VISITING doctors are charging public hospitals up to $90 million each year for services they haven't performed, the state's auditor-general has found.
Visiting medical officers and staff specialists, including surgeons, who make up more than half the 13,000 doctors working in public hospitals, charge more than $500 million each year for their work in the public system.
Public hospitals pay staff specialists, many of whom also run private practices, from $198,212 to $390,528 each year.
Some hospitals, which checked claims from visiting medical officers thoroughly, found errors in between 10 and 18 per cent of claims. The Audit Office of NSW estimates this rate is replicated across all public hospitals, many of which use ''minimal checks'' to support claims for payment.
The errors include multiple claims for the same patient service and for patients who were not in hospital on the day claimed.
Thursday, December 15, 2011
Tuesday, December 13, 2011
He was finally deregistered in September 2009, after he failed to pay his fees
Dr Hasil has a chequered history in Australia, including being investigated by Tasmanian police in relation to the unsolved 1995 murder of an Italian tourist, Victoria Cafasso.
The NSW Medical Board had ignored warnings from its Tasmanian counterpart that Dr Hasil lied about being jailed in Singapore in 1995 for domestic violence against his second wife, Rose Doyle, and registered him anyway.
Yesterday, the commission also told the tribunal he failed to notify the NSW Medical Board that he was convicted of high-range drink driving in September 2008.
He was finally deregistered in September 2009, after he failed to pay his fees. He was again convicted of high-range drink driving in October 2009 and has a conviction for assault.
The NSW Medical Board had ignored warnings from its Tasmanian counterpart that Dr Hasil lied about being jailed in Singapore in 1995 for domestic violence against his second wife, Rose Doyle, and registered him anyway.
Yesterday, the commission also told the tribunal he failed to notify the NSW Medical Board that he was convicted of high-range drink driving in September 2008.
He was finally deregistered in September 2009, after he failed to pay his fees. He was again convicted of high-range drink driving in October 2009 and has a conviction for assault.
Sunday, November 27, 2011
Australia has the highest rate of medical error in the world according to the World Health Organisation
http://www.medneg.com.au/truth.html
Police investigate first case of organ trafficking
POLICE are investigating their first case of organ trafficking in Australia as a global shortage of donors fuels the trade in humans for body parts.
The Herald understands that an elderly Sydney woman suffering from a kidney condition is suspected to have trafficked a younger woman from the Philippines with the intention of harvesting an organ.
It is understood the deal was allegedly made without the younger woman's full consent and discovered during screening interviews at a Sydney hospital before the procedure.
The Herald understands that an elderly Sydney woman suffering from a kidney condition is suspected to have trafficked a younger woman from the Philippines with the intention of harvesting an organ.
It is understood the deal was allegedly made without the younger woman's full consent and discovered during screening interviews at a Sydney hospital before the procedure.
Patients should be informed about CT scan radiation exposure
“Hospitals should inform patients regarding the radiation exposure they have undergone during CT scans and other such tests rather than keep them in the dark, health experts said. A study conducted by AIIMS has found that doctors, including senior and junior residents, who regularly subject patients to X-rays and CT scans were ignorant of the harmful effects of radiation exposure.”
http://www.thehindu.com/health/article2336489.ece
Pointing out that radioactive elements emitted from radiation transmit highly charged particles that can damage genetic blueprint of the cell, they said such exposure causes major health problems, including cancer.
“At times the cells can no longer function or repair itself and dies but occasionally the cell multiplies uncontrollably, taking the shape of cancer,” chairman of CT and MRI, Sir Ganga Ram Hospital, T.B.S. Buxi said.
http://www.thehindu.com/health/article2336489.ece
total of 481 cases alleged deficiencies in the informed consent process - 57% of these cases were against surgeons
Retrospective review and analysis of negligence claims against doctors insured by Avant Mutual Group Limited and complaints lodged with the Office of the Health Services Commissioner of Victoria that alleged failures in the informed consent process and were adjudicated between 1 January 2002 and 31 December 2008.
Results:
A total of 481 cases alleged deficiencies in the informed consent process (218 of 1898 conciliated complaints [11.5%]; 263 of 7846 negligence claims [3.4%]). 57% of these cases were against surgeons. Plastic surgeons experienced dispute rates that were more than twice those of any other specialty or subspecialty group. 92% of cases (442/481) involved surgical procedures and 16% (77/481) involved cosmetic procedures. The primary allegation in 71% of cases was that the clinician failed to mention or properly explain risks of complications. Five treatment types — procedures on reproductive organs (12% of cases), procedures on facial features excluding eyes (12%), prescription medications (8%), eye surgery (7%) and breast surgery (7%) — accounted for 46% of all cases.
http://mja.com.au/public/issues/195_06_190911/gog10379_fm.html
Patients could not consider these risks directly and manage their exposure to them on the basis of information about them
It is widely thought that, in order for medical procedures to be ethically justifiable in normal circumstances, patients must give valid consent for them. This is a central mechanism by which patients exercise control over their medical care and, by extension, their bodies and their lives.
Consent in medical contexts is a tricky topic, but the present case is quite clear: since patients were inadvertently exposed to improperly sterilized equipment, they could not consent even in principle. Reflecting on the pros and cons of having medical tests under these conditions and consenting on this basis was literally impossible. The result is that the powerful transforming effects of consent cannot be found here in any way.
Consent in medical contexts is a tricky topic, but the present case is quite clear: since patients were inadvertently exposed to improperly sterilized equipment, they could not consent even in principle. Reflecting on the pros and cons of having medical tests under these conditions and consenting on this basis was literally impossible. The result is that the powerful transforming effects of consent cannot be found here in any way.
The duty to procure informed consent is among the pillars of medical and research ethics
The duty to procure informed consent (IC) from patients before any significant intervention is among the pillars of medical and research ethics. The provision by the doctor of relevant information about treatment and free decision-making by the patient are essential elements of IC. The paper presents cases of IC where the free decision about treatment is not causally related to the information provided, and claims that such cases pose a difficulty parallel to that presented by the Gettier Problem in epistemology. In analogy to the original problem with the concept of knowledge, these Gettier-type cases show an indeterminacy in the concept of IC: we either need to add some explicit additional condition of causal connection between information and consent, or else we should understand the concept in a new way—specifically, since the practice of autonomy necessarily involves some consideration of the relevant information, we must understand free consent in a way that no longer refers to patient autonomy.
http://jme.bmj.com/content/37/11/642.short
http://jme.bmj.com/content/37/11/642.short
a negative study of Paxil in kids and was spun to make it sound like a positive study when it was published
We've previously on this blog discussed the case of Dr. Martin Keller at Brown University and his study of Paxil (paroxetine) in children:
http://brodyhooked.blogspot.com/2008/06/alison-basss-side-effects-another-hall.html
http://brodyhooked.blogspot.com/2011/02/universities-corporate-influence-and.html
Now, thanks to our esteemed colleague Dr. Roy Poses from Health Care Renewal blog, we're provided with this article from the Brown newspaper in which he's quoted:
http://www.browndailyherald.com/prof-s-study-linked-to-child-suicide-1.2673693#.TsZ44VbfWSo
Seems that our other esteemed colleagues at Healthy Skepticism have been after Brown to get the University's help to withdraw the Study 329 claiming that Paxil was safe and effective in children. They argue that the article continues to be cited and can be implicated in suicides in children prescribed Paxil. Brown basically has gone into hiding and has not responded to these overtures.
Thanks to the exposes noted in previous posts on this blog, we know that Dr. Keller received huge sums of money from Pharma; that Study 329 was originally by scientific standards a negative study of Paxil in kids and was spun to make it sound like a positive study when it was published; and that the published version was essentially ghostwritten by a company hack. At least that's what's now on the public record (Dr. Keller routinely refuses to comment), and if Brown knows a different version, it's about time they let us hear it.
http://brodyhooked.blogspot.com/
http://brodyhooked.blogspot.com/2008/06/alison-basss-side-effects-another-hall.html
http://brodyhooked.blogspot.com/2011/02/universities-corporate-influence-and.html
Now, thanks to our esteemed colleague Dr. Roy Poses from Health Care Renewal blog, we're provided with this article from the Brown newspaper in which he's quoted:
http://www.browndailyherald.com/prof-s-study-linked-to-child-suicide-1.2673693#.TsZ44VbfWSo
Seems that our other esteemed colleagues at Healthy Skepticism have been after Brown to get the University's help to withdraw the Study 329 claiming that Paxil was safe and effective in children. They argue that the article continues to be cited and can be implicated in suicides in children prescribed Paxil. Brown basically has gone into hiding and has not responded to these overtures.
