Sitting leaders ask you to stand up for safety

Here is an excellent letter in the British Medical Journal (18 July 2009; 339:124).



The same letter in text format (minus references) is below:

Sitting leaders ask you to stand up for safety

If junior doctors follow the recommendation of medical leaders and stand up for the safety of patients will they receive support from those leaders? (1)

“Staff concerns about safety at Mid Staffordshire trust were ‘lost in a black hole.’” (2) The evidence suggests that whistleblowers who report concerns are treated no better in the NHS now than at the time of the scandal at Bristol Royal Infirmary. (3) Medical leaders are responsible for the culture of silence. To become a medical leader one needs to compromise principles for expediency to meet the demands of politicians (in an organisation or government) with the power to advance or destroy a career. Medical leaders lack moral authority because few of them have taken the risk of speaking out on their way to the top. They are too often complicit in concealment of problems to protect their organisations or political masters.(4)

Fiona Godlee spoke at the conference and represented the BMJ.(1) The BMJ has removed from its website articles that have appeared in the paper journal purely to avoid the risk of the journal being sued for libel. The articles have not been retracted because there are no grounds for retraction of truthful reports. Does the BMJ want junior doctors to take the risk of losing their careers by speaking out when it is afraid of the financial cost of speaking?

Liam Donaldson also spoke at the conference.(1) I have had correspondence and meetings with the chief medical officer to discuss misconduct by doctors, but I am left with the impression that he is unwilling or unable to act when the allegations involve senior medical leaders. Yet Sir Liam wants junior doctors to be brave enough to speak about problems.

The motivational speeches of medical leaders to junior doctors seem to be like the pep talks of generals to soldiers at the Somme before the troops went over the top and the leaders returned to their chateau for lunch. Medical leaders must now lead from the front and share the risks.

Peter T Wilmshurst
Consultant cardiologist
Royal Shrewsbury Hospital
Shrewsbury SY3 8XQ

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Misconduct roundup 17 May 09

UK Universities Preventing openness over research misconduct

The Times Higher Education Supplement reports on the ongoing attempt in the UK to prevent proper, open, independent and transparent investigation of research misconduct. It turns out that Research Councils UK (RCUK) attempted to induce Universities UK to allow the formation of a "national body for research integrity with powers to investigate allegations of misconduct". They "consulted" with the Universities who refused to go along with this citing "concerns that such a body would be trespassing upon employer responsibilities".

So following this "consultation" RCUK simply shied away from the idea. The body will now be "advisory".

My own very thoughtful response was cited in the article:

Aubrey Blumsohn, a campaigner for greater openness in research conduct, dismissed the plans. "Experience from a multitude of cases has rudely shattered the idea that it will ever be possible for institutions to investigate themselves ... It is a bit like using a condom with hundreds of holes and calling it safe sex."

So what is this all about? It seems obvious that "investigations" of scientific misconduct should themselves align with the usual principles of scientific discourse (open discussion, honesty, transparency of method, public disclosure of evidence, open public analysis, and public discussion of reasoning underlying any conclusion). This is not what UK Universities are trying to achieve. When you see universities reluctant to investigate things properly, it provides reasonable evidence that they really don't want to investigate things properly.

And this is precisely why Universities UK (or it's Monty Pythonesque "Panel for Research Integrity") have not commented on the role of UK Universities in scientific misconduct or its coverup here, here, or here (three random examples).

More concern over osteoporosis drugs

Here back in my own area of voyeuristic interest (skeletal medicine and calcium physiology) we have a very slowly expanding issue which raises questions as to how we should define scientific fraud.

This paper just out in electronic version in the Journal of Bone and Mineral Research adds to the chatter of concerns about bisphosphonates.

Bilateral Fractures of the Femur Diaphysis in a Patient with Rheumatoid Arthritis on Long-term Treatment with Alendronate : Clues to the Mechanism of Increased Bone Fragility. J Bone Miner Res. 2009 May 6. Somford MP, et al.

