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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Online Confession of An Asian Doctor
- Jay Ilangaratne (5 December 2003)
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Wibble wibble
- John Hopkins (5 December 2003)
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Are we trying to extinguish our self?
- Rajesh R Garje (5 December 2003)
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ALL WORLD IS BUT A STAGE
- BM HEGDE (6 December 2003)
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Censorship protects dangerous people
- Brian H Jones (6 December 2003)
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Freedom of speech and responsibility.
- Juraj Gregan (6 December 2003)
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FREE SPEECH AND CENSORSHIP
- CELIO LEVYMAN,MD,MSc (7 December 2003)
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Freedom of speeh - Double edged sword.
- Umesh Prabhu (7 December 2003)
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Re: Freedom of speech and responsibility.
- Frank J Leavitt (9 December 2003)
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Utility of correspondence section in biomedical journals
- Kamal Kumar Mahawar, Parveen Kumar (12 December 2003)
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Jay Ilangaratne, Founder Medical-Journals.com
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The phrase 'freedom of speech' can disinhibit one so much,it could even lead to a public confession of one's inner feelings.By chance,I recently came across such example when trawling through an online forum for doctors. An asian Consultant confirmed online that he has no problem giving first preference to local British graduates at job interviews.He went onto justify his belief by saying that the "Indians" can always go back home and questioned where the local graduates could go. In fact,subsequently he reiterated his strongly held view. I found such public self-confession remarkable,not only because that view is wholly in conflict with principles of equal opportunity and the Race Relations Act 1976 (as amended) but the person concerned also claims to be a campaigner against racism in the NHS. Perhaps,this Consultant does not realise the seriousness of his public utterances.The worry is, he still is, and indeed,has been a decision-maker at job interviews.I wonder how many asian candidates have already succumbed--unfairly and unjustly--as a result of this decision maker's wrong and racist view.Similarly,how many more asian doctors will 'go under' at future interviews, as a result of this unlawful thought- process of one decision maker? In a legal sense,application of such belief will amount to direct discrimination and aiding an unlawful act per the Race Relations Act 1976. I am now faced with the dilemma of dealing with this matter,effectively.It will be wrong and immoral for me to ignore it completely,knowing very well the damage such views could have on innocent and competent asian doctors seeking employment in the NHS.If I ignore the matter,I too may fall foul of the Race Relations Act, and the GMC too,may frown at me. I have, of course, not forgotten the serious implications on the doctor concerned if I inform the relevant authorities about his overtly held views. Any thoughts of others will be most welcome,but it appears that I am left with very few choices. Competing interests: None declared |
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John Hopkins, GP Newton Aycliffe DL5 4SE
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Dear Dr Smith, To this reader at least, the editorial style of the BMJ owes more to Oliver Cromwell than it does to John Milton. It has been said of some editors that they spend their time watching the battle from the hills before coming down to bayonet the wounded (1). That couldnt be said of the BMJ editorial team but one thing they may have in common with other editors is the amount of time they spend reading letters written in green ink. It might make the rapid response page more colourful if responses containing certain key words were printed in green. I would nominate the following; Semeiotics, GMC Arafat Healthcare practitioner ATP Advocate Complementary Of course, there are one or two others that might be better printed in vibrant red. Yours sincerely, John Hopkins (1) Chance Witness Matthew Parris Competing interests: None declared |
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Rajesh R Garje, Senior resident, Nephrology JJH,Byculla, Mumbai-400008
