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Publish and be damned?
  1. Ian Wacogne
  1. Correspondence to Ian Wacogne, Department of General Paediatrics, Birmingham Children's Hospital, Birmingham, UK; ian.wacogne{at}bch.nhs.uk

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Medical journals have a requirement to be informative, reflect debate and controversy, and protect the rights of patients and their carers. Sometimes these aims create conflict, and such a conflict is described in order to highlight some of the issues considered by editors.

Introduction

The journal received a manuscript for consideration, which described the cases of two children, briefly as follows:

  • There were concerns about the families' ability to provide adequately for the children's needs.

  • One of the ways in which this appeared to manifest was that the children were being over fed.

  • When these children were subsequently removed to foster care their weights normalised – that is, their weights reduced to a normal range and were more appropriate for the children's height.

  • This normalisation in the care of foster carers was seen as evidence of the neglect by the parents.

  • The children were subsequently placed for adoption and successfully adopted.

  • They had been lost to follow-up and so the authors were unable to provide consent from the family for publication.

There has been significant interest recently into whether obesity is itself a safeguarding issue, with a recently published framework for practice in this area.1 These two cases would provide important illustrations of situations where obesity as neglect has been recognised and subsequently reversed, albeit after an extreme intervention.

The issues

The absent consent

Medical journals are generally rigid about consent. If you can be identified, then you should provide consent for publication of your details. The test is: ‘If someone who knew this person could pick up the journal, read it, and make the link, then consent is required’. This can take fairly abstract forms. For example, a description of a clinical course which is fairly unique, but which does not include photographs or other identifiable details, will …

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