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Lord Dorwin’s Reviews

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Lord Dorwin’s Reviews
Mauricio Goihman-Yahr MD PhD
Dermatology Online Journal 18 (8): 17

Professor(E) of Dermatology and Immunology, Vargas School of Medicine, Central University of Venezuela, Caracas, Venezuela

Isaac Asimov imagined a human Galactic civilization that was integrated into an Empire in his Foundation Trilogy [1]. The capital of this empire was a whole planet, Trantor.

Technological and scientific achievements of the empire were magnificent. Yet, there were ominous signs and symptoms of distress. Hari Seldon and a group of hand picked researchers had developed the science of psychohistory. They could predict by means of mathematical formulae the vital curve of civilizations. They determined that the Empire was going to dissemble and that its destruction would create chaos that would, if left to itself, persist for 30,000 years. Nonetheless, the duration of such chaos would be dramatically shortened (to about 1,000 years), by means of the creation of a community, that Seldon called, “The Foundation.” The latter, composed by scientists and their families, if protected at their very beginnings, would create a new civilization and Empire in the span of time mentioned above. The Foundation would start by preserving the knowledge of the Empire in a Galactic Encyclopedia. The community was established in a planet at the edge of the Galaxy, appropriately called Terminus. Encyclopedists were initially not aware of their true mission, but labored only in creating their massive compilation. This was done under the protection of the Empire. As the latter started to wilt (as it is usual in its periphery), war chiefs fashioned “kingdoms” out of fragments of previous provinces. One of these kingdoms menaced the hitherto unarmed Foundation. The latter sought help and the Empire sent its Chancellor, Lord Dorwin, to mediate, but without armed forces to back his mission. As a diplomat, Lord Dorwin had the ability to speak and write in such a way that statements cancelled each other and their net meaning was zero. The treaty that he signed with the menacing Kingdom, as well as the assurances, which he provided to the Planet Terminus had exactly the same net meaning, namely, naught.

Lord Darwin’s interests

The Chancellor did have genuine interests. These were in archaeology, particularly relating to the origin of man. Where in the Galaxy had Homo originated? This knowledge had been lost. Answering a question about this Dorwin responded (quoting directly from Asimov, including his transcription of the diplomat’s affected way of speaking): “Of cohse, no one knows exactly which system it is-lost in the mists of antiquity-. Theah ah theawies, howevah. Siwius some say. Othahs insist on Alpha Centauwi, oah on Sol, oah on 61 Cygni – all in the Siwius sectah, you see.” Later he added, that Lameth tried to show that archaeological remains in the Third planet of the Arcturian system indicated that it was the origin of humanity. Now, Lameth had written his book eight hundred years before. The questioner asked whether it would not have been better for Lord Dorwin to go to Arcturus and study the remains for himself, so as to get the information firsthand. The answer was revealing, “But wheah’s the necessity? It seems an uncommonly woundabout and hopelessly wigwamolish method of getting anywheahs. Look heah now, I’ve got the wuhks of all the old mastahs – the gweat archaeologists of the past. I wigh them against each othah-balance the disagweements-analyze the conflicting statements-decide which is pwobably cowwect and come to a conclusion. That is the scientific method.” This goes on for a while in the book, but the point is that neither Dorwin’s listeners nor Dorwin himself would ever find the true origin of Homo. Dorwin was an uncommitted reviewer, with no first hand knowledge. His purpose was to provide information about a given subject, not to provide knowledge of that subject. He was also fair and non-opinionated. He did not really choose between conflicting opinions, but merely summarized them for his listeners or eventually readers, to do whatever they pleased with that information, i.e., basically nothing.

Current Reviews

Reviews are becoming increasingly common in dermatologic literature. This has to do with the efficient tools provided by computers and available data bases. In addition, there is increasing demand for reviews because of Board examinations and recertification requirements. There is also a plethora of publications and information. Some are very pertinent, others not much so.

A rather common type of current review is put together by several individuals. The authors always describe to some length the methods used to obtain references (most commonly computer driven data bases). Papers analyzed are almost always in English only and overwhelmingly obtained from US publications, with some sprinkling of British and perhaps some North European references.

If therapy is the subject of the review only “evidence based references” are deemed worthy of analysis. This does not take into account the fact that “evidence based” trials are relatively new and that some dermatologic diseases are rare and thus defy current parameters of “evidence.” For instance, it is just not feasible to apply criteria useful to analysis of treatments of essential hypertension, to the therapies of Grover disease, familial pemphigus of Hailey and Hailey, pemphigus vulgaris, chronic urticaria, or widespread lichen planus, to mention but a few.

