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May 15th, 2010 by Ben Goldacre in bad science, big pharma, whistleblowers | 20 Comments »

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backed by evidence from 6 whistleblowers – that they illegally marketed a painkiller called Bextra which has since been withdrawn.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.


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20 Responses



  1. twaza said,

    May 15, 2010 at 6:15 am

    Today’s BMJ has a news article entitled “Scottish doctors call for better protection when speaking out about concerns”

    It is available(behind a paywall) here:
    www.bmj.com/cgi/content/extract/340/may14_1/c2591?papetoc

  2. gammidgy said,

    May 15, 2010 at 9:42 am

    I don’t fully understand what’s going on here. Exactly why are these whistleblowers “unemployable”? Unless recruiters are actively shunning people with morals…

  3. fontwell said,

    May 15, 2010 at 10:13 am

    I’m glad gammidgy asked what I was naively wondering too. Are our hospitals so badly run that every medical team fears it will be exposed by someone who blew the whistle on a pharmaceutical scandal?

  4. JH68 said,

    May 15, 2010 at 10:50 am

    There was a piece by Jed Mercurio a few years ago that’s well worth reading on the institutional culture of cover-up and “buffing the notes” in the NHS — something he had both benefited from, and been a party to:

    “We all kill a few patients as we learn”
    www.guardian.co.uk/society/2004/may/18/lifeandhealth.medicineandhealth

    Well worth a look if you want to understand why whistleblowers still make themselves so unpopular and even unemployable.

    In some cases they can even get the GMC after them, if they have gone to the papers.

  5. Frunobulax said,

    May 15, 2010 at 10:52 am

    On the subject of whistleblowers, I would like to invite Ben and all followers of Bad Science to join Dr Steve Bolsin and thousands of others in pledging support for whistleblowing paediatrician Dr Kim Holt.

    Consultant paediatrician Dr Kim Holt used to work in the Haringey clinic, run by Great Ormond Street Hospital, where the imminent danger to Baby Peter was not spotted. In April 2006 – a year before Baby Peter was seen –Dr Holt was removed from her post after she and three other doctors wrote to management warning of tragedy due to failings including staff shortages, dangerous over-working and poor record-keeping. When Baby P was found dead, the hospital allegedly offered Dr Holt money to remain silent about her complaints.

    In December 2009, Great Ormond Street promised to reach a ‘swift and amicable solution’ with Dr Holt after a damning NHS London report largely vindicated her criticisms of the Haringey clinic and recommended her reinstatement. However, Dr Holt has yet to be offered her job back.

    You can pledge your support here:

    www.gopetition.co.uk/online/34319.html

    The story has been covered by the Lancet, Private Eye, the Telegraph, Guardian and the BBC. More information is available here:

    www.telegraph.co.uk/health/7569995/NHS-bureaucrats-care-for-themselves-not-the-patients.html

    drphilhammond.com/blog/tag/dr-kim-holt/

    www.facebook.com/home.php?#!/group.php?gid=336534703005&ref=ts

    Thanks for your interest.

  6. Daibhid C said,

    May 15, 2010 at 1:33 pm

    gammidgy & fontwell – At a guess, it’s not so much that all medical centres are dodgy and fear employing someone who’s already exposed dodginess, as a misguided belief that a whistleblower “isn’t a team player” and can’t be trusted have their collegues’ collective back in other situations.

  7. CoralBloom said,

    May 15, 2010 at 5:55 pm

    Isn’t this really a problem with poor HR – promoting the egotistical dishonest bully to the positions where decent leadership is required instead?

  8. pdrg said,

    May 15, 2010 at 9:39 pm

    So we have a pool of people who are talented enough to recognise bad practice, honest enough to speak out, and who aren’t going to get direct medical work again? What a missed opportunity – you offer them audit roles knowing they can’t be bought off, have the medical skills to recognise when something is wrong, and need a decent respectable job so all those years of training don’t get wasted. Either at hospital or regional or national level it means those who feel compelled to whistleblow a real problem know they are not risking their families livelihoods – better even than a one-off cash payout.

    In my world, though, I’d staff my own hospital/company with whistleblowers, you know you’re getting decent competent caring people and heck they’ll be cheap.

  9. mikewhit said,

    May 15, 2010 at 10:44 pm

    Was there any follow-up of the fate of the “whistleblown” i.e. those who were found to have made errors but covered them up ?

  10. Barbara said,

    May 16, 2010 at 4:07 am

    Whistleblowing doesn’t necessarily pay monetarily in the U.S. either. Fortunately money isn’t really the point.

    A relative in the U.S. worked for a unit that made pills for a bigger company. He learned that his unit was systematically putting less active ingredient in the pills than they were labeled to have. He tried to fix the problem in his unit, but got nowhere. He contacted the bigger drug company. It investigated, quickly learned that my relative was correct, and shut down the entire unit, firing everyone including my relative. Let us hope that this was in order to be sure that its pills are made properly.

    My relative was a young guy when this happened. He has gone on to a successful career elsewhere, but he was shocked and upset at the time.

