Bad apples, bad barrel ?
The authors of your editorial give scant credit to the hard work and
persistence of Brian Deer, when they remark "That it fell to a journalist
to expose the extent of the misconduct in Wakefield's research is
They emphasise why " investigations into clinical adverse events
are focused more on systems of care than on individuals (so called bad
apples )". In their support they quote some wise words from Marcia
Angell, in 1992.
Seventeen years later, Marcia Angell contributed a long article,
'Drug Companies & Doctors: A Story of Corruption', to The New York
Review of Books. (1)
She wrote, " The problems I've discussed are not limited to
psychiatry, although they reach their most florid form there. Similar
conflicts of interest and biases exist in virtually every field of
medicine, particularly those that rely heavily on drugs and devices. It is
simply no longer possible to believe much of the clinical research that is
published, or to rely on the judgement of trusted physicians, or
authoritative medical guidelines.
I take no pleasure in this conclusion, which I reached slowly and
reluctantly over my two decades as an editor of The New England Journal
This is a devastating observation from an experienced observer of our
profession, who speaks now from outside the circle of wagons which we
depend on to protect us from the real world.
Marcia Angell's conclusion may make us wonder if a search for faults in
systems is less important than a greater awareness of human frailty,
reminding us, too, of the advice of Mahatma Gandhi, "..not to dream of
systems so perfect, that men do not need to be good."
(1) NYRB, January 15th 2009, p12.
Competing interests: No competing interests