The BMJ's ethics committee is open for businessBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7297.1263 (Published 26 May 2001) Cite this as: BMJ 2001;322:1263
Sandy McCall Smith
Item 1. Introductions
Item 2. Review of committee?s brief and aspects of its working methods
Item 3. Papers for discussion
- Competing interests. We agreed that ethics committee members should fill out the standard BMJ form declaring their competing interests. RS to update members on our competing interest policy for editors at the next meeting. Committee members to declare competing interests in relation to specific items in advance of each meeting.
- Power of the committee. Committee will be mainly advisory with the proviso outlined in ATs original paper dated Aug 29 2000: If editors decide to over ride the committee?s advice they will justify their actions in writing to the chairman. The chairman can appeal to the journal committee in the event of a dispute.
- The committee?s workings must be as transparent as possible. Decisions will be posted on the bmj.com in an anonymised, abridged form with some indication of the size of the majority.
- Access to confidential papers: Papers need not be anonymised if BMJ authors and potential authors have fair warning that an ethics committee might scrutinise their paper. A paragraph in "guidance to contributors" on bmj.com is a satisfactory solution .
- The committee will meet 4 times a year. Advice will be given at other times facilitated by an email server. The Chairman will take decisions alone only in exceptional circumstances.
Two ophthalmologists from a tertiary referral centre report a case referred to them by another hospital where, they imply, her care was suboptimal. She never recovered her vision and is now nearly blind. Two external reviewers saw the report and both agreed that her eyesight could and should have been saved. One responded that the patient had grounds to sue the initial hospital for negligence.
RS wrote to the authors from the tertiary referral centre, sending them the reviewer?s reports and asking whether they thought further action was warranted. They did not reply.
We agreed that the editors had a duty towards the wronged patient, although we were unable to define the limits of that duty. The editors have clear advice that the patient was treated poorly and should sue for negligence. The editors have no legal obligation towards the patient, however.
Committee?s comments, paraphrased:
AS: The journal has hearsay evidence about this patient, so their position is weak. The authors are much closer to the case and the responsibility to the patient lies mainly with them. We should encourage them to take the matter up with the patient or the referring hospital.
PS:This patient is the victim of a medical mistake. Naming, shaming, and blaming (ie telling the patient she has grounds to sue) is the wrong approach if we want to move on from the blame culture in medicine and acknowledge that mistakes happen because of faulty systems, not people. Taking steps to change the system is a more progressive approach
TW: True, but the only way this patient can get the compensation she needs to alleviate her disability is by suing the hospital for negligence.
RS to pursue the authors for a response to his letter, and a robust reassurance that they will report to the initial hospital their concerns over this woman?s care. He might also suggest that we will if they don?t.
After an editorial on cheating at medical school, two junior doctors wrote to the editor reporting that some 60% of the students at their medical school had known in advance about topics that would be examined in the objective structured clinical examination part of their finals. The medical school did not know. More students than normal were awarded distinctions that year.
RS responded that he was now implicated by his knowledge of the affair, but reassured them that they would remain anonymous whatever action the journal decided to take
The Committee on Publication Ethics (COPE) has already advised that RS tell the medical school what has happened. This committee agrees unanimously. PS commented that the medical students were not yet whistleblowers but they would be if we informed the medical school of the contents of their letter. We therefore must ask their permission first.
RS to inform the medical school of the incident after asking for permission from the two junior doctors who wrote in. Reassure them that they will remain anonymous, and congratulate them for doing the right thing by writing to the BMJ in the first place.
A doctor from outside the UK submitted a paper describing a new theory of disease. It made little or no scientific sense. The covering letter said he had treated himself and many patients with a dietary treatment (unspecified) arising from his theories, and that the treatment had been universally successful for a range of diverse diseases.
This paper prompted a discussion on the editors? "duty to warn". It was agreed that editors have such a duty, but that it has limits. Those limits are still undefined but the committee?s deliberations will be an evolving "case law". Authors should be aware that the editor?s duty to warn may over ride their rights to confidentiality (in other words, we may alert the authorities to their research), and AT will add a paragraph to "advice to contributors" making this clear. Circumstances that might drive us to breech confidentiality will be clarified as the committee gains experience. There will eventually be a formal policy. Authors can follow developments on bmj.com.
RS noted that our policy of confidence to authors was based on a doctor?s duty of confidence to a patient. He felt this was na?ve, and probably inappropriate.
