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Background There is a lack of consensus regarding the definition of advance care planning (ACP), the people for whom it is most beneficial, how and by whom it should be conducted, its integration in health care, and what appropriate outcomes measures are. Further, there are considerable differences worldwide in the willingness of health care providers, patients and relatives to discuss issues related to disease progression and end-of-life care, and the integration of these discussions in the health care system. Aim To draft a white paper about ACP that is based on scientific evidence and transcultural consensus building that describes a common understanding of the definition the key elements of ACP. This white paper is commissioned by the European Association for Palliative Care (EAPC). Methods and expected results A three-round Delphi study will be conducted by a core group of 14 experts from 8 countries. The first round took place in June 2014 in a 2-day expert meeting. Five core domains were established: concept, content, system, measurements, and challenges/concerns. Subsequently, based on literature, a set of 50 recommendations related to these domains were drafted. These will be assessed in two rounds on its importance by a multidisciplinary expert panel (n = 100 from 16 countries). In addition, a research agenda for future ACP research will be constructed. Conclusion The ACP white paper will provide a comprehensive overview of ACP based on evidence and consensus. It can serve as a framework for clinical practice, policy and research.

More than 500 journals have adopted the uniform requirements of the International Committee of Medical Journal Editors, which stipulate that authors should “indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation.”1 One major purpose of institutional review is to ensure that informed consent is obtained when possible. We investigated how often research publications about child health report ethics committee approval or informed consent. We reviewed all research reports related to child health (involving patients

A doctor who tried to submit for publication two research papers written by others has been suspended for 12 months by a medical practitioners tribunal. Mohammed Shali, who qualified in Mysore (now Mysuru), India, in 1998, sent an email in February 2013 to the editor of the International Journal of Clinical Skills attaching two papers. He named himself as first author of “An Unusual Cause of Dyspnoea—Mural Thrombus” and as coauthor of “An Unusual Cause of Dyspnoea—Atrial Myxoma.” The first paper had already been published elsewhere under a different title, and Shali had no role in its authorship. He falsely …

The white paper focuses to a large extent on dismantling the internal market and the development of primary care. The provision of specialist services—which investigate and treat the bulk of serious ill health—get scant mention, despite their accounting for about £1.4 billion of NHS expenditure annually.1 In an almost throw away line, the white paper insists that “everyone with suspected cancer will be able to see a specialist within two weeks of their GP deciding they need to be seen urgently and requesting an appointment.” It is not difficult to understand why cancer has been singled out for this treatment. It is a common and greatly feared disease. Much work has been done around the country following the Calman-Hine report2 to set standards for cancer care, define protocols and guidelines, develop multidisciplinary teams, and identify …

Why should a journal of sports and exercise medicine include an extensive series of papers that deal exclusively with exercise physiology; indeed with a tiny subsection of that discipline? The reason is perhaps twofold. The first is that the published articles all address the novel aspects of exercise-induced fatigue and the regulation of human exercise performance. Fatigue remains a common complaint that brings patients to their primary care physicians. Surely there must be some common explanation for the types of fatigue that we feel, whether at rest or during exercise? Can the exercise sciences contribute something unique to our understanding of this important clinical phenomenon? In 1923, Nobel Laureate Archibald V Hill developed the currently popular model of exercise fatigue.1 According to his understanding, fatigue develops in the exercising skeletal muscles when the heart is no longer able to produce a cardiac output which is sufficient to cover the exercising muscles' increased demands for oxygen. This causes skeletal muscle anaerobiosis (lack of oxygen) leading to lactic acidosis. The lactic acid so produced then ‘poisons’ the muscles, impairing their function and causing all the symptoms we recognise as ‘fatigue’. The collection of articles in this issue provides several invigorating challenges to Hill's hallowed interpretation. Which brings us to the second reason why these articles are published here rather than elsewhere. For some of the articles included were reviewed unfavourably elsewhere; perhaps they were considered heretical. Clearly, some believe that ideas challenging a hallowed dogma are best left unpublished. Otherwise, we might need to update our thinking. Or worse, our teaching! The issue begins with the complementary studies of Lex Mauger et al 2 from the University of Bedfordshire and Fernando Beltrami and his associates3 from the University of Cape Town. Their studies disprove perhaps the most fundamental idea on …