Thanks to the exposes noted in previous posts on this blog, we know that Dr. Keller received huge sums of money from Pharma; that Study 329 was originally by scientific standards a negative study of Paxil in kids and was spun to make it sound like a positive study when it was published; and that the published version was essentially ghostwritten by a company hack. At least that's what's now on the public record (Dr. Keller routinely refuses to comment), and if Brown knows a different version, it's about time they let us hear it.
http://brodyhooked.blogspot.com/
A Debate on Antidepressants
Finally, the British Journal of General Practice featured a pro-con debate over prescribing antidepressant drugs. Middleton and Moncrieff start off by noting that authoritative national guidelines suggesting that drugs be restricted to moderate-to-severe depression seem to have had little impact on profligate prescribing. They summarize recent research (as we have previously reviewed in this blog) that most antidepressants are nearly indistinguishable from placebo in their effectiveness, and that the theory that depression is fundamentally a disease of chemical imbalance in the brain has been vastly overblown. They conclude that since most of the good done by antidepressants seems to be a form of placebo effect, which relies on forming a strong therapeutic relationship with the patient and showing that one takes the patient's problem seriously, cognitive-behavioral psychotherapy is an excellent alternative to drug treatment and should be more widely used.
In reply, Anderson and Haddad basically change the subject and accuse Middleton and Moncrieff of saying a number of things that they don't say. From their doubting the serotonin theory of depression, Anderson and Haddad assume their opponents are guilty of mind-body dualism and dismiss entirely the role of neurotransmitters in mood. Responding to the claim that antidepressants show very little difference from placebo, Anderson and Haddad pounce on the fact that they show some difference from placebo and therefore the placebo effect cannot explain all of what they do. Anderson and Haddad then say, "[F]or individual patients who will not or cannot engage in other approaches, shouldn't this evidence allow at least a consideration of a trial of antidepressants?" This makes them appear reasonable and moderate and their opponents dogmatic, though Middleton and Moncrieff are far from ruling out antidepressant use in every case. Anderson and Haddad then add that psychological therapy will be a failure if you go to a lousy therapist--neatly ignoring all the evidence of the serious risks of antidepressants, in order to focus on the purported risks of psychotherapy!
Of these two sets of authors, one acknowledges receiving financial support from manufacturers of antidepressants. I'll let you guess which.
Middleton H, Moncrieff J. "They won't do any harm and might do some good": time to think again on the use of antidepressants? British Journal of General Practice 61:47-49, January 2011.
Anderson IM, Haddad PM. Prescribing antidepressants for depression: time to be dimensional and inclusive. British Journal of General Practice 61:50-52, January 2011.
http://brodyhooked.blogspot.com/
In reply, Anderson and Haddad basically change the subject and accuse Middleton and Moncrieff of saying a number of things that they don't say. From their doubting the serotonin theory of depression, Anderson and Haddad assume their opponents are guilty of mind-body dualism and dismiss entirely the role of neurotransmitters in mood. Responding to the claim that antidepressants show very little difference from placebo, Anderson and Haddad pounce on the fact that they show some difference from placebo and therefore the placebo effect cannot explain all of what they do. Anderson and Haddad then say, "[F]or individual patients who will not or cannot engage in other approaches, shouldn't this evidence allow at least a consideration of a trial of antidepressants?" This makes them appear reasonable and moderate and their opponents dogmatic, though Middleton and Moncrieff are far from ruling out antidepressant use in every case. Anderson and Haddad then add that psychological therapy will be a failure if you go to a lousy therapist--neatly ignoring all the evidence of the serious risks of antidepressants, in order to focus on the purported risks of psychotherapy!
Of these two sets of authors, one acknowledges receiving financial support from manufacturers of antidepressants. I'll let you guess which.
Middleton H, Moncrieff J. "They won't do any harm and might do some good": time to think again on the use of antidepressants? British Journal of General Practice 61:47-49, January 2011.
Anderson IM, Haddad PM. Prescribing antidepressants for depression: time to be dimensional and inclusive. British Journal of General Practice 61:50-52, January 2011.
http://brodyhooked.blogspot.com/
Systematic reviews of the effects of healthcare provide essential, but not sufficient information for making well informed decisions.
Andy Oxman writes:
Health professionals, patients, policymakers and the public all want to make healthcare decisions that are informed by the best available research evidence. This requires reliable summaries (systematic reviews) of the evidence of the advantages and disadvantages of our options. It also requires complex judgements.
Systematic reviews of the effects of healthcare provide essential, but not sufficient information for making well informed decisions.
Review authors and people who use reviews draw conclusions about the quality of the evidence (how confident we can be in the estimates of effects), either implicitly or explicitly. Such judgments guide subsequent decisions. For example, clinical actions are likely to differ depending on whether one concludes that the evidence that warfarin reduces the risk of stroke in patients with atrial fibrillation is convincing (high quality) or that it is unconvincing (low quality).
http://blogs.crikey.com.au/croakey/
Health professionals, patients, policymakers and the public all want to make healthcare decisions that are informed by the best available research evidence. This requires reliable summaries (systematic reviews) of the evidence of the advantages and disadvantages of our options. It also requires complex judgements.
Systematic reviews of the effects of healthcare provide essential, but not sufficient information for making well informed decisions.
Review authors and people who use reviews draw conclusions about the quality of the evidence (how confident we can be in the estimates of effects), either implicitly or explicitly. Such judgments guide subsequent decisions. For example, clinical actions are likely to differ depending on whether one concludes that the evidence that warfarin reduces the risk of stroke in patients with atrial fibrillation is convincing (high quality) or that it is unconvincing (low quality).
http://blogs.crikey.com.au/croakey/
Saturday, November 26, 2011
it had been marketed intensively to surgeons on the basis of ''compelling'' but misleading claims
MICHELE STEGER is one of thousands of Australians whose ordeal with failing and poisonous hip implants was described by a Senate committee this week as ''intolerable and unacceptable''.
Not only had the product failed at rate several times higher than normal, the ill-functioning metal joint had spread toxic levels of chromium and cobalt into the tissue of her hip.
The Senate community affairs references committee said it believed ''insufficient information has been provided to consumers regarding concerns with the device. This is regrettable''.
Regret understates Mrs Steger's reaction when she learned in October 2010 that a previous implant that had caused her so much grief officially had been withdrawn from use 10 months previously.
The first hint she got that her DePuy ASR implant had been recalled in December 2009 came neither from her surgeon nor even health authorities.
Not only had the product failed at rate several times higher than normal, the ill-functioning metal joint had spread toxic levels of chromium and cobalt into the tissue of her hip.
The Senate community affairs references committee said it believed ''insufficient information has been provided to consumers regarding concerns with the device. This is regrettable''.
Regret understates Mrs Steger's reaction when she learned in October 2010 that a previous implant that had caused her so much grief officially had been withdrawn from use 10 months previously.
The first hint she got that her DePuy ASR implant had been recalled in December 2009 came neither from her surgeon nor even health authorities.
Wednesday, November 23, 2011
The practice of sympathectomy for treating neuropathic pain is based on very weak evidence. Furthermore, complications of the procedure may be significant.
Cochrane Summariesbeta
Independent high-quality evidence for health care decision making
http://summaries.cochrane.org/CD002918/cervico-thoracic-or-lumbar-sympathectomy-for-neuropathic-pain
Monday, November 21, 2011
Questions about safety and effectiveness of risperidone
Although it has been established that risperidone has good efficacy for reducing symptoms of DBD in the short term, its effectiveness over longer periods has not been determined and there are now significant questions in relation to safety.
In light of this, clinicians need to inform their patients (and parents) of the limitations of the evidence and the potential risks of using risperidone in the treatment of children with DBD.
Urgent investment is needed to make non-pharmacological interventions with established efficacy available to Australian families to prevent the onset and to reduce symptoms of disruptive behavioural disorder.
http://www.mjainsight.com.au/view?post=james-scott-michael-duhig-take-drugs-out-of-disorders&post_id=7141&cat=comment
In light of this, clinicians need to inform their patients (and parents) of the limitations of the evidence and the potential risks of using risperidone in the treatment of children with DBD.
Urgent investment is needed to make non-pharmacological interventions with established efficacy available to Australian families to prevent the onset and to reduce symptoms of disruptive behavioural disorder.
http://www.mjainsight.com.au/view?post=james-scott-michael-duhig-take-drugs-out-of-disorders&post_id=7141&cat=comment
multibillion-dollar cancer drug ineffective, harmful
THE Therapeutic Goods Administration will review the latest information available on a drug for advanced breast cancer but will not take it off the shelves following a ban on its use in the United States.
The US Food and Drug Administration revoked approval for Avastin on the grounds that it did not help patients with metastatic breast cancer to live longer, but exposed them to serious side effects such as high blood pressure and haemorrhaging.
The multibillion-dollar drug will remain on the market in the US as a treatment for other types of cancer.