SMcS commented that the ethics committee has a broader public responsibility than others who might also see these papers, including reviewers.
Refer paper to the author?s national regulatory authorities with a non-judgmental statement to the effect that we are not sure what to make of the paper or its author, but feel someone should take a look at what he is doing. Write to the author informing him of our action. Some committee members thought he might be a danger to the public, others that he was probably a harmless crank.
A plastic surgeon submitted a Minerva picture reporting a procedure which was later described by a reviewer as dangerous. RS put this to the author who responded with several articles showing that the procedure was used in America, and might not be dangerous. The quality of the evidence was poor. RS offered to publish a debate in the journal on the best way to evaluate experimental surgical procedures, using this case as an example. The plastic surgeon declined.
The committee was divided over whether or not this author?s technique was established enough to make it acceptable practice. AT, PS, and JT felt it was no less acceptable than many other procedures that are not supported by good evidence. Other members worried about the nature of the consent given by patients, since it was unlikely that the author told them the technique was controversial and poorly evaluated. RS was also worried that the author might be selling the technique (inappropriately) as the latest big thing from the USA.
AS suggested that we would be satisfying our concerns about the technique if we asked the ethics committee of the Royal College of Surgeons to take a look at the evidence and issue guidelines about it.
Decision (unanimous): Take no action. RS can take an editorial decision whether or not to approach the ethics committee of the Royal College of Surgeons. Consent from the author is not required, but would be polite.
A private practitioner submitted a paper reporting a case series of over 600 patients. He given them a treatment which many would regard as scientifically dubious. In addition, some had been treated with increasing doses of a new drug that has been evaluated in randomised trials and found to work. The study is effectively a dosage study of the new treatment. The author did not seek ethics committee approval for his study, and the results, in our judgement, are effectively meaningless. It would be impossible to conclude anything with confidence..
The men in the study no doubt gave their consent to treatment, although there must be doubts about how informed this consent was. It?s not clear whether or not they knew they were part of a study.
RS referred the case to the General Medical Council
The GMC agreed that the research was scientifically meaningless, but couldn?t do anything about it because there?s no system of ethical review of research in the private sector. Research ethics committees only consider research that was done on NHS patients, or premises, or notes. The committee felt that the journal should some how bring this issue to the attention of readers.
Decision. The GMC has already ruled on this case. No further action necessary. RS to decide how to debate the issue of private sector research in the journal.
A nurse submitted a personal view in which she describes being assaulted by a violent patient. We would like to publish the case as a debate including several commentaries from different experts, but would not normally publish patient information without consent. It would not be possible to approach this patient for consent, and if it were, he would be unlikely to give it. Can we publish without?
Discussion and decision: The committee agreed that the editor should go ahead and publish anonymously if: The author can reassure editors that the subject?s violence was not a symptom of his illness and that he had insight into what he was doing, and that he has been charged and found guilty of assault (or similar). If the first is true, this is a case of common assault in the workplace and we owe him no duty of confidentiality. If the second is true, the case is already in the public domain. Removing the nurse?s name and details from the case reduces the risk of identification substantially anyway.
A leading Chinese researcher submitted a report of a small phase I study in which patients were deliberately given a communicable disease as a treatment for another communicable disease. The study protocol had been approved by several American review boards then by similar boards in China. This paper reported only toxicity data. Data on efficacy were sent to another journal The BMJ rejected it, largely on ethical grounds and a spirited correspondence with the authors ensued in which they argued, convincingly, that the study and the treatment were ethical, necessary, and could be beneficial, particularly to the developing world.
Discussion and decision
After consideration of the authors? appeal and all the accompanying reference material the committee agreed that there were no unresolved ethical issues over this research. It is an editorial decision whether or not to publish in the BMJ preliminary toxicity data on a treatment for a high profile infectious disease. The publication would be widely read and cited in the lay press. TW felt publication might be irresponsible but not unethical.
A doctor from outside the UK wrote up a report of a clinical error that may have contributed to a patient?s death, but probably didn?t. The BMJ agreed to publish the case report anonymously at the centre of a debate about error and how to deal with it. The author, who committed the clinical error agreed to the anonymous publication, but wanted to write a signed commentary to go with the others. If he did this we would have to conceal from readers that he is commenting on his own error, and publish a commentary written as though he were an impartial observer. Is this an acceptable deceit?
Decision (unanimous): The author of the case report must comment anonymously, or not at all. Deceiving our readers that he is an impartial observer would be unacceptable. We have already decided that he must remain anonymous to protect the identity of the patient and her relatives.
The author accepts our decision and will incorporate his comments into the anonymous case report.
A case report describing in detail an encounter with a patient in a remote part of developing world country. We asked the author to gain consent for publication from the patient, but he replied that this would be impossible as the patient is thousands of miles away and untraceable. Can we publish the report without consent?
Discussion and decision:
The committee advises that we don?t publish this case report. Consent is impossible and we cannot relax the rules for people who happen to live in the developing world. There was strong dissent from PS who argued that there was a "public interest" case for publishing something that illustrates global inequalities in health so starkly. The public interest arguments, he says, over ride the subjects? right to confidentiality. Others disagreed equally strongly.
A letter of complaint about the journal?s biased treatment of a commercial company with global interests.
Discussion and decision: The chairman will write to the correspondent asking for evidence of a systematic bias against the company by the BMJ. He will also ask for evidence that RS refuses to discuss it. The committee will then consider the evidence and decide whether or not the journal needs to act (apologise for example).
Item 4. Next year?s meetings. Deferred
Item 5. Any other business. None
Minutes prepared by Alison Tonks, BMJ
The BMJ has an ethics committee of nine members that meets quarterly. It develops editorial policy, as well as advising on specific issues as they arise. It is an independent committee recruited through open advertisement in the lay press and the BMJ. Editors selected the chairperson after interviewing four candidates. The chairperson subsequently helped editors select the other members from over 150 applicants. Collectively, members have a broad expertise including clinical medicine, research, journalism, bioethics, law, and medical editing. They are listed below. Members are appointed for a probationary period of one year.
Alexander McCall Smith, professor of medical law, University of Edinburgh (Chair)
Derick Wade, professor of neurological disability, University of Oxford
Liz Wager, head of international medical publications (UK), GlaxoWellcome
Peter Singer, professor of medicine and director of joint centre for bioethics, University of Toronto
Anne Sommerville, head of medical ethics, British Medical Association
Tom Wilkie, adviser in bioethics at the Wellcome Trust, and editor of Scientific Computing World
Jeffrey Tobias, consultant in radiotherapy and oncology, University College Hospital, London
Richard Smith, Editor BMJ
Alison Tonks, assistant editor, BMJ
Limitations of membership:
The committee has a large majority of British members. This was not deliberate and we have plans to expand the international presence soon. There is an urgent need for input from the developing world.
What does the committee do?
1 Clarify, review, and develop existing editorial policies such as:
Policy on consent to publication of material arising from the doctor patient relationship
Policy on competing interest for authors, editors, reviewers, and ethics committee members
Policy on prior disclosure of results to research participants
Editors duty of confidentiality to authors
2 Formulate new policies?on, for example, the journal?s response and responsibility to whistleblowers, for example, or research participants from resource poor countries.
3 Advise editors on ethical questions that come up during their routine work, including scrutinising occasional papers referred by editors worried about some aspect of their conception, design, conduct, presentation, peer review, or authorship. Committee members will have access to unabridged papers that have not been anonymised. The BMJ?s guidance to contributors on BMJ.com is being changed to make it clear to authors that their work may be seen by an ethics committee.
4 Advise editors on their moral duties and responsibilities to patients, research subjects, authors, reviewers, publishers, and other editors, especially where they are in conflict. We hope that as the committee gains experience tackling the kind of problems that come up in the day to day running of a general medical journal, their deliberations and decisions will evolve into "case law" that will inform what editors do in response to common problems. A good example is the notion of an editors "duty to warn": BMJ editors read over 6000 papers each year. They are exposed to information about a range of borderline activities including poor patient care, experimental treatments, and bad judgement in clinical practice or research. The decision not to publish is easy, but do they have a duty to report their concerns to the research subjects, the authors, or the author?s institution? If they do have such a duty, what are its limits?
5 Act as a resource to help editors enhance the coverage of bioethics in the BMJ
6 Keep editors informed of developments in research and publication ethics.
How does the committee work and what powers does it have?
The committee meets in person four times a year. Between meetings, editors can consult members by email. Responses are coordinated by the chairman and a decision is made by majority. The chairman will make decisions without consulting other members only in exceptional circumstances
The committee is advisory. The editor can ignore its advice, but must justify his action to the chairman in writing. The advice and the editor?s response would both be published. In the event of a dispute, the committee?s chairman can appeal to the journal committee of the BMA.