  11. Lifewish said,

    May 16, 2010 at 10:23 pm

    In my world, though, I’d staff my own hospital/company with whistleblowers, you know you’re getting decent competent caring people and heck they’ll be cheap.

    Not once the ambulance-chasers get their teeth into you. I imagine that’s what ultimately makes the cost of responsible disclosure so high.

    Maybe after we’ve reformed libel law, we can put some thought into personal injury legislation? Or just accept that, as matters stand, it is financially non-viable for doctors to be honest about their mistakes.

  12. phammond said,

    May 17, 2010 at 9:37 am

    The Public Interest Disclosure Act is supposed to protect UK whistleblowers, but even if they do unlimately get recompense for the discrimination and bullying they suffer, it rarely makes up for it. And neither does it necessarily lead to constructive change. Private Eye broke the story of the Bristol heart scandal in 1992 and 18 years later, we still haven’t safely and sustainably reconfigured child heart surgery in the UK.

    Indeed, NHS reconfigurations appear to be forced through by bullying and ignoring the legal duty of public consultation (see the outrageous treatment of former Cornish chief executive John Watkinson
    drphilhammond.com/blog/category/private-eye/

    Ultimately, we need to stop using the perjorative term whistleblower, which has overtones of ratfink and snitch, and create a culture where anyone (doctor, nurse, patient, relative, manager, janitor) can speak up and speak out about safety concerns, and nip problems in the bud. Andrew Lansley promised this in opposition and I can’t see the Liberals objectiving. They just have to provide the leadership that allows debate and challenge.

  13. hamletsghost said,

    May 17, 2010 at 11:11 am

    There are a lot of similar issues in the aviation industry, and there is a mass of research into human factors integration, crew resource management, soft systems methodology etc.

    Anecdotally, doctors and surgeons are unwilling to incorporate many of these practices into hospital life – on the grounds that they are inappropriate.

    But some have been successfully used: eg. www3.interscience.wiley.com/journal/118498011/abstract?CRETRY=1&SRETRY=0

    It’s just bringing them into general care. As they say, you trust if the system’s just.

  14. mikewhit said,

    May 18, 2010 at 10:05 am

    I never felt the “whistleblower” /was/ a pejorative term …

  15. heavens said,

    May 20, 2010 at 6:34 am

    To quote Ben’s trademark line, I think you’ll find it’s a bit more complicated than that. At least some of these “unemployable” people weren’t the kind of people you’d choose to work with.

    I was talking to a senior pharmaceutical developer about two years ago, and he told me that he was being deposed for a lawsuit. It turned out that a former co-worker had deliberately lied on several major registration documents (apparently, to keep his department under budget and on schedule).

    After being fired (for incompetence and fraud), the co-worker turned in the company… for having only detected some of his lies.

    This so-called “whistleblower” is, in effect, going to be paid a lot of money for deceiving his employer, risking the lives of patients, and committing perjury. IMO he ought to have been sent to prison for breaking the law, not given millions of dollars for confessing to his illegal activities.

  16. xiaoxia880928 said,

    December 15, 2010 at 9:27 am

    How about going to www.onlinenewshop.com/power-balance-c-69.html for more,maybe you will find everything waht you want.

  17. miles offtarget said,

    December 22, 2010 at 3:43 pm

    hamletsghost is correct, the aviation industry has recognised the importance of open and honest reporting, especially in the context of human factors, but it’s taken some time and some crashes to get to that point.

    In 1995 the director of IATA said that such mechanisms were an essential component of the UN’s attempt to halve western built jet losses within 10 years. This was only achieved by introducing the ‘just culture’ in which exposing safety issues, unless malevolent or egregious, is rewarded rather than penalised.

    Sadly, the balance seems to tipping away from just culture again; the Italians have recently prosecuted ATC controllers at Cagliari and a crew of a TunInter ATR amongst others.

  18. Fflip said,

    December 23, 2010 at 6:55 pm

    Not good for whistleblowers in Australia either.

    forum.onlineopinion.com.au/thread.asp?article=11394&page=3

  19. Fflip said,

    December 23, 2010 at 6:59 pm

    Should have been this page

    www.onlineopinion.com.au/view.asp?article=11394&page=0

    Previous link goes to comments.

  20. KenCat said,

    January 11, 2011 at 6:47 pm

    Safety of patients is a massive problem. 1 in 10 hospitalised patients are affected by some sort of error. Very little is ever learned from these incidents. Doctors still view those who make mistakes as bad people; incident reports (of which there are about 2 million per year) are rarely actioned, in part because there are so many; there is little or no independent investigation; managers are too busy meeting targets (none of which relate to safety), and patient safety managers are usually ex-nurses with no power, training or expertise in understanding incidents or building safe systems. Morevoer, it’s difficult to distinguish between what is “whistleblowing” and what is ‘moaning’ or scaremongering by those seeking to gain for themselves (which also happens).

    In 2009 I had the opportunity to dine with Steve Bolsin, the Bristol whistleblower, who has paid a very heavy price for his actions. 18 years later, very little has changed. It’s great to see the mention of human factors [hamletsghost refers to a peice of research that's close to my heart]; but a career in applying these principles to healthcare is not for anyone requiring job security.