Published 29 October 2009, doi:10.1136/bmj.b4444
Cite this as: BMJ 2009;339:b4444

Editor's Choice

Gagging for it

First, the good news on transparency. Drug company Merck is following Eli Lilly’s lead by publishing details of fees paid to experts for speaking on behalf of the company or its products (doi:10.1136/bmj.b4409). GlaxoSmithKline and Pfizer have promised to follow suit. If drug companies were also to publish details of grants made to patient groups, along with the raw data from their research studies, then truly we would have entered a golden age.

The bad news on transparency is that certain NHS trusts’ idea of a golden age is one where tongues can be ripped out and mouths stitched up. Jonathan Gornall documents the lengths to which Liverpool Women’s NHS Foundation Trust went to stop senior consultant Peter Bousfield from going public with his concerns about management and patient safety (doi:10.1136/bmj.b3202). Part of its armoury was to incorporate a gagging clause into his termination agreement. Too bad that such clauses run counter to the spirit of the Public Interest Disclosure Act 1998 and fly in the face of repeated Department of Health guidance.

Following application under the Freedom of Information Act, details were unearthed of similar settlements made with the trust. All 11 featured gagging clauses; three of the largest payments came with clauses specifically banning the doctor from speaking to the media. The trust went even further with Bousfield, taking the extraordinary step of threatening him with an injunction if he spoke to local MPs.

Think that’s bad? Jane Cassidy relates another sorry story of how a trust’s use of gagging clauses worked against patients’ interests (doi:10.1136/bmj.b4203). This time they thwarted the sharing of concerns about a doctor’s competence, leaving the concerned medical colleague incensed "that even when two trusts were aware of repetitive behaviour they did not, or could not, join forces to save a third from employing this person." Sharing the dilemma with the GMC earned this doctor a trust disciplinary inquiry for acting inconsistently with its gagging clause. How George Orwell would have savoured the designation of these organisations as "trusts."

Which brings me to the BMJ Group Awards 2010, nominations for which close in a fortnight (so hurry along to groupawards.bmj.com). It’s too late for inclusion next year, but I’d like to propose a new award for 2011: Corporate Social Irresponsibility. The judges would be asked to identify the UK based healthcare organisation that has acted in the worst interests of its patients. Unless Liverpool Women’s NHS Foundation Trust offers up an abject public apology to its patients I think the award should be nicknamed The Liverpool.

Elsewhere Francis Bowden casts a critical eye over the "doctor-as-patient" article (doi:10.1136/bmj.b4392). "What troubles me about some transformation-through-illness stories is the apparent suddenness of the practitioner’s dawning awareness," he writes. "It begs the question–why didn’t they take notice during all those years of listening to their patients? It indicates a blind spot in our teaching and in our medical culture, for the ability to imagine ourselves in the shoes of another and the willingness to act on information that has only been related to us are among the things that make us human."

Cite this as: BMJ 2009;339:b4444

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Relevant Articles

18 Liverpool consultants reply

Elizabeth Adams, Iwan Lewis-Jones, Zarko Alfirevic, Robert MacDonald, Feroza Dawood, Shuba Mallaiah, Edwin Djabatey, Derek Parkinson, Roy Farquharson, David Patrick, Gillian Fowler, Mark Turner, Dharani Hapangama, Todd Wauchob, Charles Kingsland, Andrew Weeks, Robert Kingston, and John Kirwan
BMJ 2009 339: b4981. [Extract] [Full Text]

Author’s reply

Jonathan Gornall
BMJ 2009 339: b4986. [Extract] [Full Text]

The Doctor is sick

Francis J Bowden
BMJ 2009 339: b4392. [Extract] [Full Text]

The price of silence

Jonathan Gornall
BMJ 2009 339: b3202. [Extract] [Full Text]

Falling foul of gagging clauses

Jane Cassidy
BMJ 2009 339: b4203. [Extract] [Full Text]

Merck discloses $3.7m paid to US doctors for speeches over three months

Janice Hopkins Tanne
BMJ 2009 339: b4409. [Extract] [Full Text]

This article has been cited by other articles:

• Adams, E., Lewis-Jones, I., Alfirevic, Z., MacDonald, R., Dawood, F., Mallaiah, S., Djabatey, E., Parkinson, D., Farquharson, R., Patrick, D., Fowler, G., Turner, M., Hapangama, D., Wauchob, T., Kingsland, C., Weeks, A., Kingston, R., Kirwan, J. (2009). 18 Liverpool consultants reply. BMJ 339: b4981-b4981 [Full text]  
• Gornall, J. (2009). Author's reply. BMJ 339: b4986-b4986 [Full text]  

Rapid Responses:

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Gagging clauses do not fly in the face of Department of Health guidance

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