Discussion in 'Action Alerts and Advocacy' started by Supporters of Dr Myhill, Sep 15, 2010.
Thanks, this is so worrying - poor Dr Myhill must be extremely stressed and exhausted.
Sending Sarah my best wishes.
High court hearing postponed until after 14 January 2011.
Sarah has a follow up IOP with GMC on 23 December 2010.
This whole thing is so shameful. Now it's been postponed further--on the day of-- so her practice and patients can suffer longer? Do you know why the high court postponed?
I really hope she has representation for this level. She does not deserve this treatment.
My heart goes out to her.
The weather in the UK is atrocious, the whole country is snowed in, so that is probably the reason.
It really is a shameful business though, you're not wrong there leela.
I'd like at some point to post a full analysis of the 2nd IOP here, if I can manage the time to do so - I think it would be quite shocking for forum members to see, and it doesn't bode well that they managed to reach the conclusions that they did, based on the evidence in that transcript.
I'll have to do quite a bit of work to pull out all the precise details, so what follows is from memory and some details may not be precise, but this is the gist of the 2nd IOP transcript as I recall it, followed by some further comments on the history of the case.
The meat of the IOP hearing was in the reports from 4 expert witnesses selected by the GMC to comment regarding the allegations. The first report, regarding internet commentary, basically said that whatever a GP says on her website isn't really grounds for misconduct or whatever, it's like writing a book or similar and I think he noted that precedent is quite lenient in that regard. The tenor of the quotes from that report, even as cited by 'prosecution', came across to me that whatever she said on the website wasn't really grounds for suspension. Many months then passed...and then in the 10 days before the hearing, 3 more expert reports suddenly landed on Dr Myhill, one of them just hours before the hearing. All of them concerned details of claims made on Dr Myhill's website, from experts in the relevant fields.
The 3 further expert witnesses were all asked something like "does this comment, in your view, fall short of the minimum standards required of a GP?" The question asked was basically the charge against her, so in legal terms it's essentially a leading question - but the GMC's procedures seem to allow them to run a coach and horses through every legal principle going so that sort of thing won't be addressed by the High Court (which will address any breaches of the GMC's own procedures) - maybe the European Court of Human Rights might be another matter however, if it comes to that, which it could do since there was no right to anything resembling a fair trial here.
The first expert report had basically said that what a GP writes on her website has little relevance to the standards required in relation to a GP actually practicing, so that the whole premise of the leading question asked of the experts was seriously flawed according to the GMC's own expert report - but doubtless the 2nd group of experts weren't alerted to that point.
The 3 reports were each concerning areas of detail where comments on Dr Myhill's website were at variance with NICE guidelines. Dr Myhill had scant opportunity to present the scientific evidence those comments were based on, at such short notice, but in the limited time available she did a pretty good job I thought. The ones that jumped out as most notable to me were the evidence regarding the contraceptive pill and the evidence regarding mammograms.
In relation to the pill, which Dr Myhill does not recommend, she claimed that the pill was linked to 4 kinds of cancer. The expert asked to comment said that it is only linked to two of them and she was aware of no evidence for links to the other two cancers. In her view, this "fell well below the standard required...".
At this point I fell off my chair. The appalling crime committed here was to advise against the use of the pill on the basis that it was linked to 4 types of cancer, whereas the expert complained that according to accepted evidence the pill was only linked to two of them! I wondered whether this detail would make any difference to the recommendation to avoid the pill. But worse was to come...
The expert also raved about how women need reliable advice regarding contraception - almost as if they didn't have ample access to the NICE advice through other sources. Dr Myhill's refutation cited research that had suggested a link to the other two cancers, and described a private conversation with the researchers on that issue who had told her that it might be very hard to establish a link for technical reasons as the effect was masked by confounding factors and it would take decades to prove one way or the other, but that it was likely true.
I fell off my chair again.
In relation to mammograms, Dr Myhill was concerned about the impact of the x-rays and recommended a new non-invasive screening technique available via a private company. This expert report also got angry about the importance of reliable screening, warned about the private costs of this weird new non-invasive screening that patients would be subjected to (about which she knew essentially nothing), and insinuated (without evidence) that Dr Myhill might be profiting from referring patients there (a common and unfounded insinuation/fear that runs throughout this case and plays well to the fears of the NHS people involved). Dr Myhill explained a bit about the non-invasive technique and the history of controversy over mammography, and then (this bit really got me) pointed out that the expert themself was a consultant at a private mammography clinic, thus demonstrating that the expert actually had far more of a conflict of interest than Dr Myhill in this matter!
There was a great deal more detail than what I have sketched above, but these were the biggest things that stayed in my mind; I think they are illustrative of the rest of the arguments. Dr Myhill defended herself well - given the limited time she had to prepare her case - in relation to the allegations discussed, citing scientific evidence on which her assertions were based and explaining her perspective quite reasonably. But the first expert report, about the status of internet comments by doctors, should have made this unnecessary anyway.
There was then the question mark over telephone consultations, which was the other half of the case, but this wasn't explored in any depth. Suffice to say that everyone on this board will understand that Dr Myhill's procedures in this matter are geared around the unique situation of ME/CFS patients, and that her very detailed questionnaire and the other measures she takes to consider patient history in this matter are perfectly reasonable and very considerate - they are of course based on patient circumstances, in particular based on the situation of people with ME/CFS.
There were a couple of other issues.
There was concern, I'm sure, that Dr Myhill had criticised the GMC, and doubtless they saw her public comments about the GMC and their behaviour in a very dim light - nobody likes to be told they're an idiot, especially idiots, and the GMC had managed to lose some records relating to having been through all this stuff many times before, hence the accusation of the GMC as a body suffering from 'alzheimer's disease', which probably didn't go down well - but a hell of a lot worse could easily be said about the GMC, and fairly.