How will decisions be reported?
Minutes of all meetings, including decisions made on specific papers will be posted on BMJ.com. The minutes will be edited first to remove all identifying features from papers.
Comments that are minuted will be attributed to particular members, and the nature of the final decision will be recorded.
The committee will publish an annual report, again in an anonymised form, summarising its work over the previous year. Important decisions may also be reported in the paper edition BMJ. Alison Tonks, BMJ
BMJ Ethics Committee Members 2006
Iona Heath, general practitioner, Caversham Group Practice (chair)
Liz Wager, publications consultant, Sideview
Hilda Bastian, head of department, German Institute for Quality and Efficiency in Health Care
Charles Warlow, professor of medical neurology, University of Edinburgh
Alistair Newton, executive director, European Dystonia Federation
Derick Wade, consultant and professor in neurological rehabilitation, Oxford Centre for Enablement
John Weller, freelancer, BMJ
Derick Wade, Professor of Neurological Disability, University of Oxford
Asad Raja, associate professor, Aga Khan University, Karachi, Pakistan
Christopher F Smith, solicitor
Ainsley Newson, lecturer in biomedical ethics, Centre for Ethics in Medicine, University of Bristol
Jacinta Tan, research fellow and honorary consultant child and adolescent psychiatrist, University of Oxford
Nick Pace, lead clinician in anaesthesia, Western Infirmary, Glasgow
Fiona Godlee, editor, BMJ
Julian Sheather, senior ethics adviser, BMA
Anonymised minutes of ethics committee meeting 20th March
Sandy McCall Smith
Apologies: Peter Singer
Item 1 How should members respond to grievances or complaints?
We agreed that the committee was not equipped to deal with individual grievances or complaints against the BMJ. There are other avenues that would serve complainants better, and Richard Smith will write an editorial explaining what they are. They include: The press complaints commission and the journal committee of the BMA. The chairman of the joumal committee can approach the ethics committee for advice about grievances with an ethical component.
Item 2 How long should members serve on the committee? (minutes to follow)
Item 3 Cases for discussion. Each case is given a unique number prefixed by the year the case was referred to the committee.
A general practitioner wrote to the BMJ reporting his treatment successes with a fish oil dietary supplement. He claimed that it was effective in a variety of psychiatric disorders if taken in high doses. RS wrote to him expressing his concern about the ethics of this sort of experimentation. He replied that he was not conducting experiments or research, just offering people a dietary supplement when he thought it might help them.
TW, JT, DW, and LW felt that his indiscriminate prescribing of Omega 3 fish oil may be misguided but was within the realms of acceptable clinical experimentation. Particularly since fish oil is a dietary supplement and not a prescription only drug. JT said he thought the author was naïve about the placebo effect, and possibly deluded about the effects of the fish oil.
RS and AT and AS disagreed. It’s not clear what he told the patients about this supplement. If he told them he had no evidence that it worked in their condition but they were welcome to try it, he has done nothing unethical. It’s unlikely that he put it in those terms, however. RS is keen to debate in the journal the grey area between acceptable clinical experimentation and unacceptable research. Mostly it boils down to the information given to affected patients. He will find a way to do this soon.
Decision (unanimous):Take no action against general practitioner. Write or commission something on this issue for the BMJ.
A systematic review done originally for the UK’s National Institute for Clinical Effectiveness and submitted to the BMJ in abridged form. A previously published Cochrane review on the same subject was not mentioned, and five trials included in the Cochrane review and the NICE review were omitted from the review sent for publication. Was the omission deliberate or just incompetent? Did the advisory group for the NICE review peer review this version before submission, as claimed by the authors?
Individual comments, paraphrased
AS: I suspect the omission was deliberate. They have not responded to direct questions about pre submission peer review by the advisory committee
TW: If they were deceitful, they were very bad at it. They must have known that one of the BMJs reviewers would spot that a Cochrane review had been left out
DW, LW, AT: The authors may have been working within tight constraints laid down by NICE. It’s likely that their hands were tied about what they included and when they submitted the manuscript.
JT, AT: The review may have been written a long time ago-before the Cochrane review was published. They may have been in too much of a hurry to update once they had been told to submit for publication.
SMcS and RS: We cannot make a judgement about their motives. The question is, should we ask a higher authority to look into it? SMcS: No, we haven’t reached that point yet.
DW: The authors should be made to consider the ethical implications of submitting a systematic review that is not a systematic review just because NICE has put them under pressure.
