Uncertainties

It is impossible to be precise when I first started to worry about the way Dr Fairhurst's research work was conducted. During the early 1990s he was employing a research assistant, Debbie, to help with the day-to-day workload while he was recruiting patients for a number of cardiovascular studies running concurrently.

Inevitably during his holidays or trips abroad lecturing, his patients would encounter problems with their trial medication. One particular incident involved a trial patient whose liver function tests were abnormal. Debbie brought these to my attention, as she was worried about the significance of the results. I arranged to see the patient to discuss this and was shocked to discover that he was completely unaware that he was taking study medication. Another incident involved a patient whom I visited at home; she needed urgent admission to hospital and, while listing her medication in the admission letter, I came across clearly labelled study drugs. She too was completely unaware that she was in a pharmaceutical trial. These incidents were separated by about 18 months and were not recorded by me at the time. I tried to dismiss their significance and doubted the patient's memory or put it down to the stress of the situation and their illness. It was some time before I began to suspect my partner of entering patients into studies without their consent. It was very difficult to accept that a doctor so well respected by his colleagues could behave in such a way.

Most of Dr Fairhurst's patients were completely in awe of him. He was a large man with a charming manner and a great repertoire of jokes. Many patients said that they often forgot why they had come to see him, as he was such a conversationalist and raconteur.There are a great many patients with hypertension in any general practice and most of them appreciate special attention.This was exactly what they got while they were entered in a study: regular blood tests, electrocardiographs, and detailed enquiry into their well-being. In consequence, most patients were grateful for the special treatment they received and seemed unconcerned that they were testing new medication, mostly angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists.

Consent to be in these studies did not seem to worry the patients on the rare occasions when I discussed this with them. They thought Dr Fairhurst a marvellous man and eminent doctor who could do no wrong in their eyes. My dilemma was complete; a well-respected and connected colleague, loved by his patients, whom I suspected was behaving unethically and dangerously. At that time complaints about doctors' conduct were rare and were usually brought to the attention of the General Medical Council by aggrieved patients. I had never heard of a doctor blowing the whistle on a colleague.

I knew that Dr Fairhurst had had previous partners, some of whom had left after bitter arguments with him. Although he was generally good natured, when confronted with criticism of his behaviour or medical management he could become very belligerent and stubborn. If he could not get his own way on these occasions he would refer to his large personal list size and popularity. He would clearly state that he was prepared to dissolve the partnership and retain all his patients, effectively leaving his colleagues without a future. We had already lost a third partner, who had been threatened in this way following her complaint about his personal conduct.

I had a young family, mortgage, and a half share of large practice loans, so he had a very effective bargaining tool and one I had no answer to. Leaving the practice would have meant borrowing to repay the loans and finding another partnership. An additional worry was that any reference from him would probably have been of little help in finding another job. There was little I could do at that time but continue to work with him and to note any trial irregularities when they occurred.

Around this time I started to participate in a few pharmaceutical trials myself, most of them studying patients with asthma. I was amazed at the amount of time they took up. Dedicated sessions were necessary to provide the time for informed consent and the extensive examination and investigation. The drug reconciliation was often a logistic nightmare and meticulous care had to be taken. With this personal experience of the difficulties involved in this type of medical work, my suspicions grew that Dr Fairhurst simply could not be working to the protocols because of the limited time he allocated. I became very unhappy with my situation within the practice and increasingly concerned for the well-being of patients entered in his studies. I believed that Dr Fairhurst was so well respected by colleagues and patients that my concerns would not be listened to locally. I was trapped.

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