Principal in general practice, Alton Health Centre, Alton, Hampshire, UK

We doctors are sensitive about adverse publicity. This paper, written it should be noted not by doctors but by academic health care managers, provides concise and timely justification for that sensitivity. We are not being paranoid; 'they' - the journalists - really are out to get us. Not as individuals of course; they just don't like us as a group.

This does not surprise me because I have never liked doctors as a group much either, certainly not as much as I have liked journalists as a group. But doctors as individuals are useful to have around when you need them. I expect journalist need them as often as I do, and as often as their readers do. So it behoves us all to exercise caution before rushing to turn doctors into something new and untested.

The impression that was obtained during the Bristol hearings last year, that the press coverage was emotive and 'overwhelmingly hostile', has been abundantly and most usefully confirmed by this study. This lends indirect credence to a more recent but equally strong impression that the emerging other-side-of-the-story has received no media attention whatsoever. Informal enquiries amongst lay contacts reveal their complete ignorance of the deeply worrying possibility that one or more individuals may have been cruelly maligned.

The extraordinary disparity that remains in the record, which contrasts so markedly with the simplistic account as shown here by Davies and Shields (1999), that was given to the public to the public by the media, is demonstrated by a group of letters published in the BMJ a year after the hearings (Dunn et al. 1999). Views as to the clinical rights and wrongs of the affair clearly remain as sharply polarised between clinicians as they do between parents whose children did and did not, respectively, recover from their operations.

But there is an important lesson here for those outside medicine who are now urging clinical openness as a new idea. Anyone with access to the Internet can read these letters: the complex debate going on in the columns of the BMJ is available in its entirety, without restriction, to the world.

Anyone who doubts the openness and the willingness of the medical profession to entertain dissenting or mutually-critical views has only to spend a little time following these links in the eBMJ. They will find fullness, diversity (indeed contradiction), and balance which shows how comparatively far behind the times the British lay press has fallen as a means of informing public debate on complex issues of mortal importance.

A good starting point for journalists wishing to catch up on this balance is the paper by the emeritus professor of perinatal medicine and child health at the University of Bristol (Dunn 1998).

Without extending the analysis many times beyond the five weeks of the study it is impossible to be certain, but I am unaware that Dunn's paper received coverage of any kind in the media. This was in spite of the cogent questions it raised, its authority, and its extraordinary relevance to this matter of intense public interest. And in spite of the fact that it raised the possibility that an injustice had occurred of which the media itself was the principle perpetrator. Nor can the media claim that they simply missed it — I alerted the Guardian myself, which until these events had been for many years my daily newspaper.

After Dunn's paper, seekers of balance can follow the links to the extensive correspondence. This includes my own letter of protest (Willis 1998) at Richard Smith's editorial 'All changed, changed utterly' (Smith 1998a) which appeared in the BMJ at the time of the hearings. This editorial seemed strangely out of place in a scientific journal, and fell close to joining the bandwagon of emotive, populist journalism that is the subject of the paper under discussion.

Perhaps as a result of this, or as a reflection of Stephen Hawking’s aphorism, "the importance in science of a good name should not be underestimated" (he was referring to the name 'Black Hole'), 'All changed, changed utterly' has been cited on numerous occasions (Irvine 1999; Pringle 1999). In contrast, the very much wiser and more balanced editorial Smith wrote six months later, 'Regulation of doctors and the Bristol inquiry' (Smith 1998b), seems to have remained entirely unnoticed.

In an attempt to redress this balance I include here some of what Richard Smith said in his second, more considered but less snappily-titled editorial:

There is no reasonable doubt that it was the Bristol affair, and in particular the media outcry which followed it, which was the crucial factor in precipitating the GMC vote earlier this year in favour of regular 'revalidation' of doctors.

Certainly the GMC were persuaded that the affair made some form of regulation inevitable and voted in the belief that it had no alternative if it was to prevent the matter being taken out of its hands by the government. All of this was a logical non sequitur(Charlton 1999) because the failure in the Bristol case was not one of detection, it was a lack of effective reaction to known concerns. But this did not prevent it being used by government, GMC and media alike as a pretext for changes which served an entirely different agenda. A comparison with Sir Thomas Beecham's famous remark about music and the British public comes to mind: our rulers sometimes appear not to understand very much about science but to like the sound that it makes.

The lay press, of course, was jubilant. The Guardian captured the mood neatly on 2 February 1999 with its headline, "Doctors who fail new checks to be struck off". Articles appeared comparing doctors with airline pilots, and suggested that regular simulator-sessions would eliminate error. Doctors surgeries would be prevented from falling out of the sky.

The idea that "new checks" might, as Richard Smith had latterly seen, and as teachers all over the country had known for years, do harm if applied (as they eventually almost certainly will be) in the wrong way (Willis 1999), was not even remotely entertained. Again, this was not a simple oversight. I for one telephoned the Guardian to explain the need for balance and sent them an article on spec the following day, but did not even receive an acknowledgement.

So one thing emerges clearly from this dreadful business, and here the record is confirmed by the informal testimony of doctors who have worked in the Bristol area for years: James Wisheart was a good, caring and conscientious individual whose dedication would put many of the rest of us to shame.

Whether the same can be said of the journalists who wrote the articles condemning him is much less clear. The question must now arise whether self-regulation in journalism should also become a thing of the past, and whether doctors and colleagues should be pressing for regular revalidation and reaccredidation of journalists in the interests of public health.

Journalists have as much power to do harm as any surgeon. The pen, indeed, is mightier than the scalpel. No society can afford to view with equanimity the demotivation and inhibition of its medical workforce by a hostile and uncomprehending press. Nor can it tolerate the deliberate distortion of complex issues of life and death whether it be in support of narrow, pre-conceived ideas or in a cynical search for sensation and circulation.

Some have suggested even darker motives. The BMA head of communications Nigel Duncan, a former Westminster lobby correspondent, has been quoted as saying that politicians have declared open season on doctors and are using reporters to damage public respect for the profession to soften it up and make way for controversial policy decisions. (Wafer 1999)

Clearly the media handling of the ‘Wisheart affair’ was a disgrace to the profession of journalism. In a true sense it may well have been the real scandal of the affair. In a true sense ‘something has got to be done’ — those words which doctors know so well. Journalists have got to grow up without further delay and see their solemn responsibility to truth and balance. Society cannot tolerate questions as vitally important as the best way to motivate and control doctors continuing to be dominated by rabble-rousers.

To turn around the words of The Express of 30 May which are quoted in Davies and Shields' paper, ‘It is far better to raise suspicions about good journalists than to quell questions about bad ones’. If journalists put themselves in our shoes for a moment there is some chance they will see what pompous, simplistic rubbish this is (Davies and Shields 1999).