Dr Fiona Godlee, editor of the British Medical Journal, responds to questions about Deborah Cohen

See my piece of 30th November on Deborah Cohen, who reported for the BBC on the death of Jack Adcock and Dr Bawa Garba’s conviction for his manslaughter. On 3rd December I emailed the editor of the BMJ, which lists Ms Cohen as an Associate Editor. This email exchange, in bold, is lightly edited.

I would like to state that I have a good deal of sympathy with Mr and Mrs Adcock’s bafflement that a doctor convicted of ‘Gross Negligence Manslaughter’ can be allowed to continue practising. My view is that the conviction appears very dubious and the many concerned doctors (and others) who feel she has been scapegoated should look more at the possibility of a Supreme Court appeal rather than attacking the GMC.

4th December

Dear Dr Macfarlane,

To my knowledge Deborah Cohen has never claimed to be registered or practising as a doctor. She is entitled to the honorific “Dr” because of her completed and awarded medical degree, as confirmed by the GMC. From what you have written I see no evidence of any instances in which a claim of being registered or practising as a doctor have been made by Deborah or on her behalf. False ad hominem attacks of this sort do no credit to you or the issues you care about.

Dr Fiona Godlee FRCP
Editor in Chief, The BMJ
Editorial Director, BMJ

(‘Ad hominem’ simply means ‘to the person’, and is a term often used by doctors to ward off criticism or even questioning about professional behaviour. It sounds impressive and technical but it does not appear in any of the GMC’s professional guidance. My reply:)

Dear Dr Godlee

You do not appear to have studied what the GMC say about using the title ‘Dr’. We shall see what they make of it.

In my opinion if the medical establishment (including the BMJ) had been a bit more proactively ‘Ad Hominem’ about senior doctors involved in the Bawa Garba case & many others we would all be better off.

Thank you for commenting, but I find it disturbing that you decline to comment on the ‘defamation’ threat to Sara Ryan.

(The same day)

Dear Dr Macfarlane. Thank you for your reply.

From the GMC’s website

https://www.gmc-uk.org/registration-and-licensing/the-medical-register/a-guide-to-the-medical-register/unregistered-medical-practice

“..a person can legitimately use the title Doctor without needing registration with us, as long as they are not practising medicine or claiming to have registration with us.”

And could you direct me to where Deborah Cohen threatens Sara Ryan. From my reading she points out that what Sara Ryan tweeted was inaccurate and, in her opinion, defamatory.

Dr Fiona Godlee

(Same day)

It does not state that such a claim has to be explicit. I have outlined in the Blog piece why she makes a very strong implicit claim. As we are dealing with potential illegality it is my understanding that ‘implicit claims’ are well established in UK law.

Sara Ryan stated she felt threatened. Are you saying the parents of children dead (substantially) through the neglect of the UK medical establishment are not to be believed?

(Same day)

Dear Dr Macfarlane, I see no claim of registration on Deborah Cohen’s website, either explicit or implicit.

I am immensely saddened by the loss of any life and especially the loss of a child. But as far as I can see, Sara Ryan repeated a specific allegation – which was that Deborah did not have the transcript, and this allegation was inaccurate.

I am happy to continue this discussion but I don’t see it achieving very much if you merely continue to resort to unfounded opinion.

(6th December)

Dear Dr Godlee

There have been a number of concerns about the behaviour of senior doctors in the Bawa Garba case, including the on-call consultant on the day of Jack Adcock’s death.

It is generally understood that most senior doctors in the NHS are in the BMA.

Deborah Cohen, as an associate editor of the BMJ, is an employee of the BMA [which ‘wholly owns’ the BMJ].

Is it not reasonable, then, to have very considerable reservations about the Panorama programme which allowed the Leicester Royal Infirmary Medical Director to state ‘we did not let Dr Bawa Garba down’, without showing any questioning of that by her [Cohen]?

Also, Ms Cohen appears not to have adopted the usual Panorama approach with reluctant interviewees (with the on-call consultant in particular) of seeking them out and doorstepping them if necessary. And the programme omitted to mention the possibility of appealing the original conviction to the Supreme Court: if that was successful then the spotlight would be thrown back onto the senior doctors.

Sara Ryan’s ‘fudge’ might be considered a rather mild opinion to express about these and other aspects of the programme. But I maintain that such statements expressed by relatives well known to be seeking further answers about deaths involving substantial neglect should be seen as questions, and therefore it is unreasonable to threaten litigation even when they are stronger.

A senior BBC Panorama producer has stressed to me that Ms Cohen was only working on a freelance basis. I have some knowledge of the BBC and it does not surprise me that they do not want to offer any support for her ‘defamation’ threats.

I have returned some more questions to them, including one on how they addressed the conflicts arising from the programme being, in effect, a BBC-BMA co-production.

Your own further comment(s) would be welcome.

(The BMA statements I have looked at do not comment on whether Dr Bawa Garba was a member. If she was not, and the consultants in the hospital were, that would increase the conflict of interest issue I outline above. If she was a member, the situation is not necessarily very different: there have been cases where junior doctors have felt let down by the BMA due to the influence of consultants. [Added 10th December: I now understand that Dr Bawa Garba was not a BMA member, but am not clear which senior doctors at Leicester Royal Informary, if any, were.])

