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GP academic gives Hunt tips on appraising evidence after weekend mortality claims

A leading GP academic has issued Jeremy Hunt with a free copy of her book on appraising scientific evidence after the health secretary has been condemned for misrepresenting statistics on weekend mortality.

Professor Trisha Greenhalgh, professor of primary care health sciences at the Univeristy of Oxford and a practising GP, today tweeted a letter to the health secretary highlighting key sections in the enclosed copy of her book ‘How to Read a Paper’.

The letter, under the heading ‘Appraising scientific papers’, states: ‘Please find enclosed a complementary [sic] copy of my book: ‘How to Read a Paper’. You may find the following sections particularly helpful:

  • The hierachy of evidence, which defines uncontrolled observational studies as a relatively weak form of evidence, to be treated with caution (Page 41);
  • The important distinction between association and causation, and the reason why the former should not be conflated with the latter (Page 62); and
  • The perils of selecting evidence to fit with your assumptions and plans rather than undertaking a thorough and dispassionate review of the topics (Page 116).

’I very much hope that you will find time to read the above sections.’

Mr Hunt has been criticised in parliament and public for stating that thousands of deaths could be avoided by implementing seven day working reforms pledged by the Conservatives.

The health secretary cited a BMJ study showing patients had a 15% increase in mortality within 30 days, if admitted Friday to Monday compared to mid-week.

Though beneath the findings, study author and NHS England medical director Sir Bruce Keogh writes: ‘It is not possible to ascertain the extent to which these excess deaths may be preventable, to assume that they are avoidable would be rash and misleading.’

The Government’s use of the study to justify the imposition of a new contract on junior doctors has sparked 20,000 strong protests in the capital, with the BMA set to ballot junior doctors on strike action in early November.

Readers' comments (16)

  • Brilliant, simple brilliant.
    Professor Trisha Greenhalgh for RCGP president please :)

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  • The only paper this guy is interested in is the Daily mail and he knows how to read it perfectly well as most of his chummies are columnists !

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  • Jeremy does not come up with his tosh on his own.......in this case there will have been a whole group of advisers working on it - send as many books as you like they will be ignored

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  • He may have gone to Oxford, but with a degree in Politics, Philosophy & Law . Not a lot of complex statistics in that.

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  • Great trolling of the SOS for Health! Well played!

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  • Vinci Ho

    My worry Agent Hunt may not be able to even understand what you quoted to him in your book,professor . His brain is full of this virus FOV220,000

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  • has anyone bothered to interview Sir Bruce Keogh on his thoughts ? he's been very quiet of late, strange, as he is one of the key advocates of pushing for 7 day services.
    https://www.england.nhs.uk/2013/12/15/sir-bruce-keogh-7ds/

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  • oops my bad - found recent article

    http://www.theguardian.com/society/2015/oct/25/nhs-medical-director-weekend-effect-hospital-deaths

    the point is - his work is the basis for Hunt's push for 7 day services (even though 7 day services already exist !)

    what is interesting is that the press and public take it as a given that there are 11,000 preventable deaths cos' drs don't work weekends (lol). When pushed Keogh says he can't confirm how many are preventable - so it could be one?kind of renminds me of the Francis report - the evidence was skewed and Francis disappeared a bit when his report was being mis-represented as well. do these guys get paid extra or are they in it for the knighthood?

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  • Jeremy Hunt has decided that Government will remove Saturday and Sunday from the week. This will remove the concerns around weekends and that 365 is more easily divisible by 5 anyway #73weeksinayear

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  • Samuel Lewis

    calm down, calm down !

    politics does not proceed by control trial, though its often blind and random..

    Nor will we ever see a randomised allocation of emergencies to weekday versus weekend admission.

    Freemantle, Keogh et al have repeatedly shown a weekend mortality RATE effect, but it could have been due to weekday dilution by low-risk routine cases. They have just published the emergencies-only effect which disposes of that bias = http://www.bmj.com/content/351/bmj.h4596/rapid-responses

    They should now set about exploring why it that emergencies on Sunday die more frequently than emergencies on Wednesday.. Are there prehospital factors making them different. Does hospital care differ ? then we can mount an RCT pilot of changed care vs. usual care ?

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