Brexit—an impartial view?BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2743 (Published 22 June 2018) Cite this as: BMJ 2018;361:k2743
All rapid responses
I thank Dr Wayte (1) 22 June for his support and Dr Anand (1) 2 July for his good-humoured light touch. My rather long list of competing European interests signalled neither braggadocio nor virtue but was intended to match the detail of the editorialists and to dispel the usual characterisation of brexiteers as xenophobic. I chose not to mention that my work in Europe was and is unpaid (2). In forty years of committee and advisory work at local, regional, National and International level, remuneration was never offered, nor expected. Professor McKee (1) 2 July raises several points that I shall address.
In my original (3) and edited (1) comments I purposely avoided any argument for or against Brexit. Most on both sides are fixed in their convictions and intransigent and there is no shortage of alternative outlets for that debate.
No, my complaint was about bias in authorship and references in an article written by public health specialists and a campaigning chairman which, carrying the Editor-in-Chief’s imprimatur, made serious predictions about health. One buys the Guardian or Daily Mail, knowing what to expect in political slant. Likewise, the BMJ, in its news and views, has a definite position in the political spectrum. That is expected and accepted. However, once the BMJ makes medical statements, these must be backed up by the same rigorous standards that are applied to research articles. When dealing with health, they ought to be refereed.
I did not, as Martin McKee claims, suggest that the arguments were simply opinion. Nor did I suggest that Brexit would provide any benefit for the Health Service. Nor did I state that there are not reasonable arguments or fears against Brexit. I was also temperate in my language, short on hyperbole, and referenced my statements.
Professor McKee states that he and his co- authors “cite various authorities…all setting out in great detail the threats Brexit poses.” Yes, indeed. What they don’t cite is any alternative view. And such views do exist. An example: in his (unrefereed) editorial on the risks of leaving Euratom (4), he refers to the Lords debate on Tc-99m but fails to quote the Government Minister, at the end of the debate, who states “Euratom places no restrictions on the export of medical isotopes to countries outside the EU (5)” Does McKee suggest that the EU will ‘punish’ the UK when Brexit occurs? Evidence, please!
It is misleading of McKee to boast of the “peer-reviewed” provenance of the four cited publications when neither the article itself (6) nor the first of his four self-authored articles (4) was sent to referee. The third (7) had been peer-reviewed for the BMJ but a fresh referee might have pondered its inclusion in an editorial centred on health outcomes (6), having spotted that it was dismissed from a comprehensive systematic review of such papers (8) because it “…did not clearly refer to health outcomes (9)”.
McKee asks “what we missed?” The answer is acknowledgement that other interpretations and evidence exist. An academic department would be expected to have access to opposing as well as confirmatory literature.
For instance, a referee might have queried the editorial’s first reference (10) which has been criticised (11, 12, 13) for relying on wrongly calculated (and in some cases, unavailable) Treasury figures. Political bias is unlikely: three of the four economists involved in this research (11) voted (and would still vote) remain. What is interesting, and what the four editorialists missed (as well as the contrary research), is the lack of full disclosure of methods used by the Treasury/civil service. Had they been a drug company or research group, the BMJ would be up in arms (think oseltamivir or statins) for ignoring its campaign on open data (14).
Aware of the above, our referee would then have queried the conclusions based on Global Future’s analysis (15), having noted the lack of reference to the alternative, less pessimistic, model. One wonders what the Populus result would have been had the public been aware of the critique and been given that alternative option, with less loaded questions (13).
Those in search of a generous supply of other examples of “what we missed” can go through the numerous offerings on Briefings for Brexit. Like McKee and colleagues’ prognostications, these offerings and criticisms may be wrong. But right or wrong misses my point.
The Professor refers to ‘claims’ with the next two sentences. I am unable to comment. Which claims, where? Without references, this does smack of opinion rather than evidence.
McKee ends “It is not the role of a scientific journal to present a balance between reality and fantasy”. As long as it is clear which is which. Readers can choose which of the following sources represents reality and which fantasy.
- The media talk of the loss of NHS personnel resulting from the Brexit decision (16). Does this mean EU workers are no longer coming to the NHS? Compare two sources (17, 18).
- The cost of Customs under Brexit proposals is apparently large (19). But Jon Thompson, the HMRC chair, admitted to a Treasury Select Committee that he had taken the (£6.5 billion) cost to EU countries and added it to the UK costs to reach his £20 billion total. This quite apart from using doubtful methods of calculation (20).
I have been drawn into a debate that misses the point of my letter. The original response (3) was shortened by me and then edited by the BMJ (1). The print version (30 June, p491) left out the important fourth paragraph in which I referred to a similar complaint made in 2016 (21). There was no editorial response then, and there has been none, so far, to the current criticism.
I make no apology for re-quoting John Stuart Mill (22) “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.” and suggest that a reasoned, balanced, unemotional discussion might be better for all of us.
