The Road to Hell Is Paved with Good Intentions

There is a fantastic medical debate in the UK right now. In one corner, Maurice Saatchi, a man with no medical training but considerable clout in politics and media. In the other corner… most of the UK medical establishment. Saatchi’s Medical Innovation Bill (1) divides them. The bill has a great narrative – you’d expect nothing less from the guru of advertising. Doctors learn to “do no harm” – fine, until you’re dealing with dying patients. Here, “fear of the law” stops doctors from trying “innovative” therapies to save those patients – or advance medical knowledge. Saatchi’s opinion (2) is that “All 165,000 cancer deaths in this country every year are wasted deaths because science advances not one centimetre as a result,” adding, “Nothing new is tried […] Scientific progress is being halted by the law and fear of negligence bills.” Should something be done? The UK’s Health Secretary, Jeremy Hunt, thinks so and supports the bill.

Many doctors don’t. The Bolam test (3) is currently applied, and states that a doctor is only negligent and compensation justified “if no responsible body of medical opinion would support their treatment or if the treatment had no logical or rational justification.” Has the status quo stifled innovation? Unlikely. The NHS Litigation Authority states that such compensation claims are “vanishingly rare – 0.01 percent of such payments” (4). Might the bill help by codifying doctors’ stance and avoiding the need to interpret case law? If you innovate by “departing from the existing range of accepted treatments for a condition”, you must consult “with appropriately qualified colleagues” and consider “all matters that appear to the doctor to be reasonably necessary to be considered in order to reach a clinical judgment” (1). Already holes are being picked, such as “What counts as an appropriately qualified colleague?” (5). Perhaps future cases heard in court will clarify this...

Bills can be revised and loopholes closed. But I wonder how far science advances through anecdotal, ad hoc intervention? There’s no compulsion to publish or framework to pool those anecdotes to generate meaningful data. If you’re going to perform an intervention that risks depriving someone of peace or comfort in the last days of their life, then the information gathered better count for something. I see no guarantees that it will.