Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
The paramount importance of “nakedness”.
- Sergio Stagnaro (3 December 2004)
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Even more information; even greater transparency
- susanne mccabe (5 December 2004)
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Open access and Transparency
- Abhishek Puri (7 December 2004)
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Transparency and evolution
- Peter Waugh (13 December 2004)
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Getting dressed for public performance
- Roland Bal, Wiebe E. Bijker, Roland Bal (25 December 2004)
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Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics. Via Erasmo Piaggio 23/8 16037 Riva Trigoso (Genova) Italy
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Sir, In a noteworthy way, the unavoidable argument of medical review “nakedness”, is fortunately often discussed on BMJ underlining that, in relation to its direct influence on best medical information, and consequently on clinical medicine: “Transparency is important in the rarefied atmosphere of Tavistock Square, London, where we think pure editorial thoughts” (1). As regards clinical medicine benefit, brought about by such as transparency, although it can seem that “In the "real" world, transparency may be problematic”, I must point out that such a statement is truth, but exclusively as regards the appearence. On the contrary, a honest, transparent information by a world-known review, like BMJ, in my opinion, contributes really to spread scientific advances. Some examples to illustrate my concepts: to-day’s doctors, skilled in Biophysical Semeiotics (See HONCode ID N. 233736, http://digilander.iol.it/semeioticabiofisica) , can recognize easily and quickly individuals who need primary prevention against the most serious and common human diseases, as type 2 diabetes, obesity, arteriosclerosis, cancer, epidemics of our time, playing a paramount role in such as prevention (2-6). In fact, “biophysical-semeiotic” knowledge, wherein every initial intuition has passed successively through the precise, objective, critical filter, allow a “new” physical examination, based on accurate and reliable data, biological-molecular in origin, on micro-vascular deterministic chaos of all biological systems, utilizing a simple stethoscope (2-6). Fortunately, nowadays Biophysical Semeiotics is a reality and I consider praisworthy those mass-media, and particularly medicine peer review, as BMJ (weekly Rapid Response), BCMJ (2) and NEJM (4) (a part from, my recent, well motivated dispute: See, e.g., URL http://www.katamed.it/Notizia.asp?id=8027&lingua=IT&idcat=999), which spread the new that physical semeiotics is no longer the Cinderella among other numerous medical disciplines. 1) 1) Abbasi K.Why nakedness is bad. BMJ 2004;329 (4 December), doi:10.1136/bmj.329.7478.0-g 2) Stagnaro S. Depression, Anxiety and Psychosis. B C Medical Journal, Volume 43, Number 6, page 321, July-August, 2001 3) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: la manovra di Ferrero-Marigo nella diagnosi clinica della iperinsulinemia-insulino resistenza. Acta Med. Medit. 13, 125,1997. 4) Stagnaro S., West PJ., Hu FB., Manson JE., Willett WC. Diet and Risk of Type 2 Diabetes. N Engl J Med. 2002 Jan 24;346(4):297-298. [PubMed –indexed for MEDLINE] 5) Stagnaro Sergio, Stagnaro-Neri Marina. Introduzione alla Semeiotica Biofisica. Il Terreno oncologico”. Travel Factory SRL., Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm 6) Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico- Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Ediz. Travel Factory, Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm Competing interests: None declared |
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susanne mccabe, retired cf24 3pf
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In truth it is useful to have inforamtion about studies/articles etc which have been rejected for publication - in the same way as a register which showed negative results of trials would be useful. Could we not have some data every so often,perhaps something on the lines of information published in RECs Annual Reports ie how many articles/studies/letters etc were approved/accepted; which studies/articles etc are rejected, on what grounds; which are returned for revision/amendment;information on how many Editors attend each meeting. The same for R.Rs to a more limited extent - which were rejected and on what grounds ie in what category did they breach BMJ guidelines. As for even lesser degrees of transparency being realistic in the 'real' world, bearing in mind that there is no public access to Editorial meetings of most Journals,the acceptance of lesser degrees of transparency can lead to even lesser trust in certain groups making decisions which impact on others. Furthermore we live in in times of easy communication, whistleblowing, changing views about keeping information secret within small privewledged groups rather than a more democratic participation. When there is tight control over information it is likely to be leaked by discontents or on rightful moral grounds. Competing interests: None declared |
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Abhishek Puri, Dr. Patiala,Punjab 147001
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I do agree with your current article about being "naked". In the name of justice and sense of fairplay, it's important that we let the patients choose. The therapeutic options or the line of treatment needs best to be discussed with the involved person. Ringing in the same analogy, the movement for open access is gaining ground. Would it be prudent enough to announce the pattern of funding for BMJ? Do the pharmaceutical companies have any say in the final shape of the research article? Why do the journals tend not to publish the negative trials? Noone wants to be caught with pants down. As I mentioned, it makes eminent sense to be transparent. I prefer it this way because at the back of my mind, I don't want any commercial pressures to dictate my line of therapy. It takes guts to stick out your neck and that you have done with the latest issue of BMJ. Hail the new movement. I am looking forward for the day when the access to quality health care becomes non controversial and free. Competing interests: None declared |
