BMJ  2004;329 (4 December), doi:10.1136/bmj.329.7478.0-g

Editor's choice

Why nakedness is bad

Avid BMJ readers will know that we care a great deal about transparency—or nakedness, as one of our editorial team once suggested we rebrand it—but has our idealism separated us from reality? Transparency is important in the rarefied atmosphere of Tavistock Square, London, where we think pure editorial thoughts (p1345). In the "real" world, transparency may be problematic.

The Health Council of the Netherlands thinks so. It advises the Dutch government on health, food, and environment policy, with a "sharp distinction between what is displayed to the public and what is kept concealed." Roland Bal and others argue that by keeping meetings confidential the council paradoxically allows its members to be open in their views, free of lobbying (p1339). To them the performance of the council is akin to theatre, with backstage deliberations unnecessary for public consumption. If displayed they would radically change the meaning of the on-stage performance. Disagreement between committee members is best kept concealed, they say, because public dissent would hamper communication of the consensus.

Public participation may be another demand foisted on scientific advisory councils that is best left to the political arena because it is unclear how it can be enacted or what its effects will be on the advisory process (p 1307). This doesn't mean that the council is undemocratic. Other than advice from scientists it seeks "experiential expertise," which may be personal experience of a disease or attending hearings with representative groups, or a member of a patient organisation may exceptionally be invited to join the committee. Bal and colleagues conclude that "the call for transparency or a simple minded inclusion of interested representatives in the advisory process will lead to undemocratic or unscientific decisions," which leads me to conclude that it is just as well that journals allow dissenting voices, even though the Dutch scientific advisory council frowns on this. For example, should we not have published this week's paper on the doubtful long term effects of NSAIDs for knee pain (p1317), or the one that suggests low and high diastolic blood pressures in pregnancy are associated with high perinatal mortality (p1312), or the finding that medication errors commonly occur during all stages of paediatric resuscitation (p1321), because we might deviate from the consensus?

Perhaps I'm being simple minded? I recommend a little simple mindedness every now and then, and it seems BMJ readers agree. Last month's hit parade from bmj.com shows that the most read article was a news report of a simplistic study exploring the link between country music and suicide (p1350). Sensibly, Stephen Hartley preferred John Peel's musical selections (p1341). Peel, a philosopher DJ and memorable teacher, taught him the value of passion, fierce individualism, kindness, compassion, and humility. Importantly, he helped Hartley "realise that it's OK to be a doctor and play in a rock and roll band."

Kamran Abbasi, acting editor

(kabbasi{at}bmj.com)

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Rapid Responses:

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The paramount importance of “nakedness”.
Sergio Stagnaro
bmj.com, 3 Dec 2004 [Full text]
Even more information; even greater transparency
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bmj.com, 5 Dec 2004 [Full text]
Open access and Transparency
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bmj.com, 7 Dec 2004 [Full text]
Transparency and evolution
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