Professor Baum: three simple principles of clinical practice

Professor Baum’s rapid response to Margaret McCartney’s BMJ column ‘Withdraw Saatchi’s quackery bill’ may be read in full here

I have also included it here in full, for in its skilled brevity it sums up everything that is wrong with the (still) proposed legislation.

Re: Withdraw Saatchi’s quackery bill
30 April 2014
Professor Michael Baum, Emeritus Professor of Surgery UCL, London NW11 6PT

There is one thing worse than controlled experimentation and that is uncontrolled experimentation.

There are many patients we can no longer help but there are none that we are incapable of hurting.

When patients are judged beyond cure they are never beyond compassionate care.

The supporters of the Bill seem to have overlooked these three simple principles of clinical practice.

In 45 years experience involved in clinical cancer research I have never once encountered the law as an impediment to innovation.

ten years on

52 stories

10 years ago today I was on the other side of Tavistock Square when the bus bomb went off. I had been heading for Waterstones Gower St from my new place around the corner off Russell Sq. and instead ended up in the centre of a scene of terror. Traffic and people and noise, horns and alarms and then sirens surrounded me and nobody I looked to seemed to know or could comprehend what had just happened. I remember being dazed, walking the other way towards the book store and then turning back hit by a realisation I could perhaps be useful. I was a teenager with only basic first aid skills from a red cross course I’d done at 16, so I wasn’t and didn’t try to be all that useful, but I later helped some people get to UCLH with minor injuries and saw some things which, though numb at the time, had frightened me.  The phone lines went down some time later that day and the reality of what was happening began to settle amidst the dust of confusion, horror and disbelief.  I walked miles through the streets later that day to my old house in W. London. It sounds shallow in comparison to the reality but I remember exactly what clothes I was wearing, what book I had wanted to find, the exact words and conversations around me and faces, all seared into my memory. The streets walking back were filled, and many of the people still didn’t fully know what had happened.

In the coming weeks I had to walk past the BMA where the bomb exploded to get to King’s Cross; the faint smell and the flowers would remind me not to look up at the wall.  It could so easily have been any of us on the tube or the bus at the time and I felt guilty and haunted by the bus, horrified. But I was moved by the stories emerging of survivors, by recalling the incredible efforts of others that day, the brave and skilled passers-by, and by the absolutely extraordinary work, such dedication that I struggle to find the words to capture, the work of those in the emergency and health services that day.  

On this day I think of those whose lives were tragically cut short in 7/7 with sadness, and respect, those whose lives were changed forever, those who have gone on to change others, those whose efforts saved people, the emergency services, doctors, nurses, paramedics; and those who walked the streets for miles together that day, and the next day and the next week they got the tube, the bus, and went to work. As much as I can complain about London, I’m proud that London can be so strong and brilliant in its togetherness.  #WalkTogether 

Blink and it’s back, again, twice

In a fascinating display of parliamentary quick change tango, Lord Saatchi’s creation has hotfooted not only back to the Lords to be read a second time in July (with the hopes of subverting usual procedure and fast-tracking straight to the lower house for its completion- with a time limit of one year from its reappearance) but, according to the Bill’s website, it is now replicated in the PMB proposed by MP Chris Heaton-Harris in the Commons.

Of course, if this is the case then it’s gone from a, relatively, restrained misrepresenting of benefit by using the word ‘innovation’ rather than ‘experimentation'; to a wholesale misrepresentation of content. The original never contained anything that would have enabled access to treatment,at all, despite the heavy lines spun to encourage loud, urgent, understandable, support.  One suspects Lord Saatchi’s new bill will be the same when it suits him to dupe supporters into believing it’s had the ok-go from the Lords; and will be an entirely new and fresh venture when the hideous problems and wall of opposition, from doctors’ representatives, patient charities, research groups and patient safety experts, to the original attempts are pointed out.    Nobody’s quite sure whether the Bill site has told the truth or not because the Bill probably hasn’t been written yet, despite having its first reading yesterday. Nor can anyone know how many willing helpers put their names in for the PMB ballot to run it for Saatchi; brownie points all round, right?
And what dazzling speed – Britain’s got talent for something, anyway, just apparently not appropriate, considered, transparent health policy or legislative drafting.
From the website:
Screen Shot 2015-06-25 at 19.33.38Screen Shot 2015-06-25 at 19.33.58
With a typically overt disregard for quality of life or respect for human worth, the mass guinea pig market was announced in the Telegraph as well, will they be this Bill’s media partner too?
On the plus side, Tredinnick’s cleared off temporarily for his gig at Glastonbury.

