Submission on PE1517: Polypropylene Mesh Medical Devices

Submission on PE1517 on Polypropylene Mesh Medical Devices

Made by Dr Peter J Gordon

Date of submission: 17th May 2017
Submission made in a personal capacity.

The Agenda for the Public Petitions Committee meeting of the 18th May 2017 includes a most helpful summary “Note by the Clerk” on PE1517: Polypropylene Mesh Medical Devices (Document PPC/S5/17/10/1). Having read this carefully, and in accordance with the first suggested “Action” (point 45, page 8), I would like to offer evidence. Before doing so I have listed below the most relevant sections of PPC/S5/17/10/1 in relation to the points of evidence that I wish to make.

In Annexe B of PPC/S5/17/10/1 the Interim and Final Conclusions of the Independent Review are listed side-by-side.

Conclusion 1, both Interim and Final, was that “Robust clinical governance must surround treatment”

Conclusion 3, both Interim and Final, was that “Informed consent is a fundamental principle underlying all healthcare”

In  Annexe C: Parliamentary Action (page 21 of PPC/S5/17/10/1) the Cabinet Minister for Health, Shona Robison answered question S5W-07749 by Neil Findlay, MSP on the 17 March 2017, by stating:

“Informed consent and shared decision making are expected prior to any procedure being carried out. The Chief Medical Officer goes into this in more detail in her Realistic Medicine report.”

The Clerk, in point 7, (page 2 of PPC/S5/17/10/1) confirms that:

“The Scottish Government does not have the power to regulate what medical devices are licensed for use in the UK. The Medicines and Healthcare products Regulatory Agency (MHRA) regulates medical devices in the UK”

The Clerk, in point 12 (page 3 of PPC/S5/17/10/1) includes quotations from the Preface of the Review’s Independent Report:

“We found some concerning features about how new techniques are introduced into routine practice”  and that

“We are aware that some of our conclusions have wider implications and see the need to embed this in patient Safety and Clinical Governance strands of the NHS”

Points of Evidence by Dr Peter J Gordon  (GMC number 3468861)

• HDL62:  the Scottish Government has acknowledged that this 
Guidance is not being followed by NHS Boards

• There have been media reports that NHS professionals working in 
Scotland, who are involved in educating NHS staff about Mesh
procedures, have been paid by commercial sectors who have 
financial interest in Mesh products. 

• PE1493, A Sunshine Act for Scotland, was closed in February 2016 

• A Public Consultation on PE1493 was undertaken by the Scottish 
Health Council. The Scottish  public, in majority, were of the view 
that it should be mandatory for  all financial payments made to 
healthcare workers and academics to be declared in a publically 
accessible form 

• No meaningful update has been provided by the Scottish Government 
since this Public Consultation was published more than a year ago.

• I  fully support the Chief Medical Officer’s “Realistic Medicine” 
initiative and I have suggested that Sunshine legislation should be 
considered an essential part of this development  

• I agree with the Independent Review that “robust clinical 
governance must surround treatment”. I am concerned that if the 
current situation continues, where “education” of health 
professionals may be significantly based on marketing, further 
examples of iatrogenic harm may occur in NHS Scotland.

• The Independent Review concluded that “informed consent is a 
fundamental principle underlying all healthcare”. If the advice 
given to patients is based on marketing, either partially or wholly, 
then informed consent may be denied patients. Further examples of 
Iatrogenic harm may then  unfortunately occur and healthcare 
in Scotland may risk being considered as  unrealistic 
rather than “realistic”.

 

Update, 22 May 2017:

Public Petitions Committee – Scottish Parliament: 18 May 2017 (click on image below to watch the full meeting)

The official report of the Public Petitions Committee of 18 May 2017

Sunday Post, 21 May 2017: ‘Probe to examine possible conflicts of interest in troubled mesh implant inquiry’

