So where do you stand on VAR?

Watching the Newcastle vs Arsenal match on the 4th November I was struck by the inordinate amount of time it took for the off-field video assistant referee (VAR) and his team to decide that Gordon's goal was to be allowed to stand. First of all, there was a review of whether the original cross was from a ball that had crossed the line and was therefore out of play. Then there were several replays to see if there was a foul in the goal mouth immediately prior to the goal being scored. Several more interminable replays followed to see if Anthony Gordon was offside. Finally, after five minutes had passed, an increasingly restive crowd were informed that the goal should be given and Newcastle were 1-0 up, a lead they didn't relinquish. Needless to say, the Arsenal manager was apoplectic in his post-match interview and was intemperate in his comments, leading to eventual punishment. Now, as a neutral in this fixture I wasn't prepared to support him in his criticisms (although us northern football fans will always relish it when a London club comes a cropper) but I couldn't help thinking that five minutes was an inordinately long time for a review, when you have several camera angles and lots of people available to review them.

This is not the only match this season to have stirred up VAR controversy. In a recent game a goal was disallowed because the on field and off field officials misinterpreted each others comments. The UK football authorities are now attempting to address this particular issue by having presentations from pilots and air traffic controllers in an attempt to instil precision into the communication process. Now discussions are under way about extending the use of VAR into other on field situations, such a corner kicks, fouls etc. So what, you might well say. Well currently all these reviews are increasing the length of games: I recently watched a match that had 12 minutes of time added on. Can you imagine if the checks at the cash point when you wanted to get some cash out took that long?

In medicine too, the debate about checks is now starting to warm up. As you might have read, the government is planning to give all patients the right to ask for a second opinion, which seems to be a sensible thing and certainly something most of us would wholeheartedly support. However, such a move can only exist where the time available allows. It's the same with all interventions where human input is needed. In an acute emergency situation, the time for discussion is limited or frequently non-existent. We have to act with the best interests of the patient in mind. Sometimes we get it wrong and catastrophe results, but most of the time our training and experience ensures we get it right.

So, what's the point of this rather rambling discussion? It's to try to get a perspective on the drivers for decision making in our own field. Time is rarely as critical as in an acute medical emergency, but regular readers will recall that in a previous piece, the opportunity to recognise the congenital abnormalities caused by thalidomide in a timely fashion was missed, and probably resulted in several children being harmed when this could have been prevented by an earlier removal of the drug from the market. There are many other well-known examples that we've discussed before. As with such happenings on the sporting field it is important to have a robust and fair system to review decisions which might have considerable ramifications; financial, societal and ethical. That's why I'm following the VAR debate closely as it could help us in refining our decision-making process in the field of drug safety. We all want a system that is rapid, reliable, reproducible, and free from bias: we can learn a lot from others who are attempting the same journey.

And as for where I stand on VAR? I have to confess I'm still not a fan (unless the five-minute debate rules for my team!).