About the private finance initiative and the Blair government's disintegration of the NHS into a competitive market led by consumer wants rather than by national health needs, nobody has published more evidence than Pollock. For the editor of the BMJ to dismiss this as led by ideology is an impertinence. Without exception, every paper published by the BMJ starts from ideological assumptions of some kind. That the editor's assumptions apparently coincide with those of currently fashionable and conventional opinion does not change their ideological nature. Readers can make their own judgments as to which ideology has most explanatory and predictive power, either experimentally or in the more chaotic real world of practice, which in the absence of pilot projects is all we have to go on in assessing the consequences of marketisation.
This is a deadly serious business. Asked to describe the nature of the corporate state in the 1920s, before the full consequences of fascism were understood by comfortable people outside Italy, Mussolini answered that in his state the worlds of government and business would become one and indivisible. Godlee should consider how far we have already travelled along that road, and then reconsider the ethics of neutrality in such a situation. At the birth of the NHS, the BMJ had a role of which its later editors were frankly ashamed. Today, when the NHS is being buried alive, has it lost the power of speech?