Sunday, February 26, 2012

Friends of Science in Medicine: Hypocritical call to action

Update: 17-Jul-2012: There is now considerable blowback from the Medical Community towards Dwyer and his "little Friends". The MJA [Medical Journal of Australia, behind a paywall] of 16-Jul had multiple articles on this topic.

From a report on the Editorial and associated articles.

Professor Stephen Myers, SCU [Southern Cross University]:
“the real benefit of an appropriately mentored and approved university education is the exposure of students to the biomedical sciences, epidemiology and population health, differential diagnosis, safe
practice and critical appraisal."
Professor Paul Komesaroff, Monash University, on MacLennan's MJA in editorial in March-2012:
“exceed the boundaries of reasoned debate and risk compromising the values that FSM claims to support”.
Professor Komesaroff:
"while there was now an extensive evidence base in relation to complementary therapies, the concept of evidence-based medicine was highly contested and debated within Western medicine itself." 
"It is not appropriate for doctors or scientists with a particular view of medicine to impose those views on the whole community; rather, they should respect the rights of individuals to choose the approach to health care they feel is suitable for them." 
“It is important that those who seek to be friends of science do not inadvertently become its enemies. We call on the members of FSM to revise their tactics and instead support open, respectful dialogue in the great spirit and tradition of science itself”

In writing an inadvertently long piece on the Irrelevance of Marron and Dwyer's "Friends of Science in Medicine", I had to reflect on what what a convincing "short version" would be. Here's an attempt:
  • Dwyer, as a respected and long-serving medico, has to be aware of the estimated 18-35,000 preventable deaths in Australian Hospitals each and every year. [1995 QAHCS report, disputed.]
  • He must also be aware of the lack of good data on Adverse Events (AE) and Iatrogenic Injuries.
  • Similarly, the extra $2B/year estimated additional cost of treating AE's in hospitals.
  • He should also be aware of Dr Brent James reports (2001) from Intermountain Health, Utah, that only "3.5% (of patient injuries) resulted because of a human error" and from the APSF report on Iatrogenic Injuries (2001)  "The causes of iatrogenic injury appear to be systemic".
  • There is also a 2004 report on the effects and additional preventable deaths from overcrowding in Accident and Emergency. 
All of which could be used to suggest by Dwyer and friends:
Australian Medicine and Hospitals do very well in the face of insurmountable odds and lack of Political will and funding. [A justification used by AMA President Rosanna Capolingua in 2008, below.]
Only it isn't so...
Compare the complete lack of an Evidence Base for Patient Outcomes for Australians and any coherent, credible, co-ordinated plan to address this with the UK's Civil Aviation Authority's current Safety Plan
Secondly, Dr Brent James reported a 20% reduction in costs by reducing Patient Injuries through a "Do it Right, First Time" approach to Quality. This corresponds with the 2002 results from Ehsani, Jackson and Duckett. As Berwick suggests, organisational change is required to address systemic issues. Unless the system is changed, results won't change.
The CAA's Safety Plan [excerpted below] conspicuously shares a feature unknown in Australian Medical literature and seemingly in Hospital improvement plans: The Most Important Problems List.

The CAA has its "Significant Seven" and Dr James his "Bg Six List".
These seem unknown and unreported in Australian Hospitals and Health Department Plans and Operations.

Where this line of reasoning leads to:
After 50 years of large jet aircraft being used in Commercial Aviation, 'we' know exactly what has to be done to economically achieve good, reliable and safe Public Services, so why isn't this approach being advocated and adopted by Medicos and Hospitals?
From Dr. James, we also know that it is cheaper to fix systemic issues through a "Get it Right First Time" Quality approach, so after more than a decade of being known in Australia is this not being done?
How many "Adverse Events" are there in the Australian Hospital system? We don't know.
But the best evidence available is that they are not reducing. [below]
The most conservative estimates, "Sentinel Events", counts around 270 adverse events/year.
The QAHCS report estimated 18,000, the difference being direct, provable causality.
While the Australian Doctors Fund (ADF) would like us to use the American UTCOS report figure of 3.3 times less, of ~5,500 per year.

From Dr. James definitive work, the number of patient injuries is around 30 times the number of Adverse Events reported, reasonably 165,000 per year.

So why isn't Prof. Dwyer advocating and campaigning for the Medical Profession in Australia to adopt known, effective Evidence-Based Systems for itself preventing thousands of deaths, eliminating hundreds of thousands of injuries and reducing needless waste, rather than what appears to be a distracting side-show of "look at all those Bad Guys over there!".

This is the nub of his hypocrisy: Everyone else is doing it wrong, but we are beyond reproach.

From the UK CAA's Safety Plan 2010-2013:
The CAA ‘Significant Seven’ safety issues were identified following analyses of global fatal accidents and high-risk occurrences involving large UK commercial air transport (CAT) aeroplanes. 
This Plan has been developed by the CAA in partnership with industry because although the CAA has a safety oversight responsibility, industry has prime responsibility for managing their safety risk. 
We are taking a proactive approach to safety and our Plan is outcome focussed with great emphasis on safety performance. 
 We must deliver results that make a measurable difference, and ensure that we make the very best use of our available resources. 
‘Significant Seven’ Safety Issues (in priority order)
 1. Loss of Control
 2. Runway Excursion
 3. Controlled Flight into Terrain
 4. Runway Incursion
 5. Airborne Conflict
 6. Ground Handling
 7. Airborne and Post-Crash Fire 
Key Capabilities Required for the Total Aviation System
 * Integrated Safety Risk Management Process
 * Continuing Airworthiness
 * SMS [Safety Management Systems]
 * Just Culture
 * Human Factors
 * Performance-Based Oversight
 * Fatigue Risk Management Systems
 * Total System Threats

"The incidence and cost of adverse events in Victorian hospitals 2003–04", Ehsani, Jackson, Duckett. MJA 2006; 184: 551–555
During the designated timeframe, 979 834 admitted episodes were in the sample, of which 67 435 (6.88%) had at least one adverse event. 
Patients with adverse events stayed about 10 days longer and had over seven times the risk of in-hospital death than those without complications. 
After adjusting for age and comorbidity, the presence of an adverse event adds $6826 to the cost of each admitted episode. 
The total cost of adverse events in this dataset in 2003–04 was $460.311 million, representing 15.7% of the total expenditure on direct hospital costs, or an additional 18.6% of the total inpatient hospital budget.

Medical Errors Australia on "Needless Deaths":

quote from:

"The Quality in Australian Health Care Study", Wilson, Runciman, Gibberd, Harrison, Newby and Hamilton. MJA 1995; 163: 458-471

A review of the medical records of over 14,000 admissions to 28 hospitals in New South Wales and South Australia revealed that 16.6% of these admissions were associated with an “adverse event”, which resulted in disability or a longer hospital stay for the patient and was caused by health care management; 51% of the adverse events were considered preventable. In 77.1% the disability had resolved within 12 months, but in 13.7% the disability was permanent and in 4.9% the patient died.

Australia-wide estimates
The number of patients dying or incurring permanent disability each year in Australian hospitals as a result of AEs is estimated to be:
18 000 deaths (95% CI, 12 000–23 000);
17 000 (95% CI, 12 000–22 000) cases with permanent disability (> 50%); and
33 000 (95% CI, 27 000–37 000) cases with permanent disability (< 50%).
There are estimated to be 280 000 (95% CI, 260 000–310 000) AEs resulting in temporary disability.

Hospital deaths not decreasing: new study

Wednesday, 22 December 2004

The number of fatal accidents in South Australia's hospitals is not decreasing despite greater knowledge of how they occur, according to new research at the University of Adelaide.

The findings are contained in a thesis written by PhD graduate Dr Carol Grech in the University of Adelaide's Department of Public Health.

Dr Grech found that many solutions have been proposed over the years to reduce the incidence of fatal errors in South Australia's hospitals, to little effect.

"The Coroner regularly and repeatedly identifies the same factors underlying fatal adverse events," she says.

"Despite this knowledge, and the fact that many adverse events are predictable and preventable, there is little evidence that the incidence of medical fatalities is appreciably declining.

"If government and health bureaucrats are serious about preventing fatal adverse events, then significant attention needs to be given to implementing recommendations handed down by the Coroner."

"Consumers of health care services, as well as those who work in the health system, are deserving of a safer hospital system," Dr Grech says.

"Recommendations arising from impartial, transparent and objective inquiries into hospital-related fatalities have the potential to improve public health by ensuring a safer healthcare system," she says.

