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Living with ignorance (Editorial)

Living with ignorance
Knee joint dustbins
Déjà vu

The world ain't fair, it's round. That saying came from a hoary engineer-scientist who was explaining to a then young Bandolier the necessity of getting on and making do with what one has, rather than wailing about what one does not have. We have to make decisions in an imperfect world, and this issue tries to look at imperfect evidence.

Living with ignorance

In these days of instant communication, the expert patient, the worried unwell and the worried well, it is all too common to have some new medical miracle trumpeted abroad, with the coal-face practitioner the last to hear about it. Perhaps living in (relative) ignorance is something we have to learn to live with. We know we will be unaware of something important, but still have to give advice. So here are four articles for topics with limited evidence.

For lutein and macular degeneration, there is a shaky pyramid of limited scientific background, limited epidemiology, and limited clinical trial evidence. What there is seems to be pointing in the same direction, but not enough to be sure about. When it's your eyesight that is disappearing, though, this straw in the wind probably looks like an oak tree. But at least there is now something half-way sensible to say, while a year ago there was nothing.

Knee joint dustbins

The knee joint is not a dustbin. But we throw things in it, and hope they work (steroids, hyaluronic acid, laser therapy). Perhaps there is not as much evidence as we thought for some interventions, and more than we knew of for others.

Déjà vu

Duplicate publishing again. But at least not duplication. Rather more of a reminder that perhaps 1 in 20 of the original studies you read is covertly duplicated. Worrying, and something to be checked out when reviewing.

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