CervicalCheck controversy

boombang wrote: »

Not sure I get what you're saying here. The US screens every year, we screen every 3/5. The test spec in the US lab is tailored to our frequency. No informed doctor or health official in Ireland would recommend annual screening.

We did every three years, in more detail.
They did every year, in less detail.

They ended up doing every three years, in less detail than we would give.
We got the worse of both systems.

boombang wrote: »

No evidence of "incredibly poor work".

CervicalCheck had modified their policies to tell women of past errors and were doing so.

We'd expect some screened women still to develop cancer and sadly die because screening isn't perfect.

Lots of people have totally unrealistic expectations of screening and a near conspiracy theory level of paranoia about this because the media haven't been giving a level-headed interpretation of things. Scandal gets better rating than grim reality.

That's a very administrative and clinical way of saying they did not inform patients of false negatives and during that period some had died or gone beyond the point of early treatment, and they decided they may tell some patients affected if they deemed it worth the bother, egged on by a patient taking legal action.
This isn't a case of averages for a scientific tests findings, it's about decisions not to inform people and doing a more cursory check every three years instead of one.
They made a conscious decision not to inform patients of the flawed results. They decided it didn't matter. What civil servants did or didn't know and when, why we went with this particular company, is there more conflict of interest regarding this particular contract and O'Brien? We may or may not find out, but the media coverage is certainly warranted. Mary Lou might be premature looking for convictions, but if not for the media and opposition politicians would we be aware? If not best practise, would it be changed? If any wrong doing were found, would it be actioned? We need the media, especially in a state that tends not to do accountability, criminal or otherwise.

boombang wrote: »

Incorrect. The CervicalCheck contract in 2008 explicitly required that the smears were done in detail to correspond with our 3/5 interval not the annual interval. Tony O'Brien has explained this in detail.

If we had got quick screening done every three years as you describe the, yes, we would have got worse of both worlds. This is part of the reason why there's the 1.2 vs 1.8 difference that Dr Gibbons pointed out in the initial analysis before the configuration was tailored to Irish needs.




They did not have the opportunity to give this information at point where earlier treatment would have helped. They only found out about the errors AFTER women had got treatment.




1. Again, we don't do a cursory check every three years, we do a careful check every 3/5 years.

2. If you want to make reliable statements about the performance of the labs then you need to look at averages of scientific test findings. You can't get away from that.




I would be surprised if much if any would need to be changed about screening on the basis of this. More accurate HPV testing is already coming in at the end of the year. You have a positive view of the media. I think they've shone a light (good); but they've also hyped the issue and scared women unnecessarily (bad). I think the bad outweighs the good here.

The lower detection rate in the US laboratory was brought to the attention of the country's Health Service Executive (HSE) but appears not to have been acted upon.
http://www.bbc.com/news/world-europe-43961552

I have a positive view of the media because everybody has a bias and/or agenda, including various media outlets. If we were left with the government press office we would be in a very dark place, based on the states record and it's caliber of government politicians. With various sources we can decide for ourselves what is and isn't important, what is and isn't warranted. These woman didn't have that choice. If the tests are not fit for purpose we should move to improve, I know people die, things happen, but it would be nice if we tried to avoid that IMO, rather than dismissing it as par for the course. That's why it's important the people know about things, so they can drive change. One mans few patients dying due to poor standards, is another man's scandal.
There was a conscious decision to withhold information regarding clinical errors. People died as a direct result.

boombang wrote: »

100% this did not happen [edit - the dying as a result bit].

Sick people told they were fine, the company discovering they were not and nobody informing them of the find in a timely manner, if at all. Vicky Phelan for example?
Sick people being told they were fine, therefore not seeking treatment and dying.

boombang wrote: »

But they only found out the error after the women had been identified as sick.

That's very different from information consciously being withheld from sick people. People weren't told they were sick because the screening test didn't indicate they were sick.

A world of difference.

You've not shown how this is incorrect:

Matt Barrett wrote: »

There was a conscious decision to withhold information regarding clinical errors. People died as a direct result.

People died as a direct result of false readings. The company withheld false readings. We are investigating who knew what, when and why. We know Vicky Phelan only found out through her own due diligence.
If the errors were discovered sooner or when discovered patients were told immediately, could lives have been saved?

NickNickleby wrote: »

I've just read two online articles in Independent.ie

One by a Kim Bielenberg who refers to Vicky Phelan suffering because of 'botched tests'. It does not say whether or not Kim Bielenberg has any medical qualification.

The other by a Doctor Ciara Kelly, who explains the international experience of less than 100% accuracy of screening. She also refers to auditing, the purpose of which (if I read her piece correctly) is to ensure that the program being audited does not stray significantly from the international norm - in terms of its accuracy. Not to guarantee 100% accuracy.

