„Bad Pharma“ wird besser!

“Bad Pharma” is getting better!

After much debate, Brussels agreed on European drug law changes, effective in 2016. To improve transparency and safety, pharma studies in humans will have to publish all results, including negative findings.

As Ben Goldacre explained so lucidly in Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients, scientists’ and study sponsors’ tendencies to only publish findings that are interesting and/or support certain types of conclusions have skewed drug licensing and killed people.

(Bod   FAW mah   vee awed   BESS ah.)

Handschrift des Arztes muss lesbar sein

“Physicians’ handwriting must be legible” in patients’ medical records according to the current version of Germany’s patients’ rights law, passed last year.

Frank Leopold, head of a Verein that advocates for medical patients, told Spiegel.de some other salient aspects of the patients’ rights law [German Civil Code, §630a et seqq.]:

Upon request, patients must be given access to view their full medical records, unless it could harm them or endanger the rights of third parties. If the patient so desires, this access must be granted directly after treatment, “without delay” [unverzüglich]. If physicians use the “harm” reason as grounds to refuse patients access to their full medical records, an appropriate diagnosis must have been made.

Patients have the right to get copies of their medical records, though the patient must pay for the copies.

Everything in a patient’s medical record must be left there. Any corrections and changes must be made so that the original content is still apparent, and must be signed and dated by the physician.

Software that keeps medical records must meet the same requirements. All changes and original content must remain apparent.

Handwriting in medical records must be legible, even physicians’ handwriting.

Mr. Leopold was skeptical about preventing manipulation to electronic records, but said he didn’t know enough about the software to comment.

He said it’s important to talk about this in public fora, because it’s important for patients and physicians to know patients’ current rights, to prevent confusion.

(HONNED shrift   dess   OTTS tess   moose   LAZE bah   z eye n.)

Riesenzinkenlangzahnelefantose, Blödzillus seidoofus giganticus (Erreger der ansteckenden Blödheit)

Giantlongtoothelefantosis, Nonsensicus ridiculosum giganticus (a microbe that spreads contagious malarkey).

Cap’n Bluebear told his grandchildren bears the Nonsensicus germ is so full of malarkey it hurts. Which is good, because otherwise more people would catch it. Best possible cure: doing homework.

(R-r-ree zen tsink en long tsahn ella fawn TOE zah,   blid ZILL ooss   zeye D’OH! fooss   ghee GONE teak ooss,   err AE gare   dare   on SHTECK en den   BLID height.)

Patienteninformation & Patienteneinwilligung

“Patient information form and patient consent form,” often translated into English as “informed consent” which sounds like a single document rather than the German pair of patient information materials + patient’s consent statement [Einwilligungserklärung].

Medical ethics require patients agreeing to participate in pharmaceutical testing to be adequately informed about the drug or device trial and associated risks and benefits, and then to give their written consent to participate in the trial so described. Translators of these forms must take extra pains to render them in clear language because the people reading them might not be in the best of health.

As recovering law student and standup comedian Susan Calman said, “there’s no consent without informed consent!”

General practitioners in the U.K. are concerned, she said, that people there have not been sufficiently informed about the National Health Service’s plans to put physicians’ records and hospitals’ records on a “superserver,” central database, to which more than just health professionals will have access. The patient data will be at least partially anonymized, proponents said. It’s unclear what the rules will be for selling or sharing patients’ data with third parties.

People not worried about data privacy might nevertheless be concerned about any unclarity in David Cameron’s government’s communications about how it will share or not share the U.K.’s digitized medical records because his coalition’s recent privatization projects have been accused of selling at too-low prices. Protection adequacy is also in question now since the Snowden revelations.

Update on 24 Feb 2014: Despite reassurances from the British agency currently in charge of patient medical records in the U.K., the Health and Social Care Information Centre, that “data held in the new giant database would never be used for insurance purposes, stating that any such actions would represent a criminal offence,” the Telegraph.co.uk has discovered that David Cameron’s government already sold the N.H.S. medical records, to an actuarial firm that advises “insurers and actuaries on how to ‘refine’ critical illness cover,” in 2012, for two thousand pounds.

The contract to extract and anonymize patient data from individual physicians’ office records for the new central database has been awarded to a company called Atos. Atos has asked for early release from its previous government contract because of death threats to its employees.

Update on 03 Mar 2014, from the Guardian:

“A prominent Tory MP on the powerful health select committee has questioned how the entire NHS hospital patient database for England was handed over to management consultants who uploaded it to Google servers based outside the UK.”

This database contained H.E.S., hospital episode statistics, and these management consultants called themselves PA Consulting. In addition to Google, anyone tapping communications lines leading to Google, actuaries and consultants, N.H.S. patient records might have already been obtained by or available to “pharmaceutical firms, government departments [including police] and private health providers.”

