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Who blows your whistle? (Editorial)

Winston Churchill never read newspapers. His wife used to read the newspaper for him and then give him a précis plus important cuttings. Clementine, adding wisdom, probably made a better job of converting information to knowledge than the software. It was a system that prevented him being deluged by paper and having the "frog in a jam jar" feeling.

David Halberstam's brilliant book, `The Brightest and The Best', has some marvellous insights into how institutions can stifle individuals. Individuals who did not agree with American Government policy on the Vietnam War were systematically sidelined. The information, the knowledge, which they produced to show that the policies were ineffective, was discarded in favour of the military bluff. The ability of individuals to speak out, even though we may think their views are crazy, is very precious.

Accepting change

It is by listening to whistleblowing that we can make progress through a process of constructive disagreement. Constructive disagreement is particularly important when we examine the evidence-base of what we do now or plan to do in the future. Change is often disagreeable, and it is surprising that in an area like healthcare where change is the rule rather than the exception, that we do not have more information on change management.

Where we do not believe

In Bandolier 42 we ran a Question Time to see if readers' questions for which we could not find answers were answerable by others. About half the questions attracted responses of various sorts, which were passed on to the questioners, but there was insufficient evidence for a Bandolier article. One was more interesting, the use of glucosamine in arthritis.

It seemed at first that there was little evidence, and that perhaps it was negative. But we eventually found quite a number of papers (most were in the latest issue of the Cochrane Library), and so this issue has a brief review of what Bandolier was able to find. The bottom line is that it seems to work.

So, just like Hypericum for depression ( Bandolier 31 ), an unconventional approach seems to be effective. But other conventional and unconventional approaches are not supported by evidence. For instance, we report another nail in the coffin of homeopathy this month . So headaches for believers and unbelievers alike, and difficult decisions for policy makers, patients, and their carers.

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