The way of the world

doi:10.1136/bmj.39363.612095.47

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BMJ 2007;335 (13 October), doi:10.1136/bmj.39363.612095.47

Editor's Choice

The way of the world

Tony Delamothe, deputy editor, bmj.com

tdelamothe{at}bmj.com

This week I clicked the Send button without realising that myemail was being shared with the person I was writing about.I was warning colleagues that I'd banned a persistent respondent"from raving on about" his pet theory using rapid responsesand didn't want him opening up another front using feedbackto Richard Lehman's blog.

While the respondent ponders whether my "less than polite" responsedeserves wider exposure, I'm pondering whether I should have"sender's remorse" for describing his behaviour in the termsI did. After all, this followed 17 rapid responses (his count)on the same topic from him and three emails from me, askinghim to stop.

Thoughts about appropriate tone were running through my headwhen I read David Colquhoun's criticisms of our associate editor(and former US editor), Doug Kamerow, for being "excessivelytolerant" of the advance of complementary and alternative medicine(doi: 10.1136/bmj.39360.446528.BE). Colquhoun is the sort ofman who, if asked what he thought about the closure of homoeopathichospitals, would answer: "A start."

Colquhoun prefers straight talking Americans, like Gerald Weissmannand Wallace Sampson. In his article, "Homeopathy: Holmes, Hogwarts,and the Prince of Wales," Weissmann wrote, "If the trend persistsperhaps MIT or Cal Tech will march in step with the medicalschools and offer prizes for integrative alchemy or alternativeengineering." Calling for the defunding of the National Centerfor Complementary and Alternative Medicine, Sampson wrote, "Afterten years of existence and over $200 million in expenditures,it has not proved effectiveness for any ‘alternative'method."

Just last week, one of our sister journals, Postgraduate MedicalJournal, published another negative study. Its systematic reviewof all available studies of individualised herbal medicine foundno convincing evidence of benefit (doi: 10.1136/bmj.39360.499097.DB).So, how polite do we need to be about an alternative world viewthat isn't coming up with the goods?

Good manners in the 21st century apparently means suspendingjudgment, according each viewpoint equal respect. But it's "adangerous error to conclude . . . that all imaginable viewsare equally deserving," cautions Martin Rees, president of theRoyal Society, about politicians' use of science. They, andby extension the rest of us, shouldn't choose "which, if any,scientific view to adopt and which to discard, much as theymight choose one bunch of flowers over another." Science "isabout how the world is, not about what suits our prejudices"(Financial Times 1 October 2007 www.ft.com/cms/s/0/b5fca3bc-6fd1-11dc-b66c-0000779fd2ac.html).

Telling it how it is is the aim of this journal, even if sometimeswe need two goes to get it right—witness the copious Correctionsand Clarifications we publish each week. Some people are justifiablycross about these errors, but many more want to communicateto us that the journal has upset them in some way that has nothingto do with factual inaccuracies. (From recent journals, topicsinclude maternity services, physician assisted death, fluoridation,and out of hours care in general practice.) It's as if by knowingtheir sensitivities we can avoid giving offence next time. We'vealmost arrived at the point where respecting people's feelingsis more important than telling the truth.

So the last word should go to Theodore Dalrymple and to thelesson that King Lear's fatal misjudgment of his daughters holdsfor us (doi: 10.1136/bmj.39364.461736.94). "For is it not thecase that we live in an age of emotional incontinence," he asks,"when they who emote the most are believed to feel the most?"The costs may be surprisingly high: by the end of Shakespeare'splay, Lear and his three daughters were dead.