7 June 2022: Rawlins - E

Sir Michael was returned to the contemporaneous emphasis given to clinical freedom. It allowed doctors to prescribe a product at their own discretion – be it on their own head – beyond the ultimate control of the licensing authority. Sir Michael tried to answer a supplementary question (he had not fully picked up on) by relating a story of how some US military personnel/patients in their nation’s field hospital in Afghanistan were transferred to the British equivalent because the US clinicians were not allowed to prescribe certain treatments while the UK doctors could. He then explained a related shift concerning the issuing of prescriptions. Whereas it had previously been a requirement of pharmacists to dispense a named product, it became possible for them to alternatively issue a cheaper alternative if one with the same efficacy was available, shifting some power back to the state in the face of clinical freedom.

In 1998, the nation witnessed how the previous demonisation of US imported commercial blood which led to the emphasis on UK self-sufficiency, was then turned on those same UK blood sources. This was a direct result of vCJD. The continuing return to “US-bad, UK-good” (until vCJD) becomes increasingly irritating, given that the UK blood supply was pretty much as vulnerable to viruses as the US blood. But sometimes it takes a public disaster, like vCJD, to cause the change that should have been enacted some time before. The vCJD risk factors extended their concerns to include vaccines, since they might include, for example, foetal cow material, now that the possibility of species transfer were vexing the brains of clinicians – not to mentions the effect vCJD was having on the brains of those who actually contracted it.

“Guidelines had been around for a long time and was a bit of a mish-mash,” said Sir Michael. Too often, guidelines of varying levels of quality were often pulled together by a few clinicians during a coffee break, and someone then wrote them up and sent them round to their peers. The necessity was (belatedly) realised of having properly drafted, standardised, tested, guidelines  clinical across all specialisms. But that has been a relatively recent innovation.

The witness admitted how he recognised that the CSM had inadvertently harmed thousands of patients. Then that oft returning bad smelling trope of, “We were doing our best at the time,” again reared it noxious head. It is the last-ditch defence of those pathetically paternalistic physicians who hurt and too often killed those to whom they had promised to “do no harm”.

All that remained after the final break of the day were the questions from core participants.

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