"This is conditional, of course, on intended recipients of such recommendations actively learning from the findings and translating this knowledge into policies that are embedded into clinical practice."

If this does not occur, Dr Grech says, the government should either amend the Coroner's Act or consider abolishing the office.

The aim of Dr Grech's research was to establish whether the Coroner's findings have contributed to quality improvement in hospitals.

Politics and publishing: the Quality in Australian Health Care Study

"In medical research, the real news is the evidence, not the public claim" [disputing the QAHCS]

MJA 1995; 163: 453-454

Reducing the Incidence of Adverse Events in Australian Hospitals: An Expert Panel Evaluation of Some Proposals, 2007, Professor Jeff Richardson, Foundation Director, Centre for Health Economics, Monash University

The aim of this paper is to demonstrate a method for identifying policy options for reducing adverse events in Australia’s hospitals, which could have been adopted, but was not adopted, in the wake of the landmark 1995 ‘Quality in Australian Health Care’ study, and to indicate the lapse time before these measures could be expected to have a major effect.

... expertise, position and publications in the area of adverse events and quality assurance. Forty-one options were identified with an average lapse time of 3.5 years. Hospital regulation had the least delay (2.4) years, and out of hospital information the greatest (6.4 years).

Following identification of the magnitude of the problem of adverse events in the ‘Quality in Australian Health Care’ study a more rapid response was possible than occurred. Viable options for reducing adverse events remain.

[The Australian Doctors Fund is making a case for using the American UTCOS report of 3.3 times fewer 'adverse events' than QAHCS.]

Quality in Australian Health Care Study: Examined OR Exposed?

Stephen Milgate
Executive Director
Australian Doctors' Fund
25 February 2003

"In medical research, the real news is the evidence, not the public claim."

References and quotes:
The Medical Journal of Australia, Vol 163, 6 November 1995
"The idea that every time there's an injury we write a rule, that just makes the world so hopelessly complex, it would probably increase injury rates." 
Minimising Harm to Patients in Hospital. Broadcast Monday 1 October 2001. Radio National. With Dr Brent James, Executive Director of Intermountain Health Care in Salt Lake City, Utah. 
"Most adverse events referred to are systems problems and not the failings of an individual clinician."

A year after the QAHCS was released a virtually identical US study, Utah-Colorado Study (UTCOS) with dramatically different results for the same base year, was published by the very reputable Harvard School of Public Health.

This forced the Federal Government to commission the Harvard School of Public Health to investigate why QAHCS and UTCOS had produced such a wide discrepancy in results using identical methodology.

In response, the Harvard School of Public Health and others producedtwo papers, A comparison of iatrogenic injury studies in Australia and the United States 1: Context, methods, casemix, population, patient and hospital characteristics and A comparison of iatrogenic injury studies in Australia and America 11: Reviewer behaviour and quality of care.

These studies were embargoed and not published until 1999 when they finally appeared in the International Journal for Quality and Health Care.

1977USReport on the Medical Insurance Feasibility Mills DH
1991USHarvard Medical Practice Study (HMPS)
1995AUSTQuality in Australia Health Care Study (QAHCS)
1999USCost of Medical Injuries with Utah and Colorado (UTCOS)
1999US/AUSTA Comparison of Iatrogenic Injuries in Australia and America
1999US/AUSTA Review of Behaviour and Quality of Care
2001AUSTIatrogenic Injury in Australia

"Brent James: Injuries, Those were injuries, those 3,996. The fascinating thing was the overlap. Among 3,996 confirmed injuries, 138 or 3.5% resulted because of a human error."

Minimising Harm to Patients in Hospital. Broadcast Monday 1 October 2001. Radio National. With Dr Brent James, Executive Director of Intermountain Health Care in Salt Lake City, Utah.

"Most problems result from a sequence of system failures rather than a single mistake by an individual."

Data for Action, A key to safer health care, Safety and Quality Council, 1/8/01.

"The causes of iatrogenic injury appear to be systemic. The remarkable constancy of pattern across the Australian and US health care systems for serious injuries bears witness to the fact that despite all of the differences in structure, training and practice, similar patterns of iatrogenic injury are observed."

Iatrogenic Injury in Australia. A report prepared by the Australian Patient Safety Foundation, WB Runciman, October 2001, p 106

"I believe the system is much more often responsible for problems than individual practitioners."

Dr Ross Wilson, Radio National ABC, 7 July 1997. [QACHS]

Brent James: ... For example, my current Big Six list, this is based upon expert opinion, so it's probably going to get changed.

An examination of real time adverse events in hospitals in the US reveals the likely source of the underlying patterns of adverse events which exist almost uniformly across the system.

1. Adverse drug events and drug reactions (in many cases a first time unpredictable reaction)
2. Hospital acquired infections
3. Bed sores or pressure sores
4. Venus thromboembolism
5. Patient falls
6. Blood product transfusions

Minimising Harm to Patients in Hospital.

If a three-month prognosis is included in a study of adverse events the results change dramatically.

"However, after considering 3-month prognosis and adjusting for the variability and skewness of reviewers' ratings, clinicians estimated that only 0.5% (95% CI, 0.3%-0.7%) of patients who died would have lived 3 months or more in good cognitive health if care had been optimal, representing roughly 1 patient per 10,000 admissions to the study hospitals."

"Conclusions: Medical errors are a major concern regardless of patients' life expectancies, but our study suggests that previous interpretations of medical error statistics are probably misleading. Our data place the estimates of preventable deaths in context, pointing out the limitations of this means of identifying medical errors and assessing their potential implications for patient outcomes."

Estimating Hospital Deaths Due to Medical Errors, Preventability is in the Eye of the Reviewer, Australian Medical Journal, 25 July 2001.

The number of deaths from adverse events are in the eye of the beholder.

"ABS data suggest 88.5 deaths per year can be attributed to adverse events as a direct underlying cause of death, but this increases to 2,678 deaths per year if you count where an adverse event may have contributed to their death. On the other hand, extrapolation of coronial data suggests approximately 700 patients may suffer an adverse event that contributes to their death each year, while the results of the Quality in Australian Health Care Study suggest a range between 8,600 and 18,000 deaths per year."

Media Release. Data for Action: A key to safer health care.
Safety and Quality Council. 8 August 2001.

"The figure most often quoted by the media is from the Quality of Australian Health Care Study, which reported and adverse event rate of 16.6 per cent associated with hospital admissions. However, reanalysis of the study following the methods of a similar study in the US found that the Australian and US studies had a virtually identical rate of serious adverse events – about 2 per cent of cases (1.7 per cent leading to serious disability and 0.3 per cent to death). It is thought that overall, about 10 per cent of hospitals admissions in Australia and other developed countries are likely to be associated with an adverse event. Most of these are simple problems."

First National Report on Patient Safety. Safety and Quality Council. August 2001.


In the eight years since the QAHCS was first published, the priorities in improving the quality of health care and making medical treatment safer are now just being heard above the headlines of "18,000 people killed each year from medical mistakes".

Remarkably the identified problem areas have been known for many years.

Any one of them could have been nominated by any active experienced medical practitioners over the last 20 years.

There is a strong desire among all professionals in the health care system to strive for greater quality and safer care.

However, a desire and good will is not enough.

There are currently 230 million transactions between the medical system and patients each year in Australia.

Health care systems are expensive and medical intervention, particularly in the frail and elderly, is high risk and becoming riskier.

A safer health care system will certainly add costs to health care and those costs eventually have to be born by those who demand a safer and better system.

Don't put faith in hospital care, expert warns
From: The Australian October 28, 2008 12:00AM

PATIENTS need to ditch the "it'll be right" attitude to hospital visits and take more responsibility for their own care, a health expert says.

It has been widely accepted for the past decade that about one in 10 Australian patients will have something go wrong during a hospital visit, University of NSW Institute of Health Innovation director Jeffrey Braithwaite said.

Australian Medical Association president Rosanna Capolingua said the reason things were more likely to go wrong in hospitals now than in the past was because the system was underfunded.

“Sure, patients do have a role in self-responsibility but I don't think it can be matched with the role that the system has in responsibility to the patient,” she told AAP.

“Things are more likely to go wrong in hospitals because the system is underfunded, stretched and under pressure and then there are system failures that occur.”

[data, sources]

From: Medical Error Stats

New report says 1500 people die each year in Australian public hospitals because of overcrowding
A UNSW report for the Australasian College of Emergency Medicine also states that Perth’s big hospital emergency departments were the worst in the country for overcrowding.
Source: "Dying risk up 30% in crowded hospitals," The West, 10.09.08.

