vigorous entrepreneurial spirit that was undeterred by the ineffectiveness of their treatment methods

"The new-found experts developed therapeutic empires with a vigorous entrepreneurial spirit that was undeterred by the ineffectiveness of their treatment methods." (Bell DS, 1989)
Med J Aust 151 : 280-284

"It is a lie that sympatholysis may specifically cure patients

with unqualified "reflex sympathetic dystrophy". This was already stated by the father of sympathectomy, Rene Leriche, more than half a century ago.
...it is not an error, but a lie. While conceptual errors are not only forgivable, but natural to inexact medical science, lies, particularly when entrepreneurially inspired are condemnable and call for a peer intervention.

J. Neurology (1999) 246: 875-879

"we know that antibiotics are misused and overused"

Professor Cars was emphatic that although there are knowledge gaps in Australia, we must act now. “We can’t wait for the data; we know that antibiotics are misused and overused. We know that infection control could be improved without new information.”

He attributed the causes of antimicrobial resistance to three things:
• indiscriminate use of antibiotics
• indiscriminate effects of antibiotics, ie, broad activity
• global spread of resistance facilitated by the rapid dynamics of gene transfer between bacteria as a result of travel, trade and poor sanitation and hygiene.

http://www.mjainsight.com.au

Even a surgeon who was convinced that he was not obtaining good results seldom gave up lobotomy

Medical profession is the noblest of all ! . Doctors are akin to God in many ways ! They have the potential to remove the sufferings of mankind . These are the often made quotes about doctors for many centuries. Today’s medical professionals are , a strained lot to fulfil their role expected of them .They have to maintain the social identity and earn enough to sustain their image in society. The onslaught of commercial and pseudo-scientific concepts have ruined the profession considerably.

Those were the days when the family physician concept was flourishing , where in a doctor was taking care of entire family. This concept has taken a different avatar now .

Now a doctor feels , once the patient is seen by him becomes his/her patient rather a property! This perception has grown in a malignant manner , many doctors do not refer to a specialist even in deserving cases fearing patient poaching .

This possessiveness of doctors about their patients leads to many of the unethical behavior .

My case . . .my patient . . . my fees , . . .this sort of approach though appeared good in the past , is rapidly becoming a liability for the patients .Lack of organised health care by private and Government sector also amplifies the issue .It is pathetic to note , at least Govt hospitals have some accountability , majority of private health systems do not have mortality or morbidity auditing .

http://drsvenkatesan.wordpress.com/2010/12/11/why-many-doctors-consider-patients-as-their-property/

Advertised drugs were supported by evidence that was neither "of reasonable quality, nor independent"

Prof Brown is from the Department of Emergency Medicine at Royal Brisbane and Women's Hospital, and the School of Medicine at the University of Queensland.

They said the ban followed discussions with fellow emergency medicine specialists, who had aired concerns such as:

- Advertised drugs were supported by evidence that was neither "of reasonable quality, nor independent".

- There were cases of "dubious and unethical" research practices by the industry, including "ghost authorship" where scientific papers do not disclose all of their authors.

- Academics could also face industry pressure to withhold negative research, and together this could "inflate views of the efficacy" of heavily promoted drugs.

The professors also said drug ads were counter to a medical journal's mission to provide objective data that enabled doctors to make judgments based on the best available evidence.

"Meanwhile doctors - and indeed journal editors - generally deny they are influenced (by the ads), yet clearly they are," they said.

http://news.smh.com.au/breaking-news-national/medical-journal-bans-drug-company-ads-20110203-1aev8.html

How doctors think...

Review RD09 (2010)

WELFARE OF ANAESTHETISTS

SPECIAL INTEREST GROUP

Australian and New Zealand College of Anaesthetists

Australian Society of Anaesthetists

New Zealand Society of Anaesthetists

WHY DON’T YOU HAVE YOUR OWN GP?

HOW MANY EXCUSES CAN YOU FIND?

