They've published an anti-Chiropractic article without declaring their interets. Very poor form.
Showing posts with label CAM. Show all posts
Showing posts with label CAM. Show all posts
Saturday, September 8, 2012
FoSiM: More subtle anti-Alternatives Propaganda.
I recently tried to post a comment on the Choice Magazine website.
They've published an anti-Chiropractic article without declaring their interets. Very poor form.
They've published an anti-Chiropractic article without declaring their interets. Very poor form.
FoSiM: Definitive Proof of systemic bias/prejudice against Alternative Medicine/Therapies
Here's incontrovertible evidence that FoSiM are not interested in "Science in Medicine", but specifically in attacking practitioners they don't approve of. They are "Doctors against Alternative Medicine" [DAAM].
There has been no mention/coverage of this piece of science on the DAAM/FoSiM website, even though it was done by one of their own senior members, Braitwaite.
There has been no mention/coverage of this piece of science on the DAAM/FoSiM website, even though it was done by one of their own senior members, Braitwaite.
CareTrack: assessing the appropriateness of health care delivery in Australia, 20-Jul-2012.There was a related MJA editorial (I can't see) by Chirs Del Mar, one of the Skeptic/DAAM heavy-weights.
https://www.mja.com.au/journal/2012/197/2/caretrack-assessing-appropriateness-health-care-delivery-australia
Conclusions: Although there were pockets of excellence and some aspects of care were well managed across health care providers, the consistent delivery of appropriate care needs improvement, and gaps in care should be addressed. There is a need for national agreement on clinical standards and better structuring of medical records to facilitate the delivery of more appropriate care.
A dog walking on its hind legs? Implications of the CareTrack study.No mention on the DAAM/FoSiM site of this study, though there is a lot of other activity since 20-Jul-2012.
https://www.mja.com.au/journal/2012/197/2/dog-walking-its-hind-legs-implications-caretrack-study
Despite its limitations, this important study highlights a genuine need for systematised performance monitoring
Sunday, July 29, 2012
FoSiM: The local "mini-me" of Institute of Science in Medicine: Same Bull, different faces.
Dr Harriet Hall and her 26 "Founding Fellows" created the "Institute of Science in Medicine" [ISM] in mid-2009 as a "501(c)(3) organization for US federal tax purposes" registered in Colorado.
It self-describes as:
Hall and Marron would've known of each other in 2007, both appearing in "The Skeptic" magazine (Australia) and possibly met at a "Skeptics" conference, such as James Randi's TAM7 (The Amazing Meeting) which had a large Australian contingent.
By 2009, their names appear together in articles, they are both speakers on "The Skeptic Zone" by Richard Saunders and are both closely connection to a number of other high-profile Australian Skeptics like Rachel Dunlop, Kylie Sturgess and Karen Stollznow.
Dr Hall appears in the first list of "Friends", January 2012.
The "mini-me" relationship extends further with their DNS names:
Dr Hall's group has the obvious website name:
If you read the first policy document of ISM [PDF] as a Declaration of Intent, it finishes with some very worrying 'Recommendations':
Just to emphasise this is a consistent, reiterated position, a quote from another article:
ISM and their clones want any type of Healthcare they declare "not science" to be illegal, and practitioners "aggressively pursued". Once started, this is a very slippery slope. Ultimately, internal Politics reliant on funding and 'connections' will determine what treatments are allowed and which will be deemed "unscientific". The world of Medical Politics is already riven with such extreme dysfunction and violent internecine warfare that few outsiders understand how bad it is.
Are ISM and its clones seriously suggesting the public put their health, and the lives of all their foreseeable descendants, into the hands of an unaccountable, deeply discordant and divided profession with no alternatives whatsoever? That's not going to end well for us, the paying public.
This campaign by ISM is hard-core Political Lobbying by the dominant Healthcare Profession for exclusive control of the domain.
They seem to not be happy with having captured over 99% of the Healthcare Dollar and now want everything, presumably in anticipation of making a grab for a much larger slice of our income. After all, you wouldn't want to die from poor Medical care, would you?
