(Updated)– Last summer British researchers provoked concern when they published a paper raising the possibility that by following an established guideline UK doctors may have caused as many as 10,000 deaths each year. Now they have gone a step further and published an estimate that the same guideline may have led to the deaths of as many as 800,00 people in Europe over the last five years. The finding, they write, “is so large that the only context in the last 50 years comes from the largest scale professional failures in the political sphere.” The 800,000 deaths are comparable in size to the worst cases of genocide and mass murder in recent history.

In their new article published in the European Heart Journal, Graham Cole and Darrel Francis continue to explore the extent and implications of the damage caused by the Don Poldermans research misconduct case. [Update: the EHJ article has been removed from the EHJ website. For more on this see the bottom of the story.] The earlier paper demonstrated the potentially large and lethal consequences of the current European Society of Cardiology guideline recommending the liberal use of beta-blockers to protect the heart during surgery for people undergoing non cardiac surgery. The guideline was flawed because it was partly based on unreliable research performed by the disgraced Poldermans (who also served as the chairman of the guideline committee). This may seem like a highly technical question but it effects many millions of people and may, as Francis and his colleagues have demonstrated, led to many thousands of unnecessary deaths.

The new article, the first of two parts, makes no new scientific claims, but instead begins to consider the broader implications of the story. Cole and Francis briefly consider the dilemma of clinicians who may “feel unable to act in contravention of guideline recommendations recognized as ‘state-of-the-art’ by the European Society of Cardiology” and who may even be penalized for failing to follow guidelines.

They note that more than half of the lives lost– potentially more than 400,000– may “have occurred after the research was discredited,” though some of the damage may have been mitigated if doctors  changed their practice after reading about the controversy. (There was a 2 year delay after the start of the Poldermans affair until the ESC  withdrew the beta-blockade recommendation.)