Investigative journalist and GP, Dr Faye Kirkland received the 2019 HealthWatch Award at the HealthWatch AGM in October. Here is her compelling presentation.
In my early 30s I was a GP partner in a practice I had wanted to join for years. A training practice, a very traditional surgery – where the doctors knew theirpatients and generations of families were all known by one doctor. This was the view of family practice I had been given as a medical student, seeing and treating people in the context of their families and communities.
But an internal voice started to grow in intensity. The pressure on the NHS, and the movement of care from hospital to GPs, often made continuity of care for patients more difficult. Qualified GP colleagues I knew left the UK altogether and went abroad, saying their quality of life was better, while I found myself staying at work later and later to provide the type of care I would want as a patient.
The nagging noise in my mind grew louder, and I started to wonder how I could use my knowledge in a different way. On a day off, I managed to get an interview at Cardiff University for a course in broadcast journalism, and to my surprise I got in. In just a week I had resigned from being a GP partner, moved my home into storage and my life from Brighton to Bristol, where I spent 18 months in my Dad’s spare room working as a GP at the weekend to fund the course in Cardiff.
I started to learn the craft of journalism, and realised I wanted to use investigative techniques and my knowledge to shine a light on areas of medicine that other journalists or patients might not see.
Access to diagnostic tests
A few years before starting the course, a close friend of mine had become seriously unwell. He had been to Accident & Emergency several times, collapsed at home and was even told by ambulance staff to pull himself together, that he had a virus. He was finally diagnosed with a brain tumour. Dif
ficultly in accessing imaging, and people not recognising symptoms, were both major hurdles to him getting his diagnosis. The skills I had acquired allowed me to investigate whether his experience was reflected across the country. I knew from when I had worked as a GP that in some areas I couldn’t even refer for an MRI scan, but in others I could. Despite the Department of Health saying that all should be able to access this, different clinical commissioning groups had different rules. I established a picture that showed this post code lottery. It was my final piece of work on my course but ended up as an hour of live radio for BBC 5 Live Investigates.(1)
Vitamin and mineral infusions
Within months of qualifying, I became interested in the world of vitamin and mineral infusions. While researching one programme I went to Harley Street undercover, posing as a patient.
I asked doctors if the vitamin and mineral infusions they advertised would treat my supposed eczema and anxiety. At one clinic a practitioner asked me to hold up my left hand, and with my right touch various organs of my body. The practitioner pressed down on my left arm and seemed to growl as if the diagnostic technique had revealed something about the state of my body. I was provided with vials of different vitamins to hold against various organs, and again asked to repeat the arm test. This time, it seems, I was stronger. This diagnostic revelation meant I needed vitamins – and fast. An urgent infusion was offered. I politely declined.
The cost of this miraculous arm test ran to hundreds of pounds and the infusions which, apparently, I needed every few weeks were approaching £200 each time.
The importance of my investigative work became apparent to me as I looked in a
room and saw a very frail man hooked up to two drips – one in each arm.
I found more than 100 webpages claiming that vitamin and mineral infusions such as these could help treat Parkinson’s Disease, asthma, depression and hepatitis, with no evidence to support the claims.(2) It was clear at the time – this was 2015 – there were huge gaps in regulation. Were these infusions, which were straight into your vein, a medicine or not? Up to then, no one had decided. The drugs regulator, the MHRA, took the investigation seriously. They had to write to each clinic, to analyse each of the vials to decide if these drugs were medicines or not. Eventually they decided medical claims could not be made against these products, as to do so, might imply they were a medicine. The claims, they say, had to be removed. The majority of the medical claims for these infusions have now gone from the websites – in doing so I hope protecting patients. However, unfortunately, un-evidenced generalised claims of improving your well-being or giving you a glow persist.
Online health care
That was the year I came across a burgeoning new area of medicine: care online, ever accessible, at a click of a button and often at a price.
Private, glossy websites often featuring celebrity doctors and well-known brands, offering care I would not give in the surgery. You filled in an online form with pre-set questions, send it off. A doctor reviews the form, prescribes medication for you without speaking or seeing you or having access to your NHS notes, and then a UK chemist would send the drugs to your home within 24 hours.
