Intended for healthcare professionals


Time to think again

BMJ 2000; 321 doi: (Published 11 November 2000) Cite this as: BMJ 2000;321:0

Oliver Cromwell's great plea for second thoughts, “I beseech you, in the bowels of Christ, think it possible you may be mistaken” echoes through this week's BMJ.

The first plea comes from Richard Wakeford in his letter about the GMC's proposals for assessing medical competence, in particular the proposed summative assessment of every doctor every five years (p 1220). He worries that the process is potentially unfair and inaccurate and “very expensive.” He suggests instead a paper based assessment exercise of at most a day's duration. This he claims would be “accurate, economical of time, and fair”—and should be tested.

Two letters on acupuncture are perhaps even blunter. R A Moore and colleagues say that a recent report from the BMA “is quite simply wrong” in concluding that acupuncture is effective for back pain, dental pain, and migraine (p 1220). They, together with Francisco Kovacs and Maria Teresa Gil del Real (p 1221) unpick the evidence and argue that randomised trials and systematic reviews show no benefit from acupuncture. Kovacs and Gil del Real argue that, although the scientific evidence on acupuncture has not changed, public and medical opinion seems to have done so. They suggest a lesson from the past: once patients were convinced of the effectiveness of leeches for infectious diseases, “doctors prescribed them, and apothecaries sold them,” but evidence on efficacy, safety, and cost effectiveness was lacking.

But we know it takes more than evidence to convince people. Leslely Henderson and her colleagues provide an interesting example in their analysis of portrayals of baby feeding methods in the British media (p 1196). They analysed references to bottle feeding and breast feeding in newspapers and television programmes over one month. There were 235 references to infant feeding, 194 to bottle and 41 to breast feeding. Overall bottle feeding was presented as “ordinary,” while breast feeding was presented as problematic, funny, or embarrassing.

Finally, three editorials this week remind those of us in Britain who have been suffering from floods, a crumbling rail network, and the threat of protests over fuel prices that these things are all linked. Christopher Ohl and Sue Tapsell warn people not to try to drive their cars through flooded roads (p 1167). Michael Grubb comments that the floods which have ravaged Europe over the past year have at least made politicians and the media aware of global warming and that this bodes well for next week's UN meeting on climate change at the Hague (p 1169). Andy Haines and colleagues point out that policy goals on physical exercise, global warming, and reduction of pollution all point in the same direction: fewer journeys by cars and lorries (p 1168). And fuel taxes are a means to that end.


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