How to Get Bad Law That Nobody Supports Through Parliament

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Let us imagine an ex-advertising man called Lord Scratchy. After, his old PR firm, Itchy and Scratchy helped the Tory party win elections, he has now been given a seat in the House of Lords. Still working in PR, with many large American Breweries using his skills, he now introduces a Private Members’ Bill into the Lords which he calls the Free Beer Bill.

In newspapers, he says that he has been stunned that he has had to pay around £5 for a pint and wants to see a day when beer is free. However, the Free Beer Bill does not mention Free Beer. Instead, it seeks to remove the right of pub customers to complain if their beer is off or has been short measured. Scratchy says that his remarkable insight into the pub business suggests that landlords live in fear of complaints and even legal action from customers and that freed from this fear they will be able to offer a wider range of beers and some of them, somehow, might even be free. Probably.

A few people who are listening point out that there is no evidence for any of this and his hopes for free beer are completely implausible.

The Government though are keen to keep Scratchy onside. He is a big donor to their party coffers and deserves a crack at getting this legislation through. Or at least they do not want to annoy him by appearing to block this. So, they set up a public consultation on the proposed Bill. About 160 responses are received from organisations like the Campaign for Real Ale, landlords associations, legal firms who specialise in pub business and charities. Almost all of them express their concern about the Bill, how it may lower standards in the industry, let in the unscrupulous, damage trust in the trade and create legal mayhem as lawyers try to sort out the chaos. But most respondents, perhaps fearful of Scratchy’s power, express their concern over the price of beer and hope that, with appropriate ammendments, beer may in fact become free one day.

Alongside this consultation, Scracthy has been paying his PR team to set up a website to collect signatures from the public. “Do you support Lord Scratchy’s Bill for Free Beer?” Sixteen thousand people immediately sign up to this noble campaign. Scracthy submits these signatures to the consultation and proclaims “Look, only a few misfits and vested interests have expressed doubts. Most are hoping the Bill can be made to work and the overwhelming majority of the public want this. Remeber, these are your voters. Do you want to be seen to be against Free Beer?”

And so the Bill begins its trundle through the Lords. Most Private Members Bills do not make it through to the statute books, so a skillfull game is required. The Lords that turn up to the debate are deferential and polite. They express their horror at the price of beer and congratulate Scratchy on his bold attempts to bring forward the day when beer will be free. A few more knowledgable peers, understanding the Bill is nonsense, attemp with utmost respect and politeness, to introduce a few ammendemts that may defang the worst excesses of the Bill. These are rejected as unecessary by an ever so polite Lord Scracthy and so the Bill trundles through on the nod, after going through the requisite motions in the Lords committees. It is not a done thing to oppose such things. The Lords are all honourable and the Bill has honourable intentions.

Outside parliament, concern is growing about the Bill. The Bill is absurd. It has one purpose – to remove all liability for bad beer from landlords. All a landlord has to do to free themselves from the scrutiny of Trading Standards and the courts is to ensure they have asked someone else behind the bar if the beer is alright today. They have no obligation to listen to the answer and there is no obligation to actually check if anything is actually wrong with the beer. A simple checkbox of asking another person, who may know nothing about beer, will release the landlord from all obligations. Get served a bad pint? Receive a short measure? Get overcharged? Tough. The landord has been responsible in ensuring everything is alright with the beer. Where once simple remedies to a problem pint existed, now the drinker is left out in the cold. Landlords, of course, were happy with the current situation. They priced into their business the occaisional bad pint and were always happy to try to put things right. Now a new breed of unscrupulous landords could exploit customers. Or breweries might no longer care about quality control.

The industry is alarmed. But few of the leaders will speak out and lead any opposition. After all, there are knighthoods and peerages at risk here. One hundred Michelin star restauranteurs write to the Times to express their horror. But Scracthy dismisses them as being elitist and out of touch. People want free beer. A few legal firms who specialise in the pub trade point out the absurdities and again they are dismissed as greedy vested interests who will lose out under the new Free Beer regime.