The current prescription charging system could seriously undermine the aims of the government's new white paper to make healthcare services more accessible to people who need them most, MPs heard last week. The charges are likely to hinder attempts to make the health service better at helping groups of people who currently find it difficult to get the right health care, such as people in underserved deprived areas, witnesses told the health select committee as part of its continuing inquiry into NHS charges. Witnesses were asked how the present system of prescription charges affected the policy set out in the …

Surely the answer to this difference in interpretation of Freemantle and colleagues’ paper is to ask Freemantle and colleagues to respond to Jeremy Hunt in a letter to The BMJ .1 2 It is easy for lay people, such as the health secretary, to misinterpret data in scientific papers, but part of the blame lies with the authors for not making their findings clearer …

Parity of authorship should be a priority for journals, universities, and funding agencies Women have been attending medical school in numbers equal to or greater than those of men since 1996 in the United Kingdom,1 and in nearly equal numbers in the United States since 2003.2 However, despite parity in medical school admissions, substantial gender differences in rank and leadership remain in academic medicine. The progress of women attaining first and senior authorship of original research publications, the currency of success for promotion in academic medicine, will directly translate into equity of academic advancement for women in the future. In a linked paper (doi:10.1136/bmj.i847),3 Filardo and colleagues examined the prevalence of female first authorship among original research articles published over the past two decades (1994-2014) in six high impact general medical journals. This study is notable for its rigor, examining six issues a year for all selected journals throughout the 20 year study period and using online searches of authors to identify gender in those with ambiguous names. The authors report some good news—an …

To mark the 20th anniversary of The BMJ ’s website, the journal asked 20 UK and international readers, authors, friends, and former colleagues to name an outstanding article published since the mid-1990s. The result is an extraordinary mix of editorials, research papers, analysis, and comment, including an investigation, on topics as wide ranging as the MMR vaccine scare, death, evidence based medicine, and the use of stirrups for pelvic examinations. Some represent seminal moments in recent medical history, others are pieces of research that, for their sheer simplicity and focus on patient experience, have inspired our readers to think and work differently. So here is The BMJ ’s top 20 and why, according to our 20 chosen readers, they are the best. “The development of the EQUATOR Network (www.equator-network.org) to improve reports of research and the 2014 Lancet series of papers on ways of increasing value and reducing waste in research (www.researchwaste.net) are just two examples of testimony to the enduring influence of Doug’s 1994 call for “less research, better research, and research done for the right reasons.” Iain Chalmers, health services researcher and a founder of the Cochrane Collaboration “Over the past 30 years we have seen medicine transformed from being based on the opinions of ‘experts’ to being based on systematic collation of evidence from clinical studies. There is still a vast amount to do to improve the evidence base itself. But articles such as this have helped explain to doctors the key principles of evidence based medicine and have inspired a new generation of clinicians and researchers.” Fiona Godlee, editor in chief, The BMJ “This paper and a linked one ( BMJ 1996;313:987, doi:10.1136/bmj.313.7063.987) revealed the profound sense of responsibility that parents felt for their children and how deep seated their fears are of serious …

The UK Research Paper of the Year category recognises outstanding research by one or more UK authors that has potential to considerably improve health and healthcare. Nigel Hawkes describes the shortlisted papers Do stem cells taken from the bone marrow and injected into patients with heart disease improve heart function? Lots of people believe so, and meta-analyses by the Cochrane Collaboration show a significant positive effect. But individual trials produce conflicting results, for no very obvious reason. Darrel Francis, professor of cardiology at Imperial College in London, says: “Some things in the early trials didn’t add up and when we went to the journals that published them, we were fobbed off. So we decided to look at discrepancies in all the published trials.” Discrepancies were defined as two or more reported facts that cannot both be true because they are logically or mathematically impossible. The team’s paper, published in The BMJ, concluded that the more discrepancies a paper contained, the more positive its results. “This field of therapy appears to be most effective in the hands of researchers whose reports contain factual impossibilities,” say Francis and colleague Graham Cole. “Indeed, when the factual impossibilities disappeared, so did any effect of the therapy.” They expected a sharp reaction from researchers with many discrepancies. “We tried to soften the blow by not naming the hundreds of report authors directly,” Francis says. “But it was authors with few discrepancies, and small or zero effect sizes, who criticised the study most vocally.” This includes the Cardiovascular Cell Therapy Research Network, funded by the US National Institutes of Health with $30 million, whose data coordinator, Lem Moye of the University of Texas, told people to disregard the …

