Life expectancy in England is related to income (and in London, it can be mapped by a resident's nearest tube station1). The arrival of a new government offers the opportunity to review the impact of earlier policies designed to reduce health inequality. A new report from the King's Fund2 has updated Michael Marmot's 2010 publication, Fair Society, Healthy Lives, and using a wider range of determinants of lifestyle and health, has found that income-related inequalities in life expectancy have improved since that report. Department of Health policies in the 2000s appear to have contributed to this, although reductions in child and pensioner poverty and improvements in employment and social housing have also impacted positively. Nevertheless, unemployment, housing deprivation, and binge drinking remain key factors in lowering life expectancy. The King's Fund report argues that a more nuanced and integrated policy response for the NHS and other public services will be required by the new government to continue to reduce inequality, but recognises that implementation in an era of austerity poses challenges, particularly for the most vulnerable.

One criticism was that the 12-month follow-up failed to capture a true clinical picture, and that more time was necessary to demonstrate their worth. The team that carried out this original work have now published 3-year data on 330 individuals detained under section of the Mental Health Act,1 randomised on discharge to CTO or voluntary status via Section 17 leave. No improvements in readmission rates, time to first readmission, or duration of readmissions were found for those placed on CTOs. The findings are even more powerful than the original results; CTOs now exist in various forms in over 75 jurisdictions, but no solid scientific evidence has yet been produced to support them. If there are subpopulations for whom (or specific circumstances in which) they work, such characteristics have yet to be delineated. A ‘least restrictive’ principle underpins the Mental Health Act, and a strong rebuttal is needed to justify ongoing CTO use – so-called ‘revolving-door patients' should not be replaced by revolving-door policy.

Antidepressant effectiveness is a topic seldom out of the scientific or popular press, with claim and counter-claim about the disclosure, reporting, and interpretation of data. Hieronymus and colleagues1 have thrown their hats into the ring: noting that about half of company-sponsored trials failed to show any superiority over placebo, they challenge that most studies evaluated changes in total scores on the 17-point Hamilton Rating Scale for Depression (HRSD-17), but that this might mask improvement in important subcomponents. Not all items equally correlate with illness burden, so they undertook patient-level post hoc analyses focusing on the four-point depressed mood subcomponent in 18 placebo-controlled industry trials of various selective serotonin reuptake inhibitors (n = 6669). The choice of this question was based on its diagnostic importance and the fact it had the highest baseline severity in the pooled sample. The result was that 91% of comparisons showed superiority of the active drug over placebo, compared with 46% where the summed scale was used (P<0.001). The authors argue that the summed scale is insensitive, and clouds current views on medications. The end of the debate? We think not …