Intended for healthcare professionals


Prepare to be unsettled

BMJ 1998; 317 doi: (Published 19 December 1998) Cite this as: BMJ 1998;317:0

A successful Christmas issue of the BMJ will divert, amuse, amaze, instruct, infuriate, and—most of all—unsettle. Life shouldn't be quite the same after reading it. This one will, I think, do the trick.

The unsettling comes from the overturning of treasured myths and the slaughtering of sacred cows (including a one-off contribution here on the BMJ's abhorrence of hyphens). Christmas is a time when traditionally we do battle with our families. We will try to shove our children to bed with the maxim “Early to bed and early to rise makes a man healthy, wealthy, and wise” and stop them eating sweets because they will shorten their lives. “Find-other-messages- if-you-want-to-be-evidence-based” is the message from this issue.

One study shows that those who rise early are no healthier than lay-a-beds (p 1675),while another finds that “non-consumers of candy” [What happened to our famed clarity of language? Ed, BMJ] die younger than consumers(p 1683).The authors of the early-to-rise study suggest it may be unethical to get your children to go to bed with false information. Ethical issues also arise in the CRACKPOT trial of fly-fishing in that the water-bailiff gave proxy consent on behalf of the trout (p 1678).

Ethical or not, the CRACKPOT trial is a huge step forward in evidence-based trout-fishing. It provides the first scientifically-sound evidence that trout can tell one fly from another. Zealots for evidence-based medicine may detect some satire in the paper, and they may be bothered that evidence-based medicine came top of the pile of sacred cows to be slaughtered (p 1720). It is duly slaughtered by Nigel Molesworth, who writes (p 1720) : “Some say all EBM-ers are arrogant controvershal and seducitve. Others say they are parasites and alkemists. Also many hav beards (my ovservashun). This is called evidence.” Clinical governance is also slaughtered —so effectively that this big-idea-to-save-us-all may never recover (p 1725)

The deepest—but still very accessible—reading can be had from our pull-out-and-keep section on the decade of the brain (pp 1693-708). The hot topic of consciousness is explored by some very brainy people, but the papers don't quite answer the question, “How does the clockwork generate the experience of vision, the leaping light of the fireside, the shimmering of snow?” (p 1696)

Normally, I advise readers against reading every word of an issue of the BMJ. But I think every word of this one is worth reading (apart from the 405 in this column you have already read). Happy Christmas.


To receive Editor's choice by email each week subscribe via our website:

View Abstract

Log in

Log in through your institution


* For online subscription