Reviews PERSONAL VIEW

Who'd be a reformer?

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7426.1295 (Published 27 November 2003) Cite this as: BMJ 2003;327:1295
  1. Jonathan Shepherd (Shepherdjp@cardiff.ac.uk), professor of oral and maxillofacial surgery
  1. University of Wales College of Medicine, Cardiff

    Ten years ago I was not prepared for the critical letter from the president of my surgical association, after the publication of a BMJ editorial I had jointly written (1994;309: 620-1) on surgical removal of third molars–one of the commonest operations. We said, on the basis of convincing evidence, that prophylactic removal should be abandoned. I had, apparently, been naive. He was certainly right in one respect: I had been naive enough to think that our conclusion–later reached by the National Institute for Clinical Excellence in its first technology appraisal–would, in the age of evidence based medicine, be welcomed.

    The ensuing debate in the BMJ's letters pages was polarised by the media. A Times article starkly contrasted our conclusion with the opposite view of a consultant colleague in my own department. The headline in the Independent on Sunday, “Millions wasted on wisdom teeth,” spanned a whole page. This taught me something else: that professional and public controversy can …

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