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CervicalCheck controversy

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  • Moderators, Category Moderators, Computer Games Moderators, Society & Culture Moderators Posts: 8,452 CMod ✭✭✭✭Sierra Oscar


    The interview with Emma Ní Mhathúna on Morning Ireland was harrowing stuff. It's available to listen back on here. Perhaps one of the most profound interviews I have ever listened to on Irish radio.

    It's a disgrace that there has been absolutely no accountability over this scandal. Fair play to Sinn Féin for putting the pressure on. If Harris doesn't act on Tony O'Brien then he himself should resign.


  • Registered Users Posts: 2,108 ✭✭✭boombang


    As harrowing as it is there's no clear scandal yet.

    I think we need to very carefully assess the false positive rates of the three labs. CervicalCheck have stated in a Dail committee that they don't see a difference between the labs in this respect. I think this needs to be scrutinised carefully (by medical statisticians) to see if this stands up.

    There are certainly questions to be asked. They need to be asked and answered carefully.


  • Registered Users Posts: 13,365 ✭✭✭✭McMurphy


    The interview with Emma Nhathúna on Morning Ireland was harrowing stuff. It's available to listen back on here. Perhaps one of the most profound interviews I have ever listened to on Irish radio.

    It's a disgrace that there has been absolutely no accountability over this scandal. Fair play to Sinn F for putting the pressure on. If Harris doesn't act on Tony O'Brien then he himself should resign.

    That's pretty hard to listen to tbh.

    That poor woman, those poor kids.


  • Closed Accounts Posts: 1,800 ✭✭✭tretorn


    Tony O Brien is being very bullish and obviously confident enough to know the enquiry wont find he was neglgent in anyway.

    I dont think any public servant has stood up to the hyprocrisy of politicans the way he has.

    Its nauseating to think Simon Harris and Leo Vradkar actually requested a meeting with Vicky Phelan, if anyone needs to take responsibility for this "scandal" its them.

    I dont believe there was a scandal though. No one knew Vicky Phelan had cancer and kept this information from her, that is what we we ned to remember even though the media have whipped this up. It was on Joe Duffy for days with women ringing up saying they had demanded a check on Thursday morning and they were getting it regardless of other people who needed the services of their GPS. Most of these women didnt need to be rechecked but they thought they did because of irresponsible media reporting. Joe Duffy was followed by Ray of sunshine Darcy and then Mary Wilson and her pals continued with it for another two hours.


  • Registered Users Posts: 1,813 ✭✭✭NickNickleby


    How is a False Negative identified? I'm going to presume a lot here:

    One would expect that ALL negative results are treated as True Negative when first presented.

    Is a review done of ALL test results? Would this be the same thing as conducting tests twice in quick succession (I'm talking about time and cost)?

    If ALL results are reviewed,are THOSE updated results subject to the same acceptable failure rate, or are the reviews more rigorous? If the audit results are expected to be foolproof, presumably much more rigour is applied. Presumably then, trying to audit ALL results is an almost impossible task - not to mention time and cost.

    Bear with me, this is going somewhere.....

    Therefore, is the rationale :
    "well, let's go back to the previous result for each person who tests positive, just in case they were actually positive last time - which we'll find out by using more rigorous (ie expensive and time consuming)methods."

    Why??? we know the unfortunate person has the disease, what will change after the audit??

    "yes, but if we find the last one was actually a positive that was missed, its important TO THE PROCESS, because if too many of these are happening, somethings wrong"

    So (at last) we come to the nub.

    How many is too many?

    Well a politician with plenty of someone's else's money and little knowledge of, or thought for the realities of the screening process might say "ONE is too many". (this is quite different from "my mother is one too many" - I don't believe that emotion can be brought into it, because as with anything there can be no absolute guarantee). So now, some politician having declared that a totally foolproof screening system is possible if only people would pay for it, people will believe that.

    That last paragraph in particular was written because I heard a one liner on the radio yesterday that the Board of the HSE was going to be replaced, sort of suggesting that the problem would now be fixed, and perhaps raising people's expectations that there'll be no more False Negatives.

    By the way, I'm all for a no blame compensation policy in a case like this. Trying to establish blame is what creates all the additional heartache. If blame is appropriate, the audit should reveal it.


