In 1998, an Observer investigation revealed medical evidence linking long flights with blood clots, but more than two years on the airlines have done little to alert the public, John Sweeney reports
Special report: transport in Britain
The most harrowing moment for Ann Egerton wasn"t when she woke up from a long-haul flight more dead than alive - having suffered a massive blood clot to her lungs thanks to "economy-class syndrome". She survived - although she will never be the woman she was before the long-haul British Airways flight from South Africa.
The worst moment came more than two years later when she saw the mother of Emma Christofferson - a fit 28 year old who died of a massive blood clot last October after stepping off a plane from Australia - say on television: "If only we had known."
Ann said: "That makes me so angry. The airlines have known about the dangers for years, and yet they have done too little. Emma Christofferson is one of hundreds of people who have died needlessly. The truth is that while flying you are more likely to die from a blood clot than in a plane crash - and that is a truth the airline companies have been keeping from us."
An Observer investigation today reveals that British airline companies have for decades sat on evidence that "economy class syndrome" - blood clots caused by immobility during long-haul flights - is a "real and mortal danger" to their customers.
Ann Egerton's case was raised in a previous Observer investigation two years ago. "Had the airlines acted on The Observer"s report, then Emma and the others would not have died," she said. "Emma should have known of the dangers. The complacency of the airlines has cost many lives of people who need not have died," said Ann.
The Observer"s inquiries into deep vein thrombosis (DVT) on long flights has uncovered a mountain of medical and other evidence that makes a damning indictment of the airlines - one study suggests that hundreds of Britons may be dying each year of the disease.
Doctors have been aware of the dangers of immobility since 1940 - but airlines such as British Airways and Virgin Atlantic have only just started to highlight its dangers to the travelling public. Many other airlines remain silent about the risks.
Our investigation has uncovered a culture of deceit by some airlines which has been allowed to thrive thanks to woeful complacency at the Department of Health and the Civil Aviation Authority.
Today we reveal:
Farrol Kahn of the Aviation Health Institute said: "There has been a major failing of the protection of the public health."
Ann Egerton's life was saved by the prompt action of her husband, Dr Dale Egerton, a Hampshire GP. He said: "Since the 1998 article I am appalled at the attitude of the airlines. They have continued to sit on evidence of real and mortal danger to their customers and the authorities have let them get away with it. It is an appalling scandal. Only now are things beginning to change - but it is too late."
The Observer has established that specialists have known about the dangers of sitting immobile since 1940 when Dr Keith Simpson investigated the mysterious deaths of 23 people who had slept in deckchairs in the Underground during the false Blitz of 1939. Simpson established they died from blood clots to the lungs, and the authorities acted swiftly. Deckchairs were banned and replaced by bunkbeds and the deaths stopped. Sixty-one years on, the authorities - the Department of Health, the Department of Transport and the Civil Aviation Authority - have no idea just how many people are suffering, or have died from, blood clots caused on long-haul flights.
That is not because there has been a lack of evidence. In 1968 doctors P H Beighton and P R Richards wrote a paper on cardio-vascular disease in air travellers, alerting the airline business to the dangers of DVT from long-haul flights. In 1973 Richards wrote again. In 1985 doctors Yvonne Hart, D J Holdstock and William Lynn from Ashford Hospital, near Heathrow, wrote to the Lancet : "We see a steady stream of illnesses which have developed in flight. The major manifestation of the illness may not occur until after disembarkation. We have seen several patients with thromboembolism presenting in this way, with a near-fatal outcome in one case." The letter goes on: "We understand that airline passengers, even those on very long flights, are given no specific advice to prevent venous thrombosis."
Dale Egerton said: "It beggars belief that the medical team at British Airways did not read that letter to the Lancet in 1985. The letter sets out the problem that the syndrome can develop after disembarkation and that calls for research. If it is known that people suffer DVTs after they leave the airport, then the airline companies had a moral responsibility to do the research. But nothing was done - an utter disgrace."
New research by Dr John Scurr of University College Hospital, London, provides conclusive evidence that flying long-distance can kill. In a paper to be published shortly in the Lancet Scurr reveals his evidence. Blood tests were carried out on long-haul passengers before and after long flights. "The results will show a very definite link between long-haul flights and DVT," he said.
The critical question is how many people die from pulmonary embolisms after flying. In 1998 British Airways" senior doctor, Dr Michael Bagshaw, told Dale Egerton there were only two cases a year worldwide. But is the number higher?
The closest hospital to Heathrow is the Ashford. There, Dr John Belstead sees 10 deaths a year from pulmonary embolisms of people coming off long-haul flights. Belstead said: "I would estimate that 15 people a year die nationally from DVTs developed on long-haul flights."
But Scurr believes this is an under-estimate: "It can take up to 10 days before a blood clot breaks off and moves to the lungs. What this means is that you can die of the pulmonary embolism days after the flight. I believe that hundreds of Britons are dying every year because of this disease."
In our original article in 1998, The Observer identified 12 cases of the disease - including Gateshead landlady, Val Clark, who lost a leg because of economy class syndrome. The time delay - depressing the prevalence of the disease - was evidenced by the case of 1-year-old Angie Ruby, who died of a pulmonary embolism 14 days after stepping off a plane from Cuba.
Her father, David Collins, said they had not been warned about DVT before the nine-hour flight to London. "The seats were so packed we could hardly move our feet," he said. "We were told nothing of the risks or what to do to minimise them."
Scurr said: "This suggests that there are many other cases out there that we do not know about. Research is vital and it is not being done."
British Airways points to its website which includes "facts and research" on "traveller"s thrombosis". It reads: "A paper published in "Chest" (February 1999) showed that recent travel is a risk factor for developing DVT. However, of the 160 patients seen, only nine had travelled by air in the past four weeks."
Dale Egerton said: "For British Airways to highlight this study is grotesquely misleading. It was done in Nantes, a French provincial city which has no international airport - so no wonder there are so few cases of air-related DVT."
The BA website continues: "BA has supported a study of DVT by Dr Patrick Kesteven of Newcastle University. The findings are similar to those above and confirm that although recent travel appears to be a risk factor there is no conclusive evidence that flying is a specific risk in itself."
But Kesteven told The Observer : "They are being a bit selective on the website. I am in no doubt that there is a link between long-haul flights and DVT and almost no one in the field doubts this. There is compelling evidence out there. If we could all straighten our legs, then everything would be better."
Kesteven pointed out that he has received no research money from BA. He did request access to its passengers so he could continue his research, but the request was declined.