Comments by "Keit Hammleter" (@keithammleter3824) on "7NEWS Australia"
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Andrew Smith: The only problem with Thalidomide was birth defects, like missing muscles or really short arms. Thalidomide was never intended for pregnant women and was never tested on or for pregnant women. But when it was released, GP's in Australia and the USA mostly prescribed it for pregnant women. It was not the manufacturer or the regulation authorities that was the problem, it was stupid GP's.
Incidentally, Thalidomide is still in use today. My cousin is on it. It works quite well at its intended use -stopping nausia. There's no chance of her being pregnant - she's 80 years old, so no risk.
GP's are still dumb and stupid when it comes to drugs. My wife was prescribed a new drug for back pain. It's a new type of synthetic narcotic. I said to the GP - is this wise? - by definition a narcotic induces tolerance and is therefore addictive and the patient needs more and more over time to get the same effect. He said, "no, no, its a new type, it won't be addictive, and I won't need to increase the dose." One year later the authorities banned GP's from prescribing it without approval, because it only works well for a while and is very addictive.
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@hansnotsolo : I'm not a doctor, I'm a professional engineer.
In engineering, we have peer review meetings - especially where safety of the public could be impacted. In these meetings, the engineer responsible for a project describes his decisions and reasons to a peer group, thus creating an opportunity for other minds to spot things he didn't think of. Also, there is nothing like explaining to others in clarifying one's own thoughts - it works better if they actually lack knowledge. But what to do remains his decision. After all, he is the only one there who is intimately familiar with his case.
In business management, however, a thing called 6-sigma became fashionable. In 6-sigma meetings, a consensus opinion is sought - they even take votes on what to do. In business, that works - there is often no clear best option.
In engineering, 6-sigma and consensus doesn't work. When you have an expert, the votes of other, inherently less experienced and less informed people only dilute the expert's expertise. This seems to be Charlie Teo's reason for not liking MDT meetings.
So, Reeds, tell me honestly, which way do MDT meetings work? Peer review or expert dilution?
My wife had cancer. She got an opinion from her oncologist who proposed a treatment protocol we were not expecting, and we said so. We respectfully challenged her, wanting her reasoning. The oncologist then said she had discussed my wife's case with Dr xxxx, who is the city's best expert. We said, ok, but we want an appointment with Dr xxxx and hear it from the horse's mouth. Reluctantly, the oncologist gave us the necessary referral. On seeing Dr xxxx, he confirmed his opinion that he had given. But on carefully going through all the lab results and imaging etc in our presence, which he had not done in the meeting with the oncologist, he radically changed his opinion. So, tell me, Reeds, what went wrong here?
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@andrewsmith1257 : I'm glad you were unaffected by the Thalidomide your mother took. Glad for your mother's sake too.
I once knew a girl (very pretty) who, due to thalidomide, was born with the muscle that raises the forearm missing on one arm, rendering the arm useless. She got very adept at using her feet to do things. Think about how a how a girl puts her bra on though. At about 12-13, she asked to have the elbow joint surgically frozen at a 90 degree angle, so she could put a handbag strap or shopping bag strap over her arm and look almost normal. Her mother was not keen on it but took her to their doctor. The GP, the same useless drip who had prescribed the thalidomide, refused to do anything. At 15 she ran away from home, managed to get a job, found a decent doctor, and got referred to specialists who carried out her wishes and fixed up some other minor muscle problems. It worked out well. She used to look pretty odd because the shoulder muscles and other arm muscles remained small due to lack of load carrying, but after the surgical intervention, they grew to almost normal size.
I see you and I agree in much of this. But, as you can imagine, I once read up on thalidomide, and, at least in the US and here in Australia, it wasn't a Big Pharma problem. The problem was GP's using it for something it was not intended for. They call it "off-label use". It still happens. There is some tightening up now - in Australia, some drugs are only listed on the PBS (a govt subsidy scheme to make expensive drugs cheap to the patient) for specific medical cases. However, off-label prescribing is still legal.
If you get prescribed a drug for a medical condition off-label (i.e., not a condition listed by the manufacturer), be careful. It's not necessarily bad, but it just might be. Ask questions.
I can't offer an opinion on specifics in Great Britain, except to say that with their National Health Service, which has operated since the early 1950's, whereby treatment is free and almost all doctors and dentists work for the government, quite a number of bad things have been happening over the years due to the inevitable "bean-counter" approach. We have the same problems with Medicare - eg Royal Perth Hospital refused for a while certain medical supplies - because it was cheaper to re-use equipment designed for use only once, so they did. And what is not designed to be cleaned and sterilised can't be thoroughly sterilised.
Regulatory authorities like the TGA in Australian are constantly being cited by politicians as being thorough, very competent, and independent. But what the TGA does is a desk audit of data supplied by the drug manufacturers. Getting their own data would cost too much i.e., more than the politicians would accept. Hence Big Pharma issues - i.e., selective data supplied.
As I understand it, our TGA does contract a limited amount of batch testing if they consider it necessary. Now there are 2 kinds of testing - Validification Testing (checking that it does what it should do, and doesn't do what it should not do) and Verification Testing (checking that the content conforms to the manufacturer's specification and there is no contamination). The only testing done by the TGA, when they test at all, is Verification.
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