Thursday, July 4, 2013

Medical ethics violations by anti-wind lobbyists receiving attention

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There are at least three former medical professionals who are leveraging their no-longer-active medical credentials to lend weight to their campaigns against wind energy and performing research without oversight. Medical ethics watchdogs are starting to take note.

Perhaps the most prominent is Nina Pierpont, a former paediatrician who advertised via anti-wind groups looking for people who blamed wind farms for their health conditions, interviewed 23 of them in ten families by phone only, accepted hearsay evidence on a further 15, did no direct examinations or medical histories and on the basis of this self-published a 294-page book with 60 pages of charts and graphs. From this remarkably flimsy tissue, she proclaimed a new medical condition, Wind Turbine Syndrome, and established a cottage industry for herself and her husband. They preside over a website of the same name where dissenting opinions are not welcome and comparisons of wind energy supporters to Hitler and Nazis are regular features.


In Canada, Carmen Krogh, retired pharmacist and member of the Advisory Group of the anti-wind energy campaigning organization, the Society for Wind Vigilance regularly speaks to media and groups, and regularly submits to wind farm siting reviews against wind energy.

In Australia, the dubious distinction of being the theoretically credentialed anti-wind medical activist goes to Sarah Laurie, a former general practitioner who is now unregistered and in fact has been non-practicing longer than she was actively helping people. She is the CEO of the Waubra Foundation, an anti-wind lobbyist group with strong fossil fuel ties, a Board made up of rich NIMBYs and a track record of questionable behaviour. Ms. Laurie’s ethics infractions are the subject of this article.


 

A primary principle of medical ethics is “First, do no harm”.  An outcome of that principle is that medical professionals must take care when doing any research or asserting any health implications that they do not cause worse problems than they are researching. As such, any medical research, especially that involving direct contact with a study group, involves a medical ethics assessment by a group set up for that purpose.

Since 2009 at least, a strong hypothesis for increasing health complaints near a subset of wind farms in English-speaking countries has been that they are being caused by the nocebo effect, and are in fact a psychogenic or communicated disease. The nocebo effect, first named by WP Kennedy in 1961, is the negative side of the placebo effect (The Nocebo Reaction, Kennedy, W P., Medical World, Vol.95, (September 1961), pp.203-205).  Instead of suggestions leading to positive health outcomes, suggestions lead to negative health outcomes. The nocebo effect causes health issues in psychogenic health hysteria's such as “fan death” in Korea, where people believe that a fan in a closed room chops oxygen molecules in two, causing them to be unable to breathe. It causes some side-effects of medicine, challenging ethical disclosure of potential side-effects.  It’s a confounding factor in clinical trials of medication and treatment. It’s such a powerful and evident effect, that direct studies into the nocebo effect have been banned due to medical ethics concerns since roughly the 1970s.

Researchers are now assessing the nocebo and psychogenic hypotheses and finding strong evidence that they are the cause of the majority of complaints and are responsible for significant increases in numbers and severity of complaints.  Professor Simon Chapman and team of the Public Health Faculty of the University of Sydney of Australia found strong supporting evidence for the psychogenic hypothesis being the dominant factor in wind farm health complaints in a recently epublished study undergoing formal peer review and publication now.  Ms. Fiona Crichton and team of the University of Auckland in New Zealand found strong supporting evidence for the nocebo effect being the cause of significantly increased numbers and severity of symptoms attributed to infrasound, one of the key bogeyman in the pseudo-scientific attack on wind energy.

Studies such as Crichton’s which assess the nocebo effect must ensure that the larger goals of the study are expected to have positive health outcomes, that the negative impacts of the nocebo effect are monitored during the study and the study terminated if they become too severe, and that study participants are clearly told after the study that the goal was assessing the nocebo effect and that symptoms they felt were caused by that, not by the purported cause, in Crichton’s case infrasound.