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I read the article “Missing women—revisited” by Nobel laureate Amatya Sen. It invokes a serious question in my mind that by allowing selective sex proliferation (which is against the nature’s rules), are we trying to extinguish our self? The fact that women are essential part of human race can’t be denied. We have already disturbed our ecosystem by decreasing many plant and animal species. The effects of this are already started. In male dominated societies, sex bias is present in relative care of children. To some extent it my look beneficial to families, but in long run it won’t last much. It is our traditional cultural definitions, which label females as weaker sections of society and allow only males to dominate. Looking at the terrible figure of missing women (101m worldwide), I think doom’s day is not so far! Governments can take many steps to prevent this imbalance. It is good that Indian Government is giving some opportunities to women to come up. The most effective measures will be a worldwide public awareness programme to spread the gravity of the problem and developement of effective means to tackle the situation. Mere outlawing sex determination of the fetus and many other such laws will not suffice. Competing interests: None declared |
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BM HEGDE, Retired Vice Chancellor Mangalore, India
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Dear Sir, I am in total agreement with Richard Smith. Just as Milton, the Nobel Laureate Indian poet, Rabindranath Tagore, had said in his Nobel winning poem Geetanjali that for wisdom to dawn on mankind man must live in a world where knowledge flows freely without any restrictions whatsoever. Another Nobel Laureate Kary Mullis, the father of the PCR test, writing the foreword for the book Inventing the AIDS Virus by a noted virologist, Peter H. Duesberg, of the same University, has this to say about the AIDS drama. “I like and respect Peter Duesberg. I don’t think he knows necessarily what causes AIDS; we have disagreements about that. But we’re both certain about what doesn’t cause AIDS. We have not been able to discover any good reasons why most of the people on earth believe that AIDS is a disease caused by a virus called HIV. There is simply no scientific evidence demonstrating that this is true…….we have also been not able to discover why doctors prescribe a toxic drug called Zidovudine to people who have no other complaint than the presence of anti-bodies to HIV in their blood. We wonder why humans take that drug for any reason……..” Is this book a myth or are we all barking up the wrong tree? This brings to mind the infamous story of Beri beri. In a paper in the Lancet in 1887 Kanehiro Takaki refuted the bacteria hunters claim that beriberi was due to a bacterium and showed that it is due to diet deficiency. He was laughed at in the beginning. Similar is the story of the SMON fiasco. This was a frightening disease that struck Japan in the 1950s when the polio epidemic was raging and quickly it was declared to be a viral disease by many virus hunters. After hundreds died the real cause was found out. It might be coincidence that Gajdusek published his findings that SMON (Sub-acute Myelo-optico-neuropathy) was due to slow virus in the famous journal Nature and was lauded by his fellow virologists. Another virus discovery came from the Middlesex Hospital in 1964! Finally, this syndrome was shown to be due to the side effects of a then commonly used drug clinoquinol! Friends let us not be deluded easily. “And see, no longer blinded by our eyes.” Rupert Brooke. William Shakespeare was dead right when he wrote that the whole world is but a drama stage. Most of what we see or hear are myths. Recently we have had the world AIDS day. It was celebrated with fan fare all over. Next we would again think seriously of AIDS a year later. In the meantime the drama goes on back stage where the drug companies and the technology companies play their part in creating the hype that AIDS is going to annihilate mankind on this planet and the panacea for that are the drugs sold by them. Most of us buy that argument without going into the real truth of the matter as we do not have the wherewithal to do so and the ones that have to go deep into the real world have no inclination or time to do so. Many times medical education of students, as also the continuing education of doctors, is given by the drug companies. In America this has been elegantly shown to be true to the extent that even the text books are written with the help of drug company money. Medical research relies on funding from these agencies what with all government funding drying up everywhere. Naturally the funding agencies would want see what they want to see in medical research. Hence the medical world believes in this kind of half truths and falsehood. We in India have been recently bombarded with the frightening news that most of the major killers like heart attacks, high blood pressure, and diabetes are going to come here in a very big way and most of us, if not all of us, are in danger unless we go with the establishment to get ourselves routinely checked up for all those maladies and take the drugs suggested by them! There is no truth in any one of the above statements. None of them is based on sound scientific validation. Most of it is only hype created by the vested interests to make money. AIDS is not a disease. Rather, it is a syndrome- a conglomeration of symptoms and signs- seen in certain patients who have many