Medical malpractices: Is there light at the end of the tunnel?

Shobha Shukla and Bobby Ramakant, CNS
Dr Peter Gotzsche
The noblest professional of all-to heal fellow human beings- is certainly witnessing its worst decay. Dr Peter Gotzsche, Director, Nordic Cochrane Centre and Professor in University of Copenhagen, said to Citizen News Service (CNS): "There is a lot that needs to change in healthcare. It is one of the most corrupted sectors in society. In Denmark, for example, we have thousands of doctors who are on industry payrolls - they are consultants, they sit on advisory boards - but in reality it is a soft form of bribery because if you do not behave as expected you will no longer be on the payroll." Dr Gotzsche is one of the sanest voices in medical fraternity striving hard to bring evidence-based medicine, ethics and integrity back in fashion.

Dr Gotzsche spoke with CNS on the sidelines of 22nd Cochrane Colloquium.

Normalization of practices that stink of 'soft bribery' such as gifts, incentives or other financial favours of pharmaceutical companies and other medical manufacturers to medical professionals is indeed a slap on the face of medical ethics. The conflict of interest between pharmaceutical companies/medical manufacturers, and public health is seldom made evident. "This contributes to using expensive drugs, or at times using drugs that are not totally rational, or even using drugs instead of thinking of other evidence-based treatments - this has been well documented. I have tried to change attitudes towards accepting industry money. We should learn to say, 'No, Thank you'" asserted Dr Gotzsche.

Not just corrupted, but medical practices are often not evidence-based. Despite strong evidence pointing to the contrary, they remain popular as some strong opinion makers in medical field keep propelling them. Despite Cochrane review showing that directly observed treatment therapy for anti-tuberculosis treatment has no edge over self-administered therapy, there was no hesitation in aggressively promoting what we knew will not give any better results. Similarly mammography screening for breast cancer remains popular despite research evidence pointing against it.

Mammography breast screening doing more harm than good
"We have done research on using mammography screening for breast cancer for over 15 years and have documented that mammography screening does more harm than good. I am only waiting for the first country to stop mammography screening in wake of the existing strong evidence. We found that mammography screening leads to 50% over diagnosis. All these additional 50% women diagnosed with breast cancer are just harmed by getting a cancer diagnosis. Many times we have found that breast disease disappears by itself and it would not have bothered many of these additional women who got detected by mammography screening.  Radiotherapy is very good if you have a real dangerous breast cancer not detected by screening. But when we use radiotherapy on healthy women we kill some of them through increasing their likelihood of developing lung cancer, heart disease and other cancers.  Radiotherapy is lethal when we use it on healthy women. " said Dr Gotzsche.

Mammography screening does not seem to have any mortality benefit because even if it had any effect on breast cancer deaths, the increase in deaths due to treating additional 50% over-diagnosed women far outweighs any benefit. "We also have false positives if we use mammography screening for breast cancer. If we screen 10 times for over 20 years, a quarter of all women will get at least one false positive diagnosis. What my colleagues at Copenhagen found was that even 3 years after false positive diagnosis, the women are still worried and anxious about it, and their anxiety lies between those who have breast cancer and those who were told that everything is fine on screening. So we should factor-in the psychological harm that hits one quarter of all women who go to such screenings. Also it is likely that it has no mortality benefit. Mammography screening is definitely harmful and it should definitely be stopped."

Is this another manifestation of gender-based inequalities in our patriarchal society? "It is a gender issue too. Males have been honestly informed that screening for prostate cancer is a very bad idea. We do not do prostate cancer screening in Europe but women have never been honestly informed about harms of breast screening. They have just been told 'come to screening'. This is a patronizing attitude that I do not understand but which women have accepted."

General health checkup is not beneficial either!
"People think general health checks are like sending your car for servicing every year. But it is not the same because human beings can heal themselves at times which a car can never do. We did a Cochrane review on general health checks and to our big surprise there were actually a number of very large trials out there. When we analyzed them we found that it does not work at all and does not decrease mortality. It leads more healthy people to get diagnosed that would not help them, but that might harm them. Because of our review Danish government decided not to introduce general health checks" said Dr Peter Gotzsche.

He added: "We were in a fortunate situation because new Danish government had plans to introduce general health checks and then it is much easier to say 'no' when you have the evidence. Whereas in the UK they had introduced general health checks few years back and they did not pay any attention to our reviews which came later - because that is how politics is – when you have introduced something like that it is almost impossible to stop it again. Issue of general health checkup has come up again in Denmark because soon we will have general elections. The health minister has not paid any attention to the Cochrane review based upon evidence from 240,000 individuals! The whole idea is political – as it is popular to offer something to the population that they think will help them. This can give them votes. We have reacted strongly citing strong evidence against general health checks."

People before profits when it comes to information

"I and my PhD students were the first in the world who got access to unpublished clinical studies at the European Medical Agency - no one had ever gotten access to such studies anywhere in the world. The agency would not give us access because they wanted to protect commercial interests. Our health authorities do not think about protecting patients but they think about protecting the health industry, which is very bizarre. We complained to the European Ombudsman and the process took three years, after which European Ombudsman accused the European Medical Agency with maladministration. Then they needed to do something and they changed their policy and we got access" said Dr Gotzsche.

"I am also working in the European parliament trying to influence the European trials directive which in its final form was much better than what was proposed by the European Commission. We will now have access to much more data, from all trials from 2016. If we do not have access to all the data we may be harming our patients as we do not know what the value of our treatments are."

Shobha Shukla and Bobby Ramakant
Citizen News Service - CNS
26 September 2014