Lord Scratchy is delighted with the progress. His power connections have allowed him to recruit the Torygraph newspaper to be his official media partner for this Bill and they print a series of glowing articles proclaiming the imminent arrival of free beer. After the Bill passes the Lords, Scratchy proclaims his Bill has been thoroughly scrutinised and there can no longer be any honest opposition to this Bill. All that needs to happen now is for the Bill to slip through the Commons on a quiet Friday with a nod to procedure and without a vote. After all, why tie up precious Commons time? Everybody wants Free Beer. The Lords have done a fantastic job of honing and refining. Let’s get this through and everybody can get down the pub.


 

I thought you should know that Lord Saatchi’s Medical Innovation Bill passed through its final reading in the Lords last week. It had its first reading in the House of Commons yesterday without a debate. It is difficult to find any professional body, academic or major charity who supports this Bill. It has one purpose: to remove the right of patients to seek redress in the courts if they are the victim of negligence or quackery. It applies to all treatments – not just terminal illnesses. All the doctor has to do to remove their liability is to ask another doctor their thoughts on the treatment. That other doctor does not need to see the patient, understand the treatment or even consent. The act of asking will be enough.

Lord Saatchi says this will free doctors to innovate and find a cure for cancer. It is not clear how this will happen.

One significant ammendment was added to Saatchi’s Bill in the Lords. It is going to require the GMC to keep a public register of all these ‘non-standard’ treatents. This was rather dumped on the GMC. At the moment there are major questions over this such a what is actually meant by a non-standard treatments (as doctors will say, there is no such thing as a standard patient). Also, there are obvious concerns about patient confidentiality and security. Someone will a rare enough disease will certainly be identifiable. It is also not clear how such a register will add to scientific knowledge – it will just be a hodge podge of anecdotes. And no doubt the unscrupulous quack doctor could record their ‘successes’ in there as more advertising.

The Bill still needs to go through the Commons. It could just get through on the nod. What will stop this is if just one MP objects and then the Bill will have to be scrutinised by the House. It will take a brave MP to do that. Given the short timeframe between now and the General Election, any objection could almosr certainly kill the Bill in this parliament. There will be some unhapy bunnies if that happens.

But this is an important Bill that all medical, legal and academic commenters have suggested will create legal chaos, is completely unecessary and cannot have its stated intentions of helping find a ‘cure for cancer’.

Full Commons scrutiny of the Bill is required. Full democratic oversight should be the minimum standard. Instead, this Bill could get through on patronage, power and PR.

The Medical Innovation Bill is bad for patients, will cause legal chaos for doctors and will harm medical research.

An MP needs to object. Support the Stop The Saatchi Bill campaign.

On this theme…

11 Comments on How to Get Bad Law That Nobody Supports Through Parliament

  1. I have been puzzled as to why Saatchi is so excercised over this issue.
    Doctors and medical scientists have been seeking ‘new ways to treat incurable disease’ since time immemorial. The laws and ethical standards we have today assists this noble cause, does not prevent innovation, and protects patients.
    Clearly Saatchi has a problem

    The answer might be found in a piece he penned for the Daily Telegraph the day after the Lord’s approved his bill:
    “At last, we have hope of finding new ways to treat incurable diseases.”

    As usual, he is simply wrong. We have always had that hope. His bill will achieve nothing except to let quacks off the hook.

    He claims “No one has objected to the principle of the legislation.” Is that true?
    The bill expects there to be an ‘open register’ of innovative techniques – when even regular techniques are not properly registered. Ask Ben Goldacre and the ‘All Trials Campaign’.
    And who will pay? The GMC? That means the medical profession.
    I think not, we have dedicated our careers to avoiding quackery.

    Saatchi’s suggestion that ‘voters want to see change’ and that his bill will help is a combination of arrogance and impertenance.

    His piece does however explain his psychological status:
    “The Bill was born in the mire of my personal grief….What is my motivation? Do I have an axe to grind? What is my interest?…I am doing this in memory of my wife and all those who have died of cancer.”

    Saatchi expresses precious little concern for all those who might be exposed to false claims, quackery and fraud.
    But at least his own feelings will be asuaged, so that’s alright.

  2. Let’s stop those experimental Ebola treatments now!

    There’s plenty of quackery in conventional medicine we need to stamp out first. Went to a NICE training day yesterday. I always thought that only 40,000 patients a year die of acute kidney injury but the Professor of nephrology leading the event is convinced 60,000 is more accurate. Large slice induced by conventional drugs!!
    I think the folks at Sense About Science need to grow a pair and look at the real issues instead of peeing around annoying a few homeopaths.

