Bully surgeons have nowhere to hide now, top doctor says: "After detailing cases of physical abuse in operating theatres and female trainees being propositioned for sex in return for tutoring, the final report recommended the College set up mentoring and coaching for surgeons that need to change their behaviour.
Commenting on this recommendation, Mr Campbell said surgeons who had been misbehaving should expect to get pulled up because bystanders were being encouraged to show leadership.
"Bystanders have been silent for too long. We want people to be tapped on the shoulder. If it's done at a relatively early stage and it's just some bad jokes, we'd want it to be dealt with relatively informally in an educational way," he said, adding that many of the accused would likely be good people who need only education.
But Mr Campbell warned that serious offenders would be referred to the police, the Medical Board of Australia, or an equal opportunity commission. He said the College was continuing to run its complaints line that connects callers to a college counsellor, not a fellow surgeon. Former federal discrimination commissioner Susan Halliday has been appointed to independently review the College's management of complaints every six months.
The expert advisory group's damning report on discrimination, bullying and sexual harassment in surgery said the problems were rife in the profession. A survey of 3500 people found about half of surgeons, trainees and international graduates had suffered some form of abuse.
Women and people new to the profession bore the brunt of it - 54 per cent of surgical trainees said they had recently been bullied, compared with 31 per cent of surgeons with more than a decade of experience. Six out of 10 women said they had been bullied and three in 10 said they had been sexually harassed.
One woman told of how she would be considered for a job only if she had her "tubes tied". A man who stood up for his female colleagues said that he then been singled out for ill treatment, while other respondents spoke of being kicked under the table during operations. International graduates reported being ganged up on or threatened.
The expert advisory group, which was chaired by former Victorian health minister Rob Knowles AO, said hospitals, governments and others health sector organisations had to work on the problem. The College has committed to publishing an action plan in November.
"The College has shown courage and commitment in establishing the EAG (expert advisory group) and in accepting in full the findings and recommendations of the draft report," Mr Knowles said. "
'via Blog this'
Tuesday, September 29, 2015
Thursday, September 24, 2015
Psychiatrist Alex Sharah, who compared lesbians to paedophiles, disqualified
Psychiatrist Alex Sharah, who compared lesbians to paedophiles, disqualified: "Psychiatrist Alexander Anthony Sharah, 80, has been disqualified from registering as a medical practitioner after inappropriate treatment of patients, having also compared lesbians to paedophiles, because both "don't know that they are doing something wrong so we still have to love them".
In a decision handed down on Wednesday, the Civil and Administrative Tribunal rebuked Mr Sharah – a former candidate for the Christian Democratic Party – for encouraging his patients to explore religion to ease their mental health problems.
The decision said: "More than one of the patients referred to the displays of religious objects and material in his waiting room and consulting room, something which, in our view, is clearly inappropriate.
"[Mr Sharah] was indifferent, we consider, to whether patients might find unwelcome and confronting references to the power of prayer, religious beliefs and gestures that had religious symbolism, such as clasping hands and presenting crucifixes."
Mr Sharah is also a "figurehead" in the Men's Justice Movement, which believes the Family Court favours women over men after marriage breakdowns."
http://www.smh.com.au/nsw/psychiatrist-alex-sharah-who-compared-lesbians-to-paedophiles-disqualified-20150923-gjt969.html
(moderator: was he not disqualified because he failed in treating his patients? rubbing 'holy water' on someone's forehead is not an accepted treatment, at least I was not able to find any clinical trials in any of the peer reviewed journals. This one example proves the power medical professionals have. There is little doubt that the 80 (!) year old psychiatrist has been doing this kind of 'treatment' most of his working life. Is this the first time he is challenged (and disqualified for 2 years...)?
In a decision handed down on Wednesday, the Civil and Administrative Tribunal rebuked Mr Sharah – a former candidate for the Christian Democratic Party – for encouraging his patients to explore religion to ease their mental health problems.
The decision said: "More than one of the patients referred to the displays of religious objects and material in his waiting room and consulting room, something which, in our view, is clearly inappropriate.
"[Mr Sharah] was indifferent, we consider, to whether patients might find unwelcome and confronting references to the power of prayer, religious beliefs and gestures that had religious symbolism, such as clasping hands and presenting crucifixes."
