The Punchline from
Why did the WA Family Court IGNORE the globally accepted gold standard Cochrane evidence, before ordering chemotherapy for six year old boy, Oshin Kiszko, suffering brain cancer, after his parents refused?
The Cochrane Collaboration review of chemotherapy treatment for brain cancer known as Medulloblastama concluded –
“The meta-analysis showed no significant difference between treatment including, and treatment not including, chemotherapy”
– see Chemotherapy for children with medulloblastoma – Michiels – 2015 – The Cochrane Library
My post covers eight points:
- What the Cochrane review concluded about the scientific evidence?
- Why did the Family Court over-ride the parents’ informed consent BUT IGNORE the gold standard Cochrane evidence?
- Why did the media report this legal action BUT IGNORE the gold standard Cochrane evidence?
- Why did the doctors overide the parents’ informed consent BUT IGNORE the gold standard Cochrane evidence?
- Why did the Hospital support its doctors, and take legal action to overide the parents’ informed consent BUT IGNORE the gold standard Cochrane evidence?
- Why did the WA Health Minister, and the Commonwealth Health Minister condone this legal action BUT IGNORE the gold standard Cochrane evidence?
- Why did the AMA condone this legal action BUT IGNORE the gold standard Cochrane evidence?
- Why did the Friends of Science in Medicine condone this legal action BUT IGNORE the gold standard Cochrane evidence?
1. What the Cochrane review concluded about the scientific evidence?
The Cochrane Collaboration review of chemotherapy treatment for brain cancer known as Medulloblastama found at Chemotherapy for children with medulloblastoma – Michiels – 2015 – The Cochrane Library concluded “the meta-analysis showed no significant difference between treatment including, and treatment not including, chemotherapy”.
Why is it that we “consumers” can easily read this Review at Chemotherapy for children with medulloblastoma – Michiels – 2015 – The Cochrane Library, but no treating doctor, public hospital administrator, Health Minister, legal counsel or investigative journalist could find this information?
I can always bet on the Friends of Science in Medicine and the AMA to ignore any gold standard Cochrane review of “orthodox” treatments, because they want to preserve their gravy train of subsidies, NHMRC research grants, Big Pharma “marketing benefits” and of course the public’s trust in them to be the guardian of our $150 billion p.a. health system.
Other key Cochrane conclusions include:
- None of the studies evaluated quality of life.
- the total number of identified RCTs was eight.
- Seven studies compared children with medulloblastoma receiving chemotherapy as a part of their treatment with children not receiving chemotherapy as part of their treatment.
- One study compared children with medulloblastoma receiving standard-dose RT without chemotherapy with children receiving reduced-dose RT with chemotherapy.
- We excluded 3459 articles based on the title or abstract (or both) since they were not RCTs, did not compare children treated with chemotherapy with children treated without chemotherapy, did not include children at all or did not include children with medulloblastoma.
- We excluded a further four articles after assessing the full-text article for reasons described in the Characteristics of excluded studies table.
- None of the seven studies blinded care providers and participants to treatment. However, it should be noted that due to the nature of the interventions blinding of care providers and participants was impossible.
- In all studies, it was unclear if the outcome assessor was blinded to treatment.
- In conclusion, selection bias (based on concealment of treatment allocation) could not be ruled out in five of the seven included studies.
- Performance bias (based on blinding of the care provider and participant) could not be ruled out in any of the included studies.
- Detection bias (based on blinding of the outcome assessor) could not be ruled in any of the studies evaluating EFS/DFS and adverse effects.
- Attrition bias (based on the use of an ITT analysis and completeness of follow-up) could not be ruled out in any of the studies evaluating EFS/DFS, OS and adverse effects.
- Unfortunately, different definitions of study end points, numerous chemotherapy regimens and doses (none of which would be considered standard of care today), changes inherent to three decades of technological and histo/biological knowledge and the fact that, in most studies, results for different risk groups were not reported separately were major obstacles in comparing the results of the different studies.
- The studies used three different definitions of EFS and DFS, and one study provided no definition of DFS. This made pooling of the results of all studies impossible.
- Eleven different drugs were administered in seven different regimens and the actual received doses of chemotherapy were not mentioned in most of the studies. For evaluation of the effect of chemotherapy, this is important information. The lack of efficacy of a certain chemotherapy regimen might be due to dose reduction due to toxicity.
- Adverse effects (grade 3 or higher) were scarcely reported. Most adverse events were only mentioned in one RCT, or data were only provided for the chemotherapy arm and not for the RT only arm. Thus, as the risk of underreporting was real, caution must be taken in interpreting these results.
- ‘No evidence of effect’, as identified in this review, is not the same as ‘evidence of no effect’. A benefit of chemotherapy cannot be excluded.
