Read Quick Comments published in the past 1, 2, 3, 4, 5, 6, 7, 14, 21 days.

16 Quick Comments published for 8 different topic sources.

Articles			Letters
	Essay: On a wing and a prayer: surgeons learning from the aviation industry Singh (1 September 2009) [Full text] [PDF]		Comparisons with the past Mark R Savage   (2 October 2009) Surgeons and Safety William G Notcutt   (2 October 2009) Read every Quick Comment to this article
	Research: Independent sector treatment centres: the first independent evaluation, a Scottish case study Pollock and Kirkwood (1 July 2009) [Abstract] [Full text] [PDF]		Evaluation of contract in ISTCs Allyson M Pollock, et al.   (21 October 2009) Read every Quick Comment to this article
	From the Editor: Three deadly sins: hierarchy, etiquette and conformity Abbasi (1 November 2009) [Full text] [PDF]		The struggle against sins. john main   (17 November 2009) Read every Quick Comment to this article
	From the James Lind Library: Surgery for the treatment of psychiatric illness: the need to test untested theories Wessely (1 October 2009) [Full text] [PDF]		A rather simplistic view of CFS Ellen Goudsmit   (13 October 2009) Dr. Wessely continues to feel abused Margaret M. Bailey   (13 October 2009) CFS and Psychiatry Tom Kindlon   (13 October 2009) Read every Quick Comment to this article
	Research: Examination performance of graduate entry medical students compared with mainstream students Calvert et al. (1 October 2009) [Abstract] [Full text] [PDF]		The LRCP J. Clifford Jones, et al.   (3 November 2009) What is the impact of medical education in the early years? Brendan S Fletcher   (13 October 2009) Read every Quick Comment to this article
	Essay: Complementary and alternative medicine: what the public want and how it may be delivered safely and effectively Lewith and Robinson (1 October 2009) [Full text] [PDF]		Re: Cure or cocoa? George T Lewith, et al.   (3 November 2009) Re: Cure or cocoa? Peter A Fisher   (3 November 2009) Cure or cocoa? Nick Ross   (16 October 2009) A point of medical semantics. J. Clifford Jones   (13 October 2009) CAM practitioners offer what modern physicians do not Arun S. Nanivadekar   (13 October 2009) Read every Quick Comment to this article
	Editorial: Thomas Wakley: relevant to today's society Baum (1 October 2009) [Full text] [PDF]		Relevant to today's society? Evidence. George T Lewith   (3 November 2009) Read every Quick Comment to this article
	From the Editor: Naming peer reviewers in JRSM Abbasi (1 October 2009) [Full text] [PDF]		Peer review and "openness" Michael Swash   (13 October 2009) Read every Quick Comment to this article

Essay: On a wing and a prayer: surgeons learning from the aviation industry Singh (1 September 2009) [Full text] [PDF] On a wing and a prayer: surgeons learning from the aviation industry Comparisons with the past 2 October 2009 Mark R Savage, Doctor - Emergency Medicine Send letter to journal: Re: Comparisons with the past savagehaus{at}gmail.com Mark R Savage A very interesting article. I am interested by the potential lessons medicine can learn about safety and teamwork from aviation. In this time of EWTD angst, I am also interested in the debates regarding hours of experience and quality of consultant at the other end. One thing that stands out to me is that we have, as far as I am aware, no scientific evidence regarding the training of the past, to which so many refer currently. Doctors worked many hours and performed much more surgery, but it is not simply a matter of number of hours, rather what happens during those hours. There is no substitute for clinical experience, yet one must be able to learn properly from that experience. Hospitals are, I am informed, busier now than in the past, with sicker patients. Surgeons specialise much more than previously. Upper GI, lower GI, Vascular etc., etc. I wonder if the actual range of operations performed now by a trainee is less, and therefore experience is more concentrated than before? The opposite problem occurs In my specialty. Patient attendances have risen dramatically since the earliest casualty departments. So, whilst I may work less hours than previously, the chances may be that I am seeing a similar number of patients. With this, though, comes less opportunity to follow- up patients and learn from a case, particularly with the four-hour limit. EWTD/MMC are here for the forseeable. It is up to the medical profession to seize the initiative in making sure that training is relevant and provides sufficient experience at the same time as optimising the outcomes for patients. On a wing and a prayer: surgeons learning from the aviation industry Surgeons and Safety 2 October 2009 William G Notcutt, Anaesthetist James Paget University Hospital, Great Yarmouth NR31 6LA Send letter to journal: Re: Surgeons and Safety willy{at}tucton.demon.co.uk William G Notcutt So surgeons are looking to the Airline Industry now for guidance on safety. What a pity they don't glance over the screen at the top of the operating table to the Anaesthetist. We have been doing "Cockpit Drills" for 30 years or more. The parallels between the processes of flying and anaesthesia are closer than with surgery. Over the years I have observed that Anaesthetists in general spend far more time than the surgeon in undertaking pre- assessment, both of the patient and of the work environment. How long have I waited in theatre for the X-Rays or a favoured surgical tool to be found, which a little forethought would have made available when needed. Learn about preparation by all means but don't bother to go to the hangar, ask on the other side of the screen.

