Everything has a beginning and an end even the universe after a period of expansion is expected to undergo contraction possibly down to a very small but dense point. Then who knows it may start all over again. We certainly will not be around to cover that story but in my career the Journal has come and gone. Created sometime in the eighties (history does not relate exactly when) through the hard work of Richard Ellis and the combined editorial work of the Society and Institute of Orthopaedic Medicine we received three or four issues a year of the Journal of Orthopaedic Medicine. As a budding young orthopaedic physician then it was not easy to find academic texts in the main medical journal or textbooks (apart from the classic Cyriax texts) that seemed to address so specifically the clinical issues encountered in everyday practice. To the rest of the world ‘tennis elbow’ was a uniform condition that either responded to steroid injection or resolved on its own; low back pain (a murky non- specific pain of dubious origin) was treated with rest and NSAIDs. However, those pioneers who researched and studied and wrote for the journal opened our eyes to the myriad forms and manifestations of these common problems and proposed even more fascinating ways in which they could be treated. One article written by a Cornish doctor on Impact therapy provided instruction on making bags with a specific grade of builder's sand with techniques for localizing the longitudinal pressure wave set up to the target tissue to relieve pain and stimulate the healing process. For a while it was possible to purchase a kit ready to use. Was this the forerunner of extra corporeal shock wave therapy or Power plate exercise? In those early days the lack of evidence was less important than having something to offer – ways of interrogating the body tissues, listening with the tactile sense, logical and consistent ways of explaining problems to patients that gave their condition a name and a meaning. We were provided with a range of potential solutions waiting to be tried and tested in the grand in vivo experiment of n = 1. The need to test these treatments in larger ‘homogeneous populations in randomised trials’ came later and fortunately after many of us developed a strong personal conviction in the effectiveness of say manipulation, or epidural steroid injections and prolotherapy.
The fact that we as believers offered solutions to patients in need of something surely must provide the strongest placebo effect. Yes, says Paul Dieppe in an editorial (Dieppe et al. 2104 J IMM 14 [3]) the placebo effect may be the most powerful tool we have in our armament and what is wrong with that?
…Recent research has suggested that a useful communication strategy in health care is the validation of patients’ symptoms, and that invalidation can have negative effects…
In contrast, the nihilism of ‘there is nothing seriously wrong’, ‘we can't tell you exactly what is wrong’ and ‘there is no evidence for any particular treatment' or ‘but you could try these tablets’ may have a nocebo effect 4–5 times more powerful even though it is not intended.
Yelland argues in his Editorial (J IMM 2011 33 [1]) that we must address the patient's expectations of a consultation which may not always comply with evidence- based guidelines or fit with the doctor's model of best practice. Patients want a thorough examination, some sort of imaging, and a diagnosis. They want pain relief no matter how small in chronic pain scenarios.
Richard Ellis, Rheumatologist and FRCS, taught orthopaedic medicine around the world and by his example and untiring work as Chief Editor kept the Journal going for almost its entire life inviting contributions from colleagues around the world. No mention can be made of the passing of this Journal without acknowledging the tremendous contribution Richard Ellis has made with his light hearted, common sense and fun loving touch to his editorial production. Here is an extract from an editorial in 2008 discussing perverse incentives generated by the Payment by Results system:
Maybe the payment system should be devised on the basis of our promise to put the patient first. We can construct a table of what the patient will want and the ways to judge it.
We may laugh at some of these, but it's a thorny path to follow. So let us now measure the practitioner's delivery of the essentials.
It is easy to see how drugs like steroids and opioids, and even opiates, can become overused, and how incomplete care can be given. The perverse incentives creep into all such exercises: we can be forgiven for feeling that patient care loses as much ground as it gains – and the monitoring is expensive. And while these incentives have been working away ‘at’ us, have we lost our reputations as altruistic, caring professionals? We might protest that we're not being seen as what we really are. Let's prioritise our good reputation.
Richard Ellis was able to bring in the International Academy of Manual/ Musculoskeletal Medicine formed from the Federation (FIMM) to bring the evidence base of MSK into the twenty-first century. The IAMM like BIMM have been subscribers and contributors to the new Journal of International Musculoskeletal Medicine since 2008 under the leadership of Olavi Airaksinen and Jacob Patijn. To mark the occasion our Editor produced an issue of five articles from the previous 10 years which he felt illustrated the evolving nature of MKS thinking and I urge you to refer to it (JOM 2007 vol 29 [3]) lest you forget. We have to accept that funding follows research that is published in high impact factor journals and increasing availability of open access and on line journals is now a reality but inevitably affects the viability of grass roots journals.
We are extremely grateful that Taylor and Francis will provide on line access for perpetuity to every Issue dating from 1992 and I urge you to spend time browsing through the back copies because you will re discover fascinating compilations, proceedings, reviews of some topics, and some original empirical observational studies on clinical problems that are hard to find elsewhere.
Unfortunately the Journal, like Musculoskeletal Medicine (namely BIMM) has had to face up to the changing world. It has been harder to obtain copy of adequate scientific merit partly because musculoskeletal practitioners find themselves too busy in their clinical work to conduct research and those that do have good data to publish will chose academic journals with a higher index rating and impact factor. So it is with a heavy heart I acknowledge the loss of a Journal that has always been a good read, never too dry, and always stimulating.
On a positive note, here in the UK we look forward to a ‘new universe’ expanding, with the relocation of MSK from BIMM in the bosom of BASEM. We anticipate enrichment of both SEM and MSK disciplines through conjoined efforts. There may yet be a need for a publication again for the fruits of this collaboration.