BMJ  2005;331 (22 October), doi:10.1136/bmj.331.7522.0-f

Editor's choice

Better decisions

The world seems to have shrunk this year. The South Asian earthquake and the possibility of a bird flu pandemic—coming hard on the heels of the Asian tsunami, the sub-Saharan famine, and hurricane Katrina—continue to bump national politics and celebrity gossip off our front pages and screens. Not so long ago, natural disasters and diseases affecting the world's poorest and most disadvantaged people would grab headlines for only a few days. Is the richer world genuinely more interested now? It should be, and not only for humanitarian reasons: these events and the responses to them can inform and improve policy decisions in our own countries (p 916, p 921, and p926).

National politics never goes away completely, though, and the debate on the future of the NHS rages on. Ian Kunkler, an oncologist from Scotland, calls for an independent regulator to see that commercial interests and unfair pricing don't disadvantage the public and cause long term damage to health care (p 965). How political should a medical journal be? Allyson Pollock (p 964) and Julian Tudor Hart (p 964) chastise the BMJ for staying neutral over NHS reforms, while John R Cherry and Andrew J Ashworth say that we went too far in publishing last week's personal view on Tory Kenneth Clarke's interests in the tobacco industry (http://bmj.com/cgi/eletters/331/7521/912).

The ethical standards we expect from clinical research may inadvertently manipulate and bias important results, as two papers show this week. Recruiting people to an observational study, Junghans and colleagues (p 940) randomised patients to opt in or out of giving consent and found that those opting in were less ill than the rest. Al-Shahi and colleagues (p 942), who found similar, though less predictable biases in their study, say it may be more ethical to do away with consent for health services research and epidemiological studies, thereby delivering the greater good.

Some of you say we overdo the BMJ's coverage of global health, politics, and ethics and should stick to clinical topics. This week you'll find, among other things, up to date evidence on preventing myocardial infarction in elderly surgical patients (p 932, p 935) and preventing cervical cancer (p 915). And on this page we're launching a new weekly column—bmjupdates+—to pick up important evidence you may have missed. The column will summarise recent citations selected for scientific quality and relevance from more than 110 premier clinical journals. To get free email alerts from bmjupdates+, tailored to your interests, sign up at http://bmjupdates.mcmaster.ca/index.asp. These alerts could help you to make better clinical decisions, although you might also want to take Rollnick and colleagues' advice, in their article on health promotion, to "nudge, listen, summarise" when sharing decisions with patients (p 961).

Trish Groves, senior assistant editor

(tgroves{at}bmj.com)

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Relevant Articles

Cervical cancer, human papillomavirus, and vaccination
Catherine M Lowndes and O Noel Gill
BMJ 2005 331: 915-916. [Extract] [Full Text] [PDF]

Left behind: the legacy of hurricane Katrina
David Atkins and Ernest M Moy
BMJ 2005 331: 916-918. [Extract] [Full Text] [PDF]

East Asia is most at risk of human flu epidemic, experts say
Michael Day
BMJ 2005 331: 921. [Extract] [Full Text] [PDF]

Foundation hospitals are not accountable to their communities
Michael Day
BMJ 2005 331: 926. [Extract] [Full Text] [PDF]

Consultations about changing behaviour
Stephen Rollnick, Christopher C Butler, Jim McCambridge, Paul Kinnersley, Glyn Elwyn, and Ken Resnicow
BMJ 2005 331: 961-963. [Extract] [Full Text] [PDF]

Evidence not ideology: The BMJ should take a position on the evidence about privatisation
Allyson M Pollock
BMJ 2005 331: 964. [Extract] [Full Text] [PDF]

Time for Ofhealth
Ian H Kunkler
BMJ 2005 331: 965. [Extract] [Full Text]

Appropriateness of use of medicines in elderly inpatients: qualitative study
Anne Spinewine, Christian Swine, Soraya Dhillon, Bryony Dean Franklin, Paul M Tulkens, Léon Wilmotte, and Vincent Lorant
BMJ 2005 331: 935. [Abstract] [Full Text] [PDF]

Recruiting patients to medical research: double blind randomised trial of "opt-in" versus "opt-out" strategies
Cornelia Junghans, Gene Feder, Harry Hemingway, Adam Timmis, and Melvyn Jones
BMJ 2005 331: 940. [Abstract] [Full Text] [PDF]

{beta} blockers for elective surgery in elderly patients: population based, retrospective cohort study
Donald Redelmeier, Damon Scales, and Alexander Kopp
BMJ 2005 331: 932. [Abstract] [Full Text] [PDF]

Bias from requiring explicit consent from all participants in observational research: prospective, population based study
Rustam Al-Shahi, Céline Vousden, Charles Warlow for the Scottish Intracranial Vascular Malformation Study (SIVMS) Steering Committee
BMJ 2005 331: 942. [Abstract] [Full Text] [PDF]

Rapid Responses:

Read all Rapid Responses

For Better? Or For Worse?
Balaji Ravichandran
bmj.com, 21 Oct 2005 [Full text]
Better Wisdom
Michael G Peckitt
bmj.com, 26 Oct 2005 [Full text]
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