Intended for healthcare professionals

Editor's Choice

April fools

BMJ 2006; 332 doi: (Published 13 April 2006) Cite this as: BMJ 2006;332:0-f
  1. Tony Delamothe, deputy editor (tdelamothe{at}

    It can now be revealed that our news story on motivational deficiency disorder (1 April, p 745) was a hoax. Apologies to all those who were fooled, especially New Zealand's Dominion Post. “Credibility is hard earned,” its editor lectured us; “You damaged yours and ours as a result.”

    Subsequent questions about how often we have published hoaxes had me flicking through previous 1 April issues. A discussion of the use of aeromedical blimps for emergency transport certainly qualified in 1989, as possibly did a letter on lottery distress disorder in 1995.

    But what really caught my eye was the familiarity of the political themes in BMJs published 17, 11 and 6 years ago. The issue of 1 April 1989 read like an extended critique of Working for Patients, the UK government's white paper on the internal market, self governing trusts, and the like. The Joint Consultants Committee regretted that changes were being introduced before pilot schemes had been evaluated. An economist and an orthopaedic surgeon wrote, “The days of the local hospital having a natural monopoly are numbered,” and a general practitioner said, “I suspect that practice budgets will become an insidious way of commercialising primary health care.”

    1 April 1995 was calmer: thoughtful discussions on waiting lists and the future of the hospital consultant, although there were also letters on the increasing numbers of emergency medical admissions. By 1 April 2000 things had clearly deteriorated. Editor's Choice was entitled “The NHS: last act of a Greek tragedy?” “Imagine that you are the British prime minister sitting in 10 Downing Street being driven mad with frustration. The damn NHS won't deliver…” wrote Richard Smith. “Last week the government reached for the ultimate weapon, the one it least likes to use: money. The NHS is going to receive an extra £19.4bn over the next four years, an annual increase of 6.1%.”

    In fact the boom lasted seven years, not four, and is almost over. Downing Street is even madder with frustration. The main problem is that productivity has not kept up with the increased NHS spending. In this week's journal Alan Maynard and Andrew Sweet come up with four ideas: reforming NICE, providing incentives for doctors, developing a structured payment system, and collecting better outcome data (p 906). How will these recommendations look in 2017, when 1 April next falls on a Saturday?

    Presumably by then we'll know how the bird flu pandemic panned out. Predictably, the H5N1 strain has now reached Britain (p 873), but much harder to predict is whether we'll end up with a virus that spreads from person to person. The fact that we haven't—despite the conditions for its emergence being present since at least 1997—is grounds for hope. For readers for whom motivation is a problem (p 916) now may be the time for a quick catch-up on the topic: the journal has published 100 relevant articles over the past few years, all of which can be accessed at:

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