GMC under attack

The medical community has become split over what to do with its overseeing body, the GMC. Can it reform itself, or will Government have to step in?

By | December 28, 2000

It has all the makings of an epic drama. The UK's main body overseeing the medical profession, the General Medical Council (GMC), is under siege. Attacked by the public for negligence over a series of high profile cases, distrusted by many inside the profession, and criticised by eminent observers such as the editor of The Lancet, the Council enters 2001 fighting for its life.

Specific cases include a doctor who was convicted of sexual abuse but was allowed by the GMC to continue practising while under investigation. Recent cases of fraudulent research work have come to light, with the GMC failing to take any action, despite giving written assurances that it would act.

Spearheading the campaign to reform the council is Richard Horton, editor of The Lancet. "The GMC has screwed up," he says bluntly. "But there is a terrible split in the medical community about what should be done." There are many doctors who argue that the council should be strengthened and made more accountable, but that it should not lose its basic make up — the majority of its board members coming from the medical profession.

Such self-regulation would, in Horton's view, simply prolong the death-throes of the organisation. The council's original purpose was to act as a self-regulatory body for the profession, but it has signally failed in this task. "It's not particularly surprising or controversial," says Horton. "Every organisation which runs itself has the same problem."

He proposes that the GMC should reform by introducing a majority of non-medical board members, appointing a non-medical chair and ensuring that the council operates in an independent fashion. This is certainly the view of the UK Government. One minister commented that the GMC is "an absolute disgrace" and is very likely to be reformed or even abolished in 2001.

Richard Horton believes that doctors fear being victimised, as a kind of witch-hunt proceeds. During 2000 there has been the Harold Shipman case and a series of sexual abuse cases, which have brought the profession into disrepute. Documented cases of fraudulent research work, including work on the use of interferon to treat failures of the autoimmune system, have further dented public confidence in scientific research. Richard Horton was forced to issue a retraction of a paper on this subject in The Lancet, his only such case so far.

Yet among the research community there are some powerful voices for the defence. Professor Richard Peto, whose work on the links between smoking and cancer has established him as one of the UK's foremost scientists, argues that the issue of fraudulence is a red herring. The real issue, he maintains, is the mass of regulations and bureaucracy, which has been imposed on scientific research hampering the profession's ability to achieve results.

"Trial samples are too small by a factor of ten," he says. "Getting trials wrong results in unnecessary deaths." He prefers to call most cited cases of fraudulence 'pathetic behaviour' rather than true fraud. "You just think 'what a nerd', whereas going in the direction of greater regulations will cause damage rather than good." Richard Horton sympathises with Professor Peto's frustrations at the restrictions on research and describes him as among the best of the UK's scientific minds. "At The Lancet we see the good and the bad of research," he says. "Peto is very good, but the bad is extraordinarily bad. We propose that training in medical ethics, values and integrity needs to be strengthened. The GMC needs to be really tough on fraudulent research." But he doesn't believe that such measures would impede researchers' ability and freedom to do their work.

It is an issue of trustworthiness. As in many areas of life, those who abide by the law have nothing to fear and it does seem strange to hear someone as high in the scientific community as Richard Peto arguing for tolerance of unethical behaviour. His real grouse is with the pharmaceutical industry, which has colluded with bodies such as the FDA and the Japanese and European drugs regulators to introduce a series of burdensome regulations in order to achieve quicker authorisation processes.

But this is a different issue to the fraudulence problem and is only linked by Peto in terms of the gradual accumulation of 'details', which hamper research. "Those investigating often seriously misrepresent the situation," he says. "It's not a serious problem compared to trials failing." He believes that the small samples used to trial the breast cancer drug tamoxifen, for example, may have caused many thousands of unnecessary deaths. Its long-term effects were trialed on 1,000 patients rather than the 30 or 40 thousand, which Peto says, would have produced more accurate results.

It has become an emotive issue, with critics accusing the GMC of covering up wrongdoing in order to protect the profession. Researchers, such as Professor Peto, counter, "People say they are making war on fraud. I'd like to make war on death!" In between is the GMC, looking increasingly powerless to act, and incurring the wrath of the Government.

A further voice in the debate is the Committee on Publication Ethics (COPE), which claims to have evidence of 110 cases of research misconduct, 30 of them occurring during 2000. "We have no idea what fraction of the whole this represents," says Professor Michael Farthing, who heads COPE.

There is general agreement (with the exception of those such as Professor Peto) that action must be taken to reform the GMC. What form this will take will depend on the readiness of the GMC itself to put its own house in order and the robustness of a Labour Government approaching an election and sensitive to public disquiet on many health-related issues.

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