Saturday, 31 January 2015

'Re: Medical corruption in the UK' by Dr Peter J Gordon in the BMJ

'Re: Medical corruption in the UK' by Peter, J. Gordon, Psychiatrist for Older Adults, NHS Locum, 31 January 2015 
[In Response to 'Medical corruption in the UK' Fiona Godlee, editor in chief, The BMJ, 29 January 2015; BMJ 2015;350:h506]

"Fiona Godlee, Editor of the BMJ, has concluded that: “The profession must take the lead to protect patients and maintain public trust. The GMC should act, and a public register of UK doctors’ financial interests is long overdue.”(1)

In response, Niall Dickson, Chief Executive of the GMC, has stated that: “Our guidance is comprehensive and clear in respect of the responsibilities of individual doctors and we have taken appropriate action against individual doctors in the past where there has been evidence that our guidance has been breached”. (2)

I have petitioned the Scottish Government for a Sunshine Act regarding health professionals’ financial conflicts of interest. (3) This was considered most recently at the meeting of the Petitions Committee on 27th January. The evidence accumulated so far demonstrates that existing Scottish Government guidance, in place since 2003, has never been followed in NHS Scotland. FOI response from the GMC confirms that no doctor has been formally investigated in Scotland for breaching guidance on financial interests. (4)

Niall Dickson has stated on behalf of the GMC that “Parliament has not given us powers”. It would seem that Fiona Godlee has correctly identified what needs to be done, and it is clear that governments will need to act."

References:

(1) Godlee, F. Medical corruption in the UK. 29 Jan 2015 http://www.bmj.com/content/350/bmj.h506
(2) Dickson, N. The GMC responds to the special report in the BMJ on regulating doctors’ financial and commercial interests; 29 Jan 2015 http://www.bmj.com/content/350/bmj.h396/rr
(3) Gordon, P.J. PE01493: A Sunshine Act for Scotland http://www.scottish.parliament.uk/GettingInvolved/Petitions/sunshineact
(4) General Medical Council response to Dr Peter J Gordon. F13/5915/EH; dated14 Jan 2014



'Medical corruption in the UK' Fiona Godlee in the BMJ

'Medical corruption in the UK' Fiona Godlee, editor in chief, The BMJ, 29 January 2015; BMJ 2015;350:h506

"Last year The BMJ launched an international campaign against corruption in healthcare. A single article was the spark: a personal view about the endemic culture of kickbacks to doctors in India (doi:10.1136/bmj.g3169). The campaign received widespread support from Indian doctors and the media, and it seems to have led to some positive change, if not yet enough. In an unprecedented move India’s then health minister acknowledged that corruption was a big problem. The government set up a special committee and has banned gifts to doctors and conference sponsorship by drug companies. The Indian Medical Association is working on a new code of medical ethics for private hospitals. And the Medical Council of India, which regulates India’s doctors, has committed itself to act against any doctors reported to have received kickbacks.

A linked editorial made it clear that India was not alone in having a deeply embedded culture in medicine of tolerance to and even promotion of corruption (doi:10.1136/bmj.g3169). If anyone doubted this, recent news from the United States suggested that healthcare corruption was equally endemic there. On top of evidence that the US loses billions of dollars each year to medical embezzlement (http://econ.st/1BuAiFW), high profile cases are now making clear the mechanisms and the human cost. Six doctors in Chicago are currently being prosecuted for allegedly taking kickbacks. Their alleged crimes includes referring patients to hospital who didn’t need admission and performing unnecessary but lucrative tracheotomies, leading to avoidable deaths (doi:10.1136/bmj.h22).

Nor, sadly, is the United Kingdom immune. A BMJ investigation published this week reports clear evidence of UK doctors receiving covert financial inducements to refer patients to private hospital groups. Some London based doctors have benefited by tens, sometimes hundreds, of thousands of pounds (doi:10.1136/bmj.h396).