Most of the research done by anti-wind campaigners has been conducted outside of the ethical framework that registered practitioners are expected to submit to. Amanda Harry’s surveys of health complaints in the UK were riddled with challenges that were likely to increase negative impacts. Michael Nissenbaum, also of the Society for Wind Vigilance, performed similarly challenged surveys in Maine, and then collected data from the same wind farms which he wrote up in a study, one of many challenges with his report (see two critical reports in the same journal).

However, these biased researchers who are operating without ethical oversight have received a free pass from medical oversight organizations.

Until now.

On April 23rd, 2013 it was reported in an Australian media outlet, the Crikey, that Sarah Laurie was being investigated for medical ethics violations by the National Health and Medical Research Council of Australia. She might be subject to a $30,000 fine for her transgressions of ethics. Further, this would reasonably lead to questions of whether she could be the subject of lawsuits for the harm she has caused.  As she has ignored open letters requesting that she stop promoting health scares and causing negative health impacts — just as Carmen Krogh has rejected direct questions on the subject –, it’s good that formal interventions are occurring.

The Waubra Foundation responded with a media release on May 9, 2013.  In it, they say that there is a conspiracy out to get them and declare that an Independent Commission Against Corruption or Royal Commission should be struck to determine who is at the bottom of it.  They do not provide any explanation as to why Ms. Laurie’s public record statements regarding research she is undertaking without oversight and people she is providing health guidance to while unregistered were misinterpreted, they merely deny the charges and claim they are malicious.

They claim that these accusations will damage Ms. Laurie’s reputation, but it’s hard to see how as she is already listed on Australia’s Quack Watch site and is a nominee for the Australian Skeptic’s association’s Bent Spoon Award for 2013. Anyone who is paying attention and is not an anti-wind energy True Believer already knows she is a dangerously deluded individual on a mission. She is typically referenced in the same sentences as Australia’s also dangerously deluded anti-vaccination campaigners. When she appears under oath she suffers badly even under the friendliest of examination. How much worse could her reputation get?