An increasingly common menu of authors is a group of which the first author is somebody with a BA, the other authors are residents or very junior faculty, and the last author is a Professor of Dermatology. The BA is likely a medical student or somebody with some basic science knowledge and who is deft with computers. This person will do the basic work of getting the bulk of references. The junior physicians will do the first culling and the Professor will eliminate some of the blatant errors or omissions and will incorporate some bits of wisdom here and there. The resulting corpus is dressed in a uniform of saintly orthodoxy. This includes a structured summary, names of sections that are similar or identical in most reviews, and conclusions couched in aseptic language. For instance, “Our review indicates that X or Y substance may be helpful in treating VW disease” or that a given substance or structure may be involved in the pathogenesis of basal cell carcinomas. These kinds of aseptic statements are difficult to prove wrong, but mean little or nothing. The purpose of a study is to review whether or not a medication is clearly active or whether or not a working hypothesis is accurate. Similarities to Lord Dorwin’s statements should be obvious.

Furthermore, language employed is often stilted. A reader might date a review by the use of certain words. I think that employing “of note” is about five years old or so. Are all reviews as described above? Of course not. Reviews may be extremely informative and even works of art in their clarity, completeness, and elegance of language. A useful manuscript is written by authors with hands on knowledge of the subjects that they analyze. Many times they are also able to read and understand pertinent papers written in more than one language. Some reviews do need the collaboration of several authors, but these should be all proficient in their own field.

Allow me now to give some examples that illustrate the points made above. I have decided not to include any relating to the field of dermatology, strictly speaking. This list is far from being comprehensive:

  • Clinical Microbiological Reviews is a journal published by the American Society for Microbiology. In this journal, the papers are written by one or several authors. The reviews feature an introduction and conclusions, but not a summary [4, 5]. At the end of the paper, after references, photographs, and a mini biography of each author are included. The reader can thus have a clear idea of the scientific level of the authors. Most references are in English, but usually there is mention of papers written in other languages. I have found several of the papers to be of interest to me. For instance, in the July 2011 issue there were articles on N. gonorrhoeae, Onchocerciasis, Mycoplasma, and Chagas disease [4, 5].
  • Reviews in the journals Science or Nature tend to be of very high quality.
  • The Journal of Immunology prints “Brief Reviews,” which are usually excellent and concise without being telegraphic. They do have a summary but it is not structured and language is austere but not stilted [2].
  • I have just run across an outstanding paper by Stephen Malawista and coworkers, “Inflammatory Gout: Observations over Half a Century.” This was published in the December 2011 issue of the FASEB Journal [3]. The authors state, “that it addresses the evolution of our current understanding of the interactions between urate crystals and key cellular components of the gouty inflammatory paroxysm.” It was a pleasure to read.


The point that I want to make is this: In any paper, but mostly in reviews, the role of previous first-hand knowledge by authors is paramount. Meaningful information does include the reviewer’s preferences and dislikes. The reader should want an expert to provide not only data but his own interpretation based on knowledge and experience.

Reading an “aseptic” review á la lord Darwin’s is like kissing a corpse.

The viewpoints expressed in this paper are the author’s alone. They do not represent nor purport to represent the viewpoints of the Vargas School of Medicine, the Central University of Venezuela, or the Dermatology Online Journal.


1. Asimov I, Foundation. Bantam Dell. New York, NY, USA (e book) 2004.

2. Hart GT, Hodgquist KA, Jameson SC, Krüppel-like Factors in Lymphocyte Biology (2012). J Immunology. 188: 521-526. [PubMed]

3. Malawista, SE, deBoisfleury, AC, Naccache, PH, Inflammatory Gout: Observation over a Half Century (2011) FASEB Journal. 25:4073-4078 [PubMed]

4. Tamarozzi F, Halliday A, Gentil K, Hooerauf A, Pearlman E, Taylor MJ. Onchocerciasis: The Role of Wolbachia Bacterial Endosymbionts in Parasite Biology, Disease Pathogenesis and Treatment (2011). Clinical Microbiological Reviews. 24: 459-468. [PubMed]

5. Unemo M, Dillon JAR. Review and International Recommendation of Methods for Typing Neisseria gonorrhoeae Isolates and their Implications for Improved Knowledge of Gonococcal Epidemiology, Treatment and Biology (2011). Clinical Microbiological Reviews. 24: 447-458. [PubMed]

© 2012 Dermatology Online Journal