HERE ARE 21 !

after Dr Peter Arnold

Australian Medicine November 1997

1. Taking a health problem to another doctor lays me open to professional ridicule for not recognising, myself, that the problem is a) trivial or b) serious.
2. I don’t believe that my symptoms really amount to much; they’re probably just something simple. If I wait awhile they will go away.
3. If I take my symptoms to another doctor, my own diagnosis might be proved wrong!
4. It would place me in a position where I would have to take the “submissive” role of patient and “counselee”, rather than my usually assertive role as doctor and counsellor.
5. I wouldn’t know how to be a patient, being accustomed to being the doctor.
6. Going to another doctor would make me dependent on someone else, when I am used to people being dependent on me.
7. I would have to accept the other doctor’s opinion, whereas I would know more than he/she does on the subject. In particular I would know this patient better than he/she ever could.
8. I can manage my own minor problems - if I’m seriously ill I refer myself to a specialist; why do I need a GP?
9. I’m embarrassed at possibly having to discuss my anxieties about my health - I could be labelled a hypochondriac.
10. I wouldn’t like my life insurance company to know about any illnesses I might have - they might load my policy. If I don’t consult another doctor, they’ll never know.
11. I’m fearful of possibly being forced to disclose aspects of my personality or sexuality which I would rather remained secret
12. Revealing my inner self to a colleague would place him or her at an unfair advantage in our competitive commercial world
13. I know how I would manage a patient presenting with my problems. How can I accept a different way of going about it?
14. Can I place my trust in another doctor, whose training and experience may not be as good as my own? I can accept that a specialist would know more about his/her field of practice than I would (unless he/she is in the same speciality) but how can I accept that a GP might know more than I do?
15. How much do I discuss management, suggest investigations or referral to a specialist? After all, this is the age of patient-doctor partnership. Shouldn’t I have a say in my own management?
16. Any GP would be intimidated by having to attend to me (especially if I am a specialist); he/she would not be able to treat me objectively.
17. How well will the GP respect my confidentiality? Will he or she mention me to a spouse? Indeed the spouse might well be the receptionist! How would that affect our relationship, especially in our close-knit neighbourhood?
18. It isn’t convenient to find the time to see a GP; I’ve got too much work to do looking after my own patients.
19. How do I make an appointment without being embarrassed about having to front up to the receptionist? Do I sit in the waiting room with the other patients, some of whom may have been MY patients too ?
20. How confidential will my records be? Will the receptionist read them?
21. How do I pay the bill? Do I ask to be bulk-billed, or do I pay, and if so at what rate? Do I give a present in appreciation? If so, do I keep giving presents?

http://www.anzca.edu.au/fellows/sig/welfare/review-rd09-why-don2019t-you-have-your-own-gp.html

Medical schools act on pharma influence

Professor James Angus, president of the Medical Deans Australia and New Zealand (the peak body representing medical education in the two countries), said he would address the issue at the next executive meeting of deans later this month.

He was commenting on the results of a survey of 20 Australian medical schools, which assessed their policies regarding disclosure and management of conflict of interest with the pharmaceutical industry, published in the latest MJA.(1)

Coauthor of the study Professor Martin Tattersall, professor of medicine at the University of Sydney, said he suspected there would be some reform and further attention to policies as a result of publication of the study.

However, the current generation of doctors employed in universities, hospitals, public health departments and elsewhere also needed to be much more transparent to their employers and patients about their conflicts of interest, Professor Tattersall said.

“I think the current environment is probably doing medicine and the medical profession a fair amount of harm,” he said.

1. MJA 2011; 194: 121-125.

High doses of common painkillers increase stroke risk

British Medical Journal study links ibuprofen to highest risk of stroke over long term.

The fears relate to non-steroidal anti-inflammatory drugs as well as newer anti-inflammatory drugs known as Cox-2 inhibitors.

Doctors regularly prescribe such drugs to treat painful conditions, including osteoarthritis.

They are given at much higher doses than those found in over-the-counter remedies, which are used for occasional headaches, aches and pains.

