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EDITORIALS: Tony Delamothe How political should a general medical journal be? BMJ 2002; 325: 1431-1432 [Full text]

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Politics

J. Freedhoff   (20 December 2002)

politics=health

mike r dematteo   (20 December 2002)

Don't Put Your Heart into Politics

John M. Williams   (20 December 2002)

Well done!

Gunnar Edman   (20 December 2002)

Health is political

Pandora Pound   (20 December 2002)

not at all !

dr.manan vasenwala md,mrcp   (20 December 2002)

Good question!

Steven Ford   (20 December 2002)

As much as your data allows

Christopher M. G. Buttery   (21 December 2002)

Politics and the BMJ

John Hurdley   (21 December 2002)

Medicine and human affairs

Carmen Martin-Marero   (21 December 2002)

medicine and politics

susanne stevens, none   (21 December 2002)

The answer is not to be found in readers’ surveys. Response to Delamothe

Samer Jabbour   (21 December 2002)

BMJ's Political Role in Accepted Papers

Bill D. Misner   (22 December 2002)

Keep the "bastards" honest

Michael D Innis   (22 December 2002)

No Place for Politics

Pennie Marchetti   (23 December 2002)

You just can´t

Julian A Lopez   (23 December 2002)

Health and politics- a conjoint twin!

Sachin Maiti   (24 December 2002)

Evidence based politics?

Adam Jacobs   (24 December 2002)

Plurality is more important!

Louis D Brassey   (24 December 2002)

Health as a political issue

patrick john chuter   (24 December 2002)

war against Iraq

Lindsay S Ward   (24 December 2002)

Politics is unavoidable

Michael Peel   (24 December 2002)

Politics in a general medical journal

Morris Doublet-Stewart   (24 December 2002)

Medicine and Politics are Synonymous

Ron Law   (25 December 2002)

A Medical Journal should be "medical"

ravi prashant   (26 December 2002)

More political Medicine.

Maysara H Bahja   (27 December 2002)

Politics pervades everything

Bert P. van Leeuwen   (27 December 2002)

How Political Should a General medical Journal Be?

Tony M Hirst   (27 December 2002)

Confused?!

Vassilis I Dimarelos   (27 December 2002)

Why BMJ should be more political

Allan J. Wilke   (29 December 2002)

We Cannot be Apolitical

Guillermo Arturo Herrera Taracena   (29 December 2002)

Re: Evidence based politics?

Marco Caputo, Italy   (29 December 2002)

Same opinions as last years

Regina B Stroebele   (29 December 2002)

Ethics of Medical practice under threat

Nasim Mahmood, --   (29 December 2002)

Politics and Health

John G McGough   (30 December 2002)

A brew of health and politics

Max Price   (30 December 2002)

Politics, health and justice

Colin D Butler   (31 December 2002)

Connections

Pirkko Kiviluoto   (2 January 2003)

Medical Rubbish.com

Derek L Connolly, B71 4HJ   (3 January 2003)

ORGAN OR FORUM ?

john s hyslop   (10 January 2003)

Health is nothing but complete physical, mental, social, economical, political & moral wellbeing

Ioannis D Dimoliatis   (22 January 2003)

Refine the question

David T Parry   (11 April 2003)

Iranian Twins - The Ethical Questions

ze david, Stanley, lisa   (12 July 2003)