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  • Registered Users Posts: 1,813 ✭✭✭NickNickleby


    By the way, in my speculation about the audit, I wondered how a choice was made on which results to audit. It would sound absurd if the audit was random, hence my choice of going after the now-positive-results.


  • Registered Users Posts: 2,108 ✭✭✭boombang


    When a woman with a prior screening history is diagnosed with cancers they go back to audit her previous smears to see if they miss anything. The audit is triggered by a diagnosis for each woman.


  • Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    boombang wrote: »
    As harrowing as it is there's no clear scandal yet.

    I think we need to very carefully assess the false positive rates of the three labs. CervicalCheck have stated in a Dail committee that they don't see a difference between the labs in this respect. I think this needs to be scrutinised carefully (by medical statisticians) to see if this stands up.

    There are certainly questions to be asked. They need to be asked and answered carefully.

    Your idea of 'scandal' differs from others.
    Not passing on information that could prevent deaths, be it due to negligence or conscious decision is a scandal.


  • Moderators, Society & Culture Moderators Posts: 12,521 Mod ✭✭✭✭Amirani


    Your idea of 'scandal' differs from others.
    Not passing on information that could prevent deaths, be it due to negligence or conscious decision is a scandal.

    Passing on information in these cases could not have prevented deaths, the women in question had already been diagnosed and were receiving treatment.


  • Registered Users Posts: 1,571 ✭✭✭Red_Wake


    boombang wrote: »
    As harrowing as it is there's no clear scandal yet.

    I think we need to very carefully assess the false positive rates of the three labs. CervicalCheck have stated in a Dail committee that they don't see a difference between the labs in this respect. I think this needs to be scrutinised carefully (by medical statisticians) to see if this stands up.

    There are certainly questions to be asked. They need to be asked and answered carefully.

    Your idea of 'scandal' differs from others.
    Not passing on information that could prevent deaths, be it due to negligence or conscious decision is a scandal.
    Matt, it's been explained to you multiple times that the smears weren't known to be inaccurate until after the women in question had already been diagnosed with cancer, and as such the decision not to inform them of the smear's inaccuracy had no bearing on their subsequent and ongoing treatment.

    Not telling the women that the smears were inaccurate did not kill anyone, as they had already been diagnosed with, and were receiving treatment for cancer at this point.


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  • Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    My understanding is people were misdiagnosed. They either died or were later discovered to have cancer and are receiving treatment or in some cases it's too late to bother. Also the company wanted this kept quiet as per the Phelan case.
    What am I missing here?

    Was this 100% purely administrative error or a cover up or both remains to be seen.


  • Registered Users Posts: 5,336 ✭✭✭Mr.Micro


    2Scoops wrote: »
    It's not easy even for trained cytologists - otherwise there wouldn't much false negatives/positives. Cellular atypia is not a simple game of good and bad. Every cell is looked at, or at least it's supposed to be, and it does indeed take forever as a result - that's why there was a 6 month backlog before the HSE outsourced tests to the US lab.

    No. It's sheer number of specimens that causes delay. Any slide under a microscope is looked in a certain fashion. Obvious positives will show up relatively quickly, through the large number of cells that are abnormal. When there are less abnormal or doubtful cells on the slide, these can be missed. Every cell cannot possibly be looked at by a technician. Like any test, it is not foolproof or without flaws. It is an indicator.


  • Moderators, Society & Culture Moderators Posts: 12,521 Mod ✭✭✭✭Amirani


    My understanding is people were misdiagnosed. They either died untreated or were later discovered to have cancer and are receiving treatment or in some cases it's to late to bother.
    What am I missing here?.

    You're missing that the misdiagnosis was only discovered AFTER a subsequent test established that they had cancer.

    So it was only when treatment already began that the HSE/Labs discovered that the initial diagnosis was wrong. At this point, telling the patient of the misdiagnosis achieves nothing from a medical point of view as it's already established that they have cancer now.


  • Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    Amirani wrote: »
    You're missing that the misdiagnosis was only discovered AFTER a subsequent test established that they had cancer.

    So it was only when treatment already began that the HSE/Labs discovered that the initial diagnosis was wrong. At this point, telling the patient of the misdiagnosis achieves nothing from a medical point of view as it's already established that they have cancer now.

