Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Bores
- Jamie Cunliffe (3 June 2005)
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The shrinking violet and its revitalization
- Mark Struthers (3 June 2005)
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Anger is the weed, hate is the tree.
- Dr. Herbert H. Nehrlich (3 June 2005)
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A welcome move
- John Hopkins (3 June 2005)
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Good to see
- Sandip Talukdar (3 June 2005)
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The right decision
- Brian Deer (5 June 2005)
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Other fora and technical means
- Adrian K Midgley (5 June 2005)
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Re: The right decision
- Stevie M Gamble (6 June 2005)
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"Hapless parents" and dubious data: jump, don't cut.
- Lenny Schafer (6 June 2005)
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High absurdity
- John Stone (6 June 2005)
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Re: Revitalising rapid responses
- Theo H Fenton (7 June 2005)
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Time to 'Get Real'
- Michael D Innis (7 June 2005)
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Re: Re: Revitalising rapid responses
- Stevie M Gamble (7 June 2005)
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Little Weed
- MAGDA TAYLOR (8 June 2005)
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The evil of silencing opinion
- James Penston (11 June 2005)
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The Supreme Liberal
- John Hopkins (12 June 2005)
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Applause...
- John P Heptonstall (12 June 2005)
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Re: The evil of silencing opinion
- Jayaprakash Gosalakkal (12 June 2005)
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Re: The evil of silencing opinion
- Nicholas Bennett (13 June 2005)
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Two suggestions for revitalising rapid responses.
- Clément Vidal (15 June 2005)
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Jamie Cunliffe, Retired SO45 4PB
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I, myself, may be guilty of being judgmental but .... OK, I can see that certain contributors may seem to behave in a tediously repetitive and self preoccupied way. But “bores”? That, to me, evokes an air or absoluteness and condemnation – it seemed far too judgmental to me; far too “we know best” for my liking. Perhaps it wasn’t meant to sound like that. Then you talk of the Lancet, “lifting” most of the BMJ.com’s submission guidelines verbatim. Surely “adopting” would have been far less judgmental and even a pat on the back for the BMJ in getting it right the first time. It struck me that more than a smattering of emotional condemnation might have surfaced in this leader and, more worryingly, I was left with a feeling that “we (the BMJ) know(s) best”. I hope you can reassure us that you will adopt a truly objective, non -emotional and non-judgmental approach to editing what you believe is worthy of publication. I’m left disturbed that you possess certainty about what is worthy of publication As Voltaire observed, “Doubt is not a pleasant condition, but certainty is absurd”. Yes – I know - even that is stated absolutely but the message is clear. Competing interests: None declared |
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Mark Struthers, GP Bedfordshire, UK. mark.struthers@which.net
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“O thou weed! [1] Who art so lovely fair and smell’st so sweet” Othello act 4, sc. 2 ……….“Who are the violets now That strew the green lap of the new come spring?" Richard II act 5, sc.2 [1] Struthers M. Thrills, spills and happy pills. [electronic response to Abbasi K. Pills, thrills, and bellyaches. (Editor's Choice.) BMJ 2005;330:0-h]. http://bmj.bmjjournals.com/cgi/eletters/330/7488/0- h#97953 Competing interests: None declared |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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I understand what mountain the new wind is blowing from. It will be interesting to observe the smoke coming from placid chimneys and billowing in different directions. Weeds are not candles in the wind. What is a weed, though? A plant whose virtues have not yet been discovered? A flower in disguise? A weed is but an unloved flower? Greater minds than can be paid for by the BMJ have not been able to separate the weeds from the flowers. Personally, I find some of the weeds on this site very interesting and, to me, a garden without weeds is like a church without sinners. In closing, may I remind our brave editors that weeds tend to grow in any soil, a characteristic conducive to genetic superiority through the abundance of available nutrients. Competing interests: Sharon and Tony, editors par excellence. But who is the flower and who the weed. |
