War of words over IraqBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7382.230 (Published 25 January 2003) Cite this as: BMJ 2003;326:230
Should medical journals have a role in the debate over military intervention?
The possibility of a war against Iraq currently has some medical editors at each other's throats. What is at issue, however, is not so much the potential conflict itself, but whether or not medical journals should contribute to the debate over military intervention.
This war of words has broken out among members of the World Association of Medical Editors or WAME (http://www.wame.org/), which is open to the editors of peer reviewed medical journals worldwide. One of WAME's founding principles was that member journals should inform readers “about non-clinical aspects of medicine and public health including … political issues.” This does not mean, however, that editors agree on how far the potentially devastating humanitarian consequences of an Iraqi war is their business.
Mark Graczynski, editor of the Medical Science Monitor, an online journal produced from New York, is one of many contributors to the debate raging on WAME's online discussion forum. He believes that medical journals have no place meddling in the Iraq question.
“It's all very well looking at the public health implications of war, but people can't help but stray into more general political issues. It's human nature. Once you start debating these issues, where do you stop? For example, people have been commenting that the US only want to get their hands on Iraqi oil—that's a political issue. It is misplaced in medical forums,” he said.
He was referring to a message posted by Ian Roberts, professor of public health at the London School of Hygiene and Tropical Medicine, accusing a Lancet editorial (2003;361:95) of buying into the US position that Saddam Hussein is harbouring weapons of mass destruction.
To Mr Graczynski, Professor Roberts' comments were nothing short of abuse of a medical listserve to spread political propaganda. It highlighted the dangers of medical journals straying off their patch. Even seemingly innocent comment pieces, such as the Lancet's, which considered the type of humanitarian assistance that would be required in a war with weapons of mass destruction, were open to interpretation, he said.
“Everybody has a right to express their political concerns, but they should do so in the appropriate forums, such as Newsweek,” said Mr Graczynski. “It's like buying Cosmopolitan—you might find a recipe for cookies, but you don't expect them to enter into a debate about war. It hasn't been designed for that purpose. And that's how I feel about medical journals.”
In the opposite corner is Barry Pless, editor of the Canadian journal Injury Prevention and WAME member. “I can't believe it: how can editors of medical journals … MEDICAL [his caps] journals not accept that war has something to do with what they are all about!!” he wrote on the WAME forum. “I understand the concern about politics, but if politics are on the pathway to deaths from injury, it seems little different than a similar concern about examining the implications of poverty and disease or social inequality and disease, both of which have political dimensions and which have not elicited this sort of objection,” he added.
Speaking to the BMJ, Mr Pless said that “nothing I have read since changes my opinion, the topic is certainly one that belongs in the journals and on listserves like WAME.”
Lancet editor Richard Horton was clear that his journal would be at the centre of debate about the whys and wherefores of Western intervention in Iraq. “You can't treat war any differently from other risks to health,” he told the BMJ. “We get a mixed response from readers whenever we publish anything political, such as on the Middle East conflict. There has been very strong criticism about a medical journal making an incursion into the political arena, while others support the point of view that we have an essential part to play. You have an issue like Iraq that people debate in an orthodox way and our job is to put a fresh perspective on that orthodoxy. If you look at it in a different way maybe you will get a different answer. That is all we claim to be doing.”
Even the World Health Organization now listed war as a risk factor to health, he said. “Each year it releases figures for casualties of world conflicts. So all we are doing is simply developing a much wider debate in the health community about the serious implications of war on public health.”
When the BMJ asked readers in the Christmas issue how political a general medical journal should be 45% (out of 366 respondents) said that the BMJ should devote “more” or “much more” space to political issues. Around a third (31%) thought the BMJ had the current mix right. That verdict may soon be tested as the build-up to war intensifies.
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