I believe its because of this mixed type of reporting that we can have almost diametrically opposite opinions on what has happened.

Sadly, our Public Service Broadcaster has not clearly and unambiguously reported THE FACTS.

BTW, Dr Kelly's article is not written in a way to exonerate the HSE - she highlights their deficiencies in communicating the information about the false negatives.

While we should ensure the right heads roll, if any, we should also not be too quick to go down the time honored, 'nothing to see here, move along' route.
I believe O'Brien and Varadkar have taken part in a conflict of interest elsewhere, (Lynch/Taisoseach then health minister/head of HSE) time will tell what develops here, as long as we don't follow the ALT-Right Trump agenda of dismissing all media we don't like for what ever reason.

boombang wrote: »

Matt, I'm not mudslinging here, but if this is your understanding your understanding is wrong. This is really important. People need to understand what happened to appreciate the importance of what went wrong.

The company did not withhold false readings. Women received a correct diagnosis and then they looked back at previous results. At this point they found errors in the previous results. Whether the women were told or not at this stage would not alter their care because they already had a correct diagnosis at that point. It would have been more open an honest to tell them that there had been a previous error, but nobody knew these previous screens were in error till it was too late. Hence no knowing withholding of information.

If people don't understand the order of events, then they're likely to misunderstand the story and overstate the significance of what went on.

I read and understand what you are saying. I interpret it differently to you. It's your reasoning I disagree with. There were errors, we do not know the finer details or the entire issue yet. Your view exonerates the company and doubts any wrong doing on anyone's part before we've even completed looking into it.

The storm over cervical cancer screening began when terminally ill mum-of-two Ms Phelan was awarded €2.5m in a High Court settlement against a US lab after she was not informed about an incorrect smear test in 2011.https://www.independent.ie/irish-news/health/three-women-whose-cases-are-similar-to-vicky-phelan-have-died-state-claims-agency-confirms-36885928.html

These errors only came to light because of the Phelan case.

THE US LABORATORY at the centre of the cervical cancer screening controversy in Ireland sought a confidentiality clause in the legal challenge brought forward by Vicky Phelan.
http://www.thejournal.ie/cervicalcheck-scoping-inquiry-3999094-May2018/

The minister said he is "mad as hell" about the information that has come to light in recent days about the controversy, and the impact it has had on women across the country.

Mr Harris said that people who were in important positions in the health service have let people down and he wants a statutory inquiry to get answers.
https://www.rte.ie/news/politics/2018/0502/959759-cervicalcheck-reax/

Someone tell Harris, sh*t happens?

boombang wrote: »

It's not a matter of interpretation. The company did not withhold results from women. They made errors. What the errors represent is a matter of interpretation. However, it is a solid matter of fact that nobody knowingly withheld results from women that would have advantaged their care.



Error - yes, by the labs


Withholding knowledge of errors from women -yes, by CervicalCheck/Doctors


Withholding knowledge of errors at a time that compromised women's chances of survival - No, not by CervicalCheck or the company.

You are welcome to that belief and your seemingly complete faith in the company, O'Brien and the HSE. I'll await the outcome of any investigation.

We all know errors happen, again, that's not the complete issue at hand.

boombang wrote: »

I don't have complete faith in TOB, the HSE and the company, but I'll wait the outcome of the investigation before I call for sackings etc.

The point is that the withholding of errors didn't compromise care is the hard point that I'm trying to get across. I accept everything else can be questioned and debated, but it is incontrovertible that the withholding of knowledge of the errors did not compromise these women. This is separate from the opinions that you and I are entitled to hold.

So say the company.

boombang wrote: »

No, so says logic. Errors were discovered AFTER women received a correct diagnosis.

Speaking today, Taoiseach Leo Varadkar said he is “very angry” that women were not told earlier about their smear tests being reviewed.
http://www.thejournal.ie/cervical-check-timeline-3985728-Apr2018/

This gives the impression the information was at hand but nobody notified. If I were told I received a false negative on a test, I'd want to be re tested. They took that option away.

27.9.2017 – Dr Hickey writes to Limerick GP Dr Valerie Keating informing her that he discussed with Ms Phelan the audit of smear tests. He also says ‘we just wanted to let you know the results of this audit process as it was only sent to us in communication as the treating gynaecologists and not to the patients themselves or the GPs.’

This letter comes over 14 months after the correspondence began, six years after the initial botched test, and three years after Mrs Phelan is finally given her (delayed) cancer diagnosis.
https://extra.ie/2018/04/29/lifestyle/health/vicky-phelan-timeline-smear-test-scandal

The idea that all these deaths would have happened anyway, despite these errs and conscious decisions to withhold the information, remains to be seen in entirety, regardless of what the company may say.
Also, in the least how these companies operate is obviously lacking.