BMJ pico for original research in the print BMJBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3168 (Published 06 August 2009) Cite this as: BMJ 2009;339:b3168
All rapid responses
As busy clinicians struggling to select clinically relevant research
among the multitude of papers on offer, we do appreciate the potential of
the PICO initiative. We believe -however- that if it fails to acknowledge
the difficulty that most individuals experience with data interpretation
it may fall short of its laudable aim. We refer in particular to the
editorial comment that the shortened articles will be accompanied by a
table showing ratio measures [relative risk, odds ratio]. This is
perplexing because published evidence consistently shows that even
experienced professionals may fail to interpret correctly data reported as
ratio measures [1,2], which may in turn affect decision-making  and
communication with patients . Better ways of conveing information are
being developed [5,6] and the BMJ should not miss the opportunity to apply
them if the PICO articles are to fulfill their potential.
1) Bobbio M, Demichelis MD, Giustetto MD - Completeness of reporting
trial results : effects on physicians willingness to prescribe - Lancet
1994 vol. 343 : 1209
2) Bramwell R, West H, Salmon P - BMJ 2006 vol. 331 : 284
3) Fahey T, Griffiths S, Peters TJ - BMJ 1995 vol. 311 : 1056
4) Steiner JF - The language of population and the language of
individuals - Ann Intern Med 1999 vol.130 : 618
5) Gigerenzer G, Edwards A - simple tools for understanding risk :
from innumeracy to insight - BMJ 2003 vol. 327 : 741
6) Gigerenzer G, Gaissmaier W, Kurz-milcke E, Schwartz LM, Woloshin S
- Helping doctors and patients to make sense of ehalth statistics - Psych
Science in the Public Interest 2008 vol.8 : 53
Competing interests: No competing interests
Rapid responses in many, perhaps most, cases resemble radio phone-
ins, where Jeff from Milton Keynes or Mitch from Ashby-de-la-Zouch ring,
talk, and manage to take up time without having anything much to say. In
the rare instance when they do have something to say, I suspect that
people in the position to change things don’t actually take any notice. It
took me submitting less than half a dozen rapid responses to realize this
and I have not submitted any for the last 4 years. However, encouraged by
the BMJ and by my colleagues, I am submitting one again.
The proposed BMJ Pico is pico-minded, by pico - mind people. To
paraphrase what I wrote to the BMJ in response to the drive for bite-size
education, such education - and now pico-size education – is for bite size
and pico size brains.
One can see the slogans: Read BMJ on the go! Pico papers for the busy
clinician! Pico - all you need to know in just a few minutes!
And why stop at Pico? Be bold BMJ! In a few years when Pico becomes
the new ‘normal’ standard, go for nano – one quarter of a page. When nano
is too much of a burden to read, go for femto – just one-liners.
Preferably on Twitter. Open up a new Twitter group format: electronic BMJ
Twitter Research. And why not team up with O2 and send the one-liners by
mobile phone, just as football fans can get their football results.
Pico Editors, pico BMA leaders for a generation of pico doctors. With
femto and nano to look forward to.
The best for me would be if you split BMJ into two journals:
1. Pico BMJ - all the assorted infotainment: latest news, fillers,
consumer correspondence, rapid responses, obituaries, career advice, Pico
research, snippets, 'all you need to know from other journals',
advertisements, blogs (including the self-indulgent musings of the self-
confessed medicine-hater Richard Smith, on the highly scientific topic 'Am
I going to hell?') etc. Consider adding fashion, financial advice, the
housing market, stocks and shares, second-hand cars, bric-a-brac, lost and
found, lonely hearts, recipe swaps, holiday homes for rent, travel section
etc. There are a number of journalists on the BMJ payroll that would be
able to advise you on BMJ Pico.
2. Normal BMJ, the format used by JAMA, NEJM, the Lancet, Archives,
Annals, American Journal of Medicine, Journal of Clinical Endocrinology
and Metabolism, Endocrine Reviews, Human Reproduction, Fertility
Sterility, Diabetes Care and many other highly read and highly-rated
BMJ pico will suit those who would like to get medical education by
freelance journalists (1) and advice on clinical practice from FY1 doctors
(house officers) (2) and those who do not mind flawed research (3,4), to
give some examples.
Surely, if one were a lay member of the public and wanted the low-
down on the influenza virus by a journalist, one would buy a newspaper.
The day someone with a medical degree starts relying on journalists to
inform him on important medical topics is the day this person should
consider packing it all in. If you think these are empty words and
posturing, check the paper (1), for it is factually wrong.
What were the BMJ editors thinking when commissioning an FY1 doctor
(house officer) to write up a clinical review (2)? With all due respect to
the said FY1 doctor, it seems very presumptuous of the BMJ to think that
an FY1 doctor would be able to distil his pediatric clinical experience
(how much) and appraise the voluminous body of literature in order to
inform the tens of thousands of GPs and pediatricians who see babies and
toddlers on daily basis and have being doing so for years.
While the points made above may be simple to address, weeding out
flawed research would be a serious undertaking. For example, why a deputy
editor of the BMJ would think herself an expert in opinion polling (3)
remains a mystery. The poll is obviously unrepresentative and therefore
Why peer reviewers and editors would accept a definition of
peripheral artery disease that is contrary to recommended clinical
practice (5-9), including the UKPDS’s (10) and BMJ’s own (11,12), by word
of mouth, and as a consequence publishing flawed research (4), is beyond
Editors will need some more training and will need to work harder.
Some peer reviewers will simply need to be dropped.
Some doctors may prefer to subscribe to BMJ Pico only, some to BMJ
Normal and some to both. BMJ would most likely increase its net
subscription: those that do not currently subscribe (Pico doctors that may
be put off by sight of 3-5 pages research papers and normal doctors that
are put off by the infotainment) might well decide to. Initially BMJ Pico
and BMJ Normal by necessity will have to share editors and peer reviewers
but in time, as Pico and Normal diverge, these will be different to care
for their different readership.
Pico: a millionth of a millionth part (Sp. pico, a small quantity)
1. Watts G. Pandemic flu: A/H1N1 influenza virus:the basics. BMJ
2. Apps JR, Beattie RM. Cow’s milk allergy in children. BMJ 2009;339:b2275
3. Groves T, Schroter S. BMJ pico for original research in the print BMJ.
4. Belch J, MacQuish A, Campbell I et al. The prevention of progression of
arterial disease and diabetes (POPADAD) trial: factorial randomised
placebo controlled trial of aspirin and antioxidants in patients with
diabetes and asymptomatic peripheral arterial disease. BMJ 2008;337:a1840
5. Hirsh AT, Criqui MH, Treat-Jacobson D et al. Peripheral arterial
disease detection, awareness and treatment in primary care. JAMA
6. Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Does the clinical
examination predict lower extremity peripheral artery disease JAMA
7. Ouriel K. Peripheral arterial disease. Lancet 2001;358:1257-1264
8. White C. Intermittent claudication. N Engl J Med 2007;356:1241-1250
9. Amaerican Diabetes Association. Peripheral arterial disease in people
with diabetes. Consensus Statement. Diabetes Care 2003;26:3333-3341
10. Adler AI, Steven RJ, Neil A, Boulton AJM, Holman RR for the UKPDS.
UKPDS 59: Hyperglycemia and other potentially modifiable risk factors for
peripheral vascular disease in Type 2 diabetes. Diabets Care 2002;25:894-
11. Simon RW, Simon-Schulthess A, Amman-Vesti BR. Intermittent
claudication. BMJ 2007;334:746
12. Kassar K. Intermittent claudication. BMJ 2006;333:1002-5
Competing interests: No competing interests