other things in common. Every syndrome has multiple facets. There is no direct one to one cause-effect relationship in any syndrome. In the AIDS syndrome drama, probably, the HIV virus could be the hero, but there are the heroine and other actors who are as important, if not more important, than the hero for the final outcome. No human illness should be viewed through a reductionist glass. Although the AIDS syndrome was first described way back in 1981 in two homosexual males, one in San Fransisco and the other in Paris, having similar clinical presentations and sure death, no one to date has shown that the HIV virus is the sole cause of AIDS. For the first time the announcement of a new disease in the scientific world came through a press conference and not through any scientific study published in a good peer-reviewed journal. Of course, lately lot of so-called researchers are jumping on to the AIDS bandwagon, mainly because the US National Institute of Health annual budget for AIDS research is $ 8 billion, while the cancer budget, for the same period, is only $ 2 billion.! “When it is a question of money, everybody is of the same religion” wrote the great French philosopher Voltaire. Scientists are no exception. The drama of AIDS syndrome starts with poverty which is the mother of all illnesses. The poor and the very poor in the third world countries, especially Africa, are the worst hit. They have very little to eat and, consequently, have very low blood protein levels. Proteins are the antibodies to fight any disease. “Any disease is directly related to the virulence of the cause but inversely related to the resistance of the host,” wrote Theobald Smith, an American physician, in the year 1915. That was the beginning of the new science of host resistance, now called immunology. Up until that time the medical world was lost in the Koch’s postulates where the disease was caused by a germ. The host factor was not taken into consideration. Immunology progressed at a breath taking speed only after white homosexuals died in 1981 with depressed immune systems. Next to poverty the other actors in the depressed immune system drama are the life styles that modern man has adopted for himself. Drug addiction, even tobacco and alcohol are bad drugs, unnatural sex habits- anal and oral sex could depress the immune system by depositing the highly antigenic human semen into the gut, are the other actors! Many of the therapeutic drugs that we doctors give on long term basis for chronic diseases add to the burden. Fear, extreme fear at that, could also depress the immune system. Therefore, in the AIDS drama there are many powerful actors that dictate the final outcome and not the HIV family of viruses alone. In fact, the HIV viruses, probably, do not play such a major role. This was indirectly shown by the recent revelation that some of the prostitutes that have been in constant business in their trade have been strongly positive for the HIV virus antibodies since 1981. They are in robust health, though! Many of them have healthy children too. Saloma Khatoumi, a Nigerian, aged 42 years, is one such example. She has been servicing about 10-15 customers per night and has been HIV positive for decades but in good health. She has one healthy child too. It is from her blood that the Oxford AIDS researchers found a peculiar phenomenon that a variant of the HIV virus could improve the immune functions! The Oxford Group has since produced a vaccine based on this knowledge. This vaccine is undergoing pilot trials and could be available for human use in the next decade or so. The story of the anti-AIDS drugs has not been any different from many other anti-microbial drugs. Each one, from the first Sulpha and penicillin to the latest drug, has had a huge advertisement about its efficacy and its capacity to save lives. The truth, however, is that most of them have now created the monster of drug resistant germs, called super bugs, that threaten to annihilate mankind on this planet, unless we wake up and do something about it. Not a single germ related disease has been conquered by anti-microbial drugs to date. The only disease that man was able to eradicate, small pox, was done by vaccination that was in use in India for “times out of mind”. The saving grace would be the immune boosters that Indian medical systems had for thousands of years in use. The good news is that the Indian Council for Scientific and Industrial Research has been able to patent a very powerful immune booster derived from cow’s urine lately. Immune boosters would be the future panacea for immune depression syndromes of all hues. “History repeats itself; if you do not learn from history you will have to relive history,” wrote Cicero, the great Roman thinker. India has learnt a very bad lesson in the past in the area of anti-TB drugs. Let us not repeat that with anti-AIDS drugs! Dr. J.R.Bignall, one of the world’s greatest TB specialists, was invited by our government in 1956 to advice us about the TB scenario in the country. A few anti-TB drugs were intermittently available at that