Politics 20 December 2002
J. Freedhoff, Physician Ottawa K1T 1E3 Send response to journal: Re: Politics	If I wanted to read about politics, I'd buy the Economist. Competing interests:   None declared
politics=health 20 December 2002
mike r dematteo, hospitalist baystate medical center; springfield, ma;01199;usa Send response to journal: Re: politics=health	Activated protein C costs $10,000 (US) dose. It may, or may not, be useful for treatment of sepsis. There is, however, no doubt that $10,000 (US) could be put to unnassailable good use in any third world village. You do the math. Competing interests:   None declared
Don't Put Your Heart into Politics 20 December 2002
John M. Williams, (business owner) Markanix Co., PO Box 2697, Redwood City, CA 94064 Send response to journal: Re: Don't Put Your Heart into Politics	In response to the question, "How Political Should be a General Medical Journal?", I think it depends entirely on how one defines "political". For any decision to be useful, there has to be a good definition or test for "political" first. Whatever this might be, it surely differs from that of "medical", so the journal clearly should delineate political content from medical content. On this point, I disagree with the quote from Virchow. I think the question should be, How should a medical journal contribute to political matters? In practice, these matters almost always resolve to discussions or debates. So, what should a medical journal contribute? Clearly, such a journal should take stands on matters directly relevant to the practice of medicine. For example, legislation either favorable or obstructive to good practice should be respectively endorsed or condemned. But as an editorial, not medical, exercise. Marshalling of medical data in support of a position is not a medical practice. A medical journal also should be ready to pounce upon ethical threats bearing on the Hippocratic Oath, gutting them before they turn into legislations or regulations. I am thinking of executions and assisted suicide here; but, surely other such challenges to goodness will arise in the political arena and will have to be faced. The definition of death, and the agony of removal of life support, fall here, in my opinion. Most of the issues in the editorial seemed to be oriented toward international military adventures, including oppression of civilians. Clearly, denial of treatment of such persons, civilian or not, should be an issue. A nation ignoring the laws of war and peace should be condemned. I think the effects of biological, chemical, and electromagnetic weapons should form a valid point of opinion, because of the expertise in evaluating harm from such weapons. Some of these devices have the lethality of cigarettes. Smallpox, for example, is a habit noone so far has been able to break, or so it seems. I am not so sure of the value of a medical opinion on whether, where, or when war should be waged. It seems that on such topics, one persons well-educated guess is as good as anothers. So, my suggestion is to base the political decisions on the interests of medicine, its practitioners, and its subject matter, humanity. If there is a medical outcome to a political action, then a medical journal at least should point out this outcome. If there is a medical interest in the outcome, such a journal should take a side in the politics determining it. Competing interests:   None declared
Well done! 20 December 2002
Gunnar Edman, Aossicate professor of med psychology Danderyd's hospital, SE-18287 Danderyd, Sweden Send response to journal: Re: Well done!	During the circumstances, a remarkably sensible comment! Competing interests:   None declared
Health is political 20 December 2002
Pandora Pound, Research Fellow Dept of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 Send response to journal: Re: Health is political	Of course a general medical journal should be more political. Health is political. It is so political that those who really want to have an impact on health shouldn't bother becoming doctors, but should attempt to tackle the major causes of ill health such as inequality and poverty. Competing interests:   None declared
not at all ! 20 December 2002
dr.manan vasenwala md,mrcp, consultant-cardiologist (non-invasive) aligarh-202002. india Send response to journal: Re: not at all !	a medical journal should be totally apolitical. we have enough political journals, and media to satisfy our political appetites. a medical journal should strictly be medical. it should not even be nationalistic. it should subscribe to no ideology or ism. it should be secular and should contribute to medical science. it should appeal to an international audience in furthering medical science. no ifs and buts here! if mistakes have been made in the past, no matter. what is important is the future and to see that the journal remains a scientific organ and not a tool for manipulation or a battlefield of ideologies. Competing interests:   None declared
Good question! 20 December 2002
Steven Ford, GP Health Centre, Haydon Bridge. NE47 6HG Send response to journal: Re: Good question!	Sir By chance I read your editorial within minutes of having finished my monthly medical page in our Parish Magazine. The need to avoid complacency about terrorism, even in a rural community, was a prominent sentiment. The real practical consequences of the use of chemical, biological and radiological weapons are legitimate concerns of medical journals. The factors underlying their use are political but necessarily inseparable. Therefore politics, in this context at least, is unquestionably proper. In other contexts I would welcome a positively militant political stance in the BMJ too. So little of what is done in the elector's name meets with widespread approbation that authoritative and outspoken commentary is an essential component of political debate. If you know a better barricade - go to it. Happy Christmas. Steven Ford Competing interests:   Those living in rural communities are not isolated from risk. I am one such.
As much as your data allows 21 December 2002
Christopher M. G. Buttery, Adjunct Professor of Public Health Richmnnd VA 23298 Send response to journal: Re: As much as your data allows	I understand your confusion about the role politics plays in medical journals. An Association, in which I have been a member for 40 years, has been having similar debates. Many of us have passions about specific areas (Tobacco, guns, drunken driving, lead poisoning). However, our passions are often based on feelings (a lifetime of events) rather than science. We have agreed among ourselves that we would respond publically, as a medical association, when we had good data. As epidemiologists we continually carp about poorly prepared articles and furor in the newsmedia, generally, where there is little data. As long as the editors note where opinion pieces are based on beliefs vs. data a reasonable mixture (25% personal feelings, 75% science?) maybe fine. It is important to have full disclosure on the mixture. The problem, is who decides? Hopefully, anough readers will respond to provide you guidance. Competing interests:   None declared
Politics and the BMJ 21 December 2002
John Hurdley, Retired anaesthetist B17 9JG Send response to journal: Re: Politics and the BMJ	I am with Virchow, politics is medicine writ large. Competing interests:   None declared
Medicine and human affairs 21 December 2002
Carmen Martin-Marero, Registrar-COTE St. Mary's Hosp, London,W2 1NY Send response to journal: Re: Medicine and human affairs	Interesting question... As far as I'm concerned, wherever there are two or more people discussing a matter, there is already politics at play. As each individual will -consciously or not- try to get some advantage in the discussion,the result may not be a fair and balanced one, where "everybody wins". In this case, there will be individuals or human groups with the worse side of the "deal", which leads to physical/psychical distress and disease, independent of whether it is on a local, national or worldwide scale. Here is where we, as doctors, are usually "called in". But, as I see it, we cannot care for our patients appropriately if we don't take into account their personal, social and financial circumstances as well as their medical problems. From the local to the worldwide scale, yes, we should have a voice in so called "Politics", as it directly affects people's health, and therefore involves us as humans first and second as health professionals. My answer to your question: a medical journal should be as political as needed to, in order to help improving health in society. Competing interests:   None declared
medicine and politics 21 December 2002
