Great spirits have always encountered violent opposition from mediocre minds.
The mediocre mind is incapable of understanding the man who refuses to bow blindly to conventional prejudices and chooses instead to express his opinions courageously and honestly. Albert Einstein
The Human Tissue Act 2004 is an act of the UK parliament in England and Wales which was brought about in response to the Alder Hay scandals in the 1990s. The Human Tissue Authority was also created and given the responsibility for regulating and enforcing the act.
Each premises conducting work with human tissue is required to be licensed and a designated individual – DI – is assigned to oversee this work and given discretion as to the kind of work and access given to licensed premises.
For the most part the HTA does a good job of working with the anatomy world, but in the case of giving DIs power, the potential for a disconnect can happen. The HTA gives no written guidance to the DI in terms of who should be allowed in, assuming that they are intelligent people with a degree of common sense. The primary responsibilities of the DI are threefold:
- that suitable practices are used in undertaking the licensed activity
- that other persons working under the licence are suitable
- that the conditions of the licence are complied with.
In 2016 I was invited to run courses at Nottingham University Hospital and offered an NHS service level agreement by the trust. The feedback from the courses I ran was outstanding and I was invited to take part in anatomical research by a surgical team from within the trust. The team running the centre are on record as saying that my classes were among the very best they had ever seen and everyone seemed very happy. Attendees from physiotherapy positions at Premier League football clubs, Formula One racing teams and clinical specialists from within the NHS had attended and were massively impressed with the content and teaching.
In November 2017 however, the DI, Dr Ian Scott, decided that he would move to terminate my activity at Nottingham University Hospital, and aided in this by the trust secretary Mike O’Daly, issued a letter which, even though based on false content, stopped my work in its tracks and resulted in the cancellation of classes already booked and agreed with by NUH.
The reason? Dr Scott, a published scientist of the highest order and presumably a stickler for accurate referencing, didn’t like my opinion based blog posts. From emails obtained after three months of pressing the NUH to comply with a freedom of information act request, it can be seen that Dr Scott used out of context quotes and ad hominem arguments to support his stopping of my work to his trust secretary Mr O’Daly.
He reasons also that the study of fascia is “an abstract sideline of anatomy”, although a simple Google search of ‘study of fascia’ might have helped to counter that thought, returning 286,000 results in 0.3 seconds. The idea that perhaps he should attend one of my classes and actually engage with the process didn’t occur to him, even when invited to sit in. Indeed he was urged to do so by his own team, who praised and strongly supported me and my work and wished to see the classes continue in Nottingham.
Dr Scott did not phone me, write to me, interview me, or in any way attempt to ascertain what I was doing on the premises. He refused to enter a mediation process and refused to allow any independent assessment of my work, insisting that in spite of ten years of experience in dissection, I was “not qualified” to teach anatomy, regardless of the fact that I have never claimed to ‘teach anatomy.’ The Scientific Method indeed.
Although promising to be guided by the team running the centre, and to defer to his clinical lead in the teaching of anatomy, he went against their advice and opinion. The issues that Dr Scott as DI had to satisfy himself were simply the three mentioned above. From my own perspective and as a matter of record of that of the team involved in the day to day running of the centre, all three conditions were met. At no stage was there any suggestion or claim of wrongdoing on my part from Dr Scott or his team, and no reason was given for the termination of my classes, details supporting his decision only coming to light after a freedom of information request.
Science and its progress has no room for personal enmity or beliefs, yet Dr Scott seemed to have the personally held and demonstrably unfounded belief that what I did was not appropriate, without having properly evaluated the content and ironically at the same time, cherry picking my own blog posts to suggest how unscientific I am. Feedback and comments from the many clinicians who have attended and witnessed my class was also ignored. His assertion that the classes were “unlawful” under the terms of the act and the permissions obtained by NUH was concerning but according to the HTA and independent legal opinion, was not the case. Dr Scott is not a lawyer. A collaborative approach, where willingness to work together and develop better systems and clearer permission forms, would have seen Nottingham become a worldwide centre of excellence for the teaching, study and understanding of human movement and muscular skeletal pain and discomfort and was on course to attract research and interest from around the globe.
The attendees themselves were also the target of Dr Scott. Apparently unaware of the existence of the nine regulatory health care bodies in the UK including Chiropractic and Osteopathy, Dr Scott is on record as saying that he, “didn’t consider Chiropractors or Osteopaths as professional,” that they were “unregulated” and that, “…we see the adverse effects of that practice. Torn ligaments. They do things we have to put right.” Only HPC practitioners (including dieticians and art therapists) registered in the UK are acceptable to attend dissection classes as far as he is concerned . He even expressed incredulity that a nurse practitioner should attend a class on the thorax, heart and lungs.
Holding up scientific progress and important medical research and preventing inward investment and income for the NHS, while at the same time making poorly judged and false comments about regulated health professionals is not something you would expect from someone holding a position of major responsibility. With power comes responsibility. Decisions which affect the future of medical endeavours should not be made without due consideration to evidence. Fabrication and hyperbole are not a basis for sound decision making.
What this highlights is the distance between the regulation and enforcement of the Human Tissue Act and those who use their ‘discretion’ to prevent wider engagement for reasons that are unclear or unsound. Perhaps the time has come for a debate about how best to control access to those who sincerely wish to study and understand anatomy and human movement, but who are not registered health professionals.
The Human Tissue Act places no restrictions in terms of access, but simply asks that appropriate permissions have been given by donors. The interest in anatomy and the study of the human form is growing. Thousands of practitioners all over the world are taking care of the aches, pains and problems of populations. Without them the UK’s NHS would implode. They should be taught properly and fully and have access to good study material, including dissection classes. Far from being a drain on NHS resources, classes such as we offer, bring income to otherwise under or even unused facilities as well as providing research opportunities to advance the understanding of the human form.
Everyone entering a dissection room should be (and in our case is) carefully vetted and strict guidelines put in place. Institutions and operators can and should collaborate to ensure that respect and diligence is applied when dealing with cadaveric material. But putting up a wall, creating an ‘us and them’ environment does not help.