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John Hopkins, GP Newton Aycliffe DL5 4SE
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Dear Ms Davies, The BMJ is to be congratulated for this move. We all like the sound of our own voices and there is a particular thrill to be had from the sight of a rapid response bearing one's own name. However, for most us the penny eventually drops that the more you say the less attention it will get. And perhaps the biggest problem is not so much with the boredom as the absurdity of certain types of response which may then claim the imprimatur of the BMJ. John Hopkins Competing interests: None declared |
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Sandip Talukdar, SAS Grade Psychiatrist CA1 3SX
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Editor, I would like to congratulate you on the adoption of new guidelines for "Revitalising Rapid Responses" (1). Though others may wish to enter into a debate about the meaning of "bores" and whether there is a judgmental tinge to the entire approach; I do believe that the standards of BMJ editorial board (which exist from the pre-internet centuries) will continue to be upheld. As a member of the BMA, I found it rather depressing last year to see the Rapid Reponse page dragged down to the level of a sectarian exchange of words on the publication of an article that had nothing to do with either health or medicine(2). There is no shortage of other examples, all dealing with quite important health and public issues. [One has only to type "Meadow" or "MMR" in the blue search box on the upper left hand corner of the BMJ home page and look up the results]. I do feel that the BMJ has had some responsibility in letting the border between scientific scepticism and personal incitements "virtually" (pun intended) disappear over the last few years. There is now the hope that those boundaries may still be re-established. If it calls for a degree of "judgmental" attitude, that may be still be preferable as the bitterness of a therapeutic pill. Sandip Talukdar (1)Revitalising rapid responses Sharon Davies, Tony Delamothe BMJ 2005:1284, doi:10.1136/bmj.330.7503.1284 (2)BMJ 2004;328:800 (3 April), doi:10.1136/bmj.328.7443.800 Competing interests: Subscribing member of the BMA |
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Brian Deer, Journalist The Sunday Times
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A drastic pruning of the rapid responses is clearly right. In addition to the reasons given, the editors should note that in one tedious, tedious, area - the MMR debacle - countless BMJ rapid responses, essentially claiming that immunisation policies are a murderous conspiracy, have been routinely lifted wholesale and republished across the web as apparent content from a medical journal. What hapless parents are supposed to make of some of this stuff, seeming to carrying the authority of a prestigious British publication, god only knows. Call me censorious, but we should be glad to see the back of it. Competing interests: None declared |
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Adrian K Midgley, GP Exeter, EX2 1QS
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The introduction of editing into Rapid Responses is on the whole good and for the reasons stated in the editorial.
The problem of mad, bad or boring posters in on-line communities is one that has existed as long as internetworks - USENET was the first system I had knowledge of being affected by it.
Several technical responses have evolved, and work, and use the scalable characteristics of the internetworked systems to ease the load of human administrators, and demonstrate that exclusions or aadjustments are not arbitrary or unjust.
The simplest is the individual user's killfile, a list of users from whom postings are not seen. This may be elaborated into a group or communal blacklist, by sharing killfiles under some algorithm.
Slashdot, the high-tech forum and news site assigns karma points based on communal judgement and regulated by meta-moderating, and allows users to browse only postings with a karma level above whatever they choose to set.
Simply threading the comments allows users to eliminate whole (boring) trees of postings where a particular argument is continued (and will be from experience) ad nauseum, it also allows more logical structure to be preserved in the discussion than the straight listing here at present.
The Wikipedia collaborative encyclopaedia project leaves all users free to edit any posting. Vandals are dealt with by various means including blocking their access for a time or forever.
In this system, restricting moderation (voting on quality) to logged-in subscribers, or to medically-qualified readers would seem logical.