The Lancet has retracted a 1992 study by the Canadian self proclaimed “father of nutritional immunology,” Ranjit Kumar Chandra, on the grounds that its reliability “can no longer be assured.”1 The study—a major trial that reported an improvement in older people’s immunity and infection risk after taking nutritional supplements2—was the second of Chandra’s studies to be retracted within the past six months. In October The BMJ retracted his 1989 study into the immune benefits of baby formula after receiving a suppressed report of an inquiry of his research, completed in 1995 by his former employer, Memorial University of Newfoundland, after allegations of data fabrication.3 Doubts about the plausibility of the Lancet study first …

According to the back cover of this booklet, The British Nutrition Foundation promotes the nutritional wellbeing of society by interpreting and disseminating scientifically based knowledge and advice. Here they tackle the science and practice of sports nutrition, acknowledging that although the information is underpinned by rigorous research in exercise physiology and metabolism, it must be …

Two papers that reported that the blood pressure drug ramipril was beneficial in patients with intermittent claudication due to peripheral artery disease have been retracted after an investigation found that data were fabricated by the studies’ lead author, Anna A Ahimastos, a researcher at the prestigious Baker IDI Heart and Diabetes Institute in Melbourne, Australia. The first paper,1 published in JAMA in …

Errors are linked to retraction, but are an unreliable marker for fraudulent or harmful research

New electronic media such as the internet offer great possibilities for spreading serious medical information from healthcare professionals, organisations, and authorities to the public. However, there is also a reverse side to this coin. Some companies misuse the new medium for uncontrolled distribution of drugs that have not been tested properly by national authorities or medical societies. These companies deceive patients in their advertising messages. By using citations from serious medical journals, they lead people to believe that their drugs are “highly effective.” In addition, use of such drugs may encourage patients to abstain from the usual drugs administered by doctors. In response to a patient's question about the usefulness of a multivitamin preparation in preventing and treating some cardiovascular diseases, we evaluated some of the claims made about Vitacor 20/90, which is being advertised intensively on the internet by Health Now (San Francisco, California, USA,www.healthnow1.com and is distributed in Germany from the Netherlands. #### Summary points

Objectives: To determine the publication rate of abstracts presented by UK emergency physicians at major emergency medicine meetings, and to identify the site of publication of papers. Method: All abstracts presented to the annual scientific meetings of both the British Association of Emergency Medicine and the Faculty of Accident and Emergency Medicine between 2001 and 2002 were identified retrospectively from conference programmes. To identify whether the work relating to the abstract had been published in a peer-reviewed journal, the Medline database (Ovid interface) was searched using the first and last authors as well as key words from the abstract. Results: Of the 404 abstracts identified, 124 (30%) had been published as full articles. For abstracts presented in the oral sessions, 83 (57%) resulted in publication. A range of journals accepted papers for publication. Conclusion: The abstract-to-publication ratio for UK emergency medicine is lower than for other specialties, but broadly similar to emergency medicine in the US and Australia.

Researchers are facing calls to retract published findings that link chronic fatigue syndrome to a retrovirus called xenotropic murine leukemia virus related virus (XMRV) after new scientific criticism of their validity. Editors of the journal, Science , have issued an “editorial expression of concern” over a research paper it published in October 2009, saying the report is “now seriously in question.” The study, “Detection of an infectious retrovirus, XMRV, in blood cell of patients with chronic fatigue syndrome,” was led by Vincent Lombardi and Judy Mikovits of the Whittemore Peterson Institute, Reno, Nevada ( Science 2009;326:585). It purported to show that a retrovirus XMRV was present in the blood of 67% of patients with chronic fatigue syndrome (CFS) compared with 3.7% of healthy controls. The study caused a stir when it appeared and led to some CFS patients, believing XMRV to be a possible contributor to their condition, seeking antiretroviral treatments marketed to combat HIV. But Science , which is the weekly journal of the American Association for the Advancement of Science, has now highlighted “flaws” in the paper. Since 2009, it says, at least 10 studies conducted by other investigators and published elsewhere have failed to detect XMRV in independent populations of CFS patients. Furthermore, Science …

