AHPRA: RATS ABANDON SINKING SHIP AFTER FETTKE BAN?

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By Marika Sboros

The Australian Health Practitioner Regulation Agency (AHPRA) appears to be collapsing. It is facing mass resignations from its medical boards nationally. There were more than 90% in Tasmania alone. The only states that don’t show significant resignations are New South Wales and Queensland. Both declined to work under AHPRA’s jurisdiction.

Resignations follow in the wake of the lifetime ban it slapped on orthopaedic surgeon Dr Gary Fettke in 2016. AHPRA does not want Fettke telling patients with diabetes not to eat sugar. Resignations also follow the ongoing Senate Inquiry into AHPRA’s secretive medical complaints process. The inquiry heard shocking details of endemic bullying and harassment of doctors in Australia’s medical profession. However, it just may be Fettke’s ban that has made so many rats abandon AHPRA’s sinking ship.

AHPRA’s three-yearly call for applications to fill vacancies shows unusually large numbers since its inception in 2010. In Victoria, Tasmania, South Australia and Western Australia, there were 38 resignations out of 55 positions. Thus, at 69%, more than two-thirds of doctors in four states have jumped ship. In Tasmania, Fettke’s home state, there were 11 out of 12 resignations – a whopping 92%.

Dr Gary Fettke

In New South Wales, there have been three out of nine resignations and none in Queensland. Therefore, there have been only three in 20 resignations in those two states. Interestingly, AHPRA Nursing Board vacancies in Tasmania show a similarly high attrition rate. There have been eight out of nine resignations. That makes 19 out of 21 resignations of both doctors and nurses.

AHPRA downplayed the numbers in response to my questions. It would only say that vacancies “become available as part of a scheduled cycle every three years”. AHPRA also refused to comment on reasons for so many vacancies. And it wouldn’t comment on the timing of calls for applications that close on March 20 or how it distributed these to members. Was it just coincidence that they publicised vacancies more widely only after the close of submissions to the Senate resumed hearing on March 17?

(Editor’s update: AHPRA replied again on March 21, insisting that there have been no mass resignations and the numbers are “not unusual”. It also claims to have “advertised widely to attract a wide field of applicants”.)

As well, AHPRA has refused to answer all my questions related to Fettke’s case, citing privacy rules. However, AHPRA has commented publicly – and negatively – on his case.

Before the ban, AHPRA investigated Fettke for more than two years after an anonymous dieititian lodged a complaint against him. The dietitian is a member of the self-regulated Dietitians Association of Australia (DAA). She also objected to Fettke telling patients with diabetes to reduce sugar and processed carbohydrates – both of which are now mainstream recommendations.

DAA itself is under intense public scrutiny for compromising links with food industries and for the advice it dishes out. As with dietitians’ associations in other countries, DAA has attempted to appropriate for itself and its members a virtual monopoly on dishing out dietary advice to the public. It has a special antipathy towards doctors, such as Fettke, who give dietary advice that differs from industry-led dietary guidelines.

AHPRA appears to condone that position and collude with dietitians. In a public statement last year, it spoke of the “expectation” that all doctors would give “appropriate” dietary advice.

AHPRA probably did itself no favours by adding an odd element to its ban on Fettke. Fettke promotes low-carbohydrate, healthy-fats (LCHF) diets to reduce the risk of limb amputation for diabetes. AHPRA said that even if LCHF becomes mainstream in future, he still can’t advise patients on nutrition.

Click here to read:  FETTKE: VICTIM OF KANGAROO COURT? PART 1

 

That added to global outrage at the action against Fettke. Legal experts have called AHPRA’s handling of the case against Fettke Kafkaesque and a real, live kangaroo court.  Claire Deeks, enrolled barrister and solicitor of the High Court of New Zealand, said that Fettke was the victim of “gross injustice”.

Fettke gave a powerful submission to the Senate Inquiry into AHPRA’s complaints processes. He described bullying and harassment he experienced from doctor colleagues. He testified about the devastating effects of AHPRA’s investigation on him professionally and personally.

His wife, Belinda, initially became his “voice” and set up an I Support Gary Fettke Facebook Page to continue his views. Fettke has since bounced back from the initial shock of the ban. He has now chosen simply to ignore it. However, he only did so after asking AHPRA to clarify the ban in detail. To date, AHPRA has not responded. Fettke continues to talk to patients about nutrition and to give presentations by invitation at conferences abroad.

