Tag Archives: patients

Telegraph: The fear of being sued is ruining modern medicine by Dr Max Pemberton

Dr Max Pemberton writes about why he supports Maurice Saatchi’s Medical Innovation Bill in the Telegraph.


By doctor and Telegraph journalist Max Pemberton

Published 9th December 2012

Read in the Telegraph.

Doctors are too scared to deviate from evidence-based medicine and innovation is being stifled.

In recent years there has been a seismic shift in the way that doctors practise. The mantra that young, fledgling doctors repeat to themselves endlessly is “evidence-based practice”. On the face of it, this seems sensible. Of course doctors should only prescribe or recommend treatments for which there is a clear, empirical evidence base. Modern medicine is founded on the principles of scientific inquiry; a hypothesis is put forward, tested and proved or disproved. But, as any doctor will tell you, in real life things are a lot messier than that, and nowhere more so than in cancer management.

Here, evidence is not always as clear and decisive as we would wish it to be. When I worked on a paediatric cancer ward a few years ago, I remember being struck by how little evidence was available to support many of the treatments that were at the clinicians’ disposal. While evidence-based practice is noble in theory, in reality, it’s simply not always realistic, given the complex nature of cancer when its multiple variables, contributing factors and idiosyncrasies are taken into account. This is what makes medicine as much an art as a science.

But worryingly, while doctors know that evidence-based medicine is not always the best choice for treating their patients, they have, in recent years, become increasingly scared of deviating from the standard treatments available to them, even if these don’t appear to be working. One man is trying to change this. Maurice Saatchi, the advertising guru who sits in the House of Lords, last week launched his Medical Innovation Bill, with the specific aim of changing the current culture within medicine that makes doctors fearful of the new and untested. I give it my wholehearted support because I despair at the way medicine is heading.

It’s a tragic indictment of modern medicine that too often innovation is jettisoned in favour of the status quo – not because it’s in the patient’s best interest, but because of the fear of being sued. This defensive medicine is at the heart of so much clinical practice now. Several factors have coalesced to create an environment whereby evidence-based medicine is something to hide behind, rather than simply a gold standard to inform decision-making.

The seeds of this defensiveness were sown in the medical profession’s consciousness following the fall-out from the Harold Shipman case. One of the unintended consequences of the regulation that came in as a result was that, suddenly, doctors and what they did for their patients was under incredible scrutiny. It was no longer assumed that the doctor would, de facto, have the patient’s best interests at heart. The authorities became increasingly suspicious of doctors and what they got up to behind the closed doors of their surgeries. A culture of fear crept into the medical profession. This was against the backdrop of the insidious creep of the compensation culture and the rise of the no-win no-fee lawyer.

Also, as hospitals have become run increasingly like businesses, so a new ruling class has emerged from within health care – the managers. They tend to be wary of any innovation or deviation from protocol that might expose the hospital to litigation risk. With often little or no experience of health care at the coalface, they struggle to grasp the speed, daring and courage needed for medical innovation. So they hide behind protocols and policies and mete out punitive consequences for any clinician who deviates from them. Protocols have solidified into monolithic rules – not to help patients but so they could be waved across a courtroom to defend the hospital against complaints.

The current climate has resulted in a loss of professional autonomy and transmogrified doctors into tick-box automatons, no longer guided by guidelines but strangled and suffocated by them. Mavericks used to flourish in medicine, but they have now been stamped out – branded unacceptable variables of unpredictable risk.

All of this has coalesced to mean that the fear of being sued has ruined modern medicine. It’s not good for the doctors, who are constantly questioning what they do and don’t do – not on behalf of the patient, but because they fear having to justify what they are doing in front of cross-examination. And it’s not good for patients, who are denied the chance of cutting edge, untested and unlicensed treatments when they have little or nothing to lose. Things that might be in the patients’ best interests are not pursued, meaning that nothing moves forward for them, or indeed future generations.

It’s this that the Saatchi Bill is designed to address. Its origins lie in Lord Saatchi’s devastation as he watched his wife, the novelist Josephine Hart, die of ovarian cancer last year. He has managed to turn his grief and sense of loss into something that has the potential to bring untold benefit to future sufferers.

The drafting of the Bill, Lord Saatchi explains, is designed to safely advance the freedom of doctors to innovate and strive for advancement, rather than simply accept the status quo because it means that no one can sue them. This doesn’t mean that doctors will have free rein to experiment on a patient. They are still bound by professional guidance and their duty of care still remains to their patient. But what it does mean is that, in cases where the evidence is shaky or wanting, or is not yet clear, the Bill sets out a code by which doctors can try alternatives. In this way, it actually offers the patient more security than they have at present because it provides, for the first time, a robust legal framework to encourage responsible innovation in diagnosis and treatment.

One in three of us will get cancer. If the survival rates are going to improve, doctors must be free to innovate, and this is what Lord Saatchi’s Bill does. I hope our politicians can see this, too.

→READ in the Telegraph: Dr Max Pemberton writes about why he supports Maurice Saatchi’s Medical Innovation Bill in the Telegraph.

Why innovation would help patients with womb cancer


Photograph ©_honus_ on flickr 

By Kaz Molloy

As a womb cancer survivor I endured surgery, chemotherapy and then radiotherapy – often referred to as the slash, poison and burn approach to dealing with cancer.

Over the past few decades there have been many advances in detecting cancers early but the standard approaches to treatment remain mostly unchanged. In some cases the treatment regime has been the same for decades, leaving patients at the mercy of sometimes ineffective and often barbaric treatments.

