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.

 

I had a project as a little boy

In this film, which is based on the title screenshots of my films, I endeavour to contrast Peter and Sian harmony with today’s unnatural divide between science and philosophy:

I had a project as a tiny boy from omphalos

Music credit:
Sian said “oh Peter, you will like this, it is by John Grant and Guy Garvey”

Sian was right.

The world is a more wonderful and a more surprising place

This is a film based on the chaotic pendulum.

My friend, David Harrowes, took me to St. Mary Redcliffe parish church in Bristol.
I cannot recall the year. But it was not so ‘long ago’.

The world is a more wonderful and a more surprising place from omphalos

Music credits:
Thomas Tallis – Third Tune for Archbishop Parker.

Dedication:
This film is for Chrys Muirhead.

Janet B Wood

“What is in a name? That which we call a rose. By any other word would smell as sweet”
(Romeo & Juliet Act II, Scene II).

If a rose was not called a rose would it still be a rose?

Many years ago an old lady let me take cuttings of a rambling rose that I had admired growing up her garden wall. This old lady told me that this Jacobean rose had been ‘rediscovered’ by her grandmother, Janet B Wood.

The cuttings took. Janet B Wood climbed the mature sycamore tree with equal vigour but greater beauty. That tree is no more and now rose Janet B Wood is growing up our arched pergola.

I was reminded of this rose, its name, and the story when I recently read the diaries of the poet William Soutar who was confined to bed for decades due to progressive ankylosing spondylitis:

 

A Devil’s Dictionary

This is the title of an Editorial in the October 2017 BJPsych Bulletin. It is a personal view by Dr Philip Timms  a retired Consultant Psychiatrist.

Dr Timms gave two pages of examples. I was interested in his selection as to me many of these terms were part of a system of language that has developed across medicine rather than related specifically to mental health.

Each of us would produce a different list. I would have included words like anosognosia, insight, capacity, subjective, objective, disorder etc

However I have chosen two examples as selected and defined by Dr Timms in his Devil’s Dictionary:

I have a question about Duty of Candour

This post considers the question that  Maree Todd, MSP, asked at this Parliamentary committee.

As an NHS employee of 25 years I will close this post with a similar question.

Shona Robison Paul Gray NHS Scotland (1)

Shona Robison Paul Gray NHS Scotland (2)

Shona Robison Paul Gray NHS Scotland (3)

Shona Robison Paul Gray NHS Scotland (4)

Shona Robison Paul Gray NHS Scotland (5)

The role of prescribed persons from omphalos

Shona Robison Paul Gray NHS Scotland (6)

Shona Robison Paul Gray NHS Scotland (7)

Shona Robison Paul Gray NHS Scotland (8)

My question:
Is there any reason why Government officials (elected or otherwise) should not be included in Duty of Candour legislation?

Being told you are in the “mortality relegation zone”

This post is based on an Editorial published in the BMJ on 27 September 2017: Identifying frailty in primary care.

The full article can be read here.

Might the experts themselves be confused?

I recently read a British Geriatrics Society (BGS) blog which was titled:
“Antidementia medication may improve survival in Alzheimer’s disease”.

Having read this blog several times I wrote to the author on the 22nd September 2017 with some questions that arose for me:

Dear Dr Mueller,
I am wondering why you have chosen not to use the term dementia (the clinical syndrome) in this blog – instead you talk about “Alzheimer’s disease” ?

The BNF, section 4.11 is entitled “DRUGS FOR DEMENTIA” and the indications for use of acetylcholinesterase inhibitors are described as:

mild to moderate dementia in Alzheimer’s disease[bolding mine]

I am wondering if you may be asking (or encouraging) professionals to diagnose Alzheimer’s disease out-with the clinical criteria for dementia (DSM and ICD) ? If so what criteria should clinicians follow (research criteria being quite different to internationally standardised clinical criteria).

Might you be able to provide me more details of the evidence that supports this robust conclusion:

“Acetylcholinesterase inhibitors are not only helpful for memory, psychiatric symptoms and functioning, but may also improve survival. They should be strongly considered in every patient diagnosed with Alzheimer’s disease.”

Are you saying that acetylcholinesterase inhibitors are disease modifying? The scientific advisors for Alzheimer’s Society state quite emphatically that they are not and that they do not improve overall outcome? The World Health Organisation say likewise.

Mixed messages can be confusing to the public and professionals alike. The public are already confused about the loose (and unhelpful) use of language by professionals and the media: such that “Alzheimers” is often synonymously misunderstood as dementia.

A few years ago I debated in an RCPsych Congress advocating a timely approach to the diagnosis of dementia. Prof Ballard advocated diagnosing “early Alzheimers disease”. He lost the debate and was not able to give the audience necessary clinical guidelines on how to diagnose “early Alzheimer’s disease” without risking false-positive or false-negative diagnoses of dementia.

Prof Ballard has also stated in a Lancet publication that plaques and tangles may not be “paradigmatic” (the exact quote is below).

I would welcome any thoughts you may have.

With kindest wishes,
Dr Peter Gordon

Footnote:
The 2008 - 2012 period that forms the data for this 
retrospective survival analysis was the period when 
early diagnosis was encouraged and in some instances, 
financially incentivised. 

Might it be that this resulted in a higher number of 
false positive diagnoses of "dementia"? 

Thus, a potential explanation of this "reduced mortality 
in Alzheimer's disease" is that it may actually relate to 
misdiagnosis of non-progressive mild cognitive impairment?