Four years ago, I found sites offering to cure sexually transmitted diseases after a few questions, with no warnings that their treatments were suboptimal and might not cure your infection.(3)
The familiar brand, Superdrug, was at that time making antibiotics available online for gonorrhoea, without the customer necessarily having proved they had it, and providing antibiotics which did not meet national guidelines. This was at a time when some patients were having to be treated for gonorrhoea in hospital, having acquired multi-resistant strains.(3) Following the investigation for BBC 5 Live Investigates, there was intervention from the British Association of Sexual Health and HIV, and a letter from The Chief Medical Officer and Chief Pharmaceutical Officer to all online clinics and GPs.(4) Since then there has been a massive change. Superdrug no longer provides antibiotics for this indication – instead they advise you, correctly, to seek treatment at a suitable clinic.
This experience made me wonder what else you might be able to buy online.
As with all such things, digital health care has stayed one step ahead of the regulators. In 2016, again with BBC 5 Live, we went undercover posing as patients. My colleague was able to buy drugs for an ear infection, supposedly of three days’ duratio
n, therefore probably viral and hence not curable by antibiotics. Some halfway through the questionnaire we were abruptly asked about sexually transmitted disease and a vaginal discharge. Following this, drugs were prescribed that I have never given for an ear infection. This was all delivered to the house and was signed off by a practising UK doctor.(5)
How could this be allowed to happen?
We asked the company which had provided this medication. They blamed a computer problem saying the questionnaire about vaginal discharge had got mixed up with the one for ears and actually we had been sent antibiotics for the wrong condition.
We asked the Care Quality Commission (CQC) – the health regulator in England – and the General Medical Council (GMC), the doctor’s regulator, to respond. The CQC brought forward a wave of inspections, with the clinic exposed being one of the first. It was suspended. The GMC investigated the doctors. Clear online health care standards for online companies were published by the CQC the following March.(6)
A step forward you may think? But last year, with the BBC’s Panorama, I found the sites were once again one step ahead. Not only were they supplying antibiotics but often drugs of misuse, such as opiates.
Some sites moved their headquarters out of England and therefore avoided regulation by the CQC, most choosing to base their companies in Romania. Now their online doctors’ care could not be regulated, and the prescriptions could be sent electron
ically from Romania to pharmacies in the UK and still delivered to your door.(7)
Panorama ‘Online doctors uncovered’
Still with Panorama, I wanted to see these Romanian companies – the supposed hub for these online doctor sites – for myself. But instead of finding a hive of doctors doing online consulting, I found empty flats. Just an address, that means the CQC cannot regulate and keep patients safe.
After the Panorama programme was broadcast last year I was contacted by a family whose daughter had been able to buy codeine from 18 online UK pharmacies, as well as continuing to obtain these drugs from her GP, who had not been informed. She had collapsed and died behind her front door. She was in her early 40s. Her inquest is yet to take place but her family believe the codeine contributed to her death.(8)
Also following the programme, and in part as a result of it, the General Pharmaceutical Council has also moved to stop pharmacies in Great Britain from dispensing certain high-risk medications to patients without their family doctors being informed.
Also in response to Panorama, the CQC asked the Government to change legislation. They are still waiting for this to happen.
Investigative journalism has taken me to places I never imagined, secret meetings, being given leaked documents and holding power to account. Continuing to be a doctor is a privilege but helping to create change on a national level can be an even greater one.
Freelance investigative journalist and GP, London
1. BBC Radio 5. 5 Live Investigates – Brain tumours. 26 Oct 2014. https://www.bbc.co.uk/programmes/b04mbk68
2. BBC Radio 5. 5 Live Investigates - Discharging mental health patients & Phishing emails, 18 Jan 2015. https://www.bbc.co.uk/programmes/b04yg8f1
3. Kirkland F. Concern over online gonorrhoea treatment. BBC News, 1 Mar 2015. https://www.bbc.co.uk/news/health-31649099
4. Gallagher J. Gonorrhoea 'could become untreatable'. BBC News, 27 Dec 2015. https://www.bbc.co.uk/news/health-35153794
5. BBC Radio 5. 5 Live Investigates - Online antibiotics. 2 Oct 2015 https://www.bbc.co.uk/programmes/b07xf2xr
6. Kirkland F. Buying medications online 'can put health at risk'. BBC News, 3 Mar 2017. https://www.bbc.co.uk/news/health-39134061
7. Kirkland F. Safety concerns over websites selling prescription drugs. BBC News, 6 Aug 2018. https://www.bbc.co.uk/news/health-45084555
8. Kirland F. Clampdown planned for British online pharmacies. BBC News, 16 Apr 2019. https://www.bbc.co.uk/news/health-47933346