“If doctors make a complaint maliciously, with no real basis, for instance if they’re in competition with another doctor, then that could still leave them open to these sorts of actions”, he said.
MJA InSight has previously reported on doctors misusing mandatory reporting requirements for personal agendas. (4)
http://www.mjainsight.com.au/view?post=defamation-risk-in-reporting-colleagues&post_id=8987&cat=news-and-research
SOME doctors are misusing the new mandatory reporting requirements for their own personal agendas, according to a medical defence organisation and other anecdotal reports.
In a comment article in this week’s MJA InSight, the chief executive officer of Avant, David Nathan, says that a quarter of members’ requests for support on mandatory reporting come from doctors who have been reported to AHPRA. (1)
“Unfortunately, several of these cases involve an undertone of market competition or a personal agenda driving the making of such reports”, Mr Nathan wrote.
Dr Mukesh Haikerwal, chair of the World Medical Association and former president of the AMA, said he was also aware of cases where reports had been made “not in good faith”.
http://www.mjainsight.com.au/view?post=mandatory-reporting-%25e2%2580%259cmisused%25e2%2580%259d&post_id=6941&cat=issue-41-31-october-2011
huge percentages of people who give their informed consent to treatment do not really understand what they have chosen
Informed consent is one of the foundations of bioethical discourse. Bureaucrats have forced doctors and researchers to fill out endless forms in the belief that informed consent will enhance patients’ autonomy.
However, questions are being asked about whether this business of informed consent is really working. In an early online article in the Journal of Medical Ethics, Neil Levy, the Australian editor of another journal, Neuroethics, argues that bioethicists need to rethink informed consent.
Why? Because the lesson of all of modern psychology and of post-modern philosophy is that our rationality is terribly flawed. We are blind to the future consequences of our actions; we are not objective in assessing claims that touch us personally; we overestimate the effects of setbacks on our well-being; we are unreliable in estimating how bad or how good events made us feel. In short, human reasoning is subject to many fallibilities. it seems utterly naïve to think that Yes always means Yes and No always means No. So Levy declares that doctors need to return to paternalism, to some extent:
Somewhat surprisingly, Arthur Caplan, of the University of Pennsylvania, probably the best-known bioethicist in the US, agrees with Levy. In a companion article, he says:
http://www.bioedge.org/index.php/bioethics/bioethics_article/9979#comments
However, questions are being asked about whether this business of informed consent is really working. In an early online article in the Journal of Medical Ethics, Neil Levy, the Australian editor of another journal, Neuroethics, argues that bioethicists need to rethink informed consent.
Why? Because the lesson of all of modern psychology and of post-modern philosophy is that our rationality is terribly flawed. We are blind to the future consequences of our actions; we are not objective in assessing claims that touch us personally; we overestimate the effects of setbacks on our well-being; we are unreliable in estimating how bad or how good events made us feel. In short, human reasoning is subject to many fallibilities. it seems utterly naïve to think that Yes always means Yes and No always means No. So Levy declares that doctors need to return to paternalism, to some extent:
“patient autonomy is best promoted by constraining the informed consent procedure. By limiting the degree of freedom patients have to choose, the good that informed consent is supposed to protect can be promoted…
“autonomy is fundamentally inadequate in healthcare settings and requires supplementation by experience-based paternalism on the part of doctors and healthcare providers…
“A large number of studies have shown that huge percentages of people who give their informed consent to treatment or to their involvement in research do not really understand what they have chosen. Autonomy lives with hope and hope, in the form of the therapeutic misconception, often trumps autonomy.”
Questioning informed consent shakes a pillar of modern bioethics and the call for more benevolent paternalism is sure to face stiff opposition.http://www.bioedge.org/index.php/bioethics/bioethics_article/9979#comments
medics in the UK offering to carry out the illegal procedure on girls
As many as 100,000 women in Britain have undergone female genital mutilations (FGM) with medics in the UK offering to carry out the illegal procedure on girls as young as 10, it has been reported.
Investigators from the Sunday Times said they had secretly filmed a doctor, dentist and alternative medicine practitioner who were allegedly willing to perform FGM or arrange for the operation to be carried out. The doctor and dentist deny any wrongdoing.