(Pot YENT en in foh mah tsee own   oont   pot YENT en eye n vill ee goong.)

Primum non nocere

“First, do no harm.” If you have no access to good things, then strive for the absence of bad ones. A logical short-term choice but no permanent way to live. Good things have to be too. If they’re not present eventually you’ll have to make them, somehow.

In cultures that brew bad beer or e.g. confuse sediment and microbial contamination with personality you might be able to get by for a while by drinking beer that’s as watery as possible. But that’s no way to live. You can’t not talk about religion and politics forever, especially when people are taking advantage of the vacuum to make culture war. Another example: women readers probably can’t enjoy science fiction from fun thinkers such as Robert Heinlein unless it’s a work with no female characters, just humans and aliens. But as tempting as a modern moratorium on female characters sounds, it would create more generations of… uninformed writing about women.

Fortunately, the world’s goodnesses are multiplied by good discussions. Useful ideas shared are solutions doubled and time/effort halved. As we get older the problems we haven’t solved yet seem impossible, and yet one entertaining lunch with a curious friend can save you five years of frustration.

Mit Steuermitteln geförderte Dopingforschung

Taxpayer-funded performance-enhancing-drug research.

In 2011 historians from Humboldt and Münster universities finished an 800-page report called “Doping in Germany from 1950 to the present” that remained unpublished supposedly because of data privacy concerns for the many West Germans named in it. It found that a West German institute called the Bundesinstitut für Sportwissenschaft (“German Institute for Sports Science,” B.I.Sp.), founded in 1970, systematically with politician support researched performance-enhancing substances. At the time the researchers said they were trying to prove substances did not enhance performance, but when they found one that did it was then widely administered to West German athletes. The sports medicine physicians conducting the human experiments and administering the substances to athletes said West German politicians explicitly wanted this. This was not a reaction to East German doping; it was done in parallel, starting as far back as the 1950’s even before the East-West Germany conflict, according to sport historian professor and pundit Giselher Spitzer.

Athletes were not told about side effects. The substances were given to children, “to test age effects.” Pro soccer players doped too (pervitin and then amphetamines), though apparently there were few sports not involved. Epo experiments were done as early as 1988. The scientists worked with national sports groups to help doped athletes elude capture in competition testing. Sponsoring money for the performance-enhancement research was considerable, flowing from the West German government and from private sports associations mostly to the Freiburg university hospital but also to sports medicine centers in Cologne and other cities.

The Humboldt University sports history study was ordered by the Bundesinstitut für Sportwissenschaften (B.I.Sp.) and sponsored by the Deutscher Olympischer SportBund. Its findings were kept unpublished for two years. After an 03 Aug 2013 Süddeutsche Zeitung article about the report a spokesperson for the Deutscher Olympischer SportBund said the failure to publish and resulting ongoing exclusion from public discussion and review was the researchers’ decision. On 05 Aug 2013 the B.I.Sp. finally published it and apparently Hans-Peter Friedrich (C.S.U.)’s Interior Ministry, which the B.I.Sp. is still a part of, also released it.

What we still don’t know: Before the evaluation, many important files were apparently shredded. Files requested in 1991 from B.I.Sp. to use to answer a parliamentary inquiry from the S.P.D. party turned out to have been destroyed, for example (and apparently the B.I.Sp. started the Humboldt University research project at about the same time??). Not all the relevant original files were apparently registered in a-or-the federal archive [“Bundesarchiv“?], so historians will be unable to find them there due to that library guerrilla move. The Deutscher Fussball-Bund reportedly set unacceptable conditions for access to its archives, so information they contain did not flow into the study. Joseph Blätter’s international soccer organization Fifa only recently (2011) stopped destroying World Cup soccer players’ test samples only three months after collection. People are upset that anonymity and lack of prosecution have been apparently enjoyed by West German sinners but not East German. The study was sponsored to investigate only up until the year 1990. Apparently the published version is missing several hundred pages.

Solutions: Justice ministers from several German states are demanding a federal-level anti-doping law making the use of banned performance-enhancing drugs a criminal offense; this has been under discussion for years now. The president of the Deutscher Leichtathletik-Verband called for more such research to prevent all West German athletes from that era from being suspected of having illegally taken performance-enhancing drugs. Also, as news anchor Claus Kleber pointed out, because the actors have never admitted culpability we can’t know whether the unethical practices were stopped. They might still be going on today.

(Mitt   SHTOY ah mitt ellll n   geh FUR dirt teh   DOPINGK for shoong.)

