David Nicholl has been asking legitimate questions. It is the government’s urgent duty to answer them, say Martin McKee and Trish Greenhalgh
The imminent re-release of the 1949 movie The Third Man has led the writer and broadcaster Danny Leigh to draw parallels with Brexit. Set in post-war Vienna beset by shortages of medicines, The Third Man recounts the actions of the disaster capitalists of the day trading in counterfeit penicillin. The anti-hero, Harry Lime, looks down from a Ferris wheel at the people below and asks, “Would you really feel any pity if one of those dots stopped moving?”.
Doctors, if their professional virtues were fully honed, would feel more than pity. They will feel compelled to act. The UK General Medical Council’s guidance, Duties of a Doctor, advises doctors to “make the care of your patient your first concern”, “take prompt action if you think that patient safety … is being compromised” and “be honest and open and act with integrity.”
David Nicholl is a consultant neurologist specialising in the care of people with epilepsy—one of several conditions which the UK government highlighted in its no-deal Brexit planning, codenamed Operation Yellowhammer, when it predicted potential drug shortages. Nicholl had been involved in preparing advice to government, but unlike many of his colleagues, he had not signed any non-disclosure agreements. Knowing that patients with epilepsy are especially vulnerable to interruptions in supply of their medicines, he repeatedly voiced his concerns in the media.
In a live radio phone-in on 2 September, Nicholl challenged Conservative MP Jacob Rees-Mogg to be open about the threat to patients’ health of a no-deal Brexit. Rees-Mogg responded by accusing him of fearmongering, adding that he could not see any reason why people might die. This was despite the Operation Yellowhammer report, along with more detailed analyses from academic researchers and policy thinktanks which had set out the risks involved. Exceptionally, the Royal Colleges had spoken out, with the President of the Royal College of Physicians making clear his lack of confidence in the government’s reassurances.
Rees-Mogg’s radio exchange with Nicholl had political consequences. A Conservative MP, Philip Lee, who is also a general practitioner, cited it as “the straw that broke the camel’s back” after he defected to the Liberal Democrats, crossing the floor of the House of Commons on 4 September as the prime minister was speaking.
On 5 September, Rees-Mogg stated twice in the House of Commons that he considered Nicholl to be “as irresponsible as Dr [Andrew] Wakefield”, the doctor responsible for the falsified (and subsequently retracted) 1998 paper linking the measles, mumps, and rubella (MMR) vaccine to autism. Several MPs immediately took to social media to express outrage that a “whistleblower” doctor who had sought to draw attention to what he believed to be a significant threat to patient safety was being compared with one who had been found guilty of malpractice and struck off the General Medical Council’s register.
The Chief Medical Officer for England, Professor Dame Sally Davies, expressed her concern in a formal letter sent only hours after Rees-Mogg’s statement. Describing the comparison with Wakefield as “disrespectful”, Dame Sally reminded the Leader of the House that “the fraudulent and incorrect measles campaign launched by [Andrew Wakefield] resulted in the re-emergence of measles in this country”.
When he spoke in parliament, Rees-Mogg was protected by parliamentary privilege, a special right dating back to the 1689 Bill of Rights, designed to ensure that Members of Parliament could speak freely in the chamber secure in the knowledge that they would not be subject to challenge in the criminal or civil courts. Leaving aside general questions about when parliamentary privilege might be deemed to have been abused (and the requirements of the Ministerial Code), it is noteworthy that the prime minister himself was moved to state that he “does not share” the views expressed by his Right Honourable colleague.
This recent incident raises the question of just how close the parallels of a no-deal Brexit could be to 1949 Vienna. Drug manufacture and supply chains are undoubtedly more globalised and interdependent, and many drugs on which lives depend are now imported from the European Union. Patient groups have added their voices to a recent call from leading doctors, including the President of the Faculty of Public Health, for the government to make a clear commitment to “do no harm” when making decisions on Brexit.
In her letter to Rees-Mogg, Sally Davies considered it entirely appropriate for doctors (and, she might have added, patients and citizens) to raise “questions regarding the ramifications of a disrupted distribution and consequent risk to life” and that “[p]olitical leaders should be prepared to answer these questions with respect”.
The Chief Medical Officer’s intervention was timely and welcome, and seems very likely to have played a part in Rees Mogg’s eventual apology to Nicholl. Doctors treat patients without regard to their political views, and whistleblowers’ alerts about risks to patient safety and wellbeing tend to be driven by professional commitments, not political ideology. Nicholl has been asking legitimate questions. It is the government’s urgent duty to answer them.
Martin McKee is professor of European public health at the London School of Hygiene and Tropical Medicine.
Trish Greenhalgh is professor of primary care health sciences at the University of Oxford.