Editor's Choice
What’s your weakness?
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2742 (Published 21 May 2015) Cite this as: BMJ 2015;350:h2742- Kamran Abbasi, international editor, The BMJ
We all have weaknesses. Tickets to the Chelsea flower show, a test match at the Oval, La Traviata at Glyndebourne, or a Paul McCartney concert at the O2
arena. What tempts you most? One of these five star events, with
hospitality thrown in, surely will? We all have weaknesses, and
companies know it. The world of corporate hospitality depends on it.
Shouldn’t we expect politicians, of all people, to understand that there
are no free lunches? The payer wants something from you. It might be
something trivial, like your heart, but it might also be your integrity.
What if those free tickets were offered by a tobacco company? What’s in
danger, your heart or your integrity?
Jonathan Gornall’s
inquiry into the influence of the tobacco industry on UK
parliamentarians reveals that 38 members of parliament have accepted
hospitality from the tobacco industry on 55 occasions since 2010 (doi:10.1136/bmj.h2509).
Nine peers own shares in tobacco companies. In 2013 one of those
companies, Japan Tobacco International, made an operating profit of
£3bn. Japan Tobacco International is usually shortened to JTI, so the
nature of the company may not be immediately obvious when scouring
parliament’s register of members’ interests. Importantly, 20 of those 38
MPs voted against plain packaging on tobacco products earlier this
year. The MPs will argue that they were not persuaded by hospitality,
but it is clear from Gornall’s report that the tobacco industry sees
hospitality as a way of exerting its influence to ensure “some balance
remains in the debate.”
In certain circumstances our
tolerance of tobacco is now casual. Waterpipe smoking, better known as
shisha or hookah, was once a social pastime in decline. Now it is a
youth phenomenon and a global public health epidemic. It is made
palatable by flavoured, sweetened tobacco (maasel); made fashionable and
feasible by sharing information on the internet and social media. The
hazards of waterpipe smoking are quickly emerging (doi:10.1136/bmj.h1991).
Wasim Maziak explains that there is an expected association with known
risks of tobacco smoking, such as lung cancer and cardiovascular
disease. But waterpipe smoking also brings unique health problems.
Several cases of carbon monoxide poisoning are reported, with a
particular concern about the popularity of waterpipe smoking among women
and its effects on pregnancy. Crucially, waterpipe smoking thwarts
smoking cessation initiatives, initiates cigarette smoking, and harms
non-smokers. Despite the growing evidence base, waterpipe smoking
remains under the radar of most tobacco control policies. We need a
clear and comprehensive regulatory approach.
Being guided
by the evidence mattered to David Sackett. He invented clinical
epidemiology and coined the phrase “critical appraisal.” He was widely
recognised, says Richard Smith in an obituary of Sackett, as “the father
of evidence based medicine” (doi:10.1136/bmj.h2639).
Sackett was against the concept of “experts” and argued that after 10
years of being an expert you should stop. True to his word, he delivered
his last lecture on evidence based medicine in 1999. Evidence based
medicine has advanced several steps since, including with the movement
to make anonymised patient level data from clinical trials widely
accessible. The BMJ is intimately associated with the evidence based medicine movement and the push for data sharing (www.bmj.com/open-data). From July our data sharing policy will be extended from trials of drugs and devices to all clinical trials (doi:10.1136/bmj.h2373). Companies have their weaknesses but, as Sackett acknowledged with his 10 year rule, so do academics.
Notes
Cite this as: BMJ 2015;350:h2742
Footnotes
- Follow BMJ Editor Fiona Godlee on Twitter @fgodlee and the BMJ @bmj_latest
