BMJ 2000;321 ( 23 December )

Choice GP

A pile of strangeness

"This anthology amassed itself like a cairn," write Seamus Heaney and Ted Hughes in the first line of their marvellous collection of poetry The Rattle Bag. It's the same with the Christmas BMJ. There is no master plan. Rather we wait to see what accumulates, and this year, I judge, we have a goodly pile.

The essence of the Christmas BMJ is strangeness. It's our left brain issue. We want everything to be not as it seems. Thus streptokinase is used not to treat patients but to do the laundry (p 1554). Instead of high powered ophthalmology we have a surgeon describe how to make an ophthalmoscope for less than £1 (p 1557). The reviewer didn't bother with words and references: he simply saw if he could follow the instructions (p 1559). He could. So we published.

Studies of inequalities in health are common fare in the BMJ, but our Christmas paper has a strange, historical twist (p 1547). The authors have taken Charles Booth's 1896 map of poverty in London and matched it to 1990s mortality. They discover that some causes of death in the 1990s are predicted more strongly by the distribution of poverty in 1896 than in 1991.

The full moon is a time for the strange, and it's only to be expected that BMJ authors would ask themselves whether animals bite more at the full moon. It's so much to be expected that two sets of authors have tried to answer the question. Most satisfyingly, the Bradford authors find more bites at the full moon (p 1559), whereas the Australian authors do not (p 1561). Dogs may have been under suspicion in these studies, but three cases show dogs in a good light as they detect their diabetic owners' hypoglycaemia (p 1565).

History is a rich hunting ground for connoisseurs of the strange, and James Whorton's history of constipation illustrates how odd we've always been about our bowels (p 1586). The picture of the abdominal massage machine on p 1587, one of many crazy cures for constipation, should be imprinted on the mind of every medical student. Might it be that your modern treatment will eventually be judged as equally bonkers? Herbert Kinnell disturbs our equilibrium further by proving that, far from being an exception, the mass murdering doctor Harold Shipman was the latest in a long line of doctors who were serial murderers (p 1594).

But the strangest article of all this year shows how those of you who sleep in beds with pillows might avoid low back pain (p 1616). Throw away your bed and your pillow and sleep on the floor like a gorilla or a dog. Next Christmas we hope for a randomised trial of these ideas.

Footnotes

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