Editor's Choice

Questions for research

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c94 (Published 07 January 2010) Cite this as: BMJ 2010;340:c94
  1. Fiona Godlee, editor, BMJ
  1. fgodlee{at}bmj.com

    Continuing last week’s focus on the BMJ’s research papers (BMJ 2009;339:b5632, doi:10.1136/bmj.b5632) it’s gratifying to see them performing so well in Journal Watch’s first ever listing of the medical stories that were most read in the past year.

    Journal Watch, run by the Massachusetts Medical Society, which owns the New England Journal of Medicine, gets its team of contributors to summarise what they see as the most interesting and important articles published in each field. Now Journal Watch has also summed up readers’ choices during 2009. BMJ research articles feature more than those from any other general medical journal in the top 10 “most read” lists for hospital medicine, general medicine, emergency medicine, and psychiatry (www.jwatch.org).

    Interestingly there’s no primary care list, which says something about the Massachusetts Medical Society’s priorities, or US medicine, or both. Or could primary care research itself be to blame? Back in 2003, the editor of the Lancet, Richard Horton, provoked an indignant response from academics in primary care by asking whether primary care research was a lost cause. A report from the Academy of Medical Sciences has now explored this question more deeply.

    As Chris Del Mar summarises in his editorial (doi:10.1136/bmj.b4810), the report rightly credits primary care with championing prevention as a key priority for clinicians (something we now take for granted) and for increasing our understanding of what happens when patients talk to doctors, which has led to the concept of patient centredness. But the report goes on to warn of the need for more research into the clinical care of diseases encountered in primary care, and for more translational research, which Del Mar usefully equates with evidence based medicine.

    Del Mar blames a lack of self confidence within the discipline for the change in research focus from clinical management to the organisation of care. What we need, of course, is research into both. Funding is growing. In the UK about £50m of the National Institute for Health Research’s £1bn budget is now devoted to primary care research. The harder task is getting clinicians to take up research. The UK’s School for Primary Care Research, set up in 2006 and now comprising eight centres of excellence, has a crucial part to play (www.nspcr.ac.uk).

    Meanwhile, this week’s journal throws up at least one intriguing primary care question ripe for research. As Mona Nabulsi (doi:10.1136/bmj.b3540) and Alan Fowler (doi:10.1136/bmj.b3874) point out, fever is a beneficial immunological response to disease. So why do we dose our feverish selves and children with antipyretics? Fowler says the lack of research into the effects of body temperature in people with influenza is down to “a deep seated fever phobia stemming from pre-scientific medicine when fever was perceived as an illness in itself.” Nabulsi calls for education of parents about the immunological usefulness of fever and the risks of antipyretic abuse. And Chris Barrett (doi:10.1136/bmj.b5660) admires the iconic 19th century painting of The Doctor waiting for nature to take its course.

    Notes

    Cite this as: BMJ 2010;340:c94

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