Abstract
Diana Brahams writes
Deeply held opinions and beliefs can be difficult to shift even when there is strong and reliable evidence that shows them to be unsustainable. Some will dismiss such evidence or refuse to look at it and choose instead to consort only with those whose outlooks are similar and who will be intolerant of those whose views do not agree with theirs. These people will be reluctant to acknowledge their hero has flaws – this hero may be a pop or film star, or even the leader of a political party in a democracy. Berlusconi in Italy continued to enjoy huge popularity as is the case of ex-president Trump, to whom many Republicans remain steadfastly (and some would argue foolishly) loyal in the USA. Mr Trump is facing a slew of court actions (including criminal charges) and continues in the face of overwhelming evidence to deny that he lost the last election to President Biden and it seems his loyal supporters just can't believe that a majority would vote for anyone else.
We often complain about the calibre of people who seek to be politicians. But a cynic might say that an honest and decent person would struggle to find a way through the mire and not merely in the USA where huge financial backing is a must, but in any political arena. Manoeuvring in such places and working one's way up the “slippery pole” requires not just ambition and good physical health, but super sharp wits and elbows combined with some less attractive skills. Notwithstanding, we need to protect our political systems from rotten apples and ensure there continues to be open debate – and when good people legitimately fear entering these kinds of places there is cause for serious concern.
When something strikes us as wrong we need to speak up. But fear of an unpleasant backlash is a key reason why people stay quiet. The backlash may come from a powerful institution that feels threatened in some way by adverse comments, or it may come from a small but vituperative minority that is determined to have its way. But if we do stay quiet, then what? Grumbling privately to like-minded friends or colleagues will not protect our precious right to freedom of expression which will be eroded bit by bit. Meanwhile it is left to a few bold protagonists who do not stay silent and who may be pilloried or suffer damage to their health and career paths. In a separate category are the whistleblowers whose concern for the safety and environment where they work will compel them to take action. They need better protection.
Historically, religious institutions have feared bad publicity (hence the silencing of complainants of child abuse for centuries). They also feared that scientific discoveries might weaken their message and challenge their authority; they aimed not just to discourage these activities but to shut them down completely. Some fundamentalist religious groups and cults today, unable to turn back the clock and un-discover unwelcome information, will ignore it and take steps to prevent children of their community from studying science or other disturbing material which might cause doubt. Cultural and religious responses, that are commonly nurtured from early childhood, may be difficult to dispel later in life, particularly when a challenge to the status quo is rewarded with the threat of expulsion from their community. They keep to the rules or they must go for ever. As the Jesuits have it, give us a child until he is seven …
An excellent illustration of ill-judged and ineffective abuse of influence and power by the Catholic Church is in its harsh treatment of Galileo Galilei, a brilliant Italian astronomer, mathematician and physicist (1564–1642). In addition to his many other achievements he was the first man we know of who recorded his studies of the sky seen through a telescope. In 1611 he excitedly proved that the Earth moved around the Sun, explaining that Copernicus’s theory was right and Ptolemy was wrong. The supporters of Ptolemy within the Church (who gained the Dominicans’ approval) secretly denounced Galileo to the Inquisition in Rome, claiming his theories were invented and blasphemous. Apparently, fearing a scandal that would weaken the Catholic Church's struggle with Protestantism, the book of Copernicus was subsequently suspended by the Pope in 1616, and Galileo was warned that he must not hold nor defend the doctrine, though it could be discussed as a “mathematical supposition”. Galileo bravely continued to study and write while he struggled to have the restrictions on him lifted and then obtained a limited licence from the Church's censors to publish his later research in 1632. Although his work was applauded as a critical and literary masterpiece elsewhere it caused a crisis in Rome. Under interrogation by the Inquisition (a member of which is believed to have planted a fake but compromising document in the file), Galileo found himself forced to retract his findings and to curse his past errors. He was sentenced to prison for the rest of his life but this was commuted to house arrest under which he spent the last eight years of his life. Notwithstanding, he continued bravely with his scientific correspondence, writings and even some teaching (Encyclopaedia Britannica, volume 19).
Charles Darwin (1809–1882), though never prevented from publishing his scientific work by the Church, was notwithstanding inhibited by the prospect of its disapproval, while the blasphemy laws and the fate of Galileo weighed heavily on his mind, and he delayed the publication of his theory on the origins of man and life on Earth for many years. It was when he learned that Alfred Russel Wallace (who had, independently, come to the same conclusions) would soon present them that he agreed they should give a joint paper in 1858. A year later in 1859 Darwin published On the Origin of the Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life. By 1872, this had run to six editions. As its findings were totally inconsistent with aspects of orthodox Christian teaching so it had to be robustly defended before the religious public and the clergy and indeed Darwin's wife (with whom he had ten children). She was a devout Christian and publication of this and his other findings troubled her deeply and caused strains in their relationship and Darwin's health.
