Birte Twisselmann

Use of Google as a diagnostic aid: summary of other responses.

A few of the 40-odd respondents to the article by Hang and Ng think that the idea of the Google search engine being used as a diagnostic aid is downright laughable or dangerous, but most like this “new” facility, some even rating it quite highly.1 Several doctors identify the need for training in using search engines; this seems to have been implemented …

Circumcision: right or wrong? Summary of responses.

The head to head debate on whether infant male circumcision is an abuse of the rights of the child provoked almost 100 responses,1,2,3,4 all forceful and emotive opinions on a custom whose foundations seem to be primarily sociocultural and religious. Respondents—most of them men—included a doctor who had never received any complaints from his circumcised patients in many years of practice and respondents reporting their own beneficial or adverse effects of the procedure; advocates of circumcision and adversaries who see it as an act of trauma, betrayal, or aggression, tantamount to amputation or mutilation. Reasons for infant circumcision include medical indications and protective effects in the transmission of sexually transmitted infections (especially HIV/AIDS). Reasons against include the lack of a medical indication, without which it is “cosmetic” surgery at best and abuse and mutilation at worst. The side effects can be serious, and deaths have been reported. The foreskin has a role in male sexual health, and circumcision is more than merely another disagreeable experience like vaccination that infants are being subjected to. Were circumcision a new procedure, ethics approval, scientific support, cooperation from colleagues, trial participants, and government or charity funding would not be forthcoming. The costs to the NHS of an “unnecessary” procedure also need to be taken into consideration. In the United States reconstructive surgery is a lucrative industry. Many respondents suggest postponing circumcision to adolescence or even adulthood to avoid conflict between the rights of the child and those of the parents. Others think that it is the parents’ right to decide to have their baby boy circumcised, in the same way that they decide what’s best for him in other respects. Some call for studies of a cohort of circumcised men to establish how much they may have been harmed physically and psychologically from being circumcised as babies. Some think that stopping male circumcision world wide would end female genital mutilation too.

Readers respond to the Hadiza Bawa-Garba case

We’ve received correspondence from readers around the world expressing their concerns about system failures, using e-portfolios in legal proceedings, and the threat to duty of candour

Climate change: Summary of responses.

Although not everyone agreed that climate change is a suitable topic for a general medical journal, most respondents agreed that its impact on health made it undeniably important and unavoidable.1-4 Even so, several respondents severely criticised the lack of a rigorous scientific approach in the articles, as well as their naivety or “preachiness”—and a couple challenged why the BMJ is sent out in plastic wrappers and not recyclable paper envelopes. Many agree that, in spite of the gloomy scenario outlined in the articles, doing anything at all is better than nothing—even if it is turning down the water thermostat in hospitals, as one correspondent suggests; turning off unnecessary lights; using bicycles; not buying produce flown in from abroad; restricting the number of people living on the planet by sensible means; and generally developing a much greater carbon awareness. Some remind us that the imbalance between individuals in terms of polluting the environment may not be as big as that between countries, although still substantial. Hospitals without air conditioning, heating, or car parks are cited as examples of what would not work, and, elsewhere, the 1 tonne limitation leads a correspondent to conclude that this would impose a lifestyle that would pre-date her own lifetime and that most people in the modern world just could not imagine. One UK doctor describes the obstacles he experienced in including considerations of how to save energy in plans to build a new practice. Altogether, correspondents chipped in many good ideas, but it still looks like “too little, too late.” It is obvious that individuals, however hard and focused their attempts, will not achieve enough critical mass to counteract the effects of climate change and that the problem needs to be tackled on a collective scale. How consoling, then, that one correspondent points out that, although global warming undeniably exists, every mass extinction in the fossil record was actually accompanied by global cooling.

What readers thought about The BMJ’s articles on assisted dying

The strongest argument against assisted dying, among more than 90 responses from readers to our recent cluster of articles (bmj.com/content/assisted-dying), was that under no circumstances should doctors intentionally kill patients. Eunice Minford, consultant surgeon in Northern Ireland, quoted Elizabeth Butler-Sloss: “The law . . . rests on the principle that we do not involve ourselves in deliberately bringing about the deaths of others. Once we start making exceptions based on arbitrary criteria such as terminal illness, the frontier becomes just a line in the sand, easily crossed and hard to defend.”1 Assisted suicide might also be open to abuse, some readers thought. Barry Cullen, retired GP from Fareham, Hampshire, asked, “Would there be the same level of support for physician assisted suicide if it were introduced as a cheaper alternative to palliative care in an NHS already starved of resources?”2 …

What readers thought about The BMJ’s call to legalise drugs

The BMJ’s recent re-assertion for reform of laws prohibiting use of drugs like heroin and ecstasy generated much debate, as Birte Twisselmann writes

What readers thought about declaring religious belief as a competing interest

Should those involved in public debate declare relevant religious views? A recent contentious article generated nearly 40 responses, as Birte Twisselmann summarises

Through the Microscope: Chelsea garden inspired by breast cancer research

Mark Thomas After winning the silver gilt medal and “best in category” for her Breakthrough Breast Cancer garden at the RHS Chelsea Flower Show 2015, garden designer Ruth Willmott returns this year with a variation on the theme. “Through the Microscope” is inspired by the work of …

No gruel, and Spode china: eating at the Foundling Hospital

A new exhibition in London considers a fundamental, yet little examined, aspect of life at the capital’s former Foundling Hospital: food. “Feeding the 400” represents the multifaceted effect of food and eating regimens on children at the hospital …

Christ Stopped at Eboli

Born in Turin, the doctor, artist, and writer Carlo Levi was exiled to the arid Basilicata region in southern Italy in 1935 after being arrested in connection with his political activism. His memoir of the year he spent there, Christ Stopped at Eboli , written while he was in hiding in Florence eight years later, introduces readers to a world that is more than just geographically remote from the affluent, cultured north of Italy. Ostensibly banished to the area to paint, Levi reflects repeatedly on the public health aspects of Italy’s great north-south divide and cannot help being drawn into practising medicine—while being regarded as something of a sorcerer by …