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EDITOR'S CHOICE: Trish Groves Better decisions BMJ 2005; 331: 0-f [Full text]

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For Better? Or For Worse?

Balaji Ravichandran   (21 October 2005)

Better Wisdom

Michael G Peckitt   (26 October 2005)

For Better? Or For Worse? 21 October 2005
Balaji Ravichandran, Medical Student Madras Medical College, Chennai, India Send response to journal: Re: For Better? Or For Worse?	The editor is right - the world has shrunk. Is the richer world genuinely interested? Absolutely not. Did the G8 meeting at Gleaneagles achieve anything? Has the USA cut down its green house emissions? Has money reached the dying poor in Niger, in Malawi and in Darfur? Do the victims of Pakistani earthquake have shelters to live in? Foreign aid poured in for the victims of Tsunami - were they adequately distributed to those most desperately in need? Do the millions afflicted with HIV in Asia and Africa get adequate treatment? Having seen the ground reality firsthand, I can provide the answer for the last two questions with authority - NO!!! Dr. Groves bemoans, "some of you say we overdo the BMJ's coverage of global health, politics, and ethics and should stick to clinical topics." Perhaps, she hasn't understood why some of its readers (I can't quite advance any statistic), are worried about the status of BMJ as one of the most respected and serious medical journals - which is why she is on the defensive. It is not because of coverage of global health, politics and ethics alone - all of which are indispensable for the BMJ as an international journal. But, the frequency of impactful original research does seem to be diminishing. Breast cancer and left-handedness? Surely, there are more important variables that an oncologist ought to be worried about than left-handedness. A search through the archives and comparison with recent issues does indicate that the trend in which BMJ is heading is worrisome. Another worrying aspect seems to be a policy of appeasement in many controversial isses. I would think that sometimes, in controversial issues like euthanasia, the lay public (and sometimes the professionals) will look to the opinions of experts who will analyse the problem objectively and not just bend under the pressure of shifting public opinion. The recent (and frustrating) stance of the BMA in legalising euthanasia and physican-assisted suicide, and the lack of any word from the editors of BMJ about their position on the Smallwood report are just two examples. Publishing a couple of editorials which doesn't add much to the controversies surrounding CAM doesn't help either. Yes, it is high time the BMJ took its stance as a general medical journal seriously, and devoted more of its pages to scientific and clinical content (including areas of basic medical sciences) than just publishing disparate epidemiological correlations, meta-analyses and systematic reviews, with which the BMJ pages recently seem filled. The BMJ does well to advertise its lack of space in each section of each issue of the journal. Yet, I don't see the need for reviews of TV programmes and popular science textbooks in the print version of the journal - they might well be limited online. BMJ is still one of the most respected medical journals in the world - it must do everything to maintain its appeal to medical professionals in the first place. Competing interests: None declared
Better Wisdom 26 October 2005
Michael G Peckitt, University tutor University of Hull, c/o Philosophy Dept, Hull, East Yorkshire, HU6 7RX, UK Send response to journal: Re: Better Wisdom	Clincal papers should always be the staple diet of the BMJ. However, issues such as "global health, politics, and ethics" should not be avoided or regulated to the JME - fine journal that it is. The reason the BMJ should have a mix of clinical and 'non-clincical papers' is by not publishing such paper helps remove both medics and non-medics from debates where they are both sorely needed. I have always enjoyed the 'Minerva' section of the BMJ. However Minerva was was the Goddess of arts, craft and wisdom. 'Wisdom' extends beyond the medical world, does medical wisdom have to end with clinical reports? Competing interests: The Author is Member of the Association for Medical Humanities