Anticoagulation, powdered owl & an outlier on the spectrum of reason

A GP with decades of experience in practice and medical education, Dr Wollaston became an MP in 2010 after an open primary in Totnes. Her invaluable experience and insight on national and local issues of importance as well as her specialist expertise made her the ideal choice to inform the Westminster vacuum.

She was soon appointed to the Health Select Committee, a cross-party committee to hold the government and health bodies to account and make policy recommendations. In 2014 she was elected Chair. She did a fantastic job in the role and it would be a terrible disservice to health policy, the committee and the government’s credibility if she were not Chair again. Very few are as qualified and appropriate for the role and,  felt keenly with the absence of such MPs as Julian Huppert on this occasion, we need to maximise the insightful few that we have. She’s also a rather great role model.

Her challenger for the role is David Tredinnick.

Why is that news? Well it’s perhaps not that newsworthy I guess, and that’s what’s scary. 

David Tredinnick’s appointment to the Health Select Committee itself was really quite shocking, but that was way back in 2010. Though inapposite, add in the company of other desperately unqualified persons such as Nadine Dorries and it’s no longer a surprise.   

Tredinnick, MP is so out there he’s ‘a hallucinogenic substance in his own right’.  He is a big supporter of his own variant of astrology, not only claiming for personal development courses, but once claiming expenses from taxpayers for £755.33 of ‘computer software and consultancy to investigate whether astrology can be linked to alternative medicine.’

In the House of Commons he has stated emphatically that blood does not clot on a full moon, and surgeons won’t operate on full moons. Indeed his fear of the moon has been raised on a number of occasions.   He launched a tirade of EDMs at the indignance of people who knew what they were talking about to talk about stuff, like homeopathy; and relied upon so-completely-unambiguously-discredited studies to support his claims, even those which claimed to cure cancer and where authors asked to be removed from papers. 

Like Australia have concluded, our Science and Technology Committee found homeopathy useless. David Tredinnick then joined the Committee.  

He still believes astrology should be used more often in healthcare in the UK.  Recently in 2015 he reiterated the virtues of astrology as “a useful diagnostic tool enabling us to see strengths and weaknesses via the birth chart” and proclaimed that astrology and complementary medicine “would help take the huge pressure off doctors”. So much for Francis and safe staffing. Perhaps NICE have already a-okayed this as it’s clearly cheaper to replace legitimate health policy with the nuttier side of woomongery’. 

‘How to handle the ongoing issue of having this bizarre, deeply wrongheaded man in a position of influence over matters that demand evidence-based decision making?’ asked Adam Rutherford, 5 years ago.   The indulgence of his personal interest in astrology to the detriment and exclusion of real matters for his constituents and for the health of the nation has not gone unnoticed in parliament either. 

But now this man, who Professor Brian Cox politely termed ‘an outlier on the spectrum of reason’  not only wants to be on it, he has been nominated to chair the Health Select Committee. 

Beating cancer with astrology

Beating cancer with astrology

Almost impossible to parody it’s not actually funny.

These are not the affable, eccentricities of your distant uncle or your old headmaster. This is not harmless.

Championing discredited studies as evidence in parliament, including for cancer treatment, is deeply contemptible. Steering health policy in this way is like crashing it into the dover cliffs. It’s not “the awesome power of the moon” flinging it there – it’s Westminster sinking itself, and the rest of us in the process. 

More from Professor Cox here. 

