Why nakedness is bad
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7478.0-g (Published 02 December 2004) Cite this as: BMJ 2004;329:0-g
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This week’s editorial on transparency raises some truly fascinating
dilemmas for the modern age of communication. On the one hand it would be
very reassuring to think that if we were all totally transparent that the
conclusions that we draw from the same evidence would be the same. This
assumption is generally true when the proposition is straightforward
although there are exceptions. If the proposition is less straightforward
there may be a variety of conclusions and some of these may be
contradictory. MMR would be an example.
I believe that the main source of this apparent contradiction stems
from the basic ideas of perception and cognition. We perceive and
understand the world around us based on experience that has been built up
over time. In many cases we draw on the perception and understanding of
others as a short cut to creating a sufficiently comprehensive library
that makes most of us independent functioning units.
Unfortunately, much of this experience may have been translated using
the perceptions and conclusions of others and therefore fails an important
test. It is not always accurate and we don’t always test it ourselves for
accuracy and consistency. For perception and understanding to result in
the same outcome it must be subjected to exactly the same processes and in
most circumstances this is not the case. For example the art of the
magician exploits these differences in a clever way.
The value of education is to make us critical in our approach and to
dissect the conclusions of others. Unfortunately, there are many and
various reasons why some people do not do this, perhaps from laziness but
also where the outcome might not suit the individual’s purpose. Genuine
disagreement between people who have no stake in the outcome of a debate
provides much needed succour to those who have either already made up
their minds or are trying to exploit the situation. Much of what is
written in the popular press can be described in this way although to be
fair, many people do not want to have to live in a world where every
conclusion they reach has been coherently analysed. Life is too short for
that and it would also be like living in a house full of teenagers!
Which then is the best option? Have the disagreement in private and
then reveal the consensus or present the arguments and risk a diversity of
conclusions. I favour the latter simply on the basis of the fact that in
the long term those who reach the more bizarre conclusions will eventually
remove themselves from the gene pool and this is the only way that the
human race will survive. The diversity of the human gene pool owes
everything to the symbiotic influence of human endogenous retroviruses.(1)
Are not ideas very similar in this context?
The question that was not asked is, of course, what should we do
about the sloppy thinkers and the ignorant but plausible influencers. The
intellectual equivalent of flawed treatment services and a bizarre public
mental health system or do we simply let Darwin handle it for us. Do we
have a duty of care and in the end how do we know that we are right?
Perhaps Darwin has the answer again.
1 Ryan FP. Human endogenous retroviruses in health and disease: a
symbiotic perspective. J-R-Soc-Med 2004;97:560-5, ISSN:0141-0768
Competing interests:
None
Competing interests: No competing interests
I do agree with your current article about being "naked". In the name
of justice and sense of fairplay, it's important that we let the patients
choose. The therapeutic options or the line of treatment needs best to be
discussed with the involved person.
Ringing in the same analogy, the movement for open access is gaining
ground.
Would it be prudent enough to announce the pattern of funding for
BMJ? Do the pharmaceutical companies have any say in the final shape of the
research article? Why do the journals tend not to publish the negative
trials?
Noone wants to be caught with pants down. As I mentioned, it makes eminent
sense to be transparent. I prefer it this way because at the back of my
mind, I don't want any commercial pressures to dictate my line of therapy.
It takes guts to stick out your neck and that you have done with the
latest issue of BMJ. Hail the new movement. I am looking forward for the day
when the access to quality health care becomes non controversial and free.
Competing interests:
None declared
Competing interests: No competing interests
In truth it is useful to have inforamtion about studies/articles etc
which have been rejected for publication - in the same way as a register
which showed negative results of trials would be useful.
Could we not have some data every so often,perhaps something on the
lines of information published in RECs Annual Reports ie how many
articles/studies/letters etc were approved/accepted; which
studies/articles etc are rejected, on what grounds; which are returned for
revision/amendment;information on how many Editors attend each meeting.
The same for R.Rs to a more limited extent - which were rejected and
on what grounds ie in what category did they breach BMJ guidelines.
As for even lesser degrees of transparency being realistic in the
'real' world, bearing in mind that there is no public access to Editorial
meetings of most Journals,the acceptance of lesser degrees of transparency
can lead to even lesser trust in certain groups making decisions which
impact on others. Furthermore we live in in times of easy communication,
whistleblowing, changing views about keeping information secret within
small privewledged groups rather than a more democratic participation.
When there is tight control over information it is likely to be leaked by
discontents or on rightful moral grounds.
Competing interests:
None declared
Competing interests: No competing interests
Sir,
In a noteworthy way, the unavoidable argument of medical review “nakedness”,
is fortunately often discussed on BMJ underlining that, in relation to
its direct influence on best medical information, and consequently on
clinical medicine: “Transparency is important in the rarefied atmosphere
of Tavistock Square, London, where we think pure editorial thoughts” (1).