Dying risk ‘up 30pc in crowded hospitals’ [via Internet Archive]
10th September 2008, 6:00 WST

People who need treatment in Perth’s overcrowded hospital emergency departments face as much as a 30 per cent higher risk of dying,a national summit on hospital overcrowding will warn this week.
A University of NSW report for the Australasian College of Emergency Medicine meeting in Melbourne on Friday estimates more than 1500 people die in Australia’s public hospitals each year because of overcrowding.

Australian Medical Association WA emergency medicine spokesman Dave Mountain, who will speak at the summit, said WA faced some of the worst levels of overcrowding and the situation had reached critical levels in Perth hospitals in recent weeks.

Monday, February 20, 2012

Friends of Science in Medicine: Irrelevant and Inconsequential?

Peter Jean, Health Reporter for the Canberra Times, wrote a good piece (clear, informative, balanced) about FoSiM, Sunday 19th Feb, 2012: "Accessing the Alternatives".


In researching a follow-on piece to Peter Jeans', I took 4,500 words of notes - without covering anywhere near the number of topics I wanted to bring together. I wrestled with:
a) how to meaningfully condense such a wide field, and
b) Just what is the story here?

This piece is in several parts:
  • an introduction,
  • a quick assessment of FoSiM and their likely future,
  • some specific observations on FoSiM and
  • the part of my research that really disturbed me - the 2005 Queensland Public Hospitals Commission of Inquiry, including but far from limited to, the actions of Jayant M. Patel, "Doctor Death" of Bundaberg.
The crux of my dismay and discomfort with FoSiM, Marron and Dwyer is their outrageous attack on a relatively benign and low-impact Healthcare Services ("Complementary and Alternative Medicine" [CAM]), whilst ignoring massive, real and pervasive fundamental problems with mainstream Medical Healthcare.
FoSiM, Marron and Dwyer are asking us to shutdown and prevent from practicing those who account for under 1% of Medical fatalities and errors, whilst comprehensively ignoring the major problems. What is going on here???
Compare FoSiM and MEAG: The Medical Error Action Group started in 1992 after an avoidable, severe medical outcome to a family member ('the needless death of ...'). They've since gone on to document and support many injured parties.

Marron has taken it upon herself to:
a) pursue action on behalf of others, those whom she doesn't even know, and
b) presumes to appoint herself Judge and Jury of Everybody Else, whilst not just turning the same searchlight on the most dangerous and outrageous Medical Practitioners, but the opposite: trumpeting them as exemplars of Best Practice and Science.

It is more than ironic that the most documented example of a failed healthcare system is in Marron's home state, Queensland.

This isn't simple bias, but something much deeper and much more sinister...
Why didn't Marron join one of the long-established groups to pursue her aims of Medical Reform?

Just to show this isn't limited to Queensland or Victoria, from NSW, the recent Grace Wang injury - a young mother permanently disabled in a preventable, foreseeable repeat incident - that has not led to an Inquiry or personal consequences to those responsible. How has this simple error leading only to permanent disability or death, been allowed to be repeated with apparent impunity?

Criticism is all too easy and so very simple, but where's the proof that something better is possible?
The sort of systemic and fundamental changes that FoSiM and its supporters should be putting their considerable energy and time into supporting and furthering?

More than 5 years before Patel fled the country in disgrace, the following piece was broadcast nationally. There is no excuse for any Medical practitioner or Medical Administrator to not be fully cognisant of the proven/demonstrated methods, contents and claims from one of the their own:

Dr Brent James, Intermountain Healthcare: Minimising Harm to Patients in Hospital", (2001).
It reports definitive results of a "Do it Right, First Time" approach to Quality, and
the prior major US report "To Err is Human: Building A Safer Health System" (1999).

A 1996 article on the topic by Donald A. Berwick, from the British Medical Journal, is referenced with excerpts at the end.

To underline the bias and misguided intent, excerpts from the FoSiM "Invitation" letter recruiting supporters [including comments, thusly]:
Our Vision Statement:
"To reverse the current trend which sees government-funded tertiary institutions offering health care ‘science’ courses not based on scientific principles nor supported by scientific evidence”.
[Note: this doesn't acknowledge the serious problems within mainstream Medical Healthcare, nor that they are the overwhelming danger to patients.]
We hope to provide the voice of reason and credibility to help the public make informed choices in medical care and not be subjected to false claims of efficacy nor take unnecessary risks of harm from unproven therapies or from delay in seeking proven treatment.
[Note: removing everything after 'from unproven ...' changes this to a credible and laudable sentiment or aim.]

Friends of Science in Medicine:

Loretta Marron, CEO and the apparent Power behind the Throne, is the medical equivalent of Pauline Hanson: industrious, opinionated, loud, self-promoting - and ultimately mostly irrelevant.

Prof. Dwyer and his other "Executives" are all well-known, reputable medical scientists and academics with an axe to grind. It appears they are upset that they don't control or regulate every aspect of Medicine, mainstream and Alternative. Appearing so very "50's" and "Doctor knows Best".

FoSiM is poorly organised, lacks PR skills (no website or verifiable email address), possibly is unfunded and run by "a one-(wo)man band" and hence unable to effectively lobby politicians, commission expert reviews or reports, respond or initiate litigation - all the normal and required activities of a real Lobby Group. Perhaps their intention is to gain notice/notoriety, and then leverage that into financial support. Not unlike the "Association of Australian Retailers" being funded by Big Tobacco.

FoSiM are incredibly naive politically and misguided in their approach. They cannot stop the advance of Complementary and Alternative Medicine now, any more than they can command the sea to turn back. 40-50 years ago, they may have stood a chance, but that opportunity is long gone.

If FoSiM have real concerns about public Health Services and standards, not just running a Power Play or shamelessly self-promoting themselves, Dr Hambleton, in Peter Jean's piece, gives them a very precise recipe to achieve real, lasting change [my paraphrasing]:
work with, not against, the alternative practitioners that the public have demonstrated they prefer to mainstream medicine.
To reverse the trend away from Mainstream Medicine, positive attributes must be demonstrated to draw the public back, not throw mud at the perceived opposition. (Throwing mud is never a good tactic, you can never get away clean.)

Hurling accusations, insults, abuse and belittling or denigrating comments around is easy and attracts media coverage. It has given Marron and her projects a public profile.
But if anyone decides to ask FoSiM for the same Evidence of Claims they require of others, it isn't going to be pretty.
There's the risk of Defamation actions, Class Actions from harassed groups (starting with injunctions on media comments) and even an ACCC action under "false or misleading advertising".
Spouting off in the press its "pseudoscience" or "voodoo and witchcraft" is one thing, defending that claim with proof, either academically or legally, is another.

There have already been two recent successful actions in Australia against those attacking CAM practitioners and their practices. Thinking that the recent Simon Singh case (vs UK Chiropractors) gives legal immunity is bizarre and incredible.
The final ruling of "Lord Judge" is clear and specifc: Libel cannot be held in Scientific debates.
Making unproven statements in the general press by non-scientists, or those not engaged in true "scientific debate", rather character assassination etc, won't be protected.

Friends of Science in Medicine is as irrelevant and inconsequential to the Healthcare Services debate as "One Nation" is now to Australian Politics.

I don't know if they will become the same laughing stock, but I expect like them, they will attract rabid followers and the attention by "shock-jocks" and tabloid media. Cheap shots and stunt-media always get ratings.
Plus you'd have to wonder if like "One Nation", people of the calibre of David Oldfield will move in and use FoSiM to further their own careers, pursue their own aims/agendas, damaging organisational credibility and undermining their goals.

None of which will create lasting change, but will cause grief to the groups and individuals they choose to target and a lot of stirring copy in the media.

Which raises the question: Is this group (FoSiM) prepared or able to defend itself from media or legal campaigns directed against it? They are picking a fight, but do they know they can win it?

FoSiM have uncertain staffing and funding, no political and media experience, appear poorly organised, but worst of all, don't have a clear agenda or set of goals - no simple, defining purpose, and seemingly just for fun have decided to grab a sleeping tiger by the tail and shake it up.
For me, it would be an incredibly problematic organisation to have my name publicly linked with.

As soon as "a line is crossed" and there is public outcry with an investigation by the 'serious' (not tabloid) media, many of the FoSiM "supporters" will realise the implications of FoSiM's full agenda and probably flee. Focussing the spotlight on the "rusted on" adherents and leaving the Association officials to carry the can and defend themselves.

