Distilling ethics, compassion, science and the art of medicineBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6510 (Published 05 December 2016) Cite this as: BMJ 2016;355:i6510
- Leong Ng, consultant physician-specialist medical oncologist and family practitioner,
- Yolande Lucire, consultant forensic psychiatrist and specialist in pharmacogenomics
We agree with Wise.1 Clinicians, patients, their families, and regulators must all understand the difference between treatments that are potentially curative and the majority that are palliative. Based on risks, benefits, and possibilities, the patient gives informed consent for an intervention.
In Sydney, Australia, oncologists in a reputable hospital have arranged to have a senior colleague charged with “underdosing,” creating the impression among the public that potentially curable cancers have been improperly treated and that his patients needed to be found and warned.2
Some clinicians, blind to the machinations of the drug industry, feel empowered, even invincible, when they follow clinical practice guidelines and standard of care recommendations that have been sanctioned by the state. They assume that they are underpinned by science.
Other doctors, aware that the goal of the drug industry is to market their drugs, review both positive and negative data and apply clinical judgment. There are no grounds for using information from a drug company to undermine an experienced clinician with a broader view.
Any guidance offered by the drug industry warrants investigation of patient level information, as conducted by the Nordic Cochrane Collaboration and the AllTrials initiative.3
Dosing algorithms, beloved by industry and health bureaucracies, that underpin guidance are based on the assumption that “one size fits all” when it obviously does not.
The Texas Medication Algorithm Project promoted new generation drugs for psychiatry in a way that did not reflect how they had performed in clinical trials.4 Clinical practice guidelines were commissioned for many countries to be signed by “key opinion leaders” and unwittingly adopted by institutions and regulators.
Guidelines and recommendations that interfere, in a dangerous way, with the doctor-patient relationship are being overenthusiastically imposed by the state. This has been determined by the High Court of Australia to be unlawful and unconstitutional.5
Competing interests: None declared.
Full response at: http://www.bmj.com/content/355/bmj.i5792/rr-6.