susanne stevens, researcher cardiffcf 3pf, none Send response to journal: Re: medicine and politics	Remember the feminist cliche - the personal is the political? As so many - it is has a prfound truth. We are all in the world for a short time together, we come in and go out the same way. How wonderful if we could all look after each other as having an equal right to all it's riches - including health care Competing interests:   None declared
The answer is not to be found in readers’ surveys. Response to Delamothe 21 December 2002
Samer Jabbour, Assistant Professor Faculties of Health Sciences & Medicine, American University of Beirut Send response to journal: Re: The answer is not to be found in readers’ surveys. Response to Delamothe	Sir, Delamothe is to be commended for raising the question of how political a medical journal should be. (1) However, the framing of the issue requires clarification, re-orientation and expansion. It is laudable that BMJ is seeking feedback from its wide readership. As is the case with all political questions, however, the proposed answers will, necessarily, depend on the political positions of the respondents. For those whose national, racial, class and gender sensitivities are "offended" by the discussion of politics in relation to the health of society, the obvious answer will be no. But this “no” itself is political as it represents a desire to oppress the more complete view of health as a sociopolitical sphere. It must be clear that it is elusive for the BMJ to look for a consensus, for no such consensus exits. Suppose that the majority of respondents indicated they would prefer a “less political” journal. What would BMJ’s action be in this case? Considering that the respondents represent a small number of readership, their position would be more telling about their own politics and less informing about what BMJ should do. In such a case, feedback from readership cannot replace the visions of the leadership. Approaching the question requires a different orientation. The issue is not finding a “clear dissecting plane” but projecting a clear position of direction. For this, BMJ’s self-reflection and explicit expression of its own positions on health and politics are needed. Once such positions are identified, it would be easier to answer your question. A well-done retrospective study of your past publications would inform you about whether your coverage addressed your stated needs. A well-planned prospective intervention would then help you bridge the gap between current situation and future goals. What issues should BMJ consider as it rethinks its positions? The first issue is the need to admit the very political nature of health literature. As Vicente Navarro has demonstrated in over 30 years of research and critique of the "mainstream" published health literature, all discussions of health and disease are political. (2,3) This is especially the case for literature that avoids politics on the grounds of "objectivity" and "neutrality." That most medical journals do not include even the slightest coverage of political issues, or include it from a position of professional self-interest, is itself political. Such actions represent conscious or unconscious decisions to stay away from exposing the appalling injustices in health determinants for which medicine has been, equally appallingly, a silent witness, and from taking an active role in the radical structural changes needed to make a difference. This process has coincided with a similar re-orientation of health research towards emphasis on the “technical” and “scientific” rather than on the social, economic and political. I have already alluded to the second issue, i.e. identity. The BMJ today projects a certain identity and ideological position, which many of us find attractive. Such an identity is not a static description; the question posed attests to the pains of self-reflection which may invite profound changes to human functions. More coverage of politics of health must not be the product of un-focused or un-clear discussion but should reflect a profound re-assessment of identity. This process must not be subjected to the whims of the (very political) moment in which we live. The third issue is BMJ’s contribution as compared with other medical journals. Assessment of how other journals address the politics of health can contextualize BMJ’s contribution in a broader picture. Obviously there is a need for comparative research to better describe the differences among journals. Today most of what is published in "prestigious" medical journals makes little difference to the health status of people around the globe. This is the case not only for those who reside in poor countries, but is also true for residents of all countries. BMJ’s coverage of political issues adds an advantage point, a uniqueness in an era of proliferation of biomedical journals devoted to “hard-core” science and explosion of medical information of technological nature. The fourth issue is BMJ’s responsiveness to needs of the global health community. Whether through its pioneering position in providing free access, through its expressed interest in health issues in poorer countries, or through the coverage and editorials, BMJ is indispensable for us. A more politicized BMJ would be even more appreciated. For example an article recently published in the BMJ representing a perspective from the Arab and Muslim world on September 11 would have a hard time being accepted in other journals. (4) Indeed this article was rejected from a couple of prestigious North American journals on the grounds that it did not “fit the needs of readers.” The BMJ and a few other journals present a platform for expression that rarely exists elsewhere. Seen from a global perspective, this platform should be expanded, not diminished. The fifth issue is how coverage of politics would correspond to health priorities. Just as evidence guides our approach to medical problems so should evidence guide BMJ in deciding its choice of political coverage. It can be easily deduced that the political situation is one of the key factors, if not the main factors, in producing and re-producing the current health state of the world’s population. This is not only the case for areas of political conflict in Africa, Asia and the Middle East in which millions have died, and innumerable numbers continue to suffer, because of war, displacement, sanctions, disease and malnutrition. It is also true that the health status of all people is most strongly correlated with their socioeconomic, ultimately political, conditions. By focusing more on the political dimensions of health, BMJ would be practicing in the best tradition of evidence-based medicine as it has emerged in the UK over the past decade. The sixth issue is the content of coverage of politics and health. Not all political coverage is created equally. Take for example the literature on health inequalities. Equality and equity have become buzzwords in health research today. However, very little of this literature discusses the structural factors behind them and the need for structural changes. Capitalism and its exploitations, and therefore the need for system changes, are not considered. Many of us look with suspicion at such depoliticized literature on health and politics. BMJ would do the world no service by becoming another venue for such literature. On the contrary, if BMJ were to commit to publishing literature that carries profound political messages, it would become a truly unique general medical journal. The seventh issue is impact. More coverage of political issues must reflect BMJ’s commitment to producing a new level of impact along the lines thus far discussed. This commitment is linked with the recognition of responsibility. BMJ today is expected to continue a path of brilliance in which it has exerted considerable impact. BMJ may not be able to radically change the politics of health research or practice. However, exposing such politics can be assured to ameliorate the current situation and impact it in favor of those most in need. It is doubtful that the CNN-style polling of readers’ responses on BMJ’s website would answer the question of how political a general medical journal should become. More self-reflection by BMJ is paramount. All journals indeed must ask the same question of themselves. As they ponder the answers through review and self-critique, many journal editors will find themselves asking an equally difficult question: “Why haven’t we done enough to expose the politics of health?” 1. Delamothe T. How political should a general medical journal be? BMJ 2002; 325: 1431-1432 2. Navarro V. A critique of the ideological and political position of the Brandt Report and the Alma Ata Declaration. Int’l J Health Services 1984: 14: 159-172 3. Navarro V. Assessment of the World Health Report 2000. Lancet 2000; 356: 1598-1601 4. Jabbour S. After September 11: A doctor’s perspective. BMJ 2002; 325: 1045 Competing interests:   None declared
