Muckraking is an honourable trade

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Muckraking is an honourable trade

• Richard Smith
• Editor, BMJ

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What I want to talk about

• Examples from a muckrakers case book-part 1
• Guidelines on criticising doctors
• What is muckraking?
• What has muckraking achieved?
• Why do we need it in medicine?
• Why dont we have it?
• Tips on working with the media
• Examples from a muckrakers case book-part 1

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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 shouldnt have done.
  The other medical students assumed she would be
  failed. She passed.
• What would you do?

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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?

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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?

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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

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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

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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
  Pilgrims Progress

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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

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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

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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

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Achievements of BMJ muckraking

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

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Why is there no medical Private Eye?

• Proper investigative journalism is very expensive
• Gossip is cheaper but less useful
• Restrictive libel laws
• Doesnt fit with medical culture
• Humour is hard to write
• No business case? No entrepreneur?

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Working with the media

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

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Working with the media

• Remember they need you as much as you need them
• Be proactive - be positive
• Dont bother too much with complaining
• Be open
• Be friendly

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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 its rarely that important

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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?

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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 its Nazi style managers.
• What do you do?

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Editorial freedom

• The freedom to print those of the proprietors
  prejudices that dont upset the advertisers.