Mr Sharah is also a "figurehead" in the Men's Justice Movement, which believes the Family Court favours women over men after marriage breakdowns."
http://www.smh.com.au/nsw/psychiatrist-alex-sharah-who-compared-lesbians-to-paedophiles-disqualified-20150923-gjt969.html
(moderator: was he not disqualified because he failed in treating his patients? rubbing 'holy water' on someone's forehead is not an accepted treatment, at least I was not able to find any clinical trials in any of the peer reviewed journals. This one example proves the power medical professionals have. There is little doubt that the 80 (!) year old psychiatrist has been doing this kind of 'treatment' most of his working life. Is this the first time he is challenged (and disqualified for 2 years...)?
Tuesday, September 22, 2015
Anti-depressant paroxetine linked to youth suicide and no more effective than a placebo, researchers find - ABC News (Australian Broadcasting Corporation)
Anti-depressant paroxetine linked to youth suicide and no more effective than a placebo, researchers find - ABC News (Australian Broadcasting Corporation):
'via Blog this'
'via Blog this'
Sunday, September 20, 2015
Approved anti-depressant deemed unsafe
Approved anti-depressant deemed unsafe:
Studies suggest that patients, clinicians, and society often hold unrealistic expectations about the effectiveness of tests and treatments. Two articles in this issue add to that literature. In New Zealand, Hudson et al3 surveyed 977 primary care patients and found that many overestimated the benefits of cancer screening and chemopreventive medications. The minimum benefit from screening that respondents deemed acceptable was less than their known benefit. The survey had a modest sample size and low response rate (36%), and its findings might not be fully applicable to other countries, but US studies have reported a similar problem. For example, a variety of studies document Americans' appetite for procedures of dubious effectiveness and their overestimation of benefits.4,5
Physicians are not immune to false beliefs about clinical efficacy or complication rates.8Correcting such misperceptions has always been part of the impetus for the evidence-based medicine movement and its promulgation of systematic evidence reviews, practice guidelines, and other tools that present the facts on benefits, safety, and scientific uncertainties. Even these tools, however, can reflect the misconceptions of those who produce them. The specialists who serve on expert panels derive much of their clinical case knowledge from the patients with advanced disease who fill their clinics. Having seen the worst of the worst, they are less sympathetic to expressions of concern about the potential harms of interventions or imperfections in efficacy studies.9Whereas epidemiologists consider the population denominator to put the numerator in perspective, the world of specialists is confined to the numerator, giving them a skewed basis for judging the population prevalence of diseases or benefit-risk ratios. Were this not enough, the preeminent scientists who often serve on guideline panels bring additional biases, such as being the authors of key studies under review or having financial ties to industry.10
http://www.annfammed.org/content/10/6/491.full
Studies suggest that patients, clinicians, and society often hold unrealistic expectations about the effectiveness of tests and treatments. Two articles in this issue add to that literature. In New Zealand, Hudson et al3 surveyed 977 primary care patients and found that many overestimated the benefits of cancer screening and chemopreventive medications. The minimum benefit from screening that respondents deemed acceptable was less than their known benefit. The survey had a modest sample size and low response rate (36%), and its findings might not be fully applicable to other countries, but US studies have reported a similar problem. For example, a variety of studies document Americans' appetite for procedures of dubious effectiveness and their overestimation of benefits.4,5
Physicians are not immune to false beliefs about clinical efficacy or complication rates.8Correcting such misperceptions has always been part of the impetus for the evidence-based medicine movement and its promulgation of systematic evidence reviews, practice guidelines, and other tools that present the facts on benefits, safety, and scientific uncertainties. Even these tools, however, can reflect the misconceptions of those who produce them. The specialists who serve on expert panels derive much of their clinical case knowledge from the patients with advanced disease who fill their clinics. Having seen the worst of the worst, they are less sympathetic to expressions of concern about the potential harms of interventions or imperfections in efficacy studies.9Whereas epidemiologists consider the population denominator to put the numerator in perspective, the world of specialists is confined to the numerator, giving them a skewed basis for judging the population prevalence of diseases or benefit-risk ratios. Were this not enough, the preeminent scientists who often serve on guideline panels bring additional biases, such as being the authors of key studies under review or having financial ties to industry.10
http://www.annfammed.org/content/10/6/491.full
Friday, September 18, 2015
Baker IDI Melbourne fabricated research results
“Fabricated results” retract JAMA clinical trial, plus a sub-analysis of the data - Retraction Watch at Retraction Watch: "“Fabricated results” retract JAMA clinical trial, plus a sub-analysis of the data
with 2 comments
A JAMA clinical trial that suggested a blood pressure drug could help patients increase their physical fitness, and a sub-analysis of those data, have been retracted after “an admission of fabricated results” by the first author on both papers.
