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An interesting view of events around the last minute ‘pull’ of the PREVAIL study from the ACC program last weekend.

Old CardioBrief

SPIN
The biggest story at the American College of Cardiology meeting last week was the missing story. As reported here and just about everywhere else, the PREVAIL trial, probably the most-anticipated late-breaker of the meeting, was pulled from the program at the last minute by the ACC leadership after Boston Scientific broke the embargo by issuing a press release several hours before the scheduled presentation.

To understand this event we first need to know what happened in the week before the ACC. And there’s a major gap in the story that has not come out before that I think holds the key to a full understanding of the story.

More than a week before the scheduled presentation I received an email invitation from a PR firm representing Boston Scientific:

“If you have any interest in speaking about the trial under embargo with Dr. Ken Stein, chief medical officer, Cardiac Rhythm Management, Boston…

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Dear Will,

Thank you for registering to attend ACC.13, March 9-11 in San Francisco.

Our records indicate that you signed up to participate in the 5K CardioSource Fun Run event, scheduled for Monday, March 11, 2013. We are writing to inform you that this event has been cancelled due to liability issues caused by the change in Daylight Savings Time while we are in San Francisco which has impacted our ability to effectively manage the run.  We apologize for any inconvenience, and look forward to welcoming you to ACC.13.

Sincerely,

The ACC Registration Team

When I started blogging about a year ago I made the un-bold decision that I would keep by blog and the associate twitter account anonymous. It wasn’t a real attempt at anonymity and in fact has become a bit of a joke. The identity of @LastCardiology is one of the worst kept secrets amongst my peers!

That being said, the decision not to link my name to the blog did have some basis.

Firstly, I was at the time responsible for convening a large medical scientific meeting – probably the largest in the country in terms of attendance and budget. The meeting, its brand and its outcome – whilst a matter of great interest to me – really belong to the learned society of which I am a member. Consequently, whilst wanting to help promote the merits of the meeting I had no desire to use that as a cheap source of publicity for my own online activity and even less desire to see something that I might write have a negative impact on the outcome of the meeting.

Secondly, I was at the time somewhat taken by the multitude of blogposts on the risks of social media to the practice medical professionals and being new to the game, it was not my desire to run the gauntlet of this potentially perilous activity.

So almost a year on, with the meeting successfully out of the way and a considerably better feel for the risks and benefits of ‘the social media’ I was just about to lower my guard and formally blow the (laughably transparent) veil of anonymity away from my blog.

And then this…

‘Preliminary Consultation Paper on Social Media Policy’ from the Australian Health Practitioner Regulation Authority (AHPRA).

Above all, as a researcher as well as a clinician, I had begun to feel that the the social media had a compelling role in the future dissemination, promotion and integration of research activity. And there’s the rub. If as a clinician/researcher I am ‘out there’ promoting the merits of the clinical research of our group, cross blogging positive editorial comment, extolling the virtue of translating the findings of our work into daily clinical practice – will I fall foul of the law as interpreted by AHPRA?

After all…

‘The definition of advertising under the Advertising Guidelines is broad…’

and…

A person advertising a regulated health service may contravene the National Law even if they are not themselves a registered health practitioner. As a result, a person may be found to have ‘advertised’ a health service even though they did not intend to advertise or promote their health service.’

Above all,

‘Testimonials, or comments that may amount to testimonials, made on social media sites by patients or other people may contravene the National Law and expose the registered health practitioner and/or the holder of the social networking account to liability.’

To me, the document appears uniformly negative, short-sighted, misguided and even somewhat paranoid. The sort of thing that one might have read in the tabloid press concerning the perils of the ‘information super highway’… about 15 years ago.

I’d be most interested others comments and advice on this matter either here or through my blog at https://thelastgeneralcardiologist.wordpress.com but please be careful not to saying anything positive about me!

Thanks.

@LastCardiology

For additional commentary see

http://blogs.crikey.com.au/croakey/?p=8923 and http://blogs.crikey.com.au/croakey/?p=8939

This post relates to

2011 Queensland Maternal and Perinatal Quality Council, Review of Pregnancies, Births and Newborns in Queensland

This was a report released by the Queensland Government toward the end of last year. Had I been blogging then I would have posted hot off the press but in any case it remains most important. It’s a big doc but the Executive Summary on page 7, 8 and 9 is a a quick read.

Maternal health is excellent in Australia but as you can see from the report cardiovascular disease and mental health remain significant issues that account for the vast majority of indirect maternal mortality (see the report for definitions). The report doesn’t address the issue of cardiovascular morbidity which is considerable but does make some important, cardiac specific recommendations.

Including that

When pregnant women present with common symptoms such as chest pain, palpitations, syncope and shortness of breath, there should be a low threshold for considering significant cardiovascular disease and referral for specialist opinion and investigation within a clinically appropriate time frame,

and that,

In the event of sudden cardiac death, autopsy is essential and arrangements should be made for cardiac tissue to be examined by a pathologist with a specific interest in cardiac pathology where initial findings are negative. Pathologists and clinicians should be aware of the emerging role for molecular autopsy in cases of possible arrhythmic death. 

You can download the whole report or sections here

On the face of it, it is hard to see the exact motive behind Tony Webber’s spray that was published in the Medical Journal of Australia this week. Sour grapes at the DoHA in their failure to respond to some of his concern? Frustration that despite all that hard work as chair of the Professional Service Review Board he was unable to implement any real improvement in an inherently flawed system? Or just good old fashioned professional jealousy?

Either way, cardiologists were clearly in the firing line.

As others have been quick to point out, the position chairing the committee responsible for dealing with the worst cases of abuse of the Medicare system is perhaps not the best vantage point for taking an objective view of the functionality of the system as a whole. Furthermore, the cost of ‘waste’ quoted at $2-3billion per annum appears to be little more than Webber’s personal estimate based upon a calculation that he doesn’t care to share with the readership.

In fact, Dr Webber’s tilt at cardiologists seems a little misplaced. Whilst mourning the inability of Ms Roxon to arrange to cut the medicare rebate to ophthalmologists for cataract operations by 50% he simply ignores the fact that in the same budget cardiology practices and their patients were forced to absorb a 20% reduction in the rebate for cardiac catheterisation without any discussion, consideration or consultation. Add to that the fact that rebates for cardiac diagnostic imaging services such as echocardiography have not been indexed in the memory of most practising cardiologists (resulting in an effective cut of >40% compared to CPI) and his assertion that once rebates have been set they are never reconsidered seems at best baseless, and at worst a deception.

Whilst Webber goes to some lengths to point out that not all specialists abuse the Medicare system it’s unlikely that this is how his comments will be interpreted. At least not if the first round of associated newspapers headlines are concerned

Sydney Morning Herald – ‘Medicare rorts cost $3bn’

The Age – ‘Don’t let rorters undermine Medicare’

Fortunately, we were able to rely on the journalists from The Australian who weren’t able to see too much past the fact that…

‘…the safety net has been used to “subsidise cosmetic procedures such as surgery for ‘designer vaginas’…

Fundamentally, Webber’s comments are poorly written, randomly directed, lacking detail and unsubstantiated. In many ways it is surprising that the MJA even agreed to publish the article in this form. Perhaps even more disappointing is the total lack of even a suggestion of a solution. Without that it is likely that as Webber slides back into obscurity as a suburban Sydney GP his comments will follow him.