(/. is the location of the very top of the Unix filesystem on a single computer)
Competing interests: None declared |
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Stevie M Gamble, retired HMIT EC2Y 8BL
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Brian Deer suggests, in his Rapid Response of 5th June, that your correspondence columns have been infested with 'countless BMJ rapid responses, essentially claiming that immunisation policies are a murderous conspiracy'. In the interests of balance therefore, may I put forward my own observations? For the avoidance of all possible doubt, I know no-one with autism, nor do I know anyone with a relative suffering from autism; as far as I am aware, my life is now and has always been an entirely autism-free zone. I have received all the vaccinations ever offered by my doctors, as has my child, and to the best of my knowledge none of those vaccinations has ever given rise to an adverse effect. Furthermore, I know a number of individuals, as fellow hospital patients, who have suffered one of the most feared consequences of childhood infectious diseases; the incurable lung condition, bronchiectasis. The article 'Waiting for a transplant' (1) gives a flavour of what it is like to live, and die, with bronchiectasis. I myself have severe bronchiectasis, though of unknown origin. My attitude to all medical interventions is entirely pragmatic; the only thing which interests me is whether it works. There is, however, one very major snag. One of the known causes of bronchiectasis is mercury intoxication; broncho-pneumonia was a leading cause of death in pink disease. In 1993 research took another step forward when the BMJ published the paper 'Was Young's syndrome caused by mercury exposure in childhood?' 2 (Young's Syndrome is the triad of chronic sinusitis, bronchitis or bronchiectasis in men with obstructive azoospermia.) The final paragraph of that paper reads as follows: ‘Mercury is still on sale in London in 1993 in skin lighteners and is being prescribed in ethnic remedies. Previous studies suggested that there were no long term sequelae of pink disease. This study shows that this is not so and emphasises the vital importance of recognising and eliminating such toxic factors from our environment.’ That is a clear and unequivocal declaration of specific hazard by a group of highly reputable researchers, who were recognised as knowing more about mercury intoxication, and its consequences, than any other practitioners of their generation. The paper was peer-reviewed and published in one of the world’s leading medical journals. No-one, to my knowledge, has ever challenged it. No rational person would contend that the words can be construed to suggest, for example, that injecting mercury into babies and young children is fine, provided it isn’t an ethnic remedy; no judge, at least in this jurisdiction, would accept such a distortion of the clear meaning of the passage. I do not know why vaccine manufacturers ignored that paper, and I do not know why Brian Deer ignored that paper. Since Brian Deer, at least, is a reader of your columns, it would be helpful if he explains. Stevie Gamble 1. BMJ 2001;322:293-295 ( 3 February http://bmj.bmjjournals.com/cgi/content/full/322/7281/293?maxtoshow=&HI TS=10&hits=10&RESULTFORMAT=&fulltext=bronchiectasis&andorexactfulltext =and&searchid=1117993639818_8240&stored_search=&FIRSTINDEX=0&sortspec= relevance&resourcetype=1 2.BMJ 1993;307:1579-82. Hendry WR, A'Hern RP, Cole PJ. Competing interests: None declared |
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Lenny Schafer, Editor Schafer Autism Report 9629 Old Placerville Rd. Sacramento, CA USA 95827
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I am happy to report that parents, at the least
the ones
with family autism, are on the way to recovering their haps and do not
require
the handholding of prestigious and not so prestigious patrons to
navigate
medical journals (or the internet at large), despite the concern of the
BMJ and
Mr. Brian Deer. That the internet is
awash with dubious, if not boring data is not breaking news. Generally, if an inclined parent is literate,
intelligent
and net-skilled enough to be here reading this post, they are skilled
enough to
check the accuracy of any presented data. "A filter! A filter! My kingdom for an internet noise filter!" As the editor of a daily autism news digest, I am
keenly aware of the kind of poor signal-to-noise information ratio that the BMJ
editors and readers suffer. I have read tedious screeds here that I
would not publish as
a matter of self-preservation. I would like to share a description of a
letters
publishing method that allows for greatest range and length of reader
postings.