A very uncomfortable, costly and unflattering position for anyone to find themselves in.

Some observations on the FoSiM goals:
  1. Any call for Science in Medicine is fraught for mainstream medical practitioners. If the spotlight is turned on them and they are required to provide Evidence of Competency themselves, even expected to practice "Real" Quality, their life will get much more difficult. This is a dangerous double-edged sword that can rebound and inflict more damage on those wielding it.
  2. This appears solely to be a turf war. Since the 1950's Doctors have lost their high-standing in the community and automatic respect from the public. They are no longer "King of Castle" and are resentful of interlopers claiming their patients. Respect and Trust cannot be demanded, they must be earned and actively maintained. Doctors have lost the unquestioning confidence of the public, who decided to look elsewhere for compassionate, engaged care. They've created this problem themselves and have to actively address it to win back at some public support.
  3. This is mostly about money. Doctors don't practice solely for the love of it. GP's are small businesses who collectively try to both defend their income and look for ways to increase it.
    If this aspect isn't acknowledged and discussed openly, the whole debate will become very murky indeed.
  4. There is a real problem under all this: vulnerable people are conned all the time. They want to believe in miracles, snake-oil and panaceas and resist all attempts to be warned or enlightened.
    This isn't a recent phenomena, nor confined to Medicine of any description.
    Any approach addressing this has to work across the entire Healthcare Services area.
    There are two sides to the equation: Client and Practitioner.
    FoSiM appears to be advocating for a unilateral approach: Ban the Bad Guys (practitioners).
    The 1920's "Prohibition" in the USA and the current "War on Drugs" shows that you can't just legislate problems away. This simplistic approach of FoSiM will not work - there is overwhelming evidence of this, which makes you wonder what sort of 'Scientists' these folks are.
    What's needed is a bi-lateral approach, with the public getting information, support, and training on avoiding and dealing with crooks and frauds, and all Medical practitioners having incentives to keep their own disciplines "clean" and report any suspect activity, especially not try to "deal with this in-house" or attempt cover-ups.
  5. The Internet is a searchlight that illuminates dark corners everywhere.
    FoSiM should be calling for a definitive on-line wikipedia-style 'register', not registration, of all Health Practitioners. It would allow the relatives and friends of people entrapped by shonks of any kind (including AHPRA registered and certified) to uncover warning signs and to warn-off others.
    People in the thrall of a conman cannot, and will not, hear anything against them until they are ready to accept it.
  6. Mainstream Medicine gets a "free pass" from the ACCC with their business model.
    They don't have to refund the cost of "failing to provide the service advertised" as does every other retail business.
    Currently, we have the PIP implants scandal - implicitly advertised as "safe" because of the regulatory approval. The devices "failed to provide the advertised service" (be safe), so in any other business, the women would have the right both to a full refund, but free removal.
    The same goes for incorrect diagnoses and missed conditions: at least all the "second opinions", tests and treatments paid for by the client pre-correct diagnoses/treatment should be automatically refunded.
    If Doctors wish to enforce Accountability on others, they should be prepared to give up their privileged position and join the rest of us in ordinary business.
  7. What s Loretta Marron's motivation? I cannot understand her complaining and campaigning about other people's problems when she is not a Healthcare Practitioner of any type.
    If she is looking for a way to usefully fill her time in retirement, this is not constructive or helpful.
    Only in movies and comic books do people need "Super Heroes" to look after them and defend them from the ranged Forces of Evil. Adults in the real world need Information, Training and Support - not being "stood up for" by some self-appointed 'guardian'.
    There is a word for this in law-enforcement: Vigilante.
    In other times, a village would deem these the actions of an interfering gossip.
  8. Loretta Marron, interview on 4BC and her constant untested accusations of "voodoo and witchcraft", seemingly against all CAM (as MP3). Love her or hate her, you need to hear the lady in her natural element. I found it hugely ironic that she was preening herself over being the first person ever to be recipient of dual "Australian Sceptic of the Year" awards (2007, 2011) - an self-appointed organisation built on judging others and requiring evidence but the antithesis of "open and transparent" themselves. All while she threw nothing but untested, unproven accusations and innuendo around. One standard for her, another for everyone else...

Queensland Public Hospitals Commission of Inquiry, 2005:

While the site for the Davies Queensland Public Hospitals Commission of Inquiry is still on-line, that for its immediate predecessor, Morris' Bundaberg Hospital Commission of Inquiry is not, existing only in The Internet Archive.

Initially I was going to start this piece with this bunch of aphorisms relevant to FoSiM and their performance and bias:
  • "by their actions you will know them"
  • "ends must match the means"
  • "first remove the log from your own eye"
  • be unreproachable, a prerequisite for Credibility, "first, get your own house in order"
  • to comment or adjudicate on an issue, you can't have an interest. i.e. "I don't have a dog in this fight".
    • Medical practitioners can't directly judge another field: they have an inherent Conflict of Interest.
    • hence, they should be asking for an Independent body to be set up to do a review.
  • FoSiM's approach is attack-only, the tactic of "wedge politics". It's:
    • divisive and destructive only, not about finding solutions. It isn't about "best serving the community together", but annihilation of the enemy/opposition.
    • all modalities and all practitioners are "tarred with one brush" by FoSiM.
      Patently, not true, there are some extremely good 'Evidence based' practitioners and disciplines out there, probably the overwhelming majority of CAM practitioners.
While these are still relevant and appropriate, indicating that FoSiM, Marron and Dwyer are being driven by a hidden agenda, I was derailed by the next thought:
Just how Professional are Mainstream Medical Practitioners? (could they really withstand a serious Inquiry?)
For example Jayant Patel (JMP), "Doctor Death" of Bundaberg.
Reading the ~550 pages of the Davies Inquiry report I was struck by many things:
  • The only reason there was ever an Inquiry is that a single nurse, Toni Hoffman, sacrificed her career by whistle-blowing. Otherwise none of this would have happened, raising the question: "How many incidents like this had happened previously without comment?"
    • It took many years for nurse Hoffman to be heard by anyone, despite being a highly-experienced and competent Healthcare practitioner.
    • All "checks and balances" at the Bundaberg Base Hospital failed. That this went undetected and unnoticed is a massive systems failure in itself.
    • The Inquiry was only setup after a journalist investigated Patel and was published. This followed tabling of claims under Parliamentary privilege. Hoffman had been unable to garner Media interest for many years previously. Just when are dead patients "Newsworthy"?
  • Although Patel's "Mortality and Morbidity" statistics implicated him in 30 or more deaths, the legal system requires proof of causality. Hence he was only prosecuted for a small number of cases.
  • Jayant Patel was by far not the only "renegade" practitioner identified by the Inquiry, nor the only person whom the Inquiry made recommendations about.
  • There were multiple other hospital districts found to be delivering unsafe care to patients. This is further evidence of wide-scale, systemic failures in Queensland Health.
  • There were serious systemic problems within Queensland Health, including its treatment of local medical graduates and GP's (as VMO's, Visiting Medical Officers).
    • At one time nearly all UQ medical graduates stayed in the State, now almost none do.
    • The participation rate of VMO's has halved, stressing the hospitals and compromising continuity of patient care.
    • Over 30 years, the population of QLD has doubled, but the number of medical training places (225) at UQ has remained static.
  • These origins of these problems is complex and due to Political, Public Service Administration and Medical Profession issues - going back 30-40 years.
  • Both the Director of Medical Services (Keating) and District Manager (Leck) escaped prosecution in QLD, despite the Inquiry recommendations, have fled to Western Australia and are practicing "in public health". Keating cancelled his QLD Medical Board registration before deregistration proceedings were taken against him.
  • Margaret Cunneen SC, in "The Patel Case – Implications for the Medical Profession (Medico-Legal Society of NSW, 2010), points out:
    • Queensland has a "Criminal Code of Law" which made the criminal prosecution of JMP possible.
    • Patel, and any doctor acting maliciously, could not be charged with a criminal offence in NSW and most other Australian jurisdictions.
    • Cunneen says little has changed in NSW in over a century:
      She reviewed an 1893 case of a person practicing as a doctor, but not legally qualified. He failed to deliver a baby, causing it severe injuries and death - but the charges were dismissed because the man had no case to answer under the law then, or now.
    • Cunneen, a senior prosecutor, says:
      "because of this expectation that doctors will not do something maliciously against a patient, that they will only make a mistake which may or may not be civil negligence."
    • There have been no calls by the Australian Medical Profession to address these problems of Jurisdiction, consistent Medical Board judgements or malicious injury by doctors.
  • In late 2011, Premier Anna Bligh "dismantled" Queensland Health following a $16M fraud. Five years after the Davies Inquiry, it seems there has been little change or improvement.
There is overwhelming evidence that Queensland Health has had pervasive, systemic problems for decades. Is that Politically acceptable or a proper use of Public Monies?