    Don’t get me started on type 2 diabetes treatments!!

    • Way off topic Robin – but let me asj you this. When was the last time Sense About Science did anything about homeopathy? And what is their largest campaign at the moment? (hint: AllTrials)

      • All Trials? And what is the evidence base for evidence based medicine?
        If there are five thousand licensed drugs in the BNF and a patient takes five medicines then the possible combinations are 4.4 quintillion combinations. Have we done clinical trials on each of these combinations in sufficiently powered trials. Er no. So how the hell do we know these combinations are safe or effective in real life 85 year old patients with CKD, reduce liver function etc.

        Evidence based medicine has major limitations. Do read the RCGP latest report on “patient-centred care”. I hope the days of cook book medicine are declining. Some people are starting to see the light.

      • Nobody will claim there are not serious problems in the evidence base for many medicines. But what alternative do you propose to gathering more evidence?

      • The topic here is the Medical Innovation Bill.

        Saatchi claims that under his Bill “Doctors who innovate must record and share the results – good and bad- of their innovations on an open register. Doctors and scientists must know what works and what doesn’t.”

        That is, he supports evidence based medicine.

        So Robin, your point (on this topic) is…?

      • Yes, polypharmacy is increasing and it is a problem. It is likely that a not insignificant proportion of iatrogenic injury and death are linked to polypharmacy. It raises the likelihood of prescribing/dispensing/monitoring/administration errors and ADRs. I’d recommend the King’s Fund report http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/polypharmacy-and-medicines-optimisation-kingsfund-nov13.pdf and it should alarm anyone who reads it. It’s a moot point how the challenge of an aging population with complex co-morbidities should be dealt with and by extension how polypharmacy should be managed but I don’t think you can make anything other than the vaguest link between it and the Saatchi bill except in terms of oversight and governance. Unless, perhaps, the Saatchi bill would also remove the right of patients or their next of kin to seek legal redress in the case of iatrogenic injury or death, full stop?

      • Interesting points Malleus.
        In my opinion, the best way of preventing deaths from polypharmacy would be to stop the prescribing of drugs or therapies without primary end point data. Take type 2 diabetes, we have only one drug, metformin, which has robust data yet we continue to prescribe drugs to hit narrow HbA1cs when the evidence is that tight blood glucose control does more harm than good. A 12 fold increase in infections with gliptins. No thanks!

        http://www.thennt.com helps show how a lot of what we do in medicine and pharmacy has no evidence base. Like homoeopathy, but with harm.

        One drug that is effective and I would keep is amitriptyline for neuropathic pain NNT=2. Interesting it has no license for this indication. An example where the Medical Innovation Bill would allow the evolution of novel uses of existing therapies (in this case a licensed pee poor antidepressant).

  3. Robin: You’re still stretching to make your concerns relevant to this particular topic. In the case of your quoted example, amitriptyline is already being used quite widely for neuropathic pain. There are numerous other examples of drugs being used “off license” already. Having no license for a particular indication simply means the manufacturer cannot market a drug for that indication. The current system does not prevent novel use of existing therapies: as long as it plausible and there is some evidence for its use, or it is part of a properly conducted clinical trial, the doctor is unlikely to be sued.

    I agree with Andy. The proposed bill will undermine protection for patients while doing nothing for useful innovation.

  4. I wonder if anyone knows if this bill will have force in either Scotland or Northern Ireland with the different legal systems and NHS organisations? I am as exercised over this piece of excretion that is the bill, but if I’m to contact my SNP MP and ask him to help stop this bill will their policy of not voting on bills that do not affect Scotland mean I will be wasting my time?

    • The Bill applies to England and Wales only.

      The Legislative Consent Memorandum in the Welsh Assembly, which is the Assembly saying whether or not they want it in Wales, was discussed late this afternoon. It can be watched here, starting sometime around 4h 30 minutes (I haven’t checked). It was good to see some proper scrutiny of the Bill for once and not the polite kowtowing and deference we’ve seen in the House of Lords.

      The LCM fell, with 54 votes against it and zero votes for the motion. A complete and utter defeat, but will Saatchi – and MPs – take note?

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