I salute the PR industry for finding new and elaborate ways to muddy the waters.
(Ben Goldacre — Guardian, 20 November 2010)
When Ben Goldacre wrote those words, he was talking about the use (or misuse) of PR to guide people into answering survey questions the way the PR company wanted them answered instead of how they would naturally be answered. I’m appropriating his words to introduce this article because they aptly describe how the campaign supporting the Medical Innovation Bill has been run.
The bill’s campaign director, Dominic Nutt, no doubt cross that Solicitor’s Journal have run a number of pieces highly critical of the bill, has written a response to that criticism, which they have been more than fair in publishing for him. Actually, he hasn’t written a response to that criticism, what he has done instead is to write another piece that attempts to justify the bill, while answering none of the genuine concerns.
As far as I can see, Mr. Nutt makes a number of erroneous claims, most of which we have seen before. In this article, the latest instalment in a series looking at the campaign’s “truthiness”, I’ll briefly discuss each of the major claims, pointing where appropriate to where they have previously been debunked, before looking more closely at the statements he makes about the use of PR in the campaign.
These are what I think are the major claims made in the article. If you think I’ve missed any, or have misinterpreted them, let me know in the comments.
Claim: The bill will reduce medical litigation
This claim forms the headline for the article — “Saatchi Bill will stifle explosion of NHS litigation.”
However, the Saatchi campaign has not been able to demonstrate a single case of litigation arising from innovation, not a single one, and neither has their staunch supporter, Lord Woolf, who appears to think it impertinent for anybody even to question the accuracy of his vague recollections. None of the bodies responsible for protecting doctors or regulating their practice can find evidence of a single case to support the bill either. There are genuine problems with innovation, but this, it seems, ain’t one of them.
As a substitute for evidence, the bill seeks to conflate non-existent litigation arising from innovation with real litigation arising from bad medical practice. There’s a worthwhile conversation to be had about whether there is too much of this type of litigation, but the Saatchi campaign appear not to want this conversation. Instead, they aim to sweep away the patient’s ability to seek redress if a doctor mistreats them.
Claim: The bill team have consulted extensively, and the bill has been adapted as a result
- Selling the Sizzle
- Time to Call a Halt
- Never Say You’re Wrong
- What The Lords Missed
- Lords of the Round Table
This claim has been dealt with extensively, to say the least, so I don’t need to spend much time on it here, except to say that I plan to return at a later date to the subject of the official DoH consultation, which the Saatchi campaign tried to sweep under the carpet after the strength of opposition became clear, supplanting it with their own on-line petition. Part One of that saga was described in Selling the Sizzle. Part Two soon…
I do find it interesting, though, that Dominic Nutt should say
For two years, Lord Saatchi, parliamentary counsel Daniel Greenberg and I have been talking to doctors, lawyers and patients about how best to encourage medical innovation
It’s the use of the word “to” that leaps out at me there. They have been “talking to” people. Not “with”, not “consulting with”, no, they’ve been telling these groups what needs to be done. “Talking at” might be a better description, because they haven’t been listening. When the heads of the Royal Medical Colleges tried to explain the problems with the bill, Saatchi didn’t listen. When a group of more than 100 oncologists wrote to oppose the bill, he attacked them in a way that Lord Turnberg was moved to describe as “unfortunate and inappropriate”. Almost all the amendments suggested by Lord Saatchi’s noble colleagues to try to curb some of the extensive dangers of his bill have been rejected.
Claim: There are insufficient trials for rare diseases. The bill will help patients for whom no trial is available. Evidence-based medicine is not appropriate for patients who are about to die.
This subject is something I shall return to with a more detailed article when I get a chance. In the meantime, some observations.
It’s worth reminding ourselves at this point that the bill doesn’t just apply to patients with a terminal illness that has no known cure. It applies to treatment for any illness, major or minor, even if that illness has an effective treatment already available to cure it. Anyway, moving on.