The three-year clinical trial was published in JAMA in 2013. It was retracted this morning.
The trial found ramipril helped patients with artery disease walk longer and with less pain, according to the abstract:
Among patients with intermittent claudication, 24-week treatment with ramipril resulted in significant increases in pain-free and maximum treadmill walking times compared with placebo. This was associated with a significant increase in the physical functioning component of the SF-36 score.
The retraction note explains how the fabricated data came to light: "
with 2 comments
A JAMA clinical trial that suggested a blood pressure drug could help patients increase their physical fitness, and a sub-analysis of those data, have been retracted after “an admission of fabricated results” by the first author on both papers.
The three-year clinical trial was published in JAMA in 2013. It was retracted this morning.
The trial found ramipril helped patients with artery disease walk longer and with less pain, according to the abstract:
Among patients with intermittent claudication, 24-week treatment with ramipril resulted in significant increases in pain-free and maximum treadmill walking times compared with placebo. This was associated with a significant increase in the physical functioning component of the SF-36 score.
The retraction note explains how the fabricated data came to light: "
Saturday, September 12, 2015
"for any inappropriate care to occur, complicit action on a large scale is required" - MJA
Med J Aust 2015;; 203 (4): 161-162.: "Instead of dismissing, we should consider that for any inappropriate care to occur, complicit action on a large scale is required. To deliver a do-not-do procedure a medical practitioner must first be credentialled, have a defined scope of practice and operate within their clinical team alongside support services and the governance structures of an organisation. Start counting how many people are involved. Therefore, the question we should be asking is: how is it possible for inappropriate care to occur? And what systems-level agreements perpetuate this situation?"https://www.mja.com.au/.../it-not-appropriate-dismiss...
and:
"Far too many patients in some Australian hospitals get a treatment they should not receive, against all evidence that the treatment is unnecessary or does not work.
This report identifies five treatments that should not be given to certain types of patients. Yet this happened to nearly 6000 people – or 16 people a day – in 2010-11." http://grattan.edu.au/.../questionable-care-avoiding.../
"the Royal Australasian College of Surgeons has discovered its ranks are riddled with bullies, creeps and bigots"
"Royal Australasian College of Surgeons revelations: Patients complicit in promoting surgeons' God complex" - you see? it's your fault if you are mistreated or abused by your surgeon...
"Yet the Royal Australasian College of Surgeons has discovered its ranks are riddled with bullies, creeps and bigots."
Read more: http://www.smh.com.au/…/royal-australasian-college-of-surge…
Follow us: @smh on Twitter | sydneymorningherald on Facebook
or archived page:
https://archive.is/AYnuj
Follow us: @smh on Twitter | sydneymorningherald on Facebook
or archived page:
https://archive.is/AYnuj
Saturday, August 15, 2015
Doctor Skeptic: Fixing a hole
Doctor Skeptic: Fixing a hole: Migraine is common, affecting millions of people worldwide. A patent foramen ovale (PFO – a ‘hole in the heart’ that lets blood cross from...
Tuesday, December 23, 2014
This study of hype in press releases will change journalism | Science News
This study of hype in press releases will change journalism | Science News: "The most important thing to remember is that there are people, and sometimes patients, waiting on the end of the news cycle. “I wouldn’t be doing [healthnewsreviews.org] if I didn’t think that these kinds of messages and misleading conclusions and observations and statements made in many news releases have the potential — and indeed I think that potential is realized — of hurting people at the end of the food chain,” Schwitzer says. Everyone in the news cycle bears responsibility, in the end, for getting it right."