The practice, which involves the surgical removal of external genitalia and in some cases the stitching of the vaginal opening, is illegal in Britain and carries up to a 14-year prison sentence. It is also against the law to arrange FGM.
http://www.guardian.co.uk/uk/2012/apr/22/female-genital-mutilation-uk-medics
Investigators from the Sunday Times said they had secretly filmed a doctor, dentist and alternative medicine practitioner who were allegedly willing to perform FGM or arrange for the operation to be carried out. The doctor and dentist deny any wrongdoing.
The practice, which involves the surgical removal of external genitalia and in some cases the stitching of the vaginal opening, is illegal in Britain and carries up to a 14-year prison sentence. It is also against the law to arrange FGM.
http://www.guardian.co.uk/uk/2012/apr/22/female-genital-mutilation-uk-medics
Mandatory influenza vaccination in healthcare professionals? Strong arguments are missing and important risks are taken
As stated previously2, vaccinating HCW would go against the principle of autonomy and restrict the right of HCW in the context that a public health intervention should be proportional to the available evidence on benefits of vaccinating. In this case, it does not seem justified since there is not available a highly effective seasonal flu vaccine3 and grade A evidence about the effectiveness of influenza vaccination among HCW preventing flu morbidity and mortality in patients is nonexistent4. Besides, vaccinating against influenza it is not a universal recommendation and infection has other ways to reach patients, since coverage does not confer herd immunity. Moreover, the unpredictability of their efficacy (there is not always a good match between circulating and vaccine virus strains) must be acknowledged.
http://www.bmj.com/content/344/bmj.e2217/rr/580256
http://www.bmj.com/content/344/bmj.e2217/rr/580256
Canadian trainees could be accused of “battery” for performing pelvic examinations under anaesthesia, say legal analysts
http://www.bmj.com/content/344/bmj.e2426
The reasons why doctors traditionally take so long to question dogma are complex
“I cannot help but wonder how such a situation came to develop… If I had been told by a physician, no matter how senior, that infants don’t feel pain, I would never have believed it. What constitutes the difference between my reaction and that of the thousands of physicians who did believe it?” Jill Lawson, 1988
JILL Lawson was one of the leaders of the parents’ campaign of the mid 1980s to shield infants from surgical pain.
In a letter published in the New England Journal of Medicine she questioned why doctors did not react as individuals to such an incomprehensible assertion.
The reasons why doctors traditionally take so long to question dogma are complex but we are known to be a rather conservative group of people. As late as 1974, experiments were still being conducted to ascertain whether infants felt pain.
http://www.mjainsight.com.au/view?post=charlie-teo-let%E2%80%99s-extend-our-compassion&post_id=8674&cat=comment
JILL Lawson was one of the leaders of the parents’ campaign of the mid 1980s to shield infants from surgical pain.
In a letter published in the New England Journal of Medicine she questioned why doctors did not react as individuals to such an incomprehensible assertion.
The reasons why doctors traditionally take so long to question dogma are complex but we are known to be a rather conservative group of people. As late as 1974, experiments were still being conducted to ascertain whether infants felt pain.
http://www.mjainsight.com.au/view?post=charlie-teo-let%E2%80%99s-extend-our-compassion&post_id=8674&cat=comment
Drug trial results must be made public
A team of public health experts has called for the release of all clinical drug trial results for independent analysis following a “frustrating” three-year battle for access to data on controversial flu drug Tamiflu.
The team, which includes Bond University Professor of Public Health Chris Del Mar, says that in the case of Tamiflu – stockpiled by many countries at enormous cost to taxpayers – drug companies, drug regulators, and public health bodies such as the World Health Organisation have all made discrepant claims about its clinical effects.
Despite a recent review that raised questions about the efficacy of Tamiflu, the drug remains on the World Health Organisation’s List of Essential Medicines.
On several occasions in recent years, health bodies in Japan have raised concerns about the side-effects of Tamiflu after children who were taking the drug apparently committed suicide or harmed themselves.
“We are worried about the side-effects of [Tamiflu], which have been inconsistently reported,” Professor Del Mar said.
http://theconversation.edu.au/drug-trial-results-must-be-made-public-6358
The team, which includes Bond University Professor of Public Health Chris Del Mar, says that in the case of Tamiflu – stockpiled by many countries at enormous cost to taxpayers – drug companies, drug regulators, and public health bodies such as the World Health Organisation have all made discrepant claims about its clinical effects.
