Freitag, 31. Juli 2009

Wenn whistleblowers für Transparenz sorgen...

Jane Smith, deputy editor
Transparency is a major theme in this week’s BMJ. It’s explicit in Rosalind Smyth’s editorial on making information about clinical trials publicly available (doi:10.1136/bmj.b2473). She explains how trial registration in Europe has come through an unusual route, through regulations on testing drugs for use in children. These require all trials of paediatric drugs conducted in Europe to be made publicly available on the EudraCT database. There seemed no logic to insisting on information on trials in children but not in adults, so now the database will include protocols of all trials, with a requirement for results to be available too.
Perhaps surprisingly, transparency also emerges as an important element in improving the world’s supply of healthy food. In their article on the causes and effects of rising food prices Karen Lock and colleagues describe how agricultural subsidies favour high fat, energy dense foods at the expense of healthy ones such as fruit and vegetables (doi:10.1136/bmj.b2403). Changing these policies requires action at a global level because of the influence of large producers in forums like the World Trade Organization. Indeed, in his accompanying editorial, Tim Lobstein argues that the intractable problems in food policy lie in "the power relationships . . . between highly financed corporations . . . and the governmental agencies such as the United Nations Food and Agriculture Organization, the World Health Or ganization, and the World Trade Organization" (doi:10.1136/bmj.b2527). These dealings occur mostly out of view and "need to become transparent, routinely documented, and exposed to challenge and accountability."
Transparency is, of course, implicit in what whistleblowers do. In this week’s feature Jane Cassidy describes some well known episodes of whistleblowing—and what happened to the whistleblowers (doi:10.1136/bmj.b2693). Too often organisations find it easier to suppress the message and vilify the messenger than to tackle the problem that the whistleblower has identified. Dr Steve Bolsin, who first drew attention to high mortality rates in babies undergoing cardiac surgery at Bristol Royal Infirmary, now works in Australia. He thinks that the more supportive culture in Australia, together with a strictly enforced public interest disclosure law, make it easier for doctors there to speak out and prevent problems.
John Roddick’s Personal View, however, suggests that, in Britain at least, the problem of whistleblowing isn’t confined to medicine (doi:10.1136/bmj.b3055). He’s a retired engineer who thinks that the corporate climate and other pressures make it difficult for professionals make a stand. But he wants to encourage them to reassert their "true professionalism" and proposes that the professions should band together to provide confidential support and advice for those in other disciplines who face an incident that compromises their integrity.
Meanwhile Bob Roehr reports that it is Barack Obama’s failure to level with the public, by focusing on abstract principles rather than detail, that has delayed until autumn a vote on US healthcare reform (doi:10.1136/bmj.b3063). In his Observations column Doug Kamerow observes despairingly that no one in US health care wants to give anything up—and nobody wants to be the one who says no to inappropriate care (doi:10.1136/bmj.b3042).

Cite this as: BMJ 2009;339:b3088

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