Research: Independent sector treatment centres: the first independent evaluation, a Scottish case study Pollock and Kirkwood (1 July 2009) [Abstract] [Full text] [PDF] Independent sector treatment centres: the first independent evaluation, a Scottish... Evaluation of contract in ISTCs 21 October 2009 Allyson M Pollock, Professor and director Centre for International Public Health Policy, University of Edinburgh, Graham Kirkwood Send letter to journal: Re: Evaluation of contract in ISTCs allyson.pollock{at}ed.ac.uk Allyson M Pollock, et al. Nick Black questions whether our paper on Scotland’s only ISTC, in which cataract surgery, knee and hip replacement, and other treatments are delivered to NHS patients by for-profit companies in mainly private facilities is the first independent evaluation. Our study is the first and only independent evaluation of public money paid for an ISTC contract in the UK; it showed that in Scotland’s only ISTC, the company Netcare may have been paid up to £3 million for treatment that had not been provided to patients in the first year of the contract worth six million pounds a year. In contrast, Black’s study, to which we refer, was a questionnaire survey of patient reported outcomes of 1,895 patient treated in NHS hospitals and 769 patients treated in six ISTCs. This week the Scottish health minister responded to our academic evaluation by deciding not to renew the contract with Netcare and to return the services to the NHS. This is in sharp contrast to England where the £5 billion Independent Sector Treatment Centre (ISTC) programme is still unevaluated, on account of the contracts remaining commercial in confidence. Academic scrutiny of value for money claims cannot be undertaken. Furthermore, unlike Scotland any evaluation of the ISTC programme in England is further hampered by lack of data and incomplete and poor quality data returns. Although all ISTCs are required to submit hospital episode statistics on all NHS patients treated, the Healthcare Commission (HCC) found that during 2005-6 fewer than half of them returned any data.[1] Of the data returned, 43.4% were missing primary procedure codes and 7.6% had invalid primary procedure codes.[2] For 2006-7, 18.8% of episodes were missing primary procedure codes and 1.3% were invalid.[2]. Patients attending such centres are healthier and better off than those attending the NHS. Black et al have shown that patients attending ISTCs are routine and straightforward elective cases —that is, with fewer complications and co-morbidities than other NHS patients—the HCC has shown that ISTCs also treat a lower proportion of patients in the lowest socioeconomic group than the rest of the NHS.[1] The contribution of ISTCs to reducing waiting times and improving access can not be evaluated without complete data on all patients. While patient reported outcomes are an important aspect of health care evaluations they provide a partial picture of access and quality of care. It is unfortunate that the government in England has thus far failed to place the contract data in the pubic domain or to ensure the completeness and quality of routine data on all NHS patients. Unlike Scotland, the lack of data means that policy of using private for- profit companies in the NHS is not subject to proper informed public and parliamentary scrutiny. It’s time that England took a leaf from the Scottish health minister’s book. 1 Healthcare Commission. Independent sector treatment centres. A review of the quality of care. 2007. www.cqc.org.uk/_db/_documents/ISTC_Final_Tagged_200903243502.pdf 2 Healthcare Commission. Independent sector treatment centres: the evidence so far. 2008. www.cqc.org.uk/_db/_documents/Independent_sector_treatment_centres_The_evidense_so_far.pdf

