more_vertIn letters to The Lancet, the President of the Karolinska Institute has sent the results and conclusions of the final investigation that has identified serious flaws in the conduct and reporting of the study by Philipp Jungebluth and colleagues.1 The report concludes that part of the series paper by Stephen Badylak and colleagues2 referring to the Jungebluth and colleagues’ research article is therefore misleading. In accordance with a request from the Karolinska Institute, The Lancet is retracting the series paper from the scientific record.
Preference: Law
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[Editorial] Progress towards a tobacco-free world
Last week, global anti-smoking efforts made substantial progress. Australia won a landmark victory in a major trade dispute over its plain packaging for cigarettes, with the World Trade Organization panel rejecting complaints concerning its tobacco packaging law. Additionally, the WHO Framework Convention on Tobacco Control (FCTC) announced that the Protocol to Eliminate Illicit Trade in Tobacco Products would enter into force, representing a milestone in providing the legal basis for strengthening the international community’s actions in tobacco control.
[Perspectives] Nyovani Madise: shining a light on the social determinants of SRHR
From Malawi to the UK and back again and from Kenya to the UK and now, once again, to Malawi. There is, Professor Nyovani Madise admits, no grand scheme in her geographically oscillating career path; each move has been made in response to a particular need or opportunity. But the pattern has proved beneficial. Working in the UK has broadened her horizons and offered opportunities for her main field of research: the social determinants of sexual and reproductive health and rights (SRHR) in low-income and middle-income countries (LMICs).
[Comment] Addressing the unfinished agenda on sexual and reproductive health and rights in the SDG era
The autonomy and empowerment of women are essential not only for their own health and wellbeing but also for those of their families and communities and, ultimately, for sustainable development. Sexual and reproductive health are, in turn, fundamental for women’s full participation in society. Recognising this, in 1994 in Cairo, Egypt, the International Conference on Population and Development (ICPD) formally recognised that reproductive rights were linked to human rights already protected under international law, created a definition of reproductive health that explicitly relied on the ability of individuals to decide if, and when, to reproduce, and compiled a list of essential elements of reproductive health care.
US doctors want to ban assault weapons
American doctors have called for a ban on the sale and ownership of all assault-type weapons.
The American Medical Association voted in June to amend its policy on firearms, resulting in the United States’ biggest doctors group taking a stance against gun violence.
The AMA declared it to be a public health emergency.
The Association also raised the issue of bump stocks, which basically turn semi-automatic firearms into automatic ones, saying sale of them should be prohibited.
And it called for an end to the sale and ownership of high-capacity magazines and armour-piercing bullets.
The AMA also supports laws to require all firearms to be registered, to ban sales of guns to people under the age of 21, to make it illegal for anyone found of guilty of domestic violence to be in possession of a gun, and to keep schools gun-free zones.
Debate on all of the issues was reported to be contentious, with delegates who were gun owners wanting more time to review the language used in the resolution.
But the delegation voted overwhelmingly in favor of the ban on assault weapons resolution, 446 to 99.
In America this year alone, more than 6,300 people have died from gun violence.
CHRIS JOHNSON
American Medical Association reviews its position on assisted death
The American Medical Association is reviewing its opposition to medically assisted death, following a motion to maintain its position being rejected at the Association’s annual meeting.
Delegates at the meeting, held in Chicago in June, voted instead for the organisation to continue reviewing its guidance on the issue.
A lengthy debate looked at whether the doctors’ group should revise its Code of Ethics, resulting in what is known as the House Delegates voting 56 per cent to 44 per cent that its Council on Ethical and Judicial Affairs should further review its current position.
Delegates did not, however, vote that the Code of Medical Ethics be amended
The decision was to send a report into the position back for further discussion, meaning the position remains the same for now.
The further review is set to take place at a future policy making meeting.
The current position is that physician-assisted suicide is “fundamentally incompatible with the physician’s role as healer” and was adopted a quarter of a century ago.
Six States plus the District of Columbia (DC) have legalised medically assisted death. California’s law, however, was recently overturned in the courts.
CHRIS JOHNSON
HealthEngine may be in breach of privacy law in sharing patient data
This week it was reported an online medical appointment service, HealthEngine, was sharing patients’ private information with a firm of solicitors specialising in personal injury claims.
As reported, HealthEngine, which boasts 15 million annual users, requested details of the patent’s symptoms and medical conditions as part of their booking process. It then passed this information to law firm Slater and Gordon at an average rate of 200 patients per month. This was called a “referral partnership pilot” program, and operated between March and August of 2017.
HealthEngine denies sharing this information without patient consent, stating consent was provided by way of a “simple pop up”. Despite the company’s best efforts, HealthEngine continues to face queries regarding their treatment of patient information.
On the face of it, it appears several Australian Privacy Principles may have been breached.
Did patients provide informed consent?
HealthEngine assures visitors to their website the collection of information is done strictly by consent, and it has provided disclosures of the use of collected information.
For instance, in its Privacy Policy, HealthEngine notes information may be disclosed to third parties “but only for the purpose of providing goods and services to [HealthEngine]”.
HealthEngine also notes disclosure may be made to:
other persons notified to you at the time we collect your personal information, who you give consent to, or to whom we are authorised or required by law to make such disclosure.
