At first glance, three articles published this week in The BMJ appear to have limited relevance to medicine. One, written by an economist, discusses the challenges faced by demographers when making predictions about population changes; a second deals with international drug control treaties and the need for policy experiments to evaluate the benefits and risks of drug legalization; and a third discusses whether it is ethical to hire sherpas when climbing Mount Everest.
But these articles address issues that are important to physicians. Predicting the size of the population in the future is important for healthcare policy. Drugs, and the war on drugs, have a direct impact on health outcomes and lead to deaths. And paying someone to assume risks for the benefit of others is a challenge that medical ethicists also face when examining early phase clinical trials. These articles are within the purview of a medical journal like The BMJ: physicians must be informed about—and engage in—debates that go beyond the clinic and the laboratory because social, political, and economic factors affect the health of individuals and populations.
But I also enjoy clinical and research papers.
As a neurologist, I often see patients in the emergency department wearing a neck brace because they fell or sustained some other trauma, and there is concern about a cervical injury. Is it safe to remove the brace? To answer this question, particularly if the patient is unconscious or has neurologic signs, it is imperative to methodically review imaging studies—most often a CT scan, but in some settings plain radiographs—before making a decision. A wrong decision may have dire consequences.
In a Practice paper just published in The BMJ, Leonard King describes in detail the anatomy of, and the radiological approach to study, the cervical spine, with emphasis on the commonly used imaging modalities. I found this Practice article clearly written, comprehensive, and clinically relevant. I am certain that it will be of value to any physician working in an emergency setting.
The Research Methods and Reporting section of the journal aims to publish papers that describe innovative research and analysis methods, and new ways to present research data. I think of RMR papers as “how to” guides, which help clinicians who are engaged in clinical research acquire the knowledge they need to discuss methodological aspects of their work with their biostatistical and epidemiological colleagues. The sophisticated clinician can also benefit from these papers as they shine a light on the methods used in the studies on which treatment decisions are based. An RMR paper by Wolkewitz and colleagues published yesterday achieves these objectives. The paper very clearly explains how to compare and interpret risks in survival analyses when there are competing risks.
In my opinion, medicine is a rewarding field precisely because so many issues fall within its purview.
Jose G Merino is US clinical research editor, The BMJ.