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Rapid Responses: Rapid Responses published:
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Surely a new low for the BMJ?
- Richard J. Aspinall (8 October 2004)
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Only dead fish go with the flow re: Surely a new low for the BMJ?
- Adrian S. Blaj (9 October 2004)
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Let's not add to the 85%
- Andrew P Moltu, Alexander Molassiotis (9 October 2004)
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Re: Surely a new low for the BMJ?
- Alexander Molassiotis (11 October 2004)
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Richard J. Aspinall, Research Fellow Division of Gastroenterology/Hepatology, Scripps Clinic, La Jolla, CA92037
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Having read many correspondents lament the decline of the BMJ as a serious medical journal, I sadly must now agree. It has come to this: The publication of a letter castigating almost all established medical and surgical therapies as having no scientific base. And the supporting evidence cited for this sweeping statement? An online article from an Australian organic food delivery website, itself composed of hearsay, second hand quotations and the kind of data which supports the old saying that "approximately 85% of all statistics are made up on the spot". Competing interests: None declared |
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Adrian S. Blaj, Psychiatrist Case Farm Hospital, The Ridgeway, Enfield, EN2 8JL
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One must recognise, Richard has invested a fair chunk of time browsing through the laments of various Jeremiahs in respect of the supposedly decline of the British Journal of Psychiatry. It is very sad that Richard has reached a depressive conclusion. Perhaps he should refer to Professor Tom Burns' inspired words when asked 'what is the most important advice you could offer to a new trainee?' He simply replied: 'Make sure you overdo it in the beginning. Don't be measured or cynical' (Burns, 2004) http://pb.rcpsych.org/cgi/content/full/28/9/352 A characteristic of the present - interestingly enough - is the fact that almost invariably people grumble about it and see the past as a golden era in comparison. My personal view is that one should not blame the vehicle of knowledge, in our case the BMJ - from a sociologic point of view, there is value both in negative and positive events as well as in the lack of them. There is no need to remind Richard that everyone has a right to a personal opinion and is superfluous to say that in the real life we need to learn that sometimes we should agree to disagree. As very rarely there are clear rights and wrongs and most of the time we simply don't know and have to live with the unknown, I think it is totally unbalanced to criticise the Trainee BMJ of the new information era. The BMJ is neither a judge to pass sentences, nor an autocratic entity to censure those less than orthodox views (after all, if the editor becomes ruthless, most of us are going to grumble about censorship, freedom of expression, etc). People fail to understand that we live in times of information revolution which is going to change many habits regardless of our personal wants. It is interesting to find out whether the chorus of lamenting Jeremiahs belong somehow to the 'Old Guard' which cannot tolerate the blasphemy of the new generations asking 'rude' questions. The old order is about to crumble - the silent information revolution is going to unmask the rigidity, inflexibility, intolerance, etc and expose it to the Whole World Wide Web . As my daughter 'encouraged' me recently: 'Daddy, only dead fish go with the flow!' Reference: Fannon, D. e-interview - Tom Burns - Psychiatric Bulletin, Vol 28; 352 Competing interests: None declared |
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Andrew P Moltu, GP Limes Medical Centre LE19 2DU, Alexander Molassiotis
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Whilst I have no reason to deny an individual his or her right to spend their own money on their health care as they see fit, assuming they are suitably informed as to the risks and benefits, as a taxpayer I would object to paying for a host of "new" therapies being funded on the NHS without a sound evidence base to justify their inclusion. Simply saying that 85% of existing therapies used by conventional medicine have little or no evidence base does not justify the inclusion of more therapies lacking evidence. Retrospectively justifying the existing 85% of accepted practice may not be practical in the short term but certainly before any new treatment is accepted for mainstream NHS funding it should first stand up to scientific scrutiny. Surely it's not too much to expect all new therapies (conventional and complimentary) to have a sound evidence base before being funded on the NHS. (Who pays for the research is another matter!) Competing interests: None declared |
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Alexander Molassiotis, Reader in Cancer & Supportive Care University of Manchester
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I can appreciate the comments made by Dr Aspinall, but if he had taken the time to read the information provided on the website, he would realise that these numbers came from prominent (orthodox) medical academics. Such numbers also reflect the large number of scientific peer reviewed studies showing that level 1 evidence in many medical specialities is not as high as we would expect (varied by speciality) (1- 7). I am glad, however, to see the point on the website information raised, as it shows that some of us tend to discredit and dismiss information if it doesn't conform to the orthodox and traditional ways of disseminating information, not accepting that the world wide web is nowdays a major and common means of disseminating information. Often the same happens with complementary therapies, we pass judgements and dismiss them without taking the time to consider all facts available. Of course there is no doubt that complementary therapies should be evidence based with the same standards applied as in orthodox medicine. But, are we too quick to be judgemental and dismissive? 1.Borrill et al 2003, BMJ 327:1136-38; 2.Horton 1996, Lancet 347: 984 -85; 3.Howes et al 1997, Br J Surg 84: 1220-23; 4.Michaud et al 1998, Arch Intern Med 158: 1665-68; 5.Ellis et al 1995, Lancet 346: 407-10; 6. Gill et al 1996, BMJ 312: 819-21; 7. Lee et al 2000, Ann Thorac Surg 70: 429- 31. Competing interests: None declared |
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