This year’s judges have to choose between three randomised controlled trials, each of which finds that a relatively simple intervention could save many lives. The research topics ranged from screening for colorectal cancer and reducing bleeding in injured patients to treating malaria in children (see box). #### Research questions of the shortlisted papers Elizabeth Loder (clinical research editor) and I looked separately at all 150 or so nominated papers and then met to discuss our choices. We hadn’t planned to shortlist only trials: there were plenty of great papers whose research questions were appropriately and robustly answered with observational study designs. But, in the end, we were clear that these …

An analysis that compared clinical trial documents that were released because of a lawsuit with the corresponding papers published in medical journals has generated further concern about the integrity and reliability of research and of publishing. The analysis, by researchers at Johns Hopkins University, Baltimore, and published in PLoS Medicine , was based on 21 trials of the off-label uses of gabapentin sponsored by the drug companies Pfizer and Parke-Davis.1 Only 11 of the trials were eventually published. But the extensive cache of documents was made public because of litigation over illegal marketing practices for the drug. “For three trials there was disagreement on the number of randomized participants between the research report and publication,” summarized the senior …

The Lancet has retracted the 12 year old paper that sparked an international crisis of confidence in the safety of the measles, mumps, and rubella (MMR) vaccine when its lead author suggested a link between the vaccine and autism. Andrew Wakefield was found guilty by the General Medical Council last week of dishonesty and flouting ethics protocols. The UK regulator held that Dr Wakefield abused his position, subjected children to intrusive procedures such as lumbar puncture and colonoscopy that were not clinically indicated, carried out research that breached the conditions of ethics committee approval, and brought the medical profession into disrepute. In a statement published online (www.thelancet.com) the editors of the Lancet said: “Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation. “In particular, the claims in the original paper that children were ‘consecutively referred’ and that investigations were ‘approved’ by the local ethics committee have been …

A former professor of pediatrics who held an endowed chair in diabetes research at the University of Kentucky has been censured by the US Office of Research Integrity (ORI) for research misconduct spanning 10 years.1 Eric J Smart, who held joint appointments as professor of pediatrics and of physiology, resigned from the university last May after an investigation. He faked data in 10 published papers, seven grant applications, one submitted manuscript, and three progress reports, ORI said. Smart, who held a number of research grants from the National Institutes …

It's not often that a paper changes practice before it is published. It happened to m,however, and, as its a paper that's only recently been published, 1 2I wait to see whether it will change many other general practitioners'practice too. Paul Little and colleagues' study published on 3 August 2002 on the different methods of measuring blood pressure in general practice was carried out in my practice (though I was not involved). Having tried wearing an ambulatory blood pressure monitor for 24 hours some years ago, I knew …

The Palliative Care Congress (PCC) is a biennial conference co-hosted by The Association for Palliative Medicine (APM) and The Palliative Care Research Society (PCRS). Each year there are a number of poster presentations, but currently there is no objective measure of the scientific content of this. Establishing the proportion of posters that progress to publication in peer-reviewed journals is one possible measure. The publication rate reported by other European medical societies ranges from 10% to 70% (median 42%). This is the first study to measure the publication rate of poster presentations at a palliative care meeting. Aim To establish what proportion of the posters presented in the PCC progress to publication in peer reviewed journals, and to compare the results with the publication rate of other European medical societies. Method All posters presented from 2002 to 2008 were included. Posters from 2010 were not considered as sufficient time for publication was not considered to have elapsed. MEDLINE, Pub Med, Google Scholar, Embase and HighWire were searched to look for peer-reviewed papers generated from each abstract. Search terms used included each author9s name and key words of the abstract title. Results Over the four congresses studied, a total of 204 posters were presented, with 72 of these progressing to peer reviewed publication (35%). Publication rate ranged from 26% in 2002 to 40% in 2006 and 2008. Publication was across a range of journals, with the majority appearing in palliative care and pain medicine literature. Conclusions The PCC is generating poster abstracts of comparable academic value to other specialist societies throughout Europe. Using this method of analysing objectively, the publication rate may be a useful way of providing feedback to the specialist interest groups of the PCC as a way of incentivising research areas.

