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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Unnecessary nudity
- Caroline Richmond (22 April 2005)
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Written consent for publishing pictures in a medical journal: patients don't always ring twice
- Jorge Soler-González, M.C. Ruiz Magaz (25 April 2005)
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double standards
- Robert D H Boyd (25 April 2005)
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Sorry
- Trish Groves (25 April 2005)
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Re: double standards
- James W. Gerrard (25 April 2005)
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Re: Sorry
- JK Anand (26 April 2005)
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Re: Written consent for publishing pictures in a medical journal: patients don't always ring twice
- Antonio García (27 April 2005)
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Re: Sorry
- Mark Struthers (28 April 2005)
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Caroline Richmond, Obituary writer, medical journalist SW3 5AQ
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Now that the BMJ and the medical community has covered the matter of patient consent to publication of photographs, can it now address the matter of unnecessary nudity? As an example, I have on my shelf Essential Haematoloogy by Hoffbrand, Pettit and Moss ((4th edition, Blackwell 2001). It contains a photograph of a girl aged about 10 with a portable infusion. The pump is strapped to her thigh and the infusion enters her body to the side of her navel. She is stark naked. The photo is cropped, removing the top half of her face. She would probably be recognisable to anyone who knew her. The picture would be just as informative if she were wearing briefs. Having once been ten years old myself, I think it quite probable she felt mortified while posing for the picture. Competing interests: None declared |
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Jorge Soler-González, MD CS Rambla de Ferran. Lleida. Spain., M.C. Ruiz Magaz
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Dear Editor, We have read with interest your editorial and we agree that the consent for publication of images is a necessary legal requirement (1). Nevertheless, we think that the consent made by a journal is not always the better option. We frequently take photographs in our consulting room because we know that they have a lot of applications (2). Publication is just one of them. Usually, when we take a photograph of a patient, we don’t know its final application in that moment. In the case that we use it as a publication illustration perhaps we won’t have the possibility to see the patient again to fill in the journal consent. In the consulting room, we have our own consent form and we use it as another bureaucracy document. We think that if this document is similar in content as yours (3,4) the journal should accept it for two main reasons. The fundamental one is that perhaps we will never have the opportunity to see again the patient to sign the consent when the journal asks us for it, even if the image is essential for that publication. The second reason is to allow photographs taken in countries where English is not spoken to be published in international journals. Our patients usually don’t know English, so they can’t sign a legal document without understanding it. In this way, we propose to biomedical journals that they are flexible by accepting different consent forms to theirs. We coordinate a medical digital image web named fotomedica (5), and like the BMJ, it is open to everybody for free. We supervise not to hang pictures with recognizable faces, and we always erase the name of the patient on the radiographies. Just sometimes we use image programs to improve the image. We recommend to obtain the consent form at the same time you take the photo, because the postman rings twice, but the patients don’t always. Yours sincerely, Soler-González J, MD, www.fotomedica.com webmaster
CS Rambla de Ferran, Lleida, Spain References: 1. Groves T, Croot J. Using pictures in the BMJ. BMJ 2005;330:916 2. Soler-González J, Martínez M, Riba D, Rodríguez-Rosich A. Authorization to use photography images in Primary Care Education. Aten Primaria. In press 2005. 3. BMJ. [homepage on the Internet]. Consent form. Available from: http://bmj.bmjjournals.com/collections/informed_consent/draft_f.shtml (accessed 22 Apr 2005) 4. The New England Journal of Medicine. [homepage on the Internet]. Release Form for Photographs of Identifiable Patients. Available from: http://authors.nejm.org/misc/patientid.pdf (accessed 22 Apr 2005) 5. Fotomedica.com [homepage on the Internet]. Lleida (Spain); [updated 2005 Apr 22; cited 2005 Apr 22]. Available from: http://www.fotomedica.com Competing interests: None declared |
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Robert D H Boyd, emeritus professor of paediatrics SK10 4NU
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Your leader, "Using Pictures", prompts me to a delayed complaint. You emphasise privacy and, in regard to pictures sourced from agencies, it is claimed that, if there is doubt an individual "could have given consent", the journal tries "to avoid images that might allow that person to be identified". Why then on page 271 of the 5th February issue was an agency shot of Harold Shipman's daughter Sarah, as a child, too young to have given consent but probably clearly recognisable, included? I,for one, was outraged. Sins of the father? yours sincerely, Robert Boyd Competing interests: None declared |
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Trish Groves, senior assistant editor, BMJ BMA House, London WC1H 9JR
