Sunday, 18 October 2009

59. Medical Gloom

This week's BMJ contains an excessive dose of sad or worrying news. And a lot of the problems are insoluble.

It begins with an editorial on obesity. Fat people suffer more anxiety and depression, and depressed or anxious people get fatter. Antidepressants cause weight gain - and the manufacturers do not warn of this, as it would reduce their sales.

We are all aware of cases of sudden infant death syndrome - SIDS. There have been some notorious cases, including the enigmatic statements in court by professor Meadows. Yet mothers remain ignorant: they continue to sleep together with the baby, especially on a sofa; they smoke, and they drink. Avoiding these factors would reduce SIDS by more than half. Furthermore, mothers' smoking during pregnancy increases stillbirths by 38% and infant deaths by 31%. Perhaps, at the funerals, the priests should tell the parents that it was their fault?

Fraud and greed in medical research is frightening. All journal editors have just agreed on a stricter honest and transparent disclosure of their competing interests'. But greed is likely to continue.
The bribes involved are enormous. For example, the US government compelled manufacturers of prosthetic hip and knee joints to declare all payments to doctors in 2007. They compared this with the payments from these manufacturers that were declared by orthopaedic surgeons at their annual meeting in the following year, when these products were discussed. Sixty doctors concealed payments of 12 million dollars in total !

In Germany, another scam is being used. Drug companies pay GPs up to £1,000 per patient for prescribing their new drug - and providing them with documentation of its effect. It is estimated that 25% of all
German GPs take part in such 'trials', on more than 200 drugs. The patients are not aware, that they are being used as guinea pigs without their consent; and that they are providing the GP with a lot of extra income. Furthermore, the patients, or their insurers, have to pay for these often expensive drugs - they are not donated by the manufacturers.

Corruption goes deeper still. Dr Hurlstone, an award-winning consultant gastro-enterologist at Sheffield university, has just been discovered falsifying results and forging the signatures of co-authors in 3 published papers since 2007. Such dishonesty does not emerge suddenly: How was he not unmasked during more than ten years of his career progression?

And inevitably, fraud by drug manufacturers continues. GlaxoSmithKline are being sued in Philadelphia. They appear to have concealed their research findings, that the antidepressant Seroxat caused serious birth defects in infants of mothers who took it during pregnancy. Remember Thalidomide?
Sometimes the fraud is discovered almost by chance.
GlaxoSmithKline (the same) manufacture 'ready-to-drink' Ribena in cartons. They boast that it contains 'four times as much vitamin C as oranges'. Two girls aged 14 in a school experiment found that Ribena in cartons contained almost no vitamin C. They received a 'brush-off ' from GSK but went to a newspaper and a TV company. They won, and in court GSK were fined a hefty sum. The two girls have now been voted New Zealanders of the Year.

Among all this gloom, there is one column-inch of good news. Recently a kind and caring nurse exposed poor standards of care at the Brighton and Sussex university hospitals NHS trust. She was tricked by television to give some innocent particulars. For this, the nursing and midwifery council struck her off: she lost her income and her career. [Later addition: I have just watched this council's spokeswoman explain their verdict: the bitch was brazenly defending the cruelty and incompetence of the Brighton hospital management's mistreatment of these helpless old people!]
So I was delighted to read that after appealing to the high court, the nurse has been allowed to return to work.

I know what I think of
the nursing and midwifery council... and of the drug manufacturers... and of some academic researchers... and greedy German GPs... and of some members of our parliament...

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