Vorsyndromliche Syndromverfolgung

“Pre-syndrome syndrome tracking,” by starting long-term medical studies on groups of workers known to have undergone exposure to certain hazards limited by time and place. To prevent the clouds of confusion of another Gulf War syndrome, reliable medical schools could ask for volunteers for long-term studies on the health developments of veterans of the Second Gulf War, TSA workers who had to stand next to X-ray machines, Fukushima cleanup workers, etc. Regular good checkups and tests might also benefit any American workers who lack health insurance. The questionable environments to which they were exposed should also be evaluated sooner rather than later, recording and taking samples of possible toxins that can be compared to outcomes decades from now.

More than one institution should study each cohort in case their study’s funding gets cut one day.

(FORE zyn DROME lichh ah   zyn DROME fair fol goong.)

UAW-Datenbank

 

“Adverse events database” (unerwünschte Arzneimittelnebenwirkungen-Datenbank). BfArM (Bundesinstitut für Arzneimittel und Medizinprodukte, the regulatory German Federal Institute for Drugs and Medical Devices) has created an online portal providing free access to its database of all suspected side effects reported to BfArM for all drugs since 1995. The UAW-DB is for doctors, patients, scientists and the merely curious.

The suspected side effects were submitted by hospitals, physicans and patients themselves, but not from clinical trials. Unlike the confirmed ones listed in package inserts and expert information sheets, the side effects listed here may or may not have been proven to have been caused by the medications used.

(OO AH VEY dot en bonk.)

von Bodelschwinghsche Stiftungen Bethel in Bielefeld-Gadderbaum

The Bethel foundation for the mentally ill in Bielefeld-Gadderbaum, a Protestant institution founded in 1867 by a Pastor Bodelschwingh that is one of the most impressive institutions of its kind in the world, and one of the kindest. Treating about 185,000 patients each year, both inpatient and outpatient, with assisted living group apartments in varying degrees of autonomy; many of the ~16,000 caregivers live in the community (in very nice apartments).

(Fon   BOH dell SHVING sheh   SHTIFF toong en   BEY tell   in   BEE leh feld   GODDA bow! m.)

Kassenvertreter

“Representatives of Germany’s health insurance schemes.” Who have been demanding that a gap be closed in German law, after the German supreme court (Bundesgerichtshof) found six months ago that practicing physicians could not be punished for preferentially prescribing pharmaceuticals from companies that had given them gifts, because the relevant German regulations applied only to employees and not to the self-employed. Germany’s health insurance companies are pushing for this loophole to be closed by new rules, with fines or prison terms of up to three years for culpable physicians. Politicians from opposition parties accused the Ministry of Health (Bundesgesundheitsministerium) under Daniel Bahr (FDP) of not fixing the problem in order to allegedly protect practicing physicians, who are loyal FDP voters. The health insurance representatives estimate that one in five German physicians has accepted money or gifts from the pharma industry.

(COSS en fer TRAY terrr.)

Beschleunigtes Vergabeverfahren

“Accelerated distribution process.” A paperwork system at least one physician, working at Göttingen and Regensburg university hospitals, was caught manipulating to artificially improve some statuses in lists of patients awaiting organ transplants. It turns out a suspiciously high percentage of hearts and livers has been allocated using the alternate, accelerated procedure in Germany. Records are now being re-examined and the organ allocation system will be overhauled. More transparency has been promised, to restore public confidence. This will be accomplished via “more intensive inspections” (unannounced and “end-to-end”), publication of inspection reports and implementing an “extra eyeballs” principle ensuring more than one person will be checking steps executed in the process.

The responsible medical administrators do not want government involvement additional to these agreed changes to be superimposed on these ethical decisions. Patient rights organizations do, however, and have asked for a central authority to be created to oversee related medical ethics considerations. Both sides agree that the penalties for such manipulation should be made tougher.

Update on 03 Jan 2013: Munich was also caught doing this. Now Leipzig University Hospital physicians have been implicated in a similar scandal. The Leipzig problem was discovered by the Göttingen, Regensburg and Munich reforms, which included a review or audit commission (Prüfkommission), “extra eyeballs” principle and increased risks and penalties for tricksing.

Update on 04 Sep 2013: The investigation has found that Münster was also doing this. There is a discussion about the incentives to doctors and hospitals for performing organ transplants in Germany. It’s more subtle than just money, examining ego but also structures that encourage competition among medical departments. Meanwhile, burghers have shown they have less incentive to opt in as organ donors until these issues are clarified.

(Beh SHLOY nick tess   fer GOB eh fer FAR en.)

Bierleiche

“Beer corpse.” A temporary condition induced by Oktoberfests, Schützenfests, Kirmess fairs, Kirschenfests, Leinenweberfests, Mandelblütenfests… People who have transitioned into the “beer corpse” state have to be carried to a special tent.

(BEER like ah.)

schröpfen

Squeeze money out of someone. Also, a cupping treatment used in the Middle Ages.

(SHRUP fen.)

Machen Sie sich frei.

“Make yourself free.” What German doctors say when they want you to take off your clothes.

(MOCK en ZEE zick fry.)

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