But it is not subsidised through the Pharmaceutical Benefits Scheme for this use.
Avastin is also approved in Australia to treat a range of other cancers including metastatic colon cancer, renal cancer, small lung cell cancer and grade 4 glioma.
It is an antibody that binds to and blocks the action of a substance that helps tumours spread, called vascular endothelial growth factor.
The US Food and Drug Administration revoked approval for Avastin on the grounds that it did not help patients with metastatic breast cancer to live longer, but exposed them to serious side effects such as high blood pressure and haemorrhaging.
The multibillion-dollar drug will remain on the market in the US as a treatment for other types of cancer.
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Avastin was approved in Australia by the TGA in 2008 for use in eligible women with advanced breast cancer in combination with the drug Paclitaxel.But it is not subsidised through the Pharmaceutical Benefits Scheme for this use.
Avastin is also approved in Australia to treat a range of other cancers including metastatic colon cancer, renal cancer, small lung cell cancer and grade 4 glioma.
It is an antibody that binds to and blocks the action of a substance that helps tumours spread, called vascular endothelial growth factor.
Sunday, November 13, 2011
Peer review and the corruption of science
Peer review is the process that decides whether your work gets published in an academic journal. It doesn't work very well any more, mainly as a result of the enormous number of papers that are being published (an estimated 1.3 million papers in 23,750 journals in 2006). There simply aren't enough competent people to do the job. The overwhelming effect of the huge (and unpaid) effort that is put into reviewing papers is to maintain a status hierarchy of journals. Any paper, however bad, can now get published in a journal that claims to be peer-reviewed.
The blame for this sad situation lies with the people who have imposed a publish-or-perish culture, namely research funders and senior people in universities. To have "written" 800 papers is regarded as something to boast about rather than being rather shameful. University PR departments encourage exaggerated claims, and hard-pressed authors go along with them.
Not long ago, Imperial College's medicine department were told that their "productivity" target for publications was to "publish three papers per annum including one in a prestigious journal with an impact factor of at least five.″ The effect of instructions like that is to reduce the quality of science and to demoralise the victims of this sort of mismanagement.
The only people who benefit from the intense pressure to publish are those in the publishing industry. Hardly a day passes without a new journal starting. My email inbox is full of invitations to publish in a weird variety of journals. They'll take just about anything. The US National Library of Medicine indexes 39 journals that deal with alternative medicine. They are all "peer-reviewed", but rarely publish anything worth reading. The peer review for a journal on homeopathy is, presumably, done largely by other believers in magic. If that were not the case, these journals would soon vanish.
But it isn't only quack journals that have failures in peer review. In June, the British Journal of General Practice published a paper, "Acupuncture for 'frequent attenders' with medically unexplained symptoms: a randomised controlled trial (CACTUS study)". It has lots of numbers, but the result is very easy to see. All you have to do is look at their Figure.
http://www.guardian.co.uk...rish-peer-review-science
The blame for this sad situation lies with the people who have imposed a publish-or-perish culture, namely research funders and senior people in universities. To have "written" 800 papers is regarded as something to boast about rather than being rather shameful. University PR departments encourage exaggerated claims, and hard-pressed authors go along with them.
Not long ago, Imperial College's medicine department were told that their "productivity" target for publications was to "publish three papers per annum including one in a prestigious journal with an impact factor of at least five.″ The effect of instructions like that is to reduce the quality of science and to demoralise the victims of this sort of mismanagement.
The only people who benefit from the intense pressure to publish are those in the publishing industry. Hardly a day passes without a new journal starting. My email inbox is full of invitations to publish in a weird variety of journals. They'll take just about anything. The US National Library of Medicine indexes 39 journals that deal with alternative medicine. They are all "peer-reviewed", but rarely publish anything worth reading. The peer review for a journal on homeopathy is, presumably, done largely by other believers in magic. If that were not the case, these journals would soon vanish.
But it isn't only quack journals that have failures in peer review. In June, the British Journal of General Practice published a paper, "Acupuncture for 'frequent attenders' with medically unexplained symptoms: a randomised controlled trial (CACTUS study)". It has lots of numbers, but the result is very easy to see. All you have to do is look at their Figure.
http://www.guardian.co.uk...rish-peer-review-science
Monday, November 7, 2011
patients might lose confidence if become aware of the `unknowns and risks' which might be revealed in medical and health records
The final report of the Professional Indemnity Review (PIR) also noted that doctors feared litigation. PIR pointed to doctors' fears that patients might `lose confidence in the health care system and the advice of health care professionals' if patients were more aware of the `unknowns and risks' which might be revealed in medical and health records. [43]
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/1996-99/medical/report/c02.htm
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/1996-99/medical/report/c02.htm
Sunday, November 6, 2011
ONE in 15 medical practitioners registered to work in NSW has a criminal past
ONE in 15 medical practitioners registered to work in NSW has a criminal past, new figures reveal.
The first look into the criminal histories of 13,000 doctors, dentists, psychologists, nurses and pharmacists - many of whom were graduates and foreign medical professionals registering for the first time - has led to calls for further background checks.
There are 156,000 people working in NSW who have not been checked by police under the new system, which does not take into account driving infringements.
But eyebrows have been raised by the findings of the Australian Health Practitioner Regulation Agency, the national body established last year to replace a patchwork of more than 80 medical boards around Australia.
Of the 13,421 medicos checked by NSW police at the request of the agency, 936 - or 7 per cent - were found to have ''disclosable court outcomes'' such as convictions for theft, fraud and sexual offences. The figure was slightly higher than the national average of 6 per cent.
The first look into the criminal histories of 13,000 doctors, dentists, psychologists, nurses and pharmacists - many of whom were graduates and foreign medical professionals registering for the first time - has led to calls for further background checks.
There are 156,000 people working in NSW who have not been checked by police under the new system, which does not take into account driving infringements.
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The Minister for Health, Jillian Skinner, and the Australian Medical Association insist the industry is ''weeding out'' unsuitable people.But eyebrows have been raised by the findings of the Australian Health Practitioner Regulation Agency, the national body established last year to replace a patchwork of more than 80 medical boards around Australia.
Of the 13,421 medicos checked by NSW police at the request of the agency, 936 - or 7 per cent - were found to have ''disclosable court outcomes'' such as convictions for theft, fraud and sexual offences. The figure was slightly higher than the national average of 6 per cent.
Friday, November 4, 2011
Breast cancer screening review set up amid fears risks outweigh benefits
http://www.guardian.co.uk/society/2011/oct/26/breast-cancer-screening-review-launched
Friday, October 28, 2011
lack of efficacy and safety data for paediatric flu vaccines in general
However, other experts believe the 2006 data should have been acted on, particularly as the rates of fever in children were almost double what had been seen in 2005 data from the same study.
“How a government agency can say it didn’t matter that the side-effect profile was twice what we saw before I find astounding”, said Professor Peter Collignon, professor of infectious diseases at the Australian National University.
Professor Collignon said the argument that the high rates of adverse events seen in 2010 were a one-off event linked only to the 2010 seasonal flu vaccine was becoming questionable.
“There’s enough evidence to show that at least fevers were occurring at higher rates at other times”, he said.
He said increases in fever rates, regardless of convulsion rates, were significant in their own right.
“You don’t have a febrile seizure unless you have a fever”, he said.
Professor Collignon said the bigger issue was the lack of efficacy and safety data for paediatric flu vaccines in general, based on long-term prospective studies involving thousands of children.
“Those studies haven’t been done and they need to be done.”
- Sophie McNamara
MJA InSight,
“How a government agency can say it didn’t matter that the side-effect profile was twice what we saw before I find astounding”, said Professor Peter Collignon, professor of infectious diseases at the Australian National University.
Professor Collignon said the argument that the high rates of adverse events seen in 2010 were a one-off event linked only to the 2010 seasonal flu vaccine was becoming questionable.
“There’s enough evidence to show that at least fevers were occurring at higher rates at other times”, he said.
He said increases in fever rates, regardless of convulsion rates, were significant in their own right.
“You don’t have a febrile seizure unless you have a fever”, he said.
Professor Collignon said the bigger issue was the lack of efficacy and safety data for paediatric flu vaccines in general, based on long-term prospective studies involving thousands of children.
“Those studies haven’t been done and they need to be done.”
- Sophie McNamara
MJA InSight,
Posted 24 October 2011
Monday, October 17, 2011
if more than one child in 1000 has a febrile seizure, the vaccine is doing more harm than good
PUBLISHED research linking CSL’s influenza vaccine to high rates of fever in children was omitted from the product information for its 2010 Fluvax product, which caused serious adverse reactions in children.
The product information (PI) included data from the 2005 flu season showing that after receiving Fluvax, fever was experienced by 22.5% of children aged from 6 months to less than 3 years and 15.6% of children aged from 3 years to less than 9 years.
