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extreme weather events
flooding 2011
global health
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health
Health workers
Healthcare and health reform
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adverse events
aged care
allied health care
Australian Medical Association
cancer
cardiovascular disease
child health
Choosing Wisely
chronic diseases
co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
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health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
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#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
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#PreventiveHealthStrategy
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alcohol
consumer health matters
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food and nutrition
gambling
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media-related issues
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The hijacking of medical education

Brett Forge, a physician and cardiologist from Warragul in Victoria, has sent in the
following comments regarding his inclusion on the Crikey Register of Influence:

Dear Crikey

Many thanks for the dubious honour of being included on your register of influence.

It is an inadequate way of investigating medical corruption but it may at least start a discussion on this vital topic.

The problem is that the medical education agenda has been hijacked by vested interests, particularly the pharmaceutical industry but in other cases it may be equipment or prosthesis manufacturers.

Every doctor is the recipient of drug company sponsored hospitality. This hospitality is lavish but the educational agenda is primarily the attraction. Conferences which provide high quality education are very well attended.

The way in which this process to some extent corrupts or influences the doctors attending  is subtle but significant as the agenda tends to be focussed on areas for which drugs are effective available and profitable.

The reason for which I was named in your column was for an article about absolute risk. This is an area I have worked in for over 15 years. The result of my research was to develop a risk calculator to help doctors decide when to take drugs for cholesterol and hypertension. The main effect of utilising this tool was to reassure patients that they were actually low risk and did not therefore need to take expensive drugs.

In 2001 I undertook a study using the tool which was published in the Medical Journal of Australia. 1 of the conclusions of the study was that up to 60% of people in Australia taking cholesterol lowering drugs were in fact low risk and shouldn’t be taking them, this implied that we were inappropriately prescribing several hundred million dollars of drugs every year in Australia.

In spite of the fact that the article and the conclusions were not challenged there was no public discussion about the paper, no interest from government health officers and no invitations for me to discuss my data at meetings. Data suggesting an overuse of expensive drugs does not draw headlines in journals that are funded by drug companies or meetings subsidised by them.

The program that I developed has been downloaded for free by hundreds of doctors in Australia and overseas, but I receive no funding to continue development or research. Needless to say drug companies have no interest in supporting my program nor in inviting me to speak to their conferences as my message is clearly not to their benefit.

What is interesting is that some of my learned colleagues have co-operated with the pharmaceutical industry to produce risk calculators that present data in a way that encourages overuse of drugs. These calculators are purchased by the pharmaceutical industry and then distributed to doctors for free.

The advertorial that I was extensively quoted in was in fact stressing this message that proper risk assessment reassures the worried well that they don’t need to take medication.

For your list to take on more meaning, it would need to understand and detect a conflict of interest. As I received no income for my contribution to the article nor from selling my program (which is free) and as I receive no income from drug companies, I don’t have a conflict of interest. I do receive sponsorship for conferences and payment for speaking to other doctors but this is a tiny part of my income.

I doubt that many of the doctors quoted in your list received remuneration for their comments or endorsement.

Sometimes when I am asked to do an educational talk by a drug company, they wish to know what my thoughts are about their product or even to check the content of my talk. Colleagues have told me that they have been told they will not be invited to talk if their attitudes are not supportive of the company’s product. Clearly this is unacceptable but very difficult to detect and expose.

There are, however, areas of massive conflict of interest where doctors make decisions or recommendations that have large influence both on the practise of medicine and their incomes.

Possibly the most glaring example is in the area of interventional cardiology. Interventional cardiology includes the practise of inserting stents into blocked or narrowed coronary arteries. This practise is widespread and probably the single most expensive procedural item on the commonwealth health bill. Guidelines for deploying the procedure are written mostly by the proceduralists themselves who make in some cases over a million dollars per year from this activity.

An example will serve to illustrate the point. A personal friend recently attended a GP with a history highly suggestive of stable angina. He only had chest tightness on exertion and had not started any medication. He was referred to a leading cardiologist at one of Melbourne’s leading private hospitals. Without any discussion he had an angiogram and a stent was inserted into his coronary artery.

The cost of this procedure was $6000 for which he was not covered by insurance.

He was not told by the cardiologist that extensive randomised trials have found that stents provide no survival benefit nor do they reduce the risk of heart attacks. He was also not told that he would be obliged to take 2 antiplatelet drugs for at least 12 months which would expose him to a higher risk of bleeding, and were he to need urgent surgery for an unrelated condition he would be exposed to a very significant risk of having an acute blockage of his stent. The appropriate treatment of this patient is to have active risk factor management and aggressive cholesterol lowering.

Now this is not an isolated example, I suspect it is pretty much standard care, but of course statistics are not readily available on this form of malpractice.

Similarly, guidelines for the management of certain types of heart attacks are strongly in favour of early intervention and stenting. These guidelines are written predominantly by proceduralists and ignore recent evidence that early stenting does not reduce risk.

The same can be said for coronary bypass surgery which as an industry is largely being replaced by stenting. The only properly conducted randomised trials into bypass surgery are over 20 years old, showed only small benefit in a subgroup of patients and did not include any of the medical treatments that have dramatically changed the outcome for these patients. These procedures are very useful at reducing angina but many patients are told or believe that they are having it to reduce their risk of death or heart attack.

The history of medicine has many shining examples benefitting mankind and reducing suffering.

Parallel to this is the presence of massive profiteering from procedures which appear rational but which are later proved to be of no benefit. Examples include routine tonsillectomy, circumcision, hysterectomys, Caesarean section, radical mastectomy, and prostate cancer screening.

However in terms of cost to the community the cardiac interventional industry probably takes the cake.

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#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016