BMJ 2001;323 ( 13 October )

Choice GP

War, normality, and a time for women

The Chinese ideogram for "crisis," observed Winston Churchill repeatedly, is composed of two characters that separately mean "danger" and "opportunity." This observation might offer some comfort with bombs falling on Afghanistan, the United States in high anxiety over bioterrorism, millions of Afghanis starving now, many in the developing world starving soon (p 824), and the prospect of a third world war (pp 822, 823). Could something good possibly come of this? Douglas Holdstock thinks it might if an international criminal court comes into being sooner than it otherwise would (p 822). It might also if it causes us to recognise our global interdependence. The Americans are dropping food and medicines on Afghanistan as well as bombs, and surely every doctor must hope that the food and medicinesand aid for Afghanis to produce their ownwill continue long after the bombs have stopped.

Against this backcloth "normality" can seem hard to sustain. Should we stop routine business in the BMJ and devote every page to the implications of the world crisis? Most readers will, we think, be pleased that we haven'tparticularly as our need to say something might overwhelm our capacity to say something thoughtful and well observed (as has perhaps happened to many of the mass media).

Normality this week isin the week before the meeting of the Cochrane Collaboration in Lyons (p 821)an orgy of debate on evidence based medicine. A review of Cochrane reviews finds major methodological problems in a third of the reviews (p 829). Another study finds that clinical practice guidelines on smoking cessation do use systematic reviews as evidence but could use Cochrane reviews much more (p 833). The first in a series on evidence based paediatrics finds a lack of evidence for most screening of well children (p 846).

Evidence alone can never be enough for most medical decisions, and little shows this better than the debate over the benefits and risks of MMR vaccine. Many parents believe in a link with autism despite little evidence. Most parents have never seen the severe consequences that may follow measles. These issues are debated in a three way discussion in the primary care section (p 838), two letters (p 869), and a personal view (p 875).

Finally, something very abnormal has happened in one of the routine sections of the journal. For the first time in 160 years every obituary is of a woman (p 871). Women are finally becoming equal with menand not before time. Does it mean anything that every one of the suicidal terrorists of 11 September was a man and that all the major figures in our current "war" seem to be men?

Footnotes

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