An eclectic but combustible mix of shareholders, sex, societies, and spinal manipulation

Abstract

JRSM readers often tell me that they find the journal to be an eclectic mix, leaving me unsure whether I have just received a compliment or a complaint. But if ‘eclectic mix’ means ‘something for everybody’, I'm all for it. On that basis, this issue of the JRSM will not disappoint. Journals struggle to convince their readers to change behaviour. Many journals are written in an inscrutable scientific script that defies understanding. Those that are readable—something the JRSM aspires to be, but which you may believe we fail to achieve—struggle to publish enough of direct relevance to clinical practice. Even when they do, there may be powerful external forces, such as companies and governments, unwilling to allow them to change behaviour based on the evidence. Increasingly, journals try to modify the practices of companies and governments. While changes in clinical practice can be difficult to measure, a drop in share price or a U-turn in government policy are rare but highly visible events. When the JRSM and others began a campaign against Reed Elsevier's support of arms exhibitions—were they about saving lives or ending them?—there seemed little hope of immediate relief for the unhappiness of the editorial team and readers of the Lancet, Reed Elsevier's premier healthcare journal. Richard Smith took the campaign to Reed Elsevier's annual shareholders' meeting, where he and his fellow minority-shareholders-in-arms bombarded the Board with questions (JRSM 2007;100:350). A thin crowd, writes Smith, didn't care much for him and his fellow lobbyists, although he believes they made an impact with the Board. This was one example of the visible campaign against Reed Elsevier. Meanwhile, a less publicised campaign by the Lancet's editorial team exerted internal pressure upon senior management. Hence, last month's decision by Reed Elsevier to exit the arms exhibition business was a triumph for the Lancet's editorial team, a smaller but significant triumph for the journals and scientists who campaigned on behalf of the Lancet, and a victory for minority shareholders. As Smith and his dissidents showed, it doesn't pay to hold your tongue. I once made that mistake in my brief stint in psychiatry, when I failed to ask a patient her sexual history. As a very junior doctor, I felt embarrassed at probing a depressed woman's intimate details—but my consultant damned me for being ‘mealy mouthed’. After that I made it a habit to ask tricky questions, even when there was probably no need to—a good training for journalism. With Kevan Wylie's editorial kicking off a series of articles on sexual health (JRSM 2007;100:300-301), I now realise that being mealy mouthed is a problem for many doctors. Qualitative research has shown that doctors fear opening up ‘a can of worms’ or sexualizing the consultation, for example. Wylie, a free-talking consultant in sexual medicine, has no truck with such inhibitions, stating that ‘Knowledge is necessary to secure the confidence of the physician to broach and manage the topics within the specialty.’ This new series is an attempt to bridge this knowledge and confidence gap, and begins with an article on sexual assault (JRSM 2007;100:321-324). The JRSM's eclectic mix becomes combustible else-where, as Alan Maynard launches a few grenades at the Royal Colleges (JRSM 2007;100:306-308). Are they fit for purpose? They need to be, he argues, ‘but they have grown without regard to purpose and value for money.’ Another well known agitator, Edzard Ernst, revisits the safety of spinal manipulation with a further systematic review which concludes that, because of the uncertain incidence of adverse events, ‘In the interests of patient safety we should reconsider our policy towards the routine use of spinal manipulation’ (JRSM 2007;100:330-338) I can hear the complaints whizzing into my email inbox already—an adverse effect of the eclectic mix.