(Same day)

Dear Dr Macfarlane. I do hope you will consider writing a rapid response to one of the many articles we have carried in The BMJ on the implications of the Jack Adcock/Hadiza Bawa-Garba case. You can find the collected coverage here.

https://www.bmj.com/bawa-garba

Two things in particular to draw your attention to, both of which raise the question of senior accountability for what happened and question why this has not been more of a focus for action.

1. BMJ Editorial

https://www.bmj.com/content/360/bmj.k479

“Many questions remain. Was it not the consultant’s, medical director’s and management’s responsibility to ensure adequately supported medical and nursing provision? Given the hospital’s inherent conflict of interest, why was there no independent review? Why did the GMC feel compelled to pursue an appeal? It says it could not allow its tribunal to go behind the decision of a jury in a criminal case and wanted to avoid a loss of trust in the profession.6 But the Medical Practitioners Tribunal Service (MPTS) was able to hear about important system factors that the jury in the criminal case was not,7 and other doctors with criminal convictions have been allowed to continue to practise.8”

2. Panel discussion, with my summary at the end [last 10 minutes] which raises the issue of lack of senior accountability.

https://www.bmj.com/content/361/bmj.k2118

As for what you see as a link between the Panorama programme and, via Deborah Cohen’s work, the BMA, I can only say that The BMJ is editorially independent of the BMA and had no role in the Panorama programme which, however, I thought did a good job of exploring difficult issues. Deborah Cohen has been employed on the staff of The BMJ for some years and has done excellent investigative work of which we are extremely proud. She now works as a freelance investigative journalist.

None of the coverage so far – either by the BBC or the BMJ – can be considered to be the last word on this matter. You should, as I say, feel free to submit your own thoughts in a rapid response, outlining where you think future attention should be placed. I can’t promise publication until a response has been submitted, but would welcome a response that raises important remaining questions and looks ahead to what needs to change.

Best wishes, Fiona Godlee

(These increasingly lengthy responses suggest that Dr Godlee is now taking the issues seriously. ‘Rapid responses’ are useful but I think I will try to hold out for a substantive piece. The links she provides to some extent back up her claim that she herself has not stopped repeatedly raising questions about the senior doctors involved, but in the video discussion (second link) she uses ‘tragic’ and ‘tragedy’ several times which convey a sense of Jack Adcock’s death as unpreventable. Overall the pieces published in the BMJ downplay the issue of appealing the conviction to the Supreme Court.)

(Same day)

Dear Dr Godlee

Many thanks for those links and quotations.

One last point for today. Is Ms Cohen still an associate editor (photo)? When did her non-freelance employment in that role end? Is she still employed by the BMJ as a freelance?

Best wishes

Cohen-BMJ

(Same day)

Dear Dr Macfarlane.

Yes Deborah Cohen is an associate editor. I wonder why you would doubt this as she is listed as such on our website.

Associate editors work on a freelance basis and are not therefore employed as staff on The BMJ. They are paid for any work they do for us and are free to work for others.

I believe that Deborah has been an associate editor since October 2015.

Best wishes.

 

To be an ‘associate editor’ must be a guarantee of regular paid work, so I would question whether that is ‘freelance’. And I think any reasonable person would consider that such an editor’s work done for others (the BBC in this case) has substantial reputational issues for the BMJ. As do poorly founded threats of litigation to anyone, especially non-professionals.

Dr Godlee talked about ‘editorial independence’ a year ago. She stressed the critical position the BMJ has taken on how pharmaceutical companies (Pharma) continue to distort evidence and overmarket their products. I am very concerned about this, and I agree that the BMJ has a good deal of credibility on the issue.

But such ‘editorial independence’ is not straightforward. With Pharma in relation to mental health, the BMJ has promoted the work of what I now call ‘anti-diagnosis purists’ (having dropped ‘extremists’) such as Joanna Moncrieff, Sami Timimi and Peter Gøtzsche [added 11th December: also Derek Summerfield]. I have argued that such views are quite compatible with ‘small state’ neoliberalism and conservatism, and may be useful in suppressing spending on people with mental health problems and developmental conditions (Jack Adcock had Down’s Syndrome and Sara Ryan’s son Connor Sparrowhawk had learning disability and autism). Most such purists tend to expound left-wing and progressive views, which can serve as a further distraction.

The BMA regularly negotiates doctors’ pay, terms and conditions with the Government. On areas such as mental health and learning disability any relief for the Treasury, however small, may be welcome.

I think it unlikely that there is anything resembling a conspiracy between the BMA-BMJ and the BBC with Panorama’s programme on Jack Adcock and Dr Bawa Garba. But it is clear that professional organisations, NHS trusts and charities are all increasingly employing ‘communications professionals’, just like Pharma has done for decades.

If Dr Godlee wants to demonstrate the BMJ’s independence regarding the wide range of concerns relatives have with services for people with learning disability and related conditions she might start with asking Deborah Cohen to make a statement.

The GMC have not yet informed me of their decision on the issue of whether she falsely claims to be registered.

(Next piece: how ‘our reporter’ Deborah Cohen became ‘a private individual’ when a senior BBC Panorama producer was pressed about her ‘defamation’ threats to Sara Ryan.)

[Added 8th December: I have written about a Supreme Court appeal but it occurs to me now that as the Appeal Court refused leave to appeal then seeking such leave again would probably be the appropriate step.]

 

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About Dr Neil MacFarlane MRCPsych

Independent Psychiatrist providing culturally informed mental health opinion, advice, and a few new facts. Based near London, UK. Main qualifications: BA MBBS MA MRCPsych.

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