BMJ  2005;331 (10 December), doi:10.1136/bmj.331.7529.0-f

Editor's choice

Cure or care?

Dogmatism is something we try to avoid at the BMJ, whether our own or other people's. How far we succeed may be open to question. Our predecessors, however, suffered no such qualms, if an editorial published in 1880 is anything to go by. "The nurse," it says "must be a person who pays blind obedience to [doctors'] orders." Admirably clear cut, but as Nick Black points out in his article on the rise and demise of the hospital (p 1394), the apparent confidence of these words hides layers of antagonism and insecurity.

At the end of the 19th century, medicine and nursing were in the grip of conflict. Doctors feared that nurses were undermining their authority—fears that were fuelled, according to Black, by social insecurities based around class and sex. Nurses tended to be well educated with independent incomes. As Black puts it, "men had little or no experience of working with women of equal (or even superior) status."

Are things between doctors and nurses so very different today? Nurse prescribing has opened a potentially ugly demarcation dispute in the UK, as has the decision by some states in America to allow nurses to set up independently. Doctors' representatives on both side of the Atlantic are calling foul. But Ghislaine Young, a nurse practitioner who is a salaried partner in a general practice in West Yorkshire, says that she and her colleagues don't want to be mini-doctors but maxi-nurses (p 1415). And this could make sense, provided nurses continue to be cheaper and have more time than doctors to spend with patients.

One question though. If, as she argues, the distinction between medicine (cure) and nursing (care) will become increasingly blurred, how much blurring will it take before the distinction becomes meaningless?

There's another conflict we can't get away from—between medicine and industry. Last week's journal carried a warning that drug company sponsored trials may often breach the uncertainty principle that provides the ethical basis for randomisation. This week, Kenneth Rothman and Stephen Evans come to the defence of drug industry trials (p 1350). They say that JAMA's new policy requiring such trials to have independent statistical review is draconian and absurd. Even if it were workable it would still be unfair to judge work solely on the affiliation of the authors, they say.

Meanwhile, there is shock in some quarters that the word "trial" has become a verb, as in "to trial a drug." Should it not be "try" asks a respondent, as in "to try a prisoner"? We hadn't considered that option and instead had already moved recklessly on into the present continuous tense with the word "trialling" on last week's cover. What our respondent cannot have known but I am here to tell him, is that we had a heated debate about how we should spell this new word, whether with one "l" or two? In the end our style experts went for two. But I'm not so sure.