Former editor of The BMJ says, “It's interesting to me in a way that journals are still alive, because I think there are a lot of reasons why they should be dead.”
Another brilliant piece Maryanne. I guess one of the challenges we all have, is that if you bind your life to a belief, or a set of beliefs, then you live in a corridor where genuine curiosity cannot exist. If I hold a belief that science is infallible, or that peer review is beyond question, then I am a fool who's imagination has abandoned him. I become a drone to the belief and will defend everything about it. This is a danger we all face, shutting out ideas and perspectives that do not belong in our corridor. And no amount of education or professional prestige shields from such a malaise. This is the domain honest of self inspection, personal integrity and the existence of an unshakeable moral compass. Money can interfere with this domain and it clearly has for some of the brightest minds on the planet.
Decision making in medicine is generally based on an amalgam of scientific understanding, practitioner experience, patient desires, research findings and intuition.
This is the "art of medicine".
I have never relied solely on one tenet alone.
If a new treatment has no "evidence" against its use, the patient wishes to try it, but I have witnessed 3 patients die from its use, I will not use it.
My concern with modern medicine is that practitioners place their full trust in what the journals tell them, usually via the filter of "the experts", or even the media, and ignore the other tenets of decision making.
This seems to me to be a part of the same process which led to encyclopaedias being edited by the public, books self published and news published by bystanders at events.
The public is becoming distrustful of the influence of government and big money on some social media, newspaper and TV news publishers, encyclopaedia editors and particularly medical journals editors and reviewers.
We see repeated examples of evidence of interference in scientific publishing - direct from the scientists themselves and now in the courts and leaks to journalists.
Substack is not subject to commercial and government pressures in the same way [for now!]
Another brilliant piece Maryanne. I guess one of the challenges we all have, is that if you bind your life to a belief, or a set of beliefs, then you live in a corridor where genuine curiosity cannot exist. If I hold a belief that science is infallible, or that peer review is beyond question, then I am a fool who's imagination has abandoned him. I become a drone to the belief and will defend everything about it. This is a danger we all face, shutting out ideas and perspectives that do not belong in our corridor. And no amount of education or professional prestige shields from such a malaise. This is the domain honest of self inspection, personal integrity and the existence of an unshakeable moral compass. Money can interfere with this domain and it clearly has for some of the brightest minds on the planet.
Decision making in medicine is generally based on an amalgam of scientific understanding, practitioner experience, patient desires, research findings and intuition.
This is the "art of medicine".
I have never relied solely on one tenet alone.
If a new treatment has no "evidence" against its use, the patient wishes to try it, but I have witnessed 3 patients die from its use, I will not use it.
My concern with modern medicine is that practitioners place their full trust in what the journals tell them, usually via the filter of "the experts", or even the media, and ignore the other tenets of decision making.
This seems to me to be a part of the same process which led to encyclopaedias being edited by the public, books self published and news published by bystanders at events.
The public is becoming distrustful of the influence of government and big money on some social media, newspaper and TV news publishers, encyclopaedia editors and particularly medical journals editors and reviewers.
We see repeated examples of evidence of interference in scientific publishing - direct from the scientists themselves and now in the courts and leaks to journalists.
Substack is not subject to commercial and government pressures in the same way [for now!]
It is hard to trust science or medicine- after what we have gone through in last few years. So journals will suffer.