BMJ's Political Role in Accepted Papers 22 December 2002
Bill D. Misner, Director Research & Product Development E-CAPS Inc. Send response to journal: Re: BMJ's Political Role in Accepted Papers	Tony Delamothe writes, "Just how political should a general medical journal be? We define the BMJ's scope as covering the "clinical, scientific, social, political, and economic factors affecting health. This means that our content ranges over such diverse topics as poverty, unemployment, and Britain's private finance initiative, as well as the more customary concerns of medical journals. Not all readers are happy with our choice. Their most frequent criticism is that we've got the balance between political (or "sociological") material and clinically useful material wrong..." I am one of BMJ's readers who is not happy with the subjective choices made for published papers. I propose to examine the question from an "Outsider's" critical perspective. When I say "Outsider," I mean often a contributor to BMJ's online "Rapid Responses," but often rejected online printed contributions. Since my research is in the non-prescriptive field of alternative medicine, specifically ergogenic supplements, rejection of open label non-placebo case studies are poorly regarded by both British and American Medical Journals as though they were have no effect on general health outcome. With millions of Brits and Americans taking exogenous doses of this and that in order to preventatively fortify food for health effects, one would logically conclude that BMJ would be open to critically reviewing what those in alternative medicine protocols are reporting. It is my opinion that paper publication acceptance in a medical journal depends more on one's political relationships, the type of "M.D.," and from what institution the degree was earned. One day I hope to be approached by an editor (such as Mr. Delamothe) for writing a review paper the top ten oral best versus the top ten worst supplements with which modern conservative practioners should be familiar. How about an editorial review which corrects the balance between BMJ's politics in paper selection which would further expose your readership to clinically useful material, Mr. Delamothe? Bill Misner Ph.D. C.S.M.T. Competing interests:   The author discloses competing interests as a researcher in exogenous ergogenic supplements.
Keep the "bastards" honest 22 December 2002
Michael D Innis, Director Medisets International Home 4575 Send response to journal: Re: Keep the "bastards" honest	Editor, The founder of the Democratic Party in Australia did so to “keep the bastards honest”. By definition the “bastards” are the current government and, of course, the chief “bastard” is the leader of that government whose fawning endorsement of the views of his counterparts in America and Britain infuriates some Australians. His recent threat of a “pre-emptive strike” on suspected “terrorists” in neighbouring countries was swiftly silenced and ridiculed as nothing more than pompous impotent rhetoric. The tragedy in Bali was attributed by some to his association with the anti-Muslim activities of Bush and Blair of which he approved and participated in by assisting the naval blockade of Iraq, an act which is killing hundreds of Muslim children ---but he and his fellow conspirators are unable to see the connection. They are unable to comprehend that killing the children of another country is bound to result in retaliatory measures against citizens of their own country. In the impending slaughter of innocent people in Iraq contemplated by America, Britain and Australia, on spurious charges of non-compliance, it is the duty of a Journal such as the BMJ to expose the real motives of these “bastards” whether it be a personal vendetta “they tried to kill my daddy” as Bush is alleged to have said or boosting the sales of his armament merchants. While you are about it you could advertise for volunteers among your readers (count me in) to assist the victims of these new style, big time, terrorists. Perhaps a picture of Bush, Blair, Howard and Hitler together would bring home the message Michael Innis Competing interests:   None declared
No Place for Politics 23 December 2002
Pennie Marchetti, Family Physician Stow Primary Care, 4465 Darrow Road, Stow, Ohio 44224 Send response to journal: Re: No Place for Politics	The problem with medical journals entering into politics is that it subjects you to the accusation of bias. Your own editorial reveals this in its reference to a "phoney war." That's a cheap shot, and not worthy of an editor of one of the most prestigious medical journals in the world. You may disagree with your government's stance on Iraq, but that disagreement has no place in a medical journal. Cataloging the health effects of weapons of mass destruction, or debating (honestly and fairly) the merits and demerits of smallpox vaccine are appropriate for the pages of the journal. It isn't appropriate, however, for you to use your influential position to trumpet your own political biases. Continuing to do so only discredits the journal. How will we know you haven't rejected papers simply because their findings disagree with your politics? Competing interests:   None declared
You just can´t 23 December 2002
Julian A Lopez, Ob gyn. Student of Doctorate Universidad de Salamanca (Spain) Send response to journal: Re: You just can´t	The dilemma, reminds me of the long discussion in Philosophy about the judgement of the facts. Science is all about facts, and one must try to hold with the facts without any value´s judgement. But nowadays we just realized that this goal, if it´s not impossible, it´s real difficult to achieve. Every fact has a value and in the way of we think, these two "facts" are really difficult to be separated. In this globalized word, it´s imposible that any scientific work of importance, wouldn´t have any political significance. I think that the place of a journal should be to be impartial and allows the exchange of ideas, wherever they come from, and promoting that everyone makes his own conclusions. That´s the new ethics, we must realize that the plurality in the world exits, and we should allow it to take place, being respectful of others' ideas, includes to have respect of the ideas of even those that don´t tolerate our own. That´s the form of getting closest to the thruth, which everyone by the way, has his own. Competing interests:   None declared
Health and politics- a conjoint twin! 24 December 2002
Sachin Maiti, Research Registrar-Obst & Gynae Wirral Hospital NHS Trust, Arrowe Park Road, Upton, Wirral, Merseyside, CH49 5PE Send response to journal: Re: Health and politics- a conjoint twin!	Dear Sir, I support Virchow's comments in your interesting article 'How political should a general medical journal be?'.World Health Organisation defines health as “Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity.” Though a medical journal(especially with international appeal) should focus on the unbiased scientific research based data, it is extremely difficult and unethical to ignore political issues affecting the global public health directly and indirectly. Competing interests:   None declared
Evidence based politics? 24 December 2002
Adam Jacobs, Director Dianthus Medical Limited, London SW19 3TZ Send response to journal: Re: Evidence based politics?	I agree entirely with Delamothe that it is very difficult to separate politics and health, and I believe that it is perfectly legitimate for journals such as the BMJ to print articles that discuss political issues. Since the BMJ has done such a good job of promoting evidence based medicine, perhaps the most important challenge for the BMJ in discussing the politics of health is to set an agenda of evidence based politics. It seems to me that politicians too often make policies on the basis of personal whims and dogma, rather than evidence. If the BMJ could shame politicians into introducing policies only if they can be justified by evidence, it will truly have done a good job. Competing interests:   None declared
Plurality is more important! 24 December 2002
Louis D Brassey, Primary Care Doctor Hampstead Group Practice, 75 Fleet Road, London NW3 2QU Send response to journal: Re: Plurality is more important!	More or less "political"? As the BMJ always follows the "liberal" consensus, perhaps espousal of the same views are best left to better-written newspapers and journals such as the Guardian, the Independent and the New Statesman? Competing interests:   None declared
Health as a political issue 24 December 2002