At best, this communique will serve only to inflame their hardest core supporters, while alienating more moderate and intelligent people who were on the fence. Groups which have been taking advantage of her in their fight against clean, safe wind energy will think twice and likely many will disassociate themselves with her. In fact, it’s surprising that the other Directors of the Waubra Foundation didn’t ask her to stand down from her duties until the investigation had run it’s course; if they truly were a devoted public health organization, that would have been the reasonable thing to do. It’s hard to see what they possibly thought this particular response would gain them.
Here’s the full text of the complaint. See the Croaky post for all supporting evidence:
Research being conducted by the Waubra Foundation
There are consistent references on the public record to research activities of the Waubra Foundation’s Chief Executive Officer (formerly Medical Director), Sarah Laurie. Attached are a selection of quotes by Dr Laurie about her research methods and findings, together with relevant quotes from a range of media articles and quotes from two ‘subjects’ of Dr Laurie’s research taken from submissions to the 2011 Federal Senate Inquiry into the Social and Economic Impact of Wind Farms. The attached references date from October 2010 through to January 2013.
Of particular note are 2 presentations given by Dr Laurie (references 12 and 16 on the attached list), which explicitly describe the following sources of data for her research:
  • Interviews with affected residents
(Interviews with affected residents are also listed in references 1, 8, 14, 15, 17, 18, 19, 20, 22, 24, 25 and 27). The most recent reference states that over 120 residents have been interviewed.
  • Medical records
(Medical records, clinical history, medical symptoms and personal health journals are also noted as sources of data in references 1, 6, 8, 9, 18, 20-22, 25, 26 and 27)
  • Treating physicians
(Obtaining information from, collaborating with, or providing advice/education to treating health practitioners is also noted in references 3, 5, 6, 8 , 14, 18, 19, 24, 25, 26 and 27)
  • Personal health journals
  • Acoustic monitoring inside homes
In addition to the above, the following are noted:
  • Discussion of blood pressure data collection being undertaken as part of Dr Laurie’s research in references 2-6, 8 and 12. Reference 3 also contains an invitation by Dr Laurie to provide blood pressure results to her. These data appears to have been collected in conjunction with personal health journals, and used in public presentations and documents by Dr Laurie to suggest that exposure to wind turbines is correlated with high blood pressure. Some of the data collected by Dr Laurie was provided to the South Australian Environment, Resource & Development Court for a Jan 2011 hearing (see references 6 and 7). We note it was analysed by an independent expert from Adelaide University, who found no correlation between high blood pressure and wind turbine exposure.
  • Explicit reference to ‘research subjects’ in references 6, 9, 10 and 11.
  • Medical advice and/or clinical judgement by Dr Laurie contained in references 18 and 21.
As a former medical practitioner, Dr Laurie  should be aware of the National Health & Medical Research Council National Statement on Ethical Conduct in Human Research. We note “the National Statement sets national standards for use by any individual, institution or organisation conducting human research. This includes human research undertaken by governments, industry, private individuals, organisations or networks of organisations” (page 7). The Statement also provides a definition of human research, which includes: taking part in surveys, interviews or focus groups; undergoing psychological, physiological or medical testing or treatment; being observed by researchers; or researchers having access to information (page 8).
Based on the National Statement, Dr Laurie’s activities appear to clearly meet the definition of research involving human subjects. Accordingly, the Waubra Foundation should be asked to answer the following questions:
  • Has Dr Laurie’s research been subject to review by a Human Research Ethics Committee?
  • If so, which committee approved the study protocol and is/was responsible for monitoring how the research is conducted?
  • If the research was not reviewed by an Ethics Committee, on what basis were Dr Laurie’s activities exempted from this requirement?
With regard to collecting information from treating health practitioners:
  • How many treating physicians has Dr Laurie gathered information from?
  • Which treating physicians have provided information, and what protocol has been followed to obtain this information?
  • What has this information consisted of?
  • Is the data collection listed above ongoing? If not, when did it cease?
Regarding the data collected, in an interview with Wind Wise radio on 19 February 2012 (reference 19), Dr Laurie stated that she has been “sharing information, the clinical information that I’m gleaning from the residents and their doctors, and sharing it with people from other disciplines so that we can get a multidisciplinary dialogue going on.” Objective 3 of the Waubra Foundation is also listed as “build the existing and new data into a high quality database suitable as a start point for properly constructed studies and review by qualified others”.
  • To whom is the database available?
  • What information is included in the database?
  • How is the information on the database being managed and shared in accordance with standards of ethical research?
Dr Laurie is not currently registered as a medical practitioner. The Medical Board of Australia in conjunction with the Australian Health Practitioner Regulation Agency advises that medical practitioners should be registered if they have any direct clinical contact with patients or provide treatment or opinion about individuals. It also provides advice for practitioners to be registered when they are directing, supervising or advising other health practitioners about the health care of an individual(s). 