The study, in the British Medical Journal, found that compared with a dummy drug lumiracoxib increased the risk of heart attacks, while ibuprofen was linked to the highest risk of stroke (more than treble the risk).

Diclofenac almost tripled the risk, while etoricoxib and diclofenac were associated with around a fourfold increased risk of suffering death from cardiovascular causes.

The authors, from the University of Bern in Switzerland, said: "Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms."

http://www.guardian.co.uk/science/2011/jan/12/high-doses-painkillers-stroke-risk

Fraud Case Rocks Anesthesiology Community

In what experts are calling one of the largest known cases of academic misconduct, a leading anesthesiology researcher has been accused of falsifying data and other fraud in potentially dozens of published studies.

Scott S. Reuben, MD, of Baystate Medical Center in Springfield, Mass., a pioneer in the area of multimodal analgesia, is said to have fabricated his results in at least 21, and perhaps many more, articles dating back to 1996.


A recent PubMed search for Dr. Reuben’s name turned up 72 citations, the most recent an article in the December issue of the Journal of Cardiothoracic and Vascular Anesthesia on preventing the development of chronic pain after thoracic surgery.

What’s particularly surprising given the dimensions of the case, Ms. Johnston said, is that Dr. Reuben’s research managed to raise no alarms among peer reviewers. However, she added, “the peer review system can only do so much. Trust is a major component of the academic world. It’s backed up by the implication that your reputation will be destroyed if you violate that trust.”
http://www.anesthesiology...;a_id=12634&ses=ogs


Reuben prompted a furor in the medical community in March, when he was accused of making up research results in at least 21 published studies and inventing patients in certain instances.
http://www.masslive.com/n...uben_former_chief_o.html

the scope of the Reuben fraud “massive.”

The retractions came after an internal investigation by Baystate turned up evidence of widespread fraud in Dr. Reuben’s research. Jane Albert, a spokeswoman for Baystate, said the inquiry was undertaken after an internal reviewer at the medical center had raised questions last year. Ms. Albert said the hospital’s investigation raised “no allegations concerning any patient care. This was focused on academic integrity.”

A recent PubMed search for Dr. Reuben’s name turned up 72 citations, the most recent an article in the December issue of the Journal of Cardiothoracic and Vascular Anesthesia on preventing the development of chronic pain after thoracic surgery.

Josephine Johnston, an attorney specializing in research integrity at the Hastings Center, in Garrison, N.Y., called the scope of the Reuben fraud “massive.”
http://www.anesthesiologynews.com/ViewArticle.aspx?d_id=3&a_id=12634&ses=ogst

6% admitted failing to present data if it contradicted their previous research

Firstly, if you're planning a career in scientific fraud, then medicine is an excellent place to start.

Findings in complex biological systems - like "people" - are often contradictory and difficult to replicate, so you could easily advance your career and never get caught.

And fraud is not so unusual, depending on where you draw the line. In 2005 the journal Nature published an anonymous survey of 3,247 scientists: 0.3% admitted they had falsified research data at some point in their careers, in acts of outright fraud; but more interestingly, 6% admitted failing to present data if it contradicted their previous research.

Reuben (Scott S Reuben) was at the other end of the scale. He simply never conducted various clinical trials he wrote about for 10 years.

In some cases he didn't even pretend to get approval to conduct studies on patients, but just charged ahead and invented the results all the same.

The details haven't come out yet - investigators have asked various academic journals to formally withdraw at least 21 studies - but fabrication is often easier to spot than selective editing, and some people have argued for various fraud detection tools to be used more commonly by academic journals.

...

And in medicine, data isn't an arbitrary or abstract thing: Reuben's work examined the best way to manage pain after operations, and he provided evidence that non-opiate medications are equally effective.

Now that field is in turmoil. And pain really matters.

http://www.guardian.co.uk/commentisfree/2009/mar/14/bad-science-medicine-fraud

fraud and bias in medical research - BMJ 12 Feb 2009

Because of the massive quantity of material published each month in medical journals, readers of those journals are likely to focus on reading the prestigious ones. Readers are likely to assume that these prestigious journals would be less likely to have an industry bias in their selection of articles for publication. That assumption is questionable, at least in the UK, according to a new study published in the British Medical Journal (12 Feb 2009).