For missives over 500 words, simply "jump" the balance to an unbranded
webpage. Readers can then elect to
follow the jump or not, just like it is done with material in paper
publications. Or, readers can jump
the balance of any letter of theirs, of any length, to their own
website. This
can be done now. What would
there be to quote if The Bard was limited to 500 words? Similarly, an unbranded
rejected letters page can be used to park the "unpublished" balance
that is deemed not suitable for the regular responses section. The link for this page would be readily
visible and again, readers can elect to visit there should they so
choose. Competing interests: My own dear health. |
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John Stone, none London N22
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I have been unable with a Google search to substantiate Brian Deer's claim that eletters from this site have been widely reproduced, let alone quoted out of context as the views of the journal. Perhaps he could cite half-a- dozen examples. His view that ordinary people are incompetent to judge the context is deeply patronising. Competing interests: Contributer to MMR Responses |
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Theo H Fenton, Consultant Paediatrician Mayday Hospital, Croydon CR7 7YE
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John Stone says that he has been “unable to substantiate
Brian Deer's claim that eletters from this site have been widely reproduced, let
alone quoted out of context as the views of the journal”. Brian Deer didn't exactly claim that, but did say that
“countless BMJ rapid responses, essentially claiming that immunisation
policies are a murderous conspiracy, have been routinely lifted wholesale and
republished across the web as apparent content from a medical journal”. This seems to be true. A few of examples are: 1)
http://www.altcorp.com/DentalInformation/antivaccinationists.htm 2)
http://www.whale.to/vaccines/mmr.html 3)
http://www.whale.to/vaccines/scheibner.html 4)
http://www.whale.to/a/miller_h.html Failure to distinguish between published letters and rapid responses occurs in other contexts, e.g: 5)
http://64.41.99.118/vran/vaccines/mmr/regressive4_mmr.htm In that piece, Yazbak claims that “Another critique by
Branell (Sweden) points to serious flaws in the other part of the equation in
the Kaye study, the MMR vaccination rates (24).
It was also published in the BMJ and was titled How was the ‘MMR Prevalence’
estimated”. Another example of Yazbak representing an eBMJ rapid
response as a genuine BMJ reference occurs here: (see the third paragraph under heading of “The issue of Shaken Baby Syndrome”).
Competing interests: None declared |
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Michael D Innis, Director Medisets International Home 4575
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Editor, “When this mother fought to win proper care for her autistic sons, social services branded her an attention-seeker. The slur went on her medical files - and when she got cancer, doctors didn't believe she was ill. Today is her funeral.” JENNY JOHNSTON DAILY MAIL DATE: 03 Jun 05 EDITION: ED_1ST_04 PAGE: 36;37;38 The decision to rid the BMJ’s Rapid Responses of “noisome weeds” will ensure doctors remain blissfully ignorant of the harm that can be caused by their dogmas and insensitivity to the concerns of the public seeking a proper evaluation of Vaccines forced upon them by the Establishment. The “Wholesome flowers” which the Editors seek to cultivate will no doubt be more Epidemiological Surveys which ignore the legitimate criticism of their results and the need to look at the affected children as did Wakefield and his co-authors. The Dogma of the safety of Immunization was advanced for immunization being a “non-starter as an explanation of for his (Harry Clark) death”. It is this Dogma that was responsible for the incarceration of Sally Clark It is noteworthy that the GMC ignored the association of Harry Clark’s death and his immunization history. Such is the power of “wholesome flowers” – they can be poisonous. Michael Innis. Competing interests: A "noisome weed" advocate. |
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Stevie M Gamble, retired HMIT EC2Y 8BL
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Theo H Fenton, Consultant Paediatrician, suggests in his Rapid Response of 7th June that Brian Deer’s statement that “countless BMJ rapid responses, essentially claiming that immunisation policies are a murderous conspiracy, have been routinely lifted wholesale and republished across the web as apparent content from a medical journal” seems to be true, and proffers references in support of this. Having dutifully followed the first of these I find: ‘The anti-vaccinationists are a menace to society for if they had their way they would gladly put the greater population at risk of illness, disability and death from preventable diseases by eliminating mandated immunizations.’ (1) I am unable to construe that statement as meaning anything other than an assertion that the murderous conspiracy is on the part of the anti- vaccinationists. Perhaps Theo Fenton could explain why he thinks otherwise? Stevie Gamble 1. http://www.altcorp.com/DentalInformation/antivaccinationists.htm Competing interests: None declared |
