Harvey Marcovitch

When are paediatricians negligent

In 2009/2010, the National Health Service Litigation Agency (NHSLA), a Special Health Authority responsible for handling both clinical and non-clinical negligence cases on behalf of the NHS (in England only), spent £787 million (

Editors should not be propagandists

1244.5 million; €923.5 million) dealing with 6652 clinical negligence claims. The cost is increasing by about 10% annually. Paediatrics is not a high-risk specialty, in terms of the number of claims, although some of the largest financial payouts have been for multiply disabled children, whose injuries were perinatal and whose life expectancy is long.nnUntil publication of the data from France in this months ADC ,1 information in journals on paediatric malpractice claims has been available exclusively from the United States. Indeed, the French group have reported previously a systematic review of six such studies.2 In this first European series of paediatric negligence claims, they interrogated the database of the French national insurer, Sou Medical-groupe MASCF, and discovered 228 claims from 2003 to 2008 involving children, where the defendant was coded as a paediatrician or general practitioner.nnClaims involving paediatricians employed by NHS Trusts are defended by the NHSLA in England, with similar bodies in Scotland, Wales and Northern Ireland. The latest factsheet from NHSLA3 does not include paediatrics in its comparative claims data (see figure 1).nnnnFigure 1 nNHSLA: total number of reported clinical negligence scheme for Trusts (CNST) claims by specialty as on 31 March 2010 (since the scheme began in April 1995, excluding ‘below excess’ claims handled by trusts).nnnnHowever, from April 2003 to March 2008, NHSLA specialty coding listed 992 claims as paediatric and 87 as paediatric surgical. (Personal communication, NHSLA). It is not clear whether children might also be coded elsewhere—for example, under general practice, anaesthesia, accident and emergency (or obstetrics when perinatal claims are considered), so it is not …

When science sneezes the journal catches a cold

> Perspective on the paper by Hilton et al (see page 831)n> n> nnNobody doubts that the flawed paper on non-specific colitis and pervasive developmental disorder in children1 provoked a public health crisis and increased the risk for children in the UK of contracting measles. In this month’s journal, a group of social and public health scientists examine the response to the paper by several journals likely to be read by those responsible for providing advice to individual families regarding immunisation.2 They conclude that the journals “missed opportunities to accurately inform practitioners about the evidence” and seemingly preferred to “stand back and wait for consensus to develop”.nnShould the editors of the magazines Health Visitor , Community Practitioner , Practice Nurse , Nursing Standard and Pulse as well as the combined peer-reviewed medical journal and magazine BMJ accept that they failed their readers? I’m not sure what scientific pretensions the first group of these profess. If, as I suspect, they commission mostly freelance journalists to write their opinion pieces then there is little reason to expect any deeper analysis of a scientific disagreement that that of those writing feature items for any magazine or newspaper designed for an intelligent lay audience. Unless individual journalists have a bee in their bonnet about a topic or a competing interest, such as a deeply held personal belief or alarming personal experience, they are unlikely to come down on one side or the other on what they see as disputes between equally “respectable” scientists or clinicians. To do otherwise might lead to an accusation of publishing propaganda rather than news or unprejudiced opinion.nnThe issue may be different for a journal such as BMJ , edited and largely written by medically qualified individuals. In the 1970s, Robert Merton of Columbia University used the …

AGING AND PAEDIATRIC PRACTICE

This month we have published an anonymous contribution warning of a bleak future for UK paediatric clinical research. As editors we are already feeling the draught. Some senior academics refuse our request to review papers; one told us that his …

Getting ADC to paediatricians in developing countries

Scientific journals from around the world have agreed to take part this year in a global themed issue on aging—an initiative coordinated by JAMA . How do we justify a contribution from the Archives of Disease in Childhood to this important theme? One thing that distinguishes paediatric practice is that health and disease are observed against a background of growth and development. Perhaps analogous to this is the practice of geriatrics, where biological senescence, and all its psychosocial implications, is the backdrop against which health and disease are observed. Yet this philosophy becomes clouded when we consider that development and aging (or senescence) cannot be readily pulled apart. Although development implies an advantageous adaption to life, and aging implies irreversible deterioration it is none the less true that development is not only a precursor of aging but also influences it profoundly.nnIf we are serious about health promotion as a science we need to have a better understanding of the factors that govern the various markers of morbidity in adult life, such as obesity. The relationship between parental obesity and obesity in childhood is well known. In this issue, Julie Lake and colleagues (see p 376), using …