10th May 2014
The Saatchi (Medical Innovation) Bill campaign, unsurprisingly given its origins, has been a slick marketing operation. In fact, it could easily paraphrase the tagline of a popular brand of toilet paper: soft, strong…
…and afterwards leaving you with a lingering shitty smell.
The smell comes from the reek of serial untruthfulness that has hung around the campaign. Numerous commenters on Twitter – one of the Bill’s liveliest battlegrounds – have mentioned it. I’m not talking here about the utter hollowness of the bill’s central argument, the assertion that clinicians don’t innovate because they are forced to follow a standard practice, and they won’t deviate from that standard practice for fear of litigation. I’m not talking about the complete lack of evidence for that assertion, and the failure of the bill’s supporters to engage with people asking for that evidence.
No, here’s a list of things that the Saatchi Bill campaign has indulged in, which I think have been unfair, or obfuscatory, which have basically detracted from clear, open debate on the bill and its stated aims, rather than helping move things forward.
1) The Conflict of Interest
Much of the discussion of the bill was kick-started by and centred on an article published in the Daily Telegraph, which extolled the virtues of a bill which would be the saviour of cancer patients and of other seriously ill people. “The fight to win hope for the seriously ill” trumpeted the headline. If you don’t know what I’m about to say, take a look at the article now, and then come back to read the next bit.
What was not stated anywhere in the article was that its author – Dominic Nutt – was Director of Communication for the Saatchi Bill campaign.
This is a serious undeclared conflict of interest, and if you didn’t know it before, go back and re-read the article again, and consider how it completely changes the way you view the claims being made.
Given this is a bill about medical practice, it would be an illuminating exercise to consider what would happen to a medical researcher publishing a paper with a similar undeclared conflict of interest. Spoiler alert: they’d be in very deep trouble.
2) The False Consultation.
All over the Saatchi Bill campaign’s, er, campaigning, including in the Telegraph article referenced above, they exhorted us, the public, to make our views on the Saatchi Bill known. They gave a handy link to where we could respond to the consultation.
What they didn’t tell us was that the link they were providing wasn’t to the consultation at all, but to their own page on tumblr.com. Effectively, they were directing respondents away from the government’s own consultation page towards their own. According to the Saatchi campaign, more than 18000 people have responded, but they have been utterly unclear about whether that figure is for people who responded to the official consultation, or to their own. In fact, their statements have failed to acknowledge that there even were two means for people to respond, failed to say anything about what they are doing with the data they have gathered or whether anybody else will be allowed to see it, and failed to make clear whether or not they have had access to the results of the official government consultation.
It is hard to conclude that the data they have gathered by this arguably underhand route is anything other than completely tainted, so their claim, again in the Telegraph, that 18655 people responded positively and less than 100 negatively, cannot be trusted. Nobody else has seen the data, and the process hasn’t been independently monitored. Even if we accept that they wouldn’t just publish the positive comments and bury the negative ones, there is a serious question-mark over their ability even to identify a negative comment when it is staring them in the face, as we shall shortly see.
3) The Bait and Switch.
Like so much of this campaign, this next point needs to be viewed in the context of the social media onslaught that characterised the Saatchi Bill. This bill had its own Twitter account. So it is natural that much of the discussion and flow of ideas would happen in that medium.
What seemed odd to me was that often when a critic made a strong, clear point about the drawbacks of the bill, a Saatchi Bill proponent would answer to say that there was already a new draft of the bill on the way, that all the concerns had been addressed, and that they shouldn’t worry. After a time, the responses became more belittling, so that people sceptical of the bill would start to be dismissed or brushed off. Why are you still harping on about this, the responses seemed to say, we know what we are doing and we have seen that it is good, so why are you complaining?
So here’s the thing, Saatchi Bill campaign. You have a consultation on a new bill. You give us the text of the bill and ask for comments about specific aspects of it. What is it that you expect us to do? All we have in front of us is the text you have given us. If we can see that it is badly-written, then all we can do is say so, and say why we think it is bad. If we do not, if we sit back and wait, on your assurance that the all-new shiny version 2.0 of the bill will solve all the problems in 1.0, then it could easily look as if we are just going along with it. We are not going along with it.
And then, when you start to get (completely fair) negative feedback, why do you draft a new bill (which you won’t show us) before the consultation is even complete? Will you consult on the second version, which is apparently the one you wanted to do in the first place, because this first one was just to test the waters? What was the point of the consultation in the first place? Are you just deliberately wasting our time?
The strategy of diffusing (or defusing) negative feedback in this way is an old one. Let everybody vent their ire and waste their effort on the first (completely outlandish) draft and then, when your critics are exhausted, offer a compromise version which is still rubbish but which is much more likely to sneak through than it would have if you had jumped straight to that version in the first place. Meanwhile, you can claim you have listened and taken comments on board, and when people subside into grumbling rather than howling in protest you can start to claim they now agree with your plans. This is significant when you look at what the Saatchi bill campaign claims as positive feedback, as we shall shortly see.
4) It’s only lawyers who are opposed, and they just want to keep on lawyering.
One of the mischaracterisations being used about the opposition to the bill is that it’s just lawyers eyeing up their fat fees who are against it. Here’s an example from the campaign’s own tumblr page:
They must not be forced to wait until their decision is tested in expensive and traumatic litigation or disciplinary proceedings. Nobody wants that, except perhaps a small group of lawyers who make their living from the existing litigation-focused system.