In the USA they've increased National Healthcare Expenditure (NHE) from ~5% in 1960 to ~18% now, with the numbers of uninsured and under-serviced folk steadily increasing, but without any commensurate improvement in the most basic of Healthcare Outcomes: Life Expectancy.
The USA is ranked globally around 80th on that measure, whilst spending 50-100% more of GDP...
Projections on the CMS site include that by 2050, NHE will account for 30% of US GDP. They don't suggest how much higher than the current ~25% the rate of uninsured will be.
It self-describes as:
ISM is a non-profit educational organization dedicated to promoting high standards of science in all areas of medicine and public health.and in PDF files includes:
Institute for Science in Medicine, Inc. (ISM) is an international, educational and public-policy institute, incorporated in the State of Colorado, and recognized as a 501(c)(3) organization for US federal tax purposes.The local Australian variant, "Friends of Science in Medicine" [FoSiM] self-describes as:
Our Association was formed at the end of 2011 out of concern about the increasing number of dubious interventions, not supported by credible scientific evidence, now on offer to Australians.FoSiM was created by Loretta Marron and John Dwyer and three other of their little friends. It took them several months to incorporate an Association in NSW and register a website. The five "Founders" were necessary under NSW law to form an Association.
Hall and Marron would've known of each other in 2007, both appearing in "The Skeptic" magazine (Australia) and possibly met at a "Skeptics" conference, such as James Randi's TAM7 (The Amazing Meeting) which had a large Australian contingent.
By 2009, their names appear together in articles, they are both speakers on "The Skeptic Zone" by Richard Saunders and are both closely connection to a number of other high-profile Australian Skeptics like Rachel Dunlop, Kylie Sturgess and Karen Stollznow.
Dr Hall appears in the first list of "Friends", January 2012.
The "mini-me" relationship extends further with their DNS names:
Dr Hall's group has the obvious website name:
www.scienceinmedicine.orgWhere the local "mini-me" has a website name unrelated to it registered name, "Friends of Science in Medicine", but exactly congruent with being the local arm of ISM.
www.scienceinmedicine.org.auThere is a test/development site at:
www.loretta.fosim.orgWhy does this matter?
If you read the first policy document of ISM [PDF] as a Declaration of Intent, it finishes with some very worrying 'Recommendations':
This unambiguous Declaration of Intent gives the ISM, and it's mini-me, FoSiM, specific Agenda:NEEDED POLICYThe world’s health care systems need to be rooted in a single, science-based standard of care for all practitioners.Effective, reliable care can only be delivered by qualified professionals who practice within a consistent framework of scientific knowledge and standards.Practitioners whose diagnoses, diagnostic methods, and therapies have no plausible basis in the scientific model of medicine should not be licensed by any government, nor should they be allowed to practice under any other regulatory scheme.Any statute permitting such practices should be amended or repealed as necessary to achieve this policy.Unscientific practices in health care should further be targets of aggressive prosecution by regulatory authorities.
- It is an explicit recognition that this is a Political not Academic or Scientific 'debate'. ["As a consequence of these practitioners being legitimized through political rather than scientific means, ...] In no way are either of these bodies "Educational" or "about Science". They are only Political Lobby groups, yet aren't registered as such.
- ISM/FoSiM want nothing less than making the practice of "Alternative" Medicines illegal ["change of statues"] and practitioners subject to "aggressive prosecution".
- Who will judge what has, and has not, a "plausible basis in the scientific model of medicine"?
- They don't define either "Science" or it antithesis, "Pseudo-Science", i.e. on the formal, strict basis for this rather extreme decision.
- They don't suggest a forum in which this 'debate' might occur and the formal bodies that will be charged with these judgements. There is no, and can never be, a Global Council of Science charged with making ultimate decisions of what is/is not "True Science".
- Nor do ISM/FoSiM suggest whom has adequate qualifications in both Science and Jurisprudence to even suggest answers to these problems, define the Terms of Reference for any Tribunal convened and the training and selection of whom might be selected to sit in Judgement.
- Do ISM and their "mini-me"s assume that Politicians will have sufficient knowledge, be free from bias and all Conflicts of Interest to sit on these Tribunals?
