Time is the most continuous of all continuous variables. And yet it is almost as certain as one second following another that humans view time as discontinuous, and that our lives are lived rubato, not in strict tempo. Time “flies.” It sometimes “stands still.” We take “time off.”
At this point in the year many of us try to slow time down. With holidays and family gatherings we hit the pause button, and if we're lucky we can “take time” to reflect on the passing year. At CMAJ, the publication cycle pauses and, in fact, skips a beat by omitting an entire issue.
As we contemplate the year 2001, the terrible events of Sept. 11 dwarf all others. The world has changed, even if human nature hasn't — or, at least, the reactions of politicians and policy- makers and ordinary people are beginning to create a world that feels new and strange. New balances are being struck between privacy and security; a new kind of war — against a behaviour rather than a nation — is being waged. Only time — decades of it — will tell to what degree and in what ways the world has changed, and remained the same.
This year our reflections on time include the apparent permanence of CMAJ, now in its 90th year of publication. We compared the first volumes of 1911 with those of 2001.1 (see page 1631) This year we published 25 editorials, signed CMAJ, on topics as diverse as homelessness, mental illness in our communities, prevention of adverse drug reactions, decriminalization and medical use of marijuana, cell phones and global warming. In 1911, under the editorship of Andrew Macphail, CMAJ published 34 unsigned editorials that addressed the care of the “feeble minded,” tuberculosis, government laboratories, medical manpower and medical school enrolment. Plus ça change …
Has medical practice changed since 1911? It would be difficult to argue that little had changed, in view of vaccines, antibiotics, HIV, the medicalization of behaviours, addictions and states of mind, and the introduction of universal health insurance. But much has remained the same. Despite Tim Berners-Lee's remarkable invention and the subsequent ease with which the public can get medical information on the Web, the overwhelming majority of patients rely foremost on their physicians for advice and counselling about serious health problems. In 1911, Osler, writing in CMAJ about what we now call transient ischemic attacks, was intuitively aware of the influence of lifestyle on risk. He comments on the case of a 43-year-old man “who had driven his engines at a maximum speed for 25 years … intensely devoted to Bacchus, Venus and Vulcan.” Physicians saw their role then as not just dispensing remedies, but also as attempting to educate patients. Today, the advice of a physician is repeatedly shown to be the most important motivating factor for behavioural change among patients. Plus ça change …
And so we offer this holiday issue with an annotation above the score: “lightly, but with reflection.” Happy holidays. — CMAJ
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