As noted in references 2, 3, 4, 5, 6, 8, 12 and 16, it appears that Dr Laurie has had direct clinical contact with individuals, particularly in relation to collecting blood pressure data, personal journals and clinical histories. The document ‘Suggested Health Assessment Guidelines’ prepared by Dr Laurie (reference 18) provides advice intended for health professionals, and would also appear to be in breach of Medical Board of Australia guidelines. Dr Laurie should be asked to explain why she is undertaking these activities while not registered to practice medicine.
In the event that the Waubra Foundation media release is removed or altered in the future, here’s the full text:
Public Statement 
Waubra Foundation Calls for Full Public Inquiry 
The Foundation has been informed that an “anonymous” document appeared at the office of Michael Moore, CEO of the Public Health Association of Australia alleging that the Foundation’s CEO, Dr Laurie, is “conducting research without ethics committee approval” and that Dr Laurie is “practising medicine without being registered”. These are serious, and reputation- damaging, accusations, deliberately made. 
Moore then transmitted this anonymous and malicious document to the National Health and Medical Research Council, the Australian Health Practitioners Regulatory Authority and the South Australian Health Care Complaints Commission. It was then leaked to the media before the NHMRC asked Dr Laurie for a response. 
The Foundation and Dr Laurie unequivocally deny both allegations and consider the “supporting” information provided to be inherently and embarrassingly weak and circumstantial. 
It is clear that the allegations have been made to denigrate and distract from the Foundation’s campaign to induce governments and industry to fund acoustic and clinical research inside the homes of residents reporting serious health problems and home abandonment's. 
The Foundation is not resourced to undertake research on its own account or for others. It is, however, a strong advocate for research by appropriately skilled independent researchers. 
Why has the research not yet been done? One only has to ask who or what organisations might be damaged by the results. 
What should properly interest a professional journalist is that the people making these allegations do not have the courage to identify themselves. The obvious conclusion is that they have much to hide. 
The Board of the Foundation considers that what has transpired, plus the contemporaneous and coordinated press campaign prominently featuring chronic critics of the Foundation’s works, is properly the subject of a referral to an ICAC or a Royal Commission. To ignore the documented suffering of people, and openly to ridicule them, is not only unethical, it is immoral, if not criminal. That, however, is precisely what is occurring here all under the cloak of “renewable” ideology. It’s time Australians woke up to what is going on. The Waubra Foundation relishes the opportunity of exposing what is a corrupt system being driven by huge financial incentives.
Here’s the full text of the Crikey article:
The National Health and Medical Research Council confirms it has received a complaint regarding the research being conducted by Laurie, the CEO of the Waubra Foundation (a small but powerful anti-wind farm activist group). A spokesperson told Crikey: “NHMRC takes all complaints received seriously and are following up on this matter.” 
The concerns about Laurie’s research ethics are outlined in a document written by an anonymous academic and first sent to the Public Health Association Australia. The document alleges Laurie is not currently registered as a medical practitioner but has been conducting activity that meets the definition of medical research involving human subjects. On her website, Laurie uses the title of “Dr” and describes herself as a former GP. 
The dossier outlines the incidents where Laurie claims to have conducted interviews with residents affected by wind turbine health issues, collected blood pressure data, given medical advice and/or clinical judgment, referred to people as “research subjects” and discussed accessing medical records and personal health journals. It also asks if Laurie’s research has been reviewed by a Human Research Ethics Committee: 
“The Medical Board of Australia in conjunction with the Australian Health Practitioner Regulation Agency advises that medical practitioners should be registered if they have any direct clinical contact with patients or provide treatment or opinion about individuals.” 
After examining the document, the CEO of the Public Health Association Australia, Michael Moore, forwarded it on to the heads of the NHRMC, the Australian Health Practitioner Regulation Agency, the Health and Community Service Complaints Commissioner of South Australia and the Waubra Foundation. 
“It was something which should not be ignored because I thought there were serious ethical issues which had been raised, ethical issues that would distort the debate over the appropriateness of wind farm technology,” Moore told Crikey. 
For years Laurie and her Waubra Foundation (named for the Waubra wind farm in NSW) have campaigned against the use of wind farm technology, claiming wind turbines have serious health impacts — known as “wind turbine syndrome” — for local residents. As Australia’s most prominent anti-wind farm campaigner, Laurie is regularly used as a media commentator about wind farm health issues; she recently appeared on ABC Radio National and 2GB. 
“From our perspective, it’s a matter of ensuring that policy debates take place on sound evidence and that the research is appropriately conducted,” said Moore. 
A new study by public health professor Simon Chapman indicates health complaints about wind turbines were rare until anti wind-farm groups began a campaign against supposed medical issues in 2009. Another recent study led by University of Auckland researcher Fiona Crichton demonstrates that residents who expect health issues from wind turbine health issues are more likely to develop the symptoms. 
When called to ask about the document and its claims, Laurie told Crikey it was “inappropriate for me to comment at this time”. 
The Health and Community Service Complaints Commissioner of SA and the Australian Health Practitioner Regulation Agency told Crikey they don’t comment on individual cases. An AHPRA spokesperson notes it is an offence under the Health Practitioner Regulation National Law to present as a registered medical practitioner if you are not, and a court may impose a maximum penalty of $30,000 for an individual “holding out”.

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