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Chief medical officers: the need for public health at the heart of government

BMJ 2013; 346 doi: (Published 5 February 2013)
Cite this as: BMJ 2013;346:f688

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As Scally says [1], the chief medical officer (CMO) of England is also the chief scientific adviser (CSA) to the Department of Health. Every government department has a CSA. [2] In addition, there is an overarching government chief scientific adviser (GCSA), Professor Sir John Beddington. [3] But I fear Scally may be too optimistic about the real influence of the CSAs on government policy and decision-making: even the GCSA struggles to influence departmental policy, as his experience with homeopathy shows.

In 2012, the GCSA, giving evidence to the House of Lords Science and Technology Committee, described continued funding of homeopathy by the Department of Health and NHS as a failure; it was “crazy”. [4] Beddington argued there was no scientific basis for this funding, adding that he had expressed this opinion publicly on numerous occasions. Further, in January this year, the CMO/departmental CSA, giving evidence to the House of Commons Science and Technology Committee, said homeopathy was “rubbish”, explaining that any apparent impact was due to the placebo effect. [5] She also stated: “I am perpetually surprised that homeopathy is available on the NHS.” In response, the Department of Health told a newspaper it was up to local NHS organisations to decide whether to fund homeopathic treatments. [6] Before being appointed Secretary of State for Health in September 2012, Jeremy Hunt openly supported the provision of homeopathy on the NHS. [7]

1. Scally G. Chief medical officers: the need for public health at the heart of government. BMJ 2013;346:f688. (5 February.)
2. Government Office for Science. Chief scientific advisers across government. 2013.
3. Government Office for Science. The Government Chief Scientific Adviser. 2013.
4. House of Lords Science and Technology Committee. 4th Report of Session 2010-12 – The role and functions of departmental Chief Scientific Advisers. 2012.
5. House of Commons Science and Technology Committee. Chief Medical Officer, Department of Health - uncorrected evidence - 23 January 2013. 2013.
6. Silverman R. Homeopathy is 'rubbish', says chief medical officer. Daily Telegraph 2013 Jan 24.
7. Chivers T. Jeremy Hunt, Health Secretary, thinks homeopathy works. Daily Telegraph 2012 Sep 4.

Competing interests: None declared

Alex C W May, independent researcher

N/A, Manchester M13 9DP, UK

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Gabriel Scally rightly praises Liam Donaldson for using the role of Chief Medical Officer to pressure the Government to act on smoking, but is wrong in stating that this "broke new ground".

The ground was well and truly broken by perhaps the greatest of all Chief Medical Officers, Sir George Godber (1960 - 73), of whose comments about smoking the Times reported that, "Sir George Godber has embarrassed the Government about as much as a civil servant can”.

Competing interests: None declared

Mike Daube, Professor of Health Policy

Curtin University, Perth, Western Australia, GPO Box U1987, Perth, Western Australia 6845

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Mike Daube correctly praises George Godber, one of the greatest English CMOs, for his active campaigning stance on tobacco. Indeed John Charles, his predecessor, showed just how dangerous a weak CMO can be to the public's health by his supine approach in the face of the emerging evidence on tobacco harm.

What Sir liam Donaldson did however was not just prod, push and embarrass the Government into action on health problems. He felt it necessary on the hotly contested issue of environmental tobacco smoke, where there was a firm Government position, to make public his advice to ministers which was in conflict with that Government position. Faced with the very real choice of resigning or taking this unique step and putting up with the consequences, Sir Liam took the decision to break new ground and, happily, both succeeded and survived.

The very first English CMO, John Simon, took a rather different approach to dissent on health policy matters and was the author of several anonymous letters to The Times criticising a Bill before Parliament. Simon, Godber and Donaldson, in their different ways, illustrate what is best about the role of Chief Medical Officer.

Competing interests: None declared

Gabriel J SCALLY, Professor

University of the West of England, Fenchay Campus, Bristol BS16 1QY

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