He couldn’t have chosen more alarmist language. With almost biblical fervor and no hint of doubt, he declaimed: “Around 6,000 people lose their lives every year because we do not have a proper 7-day service in hospitals.”1
Would you feel entirely comfortable taking your beloved to hospital on a Saturday after a ringing denouncement like that? Many clearly didn’t. In the weeks following Jeremy Hunt’s propaganda about too few doctors causing excess weekend deaths in hospitals, reports began to emerge of patients staying away. The cancer patient left paralysed after the ‘weekend effect’ frightened her away from hospital. A woman left partially blinded after delaying her trip to A&E until Monday morning.2 Even a toddler that died.
Someone who knows better than most the catastrophic potential of spinning a spurious claim as medical fact is the editor of the BMJ, Dr Fiona Godlee. “Such a breach of trust is deeply shocking,” she states. “And even though almost certainly rare on this scale, it raises important questions about how this could happen, what could have been done to uncover it earlier, what further inquiry is now needed, and what can be done to prevent something like this happening again.”3
Except the breach of trust she refers to is not the Secretary of State’s, but that of one of the most notorious doctors in British medical history – the disgraced gastroenterologist, Andrew Wakefield. His infamous 1998 Lancet publication fraudulently claimed that the measles, mumps and rubella (MMR) vaccine caused autism in children.4 Eventually, Wakefield was struck off the Medical Register for unethical conduct, but not before fearful parents in droves prevented their children from being vaccinated. As vaccination rates plummeted, epidemics broke out of mumps and measles, causing several child deaths and cases of permanent brain damage. Subsequent studies ruled out any link between autism and the vaccine.
The BMJ, who exposed some of Wakefield’s fraudulent practices, pulled no punches in accusing their rivals, the Lancet, of complicity in the fraud. The journal’s “scramble to protect reputations and discredit the story” amounted to nothing less than “editorial misconduct”, stated Fiona Godlee at the time.5 Another BMJ editorial elaborated that: “journal editors may find it hard to put aside their own investment in a piece of research that they have decided to publish and defended against post-publication criticism”.6
For the BMJ today, these sage – yet rather lofty – pronouncements are proving awkwardly prophetic. For it is the BMJ who published the paper upon which Jeremy Hunt’s ‘weekend effect’ scaremongering is based.7 No one is accusing its authors of fraud, but of something else that threatens scientific integrity – the deliberate veiling of conflicts of interest.
Scientific rigor rests on impartiality. All the authors of Hunt’s ‘weekend effect’ paper of choice signed a form declaring no conflicts of interest, but one of them, Sir Bruce Keogh, happens to be the medical director of NHS England, something he – and the BMJ – neglected to mention in the competing interests statement. Nor did Keogh and his fellow authors reveal that NHS England had in fact commissioned the research. Nor that their paper’s findings had been shared with the Department of Health before the paper had been accepted for publication – even though the BMJ’s own guidance requires this admission. Perhaps most suspiciously of all, Jeremy Hunt himself somehow knew the conclusions of the paper for his infamous ‘weekend effect’ speech, a full thirteen days before the BMJ made a provisional offer to the authors to publish the paper.
Given Fiona Godlee’s unequivocal condemnation of “editorial misconduct”, I’m bewildered why the BMJ hasn’t demanded from lead author, Nick Freemantle, Bruce Keogh and the others, a comprehensive explanation of the full political context to their ‘weekend effect’ paper. Surely BMJ readers have a right to know, to enable them to assess its credibility for themselves?
Most fundamentally though, I expect Jeremy Hunt to justify why he claimed lack of doctors caused excess weekend mortality, when even the paper’s own authors admitted it would be “rash and misleading” to do so. To me, that makes Jeremy Hunt akin to a political Wakefield – someone playing fast and loose with patients’ lives to further their own agenda. Wakefield’s objective was money. Hunt craves votes – or perhaps a shot at Number 10 one day. Either way, scaremongering patients for political ends is wholly, irredeemably self-serving.
Today, the University of Manchester published a study showing that Hunt’s weekend effect may be a statistical artefact, explained by the fact that sicker patients are admitted at weekends, not that fewer doctors are imperiling patients’ lives.8 No doctor I know is surprised.
Here, for the record, are my competing interests. I am a junior doctor. I believe that Jeremy Hunt’s new contract for juniors will unequivocally endanger my patients. I believe that scaremongering is bullying though fear. And I expect more than mere spin from my elected representatives. Just as we practice evidence-based medicine, I expect them to deliver evidence-based politics.
- Hunt J. Making healthcare more human-centred and not system-centred. Speech at King’s Fund. www.gov.uk/government/speeches/making-healthcare-more-human-centred-and-not-system-centred. 16 July 2016.
- Weaver M, Campbell D. The Hunt file: doctors’ dossier of patients ‘put at risk’ by health secretary. Guardian. 7 October 2015.
- Godlee F. The fraud behind the MMR scare. BMJ 2011; 342
- Wakefield AJ et al. Ileal lymphoid nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [retracted]. Lancet1998;351:637-41.
- Godlee F. Institutional and editorial misconduct in the MMR scare. BMJ 2011; 342.
- Opel DJ. Assuring research integrity in the wake of Wakefield. BMJ 2011; 342.
- Freemantle N et al. Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ (Clinical research ed) 2016; 352(i1762).
- Meacock, R et al. Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission. J Health Serv Res Policy 2016. doi:10.1177/1355819616649630