'via Blog this'
'via Blog this'
Exaggeration in health science news releases - exaggerations communicated by reporters are frequently already present in press releases put out by academic institutions
Exaggeration in health science news releases & what we're going to do about it: "“For me, the takeaway from this study is that there are multiple messengers to blame when it comes to exaggeration in health care news stories. As we’ve shown at HealthNewsReview.org, journalists often need to do a better job of vetting scientific research in their stories. But according to these results, the exaggerations communicated by reporters are frequently already present in press releases put out by academic institutions. This suggests that press officers who write the releases, and the researchers who collaborate on them, are also key players when it comes to the promotion of misinformation.
The study authors make a great point, which is that if academic institutions are the ones initiating the introduction of misleading claims, then there’s a tremendous opportunity for them to improve the quality of health care news if they can change their ways. I think our new effort to review news releases will help with that transition, because it provides a level of accountability that’s been missing until now. I’m really excited to see that our instincts about the need for this service are being emphatically confirmed by these results.”"
'via Blog this'
The study authors make a great point, which is that if academic institutions are the ones initiating the introduction of misleading claims, then there’s a tremendous opportunity for them to improve the quality of health care news if they can change their ways. I think our new effort to review news releases will help with that transition, because it provides a level of accountability that’s been missing until now. I’m really excited to see that our instincts about the need for this service are being emphatically confirmed by these results.”"
'via Blog this'
Thursday, December 4, 2014
Evidence based medicine is broken | The BMJ
"How many people care that the research pond is polluted,5 with fraud, sham diagnosis, short term data, poor regulation, surrogate ends, questionnaires that can’t be validated, and statistically significant but clinically irrelevant outcomes? Medical experts who should be providing oversight are on the take. Even the National Institute for Health and Care Excellence and the Cochrane Collaboration do not exclude authors with conflicts of interest, who therefore have predetermined agendas.6 7 The current incarnation of EBM is corrupted, let down by academics and regulators alike.8"
http://www.bmj.com/content/348/bmj.g22
http://www.bmj.com/content/348/bmj.g22
Saturday, November 29, 2014
"the standards for the evidence are often low and tainted by commercial or personal interests"
In the eyes of doctors and the public, evidence-based medicine is the gold standard of clinic practice. If it’s based on evidence from trials and laboratories, it must be right.
However, evidence-based medicine has its critics, as a bilious outbreak of comment and letters in the BMJ demonstrated recently. Early last month a Glasgow GP, Des Spence, said that the system of EBM had been corrupted. “If we don’t tackle the flaws of EBM there will be a disaster, but I fear it will take a disaster before anyone will listen,” he wrote.
How could anyone fault the notion of treatment based on scientifically validated evidence? No one. But the critics of EBM argue heatedly that the standards for the evidence are often low and tainted by commercial or personal interests. Dr Spence accuses drug companies of
manipulating the gold standard to their own benefit. “Today EBM is a loaded gun at clinicians’ heads. ‘You better do as the evidence says,’ it hisses, leaving no room for discretion or judgment. EBM is now the problem, fueling overdiagnosis and overtreatment.”
A number of letters pointed out that, while EBM had its flaws, doctors still need to exercise their clinical judgement. They write the prescriptions, not the drug companies.
Dr Spence was supported by Dr Miran Epstein, a medical ethicist at The London School of Medicine. He writes that “EBM “does not regard polluted information, whether it involves misconduct or not, as a sufficient condition for rendering disclosure inadequate. Thus, it lets informed consent degenerate into a legal fiction and the principle of autonomy into a cynical farce. Worst of all, it is perfectly ethical: being the codified expression of the collective conscience of our medicine, it naturally purports to be moral.”
manipulating the gold standard to their own benefit. “Today EBM is a loaded gun at clinicians’ heads. ‘You better do as the evidence says,’ it hisses, leaving no room for discretion or judgment. EBM is now the problem, fueling overdiagnosis and overtreatment.”
A number of letters pointed out that, while EBM had its flaws, doctors still need to exercise their clinical judgement. They write the prescriptions, not the drug companies.