Unusual fractures of the femur diaphysis have been reported in patients treated with alendronate and although no causal relationship has been established, excessive suppression of bone turnover and length of treatment with alendronate have been implicated in their pathogenesis. We report here clinical, biochemical and radiological findings of a patient with rheumatoid arthritis and multiple risk factors for fractures who was treated with alendronate for 8 years and developed spontaneous bilateral subtrochanteric/diaphyseal fractures. Bone biopsies obtained form the iliac crest and the femur revealed decreased bone formation with histomorphometric evidence of markedly increased bone resorption at the femur. These results show for the first time that an imbalance between bone resorption and bone formation at the affected bone is associated with the occurrence of these atypical femur fractures. The cause of this imbalance is currently unknown and further studies of the epidemiology and pathogenesis of diaphyseal femur fractures are warranted.

In my view, these are very useful drugs. However, I suspect we are going to see a lot more of this and other problems with time. Perhaps there will be the usual faux regret that we didn't get the thresholds at which undoubted benefit exceeds risk quite right.

Is this fraud? There is a type of "groupthink" and incremental data manipulation by bribed clinicians that has led a whole field of science astray.

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The fall of the General Medical Council - Part I: Confidence or con

Last week I received a tentative invitation (via the group Justice in Health) to "attend" an "event" at Westminster on 24 July 2008. The event "The Future of Health Professional Regulation" is hosted by the Council for Healthcare Regulatory Excellence (CHRE) and the Department of Health. It is supposedly about sorting out professional medical regulators in the interests of patients.

I will not be attending.

Sham public consultation has become a dismal hallmark of this Labour government. They have not learned to listen.

One of those regulators is the General Medical Council (GMC). The GMC is the body that registers and is supposed to "regulate" the integrity and "fitness to practice" of UK medical doctors. This is an important job. The GMC have a huge credibility problem.

If the DoH and the General Medical Council really wanted to find out how to reform themselves in the "patient interest" then they would invite their fiercest and most thoughtful critics to explain the problems that have arisen. There are many such critics. Those critics would detail lamentable and inappropriate behaviour. They would explain how "regulators" have acted to hide fraud, misconduct, and other activities which have damaged patients and science. They would explain how the GMC has bullied some individual doctors, while ignoring parallel but far more serious integrity failings involving the "old boy's network".

There are many people they could invite to present aspects of the regulatory problem in detail. I am relatively sensible. Others provide a range of insights - Peter Wilmshurst, Rita Pal, Charles Medawar, John Abraham to name a few. Many patients tell compelling stories of obvious regulatory obstruction.

But inviting thoughtful hard-hitting criticism is not the intent.

Instead we have a profusion of "reports" which have no meaningful intersection with the real world.

Here is one from a week back:

"Implementing the White Paper - Trust, Assurance and Safety: enhancing confidence in healthcare professional regulators - final report and DH response to recommendations" (2 June 2008). Read it here.

The woefulness is implicit in the title. The report is not about the actual integrity, plausibility, honesty and consistency of medical regulators. It is about "enhancing public confidence in the regulators of healthcare professionals". It is about inducing confidence in the unacceptable. It is not about real confidence. It is a con.

I talk regularly to doctors and patients about the systems that regulate integrity in the UK. I discuss the malfunction of professional and pharmaceutical regulators, sham investigations, and the bizarrely inconsistent approach of the General Medical Council to the telling of lies by doctors. My thoughts are marginally less boring, irrelevant and nausea-inducing than "Implementing the White Paper". Here is the feedback form from my recent teaching session with postgraduate general medicine trainees in Sheffield. No nausea is reported.

So, Department of Health (and the General Medical Council), why not invite your critics to explain how you need to restore decency and relevance to regulation? Invite them to explain in detail - not under conditions of a carefully controlled "consultation". The ghosts of the Bristol babies, the many patients who have died as a result of corrupted pharmaceutical research and the victims of Harold Shipman might applaud. I doubt they would applaud throwing time and public money at an irrelevant confidence scam.

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