Thursday, March 8, 2012

Friends of Science in Medicine: Irrelevant #2

The Dwyer/Marron Friends of Science in Medicine, finally have a public website where we can learn a little more about them.

Their constitution lists their "Objects" as:
to foster Good Science in Medicine [my capitalisation]
Their home page states:
We are currently campaigning:
"to reverse the current trend which sees government-funded tertiary institutions offering courses in the health care sciences that are not underpinned by sound scientific evidence"
I'm not aware of any usage of "to foster" that translates into attacks and calls for banning properly instituted and checked activities... Buts that's a side-show to the real game.

The Dwyer/Marron group choose to ignore multiple Elephants in the room, hospital deaths, medical adverse events and patient injuries in favour of a campaign that's been termed "a witch hunt", and even if completely successful would achieve so little as to be farcical.

The only fact I can present in support of this is: There are no facts.

Which in itself is a complete failure of Governance and Safety/Quality systems of the Australian Medical system and Profession.

What's the ratio of fatalities to Adverse Events (AE's), those caused by Human action or inaction?
We've no idea...

An early Australian report is summarised as: 18,000 fatalities due to AE's at a cost of $2B/year :
The total costs (health, economic and social) of adverse events are significant. Studies in recent years that have identified the magnitude of the economic and social cost:
  • The Quality in Australian Health Care Study (QAHCS) found that 16.6% of hospital admissions were associated with an Adverse Event, and that 18.5% of these Adverse Events resulted in permanent disability or death. This equates to approximately 18,000 deaths that are attributable to Adverse Events. The estimated annual cost of Adverse Events to the Australian healthcare system is AUD$2 billion. [Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The quality in Australian Health Care Study. MJA. 1995;163:458-471]
Dr Ross Wilson, the author, is quoted in the media ten years later, as saying that "things are likely the same" because we still don't have figures being reported and collated.

In 2009, the SMH reported a government study or report estimating "Hospital errors claim the lives of 4550 Australians a year". A more acceptable figure? But it's still in line with the near 20,000 "Adverse Events" Dr Wilson estimated.

We do know, from the 2002 "Second National Report on Patient Safety Improving Medication Safety"  that GP visits include "400,000 of these thought to involve adverse drug events." (around 0.25%)

The much weaker figure, "Sentinel Events" is discussed in an AIHW (Australian Institute of Health and Welfare) document, "Sentinel events in Australian public hospitals 2004–05". They describe "Sentinel Events", and their need as:
there are occasions when patients suffer harm that is unexpected and unintentional. Sentinel events represent a very limited range of serious events, which can provide a ‘window’ into the vulnerabilities and safety of the health care system.
This report analyses 130 events that caused or had the potential to cause serious harm to some of those patients.
We've no information if the "Sentinel Event" causes identified in the AIHW report have been eliminated in all Hospitals and Health systems. But why would they be after only five years? It's not like people are dying needlessly every day, is it? [apologies for using sarcasm.]

The responsibility for collecting and reporting "Sentinel Events" was devolved to the states.

Sadly, from the AIHM website, which you'd expect to be definitive, it appears that only WA and Victoria have taken up Sentinel Event collection and reporting.

WA reports 1 Sentinel Event in 10,000 patient separations, and that they'd achieved a 10% improvement in the year. The WA figures (96 events or 0.01% of separations) don't exactly tally with the AIHW figures for patient separation. The WA figures report 0.96M separations in WA of 2.3M population. For the whole 22M Australian population, it would be 9.1M separations, versus the 8.5M reported by the AIHW.

This seems to demonstrate a convincing, overpowering view by administrators of the other Hospital systems that such data is unnecessary and not useful... A very disturbing view to me.

What's the ratio of "Sentinel Events" in hospitals to Adverse Events?

From the estimates available this is 130:18,000, or about 140:1, possibly worst case because the definition of "Sentinel Event" is still being refined and increasing.
Which is why the "Sentinels" were chosen, as "canaries in the coal mine". Simple to measure and quickly and easily show if things are getting better or worse...

We know from the hard-data reported by Dr Brent James around 1999, that the ratio of Adverse Events to "Patient Injuries" is 80:1 (eighty times).

If we are conservative in our assumptions and use the WA Sentinel Event rate (0.01%), a lower ratio of Sentinel to Adverse Events (1:100) and a lower ratio of Adverse Events to Patients Injuries, then the 8.5M patient separations reported by the AIHW for 2009-2010 (costing $33.7B for Public Hospitals),
resulted in:
Sentinel Events: 850 (÷ 10,000)
Adverse Events: 85,000 (* 100)
Patient Injuries: 4.25M (*50)
 More in keeping with Dr Wilson's estimate, would be an SE:AE ratio of 20:1, giving:
Sentinel Events: 850 (÷ 10,000)
Adverse Events: 17,000 (* 20)
Patient Injuries: 850,000 (*50)
Which is still an incredible figure indicating a massive, needless waste of money, not to mention the impact of unnecessary injuries and treatment upon patients.

The Irrelevance of Friends of Science in Medicine:

The Dwyer/Marron group make no claims for the numbers of Patient Injuries, nor their severity, attributed to their foes, "Complementary and Alternative Medicine" (CAM).
Are they claiming figures of 1,000,000 injuries and a few thousand fatalities: in the ball-park of known good estimates for Medical and Hospital systems?
If they aren't then:
  • They should say nothing until they go out can get some hard-data on the actual injury and fatality rates.
    • Unfortunately, a single media appearance by Lorreta Marron exposing and shutting down one uncertified backyard operator, while preventing a few injuries, does NOT constitute research or evidence.
    • Friends of Science in Medicine need to apply their own standards to themselves.
      Without strong evidence, what anyone says is completely irrelevant, misleading and potentially harmful.
  • Estimates of use of Alternative Medicine and Therapies in the general population vary between 40-60%. How many visits and treatments does this translate into? NOT anywhere close to the 100M/year visits to GP's? What about the total patient injury rate via CAM?
    • Even the anecdotal evidence doesn't support the view that there are close to the same number of patient injuries as from doctors and hospitals.
    • Get some data before you criticise everyone else.
If even a guesstimate (that's a valid Engineering term and process) put the total Patient Injuries by CAM at 10% of mainstream Medical and Hospital, I'd be very surprised.

And if fatalities were even has high as 1,000th of the known, preventable deaths in Hospitals, I'd be astonished. Do we lose as many as 5 people to certified, registered Alternative Therapy practitioners in a year? You'd have to make some outrageous assumptions to even get there.

So why do these people want to shine a light in an area where the total potential for harm and injury is not even a rounding error in the statistics of the practices they are so virulently supporting?

The irrelevance and hypocrisy of Dwyer/Marron and their The Friends of Science in Medicine is that they know full well the scale and scope of the preventable failures of mainstream Medical and Hospital system, but they then choose to "raise Cain" about areas of relative inconsequence. What's going on?

My message to the Dwyer/Marron group:
Practice what you Preach and Get your own house in order first.

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