From the Editor: Three deadly sins: hierarchy, etiquette and conformity Abbasi (1 November 2009) [Full text] [PDF] Three deadly sins: hierarchy, etiquette and conformity The struggle against sins. 17 November 2009 john main, consultant nephrologist james cook university hospital, middlesbrough Send letter to journal: Re: The struggle against sins. john.main{at}stees.nhs.uk john main Your highlighting of the three deadly sins of hierarchy, etiquette and conformity as barriers to good prescribing seems highly appropriate. These of course are not new, although hierarchy (at least in physicianly specialties) may be somewhat less of a problem than it used to be. On my first ever attachment as a student to a medical "firm" (remember them?), in the Royal Infirmary of Edinburgh in the late 1970s, one particular weekly consultant round was extremely hierarchical, with the massed retinue speaking only when spoken to. Many prescribing decisions were made and carefully entered by the house officer on the drug chart at the foot of the bed. The registrar took careful notes. When the round was finished, the ritual tea with sister drained (punctuated by classic Edinburgh senior physicianly observations - "I hear the porters are going to work to rule - that'll be a big improvement"), and the consultant departed, off we went again. This time the registrar was in charge. Only selected beds were visited, no patients were spoken to, only drug charts were perused. The mornings more eccentric prescriptions were replaced with conventional treatments, and the explanations were valuable lessons in therapeutics. Indeed there were many lessons to be learnt in those hallowed corridors, not all of them available in conventional textbooks. Where does my registrar go after my ward rounds? John Main

From the James Lind Library: Surgery for the treatment of psychiatric illness: the need to test untested theories Wessely (1 October 2009) [Full text] [PDF] Surgery for the treatment of psychiatric illness: the need to test untested theories A rather simplistic view of CFS 13 October 2009 Ellen Goudsmit, Health Psychologist UEL Send letter to journal: Re: A rather simplistic view of CFS ellengoudsmit{at}hotmail.com Ellen Goudsmit As a senior psychologist who specialises in fatigue syndromes, I am both aware of, and able to interpret the psychological literature on CFS. What Prof. Wessely failed to mention with regard to the meeting at the RSM is that the proceedings were dominated by those who adhere to one particular view. This view, which I refer to as the CBT model', is largely based on assumptions, and its proponents have shown little interest in the growing number of alternatives to CBT (1). In short, it may be argued that the tensions discussed by Wessely have less to do with misinformed patients or prejudices, and more with the lack of balanced information at meetings and in articles. To put it another way, if you don't promote the CBT model, you are persona non grata; an outcast; a dissident. I am perhaps more ambitious than the proponents of the CBT model. I want information about additional therapeutic options so I can offer patients an individualized programme based on needs, preferences and circumstances. If they are as effective as CBT, and many are, then why not invite those with the relevant knowledge? For example, the people at the RSM know of my work yet I have never been asked to speak at any of the meetings on CFS. Could it be that it serves the CBT school to portray pacing, the strategy which I devised, as a lay concept without a sound theory and with little empirical support? I am not happy with the psychiatrists' 'one therapy fits all' approach. Yes, they have dominated the research. However, given the lack of balanced information at meetings and in the British journals, this may have more to do with the workings of in-groups than a lack of good evidence from other specialists. 