Dr Myhill's challenges of legal points didn't seem to hit the mark at all, she's not a lawyer after all, and didn't have one present due to GMC's previous persecution of her making insurance a problem. But I was not about to wade through legal documents to determine the rights and wrongs of the points she raised so I can't comment on them.
There were also allegations that Dr Myhill had breached the terms of the first interim order by failing to notify a health trust of her interim order status, in response to which she explained exactly how this administrative oversight easily arose and apologised for it. This only served to highlight how draconian that requirement was and how administratively difficult it must have been to comply with: imagine having an obligation to write to every health professional or body with whom you have a direct or indirect relationship to tell them that the GMC have told you you can't prescribe medication for the next 18 months, and imagine too the impact on your professional reputation that can be imposed by such an interim measure, without any kind of fair hearing being required to impose it. And ponder the vindictiveness of that requirement that you must alert all these health professionals to the restrictions with which you are complying.
And so the panel retired and reached its verdict to suspend her completely, giving a list of completely vague reasons about their concerns and suspicions that seemed to have nothing to do with the allegations directly. The list is quite interesting in that pretty much all the points seem to apply rather well as criticisms of the NHS's treatment of ME/CFS.
And the Bad Science mob threw a big party and laughed and laughed, and celebrated "the afterglow", as if the whole business were some kind of cool new internet game to play during lunch breaks, without consequence for real people. No sympathy was expressed at this party for the feelings of Dr Myhill, nor for her patients and supporters, who the BSers seem to think are all mad and unhinged and thus suitable objects of ridicule, and who they nevertheless claim to be protecting, whilst showing not a trace of compassion for them.
Some analysis of the choice of the phrase "afterglow" for this celebration seems to me quite illuminating. Given the insult of choice of the BS crowd, which they used frequently and casually to describe Dr Myhill - a sexist swear word which I will not repeat here - and given that Dr Myhill, and a disproportionate number of ME/CFS patients, are women, whereas the majority of the BS members appear to be grown men behaving like adolescent boys, given all these factors the metaphors can easily be extended to describe the BS members themselves, and what they have done, but, again, that kind of language is not welcome here.
The behaviour and language of the BSers throughout the whole of this prelude was quite atrocious and gave a very good insight into the nature of such quackbusters, prompting a strong rebuke from Ben Goldacre, which I might also quote here later because he said some very good and principled things in that statement which deserve praise even if they were only aimed at covering his own back, despite still feeling that 'good work' (which I missed) had been done on the thread. It seemed clear that Mr Goldacre was shocked and dismayed by some of the things that had happened on his forum, which makes it a shame that he didn't pay any attention to it until the case had been concluded.
As some members of this forum are all too well aware, several very aggressive clashes occurred between members of various ME/CFS forums and members of the BS forum, both on the BS forum and also on this one. The trolling by BS members on this site came at a very sensitive time for our community, and from my perspective I can say confidently that this was a significant contributing factor fuelling the divisions which arose here around that time. Many former members felt that the PR moderation team were too tolerant of the BS trolling, and I have to say, in retrospect I think they were right about that. We wanted, as we always do, to allow a wide diversity of viewpoints to meet here and discuss ME/CFS issues, but I think we were naive about the difference in culture of the BS crowd, who don't seem to be accustomed to expressing themselves with the same levels of respect and tolerance we value here.
I will take this opportunity then to apologise personally and on behalf of PR for our failure to adequately protect members from abuse during that time. There's no question that a great deal of hurt and stress was caused to patients and their advocates during that episode, though it all seemed like jolly good fun to the BSers.
There were numerous spin-off issues raised along the way: various people thought legal action might be warranted about what was said on the giant BS thread about the issue and elsewhere; some campaigners (myself included) used the evidence on the BS thread very successfully to gain sympathy for our cause; and the thread itself seemed to be shaping up very nicely as an expose of the dynamics on the front-line of a war between self-styled 'quackbusters' and their victims.
Then the giant thread where the whole thing had taken place was conveniently lost by a BS admin, who explained that the site explicitly instructs all search engines not to index the site so it hasn't been archived, and that the backups had been overwritten, so the thread is lost for ever - but please note that if you point out this was 'convenient' and take an open mind on whether that destruction of evidence may have been deliberate, that makes you a conspiracy theorist, and note also that all members of the BS forum are agreed that the loss of the thread was definitely, obviously, clearly not deliberate (indeed it's quite hilarious to suggest such a thing), this being a good example of one of the few types of belief that should be held by all people without any need for evidence, because it's just obvious.
And doubtless more of this BS will go on, much in the same vein, and all assertions will be challenged with "evidence or stfu", including in cases where they themselves have destroyed the evidence. And doubtless they will continue to fervently agree with each other that other forums like ours that host wider ranges of opinion than their own are "echo chambers", without any hint of irony or self-awareness. And doubtless few if any of them will pause for thought and seriously wonder whether what they have done is a good thing, or a fair thing, since after all, they were just "having fun".
And Dr Myhill will, I am sure, battle on, as she always has, providing care and effective, evidence-based treatment, in whatever way she is able, to British ME/CFS patients whose needs the NHS so callously and systematically ignores.
And just as she stands by us, we patients in turn will continue to stand by her, and we will support her struggle for justice, for herself and for us, in any way we can.
I've moved the discussion of Bad Science that started on this thread to here:
GMC Fitness to Practice Panel (Interim Orders Panel)
Thursday 14 October 2010:
View attachment Transcript GMC vs Myhill IOP 14 Oct 2010.pdf
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