Credible or incredible: experience is evidence

A senior Scottish figure once gave me advice that it is very important to be perceived as “credible”.

I was thinking about this advice recently when the convener of the Parliamentary Committee considering polypropylene Mesh implants concluded:

It is not surprising, therefore, that those who have experienced harm from healthcare may feel that they are not being listened to.

In the same week another example featured in a week long series of articles in the Herald: “A Bitter Pill”. On a background of ever increasing prescribing of antidepressants it appears that my profession is still struggling to accept the value of people’s experience (which may not always be positive) and can respond defensively:

One responder has already articulated my feeling about this:

My understanding is that this series in the Herald arose, at least partly, because of a petition to the Scottish Parliament which seeks consideration of prescribed drug dependence and withdrawal.

One of the explanations for the rising prescribing of antidepressants is that people are often taking them for many years. Another way of looking at this is that people are not stopping these drugs. It is still the case that we really do not understand why this may be and we are not going to understand this until we listen to the experience of those taking these medications.

Experience is evidence and I find it incredible that we do not listen carefully enough to it.

 

 

 

 

Neil Findlay’s support for those harmed by Mesh implants

What follows below are several extracts from Socialism and Hope by Neil Findlay, MSP.

If you wish to purchase this book please do so through socialismandhope.com as this means a greater donation goes to good causes.

Conflicts of interest and polypropylene Mesh implants

The following is a shared consideration of the potential for conflicts of interest to have had a significant role in the harm caused to Scottish women by Mesh implants. This is taken directly from the official report of this Scottish Parliament evidence session.

I commend Neil Findlay, MSP for raising this important issue with and Dr Agur for his  considered responses.

I would also hope that the Review of the “independent review” that Professor Britton is undertaking will consider the issue of conflicts of interest specifically.

The evidence gathered for PE1493, A Sunshine Act for Scotland, established that NHS Scotland governance is failing here and that NHS Boards have routinely ignored the guidance offered.

PE1493 closed a year and a half ago, after a public consultation exercise under taken by The Scottish Health Council. The majority of those consulted were of the view that there should be a public register open to all and that it should be mandatory for all healthcare staff and academics to declare all competing financial interests.

I am a worrier and I worry for Scotland’s Minister for Health

If this headline represents the approach of the Scottish Government, well I worry.

It is doctors, not pharmacists, that are licensed to prescribe and to withdraw any prescription.

The scientific community shares the conclusion that it easier to start medications than to stop them.

Scotland’s Minister for Health would seem to be asking pharmacists (unregulated by the General Medical Council) to provide:

“stricter checks on medication involving addictive medications”.

Meantime, my profession and our regulators would seem to avoid issues such as:

  • the continuing “education” of NHS doctors (those who are licensed to prescribe) by financially vested interests
  • that withdrawal from psychotropic medications may precipitate (for some) a “relapse” with symptoms worse than those for which medication was first prescribed.
  • that long-term exposure to psychotropic medication may have unforeseen consequences.

I am a worrier and I worry.

 

Mesh implants and “fully informed consent”

Since my last post on PE1571, Polypropylene Mesh Medical Devices, there has been further consideration of this petition, with evidence given by Dr Wael Agur and the petitioners Elaine Holmes and Olive McIlroy:

What follows are some of my reflections on the parliamentary committee session of the 28th September 2017:

Before the committee began I suggested to interested colleagues:

“The petition on Mesh implants will start taking further evidence today. This could potentially be a watershed moment for the Scottish Government’s Department of Health?”

Dr Agur was extremely good in giving evidence. He came across to me as open, genuine, careful, scientific and reflective. Dr Agur disabuses the stereotypical notion that surgeons struggle to combine pragmatism with philosophy.

Dr Agur was entirely open about his declarations. Here he is an exemplar.

However I retain the concern that manufacturers may have had a greater share in “shared decision making” on Mesh surgery than we are currently able to determine?