During my medical house job the only people with hypertension whom I saw were those who were admitted with the consequences of cardiovascular disease. I was therefore desperately worried that my father who was hypertensive was about to have a stroke or a myocardial infarction. Fortunately, my next job was a trainee in general practice, where I daily saw people with hypertension who were living fairly normal lives, which helped to get things back in perspective. That latter post, and one in accident and emergency, followed by three years out of medicine, helped me to put the acute and chronic pathology I had seen and read about into a population …

Research studies on the side effects of commonly prescribed drugs constituted the three most read papers published by the BMJ in 2005, according to an internal audit that assessed their use by readers. Studies that showed increased risk of myocardial infarction in patients taking cyclo-oxygenase-2 (COX 2) inhibitors and that explored the link between selective serotonin reuptake inhibitors and suicide came top. For the audit Sara Schroter, the BMJ 's senior researcher, analysed research papers using three measures: the number of citations a paper received, the number of times it was accessed on the web, and the number of rapid responses it generated. The top scoring paper was a case-control study that showed greater risk of myocardial infarction in patients taking the COX 2 inhibitor rofecoxib (Vioxx) and in patients taking diclofenac …

This annual BMJ award recognises outstanding original research with potential to contribute considerably to improving health and healthcare. Trish Groves introduces the shortlist

Edited by J Chitnis, G Cumberbatch, A Gankande. (£18.56). Wiley-Blackwell, 2010. ISBN 978-1-4443-3068-7 A fiercely competitive exam with a dearth of resources to prepare with, the first part of the Membership of the College of Emergency Medicine gives shudders to all emergency medicine trainees—past, present and future. This book provides the reader high-yield facts in the form of 11 practice papers with 50 questions in a true/false format similar to the exam layout. Perhaps more tailored to the candidate who is looking for some mock exam practice, this book will benefit anyone thinking of sitting the Part A exam. The questions are tough and logic provoking, and so …

Despite increases in the number of women doctors in the United States over the past 40 years they are still under-represented as first or senior authors on papers published in leading journals, finds research in the New England Journal of Medicine (2006;355:281-7). The observation that many papers in leading journals were written by men prompted the authors to wonder what message that sent to ambitious young women. “Publication in medical journals is an important measure of academic productivity. It is also highly emphasized in the academic promotion process and an important means by which the academic medical community communicates,” they wrote. The study looked at original articles published in 1970, 1980, 1990, 2000, and 2004 in the New England Journal of Medicine , JAMA , the Annals of Internal Medicine , the Annals of Surgery , Obstetrics & Gynecology , and the Journal of Pediatrics . The researchers were able to identify the sex of 99% of 7249 US doctors listed as first or senior authors on these papers. They also looked at the sex of authors of guest editorials in the New England Journal of Medicine and JAMA . Overall the percentage of female first or senior authors increased from 6% in 1970 to 29% in 2004. The percentage of women who wrote guest editorials also rose overall. In JAMA the percentage rose from 0% in 1970 to 19% in 2004, while in the New England Journal of Medicine it rose from 2% in 1970 to 20% in 2000, although it then fell to 11% in 2004. The greatest increases occurred in the Journal of Pediatrics and Obstetrics & Gynecology , while the smallest gains were made in the Annals of Surgery , changes that broadly reflect the numbers of women in these specialties. In 1960 6% of medical students were women; now they make up 49% of the total number. One in four practising doctors is a woman, and in academic medicine almost a third of full time faculty members are women. But women represent only 10% of medical school deans, 11% of departmental chairs, and 14% of full professors. In an accompanying editorial (2006;355:310-2) four women doctors say that the authorship sex gap will narrow only when more women reach senior faculty positions. They wrote, “Each author … has experienced the challenges of raising children while working full-time in careers in medicine and science. Spending more time on scholarly activities necessarily means less time with family; women may be less likely than men to accept this trade-off.” Career paths in medicine should be more flexible and success less narrowly defined, they say. The paper’s first author, Reshma Jagsi, an assistant professor of radiation oncology at the University of Michigan Medical Center in Ann Arbor, said that formal mentoring and additional financial support would help the goal of increasing diversity in the medical workforce to be met.