“As a critical friend”: awareness campaigns

I have just read:009 as a critical friendIt begins: [we]010 as a critical friend011 as a critical friendAs a doctor who openly asks questions I see great value in being a “critical friend”:008 as a critical friendThe Alzheimer Scotland Strategic Review outlines significant progress:012 as a critical friendThe current campaign by Alzheimer Scotland encourages “difficult conversations”:2 Feb 2015 Alz Scot early diagnosis aThis Alzheimer Scotland campaign promotes early diagnosis. As a critical friend I have expressed concerns about this campaign:014 as a critical friendA few months before this campaign was launched, Alzheimer Scotland:015-as-a-critical-friendThe Glasgow Declaration, signed by the then Cabinet Minister for Health, Alex Neil, enshrined “timely diagnosis” (below). It has now been signed by 1815 individuals and 50 organisations across Europe. This international agreement does not advocate early diagnosis.Glasgow-declaration signed Dr Margaret McCartney asked in her book “The patient paradox”:  001 as a critical friendand offered this concern:002 as a critical friendAge related memory loss (that is not dementia) can be a reality for us all as we age. It is however very far from inevitable. Such mild impairments generally follow a parabolic distribution through life. The following book by Douwe Draaisma covers the science of this:005 as a critical friendDr McCartney raised the following consequence of “awareness campaigns”:004 as a critical friendand concluded that:003 as a critical friendIt would seem to me that is virtually impossible to open a newspaper or watch any form of broadcast media today without being made aware of dementia or “Alzheimers”.

Such awareness may have unintended consequences:007 as a critical friendNeil Hay, SNP candidate for Edinburgh South, has followed the awareness campaigns by Alzheimer Scotland, a charity also based in Edinburgh:    Neil Hay 03Last week on social media, Neil Hay, SNP candidate for Edinburgh South expressed that older folk:018-as-a-critical-friendPerhaps then the question posed by Dr McCartney should not be:001 as a critical friendInstead we might ask, all as ‘critical friends’, the evidence and ethics behind such “awareness campaigns”.

Furthermore, in seeking health, should we be more wary of simplified messages that might carry unintended consequences such as anxiety, fear, ageism and stigma.

NHS Scotland: “leading Integration”

This event has been widely advertised. When I first read the Conference title I assumed that it was about integration of health and social services.222The pledges on the NHS for the key political parties are outlined in the current BMJ:pledges 2015 healthbThe Scottish National Party, who are currently in government in Scotland, and have full devolved responsibility for the NHS, have made this pledge:pledges 2015 healthcHaving now read the 13 page “Exhibitor and Sponsor brochure” it appears that this event is also to do with integration of the NHS and the private sector:LIQ01The plenary Speakers include, amongst one or two others, four MSPs, two of the country’s most senior civil servants, and the National Clinical Lead for Patient Safety and Improvement at the Scottish Government:Plenary speakers 2015Here is the headline pledge to exhibitors and sponsors:CropperCapture[3]The following excerpts are from the 13 page “Exhibitor and Sponsor brochure” [highlights are mine]LIQ04 LIQ06 LIQ07 LIQ08 Exhibitor costs are significant:  111 Further “sponsorship and advertising opportunities” are offered for this NHS event:LIQ09d LIQ09e LIQ09f LIQ09g LIQ09h LIQ09iPresumably private companies are happy to pay these sponsorship costs in the hope that public money will be spent in their businesses. That there is clear transparency regarding the sponsorship opportunities at this event should be welcomed, but there should be a difference between conferences, especially those involving the public sector, and trade-fairs.

There is wide support amongst patients for the NHS. They also expect public money to be well spent and not diverted into the private sector. I am not sure the current Scottish Government is following this SNP pledge:pledges 2015 healthc

 

 

 

 

The diary that washed ashore

Chapter 18 of ‘This is Not yesterday’: Alec MacCallum Scott (1874 – 1928)
At 3pm on Wednesday the 29th August 1928 the diary of Alexander MacCallum Scott washed up on the shore of Discovery Bay, Canada. The following day Mrs MacCallum Scott’s body was washed ashore and after a further week the body of MacCallum Scott himself. This chapter tells the story of our most politically able ancestor. It is not a story recalled in family recall except that I now realise, like MacCallum Scott’s diary, artefacts have been washing around the shores of my consciousness. I had no idea why my mother’s family, the Scotts, had a large picture of Winston Churchill as you entered the house or why John Buchan books were specially treasured.

washed ashore

Alexander MacCallum Scott was born at Boathouse, Blantyre in 1874. The cottage of his birth was the old Ferryman’s house and nestled beside the Priory and opposite the village of Uddingston. Apparently it is thought that Boathouse was part of the original orchard planted by the Augustinian Monks from the nearby Priory, who originally came to Blantyre, from their Mother Abbey in Jedburgh, in the early part of the 13th century. Whatever may be, it was here that in 1866, MacCallum Scott’s father, John Scott, started a market-gardener. The Scott family were grafters of fruit and had honed their skills in the orchard, by swinsy hill, Carluke.