While Darwin was publishing his work, the ignorance of doctors everywhere was exposing their patients to great risk of infection and much else. Dr Ignaz Semmelweiss (1818–1865) realised by 1846 that simply washing and disinfecting their hands after leaving the dissection room and before they examined patients would greatly reduce infection rates and thus survival outcomes. Yet, despite his best efforts and a small trial that demonstrated this simple procedure was effective, he was unable to convince the senior doctors in Vienna's Allgemeines Krankenhaus. They continued to go straight from the dissection room into the gynaecological ward, ignoring his trial findings that showed maternal mortality fell from 9.9% to 1.3%. Why was this? Perhaps they could not bear to accept their actions were spreading infection and causing many of their women patients to die from sepsis? Was it because the advice to alter their practice came from a junior Hungarian doctor from Budapest (then part of the Austro-Hungarian Empire)? Discouraged, Semmelweiss returned to Budapest where he was appointed Professor of Obstetrics in 1855; at least there he could ensure basic hygiene was in force. In 1861 he formally presented his finding but yet again, these were discounted by the arrogant physicians in Vienna. After returning again to Budapest Semmelweiss suffered a mental breakdown. He died at age 47, ironically from an infected operation wound, the very danger from which he had tried to protect his own patients. (Source: The Oxford Medical Companion.)
The hostile reaction to each of these three important pieces of research resulted in there being a damaging delay in their wider dissemination and application which, in the case of Semmelweiss, allowed many women to die from avoidable sepsis. There are many other examples of situations where research produces evidence that some would prefer to disregard for any number of reasons, including political expediency where money has been wasted on projects that were ill-judged and either ineffective or even proved harmful. Currently, many people’s fear of ‘woke’ warriors (e.g. with a frank discussion of some trans issues) or the laudable wish to avoid where possible the presentation of material that may aggravate racial tensions (as in the Rotherham abuse scandal) can be very inhibiting as was the Church’s disapproval in the past.
We need to protect the freedom to challenge accepted practices and to consider and to discuss evidence-based research findings that some interested parties may do their best to hide or even destroy to protect their business or political interests or reputation. We all have a duty to speak up when occasion demands it and Editors have a particular duty to ensure that different voices can be heard, for it is enough that good men stay silent for evil to triumph.
Jane Turner writes
One of the main roles of a journal editor is to select the content for a journal. Editors are in a position where they can facilitate or prohibit free speech. The Medico-Legal Journal follows the recommendations of the International Committee of Medical Journal Editors (ICMJE). 1 Editors need to be ethical and objective in their choice of articles. Journal owners need to make sure they have adequate legal cover as publishing free speech, whilst uncommon, occasionally can have a backlash where an unpopular opinion might be expressed.
In 2015, our previous medical editor, Daniel Haines, wrote a helpful guidelines editorial on the papers we choose to publish. 2 His article explains the main duty of the journal to publish the talks to the society which can take up a third of the journal. The remainder of the journal is for research articles, legal opinions, case reports and letters. He summarised what we look for in a paper and little has changed since I have been medical editor, apart from increasing numbers of submissions and therefore increasing numbers of papers being rejected.
To summarise his points, we look for articles that will interest our readers who come from a diverse group. We look for originality. We need articles to be short as we have limited space. Good English and inclusion of only the relevant references is our preference. Photographs can be helpful so long as they are useful to a wide audience. These points have not changed, and the direction of the journal is similar.
What I’ve noticed, since I’ve been medical editor, is that we have a very diverse group of authors and readers. This is something that should be celebrated. Diversity and inclusion are in the ICMJE standards and their document states: “To improve academic culture, editors should seek to engage a broad and diverse array of authors, reviewers, editorial staff, editorial board members, and readers.”
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The ICMJE
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and the World Association of Medical Editors (WAME)
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both have the same definition of editorial freedom. They hold that editors in chief have full editorial authority over the entire content and timing of the journal content. “Editors should base editorial decisions on the validity of the work and its importance to the journal's readers, not on the commercial implications for the journal, and editors should be free to express critical but responsible views about all aspects of medicine without fear of retribution, even if these views conflict with the commercial goals of the publisher.”
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Editors need to make sure that work is both valid and important to readers. Peer review assists us hugely with both aspects and we are very grateful to our reviewers. Sometimes this does hold up certain articles longer than others. This is because we have a range of reviewers with niche specialities, and we receive a wide range of articles and sometimes need to seek out reviewers with specialist knowledge and it can take time to identify these reviewers. Opinion pieces can bring their own controversies: editors/journals don’t necessarily have to agree with viewpoints of authors to publish them. This can happen more often for a journal such as the Medico-Legal Journal which does publish opinion pieces more frequently. This should not preclude a valid article from being published though it still needs to meet rigorous criteria as do other articles.