time. Bignall studied the disease pattern exhaustively and advised the government not to let those anti-TB drugs be used here for at least ten years! His argument was that if we get those drugs the use of the drugs will be irregular and that might produce resistant germs of TB. If drugs are not used and the patients given proper food and sanitation those that survive would get better and the germ dies in them because of the immune system. Those that are very bad would die anyway and the germ also dies with them, buried or burnt. In either case in the following ten years TB germs would almost disappear from India. But he said that detection and isolation was of paramount importance along with the sanatorium line of management. The powers-that-be at that time ignored the report and today we have a huge amount of resistant TB in India that we will not be able to tackle. AIDS will pale into insignificance when you think of the ravages that the White Death (TB) caused in this world. It was worse than the Black Death of plague! Similar and still worse will be the fate of anti-viral drugs in AIDS. In the first place all anti-viral drugs are partially effective. They have serious side effects that the drug might kill quite a FEW victims. Apart from the drug company propaganda and education these drugs have not been shown to have made an impact on AIDS. What would make an impact is health promotion in our poor people. Good food, clean water, a roof on top of their heads, a toilet for every house to avoid the ravages of hookworms, and health education regarding safe sex, drug addiction, alcohol and tobacco would save millions of lives in the future. There is no pill for every ill, but there is a definite ill following every pill. Only a holistic view would be beneficial. I am wondering as to when modern medicine would realize its folly and follow the correct science of holism, non-linear mathematics and the science of CHAOS. God save the poor people. “Science is always wrong. It never solves a problem without creating new ones.” George Bernard Shaw Competing interests: None declared |
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Brian H Jones, Mental Health Specialist Sydney Australia 2000
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Dear Richard; Interesting to read your editorial, missed the recent bruhaha given that I live at the top of the world...in Australia, you know the country that allowed you to have the world cup! Anyway, it oft irks me to hear the inane ramblings of zealots, nere- do-wells & self promoters. Having said that, I believe that it is incumbent on those of us who are liberated free thinkers to invite such people to speak openly, least we drive them underground. We had here a polititian who espoused Zenophobic policies, by allowing her to speak freely in the open press our liberated society was shocked out of its complacency, more importantly biggots among us were identified. Hopefully we are now a more aware and tollerant society. Keep up the free press. In support Brian H Jones Sydney Australia Competing interests: None declared |
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Juraj Gregan, postdoctoral researcher Research Institute of Molecular Pathology, Dr. Bohr-Gasse 7, A-1030 Vienna, Austria
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I strongly support policy of scientific journals to publish responses of readers. The BMJ (British Medical Journal) is one of the few scientific journals which allow readers to respond. Similarly as the Nature journal in its correspondence section, responses of the readers are mostly published without peer-reviewing. This section of the journal is undoubtedly attractive to a wider non-scientific community and gives the journal a new dimension, making the science more accessible to society. Therefore I was shocked by the attitude of the AIDS researchers ignoring the 'AIDS revisionists' postings published as rapid responses by the BMJ (1). I believe that scientists should respond also to non-scientific or anecdotal arguments and the policy of not responding is in my opinion a mistake. Freedom goes hand in hand with responsibility and when journals support freedom of speech, scientists should take their responsibility to communicate with society. 1. Butler, D. Medical journal under attack as dissenters seize AIDS platform. Nature 2003;426: 215 Competing interests: None declared |
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CELIO LEVYMAN,MD,MSc, Neurologist Headache and Neurology Clinic,Rua Jose Janarelli,199,cj. 22,Sao Paulo,Brazil,CEP 0156-010