1. Van Houdenhove, B and Luyten, P. Treatment of chronic fatigue syndrome: how to find a 'new equilibrium'? Pat Educ Counseling, 2009, doi:10.1016/j.pec.2009.09.001. E. Goudsmit. C.Psychol. FBPsS Psychologist and Member of the Psychiatry Section Surgery for the treatment of psychiatric illness: the need to test untested theories Dr. Wessely continues to feel abused 13 October 2009 Margaret M. Bailey, Librarian None Send letter to journal: Re: Dr. Wessely continues to feel abused auntiem6{at}ptd.net Margaret M. Bailey Dr. Wessely makes a great deal of the fact that he is unwanted at conferences involving Chronic Fatigue Syndrome and Myalgic Encephalomyelitis. While it may be a truism that psychiatry has something to offer all illnesses, the primary effort and focus needs to be an understanding of the physical bases to these illnesses. It is counterproductive for patients and non-psychiatric medical professionals to repeatedly be sidetracked or discouraged by an insistence on a psychiatric approach. Psychiatrists such as Dr. Wessely, who take up spaces at conferences which could be given to researchers and doctors the patient community does trust, do harm, not good, with their efforts. Perhaps that should have some bearing on the invitations they receive, and accept. Surgery for the treatment of psychiatric illness: the need to test untested theories CFS and Psychiatry 13 October 2009 Tom Kindlon, Information Officer (voluntary position) Irish ME/CFS Association Send letter to journal: Re: CFS and Psychiatry tkindlon{at}maths.tcd.ie Tom Kindlon Simon Wessely refers to the hostile attitude of Chronic Fatigue Syndrome (CFS) patients to the involvement of some psychiatrists in the field of CFS (1). One interpretation is that this is due to some sort of prejudice. I would like to suggest that alternative explanations are possible. Rehabilitative strategies such as Graded Exercise Therapy (GET) and a form of Cognitive Behavioural Therapy (CBT) based on encouraging CFS patients to do more activity, have long been championed by him and some of his colleagues as safe and effective evidence-based treatments for the condition. However, high rates of adverse reactions to exercise programmes have been reported (2), information that rarely if ever is imparted by many psychiatrists when these treatments are being recommended. The efficacy of rehabilitative therapies for CFS may not as large as people are led to believe: a meta-analysis of CBT for CFS (which included GET programmes) estimated the Cohen's d effect size to be 0.48 (3), less than the 0.50 threshold generally set for a treatment to be seen to have a moderate effect. CFS is increasingly being recognised as heterogeneous condition (4). However, many psychiatrists give the impression that rehabilitative strategies for CFS will be safe and effective for all, rather than for sub -groups. Patients often prefer management strategies based around the pacing of activities. A US trial of non-pharmacological interventions found that a programme based around the pacing of activities produced better results than the CBT and exercise programmes (5). Yet, for some reason, many from the psychiatric profession will not recommend pacing to CFS patients. I posit that, looking at the issues in this way, one can see that it is not necessarily an inherent prejudice that causes some patients to question psychiatry's involvement in the field. Incidentally, one of the reasons that patients objected last year to the CFS conference Prof. Wessely refers to is that, on the six-person organising committee, the four members with a special interest in CFS all happened to be psychiatrists! References: [1] Wessely S. Surgery for the treatment of psychiatric illness: the need to test untested theories. J R Soc Med 2009;102:445-451 [2] Kindlon T, Goudsmit EM. (in press). Graded exercise for CFS: Too soon to dismiss reports of adverse reactions. J Rehabil Med [3] Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS. Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clin Psychol Rev. 2008 Jun;28(5):736-45. [4] Jason LA, Corradi K, Torres-Harding S, Taylor RR, King C. Chronic fatigue syndrome: the need for subtypes. Neuropsychol Rev. 2005 Mar;15(1):29-58. [5] Jason LA, Torres-Harding S, Friedberg F, Corradi K, Njoku MG, Donalek J, Reynolds N, Brown M, Weitner BB, Rademaker A & Papernik M. Non-pharmacologic interventions for CFS: A randomized trial. Journal of Clinical Psychology in Medical Settings 2007,14,275-296.

