BMJ  2006;333 (7 October), doi:10.1136/bmj.333.7571.0-f

Editor's choice

Questions, questions

Editors spend a lot of time debating whether the questions examined in research studies are important, interesting, new, and relevant enough to readers' practice and decision making. It's only when we're happy with a research question that we move on to look at methods and findings.

Here's a question we decided to air in the BMJ:do field tests for visceral leishmaniasis (kala-azar) work well enough in endemic areas? There are half a million new cases of kala-azar a year worldwide, mostly in poor rural areas of east Africa, South Asia, and Latin America. It can be fatal if untreated, but its diagnosis by microscopy of tissue smears (aspirated from spleen, bone marrow, or lymph node) often proves too difficult and dangerous where resources are scarce. Chappuis and colleagues show in a meta-analysis that two field tests based on serology perform pretty well (p 723). But Diana Lockwood and Shyam Sundar warn that lack of commitment from industry for this neglected disease could make even these affordable tests—and further research—hard to come by (p 711). In their rapid response from Iran, Abdolvahab Alborzi and Behrooz Astaneh echo the need for more evidence and pose further questions about testing, particularly in children (bmj.bmjjournals.com/cgi/eletters/bmj.38917.503056.7Cv1).

Another research question yields a less definite answer. But the question is clear, important, relevant, and timely, and that's why we have published the research (p 729). Flood and colleagues asked whether joint crisis plans—advance directives about emergency care for psychosis, agreed between a clinical team and individual patients when reasonably well—are better than general service information in cutting healthcare costs and reducing the need for coercive care and treatment. The answer, from the economic evaluation of a randomised trial, is "yes, probably."

Now, does this count as a question? "This is what we intend to do; tell us how much you agree" is often asked in modern consultation exercises. Given that the consulters don't really want to know anyone's views, Jeff Aronson says responders might as well use his Likert scale: agree/agree strongly/agree very strongly/agree enthusiastically/couldn't agree more (p 737).

At the BMJ we're more optimistic and still believe in two way communication, even with people in high places. To prove it, we're giving you the chance to quiz Sir Liam Donaldson, England's chief medical officer, as part of our first BMJ interview (p 722). Please send your questions to thebmjinterview{at}bmj.com by 16 October. You will be able to hear the interview from Friday 20 October on bmj.com/misc/audio.

Sir Liam will be interviewed by Sue MacGregor, former co-host of BBC Radio Four's Today programme. Today is the one show on which Britain's politicians love to appear, and it's such an institution that submarine commanders are told to assume, apparently, that the country is under nuclear attack if they cannot pick up the programme for a few days (http://en.wikipedia.org/wiki/Today_programme). Can this really be true? Now there's a question.

(tgroves{at}bmj.com)

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