Thursday 29 May 2014

The Case of Dr Henry Mannings

It was back in December 2012 that I first wrote about the case of Dr Henry Mannings, the founder of Star Throwers, a charity in Norfolk that helps late stage cancer patients with nowhere else to go. Let me state at the outset that I am a Trustee of Star Throwers and proud to be one. Henry Mannings treated my son George when we had no place else to go. In the many years of treatment that my poor son endured before his death, we met few doctors as dedicated, concerned and open minded as Henry Mannings. George was the first patient that Henry treated with Coley’s Toxins, but by then the disease was so advanced that nothing could stop it – but George, and the rest of the family, appreciated the care and advice from Henry, and the hope that the treatment gave us when there was no place else to turn. And, let me add, Henry made no promises, he did not give us false hope and everything he said or recommended he backed up with evidence and reasoning. In the years since George’s death I have come to know Henry Mannings well and I know that the trust he inspired in us he continues to inspire in the many patients who come to Star Throwers.

However, his popularity with his patients, and his open-minded approach to oncology, makes him unpopular with some of the powers that be. And so in late 2012 a complaint was made by a senior oncologist in Norwich to the General Medical Council. The complaint alleged that Dr Mannings was prescribing chemotherapy drugs in an unsafe manner that put patients at risk, with specific mention of two cases. In neither case was the complaint made by the patient or the patient’s family. In fact the complaint was made without first asking the people concerned whether they had any complaints to make against Dr Mannings.

Based on these complaints the GMC instituted proceedings against Dr Mannings, and initially took the step of taking away his power to prescribe treatment at Star Throwers. This meant that patients who were being actively treated had to stop treatment, even if these treatments were successfully keeping cancer at bay. In response there was an outpouring of support from patients and patient families, from other clinicians familiar with Dr Mannings and his work and from experts in the field who could see no wrong in the work that he was doing or the scientific rationale behind it. He wasn’t offering miracle cures or ripping patients off or acting in any way unethically. The restriction on prescribing was removed in January 2013 but in many senses the damage had been done - doubt had been cast on Dr Mannings competence and the work he did to fund himself while working for free at Star Throwers dried up. More than that, it put him under great personal strain and incredible levels of stress that no amount of public support from patients and friends could quite counteract.

What was also apparent very quickly is that the original charges against him - to do with prescribing metronomic doses of standard chemotherapy drugs - were unfounded and of no consequence. However, the investigation soon switched tack and focused instead on the use of Coley’s Toxins, which had not even been mentioned in the original charges and for which Dr Mannings had MHRA approval to treat patients. It was also apparent that the senior oncologist who had made the original charges had lied. I am being careful with my words here, the original complainant had not been devious or slippery in his language, he had outright lied. Not just in his original complaint, he subsequently lied to BBC journalists and when he was caught out he lied that he had not lied. Despite having documentary evidence of these facts the GMC showed little interest in the matter.

Finally, in May 2014 the GMC process has ended and all charges have been dropped by the GMC. While this is a great relief to all concerned, especially to Henry Mannings himself, it’s also an outrage that it took that long to reach a conclusion when it was clear very early on that there was no substance to the original charges.

And there’s a wider significance here than the personal injustice that Henry Mannings has suffered. I attended the last public consultation on the Medical Innovation Bill at which Lord Saatchi laid out the revised Bill. The medical innovation that the Bill describes is not about drug companies innovating new drugs or treatments, it’s about doctors making innovative treatment decisions when patients have nowhere else to go. It’s largely about end of the line treatment options when all the standard therapies have been exhausted – this is precisely what Henry Mannings is doing at Star Throwers. In his presentation Lord Saatchi suggested that it is fear of litigation from patients that is stopping doctors making these innovative treatment decisions. Therefore, in his opinion, the correct thing to do is to give the Multi-disciplinary Team (MDT) meeting (also called the Tumor Board in some countries) the power to decide whether these treatments decisions can be made or not – they are the arbiters not the treating physicians or the patients.

I was initially very positive about the Medical Innovation Bill - it seemed to be an ideal opportunity to make some changes to law that would encourage the approach that people like Henry Mannings have adopted. But now I feel very depressed about the direction it has taken, for two reasons primarily. The first is that in practice the MDT is incredibly busy, often barely able to keep on top of the workload of deciding on standard treatments. Where will they find the time and the space to assess all of the evidence from pre-clinical studies, case reports, clinical trials and so on? For anyone who has ever seen an MDT in real life the idea that they will be in a position to do this important task is laughable. Secondly, the MDT is at the core of the existing institutional culture. This is where the conservatism and ‘not invented here’ attitudes are embedded. This is the arena that the senior oncologist of the type who complained against Dr Mannings rules the roost. Far from encouraging medical innovation, very often this is the body that stamps down on it.

And let us be clear once more, the case of Henry Mannings is instructive. It wasn’t a patient who complained. It was another doctor. The families of the patients mentioned in the case where fully supportive of Henry Mannings. So perhaps Lord Saatchi is wrong, and that ultimately his Bill will succeed in entrenching the culture that stops innovation rather than encouraging it. If this is the case then we all lose.

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