Skrabanek dedicated his life to generating scepticism

BMJ 1998; 317 doi: (Published 01 August 1998) Cite this as: BMJ 1998;317:351
  1. Simon Mills, General practitioner
  1. 27 John Dillon Street, Dublin 8, Republic of Ireland

    EDITOR—In their book Follies and Fallacies in Medicine Skrabanek and McCormick cited Mencken: “for every complex problem there is a solution that is simple, direct and wrong.”1 One of the authors, Petr Skrabanek, has been accused of being a consultant to the tobacco industry.2 These accusations have been dismissed as libel by those who worked with him, but as Skrabanek is dead he lacks any legal recourse.

    Skrabanek and McCormick's book does not mention cigarettes. With refreshing heterodoxy it castsa critical eye over medical complacency and received wisdom. The probing arguments within it are more persuasive than didactic. If there is a school that says that medicine should not be the subject for scepticism then it is a counter- productive and blinkered one. Elsewhere Skrabanek alludes to the definitive nature of the link between smoking and lung disease3—hardly evidence of a man hell bent on defending tobacco. His work is that of a man dedicated to thinking twice before embracing weak implications of medical research.

    To hail as gospel any document from a tobacco company seems strange. Those people who do so noware those who would be slow to accept this “leak” under any other circumstances. Are they damning the dead solely to further the war with tobacco? Furthermore, the critical faculties that Skrabanek hoped to inculcate are casualties of this row in the same way that Skrabanek's reputation is a casualty.

    “Conflicts of interest” do not preclude valid work. But scepticism about motives is not the same as flat rejection. Context is all. In the case of Skrabanek one has merely to set the particularagainst the general. On one hand is the accusation that he sought, for payment, to disarm smoking's critics. On the other is a man who dedicated his academic life to generating scepticism in more than one contentious arena. If he was paid with tobacco money then he was paid for doing what he did universally and, on balance, to great benefit. How many of us can say as much? He was a remarkable teacher and a clearer thinker than many who now believe innuendo rather than the evidence of alife lived well. He taught medical undergraduates to regard the doctor, not the patient, with a jaundiced eye. That would justify him being in the pay of far worse.

    There is another quotation from Mencken that springs to mind. “Puritanism. The haunting fear that someone, somewhere, may be happy.”4Conflict of interest? I was taught by Skrabanek.