Editor's Choice Editor's choice

Trust me

BMJ 2006; 333 doi: http://dx.doi.org/10.1136/bmj.39028.561875.43 (Published 09 November 2006) Cite this as: BMJ 2006;333:0-f
  1. Fiona Godlee, editor (fgodlee{at}bmj.com)

It's good to hear that, yet again, doctors have been voted the most trusted profession in Britain (doi: 10.1136/bmj.39027.673924.DB). In the annual MORI poll, commissioned by the Royal College of Physicians, 92% of the British public said they trusted doctors to tell the truth, compared with 75% for judges and members of the clergy, and around 20% for politicians and journalists. Whether the public is right to put so much trust in doctors is another question, but it seems important that we should do all we can to preserve it. As the actress Vanessa Redgrave is quoted as saying, “Integrity is so perishable in the summer months of success.”

And there is no shortage of threats to our individual and collective integrity. Drug company funding for continuing professional education is one, says Adriane Fugh-Berman in this week's BMJ (doi: 10.1136/bmj.39024.654086.59). “As a last resort, we physicians could actually pay for our continuing education, as do lawyers, accountants, business people and aerobics teachers, to mention a few.” The media is another, says Jonathan Gornall, himself a journalist, describing the dark side of its campaign for more transparency in family courts (doi: 10.1136/bmj.39027.665220.59). Transparency has always been (and remains) the BMJ's byword for creating and maintaining trust. Our open peer review process requires peer reviewers to sign their reports, which almost all are willing to do. But removing anonymity for expert witnesses in high profile child protection cases may mean doctors are no longer willing to do this work. Who then will speak for the child?

Trust is at stake in every decision doctors make, and unchecked clinical enthusiasm can threaten professional integrity. Above all, beware of optimism bias, mentioned in Editor's Choice two weeks ago in relation to flu vaccine. Two papers in the BMJ suggest that this “unwarranted belief in the value of interventions” has been at work with statins. It would be great, of course, if statins turned out to be another wonder drug like aspirin, with proved benefits in an ever expanding range of conditions. Observational studies have raised this possibility in severe infections and in preventing perioperative cardiovascular events. But Majumdar and colleagues do a more complete adjustment for confounders and conclude that any benefit in cases of infection is due to the healthy user effect (doi: 10.1136/bmj.38992.565972.7C); and Kapoor and colleagues' systematic review (bmj.com doi: 10.1136/bmj.39006.531146.BE) finds inadequate support for routine use of statins perioperatively.

Those who are trusted can lead and inspire others, as Ian Jacobs, interviewed in this week's BMJ, has manifestly shown in his successful worldwide championing of women's health (doi: 10.1136/bmj.39028.439907.DB). We issue a call this week for health professionals to show leadership in relation to climate change (doi: 10.1136/bmj.39028.427164.BE). And by the time you read this, we will know who the next leader of WHO will be. As Ruth Levine says in her open letter to the new director general, he or she has a huge task ahead to restore trust in the organisation's abilities to deliver on global health (doi: 10.1136/bmj.39020.383102.68).