Editor's Choice

Making sense of things

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7503.0-g (Published 02 June 2005) Cite this as: BMJ 2005;330:0-g
  1. Jane Smith, deputy editor (jsmith{at}bmj.com)

    Journals demand a lot of their readers. Each week we present a bundle of disparate articles with the tacit challenge to “make sense of that.” It's no wonder that journal articles don't play much part in helping doctors to change their practices—but they can, at their best, help create a climate for change, increase understanding, prompt thought, and provoke debate.

    Research studies in particular are submitted and published in no particular order, and something we publish this week might contradict something we published two months ago—or, probably even worse—might be on the same subject but pursue a completely different line of inquiry.

    Sometimes journals can be more helpful. When we have more than one paper in our pipeline on the same subject we can publish them together and help make sense of them by commissioning an editorial to tell the story so far and say where these latest studies fit in. The drawback of such “clustering” is that it reduces variety for readers who have no interest in that subject. But for those who do have an interest, the advantage is that the story can be more coherent.

    A good example this week is Heather Dickinson's editorial on the causes of childhood leukaemia (p 1279). This accompanies two studies: one, by Clare Gilham and colleagues, shows that increased amounts of social activity outside the home in the first year of life reduced the risk of a child developing acute lymphoblastic leukaemia (p 1294); the other, by Gerald Draper and colleagues, shows a higher risk of developing leukaemia among children who lived close to power lines at birth (p 1290). Dickinson's editorial concisely summarises what we know about childhood leukaemia and shows how the study by Gilham et al fits a body of evidence that early protection from infection seems to increase a child's risk of leukaemia. The finding about power lines, however, is more puzzling. As the authors themselves say, there is no accepted biological mechanism to explain their results and “the relation may be due to chance or confounding.” So we've reached the limits of what we know now. As Dickinson says, we will have to wait for the advancing technology that will help us understand the molecular events that drive leukaemic changes. Making sense is therefore something that we can sometimes only do with hindsight.

    Something else we are doing with the benefit of hindsight is tightening up our approach to rapid responses—our letters on bmj.com. As Davies and Delamothe explain in their editorial (p 1284), we fear that the weeds may have taken over the garden—that trivial, boring, cross, and obsessive responses are driving out more serious and thoughtful contributions. Our experiment in free speech has sadly failed, and we are reverting to more traditional editorial values. Davies and Delamothe do emphasise, however, that the last thing we want to do is endanger debate: to continue the gardening metaphor, our challenge as editors is to control the weeds while letting even wild flowers flourish.

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