Science and Technology CommitteeWritten evidence submitted by Margaret McCartney

1. I am Margaret McCartney, a general practitioner in Glasgow. I have been writing about medicine in society over the last decade for the British Medical Journal, the lay press, Radio 4’s Inside Health and I am the author of The Patient Paradox—why sexed up medicine is bad for your health. I have won national and international prizes for my writing about evidence based medicine including the Healthwatch Award. I am a member of the Royal College of General Practioners. The non publication of clinical trials is of major concern to me and I have written about this over the last decade.

2. I have no conflicts of interest, except that as a GP and a patient myself, my patients and I suffer directly when there are unpublished clinical trials into healthcare interventions I prescribe or take.

3. The problems generated by the non publication of clinical trials are:

(a)I can have no faith that patients taking part in clinical trials are not doing themselves harm. This is because previous trials may have been done showing that the intervention is dangerous but have gone unpublished. This means that I cannot be sure that the intervention is reasonable to test. This means that I cannot trust the clinical trials recruitment process, and useful developments are less likely to occur.

(b)I can have no trust that the healthcare interventions I prescribe or suggest do more good than harm. This means that I give patients less good information than they should have about the risks and benefits of an intervention. This means that I may be doing more harm than good, but I do not know this is the case. This causes unnecessary risk to patients.

(c)The scientific process is the best way we have of sorting out which healthcare interventions are best for people. However this noble process has been subverted because of the desire to profit. The profit motive—which I believe has caused many of the problems of no-publication of research—has meant a lack of trust in the medical research process. This means that many people may be unwilling to be entered into a clinical trial, and it also means that many people may turn to alternative medicine. This in turn also causes harm, including financial.

(d)I was approached by a drug company two years ago seeking to perform a clinical trial in my practice. I asked what would happen if they did not publish the trial results, and I did. The bottom line was that they would sue me. Of course I did not get involved in the trial. This is evidence that doctors who believe in data being published can have no guarantee that the trials they are involved with will reach the light of day. This means that I in turn, as a GP, can not trust the drug companies.

(e)As quoted in my book, The Patient Paradox, GPs have been accused by head of the British Pharmaceutical Industry as being “luddites” for not prescribing new drugs quickly. Because doctors are afraid of the data they don’t know about, they are rightly often sanguine when it comes to new drugs on the market. But healthcare charities often receive money from the pharmaceutical industry. It is often charities, rather than the pharmaceutical industry directly, who make plays for new drugs to be prescribed. Yet the same charities are offering “educational” material to doctors, as well as urging NICE to recommend new treatments. I believe that this financial bind causes many charities not to question the non publication of clinical trial results and the harms that the non publication of clinical trials can cause.

4. The non publication of clinical trials would be easy to rectify. A law could ensure that all clinical trial data was published online by 12 months after close of trial. We protect citizens through law in all sorts of other ways—why not this also?

I really don’t see why this would be difficult to do.

February 2013

Prepared 16th September 2013