Medicine

Covid in Australia – a Doctor’s Perspective

There follows a guest post by a doctor in Australia, who prefers to remain anonymous, about his experience of the pandemic Down Under.

I entered General Practice 34 years ago in rural New South Wales. Needless to say, the changes since then have been immense.

In 1988, most GP’s admitted and cared for patients in hospitals, did regular house calls, delivered babies, performed surgery and practiced anaesthetics. Now, other than in remote rural locations, very few provide any of these services. As many patients inform me, most GPs seem to want to only look at their computers, order tests, prescribe drugs, give immunisations and refer to the specialists.

Twenty years ago, I underwent specialist training in Sports and Exercise Medicine, and now work purely in that area. I remain, however, registered as a General Practitioner. The Australian health system has plenty of similarities with the British system, though has a number of features which differentiate the two. In Australia, the vast majority of GPs work in the private system, working as contractors to health centres, being employed by private practices, running practices themselves, or in a dwindling number of cases working as solo GPs. Very few work as employees of the public sector or NGOs.

Each state has a Health Department, which can impose different regulations on GPs, such as Covid vaccination requirements, and runs the public hospitals in that state; the Federal Government also has a Health Department which oversees the registration of doctors, pharmaceutical benefits scheme and health budgets. Registration is governed by the Australian Health Professional Regulation Agency (AHPRA) via the Medical Boards. The Therapeutic Goods Administration (TGA) controls drug and device availability. There are both Federal and State Chief Medical Officers (CMOs) dictating policy settings. The Australian Medical Association (AMA) is a lobby group representing less than 15% of doctors, but has political sway. Continuing education and training is provided by the Colleges – in the case of General Practice, this is both the Royal Australian College of General Practice (RACGP) and Australian College of Rural and Remote Medicine (ACCRM).

Early on after the advent of the Covid vaccination program, the TGA banned prescription of hydroxychloroquine and ivermectin for Covid infections, partly as they were seen as possible threats to vaccine uptake. Recently, the prescription of hydroxychloroquine for Covid infections again became legal, though only in Queensland.

Medicine is Corrupted By Dominance of Big Pharmaceutical Companies, Which Suppress Negative Results and Hide Adverse Effects, Says Peer-Reviewed BMJ Article

Evidence-based medicine has been corrupted by corporate interests, failed regulation and commercialisation of academia, which act to suppress negative trial results, conceal adverse events and withhold raw data from the academic research community, according to a peer-reviewed article in the British Medical Journal by Jon Jureidini of the University of Adelaide and Leemon B. McHenry of California State University.

Medicine is largely dominated by a small number of very large pharmaceutical companies that compete for market share, but are effectively united in their efforts to expanding that market. The short term stimulus to biomedical research because of privatisation has been celebrated by free market champions, but the unintended, long term consequences for medicine have been severe. Scientific progress is thwarted by the ownership of data and knowledge because industry suppresses negative trial results, fails to report adverse events, and does not share raw data with the academic research community. Patients die because of the adverse impact of commercial interests on the research agenda, universities, and regulators.

The pharmaceutical industry’s responsibility to its shareholders means that priority must be given to their hierarchical power structures, product loyalty, and public relations propaganda over scientific integrity. Although universities have always been elite institutions prone to influence through endowments, they have long laid claim to being guardians of truth and the moral conscience of society. But in the face of inadequate government funding, they have adopted a neo-liberal market approach, actively seeking pharmaceutical funding on commercial terms. As a result, university departments become instruments of industry: through company control of the research agenda and ghostwriting of medical journal articles and continuing medical education, academics become agents for the promotion of commercial products. When scandals involving industry-academe partnership are exposed in the mainstream media, trust in academic institutions is weakened and the vision of an open society is betrayed.

The corporate university also compromises the concept of academic leadership. Deans who reached their leadership positions by virtue of distinguished contributions to their disciplines have in places been replaced with fundraisers and academic managers, who are forced to demonstrate their profitability or show how they can attract corporate sponsors. In medicine, those who succeed in academia are likely to be key opinion leaders (KOLs in marketing parlance), whose careers can be advanced through the opportunities provided by industry. Potential KOLs are selected based on a complex array of profiling activities carried out by companies, for example, physicians are selected based on their influence on prescribing habits of other physicians. KOLs are sought out by industry for this influence and for the prestige that their university affiliation brings to the branding of the company’s products. As well paid members of pharmaceutical advisory boards and speakers’ bureaus, KOLs present results of industry trials at medical conferences and in continuing medical education. Instead of acting as independent, disinterested scientists and critically evaluating a drug’s performance, they become what marketing executives refer to as “product champions.”

I suspect the authors’ confidence in Government and public funding to free medicine from predetermined agendas is misplaced, as the Government propaganda during the pandemic (and on numerous other issues) has shown. But the points about the corruptions that the dominance of big pharmaceutical companies bring to the development and testing of medicine deserve to be taken seriously.

Worth reading in full.