The Second Reading of the dreadfully misconceived and dangerous Medical Innovation Bill took place in the House of Lord’s last Friday. Condemned as a Quack’s Charter for attempting to remove legal protections from patients against maverick, quack and incompetent practice, the team supporting the Bill have been relying on emotive language and anecdotes about cancer patients to push this through.
Lord Saatchi started the debate with a condemnation of doctors in cancer wards,
“The sentence of this Court is that you be taken from hence to the place of execution and that each of you there will be hanged by the neck until you be dead. And may Almighty God have mercy on your souls”.
So wrote Charles Dickens, 150 years ago. It sounds medieval—barbaric even—does it not? Yet much the same can be heard in every cancer ward in every NHS hospital every hour of every day, with only one difference. In Dickens, the condemned were sentenced to death by a court of law. I am not aware that the cancer dead or the victims of any other terrible disease are guilty of any crime. Death by hanging, by firing squad, by electric chair—no human being has ever devised a more brutal execution than death by cancer. Perhaps only the Benches of the right reverend Prelates can advise us on the vexing theological question of why bad things happen to good people.
Either way, those condemned by cancer suffer a worse fate than the worst mass murderer. While they await execution, they are tortured.
This is the sort of rhetoric that we can usually expect from the ‘cut, poison, burn’ cancer quacks. Although Saatchi’s intentions are born from his own loss, there appears to be a very strong anti-medical worldview in how he is pushing forward his Bill. Indeed, one of the major criticisms so far is that the Bill team have failed to take into account the significant and consistent concerns of the medical profession.
I am sure many doctors involved in the care of cancer patients will find these words highly offensive. Cancer can be a brutal disease. And for so many, there are only limited answers as to what can be done and often the treatment can appear to be equally brutal. But to suggest that doctors are personally condemning their patients to death in a ‘medieval’ way is absurd. Care and compassion abounds within our health service.
All cancer deaths are wasted lives. Scientific knowledge does not advance by one centimetre as a result of all these deaths, because the current law requires that the deceased receive only a standard procedure—the endless repetition of a failed experiment. In this way, the current law is a barrier to progress in curing cancer. It defines medical negligence as deviation from standard procedure. In other words, any deviation from standard procedure by a doctor could currently result in a verdict of guilt for medical negligence.
Saatchi has repeated this claim several times that cancer deaths are wasted lives. It is as if our lives are measured by what we can add to medical knowledge at the end. Perhaps, Stephen Sutton MBE might offer an alternative vision. Or even just the countless good lives that have to end in one way and perhaps through cancer.
And in any case, what Saatchi says is just incorrect that doctors have to stick to some rigid formula in treatment. Each patient is different and treatment regimes vary according to the patients needs, make up and wishes. Doctors may not offer unproven treatments precisely because the consequences are not know and may well not be in the best interest of the patient. Suck it and see approaches might quite rightly be seen as negligent.
The rest of the debate was pretty depressing – with a few exceptions. Most Lords accepted what Saatchi was saying at face value. Most worryingly were Law Lords who did not appear to understand the nature of the Bill in front of them and the corresponding law. There were dissenting voices.
Baroness Masham said,
The Bill’s provision may have no positive impact on innovation. It will have no effect on funding, research programmes, clinical governance or professional and medical product regulation. Properly considered, the law already protects a doctor against an allegation of negligence if he innovates responsibly.
She systematically set out the problems with the bill and finished up with,
I have two questions. What evidence is there to suggest that doctors have been discouraged from using innovative treatments for conditions such as Parkinson’s due to concerns about litigation? How many clinical negligence claims in recent years have been linked to innovative medicine?
For taking her time to spell out the problems, Lord Newby (Liberal Democrat) responded,
My Lords, perhaps I may remind the House of what I said at the start of the debate; namely, that it is a firm convention that the House should rise at around three o’clock on sitting Fridays.
Heaven forbid that discussion of such a Bill that might wreck lives drag on and spoil the Lord’s chance to knock off early.
Fortunately, Lord Winston expressed his dismay at such a rebuke,
This is a Bill of colossal importance and to truncate speeches to six minutes, even though it is a Friday, seems to be highly undesirable. It needs to be discussed because there are many implications behind this piece of possible legislation.
Lord Winston was one of the few Lords that appeared to have considered the criticisms of the Bill seriously. He warned his peers,
I conclude with the words of Michael Baum, one of the leading innovative surgeons in cancer in this country, whose contribution to breast cancer is second to none. He has said to me that in his view, “Their Lordships are walking over a precipice if they pass this Bill”.
The government response to the debate came from Earl Howe who made the rather chilling remark,
Noble Lords have highlighted the need to strike a proper balance between innovation and safeguards. That balance is a delicate one. Clearly, patient safety is vital and we would all agree that rogue doctors seeking to take advantage of patients with evidence-free treatments must be stopped. Yet a necessary focus on patient safety must not stifle responsible innovation.
Let’s just repeat that. A focus on patient safety must not stifle innovation.
What was so worrying about this debate is how little attention was actually paid to the views of doctors and medical lawyers. It was as if the Lords knew better and had to legislate in patients’ interests against stubborn professions protecting their interests. The Government did indeed consult on the Bill but that consultation has not been published. The Lords debated in ignorance of the views of the professions. However, on the site that I have set up with Alan Henness (Stop the Saatchi Bill) you can see collated all the responses that have been made public so far. Almost universally, doctors and lawyers, their professional bodies and medical charities have severe misgivings and fears about the Bill. You will not have known about that in the Lords debate.
Most recently, Sir Robert Francis QC, with the support of Professor Sir Ian Kennedy QC, has presented a damning critique of the Bill. It should be enough to stop the Bill in its tracks. It concludes,
This Bill is, like its two or three predecessors, based on the fundamental misapprehension that the law of negligence inhibits genuine and responsible innovative treatment.
Not only that, but for all its good intentions, it is actually dangerous for patients because it proposes “safeguards” which are illusory and which may give free rein to mavericks peddling dangerous remedies to vulnerable and desperate people.
To sum up my fears, let me quote from someone not in the Lords.
Chris Woollams, like Saatchi, is another person who has made his fortune through marketing. And like Saatchi, he lost someone close to him through cancer. Woollams ad agency was bought by Saatchi in 1986, However, after losing his daughter, Woollams set up a charity, CANCERactive that promotes all sorts of ‘complementary therapies’ for cancer. He describes himself as a “Cancer researcher” and “Britain´s leading writer on cancer”.
At this point I am totally in agreement with Maurice Saatchi who I know from my advertising days. Oncologists in the British health system have become myopic. It is very frustrating for two ex-admen to observe the medical profession at work. Love them or hate them, Advertising people at the top are very bright. They believe totally in the power of research. But as a guide. “Wise men use research, fools follow it” was David Ogilvy’s quote. Ad men then think inside and outside the box. They will use whatever it takes to get the job done. To deliver. We are just not the sort of people who would vaguely chuck a drug into someone in the hope it might work. And we would be very concerned about the side-effects and damage that might be caused, in the process. We are the mirror image of the majority of British oncologists. We have both seen their efforts first hand. It is no wonder we both scream that there must be a better way.
We should be very afraid of such words. Join us at http://www.stopthesaatchibill.co.uk/.