1. Wayte C (22 June); Anand JK (2 July); McKee M (2 July). 2018 Re Brexit – an impartial view? BMJ 2018;361:k2743
2. Mintzes B, Grundy Q. Rise in vague competing interest declarations BMJ 2018;361:k1464
3. Barlow D. Brexit – an impartial view? (23 May)
4. McKee M . Why we must stay in the European Atomic Energy Community. BMJ 2017;358:j3527. doi:10.1136/bmj.j3527 pmid:28747305
5. Lord Prior of Brampton 2017 https://hansard.parliament.uk/lords/2017-07-20/debates/02A1B589-EBE5-4E7.... Column 1795
6. Gill M, McKee M, Malloch Brown M, Godlee F. Brexit is bad for our health. BMJ2018;361:k2235. doi:10.1136/bmj.k2235 pmid:29794034
7. Loopstra R, Reeves A, Taylor-Robinson D, Barr B, McKee M, Stuckler D
Austerity, sanctions, and the rise of food banks in the UK. BMJ2015;350:h1775. doi:10.1136/bmj.h1775 pmid:25854525
8. Parmar D, Stavropoulou C, Ioannidis JPA. Health outcomes during the 2008 financial crisis in Europe: systematic literature review. BMJ2016;354:i4588. doi:10.1136/bmj.i4588 pmid:27601477.
9. Parmar D, Stavropoulou C, Ioannidis JPA. Research authors’ reply to Barlow and Barr and Taylor-Robinson. BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6639
10. Nardelli A. This leaked government brexit analysis says the uk will be worse off in every scenario. Buzzfeed. 2018. www.buzzfeed.com/albertonardelli/the-governments-own-brexit-analysis-say....
11. Coutts K, Gudgin G, Buchanan J. How the economics profession got it wrong on Brexit (Jan 2018) http://www.cbr.cam.ac.uk/fileadmin/user_upload/centre-for-business-resea...
12. Minford P. 2018 Economists for free trade. https://www.economistsforfreetrade.com/News/civil-servants-totally-misle...
13. Gudgin G. 2018. Project fear alive and well. https://briefingsforbrexit.com/
14. The BMJ. Open data. https://www.bmj.com/open-data
15. Global Future. Too high a price? The cost of Brexit: what the public thinks. 18 April 2018 http://ourglobalfuture.com/reports/too-high-a-price-the-cost-of-brexit-w....
17. NHS staff with EU nationality https://t.co/PNjCD8P5DA
18. NHS Digital 2018. HCHS staff with European Nationality 2010-2018 https://digital.nhs.uk/data-and-information/find-data-and-publications/s...
19. ‘Brexiters' customs model 'could cost £20bn for UK business'
20. Gudgin G, Mills J. 2018 Customs costs post Brexit https://briefingsforbrexit.com/customs-costs-post-brexit-long-version/
21. Barlow D. 2016. Bias in medical literature on health outcomes: bias in commentary?BMJ2016;355:i6634. doi:10.1136/bmj.i6634 pmid:27986706
22. Mill JS. On liberty. Longman, Roberts and Green, 1859
Competing interests: My full competing interests can be found with my first comment
This is a response to Dr Barlow and Prof McKee
1. There cannot be an impartial view. Ever. Our views are always coloured, may I say TAINTED. By our experiences as we perceived them. And, by the way, our language is mischievously misleading.
Dr Barlow says that two of his children married Europeans.
I was under the impression that the BRITS are also EUROPEANS. No?
Europeans married Europeans. What is so noteworthy about it?
And I see that TURKEY is also in Europe (according to the BBC). The geography books in my childhood used to describe Turkey as an Asian country which had only a toe left in Europe.
2. The whole Brexit debate in the BMJ (before the referendum) was, to me, unilluminating. That may have been due to my inadequate cerebral strength. Just possible that the debaters were being “economical with the truth”? Or, they knew not what the truth is? I think the second is more likely.
3. In the seventies referendum, I voted against joining the EEC.
Although my wife was from a country across the English Channel, north of the Mediterranean, west of the Eastern Block.
How it will pan out, economically, I know not. But, if we are drawn closer into the Washingtonian net, I should be sad. Unfortunately the BREXETEER language has demonised perfectly decent EC citizens working here. When they go back they are hardly likely to paint a beautiful picture of Britannia (which no longer rules the waves) and Her Majesty’s Subjects (using the old legal terminology). Our “ hostile” atmosphere will be to our detriment.
4. I am perfectly happy for the BMJ editorial team to adopt partisan postures on all subjects and to carry out agitation (not the prerogative of the labouring classes) or propaganda (not the exclusive domain of the long departed Joseph Goebbels). But, please, continue to permit us, the readers, to shaft an occasional arrow at your breast plates.
Competing interests: No competing interests
Dr Barlow suggests that the arguments we put forward were simply opinion rather than evidence and he calls for other views to be presented in the interests of balance. We cited comprehensive analyses published in leading peer-reviewed journals and detailed reports from professional bodies and parliamentary committees, all setting out in great detail the threats Brexit poses. It would therefore be very helpful to know what we missed. So far, those who support Brexit have failed to provide any evidence that Brexit can provide any actual benefit to the NHS, with their claims failing to withstand even the most basic scrutiny. Those that have been suggested lack any credibility and, even if possible in theory but not reality, are vastly outweighed by the enormous damage that even the softest of Brexits will cause. If Dr Barlow really believes that alternative evidence exists it is regrettable that he failed to cite it in his letter. It is not the role of a scientific journal to present a balance between reality and fantasy.
Competing interests: i was an author of the editorial in question
An excellent repsinse by Dr Barlow whic very cogently points out the BMJ's current besetting weakness in campaigning for issues in a one-sided and partisan way, with little regard for balance and fairness. I always thought that the BMJ was a medical journal, but increasingly it seems to see itself as a campaigning vehicle for promoting various opinions, with biased and one-sided articles. Time to clean up your act BMJ.
Competing interests: No competing interests