Lurking treasures

BMJ 1997; 314 doi: (Published 10 May 1997) Cite this as: BMJ 1997;314:0

This column, which is usually–but not always–written by the editor, has three main functions. It must provide links among articles that have a common theme but are scattered throughout the journal. It provides a place to make announcements about the journal. And–perhaps most importantly–it is intended to direct readers to corners of the journal where treasures lurk. This week Fiona Godlee takes on the task of linking papers on international health (p 1359). She does so as the World Health Assembly meets after the announcement last week from the much criticised director general that he will not be seeking re-election (p 1367). Editor's choice can thus luxuriate in lurking treasures.

Can, a reader asks on p 1380, the beating of the heart be explained at a molecular or an atomic level? He or she might as well have asked whether all biological functions might eventually be explained at a molecular or atomic level. There is a current in modern scientific thought that suggests it is so. Such a question can never be answered positively, but it can be answered negatively. Thus a single black swan provides an answer to the question “Are all swans white?” in a way that a million white swans cannot. Denis Noble, professor of cardiovascular physiology in Oxford, answers that “There is no molecular, still less atomic, oscillator that generates the heartbeat.” The beat is provided by a cluster of cells. Perhaps, suggests Professor Noble, “we should recognise the existence of a æphysiome'–that is, a logic of physiological systems–whose study is just as important as that of the genome.”

An equally fascinating question–whether patients trust doctors who express uncertainty more than those who don't–is answered on p 1389. Two Australian authors have conducted qualitative research into the experience of women who have had an abnormal cervical smear test. Along the way they discovered that “The doctors described as honest were those who expressed uncertainty about their own lack of knowledge and the long term outcome of the condition. Perhaps surprisingly, such candour enabled women to trust their doctors.” Perhaps it isn't surprising–because people know that this is a very uncertain world and may be suspicious of those who pretend otherwise.

Finally, the 11 year old son of a British general practitioner imagines on p 1410 what it will be like to be a doctor in 2020. The answer is like now, only much worse. Adrian Connor shaves “with baggy eyes that weighed at least five tonnes, after getting home late last night…” He has “rioting children,” is stopped by the police for breaking the 140 mile per hour speeding limit, and is harassed by “crowds of receptionists,” patients who waste his time, hypochondriacs, and people vomiting over his suit. The only good point in his day is reading the BMJ in a long warm bath.

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