Peter C Gotzsche and Cochrane

Peter Gotzsche, writing in the BMJ 8 November 2018: “When Iain Chalmers started the Collaboration 25 years ago, he wrote in the invitational letter to 50 people, including me, that the collaboration is “committed to opposing any tendency for it to become dominated by any nation, institution, or individual.” Unfortunately, Cochrane has gone in that direction.

Academic freedom has gone, scientific debates are unwelcome, and transparency is a thing of the past. Cochrane’s public statements deny this, but I am a witness on the inside…”

Peter C Gotzsche: Cochrane – no longer a Collaboration. BMJ Opinion, 8 November 2018.
https://blogs.bmj.com/bmj/2018/11/08/peter-c-gotzsche-cochrane-no-longer-a-collaboration/

 

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Posted in citizen safety, clinical trials, cochrane, Collaboration, healthcare modernisation, openness, patient safety, Public safety | Tagged , , , , , , , , , , , , | Leave a comment

Breast screening – National Audit Office (NAO) investigation into four screening programmes.

“The breast screening incident saw former health secretary Jeremy Hunt apologise to MPs for “a computer algorithm failure dating back to 2009” that meant up to 450,000 women had not been called for their final breast screen.

It is the subject of an internal inquiry by PHE officials and an independent inquiry chaired by Lynda Thomas, the chief executive of the Macmillan cancer charity.

Both inquiries are expected to be completed before the end of the year though in September HSJ obtained a copy of an internal review of the breast screening programme compiled by management consultants PwC as part of PHE’s internal inquiry.

PwC found that the algorithm was not responsible for the error. It said a misunderstanding about how the breast screening programme operates, dating back to 2013, combined with poor governance and a loss of “corporate memory” at PHE lay behind the incident.”

National Audit Office Investigating NHS Screening Programmes. Jack Serle, HSJ, 24 October 2018.

https://www.hsj.co.uk/quality-and-performance/national-audit-office-investigating-nhs-screening-programmes/7023607.article?

Posted in Breast Cancer, breast screening, Campaigns, citizen safety, evidence-based medicine, harms, healthcare modernisation, informed consent, mastectomy, medicine's flaws, Over-medicalisation, overdiagnosis, overtreatment, personal autonomy, Public safety, Screening, Screening Mammography, screening prostate cancer, Uncategorized | Tagged , , | Leave a comment

Vaccination programmes: effectiveness, safety and public trust

“Peter Doshi tells a tale of two vaccines rapidly deployed by GSK in 2009 amid fears of a flu pandemic (doi:10.1136/bmj.k3948). There were early internal safety reports showing a higher rate of serious adverse events logged in relation to one of the vaccines, Pandemrix, but these reports were not actively shared with the public, and the vaccine continued to be promoted well into 2010.”

Why was the public not alerted? (Fiona Godlee, bmj Editor’s Choice.)

The many rapid responses are enlightening (open access).

Pandemrix vaccine: why was the public not told of early warning signs? Peter Doshi, BMJ 2018;362:k3948

What ever happened to ‘first do no harm’?

Posted in evidence-based medicine, harms, healthcare modernisation, information, informed consent, medicine's flaws, patient safety, patient/doctor communication, Public safety, vaccination programmes | Tagged , , , | Leave a comment

What happens when someone speaks out against the drugs industry?

People who work in healthcare and speak out to protect others pay the cost. What happens when someone with integrity speaks out against the financial interests of the pharmaceutical industry:

‘One of the medical world’s most respected expert bodies is in turmoil as its annual meeting gets underway in Edinburgh, Scotland, after its governing board voted to expel a member. The Cochrane Collaboration, which reviews the scientific literature in areas of clinical research and produces widely cited analyses that help guide clinical practice, kicked out a member who has been an outspoken critic of certain vaccines and has blasted the profession of psychiatry for pushing unsafe drugs on unsuspecting patients…’

https://www.statnews.com/2018/09/16/expulsion-cochrane-peter-gotzsche-medicine/

In a letter circulated by Peter Gotzsche on 14th September 2018 he wrote:

‘As most people know, much of my work is not very favourable to the financial interests of the pharmaceutical industry. Because of this Cochrane has faced pressure, criticism and complaints.

My expulsion is one of the results of these campaigns.

What is at stake is the ability of producing credible and trustworthy medical evidence that our

society values and needs.’

