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/
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