the medical profession is so trusted that its activities are rarely questioned

By Paul Komesaroff, Monash University; Ian Kerridge, University of Sydney, and Wendy Lipworth, University of New South Waleshttps://theconversation.edu.au/big-debts-in-small-packages-the-dangers-of-pens-and-post-it-notes-4949

The loss of trust in the medical profession

Although rarely explicitly stated, it’s expected that physicians will act with humanity, integrity and care. And, on an individual level, it seems that most do.
Those training as doctors also make a substantial personal investment of resources, time and intellect. Lengthy years of training coupled with high levels of individual responsibility and professional accountability are the norm.
In return for their efforts, doctors are given considerable professional autonomy, respect, social prestige and financial reward. As a result of their specialised knowledge – and the unique power that comes with it – they are afforded privilege and trust above that of many other professional groups.
This reciprocity is the basis of the social contract in medicine, which emerged in the 19th century. In return for status and financial rewards, physicians would meet the medical needs of society through service and altruism.

Threats to the social contract

The expectation of reciprocity inherent within this social contract still arguably influences how health care is funded and structured in this country. But the fundamental spirit of this contract appears under threat on a number of fronts.

In his recent analysis of Medicare expenditure, former director of the Professional Services Review (PSR), Tony Webber, noted that an estimated two to three billion dollars are inappropriately spent every year. Much of this, he claims, arises from misuse of medical benefits scheme funding by individual physicians and corporate owners of medical businesses. Such observations undermine public trust in doctors and in their social contract.

Regarding medical care purely as a business transaction places the clinical encounter at the intersection of commerce and science – away from its traditional place at the nexus of humanity and science. For the public, this may be seen as a moral shift that signals doctors will place self-interest above the common good.

Finally, high profile failures of the medical profession to effectively self-regulate (another benefit traditionally bestowed them under the social contract) have contributed to recent legislative change. The introduction of national registration now requires mandatory reporting of poorly performing, or impaired colleagues across Australia. Public perception that the profession as a group has failed to act in the public interest and effectively sanction unprofessional colleagues has further eroded public trust.
Sylvia Cruess notes, “The loss of trust in the medical profession (although not necessarily in individual physicians) comes from a better informed citizenry, which is demanding greater levels of accountability, more transparency, and greater assurance of quality. The greatest challenge to medicine’s professional status at the present time comes from the general public.”
If health care is a shared social good funded primarily through public investment, the public deserves a stronger role in determining how these goods are distributed. In the United Kingdom and in the state of Oregon in the United States stronger public participation in key areas of health care has been achieved with some success through citizen’s juries. Such models could be considered in Australia.


http://theconversation.edu.au/power-and-duty-is-the-social-contract-in-medicine-still-relevant-3941

compensatory sweating was perceived in 56% of the adults and all of the children, or CS was lower in children - illustrations of typical contradictions about effects of ETS

compensatory sweating was perceived in 56% of the adults and all of the children. With the compensatory sweating, the effect on the life was severe in children and the patient's satisfaction was 50-60%, showing a large difference from the satisfaction of the adult patients at nearly 100%. As for other complications, neuralgia was recognized in 9% of the adults, but not in the children, and the crisis of perceptual disorder, hemorrhage and Horner's syndrome did not occur in both the adults and children. The compensatory sweating in the child patients was more remarkable than in the adult patients and the postoperative satisfaction was low, and it seems better to perform thoracoscopic sympathic blockade after the adolescence.
http://sciencelinks.jp/j-east/article/200513/000020051305A0251361.php