The Lancet has retracted a paper by researchers at the Medical University of Innsbruck in Austria after an official investigation found that the clinical trial it reported had serious ethical and procedural flaws. Austria’s Agency for Health and Food Safety says that the urologists who conducted the trial of stem cell treatment for stress incontinence in women failed to get proper ethical approval and neglected to adequately inform patients of the experimental nature of the procedures. In one case an insurance confirmation form seemed to have been forged. “In our view, the conclusions of this official investigation pinpoint so many irregularities in the conduct of their work that, taken together, …

EDITOR—Dimoliatis raises some important points in his personal view asking whether reviewers of papers should have their names published.1 There are two aspects of the debate on open access reviewing that strike me as interesting points from a qualitative perspective. The first is whether the authors think that the paper has been genuinely …

I recently reviewed a paper, which I ended up loving. I felt as though the paper was mine. Although my name is nowhere to be found in the published version, I am in there. I spent much time and effort on it: I wrote hundreds of words in recommendations, some of which were important and accepted by the authors, improving the first version of the manuscript and resulting in version two. Then a new cycle began. And all this depended on my dedication and voluntary contribution—at the expense of my own papers, and at the expense of building my own curriculum vitae. Reviewing does not seem to count for much. But why not? Shouldn't it? Some two months later the editor asked me to review the second version of the manuscript. In doing so I felt—besides helping the authors and editors—a great responsibility to readers. I felt I needed to protect the readers from “junk information” and to contribute to the dissemination of the truth (and …

This book continues to impress. The first edition was excellent, the second and third even better. But the fourth edition is the best yet. Even if you own the previous editions, it is worth adding this one to your library because two new important chapters have been added on complex interventions and quality improvement (topics missing from other standard EBM textbooks). As an EBM educator, researcher, and practitioner, I am unclear exactly for whom the book is best suited. I feel it is most suitable for those with …

More than three years after publishing a research paper in Nature Medicine , 15 German scientists retracted it because of “several incorrect statements and the erroneous presentation of primary data, results and conclusions” ( Nature Medicine 2003;9: 1221 ). The paper, whose lead author was Alexander Kugler, then senior registrar in the urology department of Gottingen University Hospital, presented a small clinical trial …

Editor—In January 1996, Gough et al reported the potential adverse effects of minocycline1; an editorial in the same issue amplified the position.2 Their paper highlighted the fact that minocycline is the most widely prescribed systemic antibiotic for acne, and one for which no resistance has yet been described. They noted, …

How to read a paper. The basics of evidence based medicine . Bytrisha greenhalgh. (Pp 222, £16.95). Published by BMJ Books, London, 2001. ISBN 0 7279 1578 9 The title of this slim paperback is somewhat misleading, as it covers considerably more than reading scientific papers (including how to deal with a visit from a drug rep!). There are two chapters which orientate the reader on why and how to keep abreast of the medical literature, including its electronic forms, nine on various aspects of reading papers, and one on implementing evidence based data. All necessary skills for the medical academic, of course, or for someone approaching a little aired but thorny issue. However, the author works in primary care, and much of her guidance seems directed towards drug trials, and particularly to the needs of her colleagues who may be wondering “how shall I treat the patient actually sitting in my surgery today?”. Good as the advice she gives may be, it is difficult to picture the general practitioner, medical registrar, or even less the tyro casualty officer, asking the patient to wait while he or she boots the computer and searches the medical literature, starting with a couple of systematic reviews and delving into an …

Now in its third edition, this respected book guides the reader through medical research and the jungle of jargon it comprises. The subject matter is divided into types of research, literature searches, presenting and analysing data, and publication and appraisal of research. Its definitions are superb, and it clearly delineates between commonly confused topics such as reliability and validity, systematic reviews and meta-analyses, and protocol and guidelines. In the 12 years since the book’s inception evidence based medicine has evolved from illegitimacy to prodigy, thanks to champions such as David Sackett, Brian Haines, and Greenhalgh herself. They encourage clinicians to formulate the right question with three specific …

