Muckraking is an honourable trade Richard Smith Editor, BMJ

What I want to talk about Examples from a muckraker’s case book- part 1 Guidelines on criticising doctors What is muckraking? What has muckraking achieved? Why do we need it in medicine? Why don’t we have it? Tips on working with the media Examples from a muckraker’s case book- part 1

Case of the cheating medical student An anonyomous letter suggests that one student at a medical school cheated in her final exams. She looked at a book when she shouldn’t have done. The other medical students assumed she would be failed. She passed. What would you do?

Case of the whistleblower An anaesthetist rings to you that he has data that show that one of the surgeons where he works has very poor outcomes. Patients may be dying unnecessarily. What do you do?

Case of the whistleblower II Later he rings to make clear that the hospital managers refuse to consider his data. They say there is “No problem.” What now?

Guidelines on criticising doctors Individual doctors should not be “tried by media,” unless the editor has no way to ensure due process is used or he/she has good reason not to accept due process If the aim is to allow readers to learn from an episode then the case may be reported but there must be as much anonymity as possible

What is muckraking? Finding and publishing stories, perhaps using underhand methods, that expose misconduct, corruption, hypocrisy, or the like. Publishing (perhaps invented) stories that give salacious details of peoples’ private lives

Muckraking: the origins “The man who could look no way but downward with the muckrake in his hands; who neither look up nor regard the crown he was offered, but continued to rake to himself the filth that was on the floor.” Theodore Roosevelt, quoting John Bunyan in Pilgrim’s Progress

Achievements of muckrakers Sales of 3m in the US in 1906 Pure Food and Drug Act Meat Inspection Act Child labour laws Pensions National forests Saved Alaska and Niagara Falls

Why might medicine need a satirical, muckraking publication? To expose corruption “News is what somebody somewhere wants to suppress. All else is advertising.” To expose incompetence--when existing systems are failing To expose misconduct To expose hypocrisy

Why might medicine need a satirical, muckraking publication? To prick the pomposity of the medical profession To increase accountability To amuse us all To attract readers To make money

Achievements of BMJ muckraking An end to baby farming Regulations of medicines All in the 19th century. Why none now?

Why is there no medical Private Eye? Proper investigative journalism is very expensive Gossip is cheaper but less useful Restrictive libel laws Doesn’t fit with medical culture Humour is hard to write No business case? No entrepreneur?

Working with the media Build relationships Suffer fools gladly Help the media Give them stories - real ones Work out who you can trust

Working with the media Remember they need you as much as you need them Be proactive - be positive Don’ t bother too much with complaining Be open Be friendly

Working with the media Tell them things off the record - but make clear what is off the record Speak easily. No jargon. Be relaxed Remember it’s rarely that important

Case of the homophobic consultant Two medical students describe a consultant telling them that he had a nurse removed from his team because he was a homosexual. He ostensibly had him removed for poor performance. What do you, the editor, do?

Case of the dysfunctional hospital A doctor contacts you to say that he has evidence on how his hospital has manipulated waiting list data. You make enquiries and discover that up to 70 doctors are unhappy with the way they hospital is run and it’s “Nazi style” managers. What do you do?

Editorial freedom “The freedom to print those of the proprietor’s prejudices that don’t upset the advertisers.”