Rapid Responses to:

EDITOR'S CHOICE: Richard Smith A very obstetric issue BMJ 2003; 327: 0-g [Full text]

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Rapid Responses published:

Midwives on labour ward

David Barnes   (13 September 2003)

New Management Disease

Paul M Fenton   (30 September 2003)

Modern day Caesars

B.C. Rao   (3 October 2003)

Midwives on labour ward 13 September 2003
David Barnes, Semi-retired home Send response to journal: Re: Midwives on labour ward	COMMENTS: What a searching and informative piece of fundamental research this is. I am reminded of articles signed by Pasteur and Koch. We really must have enough midwives who are trained and up-dated working in the labour ward. If only we had known... Our gratitude must be extended to the authors of these long awaited conclusions. We now understand so much which yesterday was a complete blank. Well done editor to have acquired this hopefully exclusive and mind-numbing revelation. The authors need double payment and Nobel prize nominations. Yours etc., David Barnes MB BS LLB(Hons) Competing interests:   None declared
New Management Disease 30 September 2003
Paul M Fenton, retired France Send response to journal: Re: New Management Disease	One of the unexpected side effects (unexpected to me, at least) of the modern feature of being able to respond electronically, instantaneously, "from the hip", to something that one reads in a journal is that no one takes the slightest notice of the said response! Anyone can have their say and, as a consequence of this empowerment of the masses, one may as well say nothing. One could probably write a random selection of words to the BMJ electronic rapid responses section and get it "published", provided there were no four-letter words which are probably removed automatically. I should try this someday. Certainly, typographoical errors are never corrected so if there is any human, editorial input it is either semi-literate or hurried. In journals today expert opinion (usually one's own) is diluted with EastEnder wisdom in a bland, homogeneous mix and some random decision is made based on statistical meta-analysis which, when it is totally, politically correctly, inclusive will always sum the significance of any outcome either to the expected result or to zero. Evidence, Cochrane, NICE must all be involved to get this result. To Dr Barnes' letter in rapid responses: I think I detected sarcasm in his applauding the BMJ for publishing something that is so obvious (ie: midwives are needed on the labour ward, not talking about labour somewhere else) that it should not need saying. The new feature ("what is already known......... what this study adds") should have weeded out this paper perhaps? My own study in the same edition of the BMJ should likewise have been weeded since the important conclusion of we three authors was that people with hypovolaemic shock should have a drip put up. An alternative view is perhaps that the inclusion of these obvious, "back-to-basics" papers is no more than a symptom of the new, autoimmune disease that is affecting the developed world today. To wit: New Management Disease. Their publication is an indication that, even now, there are people within the editorial offices of the journals themselves severely affected, battling with others who are immune. NMD is incurable and will be found to be a prion disease or similar so, in retirement, Dr Barnes, there is no point in putting up one's blood pressure but for palliative therapy I can do no better than to refer you to a rival journal, (though not especially a better one): The Lancet, namely Johannes Borgstein in "Jabs and Jibes", 19th July 2003 Vol 362, No 9379. Yours Sincerely, Paul Fenton Competing interests:   None declared
Modern day Caesars 3 October 2003
B.C. Rao, G.P 847,2nd cross,7nth main,H.A.L.2nd stage,Bangalore560008,India Send response to journal: Re: Modern day Caesars	Julius Caesar was a Roman emperor who achieved his empire by putting to sword hapless opponents. Our modern day Caesars [obstetricians] are doing this to our pregnant women. This is particularly true in Urban India. One study published in the National medical journal of India from Madras put the rate conservatively at 42%! It is easy to make some surmises. There must be some justification in some but in most it is for gain. A surgical delivery is much more lucrative than the natural one with the added attraction of being able to do at his [her] convenience! B.C.Rao Competing interests:   None declared