patrick john chuter, gp stirchley medical practice,TF3 1FB Send response to journal: Re: Health as a political issue	Many of the greatest improvements in health have occurred as a result of (sometimes compulsory) public health issues; examples include smallpox vaccination, clean air acts, removal of the Broad street pump handle, the NHS. Issues such as child obesity, obesity related diabetes, smoking and alcohol consumption can only be tackle successfully as national public health issues. Internationally, famine, corrupt political institutions, and war can be influenced through political pressure Competing interests:   None declared
war against Iraq 24 December 2002
Lindsay S Ward, GP partner Stirchley HC, Sandino Rd, Telford TF31FB Send response to journal: Re: war against Iraq	I feel that it's vital the BMJ helps its readers assess the potential risks (in medical and humanitarian terms) of a war, as it would for other issues relating to public health. Most public health issues have a political dimension but remain a very suitable subject for a journal such as the BMJ. In this case we do have an (albeit slim) opportunity to avert a humanitarian disaster by debating the issues openly and letting the politicians know our views. I personally read the BMJ avidly and rely on it for a source of (as far as possible) unbiased information. I would be disappointed if the decision was made to avoid issues such as this because of the politics. Competing interests:   None declared
Politics is unavoidable 24 December 2002
Michael Peel, Doctor medical foundation, london, nw5 3ej Send response to journal: Re: Politics is unavoidable	Delamothe asks “How political should a general medical journal be?” (1) The answer is that it cannot avoid politics, but it must be impartial in its information. Decisions, particularly about healthcare, are inevitably political. We make choices based on our political beliefs. To be “apolitical” simply means accepting the status quo by default. It is interesting note that there were few (if any) complaints about giving coverage to the healthcare manifestos of the main political parties prior to a British general election. The complaints occur when articles appear that are considered to support one side in a conflict. With other writers, he describes four futures for medical publishing, (2) which ignored the fact that different journals are read for different purposes. Lisa may well be typical of experts exchanging information about their specific areas of interest, but I would hope that she and her colleagues still keep in touch with the general issues implied in the first title. The strength (for me) of the BMJ is that is keeps specialists in touch with mainstream medical issues, some of which provoke interesting discussions amongst specialists. This must include health aspects of “political” issues that are not covered in the mainstream media.. I would assume that the BMJ, for all its content, firsts asks the question “Is this accurate?” then “Is this relevant?”, then “Does this help to keep the journal balanced in the medium term?” The same standards should apply for all content. An item like the Kuwaiti babies that is published in good faith should be retracted with the same force as research that turns out to be fraudulent. To say that Iraq had used chemical weapons was true. That they were likely to do so again was speculation, and perhaps better avoided (although to say I am likely to be hit by a car if I run over a busy road is still true even if I get to the other side unscathed). If the BMJ receives accurate, relevant information from unbiased sources for which there is space, it should be published. Conflict of interest statements should include political as well as financial conflicts. If data are published about injury patterns in one side of a conflict, there is nothing to stop a further paper on healthcare responses to injuries on both sides. In an ideal world, politics would be an evidence-based activity, and The Sun gives confidence intervals for its statistics, we rely on studies published by journals such as the BMJ to know what is happening in the world. They are useless if they are perceived as being biased. In other topics you commission an editorial or a commentary to put a paper in perspective. Treat “political” topics as you would any other. Dr Michael Peel The opinions in this letter are my own, and not necessarily those of any organisation with which I am associated. 1 Delamothe T. How political should a general medical journal be? BMJ 2002;325:1431-2 2 Abbasi K et al. Four futures for scientific and medical publishing. BMJ 2002;325:1472-5 Competing interests:   I am employed by the Medical Foundation for the Care of Victims of Torture in London. Some of my work might be considered “political”. I am irritated by journals that force me to go to a library to access information because they want to charge me for the online version.
Politics in a general medical journal 24 December 2002
Morris Doublet-Stewart, GP Principal Grasmere Street Health Centre, Leigh, Lancs. WN7 1XB Send response to journal: Re: Politics in a general medical journal	No politics in a general medical journal? This would be the thin edge of the wedge and next thing you know there would be a ban on art, history, humour... Morris Doublet-Stewart. Competing interests:   None declared
Medicine and Politics are Synonymous 25 December 2002
Ron Law, Beyond Alternative Solution Middle Earth Send response to journal: Re: Medicine and Politics are Synonymous	Comments on this eitorial such as "The problem with medical journals entering into politics is that it subjects you to the accusation of bias" forgets the simple fact that modern medicine exists in its priviledged position in society simply because of politics. The divide between complementary medicine and legal mediconly exists because of politics. When I travel, I often take some time out to look at professional assocations buildings -- they are invariably within a stones throw of parliament buildings providing prima facie evidence of the close bond that exists between the 'pofessions' and politics. Competing interests:   None declared
A Medical Journal should be "medical" 26 December 2002
ravi prashant, staff grade in clinical oncology University Hospitals Coventry and Warwickshire, cv2 2dx Send response to journal: Re: A Medical Journal should be "medical"	I would disagree with the view that political issues should find more space in a medical journal. Even in a society like Britain where Government policies can adversely affect health resource allocation, a journal's content when sidetracked by political issues dilutes the proffessionalism that earns any proffession its respect. There should be other fora to discuss the health implications of political decisions- like BMA meetings and political issues when relevant can be printed in its newsletters.The magazine , I feel, should distance itself from political gossip and concentrate on health issues and focus on public health information and epidemiology which will otherwise be neglected because its so easy to start the blame game. Lets remind ourselves that people are really not interested in what their doctor thinks about political issues than he or she is about how quickly their problems can be solved. Competing interests:   None declared
More political Medicine. 27 December 2002
Maysara H Bahja, SHO In Neonatal Northwick Park Hospital Send response to journal: Re: More political Medicine.	Sir How we can separate our and our patient’s health from what’s going on around us? When you treat for instance a child with infectious disease or traumas and pullet injuries or leukaemia, does it make since to know whether this child comes from Africa, North Sri Lanka, the Palestinian occupied Land or even from south Iraq where the uranium was used in the first Gulf war against the Iraqis? As all of us know that doctors do not even have time for there own life families as well as they do not have time to read the enormous amount of political newspaper and magazines or to watch the news regularly. Therefore I believe it’s very important for us to have a feedback about the health disasters and medical conditions which caused by politics and politicians rather than a pug. Competing interests:   None declared
Politics pervades everything 27 December 2002
Bert P. van Leeuwen, MD in Drug Safety Dept. Pharm. industry Send response to journal: Re: Politics pervades everything	As the origin of the word politics suggests, it touches on every apect of life, including medicine/health. This does not mean that that a medical journal has to be political. But whenever a political decision has medical consequences, this should be recognised and published. The WTC- attack did not have direct medical consequences, while the decision of the British government to consider the threat with biological weapons as realistic, did/does. As long as this is correctly reported ("as the government perceives this threat to be real, it bought small pox-vaccine") it should be in the journal. I think the BMJ could be a little less stringent in avoiding the border politics-medicine. Competing interests:   None declared