Fettke spoke at the recent and hugely successful, international Low-Carb Breckenridge 2017 conference in the US.

“If you don’t tell people that sound nutrition has a central role in their health, you are failing in your duty of care,” Fettke said.

Fettke has said that he only ever talks to patients about the concepts of eating to prevent the worst complications of diabetes.  And, of course, he only dispenses advice that is evidence-based.  He does not give meal plans and usually uses the analogy of the right fuel in a vehicle’s engine.

The question, therefore, becomes what AHPRA and Fettke consider the “right” or “appropriate” fuel.

“The fuel we have recommended for the past 40 years clearly isn’t working,” Fettke said. “I see patients every week who have to have bits of their anatomy amputated. I can’t wait for AHPRA to catch up.”

“There is no question that your car will run more efficiently if you use the right fuel. After all, you wouldn’t put a little diesel in the petrol.”

Real food, by definition, is low-carb, healthy-fat, Fettke said. He tells patients to avoid sugar and highly processed foods and not be afraid of healthy fats. If they need further information, he refers them to dietitians who know about optimum nutrition.

He dismisses out-of-hand criticism of conflict of interest (COI) for referring patients to the Nutrition for Life dietitians’ clinic. He and Belinda set up the clinic in 2014 at significant personal expense: Aus$700,000.

Dr Gary Fettke and Belinda Fettke

The clinic is nothing more than the common “vertical integration”, which many doctors practise, he said. For example, doctors routinely employ physiotherapists and dietitians in their own practices. They also refer to radiology and pathology services, for which they receive kickbacks.

Since he set up the clinic, Fettke has been one of 88 referring doctors, in 28 out of 1100 clients. “That’s hardly over-servicing,” he said.

He and his wife have not profited from the clinic. “We are proud of the vested interest we have in our community’s health.  And we receive no financial gain from this healthcare model,” Belinda told me.

Fettke remains a mentor to the dietitians, but only from an educational viewpoint, she said.  And he has always declared his COI to patients.

Last year, Fettke attempted to resolve the impasse by meeting the Chair of AHPRA’s Medical Board, Dr Andrew Mulcahy, accompanied by Belinda. However, Mulcahy refused to meet with Belinda present. Thus, and probably not all that surprisingly, the meeting proved fruitless.

Fettke has firm opinions on AHPRA and why the rats are abandoning the sinking ship. “Those who serve on AHPRA’s medical board have good intentions but the process is fatally flawed,” he said.

AHPRA’s website shows that board members must spend a day each month attending meetings. They must also read 1000 documents to prepare for these meetings. For that, they are paid $627 monthly.

AHPRA receives 10,000 notifications (complaints) annually, of which 53% are related to medicine. AHPRA also has 180 investigators considering complaints. Of those, 42 have some health background, 23 have nursing backgrounds and only four have some degree of medical background. The rest are community workers. That’s from a supplementary report, which AHPRA CEO Dr Martin Fletcher submitted to the Senate Inquiry last year.

Thus, investigators without legal qualifications are interpreting and implementing National Law. “Anecdotally, I think it’s fair to say that this system is fatally flawed,” Fettke said.

The Senate Inquiry has shone a light straight into the darkness of AHPRA’s secretive processes, he said. It found that these contradict all principles of natural justice.

Fettke and his wife have not referred publicly to medical board members by name. However, it’s easy enough for anyone to find the names on a public register. It is likely that these doctors are feeling increasingly uncomfortable in the Senate Inquiry’s very bright, very public spotlight.

Of course, that raises the question why the rats are only now abandoning the sinking ship. After all, board members have participated for years in processes that manifestly contradict principles of natural justice.

Fettke has openly stated his view of AHPRA:

“I respect the police and common law for processes which lawmakers developed over hundreds of years. They have tested these processes under natural justice.

“I don’t respect AHPRA for the exact opposite reasons.”

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26 Comments

    • @ Michael, For what is worth why don’t you ask Gary direct? We do not know you, neither do we know whether you are from the Fed Government or AHPRA 😉 My two cents worth: 1. Either AHPRA is now retreating fast or 2. Gary believes in the truth which should be share with patients – or, I have my way, both. Today’s Senate Inquiry interviews for which I was also a witness say it all.

