Intended for healthcare professionals

Rapid response to:

Editorials

Brexit is bad for our health

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2235 (Published 23 May 2018) Cite this as: BMJ 2018;361:k2235

Rapid Response:

Brexit – an impartial view?

Brexit divides the country, the main political parties and family members. One reason for this polarisation is the triumph of ‘opinion’ over hard data. Remainers and leavers are both guilty of confirmation bias, articulated 160 years ago by John Stuart Mill: “the only way in which a human being can make some approach to knowing the whole of a subject, is by hearing what can be said about it by persons of every variety of opinion, and studying all modes in which it can be looked at by every character of mind.” (1)

What the general public needs, if genuine risks to health exist, is a dispassionate, disinterested, objective assessment. The public needs it; we doctors expect it; you don’t provide it.

The BMJ is advising the medical profession to persuade their patients to lobby for a second (people’s) vote on Brexit (2) having selected a group of authors dedicated to this end, who use a one-sided set of references. Whether or not it is the Journal’s place to politicise the doctor/patient relationship, by doing this you ignore the BMJ’s guidelines on evidence. Is it time to re-acquaint yourselves with the principles of your various, famously and rightly lauded, Campaigns?

Evidence-based medicine “Evidence based medicine involves tracking down the best external evidence with which to answer our clinical question (3)”.

Too much medicine; To make sound judgements doctors, patients, and policy makers need to consider a broad picture; evidence on the balance of benefit and harm or different approaches as well as context, values, resources, and ethics (4)

Open data “The potential of open data is realised only when those data are subject to independent scrutiny” (5)

Partnering with patients
“Authors of…comment articles including editorials [should] co-produce their papers with patients and carers and invite contributions/comment from them.” (6)

In 2016 I criticised what was, in my view, a political diatribe disguised as a medical commentary, and bemoaned the lack of the same rigorous refereeing as was applied to the original research (7). I level the same charge today.

Finally, the BMJ Editorial office should turn over the page, in the print edition, to Dartmouth College’s Woloshin and Schwarz who will remind them, in a different context, that “…journals are not selling treatments, they are honest brokers of information.” (8)


References

1. John Stuart Mill (1859). On Liberty
2. Gill M, McKee M, Brown M M, Godlee F. Brexit is bad for our health. BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2235 (Published 23 May 2018) 263
3. https://www.bmj.com/ebm BMJ 1996;312:71
4. https://www.bmj.com/too-much-medicine
5. https://www.bmj.com/open-data
6. https://www.bmj.com/campaign/patient-partnership
7. Barlow D (2016) Bias in medical literature on health outcomes; bias in commentary?
BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i6634 (Published 16 December 2016)
8. Woloshin S and Schwartz LM (2018). Why too much medicine matters. BMJ 2018; 361:k2035 (Published 23 May 2018) 264-6

Competing interests: • I attended the Lycée Français de Londres; • In 1976/7, I held a DHSS Travelling Fellowship to the EEC (France, Germany, Holland, Belgium, Luxembourg, Denmark and Eire); • I have represented the UK (and held minor roles) on European medical committees for 28 years, ongoing): UEMS GUM representative (and Treasurer) Dermato-venereology Mono-specialty Committee (1991 – 2003); IUSTI Europe, Committee and Board member (1998 – 2010), Senior Counsellor (and Chair of Communications) (2010 – date); • In 2018 I was elected Honorary Member of the Société Française de Dermatologie (after Presidential invitation); • Two of my three children have married Europeans. • I love Europe and have good friends in some 30 European countries, but I despair of the European Union. • I subscribe to Briefings for Brexit. • I voted for Brexit in the 2016 referendum.

05 June 2018
David Barlow
Emeritus Consultant Physician, Guy's and St Thomas' Hospital Trust
London