Curb Your Enthusiasm

Abstract

This issue of the JRSM has a festive flavour. We offer three challenges to JRSM readers. Michael O'Brien's grand round will test the innermost ganglion of your brain (p 569), Anjan Panja has created a medical version of Su Doku (p 576), and our picture quiz will examine the depths of your knowledge of medical art (p 575). A special section for this issue explores medical classics, but with a twist. The enlightening power of hindsight allows several contributors to debunk ideas, theories, treatments and people that at one time or another were thought to be sacred in the world of medicine. Curb your enthusiasm is the message. ‘It is not entirely a male thing’, says Trisha Greenghalgh (p 545), ‘but the Human Genome Project has always struck me as an extension of the fantasies my three bothers used to have over their Meccano sets’. Nick Freemantle questions the contribution of the Reverend Bayes, father of Bayesian statistics (p 546), while Irvine Loudon shatters the legend of Ignaz Phillip Semmelweis, held by some to be the most famous name in the history of obstetrics (p 555). Ian Forgacs and Christopher Martyn, both editors, remind us of the worthlessness of cliches and impact factors (p 554, p 556). A straw poll of this section, however, would reveal the world of neurology as the most overhyped. Elliot Slater's description of the diagnosis of hysteria as ‘not only a delusion but a snare’ is roundly criticized by Jon Stone and fellow neurologists from Edinburgh (p 547). Saad Shafqat bemoans Jean-Martin Charcot's passion for cerebral localization and the 3-day neurological examination (p 549). And Ben Harper wonders whether Huntington Disease would have been more deservedly named Lund Disease (p 550). If this series of contributions inspires you to write then do not think that you have missed out. We look forward to publishing more revisionist contributions as an occasional series. Submissions to journals are a good indication of what is bothering people and the incessant reorganization of health services in the UK and elsewhere is subjected to some insightful analysis by the high-priests of evidence based medicine. Andy Oxman and colleagues create a new word, redisorganization, which probably rings true with many of you (p 563). They discover that the literature is almost impenetrable due to creative jargon and meaningless terminology, there are over 2500 organizational theories, and an ethics committee is urgently required to prevent ‘uncontrolled, unplanned experimentation inflicted on providers and users of health services’. Thanks to the organization of journals, Jeffrey Braithewaite and colleagues also echo these sentiments but prefer to call it restructuring, and conclude that ‘unlike sex, restructuring is not essential for the propagation of humankind’ (p 542). Finally, a scoop for the JRSM. In this month's piece from the James Lind Library, Iain Donaldson unearths Franz Anton Mesmer's attempt to organize a controlled trial of his ‘animal magnetism’ treatment, the second earliest instance of random allocation being proposed for a clinical trial (p 571). Mesmer's study never took place because of a disagreement between Mesmer and the Royal Commissioners appointed to investigate his work. One of the commissioners who chose to discredit Mesmerism was Benjamin Franklin, whose own life and work in medicine is celebrated with uncurbed enthusiasm by Lisa Gensel (p 534).