So long for now

So Des Spence has signed off. From the glowing eulogy (1) one would think that the BMJ has lost something important. Perhaps it has. So let’s examine it further and see it for what it is.

By his own admission (2) Des Spence is no academic and no expert, but a “two-bit chav GP doctor”, with typo-ridden broken prose, who does not value knowledge, but is willing to challenge the prevailing wisdom. The absurdity of this statement surely must be lost to Des Spence and the BMJ, otherwise he would not have made such a statement nor would the BMJ have published it. Firstly, both seem to think that, unlike a scientific journal, the BMJ is some kind of a 6th Form College debating society, where the ability to challenge things is praised higher than such mundane things as knowledge. Secondly, the idea that someone who repudiates knowledge should challenge scientific concepts makes as much sense as someone insisting that the Earth rotates around the Sun simply because it chimes with his everyday experience.

According to the Web of Knowledge (3) the BMJ is rated 54th out of 88 medical journals. The BMJ does not figure in the list of high impact journals published by the National Institutes of Health (4). This February the BMJ itself reported that it is no longer considered among one of the medical journals with the highest impact factor (5).

My conclusion is that with the signing off Des Spence the BMJ has indeed lost something important but not for the reasons stated by the BMJ (1) or Des Spence (2). It has lost the mirror which shows what the BMJ really is. Probably it does not matter, for on current show it is unlikely that the BMJ will notice.

In short, those who are interested in interviews and personal opinions, media snippets and advertisements, investigative journalism together with a few pages of truncated science, meta-analyses and other medical matters, will find that even though the BMJ is in the bottom half of the table (3) it is still better than the mainstream broadsheets. Those that are interested in knowledge, those looking for important and meaningful studies, excellent clinical reviews and breakthrough scientific publications will need to seek them elsewhere.

As according to Des Spence (2) not even good spelling is required in order to write weekly columns in the BMJ, I suggest that future such contributors (BMJ mirrors) be found via a lottery, where any willing adult in the UK can take part, for I would assume that most of my compatriots are ‘caring’, and that by the virtue of living ‘have accumulated some experience’ and that they readily accept the ‘uncertainties’ of life.

1. Groves T. State of the art. BMJ 2014:438;1388
2. Spence D. So long for now. BMJ 2014:348;g2343
3. https://www1.imperial.ac.uk/resources/53FF7364-2284-4ED9-87D8-8D8DF63C97...
4. http://tools.niehs.nih.gov/srp/publications/highimpactjournals.cfm
5. McCarthy M. US newspapers choose to report weaker studies, researchers discover. BMJ 2014:348;g1099

Thank you for the excellent thought provoking articles each week. Many of these probably had more impact on my practice than the 200 page national guidelines that went with each topic!

I am getting concerned about you, Des: for years you railed against the consensus and the mainstream view. I was always a great fan and went to your column first, on my way to the obituaries to check that I was still alive.

Reading these responses it seems that praising you is the consensus and mainstream view - Is that good or bad medicine?

Enjoy, what I hope is a brief retirement from your column.

I'd like to unnecessarily add a vote of thanks just because I think you deserve it. I probably agree with your conclusions about 90% of the time but I'm always impressed with your range of knowledge.

I think you take the lack of biomechanical approach just a wee bit too far, after all some patients do actually have identifiable pathology which responds to treatment with (gasp) pharmacological agents. But mostly I'm right with ya.

Don't stay retired for too long....