Do children tolerate thoracoscopic sympathectomy better than adults? CS appeared within 6 months postoperatively in 81.8% of all the patients but significantly less in children
(69.8%) compared to the others (88.5%; P < 0.001). CS increased with time in 12% of the participants, but decreased in 20.8% of the children versus 10.5% of the others (P = 0.034), usually within the first two postoperative years. The severity of the CS was also lower in children: it was absent or mild in 54.3% of the children versus 38.0% of the others, and moderate or severe in 45.7 versus 62%, respectively (P = 0.004). Fifty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS, but only one-third of them (7.9% children vs. 22.4% others, P = 0.001) would not have undergone the operation in retrospect.
http://www.ncbi.nlm.nih.gov/pubmed/17999068

hypoaesthesia in the bilateral axillar region after endoscopic thoracic sympathectomy for palmar hyperhidrosis

http://sciencelinks.jp/j-east/article/199920/000019992099A0655152.php

Heart Rate Variability before and after the Endoscopic Transthoracic Sympathectomy in Hyperhidrosis

The etiology of primary hyperhidrosis has been speculated as "unknown" hyperactivity of the sympathetic nervous system. In our clinic, we performed endoscopic transthoracic sympathectomy(ETS) for the treatment of hyperhidrosis. In this study, we studied the cardiac autonomic nervous function using heart rate variability(HRV) before and after ETS in 70 patients with hyperhidrosis, and compared with normal control. Before ETS, high frequency(HF) power was lower in hyperhidrosis than control group, however, there was no significant difference in LF/HF. After ETS, LF/HF decreased by 31%, and lower than control. No Severe cpomplications were occurred by ETS. In conclusion, on the cardiac autonomic nervous tone, hyperhidrosis patients had the relative dominance of the sympathetic nervous tone by suppression of the parasympathetic nervous tone. After ETS, the sympathetic nervous tone was suppressed. Clinical symptoms in hyperhidrosis patients were impoved by ETS. Although ETS affected the cardiac autonomic nervous tone, it was useful and safety method for hyperhidrosis.
http://sciencelinks.jp/j-east/article/200002/000020000299A0930354.php

Heart Rate Variability before and after the Endoscopic Transthoracic Sympathectomy in Hyperhidrosis.
Accession number;99A0930354
Title;Heart Rate Variability before and after the Endoscopic Transthoracic Sympathectomy in Hyperhidrosis.
Author; YOSHIDA K (Saga Medical School) UTSUNOMIYA T (Saga Medical School) HIRATA M (Saga Medical School) MOROOKA T (Saga Medical School) MATSUO A (Saga Medical School) SHIRAHAMA K (Saga Medical School) TANAKA M (Saga Medical School) HARANO K (Saga Medical School) MATSUO S (Saga Medical School)
Journal Title;Ther Res
Journal Code:Y0681A
ISSN:0289-8020 VOL.20;NO.9;PAGE.2630-2634(1999) Figure&Table&Reference;FIG.2, REF.19 Pub. Country;Japan
Language;English 

End advertising for cosmetic surgery

This week an unlikely coalition of British feminists and plastic surgeons called upon the British government to end advertising for cosmetic surgery. They say cosmetic surgery adverts serve to ‘‘recklessly trivialise’’ invasive procedures that carry ‘‘inherent health risks’’.

http://www.dailylife.com.au/news-and-views/dl-opinion/normalising-breast-surgery-20120316-1va6v.html

http://www.guardian.co.uk/lifeandstyle/2012/mar/14/cosmetic-surgery-advertising-ban

Persistent blushing as a side-effect of the surgery for blushing...

http://www.hyperhidrosis-usa.com/facial_blushing.html

It’s not unusual to hear people who have undergone sympathectomies describe themselves as feeling emotionally “colder” than before

It’s not unusual to hear people who have undergone sympathectomies describe themselves as feeling emotionally “colder” than before. Among psychologists and neurologists alike there is concern, but no evidence, that the procedure limits alertness and arousal as well as fear, and might affect memory, empathy and mental performance. Professor Ronald Rapee, the director of the Centre of Emotional Health at Sydney’s Macquarie University, says he’s counselled several people who complain of feeling “robot-like” in the long-term wake of the operation. “They’re happy they no longer blush, but they miss the highs and lows they used to feel.”
(John van Tiggelen, Good Weekend Magazine, The Age and the Sydney Morning Herald, 10th March 2012)
Full text of the article availabe here:
John van Tiggelen: RED ALERT 

our advice to patients must reflect the true potential outcomes

Dear Editor,

I refer to the article on palmar hyperhidrosis by Dr Sanjay Sharma (Managing palmar hyperhidrosis, March). I feel that the adverse effects [of thoracoscopic sympathectomy] are understated by my colleague. For example, compensatory hyperhidrosis is common, and can be disabling, leading to regret about the procedure in some patients (up to 51% in one review). Reversal of the procedure is difficult and requires sural nerve transplant if the sympathetic chain is removed.