The ferry operated between Blantyre and Uddingston and it is thought cost 1 Ha’ penny single, 1 Penny return. Villagers from on Uddingston used to attract the Ferrymans attention, by calling ‘Boat Jock, Boat Jock,’ whenever they wanted the ferry to cross the water of the River Clyde.

MacCallum Scott’s father once offered old Archie Reid a job at Boathouse:“Whit John Scott” was the indignant reply: “Wud ye ask a Latin Scholar to cairt dung tae Glasgow. Na! Na!” That same season Archie Reid was employed pulling fruit with Bob Scott of Totham cottage, Uddingston.“What dae ye call this in Latin” asked Bob, pointing to a ladder? “Ledderibus” said Archie Reid. “Weel” said Bob Scott, “tak that Ledderibus,
an gan’ tak that treeibus an pull the pearibusses!” Archie Reid was dumfounded
and gasped “when did you learn Latin Bob?”

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Figure 1: Boathouse, Blantyre

Later, John Scott removed to another fruit garden at Millhill, Polmont. There MacCallum Scott started his education at the village school, passing on to the High School at Falkirk. His father died when he was at the age of fourteen, and it was only by the self-sacrifice of his mother that he was able to complete his education. He took one of the Gaff Trust Bursaries, which enabled him to go to Glasgow University, where he graduated M.A. in 1897.

MacCallum Scott took an active part in the corporate life of the University, and gained his first experience in journalism and politics. He became in turn Editor of the “Glasgow University Magazine,” President of the University Liberal Club, and President of the Students’ Union. A contemporary and friend at University at College was John Buchan, novelist and historian. Buchan was to become a Unionist politician but he believed that Gladstone had taught people to combat materialism, complacency, and  authoritarianism; and at one stage he admitted to friends that he was “becoming a Gladstonian Liberal.”

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From College MacCallum Scott proceeded to London, where he continued to devote himself to journalism and politics. For some years he had a hard struggle to obtain a footing in the journalistic world. Having no influence to obtain a post, he had to depend entirely on his pen for a living. He visited Russia and Siberia as correspondent for the “Daily Chronicle” in 1905 at the end of the Russo-Japanese War, and was in Russia at the time when the Duma, or first Russian Parliament, was created. Having acquired a knowledge of the language, he has ever since been a keen student of Russian affairs, and has closely followed all the developments of the Revolution there.

In 1908 MacCallum Scott became a barrister-at-law at the English Bar, but he did not cease his journalistic work. At the same time he continued his public work. He was Secretary of the League of Liberals against Aggression and Militarism and of the New Reform Club and took an active part in the work of the Gladstone League in suppressing political intimidation in the English Counties. In 1908 he became Private Secretary to Lord Pentland, who was then, Secretary of State for Scotland. And in the General Election of December, 1910, he was elected Member of Parliament for the Bridgeton Division of Glasgow in succession to his old college friend, Mr J.W. Clelland.

A few months before entering Parliament he married Jessie Hutchison, the eldest daughter of Dr, John Hutchison, ex-Rector of the Glasgow High School. They had one son.

In Parliament MacCallum Scott became an active Member of the Radical Group of Scottish Members who conducted a vigorous agitation in support of Scottish Home Rule, and in favour of increased consideration of Scottish local needs. He introduced the first “Home-Rule-all-around” Bill and succeeded in carrying the first reading. The part which he took in the long discussions on the National Insurance Bill made him a recognised authority on industrial subjects. He also defended the interests of the Trade Unions, when the Trade Union Act of 1912 was before Parliament. In August 1917 MacCAllum Scott was appointed Parliamentary Secretary to Winston Churchill.

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From the outbreak of the Great War, MacCallum Scott devoted his whole energy to looking after the interests of the soldiers and sailors and their dependants. He early became an expert in all matters relating to dependants’ allowances, pensions, grants, and gratuities. At the end of the war, Members of Parliament were overwhelmed by letters from constituents, urging the immediate demobilisation of men under the special circumstances of hardship. Mr Winston Churchill, who was then Secretary State for War, appointed MacCallum Scott as “Members Friend” to deal with all these cases in the War Office. Many cases of hardship were met, and during the greater part of 1919 MacCallum Scott was dealing with cases at the rate of 2000 per week. This volume of work, in addition to the ordinary duties of Parliament, meant a severe strain, and at the
end of the war he was threatened with a breakdown in health, and had to take a long holiday. He received the good wishes of thousands of his correspondents in Bridgeton.