I have prepared a separate post on the workings of the Cochrane Collaboration and its peak standing in the medical community globally to be found at http://www.linkedin.com/pulse/systematic-cochrane-review-findings-covered-up-our-graeme?published=t
Cochrane reviews are designed simply for the public, and have a detailed analysis for the professionals as well, just like our PBS drugs do with the Consumer Medicines Information (CMI) and Product Information (PI) documents lodged by manufacturers with the TGA.
2. Why did the Family Court over-ride the parents’ informed consent BUT IGNORE the gold standard Cochrane evidence?
Quite simply, the Cochrane evidence was never tabled. Why not? It rarely is quoted when it comes to so-called “orthodox mainstream medicine” or our “safe and proven vaccine drug cocktail industry”.
Cochrane evidence seriously challenges the safety and efficacy of most orthodox treatments in Australia, and all vaccination drug cocktails administered to our pregnant mothers, babies, children and now adults.
Even a cynical health politics advocate like me can still be quite shocked and disappointed after reading the judgment of The Honourable Justice Stephen Thackray Chief Judge of the Family Law Court of WA, a now landmark decision for medical kidnapping, all too common in the USA. The Chief Judge’s decision over-rode a naturopath mother’s decision not to consent to chemotherapy treatment for her 6 year old son Oshin, suffering the traumatic brain cancer condition of Medulloblastoma.
I have included the judgment in a separate post, and endeavoured to highlight in bold the words I felt were most relevant, to help those of you concerned at what has happened to Australia – the once “lucky country”. Follow this link at http://www.linkedin.com/pulse/highlighted-judgment-from-oshkin-kiszko-cancer-chemo-graeme?published=t
A few highlights follow of the judgment of the WA Chief Judge of the Family Court, in the case of DIRECTOR CLINICAL SERVICES, CHILD & ADOLESCENT HEALTH SERVICES and ANGELA JADE KISZKO, First Respondent and ADRIAN COLIN ASTRACHAN, Second Respondent  FCWA 19 include:
- “I consider that the law is beyond doubt.
- I do take into account the fact that there will be, in all probability, a number of serious adverse impacts for Oshin.
- But when called upon to act cautiously, recognising that I am not making the decision about my own child, but making the decision about the child of others, I consider that the prospect of the long-term cure is the matter that must most heavily weigh in the decision, and it is the reason I propose to order that the treatment commence on Sunday after Oshin has had his birthday party.”
No court should have made that order for chemotherapy to take place.
I intend to write to the Chief Judge of each Family Court and put them on notice of the existence of Cochrane Collaboration reviews – we will all be holding our breath for a lifetime waiting for any of our regulators to let these Judges in on the gold star evidence secret.
3. Why did the media report this legal action BUT IGNORE the gold standard Cochrane evidence?
This media article summarises the initial order for chemo treatment – Court orders chemotherapy for cancer-stricken boy Oshin Kiszko after parents refuse
This second media article summarises a second hearing where radiation treatment was not ordered, and proceedings adjourned – Oshin Kizsko: Win for parents of boy with brain cancer as court refuses to order radiotherapy
I intend to write to the Editor of each major Australian media outlet and put them on notice of the existence of Cochrane Collaboration reviews. Let’s see if the media bias changes – I doubt it.
4. Why did the doctors overide the parents’ informed consent BUT IGNORE the gold standard Cochrane evidence?
I think this is the most critical question of all. I will write to these doctors and let’s see if they respond. I strongly believe AHPRA should discipline these doctors to the full extent possible in a landmark medical disciplinary hearing focusing upon why they ignore scientific evidence of the highest standard, which shows treatments are not proven effective and generally have major adverse event risks.
5. Why did the Hospital support its doctors, and take legal action to overide the parents’ informed consent BUT IGNORE the gold standard Cochrane evidence?
Child and Adolescent Health Service, Western Australia comprising:
is part of the Western Australian Department of Health. The Child and Adolescent Health Service is committed to providing high quality paediatric care to young West Australians.
A media release from Professor Frank Daly, chief executive of Child and Adolescent Health Service, said: “It is acknowledged that there are potential significant side effects to chemotherapy and radiotherapy. The response to these treatments will vary from child to child and it is not known in advance what the full impact of treatment will be for the individual child”.
Some immediate side effects can be improved with pain relieving and anti-nausea medication, to a point. Longer term it has been acknowledged publicly that Oshin could have visual, hearing and cognitive impairment. Other medical problems that will likely arise cannot be predicted.
The statement adds: “CAHS has a duty of care to ensure that all children attending Princess Margaret Hospital are provided with the best available medical treatment… treatment with the aim of cure and not palliative care, remains the best treatment for the child”.
I find it very interesting a WA government hospital can make claims it can cure cancer and take action in courts to prove it, over-riding the clear Cochrane evidence? Lucky they don’t practice natural therapies.
6. Why did the WA Health Minister, and the Commonwealth Health Minister condone this legal action BUT IGNORE the gold standard Cochrane evidence?
The Big Pharma corruption machine ensures a cover-up of Cochrane evidence, whenever it suits.