RS They must be clearer about their contract with NICE and the role of the advisory group.
Decision and action (unanimous).We agreed that the committee was not in a position to judge whether or not the authors had been deliberately dishonest. We have not yet reached the stage where we refer the case to some higher authority for investigation. BMJ editors have had one round of correspondence with the authors asking them to explain why the Cochrane review was omitted and to explain the precise role of the advisory committee. The authors have responded to one letter, but not to RS’s subsequent letter asking for more details. They should be contacted again and urged to respond.
A randomised trial showing that a nutritional supplement can cause a dramatic improvement in one aspect of the health of elderly people. The trial was a follow up of one published eight years ago in an international journal. We were left wondering why there was so much delay and why these results had not been reported in the previous paper. We also noted that there was only one author and the results were very dramatic if true. One of the BMJ’s statistical reviewers thought the results were fabricated. He wrote "This paper has all the hall marks of being entirely invented", noting a dramatic digit preference and significance tests that were unbelievable for the kind of health problem reported. RS wrote to the President of the author’s university in asking him to investigate.
Individual comments, paraphrased
SMcCS: There’s little more we can do here until the president of the author’s university responds
DW: Some of the test results he reports are simply not possible
RS: If we get nowhere with the president of the university the next stage might be to notify the international journal that published the previous paper. They might want to investigate that paper too.
SMcS: Another alternative would be to approach the national regulatory authorities. We have enough evidence here to suspect misconduct.
Decision and action (unanimous). Wait for a response from the university’s president, and talk to the editors of the other journal if none is forthcoming soon.
The BMJ published a paper followed some years later by two brief retractions - on the instructions of the university where the work took place. The university gave few details about what had gone wrong and who, if anyone, had been punished. One of the paper’s authors contacted RS because he felt the retractions made all authors look equally guilty, and in fact most of them were innocent of any wrongdoing. RS wrote to the dean of the medical school where the work was done, asking for more details of the case so something more satisfactory could be written in the journal.
He responded that the UK’s General Medical Council were in the middle of an enquiry, but gave no further information.
Individual comments, paraphrased
SMcS: We should let readers know that a hearing is going on. Perhaps we could publish the name of the author under suspicion. That would clear all the others. Alternatively we could report that "no action is being taken against the following authors" then list them. JT supported this view.
TW: We can’t do that without implying guilt which would be wrong. We need a detailed account from the university, which would clear the innocent authors.
AS: We need to find out when the GMC hearing will be completed, so we can publish the result.
AT: The retractions in the BMJ are inadequate, and I’m surprised the BMJ didn’t demand a fuller explanation at the time. We need a detailed editorial telling the whole story.
RS: In a sense all the authors are implicated in any misconduct. Being an author means taking shared responsibility for integrity of the results. Asking all authors to guarantee a paper may be unsustainable, however, which is why the BMJ is moving over from authors to contributors. The transition is not yet complete.
Decision and action.RS to ask the university for more details again. If they are forthcoming the BMJ will publish an account of the investigation and clear the innocent authors.
The journal will also revisit the debate comparing the notion of contributorship with authorship, and the status of guarantors.
Item 4 Feedback from decisions made at last meeting: 19th December 2000. For a full description of the case and discussions click here.
• 002.A case of cheating at medical school. Prior disclosure of topics to be examined in a final Objective Structured Clinical Examination.
The committee received a letter and a report on the university’s response to the disclosure of a cheating episode in final exams. Academic staff at the university had suspected cheating and taken steps to minimise its impact including: Writing to all final year students before the exam, and modifying the OSCE in question. No further action required
• 004.A case report of a novel surgical procedure which was considered dangerous by a BMJ reviewer
The committee received a response from The British Association of Plastic Surgeon’s immediate past president. He acknowledged a problem with the procedure but could only offer the names of experts to ask for further advice. The committee felt there was little point in pursuing the matter further. RS suggested we use the procedure to illustrate a debate on the boundary between innovative practice and unacceptable experimentation.
• 001.A lesson of the week from a tertiary referral centre describing a patient’s poor outcome after delayed referral from another hospital. One BMJ reviewer suggested the patient had grounds to sue the original hospital for negligence.
The committee received a response from a professor at the tertiary referral centre whose juniors had written up and submitted the case. He explained that any implication of wrongdoing at the referring hospital was entirely unintended. The patient had received good care there, and eventually had a good outcome. The reviewers and the committee were misled by the submitted account which did not do justice to the complexities of the case.