- There seems to be no idea of Professions being able to defend themselves on any other grounds but an undefined "scientific model" and seemingly without means of Appeal or cause for Redress.
- What isn't spelled out here, but is noted on the FoSiM site, is the assumed Dawkins Appropriation: anything ISM and their "mini-me"s decide is "Medicine" is automatically included in their Field of Practice. Which, by definition, makes that practice or technique now illegal for any other Profession to practice.
Having an organisation like FSM to kick-start a public debate about the value of science in healthcare is invaluable.
So to the extent that FSM can get the media and the general public thinking about how much they might value science as opposed to pseudoscience in their healthcare it can only be a good thing. That’s why I stopped sitting on the sidelines of the debate and signed up when I found out about them.No, this is not a "debate", this is not something of little concern, an effort of well-intentioned, altruistic experts. It is anything but that.
Just to emphasise this is a consistent, reiterated position, a quote from another article:
[From criticism of ISM/FoSiM in the MJA] Indeed, it is not melodramatic to point out that if Friends of Science in Medicine were to succeed in their stated aims, they would achieve a dystopia – a medical ‘1984’ where only one way of knowing the body in health and illness is permitted in public discourse.
Well, for starters, it IS melodramatic to call FSM dystopian. Allow me to also point out that FSM are not talking about public discourse, they are talking about university training of health professionals. The logic of this argument rests on an assumption that scientific knowledge is not special.Again, No so! Read the ISM Policy...
ISM and their clones want any type of Healthcare they declare "not science" to be illegal, and practitioners "aggressively pursued". Once started, this is a very slippery slope. Ultimately, internal Politics reliant on funding and 'connections' will determine what treatments are allowed and which will be deemed "unscientific". The world of Medical Politics is already riven with such extreme dysfunction and violent internecine warfare that few outsiders understand how bad it is.
Are ISM and its clones seriously suggesting the public put their health, and the lives of all their foreseeable descendants, into the hands of an unaccountable, deeply discordant and divided profession with no alternatives whatsoever? That's not going to end well for us, the paying public.
This campaign by ISM is hard-core Political Lobbying by the dominant Healthcare Profession for exclusive control of the domain.
They seem to not be happy with having captured over 99% of the Healthcare Dollar and now want everything, presumably in anticipation of making a grab for a much larger slice of our income. After all, you wouldn't want to die from poor Medical care, would you?
In the USA they've increased National Healthcare Expenditure (NHE) from ~5% in 1960 to ~18% now, with the numbers of uninsured and under-serviced folk steadily increasing, but without any commensurate improvement in the most basic of Healthcare Outcomes: Life Expectancy.
The USA is ranked globally around 80th on that measure, whilst spending 50-100% more of GDP...
Projections on the CMS site include that by 2050, NHE will account for 30% of US GDP. They don't suggest how much higher than the current ~25% the rate of uninsured will be.
Friday, March 9, 2012
First, Do no harm: Patient Safety and the central fallacy of the "Friends of Science in Medicine" position.
"First, Do no harm"... Or so the Hippocratic Oath is presumed to begin.
The Dwyer/Marron "Friends of Science in Medicine" campaign against the teaching, insurance/reimbursement-for and ultimately practice of Alternative Therapies and Medicines of which they, and they alone, do not approve, is based on a central fallacy:
Even in their Constitutions' statement of Object, they don't define or elaborate on their terms:
Where does that leave the Dwyer/Marron definition of "CAM"?
Invalid and irrelevant, like the rest of their bluster, assertion, dogma and prejudice parading as "the opinion of experts", because they can provide no test or Evidence to show, as Dawkins says, "what works and what doesn't".
The very real risk they face with their simplistic and naive thinking is that if they ever construct testable definitions, then a good deal of their own Establishment Medicine would be found wanting. Not an outcome most Medical Practitioners would embrace.
