There's nothing like a good spat. Spat isn't quite the right word. A spat (COD) is a petty quarrel, but this quarrel has longer legs. This Journal's esteemed editor held June's issue to be ‘straying into mildly controversial territory’, but mildly wasn't needed: this is a controversy at the heart of the NHS. Talbot-Smith et al's puncturing of Feacham et al's enthusiastic support for Kaiser Permanente was gleefully picked up by the Guardian (1 June) and must have struck a chord on high. A letter followed from Secretary of State John Reid (3 June); he was not recanting.
It is all confusing to someone unfamiliar with economics and the statistics of public health. Talbot-Smith concludes Feachem's claims are unsupported by the evidence; Feachem reckons Talbot-Smith introduces new confusions and factual errors. Sheldon in his editorial describes Talbot-Smith's critique as ‘devastating’. Well, I've generally agreed with Sheldon in the past, so I'll stick with him now. The main effect of the episode (COD: one event as part of a sequence) on me is to reinforce my view that politics is not about doing what works, but about doing what you believe in. It's all very well talking about evidence-based policy, but the evidence that underlies policy, far more so than the evidence underlying treatment, is too prone to interpretation. The interpretation depends on belief, so you may as well go with belief from the start.
So what's with the comma? In Feachem's reply to Talbot-Smith, there is thinly veiled criticism of Talbot-Smith's methods: ‘Other authors have chosen a more rigorous and analytical approach …’. Feachem first gives a lot of detail from a paper by Ham et al, before continuing, ‘In another recent study not cited by Talbot-Smith et al, Light and Dixon also examine factors …’
Not so. The sentence should have started, ‘In another recent study, not cited by …’ Light is not cited by Talbot-Smith, but omitting the comma implies, wrongly, that Ham is not cited either. He is, to be dismissed for failing to take proper account of the different populations. Ham's analysis was the basis of John Reid's riposte in the Guardian, so I'll ignore that as well.
Coming shortly: how the semi-colon can make you a better doctor, even if it won't solve your cash-flow problems.
Author's note: COD is the Concise Oxford English Dictionary; journal references can be found in the June issue. And I won't even mention the letter in the same Guardian commenting on BMJ editor Richard Smith becoming chief executive of an American healthcare company.
- © British Journal of General Practice, 2004.