As regards clinical medicine benefit, brought about by such as
transparency, although it can seem that “In the "real" world,
transparency may be problematic”, I must point out that such a
statement is truth, but exclusively as regards the appearence. On the
contrary, a honest, transparent information by a world-known review, like
BMJ, in my opinion, contributes really to spread scientific advances.
Some examples to illustrate my concepts: to-day’s doctors, skilled in
Biophysical Semeiotics (See HONCode ID N. 233736,
http://digilander.iol.it/semeioticabiofisica) , can recognize easily and
quickly individuals who need primary prevention against the most serious
and common human diseases, as type 2 diabetes, obesity, arteriosclerosis,
cancer, epidemics of our time, playing a paramount role in such as
prevention (2-6). In fact, “biophysical-semeiotic” knowledge, wherein
every initial intuition has passed successively through the precise,
objective, critical filter, allow a “new” physical examination, based on
accurate and reliable data, biological-molecular in origin, on micro-vascular deterministic chaos of all biological systems, utilizing a simple
stethoscope (2-6). Fortunately, nowadays Biophysical Semeiotics is a
reality and I consider praisworthy those mass-media, and particularly
medicine peer review, as BMJ (weekly Rapid Response), BCMJ (2) and NEJM
(4) (a part from, my recent, well motivated dispute: See, e.g., URL
http://www.katamed.it/Notizia.asp?id=8027&lingua=IT&idcat=999),
which spread the new that physical semeiotics is no longer the Cinderella
among other numerous medical disciplines.
1) 1) Abbasi K.Why nakedness is bad. BMJ 2004;329 (4 December),
doi:10.1136/bmj.329.7478.0-g
2) Stagnaro S. Depression, Anxiety and Psychosis. B C Medical Journal,
Volume 43, Number 6, page 321, July-August, 2001
3) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: la manovra di
Ferrero-Marigo nella diagnosi clinica della iperinsulinemia-insulino
resistenza. Acta Med. Medit. 13, 125,1997.
4) Stagnaro S., West PJ., Hu FB., Manson JE., Willett WC. Diet and Risk
of Type 2 Diabetes. N Engl J Med. 2002 Jan 24;346(4):297-298. [PubMed
–indexed for MEDLINE]
5) Stagnaro Sergio, Stagnaro-Neri Marina. Introduzione alla Semeiotica
Biofisica. Il Terreno oncologico”. Travel Factory SRL., Roma, 2004.
http://www.travelfactory.it/semeiotica_biofisica.htm
6) Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico-
Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la
definizione della Single Patient Based Medicine. Ediz. Travel Factory,
Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm
Competing interests:
None declared
Competing interests: No competing interests
Getting dressed for public performance
Dear editor,
Rather than arguing that ‘nakedness is bad’(1), our article on the
democratization of science advice (2) urges transparency advocates to be
specific about the body-parts that should be publicly displayed.
As scientific advisory councils find themselves at the intersections
of science and society, they necessarily transgress the boundaries of
science. This makes them vulnerable to the politicisation of their work.
Sound science advice is urgently needed in a time where our societies are
overwhelmed with new technologies. Therefore, we think that science
advisory boards do well in taking utmost care in shaping their relations
with policy actors and the citizenry.
The long standing experience of the Health Council of the Netherlands
in addressing scientific elements (colliding knowledge claims, etc.), can
be inspiring to develop methodologies and procedures to allow societal
elements into the advisory process. (3) Transparency about one’s
argumentations, allowing your readership to join you in (or dissent from)
a line of reasoning, is one of these fragile new procedures that enables
the Council to both be scientific and be useful to policy and public
debate.
Scientific journals such as the BMJ, should indeed publish dissenting
voices, as this is important for the advancement of science (although
journals also have their backstage processes, as McCabe rightly remarks in
her rapid response to your editorial). Science advisory boards, however,
are to advice government on the state of the art. Debates within the
committee further that goal, as this is useful in mobilizing the expertise
of committee members. Confidentiality of the committee process is nothing
less than constitutive for the production of such debates (public scrutiny
during the process causing experts to not show the back of their tongue).
Whereas it goes without saying that lasting dissent is not to be
concealed, it seems unwise to bring temporary dissent into the open, as
this would be easily taken up to politicize the advice and thus render it
ineffective.
Roland Bal
Wiebe E. Bijker
Ruud Hendriks
1. Abbasi K. Why nakedness is bad. BMJ 2004;329(7478):0-g.
2. Bal R, Bijker WE, Hendriks R. Democratisation of scientific advice. BMJ
2004;329(7478):1339-1441.
3. Hendriks R, Bal R, Bijker WE. Beyond the species barrier. The Health
Council of the Netherlands and the construction of objectivity. Social
Epistemology 2004;18(2-3):271-299.
Competing interests:
None declared
Competing interests: No competing interests