Editor's Choice

Easily missed

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b821 (Published 26 February 2009) Cite this as: BMJ 2009;338:b821
  1. Fiona Godlee, editor, BMJ
  1. fgodlee{at}bmj.com

    Two patient journey articles this week describe the struggle to find what Jocelyn Anne Silvester calls “the most powerful tool that doctors have – a diagnosis.” She diagnosed her own coeliac disease during a biochemistry lesson after years of ill health and investigation that labelled her a “heartsink” patient (doi:10.1136/bmj.b380). Henry Willis was nearly 4 years old when his coeliac disease was diagnosed, by which time he was severely anaemic, unwell, and undersized (doi:10.1136/bmj.a3066). Despite a family history of coeliac disease his parents struggled to convince doctors that anything was wrong. Now 11 years old and the second tallest in his class, he describes the positive effect of his diagnosis. “If you have to have a disease this is an OK one,” he writes.

    Coeliac disease affects one in 100 people in Western populations but is underdiagnosed, often with serious effects on health and quality of life. Iron deficiency anaemia and a family history are important diagnostic clues, say Roger Jones and Sarah Sleet in the first of a new series of articles highlighting conditions that may be commoner than we think (doi:10.1136/bmj.a3058). Anthony Harnden and Richard Lehman suggested the series—“Easily missed?”—as a way to help doctors in primary care recognise conditions that are underdiagnosed or serious if not spotted (doi:10.1136/bmj.b491). They have a list of possible conditions to cover and are inviting readers to suggest more.

    You can test your diagnostic skills in Endgames (doi:10.1136/bmj.b616, doi:10.1136/bmj.b737, doi:10.1136/bmj.b259) and with our interactive case report of a 38 year old woman with hypotensive shock at the onset of menstruation (BMJ 2009;338:b6, b246, www.bmj.com/cgi/eletters/338/feb09_1/b6). Read the two previous articles and contribute to the online discussion of the case before all is revealed on 7 March.

    Also this week you’ll find our second research “pico” (www.bmj.com/cgi/content/full/338/feb12_2/b354/DC5)—an informative print summary of a research article published in full online (doi:10.1136/bmj.b354). Tom Jefferson and colleagues are among the growing band of “piconeers” helping us to pilot this new approach to abridging research articles in print, on which we would like your feedback. The authors’ longstanding interest has been the poor quality of research on the effectiveness of vaccines. They find that studies that favour influenza vaccine over placebo or no treatment are of significantly poorer methodological quality than those that do not, and that the overwhelmingly favourable conclusions drawn by most studies bear little relation to the actual results. The authors suggest that this discrepancy between results and conclusions explains why governments promote influenza vaccines despite the lack of evidence for their effectiveness.

    They also voice doubts about the impact factor as a robust indicator of journal quality. Studies funded by industry were more likely to be published in high impact factor journals, even though these studies were no bigger or better than studies published elsewhere. Why this should be is worth exploring. One explanation not directly raised by the authors is that the sale of reprints of articles to industry is an important source of revenue for some journals, and editors may find themselves under pressure to publish certain articles regardless of their quality. If so, it’s a pressure they must resist.


    Cite this as: BMJ 2009;338:b821

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