Believing that Winston Churchill was ‘born to greatness’, MacCallum Scott turned a series of magazine articles into a biography whose proofs were read by Churchill before its publication in 1905. He wrote a further biography in 1916, this time called Winston Churchill in Peace and War. Churchill read the proofs, telling his wife that the notes he had provided made him ‘feel how important it is for me to put on record a full & complete account of this series of war events.’ Scott had concluded that political adversity had taught his subject restraint and an understanding of the long game, a game that he too had long sought to play. In November 2002, Winston Churchill was named the ‘greatest Briton of all time’ in a nationwide poll attracting more than a
million votes.

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Figure 2: MacCallum Scott writes the first biography of Churchill

He was also one of the few members of Parliament who had an intimate knowledge of
Russia, acquired by extensive travel in that country. In Parliament MacCallum Scott introduced the first “Home-Rule-all-around” for Scotland Bill and succeeded in carrying the first reading. He was a vocal devolutionist.

Looking back at his wish for Scotland’s devolution MacCallum Scott said: “We were not subject to oppression nor were we animated by race hatred, but we were conscious of a grievance much deeper and much more fundamental. We must examine the machinery which existed for the government of Scotland. For almost two centuries there had been no change and, no development in it. The Secretary for Scotland was a whole cabinet rolled into one, and was responsible for the complex business of managing local affairs in Scotland. We were falling behind in the matter of development of our local institutions.”

MacCallum Scott was opposed to militarian action unless there was no choice and in December 1918 he said that “he did not approve of British troops being in Russia. Those troops could not be immediately withdrawn. He was in favour of letting the people of Russia to settle their own affairs.”

Whilst in Algiers in January 1920, MacCallum Scott was sent a letter from the Home Office to inform him that he had been awarded an Order of The British Empire (OBE). He immediately telegraphed back “Home Office London. Please withdraw my name from Order British Empire. MacCallum Scott”

Having had secretarial experience at the Scottish Office, at the Ministry of Munitions, and at the War Office, MacCallum Scott was, in June 1922, appointed Scottish Liberal Whip for the Government of Mr Lloyd George. Addressing women electors that year MacCallum Scott said “that in all the great fundamental political questions involved in this election, the interests of men and women were identical. In the sphere of industry, he strongly supported the giving of equal pay for equal work.” Examination of the diaries of MacCallum Scott, do however, reveal that he had vacillated in his support of the Sufragette movement.

MacCallum Scott’s diary records a relentlessly self-critical and despondent back-bench existence. Always on the lookout for causes to make his own, he wore his radicalism conspicuously, advocating a minimum wage and reforms in housing, education, and the poor law. Philip Snowden, did not think he went down well. Scott was, he recalled, ‘a strange character. He always struck me as having the typical Scottish metaphysical mind. He spoke with great deliberation. He seemed as though he was laboriously dragging out his words, not from his head but from his chest’

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At Winston Churchill’s suggestion Lloyd George made MacCallum Scott the coalition government’s Scottish whip in the early summer of 1922

It is quite clear that MacCallum Scott felt that the Liberals, who were part of a coalition government with the Conservatives, had conceded too many of their principles. Commentators of today’s Coalition, which is of the same constitution, might conclude as MacCallum Scott did 90 years ago: “Under your leadership [Mr Asquith] at the last election a pact was made with the Conservative party which reduced the Liberal party to the position of a spare wheel in the Conservative car.”

Two years later MacCallum Scott had defeated James Maxton at the general election of 1918 but had no chance of repelling him in the Glasgow Labour surge of November 1922. Persuaded that Labour, not a disintegrating Liberal Party, was where radicals now belonged, he joined the Labour Party, Independent Labour Party, he wrote to the
former Liberal Prime Minister in late 1924: “Dear MR ASQUITH, I beg to announce to
you, the Leader of the Liberal party, that I have decided to join the Labour party.” Two years ater he was adopted as prospective Labour candidate for East Aberdeenshire, the seat held by the colourful progressive tory Robert Boothby.

AMS4Figure 3 : H.H. Asquith

James Maxton (1885–1946) was a Scottish socialist politician, and leader of the Independent Labour Party who claimed that the biggest influence in his decision to become a socialist was the grinding poverty experienced by many of the children he taught. He was well-known as a platform orator with a thin hatchet face and mane of
long black hair which fell across his face giving it a saturnine and piratical appearance. Maxton took MaCallum Scott’s seat as Member of Parliament (MP) for Glasgow Bridgeton in the 1922 general election. Once in parliament, Maxton’s forthright views often caused controversy. When Ramsay MacDonald, with whom Maxton had long since quarrelled, gave his last meandering, incoherent speech to Parliament, it was
interrupted by Maxton calling out: “Sit down, man, you’re a bloody tragedy.”