It comes down to this:
The Dwyer/Marron "Friends of Science in Medicine" campaign against the teaching, insurance/reimbursement-for and ultimately practice of Alternative Therapies and Medicines of which they, and they alone, do not approve, is based on a central fallacy:
People are much safer being treated by the Medical Establishment not using Alternative Therapies and Medicines, but exactly the reverse is true.
The number of Patient Injuries and Fatalities from 'standard' Medical and Hospital care and treatment is more than 1,000-fold greater than Alternative Therapies and Treatments, even on the flimsy data we do have on Establishment Healthcare. Why isn't there good data on our $50B/year spend of Public Money? That's another story.
This debate is "all about Evidence", as in hard-data, but Patient Safety and Quality of Care must be examined first before any debate on Effectiveness can even be started.
The flip-side is the erroneous logic that "Good Science" is somehow causally linked to "Good Patient Care", but FoSiM ignore the Golden Rule of Execution:
Science and Knowledge don't deliver outcomes, Practice does.
Before the Dwyer/Marron group can argue against any Therapy, Treatment or Medicine, by its own strict rules ("there must always be very strong Evidence"), it must:
Show us the Data! As complainants, the onus is on the Dwyer/Marron group to prove their case, not for everyone else to justify their existence to their satisfaction (which, being undefined, will never be forthcoming.)The worst logical trick and intellectual swindle played by the Dwyer/Marron group is their conflation and confusion of terms:
Where is their Evidence, the "Good Science" they want from everyone else, to demand any changes? If the modalities they are so implacably and virulently opposed to are harmful, then there must be plenty of irrefutable Evidence, not mere anecdote or self-selected collections/surveys, to support their case. If there isn't already enough, the group should go and create some definitive studies, given their self-confidence it should be extremely easy to do so. It should take them no time at all to collect and publish some statistically robust studies in a well recognised, peer-reviewed Journal.
- A slew of unrelated practices are strung together in one long line of gibberish, with no distinction between recognised, well-controlled modalities and others, with all presumed to be 'equivalent'.
If the Dwyer/Marron group cannot, or will not, distinguish between a piece of crud and a gem, what relevance or vracity do their arguments have? None whatsoever, they fail their own test of "Good Science", which requires correct, unassailable logic, not sensationalist tabloid anti-logic, innuendo and guilt-by-association.
- In Australia, there is a trivial and essential differentiator between all Medical Therapies, Practices and Medicines:
- Is there a AHPRA Registration Board? and hence
- Do Practitioners have a Medicare Provider Number?
The failure of the Dwyer/Marron group to make this simple and essential distinction invalidates all their arguments, because: - just who are they vociferously and ferociously objecting to?
- The properly certified, regulated and trained Practitioners, approved and controlled by expert Government bodies, or
- the unregulated, unregistered minority?
- For the Dwyer/Marron group to disagree with Government Policy and Processes is their Democratic right.
For them to not understand the way these decisions and processes are changed is via Lobbying and the Political process is both ludicrous and naive.
The best outcome they can have by attacking Alternate Therapy and Medicine Practitioners is to create a media spectacle and feel righteous and self-satisfied with themselves.
Without ever once having the possibility of effecting change, because they are lobbying the regulated, not the regulators - the only people in the system with the power to implement their desired changes are being ignored by the Dwyer/Marron group.
Even in their Constitutions' statement of Object, they don't define or elaborate on their terms:
- "Good Science" is a vague, ill-defind term. To quote Shakespeare's Macbeth:
"it is a tale told by an idiot, full of sound and fury, signifying nothing".
- There are "scientific methodologies" (hypotheses, test, result) and "(apparently) good or valid studies/experiments" with "strong evidence", but "Good Science" is at best a lay-person's term, not something any Professional in the field would use.
- Likewise, "Medicine" is a broad church...
There is no definition ever offered for FoSiM's frequently used acronym, "CAM", presumably "Complementary and Alternative Medicine". This has some mysterious meaning only known to the Inner Sanctum of the Dwyer/Marron group. I expect it falls in the category of "I know it when I see it", a throughly undisciplined, non-rigourous and unscientific methodology - because it is inexact, ill-defined and non-repeatable.
Where does that leave the Dwyer/Marron definition of "CAM"?
