More things not to do

BMJ 1999; 318 doi: (Published 27 March 1999) Cite this as: BMJ 1999;318:0

Medical journals are supposed to be biased towards publishing positive studies. Doctors are people of action. So journals like to please them by giving them things to do. The journals also like it because reprint sales of a study showing a positive effect for a drug can bring in tens if not hundreds of thousands of pounds. The BMJ, however, seems to have cornered the market in papers showing things that don't work, and this issue is a good example.

A large randomised controlled trial from Australia shows that eradicating Helicobacter pylori is not an effective treatment for dyspepsia in those who don't have ulcers (p 833). A systematic review cannot find evidence that day hospital care for elderly people is any better than other forms of comprehensive care (p 837), which is unfortunate as many Western countries have spent large sums on day hospitals. Terence Wilkin argues that measuring bone mineral density to predict those who will have a fracture is not useful (p 862), while three authors defend their recent conclusion that current methods for eradicating mites don't help those with asthma (p 871).

Perhaps we can put a positive spin on all this negativity. William Wordsworth wrote that “Getting and spending we lay waste our lives.” Most of us continue to do that, but we also lay waste our lives eradicating mites and Helicobacter, measuring bone density, and running day hospitals. Wordsworth recommends standing and staring: at least we won't do harm or consume resources.

The World Bank also knows about things that don't work (p 822 and p 865). Since 1990 the bank has lent $9bn to the health sector, but only 17% of its completed projects contributed substantially to the development of local institutions in poor countries and only 44% proved sustainable. Nevertheless, the World Bank has taken over from the World Health Organisation as the leader in developing global health policy. Two years ago Fiona Godlee examined the WHO for the BMJ and concluded that it was in a terrible mess. Today Kamran Abbasi begins a six part series on the bank. His general conclusion is that the bank is heading in the right direction.

This issue of the BMJ and the next are important in ways that we hope readers won't notice at all. We are changing printers. After 27 years we are changing from Pulmans (which became BPC and now Polestar) to Cradley Print. We are grateful to all those who have ensured that the journal has been published every week for all those years, and we are especially grateful to George Booth, who has been actively involved for many of those years. Twenty years ago the journal was set in hot metal. In 20 years' time we may not be printed at all but perhaps beamed directly into readers' brains.


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