Research: Examination performance of graduate entry medical students compared with mainstream students Calvert et al. (1 October 2009) [Abstract] [Full text] [PDF] Examination performance of graduate entry medical students compared with mainstream... The LRCP 3 November 2009 J. Clifford Jones, Reader University of Aberdeen, No colleagues Send letter to journal: Re: The LRCP j.c.jones{at}eng.abdn.ac.uk J. Clifford Jones, et al. Training of doctors has been a dominant feature in recent issues of JRSM at a time when I personally have been reminiscing a little about my formative years in east Lancashire. I left my home town there in 1971 to go to university to study chemistry and, apart from a three month stretch prior to emigrating to Australia in 1978, have not lived there since. I am in fairly frequent touch with a few people there and we like to discuss prominent residents of the area from the distant past, now long deceased. One such was a GP. It was known that he was the scion of a noble family, and I can recall finding him in Debrett’s. I am not sure, but I think his full title might have been ‘Dr. the Hon . . . ‘, though if that is so he did not to my knowledge ever invoke such a title. He used to make his house calls in a modest Austin delivery van, but also owned a 1920s Rolls Royce which he would sometimes put to recreational use in the summer. I recall from having looked him up in Debrett’s that one of his credentials was LRCP, Licentiate of the Royal College of Physicians. This is no longer awarded. I’d estimate that he qualified in about 1930. I don’t know whether that means that he studied for the LRCP per se or whether having passed through a university medical school he obtained the LRCP on registration. I have no doubt that there are readers of JRSM who can answer these questions about medical training at a time just about as far back as living memory goes. Comparisons between the professions can be interesting. Readers of my little pieces over the months might have noticed FRSC – Fellow of the Royal Society of Chemistry – amongst my own postnomials. That used to be FRIC, Fellow of the Royal INSTITUTE of Chemistry. The Royal Institute of Chemistry, like the Royal College of Physicians, did used to have a Licentiate grade. J.C. Jones DSc FIChemE FRSC MAIChE Fellow, RSM Reader in the School of Engineering, University of Aberdeen. Examination performance of graduate entry medical students compared with mainstream... What is the impact of medical education in the early years? 13 October 2009 Brendan S Fletcher, CT2 Anaesthetics Department of Anaesthetics, Norfolk and Norwich University Hospital Send letter to journal: Re: What is the impact of medical education in the early years? brendanfletcher{at}doctors.org.uk Brendan S Fletcher I read with interest Calvert et al’s study from the University of Birmingham and was encouraged to read that graduate entry students are out -performing mainstream counterparts in medical school examinations in the later stages [1]. Their discussion did allude to different teaching methods used in the first phase of the Birmingham course but did not suggest how much of a contribution this makes to performance in the second stage. They did not discuss how big the groups used for teaching were in both the graduate and mainstream programmes. The results included 161 graduate entry and 1386 mainstream students. If class size is potentially a factor in early years education, might the Birmingham group consider looking at their own class sizes and assessing whether or not this might also be a factor in medical education? If Birmingham is educating graduates in it’s mainstream programme, it may be interesting to see how these students perform in relation to their graduate course peers. In addition, might it be possible for school- leavers to be educated in the graduate entry programme for phase 1, to act as comparison? Presumably, when there are two different models for delivering the early years of medical education in the same medical school, there must be a reason for this and one wonders why it is not considered appropriate to apply the graduate course model to mainstream programmes. When people who entered medical school as school leavers read sentences such as: “Graduate entry students are generally more mature than non-graduate entry students” it may get their heckles up, so I was particularly pleased to read that the Birmingham group did not suggest that graduate entry students make “better” doctors on the basis of good exam results. Yours faithfully, Brendan Fletcher Competing Interests Graduated from a mainstream course References 1. Calvert MJ, Ross NM, Freemantle N, Yong Xu, Zvauya R, Parle JV. Examination performance of graduate entry medical students compared with mainstream students. J R Soc Med 2009; 102: 425-430.

