Editor's Choice Editor’s Choice

Ignorance and certainty

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2156 (Published 28 May 2009) Cite this as: BMJ 2009;338:b2156
  1. Jane Smith, deputy editor
  1. jsmith{at}bmj.com

    Most weeks the BMJ, like most other journals, adds small bits of knowledge to what we already know. But we also accumulate more things that we don’t know—and this week’s issue has some important bits of ignorance.

    We still don’t, for example, know how many cases of variant Creutzfeldt-Jakob disease (caused by exposure to bovine spongiform encephalopathy in cattle) there might be. The study by Jonathan Clewley and colleagues tested 63 007 tonsils and detected no disease related prion protein, but the confidence interval was 0 to 289 cases per million, lower than but still consistent with an earlier prevalence study done in appendixes (doi:10.1136/bmj.b1442). As Maurizio Pocchiari says in his editorial, predicting numbers of vCJD carriers remains difficult, and repeating surveys in tissue specimens may not be helpful. He thinks, however, that these negative findings mean that other countries don’t need to carry out such studies—because exposure to the BSE agent was much lower than in the UK (doi:10.1136/bmj.b435).

    Another generator of ignorance is H1N1 flu. Andrew Jack discusses the problems of developing and producing a vaccine against the new strain (doi:10.1136/bmj.b2065): whether manufacturers should switch production to vaccines directed against the new flu and how to scale up production quickly. He discusses innovations in vaccine production—the use of cell based manufacturing techniques and of adjuvants—but he warns that governments are rushing to protect their own citizens at the expense of cooperating internationally.

    Our letters illustrate confusion about swine flu. Ellen Wright, mother of a son confirmed to have swine flu, tells how her husband, who had mild symptoms, was told he could go to work even though his son was a probable case. When his son’s flu was confirmed he was told he shouldn’t have been at work. And her sister in law had to send a taxi to pick up oseltamivir (Tamiflu) because as a contact of a case she couldn’t collect it herself; yet the next day she and her daughter were asked to attend the local hospital for testing (doi:10.1136/bmj.b2093). Azeem Majeed, who found his general practice at the centre of an H1N1 outbreak, questions the shutting of the local schools, and concludes, from his practice’s experience, that the number of cases of H1N1 flu may be much lower than predicted (doi:10.1136/bmj.b2094).

    But uncertainty is sometimes better than too much certainty—at least where evidence isn’t what matters. In his Observations article on the Ryan Commission’s revelations about the abuse of children in Irish schools run by Catholic orders, Tony Delamothe points out the harm done by the Catholic church’s insistence that its priests remain celibate (doi:10.1136/bmj.b2142). And in another story from Ireland Len Doyal describes how he was stopped from speaking about euthanasia to an ethics forum in Cork (doi:10.1136/bmj.b2109). He describes what he would have said and how afterwards he aired those arguments in the Irish media—probably gaining more exposure for his ideas than if he had quietly given his talk.


    Cite this as: BMJ 2009;338:b2156

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