The most critical question is:
What has fundamentally changed so that any of this could not happen again, that these lives lost and unnecessary injury inflicted has not been in vain? [Nothing?]
We know that in Aviation that problems like these are sought out and not allowed to occur in stable democracies, like UK, USA and Australia.
In Indonesia and PNG, the systems in Aviation are not nearly as strong, showing this outcome is neither accidental nor due to improved equipment or higher funding.

These less-than-successful organisations resulted in the 2007 Yogjakarta crash: it was Predictable, Preventable and Repeatable. [Only the pilot-in-command was tried and sentenced.]

From a follow-up on ABC TV a year later, demonstrating a lack of systemic change:
Colin Weir of the Queensland based aviation safety auditing firm Flight Safety Pty Ltd, says that another crucial factor contributing to the crash is the fact the Yogyakarta airport was effectively unlicensed at the time, because, put simply, its runway is too short and he says the same disaster would occur again if a jet landed today at the same speed.
COLIN WEIR: We carried out an audit about three weeks ago and the runway and safety area has not been extended.
This begs a serious question:
Who is the better "Professional", the QF32 pilot (the A380 in which exploded an RR Trent-900 engine over Indonesia) Cpt. Richard Champion de Crespign, who saved 469 lives or your average Specialist on ~$1M/year, probably 4-5 times the pilot wages?
My rubric for Professionals:
Is there ever a reason for any Professional to repeat, or allow, a known Error, Fault or Failure?
By this test, Aviation professionals and technicians, at least here in Oz, are overwhelming more Professional that every registered Doctor. Part of the proof lies in the Open and Transparent collection and reporting of critical outcome data.
The lack of demonstrated improvement, in fact the universal absence of critical outcome data, for Hospitals, GP's and specialists suggests a fundamental, systemic failure within Australian Mainstream Medical practice.

That's something definitely worthy of FoSiM, Marron and Dwyer's time and attention, and demonstrably of massive benefit to Australia.

A quick on-line search yielded two responses by the Medical profession to the QPHCI report.
Both MJA articles called for action by others and no changes to mainstream Medical practice and oversight.

The Bundaberg Hospital scandal: the need for reform in Queensland andbeyond. MJA 2005; 183 (6): 284-285 [19-Sep-2005?]  Martin B Van Der Weyden
When will Australians be able to count on receiving health care that is safe?

Reflections on the Bundaberg Hospital failure. MJA 2005; 183 (6): 328-329.Anthony P Morton
Present-day public hospitals are often lacking in humanity, costing more and doing less, and run by executive staff with minimal clinical knowledge

[Dr Morton referenced the 1996 Berwick article in the BMJ]

"A primer on leading the improvement of systems"
Donald M Berwick. BMJ VOLUME 312 9 MARCH 1996
Institute for Healthcare Improvement,Boston, MA 02215,USA
Donald M Berwick, president and Chief Executive Officer.

Learning points:

  • Not all change is improvement, but all improvement is change.
  • Real improvement comes from changing systems, not changing within systems.
  • To make improvements we must be clear about what we are trying to accomplish, how we will know that a change has led to improvement, and what change we can make that will result in an improvement.
  • The more specific the aim, the more likely the improvement; armies do not take all hills at once.
  • Concentrate on meeting the needs of patients rather than the needs of organisations.
  • Measurement is best used for learning rather than for selection, reward, or punishment.
  • Measurement helps to know whether innovations should be kept, changed, or rejected;
    • to understand causes; and
    • to clarify aims.
  • Effective leaders challenge the status quo both by insisting that the current system cannot remain and by offering clear ideas about superior alternatives.
  • Educating people and providing incentives are familiar but not very effective ways of achieving improvement.
  • Most work systems leave too litle time for reflection on work.
  • You win the Tour de France not by planning for years for the perfect first bicycle ride but by constantly making small improvements.

Not all change is improvement, but all improvement is change.
The relation derives from what I will call the central law of improvement:
every system is perfectly designed to achieve the results it achieves.
The central law reframes performance from a matter of effort to a matter of design.

The central law of improvement implies that better or worse "performance" cannot be obtained from a system of work merely on demand. [Therefore Inquiries and Political directives that mandate change without organisational redesign are doomed to failure. This is confirmed by the outcomes we've seen.]

[This piece 3,900 words]

Thursday, February 16, 2012

"Friends of Science in Medicine": Credibility, Claims and Transparency

Yesterday I wrote up what I'd been able to find out on the web about "Friends of Science in Medicine" (FoSiM) - but it only begs more questions without any good answers. For a lobby group espousing the Scientific method in its very name and demanding the highest standards of evidence and rigour of others, this absence of transparency, rigour and completeness should be anathema. That it hasn't been addressed in a month starts to suggest this is no accident.

It's a long piece (3,000 wds) and, disturbingly, I could find few hard facts, only rather a lot of uncorroborated snippets. It's mostly "all smoke and mirrors".

Monday 30th January, 2012, I heard Fran Kelly of ABC Radio National, interview Prof. John Dwyer and Dr. Kerryn Phelps in "New lobby opposes teaching alternative medicine" and audio download.

Really interesting and important stuff, more so that someone whom I respect and consider a 'serious' journalist should seek to interview a former professor of Medicine and Oncology [in places falsely attributed as "Cervical Cancer Vaccine creator" - that was Ian Frazer, also a member of FoSiM] and an ex-President of the AMA and a very high-profile leader of "Integrative Medicine" in Australia.

I jumped on the 'Net and tried to find out more, but drew a blank.
Even though there has now been significant coverage in the mainstream media and a veritable barrage on-line, it's very difficult to get any information, let alone good answers, on anything to do with this lobby group.

Even something as simple as: "Who are you and what do you stand for?"
On-line, they are a vague, shadowy, even slippery group.

The ASIC "National Names" database has them incorporated in NSW (INC9896756) on 13-Feb 2012, which isn't consistent with the claim from "Quack Treatments Duck for Cover" republished/included by Neil Johnston.
It is all welcome news to the Friends of Science in Medicine (FSM), an Australian organisation formed in December of 2011...


If you casually search the media for "Friends of Science in Medicine", you'll find the phrase "John Dwyer, co-founder", but nobody else mentioned.
Digging finds a well known "Stunt Activist", Loretta Marron (or Mutton), both 'an Executive' and apparently CEO of the group. Is this The Power behind The Throne? I wasn't able to tell.

Important questions, especially for a high-profile Lobby Group in Health, one of our most sensitive and critical social and political areas, are unanswerable:
  • Exactly, what do you stand for?
    • Not an vague "Vision Statement", but something detailed and concrete.
  • Who are the people making decisions and taking action?
  • Who are the members?
  • What are the membership eligibility criteria?
  • What does membership entail?
  • How does the (registered) Association function?
    •  Decide it Aims?
    • Decide how it spends money, takes action?
    • Run or control the Association?
  • Most importantly, how are you funded?
    •  How does this influence you?
In the modern Internet Age, on-line presence is important and critical.
Any CEO or Executive, especially of a high-profile Lobby Group, one whom part of their aim is to influence Governments and force radical change on Health practitioners, who doesn't understand or act on this appears to be severely remiss in their duties.

There is a very strong culture in Health and Medicine of declaring "Interests and Conflicts" - of being Open and Transparent about influences, duties and loyalties. Good Governance is critical for Credibility.
For FoSiM to be officially completely opaque not only is absolutely counter-cultural, but should leave any publicly identified associate, especially those with strong reputations, very nervous indeed.

The only explanation, aside from pure naivety or ignorance, I can guess at for not creating a full, transparent website for this new Lobby Group, is deliberate obfuscation. I just don't know why...

But they have no official contact point, so I can't ask the question.

I could write to the claimed CEO at an advertised 'bigpond' address, but I can't validate it has any connection at all with the registered Association, nor if anyone replying would be whom they claim to be. Telstra hands bigpond email address out without any controls.


This is the whole of what I can glean are the Aims and Objectives of FoSiM Incorporated. It comes from an undated PDF file with an image/logo in the style of a "letterhead".  Do the signatories or the logo/letterhead correspond to the registered Association? Can't tell...
Our Vision Statement:
"To reverse the current trend which sees government-funded tertiary institutions offering health care ‘science’ courses not based on scientific principles nor supported by scientific evidence”.
Do they have a more explicit and detailed agenda?