I am genuinely saddened for patients, as it always seems to be in the best interests of our Governments, Health Ministers, the NHMRC, the TGA, the ACCC and health lobby groups, like the AMA, Friends of Science in Medicine, and the Skeptics associations, to turn a blind eye when it comes to mainstream medicine and the vaccination agenda.
However, not satisfied with ignoring the evidence base behind orthodox medicine, the same unsavoury alliance of Big Pharma, regulators, scientists and lobbyists frequently drag out Cochrane evidence to attack natural therapy professions, their practitioners, and ultimately their patients like me.
I actually learnt about Cochrane evidence first hand in 2013, when our Federal Government, through health regulator AHPRA, strongly relied upon Cochrane Collaboration evidence to seek deregistration of a natural medicine practitioner, in the longest running VCAT health practitioner case, despite the practitioner citing 906 peer reviewed journal articles on his website.
Ultimately the VCAT injustices in that case transformed my life mission into my quest, with your help, to fight pharma corruption – see www.fightpharmacorruption.com.
7. Why did the AMA condone this legal action BUT IGNORE the gold standard Cochrane evidence?
National chairman of the AMA ethics committee Michael Gannon told 720 ABC Perth it was an extremely rare case. See link at AMA ethics committee supports treatment ( 8 April 2016).
“The doctor’s responsibility is always to do the best for a patient, and when it comes to the care of a child, they need to consider the rights of the parent or guardian,” he said.
Dr Gannon said it was standard practice for complex cases to be discussed by a multi-disciplinary team including a surgeon, oncologists and others.
“I have no doubt that a case like this would’ve been discussed extensively by the doctor in charge before they took the difficult and, I think, the very brave step of involving the courts,” he said.
“It is very difficult to try and make the case to a parent or guardian that you think you know better than their wishes for their own child.
Dr Gannon said it was a vexed and difficult ethical issue.
“The burden of proof is very high, this is not something the doctors do commonly, it’s not something that they would want to do,” he said.
” The case of the medical evidence would have to be extremely strong before a judge would dream of going against the wishes of a parent or guardian.”
It is a scary thought that none of these pillars of the mainstream medical community could reference the gold standard independent evidence supplied by Cochrane reviewers, preferring biased medical evidence, no doubt discarded by Cochrane when completing its systematic review.
Dr Gannon has had a bit more luck lately than poor OSHIN and his parents, being since promoted to head honcho of AMA – see Dr Michael Gannon promoted to AMA President. No doubt the new AMA President’s “ethics” background cemented his appointment, as steering the AMA requires the perpetual cover-up of Cochrane evidence for conventional treatments.
When will the public wake up please – unfortunately I doubt the AMA ever will?
Why did the Friends of Science in Medicine condone this legal action BUT IGNORE the gold standard Cochrane evidence?
The anti-Nature lobby group , Friends of “cherry-picking” Science in Medicine, highlights the importance of Cochrane gold standard evidence on its website at www.scienceinmedicine.org, to strike out against any of the 20 natural therapy professions, or a scapegoat natural practitioner from time to time.
“Speaking with a strong voice provided by our constituency we will make every effort to ensure that Australians have access to interventions and medicines backed by science-based tertiary education and scientific evidence of their clinical effectiveness.”
Check out also this statement from the Friends of Science website
“All Research should be aimed at the evaluation of the long-term safety, efficacy and cost-effectiveness of alternative and so-called complementary interventions; all trials should be pre-registered and all results reported in mainstream, scientifically, peer-reviewed journals. With the introduction of the Cochrane Collaboration based on evidence-based health care, clinical practice and Medicine, increasing numbers of Cochrane Reviews on CAMs have uncovered the poor evidence on which their claims are based.
CAM and conventional interventions either work or do not work. Valid scientific evaluation can identify those which work. Those that do not work, whether conventional or CAM, should be discarded.”
I will also post this Post on the Friends of Science’ s Facebook page. I am confident from past experience they will ignore my substance, and “cleverly” divert readers attention, or just simply attack me personally which is their favourite social media custom for anyone who challenges their opinion as to the adequate evidence supporting conventional medicine.
What action steps are open to Oshin’s parents now?
The government authorities are generally under a model litigant requirement to put all relevant evidence before a Court, so the Cochrane review should have been tabled.
I consider all medical practitioners involved in Oshin’s treatment should be subject to disciplinary action by the Australian Health Practitioner Regulation Agency (AHPRA) for a start, and possibly the local health services complaints authority.
Our Federal and State governments should inform all health disciplinary Tribunals and the Family Court of the existence of Cochrane Collaboration reviews of most common medical interventions.
The legal decision should be annulled as a precedent and compensation awarded by the WA government to Oshin and his family.
A public apology to OSHIN and his parents by all relevant parties who failed to represent the gold standard Cochrane medical evidence before the Court, or in any media reporting of this case, or Ethics Committee.