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A perspective on perspectives
  1. I A Hughes
  1. Correspondence to:
    Professor Ieuan Hughes
    Department of Paediatrics, Addenbrooke’s Hospital, Box 116, Level 8, Cambridge CB2 2QQ, UK; iah1000cam.ac.uk

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Commentary on Perspectives

The word perspective as a noun can be defined in a number of ways depending on the context in which it is used. Its origin is from the Latin perspective ars meaning the “science of optics”. In the world of art and design, the word is applied to the art of representing three dimensional objects on a two dimensional surface so as to convey the impression of height, width, depth, and relative distance (as defined in The Oxford English Dictionary). Other definitions used in more of an interpretative or behavioural sense include “a view or prospect”,“a particular way of regarding something”, or “an understanding of the relative importance of things”. It is this latter definition that is associated with the use of Perspectives to head up a section in this and many other published journals. When consulting the Little Oxford Dictionary of Quotations, it is the art context of the word which is illustrated by examples such as: “I never saw an ugly thing in my life: for let the form of an object be what it may—light, shade, and perspective will always make it beautiful”1 and “Treat nature in terms of the cylinder, the sphere, the cone, all in perspective”.2

So what is the purpose of having Perspectives in Archives of Disease in Childhood? The term Commentary has been used previously. However, a written Perspective is something more, as the author should stray beyond merely commenting on the paper in question and view the subject with wide angle lenses. It is a case of providing background and context to the article so that journal readers obtain added value from the original article. This clearly means that Perspective authors have to be chosen not only on the basis of their expertise in the relevant subject area but also for their ability to “think outside the box” in order to get the “perspective” right. There is no point in “not seeing the wood for the trees”. To get the equation right, there is sometimes merit in choosing an author who is not a paediatrician in the general sense of that word but is expert in another discipline which subtends the area of study. That philosophy will be adopted when appropriate as well as widening the net of authors from around the world. It is not the task of the author of a Perspective to make a critical evaluation of the paper in question. That has already been done through rigorous peer review and the paper accepted for publication. Indeed, it is only original articles (in general) that have been accepted without much revision that will be considered for an accompanying Perspective should the Editors think there is something unique to highlight and develop further. The original paper is a prompt or a template on which to build a Perspective for added thought and perhaps debate. The coupling of an original paper with a Perspective to appear in the same issue has generated the need to “fast track” such articles and this can only be to the benefit of all concerned.

The current issue of Archives contains a unique blend of an original paper on circumcision to prevent urinary tract infection coupled with a duo of Perspectives on the subject.3–5 When the two experts, from Europe and the USA respectively, were chosen to write a Perspective on the original systematic review by Singh-Greval et al,3 it was anticipated that they would express opposing views. This is indeed the case; is there sufficient reason to think that they have been peering down opposite ends of the telescope! Perhaps not, but there is clearly a difference of opinion as to whether routine neonatal circumcision should be practised irrespective of the known association with urinary tract infection in uncircumcised boys. Both writers approach the Perspective from different angles and mount cogent arguments to state their case, with the European one perhaps not so readily leaping off the fence. This is not the only example of medical practice differing radically on the two continents, but at least it is not going to result in significant conflicts such as trade embargoes or other more serious disputes. I am not about to adjudicate on the topic because I am not an expert on it. But like all paediatricians, parents often ask my opinion about the merit or otherwise of circumcision. This trio of articles on the subject does certainly provide helpful reading on how to ensure at least that parents are in possession of the relevant facts and are able to engage in “non-directional counselling”. In considering the topic of circumcision, one is reminded of the classic paper by Douglas Gairdner on the fate of the foreskin.6 A former Editor of Archives of Disease in Childhood, he was certainly in favour of a “conservative” approach to the foreskin in the hope that simple hygienic measures would avoid what he opined were thousands of unnecessary circumcision operations being performed each year. It is interesting that the list of conditions he discussed which were claimed to be prevented by circumcision, such as penile cancer and venereal disease, did not include urinary tract infection. Would his conclusions have been different more than 50 years later in the context of the volumes that have been written on urinary tract infection prevention. In trying to find any other advantages of circumcision, Gairdner unearthed the intriguing observation that 25% of the mothers he interviewed to obtain a comparative maternal versus paternal view on circumcision for their son did not know whether their husbands were circumcised or not. One must assume that time has moved on.

Perspectives provide an opportunity to highlight the best of research published in Archives by tapping in to the rich resource the journal has available to draw upon for authoritative opinions and discussion. Above all, it is the readership that will gain from the breadth of knowledge generated by an eclectic mix of subjects and writers.

Commentary on Perspectives

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  • Competing interests: none declared

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