Neil Johnston in his piece, could be guessing or might be implying knowledge of the agenda and strategy:
Obviously as the "Friends of Science in Medicine" mobilise and begin to target and shoot down those activities on the "hit list", there will be an opposite reaction as the "targets" also mobilise to protect themselves.

What the "Friends of Science in Medicine" is trying to achieve is quite impressive and has the potential to clean up a lot of the "wrongs" in health generally.
As for any organisation there is the potential for some of its members to hijack the primary agenda and steer it down different pathways.

Funding for this new group will need to be adequate and at the same time remain pristine, because it represents considerable power that needs to be harnessed democratically.

It will be a magnet for every single "power broker" in the health industry.
So we are left guessing as to just what this Lobby Group is on about and what plans they might have.

That strong supporters are already sounding warnings related to Good Governance and careful control of the "Brand" should be a red-flag to those associated with FoSiM and especially anyone accepting or repeating their utterances.


What is non-accidental, incontrovertible and on-record is the "gaming" (massive manipulation) of an SMH on-line poll by FoSiM supporters:
The number of votes in the poll was about eight times more than the number of online readers of the story, a clear indicator that the poll had been gamed. Fairfax technical staff said the poll logs all but confirmed that the voting had been manipulated.

Despite his side scoring a majority in the poll, Professor John Dwyer, of the UNSW faculty of medicine and one of the founders of Friends of Science in Medicine, is dismayed that the poll was gamed.

He planned to use the result to support his argument against alternative medicine but ''clearly the numbers are all wrong and I think the poll was probably meaningless''.

Professor Dwyer said Friends of Science in Medicine members had nothing to do with the poll being rigged.
What is not on-record is an immediate, strong statement by an FoSiM spokesperson condemning the action (not mere dismay) and promising to investigate, find the culprits and completely disassociate from them. "Oh dear" is not a credible or sufficient official response.

This Lobby Group has shown it knows how to send out Media Releases, but hasn't responded here - that is a deliberate decision.
Official silence and the implied inaction and ambivalence towards the matter don't cover the group, their spokespeople, Executive or CEO with glory.  I can think of no kind interpretation for their inaction.

The apparent CEO is also on-record as using intemperate, denigrating language quite unsuitable as an official representative of a powerful, credible and important Lobby Group. This is no mere matter of a lapse of judgement, these words represent everyone associated with FoSiM and reflect very poorly on them.

In other Associations, this would be cause for instant dismissal, whilst in FoSiM it appears to be accepted without comment. Outsiders don't know if it's lauded: [edited down for brevity]
Submitted by Loretta Marron on Thu, 09/02/2012 - 09:07.

Government funded 'Faith healing' has no place in medical or health related degrees.

The real questions that no-one who supports quackery is prepared to answer are:
  • "Should tertiary institutions be teaching... as belief systems?"
  • "Should they be indoctrinating 17 year olds (as first year students)... and
  • "Should we be paying for these services in our health funds?"
If it is 'allied health' (such as hypnotherapy and massage) call it that, instead of CAM, which is an umbrella that covers all sorts of nonsense.

Of course test herbal remedies in universities but why not ... put  as a text for all health students... - so that students can learn about CAM from Prof. Edzard Ernst the first Chair of CAM in the world, instead of from texts full of mumbo-jumbo.
 Seemingly, the only stock phrases not trotted out were "Voodoo and Witchcraft" as in her 4BC interview, or "Quacks, charlatans and Witch Doctors" in Crikey!.

On another tack:
The complete lack of an official, verifiable site and contacts or representatives of this Lobby Group is exceedingly strange.

With the experience, background, knowledge and high standards of the good folk on the purported "list of supporters", or even the apparent "Executive" signatories (below), it is inconceivable to me that there's nothing official on-line. The non-CEO "Executive" signatories:
  • Prof. Marcello Costa
  • Prof. John Dwyer
  • Prof. Alastair MacLennan
  • Prof. Rob Morrison.
These are industry heavy-weights and experienced political players in this arena, how could they be making this naive, rookie mistake?

Why would they intentionally open themselves to question and ridicule at the very start of their campaign? It just doesn't make sense to me...

What make perfect sense to me is if, and I can't confirm this - only guess, this is yet another campaign being orchestrated by LJ Marron, described as, or who claims to be:
  • "a career as a computer professional" (post-nomials include MACS)
  • "a physicist with more than 20 years' experience in computer science",
  • "a science graduate with a business background",
  • "stunt activist", "Humorous stunts became her trademark." and "The Jelly Bean Lady",
  • "a science graduate with a business background",
  • "retired scientist" vs "Physics major, cancer survivor, researcher"
  • "one-woman crusader" and "(on a ) fatwa"
Is FoSiM just "a one-(wo)man band" posing as reputable and credible?
I'm still looking for evidence to disconfirm this.

What is possibly impressive and seemingly incontrovertible is Marron's assertion of the title "Australian Sceptic/Skeptic of the Year" for 2007 and 2011. Doubly so, when she is the only dual recipient of the title. Search on-line for Marron and these terms and you'll get a lot of hits.

But what you cannot find is any hard evidence:
  • There is no definitive list, not even on Wikipedia, of "Australian Sceptics of the Year" recipients.
  • There seems to be no published criteria for this accolade, nor any documented process for its bestowing. Rather important if you seek to trade on its status.
  • For a group basing its entire existence on being impartial, logical, rational and transparent, on being the arbiters of what's real or fakery, of being the ultimate in Evidence Based testing, this oversight cannot be for any good reason.
No organisation or person can hold others to high standards of Evidence and not require the same or better standards of itself without losing all credibility and being open to charges of hypocrisy and worse.

Marron seems to have traded on this 'title' to gain quite a profile and even fame, but it seems to me bogus and without credibility.

The more you look, the more this whole affair and the person seemingly behind it, is "mere puffery" and "all smoke and mirrors".

I look forward to be fully informed, to be provided with public, verifiable, official evidence...
Just like any good, paid-up member of Marron's Sceptic's Society would be.

There a great 'meme' out there, "On the Internet, nobody knows you're a dog".
People are not just anonymous, but completely untraceable and unverified...

This strange group and their apparent driving force are a great example of this.

Steve Jenkin. stevej098@gmail.comPO Box 48, Kippax ACT 2615.
(m) 0412 786 915.

Created:  Thu 16 Feb 2012 14:14:53 EST. ~1750 words.

Statement of Interests:
I am not, nor ever have been. a medical practitioner, mainstream or Complementary/Alternative.
Nor do I have a financial or business interest in any organisation or association related to Medicine or Health issues. 

Wednesday, February 15, 2012

A busy retirement: Loretta Marron, CEO FoSiM

A shy, retiring stay-at-home person the new CEO of "Friends of Science in Medicine" (FoSiM) is not, twice being declared "Australia Skeptic of the Year", appearing on TV and being written up in the media.
She become well known by Australian media, a 2009 piece, "Loretta Marron, Health Hero, On Australia’s A Current Affair", describes her as "a science graduate with a business background".

The Sunday Mail, the weekend edition of the QLD Courier Mail, published a long (1000+ wd) profile on 15-Jan 2012, ten days before the media release that created a storm on interest. The next day, local radio station, 4BC, in "Debunking Myths", also "caught up with Loretta Marron, Inaugural CEO, Friends of Science in Medicine, ...". The new CEO seems well known and well liked by her home-town media.

The Sunday Mail piece, "Campaigner ready to take on the quacks", anticipating the FoSiM release,  starts with the synopsis:
ARMED with critical thinking and humour, Queensland scientist and sceptic Loretta Marron has attracted both praise and derision in her fight against modern-day quackery.
From the article:
Science is her weapon and protecting vulnerable, often terminally ill, people is her motivation.

Marron, a physicist with more than 20 years' experience in computer science, has devoted years of her retirement to challenging the claims of alternative health practitioners and complementary medicines.

In her quest to rid the marketplace of dodgy pseudo-medical devices, she lobbies Australia's oft-besieged watchdog, the Therapeutic Goods Administration (TGA), for regulatory reform.

Marron's campaigning led to 31 medical devices being cancelled last year and nine in 2010.
The sentiment echoes through her campaigns, waged entirely from the bush-buffered Queenslander at Burpengary, north of Brisbane, she is renovating with Gavin, her husband of 32 years.

