Australian Politics
Friday, December 02, 2022
Top Qld oncologist found guilty of ‘unnecessary death’
The doctor has surrendered to his accusers but I don't think he needed to. Imunotherapy can work miracles and it can be argued that is should be tried first before leaping into surgery.
His decision to use ipilimumab is perhaps questionable. It is an older drug that can have severe side effects. Since Keytruda has now been approved for use with melanoma, that would have been a better choice. But it may not have been available under any protocol in 2018
But, as his colleagues say, he should have recognized the side-effects of ipilimumab as they emerged and gone straight into surgery at that point. So there was a degree of negligence there. But as a busy chief oncologist in a public hospital, such omissions can happen. It was probably his workload that was principally to blame
A top Queensland oncologist has been found guilty of professional misconduct, after a melanoma patient died “unnecessarily” due to the doctor’s multiple failures in diagnosis and treatment.
Paul Norman Mainwaring is a former director of oncology at the Mater Hospital and more recently practised at Canossa Private Hospital in Oxley.
He is now co-founder and chief executive of cancer diagnosis biotech company XING Technologies.
In a decision published on Tuesday, the Queensland Civil and Administrative Tribunal member John Robertson found that the 57-year-old’s “multiple failures” and, in particular, his initial treatment decision by immunotherapy for the melanoma patient in 2018 was “very serious”.
“The expert evidence against (Mr Mainwaring) is overwhelming, (his) multiple failures and, in particular, his initial treatment decision are therefore very serious,” Mr Robertson states in his decision.
Mr Mainwaring admitted during the tribunal hearing on September 15 that he “acted in a manner that was substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training and experience”, the decision states.
He also accepted his various failures in treatment decision-making including failure to seek other specialist opinions, and failure to keep notes amounted to professional misconduct.
He has surrendered his medical registration.
The decision states that a 76-year-old patient, known as PB, lost 11kg in weight and “tragically died” in Brisbane on 25 May 2018 after he developed an infection from severe diarrhoea and a perforated gastrointestinal wall which was a “known complication” of the immunotherapy called ipilimumab, with four doses by infusion between January and March 2018.
“Ipilimumab was not the appropriate treatment for the patient given the patient’s melanoma was either a stage IIB or stage IVa; has known side effects due to its high toxicity, including colitis and diarrhoea,” Mr Robertson wrote in his decision.
“The appropriate approach to the patient’s condition was to “wait and see”,” Mr Robertson wrote.
The tribunal heard that three experts in the field - Benjamin Brady, a specialist oncologist at the Peter MacCallum Centre in Victoria, Victoria Atkinson a medical oncologist at the Princess Alexandra Hospital and Brian Bell, the executive director of medical services at the same hospital - concurred that the choice of ipilimumab as a treatment was not clinically appropriate.
Dr Brady and Professor Atkinson told the tribunal that the patient “had an avoidable and unnecessary death” with Professor Atkinson stating that PB “had at worst, a completely resected stage IVa melanoma and had a very high likelihood that he would be cured from his cancer”.
Mr Mainwaring’s diagnosis of the man with a more serious metastatic melanoma “was neither clinically appropriate nor accurate”, when he was more likely to have a less-serious form of melanoma.
Dr Brady also considered that the risks and benefits of the treatment were not adequately emphasised to PB by Mr Mainwaring and that he failed to ask a colleague for a second opinion or for any help in managing PB’s treatment.
Mr Mainwaring has not practised for over three years and surrendered his registration in February 2019.
Prior to surrendering his registration, he had permanently retired as medical oncologist at Canossa Private Hospital and he told the QCAT hearing that he had no intention to return to practice.
“But for his voluntary cessation of practice in 2019, the seriousness of the conduct would ordinarily warrant the respondent be disqualified from practice for a lengthy period to send an appropriate message of denunciation to the medical profession and the community at large,” Mr Robertson wrote.
Mr Mainwaring told the tribunal he deeply regretted the tragic circumstances surrounding PB’s death and offered his sympathies to his family, and he was remorseful for his conduct.
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Revenue NSW has cancelled 33,121 fines in wake of the landmark ruling this week
Australians fined thousands of dollars for flouting Covid rules let out a sigh of relief this week with 33,000 fines ruled invalid - with many more expected to be refunded soon.
A landmark court case has seen the fines of tens of thousands of NSW residents withdrawn and the validity many more across the national thrown into doubt.
A Supreme Court judge Dina Yehia SC ruled two infringements imposed by police were invalid after hearing the wording on the penalty notices did not meet the legislative requirement of the Fines Act.
The ruling saw Revenue NSW has cancelled 33,121 fines, with the validity of another 30,000 also now in doubt.
Marrickville mother Karina Williams was fined $1,000 while buying fish and chips with her boyfriend in Croydon Park, just a few hundred metres from her home.
The single mother had failed to register her movement in the Canterbuty-Bankstown council, which at the time had been considered an LGA of concern.
Ms Williams and her partner, who had not been outside his LGA, were both slapped with a $1,000 fine for the perceived breach in August 2021.
For the mother-of-two, who was supporting her two teenage children on JobKeeper, the 'unaffordable' fine became a source of major anxiety.
