The unbearable lightness of Special K

The Adgenda: this weeks most ridiculous advert.

The new Kellogg’s advert for Special K sets out to be poignant in its first line: “from the day we are born, we are defined by a number”. If only this were the whole story; a number is pretty easy to hide. Nobody writes their measurements on their forehead before they leave the house, nor does Facebook demand a kilogram quantity as you fill in your details. We (and of course, though the advert failed to specify, this means “women”) are more defined by appearance and proportion of our bodies. However, it rambles on, asking “but is a number inspiring?” as if when women consider their size as anything other than numerical they immediately float with inspiration. Yes, maybe weight should be lost based on how we feel over how we weigh, but unfortunately how we feel rather depends on how we compare to the standard model of beauty – a standard ironically portrayed by the clingy red dress on the Special K box.

The ad claims “we believe in a more powerful motivation”, following with a stream of inspirational buzz-words that all translate into an irrational desire to fit into that red dress they love so much. And their inspiration knows no bounds: surely if they throw in a couple of other cultures and languages, it’ll show us that women across the globe should all go out of their way to feel accepted for their body shape! They seem to think they’re playing a valuable part in women’s fight to be seen as more than just a splodgy shape of either suitable or unsuitable proportions. Congratulations, you’re focusing on how women feel about themselves rather than how they look, have a cookie for ending female body issues once and for all! Nope. If how women feel about themselves still has to depend on how heavy they are, you’re not creating any sort of magical self-acceptance. “What will you gain when you lose?” I don’t know, what do you expect? Confidence, possibilidades, or perpetuated gender ideals? 

“From the day we are born, we are defined by a number” Photograph: Getty Images
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All doctors kill people – and the threat of prosecution is bad for everyone

We must recognise the reality of medical practice: just because a doctor makes a mistake, that doesn’t mean they’ve all broken the law. 

On 15 November the Court of Appeal quashed the 2013 conviction for gross negligence manslaughter (GNM) of a senior consultant surgeon in London, David Sellu. Sellu, who had completed his prison term by the time the appeal was heard, will never get back the 15 months of his life that he spent in jail. Nor will the personal and family trauma, or the damage to his reputation and livelihood, ever properly heal. After decades of exemplary practice – in the course of the investigation numerous colleagues testified to his unflappable expertise – Sellu has said that he has lost the heart ever to operate again.

All doctors kill people. Say we make 40 important decisions about patients in a working day: that’s roughly 10,000 per annum. No one is perfect, and medical dilemmas are frequently complex, but even if we are proved right 99 per cent of the time, that still leaves 100 choices every year where, with the benefit of hindsight, we were wrong.

Suppose 99 per cent of those have no negative consequences. That’s still one disaster every 12 months. And even if most of those don’t result in a fatal outcome, over the course of a career a few patients are – very regrettably – going to die as a result of our practice. Almost invariably, these fatalities occur under the care of highly skilled and experienced professionals, working in good faith to the very best of their abilities.

If one of these cases should come before a crown court, the jury needs meticulous direction from the trial judge on the legal threshold for a criminal act: in essence, if a doctor was clearly aware of, and recklessly indifferent to, the risk of death. Sellu’s conviction was quashed because the appeal court found that the judge in his trial had singularly failed to give the jury these directions. The judiciary make mistakes, too.

Prosecutions of health-care professionals for alleged GNM are increasing markedly. The Royal College of Surgeons of England identified ten cases in 2015 alone. This must reflect social trends – the so-called “blame culture”, in which we have come to believe that when a tragedy occurs, someone must be held responsible. In every one of these cases, of course, an individual’s life has been lost and a family left distraught; but there is a deepening sense in which society at large, and the police and Crown Prosecution Service (CPS), in particular, appear to be disconnected from the realities of medical practice.

Malpractice investigation and prosecution are horrendous ordeals for any individual. The cumulative impact on the wider health-care environment is equally serious. In a recent survey of doctors, 85 per cent of respondents admitted that they were less likely to be candid about mistakes, given the increasing involvement of the criminal law.

This is worrying, because the best way to avoid errors in future is by open discussion with the aim of learning from what has gone wrong. And all too often, severely adverse events point less to deficiencies on the part of individuals, and more to problems with systems. At Sellu’s hospital, emergency anaesthetic cover had to be arranged ad hoc, and this contributed to delays in potentially life-saving surgery. The tragic death of his patient highlighted this; management reacted by putting a formal rota system in place.

Doctors have long accepted the burden of civil litigation, and so insure themselves to cover claims for compensation. We are regulated by the General Medical Council, which has powers to protect patients from substandard practice, including striking off poorly performing doctors. The criminal law should remain an exceptional recourse.

We urgently need a thorough review of the legal grounds for a charge of GNM, with unambiguous directions to the police, CPS and judges, before the spectre of imprisonment becomes entrenched for those whose only concern is to provide good care for their patients. As Ken Woodburn, a consultant vascular surgeon in Cornwall who was accused and acquitted of GNM in 2001, has said: “You’re only ever one error away from a manslaughter prosecution.”

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage