Hi Paul,

Whilst I am also interested in the investigation into the potential
collusion between WHO and the drug industry, which I have no doubt
will eventually fizzle out, I am, as a GP interested in a phenomenon
you could call 'zoning out' by GPs.  This is where GPs switch off
whatever critical faculty they may ever have had, and unthinkingly, do
what they are told: to enact policy.

I am thinking of the guidelines about  swine flu vaccines and
prescribing Tamiflu.  A very easy and quick search, in 2009 by me,
revealed that Tamiflu is of uncertain benefit (there may be equipoise
on this point for some) as demonstrated by Carl Henegan's rapid
response to the BMJ, reporting his journal clubs conclusions on the
issue.

For the 'interested' there is plenty of disturbing evidence suggesting
that Tamiflu could cause more harm than do good.  Yes, it is sad, that
the government via the CMO decided to go for a "better to be safe than
be sorry" policy, sorry of course meaning sorry that you might be
blamed for causing harm, rather than sorry that you caused more harm
than good, (knowing that even if we inadvertently do more harm than
good  then this, luckily, could never be proved anyway).

It is even sadder that GPs and the RCGP just went along with it.  I
could, as a GP accept a situation, whereby a 'policy of healthcare'
might save lives even though it put large numbers at risk of small
harm.  I do this all the time by supporting childhood immunisations to
increase herd immunity. But I draw the line at completely unproven
treatment strategies aimed at populations, targetting the young and
the pregnant, for whom benefit is completely unproven. Where were you,
the RCGP, when primary health care needed you?? Where were you, you
completely trained to be unquestionng GP?? What does this say about
medical education? Ethics for the birds? Numeracy highly valued - as
long as you arrive at the right answer? Where was the global movement
for evidence based medicine? Nowhere.

Owen
Owen Dempsey, GP.


> Date published: 04/06/2010 16:12
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> This joint investigation by the BMJ and the Bureau of Investigative Journalism has found that the World Health Organisation’s (WHO) key decisions during the H1N1 influenza pandemic may not have been free from commercial influence. The investigation questions the lack of transparency involved and found that scientists advising the WHO on pandemic flu planning did paid work for pharmaceutical companies who stood to gain from the guidance the scientists were developing. The WHO did not publicly disclose these conflicts of interest and has dismissed inquiries into its handling of the A/H1N1 pandemic as "conspiracy theories."
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> The authors ask:
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> • Was it appropriate for WHO to take advice from experts who had declarable financial and research ties with pharmaceutical companies producing antivirals and influenza vaccines?
> • Why was key WHO guidance authored by an influenza expert who had received payment for other work from Roche, manufacturers of oseltamivir, and GlaxoSmithKline, manufacturers of zanamivir?
> • Why does the composition of the emergency committee from which Chan (Director General of the WHO) sought guidance remain a secret known only to those within the WHO?
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> They discuss the issues in details and write, “The number of victims of H1N1 fell far short of even the more conservative predictions by the WHO. It could, of course, have been far worse. Planning for the worst while hoping for the best remains a sensible approach. But our investigation has revealed damaging issues. If these are not addressed, H1N1 may yet claim its biggest victim - the credibility of the WHO and the trust in the global public health system.”
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> In a related editorial, the BMJ Editor in Chief calls on the WHO to publish its own report on the issue "without delay or defensive comment, [and] make public the membership and conflicts of interest of its emergency committee." She suggests that the WHO must act now to restore its credibility, and Europe should legislate. The editorialist notes, “Countries like France and the United Kingdom who have stockpiled drugs and vaccines are now busy unpicking vaccine contracts, selling unused vaccine to other countries, and sitting on huge piles of unused oseltamivir. Meanwhile drug companies have banked vast profits - $7bn (£4.8bn) to $10bn from vaccines alone according to investment bank JP Morgan. Given the scale of public cost and private profit, it would seem important to know that WHO’s key decisions were free from commercial influence”.
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> The editorial also calls on the WHO to develop and commit to stricter rules of engagement with industry that keep commercial influence away from its decision making.
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>
> Extract
> Editorial
> BBC News story
>
>
> Ash
> Dr Ash Paul
> Medical Director
> NHS Bedfordshire
> 21 Kimbolton Road
> Bedford
> MK40 2AW
> Tel no: 01234897224
> Email: [log in to unmask]
>
>