However, the PI omitted data from the 2006 season which showed that the rate of fever had increased considerably — to 39.5% in the younger age group and 27% in the older group. Of the 272 children who received the 2006 vaccine, one child in the older group experienced a febrile convulsion.
However, Professor Collignon said it was important to weigh the risks of the vaccine with the risks of influenza itself.
“By my calculations, if more than one child in 1000 has a febrile seizure, the vaccine is doing more harm than good”.
In 2010, Fluvax was found to be causally linked to a significantly increased rate of fevers and febrile convulsions among Australian children. One published estimate put the rate of paediatric febrile convulsions at 3.3 per 1000 doses, or more than 200 times the rate in the only other published population-based estimate. (3)
MJA InSight, 17 October 2011
The product information (PI) included data from the 2005 flu season showing that after receiving Fluvax, fever was experienced by 22.5% of children aged from 6 months to less than 3 years and 15.6% of children aged from 3 years to less than 9 years.
However, the PI omitted data from the 2006 season which showed that the rate of fever had increased considerably — to 39.5% in the younger age group and 27% in the older group. Of the 272 children who received the 2006 vaccine, one child in the older group experienced a febrile convulsion.
However, Professor Collignon said it was important to weigh the risks of the vaccine with the risks of influenza itself.
“By my calculations, if more than one child in 1000 has a febrile seizure, the vaccine is doing more harm than good”.
In 2010, Fluvax was found to be causally linked to a significantly increased rate of fevers and febrile convulsions among Australian children. One published estimate put the rate of paediatric febrile convulsions at 3.3 per 1000 doses, or more than 200 times the rate in the only other published population-based estimate. (3)
MJA InSight, 17 October 2011
CLINICAL practice guidelines are vulnerable to bias
CLINICAL practice guidelines are vulnerable to bias, with only 15% of NHMRC guidelines from Australia’s most prolific guideline developers including a declaration of conflicts of interest, new research has found.
Although a conflict of interest (COI) statement has long been required from authors of research papers, it is often lacking for developers of clinical practice guidelines, despite the influence of guidelines on clinical care.
The research, in the latest issue of the MJA, looked at more than 200 clinical guidelines that were listed on the NHMRC website. Its authors concluded that the NHMRC needed to “urgently promote a more ethically sound development process for guidelines”.
“Our review of the country’s most prolific guideline developers shows that only 15% of guidelines have COI statements”, they said.
“This raises questions about whether medical bodies are affected by unrecognised, and thus unaddressed, extraneous interests, and may erode the trust the community has in the profession to speak authoritatively about health problems.”
MJA InSight, 17 October 2011
Although a conflict of interest (COI) statement has long been required from authors of research papers, it is often lacking for developers of clinical practice guidelines, despite the influence of guidelines on clinical care.
The research, in the latest issue of the MJA, looked at more than 200 clinical guidelines that were listed on the NHMRC website. Its authors concluded that the NHMRC needed to “urgently promote a more ethically sound development process for guidelines”.
“Our review of the country’s most prolific guideline developers shows that only 15% of guidelines have COI statements”, they said.
“This raises questions about whether medical bodies are affected by unrecognised, and thus unaddressed, extraneous interests, and may erode the trust the community has in the profession to speak authoritatively about health problems.”
MJA InSight, 17 October 2011
Saturday, October 15, 2011
Deceit and fraud in medical research
Deceit and fraud in medical research is a serious problem for the credibility of published literature. Although estimating its prevalence is difficult, reported incidences are alarming. The spectrum of the problem ranges from what may seem as rather innocuous gift authorship to wholesale fabrication of data. Potential factors which may have promoted fraud and deceit include financial gain, personal fame, the competitive scientific environment and scientific hubris. Fraud and deceit are difficult to detect and are generally brought to the fore by whistleblowers.
International Journal of Surgery
Volume 4, Issue 2, 2006, Pages 122-126
Usman Jaffer, and Alan E.P. Cameron
International Journal of Surgery
Volume 4, Issue 2, 2006, Pages 122-126
Usman Jaffer, and Alan E.P. Cameron
Monday, October 10, 2011
many claims in Australia do not result in payments to plaintiffs
However, as with the US research, many claims in Australia do not result in payments to plaintiffs. This fact often comes as a surprise to medical practitioners as it is not well publicised.
It is not a simple matter for a plaintiff to succeed in a claim for compensation based in medical negligence. And it certainly is an expensive exercise especially when there can be no guarantee of success.
For doctors involved in a claim that is successfully defended there is usually no direct financial cost.
Ms Cheryl McDonald is claims department manager with MIGA (Medical Insurance Group Australia).
It is not a simple matter for a plaintiff to succeed in a claim for compensation based in medical negligence. And it certainly is an expensive exercise especially when there can be no guarantee of success.
For doctors involved in a claim that is successfully defended there is usually no direct financial cost.
Ms Cheryl McDonald is claims department manager with MIGA (Medical Insurance Group Australia).
MJA InSight, Issue 38 - 10 Oct, 2011
Friday, October 7, 2011
The dangers of DOGMA in medicine
'Physicians are quite as intolerant as theologians. They never had the power of burning at the stake for medical opinions, but they certainly have shown the will.'
Harriet Beecher Stowe, Little foxes (1865)
The cognitive "illusion of knowledge" also plays a role. We have to believe that we know the answer and that there is only one answer, the one we have. To accept that we do not know the answer, or that other people might know the answer while we do not, is emotionally challenging and calls into question our very professional essence. Best to believe that what we think we know is actually true.
Finally, in a world full of "experts", controversy and opinion, holding on to a dogma is reassuring and may well have life-saving functions. Yet, dogma has a dark side and its dangers may be as great as its benefits. Doctors would do well to maintain a degree of cautious skepticism for both bold new fashions and received wisdom, whether generated by he world or by the self. They would do even better to question what they do, and see such questioning as an asset. It is everyone's responsibility to find out how to ask questions systematically, find answers from searching the literature, critically appraise the literature and apply the results to practice.
www.mja.com.au/public/issues/195_07_031011/bel10866_fm.pdf
MJA195 (7) · 3 October 2011
Harriet Beecher Stowe, Little foxes (1865)
The cognitive "illusion of knowledge" also plays a role. We have to believe that we know the answer and that there is only one answer, the one we have. To accept that we do not know the answer, or that other people might know the answer while we do not, is emotionally challenging and calls into question our very professional essence. Best to believe that what we think we know is actually true.
Finally, in a world full of "experts", controversy and opinion, holding on to a dogma is reassuring and may well have life-saving functions. Yet, dogma has a dark side and its dangers may be as great as its benefits. Doctors would do well to maintain a degree of cautious skepticism for both bold new fashions and received wisdom, whether generated by he world or by the self. They would do even better to question what they do, and see such questioning as an asset. It is everyone's responsibility to find out how to ask questions systematically, find answers from searching the literature, critically appraise the literature and apply the results to practice.
www.mja.com.au/public/issues/195_07_031011/bel10866_fm.pdf
MJA195 (7) · 3 October 2011
Tuesday, September 27, 2011
ECT Pamphlet Withdrawn in Australia
| |||||||
| Distribution of a pamphlet on electroconvulsive therapy (shock treatment) published by the Mental Health Division of the Health Department of West Australia, has been discontinued, following a complaint. The pamphlet which was supplied to the public from six State operated shock facilities, the Guardianship and Administration Board, the Office of the Public Advocate and elsewhere, contained false and misleading information which served to recklessly misguide the most vulnerable members of the community, No Iframes and their family and friends. The pamphlet which carried the government seal, described ECT as a "small electric current," even though the strength of current in ECT, induced a grand-mal seizure and the Australian Safety Standards gives no such value as "small" to electric current. The pamphlet also claimed that "There is no medical evidence that the brain is damaged," even though the medical literature is littered with such instances from both the historic use and the modern method of ECT. In fact, there is a small added risk of brain damage in the modern method, from the anesthetic alone. The pamphlet and its content which "helps answer questions" was being used by psychiatrists in the process of obtaining 'informed consent' while avoiding the obligation of a truthful disclosure. As of October 2001, the pamphlet "Electroconvulsive therapy" catalogue No: HP6824 - has been given the official status, "OBSOLETE" For what it is worth, we are assured by the Health department today by phone, that they will not be publishing any information in the future on the topic of ECT. http://www.healthyplace.com/depression/shocked-ect/ect-pamphlet-withdrawn-in-australia/menu-id-1362/ | |||||||
Child shock therapy
CHILDREN younger than four who are considered mentally disturbed are being treated with controversial electric shock treatment.
Medicare figures show the use of Electroconvulsive Therapy has tripled in Victoria in the private health sector alone in six years.
