entrepreneurial medicine - predatory practices: "for any inappropriate care to occur, complicit action on a large scale is required"

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...

It is not appropriate to dismiss inappropriate care | Medical Journal of...

MJA.COM.AU

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.../

Questionable care: avoiding ineffective treatment | Grattan Institute

The courts have become the sole policing body for the medical profession

Major lawsuits, with the major judgments that go with them, may not completely keep negligent physicians from practicing, but they are the one way that currently exists to deter these individuals from practicing their inept brand of medicine. "

Over the years, we have given a lot of thought to why the medical profession adheres to this code of silence. What is it about this profession that causes it to protect its own at the expense of the public?"

Harvey F. Wachsman: Lethal Medicine

Publisher: Henry Holt & Co

why doctors did not react as individuals to such an incomprehensible assertion

“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

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..._id=8674&cat=comment

our ignorance of the mechanisms for primary hyperhidrosis and of the effect of sympathetic ablation

Cell body reorganization in the spinal cord after elective surgery to treat sweaty palms

The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.
http://www.date.hu/acta-agraria/2002-08i/welento.pdf

cross-inhibitory control of various afferent in the spinal cord

In conclusion, our results suggest that cross-inhibitory control by various afferents in the spinal cord may exist in the feet as well as in the contralateral hand. The release of cross-inhibitory control by T3 sympathicotomy results in vasoconstriction and a decrease of skin temperature on the contralateral hand and the feet.

The basic neuronal network for this reciprocal organization is probably located in the spinal level (15). Therefore, the reduction in the contralateral skin temperature may be explained by cross-inhibitory control of various afferent in the spinal cord.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722005/

Contralateral temperature changes of the finger surface during video endoscopic sympathectomy for palmar hyperhidrosis
http://www.ncbi.nlm.nih.gov/pubmed/8832515

"for any inappropriate care to occur, complicit action on a large scale is required" - MJA