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Editor's Choice

All about letters

BMJ 2009; 338 doi: (Published 08 January 2009) Cite this as: BMJ 2009;338:b23
  1. Jane Smith, deputy editor, BMJ
  1. jsmith{at}

    If you are busy in this first full week of the new year and have time to read only two pages, then make it the Letters. In a short space they illustrate well the range of issues that preoccupy doctors—and our pages: core clinical skills, the use of technology, doctors’ duties to society, improving the way services are delivered, and despair at non-evidence-based practices.

    Thus Stephen Hayes urges the importance of teaching primary care doctors the key clinical skill of detecting melanomas (doi:10.1136/bmj.a3138). In doing so he bemoans the lack of teaching in dermatology received by most British undergraduates these days. That lament is echoed in Rebecca Coombes’ news feature on Pfizer teaching pharmacology and therapeutics to undergraduates because medical schools now neglect such subjects (doi:10.1136/bmj.a3179).

    Minoo Irani also makes a plea for going back to basics. Commenting on the case of Baby P, who was killed by his mother and the men who lived with her, he says that training for professionals in child protection has moved away from physical abuse: “A whole generation of child protection professionals may not be aware of the unwritten rule that a serious unexplained injury…in any child can be a precursor to catastrophic injury” (doi:10.1136/bmj.a3137). Iona Heath also discusses Baby P in her Observations column (doi:10.1136/bmj.b7), angry that the search for blame “does nothing to acknowledge the fundamental difficulties professionals face…when working with parents who are teetering on the knife edge between mad and bad.”

    On technology, the editors of Wikisurgery describe in their letter the development of sets of operation scripts freely available on the internet—with “10 or more times the information in an operative textbook” (doi:10.1136/bmj.a3142). Geoff Watts also describes clever technology in his feature on how Google is mining searches to see if they can provide a surveillance system for flu (doi:10.1136/bmj.a3076). The US Centers for Disease Control and Prevention is interested, but Douglas Fleming, who has been running the general practice research database sentinel scheme for 40 years, is sceptical.

    Back to letters, where Michael Keegan of the General Medical Council dampens the debate about whether doctors should be asked to report knife injuries to the police by pointing out that GMC and Department of Health guidance says that they already should be doing so (doi:10.1136/bmj.a3139). And Pamela Levack and colleagues give an excellent example of improving care in malignant cord compression (doi:10.1136/bmj.a3151). They describe Tayside’s cord compression referral system, which in the first hundred patients referred reduced the median time from referral to diagnosis to one day (compared with 66 days in Scottish audit data).

    Finally, no such success for Leslie Rose and John Garrow, whose letter describes their failure to get trading standards officers to investigate claims made by manufacturers of non-evidence-based “remedies” (doi:10.1136/bmj.a3145). The manufacturers refused to provide evidence because of commercial sensitivity—and the trading standards officers accepted that; a bit like the Swiss appeal court that quashed a doctor’s conviction for treating patients with an unlicensed drug because he honestly believed that the unlicensed drug was more effective than (an evidence based) standard treatment (doi:10.1136/bmj.a3091).


    Cite this as: BMJ 2009;338:b23

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