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Debate about free speech in BMJ seems nonsense to people like me, who live in a country that, in recent past, was under a military political government, that censure all things, to the conventional papers and TV shows to an epidemic status of meningococcal meningitis,that lead many people to dead, because they don’t know thaw symptoms, there was a prohibition to launch epidemiologic measures an, when someone reaches a hospital, his or her life becomes in the hands of a periculous game, not in appropriate measures. BMJ choice of rapid responses, without peer reviews or other kind of regulations, is a powerful democratic way to doctors and non-doctors to expose opinions. Is quite clear, however, that a great number of blockheads, fundamentalists in some type of thing and other categories of such writers can reach the Web via BMJ, but the rapid responses is a forum, not a position adopted by the publication. An believe me, is thousand times better to be sometimes in the company of some strange opinions that live as a doctor and a citizen under censorship laws. I support the editorial line of BMJ in regard to rapid responses. Competing interests: None declared |
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Umesh Prabhu, Consultant Paediatrician The Pennine Acute Hospital Trust, BL9 7TA
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Freedom of speech is like a double edged sword which can be used as a dagger. It is like clinical freedom for a doctor which is absolutely essential and most doctors do use it with respect and care but the same clinical freedom gave opportunity to Dr. Shipman to kill his innocent patients and also created tragedies like Bristol cardiac babies, Alder Hey fiasco and many more. Clinical freedom is essential but there must be systems in place to regulate it and manage it so that those who misuse it are caught early and the poor patients are protected and the professional reputation is maintained. Same is true for the freedom of speech. It is absolutely essential for the mankind, humanity and the society but there are people who would misuse it and there are others who would misrepresent, misquote or take what one has said out of context and misrepresent it. Media is good at it, politicians are known to use it and there are some who do it in the name of science and others just do it to score points. Unfortunately sometimes the consequences can be devastating. These are all the facts of our life and if we believe in a free society we got to accept these harsh realities of life. Of course it would be nice if we can device a system to control some of these but then it makes a mokery of free society. Competing interests: None declared |
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Frank J Leavitt, Chairman, Centre for Asian and International Bioethics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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RE: Juraj Gregan's remark that letters to Nature's correspondence section are not peer reviewed, they must be reviewed somehow or other because they surely have rejected plenty of mine. RE: The general discussion, I support total freedom of expression. But authors need the self-discipline to keep their letters short. Competing interests: None declared |
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Kamal Kumar Mahawar, Research SHO, Department of Surgery, Arrowe Park Hospital, Upton, Wirral, Merseyside CH49 5PE, Parveen Kumar
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Sir/ Madam, I wish to applaud BMJ once again for allowing its readers to express their opinion freely. To the opponents, I can only say that truth has never submerged by a sea of lies. "The wrong" have never beaten "the right" even if they hugely outnumber the latter. It is perhaps worthwhile reviewing the role of correspondence section in the biomedical journals in this context. This section is supposed to provide a medium for the readers to voice their disagreement with the observations made in the published articles. (1) It gives readers and the scientific community as a whole an opportunity to critically review the stated observations or findings before it becomes incorporated into medical literature as true science. It is vitally important to ensure that authors don’t get away with spurious or misjudged declarations, which will then be passed down as the “truth”. Correspondence section can thus provide us with an opportunity for a much wider peer review. In my experience, this opportunity is not being fully utilized by the journals. Those letters, which criticise the work more strongly are either not replied by the authors or dumped by the editorial team. The letters, which do however find space, are the ones, which can be easily confuted by the authors. Not publishing severe criticism may help in containing bitterness but is definitely not in the best interest of science. One understands the inability to publish all the comments with severe space constraints that most journals are faced with. An attempt should however be made under these circumstances to publish the strongest criticism and not the weakest. Publishing all the responses on the website, which is being increasingly utilized by many journals like BMJ is a right step in this direction. Reference: 1. International Committee of Medical Journal Editors. Uniform Requirements for Manuscripts submitted to Biomedical Journals. Ann Intern Med. 1997; 126: 36-47. Competing interests: None declared |
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