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BMJ 2002;325 ( 7 September )

Editor's choice

Ethical conundrums: they just keep on coming

Could it be acceptable for the BMJ to continue to employ a statistical adviser who was to give evidence on behalf of the tobacco industry? We faced this problem a few years ago with Ken MacRae, who died earlier this year (27 April, p 1041. Despite being very fond of Ken, our gut reaction was no. We feared the headline: "BMJ adviser paid by tobacco industry." But then we thought that perhaps statisticians could be like lawyers: legitimately paid to advance an argument in Britain's adversarial legal system.

Our traditional solution to ethical conundrums is to publish the problem and then trust to the wisdom of our readers. This is not copping out. It's a belief in dialectic and our readers. Ken was happy for us to publish, but the tobacco company lawyers said no. We agreed with Ken that he should go, which was a great pity because he had an unequalled ability to explain complicated statistics and make you laugh at the same time. He could always make the fog clear, at least for a moment. "Consider," he would say, "the proof that running up Ben Nevis is the best treatment for myocardial infarction. The 25 patients who completed the treatment all survived 10 years. But you mustn't forget the 25 who refused the treatment, the 25 lost on the mountain, and the 25 who died while running." Now you understand the necessity of an intention to treat analysis.

Ken features prominently in David Skegg's editorial on the recent legal case where the judge decided against women who believed that they had been harmed by third generation contraceptive pills (p 504). He gave evidence on behalf of the drug companies (as he usually did), and the judge was particularly impressed by his evidence. The judge declared that his own "familiarity with algebra lay in the past and at an elementary level." In other words, he knew less statistics than the average BMJ editor. No wonder he was impressed by Ken. Skegg thinks that the millions spent on the case was money wasted.

An ethical conundrum familiar to every doctor is when to accept gifts from drug companies. The Royal College of Physicians has just updated its guidance, which is full of words like "modest" and "reasonable" (p 511). John Collins, joint author of the guidelines, says that "inappropriate relationships with business are much less likely than in the 80s." I'd like to see his evidence for that. He continues: "I suspect that the vast majority of practising physicians do not prescribe medicines because a company has funded them to go to, say, the American Thoracic Society conference. However if you were a non-medically qualified individual looking at a doctor you might wonder whether they would be influenced in any way." In other words, only a naïve patient would believe that a doctor would be influenced by a business class return to San Francisco and a week in the best hotel. We doctors know better.

Footnotes

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© BMJ 2002
 

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Related editorials in BMJ:

Oral contraceptives, venous thromboembolism, and the courts .

David C G Skegg
BMJ 2002 325: 504-505. [Full text]  

 

Other related articles in BMJ:

NEWS
Royal college issues new guidelines on gifts from drugs companies.

Ann McGuaran
BMJ 2002 325: 511. [Full text]  

 

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