 

Novel use of procedures to avoid scrutiny

Saatchi’s Medical Innovation Bill (more properly titled the unfounded novel use, irresponsible human experimentation and removal of redress Bill) was not, in the end, rushed through in the last parliament, despite the best attempts of Lord Saatchi to use his weight and talents to create extra time and special rules. In his shock that this, sanctioned by the conservatives, was not going to work out, he proclaimed that Nick Clegg was a nasty murderous sort with blood on his hands, and had handed down a death sentence to patients.

All Nick et al had done was say, hang on a minute – medical organisations, patient charities and medical defence orgs don’t want the Bill, patient safety experts and legal experts are up in arms abut the Bill, and Wales unanimously condemned it, and were quite horrified by it. Perhaps we shouldn’t rush this dangerous and widely condemned draft legislation in these circumstances and instead it warrants detailed scrutiny, at best, and certainly not to be pushed through in this cavalier fashion because of who Saatchi is how much power he wields or how much he donates.

Who he is does not make it right to risk (limitless) patients’ lives, safety, dignity and their quality of life.

Saatchi’s crew then went flat out trying to pressure the Lib Dems to cave in to the Conservative deal to allow this monster of a danger to be passed without any scrutiny by deploying the tried and tested setting up of petitions and shouting in the press at a crucial pinch point before the election. Thankfully the Lib Dems had more integrity, and some very sensible MPs who understood science. (Though Sarah Wollaston is a stalwart of sense, she has not been listened to by her own party – and has found herself surrounded by some extraordinarily inept characters.)

At the HealthWatch public debate on the Bill held at King’s College London in March, Nigel Poole QC and Nick Ross spelled out the problems with irrefutable clarity and sense.

Alas clarity, sense, science and integrity are being challenged once more by the undead Bill, raised from the ground and re-entering the House of Lords on the 8th June.

Worse still, the attempt to limit scrutiny and avert the gaze of noble Lords who may know what they are talking about has gone to new lengths. Lord Saatchi has given notice to the House to agree a motion that Standing Order 46 (no two stages of a Bill to be taken on one day) be dispensed with, allowing the Bill, which would need to be identical to that which left the Lords, to career straight through to the Commons without any stages of examination by learned peers, and be pushed through on the nod. If there’s one thing we need, it is proper scrutiny, particularly in light of the overwhelming opposition to the Bill from those who know what they are talking about, including those in parliament and experts in patient safety such as Sir Francis QC and Sir Ian Kennedy QC.

More info: Stop the Saatchi Bill

politics.co.uk and openDemocracy

A welcome decision

Stop the Saatchi Bill Alliance statement

The Stop the Saatchi Bill Alliance welcomes the decision not to move the Medical Innovation Bill at its second reading.

While we firmly support innovation, we were joined by countless charities, experts, professional and patients’ organisations in our concerns that the Bill, which was set to apply to all patients, all doctors, all conditions and all treatments, was both unnecessary and unacceptably dangerous.

The law of negligence does not impede responsible innovation and the Bill was poorly targeted on this baseless premise.

Some further concerns included that the Bill would undermine clinical trials and introduce contradictory and dangerous amendments to the law, removing a patient’s ability to access redress without providing any additional rights of access to treatment, helping neither doctors nor patients.

Importantly, it was widely agreed to be a serious threat to patient safety.

However well-meaning the originator and motivations of this private member’s Bill, it is a disgrace that the Government and Department of Health supported and encouraged dangerous primary legislation based on such lack of evidence and with such ill-conceived expectations.

The Stop the Saatchi Bill Alliance will firmly reject and repudiate any future moves to bring such legislation back. There is no legal impediment to medical innovation to be solved.

Read: Media articles about the Bill

The Saatchi Bill public debate – HealthWatch & KCL

The HealthWatch debate at King’s College London

The debate took place 4 March at KCL with Professor Sir Michael Rawlins and Daniel Greenberg proposing the motion ‘this house supports The Medical Innovation Bill’  with Nick Ross and Nigel Poole QC against.

Here’s the full debate:   HealthWatch Debate – Medical Innovation Bill

and a rather spiffing live-blog account of it at nhsshakeup.co.uk

 

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