Stop the Saatchi Bill

Driven by an extraordinary two-year PR campaign on social media and a supportive newspaper partner, this all started as Lord Saatchi’s Medical Innovation Bill, metamorphosed through several versions, and was resurrected under a new name by Chris Heaton-Harris, before finally clearing its last hurdle in the Lords this week to become the Access to Medical Treatments (Innovation) Act.
Pretty much the only thing they share is the word 'Innovation' in the title.

One day, it may be possible for politicians to ask the people who actually work in the medical field: what are the problems you face, and how can we help you overcome them?

One day, politicians may actually listen to the answers they receive, and thus try to tackle genuine problems rather than imagined ones.

One day, politicians, medics, researchers, lawyers, patient groups, charities, and the public, may work together to overcome the barriers to the development and provision of new treatments.

But it is not this day.

Read more: Not this day

Without A Parachute

Reblogged with permission from Without A Parachute by David Hills

In which Saatchi Bill rhetoric takes a bit of a nose dive

In a piece on Sputnik News today, the Saatchi Bill’s campaign director — Dominic Nutt — responds to criticism of the bill by The Lancet, which follows on from previous criticism by more than 100 oncologists. Actually, he doesn’t respond to the criticism, but instead goes off on a bit of a tangent with a parachute analogy.

“To say to such a patient that a doctor must continue with a treatment that will do nothing to prevent their death — because the treatment will ‘do no harm’ — is ludicrous.

“To state the obvious, if they are dying, then a failure to at least try to prevent their death is the real harm. Put it another way — if you are on a plane that is about to crash and there is a parachute on the door with a label on it which says: ‘do not use this parachute, it has not been tested’ would you deny the passenger the right to grab it? Or would you condemn them to death by crashing?” said Dominic Nutt, a spokesman for Lord Saatchi.

I’m going to spend a few minutes unpicking this, because it is very revealing of the problem, but perhaps not in the way that Mr. Nutt would like.

“To say to such a patient that a doctor must continue with a treatment that will do nothing to prevent their death — because the treatment will ‘do no harm’ — is ludicrous.”

It would indeed be ludicrous, if this were what the medical profession were saying. It is not, and Dominic Nutt is engaging in a straw man argument. What the medical profession is saying is that a treatment decision must be capable of being supported by a sound, logical basis that at least a few colleagues would agree with.

We move on…

“To state the obvious, if they are dying, then a failure to at least try to prevent their death is the real harm. Put it another way — if you are on a plane that is about to crash and there is a parachute on the door with a label on it which says: ‘do not use this parachute, it has not been tested’ would you deny the passenger the right to grab it? Or would you condemn them to death by crashing?” said Dominic Nutt, a spokesman for Lord Saatchi.

Actually, the ability to grab that parachute is pretty much a statement of the law as it stands. No reasonable person would prevent the plane passenger trying the parachute if the plane is about to crash, and handing them the parachute would be an entirely defensible action. Grabbing a parachute, even a potentially faulty one, would be a logical and reasonable thing to do in that situation. Once again, the Saatchi campaign misrepresents the current law by claiming that it prevents reasonable behaviour. What he claims the bill seeks is actually what the current law allows.

But the analogy is yet more revealing, because it illustrates an underlying deception of the bill, that it’s about what patients are allowed to do, rather than doctors. This is a fundamental conceit of the bill, that it claims to allow patients to demand their doctor try something new, it empowers them to demand to grab the parachute.

But the bill is nothing of the sort. It is in fact about what the doctor would in future be allowed to do, while escaping any consequence for their actions. What the bill actually would do is to allow illogical and unreasonable actions to be protected by law.

So here’s a better “air crash” description of what the Saatchi Bill would allow to happen.

  • One member of the air crew could replace the parachutes with plastic coffee stirrers. As long as they discuss the change with other members of the crew, they are not negligent to do so. They require no agreement from other members of the crew.
  • On encountering turbulence, one member of the air crew could scream “the plane is crashing!” and advise all the passengers to bail out. It does not matter whether the plane is actually crashing, as long as they discuss the decision to advise passengers to jump.
  • One member of the air crew could advise passengers to jump from the plane at 35,000 feet. This could be contrary to established guidelines that state the plane must be below a certain altitude to prevent passengers being sucked from the plane and to prevent asphyxiation, but as long as the crew member has discussed and obtained the views of their colleagues, they can still continue.
  • The plane is crashing. Instead of parachutes, the flight attendant supplies bottles of water from the drinks trolley, which they describe as “homeopathic parachute 30C” at a price of £50,000. Again, as long as they have consulted a colleague about this change, they do not require agreement.
  • The plane is crashing. The flight attendant refuses to hand over a parachute to a particular passenger, saying that they are not a suitable candidate for one. Although this is against guidelines that say that the passenger should be supplied a parachute, the decision to depart from the accepted range of actions is protected because the flight attendant discussed it with another member of the crew.
  • Remember, the Saatchi Bill is about – and is only about – defending decisions made by doctors that none of their colleagues would support. If those decisions were supportable, they would already have the protection of Bolam/Bolitho, and wouldn’t need the bill. In the aeroplane analogy, it is like one member of the flight crew making decisions about the parachutes that no colleague agrees is a good idea.

Which means that the choice of parachutes as an analogy is an inadvertently appropriate one, since what the bill would achieve is depriving patients of any protection if their treatment goes wrong. It takes away the parachute they could use to protect themselves if something breaks or the pilot crashes their plane.

The Saatchi campaign continues to nosedive under the weight of its misleading rhetoric.

Edit 3/12/14: It has been pointed out to me that I have neglected to reference the following research paper BMJ 2003;327:1459 when compiling this article. I thank the colleague who kindly pointed out the omission, and will find a suitable way to repay him. Oh yes, a suitable way.