    There's almost an accidental strawman happening here. You assume I do. When it was allegedly discovered is not my full point. They decided not to inform patients, because they decided there was no point. Medically or not, this was wrong IMO. They wanted this kept out of the media when a victim had to take them to court. Par for the course, nothing to see here?

    The facts we do know remain. People thought they got the all clear when in fact they had cancer. For Emma Nhathúna we can tell her it's par for the course and we don't see any scandal.
    Then we've the chain of communication on the issue once discovered.
    Also we've yet to find out any connection between this US company and others home grown business or political Irish interests may have a stake in.


  • Registered Users Posts: 1,571 ✭✭✭Red_Wake


    Amirani wrote: »
    You're missing that the misdiagnosis was only discovered AFTER a subsequent test established that they had cancer.

    So it was only when treatment already began that the HSE/Labs discovered that the initial diagnosis was wrong. At this point, telling the patient of the misdiagnosis achieves nothing from a medical point of view as it's already established that they have cancer now.

    There's almost an accidental strawman happening here. You assume I do. When it was allegedly discovered is not my full point. They decided not to inform patients, because they decided there was no point. Medically or not, this was wrong IMO. They wanted this kept out of the media when a victim had to take them to court. Par for the course, nothing to see here?

    The facts we do know remain. People thought they got the all clear when in fact they had cancer. For Emma Nhathúna we can tell her it's par for the course and we don't see any scandal.
    Then we've the chain of communication on the issue once discovered.
    Also we've yet to find out any connection between this US company and others home grown business or political Irish interests may have a stake in.
    This was left to the discretion of the doctors. It as not explicitly forbidden to inform patients, nor was it ordered for patients to be told.

    The same policy is in effect over in the UK. It seems to be a fair one imo.


  • Moderators, Category Moderators, Computer Games Moderators, Society & Culture Moderators Posts: 8,452 CMod ✭✭✭✭Sierra Oscar


    boombang wrote: »
    As harrowing as it is there's no clear scandal yet.

    Well it's looking like the Department of Health were aware of the cover-up effort as far back as March 2016. Leo Varadkar was Minister for Health at the time. So there's big potential for this to turn into a scandal which, to be honest, could collapse the Government.


  • Moderators, Society & Culture Moderators Posts: 12,521 Mod ✭✭✭✭Amirani


    Well it's looking like the Department of Health were aware of the cover-up effort as far back as March 2016. Leo Varadkar was Minister for Health at the time. So there's big potential for this to turn into a scandal which, to be honest, could collapse the Government.

    Chief Medical Officer tells PAC that the memo relates to the 'known phenomenon' that uptake of screening programmes drops when there is negative media coverage that damages their reputation.

    This scandal will likely cause worse health outcomes for women, not better.


  • Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    Well it's looking like the Department of Health were aware of the cover-up effort as far back as March 2016. Leo Varadkar was Minister for Health at the time. So there's big potential for this to turn into a scandal which, to be honest, could collapse the Government.

    That would only happen if Fianna Fail get embarrassed by association, which would be the height of Irony.


  • Registered Users Posts: 1,845 ✭✭✭2Scoops


    Mr.Micro wrote: »
    No. It's sheer number of specimens that causes delay. Any slide under a microscope is looked in a certain fashion. Obvious positives will show up relatively quickly, through the large number of cells that are abnormal. When there are less abnormal or doubtful cells on the slide, these can be missed. Every cell cannot possibly be looked at by a technician. Like any test, it is not foolproof or without flaws. It is an indicator.

    They look at every cell. But it's not about the number of abnormal cells in a smear, it's about how abnormal they are. The difference between a normal cell and HSIL can sometimes be obvious. The difference between normal and LSIL is subtle. The difference between normal and ASCUS can be ridiculously subtle. Those would all qualify as smears that are "not normal".

    Relatively few cases are barndoor normal or HSIL. When you need to look at every cell and make a judgement call, it takes time.


  • Registered Users Posts: 2,108 ✭✭✭boombang


    Well it's looking like the Department of Health were aware of the cover-up effort as far back as March 2016. Leo Varadkar was Minister for Health at the time. So there's big potential for this to turn into a scandal which, to be honest, could collapse the Government.

