{"id":50349,"date":"2021-05-28T16:05:17","date_gmt":"2021-05-28T15:05:17","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50349"},"modified":"2021-05-28T16:05:17","modified_gmt":"2021-05-28T15:05:17","slug":"the-governments-poor-handling-of-the-covid-19-pandemic-shows-it-is-time-to-declare-our-limitations-as-well-as-interests","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/28\/the-governments-poor-handling-of-the-covid-19-pandemic-shows-it-is-time-to-declare-our-limitations-as-well-as-interests\/","title":{"rendered":"The government\u2019s poor handling of the covid-19 pandemic shows it is time to declare our limitations as well as interests\u00a0"},"content":{"rendered":"<p><i><span style=\"font-weight: 400\">Admission of our limitations is crucial to good decision making, it is time we openly acknowledge these, says Amitava Banerjee<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">In healthcare and health research, we spend a lot of time thinking about conflicts of interest (COI). The idea is that potential, perceived, and real influences on healthcare and research are declared and minimised, where possible. During the <\/span><a href=\"https:\/\/www.scientificamerican.com\/article\/conflicts-of-interest-and-covid\/\"><span style=\"font-weight: 400\">pandemic<\/span><\/a><span style=\"font-weight: 400\">, the debate has ranged from <\/span><a href=\"https:\/\/www.bmj.com\/company\/newsroom\/conflicts-of-interest-among-the-uk-governments-covid-19-advisers-are-not-transparent\/\"><span style=\"font-weight: 400\">vaccination<\/span><\/a><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/bylinetimes.com\/2021\/04\/13\/conflict-of-interest-concerns-over-15-million-covid-contract\/\"><span style=\"font-weight: 400\">testing<\/span><\/a><span style=\"font-weight: 400\">,<\/span> <a href=\"https:\/\/www.ft.com\/content\/b1659548-7cd0-4626-8406-7b2338d04489\"><span style=\"font-weight: 400\">personal protective equipment<\/span><\/a><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/www.bmj.com\/company\/newsroom\/conflicts-of-interest-among-the-uk-governments-covid-19-advisers-are-not-transparent\/\"><span style=\"font-weight: 400\">government covid-19 advisory panels<\/span><\/a><span style=\"font-weight: 400\">,<\/span><span style=\"font-weight: 400\"> and lockdown policies. There are clear guidelines for <\/span><a href=\"https:\/\/www.england.nhs.uk\/ourwork\/coi\/\"><span style=\"font-weight: 400\">practitioners<\/span><\/a><span style=\"font-weight: 400\">, and <\/span><a href=\"https:\/\/www.nihr.ac.uk\/documents\/nihr-conflicts-of-interest-policy-funding-and-awards\/25637\"><span style=\"font-weight: 400\">researchers<\/span><\/a><span style=\"font-weight: 400\"> on managing conflicts of interest<\/span><span style=\"font-weight: 400\">, the latter explicitly based on the underlying principles of the <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/the-7-principles-of-public-life\"><span style=\"font-weight: 400\">Nolan committee<\/span><\/a><span style=\"font-weight: 400\"> on standards in public life. These seven principles are selflessness, integrity, objectivity, accountability, openness, honesty, and leadership. Although declaring competing interests fits under \u201cintegrity\u201d, it plays a role in all seven principles. As well as managing competing interests, the \u201c<\/span><a href=\"https:\/\/www.cqc.org.uk\/sites\/default\/files\/Duty-of-Candour-2016-CQC-joint-branded.pdf\"><span style=\"font-weight: 400\">duty of candour<\/span><\/a><span style=\"font-weight: 400\">\u201d applies for all practising clinicians. Despite the Nolan principles, this kind of candour has not always been visible from our government. This week&#8217;s open testimony to MPs from <\/span><a href=\"https:\/\/www.bbc.co.uk\/news\/uk-politics-57254915\"><span style=\"font-weight: 400\">Dominic Cummings<\/span><\/a><span style=\"font-weight: 400\">, previously a special advisor to the UK government,<\/span><span style=\"font-weight: 400\"> was candid and concerning, including allegations regarding competing interests at the heart of the UK government. However, the more notable allegations were about the <\/span><a href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/26\/martin-mckee-what-did-we-learn-from-dominic-cummings-evidence-to-mps-on-the-covid-crisis\/\"><span style=\"font-weight: 400\">limited<\/span><span style=\"font-weight: 400\"> ability and capacity<\/span><\/a><span style=\"font-weight: 400\"> of those in charge of making\u00a0 key decisions in the first and second covid-19 waves.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In healthcare and public health, admission of our limitations is crucial to patient safety. I am an academic cardiologist, specialising in heart failure. Even within cardiology, I regularly defer to other colleagues with different subspecialist expertise and knowledge (e.g. heart rhythm problems) Outside of cardiology, whether in public health, primary care, or dermatology, I seek the input of specialist colleagues, as necessary. Moreover, I am a clinical academic, working 30% of the time clinically, and 70% in research and teaching. Although I am experienced in all aspects of cardiology patient care, there are some aspects where my colleagues who are clinically active 100% of the time may be better placed to advise than me, e.g. detailed cardiac imaging. In research, I am trained in epidemiology and informatics, but I will always need the help of colleagues in several other disciplines in almost every study in which I am involved. I voluntarily put this information on my \u201cCOI slide\u201d in every presentation I am asked to give. My limitations are as important as whether I have accepted research grants from industry, in determining whether I am able to do my job. Whereas I am always asked about my COIs in my clinical and research roles, I cannot remember when I was last asked to declare my limitations.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Whether among government officials, policy advisors, clinicians, or commentators, every single individual has limitations in their experience and ability. If this was openly acknowledged rather than avoided, glossed over, or denied, gaps in capacity and ability could have been addressed earlier in the pandemic. For example, advisory committees have involved relatively few <\/span><a href=\"https:\/\/theconversation.com\/nurses-are-on-the-coronavirus-frontline-so-why-are-they-being-left-out-of-the-response-143658\"><span style=\"font-weight: 400\">frontline<\/span><\/a><span style=\"font-weight: 400\"> healthcare or public health professionals, which affects the applicability and implementation of findings and recommendations. Misinformation is easier to dispel if we know the limitations in experience, knowledge, or ability of the authors or \u201cexperts.\u201d However, experts are not required to declare limitations. Whether in science, clinical care, or in government responses to the pandemic, teams are required rather than individuals, and those teams rely on knowing the strengths and the limitations of the individuals involved. Perhaps it is time to make these limitations openly available.<\/span><\/p>\n<p><em><strong>Amitava Banerjee<\/strong>, associate professor in Clinical Data Science and Honorary Consultant Cardiologist,\u00a0Institute of Health Informatics, University College London.<\/em><\/p>\n<p><em><strong>Twitter<\/strong>:\u00a0<a href=\"https:\/\/twitter.com\/amibanerjee1?lang=en\">@amibanerjee1<\/a><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: none declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Admission of our limitations is crucial to good decision making, it is time we openly acknowledge these, says Amitava Banerjee In healthcare and health research, we spend a lot of [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" 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