colleagues reports a trial in Africa where over 3000 children with severe sepsis and shock were randomised to receive either boluses of fluid (albumin and saline) or no bolus in the early stages of treatment. Children with malnutrition or gastroenteritis were excluded. Amazingly, any bolus treatment led to an increase of 45% in the risk of mortality at 48 hours (relative risk 1.45; 95% CI, 1.13 to 1.86; P=0.003). The results were consistent across all subgroups of patients, and now researchers and clinicians all over the world are scratching their heads to understand whether what they have been doing since they were medical students is actually wrong and too much fluid is a bad thing in septic patients.

Intensive care, like surgery, is often cited as a difficult area of medicine for EBM to infiltrate. The traditional mantra is to give ITU patients nutritional support as soon as possible. In a trial of nearly 5000 patients, the two arms were either early initiation of intravenous (also known as parenteral) nutrition on days 1 and 2 of ITU admission, or late initiation of parenteral nutrition after day 7. Late initiation was associated with reduced complications and faster recovery. So EBM is possible in the ITU and it does change practice. What other areas of treatment of the critically unwell do we need to test?

The great swapthon

The BBC 'Great Swapathon' voucher bid to boost healthy living
A child eating a healthy lunch Families are being urged to swap the sugary snacks for strawberries or other healthy options

Families in England are to be offered £250m in vouchers in a bid to encourage them to eat healthily and exercise.

Apparently 4 million £50 voucher books will be on offer through the News of the World and Asda stores.

Health Secretary Andrew Lansley said: "It's a great example of how government, the media, industry and retailers can work together to help families to be healthy.

Is there any evidence-base for this?

Basically the money could go to 5 million familes if you give them £50. Therefore of the 16.5 million families in the UK about one in every three could get the money. see familes in Britain publication.

I filled in the questionnaire for me and my two kids, and this is the sort of advice I got

'Swap Fizzy drinks (and drinks with added sugars) for water, unsweetened juicds or milk',

'Swap fry up for grill-ups',

Swap creamy indian dishes for tomat-based sauces or grilled dishes

They then ask you to:

Tell us how it went?

Once you’ve tried your swap for a week, it’s time to share how it went. Your experiences and ideas are a valuable part of the Swapathon. Your shared tips help support everyone taking part, and encourage others on to make their own changes. See what our Swapathon community are saying.

The website annoying, it is slow, and its pretty one dimensional and repetitive. If I tried this for a week I'd be swapping my computer. In fact save your breath and swap this site for some exercise instead.

Are we surprized or do they think the public is stupid. Food policy experts have previously questioned the wisdom of allowing big brands to become involved in telling the public how to eat more healthily.

I say give the money to schools, they could do something useful with £250 million. I'll let you know when the adverts start to my email address

“Organic” is just one of the many labels thrust on the socially conscious, along with “carbon-neutral”, “eco-friendly”, “green”, “fair-trade” and “ethical”. Such labels are powerful marketing tools for the relevant industries, and people are even prepared to pay more if they feel they are doing good, particularly for their health. But are the claimed benefits backed up by evidence and should we be sceptical?