The unilateral imposition of a new contract of is the latest instalment in the ongoing doctors’ dispute. This is the most recent development in long line of NHS reforms which stretch to the limits the standards of credibility, objectivity and truth that are supposed to be the bedrock of our representative democracy. Given the calculated way in which the Government has misused statistical evidence I am reminded of Orwell’s musings about how 2+2 is made to equal five:
“In the end the Party would announce that two and two made five, and you would have to believe it. It was inevitable that they should make that claim sooner or later: the logic of their position demanded it. Not merely the validity of experience, but the very existence of external reality, was tacitly denied by their philosophy. The heresy of heresies was common sense. And what was terrifying was not that they would kill you for thinking otherwise, but that they might be right. For, after all, how do we know that two and two make four? Or that the force of gravity works? Or that the past is unchangeable? If both the past and the external world exist only in the mind, and if the mind itself is controllable – what then? (Orwell, 1984).”
There have been numerous examples of this ‘doublethink’ during the current junior doctors’ dispute. In a statement to parliament after imposing the contract on the Junior Doctors, Hunt said:
“We have now had eight independent studies in the last five years identifying higher mortality rates at weekends as a key challenge to be addressed…”
Contra to these claims, Peter Holt, author of one of the papers has stated that their analysis ‘could never have shown that higher staffing on weekends reduced mortality’, because they didn’t have the data to test for this. Another of the mythical ‘eight’ is a report by Nick Freemantle. This study found that 11000 more people died on a weekend than on a weekday. Hunt claimed these excess deaths were due to poor staffing at weekends. However, as David Craven points out in snappily titled paper ‘the statistical sins of Jeremy Hunt’, the report authors did not make any claims regarding the cause of these deaths, nor did they take a view on what proportion of those deaths may have been avoidable. In other words the authors did not say that any patients had died because they were admitted on a weekend. Fiona Godlee, editor in chief of the British Medical Journal (BMJ) wrote to Hunt, pointing out how his repeated and erroneous assertions that excess deaths were due to poor staffing implied that the deaths were avoidable. The report did not make any any such judgement. In his reply to Godlee, Hunt stated that his “comments…while giving a rough estimation of the BMJ article, [are] also drawn on…other evidence.” Given the stakes of the debate utilizing a rough estimation would seem to be ill-advised, to put it mildly. More seriously it may be indicative of willful deceitfulness and misleading parliament.
Source: 2+2 equals 5
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