"If it's not right, I have to act," Marron says, leaning forward to unconsciously emphasise her earnestness.
So, Marron compiled and distributed a booklet listing sources of credible information and telephone services to patients, surgeries and support groups.
She had found her calling. Humorous stunts became her trademark.

Marron garnered national media attention as the Jelly Bean Lady ...
This month Marron became chief executive officer (CEO) of the newly formed Friends of Science in Medicine, a group of medical and scientific specialists and consumer advocates, formed in response to Australian tertiary facilities introducing studies in "unproven alternative therapies such as 'fundamentalist' chiropractic, homeopathy, iridology, naturopathy, acupuncture and 'energy medicine'."
Marron almost off-handedly refers to her full-time, self-funded pursuit as the equivalent of Gavin's obsession with veteran and vintage cars.
FoSiM was wrtiten up in the well respected daily paper, the Sydney Morning Herald (SMH), two days after the media release: "Scientists urge unis to axe alternative medicine courses".
Prof. Dwyer, described as "co-founder", spoke for the group. A week or so later, an on-line Poll was run on the topic following a "News Review" feature/discussion on the topic.

The SMH Poll was "gamed" by FoSiM supporters, creating a furore and written up two weeks later: "Vote on alternative medicine falls victim to dark arts of the internet".  An inauspicious and perhaps overly zealous start?

Loretta Marron describes herself on the I2P site as:
"a science graduate with a business background, was Australian Skeptic of the Year for 2007 and in 2011. She edits the website"

On this, her main and a sister site, senior years, Marron notes her qualifications: "Loretta Marron BSc Assoc Dip Bus(Accnt) AAII MACS"
MACS: Member of ACS (Australian Computer Society).
AAII:  Associate of Australian Insurance Institute. (presumably)

Confusingly, she also describes herself as "retired scientist" [from Australia or Queensland and sometimes also 'business woman'], whilst the few Google Scholar publications listed for "Marron, LJ" or "Mutton, LJ" only occur after her TGA campaign begins.

The main website promotes just one piece/publication of hers,  a 2009 "A Current Affair" segment where she is both on-camera and credited as "going undercover":  "A Current Affair - exposing Cancer Quacks".

It appears that Marron's husband also shares her retirement passion and interest, apparently not just "veteran and vintage cars", a fact overlooked in the various profiles and bio's:

Her husband wrote to the TGA in August 2010, responding to its consultation on advertising arrangements. His style and a detailed 20-point list of questions/points raised closely reflect Marron's own style. His 2 page letter opens:
When a therapeutic good is accepted onto the ARTG, this good may be purchased by 100 practitioners, who may use them on 100 patients per year. In a one year period this equates to 10,000 consultations that have been paid for by patients which give them false and misleading, potentially harmful, health information.
From 2009, in the comments section of an Adelaide Now article, Marron's spouse first comments with detailed knowledge, as good or better as hers.  Again, their writing styles and content closely reflect one another. Perhaps the outcome of 32 years of marriage? :

Gavin Mutton of Queensland Posted at 1:41 PM July 07, 2009
 Pharmacy owners are leading the way in selling placebo products in their 'natural' remedies section. It's easy money for them. Studies now show that glucosamine hydrochloride, promensil (red clover) and Gingko are all failing to show any benefit. Ear Candles are banned in Canada and detox(and detox pads) are nonsense. These are one of the most trusted professionals in Australia and they put profit over patient well-being. It is not OK to sell placebos - and they know that what works and what doesn't. Some herbal remedies are fantastic, but most of them don't provide any benefit. As for Alternative Therapies - where is the evidence? A panadol and a bit of TLC work just as well (if not better). 
Comment 47 of 52

 Loretta Marron of Queensland Posted at 2:35 PM July 07, 2009
 On March 16, 2009, the NPS announced that following a six month study by 20 complementary experts from around Australia, that they had identified 'highest quality complementary medicines resources'. As the Tier One recommended sites, including the Natural Medicines Comprehensive Medicines Database, are subscription, it's just a matter of time (a year perhaps) before they are available to all consumers and health practitioners. It is a bit sad that pharmacists don't pay for access because then consumers would be able to make informed choices when buying their non-prescription drugs. As for Alternative Therapists - all I can say is there is only one type of therapist that should be offering health care, and that is one who practices a therapy that is scientifically proven to work. Sadly this is currently not the case (anecdotal evidence, for health, is not appropriate)- so it's 'buyer beware. '
Comment 48 of 52

An article in The Australian, July 2011, "The chiro kids":
A lot of these practitioners think these devices work," says Marron.
"They care about people - if they were nurses, they'd be great. But they're getting ripped off, they're investing tens of thousands of dollars in a device they think will help their patients.
The practitioners aren't my enemy.
My enemy is the TGA for not regulating [the devices] properly".
Seems at direct odds with a piece in Crikey! the year before [2010], "McGrath Foundation should break their ties with Blackmores" where she is aggressively lobbying against a local manufacturer, not the TGA.

Marron repeatedly uses the phrase "At my urging, ..." about academics and medical experts who have represented her views to organisations.

From the Crikey! piece, some more insights into and commentary on Marron, and that she isn't only campaigning against the TGA:
If she hadn't earned a physics degree and spent 20 years working in
computer science,
Marron could have made a career in comedy.
From her home at Burpengary, an hour north of Brisbane,
  this motor-mouthed 59-year-old has spent the past five years waging a one-woman fatwa against:
  • the Blakoe Energiser,
  • the Bioptron,
  • the Vega,
  • the QXCI,
  • the Bicom 2000 and
  • sundry other dubious devices sold in the name of natural healthcare.
Marron's stunt-activism ... (Jelly Beans as effective as magnets)
The Therapeutic Goods Administration has delisted dozens of devices Marron lodged complaints about, forcing hundreds of alternative practitioners to stop advertising them.

But her campaign took a new turn later last year after she learnt that Australian chiropractors were treating children for allergies, ADHD and a range of other complaints.

Marron was shocked that RMIT University in Melbourne - one of only three universities in Australia authorised to train registered chiropractors - operated a suburban clinic that treated children.

In March she enlisted 11 scientists, including Ian Frazer and John Dwyer, to put their names to a letter demanding that the Gillard Government close the clinic.
Marron had been published before [2009] in Crikey!, "Quacks, charlatans and witch doctors", with the description "a former Australian Sceptic of the Year". She starts this piece with some confusing and unsupported claims written not in a logical, rational, scientific style, but in the emotive, sensationalist tabloid style. What's of particular concern is her absolutist, "they all do this", statements. There are no modifiers, such as "some" or "in my opinion" or "my belief". It's stirring copy, but does it befit her status as a scientifically-driven sceptic or even pave the way for defamation actions?
Alternative therapists are spreading unchecked and unchallenged into the heart of our communities.
Trumpeting the benefits of tradition, these unregulated and uninsured health practitioners are setting up makeshift clinics everywhere from under homes in quiet backstreets to glamorous high street locations.

Offering holistic treatments they don white coats and claim they can cure nearly every real and imaginary health condition with an inexhaustible and continually mutating toolbox of scientifically implausible treatments and remedies.
In April, 2011, Australian Doctor also wrote of Marron and her 'chiro kids' campaign in "Blurring the lines":
 Last month, Loretta Marron, a former Australian Skeptic of the Year and one-woman crusader for science, wrote to the Federal Health Minister Nicola Roxon, urging her to shut down RMIT's paediatric clinic in Bundoora,
 Her 20-page submission ...
Marron, in her first article for "I2P" (Information to Pharmacists), "Hiring Harry Potter?" May 2008, a magazine edited by a management-consultant turned pharmacist outside Lismore, wrote of herself:
Loretta Marron BSc
From a Skeptics Perspective

Issue 71: May 2008

Physics major, cancer survivor, researcher – that’s me.
Filling in for Nutritionist Stuart Adams who has his nose in a textbook as he pounds the pavement at his local Uni.
I don’t know much about medicine but I’m not too bad with the science.
One of my favourite topics is about ‘Energy’ healing modalities.
I can’t help it; I just love my Physics.

In January this year I was published in the Medical Journal of Australia (1) as I have an interest in herbal remedies.
I’ve also attended courses at Bond Uni on Evidence Based Medicine and Cochrane, so for my first article, I thought I’d talk about sex.

1. Commercialism, choice and consumer protection: regulation of complementary medicines in Australia
In a retrospective/summary piece for I2P, Feb 2011, covering seven years of effort, "The Terror of the TGA", Marron says of herself:
Despite a career as a computer professional, I too remained frustrated with the TGAs website, but drawn to the challenge that there might be something useful in it for consumers, I persevered.

