BMJ  2005;331:1289 (3 December), doi:10.1136/bmj.331.7528.1289

News

Doctors urged to present views in an objective way to the media

London

Doctors should discuss scientific arguments in an objective way when talking to the media, the Council for Medical Ethics of the Norwegian Medical Association ruled this week.

The council was responding to a complaint that a professor of cardiology had claimed in a newspaper interview that government regulations requiring the first line use of thiazides for hypertension meant that doctors might risk "killing" their patients with a "rat poison drug."

The news report that provoked the case was a front page news story in a Norwegian national newspaper, Dagbladet, published on 11 February 2004. In the report Sverre Kjeldsen, professor of cardiology at the University of Oslo, was quoted as saying that "the authorities urge us to kill the patients with pure rat poison," in an article that suggested that high doses of cheap thiazides worked in a similar way to rat poison.

The news story came after a change in drug regulations made by the Norwegian parliament in 2004, making low dosage thiazides the treatment of first choice for the management of hypertension. Doctors have to prescribe them unless they can give an explicit medical reason for making another choice.

Jørund Straand, professor of general practice at the University of Oslo, and one of the three general practitioners working in academic medicine who brought the complaint, said that he wanted the ethics committee to review whether the statement made by Professor Kjeldsen went against the Norwegian code of medical ethics.

The Norwegian Medical Association's Code of Ethics for Doctors states: "A doctor should according to his or her ability contribute to objective information to the public and the authorities on medical matters. A doctor who pronounces on medical matters to the media should ensure that he or she will be able to check the form in which the pronouncements are made public."

Professor Straand explained: "Our main concern was the statement about doctors killing patients, not that we supported the government in its recommendation on treatment—that is another issue." He added: "We were concerned that the statement [from Professor Kjeldsen] could make it very difficult for doctor-patient relationships, if patients were anxious that their doctors might be killing them."

In its ruling on the case published in the latest issue of the Journal of the Norwegian Medical Association, the Norwegian Medical Association's Council for Medical Ethics said that doctors should be cautious when interacting with the media and should try to check the accuracy of articles for which they have been interviewed before they are printed (Tidsskr Nor Laegeforen 2005;125: 3151[Medline]). The statement noted that in meetings with the ethics council Professor Kjeldsen had explained that the journalist who had interviewed him had misunderstood some of the information and had mixed up warfarin and thiazides.

The statement said that doctors have a duty to voice disagreements with decisions that they considered might be a threat to their patients, but they should do this in an acceptable way. The council noted that although Professor Kjeldsen regretted the way the newspaper had presented the story, he did not withdraw his statement that "the authorities urge us to kill patients."

Commentators have previously expressed concern about negative reactions in the medical media to a trial—the antihypertensive and lipid lowering treatment to prevent heart attack trial (ALLHAT)—that supported the first line use of thiazide-type diuretics after showing similar rates of fatal coronary heart disease or non-fatal myocardial infarction with chlortalidone as with the calcium channel blocker amlodipine and the angiotensin converting enzyme inhibitor lisinopril (JAMA 2002;288: 2981-97[Abstract/Free Full Text]).

Writing in the BMJ, Alessandro Liberati, associate professor at the University of Modena, Italy, and Nicola Magrini, director of the Centre for Evaluation of the Effectiveness of Health Care, Modena, questioned whether drug companies and the researchers acting as opinion leaders for them behaved fairly and consistently when writing in peer reviewed journals and talking to practitioners (BMJ 2003;326: 1156-7[Free Full Text]). They argued that full scale attacks directed at the design, analysis, and interpretation of ALLHAT were published in the journal of the Italian Society of Hypertension and in an Italian weekly medical magazine at the same time as commentaries in the Journal of Hypertension praised the study's strengths and identified only minor weaknesses.

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Relevant Article

Information from drug companies and opinion leaders

Alessandro Liberati and Nicola Magrini
BMJ 2003 326: 1156-1157. [Extract] [Full Text] [PDF]

Rapid Responses:

Read all Rapid Responses

Are thiazide diuretics rate poison?

Sverre E Kjeldsen
bmj.com, 23 Dec 2005 [Full text]

Re: Are thiazide diuretics rat poison?

Lynn Eaton
bmj.com, 26 Dec 2005 [Full text]