We had beer.
Probably I’d had a few. But I recall all the conversation. With a good friend of mine, later my Best Man, we supped a pint in The End Of The World. It’s a pub. I think it’s in Camden. This is why I assume, retrospectively, that I might have had a few. It’s not an area I know and can’t think why we were there. But some out of the box thinking was there.
Very early Noughties, possibly end of the nineties, we were talking about science journalism. An idea was born, two-fold, “The Journal Of Negative Results” and “The Journal Of Anecdotal Evidence”
If you’re reading this post, you almost certainly know my feelings about the Saatchi Bill and might not believe that this was our conversation. I assure you it was. Hand on heart.
We talked, as one does, about how this could be a great idea, a non-judgemental forum (I had recently written my dissertation, ‘Whistleblowing in the NHS,’ so the idea was fresh in my mind) and it could aid discoveries and new pastures. We rallied on this idea for the evening and I was enthused that my friend, recently into web design, and I would make this happen.
We didn’t keep momentum going. I got caught in a busy job and the idea rested.
Of note my friend is now CTO of a major open access Science academic website. I said I’d give him some cash to invest. Regret not having it to hand back then.
So, anyway, the idea was born. It was well intentioned.
Fast forward (you can do the wobbly hand thing, whatever) to the current day. The Saatchi Bill hopes to promote innovation, prompt new ideas (despite specifically not applying to research) and ‘stop cancer’.
Admirable aims, no one could disagree.
I was fortunate to attend the recent debate at KCL about the Bill. It was awe-inspiring to be in the presence of so many people who have advanced scientific discovery AND healthcare. I was humbled.
A question, very fairly put, however, was ‘what you can you do when there is no data?’
If there is no data (stand back EBM!) can you justify a new intervention? Does innovation need the Medical Innovation Bill to do something new?
I felt I could pipe up here. I raised the point of a case I had dealt with where we tried an innovative treatment which was used in a patient about to go into cardiac arrest. It worked, although that is not the issue, probably. The important message is that at no point was I concerned that I would be in legal trouble for innovating. Never did that hold me back. I worked in the patient’s best interests, and I suspect that phrase was even in my mind at the time.
I felt arrogant standing in front of 130 people, boasting how I’d saved a life. That is my job, however, and it entailed an important point. In the times when there is no data, no EBM, one still feels protected by Bolam and Bolitho. The Saatchi Bill is not required.
I finished by explaining how we had written up and presented the case. We tried something new without data, with out fear of legal implications, we wrote it up to further medical education. Therefore the bill, and the proposed register, are not required.
After the debate I was asked an extraordinarily good question by a young lady. I didn’t get her name, possibly she is studying neuroscience- I don’t know.
“If you’d given the drug and it hadn’t worked, would you still have written it up?”
Glorious. What a marvellous question.
I’d love to say that we would have written it up, but that isn’t true. Should we write up negative innovation results? That stuff doesn’t make good reading (“it doesn’t tell me what I *should* be doing!”) and possibly the volume would be overwhelming. And how does it look for your workplace, if you’re constantly trying things that don’t work or are harmful?!
I had been asked a very relevant question.
Negative results are published all the time. Many are not, but may be discussed between colleagues and at conferences. For the individual case, that crucial first case, that first innovation, we do need an openness for these.
So innovation is not stunted. But perhaps our sharing of knowledge, of What Not To Try, could be better.
Let’s put the Medical Innovation Bill to bed. But let us use this chance to debate what we could be doing to share information, to share experience. We all have our own journals of anecdotal medicine and negative results in our experience. Let’s think about how we can share that more.
Now that’s a sobering thought.