Hi Antoinette
Good to hear from you as always.
I must admit it's been encouraging to see my work gain increasing
recognition. I'd like to think that it's robust. The NZ Parliamentary
Health Select Committee accepted it without question; no one has been able
to discredit it though some have tried using the, "but the benefit of
medicines are so significant that the adverse effects are acceptable"
argument.
I'm attaching five slides.
The Relative risk - meteor one is NZ data with some gaps filled with
overseas data (mainly related to food as the is no definitive NZ data
available and officials generally accept Aus/US data as being generally
similar to what can be expected in NZ. The main references are included --
I data mined every government, quasi government, sport foundation,
university, and every other data source I could think of. I also
corresponded with researchers around the world who have studied medical
injury in hospitals. None of them could recall coming across any injury
caused by supplements which means that they exist at the background noise
level.
The relative risks - bubble graph is the same data stripped to several
common causes of fatality represented with bubbles proportionate to risk.
Note that one axis is deaths per million at risk and the other is deaths
per million total total population. I'm working towards developing a
graduated range of risks for individual risk and for societal risk for use
in the regulation of supplements. The biggest problem I see is that
regulators talk in terms of 'acceptable level of risk' but they never
define it or even attempt to -- they apply the old-boy 'we know best'
method which is incompatible with an evidence based era, and with good
regulatory practice. The model is in draft form in 'amodel for
prioritising risk management policy and resources.'
The 'relative risk - Boeing 747' attachment is using Canadian data -- and
includes risk groupings on the left margins.
The Canadian Minister has acknowledged that in Canada it costs $Can 10
billion (yes billion) to deal with adverse effects of pharmaceutical drugs
alone!! And the cost of the actual drugs to the Canadian government is
about $Can 15 billion. In other words, for every dollar spent on drugs,
another (acknowledged) 66 cents is spent managing the adverse effects of
them.
The fifth slide is one by professor Lucian Leape (Harvard University) who's
adapted work by a French Aviations professor Renee Amalberti. It
demonstrates how dangerous modern medicine is compared to many other
activities. The mountain climbing relates to high altitude climbing such as
Mt Everest (30% of all successful climbers of Mt Everest are dead as a
result of climbing activities!)
If you need to mention, I was a member of the NZ government's expert group
advising the government on the reporting and management of medical injury
in our health system.
I'm undertaking a similar exercise for the UK & USA -- preliminary data for
both suggest similar patterns. Given the global nature of both medicine and
food supplements, I'll be very surprised if there is any significant
variation in results. Certainly regarding medical injury in hospital
research, that coming out of NZ, Australia, US, UK, Denmark, France all
point to an adverse event rate of about 10% with about 1:300 of all
admitted to hospital dying from a highly preventable medical injury.
Oh to be able to present all of this at Codex! Set acceptable levels of
risk and the argument becomes academic... it will then shift from
philosophical to evidence based. Perhaps you'd like to submit a discussion
paper to codex?
Kind regards
Ron
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