EDITOR—I am a jobbing general practitioner, and the paper by Holland and Weiner on Bell's palsy left me confused.1 To treat somebody is a hard decision—not to treat somebody, even harder. In 2002 the BMJ published an article about recent advances in neurology that proposed that there might be a case for prednisolone but …

EDITOR—Dimoliatis's cri de coeur for better recognition of reviewers of papers has much merit.1 Some of your respondents,2 however, are concerned that the quality of peer review could suffer as reviewers succumb to the temptation of seeing their …

EDITOR——The BMJ includes a small box with each paper, summarising the prior knowledge and what the study adds. This is laudable, but inevitably overlaps with the abstract. We suggest an alternative use for a box. We are torn between …

New allegations have been made that German scientists who received major funds from the tobacco industry played down the health effects of smoking. The allegations are in a report published online on 29 November in the American Journal of Public Health (doi:10.2105/AJPH.2004.061507). Earlier this year an article in the magazine Der Spiegel accused several German public health scientists of receiving funds for tobacco friendly research ( BMJ 2005;331:70). The article was based on an analysis of tobacco industry documents available on the internet. The new publication, by researchers from the Royal Free Hospital, London, and the London School of Hygiene and Tropical Medicine, names eminent …

In February 1998, the British government published two green papers (consultative policy statements) for England and Scotland: Our Healthier Nation and Working Together for a Healthier Scotland . These outline a strategic approach to public health that build on earlier target setting exercises that have met with limited success. The green papers are especially noteworthy in that the New Labour administration explicitly recognises the strong association between poverty and …

EDITOR— The Journal of Medical Internet Research (http://www.jmir.org/), an open access journal that I edit, has for five years practised routinely what Dimoliatis proposes1: reviewers are acknowledged at the end of each published article. In our experience, concerns over reviewers becoming too uncritical only to see their name published are unfounded. Moreover, editors …

Most patients are not manipulative but those who are can produce strong feelings of anger and hostility in doctors who treat them. George Murphy and Samuel Guze's paper, “Setting limits: the management of the manipulative patient,” is the perfect antidote.1 If you can suspend your prejudices against the facts that the authors are psychotherapists and that they wrote the article at the dawn of the permissive era you will be rewarded with a completely jargon free, well written, and commonsense guide on how to recognise and manage manipulative patients. The examples used …

As we struggle to optimise the delivery of limited medical resources our interventions become increasingly complex. Britain is a nation of couch potatoes, and increasing the prevalence of physical activity may be more important for public health than our professional preoccupations with diet, blood …

Trisha Greenhalgh, BMJ Publishing Group, £14.95, pp 196 ISBN 0 7279 1139 2 Evidence based medicine is clearly a major medical “buzz-phrase” of the 1990s. Much work has already been published on “How to do it,” and, no doubt, clinicians will continue to see much more in the future. Greenhalgh's book is intended for people wishing to “find their way into the medical literature, assess the scientific validity and practical relevance of the articles … and … put the results into practice.” Her extensive experience in teaching evidence based medicine is clearly evident, and her humorous and conversational no-nonsense style is refreshing and delightful. The …

To write prescriptions is easy, but to come to an understanding of people is hard. Franz Kafka, A Country Doctor Only about 50% of patients with chronic diseases take their medicines in therapeutically effective doses.1 Although the cost of non-compliance in illness and premature death is staggering, the issue has been neglected in the debates on healthcare resources and rationing. This week a working party of the Royal Pharmaceutical Society of Great Britain publishes its report on medicine taking.2 It was set up to consider the scale and consequences of non-compliance and to make recommendations. Many of our group, which was made up of doctors, pharmacists, nurses, and social scientists, admitted early on that we rarely took medicines as prescribed. Some confessed to abandoning courses of antibiotics after the first day or two. After we reviewed published work it became apparent that non-compliance might be no more deviant behaviour …

Opinions about the importance of various measures of disease activity in rheumatoid arthritis gathered from a survey of 20% of British rheumatologists showed a wide diversity for all clinical variables. 'Paper patients' have been developed as a method of investigating actual clinical decisions rather than expressed opinions. Assessments based on 'paper patients' correlate highly (r = +0.901) with those made on the equivalent real patients when seen in person.