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Maxton was considered one of the greatest orators of the time, both within and outside the House of Commons. Churchill, whilst holding political opinions wholly inconsistent with those of Maxton, described him as “the greatest parliamentarian of his day”. James Maxton continued in MacCallum Scott’s seat for another 24 years until his early death in 1946. Former British Prime Minister Gordon Brown has confessed to having been fascinated by Maxton as a young man and has written a biography of him, simply entitled Maxton. He also used Maxton for the basis of his PhD thesis whilst at the University of Edinburgh.

A lifelong devotee of native woodland and orchards MacCallum Scott was particularly keen for the development of aforestation, a view stimulated by what he had seen in the course of his frequent visits to Finland and other countries on the shores of the Baltic. Of orchards he said in a book on Clydesdale “Of all the delights that nature and art can combine to bestow commend me to an orchard. The farmer may prefer the ripple of the
wind upon a field of wheat or hay, the shepherd may prefer the silence that is among the green hills, the fisher loves the stream, and the hunter the wilderness. The forest and mountain peaks have also their devotees. But, for me, an orchard!”

Greatest Reward (family film on orchards): https://vimeo.com/groups/184009/videos/43660632

Now through my window (family film on orchards): https://vimeo.com/groups/184009/videos/43662180

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Figure 4: MacCallum Scott served Bridgeton for 12 years as MP. He left the Liberals for the Labour Party in 1924

MacCallum Scott did not live to aforest Scotland. At 11am on the 25th August 1928 the plane he was travelling in with his wife plunged into Puget Sound. The two pilots of the Ford 4-AT-B Tri Motor plane, and the five passengers, were all drowned. The service between Seattle and Victoria had only commenced nine days before and this was to be the first reported Canadian air disaster. MacCallum Scott was not to fight another election and Peterhead had lost its labour candidate.

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Figure 5: A Ford 4-AT-B Tri Motor British Columbis Aeroplane. Identical to the plane that crashed into Puget Sound

27th August 1928, 9.30pm. Patches of oil and two hats have been found on the Washington coast. The weather is extremely foggy.

Reuter. 28th August 1928, 1pm. An unidentified fisherman has reported that a large
monoplane circled low ever his boat and crashed into the water some distance away. By the time he reached the spot there was no sign of the aeroplane or its occupants.

In Montreal waiting for his parents was 17 year old John. He was being looked after by Mr Ramsay MacDonald, a close friend of MacCAllum Scott and who was himself was to be returned to office for the second time as Prime Minister of Britain. Left as an orphan McCallum Scott’s son, John, spent a fair amount of time staying with Ramsay
MacDonald and his family at no 10 Downing Street.

AMS3Figure 6: R. MacDonald

The Scotsman Obituary to MacCallum Scott described the traits of graft, that as a Scott I also recognize in myself: “he was an indefatigable worker, and if he was disposed to overwork the particular hobby he happened to be riding at the moment, no one could mistake his sincerity or fail to appreciate his enthusiasm.”

Apart from his 1928 diary, MacCallum Scott’s diaries, notes letters with constituents and contemporaries (including materials on the Suffragette movement), drafts of speeches, political diaries and journals of visits abroad (the latter containing his impressions of the Soviet Union and the Baltic States in the 1920s) are kept on the top floor of the University of Glasgow Special Library. The papers run to more than 400 boxes and one would need more than a lifetime to do them justice. As a neuroscientist interested in history I am left to conclude that were MacCallum Scott alive today an fMRI scan of his brain would not capture an iota of this.

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Figure 7: Margaret Scott with her children

I am certain I would have liked the self-doubting MacCallum Scott. We both have loved orchards, our family, our history and the world we live in and we share graft. Where I share nothing with him is in ability.

MacCallum Scott went on to do great things but his greatness was his ability to recognize it in others. Here we should finish with the opening lines of his 1905 biography of Winston Churchill.

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Figure 8: They were both born in 1874. This is how MacCallum Scott opens the very first biography of Churchill

“WINSTON Spencer Churchill was born in 1874. He has been in Parliament four years, and already he has won for himself a foremost place among the politicians of his day. He has made history for parties, and there be discerning men who predict that he will make history for the nation. The youth of thirty is confidently spoken of by his admirers as a future Prime Minister.”