A year passed before my persistence was rewarded when I stumbled upon the primitive Australian Register of Therapeutic Goods (ARTG) database.  Consisting of little more than a list of numbers, products and sponsors, to my delight it included a basic search facility.  If I was to prove that the TGA was endorsing thousands of placebos, it was all I needed.
Marron points in this piece to a restricted webpage, "Call to de-list natural therapies" [Nov 2006], where she self-describes as "a retired scientist from Queensland" and is quoted as saying:
the system meant the TGA was giving fake legitimacy to remedies with no basis in science, such as homeopathy. (sic)
In February 2012, the editor and possibly owner, of I2P, Neil Johnston wrote a piece very supportive of Marron and the "Friends of Science in Medicine" initiative.
Johnston and I2P are to be commended for publishing a balancing viewpoint in the same issue. Although attributed to "staff writer" in I2P, the piece by Evelin Tiralongo of Griffith Uni was first published in "The Conversation": "Why universities should teach alternative medicine".

I found Marron's reply/comment on Tiralongo's piece intemperate and more assertion/accusation as favoured by tabloids than measured, rational and scientific, as you'd expect from an acclaimed sceptic [formatted for clarity]:
Submitted by Loretta Marron on Thu, 09/02/2012 - 09:07.

Government funded 'Faith healing' has no place in medical or health related degrees.

The real questions that no-one who supports quackery is prepared to answer are:
  •  "Should tertiary institutions be teaching homeopathy, iridology, tactile healing, reiki, reflexology, kinesiology, 'fundamentalist' chiropractic and 'energy medicine' as belief systems?"
  • "Should they be indoctrinating 17 year olds (as first year students) that "innate intelligence", qi, meridians and chakras as a fact?", and
  • "Should we be paying for these services in our health funds?"
If it is 'allied health' (such as hypnotherapy and massage) call it that, instead of CAM, which is an umbrella that covers all sorts of nonsense.

Of course test herbal remedies in universities but why not put "Trick or Treatment" (Ernst & Singh) as a text for all health students (some universities are already doing so) - so that students can learn about CAM from Prof. Edzard Ernst the first Chair of CAM in the world, instead of from texts full of mumbo-jumbo.
 Johnston began his piece with:
A powerful group (The Friends of Science in Medicine (FSM)) comprised of medical academics and interested professionals has sprung into existence under the guidance of CEO Loretta Marron  (Australian Skeptic of the Year 2011), Professor Alastair MacLennan, Emeritus Professor John Dwyer, Professor Rob Morrison and Professor Marcello Costa and a cast of 400 Australian and international names.

The aim of this group is to directly challenge those universities that provide education and degrees to support some health disciplines, not deemed to be evidence-based.

This is in effect, a full-frontal confrontation to the universities that appear on the "naughty list (and there are quite a number).

It will also be confrontational to government and the agencies involved with regulating and monitoring the various health disciplines.
Notably, this was the only place I could find an unabridged copy of the 500+ word "Media Release" dated 24-Jan 2012, put out by FoSiM, "Quack Treatments Duck for Cover".

Johnston helpfully provided links to important FoSiM documents, saved on his site:
 The "Invitation" is undated, though dates in the PDF file are 30-Dec 2011 and 28-Jan 2012.
It is signed by "Executives of Friends of Science in Medicine" without Marron identified as CEO,
  • Loretta Marron,
  • Prof. Marcello Costa
  • Prof. John Dwyer
  • Prof. Alastair MacLennan
  • Prof. Rob Morrison.
The letter begins with:
Our Vision Statement:
"To reverse the current trend which sees government-funded tertiary institutions offering health care ‘science’ courses not based on scientific principles nor supported by scientific evidence”.
An unnamed PhD candidate researching "gut disorders", possibly in Adelaide, wrote a very supportive piece: "New ‘Friends of Science in Medicine’ combating pseudoscience in Australian universities", but then, strangely, had to follow it up with this piece:

Wow! Friends of Science in Medicine certainly got lots of people Googling for more information. FSM really should get their own website explaining their principles, so everyone who’s looking for information isn’t getting it from second-hand sources, such as the news, blogs, and their opponents. Plus then the public could go there to vent their spleen, rather than on my little blog. [Update: looks like FSM are discussing creating a website]
Links are provided to Facebook and LinkedIn groups for FoSiM. However, attempting to contact FoSiM via them or join the groups got me no response.

The press and discussion on FoSiM has led to many replies, rebuttals and comment - and interestingly, a backlash from some sectors of mainstream medicine. A selection:
Some Herbologists opined that "Professor Dwyer sounds like he is more interested in a witch hunt than evidence."

All this leaves me with questions about Loretta Marron and her motivations.
  • Just what is Marron's background and expertise?
    She has no on-line CV, Publication list or Bio and makes a number of different claims about her expertise and working life.
    The scientists I worked for and with at CSIRO and ANU would've taken umbrage if I used my BSc to claim "I am a scientist".
    As a strident and vociferous critic of others, especially calling for "Science in Medicine", this issue is very important. It calls into question her understanding of "Science", the meaning of "scientist" and the standards she expects of others.
    Allowing herself to be described as "a physicist" when there is no public support is equally unrealistic.
    Marron not only has to demonstrate exceptional integrity, but unreproachable behaviour and unimpeachable credentials to be credible and respected in her campaign. Otherwise she is just another nutter from Queensland wanting attention for herself and pursuing a rather destructive agenda without apparent purpose or public benefit.
    • As a sub-issue, does she ever pass herself off as her husband, or does he equally share her interest, passion and expertise?
      It'd be good if they were a team, but where's the evidence??
      I'm sure the TGA, and possibly AFP, would be unimpressed if she used another identity.
  • Just who is funding "Friends of Science in Medicine"?
    and, as CEO, is this a paid or honorary position for her? The ACCC gives CEO a very specific meaning: both Board Member and the most senior employee. Employees are by definition, paid.
    This issue goes to the heart of independence and transparency/good governance: FoSiM need to publicly declare their sponsors and funding sources to meet these standards.
    Marron is well aware of the problems of Conflict of Interest and transparency, having a "Zero Product Advertising Policy" on her websites.
  • If FoSiM is a modern Association wanting to be taken seriously, where is its on-line presence?
    Marron declared she worked "in Computer Science" for 20 years, presumably to imply competence in I.T. and web. She also publicly denigrated the TGA's public database as "primitive" in her "Terror of the TGA" piece.
    Calls for good on-line documents are even coming from FoSiM's supporters.
    As CEO, Marron is directly responsible for the public launch of the Association, preparations for that (DNS name, website hosting, contents, ...) and hiring folk to execute an suitably professional site available on launch day.
    That Marron doesn't understand these issues, or rate them of importance, is demonstrated by their total absence.
    A single "bigpond" email address is not a credible professional operation.
  • Is FoSiM just one person, working from home without pay?Her Courier Mail profile lacks any mention of associates and staff.
    Is this whole thing just Marron engaging in a media beat-up and outrageous self-promotion?
  • Marron demonstrated in her Crikey! piece that she has considerable networking and self-promotion skills and a fine ability to influence and persuade academics, researchers and medical experts to support her position and campaigns.
    Is FoSiM just the latest and largest version of this?
  • Is Marron and FoSiM a 2012 rerun of Sheryle Moon and "Alliance of Australian Retailers" in 2010?
    Articles: SMH, ABC radio, Lateline.
    AAR Website and Disclosure statement:
    • We are supported by:
      • British American Tobacco Australia Limited (ACN 000 151 100);
      • Philip Morris Limited (ACN 004 694 428); and
      •  Imperial Tobacco Australia Limited (ACN 088 148 681).
      •  Authorised by R. Stanton for the Alliance of Australian Retailers Pty Ltd (ACN 145 378 589) of 14 Ross Street, North Parramatta, NSW, 2151.
All my concerns and questions can be summed up simply:
Show me the same Evidence about yourself and "Friends of Science in Medicine" that you are demanding of others.

Steve Jenkin.
PO Box 48, Kippax ACT 2615.
(m) 0412 786 915.

Created:  Wed 15 Feb 2012 17:46:22 EST. ~3000 words.

Statement of Interests:
I am not, nor ever have been. a medical practitioner, mainstream or Complementary/Alternative.
Nor do I have a financial or business interest in any organisation or association related to Medicine or Health issues.