Routine chemotherapy for womb cancer is a very recent innovation in the NHS as studies have shown that 1 in 10 women will be helped by chemo – so it is definitely worth trying.  But maybe an individual assay of each patient’s tumour might be able to detect which tumours will be susceptible to chemotherapy and which tumours won’t. This would spare 9 out of 10 patients (and their families) a seriously distressing treatment programme.

We are now in the 21st century and yet innovation in the treatment of most cancers has not progressed because of the failure of the NHS medical establishment to try anything new. Many doctors are afraid to try new procedures because of the risk of being sued if something goes wrong.

The Saatchi Bill seeks to bring about a change in the law to protect doctors and allow them to push forward with innovation in new treatments, which is something that we all want.

As far as womb cancer is concerned, although it is often classed as a rarer cancer, it is still a cancer with a relatively good survival rate, if detected early. It is predominantly a cancer of post menopausal women, although in recent years there have been more and more younger women being diagnosed. However, when they present at their GP with all the typical womb cancer symptoms, they are often told they are too young to have womb cancer so the chance of early detection is missed.

We at Womb Cancer Support UK would like GP’s to take our symptoms more seriously. Most of us had problems with heavy bleeding, fibroids, polyps etc. for many years prior to diagnosis. Some of us have had polycystic ovary syndrome or have Lynch Syndrome in our families.

Womb cancer, like cervical cancer, commonly goes through a well-known pre-cancerous stage known as EIN :  Endometrial Intraepithelial Neoplasia  (Abnormal thickening of the womb lining). Statistically a woman with EIN is according to one researcher 45 times more likely than a woman without EIN to develop womb cancer.

Of course until there are definite biomarkers for EIN and womb cancer, it seems sensible to give at risk women a far better chance of earlier diagnosis of womb cancer. Surely it would make sense that if a woman is presenting at her GP with severe heavy bleeding, that she be monitored to see if she has EIN and if it increases or decreases.

The issue of younger women being diagnosed with womb cancer also brings up the fertility issue. At present many young women are being denied the chance of motherhood because of the pressure to have an immediate hysterectomy and/or cancer treatment. We would like to see all women of child bearing age being given details of all options available to them. In the case of early stage cancer it is sometimes possible for a woman to go ahead with a pregnancy before any treatment commences.

Of course, what we at Womb Cancer Support UK would really like to see is more research done into the causes of womb cancer which will then hopefully lead to a simple screening test.

Some of the recent media reports about women getting womb cancer because they drank too many sugary drinks; drank too much/not enough coffee; don’t get enough exercise; are too fat; etc. are not helping to raise awareness. They are simply trying to blame the patient for getting cancer.  I know of women who have never drunk sugary drinks, who ran marathons and are/were far from being obese yet they still got womb cancer.

The blame game has to stop. Instead we need proper research to find out the causes of womb cancer.  GPs need to focus not on stereotypes, which can be misleading, but on symptoms, which are very clear.  To be fair to GPs, they need rapid access to diagnostic tests.  It’s not rocket science that when symptomatic patients have direct access to specialists they are diagnosed with cancer at a much earlier stage.

And just as one-size-fits-all cancer treatment isn’t suitable for every individual patient, neither is the NHS standard test for womb cancer: one-size-fits-all quick, cheap and nasty outpatient hysteroscopy/biopsy with no pain-relief.  This test may be well tolerated by some fortunately tough patients but may prove a nightmare and a deterrent for other patients.

Womb Cancer Support UK (WCSUK) started out in April 2011 as an online support group for women who had or had had a womb cancer diagnosis. It soon became apparent that there was very little awareness of womb cancer so we try to raise awareness of the signs and symptoms as well as offering support and advice to women who have been diagnosed.

About the author:


Kaz Molloy, founder of Womb Cancer Support UK, was diagnosed with womb cancer at the end of 2009. After treatment which involved surgery, chemotherapy and radiotherapy she became aware of a lack of dedicated support for women with womb cancer so set up an online support group in April 2011.

They now raise awareness of womb cancer as well as continuing to offer support and advice.

Kaz is married and lives on Isle of Bute, off the west coast of Scotland.


Update: 18th October – A chance for Parliamentary progress

The next important Parliamentary event for the Bill will take place on Friday 18th October.   

The Bill is on the House of Commons’ Order Paper for 18th October as one of the Bills waiting for Second Reading.

Friday 18th is a private Member’s Friday, which means that there is a long list of private Members’ Bills for Second Reading on that day, and they will be debated in order from 09:30 until 14:30.

Our Bill is much too low on the list to have a chance of sharing in the available debating time.

But at 14:30 when debating time runs out, every Bill on the list will be “called over”: that means that the Member in Charge of the Bill, in our case Michael Ellis MP, will get a chance to move the Question that the Bill should be given its Second Reading.

If nobody in the Chamber at the time shouts out “Object”, the Bill will be treated as having passed its Second Reading stage and will proceed automatically to its next stage, Committee.

So we need to persuade everyone who is likely to be in the Commons Chamber at 14:30 on Friday 18th October (including the Government’s “Whip” – or business manager) to stay quiet at that critical moment; if we succeed, the Bill will pass its Second Reading stage and will be sent “upstairs” for its Committee Stage, where its details will be scrutinised line by line in a public forum.

Friday 18th is not going to be a chance for a public debate on the Bill, but it is an absolutely critical opportunity for the Bill to make process towards public debate and Parliamentary progress in the Commons.

A number of MPs who have been lobbied so far have replied that the Bill is too low on the Order Paper for 18th October to be debated that day.

It is important to reply that we know that, and that our objective for 18th is not to have the Bill debated, but to have it passed “on the nod”, without debate, through Second Reading and into Committee.