The procedure can be effective and worthwhile, but our advice to patients must reflect the true potential outcomes.

Dr Ian Gilfillan, Cardiothoracic Surgeon


http://www.medicalhub.com.au/wa-news/letters/3217-palmar-hyperhidrosis-revisited

post-sympathectomy neuralgia is frequent

Surgical sympathectomy has a long heritage for the treatment of peripheral vascular disease and various chronic pain problems.

Despite concerns expressed as long ago as 1942 about the efficacy of surgical sympathectomy for the management of non-cancer pain, the procedure was enthusiastically pursued for the management of reflex sympathetic dystrophy or complex regional pain syndrome (CRPS), migraine, dysmenorrhea, epilepsy, chronic pancreatitis, postherpetic neuralgia of the trigeminal nerve, postdiscectomy syndrome, and phantom limb pain. However, systematic reviews have found no tangible evidence supportive of sympathectomy for the management of neuropathic pain. Furthermore, postsympathectomy neuralgia is a common complaint with a reported incidence between 15% to 50%.

As surgery is often mentioned as a cause of CRPS, it is somewhat illogical to consider surgery as an effective treatment. Nonetheless, surgical sympathectomy has a long anecdotal history in the treatment of RSD, and more recently endoscopic and radiofrequency sympathectomy has been tried.

Bonica's Management of Pain,

Lippincott Williams & Wilkins, 2009 - 2064 pages

scientific fraud was often misrepresented as the work of aberrant individuals

Aubrey Blumsohn, a senior lecturer in metabolic bone disease at the University of Sheffield, said scientific fraud was often misrepresented as the work of aberrant individuals.

But, he told the conference, “It is not rare, it is a group activity.” He said it could involve collusion between drug companies, researchers, journal editors, ghost writers, and regulators.

He said the mechanism for fraud was usually more nuanced than direct fabrication of scientific findings and involved techniques and behaviour that could “disturb the scientific record.”

He said the details of fraud often only emerged during litigation but that this “should not be the most important part of the process.”

http://www.bmj.com/content/344/bmj.e1526?etoc=

scientific fraud was often misrepresented as the work of aberrant individuals

Aubrey Blumsohn, a senior lecturer in metabolic bone disease at the University of Sheffield, said scientific fraud was often misrepresented as the work of aberrant individuals.

But, he told the conference, “It is not rare, it is a group activity.” He said it could involve collusion between drug companies, researchers, journal editors, ghost writers, and regulators.

He said the mechanism for fraud was usually more nuanced than direct fabrication of scientific findings and involved techniques and behaviour that could “disturb the scientific record.”

He said the details of fraud often only emerged during litigation but that this “should not be the most important part of the process.”

http://www.bmj.com/content/344/bmj.e1526?etoc=

Healthcare is still plagued by statistical deception and bad science

Healthcare is still plagued by statistical deception and bad science that distort policy and put patients at risk, the Radical Statistics group’s annual conference heard on 24 February.

Senior academics said flawed and fraudulent use of data was having a malign effect and many parties were to blame, including the government, economists, drug companies, regulators, medical publishers, and researchers.

http://www.bmj.com/content/344/bmj.e1526?etoc=

Permanent pain following sympathectomy

The mean inpatient pain scores were significantly higher in the biportal group (1.2±0.6) than that in the uniportal group (0.8±0.5, P=0.025). For the first three weeks after operation, four out of 20 (20%) patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 (32%) cases in the biportal group (P=0.366). Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics.
Chinese Medical Journal, 2009, Vol. 122 No. 13 : 1525-1528