Thinking caps onBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5471 (Published 16 December 2009) Cite this as: BMJ 2009;339:b5471
All rapid responses
Following a recent consultation with a patient I want to express my
desire to open up a lobby group to squash QOF, abolish the PHQ9 and most
of the prompts that appear as postits on my computerised record.
I chatted to the patient. She wants to die rather than have her
disability allowance downgraded. She rose freely from her chair to show me
how she cannot straighten up properly, she can only go to church or to her
child’s school if given a lift, and then needs crutches (sticks I think).
I have come to the conclusion that the prompts interfere with the
natural flow of my work & my thinking processes; that my manager
telling me I did not score points for this or that likewise in reality
make patient care worse. We need, I think, to rebel, throw out this
dreadful stuff and tell the auditors and inspectors to get lost. Peer
review spear review. Let us judge ourselves & the patients choose who
Competing interests: No competing interests
Dear Dr. Delamothe,
The peer-review system has become a sine-qua-non of all scientific
writings. Without going through this system nothing gets published in the
“so called” reputed indexed journals! If you make even a statement gleaned
from your fecund experience on the bed side, the editor would jump at it
and say where is the reference? If there IS a reference, it does not
become new knowledge at all; it is second, third or, nth hand knowledge.
Cicero, the Roman thinker, had warned us years ago that if we do not learn
from history we will be condemned to relive history.
A couple of examples will suffice. Ptolemy, the Egyptian astronomer,
thought that the sun went round the earth-the geocentric concept. For the
next five centuries all scientists of repute followed that illogical
logic. It was in the seventh century that Copernicus, the Greek
astronomer, reversed it to get at the correct heliocentric concept.
Electron, that mirage, has been described by generations of Nobel
Laureate physicists in different ways, still eludes us to remain an
enigma. Babbitt, Charles Leadbeater and Annie Besant were probably right
in their description of the real and ethereal worlds noted in their great
book, Occult Chemistry. (Oxford University Press, Madras, 1920)
Galen, that venerated medical scientist of all times, thought and
taught that the liver circulated the blood through the human system. For
the next 1500 odd years this was the gospel truth for science and every
peer reviewer swore by it. When in 1628 William Harvey, a simple London
family physician, thought and showed how the heart could be the organ
responsible for circulating the blood through the system in his
Exercitatio anatomica de motu cordis et sanguinis in animalibus
(concerning the motion of the heart and blood) simply called, De Motu
Cordis, his peers wanted to kill him, leave alone reviewing or rejecting
the idea. Was this not the height of intellectual terrorism?
I am afraid, similar peer review mentality prevails even to this day.
Instead of trying to kill the person as they did in seventeenth century
London, today’s peers effectively kill any new idea. Peer-review can
never detect any fraud in the research work as long as the data conform to
the accepted statistical model. We have had totally false data being
published even in the respected journals only to be retracted when the
fraud was detected by chance at a later date.
In short, what good is the peer review system except to record that
the material to be published is fully and correctly referenced and is on
the accepted lines? Flowing blood, as it moves through larger vessels,
will have to generate its own power to move forward in the capillary
system. That is possible by the whirling movement as seen in storms and
Tsunamis! We have been trying to make a mathematical model of blood
circulation without much success to date although; I have been knocking at
the doors of thinking mathematicians and physicists for help. (1)
John von Neumann, a Hungarian born American scientist, said that all
science is only making models, mostly mathematical constructs, which with
verbal jargon, are supposed to work!
“More people make a living OFF hypertension than dying OF it,” wrote
Sir George Pickering, a doyen of a hypertension researcher of his time.
Flowing fluids find it difficult to exert any lateral pressure on the flow
tube as it would impede their flow. (Cosine 90=0) Our definition of blood
pressure is the “lateral pressure exerted on the vessel wall by the
flowing blood.” Incongruous, indeed! That apart, the body’s health depends
on the mean capillary pressure that has very little relevance to the
arterial pressure that we measure and try to set right using potentially
harmful and very powerful chemical molecules beset with multitude of
adverse reactions, some of which could be worse than the original problem.
Douglas C Wallace, a noted geneticist, using his new MITCHIP, has
elegantly shown that most reductionist chemical drug molecules would
damage the hardware inside human cells while the Asian herbal drugs that
work holistically encourage the soft ware of the cell to function better!
I would quote Churchill here:”he only has a right to criticize who has a
heart to help”!! I would agree one hundred per cent with Bertrand Russell
(1872-1969) when he wrote: “Intellectual integrity made it quite
impossible for me to accept the myths and dogmas of even very great
scientists, more particularly of the belligerent and so-called advanced
nations. Indeed, those intellectuals who accepted them were abdicating
their functions for the joy of feeling themselves at one with the herd.”
“All the knowledge I possess everyone else can acquire, but my heart
is all my own.”(Johann Wolfgang von Goethe.)
1) Hegde BM. Is the human heart a simple muscular pump? Jr. Indian
Academy of Clinical Medicine 2008; 9: 173-175.
2) Wallace DC. Mitochondrial Chi. Genetics 2008; 179: 727-735.
Competing interests: No competing interests