Dr. Ben Goldacre writes:

The British Medical Journal this week publishes a complex study that is quietly one of the most subversive pieces of research ever printed. It analyses every study ever done on the influenza vaccine - although it's reasonable to assume that its results might hold for other subject areas - looking at whether funding source affected the quality of a study, the accuracy of its summary, and the eminence of the journal in which it was published....

We already know that industry-funded studies are more likely to give a positive result for the sponsors' drug, and in this case too, government-funded studies were less likely to have conclusions favouring the vaccines. We already know that poorer quality studies are more likely to produce positive results - for drugs, for homeopathy, for anything - and 70% of the studies they reviewed were of poor quality. And it has also been shown that industry-funded studies are more likely to overstate their results in their conclusions.

But Tom Jefferson and colleagues looked, for the first time, at where studies are published. Academics measure the eminence of a journal by its "impact factor": an indicator of how commonly, on average, research papers in that journal go on to be referred to by other research papers. The average journal impact factor for the 92 government-funded studies was 3.74; for the 52 studies wholly or partly funded by industry, the average impact factor was 8.78. Studies funded by the pharmaceutical industry are massively more likely to get into the bigger, more respected journals.

http://www.guardian.co.uk/commentisfree/2009/feb/14/bad-science-medical-research

reporting bias is a widespread phenomenon in the medical literature

Reporting bias represents a major problem in the assessment of health care interventions. Several prominent cases have been described in the literature, for example, in the reporting of trials of antidepressants, Class I anti-arrhythmic drugs, and selective COX-2 inhibitors.

Regarding pharmacological interventions, cases of reporting bias were, for example, identified in the treatment of the following conditions: depression, bipolar disorder, schizophrenia, anxiety disorder, attention-deficit hyperactivity disorder, Alzheimer's disease, pain, migraine, cardiovascular disease, gastric ulcers, irritable bowel syndrome, urinary incontinence, atopic dermatitis, diabetes mellitus type 2, hypercholesterolaemia, thyroid disorders, menopausal symptoms, various types of cancer (e.g. ovarian cancer and melanoma), various types of infections (e.g. HIV, influenza and Hepatitis B), and acute trauma. Many cases involved the withholding of study data by manufacturers and regulatory agencies or the active attempt by manufacturers to suppress publication. The ascertained effects of reporting bias included the overestimation of efficacy and the underestimation of safety risks of interventions.In conclusion, reporting bias is a widespread phenomenon in the medical literature. Mandatory prospective registration of trials and public access to study data via results databases need to be introduced on a worldwide scale. This will allow for an independent review of research data, help fulfil ethical obligations towards patients, and ensure a basis for fully-informed decision making in the health care system.

http://www.ncbi.nlm.nih.gov/pubmed/20388211

Superior results in the leucotomized groups - Medical bias and conflicts of interest

Abstract

During the past two decades intracranial surgery for intractable mental disease has evolved in the direction of greater precision in and the making of smaller lesions. The most experience has been with bilateral stereotactically produced lesions of a few milliliters' volume in the white matter related to the limbic system. These have been placed just above the anterior half of the corpus callosum in the fibers deep to the gyrus cinguli or in the fibers below the anterior horns of the lateral ventricles or in both areas. Such operations have nearly eliminated the sequelae of the earlier much more extensive lobotomies. Critical and thorough evaluations in Great Britain of relatively small numbers of patients operated on compared with retrospectively matched controls not operated on have revealed superior results in the leucotomized groups. The mental disorders most clearly responding to this surgery appear to be those characterized by stereotypy of an excessive and futile emotional response — i.e., phobias, anxieties, obsessions, depressions and the affective component (when present) of schizophrenia. (N Engl J Med 289:1117–1125, 1973)

William H. Sweet, M.D., D.Sc.

N Engl J Med 1973; 289:1117-1125November 22, 1973