Patient Safety and Medical Innovation

Debate between Julian Huppert and Sarah Wollaston

Tuesday 9th December 2014 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Like books, one should never judge a Bill by its cover. Later this week, the Medical Innovation Bill reaches Report stage in the House of Lords, but I would like to demonstrate that it is fundamentally flawed in its premise, it is unnecessary, it removes essential protections for patients, and it increases the risks of their exposure to maverick doctors. I believe it will undermine not only patient safety but medical innovation and so will have precisely the opposite effect to that intended.

Under current law, a doctor is negligent if he or she acts in a way which no responsible body of medical opinion would support, or which is irrational or illogical—the so-called Bolam test, as refined in the case of Bolitho. The Bill would rewrite the law on clinical negligence and a doctor whose decision to treat would not be supported by any responsible body of medical opinion, or was illogical or irrational, would be able to call on a new Saatchi defence if they fulfilled the procedural requirements of the Bill. That is important: the Bill’s protection of doctors applies if the procedural requirements are met. The Bill states:

“For the purposes of taking a responsible decision to depart from the existing range of accepted medical treatments for a condition, the doctor must…obtain the views of one or more appropriately qualified doctors in relation to the proposed treatment”.

There is no requirement for the second doctor to have seen the patient or even read their notes, and no requirement for them to be independent. They could be working at the same private clinic. It is of little reassurance that the treating doctor must

“take full account of the views”

of the second doctor if the second doctor is in collusion with the first in that treatment, which may be unreasonable.

If the Bill is passed, we will put patient safety at risk and we will no doubt have to return to amend the legislation subsequently. Let me quote from a letter forwarded to me by a constituent who had met a visitor to my constituency who managed to convince him utterly that this individual’s company had found a cure—a miraculous treatment—for cancer, but was being obstructed by a vast conspiracy in the medical community. In the letter, David Noakes, who describes himself as the chief executive of a biotechnology company, refers to a compound he calls GcMAF, which he describes as

“a human protein, present in 5 billion healthy people, that removes a number of diseases, including terminal stage 4 cancer. It has no side effects.”

He attaches a couple of scientific-y looking papers, which have no bearing on proving its clinical effectiveness. Mr Noakes continues:

“It’s always difficult to get feedback, but we have hundreds of superb results. In Guernsey, we treat over 100 people and…have 50 successes including 10 excellent cancer results. We have perfect feedback in our German and Swiss clinics, where our 7 doctors reduce tumours at the rate of 25% a week”.

He says that he cannot do it in the UK

“because the law is so destructive.”

Here is the bit that really worries me. Mr Noakes states:

“But we state that if you have terminal stage 4…cancer, have not had chemotherapy, and you do the”

so-called

“GcMAF protocol, you have an 80% chance of being cancer free in a year.”

In other words, what the company is specifically saying to people is that they can look forward to that result if they do not have chemotherapy—it is actively encouraging people not to have evidence-based treatment and promising that it has a cure for cancer.

Mr Noakes says that

“The pharmaceutical industry is not interested in”

this treatment, because there is no profit in it—

“it is too cheap, and can’t be patented”.

He says:

“The chemo lobby is so powerful it has changed British law so that doctors are only allowed to prescribe the poison of chemo for cancer when there are…better treatments.”

He adds, specifically:

“Lord Maurice Saatchi is trying to get that law changed with his Medical Innovation bill, but against so powerful a lobby”—

and so on. In other words, for this individual and the seven doctors to whom he refers, the Bill would be carte blanche. They see it as a Bill that would provide them with protections. The Bill specifically refers to medical practitioners and doctors as the people who can take this forward—not homeopaths or unregistered doctors. He says that he has seven doctors in his company. If one of those seven consulted another doctor in the clinic, it is highly likely that they would agree that this was an eminently sensible treatment.

[Dr Julian Huppert (Cambridge) (LD)]

I thank my hon. Friend for giving way and for securing this debate on an important subject. It is a shame that more people are not in the Chamber to discuss it. There are some very real concerns. Does she agree that people who are terminally ill may be desperate for treatment, and that simply makes them prey to people who may be unethical, who may be trying to push the envelope, and who may be doing things that would harm them but that sound quite good?