A VicHealth report confirms more than 18,000 treatments were conducted in Victoria in 2007-2008.
Federal Government statistics show the use of ECT - an electric shock delivered straight to the brain - in the state's private health system increased from 1944 treatments in 2001-2002 to 6009 in 2007-2008.
About 12,000 treatments were performed in the public health system last financial year.
Medicare statistics record 203 ECT treatments on children younger than 14 - including 55 aged four and younger.
Two of the under-4s were in Victoria.
Last financial year, 6197 ECT treatments were given to Victorians against their will.
This news comes as the Western Australian Government moves to ban ECT procedures for children under 12.
The Victorian Government would not say if it would follow.
The figures have shocked some experts.
Prof Pat McGorry, chair of the National Youth Mental Health Foundation, said ECT treatment for children whose brains were still forming was worrying.
"That is of great concern, a very worrying trend and we need to know why," he said.
"Why has its use increased at that rate? I am shocked and amazed that children that young are being treated this way."
Though doctors are still mystified as to how it works, ECT is used to treat mental disorders such as manic depression and psychosis.
The figures show nearly three times as many women had shock treatment compared with men.
Side effects include memory loss, seizures and headaches.
Modern treatment involves anaesthetic before each ECT treatment, which occur at intervals during a few weeks.
http://www.heraldsun.com.au/news/victoria/child-shock-therapy/story-e6frf7kx-1111118657718
Medicare figures show the use of Electroconvulsive Therapy has tripled in Victoria in the private health sector alone in six years.
A VicHealth report confirms more than 18,000 treatments were conducted in Victoria in 2007-2008.
Federal Government statistics show the use of ECT - an electric shock delivered straight to the brain - in the state's private health system increased from 1944 treatments in 2001-2002 to 6009 in 2007-2008.
About 12,000 treatments were performed in the public health system last financial year.
Medicare statistics record 203 ECT treatments on children younger than 14 - including 55 aged four and younger.
Two of the under-4s were in Victoria.
This news comes as the Western Australian Government moves to ban ECT procedures for children under 12.
The Victorian Government would not say if it would follow.
The figures have shocked some experts.
Prof Pat McGorry, chair of the National Youth Mental Health Foundation, said ECT treatment for children whose brains were still forming was worrying.
"That is of great concern, a very worrying trend and we need to know why," he said.
"Why has its use increased at that rate? I am shocked and amazed that children that young are being treated this way."
Though doctors are still mystified as to how it works, ECT is used to treat mental disorders such as manic depression and psychosis.
The figures show nearly three times as many women had shock treatment compared with men.
Side effects include memory loss, seizures and headaches.
Modern treatment involves anaesthetic before each ECT treatment, which occur at intervals during a few weeks.
http://www.heraldsun.com.au/news/victoria/child-shock-therapy/story-e6frf7kx-1111118657718
Shock therapy forced on patients
THE number of mental health patients forced to undergo electroconvulsive therapy in NSW has doubled in the past decade, and a lack of legal representation is leaving some of the state's most vulnerable patients without a say over their own treatment.
The case of one 84-year-old pensioner who did summon legal help to avoid ECT has highlighted a situation that leaves involuntary patients - and their families - powerless to challenge psychiatrists.
In NSW, involuntary ECT requires the approval of the Mental Health Review Tribunal. All mental health patients are entitled to a lawyer, but only one in 10 patients is represented in the tribunal's hearings.
The tribunal held 315 hearings for involuntary ECT in 1998. In 2007 there were 626 hearings. In that period legal representation in ECT hearings wavered between 4.9 and 8.9 per cent. Ninety-eight per cent of applications for involuntary ECT were approved.
The chief executive of the Public Interest Advocacy Centre, Robin Banks, said the wishes of involuntary patients were given little consideration. She believed the absence of lawyers was "a serious loss of freedom" and a situation that undermined Australia's commitment to human rights.
"A minimum protection within any decision-making process like this … should be that the person can have access to legal representation," she said. "It's a pretty basic right we're talking about: the right to control your own body and what treatment you receive."
The tribunal, too, would welcome more input.
"We can't force Legal Aid to give legal aid to everybody," said the tribunal's president, Greg James, QC. "[But] patients, the public and the tribunal would be much better off if legal aid were available. The whole reason we do this monitoring of ECT is to make sure the public can feel protected. There is a distrust in the community of such psychiatric treatments."
The case of one 84-year-old pensioner who did summon legal help to avoid ECT has highlighted a situation that leaves involuntary patients - and their families - powerless to challenge psychiatrists.
In NSW, involuntary ECT requires the approval of the Mental Health Review Tribunal. All mental health patients are entitled to a lawyer, but only one in 10 patients is represented in the tribunal's hearings.
The tribunal held 315 hearings for involuntary ECT in 1998. In 2007 there were 626 hearings. In that period legal representation in ECT hearings wavered between 4.9 and 8.9 per cent. Ninety-eight per cent of applications for involuntary ECT were approved.
The chief executive of the Public Interest Advocacy Centre, Robin Banks, said the wishes of involuntary patients were given little consideration. She believed the absence of lawyers was "a serious loss of freedom" and a situation that undermined Australia's commitment to human rights.
"A minimum protection within any decision-making process like this … should be that the person can have access to legal representation," she said. "It's a pretty basic right we're talking about: the right to control your own body and what treatment you receive."
The tribunal, too, would welcome more input.
"We can't force Legal Aid to give legal aid to everybody," said the tribunal's president, Greg James, QC. "[But] patients, the public and the tribunal would be much better off if legal aid were available. The whole reason we do this monitoring of ECT is to make sure the public can feel protected. There is a distrust in the community of such psychiatric treatments."
Monday, September 26, 2011
The influenza vaccine debate - 57% of 209 children aged 6–59 months who received CSL TIV experienced a febrile reaction, compared with 17% of 110 children who received another TIV
The 2010 trivalent influenza vaccine (TIV) manufactured in Australia by CSL Biotherapies (CSL) caused an excess of febrile reactions, including febrile convulsions, among Australian children.1 A retrospective cohort study conducted in Western Australia found that 57% of 209 children aged 6–59 months who received CSL TIV experienced a febrile reaction, compared with 17% of 110 children who received another TIV (P < 0.0001).1 The Australian Technical Advisory Group on Immunisation concluded that the rate of febrile convulsions among children vaccinated with the 2010 CSL TIV may have been as high as 1 per 100.2 The Therapeutic Goods Administration (TGA) stated that the cause of these reactions had still not been determined as of 8 July 2011.3
In the United States, CSL TIV was initially approved by the Food and Drug Administration (FDA) in 2007 for use in adults, and in 2009 for use in children aged 6 months and older.16 On 15 June 2011, the FDA issued a warning letter to CSL.17 After reviewing the US regulator’s findings, the Australian regulator (the TGA) concluded that, “The two regulators are in agreement over the problems identified at CSL”.3 The FDA highlighted potential issues with the splitting procedure used by CSL.17 According to the FDA, sodium taurodeoxycholate lots that failed identification tests at CSL were nonetheless accepted for use. The FDA also stated that CSL “failed to determine optimal splitting conditions for new virus strains before the strains [were] used in production” and that “the tests used to evaluate the completeness of virus splitting [were] deficient” as the assays used were not “validated for their ability to discriminate between split and whole virus”.17 These concerns, together with the previous Canadian and European experiences, suggest that incompletely split virus, and perhaps other factors related to the use of deoxycholate, provide a plausible explanation of the AEFI associated with the 2010 CSL TIV.
http://www.mja.com.au/public/issues/195_06_190911/kel10941_fm.html
In the United States, CSL TIV was initially approved by the Food and Drug Administration (FDA) in 2007 for use in adults, and in 2009 for use in children aged 6 months and older.16 On 15 June 2011, the FDA issued a warning letter to CSL.17 After reviewing the US regulator’s findings, the Australian regulator (the TGA) concluded that, “The two regulators are in agreement over the problems identified at CSL”.3 The FDA highlighted potential issues with the splitting procedure used by CSL.17 According to the FDA, sodium taurodeoxycholate lots that failed identification tests at CSL were nonetheless accepted for use. The FDA also stated that CSL “failed to determine optimal splitting conditions for new virus strains before the strains [were] used in production” and that “the tests used to evaluate the completeness of virus splitting [were] deficient” as the assays used were not “validated for their ability to discriminate between split and whole virus”.17 These concerns, together with the previous Canadian and European experiences, suggest that incompletely split virus, and perhaps other factors related to the use of deoxycholate, provide a plausible explanation of the AEFI associated with the 2010 CSL TIV.
http://www.mja.com.au/public/issues/195_06_190911/kel10941_fm.html
Wednesday, September 14, 2011
sympathectomy created imbalance of autonomic activity and functional changes of the intrathoracic organs - yet it remains a heavily advertised elective procedure
Surgical thoracic sympathectomy such as ESD (endoscopic thoracic sympathectic denervation) or heart transplantation can result in an imbalance between the sympathetic and parasympathetic activities and result in functional changes in the intrathoracic organs.
