Millennium, what millennium?

BMJ 2000; 320 doi: (Published 01 January 2000) Cite this as: BMJ 2000;320:0

Readers will, we hope, be relieved, not disappointed, that we failed to do something special for the millennium. We did contemplate a silver covered edition that would undoubtedly have included medical highlights of the past 1000 years and predictions for the next 1000, but then we decided that the millennium had become the bore of the millennium. So we've stayed away and will not mention the “m word” again—unless of course the bug proves so powerful that everything, including health care, descends into chaos.

Something far from boring is the appearance of PubMed Central, the electronic database where all biomedical research may eventually be “published” (p 8). It begins today and if successful is likely to signal the end of medical journals as we know them. After intense internal debate, the BMJ has decided to sign up for PubMed Central. We took the view that all research being available for free would be good for medicine and patients, and we hope to find a way to flourish in the new world. The fact that we have signed up means that research studies published in the BMJ will be available immediately in full on the database. (We took the final decision just before Christmas so it may take a little time to sort out the mechanics.)

Two new series begin today. The first is an ABC of heart failure (p 39). This disease already accounts for 5% of admissions to medical wards and 1% of total healthcare expenditure in Britain, and it's likely to become still more important as the population ages and deaths from acute myocardial infarction fall. Heart failure can be hard to diagnose as there are few clinical features in the early stages and many features are not organ specific. Yet early diagnosis is important because there are now very effective treatments.

The second short series examines the use of qualitative research in health care (p 50). The BMJ takes the view that the important questions in health care are too complex and varied to be answered by a limited range of methodologies. We need many methods, but we also need to be able to understand and critically assess them. Many medical journals, including the BMJ, have published much more qualitative research in recent years, and we've discovered that readers like such studies. This series will, among other things, help readers tell good qualitative research from bad.

Finally, who cannot but sympathise with a friend of George Orwell's who smoked opium regularly and every night understood the secret of the universe in a single phrase (p 49)? Usually he was too drugged to write it down, but one night he did. In the morning he read: “The banana is big, but its skin is even bigger.”