Mr. Nutt describes his neuroendocrine tumour, and says that for people with this disease there is only one clinical trial available, with an exclusion list that would prevent him taking part should his tumour recur.
There’s a site here that allows you to display a handy map showing open trials for various conditions. On a search for the key word “neuroendocrine” it shows 51 open trials in the UK. There’s more detail here. Now, some of these are not going to be of the right type, and I’m not going to go through them all here, but there’s clearly quite a lot going on in the neuroendocrine field at the moment, and it seems there are numerous trials recruiting.
It is true that there will be situations where there is no clinical trial available and no established proven treatment for a particular condition, particularly if you have complicating health factors, but in that event the doctor can still try an innovative treatment (as they can at any other time), they just have to be able to justify their decision. The answer to a dearth of clinical trials is not, as Mr. Nutt appears to be advocating, to throw evidence to the wind, his “evidence-based medicine is chimera” claim notwithstanding. As Professor Michael Baum says, there may be patients we can’t cure, but there are none we cannot harm, and harm is by far the most likely outcome of experimentation without evidence. And the answer is emphatically not to remove protections from the patient when risky procedures are undertaken, right at the moment they most need protecting.
Claim: The bill “brings forward the Bolam test” and thus gives a doctor confidence they won’t be sued for innovating
That’s an important article to read, I would suggest, as it illustrates the folly of what the Saatchi bill attempts to do. It tries to replace a strong test of whether the treatment was responsible with a weak test of whether procedure was followed before deciding to treat. It’s not Bolam at all, it’s a box-ticking exercise that exposes the patient to unfair risk while arguably failing in its primary aim of protecting the doctor from litigation. This does not bring clarity, it brings confusion.
In his latest article, even Dominic Nutt now has to admit that — despite his repeated assurances to the contrary on social media — the bill stops short of requiring that an innovating doctor has to get agreement from a suitable colleague before proceeding with an experimental treatment. Instead, they need merely to talk to one or more colleagues; not only is agreement not required, the bill team have rejected calls for the bill to require it.
Claim: The bill will cure cancer
As an aside, Lord Saatchi did once pose the question: ‘How can an Act of Parliament cure cancer?’ He answered his own rhetorical question thus: It can’t – but it will enable the men and women who will.
This is classic PR flummery. What other meaning are we supposed to take from “But it will enable the men and women who will” than the bill will lead to a cure? There’s no other meaning to that phrase, other than a completely pedantic one where Saatchi feels compelled to point out that the text of the bill itself won’t actually climb down off the bookshelf and put on a labcoat. That would be like getting on a bus, and having this conversation:
Passenger: Will this bus take me to Leeds?
Driver: No, it won’t.
Driver: But it will enable me, the driver, to take you to Leeds.
Passenger: Wait, what?
And Lord Saatchi didn’t just say this once, as Mr. Nutt claims. It has run through his entire campaign. It was the title page of the notes he sent out when the bill was launched, it was how he started his speech introducing it in the House of Lords. In the Telegraph, he was very clear what he meant to achieve:
I intend to cure cancer, you see. I mean to do it. I expect to do it
A more detailed explanation why this bill cannot find a cure for any disease, least of all cancer, will be the subject of a future article. I’m sure you cannot wait.
Claim: The debate around the bill is not a “PR war”
There has been much heat generated by the debate over the Medical Innovation Bill. Only recently, some described it as a ‘PR war’.
It is – or ought to be – no such thing, and I appeal for calm consideration on all sides.
I agree it should have not have been a PR war. And really it hasn’t been a war as such. It’s been more of a PR blitzkrieg, a rolling juggernaut of PR moves, all orchestrated by Saatchi’s PR campaign.
I’ve written on more than one occasion about how this has undermined the whole process. In Selling the Sizzle I explained how PR undermined the public consultation, and how PR skewed the way people viewed the bill. In So Untrue it’s Not True I showed some of the false claims made in support of the bill. The PR has been a central part — the entirety of — the campaign, and I described this in two articles in Guardian Blogs here and here.
