Monday, March 12, 2012

Friends of Science in Medicine: What's the Agenda?

The more research I do, the more amazed I am at the Agenda of "Friends of Doctors and Maintaining the Status Quo".
  • "Inconvenient Truths" are simply ignored or edited out by FoSiM. Would you expect less of these folk with their doctrinal attitude and blinkered views?
    • In "Doctors, Nurses Often Use Holistic Medicine for Themselves", it is reported that in the USA around 25% more Healthcare Professionals than the general population (76% vs 63%). Should as the FoSiM stance implies, they all be drummed out of the Profession? Or do they know what they doing and actually look after themselves in the best possible ways?
  • All the medicos on the FoSiM executive are well respected and highly accomplished doctors, researchers or science communicators, in their own fields. But none is expert in, nor has published in a respected 'high-quality' Journal on the validity of, EBM or RCT [not that I've found]. They are at best, "well meaning amateurs", not expert in a highly technical, very contentious and contested area of Statistics and Theory and Philosophy of Science. That they haven't provided reasoned, comprehensive rebuttals of Drs. Penston and Millers' work is proof of this. That they don't even cite this debate, stretching back at least a decade suggests to me either a lack of intellectual rigour or research, wilful ignorance or a disregard of more "inconvenient truths". None of these options "covers them in glory" or supports their arguments.
  • Fundamentals are ignored by FoSiM:
    • "Show us the Data!" FoSiM are violently and implacably opposed to "CAM" (presumably Complementary and Alternative Medicines), roundly criticise and vilify therapies they do not approve of and loudly call for all Alternative Medicine/Therapies to be justify themselves with EBM and RCT, so beloved by FoSiM. Only no data are provided to suggest this is warranted, only opinion and non-peer reviewed articles. Compared to Establishment Medical and Hospital practice and outcomes, are alternative methods etc unsafe enough to be called into question? No data, no case...
    • This is an argument first and foremost about Patient Safety, then Quality of Care and lastly about Effacy of treatment, therapies, medicines. But there is no definitive data for the outcomes of Establishment Medicine, despite them consuming consuming 10-15% of National GDP in mature, western economies to use as a baseline in discussing Effacy:
      • The only estimates of Medical and Hospital avoidable fatalities and Adverse Events (serious Injury), are horrifyingly high (4500 deaths/yr in Australia). The real problem is the non-collection of hard-data but that there is no outcry within the Profession to correct this. If FoSiM were interested in better Healthcare and better Patient Outcomes, this would be on top of their list.
      • Despite the 550+ page report of the 2005 Queensland Public Hospital Commission of Inquiry, where's the evidence of change in Queensland Health? Or any real transparency or hard-data recording and reporting?
      • Could "Dr Death" of Bundaberg be repeating, right now? Absolutely, and without being reported, actioned or with any personal consequences to those involved.
      • The Medical Error Action Group keeps collecting and reporting new deaths from the same causes. In Engineering or Aviation, this systemic failure of the Profession and its Professionals would not only not be tolerated, but those repeating, or allowing, Known Errors, Faults and Failures would be ejected from the profession and would face criminal charges. The folks who designed the World Trade Centre were not charged because they took into account all known failure modes in the early 1960's. Any Engineer who, since 2001, designs a tall building that is not survivable from large jet aircraft impact, would be criminally liable.
    • Science is not Practice. Substantially more than a few studies is needed to convert some Theory or data into reliable, repeatable Real World Practice. We know this, because it is being done intentionally and deliberately by at least one significant Healthcare System in the world, Intermountain Healthcare, Utah. Dr Brent James has spoken and written extensively about their work and results. As well, he and his team have published many papers on their results (using Real World hard-data) in peer-reviewed Journals. This is not idle speculation, assertion nor dogmatic belief. In Australia, we've know publicly about this since the ABC's Health Report interviewed Dr James in 2001: "Minimising Harm to Patients in Hospital".  A 2009 New York Times Story, "Making Health Care Better", about Dr James and Intermountain highlights their systemic and systematic approach, and that it needs constant attention and work. A letter to an under-performing Obstetrician by Dr Ware Branch, head of the Quality Committee, is quoted.
      • “You are perfectly right to question the data,” Branch wrote. “We have been found incorrect in numerous cases.” But for all its politeness, Branch’s letter was also pointed. With it, he attached a list of every elective induction the obstetrician had done recently and invited him to identify any that had been incorrectly classified. Branch also enclosed statistical profiles of other, similarly busy obstetricians. They performed fewer C-sections and had shorter delivery times. The letter’s final section included the following:
        “Lastly, quality improvement is a process, not an event. In part it works by finding variation and drawing attention to it, as has happened with you and others in this effort. And well-done quality improvement is not punitive; it’s educational. It is also worth noting that those docs determined not to learn, never do.” [my italics]

      I can't imagine any hospital I know in Australia either writing to that Obstetrician in the first place, nor responding to them in this way. Shouldn't this be what the FoSiM should be advocating for? Real, Enduring Change?
  • There is a well-known, perfect model for how to create an Industry-wide Quality and Safety Culture, in one of the most cut-throat profit-driven businesses ever: Aviation.
    A recent piece in The Journal of Patient Safety, "An NTSB for Healthcare, Learning from Innovation: Debate and Innovate or Capitulate"  by both experienced, highly-competent Aviators and Medicos makes a very strong case for in both describing the systemic problems (the figures on waste, fraud and over-servicing are horrifying) and for outlining a solution:
    • Adopt what is known to work in Aviation, and
      has been proven to be Cheaper, Safer and Better on every metric for coming up to 2 decades by Intermountain Healthcare with their "Do it Right, First Time" Quality approach.
    • Isn't it odd that the self-appointed, self-proclaimed "experts in all things Medical", the FoSiM, haven't suggested this approach nor flagged that our Hospitals and Medical system are far from World's Best Practice.
    • Instead of seeking to improve their own failed Profession, they are seeking to attack and discredit "The Competition", or at least those that they can identify and target.

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