Invalid and irrelevant, like the rest of their bluster, assertion, dogma and prejudice parading as "the opinion of experts", because they can provide no test or Evidence to show, as Dawkins says, "what works and what doesn't".
The very real risk they face with their simplistic and naive thinking is that if they ever construct testable definitions, then a good deal of their own Establishment Medicine would be found wanting. Not an outcome most Medical Practitioners would embrace.
It comes down to this:
The Dwyer/Marron group have no documented process or methodology to define the Alternative Therapies and Medicines of which they, and they alone, do not approve. They have a loose, informal, self-referential definition: "Good Science, it's what we say it is".
They are self-appointed experts and judges, without credentials, special expertise or relevant experience, who are presuming to force their opinions, biases and prejudices upon the rest of us.
Whenever they cry "Show us The Evidence" or "That's not Good Science", all they are displaying is their own ignorance, ineptitude and biases.
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:
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 :
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:
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:
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).
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:
Their constitution lists their "Objects" as:
to foster Good Science in Medicine [my capitalisation]Their home page states:
We are currently campaigning: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.
"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"
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: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.
- 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]
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.and
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)More in keeping with Dr Wilson's estimate, would be an SE:AE ratio of 20:1, giving:
Adverse Events: 85,000 (* 100)
Patient Injuries: 4.25M (*50)
Sentinel Events: 850 (÷ 10,000)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.
Adverse Events: 17,000 (* 20)
Patient Injuries: 850,000 (*50)
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.
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.
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:
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]:
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]:
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:
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:
The most critical question is:
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:
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
Reflections on the Bundaberg Hospital failure. MJA 2005; 183 (6): 328-329.Anthony P Morton
[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:
THE CENTRAL LAW OF IMPROVEMENT
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]
Introduction:
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.
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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
Just how Professional are Mainstream Medical Practitioners? (could they really withstand a serious Inquiry?)Reading the ~550 pages of the Davies Inquiry report I was struck by many things:
For example Jayant Patel (JMP), "Doctor Death" of Bundaberg.
- 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.
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.
THE CENTRAL LAW OF IMPROVEMENT
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]
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.and
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.
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 www.healthinformation.com.au."
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.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.
"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".
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 inMarron 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?
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:Marron's stunt-activism ... (Jelly Beans as effective as magnets)
- the Blakoe Energiser,
- the Bioptron,
- the Vega,
- the QXCI,
- the Bicom 2000 and
- sundry other dubious devices sold in the name of natural healthcare.
...
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.
Alternative therapists are spreading unchecked and unchallenged into the heart of our communities.In April, 2011, Australian Doctor also wrote of Marron and her 'chiro kids' campaign in "Blurring the lines":
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.
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 BScIn a retrospective/summary piece for I2P, Feb 2011, covering seven years of effort, "The Terror of the TGA", Marron says of herself:
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.
References:
1. Commercialism, choice and consumer protection: regulation of complementary medicines in Australia
www.mja.com.au/public/issues/188_01_070108/har10522_fm.html
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.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:
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.
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.Johnston began his piece with:
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: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.
- "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?"
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.
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.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".
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.
Johnston helpfully provided links to important FoSiM documents, saved on his site:
- List of supporters [dated: 22-Jan 2012]
- Invitation to join FSM
- Global media releases [file entitled 'References', contains many links]
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.
Our Vision Statement: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:
"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”.
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:
- Academics supporting Alternative Medicine 'it can be scientific',
- An on-line petition wanting to protect University courses in Natural Medicine,
- Australian Integrative Medicine Societh [headed by Kerryn Phelps, former AMA Presidents] rejected FoSiM's call to stop Universities teaching Alternative Medicines. and
- apparently current AMA President, Steve Hambleton from Queensland, "immediately withdrew his signature". (posted 10-Feb 2012).
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.
- As a sub-issue, does she ever pass herself off as her husband, or does he equally share her interest, passion and expertise?
- 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.
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Show me the same Evidence about yourself and "Friends of Science in Medicine" that you are demanding of others.
Steve Jenkin. stevej098@gmail.com
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.
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