UK: Without Innovation, We’ll Never Cure Cancer

(Originally published by Maurice Saatchi at: http://www.telegraph.co.uk/health/10166690/Without-innovation-well-never-cure-cancer.html)

The Prime Minister reminds me of Adlai Stevenson’s striking description of President Kennedy as “an idealist without illusions”. He is a realist to say we have quite a way to go to get close to the Government’s goal of “every clinician a researcher” and “every willing patient a research patient”.

Speaking of Britain’s 34 Nobel prizes for medicine, David Cameron says: “We must ensure the UK stays ahead”, and that “to keep pace with what’s happening, we’ve got to change radically… the way we innovate.” And that would mean, he adds, that “every time you use the NHS you are playing a part in the fight against disease.”

Unfortunately, his vision is about to hit a roadblock. The irresistible force of his dream will soon meet an immovable object – the law. Scientific discovery is blocked by law. And all cancer deaths are wasted lives.

The law obliges the doctor to follow the status quo, even though he/she knows it leads only to poor life-quality followed by death. Science learns nothing from these thousands of deaths. Scientific knowledge does not advance by one centimetre, because the current law requires that the deceased receive only the “standard procedure” – the endless repetition of a failed experiment.

The pre-eminence in law of the standard procedure is a barrier to progress in curing cancer. Any deviation by a doctor is likely to result in a verdict of guilt for medical negligence. The law defines medical negligence as deviation from that standard procedure. But as innovation is deviation, non-deviation is non-innovation. This is why there is no cure for cancer.

The present emphasis of the law on medical negligence means the parties line up sets of opposing expert opinion and require the courts to choose between them. The ambiguity and uncertainty of a trial inevitably makes it the safest course to adhere to established practices, irrespective of how long and how unsuccessfully they have been applied.

The result is that a doctor deciding how to treat a case starts with the knowledge that as soon as he or she moves away from established standards within the profession, there is an automatic and serious risk that he or she will be found guilty of negligence if the treatment is less successful than hoped. Where there is only one established practice, even if it is the same treatment that has been applied unchanged for 40 years without any particular success, it will be impossible for a doctor to depart from it with confidence that he or she will not be exposed to litigation.

You will hear it said that the law of medical negligence hasn’t changed for decades and medical innovations have still been made – penicillin, for example. So why is a law change suddenly so urgent? The law may not have changed much, but society has. We are more informed, less deferential and more litigious. The number of lawsuits filed against the NHS has doubled in four years – last year’s pay-out was £1.2 billion, while the Treasury provision for claims against the NHS has now reached £19 billion.

So doctors are increasingly frightened of being sued, and even less likely to feel able to innovate. “Risk-management” processes within the NHS and insurers’ policies designed to stem the rise of litigation can only increase this anti-innovative pressure.

Growing fear of litigation leads to growing bias against innovation. This is why the Prime Minister’s vision – every clinician a researcher – cannot be realised without a change in the law.

We don’t want patients to be treated like mice. But, on the other hand, we do want bold scientific innovation, which alone can bring a cure for cancer. The Medical Innovation Bill, which arrives in the House of Commons today, supported by MPs George Freeman and Michael Ellis, sets out in law for the first time the difference between reckless experimentation and responsible, scientific innovation.

The Bill strengthens the ability of the medical profession to prevent irresponsible innovation and to control the manner in which responsible decisions to innovate are taken. The good doctor will feel safer, and the bad doctor revealed as negligent.

The Bill’s requirement for the approval of any proposed innovation by the hospital’s Multi-Disciplinary Team is a severe test – more severe than the “two doctors” authorisation required in order to carry out an abortion under the Abortion Act, or sectioning in an institution under the Mental Health Act. However severe, it is better than the current position, in which the road ahead to any innovation in cancer is closed by law.

The Bill will strike a better balance between therapeutic conservatism and therapeutic innovation. It will help the Government to move the culture safely towards the innovation Mr Cameron so wisely seeks. I intend to do everything in my power, to devote my life in fact, to make the Prime Minister’s dream come true.