Not all doctors believe that honesty is the best policy, according to a new survey published in Health Affairs

Your Doctor May Be Keeping Secrets - ABC News: "Not all doctors believe that honesty is the best policy, according to a new survey published in Health Affairs. When a team of researchers surveyed almost 2,000 physicians nationwide, they discovered a disturbing trend of white coats telling some white lies:

34 percent of doctors don't think they should disclose serious medical errors to patients, and nearly 20 percent said they didn't disclose an error last year for fear of a malpractice case.

Almost two-fifths of doctors don't think they need to share their financial relationships with drug companies to patients.

Just over 10 percent of physicians say they told their patients something that wasn't true in the past year."

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Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.
http://www.peh-med.com/content/3/1/14

Pfizer to Pay Record 23 Billion Fine

Pfizer to Pay Record 23 Billion Fine: "In the largest health care fraud settlement in history, pharmaceutical giant Pfizer must pay $2.3 billion to resolve criminal and civil allegations that the company illegally promoted uses of four of its drugs, including the painkiller Bextra. The other drugs were the antipsychotic Geodon, the antibiotic Zyvox, and the anti-epileptic Lyrica.
Once the Food and Drug Administration approves drugs, doctors can prescribe them off-label for any use, but makers can't market them for anything other than approved uses. Pfizer subsidiary Pharmacia & Upjohn pleaded guilty to a felony violation for promoting off-label uses of Bextra. At the FDA's request, Pfizer pulled Bextra off the market in April 2005 because of its risks."

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Flu Vaccine Increases Risk of Serious Pandemic Flu Illness

Flu Vaccine Increases Risk of Serious Pandemic Flu Illness: "The Canadian press recently broke the story that new research confirms initial findings that the flu vaccine appeared to actually increase people's risk of getting sick with H1N1, and cause more serious bouts of illness to boot.

According to the Vancouver Sun:1

"Researchers, led by Vancouver's Dr. Danuta Skowronski, an influenza expert at the B.C. Centre for Disease Control, noticed in the early weeks of the [2009 H1N1] pandemic that people who got a flu shot for the 2008-09 winter seemed to be more likely to get infected with the pandemic virus than people who hadn't received a flu shot. Five studies done in several provinces showed the same unsettling results."

New Study Confirms: Flu Vaccine Really Does Increase Your Risk of Serious Pandemic Flu Illness"
http://www.abc.net.au/news/2011-03-04/vaccines-may-have-increased-swine-flu-risk/1967508

PFIZER has been fined for breaches of the Medicines Australia Code of Conduct over misleading promotional material

PFIZER has been fined for breaches of the Medicines Australia Code of Conduct over misleading promotional material for the arthritis drug celecoxib (Celebrex) and pneumococcal vaccine Prevenar 13.

The separate complaints resulted in fines of $35,000 and $10,000 respectively and orders to cease using the misleading claims.

The $35,000 fine was imposed for claims about celecoxib contained on the cover of promotional material that implied osteoarthritis caused other conditions, including depression, sleep disorders, neuropathic pain and musculoskeletal pain. The complaint was made by a health professional.

Initially Pfizer was also found to be in breach of the code on another count, for a comparison to oral opioid analgesics. An $85,000 fine was imposed for the two breaches.

Medical Observer, 23rd Jan 2013

after sympathectomy "the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation"

1. Sympathectomy is analogous to the act of killing the messenger. The sympathetic nervous system has the critical job of properly controlling and preserving the circulation in different parts of the body, especially in the extremities. By paralyzing the system, the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation.

Sympathectomy is similar to permanently removing the central heat and air-conditioning system and never replacing it because of malfunction.

Sympathectomy permanently damages the temperature regulatory system. The reason sympathectomy does not cause side effects other than ineffective control of pain as well as impotence and orthostatic hypotension is because it is invariably partial and incomplete.H. Hooshmand, M.D.: Chronic Pain

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9780849386671

Chronic Pain: Reflex Sympathetic Dystrophy Prevention and Management

Hooshang Hooshmand

ISBN 10: 0849386675 / 0-8493-8667-5 

ISBN 13: 9780849386671

Publisher: CRC Pr I Llc

Publication Date: 1993

Binding: Hardcover

German doctors shaken by corruption allegations

BioEdge: German doctors shaken by corruption allegations: "The German Medical Association has investigated nearly 1,000 cases of corrupt doctors over the past few years, according to its president, Frank Ulrich Montgomery.

Dr Montgomery told Der Spiegel that more than half of the case involved alleged bribes from an Israeli pharmaceutical company, Ratiopharm. The doctors were paid for prescribing its drugs to their patients. This was “clearly prohibited”, says Dr Montgomery.

“The Medical Association punished 163 Ratiopharm doctors after state prosecutors made the files available to us,” said Montgomery. He wants the government to pass legislation which would permit the Medical Association itself to conduct searches and confiscate files.

However, this is opposed by health insurance companies. “Corruption is not a minor offence which doctors can regulate amongst themselves,” said an industry spokesman."

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Doctor earning $1m and huge debts: the state of our hospitals

Doctor earning $1m and huge debts: the state of our hospitals: "A MILLION-DOLLAR doctor, thousands of unpaid bills and debts that exceed assets: that's the financial shape of NSW hospitals says the Auditor-General.

Six employees earned more than half a million dollars over the past three years, and one was paid more than $1 million in overtime and call-backs over three years.