The Saatchi campaign has responded to opposition either by bypassing it, in the case of the Department of Health consultation, ignoring it, as with the overwhelming negative response from medical and legal organisations, patient groups and charities, or by attacking it. When a group of oncologists opposed the bill, Saatchi struck out at them in an extraordinary piece in the Guardian. Lord Blencathra went on Radio 4’s PM programme to support the bill and to attack the legal profession, saying they should be rounded up and experimented on, or euthanised. The campaign has gone so far as to claim support where support does not exist. In his latest article, Mr. Nutt talks about “former opponents” as if they have won those opponents over. Would these “former opponents” include Cancer Research UK, who say they see no pressing need for the bill, even while the Saatchi PR machine claims them as having been won over? Or the Royal Colleges, who said “we do not believe the Bill should become law” while Dominic Nutt was claiming this:
The PR has been a one-sided avalanche. How could it be any other way? Lord Saatchi exerts massive influence, placing articles in the press pretty much at will, using his position in the Lords to drive the bill forward against all reasoned opposition. The Stop the Saatchi Bill Alliance, by contrast, is formed of doctors, legal experts, patients and bloggers — a bunch of medical nerds, basically. We have none of the PR skills, none of the influence, and our expenditure so far has been £85. How has Saatchi reacted to our concerns? By smearing us. Our concerns, incidentally, are shared by the organisations opposing the bill. They have given calm consideration to the bill. None of them have called for people who disagree with them to be euthanised.
Perception is reality
Lord Saatchi himself made clear at the outset what sort of campaign he was going to run.
In democratic politics, perception is reality. If the people perceive a problem, there is one.
The Saatchi campaign has set about ensuring that people perceive the problem the way he wants it to be perceived. Remember, this is a bill with its own Twitter account, a promotion team including a campaign director, no less than two official websites, and even a nominated media partner in the form of the Daily Telegraph. It has been backed by the might of Lord Saatchi, whose PR nous helped put the Conservative party in power and cigarettes in the hands of punters.
We’ve seen shifting, contradictory claims made for the bill. It will cure cancer, Saatchi claims, but we didn’t really claim that, yet (nudge nudge) it will really cure cancer. It will help research, but mustn’t be used for research purposes. It will protect doctors from being sued by patients, while at the same time allowing those patients still to sue their doctors, nay, it will increase patient protections. Doctors cannot innovate at the moment, although we know they regularly do, they’re just afraid to, but no we won’t give any examples. Treatment under the bill requires agreement from a qualified colleague, but agreement isn’t actually required required. All this apparently offered with a straight face, underplaying or ignoring the drawbacks of the bill while talking up non-existent advantages, and continually, repetitively making claims that they should by now know are at best seriously misleading.
So, if Dominic Nutt wants debate over the bill not to be a PR war, if he wants calm consideration, perhaps he could speak to his boss about it? Perhaps he could ask him to correct some of the untrue statements he has made? Perhaps he could acknowledge some of his own errors, and stop repeating them? Perhaps they could apologise to the groups they have insulted? Perhaps they could, oh I don’t know, start listening to some of those who oppose this bill or even start addressing their arguments instead of attacking people who are raising legitimate concerns? All I can say is that it would be about time.
I’m not expecting the Saatchi campaign to start talking to me — the only time they’ve ever responded to my repeated overtures has been on one occasion, to distance themselves from a struck-off doctor who claimed to have carried out work for them. But they could respond to this blog post from Nigel Poole QC — True or False? — he has asked a number of highly relevant questions which have never been answered.
So anyway, there’s a bit more to that Ben Goldacre quote I mentioned at the start…
I salute the PR industry for finding new and elaborate ways to muddy the waters. And I salute the nerds who bust them for it.