BMJ journal pulls case report after UK tabloids publish graphic photos

A BMJ journal has retracted a medical case report about a couple in the United Kingdom who were infected by parasitic worms while on a Caribbean cruise.

The paper in BMJ Case Reports included graphic photos of the patients’ buttocks, the site of the infection, which were republished within a week by UK tabloids.

Specifics about when and why the journal retracted the paper remains unclear. BMJ Publishing Group, the journal, and the corresponding author have not responded to multiple requests for comment.

A UK-based lawyer, who has represented doctors in cases that touch on publishing and media law, told us there could be legal trouble. Martin Soames, of London firm Simons Muirhead & Burton, told Retraction Watch that UK laws governing patient confidentiality or protection of personal information could apply, raising problems for both the publisher and the doctors who wrote the paper. [See update at the end of the post, in which the editor says the paper was removed, and “does not consider that there are any issues of liability.”] 

The journal raised the issue of liability in the retraction notice, which was spare and undated. Aside from basic information about the article, the notice only said:

This article has been withdrawn. With no admission of liability, BMJ has removed this article voluntarily at the request of the patient concerned.

The retraction marks the second time in the last year that a BMJ journal has mysteriously withdrawn an article, potentially motivated by privacy concerns. In August 2017, BMJ removed a 15-year-old documentary film review after receiving a request from one of the film’s subjects that cited the European Union’s “right to be forgotten” law.

The original article, “Cutaneous larva migrans with pulmonary involvement,” was published Jan. 12.

The notice does not provide a retraction date, however, an archived version of the paper is a snapshot taken Jan. 20, which suggests BMJ Publishing Group acted after the case report was picked up by multiple British tabloids, including the Mirror, which published its story Jan. 16, and the Daily Mail, which published on Jan. 17.

Soames said that the question of liability depends on what, if anything, the patients agreed to when they were treated at Addenbrooke’s Hospital in Cambridge, UK:

If the patients signed something where they agreed to information about them and their treatment being used in medical research, they might have thought that was going to be something completely different from this…They might not have thought it would extend to publication in a medical journal and onward publication in national newspapers.

Sometimes, patients sign away confidentiality to benefit medical research without reading the fine print or giving thought to the consequences, Soames said. He gave a personal anecdote about a recent visit to the doctor:

[The doctor] said, “Oh I’m doing research on this topic and are you willing to have your results used in that?” I said, “Yeah, I’m fine about that,” and I signed something having skimmed it quickly.

Which is, I guess, what everybody does, even lawyers.

Update, March 6 2018, 14:43 UTC: The day after this story appeared, BMJ Case Reports editor Seema Biswas sent us an email (which we unfortunately missed until now), explaining what happened:

BMJ takes such concerns seriously, and has for many years ensured that we have the consent to publication from any patient who is reported on individually and might be identifiable in an article.

The position in relation to the article in question is as follows.

Firstly, the article was not retracted, but was withdrawn.

Before publishing the article, BMJ Case Reports received the patient’s written consent to publication.  By signing the consent form, the patient indicated their understanding that complete anonymity could not be guaranteed and it was also made clear in the consent form that BMJ publications are viewed by many non-doctors, including journalists.

Following publication of the article, and subsequent press coverage containing the relevant photographs (which was not generated directly by BMJ as BMJ did not press release the article), the patient contacted the journal and explained that they were concerned about being identified by close friends and/or colleagues, as a result of the subsequent media coverage.  For the avoidance of doubt, the article did not identify the patient and provided minimal information about them.

The patient’s concerns did not amount to a legal threat and BMJ does not consider that there are any issues of liability, given the form in which consent was obtained. Nevertheless, the journal took the editorial decision to remove the article, because of the distress the patient had suffered. This is reflected in the wording now published at the relevant URL, namely that this was a voluntary decision. To be clear, the removal of the article does not amount to a retraction and the journal stands by its factual content.

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