Dr Spence was supported by Dr Miran Epstein, a medical ethicist at The London School of Medicine. He writes that “EBM “does not regard polluted information, whether it involves misconduct or not, as a sufficient condition for rendering disclosure inadequate. Thus, it lets informed consent degenerate into a legal fiction and the principle of autonomy into a cynical farce. Worst of all, it is perfectly ethical: being the codified expression of the collective conscience of our medicine, it naturally purports to be moral.”
And he was supported by lawyer and ethicist Charles Foster, writing in the Practical Ethics blog. He believes that the editors of journals need the help of a regulator to sift the wheat from the chaff. “Journals can’t do it all. We need a cynical, skeptical, well-funded, well-staffed and ideologically very left-wing regulator. With huge teeth.”
Evidence-based medicine comes under attack
by Michael Cook | 8 Feb 2014 |
tags: commercialization, evidence-based medicine
http://www.bioedge.org/index.php/bioethics/bioethics_article/10841
by Michael Cook | 8 Feb 2014 |
tags: commercialization, evidence-based medicine
http://www.bioedge.org/index.php/bioethics/bioethics_article/10841
Thursday, November 27, 2014
Publication bias distorting evidence base, systematic reviews and clinical guidelines
For decades, the systematic review of published randomised controlled trials has been considered the gold standard in medical research, and this was what the original Cochrane reviewers did.
By combining data from all published trials on a particular subject, researchers are able to see effects in much larger numbers of people than would typically be included in a single trial, in theory making their conclusions more powerful.
In theory. The problem in reality is a small thing called publication bias.
Some trials are simply more likely to be published than others, potentially skewing the results of this kind of meta-analysis.
MJA InSIght, Monday, 14 October, 2013
Jane McCredie: Sharing evidence
Monday, November 3, 2014
"pharma giant used fictitious patient quotes to promote its fluticasone product"
"GLAXOSMITHKLINE is among three companies to be fined for breaches of Medicines Australia’s Code of Conduct after the pharma giant used fictitious patient quotes to promote its fluticasone product, Seretide.
MA said in its July–September quarterly report that the Code of Conduct committee dealt with allegations by Mundipharma that GSK’s promotional material on Seretide was false and misleading.
The committee said that while publishing fictitious patient quotes is itself a breach of the code, GSK had exacerbated its breach by placing the statements in quote marks beside the image of a young woman.
“GSK had agreed during intercompany dialogue to make clear that the statements were not from real patients,” the committee said."
The committee said that while publishing fictitious patient quotes is itself a breach of the code, GSK had exacerbated its breach by placing the statements in quote marks beside the image of a young woman.
“GSK had agreed during intercompany dialogue to make clear that the statements were not from real patients,” the committee said."
Medical Observer,
False claims: Pharma companies fined
Warwick Stanley 3rd Nov 2014
Thursday, August 7, 2014
“In no other area than Sympathetic Surgery, disagreement, conflicting opinion, different definitions and misleading interpretations of the data exist"
8th ISSS Symposium New York, 2009:
“In no other area than Sympathetic Surgery, disagreement, conflicting opinion, different definitions and misleading interpretations of the data exist. Mainly regarding surgical indications, the level and extent of the procedure and results evaluation”.
ATS Expert Consensus for the Surgical Treatment of Hyperhidrosis powerpoint presentation – October 6, 2012, XVI Congreso Boliviana de Cirugia Cardiaca, Toracica y Vascular, Santa Cruz de la Sierra, Bolivia.
http://cirugiadetorax.org/2012/10/09/vats-sympathectomy-for-hyperhidrosis-dr-jose-ribas-de-milanez-de-campos/
or:
https://archive.today/Q047q
Thursday, July 3, 2014
medical procedures are misrepresented in the media
"If your patients rely on the mainstream media for medical advice, they may well think that cancer has been cured many times over, and have other inflated views about the benefits of new treatments and tests.
AND they probably would be shocked to learn about the potential downsides of many medical interventions, let alone costs.
That’s the conclusion of a comprehensive analysis of almost 2000 medical news items published in the US by print, online and television outlets between 2006 and 2013.
It was undertaken by the media watchdog Health News Review, and recently published in JAMA Internal Medicine (5 May, 2014). Most stories were judged unsatisfactory in how they covered the costs, benefits, harms and quality of the evidence supporting the new treatment or test, and how it was compared to alternatives.