    CervicalCheck changed their policy in 2016 to inform women of prior screen misses, subject to clinical discretion. Moving towards disclosure is the opposite of cover up. Plus, I think it's not very meaningful to speak of covering up something that most doctors know happens. There's no big secret that false negatives occur.


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  • Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    boombang wrote: »
    CervicalCheck changed their policy in 2016 to inform women of prior screen misses, subject to clinical discretion. Moving towards disclosure is the opposite of cover up. Plus, I think it's not very meaningful to speak of covering up something that most doctors know happens. There's no big secret that false negatives occur.

    Again, can we take it as given everyone knows no tests are 100% accurate 100% of the time? That's not the issue here.
    Also deciding when and how to divulge a persons medical information to them is one thing, seeking a media black out is another and of course they had all the best intentions, in a timely manner, in the world, because they said.


  • Registered Users Posts: 2,108 ✭✭✭boombang


    Again, can we take it as given everyone knows no tests are 100% accurate 100% of the time? That's not the issue here.
    Also deciding when and how to divulge a persons medical information to them is one thing, seeking a media black out is another and of course they had all the best intentions, in a timely manner, in the world, because they said.

    Given the total panic caused by the media shít fit over this it seems they were dead right to put the breaks on.


  • Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    boombang wrote: »
    Given the total panic caused by the media shít fit over this it seems they were dead right to put the breaks on.

    For who's benefit?
    Maybe if there were no errors, no deaths, not delays in passing on information and no Vicky Phelan needing to take them to court and no attempt to keep it all quiet, no Emma Nhathúna given a virtual dead sentence, no basket case HSE and questions regarding possible conflict of interest, the media would have no material to work with. Why we need the breaks put on escapes me.

    With the old chestnut;
    CervicalCheck memos 'were not brought to health minister's attention'
    https://www.rte.ie/news/politics/2018/0510/962495-public-accounts-commitee/

    being wheeled out, it can only mean there's more to come.

    I thought this was a nice touch for Taoiseach;
    It said the documents were not shared outside of the department's Chief Medical Officer and the HSE's Acute Hospitals Division and were not brought to the attention of any Minister for Health.


  • Registered Users Posts: 2,108 ✭✭✭boombang


    For who's benefit?

    Given that so many have misunderstood the facts of this controversy (including you apparently) it seems there would have been an advantage of finding a way of getting the truth to women whose PREVIOUS smear results were found to be in error in a way that did not cause grossly disproportionate concern among the population. They evidently failed. The media can't seem to handle the truth here and have gone for headlines. This has prompted unnecessary concern, rescreening and congestion in the primary care system.


  • Registered Users Posts: 2,108 ✭✭✭boombang


    no Emma Nhathúna given a virtual dead sentence

    I wish people could show some class and not throw statements like this around. The matter is too grave. No virtual death sentence has been given to that poor lady: she's the mostly likely simply the very unfortunate victim of probability.


  • Registered Users Posts: 2,108 ✭✭✭boombang


    TOB has gone now anyway. Hope the pitchfork brigade are satisfied.


  • Closed Accounts Posts: 1,253 ✭✭✭ 1cjd9p5utsrbva


    Can anyone clarify if he gets a lump sum and full pension?


  • Registered Users Posts: 755 ✭✭✭Foggy Jew


    Oh FFS. Tony O Brien accepted a high powered job with a huge salary. The downside to collecting mega-bucks weekly was to take responsibility. He f*ucked up. Royally. Women are dying. He tried to deny knowledge & responsibility. Off with him, and for God's sake Do Not Pay Him His Pension. Let there be a modicum of responsibility here. May Vicky, Emma & all the others find some solace. God help them.

    It's the bally ballyness of it that makes it all seem so bally bally.



  • Registered Users Posts: 4,502 ✭✭✭Topgear on Dave


    Hes actually being supported by some GPs on twitter.

    https://twitter.com/ConorTMcGrane/status/994677311483019269


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  • Registered Users Posts: 2,108 ✭✭✭boombang


    Foggy Jew wrote: »
    He f*ucked up. Royally.

    What, specifically, did TOB mess up? Can you show clear evidence of what particularly he did wrong?


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