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MAGDA TAYLOR, Director of The Informed Parent P O Box 4481, Worthing, West Sussex, BN11 2WH
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If I remember correctly 'Little Weed' in the children's series 'Bill and Ben' was the smartest character on the programme. To cultivate also means to develop a person's mind and this requires a wide spectrum of information. So please don't be too over enthusiastic with your pruning. This facility by the BMJ is an excellent opportunity for healthy debate, and that is paticularly needed in the area of medicine. Keep up your good work! Competing interests: None declared |
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James Penston, Consultant Physician/Gastroenterologist Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, North Lincolnshire DN15 7BH
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Editor, Bores threatening to take over the rapid responses… obsessive individuals infiltrating the electronic letters with their pet topics… others abusing the imprimatur of the BMJ – surely Davies and Delamothe [1] are justified in taking action to prevent such dreadful crimes? We are informed of respondents who shy away from contributing because of the “conditions of engagement” – shouldn’t Davies and Delamothe be praised for carrying out their duty to protect the meek and the feeble? And, of course, we are reminded that readers’ attention is not unlimited – in this age of dumbing down, could anyone possibly fault Davies and Delamothe’s desire to attend to the needs of those with the attention span of a sparrow? It is hard to accept that such trivial problems justify the decision to censure the electronic letters. Indeed, it is interesting to note that unorthodox views on such matters as MMR and AIDS are cited as reasons to support the changes to the processing of rapid responses. [1,2] Whilst I take no sides on either of these issues, there is more than a whiff of political correctness about this whole affair. It is almost as if the rapid response section is perceived as having got out of control and now must be brought to heel. We should, though, be very wary of tampering with this free and open exchange of views. “But the peculiar evil of silencing the expression of an opinion is, that it is robbing the human race; posterity as well as the existing generation; those who dissent from the opinion, still more than those who hold it. If the opinion is right, they are deprived of the opportunity of exchanging error for truth: if wrong, they lose, what is almost as great a benefit, the clearer perception and livelier impression of truth, produced by its collision with error.” By all means set a limit to the length of letters and continue with the rejection of offensive or libellous contributions. But let’s take seriously the wise words of John Stuart Mill and proceed no further down the road to censorship. It is all so very unnecessary. [1] Davies S, Delamothe T. Revitalising rapid responses. BMJ 2005;330;1284. [2] Rapid reponses. http:/bmj.bmjjournals.com/cgi/eletters/330/7503/1284 [3] Mill JS. On Liberty. 1860 Competing interests: None declared |
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John Hopkins, GP DL10 6SQ
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Each to his own, I am more of a John Locke man myself. He was as liberal as Mill on toleration and freedom of speech. However, he also required that no man’s knowledge can go beyond his experience (1). The only test for material published by a scientific journal like the BMJ is that it should have some passing relationship with the Scientific Method, in particular a respect for calm observation of the natural world. In a free society people are perfectly entitled to claim the moon is made of green cheese, but let us not fall into the trap of denying the values of the European Enlightenment without which neither medicine nor the BMJ would exist. Yours sincerely, John Hopkins (1) Locke J Essay concerning Human Understanding Competing interests: None declared |
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John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG
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I applaud Sharon and Tony, and all those who have assisted in the enrichment of this once dismally unenlightening publication, for their efforts. I know of no other electronic publication of such standing that exudes the strength of character and determination of its editorial staff, through equitable provision of the opinions and expertise of respondents, thereby creating a beacon of light and enlightenment for many citizens who would be disenfranchised yet who are the lifeblood of the nations these publications are deemed to serve. Flowers may provide a pretty face, but weeds heal wounds hidden beneath surface beauty; weed-killers serve only to impede that healing. Long may enlightened BMJ electronic editorial principles survive, and be adopted by more of the disenfranchising periodicals serving limited interests whilst purporting to serve public interest. The BMJ hard copy might learn from its electronic precursor. Were the BMJ to return to unrestricted access, its policy-makers could fully engage with the very priciples upon which our country was founded, and for which our people fought, died and sacrificed so much - freedoms of speech, truly democratic representation, and equality. Regards John H. Competing interests: None declared |