  1. As I see it the current issue is the marginalising of individual clinician judgement by algorithms. These algorithms, of course, are established by the Key Opinion Leaders who dominate the process that controls the generation of the intellectually flawed “practice guideline mentality”.

    Such guidelines can be used to guide and control clinician behaviour regardless of their (admittedly unacceptably low) validity, and their even worse supporting evidence base.
    However, the thoughtful practitioner will see that this guideline process, along with the ever increasing intrusion of technology in to clinical decision making, and the aggressive imposition of “guideline based medicine” will result in an inevitable marginalising of individualised medicine, it will erode the confidence of doctors to make their own choices based upon the individual features of the patient/case sitting before them. In the end the outcome will be a sort of cybernetic medicine, where the independant observation of the mature clinician is replaced by an algorithm that can be applied to a symptom cluster to produce a recommended treatment even by a second rate, out of date Windows computer.

    What we will see is a series of algorithms that are all approved by the Key Opinion Leaders (as anointed by their sponsors in the pharmaceutical companies0 and all of which lead to the decision to spend large amounts of taxpayers money on pharmaceuticals of dubious value.

    This Brave New World of medical decision making will ensure that the individual discretion of the treating physician is eliminated and, for the most part, medical consultation will be automated by a series of questions that are fed into a computer that will spit out the recommendation for the appropriately expensive agent to treat the inadequately diagnosed problem,However the most important feature of this approach is to ensure that the discretion of the mature clinician is removed from the decision making loop.

    The AHPRA decision against Dr Fettke is reprehensible, and is utterly indefensible, but I doubt the doctors behind it realise just how destructive the consequences of their decisions might be.

    AHPRA CEO Martin Fletcher has been caught out justifying an inexcusable decision, and it is time he was made accountable for the out of control behaviour of his organisation.

  2. I have been to a couple of conferences for General Practitioners over the years, and what has always struck me has been the fact that every lecture given by dietitians always features heavy advertising from Big Food Companies, and that the information given by the dietitians is very limited, and often well out of date. This is also highlighted by both Dr Malcolm Kendrick and Prof Tim Noakes.

    It is very clear that the current climate of excessive reliance on Guidelines (usually based on evidence which is out of date and was incomplete at the time of the writing of the guidelines) and overly aggressive pressure to conform to those guidelines is strangling innovation and personalised care and is penalising those doctors who try to keep themselves properly up to date by going the extra mile with investigating new research.

  3. I wonder how AHPRA and the Dieticians would go trying to sanction the Scientists at the C.S.I.R.O and their latest findings. Also I would like to see the management of AHPRA stand before a Senate Committee meeting and divulge exactly what sort of funding they are receiving from vested interest companies. Be sort of enlightening wouldn’t it?

  4. People need to get this through their heads:

    Reversing symptoms does NOT equal cured.
    If you were CURED, you could return to eating the same junk food diet that got you in trouble in the first place without negative results.
    Doesn’t work that way.
    A smart diet can REVERSE the SYMPTOMS of diabetes. If you get your A1c down to 5.5, you are not CURED of diabetes. You have almost normal blood sugars.
    NOT cured. IF you continue to eat smart, you get to continue to have good blood sugars.
    But that is NOT cured.
    If you were CURED, you could go back to eating sugary junk food and your blood sugars would remain normal.
    Will NOT happen. NOT cured. A reprieve. But NOT cured.

    • Agree wholeheartedly with all you say. Still think it’s really just semantics, though. Who in their right mind would return to eating the way that brings on the symptoms after reversing all symptoms with a different diet? Except anyone with a death wish, or stupid or gullible enough to believe doctors and dietitians who say people can eat what they like and just take drugs to control diabetes? Reversal is as close as modern medicine currently comes to a ‘cure’.

  5. When the wind blows the cradle will fall.

    Thanks Marika for the large amount of wind, if you see what I mean, also for exposing the windbags who reveal themselves above, defending the indefensible.

  6. You are beyond ill informed and do not know what you are talking about, nor understand how vacancies work within Australia and National Boards. Go spread your ignorance someplace else.

    • Thank you for your elegant reply, Anne. Unfortunately, I understand all too well how vacancies work within Australia and National Boards. I do my research. Fortunately, we inhabit a global village these days and it isn’t only Australians who know the inner workings of their various medical and dietetic organisations, whether regulated or self-regulated. Anyone who thinks that is the case is sadly mistaken and prone to jingoism.

