Views & Reviews Drug Tales and Other Stories

Cover to cover

BMJ 2010; 341 doi: (Published 01 December 2010) Cite this as: BMJ 2010;341:c6859
  1. Ike Iheanacho, editor, Drug and Therapeutics Bulletin
  1. iiheanacho{at}

As contests go it’s hardly The X Factor. There’s no rip-off phone voting, the audience isn’t screaming (not usually, anyway), and if the participants are on heartwarming or sick making “journeys” then they’re good enough to keep it to themselves.

In fact, without such defining features the BMJ’s effort may not seem much like a talent show at all. But consider this: every year hundreds of books arrive, typically unsolicited, in the journal’s editorial office, seeking an appearance on the reviews pages. Ranging from slim, pocket friendly softbacks to the sort of huge triple deckers that could halt a charging rhino, most get nowhere in this quest for fame. For the lucky chosen few, though, the resulting greater recognition presumably makes even the most caustic review a prize worth having.

The constant flow of new books on all topics and of every style can mask the fact that too many—particularly those on disease management—present little that’s original, let alone groundbreaking, however well written and scholarly their execution. Such offerings are never going to be game changers, not least because they tend to be too respectful of, and dependent on, established ways of doing things.

A million miles from this cosy world of mirrored thoughts and echoing practice are very different books just aching to be written and widely read. What about, for example, more texts that champion sensible non-intervention in modern medicine?

This valuable but threatened skill could do with support, especially given the factors now assembled against it. These include the widespread misapplication of another great art: evidence based medicine. It’s too easy to assume that the combination of hard data and good intentions automatically represent a force for moral good that makes intervention not merely worthwhile but noble. Against such misguided crusading, nagging doubts about the effect that treatment would have on particular patients, and any reluctance from these individuals to accept it, might seem churlish—or even negligent.

Other influences too conspire against well considered decisions not to investigate or treat patients when they really don’t want or need such “help.” Chief among these is the type of overweening but unworldly guidelines perceived as restricting clinical freedom and prescribing schemes that offer rewards for meeting inflexible, questionable targets.

It’s not that management in the face of these potentially hostile elements hasn’t been tackled to some extent in some already published books. But what’s out there is far outweighed by “me toos” that repeat a rigidly disease focused approach that pays lip service to the messy reality of patient care. As in The X Factor it’s these endless cover versions that hold centre stage in medical publishing.


Cite this as: BMJ 2010;341:c6859

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