How Political Should a General medical Journal Be? 27 December 2002
Tony M Hirst, GP Darwen Health Centre BB3 0DA Send response to journal: Re: How Political Should a General medical Journal Be?	Dear Sir, I write in response to this weeks editorial (How political should a general medical journal be?; Tony Delamothe; BMJ 2002; 325: 1431-1432). I do not believe that there is a clear dividing line between politics and medicine. However it is the job of medical journals like the BMJ to use the power of scientific debate and scientific evidence to inform and direct the politicians whose job it is to convert the science into policy and law. The science is paramount and must not be compromised by emotive argument. Take for instance a hypothetical discussion amongst the members of an NHS organisation on the merits of fluoridation of the water supply. There is compelling scientific evidence that fluoridation is both safe and cost effective at reducing tooth decay. The area where this hypothetical discussion takes place has higher than average levels of decay in its population. The clinicians on the board are all convinced by the scientific argument. However the non-clinical members of the board are not swayed by this argument. They are influenced by the politics of the situation. They point out the findings of various pressure groups who believe that fluoridation is dangerous and a breach of the rights of the individual to choose. This evidence is poor scientifically and selective. The board feel powerless to influence the situation and are not able to take any action. I believe that it is in these sort of situations that medical journals such as the BMJ must become involved in the political debate but only as the upholders of scientific argument. It is our job as scientists to convince the politicians and the public at large that interventions such as water fluoridation work and are desirable. Tony Hirst Competing interests:   None declared
Confused?! 27 December 2002
Vassilis I Dimarelos, medical student Thessaloniki, Hellas (GR), 41500 Send response to journal: Re: Confused?!	I voted Less than now, but HOW exactly do you define political envolvement? If you publish an article on Palestinians' health is considered political by Israelis no matter how "medically" is written. If you keep telling us about the Iraq's nuclear risk, you are forgetting USA's nuclears and you talk politics again. Personally, I don't feel safe as long as there are nuclear weapons out there and if you ask me I don't care if they are controlled by Americans or Arabs. However, I do care that BMJ promotes ethics and world -not American's or somebody's- justice. Thus, I suggest you keep your editing/publishing ethics away from politics and act according to well-known medical tradition. I think that poll results just show how confused readers are about the effect politics has on health issues and how this relationship is expressed through BMJ. Competing interests:   None declared
Why BMJ should be more political 29 December 2002
Allan J. Wilke, Assistant Professor Medical College of Ohio, 43614 Send response to journal: Re: Why BMJ should be more political	Medicine, medical science, and medical care do not exist in a vacuum. I didn't become a doctor solely because I thought it would be an interesting lifework. People need care. Getting that care will require changing the political system. Politics is all about how the pie is sliced. Competing interests:   None declared
We Cannot be Apolitical 29 December 2002
Guillermo Arturo Herrera Taracena, Medical Epidemiologist Ozvantan Sokak 17/2, Teras Eveler, Yukari Ayranci, Ankara, Turkey. Send response to journal: Re: We Cannot be Apolitical	Dear Editor, Every medical article published in any scientific or non-scientific journal is the culmination of a long journey that started from a political decision: devoting resources to medical care and research. Is there anything in life that can be considered non-political? I am a person who believes that everything we do is political or has political undertones and ramifications. If we come to accept this premise, we can then commit ourselves to open and honest political debate. There is nothing to fear about being political, as long as we are prepared to accept the consequences and deal with the criticism of many who strongly believe that a person or a journal, specially a scientific medical journal, should be apolitical. The BMJ’s political stand is the “clinical, scientific, social, politic, and economic factors affecting health.” (1) I think this “political platform” makes the BMJ a responsible medical journal. What a reader like myself expects from a journal like the BMJ is that it maintains a balance in terms of the views expressed and scientific articles published. If there is controversy, it has to be stated and if there are conflicting views on the same topic, they have to be given equal time and coverage. That is to be politically responsible and so far, the BMJ has shown to be so. What a journal like the BMJ cannot afford is to become politicized by allowing only one point of view to be expressed. For example, publishing research dealing on the type of injuries suffered by Palestinians and not publishing research on the same topic among Israelis. Also, the journal cannot afford to politicize the argument and carry on publishing a long series of articles dealing solely with September 11 and its aftermath. The reason: September 11 is an end point event on a series of end point events that are transforming our world. To fully understand September 11th, we have to analyze the unequal relationship and existing misunderstanding between the West and Islam and vice versa; this implies dealing with historical, political, and cultural facts and events. Is the BMJ or any other medical journal the right place to deal with September 11 and bridge the mistrust and misunderstanding between the west and Islam? Certainly, I would not pick up the BMJ or the Lancet as my first source of reference or information regarding these issues. However, I do agree with the decision of marking the event by publishing articles on ”the victims account” as September 11 has profound repercussions on how we see ourselves as human beings. How much space should be devoted to politics? As much as it is necessary as long as you keep open to honest political debate and do not become politicized. 1. About the BMJ. htpp://bmj.com/aboutsite/aboutbmj.shtml Competing interests:   None declared
Re: Evidence based politics? 29 December 2002
Marco Caputo, Azienda Ospedaliera 37126 Verona, Italy Send response to journal: Re: Re: Evidence based politics?	Sir, it would be great an EBP! But completely unrealistic. A Logician would label it as a "contradictio in adjecto". A medical journal cannot avoid politics: just try keeping political parties and their dogmata out of the business. Competing interests:   None declared
Same opinions as last years 29 December 2002
Regina B Stroebele, Do I really need to mention? D- 81677 MUNICH Send response to journal: Re: Same opinions as last years	I appreciate your contributions to transparency and your courage in reporting also unfavourable things about U.K.'s doctors, NHS and developments in foreign countries. Competing interests:   None declared
Ethics of Medical practice under threat 29 December 2002