A moral governance crisis: the growing lack of democratic collaboration and scientific pluralism in

Cochrane. Peter C Gotzsche, Professor, Director, MD, DrMedSci, MSc, Nordic Cochrane Centre, Rigshospitalet, Dept 7811.

https://nordic.cochrane.org/sites/nordic.cochrane.org/files/public/uploads/moral_crisis_in_cochrane.pdf

See also BMJ blogs

https://blogs.bmj.com/bmj/2018/09/17/ray-moynihan-lets-stop-the-burning-and-the-bleeding-at-cochrane-theres-too-much-at-stake/

https://blogs.bmj.com/bmj/2018/09/17/trish-greenhalgh-the-cochrane-collaboration-what-crisis/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+bmj%2Fblogs+%28Latest+BMJ+blogs%29&g=w_bmj-com

and

https://www.bmj.com/content/362/bmj.k3927/rapid-responses

Posted in bad science, citizen safety, clinical trials, evidence-based medicine, healthcare modernisation, medicine's flaws, patient safety, Public safety | Tagged , , , , | Leave a comment

The world is waking up to the lack of benefit and harms of screening.

Renaming low risk conditions labelled as cancer BMJ 2018;362:k3322

This Analysis article discusses our changing understanding of the prognosis of cancers:

‘…These small papillary thyroid cancers are increasingly being detected because of new technologies, increased access to health services, and thyroid cancer screening.4 Studies show that rates of metastases, progression to clinical disease, and tumour growth in patients with small papillary thyroid cancer who receive immediate surgery are comparable with those in patients who follow active surveillance…’

https://www.bmj.com/content/362/bmj.k3322

and

‘What can add five years to your life without lengthening it by a single day, improve the performance of the NHS while wasting its resources, and make people grateful for unnecessary suffering?’

– this superb article by Michael Blastland in Prospect magazine explains precisely what – and why:

‘The dark side of early diagnosis’. – surely a ‘must read’ for anyone with the slightest interest in health and screening.

https://www.prospectmagazine.co.uk/magazine/early-diagnosis-cancer-screening-women-risk

Posted in Breast Cancer, breast screening, Campaigns, cancer, citizen safety, Compassion in healthcare, diagnoses, evidence-based medicine, harms, healthcare modernisation, information, informed consent, mastectomy, medicine's flaws, Over-medicalisation, overdiagnosis, overtreatment, patient/doctor communication, psychological harm, Public safety, Screening, Screening Mammography, speaking out, Uncategorized | Tagged , , | Leave a comment

Want to know?

What your patient is thinking – this book spills the beans, plus it has discussion sections and research links to better/evidence-based practice: Nothing Personal, disturbing undercurrents in cancer care. Radcliffe Publishing (Taylor & Francis – Routledge); CPD certified. (Winner, Medical Journalists’ Association Open Book Award 2009; RCN’s essay prize 2009.

“Today’s patients continue to raise the same issues, but clinicians are now being encouraged to get in touch with their feelings, so perhaps my story could be useful to patients and professionals alike.”

Posted in anal cancer, biopsies, books, Breast Cancer, Campaigns, cancer, citizen safety, clinical trials, Compassion in healthcare, complaint, CPD accreditation, death, diagnoses, dying, evidence-based medicine, guidelines, harms, healthcare modernisation, humour, information, informed consent, medicine's flaws, multidisciplinary team meetings (MTDs), nhs staff, openness, palliative care, patient safety, patient/doctor communication, patient/public involvement, personal autonomy, poetry, psychological harm, Public safety, rarer and uncommon cancers, speaking out | Tagged , , , , , , , , , , | Leave a comment

Breast cancer: old news re reduced need for chemotherapy

‘Good News for Women with Breast Cancer: many don’t need chemotherapy’ writes Denise Grady in the New York Times, 3 June 2018 reporting on a major international study.

The gene test, called Oncotype DX Breast Cancer Assay, is the focus of the study.

‘The availability of the gene test in 2004 helped researchers sort out women with very high or very low risk.

“But we really didn’t know what to do with women in the middle,” Dr. Mayer said. “Some seemed to benefit and some didn’t. We were back to square zero, safe rather than sorry, giving chemo to a lot who didn’t need it.”

“We can spare thousands and thousands of women from getting toxic treatment that really wouldn’t benefit them,” said Dr. Ingrid A. Mayer, from Vanderbilt University Medical Center, an author of the study. https://www.nytimes.com/2018/06/03/health/breast-cancer-chemo.html

– However, media cancer hype is usually followed by scientific/commonsense explanations and this ‘good news’ is no exception – see responses to the bmj article ‘Seven in 10 women with early breast cancer do not need chemotherapy, study finds’:

BMJ 2018;361:k2473

https://www.bmj.com/content/361/bmj.k2473/rapid-responses

 

Posted in Breast Cancer, breast screening, cancer drugs, clinical trials, evidence-based medicine, healthcare modernisation, medicine's flaws, overtreatment, patient safety | Tagged , , , | Leave a comment