In their “Collection Notice” – one of three policies to which patients must agree, HealthEngine further states it may disclose personal information to “third party providers who may be of interest to the patient”, including health insurance comparison providers, finance companies for credit for cosmetic or dental procedures, and providers of legal services.
This appears to contradict their Privacy Policy, which is itself bound by the Australian Privacy Principles.
The Australian Privacy Principles
The Australian Privacy Principles specify requirements regarding how organisations collect and use patient information. These include how and in what circumstances information is shared with third parties. The principles specify all information collected by HealthEngine must be reasonably necessary for the provision of services.
And they must not collect information unless there is consent, the information is necessary for the function of the organisation, or there’s a “permitted health situation”, which means the information must be necessary to provide services to the patient.
Click-wraps and bundled consent
A type of agreement HealthEngine uses to ensure patients using their services agree to the terms and conditions, called the “click-wrap”, involves the patient clicking through the booking process and thereby agreeing to the terms and conditions, links to which are provided.
So the patient is agreeing to three separate sets of agreements (called the “bundled consent”) — the Terms of Use, the Privacy Policy, and the Collection Notice — in the one action. This also means agreeing to secondary use of patient information and the provision of direct marketing, as found in the Collection Notice.
The privacy principles broadly prohibit direct marketing unless there is informed consent. And they require the patient to be provided with a simple way to opt out of direct marketing. HealthEngine assures patients they’re under “no obligation” to provide their information, though accepting these bundled terms is necessary to complete the booking and there is no option to opt out.
Informed consent requires the individual to be able to have a genuine ability to provide or withhold consent. This means having informed knowledge of the impact of their decision. It’s evident that with contradictory policies, bundled consent, and potentially misleading terms, a patient could not make a truly informed decision of the impact of their choice to use HealthEngine as the provider of this service.
Where to from here?
Laws that ought to protect individuals online do exist, but the potential for harm online is neither immediate nor always evident. So, as an immediate recourse to online threats, people need to take greater care with personal information online and ensure they seek recourse when issues arise. This requires being better informed about both the law and and individual’s rights and responsibilities online.
The Australian government also needs to take individual privacy and personal information protection more seriously and crack down on violators.
The establishment of the Office of the eSafety Commissioner was a positive move forward, but effective cuts to funding to the Office of the Australian Information Commissioner has the potential to hinder progress.
Paul Maluga, Sessional Academic, Solicitor, Macquarie University
This article was originally published on The Conversation. Read the original article.
AHPRA links complaints on its register, even unfounded ones
Have you had a complaint against you that was dismissed in a tribunal as without merit? Your entry in AHPRA’s publicly accessible online registry of practitioners will still list this complaint and link to the relevant court or tribunal ruling, the regulator has decided.
The Australian Health Practitioner Regulation Authority has announced that it has already begun to publicly link disciplinary and court decisions to the registration details of doctors, regardless of whether the doctor has been found guilty of anything.
Around 50 rulings made since February have already been added to the register, implementing a recommendation made by an independent review authored by Professor Ron Paterson on the practice of chaperoning to protect patients from doctors subject to allegations of sexual misconduct. In that review, Professor Paterson recommended that “the public register of health practitioners include web links to published disciplinary decisions and court rulings”.
Also quoted in that review is the Chair of the Medical Board of Australia Dr Joanna Flynn, who says that “the public has a right to know if there are conditions on a doctor’s registration or if there have been serious disciplinary or criminal offences proven against a doctor. It’s long overdue.”
The register will now include links to all court and tribunal rulings concerning a doctor, except for those which involve the doctor’s health.
But many are concerned that posting all rulings in the register, even when no rulings are made against the doctor, is going a step too far.
Medical defence organisation Avant says the move is “unfair and punitive, particularly for practitioners with no adverse findings against them”. Although the Medical Board of Australia has said that “no adverse finding” will be noted on the register, Avant says it is “concerned that this will be misinterpreted and misunderstood”, and that the allegations will be given more weight than the findings.
Earlier this year, Avant’s Chief Medical Officer Dr Penny Browne spoke on the issue at the AMA’s National Conference.
“A finding made many years before, that has no relation to the doctor’s current practice or conditions, will remain linked to the AHPRA register in perpetuity,” she told delegates.
“Imagine that you or I have been through the stress of a tribunal hearing and finally the findings state ‘allegations not proven’. It’s all over. You then try to move on with your life and later discover that the link to the decision is placed against your name on the AHPRA register with a subscript stating ‘allegations not proven’.”
She said that while transparency was important, the medical complaints process was already stressful for doctors.
AHPRA’s most recent annual report notes that of the 2718 matters involving medical practitioners settled over the year, the vast majority (71.2%) resulted in no further regulatory action.
[World Report] From Ireland to Northern Ireland: campaigns for abortion law
After Ireland successfully overturned its 8th Amendment using grassroots activism, attention turns to Northern Ireland’s abortion laws. Angel Li reports from Dublin.
[Department of Error] Department of Error
Golestaneh L, Cowan E. Hidden conflicts of interest in continuing medical education. Lancet 2017; 390: 2128–30—In this Comment, the following statement should have read “But payments by MECCs to accredited CME providers are not subject to transparency laws designed to combat industry influence on physician behaviour, including the 2013 Physician Payment Sunshine Act that mandated public reporting of all financial payments by industry to physicians and teaching hospitals until recently. Industry can still award an unreported, unrestricted grant to an accredited organisation as long as it does not know the identity of the CME faculty”.