Nasim Mahmood, Staff Grade GOS Children's Hospital, London, -- Send response to journal: Re: Ethics of Medical practice under threat	Since 9/11,many things have changed perhaps forver. Words have changed the meaning they used to carry. Liberty, free expression, freedom and human rights perhaps alwasys only existed in the (civilized) West and USA. The poor of third world did not afford these luxuries. Still at least some professions, medical being at the top, held the flag of humanity. Patients were treated regardless of their faith, color, religion and practices. However since 9/11 doctors in Pakistan are feeling a different type of heat from the worriors of anti-terrorist war. FBI with Pakistani inteligence agencies have carried out series of operations targeted at doctors in Pakistan. Usual pretext is link with Taleban and Al-Qaeda. Gold standard proof is a visit to Taleban era Afghanistan. An eminent Orthopedic Surgeon with a (special interest in spinal surgery: a rarity in Pakistan) Dr Aamir Aziz has been abducted by the inteligence agencies at the behest of American FBI. Reason: he might have treated Taleban and Al- Qaeda activists. It was only after rare intervention by the Lahore High Court that forced the agencies to produce or free him after weeks of detention. He was not charged at any stage and no proof what so ever has been made public. Recently, an other Dr Ahmad Khawaja (aged 70) was arrested along with five other family members for alleged connections. While the world sees the ruins of Kabul & Afghanistan. The plight of Afghans in term of lack of basic medical facilities is grossly under reported. In view of the first hand knowledge that many Pakistani Doctors had, many had tried to work through NGOs and even at personal level, to do what ever can be done. Pakistani nation has done that for last 30 years to help millions of Afghan refugees. The sudden change in international climate has made it almost impossible for any voluntary work to help needy Afghans. A basic principal of helping the human beings in need is being erodded by a powerful nation. Pakistan Medical Asociation has protested to support its members who have been harrassed for paast treatment of Taleban cum Al-Qaeda activists. I remember that GPs in Britain rejected proposals by Home Office to make it necessary for the GPs to report to Police about GP contacts with illegal immigrants. This was based on principles of confidentiality, doctor patient relationship and basic right for treatment at the time of need. Will it be too political to ask the world medical community to stand up and protect this universal privilage that a doctor be free to treat who so ever turns up at his door step and the doctor not be quized about the potential crimes of their "patients". Let us not turn a blind eye to the suffering of humanity in Afghanistan, where one in ten families have lost a member in the destruction started by the Soviet Invasion. Let not the healers be made to suffer for healing the injured bodies and souls. Competing interests:   Author is a Medical Gradute from Pakistan and has had no "terrorist" links.
Politics and Health 30 December 2002
John G McGough, GP Aldeburgh, IP15 5EG Send response to journal: Re: Politics and Health	I read Tony Delamothe’s editorial about Medicine and Politics on my 59th birthday, looking forward with steadily decreasing willingness to another 6 years with the National Health Service as a GP. Yet why should that be when the NHS is something that I have always so fervently believed in, something that kept me in the UK when much more lucrative work beckoned from overseas, for I have always felt much more emotionally comfortable in a system where my patients would get the help they needed (eventually) irrespective of their ability to pay for it, and where the advice and the treatments I gave to my patients did not directly determine my income. I believe that all private health care systems are, albeit sometimes to a small degree, ultimately corrupting to doctors. I have heard colleagues overseas justifying on medical grounds the excessive investigations and treatments that they appear to be inflicting on their patients, when I see with my economically NHS-trained eyes a system in which the doctor gains financially and the patient loses by being the pawn of a situation where excessive investigation and treatment are driven both by the fear of losing a patient, and hence the income from that patient, and the fear of litigation. I once had an American lawyer friend tell me that he would not like to be treated by a doctor whose income did not depend on my friend. I would much prefer to be treated by a doctor who could make decisions about my health and my future unencumbered by fears of losing my trade. So how does that lead back to politics? I fear that in Britain the NHS has become a tool in the constant conflict between the parties in this country in their quest for re-election. That the NHS is (or at least was before the manager explosion) an extraordinarily efficient way of distributing health care in a country seems to pass them by, as does the fact that virtually all those countries with private health care systems spend a considerably greater proportion of their Gross National Product on health than the UK does. If the UK were to proceed to a health system in which part of the cost was funded privately I can see two consequences. The first is of significance to politicians as they might then be enabled to reduce taxes, implying to the electorate that something in life would be cheaper for them. The second is the more realistic one that the people of this country would ultimately end up paying more overall for their health care, for the real cost of health care is the cost to the government plus the cost to individuals, ultimately the proportion of the GNP that is spent on health however resourced. Like Tony Delamothe, I no longer trust politicians. I have heard them lie about matters concerning the health service about which I have knowledge. I perceive them as men and women who have become so convinced of their own right that they no longer represent the people who elected them. Should a Medical Journal become involved in political matters? Certainly. Competing interests:   None declared
A brew of health and politics 30 December 2002
Max Price, Editor - UCM USA Send response to journal: Re: A brew of health and politics	Health and politics are intertwined. As your government in the United Kingdom seems to influence the healthcare structure, it is therefore important that healthcare staff should be involved in decision making. We both know that over the seas and in the land of cream teas over in the UK, politicians are the same breed - they smile nicely for the cameras and are not seen to do much else. It is for the health professionals to speak out to these politicians to enable a mechanism for healthcare improvement. This is where the role of the BMJ comes into play. It should be used as a tool to voice the opinions of doctors and other health professionals who are able to influence political decisions - for the sake of the consumer. Max Price Editor www.undercovermedicine.com Competing interests:   None declared
Politics, health and justice 31 December 2002
Colin D Butler, Post doctoral fellow National Centre for Epidemiology & Population Health, Australian National University, Australia 0200 Send response to journal: Re: Politics, health and justice	I support your editorial, and the point made by several respondents, that to try to ignore politics is itself deeply political, because it allows other views to go unchallenged. I also believe that ethics and truth are moving targets, bias and error are inevitable, and objectivity is impossible. Because we can’t be certain of the right path your pages should reflect a diversity of opinion. But perhaps the clearest bias of a journal concerned with health should be towards the poorest of society, not only because they usually have the lowest life expectancy but because they are also likely to have the weakest voice (1). Clearly, health (generally) is embedded in social circumstances, and that relates not only to the division, but to the size of the pie. As well as Rudolf Virchow (2) two other outstanding figures in public health explicitly made the connection between politics and health. Geoffrey Rose wrote "medicine, health and politics cannot be kept apart, and they should not be kept apart" (3). Jonathan Mann lamented “To ensure conditions in which people can be healthy we must work to change the underlying societal conditions. However, public health has rarely been able to go beyond pointing to these larger issues, such as poverty, economic globalisation, and lack of political will” (4). Mann would certainly have voted for more explicit discussion of politics. In my opinion, a deeply ideological and political debate rages in the world, with enormous consequences to human health and well-being. On one side are forces that are (more or less) happy to keep the poor in the South in (more or less) perpetual poverty and disease, because this is seen as the best way of ensuring prosperity in the (increasingly) fortified North. The consequences of the first view include the runaway epidemic of HIV/AIDS, famine in part caused by the loss of farming expertise as a whole generation of farmers sicken and die, and a persistent unwillingness by wealthy countries to keep their numerous promises for a fairer world, whether these relate to reducing hunger, funding the Global Fund to Fight AIDS, Tuberculosis, and Malaria, or eliminating nuclear weapons. On the other side is a comparatively disorganised bunch of egalitarians. These people lament the extent of global inequality, worry about the future, and look to publications such as the BMJ and the Guardian for support. The influence of egalitarians may seem weak (except perhaps in the early years after WWII (5) but imagine the world without them! There is an opportunity to narrow this ideological divide. The genie of technology and information is out of the bottle. Globalisation has drawn us so close together that the welfare of the North is no longer best assured by maintaining misery in the South. Convergence of these two ideologies may yet save us from a future riven by hatred, revenge and the perennial fear of terrorism (5). 1. Chambers, R. 1997. Whose Reality Counts? Putting the First Last. Intermediate Technology Development Group, London. 2. Eisenberg, L. Rudolf Ludwig Karl Virchow, where are you now that we need you? Am. J. Med. 1984 77, 524-32. 3. Mann, JM. Leadership is a global issue. 1997 Lancet 350 (supplement iii), 23. 4. Rose, G. Reflections on changing times. 1990 BMJ 301, 683-7. 5. Butler, CD. Inequality, global change and the sustainability of civilisation Glob. Change Hum. Hlth 2000 1: 156-72. http://www.kluweronline.com/issn/1389-5702 Competing interests:   I am the co-founder of an aid organisation (Benevolent Organisation for Development, Health & Insight [BODHI]).