The unpaid fine attracted several fees before it eventually prevented her from reapplying for her driver's licence after a suspension.
Ms Williams, with the help of lawyers from the Aboriginal Legal Service, was able to quash the debt, but the fine remained on her police record.
There were 62,138 Covid fines issued in NSW totalling $56,587,740.
Of that total, 16,462 fines worth $14,688,520 had been paid as of September, and before Tuesday's decision just 1,363 had been withdrawn.
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What is Ozempic and why is there a shortage of it?
Judie Thompson recently drove to a pharmacy 45 kilometres from home to replenish her dwindling supply of the drug she says changed her life. Thompson, 64, from Brisbane, began using the drug in March to manage her type 2 diabetes. Since then, she has lowered her insulin usage from five injections a day to just two – and lost 20 kilograms.
“It’s changed my life totally,” she says. “I was 107 kilos when I went on it, and I started losing weight as well as noticing how well my insulin was working.
“I walk my dogs, which I haven’t done in 10 years. I’m so happy to be me now.”
The drug, Ozempic, which comes as a weekly injection, has been approved in Australia for treating type 2 diabetes but is also sought after because it can help with weight loss, as is its weight-loss-specific counterpart, Wegovy, in the United States. Ozempic is now a “Hollywood drug”, according to some reports. Asked how he got to look “so ripped”, billionaire Elon Musk tweeted it was down to “fasting … and Wegovy”.
Now there’s a global shortage of Ozempic. It will not be available in Australia until April, affecting people who use the drug to manage their diabetes.
What’s causing the shortage? Who should be using Ozempic? And is it a magic shortcut for weight loss?
Ozempic was created by Danish drug company Novo Nordisk in 2012 and approved for use for type 2 diabetes in the US in 2017 and in Australia in 2019. In July 2020, it was listed on the Pharmaceuticals Benefits Scheme (PBS) so that it costs about $40 (or $6.60 with a concession card) for a monthly course of weekly injections. The same amount on a private script, or “off label”, can cost $130 or more.
About 1.3 million Australians were newly diagnosed with type 2 diabetes between 2000 and 2020, according to the Australian Institute of Health and Welfare. Diabetes is caused by the body’s inability to use and/or produce insulin, a hormone that controls blood glucose levels.
In clinical trials by Novo Nordisk, it was discovered that semaglutide, which Ozempic contains, had a dual effect: it could also lead to weight loss in patients.
Semaglutide stimulates cells that make insulin while suppressing glucagon, affecting blood glucose levels, says leading endocrinologist and obesity specialist Professor Joseph Proietto at the University of Melbourne. “Semaglutide is an analog of one of our own hormones that we make in our small bowel called glucagon-like-peptide-1 [GLP-1],” adds Proietto, who established the weight control clinic at Austin Health. He says GLP-1 slows gastric emptying “so that it makes you feel fuller for longer, and then it goes to the brain and suppresses hunger. And both of those actions help with weight loss.”
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Rio Tinto chief scientist Nigel Steward says hydrogen ‘hype’ faces tough tests in reality
Rio Tinto’s chief scientist has fired a shot across the bows of companies and governments banking on green hydrogen “hype” as a solution to global warming, saying the company does not see hydrogen as a serious alternative to fossil fuels as an export commodity.
Speaking at Rio’s London investor day on Wednesday, Rio chief scientist Nigel Steward said the company did not believe hydrogen could be used as an “energy carrier” in the near future, given its production costs and problems with shipping it around the globe.
“Hydrogen is much hyped, particularly as an energy carrier. We don’t see hydrogen as being used as an energy carrier,” he said.
Mr Steward’s comments fly in the face of the ambitions of Andrew Forrest’s Fortescue Metals Group, which plans to spend billions in the hope of turning green hydrogen into a major seaborne commodity.
But the Rio chief scientist warned investors that recent research suggested that direct shipping of hydrogen at scale could even exacerbate global warming.
“If we want to use hydrogen as an energy carrier, and we‘re going to transport it around the world as liquid hydrogen, that’s problematic because 1 per cent of the hydrogen per day is lost to the atmosphere,” he said.
“Recent studies have shown that hydrogen actually has a global warming potential five to 16 times greater than carbon dioxide. So what this means is it is better to burn natural gas than it is to transport hydrogen around the world and then consume that later.”
Fortescue and other hydrogen hopefuls have said they plan to tackle the issue of energy loss in transporting liquid hydrogen by instead producing ammonia as a means to transport the commodity. But that would require additional chemical processes that would use even more energy, making its use less efficient.
Mr Steward said Rio believed hydrogen could have a major role to play in global energy transition, but said the mining giant believed it was best consumed where it was produced.
“We see hydrogen being used for its unique chemical properties. As a reducing agent for production of green steel, as a reducing agent for ilmenite in the smelting process to make iron and titanium, and also as a source of energy for calcining alumina in our refineries,” he said.
But even that would require a significant technological breakthrough to bring production costs down, he said, given hydrogen production requires significantly more energy to produce than even aluminium smelting.
“It’s a very, very energy intensive material. It requires four times the amount of energy per tonne to produce than aluminium – and we think of aluminium as being very energy intensive,” he said.
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