How political should a general medical journal be?BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7378.1431 (Published 21 December 2002) Cite this as: BMJ 2002;325:1431
There's no easy way to decide
The first anniversary of the attacks on the World Trade Center and the Pentagon passed without a word from the BMJ. We decided to mark the anniversary not by a minute's silence but by a whole issue's, judging we could add nothing of value to the tower of words that had already been erected in the victims' memory. In the week after the attacks, we restricted our coverage to two first person accounts written by people who had been in New York and Washington at the time. By contrast, the Lancet devoted nine articles to the attacks in its issue of 22 September 2001, with another 13 marking the first anniversary. Some of these articles contained very little medicine. So has the Lancet overdone it, confusing its role with that of a political weekly, or have we underdone it, neglecting the huge implications of the attacks?
Just how political should a general medical journal be? We define the BMJ's scope as covering the “clinical, scientific, social, political, and economic factors affecting health.”1 This means that our content ranges over such diverse topics as poverty, unemployment, and Britain's private finance initiative, as well as the more customary concerns of medical journals. Not all readers are happy with our choice. Their most frequent criticism is that we've got the balance between political (or “sociological”) material and clinically useful material wrong.
Nothing touches nerves faster than our forays into the public health consequences of conflict. These would seem a legitimate topic for us—suffering humanity is our remit—yet going much beyond the woolly generalisation that “war is not good for humans and other living things” immediately lands us in hot water. Whether it's the fate of Tamils in Sri Lanka or Palestinians in the Israeli occupied Gaza Strip and West Bank, we're robustly upbraided. “I am terribly sorry to learn that … the British Medical Journal has become a politically motivated Journal,” wrote one respondent recently of a letter describing the pattern of injuries suffered by Palestinians in the Israeli occupied territories. “I hope that this would be the first and last political letter published in this journal.“2
But plotting a non-political course through today's world is as difficult as it ever was, even if this was desirable. Before the Gulf war, we repeated the bogus story of Iraqis removing Kuwaiti babies from incubators and dumping them. 3 4 We published an editorial on chemical weapons that said that Iraq “had used these weapons recently and is likely to do so again if conflict breaks out in the Gulf.”5 (Conflict did, but Iraq didn't.) In retrospect, both articles were part of the slew of stories that stoked up fears and justified the allies' response. We didn't think we were being “political,” but we were.
Take the impending attack on Iraq, apparently over its possession of “weapons of mass destruction.” How should we respond to the British and American governments' claims regarding Iraq's nuclear, chemical, and biological arsenal, or the Iraqi government's denials? Such weapons have undeniable consequences for health, which makes them our business. But taking the claims or counterclaims at face value, or declaring ourselves unconvinced by one side, or ignoring the dispute completely, are all equally political decisions. At a time when even National Geographic magazine is devoting 35 pages to weapons of mass destruction,6 readers might expect us to come to a judgment over the risks they currently pose. They might also expect us to beconcerned with the source of the anthrax used the last time a weapon of mass destruction was deployed.
During the current phoney war, the British government has decided to focus on one just potential threat—smallpox—titrating its scare stories to keep the populace profoundly unhappy about Iraq but not actually panicking. Last week, we published an unsolicited editorial setting out the British government's interim advice on smallpox vaccination.7 Do we further oblige the government by publishing a cut-out-and-keep article on smallpox for frontline staff? Swallowing the official line is just as political a decision as treating the stories as part of the softening up process for a war against Iraq.
If recent events have us agreeing with military philosopher Karl von Clausewitz's claim that “war is the continuation of politics by other means” we might attend to what his fellow Prussian, Rudolf Virchow, was saying about medicine and politics at much the same time. For the doctor and political reformer, medicine was “a social science, and politics nothing but medicine on a grand scale.”
If Virchow is right, the chance of a medical journal finding an easy dissection plane between politics and medicine is extremely small.
And yet we need to draw a line to decide what to include and what to exclude. Looking back, one can see the line changes over time and with editors: both the BMJ and Lancet were much more political in the 19th century than they were for most of the 20th. But now we're looking forward, and we're seeking your advice. Please tell us how much space you think we should be devoting to politics, by voting in our straw poll on bmj.com.
Competing interests As the son and brother of politicians, I have developed a deep seated scepticism about “the official line”on just about everything.
Vote on how political the BMJ should be on bmj.com