“Drugs, medical devices, and other interventions were usually portrayed positively; potential harms were minimised and costs were ignored,” wrote the founder of Health News Review, Gary Schwitzer."
Melissa Sweet, Medical Observer, 24th Jun 2014
Tuesday, June 24, 2014
Lies, Damned Lies, and Medical Science
http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/
Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science. By David H. Freedman"
https://archive.today/bSQNG
Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science. By David H. Freedman"
https://archive.today/bSQNG
Monday, June 16, 2014
Pharma marketing impacts on junior doctor prescribing
JAMA Network | JAMA Internal Medicine | Association of Marketing Interactions With Medical Trainees’ Knowledge About Evidence-Based Prescribing: Results From a National Survey: "A 10-point higher industry relations index was associated with 15% lower odds of selecting an evidence-based prescribing choice (odds ratio [OR], 0.85; 95% CI, 0.79-0.92) (P < .001). There was also a significant association between the industry relations index and greater odds of choosing to prescribe brand-name drugs (OR, 1.08; 95% CI, 1.00-1.16) (P = .04).
Conclusions and Relevance Among physician trainees, our survey showed an association between positive attitudes toward industry-physician interactions and less knowledge about evidence-based prescribing and greater inclination to recommend brand-name drugs. Policies intended to insulate trainees from pharmaceutical marketing may promote better educational outcomes."
Conclusions and Relevance Among physician trainees, our survey showed an association between positive attitudes toward industry-physician interactions and less knowledge about evidence-based prescribing and greater inclination to recommend brand-name drugs. Policies intended to insulate trainees from pharmaceutical marketing may promote better educational outcomes."
Thursday, June 5, 2014
most of the existing literature is geared towards assessing only the effectiveness of the surgical sympathectomy
"Given the fact that most of the existing literature is geared towards a) assessing only the effectiveness of the surgical sympathectomy procedures, and b) publishing only studies with positive results, adverse effects and complications are not systematically reported but rather as a secondary outcome. It seems, therefore, highly likely that the complications as reported here, are truly underestimated.
The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications."
Are We Paying a High Price for Surgical Sympathectomy? A Systematic Literature Review of Late Complications
http://www.jpain.org/article/S1526-5900%2800%2944124-6/abstract
The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications."
Are We Paying a High Price for Surgical Sympathectomy? A Systematic Literature Review of Late Complications
http://www.jpain.org/article/S1526-5900%2800%2944124-6/abstract
Friday, April 11, 2014
Antiviral drug stockpile a waste of money, says study | smh.com.au
Antiviral drug stockpile a waste of money, says study | smh.com.au: "Governments around the globe may have wasted billions of dollars stockpiling antiviral drugs to use against an influenza pandemic, according to a damning review drawing on previously suppressed data.
Australia was one of several countries to stockpile the drugs known as Tamiflu and Relenza, believing they would reduce hospital admissions and complications of influenza, such as pneumonia, in the event of an outbreak of swine or bird flu.
But a review of data from trials involving more than 24,000 people, published on Thursday by the Cochrane Collaboration and the British Medical Journal, concluded the drugs were of only marginal benefit, shortening the duration of influenza symptoms by just half a day.
The review found no good evidence that the drugs prevented the spread of the virus between people, or any of its serious consequences, such as infections. It found Tamiflu increased the risk of psychiatric disturbances, renal problems, nausea, vomiting and headaches."
'via Blog this'
Australia was one of several countries to stockpile the drugs known as Tamiflu and Relenza, believing they would reduce hospital admissions and complications of influenza, such as pneumonia, in the event of an outbreak of swine or bird flu.
But a review of data from trials involving more than 24,000 people, published on Thursday by the Cochrane Collaboration and the British Medical Journal, concluded the drugs were of only marginal benefit, shortening the duration of influenza symptoms by just half a day.
The review found no good evidence that the drugs prevented the spread of the virus between people, or any of its serious consequences, such as infections. It found Tamiflu increased the risk of psychiatric disturbances, renal problems, nausea, vomiting and headaches."
'via Blog this'
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