The Auditor-General, Peter Achterstraat, said he found it astounding that one person could earn so much overtime."

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Register all trials, report all results – it's long overdue

Register all trials, report all results – it's long overdue: "If researchers go to the effort of getting funds, recruiting patients, and following them up, you would think that they would be keen to publish the results. So it’s surprising that our best estimates show around half of all completed clinical trials have never been published in academic journals. And the half we have is biased towards trials with positive results."

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Perks put patients at risk - claim

Perks put patients at risk - claim: "A SENIOR Geelong Hospital anaesthetist has been accused of putting patients at risk by prescribing a drug he was effectively being paid by a pharmaceutical company to use.

A Fair Work Australia hearing was on Tuesday told Dr Mark Colson reported colleague Dr Simon Tomlinson to the ombudsman in 2007 for accepting business-class flights from Pfizer for him and his family to attend a conference in New York.

Deputy director of anaesthesia at Geelong Hospital Dr Colin Gordon said Dr Colson also alleged the hospital had the highest prescription rate of a drug called parecoxib because of Dr Tomlinson's dealings with Pfizer and that this was ''harming patients and potentially causing patients to die''."

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Mass donor organ fraud shakes Germany | World news | The Guardian

Mass donor organ fraud shakes Germany | World news | The Guardian: "German medical authorities are calling for an extensive overhaul of the country's organ transplant programme after transplant centres across Germany were placed under criminal investigation over allegations that they had systematically manipulated donor waiting lists.

Scores of patients are believed to have been given priority access to donor organs after doctors falsified the severity of their illnesses to ensure they received treatment ahead of other patients in Europe.

The revelations have led to accusations of widespread corruption and dishonesty in the system, and shattered public trust. Since the scandal emerged last year as a handful of cases that were initially believed to be isolated incidents, the number of Germans willing to donate organs has plummeted."

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Dollars for Docs - ProPublica

Dollars for Docs - ProPublica: "Drug companies have long kept secret details of the payments they make to doctors and other health professionals for promoting their drugs. But 12 companies have begun publicizing the information, some because of legal settlements. ProPublica pulled their disclosures into a database so patients can search for their doctor. Accepting payments isn’t necessarily wrong, but it can raise ethical issues."

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in the absence of autonomic arousal, behavior that appears emotional will not be experienced as emotional

"In the presence of a barking dog, for example, the sympathectomized cats manifested almost all of the signs of feline rage. Finally, Cannon notes the report of Dana (1921) that a patient with a spinal-cord lesion and almost totally without visceral sensation still manifested emotionality.
For either the Jamesian or the present formulation such data are crucial, since both views demand visceral arousal as a necessary condition for emotional arousal. When faced with this evidence, James's defenders (e.g., Wenger, 1950; Mandler, 1962) have consistently made the point that the apparently emotional behavior manifested by sympathectomizied animals and men is well-learned behavior, acquired long before sympathectomy. There is a dual implication in this position: first, that sympathetic arousal facilitates the acquisition of emotional behavior, and second, that sympathectomized subjects act but do not feel emotional. There is a small but growing evidence supporting these contentions. Wynne and Solomon (1955) have demonstrated that sympathectomized dogs acquire an avoidance response considerably more slowly than control dogs. Further, on extinction trials most of their 13 sympathectomized animals extinguished quickly, whereas not a single one of the 30 control dogs gave any indication of extinction over 200 trials. Of particular interest are two dogs who were sympathectomized after they had acquired the avoidance response. On extinction trials these two animals behaved precisely like the control dogs - giving no indication of extinction. Thus, when deprived of visceral innervation, animals are quite slow in acquiring emotionally-linked avoidance responses and in general, quick to extinguish such responses." (p. 163)

"A line of thought stimulated by the Wynne and Solomon (1955) and the Hohmann (1962) studies may indeed be the answer to Cannon's observations that there can be emotional behavior without visceral activity. From the evidence of these studies, it would appear, first, that autonomic arousal greatly facilitates the acquisition of emotional behavior but it is not necessary for its maintenance if the behavior is acquired prior to sympathectomy; and second, that in the absence of autonomic arousal, behavior that appears emotional will not be experienced as emotional." (p. 167)

Psychobiological Approaches to Social Behavior

P. Herbert Leiderman, David Shapiro, Harvard Medical School. Dept. of Psychiatry, United States. Office of Naval Research - 1964 - 203 pages

Controversial Surgery for Addiction Burns Away Brain’s Pleasure Center | TIME.com

Controversial Surgery for Addiction Burns Away Brain’s Pleasure Center | TIME.com: "How far should doctors go in attempting to cure addiction? In China, some physicians are taking the most extreme measures. By destroying parts of the brain’s “pleasure centers” in heroin addicts and alcoholics, these neurosurgeons hope to stop drug cravings. But damaging the brain region involved in addictive desires risks permanently ending the entire spectrum of natural longings and emotions, including the ability to feel joy.

In 2004, the Ministry of Health in China banned this procedure due to lack of data on long term outcomes and growing outrage in Western media over ethical issues about whether the patients were fully aware of the risks.

However, some doctors were allowed to continue to perform it for research purposes—and recently, a Western medical journal even published a new study of the results. In 2007, The Wall Street Journal detailed the practice of a physician who claimed he performed 1000 such procedures to treat mental illnesses such as depression, schizophrenia and epilepsy, after the ban in 2004; the surgery for addiction has also since been done on at least that many people."

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