Why do anaesthesia journals publish editorials?

Medical journals need and use editorials for the same reasons that newspapers do. They provide a focus; they give direction; they stimulate interest. Editorials are part of the personality of the journal that will make readers like or loathe it, and either reaction is better than indifference. One of the more pernicious effects of evidence-based medicine has been encouragement of the belief that evidence is the sole basis for clinical decisions. This belief is coupled to denigration of the expert. In some circles, this has made the word expert more an insult than an accolade. There is a tendency for people who truly are experts in their ®elds to follow this politically correct line and to deny their own expertise. For all sorts of reasons, these responses must be resisted. Medical evidence is too often too uncertain for treatments to be driven simply by statistical number-crunching. It is my opinion that too much weight is given to the results of meta-analysis, but I accept the danger of experts picking their evidence to suit their prejudged opinions [1]. The basis of good medical advice comes from experts able to mix ± to temper? ± meta-analysis with experience. To accept this is to acknowledge that medical evidence ± whether from a single clinical trial or from a synthesis of trials ± is of value only when put into clinical context at the bedside, in the clinic, or in the operating room. Medical evidence from clinical trials is becoming more controlled. Groups are sitting down and devising structures for single trials and for systematic reviews. The authority in medicine seems to be moving from clinicians or groups of clinicians deciding best treatments by a variety of implicit mechanisms (the tacit knowledge discussed, among others, by Eraut [2]), to groups who may not include clinicians at all laying down conditions for considering the evidence for treatments. For some time no reputable journal has published a clinical trial without a statement of research ethics approval; it may not be long before journals require proof that the conduct of a trial has followed the current consensus statement for the carrying out of clinical trials. But there will still be a need for experts experienced in whatever disease is under scrutiny [3]. What better place for their thoughts than a journal editorial? The European Journal of Anaesthesiology already publishes editorials. When asked to consider this one, I scanned the editorials for the previous year. They are as mixed a dozen as one could buy in a mixed wine offer in a supermarket, as well as having resonance with this discussion so far, and being relevant to the purpose of editorials. The topics included the Cochrane collaboration for reviewing and summarizing the results of clinical trials, and the CONSORT and QUORUM statements that present algorithms for clinical trials and for meta-analysis. Three political editorials asked who should provide anaesthesia, the future of the specialty, and the status of intensive care medicine. Two housekeeping editorials discussed how procedures should be coded, and clinical governance (which is best thought of in this context as an attempt to ensure clinical safety and quality). There was an editorial about the economics of anaesthesia, which could come under either of these headings. There were only three editorials directly discussing clinical practice, and one of the topics ± a new carbon dioxide absorbent ± cannot rely on `evidence' in the same way that evidence is relied on for using one medical treatment rather than another. The only two properly clinical topics were the prophylaxis of thromboembolism, and opioid detoxi®cation under anaesthesia. All of these topics seem relevant and interesting. They provide information but give plenty of opportunity for disagreement. The political topics were aired in other journals too, and it is not the last time they will receive attention. The clinical topics were a long-running debate, and a controversial innovation. If I am critical, I wonder if thromboembolism is not better suited to a full review, with editorial comment upon it. Jefferson [4] believes that there is now no place for what he terms `desk drawer reviews', i.e. reviewers just pulling together whatever they European Journal of Anaesthesiology 2001, 18, 703±705