If ever a book was waiting to be written, it would be the history of the health warning. The earliest I can think of is King James VI's treatise A Counterblast to Tobacco, published in 1604, in which he described the dread weed as “an invention of Satan”. That was before he realised the revenue possibilities and nationalised the burgeoning tobacco industry. So very like the home life of our dear government, then.

Now, of course, health warnings are more prolific than Robert Peston. Everything from computer games to chips comes with one. We’ve got to the stage where the Natural Environment Research Council can ask without irony: “Should modern living carry a health warning?”

We hit a new low last week when the Scottish government issued a set of health statistics that came with their own health warning. The statistics in question were the surgical mortality figures for the past three years.

Before you can call them up on the internet, you have to get through two pop-up health warnings; a disclaimer and a note on interpretation. The subtext is that neither surgeons nor the government is happy to be publishing this information and that the great unscrubbed can’t be trusted to interpret it.

The surgical mortality figures were initially forced out by the Freedom of Information Commissioner in 2006, following a request by The Sunday Times, amid dire warnings that skilled surgeons would flounce out of the operating theatre if their professionalism was questioned. The best surgeons are often the ones with the highest mortality statistics, it was argued, as they take on the riskiest and sickest patients.

That may be true but the worst surgeons invariably have high mortality statistics, too. A patient needs to know their chances of snuffing it while dressed in a backless gown.

The Information Services Division (ISD) Scotland, the statistics arm of the government responsible for collating the information published last week, described the figures as “crude data”. But if the people responsible for assembling health statistics feel it is necessary to issue a health warning with them, they are not doing their job properly.

In fact, if you look at the figures, they are incredibly reassuring. The vast majority of surgeons in Scotland had a mortality rate of zero last year. Even the surgeons with the highest death rates saw well in excess of 95% of their patients pull through.

I am aware that league tables have led to all sorts of iniquitous practice. NHS bed-occupancy targets have been achieved by reducing the number of beds. Crime targets have led police to target soft crime at the expense of serious crime. Exam pass-rate targets have led to pupils taking easy subjects to give schools a better tally in the league tables. But that is not a reason for concealing important information.

In the past, the NHS’s paternalism has led to doctors withholding vital information. It encouraged fear among patients and arrogance among doctors. As a result, there has been a historical lack of scrutiny of clinicians’ work.

As recently as a decade ago, an alcoholic Scottish surgeon was able to operate in St John’s hospital, Livingston, while more than twice over the legal drink-drive limit. Had mortality statistics been published, he might have been stopped sooner.

Of course, death is an inevitable by-product of medicine, and since the Shipman inquiry a series of safeguards and appraisals has been put in place. But you don’t change a culture of paternalism overnight. Clinical practice still varies wildly between doctors even within the same department. They can’t all be applying “best practice”.

Rather than issue health warnings with health statistics, the ISD Scotland should provide meaningful statistics. If surgeons who deal with risky, elderly or emergency patients are likely to have higher mortality rates, weigh the statistics to take that into account.

As for the argument that surgeons who carry out few procedures or undertake pioneering work are likely to have higher statistics, that is exactly the sort of information patients should be given. The more experience a surgeon has of a particular procedure, the safer he or she is likely to be in performing it. If pioneering treatment is risky, then a patient may opt for a tried and tested method.

So many of the health statistics that emerge from the ISD Scotland are pointless. We are no longer collating the same data as the health service in England, so comparisons between the two countries are increasingly difficult to make. The mortality rates for surgeons are among the few Scottish medical statistics that aren’t wholly meaningless. No doubt, in time the bureaucrats will neuter and fudge them to render them useless. In the meantime, it will warn patients off them with a series of patronising health warnings.

gillian.bowditch@sunday-times.co.uk

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