Therefore, the procedures affecting sympathetic nerve functions, such as epidural anesthesia, ESD, and heart transplantation, may cause an imbalance between sympathetic and parasympathetic activities (1, 6, 16, 17). Recently, it has been reported that ESD results in functional changes of the intrathoracic organs.
In conclusion, our study demonstrated that ESD adversely affected lung function early after surgery and the BHR was affected by an imbalance of autonomic activity created by bilateral ESD in patients with primary focal hyperhidrosis.
Journal of Asthma, 46:276–279, 2009
http://informahealthcare.com/doi/abs/10.1080/02770900802660949
Therefore, the procedures affecting sympathetic nerve functions, such as epidural anesthesia, ESD, and heart transplantation, may cause an imbalance between sympathetic and parasympathetic activities (1, 6, 16, 17). Recently, it has been reported that ESD results in functional changes of the intrathoracic organs.
In conclusion, our study demonstrated that ESD adversely affected lung function early after surgery and the BHR was affected by an imbalance of autonomic activity created by bilateral ESD in patients with primary focal hyperhidrosis.
Journal of Asthma, 46:276–279, 2009
http://informahealthcare.com/doi/abs/10.1080/02770900802660949
Monday, September 12, 2011
Low HRV is a risk factor for pathophysiology and psychopathology
The intimate connection between the brain and the heart was enunciated by Claude Bernard over 150 years ago. In our neurovisceral integration model we have tried to build on this pioneering work. In the present paper we further elaborate our model. Specifically we review recent neuroanatomical studies that implicate inhibitory GABAergic pathways from the prefrontal cortex to the amygdala and additional inhibitory pathways between the amygdala and the sympathetic and parasympathetic medullary output neurons that modulate heart rate and thus heart rate variability. We propose that the default response to uncertainty is the threat response and may be related to the well known negativity bias. We next review the evidence on the role of vagally mediated heart rate variability (HRV) in the regulation of physiological, affective, and cognitive processes. Low HRV is a risk factor for pathophysiology and psychopathology. Finally we review recent work on the genetics of HRV and suggest that low HRV may be an endophenotype for a broad range of dysfunctions.
http://www.ncbi.nlm.nih.gov/pubmed/18771686
http://www.ncbi.nlm.nih.gov/pubmed/18771686
Wednesday, September 7, 2011
"Doctors knock controversial sweating treatment; Surgical procedure leaves many people dripping wet on other parts of the body."
this link.)
According to the article, the most common problem following ETS is increased and profuse sweating on other parts of the body, most often the back, legs, groin, and abdomen. This compensatory sweating, reports Macleans, can be mild to severe and occurs in 80 to 90 percent of patients. In one study of people who had surgery for excessive underarm sweating, 90 percent of the patients reported compensatory sweating and half of them were forced to change their clothes during the day because of it.
In related news, major news outlets (including "The New York Times") have reported this week on a massive insurance scam in the US in which thousands of patients from 40 states had been transported to California to undergo unnecessary surgical and diagnostic procedures. Insurers and employers have lost US $350 million in claims paid to date due to the illegal operations.
As part of the scheme, patients traveled to outpatient surgery clinics in California to receive three or more procedures in a single week. Among the procedures unnecessarily performed on these patients, according to The New York Times, was "...a highly unusual procedure to treat 'sweaty palms.'" The paper quoted an expert who said this particular surgery "posed potential risks to the patient because it involved collapsing the patient's lungs and deactiviating a nerve near the spine."
In return for undergoing unnecessary colonoscopies, endoscopies, and surgeries for "sweaty palms", participating patients were paid anywhere from $200 to $2,000 each and may have received discounts on cosmetic surgery.
http://www.sweatsolutions.org/sweatsolutions/Article.asp?ArticleCode=19570137&EditionCode=95129982
Sunday, August 28, 2011
Despite the lack of scientific evidence for its effectiveness, the lobotomy became a treatment of choice
Despite the lack of scientific evidence for its effectiveness, the lobotomy became a treatment of choice for severe mental illness in the United States and many other countries.
The history of psychosurgery contains many important lessons about the dangers of using treatment methods that have not been scientifically validated and have only testimonials and uncontrolled case studies for evidence.
http://www.baam.emich.edu...hive/BAAMbnalobotomy.htm
The history of psychosurgery contains many important lessons about the dangers of using treatment methods that have not been scientifically validated and have only testimonials and uncontrolled case studies for evidence.
http://www.baam.emich.edu...hive/BAAMbnalobotomy.htm
Wednesday, August 24, 2011
Patients need to be able to value and trust the knowledge and judgement of doctors
http://ama.com.au/node/6569
“Hired guns” still a problem for profession
MEDICAL negligence claims against some doctors are being frustrated and prolonged due to the poor quality of some expert reports, according to medicolegal experts who have renewed calls for changes to the expert witness system.
There was an element of “hired gun” experts in some cases, where legal teams selected a doctor known to hold the views that supported their case, said Cheryl McDonald, who is claims department manager for medical indemnity organisation Medical Insurance Group Australia.
“Sometimes when you see a report and it’s by Dr X you know it’s going to be critical before you’ve even turned the page”, Ms McDonald said.
She said inaccurate or “mischievous” expert witness reporting could drag out claims that had little merit and might never go to court. This increased costs for the insurer which were then passed onto doctors through indemnity premiums.
“Even if the [expert’s] claims are mischievous, they are still lending support to the plaintiff’s claim, which then causes us to continue defending the claim. It’s a problem”, she said.
The calls for changes come after the United Kingdom Supreme Court ruled to remove immunity from prosecution for expert witnesses, which means an expert witness in the UK can now be sued for professional negligence if they provide a negligent opinion. (1) Issue 14, 18 April 2011
MJA Insight
Sunday, August 21, 2011
"We should have the freedom to research all available options."
FORMER Australian of the Year Patrick McGorry has aborted a controversial trial of antipsychotic drugs on children as young as 15 who are "at risk" of psychosis, amid complaints the study was unethical.
The Sunday Age can reveal 13 local and international experts lodged a formal complaint calling for the trial not to go ahead due to concerns children who had not yet been diagnosed with a psychotic illness would be unnecessarily given drugs with potentially dangerous side effects.
Last month, psychiatrists, psychologists and researchers from Australia, Britain and the US lodged a complaint with the ethics committee of Melbourne Health, the umbrella health service that includes Orygen.
They argued there was little evidence onset of psychosis can be prevented and it was potentially dangerous to use antipsychotics on people who merely have risk factors for a psychotic illness. They said there was evidence that up to 80 per cent would never develop a disorder.
The Sunday Age can reveal 13 local and international experts lodged a formal complaint calling for the trial not to go ahead due to concerns children who had not yet been diagnosed with a psychotic illness would be unnecessarily given drugs with potentially dangerous side effects.
Last month, psychiatrists, psychologists and researchers from Australia, Britain and the US lodged a complaint with the ethics committee of Melbourne Health, the umbrella health service that includes Orygen.
They argued there was little evidence onset of psychosis can be prevented and it was potentially dangerous to use antipsychotics on people who merely have risk factors for a psychotic illness. They said there was evidence that up to 80 per cent would never develop a disorder.
Monday, August 15, 2011
Tuesday, August 9, 2011
8000 deaths in Australia each year as a result of medical errors, more than the annual road toll of about 1600
In NSW up to 130,000 patients are being harmed or experience near misses each year. There are an estimated 8000 deaths in Australia each year as a result of medical errors, more than the annual road toll of about 1600.
SMH 20.04.07- Condition critical: the poor state of the NSW health system - National
SMH 20.04.07- Condition critical: the poor state of the NSW health system - National
"Safety breaches in Australian healthcare are killing more people than breast cancer or road accidents,"
Associate Professor Bolsin (Source: SMH 11.07.07)
Catastrophic medical errors are going unreported
Catastrophic medical errors are going unreported at the Royal Children's Hospital, according to research by doctors, who have called for more measures to prevent them.
In 176 days of research, Reshma Silas and James Tibballs found 405 adverse events in 165 patients at Royal Children's Hospital, with 28 per cent classified as major - an error requiring a significant medical intervention - or catastrophic, defined as an error leading to permanent disability or death. Catastrophic outcomes were found in 12 cases - 3 per cent of the 405 events. It is not known if any children died, although the researchers said one case was the subject of legal action.
In contrast, when the researchers looked at adverse events reported through the hospital's voluntary reporting scheme over the same period, they found 166 events in 100 patients, with the vast majority of reports rated insignificant or minor. Seven per cent were considered moderate, meaning the event led to increased hospitalisation, and 2 per cent were major events, leading to significant medical intervention. No catastrophic events were reported.