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Jayaprakash Gosalakkal, Consultant Paediatric Neurology LE1 5ww
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I agree that there is a danger of subjective assesment and political correctdness when exalted people sit in on judgment over the outpourings of mere mortals.The rapid response has often acted as a safety valve for the great unwashed at various levels.People have sometimes ranted and raved but some of the writings have opened the eyes to possible alternative arguments in a deabte.I do not know if Harry Truemans comment "if you cannot stand the heat etc"would pass muster currently.It would be a shame if this succesful experiment was shut down in the name of decorum Regards Competing interests: Dont like sanctimony much |
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Nicholas Bennett, Infectious Disease Postdoc/Clinician Department of Pediatrics, University Hospital, Syracuse NY
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Dr Penston makes some relevant points, but I feel like adding my four -penn'orth to the mix, as one of the contributors to one of the most problematic threads. I am an ex-moderator of the Usenet discussion group sci.med.aids (now since defunct). As the AIDS dissent threatened to overtake the forum in the early 1990's, a decision was made to simply ban all mention of that topic. The rules were very clear and strictly enforced. As such, I and my other co-moderators were regularly accused of censorship by AIDS dissidents - and correctly so. We no more allowed that topic than we permitted commercial advertising or discussion of monster trucks. One important reason why that decision was made was that a new discussion board was established _specifically_ for the purpose of discussing the AIDS dissident views: misc.health.aids. This forum is still in existence and active, and all rejections from SMA for posting on that topic included a message to the author pointing them to that discussion group as an alternative. My point is that the use of the BMJ forums as an outlet for alterative views is simply unnecessary, except to add a fake veneer of respectibility to peoples' opinions. If the Perth Group and others want to debate in public they are welcome to post to misc.health.aids where no post is edited, moderated or censored, and in fact many of the contributors to the BMJ forum have done exactly that. The apparent restriction of views on the BMJ forums is actually no such thing - it is simply defining the remit and barriers of the forum - the BMJ can no more restrict the views of the public than the man in the moon! The Internet is a wonderful thing, in that if you look long and hard enough you will find an unmoderated discussion on just about anything - misc.health.aids being a prime example - and I think the message is more that if you want a soapbox to stand on to make your point, there are plenty of others to use. In fact, as an AIDS dissident there are plenty of forums where the orthodoxy aren't permitted at all, so they really have it quite good! I'm sure the situation is similar for other topics which might "suffer" from the new BMJ editorial policy (or more properly, the more stringent implementation of the old policy). One random point of information - the HIV+ dissident who founded MHA later recanted as his own infection progressed, and became one of the more vocal anti-dissidents. If that doesn't say it all, I don't know what does. Nick Bennett njb35@cantab.net http://groups.google.com/groups?hl=en&lr=&ie=UTF- 8&group=misc.health.aids Competing interests: None declared |
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Clément Vidal, Future student in information science. France
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Dear Editors,
I just would like to make two suggestions to improve the quality of the rapid responses. Firstly, for “hot topics” with a lot of rapid responses, it could be useful for your readers to make abstracts of the history of the responses. Although such abstracts would be different, note that journals like Brain and Behavioral Science (BBS) include an abstract of each commentary. The second suggestion is a little deeper, but could certainly prove to be very fruitful (or “flowerful” should I say). The idea is quite simple; it is to make the authors more responsible (1). You could require that authors have to answer rapid responses. This could be requested once (for example 2 weeks after publication); or better, at regular intervals. The expected effect would be that rapid responses would be more focused to precise and embarrassing questions for authors (i.e. relevant rapid responses). The assurance of a response from the author is certainly very important, and it is noteworthy that journals with open peer commentary (essentially Current Anthropology, BBS and Psycoloquy) always had this functionnality (2). Thanks you for your attention, and congratulations for being precursory in scientific communication. Clément Vidal. (1) Rennie, D., “Freedom and Responsibility in Medical Publication. Setting
the Balance Right.” JAMA, 1998;280:300-302. Competing interests: None declared |
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