It’s a similar approach to the that used when justifying changes in Legal Aid – it’s only the fat cat lawyers who see a problem with the change, they claim. This is not true as we shall shortly see.
5) Who supports this bill?
I’ve been foreshadowing this last point throughout the text, and if you’ve lasted this far, well done, and I hope you’ll find your patience has been rewarded, because this is the big one.
The Saatchi Bill has continually claimed support from doctors, patient groups, professional bodies, you name it. Here’s one by Dominic Nutt on March 6th.
Here’s Lord Saatchi himself in the Telegraph:
We now have the results. A staggering 18,655 people – including doctors and patients, relatives of the bereaved and soon-to-be bereaved, scientists, lawyers, legislators and the man and woman in the street – have responded wholeheartedly in support of this Bill. Fewer than 100 were against it. Thanks to the Telegraph in particular, which backed the Bill and the consultation from the start, this has been the biggest digital response of its kind to a Department of Health consultation by miles.
At this point, I’d like to draw your attention to two lists. One is by Nigel Poole QC (whose blog on the bill I recommend), the other by award-winning blogger Alan Henness, and they both collate responses to the consultation by professional bodies and significant individuals. I’ve read them all. Yes, I’m just that stupid.
Actually, it is really worth reading these responses in full, from the links given on those pages or the ones I provide, even if you trust my interpretation of them. If you can only read one or two, I’d recommend the Academy of Medical Royal Colleges, the BMA or the Motor Neurone Disease Association. I should also point out the Royal College of Psychiatrists’ response, which is by far the most positive in its response to the bill.
For the avoidance of doubt, I’ll make a few basic points about how I view these responses.
Firstly, saying that you support or encourage responsible innovation does not of itself mean that you support the Saatchi Bill. It’s simply stating a truism. Everybody supports innovation. Therefore, saying that you support the stated aim of the bill is not supporting the bill as such, it’s simply saying that you want to encourage innovation, because that is the stated aim of the bill. If your views are that no legislation is needed, that legal concerns are not in fact a barrier to innovation, or that in order to work the bill would have to be changed in a way that makes it unrecognisable, then you do not support the bill. If you say that you welcome the chance to give your view, that is not in itself support of the bill. These things should be blindingly obvious, but seemingly not to the Saatchi team.
I’ve described before why I think the bill would fail to meet its stated aim, but now we can see what the professionals think. I started picking out some response quotes, but they got so numerous I’ve ended up putting them on a separate page. And remember, if you think I’m cherry-picking or mischaracterising, read the consultation responses yourself. I dare you.
In summary, every one of the respondents listed (apart perhaps from RCPsych, and even they want significant changes) either sees the bill as unnecessary, or dangerous, or at the least requiring major modification to the extent that it is arguably nullified.
Dominic Nutt, the Saatchi campaign communications director, claimed on April 6th that the bill had the support of, amongst others, Cancer Research UK, the Royal Colleges, patients and doctors. Now, in light of the comments made by those organisations and also by organisations representing patients and doctors, do you think that was a fair claim to make? And how could he have made that claim on April 6th, when most of those responses hadn’t even been submitted or published?
The End
What we have seen here, in the pro-Saatchi Bill campaign, has been a sorry excuse for clear and open discussion of the issues. This has done a huge disservice to everybody involved – to patients, their families and carers, to the clinicians and researchers who treat them and try to cure them. It ignores the huge progress medical science has made over the last few decades, and the whole thing leaves a bitter aftertaste.
One can only hope that if a second draft of this bill should ever surface, the campaigning for it will be a bit more truthful, a bit more evidence-led, and a bit less characterised by obfuscation, empty promises and unanswered questions.
Speaking of unanswered questions, there is something else I’d like to know about the doings of the Saatchi Bill team, but that’s for the next post…
(Amended 10th May 2014 to attribute a web page correctly.)
Pages on the Saatchi Bill
An introduction (20th April 2014):
The Saatchi Bill – Stifling Innovation and Harming Patients
Dishonesty in the Saatchi Campaign (10th May 2014):
A list of comments on the bill by organisations and individuals (10th May 2014):
An Inexhaustively Incomplete (But Completely Exhausting) List of Saatchi Bill Comments
An article about one particular campaign supporter (12th May 2014):
A discussion of the bill and its shortcomings (Guardian Science blogs guest post) (22nd May 2014):
The Saatchi medical innovation bill will put patients at the mercy of quacks
A comment on the promotion of the latest draft (3rd June 2014):
A view on lack of patient protection in the latest draft (5th June 2014):
No protection against quackery
A view on research shortcomings in the latest draft (10th June 2014):
Comments on the consultation process (13th June 2014):
The continuing PR (12th September 2014)
An Open Letter to Lord Blencathra (22nd October 2014)
The Wandering Teacake 
A most excellent review which I suggest you send to all MPs who are doctors. Dr Sarah Wollaston for one.
This is an excellent dissection of the problems with this bill and its discussion in the media.
You said “What they didn’t tell us was that the link they were providing wasn’t to the consultation at all, but to their own page on tumblr.com.”
I provided a link to the official government consultation page in a comment under the Telegraph Saatchi bill article and another commenter flagged it up as spam for moderation. Nothing else in my comment but a link the the official consultation page