There was significant crossover between the patient groups, with three-quarters of these 100 patients involved in the systematic review, leading the researchers to conclude that systematic reporting, through interviews with staff and tracking patient outcomes, was far better at picking up adverse events than voluntary reporting.
Professor Tibballs said a compulsory system of reporting serious adverse events, known as ''sentinel events'', to health departments captured the tip of the iceberg because it only asked for gross and obvious examples of incompetence such as surgery on the wrong body part.
Source: The Age, 07.03.11.
Thousands of people are likely to be dying every year as a result of preventable hospital errors
Doctors and academics yesterday called for more funding of hospital programs to examine adverse events (unintended injuries from medical care) after The Age revealed inadequacies in the voluntary reporting system for such incidents at the Royal Children's Hospital.
Professor of health economics at Monash University, Jeff Richardson, said that if the last major Australian study to estimate the number of deaths due to preventable adverse events was right, 350 patients were dying every two weeks because of the problem.
Professor Richardson said it was astonishing that so little had been done since The Quality in Australian Health Care Study in 1995 estimated about 12,000 Australians were dying each year because of preventable events.
''The issue of adverse events in the Australian health system should dominate all others. However, it would be closer to the truth to describe it as Australia's best kept secret,'' he said.
Source: The Age, 08.03.11.
Monday, August 8, 2011
most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures
The public would probably be surprised to know that most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures they perform.
Of even greater concern is the lack of data on long-term outcomes associated with surgical interventions.
Many surgeons argue that they are too busy and do not have the time and resources to conduct this sort of follow-up. This is not entirely without foundation, but it does seem difficult to defend a stance that says “I will continue to work feverishly at the operations I do but not assess how successful my results are”.
Of even greater concern is the lack of data on long-term outcomes associated with surgical interventions.
Many surgeons argue that they are too busy and do not have the time and resources to conduct this sort of follow-up. This is not entirely without foundation, but it does seem difficult to defend a stance that says “I will continue to work feverishly at the operations I do but not assess how successful my results are”.
Guy Maddern: No excuse for poor surgical outcomes
MJA INSIGHT, 8 August 2011
Monday, August 1, 2011
complete faith in their selected practitioner
Medical practitioners are surprised when their performance is called into question. Many have a feeling of invincibility based on a lifetime of accumulated educational and professional successes.
The public add to this assumption by placing complete faith in their selected practitioner — until some misadventure occurs. Then the blame game starts.
When defending a claim, it is unreasonable to expect defence counsel to be cognisant of international medical literature concerning the condition in dispute. The defendant doctor should make it their job to amass expert opinion so lawyers can filter and present appropriately.
MJA INSIGHT Aug. 1. 2011
The public add to this assumption by placing complete faith in their selected practitioner — until some misadventure occurs. Then the blame game starts.
When defending a claim, it is unreasonable to expect defence counsel to be cognisant of international medical literature concerning the condition in dispute. The defendant doctor should make it their job to amass expert opinion so lawyers can filter and present appropriately.
MJA INSIGHT Aug. 1. 2011
12,000 Australians were dying each year because of preventable events
Catastrophic medical errors are going unreported at the Royal Children's Hospital, according to research by doctors, who have called for more measures to prevent them.
Two doctors from the hospital, Reshma Silas and James Tibballs, reported in the journal Quality and Safety in Health Care, that a systematic review of intensive care unit staff and their management of patients picked up hundreds of adverse events, including many that were not detected by the hospital's voluntary reporting system.
Professor Tibballs, a senior intensive care specialist, said the research suggested an ''epidemic of adverse events'' in hospitals that the medical community and broader population knew little about. The 2 doctors found 405 adverse events over 176 days of research. 28% were major errors and 3% were catastrophic. In contrast, when the researchers looked at adverse events reported through the hospital's voluntary reporting scheme over the same period, they found 166 events in 100 patients.
Professor Richardson of Monash University said it was astonishing that so little had been done since The Quality in Australian Health Care Study in 1995 estimated about 12,000 Australians were dying each year because of preventable events.
Source: The Age online, 07.03.11; 08.03.11.
http://www.solicitoradvice.com/
Saturday, July 23, 2011
hospital treatment is the second greatest CAUSE of death in Australia
http://www.medicalerroraustralia.com/issues/who_will_take_responsibility.php
Mandatory reporting problematic
Different cultural beliefs may make overseas-trained doctors reticent to report colleagues for impairment or professional misconduct under the new mandatory reporting laws, according to Medical Board of Australia chair, Dr Joanna Flynn.
Mandatory reporting by all registered medical practitioners came into effect on July 1 under new national legislation governing 10 health professions and their national boards, which now fall under the Australian Health Practitioner Regulation Agency (AHPRA).
Under the legislation, registered health practitioners, their employers and education providers must report “notifiable conduct”, such as working while intoxicated, sexual misconduct, or impairment placing the public at risk of substantial harm.
Dr Flynn’s concerns follow a study of almost 1900 US physicians that found 17% knew a colleague who was incompetent to practise but only two-thirds reported them.
Underrepresented minorities, graduates of non-US medical schools and doctors practising alone or with one partner were the least likely to report.
http://www.mjainsight.com.au/view?post=mandatory-reporting-requirements-problematic-for-overseas-trained-doctors&post_id=490&cat=news-and-research
When the cure is worse than the illness
http://www.smh.com.au/national/when-the-cure-is-worse-than-the-illness-20110722-1hsp3.html
Saturday, July 16, 2011
Where does the belief that medicine is based on science come from?
Writing in the “Opposing views” section of theMJA, Professor John Dwyer, emeritus professor of medicine at the University of NSW, said many alternative therapies are not based on science and it is unethical for doctors to prescribe them in most situations. (1)
Consumers were increasingly exposed to “a plethora of nonsense (non-science) claims that waste their money, distance them from effective care strategies and, not infrequently, cause harm”, he wrote.
Consumers were increasingly exposed to “a plethora of nonsense (non-science) claims that waste their money, distance them from effective care strategies and, not infrequently, cause harm”, he wrote.
Professor Dwyer criticised doctors who practised “integrative medicine”, an approach which combines conventional medicine with complementary and alternative therapies.
“To do so … is to abandon scientific medicine … for an approach that does not believe in testing, is happy to exploit the placebo effect and rejects a psychological influence on health”, he wrote.
Professor Dwyer’s comments sparked a strong response from the Australasian Integrative Medicine Association (AIMA), the peak body for doctors practising integrative medicine.
MJA INSIGHT, July 2011
fraudulent or unethical medical research represents an unacceptable breach of trust for clinicians, health policymakers and the general public
http://www.mja.com.au/public/issues/194_12_200611/myb10505_fm.html
Research fraud — where to from here?
Given the nexus between published research, medical practice and public health policy, the veracity of published medical research is vital. Melbourne newspaper The Age recently reported on an “explosion of medical research fraud” (12 May 2011), and Myburgh’s editorial in this issue of the Journal (→ Fraud in fluid resuscitation research) examines a specific incident of fraud.
Trust in the ethical behaviour of researchers is the cornerstone of medical science and publication. The Guideline for Good Clinical Practice, to which Australia adheres, provides some regulation but not enough to protect against fraud.
http://www.mja.com.au/public/issues/194_12_200611/choice_200611.html
the requirement to practise according to widely accepted professional standards implies the need to be abreast of contemporary clinical practice
http://www.mja.com.au/public/issues/194_05_070311/choice_070311_fm.html
An investigation into the unexpectedly high number of febrile convulsions in children aged less than 5 years after they had received the influenza vaccine in 2010
The World Health Organization defines four categories of serious AEFI: hospital admission or prolongation of an existing hospital admission; permanent disability; any event that is life threatening; or death.6 Using these criteria, 8% (193/2396) of the AEFI reported by passive surveillance in Australia in 2009 were judged to be serious.7 However, unlike many countries where compensation schemes exist for adverse events attributed to a vaccine, Australia has no routine approach to making the assessment of attribution.
