Climate change, peer review, and the limits of medical expertise

DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

There was a media storm on climate change last weekend in the UK. The Times led on Friday with a front page alleging that an academic journal rejected a manuscript because it did not agree with established views. The journal countered that it contained scientific flaws and published the peer reviewers’ reports. The Guardian then joined the debate. Climate change is very emotive and has implications for us all. My knowledge on climate change is limited and I cannot comment on the details of the science. But, the story has relevance to medical journals and how we deal with differing opinion.

It would be naïve to think that medicine does not have its own hierarchy of experts and vested interests. The pharmaceutical industry is often criticised and we can understand and recognise their economic agenda. But, conflict of interest extends far beyond money. Let's not pretend that academics don’t have a vested interest in promoting their own areas of interest. It helps generate research grants, leads to lectures, travel and enhanced professional reputation. They benefit from promoting their own work, their theories, opinions, research findings and deflecting criticism. If questioned or proven wrong, it would be very difficult for an academic to admit, yes, I think I may have been mistaken. Similarly, an editorialist or peer reviewer who challenges an expert, received wisdom or established opinion would need to be brave. A senior academic may speak out but someone more junior might fear it could damage their career. In medicine, we must to ensure that differing opinions are tolerated, debate is open and fair, and that journals are prepared to consider contradictory views.

It also made me wonder about medical involvement in climate change. Some high profile doctors, representatives of medical organisations, and journals have taken a position on climate change. Remembering that first piece of advice given to clinicians when attending court—don’t be drawn into giving an opinion outside your area of expertise—do doctors really know enough to step so far outside medicine?

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