Essay: Complementary and alternative medicine: what the public want and how it may be delivered safely and effectively Lewith and Robinson (1 October 2009) [Full text] [PDF] Complementary and alternative medicine: what the public want and how it may be delivered... Re: Cure or cocoa? 3 November 2009 George T Lewith, Professor of Health Research University of Southampton, Nicola Robinson Send letter to journal: Re: Re: Cure or cocoa? gl3{at}soton.ac.uk George T Lewith, et al. I am astonished that Mr Ross is not aware of the therapeutic and research contributions made by various CAM disciples to conventional medicine. For instance, the use of herbal medicines within modern pharmacology has been well documented. In our articles we are simply arguing for a coherent research strategy that is properly representative of the public’s interest in CAM. This is an issue that many CAM researchers, including Edzard Ernst, have supported for some years1. We have to sort out the wheat from the chaff and without a properly funded strategic research programme, such as those in existence in the United States and Australia, we cannot do so. This is not an irrelevant sideline, but an important therapeutic, safety and public health issue for a substantial minority of the UK’s population. 1. Lewith GT, Ernst E, Mills S, et al. Complementary medicine must be research led and evidence based. Letter. British Medical Journal. 2000; 320: 188 Complementary and alternative medicine: what the public want and how it may be delivered... Re: Cure or cocoa? 3 November 2009 Peter A Fisher, Physician Royal London Homoeopathic Hospital Send letter to journal: Re: Re: Cure or cocoa? peter.fisher{at}uclh.nhs.uk Peter A Fisher Mr Ross should have checked the evidence before making wild allegations of ‘shoddy research’. For homeopathy, even harsh critics agree that the quality of research is better than in conventional medicine: in a comparison of 110 clinical trials of conventional medicine matched with 110 of homeopathy, 50% more trials of homeopathy than conventional medicine were of high quality (21/110 v 14/110).1 It is also ironic that he raises conflicts of interest and the scale of the market: he is a trustee of Sense about Science, an organisation with an explicit anti-complementary medicine agenda and which has launched repeated attacks on it in the media. Sense about Science receives substantial funding from the pharmaceutical industry, whose scale enormously exceeds that of complementary medicine. Peter Fisher Clinical Director Royal London Homeopathic Hospital 1) Shang A, Huwiler-Muntener K, Nartey L, et al. (2005). Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet, 366:726- 32. Complementary and alternative medicine: what the public want and how it may be delivered... Cure or cocoa? 16 October 2009 Nick Ross, Journalist President, HealthWatch Send letter to journal: Re: Cure or cocoa? nickross{at}lineone.net Nick Ross In their plea for more research into complementary therapies Lewith and Robinson contend that public enthusiasm for folk remedies, including we’re told among half all cancer patients, illustrates the need for a high quality research strategy (J R Soc Med 2009:102: 411-414). Interestingly both authors assert they have no vested interest in this argument, though both head Complementary and Integrative Health Research Units which, according to Robinson’s website, are “keen to further develop”. Nor do they acknowledge that while the complementary medicine market is worth a fortune it generally chooses to commission shoddy research or none at all. But more importantly their reasoning elides popularity with effectiveness. For centuries bloodletting was popular and widely thought to be effective, but all that goes to prove is that hope often triumphs over reason. Come to think of it cocoa is very comforting too but we don’t need to divert precious medical research budgets to wondering why. Complementary and alternative medicine: what the public want and how it may be delivered... A point of medical semantics. 13 October 2009 J. Clifford Jones, Reader University of Aberdeen Send letter to journal: Re: A point of medical semantics. j.c.jones{at}eng.abdn.ac.uk J. Clifford Jones The appearance of an article on alternative treatments in the latest issue of JRSM made me think of a point which has arisen in my mind at intervals over the years. It sometimes happens that two words which have similar pronunciations and an obvious similarity in meaning are not in fact etymologically linked. The best known example, which features in at least one standard reference on word usage, is ‘census’ and ‘consensus’. Instinctively we expect that these are linked, but in fact ‘consensus’ is derived from ‘consent’ and has nothing at all to do with the process of carrying out a census. In one of the Sherlock Holmes stories Dr. Watson explains that a Turkish bath is an example of what in the medical profession of his day was termed alterative (no ‘n’). The ‘Free Online Dictionary’ which I have consulted defines an alterative as ‘a treatment or medication which restores health’. An online medical dictionary I have consulted gives a more focused definition. I don’t know to what extent doctors in this 21st Century use the term ‘alterative’. My question is whether it is in any sense a synonym for ‘alternative’ or whether ‘alterative’ and ‘alternative’ are analogous to ‘census’ and ‘consensus’. J.C. Jones DSc FIChemE FRSC MAIChE Fellow, RSM School of Engineering, University of Aberdeen. Complementary and alternative medicine: what the public want and how it may be delivered... CAM practitioners offer what modern physicians do not 13 October 2009 Arun S. Nanivadekar, Physician None Send letter to journal: Re: CAM practitioners offer what modern physicians do not asnanivadekar{at}yahoo.co.in Arun S. Nanivadekar Although modern medicine has become technologically more efficient and powerful, it has gradually slipped away farther and farther from its anchorage to the physician-patient relationship which is so vital to the caring for sick people. Our focus is now on diseases, procedures, organs, tissues, cells, and subcellular systems, but not on illnesses and the suffering of sick persons. Practitioners of complementary and alternative systems of medicine (CAM) probably satisfy this human need far more than modern physicians do. This is likely to be the main reason for the growing popularity of CAM. Modern physician-scientists will benefit from studying this phenomenon, and borrowing what is good in CAM, so as to enrich modern medicine and make it more humane.

