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


Driving across France yesterday, “Je suis Charlie” was everywhere. As I skirted Paris, every exit sign on the Peripherique flashed “Je suis Charlie” with instructions on how to access the city centre and where to park. Every radio programme discussed the march. Every small town and village showed their support. Just over 3.7 million people took part in Paris alone, and there were other major gatherings throughout the country in addition to widespread international support. Not everyone necessarily agreed with the content of “Charlie Hebdo” (circulation about 60 000), but they were demonstrating solidarity with the victims and in support of freedom of the press.

At a time of great grief in the aftermath of so many deaths, I hope its not insensitive to wonder if there is freedom of expression in the medical press? Of course there is, you say. But, it was prescient of Tony Delamothe to ask how medical journals explore difficult topics in his piece entitled “Don’t look away now” in the Christmas edition of the BMJ. Although he writes that “The days have long gone when the journal carefully picked its way through the events of the day trying to avoid any unpleasantness”, he wonders how future generations would judge the journal “if we avert our gaze from the medical consequences of what is happening to the occupants of the Palestine territories and to the Israelis next door”. There are many horrific wars with huge medical implications; closer to home, questions have arisen about medical involvement in torture. Should medical journals address these issues, and how would readers and the public react?

The reaction when doctors speak out, even about important medical issues, would not encourage anyone to address difficult topics. Richard Smith, a former editor of the BMJ, wrote a blog over the New Year on his choice of the best death. It was a challenging and provocative piece, but his was an important message about how we think about death. He was castigated by readers, both in the responses to his blog and in the national press, and he published a response to the criticism in a follow-up blog.

The story made waves nationally and internationally. However, such reactions dissuade doctors from asking hard questions about sensitive issues. It is difficult to challenge orthodoxy in a world where outrage is so fashionable. Although we would uphold complete freedom of the medical press, only the brave or foolish step out of line.