The Mesh survivors spoke incredibly well, and thankfully more openly and candidly than any of those in the systems of power that surround us.

The cross-party questions to Dr Agur and the petitioners explored the issues extremely well.

I have no idea what will happen from here on – but I support all the recommendations of this Parliamentary committee.

I dislike over-simplified summaries and yet I now offer one:

We should be especially open to the consideration of what might constitute “fully informed consent”. I do hope the Chief Medical Officer follows through on Realistic Medicine including the potential for science to be distorted, and patients harmed, by vested interests.

The above statement was part of a longer statement made by the 
Chief Medical Officer for Scotland in giving  evidence on PE1571 
on the 18th May 2017.

 

‘Robust clinical governance must surround treatment’

According to the Sunday Post of the 23rd September 2017, the former Health Minister for the Scottish Government, Alex Neil, MSP, is:

“urging the Scottish Government to stage a summit bringing together experts from around the world as the scandal of women left badly injured by the propylene implants escalates”

I am interested in the Mesh implant scandal because of my petition to the Scottish Parliament which sought consideration of a Sunshine Act for Scotland.

On the 17th May 2017 I submitted a summary as part of further consideration of on PE1517: Polypropylene Mesh Medical Devices.

Mr Neil’s call for an international summit has cross-party support in the Scottish Parliament. He also has the backing of East Renfrewshire MP, Paul Masterton, Conservative, who is campaigning at Westminster.Paul Masterton MP states:

The Interim and Final Independent Reviews on the use of Mesh implants concluded that “robust clinical governance must surround treatment”. I have argued that for this to happen the Scottish Government need to listen to the people.

We want to gain the public’s trust, but are we listening to them?

This letter written by Peter and Sian has just been published in the BMJ
(dated 20 September 2017):

Raised by the people of Scotland

Crowd-funding is nothing new. The Martyrs’ monument was funded by public subscriptions to redress the events of 50 years previously when five Scots were transported for sedition. Their speaking up for the common people was judged by those in authority to be “wicked and felonious”.

The Foundation stone for the Martyrs’ Monument was laid on the 21st August 1844:

400 people attended the laying of the foundation stone. 183 years to the day later it happened to be five of us who gathered for a peaceful protest recognising the ongoing imbalance in power between those in high office and those in the general population.

Walter Humes, writing in Scottish Review, 21st September 2015:

President Obama put this in a slightly different way:

Our protest also happened to coincide with a solar eclipse. My particular experience with high office has related to my petition for a Sunshine Act for Scotland:

Surely one of the reasons that we commemorate the past is so that we can learn from it. The voices of the people really do matter.

‘The medical untouchables’

The following is a recent opinion piece by Dr Des Spence published in the British Journal of General Practice.

I had been lined up to do the media interviews on BBC Scotland in relation to petition PE1651. However, on the day, due to changed travel arrangements, I was not available. Dr Des Spence was interviewed instead and did a better job than I could have done.

As an NHS doctor and specialist, I fully support this petition (PE1651) which calls on the Scottish parliament “to urge the Scottish Government to take action to appropriately recognise and effectively support individuals affected and harmed by prescribed drug dependence and withdrawal.”

I have submitted my response.

I feel it would be helpful to hear the views of the Chief Medical Officer for Scotland and in particular, how this matter might be considered as part of Realistic Medicine.

Three recent posts by me demonstrate the scale of competing financial interests in medical education in the UK. If you have a moment, you should have a look. Perhaps you might then share the worry that I have about this matter:

I have previously raised my own petition, PE1493, which the Scottish Public has supported. This was a petition for a Sunshine Act for Scotland, to make it mandatory for all financial conflicts of interest to be declared by healthcare professionals and academics.

My petition, supported by the public, had no support from “Realistic Medicine”. The public has had no update from the Scottish Government on my petition in 18 months. My view is that this is a shocking failure of governance and would seem to demonstrate a lack of respect for democracy.