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Having and publishing a policy on using images ethically opens us up to criticism each time we use pictures that may contravene that policy. We welcome such criticism because it will help us to follow our policy consistently. In February we posted rapid responses from two readers, Peter J Jurd and JK Anand, complaining about the photograph of Harold Shipman's daughter that Robert Boyd mentions in his response this week. That photograph appeared in the article Clare Dyer. GMC must protect patients says government minister. BMJ, Feb 2005; 330: 271. We apologise for any distress the publication of this photograph may have caused to Dr Shipman's family. We did not publish this picture on bmj.com. This picture was supplied by an agency. Our policy states clearly that we can't take responsibility for obtaining the consent of people in such images. Having said that, we should exercise judgment in choosing and using agency images, as our policy says, and we will aim to do better in future. Caroline Richmond complains about a photograph of a naked child in an old ABC book published by the BMJ Publishing Group. The child in this picture may have given consent to publication, but we did not at that time actively seek such consent, and so it's unlikely that she did so. We now regret our old, much looser policy that used to lead to the publication of such clinical pictures. We no longer publish identifiable clinical images in ABC series without patients' signed consent to such publication. Competing interests: I helped to formulate the BMJ's policy on publishing images |
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James W. Gerrard, GP Windmill Health Centre, Mill Green View, Leeds LS14 5JS
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Dear Editor, I agree with the reservations expressed regarding the stance of the BMJ on this issue and the apparent double-standard that the journal allows itself. I am not convinced of any real difference between patients and other individuals brought to our attention in the news section. Nor am I reassured that "Reputable picture agencies and other sources are unlikely to take the legal and financial risk of selling sensitive images without appropriate consent." (1) As a rather disturbing example of this there is a recent picture of a blood spattered Iraqi girl who "screams after her parents are killed by US soldiers" (2). I find it hard to believe that any meaningful consent was ever obtained from this unfortunate child or her dead parents. Either the BMJ has a duty of care to all of the individuals shown in its pages, or it doesn't. It should thus require written consent for all personal images, or for none at all. Yours sincerely, James Gerrard 1. Groves T, Croot J. Using pictures in the BMJ. BMJ 2005;330:916 2. Dyer O. UK and US governments must monitor Iraq casualties. BMJ 2005;330:557 Competing interests: None declared |
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JK Anand, Retired doctor N/A
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Ms Groves remembers the protests of Jurd (04-02-05) and myself (05-02 -05)(bmj.bmjjournals.com/cgi/eletters/330/7486/271) In my letter I asked the Acting Editor to justify the publication of the picture or to apologise to the two persons concerned. It has taken Ms Groves (or Dr Groves)over two months to issue the apology. I asked if the BMJ approves of such lapse in manners. The BMA remains silent. The Journal Committee remains silent. The fault lies basically with the BMA - it seems to approve of the idea of Groves and her department that the BMJ has to compete with "other media". The BMJ and the BMA need to decide whether the Journal should serve, first and foremost, the educational needs of doctors or, whether, it should become a tabloid. Education of the doctors does include listening to the views of the non-doctors on the way we practise medicine. Doctors do not, however, need to be titillated with irrelevant pictures (or "images"). JK Anand (retired doctor who remembers the times of Clegg) Competing interests: None declared |
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Antonio García, MD Centro de Salud (Cuba)
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We also hope that some day you will be able to publish our images with a Spanish consent form. Competing interests: None declared |
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Mark Struthers, GP Bedfordshire, mark.struthers@which.net
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Some of the correspondence following the editorial on “using pictures in the BMJ” is quite bizarre. Caroline Richmond, sometime obiturist to the BMJ, bemoaned the matter of unnecessary nudity in medical publications. She referred to the 4th edition of a text entitled ‘Essential Haematology’ published by Blackwell Science (UK). I have a copy of the 3rd edition (1993) by A.V. Hoffbrand and J.E. Pettit on my own bookshelf. On page 107 there is indeed a picture of a young girl with beta- thalassaemia major receiving a subcut infusion of desferrioxamine using a portable battery-driven pump. I agree with Ms Richmond that the nudity was unnecessary. However, in this instance, I fail to see the connection with the BMJ and its own culpability in publishing unnecessary nudity. That Trish Groves appears to accept the blame for some naked misdemeanour in an old ABC book published by the BMJ Publishing Group is most strange. Her mistake reminds me of an exchange of correspondence that took place over the gratuitous genital exposure by an elderly man in Minerva in October 2002. Richard Smith, the former BMJ editor, was categorical in saying that there would be “no return to the age of the fig leaf.” http://bmj.bmjjournals.com/cgi/eletters/325/7367/784#26083 Alas the cocksure editor was proved wrong. While ‘talking cock’, the fig leaf returned in very obvious fashion to the BMJ and that very same month. http://bmj.bmjjournals.com/cgi/content/full/325/7370/975/a The editorial eye needs to be kept very much on the ball, even if there are two or more balls to be juggled with. It seems to me that the editorial team at the BMJ still have some way to go in matters of judgement, consistency and common courtesy – pictorially as well as otherwise. Competing interests: None declared |
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