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Peter Waugh, Medical Inspector RH19 3BE
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This week’s editorial on transparency raises some truly fascinating dilemmas for the modern age of communication. On the one hand it would be very reassuring to think that if we were all totally transparent that the conclusions that we draw from the same evidence would be the same. This assumption is generally true when the proposition is straightforward although there are exceptions. If the proposition is less straightforward there may be a variety of conclusions and some of these may be contradictory. MMR would be an example. I believe that the main source of this apparent contradiction stems from the basic ideas of perception and cognition. We perceive and understand the world around us based on experience that has been built up over time. In many cases we draw on the perception and understanding of others as a short cut to creating a sufficiently comprehensive library that makes most of us independent functioning units. Unfortunately, much of this experience may have been translated using the perceptions and conclusions of others and therefore fails an important test. It is not always accurate and we don’t always test it ourselves for accuracy and consistency. For perception and understanding to result in the same outcome it must be subjected to exactly the same processes and in most circumstances this is not the case. For example the art of the magician exploits these differences in a clever way. The value of education is to make us critical in our approach and to dissect the conclusions of others. Unfortunately, there are many and various reasons why some people do not do this, perhaps from laziness but also where the outcome might not suit the individual’s purpose. Genuine disagreement between people who have no stake in the outcome of a debate provides much needed succour to those who have either already made up their minds or are trying to exploit the situation. Much of what is written in the popular press can be described in this way although to be fair, many people do not want to have to live in a world where every conclusion they reach has been coherently analysed. Life is too short for that and it would also be like living in a house full of teenagers! Which then is the best option? Have the disagreement in private and then reveal the consensus or present the arguments and risk a diversity of conclusions. I favour the latter simply on the basis of the fact that in the long term those who reach the more bizarre conclusions will eventually remove themselves from the gene pool and this is the only way that the human race will survive. The diversity of the human gene pool owes everything to the symbiotic influence of human endogenous retroviruses.(1) Are not ideas very similar in this context? The question that was not asked is, of course, what should we do about the sloppy thinkers and the ignorant but plausible influencers. The intellectual equivalent of flawed treatment services and a bizarre public mental health system or do we simply let Darwin handle it for us. Do we have a duty of care and in the end how do we know that we are right? Perhaps Darwin has the answer again. 1 Ryan FP. Human endogenous retroviruses in health and disease: a symbiotic perspective. J-R-Soc-Med 2004;97:560-5, ISSN:0141-0768 Competing interests: None |
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Roland Bal, assisstant professor Dept. of Health Policy and Management, P.O.Box 1738, 3000 DR Rotterdam, The Netherlands, Wiebe E. Bijker, Roland Bal
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Dear editor, Rather than arguing that ‘nakedness is bad’(1), our article on the democratization of science advice (2) urges transparency advocates to be specific about the body-parts that should be publicly displayed. As scientific advisory councils find themselves at the intersections of science and society, they necessarily transgress the boundaries of science. This makes them vulnerable to the politicisation of their work. Sound science advice is urgently needed in a time where our societies are overwhelmed with new technologies. Therefore, we think that science advisory boards do well in taking utmost care in shaping their relations with policy actors and the citizenry. The long standing experience of the Health Council of the Netherlands in addressing scientific elements (colliding knowledge claims, etc.), can be inspiring to develop methodologies and procedures to allow societal elements into the advisory process. (3) Transparency about one’s argumentations, allowing your readership to join you in (or dissent from) a line of reasoning, is one of these fragile new procedures that enables the Council to both be scientific and be useful to policy and public debate. Scientific journals such as the BMJ, should indeed publish dissenting voices, as this is important for the advancement of science (although journals also have their backstage processes, as McCabe rightly remarks in her rapid response to your editorial). Science advisory boards, however, are to advice government on the state of the art. Debates within the committee further that goal, as this is useful in mobilizing the expertise of committee members. Confidentiality of the committee process is nothing less than constitutive for the production of such debates (public scrutiny during the process causing experts to not show the back of their tongue). Whereas it goes without saying that lasting dissent is not to be concealed, it seems unwise to bring temporary dissent into the open, as this would be easily taken up to politicize the advice and thus render it ineffective. Roland Bal Wiebe E. Bijker Ruud Hendriks 1. Abbasi K. Why nakedness is bad. BMJ 2004;329(7478):0-g. 2. Bal R, Bijker WE, Hendriks R. Democratisation of scientific advice. BMJ 2004;329(7478):1339-1441. 3. Hendriks R, Bal R, Bijker WE. Beyond the species barrier. The Health Council of the Netherlands and the construction of objectivity. Social Epistemology 2004;18(2-3):271-299. Competing interests: None declared |
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