Intended for healthcare professionals

Rapid response to:

Where Are We Going

Technology for minimal access surgery

BMJ 1999; 319 doi: (Published 13 November 1999) Cite this as: BMJ 1999;319:1304

Rapid Response:


We are intrigued by the editors' perceptions of the 21st century BMJ.

We appreciate that the rate of growth of the body of medical information
is likely to increase and that access to on-line data will become more
widespread. These were presumably the guiding principles on which the
editors modelled their new-look journal.

In striving to present the "small minority of studies that are important
for clinicians" in as "sexy and appealing form as they can manage" the
editors adopt a paternalistic stance which lacks insight into the problems
facing deliverers of healthcare.

The editors have decided that they (or a group of their delegated
specialist sub-editors) will present information in a pre-digested précis
form. This approach sits uncomfortably with the current process of
undergraduate medical curriculum reform which aims to produce doctors
capable of life-long, self-directed renewal of their medical knowledge
base by a process of rational assessment of new publications and by using
new technologies for learning.

The problem with the pre-digested précis approach is the potential for the
introduction of an extra layer of bias. For example, in the article on
minimal access surgery (admittedly, based on an interview with an
acknowledged world expert) what is the evidence that training in
laparoscopic surgery requires "ring-fenced funding" and that minimal
access surgery is "more difficult than open surgery"? Many younger
gastrointestinal surgeons would argue that laparoscopic cholecystectomy is
often technically easier with a better view of the relevant anatomy than
at open surgery.

We accept that healthcare advances in the 21st century will be brought
about by advancement in understanding of the basic mechanisms of disease.
However, it is likely that healthcare systems will be financially capped
with allocation of treatments being influenced by fiscal issues for the
foreseeable future.

In such a climate, we feel that a crucial requirement of a medical journal
such as the BMJ is the dissemination of rational, scientifically sound,
clinical (or basic science) publications that help determine optimum
treatment in an individual patient. The presentation of the highest
quality medical science should be the goal of the BMJ in the 21st century.

Alison Siriwardena

Assistant General Practitioner

Bramhall Park Medical Centre,

Ajith Siriwardena

Consultant Surgeon

Manchester Royal Infirmary

Jones J with Cuschieri A. Minimal access surgery. Br Med J


There are no competing interests.

Competing interests: No competing interests

16 November 1999
Alison Siriwardena