Editor's Choice

The way of the world

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39363.612095.47 (Published 11 October 2007) Cite this as: BMJ 2007;335:0
  1. Tony Delamothe, deputy editor, bmj.com
  1. tdelamothe{at}bmj.com

    This week I clicked the Send button without realising that my email was being shared with the person I was writing about. I was warning colleagues that I'd banned a persistent respondent “from raving on about” his pet theory using rapid responses and didn't want him opening up another front using feedback to Richard Lehman's blog.

    While the respondent ponders whether my “less than polite” response deserves wider exposure, I'm pondering whether I should have “sender's remorse” for describing his behaviour in the terms I did. After all, this followed 17 rapid responses (his count) on the same topic from him and three emails from me, asking him to stop.

    Thoughts about appropriate tone were running through my head when I read David Colquhoun's criticisms of our associate editor (and former US editor), Doug Kamerow, for being “excessively tolerant” of the advance of complementary and alternative medicine (doi: 10.1136/bmj.39360.446528.BE). Colquhoun is the sort of man who, if asked what he thought about the closure of homoeopathic hospitals, would answer: “A start.”

    Colquhoun prefers straight talking Americans, like Gerald Weissmann and Wallace Sampson. In his article, “Homeopathy: Holmes, Hogwarts, and the Prince of Wales,” Weissmann wrote, “If the trend persists perhaps MIT or Cal Tech will march in step with the medical schools and offer prizes for integrative alchemy or alternative engineering.” Calling for the defunding of the National Center for Complementary and Alternative Medicine, Sampson wrote, “After ten years of existence and over $200 million in expenditures, it has not proved effectiveness for any ‘alternative' method.”

    Just last week, one of our sister journals, Postgraduate Medical Journal, published another negative study. Its systematic review of all available studies of individualised herbal medicine found no convincing evidence of benefit (doi: 10.1136/bmj.39360.499097.DB). So, how polite do we need to be about an alternative world view that isn't coming up with the goods?

    Good manners in the 21st century apparently means suspending judgment, according each viewpoint equal respect. But it's “a dangerous error to conclude . . . that all imaginable views are equally deserving,” cautions Martin Rees, president of the Royal Society, about politicians' use of science. They, and by extension the rest of us, shouldn't choose “which, if any, scientific view to adopt and which to discard, much as they might choose one bunch of flowers over another.” Science “is about how the world is, not about what suits our prejudices” (Financial Times 1 October 2007 www.ft.com/cms/s/0/b5fca3bc-6fd1-11dc-b66c-0000779fd2ac.html).

    Telling it how it is is the aim of this journal, even if sometimes we need two goes to get it right—witness the copious Corrections and Clarifications we publish each week. Some people are justifiably cross about these errors, but many more want to communicate to us that the journal has upset them in some way that has nothing to do with factual inaccuracies. (From recent journals, topics include maternity services, physician assisted death, fluoridation, and out of hours care in general practice.) It's as if by knowing their sensitivities we can avoid giving offence next time. We've almost arrived at the point where respecting people's feelings is more important than telling the truth.

    So the last word should go to Theodore Dalrymple and to the lesson that King Lear's fatal misjudgment of his daughters holds for us (doi: 10.1136/bmj.39364.461736.94). “For is it not the case that we live in an age of emotional incontinence,” he asks, “when they who emote the most are believed to feel the most?” The costs may be surprisingly high: by the end of Shakespeare's play, Lear and his three daughters were dead.

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