No doubt the beneficiaries will include some of the pillars of Britain’s medical establishment. Also no doubt most of those involved will believe that they themselves cannot be bought. But even if that were true, it is the perception of conflicts of interest that matters, as well as the reality. How many doctors enjoying free use of consulting rooms will have explained to a patient: “I am referring you to this hospital (or moving you to this other hospital) because I have a contract with them that rewards me for doing so”?

Some of the beneficiaries might argue that the UK’s General Medical Council has no specific guidance on private sector inducements, and they would be right. The GMC’s failure to provide such guidance, and its apparent reluctance to act on information about kickbacks that was presented to it in 2012, are the focus of a linked editorial (doi:10.1136/bmj.h474). But even without clear guidance or action from the GMC, it seems obvious that referral for any reason other than because the patient’s best interests require it contravenes professional ethics. Gornall reports that some doctors were offered inducements but declined for this reason. And one notable private hospital group keeps well away from inducements, preferring to compete on the quality of the service it provides.

The profession must take the lead to protect patients and maintain public trust. The GMC should act, and a public register of UK doctors’ financial interests is long overdue."

Response: 'Re: Medical corruption in the UK' by Peter, J. Gordon, Psychiatrist for Older Adults, NHS Locum, 31 January 2015 

Gordon, P.J. PE01493: A Sunshine Act for Scotland http://www.scottish.parliament.uk/GettingInvolved/Petitions/sunshineact 


Friday, 30 January 2015

'A Sunshine Act for Scotland' Dr Peter J Gordon, Hole Ousia: Reblog

Dr Peter J Gordon: 'A Sunshine Act for Scotland' on Hole Ousia blog:

"I cannot promise sunshine (who can) but here is a pattern that appears in the daylight of my today.

Hole Ousia found new direction after Alexander McCall Smith recommended “A Pattern Landscape”

051

This post is based on the recent considerations (27th January 2015) by the Petitions Committee on my petition for a  “Sunshine Act”

Kenny Macaskill, MSP gave this response to my petition:


Kenny MacAskill & Jackson Carlaw: A Sunshine Act for Scotland from omphalos

Kenny Macaskill states to the Petitions Committee: “we have got to give them some opportunity” [Scottish Government]  … “I don’t think that can be done quickly as it is quite complex”.

HDL-62

HDL (2003) 62 was issued 13 years ago. It was addressed to every NHS chief executive in Scotland.

Kenny MacAskill states that “it does seem to me [for there to be] a willingness to look into this”
Evidence reveals that such “willingness” has been largely ignored by NHS Boards since HDL (2003) 62 was issued more than a decade ago.

Jackson Carlaw, MSP: “can I say how I am delighted to agree with Mr MacAskill”

Appreciating this evidence, John Wilson, MSP, gave this “note of discordance” to the Committee:


A Sunshine Act: John Wilson, MSP from omphalos

20th January 2015: “Despite numerous reminders, no response has been received from the Scottish Government. In light of this and concerns raised in your correspondence with the Committee’s clerking team, it is advisable for you to direct your concerns directly to the Public Petitions Committee by way of a short written submission that will be published online and circulated for the Committee’s meeting on 27 January 2015″

I sent this reply three days later. I could not do any more.

The basis of my petition, it occurs to me, may risk being lost in procedure:


Prescribed Harm from omphalos

HDL (2003) 62 made it clear who was accountable. Alex Neil, former Cabinet Minister (17 May 2014) “asked officials to urgently investigate why some NHS boards have not put in place registers as covered by the 2003 circular. Alex Neil believes the guidance is clear that this action should have been taken, and we are looking for clarification on why some boards have not acted.”

My investigations have demonstrated that this financial basis to “medical education” is largely hidden in NHS Scotland. This despite General Medical Council guidance.

Accountability is passed like a parcel."