[Dr Wollaston]

I agree with my hon. Friend. In my constituency a medically qualified individual attempted to set up a cancer conference. It had to be pointed out that under the Cancer Act 1939 it is not legal to advertise cures for cancer. The Bill would allow people to circumvent the Cancer Act. How easy is it to get a reference to a miracle treatment planted into a magazine article, for example? This is the real danger here. While the Cancer Act protects people against blatant advertising, it does not provide protection against the back-door advertising that we already see. What is to stop individuals who are absolutely desperate—as my hon. Friend has said—going to doctors with articles saying, “This is a cure. I want you to refer me to this clinic.”

[Dr Huppert]

I will try to resist the temptation to intervene too often. Does my hon. Friend agree that this is not just about cancer? We have already had homeopathic doctors, who may practise medicine as well as homeopathy, claiming that they have powerful treatments for Ebola that the World Health Organisation will not let them work on. The Bill would open the door for all sorts of quacks who will do serious harm in the name of medical innovation.

UK Drugs Policy

Debate between Julian Huppert and Sarah Wollaston

Thursday 30th October 2014 Commons Chamber

[Dr Wollaston]

May I make a little progress and then I will come back to the hon. Gentleman?

I would like to focus on cannabis for a moment—that is the issue I have most correspondence about—and on its harms. Cannabis is often presented as somehow a harmless product, and if we compare it with alcohol and consider the numbers of deaths and injuries, alcohol undoubtedly currently causes far greater harm in our society. However, before we assume that it must therefore be acceptable to legalise cannabis, I want to focus a little on its harms. In the short term, there is double the risk of a car crash for people driving under the influence of cannabis, and in the longer term, one in six young users will become dependent. It simply not true to say that cannabis is not a drug of dependence—it is.

For me, this is about the impact of cannabis on young users and teenagers, because they will double their risk of a psychotic illness. In my career I have met many families and young people whose lives have been completely devastated as a result of psychosis—I come to this debate from that viewpoint and my real concern about what psychosis does to people, because many of them did not recover. That is particularly important for those who have a family history of psychotic illness. For example, if someone has a first degree relative with a history of schizophrenia and they start using cannabis as a teenager, they will double their risk of a psychotic illness from 10% to 20%—a significant increase.

[Dr Huppert]

It is always interesting to listen to the hon. Lady, and I do not think anybody is trying to make the case that drugs, legal or illegal, are harmless. Does she accept, however, that because we make it an illegal system, we cannot do what has been done in California, for example, where medicinal marijuana has allowed the breeding of strains of marijuana that are less psycho-harmful?

[Dr Wollaston]

That is why I want to see the longer term results from Colorado and Washington state, and whether as a result of that system the harm to young people from cannabis is reduced. Personally, I think it is too early to say what the effects will be, but I will be following the results closely. If I see clear evidence of harm reduction, I will completely change my approach to this issue.

People often write to me and say, “Well look at Portugal where there has been a reduction in drug use”, but the Czech Republic, which has the same approach in not prosecuting people for personal use, has one of the highest levels of cannabis use across Europe. We must be careful about how selectively we quote from the evidence.

Defamation Bill

Debate between Julian Huppert and Sarah Wollaston

Tuesday 12th June 2012 Commons Chamber

[Dr Julian Huppert (Cambridge) (LD)]

It is a great pleasure to speak in this debate. We face a tough challenge in trying to write defamation laws. On the one hand, we want freedom of expression and, on the other, we want protection of reputation. We want to get the balance right while ensuring that the system is affordable, because the law should support whoever is right rather than whoever is wealthiest. We should also ensure that the law is accessible to all, not just to lawyers, and we simply do not have that balance. The costs are not right—they are far too high—and there is what has been described today as the chilling effect of people being silenced for fear of large costs, even in thoroughly unmerited cases. That happens. We have heard about a number of cases, including those that involved Simon Singh and Peter Wilmshurst. We have heard of publications such as Nature, Which? and the British Medical Journal, which do not feel that they can publish articles out of fear. It applies online as well—Mumsnet, WhatDoTheyKnow and many others.

While I was writing this, a case came up in my constituency, Cambridge. Richard Taylor, a local blogger and an extremely assiduous attender of council meetings who writes them up in immense detail, described a council meeting which was looking at enforcement action against a property in Cambridge being used as a bed and breakfast without the benefit of planning permission. This has led to a rather bizarre libel threat from an organisation known as WWFS Ltd or UK Law Consultants Company, who say they are consultant solicitors. Though I am not an expert in the field, the claim appears to me to be baseless, especially since the people making the claim refuse to say which part of his description they find defamatory. They have gone on to threaten other commentators.

