[e-drug] The rights and wrongs of WHO's policy of censorship

[kirsten.myhr@relis.ulleval.no]

E-drug: The rights and wrongs of WHO's policy of censorship
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[This editorial from the Lancet is very interesting - and depressive
reading. E-druggers please note the comment on Jono Quicks article about
conflict of interest and the last paragraph. Copied as fair use. KM]

Lancet 2002; 360: 1995 (21/28 December)
www.thelancet.com/
Editorial
The rights and wrongs of WHO's policy of censorship

Senior staff at WHO are now in open revolt against a small group of senior
policy advisors who govern much of the agency's day-to-day public
activities. Privately, senior WHO officials--the Director-General, members
of her private office, her Geneva cabinet, and programme directors--are
engagingly frank about WHO's successes and failures. They debate, advocate,
give way when criticism is just, and pursue their arguments vigorously when
they believe their critics are in error. But when it comes to discussing on
the record WHO's place in the politics of world health, they fall silent.
The reason is well known to insiders.

Through the Director-General's office (DGO), WHO tries to exercise
censorship over who can say what in public. For example, when Jonathan
Quick, who leads the Essential Drugs and Medicines Policy unit, wrote about
conflicts of interest in the Bulletin of the World Health Organization last
year, a whispering campaign began in senior WHO ranks. Officials in DGO put
out the view that Quick was stepping beyond his remit, thereby undermining
the Director-General. As far as DGO was--and remains--concerned, WHO's
successes can only be publicly attributed to one person--the
Director-General. Only the Director-General or her office can control who
speaks for the organisation, decide the daily news agenda, or be seen to
lead. Until now.

When The Lancet published the results of its collaboration with the
Rockefeller Foundation (see Dec 7, p 1797)--an open letter to the Executive
Board of WHO and a commentary setting out priorities for a new
Director-General--WHO at first refused to respond. The agency declined to
take part in a debate about WHO on the BBC's World Service. Realising that
the debate would go ahead without them and that such a public forum needed a
respondent, WHO eventually put up David Nabarro, the former head of DGO, and
now one of its senior policy advisors and an executive director.

But several sources have now sent The Lancet an email written by Nabarro to
all executive directors, DGO's senior media advisors, and WHO's legal
counsel, instructing them not to respond to the accelerating debate about
WHO's work. Nabarro wrongly accuses The Lancet of undertaking "an offensive
against WHO and its staff". He writes, "It would be inappropriate for staff
to be writing spontaneously--in these or any other terms--about WHO to the
Times [where a letter from The Lancet was published concerning the
forthcoming election for a new Director-General], the Lancet, the BMJ, or
other journals, unless explicitly requested by DGO COMM [DGO's
communications unit], or the equivalent." This attempt at censorship is
remarkable for a scientific and technical agency such as WHO. It displays a
level of insecurity quite at odds with WHO's mandate to be the leading
global agency to defend the health of the world's poorest people. WHO's
executive and programme directors are not political apparatchiks. They are
all internationally respected scientists and public-health specialists. Yet
WHO denies them a voice in a debate about the past and future of an
organisation that matters desperately to the health of the poor.

This centralising tendency and aggrandising strategy for the
Director-General is also seen in Nabarro's "summary points" in response to
criticism of WHO's work. He notes that, "The process of improving WHO's
country work began when Dr Brundtland joined the organization . . . That the
world is now conscious that tobacco is a major global health threat, is due
to Gro Harlem Brundtland." Yet improving WHO's country work has been a
long-term commitment of past WHO administrations, many country
representatives, and partners who have devoted great energy to thinking
about health systems since the 1970s. The dilution of the Health for All
initiative under Brundtland has weakened, not strengthened, WHO's country
work. Moreover, the basis for WHO's skillful tobacco campaign has depended
on many individuals outside and inside WHO over many years. Placing this
success on the shoulders of one person is a travesty of the truth.

This strategy of misrepresentation and prohibition is a pity. For WHO has a
strong case to put against its critics. WHO has prepared a confidential
point-by-point rebuttal to our Dec 7 commentary. This brief document
deserves to be published and debated. It can be found on The Lancet's
website (http://image.thelancet.com/extras/211202ed.pdf) and we encourage
comment. But it seems bizarre that the only way WHO's officially sanctioned
response can be made public is via sources who refuse to bow to censorship.



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