Despite a recent review that raised questions about the efficacy of Tamiflu, the drug remains on the World Health Organisation’s List of Essential Medicines.
On several occasions in recent years, health bodies in Japan have raised concerns about the side-effects of Tamiflu after children who were taking the drug apparently committed suicide or harmed themselves.
“We are worried about the side-effects of [Tamiflu], which have been inconsistently reported,” Professor Del Mar said.
http://theconversation.edu.au/drug-trial-results-must-be-made-public-6358
most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures they perform
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 (ASERNIP-s): No excuse for poor surgical outcomes
MJA INSIGHT, 8 August 2011
sympathectomy cannot by direct effect on the muscle vessels either abolish or lessen claudication
http://pmj.bmj.com/content/29/335/459
serious misrepresentation of both the effectiveness and safety of the drug
The results were published in 2001 by Keller et al. in the journal article, “Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial”, in the Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP). The article concluded that “paroxetine is generally well tolerated and effective for major depression in adolescents”.
This was a serious misrepresentation of both the effectiveness and safety of the drug. In fact, when SKB set out their methodology for their proposed study protocol, they had specified two primary and six secondary outcome measures. All eight proved negative, that is, on none of those measures did children on paroxetine do better than those on placebo.
The published article misrepresented one of the primary outcomes so that it appeared positive, and deleted all six pre-specified secondary outcomes, replacing them with more favourable measures.
SKB papers also revealed that at least eight adolescents in the paroxetine group had self-harmed or reported emergent suicidal ideas compared to only one in the placebo group. But these adverse events were not properly reported in the published paper. Instead, some were described as “emotional liability” while others were left out altogether.
http://theconversation.edu.au/insight-into-how-pharma-manipulates-research-evidence-a-case-study-4071
This was a serious misrepresentation of both the effectiveness and safety of the drug. In fact, when SKB set out their methodology for their proposed study protocol, they had specified two primary and six secondary outcome measures. All eight proved negative, that is, on none of those measures did children on paroxetine do better than those on placebo.
The published article misrepresented one of the primary outcomes so that it appeared positive, and deleted all six pre-specified secondary outcomes, replacing them with more favourable measures.
SKB papers also revealed that at least eight adolescents in the paroxetine group had self-harmed or reported emergent suicidal ideas compared to only one in the placebo group. But these adverse events were not properly reported in the published paper. Instead, some were described as “emotional liability” while others were left out altogether.
http://theconversation.edu.au/insight-into-how-pharma-manipulates-research-evidence-a-case-study-4071
Sympathectomy useless, even detrimental
A number of surgical procedures have been developed, which, although well-intentioned, are found unfortunately by further study to prove useless, or even detrimental. It is believed at present that lumbar sympathetic ganglionectomy in the treatment of the post-thrombotic type of ulceration of the lower extremity should be placed in this category.
http://archsurg.ama-assn.org/cgi/content/summary/67/1/2
http://archsurg.ama-assn.org/cgi/content/summary/67/1/2
Aniello Iannuzzi: Conflict of power
The third, mostly unspoken, category of conflict is power, and the most obvious example is committees.
Committees are the fastest growing things in health care — teamwork, collaboration, consultation, liaison, planning, strategy, development, review are just some of the buzzwords used to justify downing tools and having a yak.
We can’t just blame government for this — have a look at how many committees the AMA has created.
Many committees are very influential. A number have remuneration and benefits attached, not to mention the time off work. They can also offer the natural companion of power — prestige.
The appointments to these committees are often driven by politics, connections and geography rather than by merit.
http://www.mjainsight.com.au/view?post=aniello-iannuzzi-conflict-of-power&post_id=8543&cat=comment
Committees are the fastest growing things in health care — teamwork, collaboration, consultation, liaison, planning, strategy, development, review are just some of the buzzwords used to justify downing tools and having a yak.
We can’t just blame government for this — have a look at how many committees the AMA has created.
Many committees are very influential. A number have remuneration and benefits attached, not to mention the time off work. They can also offer the natural companion of power — prestige.
The appointments to these committees are often driven by politics, connections and geography rather than by merit.
http://www.mjainsight.com.au/view?post=aniello-iannuzzi-conflict-of-power&post_id=8543&cat=comment
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