Ben Goldacre, The Guardian, Saturday 15 May 2010
It’s worth paying attention to medicine, because when it goes wrong, people suffer and die. But how do we know when things are going wrong? This week the BMA produced a report on whistleblowers. Of the 384 doctors they surveyed (with a dismal response rate of 12%, we should be clear): 40% said they would be too frightened of repercussions to report concerns about patient safety. Of those who had spoken out on an issue, one in ten were told this could have a negative impact on their careers. But are they being melodramatic? And what if life for whistleblowers was better?
A study published in the New England Journal of Medicine this week follows up 26 whistleblowers from the pharmaceutical industry. In the US, they know how to motivate people: speaking out is well remunerated, and if you help the government bring a successful case, you keep a significant chunk of the settlement for your own pocket.
The money is big. In September last year, for example, Pfizer paid $2.3 billion to settle allegations – backed by evidence from 6 whistleblowers – that they illegally marketed a painkiller called Bextra which has since been withdrawn. The 26 people in the NEJM study this week received an average of $3 million for their trouble, with the range going from $100,000 to $42 million.
They say money wasn’t the issue – and to be fair most were already on high wages – raising motives like personal integrity, a responsibility to protect public health, and a fear of getting caught themselves, if they became complicit in the thing they were blowing the whistle on. Nearly all had tried to fix things internally first by talking to their boss, or filing an internal complaint.
But did the money help sweeten things? Almost all were placed under enormous pressure by their companies from the outset. 13 reported stress-related health problems including shingles, psoriasis, autoimmune disorders, panic attacks, asthma, insomnia, temporomandibular joint disorder, migraine headaches, and more. 6 reported divorces, severe marital strain, or other family conflicts.
The majority were clear, furthermore, that the money was no compensation for the years of conflict, and the lasting damage to their careers. Only 2 were still employed in the pharmaceutical industry. One said he “should have taken the bribe”, another said if she’d “stayed and took stock options” she “would’ve been worth a lot more”. For at least eight, it was devastating. “I just wasn’t able to get a job,” said one. “It went longer and longer. Then I lost [my home]. I had my cars repossessed. I just went — financially I went under… I lost my 401[k]. I lost everything. Absolutely everything.”
These stories come, remember, from a country that makes whistleblowers into millionaires. Here, we expect doctors and other healthcare workers to speak out when they see that people are being harmed or dying unnecessarily, but when they do, we offer no such assistance.
In fact, quite the opposite. Dr Stephen Bolsin was the whistleblower on the Bristol heart scandal, where children were dying unnecessarily. It ruined his career, leaving him unemployable, and he now works as an anaesthetist in Australia. The examples are endless.
The General Medical Council insists that doctors must speak out in such circumstances, and ultimately blow the whistle, or be struck off the medical register. These are admirable ideals which everyone would like to think they could uphold, but we have also chosen to configure our society in a way that punishes people for doing the right thing. If we leave that unchanged, then we may have to be realistic and accept our collective responsibility for the inevitable consequences: unnecessary deaths, and unnecessary suffering.