Editorial: Thomas Wakley: relevant to today's society Baum (1 October 2009) [Full text] [PDF] Thomas Wakley: relevant to today's society Relevant to today's society? Evidence. 3 November 2009 George T Lewith, Professor of Health Research University of Southampton Send letter to journal: Re: Relevant to today's society? Evidence. gl3{at}soton.ac.uk George T Lewith One hundred and fifty years’ ago the conventional medical profession believed in blood letting and chiropractors believed that they could treat meningitis by manipulating the spine. Now both professions are medically registered and neither believes in these myths! As Professor Ernst suggests, chiropractors now adhere to the ethics of evidence based medicine. As has been pointed out to Baum (and Singh) repeatedly, the evidence for harm in the paediatric population receiving chiropractic is based on limited and questionable case reports. The evidence for chiropractic causing harm in the adult population is even flimsier with good solid case controlled studies suggesting that chiropractic manipulation of the neck is not unsafe and appears not to cause stroke (1). I have great respect for Professor Baum but unfortunately he has a particular blind spot with respect to complementary medicine which fails to create a thoughtful and informed debate. There is no doubt that we all have much to learn about CAM and the evidence for the safety and effectiveness of chiropractic will no doubt change chiropractic practice over the coming years as it has done already with respect to the way we manage back pain within the NHS. To a very large extent Dr Singh brought this battle upon himself and appears to have created a cause celebre around the libel laws possibly because he failed to win the initial hearing against the Chiropractors. 1. Cassidy JD; Boyle E; Cote P; et al. Risk of Vertebrobasilar Stroke and Chiropractic Care, Results of a Population-Based Case-Control and Case-Crossover Study. Spine 2008;33:S176-S183

From the Editor: Naming peer reviewers in JRSM Abbasi (1 October 2009) [Full text] [PDF] Naming peer reviewers in JRSM Peer review and "openness" 13 October 2009 Michael Swash, Neurologist Barts and the London Sch of Medicine & Dentistry Send letter to journal: Re: Peer review and "openness" mswash{at}btinternet.com Michael Swash The Editor states that publishing "peer reviewers names is a bold step in improving transparency" of the peer review process, and is important in achieving a more open process. While one may respect Dr Abbassi's opinion in this regard, it appears to be an opinion held without objective supporting data. The review process is supposed to be an objective process, not a process in which a couple of acquaintances get together and have a friendly chat about a research report, before recommending publication to the Editor. Locking in the reviewer and author in this way will impede independence in the reviewer's opinion. The right place for collaboration between author and uninvolved expert is at the writing stage, when an opinion from a respected expert colleague or contemporary researcher, naive to the research itself, is always a wise and usually a highly revealing process. Locking in the reviewer to the data set out in the paper, by publicising his or her name, is not, in general, a constructive idea. However, an editorial written by an enthusiastic reviewer has merit in independently considering and perhaps endorsing the work. MS