Editor's choice

Ways of learning

Smoking provides so many storiesfrom the science of addiction, through the epidemiology of causation, to the David and Goliath battles between anti-tobacco activists and the tobacco industry. This week's news round up, on smoking in public places, offers smoking as a backcloth to cultural differences (p 727). Americans and Australians resort pretty quickly to the law; in Britain few specific laws exist, but social pressure has acted to limit smoking in workplaces and public places; in France, in contrast, there are laws to limit smoking in bars and restaurantsbut social pressure to ignore them.

Another difference between societies is their attitudes to information. On p 762, for example, in describing the way that donepezil was marketed, David Melzer points out that nine months after the launch in Britain of this drug for Alzheimer's disease, the main clinical trials had still not been published. Though the American prescribing leaflet contains a summary of the findings of the main trials, the British product information does not, and no information is available from the UK's Medicines Control Agency, which "currently works in secret (although limited information would have been released if European licensing procedures had been followed)." He wants to see full trial results (in patients representative of those for whom the drug will be licensed) published before a drug is launched and an emphasis on clinical benefits and risks. He is particularly critical of advertisements that refer to data that are not publicly available.

We conclude our series on continuing medical education with an article by Linda Headrick and colleagues on interprofessional learning and working (p 771) and Peter Toghill's account of what the British royal colleges are doing (p 721). Headrick and her colleagues quote Schön, who wrote that too much education occupied the "high ground," where manageable problems lend themselves to solutions through research based theory and techniques, whereas most problems lie in the "swampy lowland" and defy technical solution. Their message is that getting the occupants of the swamp to work together on clearing it is an important part of learning and development.

Most weeks, in among the randomised controlled trials, the systematic reviews, the ABCs, and the other educational articles, we publish some small insights into how doctors really learn. Our "fillers" are the short pieces on memorable patients and other topics that fill spaces at the ends of pages, and in one this week (p 774) Olive McKendrick tells how she learnt from a 12 year old boy the importance of enabling ill people to keep some control over their livesand of how intimidating sitting in a low chair before someone in a higher one can be. We plan to list these fillers on our contents page, and we are also looking for a new name for them. Any suggestions?