The ethics committee agreed that asking for clarification from authors is an important first step whenever suspicions are aroused. The authors were able to clear this one up quickly, and convince the committee that the "bad practice" picked up by reviewers was a side effect of the reporting, not real.
• 0010. A letter of complaint about the BMJs biased treatment of a company with global interests
Committee received the latest letter from RS to the spokesperson of this company. It urged the company to draft letters for publication so the debate about editorial bias could be conducted in the open. It also said that the journal received, and therefore published, far more high calibre articles arguing against this company’s products, than in support of it, which may have given rise to the spurious appearance of bias.
• 007.A phase one study in which subjects with a dangerous communicable disease were treated by innoculation with another dangerous communicable disease.
The committee received two referees reports about this paper. Both suggested that the BMJ should reject it on scientific not ethical grounds. The paper was rejected, and the case closed.
• 003.A paper describing a new theory of disease that made no scientific sense. The author reported wide ranging success treating himself and others with supplements based on his theory.
The committee received a letter from the author expressing his disappointment at being referred to the national regulatory authorities.
We discussed how far the committee should go to chase up the authorities, and agreed that we should at least find out whether or not the referral letter had been received.
Action: RS to ask the President of the national medical association for an acknowledgement.
Item 5 Miscellaneous
• Question from technical editor about a paper already in press at the BMJ describing a randomised trial of a non clinical aspect of patient care. The authors had recruited subjects using a form of "opt out" consent, where consent was presumed unless a subject returned a slip refusing to take part.
Is "opt out" consent acceptable for a randomised trial, even if the intervention is non clinical? Can editors question the decisions of ethics committees?
This paper is due for publication in the BMJ. The authors sought and got approval from a research ethics committee in the UK to conduct the study.
Individual comments, paraphrased
TW: Opt out consent for a trial is not acceptable, although in this case the intervention is unlikely to have done anyone any harm. AT agreed.
AS: We are not in a position to judge the research ethics committee’s decision to let this trial go ahead. They had a long and detailed protocol to look at, we only have the abridged final version. It might, however, be worthwhile asking the chairman if the research ethics committee members realised that consent was "opt out".
LW: I’m not unduly concerned about this form of consent in this trial. Participants have not been harmed. Participants’ notes were scrutinised by a nurse, but she could have been the practice nurse with legitimate access.
Decision and action.Publication will be delayed until AT commissions two accompanying commentaries-one for and one against opt out consent for trials.
• Question from Gavin Yamey, Assistant Editor BMJ. In the past, the BMJ has published patient details without the patient’s consent if these details are already in the public domain. For example, the BMJ has reproduced pictures/case histories that have already appeared in books or journals that do not routinely ask for consent. Is this right?
The committee agreed unanimously that the journal is compounding a wrongdoing by lifting cases and pictures from books or journals with less stringent consent policies than its own.
Action. SMcS to draft a more just policy on publishing patient details that are already in the public domain.
• The committee received, for interest, a copy of a paper in press at another international journal. It shows that many paediatric studies do not report approval by a research ethics committee or review board
Decision.The BMJ asks authors to mention ethics committee approval in all research papers. It’s unclear whether or not they all do. It’s an important issue and the journal should investigate the proportion of papers with explicit reference to ethical approval at the protocol stage.
• Complaint from the author of a letter
Committee received correspondence between an author and RS about a letter for publication. The letter refers to a paper in another international journal, so the BMJ decided not to publish it. The author believes his letter should be published and wants to complain to the ethics committee about it.
RS terminated their correspondence after a lengthy explanation of the journal’s policy on letters that do not respond to a recent paper in the BMJ. No further action required.
• Sherwood, Lyburn, et al How are abnormal results for liver function tests dealt with in primary care? Audit of yield and impact. BMJ 2001;322:276-
The above paper (published in the BMJ in February) was billed as an audit and the authors report that they did not seek approval from a research ethics committee. Several rapid responses criticised this aspect of the study as it involved performing liver biopsies in some participants.
The committee had a brief discussion and agreed that the best way to debate this issue was via the rapid response facility on the BMJ’s website. Further, broader discussions about ethics committee approval for audit were deferred to the next meeting.
Item 6 Any other business. None.
Items for the next agenda include:
• Speeding up progress with declaring our own competing interests
• Ethics committee approval for audit
• Developing a programme for reviewing BMJ’s existing policies, such as consent.
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