Wednesday, 21 January 2015

“Undiagnosing” dementia - Letter in BMJ, Dr Peter J Gordon

“Undiagnosing” dementia  in the BMJ  

Peter J Gordon, locum NHS psychiatrist for older adults

in Letters:Target diagnosis rates in primary care.  Published 20 January 2015

BMJ 2015;350:h290

"Brunet raises the difficult subject of “undiagnosis.”1

Scotland, long before England, had a financially incentivised target for “early diagnosis” of dementia. This was HEAT target 4, which was set for all 12 NHS boards deployed at secondary rather than primary care level.2

The Scottish government, having reached this target, has not shied away from stating that it did “quite well” in reaching the target.3

As a specialist doctor in dementia I am now facing the return of elderly people who were diagnosed with “early Alzheimer’s disease,” but who many years on show no signs of dementia (they do not fulfil clinical diagnostic criteria for dementia and have shown no signs of progression).

These people thought that they had dementia or “Alzheimer’s.” Some have lived with this for seven years or more. They have generally had post-diagnostic counselling, and families and friends have also adapted to the diagnosis. Driving, autonomy, and insurance may all have been affected.

In many cases this was the direct result of an approach based on “early diagnosis” set as an incentivised target.

If we must have a target based approach (which I very much doubt), ethics must be considered from the outset."

Notes

Cite this as: BMJ 2015;350:h290

Footnotes
  • Competing interests: None declared.

References
  1. Brunet M. Target diagnosis rates in primary care are misleading and unethical. BMJ2014;349:g7235. (2 December.)
  2. Scottish Government. HEAT standard. www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance/DementiaStandard.
  3. All-Party Parliamentary Group on Dementia. Inquiry. How to improve dementia diagnosis rates in the UK. Minutes of the oral evidence session 13 March 2012:26. www.alzheimers.org.uk/site/scripts/download.php?fileID=1396.


Tuesday, 13 January 2015

Reblog: 'Haloperidol in Scotland' by Hole Ousia, Dr Peter J Gordon

Reblog of Haloperidol in Scotland by Dr Peter J Gordon

"At the start of November 2014 I wrote to all 14 regional NHS Boards in Scotland regarding the prescribing of the antipsychotic medication generically called HALOPERIDOL.

The 14 regional NHS Boards are responsible for “the protection and the improvement of their population’s health and for the delivery of frontline healthcare services”.

In this post you will find the prescribing figures and the link to the full reply by each NHS Board.

Each NHS Board area generally provided the extant protocols/guidelines that include Haloperidol as part of any treatment pathway. These may include protocols for Dementia, Delirium, Rapid Tranquilisation and alcohol withdrawal. To access these please click on NHS Board heading (in dark blue)

glasgow

Quantity of haloperidol issued in Greater Glasgow NHS Board area:

NHS Glashow haloperidol
The Excel spreadsheet can be accessed here. Greater Glasgow NHS Board confirmed that “the system used to extract this data was established in April 2010 and data prior to this is not included”.


Lothian

Quantity of haloperidol issued in Lothian NHS Board area:

NHS Lothian Haloperidol


NHS Lothian protocols can be accessed here

Grampian

Quantity of haloperidol issued in Grampian NHS Board area:


NHS Grampian Haloperidol

NHS Grampian protocols can be accessed here 

Forth V

Quantity of haloperidol issued in NHS Forth Valley Board area:


NHS Forth Valley Haloperidol

NHS Forth Valley protocols can be accessed here

Tayside

Quantity of haloperidol issued in Tayside NHS Board area:


NHS tayside, Haloperidol

Tayside NHS protocols can be accessed here
 

Ayr

Ayrshire and Arran NHS have listed all rather than tabulated in yearly summaries.
For haloperidol use 2011 – 2012 in Ayrshire & Arran NHS, click here
For haloperidol use 2013 – 2014 in Ayrshire & Arran NHS, click here
For Ayrshire & Arran NHS protocols, click here

Borders

Quantity of haloperidol issued in Borders NHS Board area:

Borders NHS Haloperidol

Borders NHS protocols can be accessed here


highland

Quantity of haloperidol issued in Highland NHS Board area:

NHS Highland haloperidol

Highland NHS protocols can be accessed here and here


Western I

Quantity of haloperidol prescribed in Western Isles NHS Board area:

Western Isles Haloperidol

Western Isles NHS protocols can be accessed here


Fife

Quantity of haloperidol prescribed in Fife NHS Board area: 

NHS Fife Haloperidol
NHS Fife Haloperidol community

NHS Fife protocols can be accessed here


dumfr

Quantity of haloperidol prescribed in Dumfries and Galloway NHS Board area:

Dumfries & Galloway NHS Haloperidol

Dumfries and Galloway NHS protocols can be accessed here


Shetland

Quantity of Haloperidol prescribed in Shetland NHS Board area:

NHS Shetland, Haloperidol

Shetland NHS protocols can be accessed here 
 

Orkney

Quantity of haloperidol prescribed in Orkney NHS Board area:


Orkney NHS Haloperidol




Lanarks

Quantity of haloperidol prescribed in Lanarkshire NHS board area:

NHS lanarkshire Haloperidol

Lanarkshire NHS protocols can be accessed here

Saturday, 10 January 2015

Reblog: “Doing damage in delirium the hazards of antipsychotic treatment in elderly people” Hole Ousia #PeterJGordon

Reblog Dr Peter J Gordon: “Doing damage in delirium the hazards of antipsychotic treatment in elderly people

"This paper was published in the Lancet in late last year. It is a two page article that is worth reading in full. All screenshots below are from this paper:


The authors commented that


002

The authors were of the view that

003

Scottish Government figures confirm that prescribing of antipsychotics is rising in our elderly. It thus seems important to consider why this may be. The authors continue:


004

There is always the risk in times of austerity, and when staffing levels are not ideal, that:


005

The authors state:

006

The promotion of off-label use of antipsychotic medication was instrumental in my petition to the Scottish parliament for a Sunshine Act:

007

The authors continue:

008

But what does the evidence have to say? The authors state:

009
 
The authors continue:

011

 The authors ask:

012

 The authors conclude with Dr William Osler:

013

I am also of the view that there is a risk that “brief screening tools” may result in “pathways” being followed that, despite good intentions, lead to greater prescribing of antipsychotics in our elderly. I am aware that currently “brief screening tools” are being promoted in Scottish NHS hospitals.

I wish to conclude with one recent example of many: an elderly woman, with terminal cancer returned to her GP after a recent period in hospital. She asked her GP “But why am I on this anti-schizophrenic drug?”"


Monday, 5 January 2015

Reblog: 'Transparency in drug company payments to doctors' by Dr Peter J Gordon, Hole Ousia

'Transparency in drug company payments to doctors' by Dr Peter J Gordon in Hole Ousia blog:

"In a BMJ “briefing” Rebecca Coombes sums up the new UK system for public disclosure of payments from drug companies to doctors

Published the 2nd January 2015 in The BMJ, here follows the full article:

Transparency-in-drug-compan

I have met Andrew Powrie-Smith of the ABPI several times. He has made it a personal mission to improve transparency for the Pharmaceutical Industry and I applaud his efforts. My concern is that the medical profession may not yet quite agree with Powrie-Smith that transparency is a “societal expectation”. I say this as (1) the voluntary register Who pays this doctor? has not exactly been burdened with declarations, and (2) my research into Registers of interest for all staff employed in NHS Scotland has evidenced very poor compliance with Scottish Government Guidance (HDL 62).

The new database, set up by the ABPI, is a most positive development. We should however be aware that it only applies to the pharmaceutical industry and not other areas of commerce: such as device makers, nutritional supplements, digital technologies etc. It is my understanding that the ABPI Register also only applies to doctors. Do we not also need to consider academics, managers, commissioners, pharmacists, nurses, AHPs, charities all of whom could be paid to “educate” us about a specific condition and a product or test for this. Or to commission a service for it.

Surely however, the main issue with this new ABPI code is that it has no legal underpinning. Doctors can opt out of declaring any financial payments and they so they will not be named.

This is why I have petitioned the Scottish Government for a Sunshine Act (or clause). America has this legislation as do several other countries."

Opt-out