Peer review and 'openness

Journal of the Royal Society of Medicine England took a leaf from the Scottish health minister’s book. Allyson M Pollock, Graham Kirkwood Centre for International Public Health Policy, University of Edinburgh, UK E-mail: [email protected] Competing interests None declared References Black N. Quality of care in ISTCs. J R Soc Med 2009;102:402 2 Browne J, Jamieson L, Lewsey J, van der Meulen J, Copley L, Black N. Case-mix and patients’ reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers. BMC Health Serv Res 2008;8:78 3 Healthcare Commission. Independent sector treatment centres. A review of the quality of care. London: Healthcare Commission; 2007. See www.cqc.org.uk/_db/_documents/ ISTC_Final_Tagged_200903243502.pdf 4 Healthcare Commission. Independent sector treatment centres: the evidence so far. London: Healthcare Commission; 2008. See www.cqc.org.uk/_db/_documents/ Independent_sector_treatment_centres _The_evidense_so_far.pdf 1 DOI 10.1258/jrsm.2009.09k066 graduate course peers. In addition, might it be possible for school-leavers to be educated in the graduate entry programme for phase 1, to act as a comparison? Presumably, when there are two different models for delivering the early years of medical education in the same medical school, there must be a reason for this and one wonders why it is not considered appropriate to apply the graduate course model to mainstream programmes. When people who entered medical school as school-leavers read sentences such as: ‘Graduate entry students are generally more mature than non-graduate entry students’ it may get their heckles up, so I was particularly pleased to read that the Birmingham group did not suggest that graduate entry students make ‘better’ doctors on the basis of good exam results. population is even flimsier with good solid case-controlled studies suggesting that chiropractic manipulation of the neck is not unsafe and appears not to cause stroke.1 I have great respect for Professor Baum but unfortunately he has a particular blind spot with respect to complementary and alternative medicine (CAM) which fails to create a thoughtful and informed debate.2 There is no doubt that we all have much to learn about CAM and the evidence for the safety and effectiveness of chiropractic will no doubt change chiropractic practice over the coming years as it has done already with respect to the way we manage back pain within the NHS. To a very large extent Dr Singh brought this battle upon himself and appears to have created a cause celebre around the libel laws possibly because he failed to win the initial hearing against the chiropractors. Brendan S Fletcher George T Lewith Department of Anaesthetics, Norfolk and Norwich University Hospital, UK E-mail: [email protected] University of Southampton, UK E-mail: [email protected] Competing interests Graduated from a mainstream course Conflicting interests None declared References What is the impact of medical education in the early years? I read with interest Calvert et al.’s study from the University of Birmingham and was encouraged to read that graduate entry students are out-performing mainstream counterparts in medical school examinations in the later stages.1 Their discussion did allude to different teaching methods used in the first phase of the Birmingham course but did not suggest how much of a contribution this makes to performance in the second stage. They did not discuss how big the groups used for teaching were in both the graduate and mainstream programmes. The results included 161 graduate entry and 1386 mainstream students. If class size is potentially a factor in early years education, might the Birmingham group consider looking at their own class sizes and assessing whether or not this might also be a factor in medical education? If Birmingham is educating graduates in its mainstream programme, it may be interesting to see how these students perform in relation to their 506 J R Soc Med 2009: 102: 505–507 References 1 Calvert MJ, Ross NM, Freemantle N, Yong Xu, Zvauya R, Parle JV. Examination performance of graduate entry medical students compared with mainstream students. J R Soc Med 2009;102:425–30 Cassidy J D, Boyle E, Cote P, et al. Risk of vertebrobasilar stroke and chiropractic care. Results of a population-based case-control and case-crossover study. Spine 2008;33:S176–S183 2 Baum M. Thomas Wakley: relevant to today’s society. J R Soc Med 2009;102:400–1 1 DOI 10.1258/jrsm.2009.09k067 DOI 10.1258/jrsm.2009.09k068 Relevant to today’s society? Evidence Peer review and ‘openness’ One hundred and fifty years ago the conventional medical profession believed in blood letting and chiropractors believed that they could treat meningitis by manipulating the spine. Now both professions are medically registered and neither believes in these myths! As Professor Ernst suggests, chiropractors now adhere to the ethics of evidencebased medicine. As has been pointed out to Baum (and Singh) repeatedly, the evidence for harm in the paediatric population receiving chiropractic is based on limited and questionable case reports. The evidence for chiropractic causing harm in the adult The Editor states that publishing peer reviewers’ names is ‘a bold step in improving the transparency’ of the peerreview process, and is important in achieving a more open process.1 While one may respect Dr Abbassi’s opinion in this regard, it appears to be an opinion held without objective supporting data. The review process is supposed to be an objective process, not a process in which a couple of acquaintances get together and have a friendly chat about a research report, before recommending publication to the Editor. Locking in the reviewer and author in this way will impede independence in the reviewer’s opinion. The right place for collaboration between Peer review and ‘openness’ author and uninvolved expert is at the writing stage, when an opinion from a respected expert colleague or contemporary researcher, naïve to the research itself, is always a wise and usually a highly revealing process. Locking in the reviewer to the data set out in the paper, by publicising his or her name, is not, in general, a constructive idea. However, an editorial written by an enthusiastic reviewer has merit in independently considering and perhaps endorsing the work. Michael Swash Barts and the London School of Medicine & Dentistry, UK E-mail: [email protected] Conflicting interests None declared References 1 Abbasi K. Naming peer reviewers in JRSM. J R Soc Med 2009;102:399 DOI 10.1258/jrsm.2009.09k069 J R Soc Med 2009: 102: 505–507 507