Connections 2 January 2003
Pirkko Kiviluoto, Head of Development Cooperation Family Federation of Finland Send response to journal: Re: Connections	Dear BMJ, You are the journal that connects me, who lives in a country far from everywhere, to the world. As a medical person, it is easy to explore the world from the pont of view of BMJ. In Finland, we have no journal like BMJ, our medical journals are strictly medical, with some local political additions, mainly just those that are related to professional concerns. I find BMJ very interesting and essential to my personal work, which is international. I deal with promoting of sexual and reproductive health and rights. I am also thankful to the Finnish medical industry, that supports financially the access of Finnish physicians to BMJ. Thank you very much indeed. I am happy to find out that most readers who have voted also welcome BMJs political and wider aspects as necessary and interesting. best regards Pirkko Kiviluoto, MD Competing interests:   None declared
Medical Rubbish.com 3 January 2003
Derek L Connolly, Consultant Cardiologist and Honorary Senior Clinical Lecturer Sandwell and West Birmingham Hospitals NHS Trust, B71 4HJ Send response to journal: Re: Medical Rubbish.com	Dear Sir, I read with interest your Christmas issue's excellent lead article by Tony Delmothe, web editor of the BMJ on "How political should a medical journal be?"1 I also noted your current persuasive advertising campaign that states that if you internet search Google for "medical journal" then BMJ.com tops the list. Interstingly, when I typed in "medical rubbish" into Google, the first link suggested was "BMJ-Editor". Life is not fair. 1 Delmothe T. How political should a general medical journal be? BMJ 2002;325;1431-2 Competing interests:   None declared
ORGAN OR FORUM ? 10 January 2003
john s hyslop, con. RCHT TR1 3LJ Send response to journal: Re: ORGAN OR FORUM ?	THE BMJ SHOULD REFLECT, AND GIVE VOICE, POTENCY TO, BRITISH MEDICAL OPINION. IT IS NOT AN ORGAN OF THE STATE OR ESTABLISHMENT. IT IS RIGHTLY LEAD BY OUR PEERS, REPRODUCING OUR CURRENT PARADIGM TO THE WORLD. LONG MAY IT BE SO, BE IT THE SCIENCE, OR THE ARTISTRY OF OUR MEDICINE. THE REGULAR REFLECTION IS SOUND NAVEL GAZING. THE DOLLAR WORLD MAY BE DOMINATED BY WEAPONS OF MASS DESTRUCTION, BUT FOR US LIFE GOES ON. I SUSPECT WE HAVE LITTLE TIME FOR THAT NARROW CONCERN BECAUSE WE HAVE NOT HAD TO COME TO LIVE WITH THE KNOWLEDGE THAT OUR NATION HAS USED THE A BOMB,AND AIR-FUEL DEVICES, PERHAPS THIS IS A RITE OF PASSAGE FOR THE U.S.A., ALL BE IT VISITED UPON US ALL. Competing interests:   None declared
Health is nothing but complete physical, mental, social, economical, political & moral wellbeing 22 January 2003
Ioannis D Dimoliatis, Assistant Professor of Hygiene & Epidemiology University of Ioannina, Greece, 45110 Send response to journal: Re: Health is nothing but complete physical, mental, social, economical, political & moral wellbeing	The representative of a big state of European Union, in the session of Ministers of Health that recently decided measures to prohibit smoking, said: "Ethics is important. Trade is more important". Please note: the Minister of Health! Not the Minister of Trade, or Agriculture or Finance or whatever... Fortunately the majority of his colleagues had the opposite opinion. Where did this "minister" of Health draw the courage to act, within the System of Health, as a minister of trade or industry (rather tobacco industry) from? From that the medical journals are "not political", I suppose… Don’t do politics; we are doctors! The time for Evidence-Based-Policy (EBP) has come. But, please, Health-EBP! Not Trade-EBP… Why s/he even could imagine s/he could be based on trade-EBP? Because s/he had no fear to face medical journals judging him/her, I suppose… Don’t do politics; we are doctors! Maybe governments have abolished the Ministries of Health. That’s why medical journals have disappear politics from their pages… Don’t do politics; we are doctors! Through our (voted) governments, WE, the "civilized" western society, prepare a war (why? bmj 2003;326:171!) against a developing country to throw it back to undeveloped era, if not to the era of cave dwelling. After that, we, the doctors of civilized society, will treat wounded and injured and Gulf-syndrome... Alas we Secretaries and Pharisees, hypocrites! Don’t do politics; we are doctors! A mass wave of Iraqi refugees will be another outcome of the “coming soon” war. They will be spread around the world, within the “first” civilized one as well. Then, we, the doctors, will offer our salary for food, clothes, shelter etc etc for the refugees, to prevent illness! Don’t do politics; we are doctors! It is not our duty to prevent war; [1, 2] it is politics. "We do not consider the one who does not participate in politics neutral, but useless", said Pericles, the leader of the only real democracy all over the world, the ancient Greek Athenian (Thucydides). We, the doctors, are not participants of democracy… Don’t do politics; we are doctors! We are not citizens of the world! We are citizens of the "civilized countries". We do not think globally and act locally. We think locally and act globally… Don’t do politics; we are doctors! we do not think socially, we think individually... CONCLUSION: we have to reverse Virchow saying that "politics is nothing but medicine on a grand scale". This is half the truth. The opposite is twice as true. Medicine is nothing but politics on a (perhaps) small scale, but surely health is nothing but politics on a global (i.e. much larger than grand) scale. Health is nothing but a state of complete physical, mental, and social wellbeing, plus economical, political and moral wellbeing –yes! we must expand WHO’s definition to include all human aspects, the time has come. World Health Organization? It is a political entity, isn’t it? Don’t do politics; we are doctors! No one would be more stupid than teachers, if doctors did not exist, says a Greek proverb… [1] World Health Organization- Europe. Freedom from the fear of war. In: Targets for health for all. Copenhagen 1985: 13-15 (ISBN 9289010347). [2] Ian Roberts. The second gasoline war and how we can prevent the third. BMJ 2003;326:171 Competing interests:   As a citizen of the world perhaps I have competing interests with "locally thinkers - globally actors"
Refine the question 11 April 2003
David T Parry, Lecturer AUT, Wellesley Street, Auckland, New Zealand Send response to journal: Re: Refine the question	Many correspondents have supported the inclusion of 'political' articles, however all of these seem to have included an unstated codecil - namely that the political statements in question are ones that they agree with. Surely the test should be whether political statements that you disagree with are included in the BMJ. Personally I dread the thought of guest editorials by Donald Rumsfeld, Yassar Arafat et. al. justifying why one particular injury is justified and another is not, and there seems no shortage of spaces for political discussion on the web or in print. Competing interests:   None declared
Iranian Twins - The Ethical Questions 12 July 2003
ze david, property investing singapore, Stanley, lisa Send response to journal: Re: Iranian Twins - The Ethical Questions	For alternative viewpoints on the death sentence upon the twins, kindly refer to this website in singapore!......http://forums.delphiforums.com/n/mb/message.asp?webtag=sammyboymod&msg=31302.98 Never trust the singapore or the iranian controlled mass media! The case is far from that reported in the propaganda machines of these two countries. Are ethics violated ? Competing interests:   Attention to the twins death saga in sngapore.