Mr Taylor writes on his blog—all this is there, if anybody would like to look at www.rtaylor.co.uk—and this should worry all of us:

“My view is that this kind of thing is one of the reasons people shy away from entering discussion of how we run our society, be it at the local level in Cambridge or more broadly.

Having received the threat of legal action I have had to consider if I am prepared to risk everything I have in order to do what I consider to be the right thing and continue to publish the material. This is to an extent the question which has to be asked before publishing any material, every blog post and every tweet could potentially be personally ruinous.

Should the case reach court, the cost of defending it, even if the judgment was in my favour, could exceed my resources.”

A number of people with legal training and others are assisting Mr Taylor in the case and I think he will be all right. He is also determined enough to get through.

The current position is not acceptable. The Libel Reform Campaign was established in 2009 to try to make a difference. Lord Lester proposed his Bill in 2010. There was a Government draft Bill in 2011, and I had the great privilege of serving, with other Members who have spoken, on the Committee which considered that. The full Bill was tabled in 2012, led by the Minister, Lord McNally. It has been nice to see how this has captured the imagination. As John Kampfner, the chief executive of Index on Censorship, said,

“When we launched the Libel Reform Campaign in 2009, only the Liberal Democrats backed change. Now the cause has cross party support.”

That is absolutely correct. I pay great tribute to him and to everybody in the Libel Reform Campaign—Index on Censorship, English PEN, Sense about Science and all the other supporters that they have.

I would like particularly to mention one extremely dogged individual who has been involved with that, as well as with the Hacked Off campaign, Dr Evan Harris. I suspect that Members in all parts of the House will have heard his comments on the issue. I am delighted by the cross-party support that we have.

This is a good Bill, but with some tweaks it could be a great Bill. I am delighted by clause 1. The serious harm test is right, but it should be coupled with a strike-out power so that cases could be quickly ended where there is no serious harm to consider. I support clauses 2, 3 and 4 as they codify the common law, which means that non-lawyers such as myself can find out what the rules are, without having to plough through case law after case law.

With regard to clause 4, I am pleased about the codification of Reynolds, but it is still a complex defence. Some improvements can be made, as Members have mentioned. I hope the Government will consider the possibility of a simpler, clearer public interest defence which would apply where defendants take appropriate action to correct any errors or inaccuracies that they have made, as has been suggested by the Libel Reform Campaign. I do not expect the Government immediately to say yea or nay to any such proposal. It needs to be considered very carefully, but I hope they will look at it. If we could find something like that, it would be an excellent improvement.

Clause 6 is a key change from the draft Bill and shows the value of pre-legislative scrutiny, which I hope will be applied to a number of other Bills, as it is shortly to be applied to the draft communications data Bill. Clause 6 is extremely welcome. I pressed hard for this. My experience as an academic scientist made me particularly concerned and I was especially pleased when the Secretary of State announced, in response to a question that I asked him, that there would be a change to give protection to academics and scientists publishing peer-reviewed articles.

Currently, journals are afraid of publishing peer-reviewed statements, and academics can be afraid of making the statements that they need to make. There has been an insidious silencing of rigorous scientific debate. A survey conducted by Sense about Science in 2010 found that 38% of editors of scientific journals have chosen not to publish certain articles because of a perceived risk of libel, and 44% have asked for changes to the way articles are written to protect themselves, not necessarily because they thought there was a genuine case to answer. Journals such as Nature, the British Medical Journal and a range of others are not libel experts and should not be expected to be libel experts.

[Dr Sarah Wollaston (Totnes) (Con)]

Does my hon. Friend accept that that should be extended to national newspapers? There is indeed a stifling of debate about scientific issues in the national press, and very many of our constituents do not read the scientific press and need access to good scientific debate in the national press.

[Dr Huppert]

I thank the hon. Lady for her comment. She is right that we need to encourage more educated scientific debate among the general public. That is a larger issue than the subject of the present debate. The question is how far one goes in providing the sort of privilege that we are talking about. Peer review processes are significantly better developed than what we see in newspapers. I would expect newspapers to have more access to lawyers who could advise on libel because they deal with a range of issues. But there may be ways of going slightly closer to what the hon. Lady suggests and I would encourage something like that to happen.