The Demolition of the Principles of Good Clinical Practice

I was fortunate enough to have studied at Leeds University Dental Institute. For me, the most important lessons were in the ethics and principles of clinical practice. These foundations exist to protect the public and ensure that they can trust us to provide any necessary care.

So what in particular did I learn and what would have prevented me from being allowed to qualify and have a licence to practice?

I had to study physiology, anatomy and pathology in great detail and be continually tested on these subjects before moving on to practical surgical and technical skills. One of the key considerations I had to have in mind when making the transition from theory and applying this to practice was to understand that not all specifically diagnosed cases are the same and that the health status of a patient is never fixed. It can be ever-changing and dynamic, so a clinician needs to be reactive to this.

We were also taught about perspective when assessing a patient. I was once pulled up by the Professor in Radiology for dwelling too long on one particular area of a radiograph in my determination to reach a diagnosis. The valuable lesson was that by doing this, I risked finding artefacts and missing the bigger picture. When it comes to safety, airline pilots, sea vessel captains and motorists should know the perils of focusing too much in one area, especially in an emergency. For Covid the bigger picture includes the latest data that shows  99.9987% of the under 20s and 97.1% of the elderly survive Covid.

Examination questions were very often designed to see how well we could accommodate these variables in order to tailor-make individual treatment plans. The complete antithesis of providing safe, effective healthcare would have been to rush in and provide a blanket ‘one-size-fits-all’ treatment plan for every patient.

Not understanding and applying these principles would likely prevent you from qualifying as a dentist or a doctor. 

Apart from individualising treatment and monitoring for beneficial and adverse effects, further prescribing principles focused on the following: patient safety, identifying the most vulnerable, informed consent and prescribing within the limitations of your knowledge, skill and experience.

So, in the context of Covid, how well – how correctly and ethically – have we applied these basic principles in tackling the disease?

Individualised, tailor made treatment plans – Recommended treatment (e.g. vaccination) does not appear to have accounted for the huge difference in Covid risk profile with respect to each person’s age and general health status.

Monitoring effects – Patients have not been provided with simple, recordable post-treatment assessment forms. For instance, surely it would have been simple enough to provide patient questionnaires to return on second or further booster visits to help monitor and evaluate the effectiveness and safety of an embryonic vaccination programme.

Informed consent – Patients have been denied a full range of possible treatment options through closing down any debate on focused protection as per the Great Barrington Declaration, improving lifestyle choices to fortify our immune systems naturally and blocking alternative drugs or pharmaceutical regimes that, evidence suggests, have proved so successful in India. Patients have been coerced into acceptance of a single treatment plan (i.e., vaccination) and have no choice but to be vaccinated when their freedom to access services or even employment is threatened without compliance.

Prescribing within the limitations of knowledge, skill and experience – Many issues are now coming to light with regard to the lockdown/vaccination strategy. For instance, the latest studies on how Covid vaccines affect blood clotting, heart muscle, the menstrual cycle and other sites or organ systems remote from the injection site which were, on roll-out, initially discounted.

In terms of safety, where has there been a consideration to pause or stop prescribing for the young, the fit and healthy, including athletes with extremely low Covid risk? There is no clear evidence that these asymptomatic subjects spread symptomatic disease to the vulnerable; the vaccinated elderly and vulnerable are protected from severe illness and it is virtually impossible to stop a virus from spreading in any case.

I’ll keep firing principles at you. The following are the five ‘rights’ that clinicians should aspire to achieving – the right patient, medication, dose, route and time. Lockdown and vaccination protocol has not reached out for these ‘rights’. In particular vaccination has been delivered indiscriminately and regardless of antibody status and evidence of pre-existing immunity and the dose and timing have been experimentally adjusted by mixing vaccines and shortening the booster intervals.

Finally, the pillars of medical ethics in the simplest terms:

  • Autonomy – respecting the patient’s right to self determination;
  • Duty to do good;
  • Duty to not do bad;
  • To treat all people equally and fairly.

I’ll let you consider whether those ethical pillars have been adhered to in the context of the backlog of non-Covid care (including cancer diagnosis, mental health, impact on education); the blanket medical treatment of low or near zero risk patients; the economic consequences that are eventually bound to impact mostly on the poorer in society; the blatant coercion and stigmatising of non-conforming or sceptical individuals; and the gross lack of a determination to record medically or publicise in the media adverse consequences of an experimental lockdown-and-vaccination strategy. It seems that all the above rules have been tramped on by a hypocritical political elite that parties-on whilst tired-out healthcare professionals wearily acquiesce.

It is only with Covid, it seems, that we have allowed the demolition of safe, ethical clinical practice.   

Dr. Mark Shaw is a retired dentist.

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