Strangely, life’s unintended consequences can be both hard and good

I knew last week was going to be a busy one. Not that it was a bad busyness mind, just full on. I took the 128-mile round trip into Manchester every day, and on different days I drove through rain, ice, frost and high winds, with every trip undertaken in the dark. Such journeys are an unanticipated consequence of making the decision nearly three years ago to accept the Chair’s role at Stockport NHS FT. I knew it was always going to be a long journey at each end of the day, but as I had taken up the post in Spring, I hadn’t given much thought to how much more difficult travelling in Winter would turn out to be. That said, I have enjoyed every moment I get to spend with my Stockport NHS health family.

It was the sociologist Robert Merton, who was credited with introducing the concept of unanticipated consequences. He described these as actions taken that have both intended and unintended consequences. We often plan, based on what we believe the intended consequences will deliver. Unintended consequences are often more difficult to recognise or anticipate. Of course, unintended consequences can be both positive and negative,

I guess many readers will know that the discovery of penicillin was the result of an unintended consequence. Alexander Fleming’s original research was into treating the flu virus. Following a Summer break from his laboratory, he returned to discover a mould in one of his culture dishes. It was a ring of mould, within which there were no bacteria growing. Quite by accident, he had discovered the world’s first early form of antibiotic. His discovery revolutionised medicine. However, as we know today, the overuse of antibiotics, particularly to treat illnesses where an antibiotic wouldn’t make a difference to the person’s recovery, has led to widespread antibiotic resistance.

Last week, I read of another accidental medical discovery that, in its own way, has also been revolutionary. It was an advertisement for one of the many BBC shows on offer this Christmas. The film is called Men Up, and tells the story of the discovery of an unintended consequence of testing the drug Sildenafil, perhaps better known now as Viagra. The drug was being tested to measure its impact on the condition angina, with a group of ex-coalminers in Merthyr Tydfil, Wales.  It was one of the trial nurses, who asked the trial participants whether they had noticed any side-effects from taking the drug. Apparently, they were all reluctant to answer, but eventually, one of the men said that he had been experiencing ‘robust’ erections during the night. All the other men eventually admitted they had all experienced similar side effects.

It is perhaps to be remembered that back in the early 1990s such conversations were likely to be rather difficult, talking about sex and bodily functions wouldn’t have come easy. Realising there might be other uses for the drug, the angina research was abandoned and a small-scale study was undertaken with a group of men in Bristol struggling with impotence. This small-scale study was a great success. Indeed, the participants, who had been given a small supply of the tablets and told to return any they didn’t use, refused to return any of their tablets.

After further clinical trials to test safety and so on, the drug was licensed for use in 1998. It has since become the pharmaceutical giant Pfizer’s biggest income-generator. By 2018, 62 million men across the world had bought it. Sales have hit many billions of £s since. Apparently, the colour blue was chosen, because it was thought it conveyed a cool, calm masculine confidence, while the diamond shape was intended to hint at the diamond-hard results it would deliver. I’m not saying anything, but I have to say it is on my Christmas must do list - watching the film that is. I might have a few 'getting older' problems these days, but thankfully this is not one of them.

Ironically, and somewhat sadly, whilst the discovery of Viagra came about through an unintended consequence of testing the drug, there are a number of unintended consequences of the drug in use; one of which has been an increase in sexually transmitted diseases. Apparently, many older men ‘tested’ the drug by visiting sex workers. Likewise, there has been an increased number of older men abandoning their wives for younger women. I say sadly, as I wonder whether these outcomes might have been anticipated, and as such perhaps avoided.

Last week, there was another story which I felt told of another apparent unintended consequence, but one that might also have been avoided. I’m referring, of course to the much-heralded successful pay dispute resolution for consultant doctors. Well, it was much heralded by the likes of the Daily Mail, but the reality is that the deal offered is so complicated that even the BMA cannot recommend consultants accept it. Sorting out the pay claim of the highest paid members of the healthcare workforce first just doesn’t seem a sensible thing to do. Already we now face the disruption of junior doctors taking further industrial action. I am fairly sure that nurses won’t be far behind. If further industrial action happens, the unintended consequence will be an increased busyness for all health and care provider organisations, most of whom are already struggling to meet an ever-increasing demand for healthcare. Unlike my last week, such busyness won’t be so good for folk to deal with.