Wednesday, November 09, 2005

The Road to Censorship: BMJ Letter Seems to be A Step in that Direction

In a rapid response to a BMJ article on the effects of smoke-free workplaces on the health of bar workers in Ireland, a public health professor suggested that BMJ should perhaps not publish comments from an individual who runs a pro-smoking internet site because these comments represent opinion rather than science.

The article essentially demonstrated that the implenentation of a nationwide smoke-free bar law in Ireland was associated with a dramatic reduction in secondhand smoke exposure among nonsmoking bar workers.

The comment from an individual who is the president of FORCES Netherlands suggested that the study does not prove that the law has started to save lives among nonsmoking bar workers, because it demonstrates a reduction in exposure, but not necessarily in disease rates.

The response (entitled "Scientific or Affective Approach to Tobacco: A Question of Ethics?") to this comment by a public health professor stated: "The article by Shane Allwright and colleagues has sound scientific basis and protocol. On the contrary, the answer by Wiel Maessen, is based on emotion from this President of Forces Netherlands, Holland (, a pro-smoking internet site. Is it the role of the BMJ to publish such type of comments? Or is it an ethical question to accept opinion as well as science?"

The Rest of the Story

What I infer this professor is suggesting is that the role of BMJ in its Rapid Responses is to publish scientific contributions based on scientific research and not opinions of individuals. The implication (in my interpretation) is that it is perhaps unethical for the journal to publish opinion rather than scientific research itself.

But this assertion is, I think, wrong for two reasons.

First, opinion is an essential part of virtually every scientific, medical, and public health journal I am aware of. Not only do these journals contain commentaries and letters to the editor, which are often expressions of individual opinions, but within scientific articles themselves, the authors offer their own opinions.

Second, and more importantly, the very nature and purpose of the Rapid Response feature of BMJ is, I think, to encourage discussion and debate about the published articles among members of the public, including non-scientists who would otherwise not have a forum in which to take part in the discussion. If you look at virtually any of the Rapid Responses to BMJ articles, you will find that the published responses are largely individual opinions.

In fact, the public health professor's response itself is an opinion. She states that the article has sound scientific basis and the response by the FORCES president is based merely on emotion, yet she offers absolutely no scientific or other documentation to back up her assertion. She suggests that BMJ should perhaps not publish these types of comments, which is itself an opinion. And she suggests that perhaps publishing opinion rather than science is unethical - again, her opinion.

Opinion is, in fact, an integral part of the Rapid Responses. This type of forum is basically one that allows people to express their opinions. As far as I am aware, there is no substantial peer review or scientific review process that goes into publishing these responses. Presumbly, most responses are published, although I imagine they are screened to make sure they are not defamatory or otherwise unpublishable. But I venture to say that screening them for the presence of opinion is not part of the review process.

Ultimately, therefore, what the public health professor is actually suggesting, I believe, is that BMJ should not publish certain types of opinions. Her opinions are apparently acceptable, but the president of FORCES' opinions are not. What is the difference? Basically, her opinions support the anti-smoking agenda and the president of FORCES' opinions do not.

So the argument basically is, therefore, that BMJ should screen opinions and only publish those that are on the side of the anti-smoking movement, but not on the other side of the issue.

That, to me, represents a call for censorship.

That response should have sounded an alarm to tobacco control practitioners and others reading it, and I was glad to see that at least the FORCES president had the insight to respond to the comment, pointing out that: "It seems to become common practice in the medical society to counter serious arguments against the outcomes or methodologies of studies with ad-hominem attacks. When opposing views do not fit in the 'modern' medical ideology, the man is attacked and not the ball. ... And this time again, Mr. Piette's only defense against the disclosure of a real flaw in this study doesn't consist of any counter argument but an attack on the source of the criticism, of whom he even doesn't know the scientific background. The criticism from the opponent is qualified as an 'opinion' while obviously his own personal interest (considering his own background as a 'health promotion & education' professor) doesn't represent an opinion at all."

While this may not sound like the most alarming story, it should at least raise a red flag and lead anti-smoking advocates to pause to consider the potential implications of this kind of thinking.

To me, the rest of the story alerts us to the very real danger of proceeding down a path that could well lead to censorship of dissenting opinion - not a road that the tobacco control movement should come anywhere close to going down.

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