Despite detailed epidemiological evidence that was consistent in this case with the causal criteria for an AEFI promulgated by the Institute of Medicine of the National Academies in the United States,8 and despite laboratory evidence showing that the polio virus recovered from this child was similarly pathogenic to a polio virus that has been accepted as causing vaccine-associated paralytic polio,9 the polio expert committee concluded that the evidence was insufficient to support a causal relationship between the oral polio vaccine and transverse myelitis. As causality has not been accepted, this child has received no compensation.
http://www.mja.com.au/public/issues/195_01_040711/kel10252_fm.html
Despite detailed epidemiological evidence that was consistent in this case with the causal criteria for an AEFI promulgated by the Institute of Medicine of the National Academies in the United States,8 and despite laboratory evidence showing that the polio virus recovered from this child was similarly pathogenic to a polio virus that has been accepted as causing vaccine-associated paralytic polio,9 the polio expert committee concluded that the evidence was insufficient to support a causal relationship between the oral polio vaccine and transverse myelitis. As causality has not been accepted, this child has received no compensation.
http://www.mja.com.au/public/issues/195_01_040711/kel10252_fm.html
Saturday, July 2, 2011
MORE than half the doctors in hospitals do not wash their hands between patients
and only legal action by infected victims is likely to get doctors to clean up their act, an infectious diseases expert, Frank Bowden, says.
Even after a two-year national campaign to urge staff to wash their hands between patients, about half still fail to do so. A national audit of doctors by the healthcare safety and quality commission last year showed 51 per cent failed to comply with hygiene standards.
The result is that hundreds of patients end up with ''hospital-acquired infections'', which can kill them.
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Professor Bowden, of the Australian National University, says it would take only one patient to sue a hospital successfully to transform doctors' behaviour.
''Once it becomes plain to the patient population that there is a clear link between the behaviour of their medical attendants and the risk of them contracting an infection while in hospital, it is only going to take one high-profile case of a patient successfully suing a hospital for the climate on hygiene to change.''
In his book Gone Viral - The Germs that Share our Lives, published yesterday, Professor Bowden says that once a legal precedent has been set, the cost of hospital-acquired infection will be ''directly measurable … not hidden as it currently is''.
Read more: http://www.smh.com.au/national/unwashed-hands-put-doctors-in-legal-peril-20110701-1gv6t.html#ixzz1QvDsiR1P
Saturday, May 14, 2011
Is he suggesting that the widely accepted espousal of evidence-based medicine is a modern myth?
The pair, along with researchers at John Curtin and the University of Miami, have published new findings suggesting an interplay between obesity and
anti-depressant medicines. The team found in tests with laboratory rats that short-term anti-depressant treatment may be an enduring cause of obesity,
even a long time after treatment is discontinued.
Wong says the perspective she and Licinio have on the anti-depressant-obesity link is ''a bit unusual and a lot of people will not agree with it''.
The scale of the challenge is illustrated by the widespread use of anti-depressants - they are now among the most prescribed drug in the US, she says,
and many would say over-prescribed. But there is meagre information on what proportion of patients taking them become obese.
Anxiety and depression together represent the second most common cause of ill-health in Australia, while obesity plays a frequent role in lethal
conditions like coronary heart disease and diabetes.
''There is a lot of difficulty in understanding depression. It is a complex disease. Studies of depression are not easy to replicate.''
On the other hand, obesity is not seen as a psychiatric disorder, she says.
Licinio and Wong have held professorships in related fields at UCLA and Miami University. Yet for somebody of his research background, it is notable
that Licinio holds deep scepticism about the efficacy of medical treatments for diseases including diabetes, cancer, psychiatry and rheumatoid arthritis.
''Today we look back 150 years ago when people were treated with leeches and think it is crazy. I think in 150 years' time people will look back [at
today's treatments] and think the same thing.''
For some psychiatric disorders, he says, ''We really don't completely understand why the drug acts and what we are doing. Some people respond to the
drug you give and some people don't. Some people have terrible side-effects and other people don't. Some people just are not touched by the drug.''
The range of responses depend on an individual's genetic ''markers'' or make-up. In many cases drug treatment ''is all guess work'', he says.
Is he suggesting that the widely accepted espousal of evidence-based medicine is a modern myth?
''It is not going to make me very popular but I think it is.''
There are several factors behind this apart from the numerous biological differences between humans, including research biased towards selected
patient groups and the complexity of reactions between drugs. According to an American survey, the average geriatric patient is on 14 different
medicines.
But amid the profusion of drugs available, Licinio points to the singular lack of real advance in psychiatric medication.
Serious depression represents a substantial problem in Australia, with 1.4 million sufferers each year. ''Yet nothing we use to treat psychiatric patients
suffering depression and other psychiatric illness today is based on anything discovered in the past 40 years - even though there has been an explosion
in neuroscience.''
http://www.smh.com.au/lifestyle/wellbeing/a-bitter-pill-from-depression-to-obesity-20110513-1em6r.html
anti-depressant medicines. The team found in tests with laboratory rats that short-term anti-depressant treatment may be an enduring cause of obesity,
even a long time after treatment is discontinued.
Wong says the perspective she and Licinio have on the anti-depressant-obesity link is ''a bit unusual and a lot of people will not agree with it''.
The scale of the challenge is illustrated by the widespread use of anti-depressants - they are now among the most prescribed drug in the US, she says,
and many would say over-prescribed. But there is meagre information on what proportion of patients taking them become obese.
Anxiety and depression together represent the second most common cause of ill-health in Australia, while obesity plays a frequent role in lethal
conditions like coronary heart disease and diabetes.
''There is a lot of difficulty in understanding depression. It is a complex disease. Studies of depression are not easy to replicate.''
On the other hand, obesity is not seen as a psychiatric disorder, she says.
Licinio and Wong have held professorships in related fields at UCLA and Miami University. Yet for somebody of his research background, it is notable
that Licinio holds deep scepticism about the efficacy of medical treatments for diseases including diabetes, cancer, psychiatry and rheumatoid arthritis.
''Today we look back 150 years ago when people were treated with leeches and think it is crazy. I think in 150 years' time people will look back [at
today's treatments] and think the same thing.''
For some psychiatric disorders, he says, ''We really don't completely understand why the drug acts and what we are doing. Some people respond to the
drug you give and some people don't. Some people have terrible side-effects and other people don't. Some people just are not touched by the drug.''
The range of responses depend on an individual's genetic ''markers'' or make-up. In many cases drug treatment ''is all guess work'', he says.
Is he suggesting that the widely accepted espousal of evidence-based medicine is a modern myth?
''It is not going to make me very popular but I think it is.''
There are several factors behind this apart from the numerous biological differences between humans, including research biased towards selected
patient groups and the complexity of reactions between drugs. According to an American survey, the average geriatric patient is on 14 different
medicines.
But amid the profusion of drugs available, Licinio points to the singular lack of real advance in psychiatric medication.
Serious depression represents a substantial problem in Australia, with 1.4 million sufferers each year. ''Yet nothing we use to treat psychiatric patients
suffering depression and other psychiatric illness today is based on anything discovered in the past 40 years - even though there has been an explosion
in neuroscience.''
http://www.smh.com.au/lifestyle/wellbeing/a-bitter-pill-from-depression-to-obesity-20110513-1em6r.html
Saturday, April 30, 2011
“Hired guns” still a problem for profession
MEDICAL negligence claims against some doctors are being frustrated and prolonged due to the poor quality of some expert reports, according to medicolegal experts who have renewed calls for changes to the expert witness system.
There was an element of “hired gun” experts in some cases, where legal teams selected a doctor known to hold the views that supported their case, said Cheryl McDonald, who is claims department manager for medical indemnity organisation Medical Insurance Group Australia.
“Sometimes when you see a report and it’s by Dr X you know it’s going to be critical before you’ve even turned the page”, Ms McDonald said.
Beth Wilson, Victoria’s Health Services Commissioner and a qualified lawyer, said the hired gun phenomenon remained a “major problem” with the legal system. She suggested expert witnesses be paid for by the state rather than by legal teams.
“I’d prefer a system where the expert witness was amicus curiae or ‘friend of the court’. Judges should be able to rely on the expert, knowing that their information is not biased towards one side or the other”, she said.
MJA InSight
Legal immunity for experts questioned
THE quality of medical information provided by expert witnesses in legal proceedings is often poor, and may be improved if immunity against prosecution for experts is removed, according to AMA president Dr Andrew Pesce.
Dr Pesce’s comments come in response to a recent United Kingdom Supreme Court judgment that abolished immunity against prosecution for expert witnesses. (1)
Although Australia still provides immunity for expert witnesses, the British case could be used as a precedent if a similar case was brought here.
Dr Pesce said removing immunity might encourage experts to do a better job and therefore protect themselves from litigation. “I don’t think it would be a bad thing. It would make doctors focus on providing reports that were of good quality and that made arguments based on good evidence,” he said.
Although Australian expert witnesses currently have legal immunity, there have been instances where medical boards have taken disciplinary action against doctors who have provided erroneous advice.
Dr Pesce said he had substantial experience reviewing expert witness reports, and had written medical advice for about 12 legal cases.
“Too often in my reviews of some experts’ reports I see things that are not backed up by evidence. Often the information is wrong, and not only is it wrong, but there’s no evidence to support it at all.
“It might be opinion but they’re presenting it as fact,” he said.
- Sophie McNamara
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