    • Anne, I know that when a doctor is criticised by a foolish dietician for ‘inappropriately’ curing diabetes, that Australia is in danger of becoming a scientific laughing stock. You’re still on board the sinking ship.

      • The good doctor was not criticized for “inappropriately curing diabetes” but for “inappropriately claiming to have cured diabetes”. A big difference. In addition there have been NO resignations from the boards, simply a statutory 3 year turnover. Marika should do her homework in a bit more detail and stop jumping to the wrong conclusions.

        • Leah’s information is not correct, according to my “homework”, which has been checked by outside sources. If Leah is a member of the board or a dietitian, but does not say so, that is disingenuous. She needs to ask unbiased, independent outsiders to verify her “homework”. Vacanies indicate resignations. Of course, the process happens routinely every three years. That is not in dispute. It’s the implications of the numbers that are significant.

          As far as Dr Fettke claiming to have “cured” diabetes seems to me it’s just semantics here. The reality is that many patients have reversed their symptoms completely simply by changing their diets. Many have also been able to go off all their medication. That is as close to a “cure” as modern medicine is currently able to come. Many doctors and dietitians appear to find the semantics a threat. Who cares about the semantics here? Only doctors and dietitians who seem to prefer that their patients continue taking drugs. I also find it very interesting that Leah appears to know more about the Dietitians Association of Australia dietitian’s complaint against Dr Fettke than he does. Perhaps she is the anonymous dietitian who made the complaint, or she knows who the dietitian is? That dietitian should make herself known and speak up for why it is not a cure when there are no symptoms of the disease?

          • Very interesting comments. I know that AHPRA Tas is in a mess because as the Chair of the Honest Peer Review Group of HPARA, I deal directly with these people. There are some ‘great pretenders’ around. They will be soon exposed. An interesting issue is why the release of the news of the reappointments took place after the Witness interview took place – why were they so tactically timed – just as Gary’s sanction three hour after his interview (now removed). They are in a right royal mess, I assure you!

          • Hi Leah, I checked Dr Fettke’s quote. He has never claimed to have cured diabetes. He simply claims that diet has reversed all the symptoms of the disease. Big difference. He is also not the only one to have claimed that. Nor is he the only doctor who has been able to help patients to reverse all their symptoms of diabetes simply by changing their diets. Many have also been able to come off all their mediation. There is a vast body of evidence to show that right diet can indeed do so. I presume you support doctors who are able to do that for patients? Seems to me you need to do a lot more homework than you have done in this case. You also owe Dr Fettke an apology for misrepresenting what he said. Or perhaps the dietitian who made the complaint against him misrepresented that to you? I presume the apology will be forthcoming? I will record that you have done so, if and when you do.

          • I was astonished at the quote “inappropriately reversing a patient’s diabetes”. To quibble a little, I do think there’s more than a semantic difference between that and “claiming” to have reversed diabetes. It’s not the *curing* that is at issue, it’s the *claiming*.

            So, speaking for myself, I would be curious to find out the exact wording of the complaint. At worst, I would need to dial down my astonishment level 😉

            Don’t get me wrong, I’m fully on board with LCHF, having it in that way myself for about seven years.

        • Leah, if a diabetic patient loses all symptoms and his or her blood glucose returns to normall, are they not cured? If not, what is a cure? Of course if the patient returns to eating sugary junk or the high-carb, low-fat diet that Australian dietitians recommend, the patient will become ill again.

          Have you seen the science on carbohydrate restriction for diabetics? The paper the DAA mentions on its site and then ignores. The supposedly ‘progressive’ unstoppable disease that disappears should make any thinking or caring person pause for thought.

          Does patient welfare come before entrenched, failed dogma? Not in Australia, it seems.

          • I have been a qualified medical practitioner for almost 40 years in four jurisdictions including Oz in the 1990s. I have not had anything false against me till I came to Australia in the mid 2000s. And, till today falsities have not been resolved. This apparently happens in the developing world but most certainly happens in Australia. Entreched dogma and commercialism and corruption all rule

          • Stephen, You forgot to mention the connection between large food companies and DAA. We can only assume that the profit margins of ‘big food’ are far more important than patient welfare. DAA’s master has spoken!

    • Anne Jarvis, why don’t you inform us of just how the process for filling vacancies does work, and support that with references? Abusive posts are not influential, informative ones are.

  7. Quote “AHPRA also has 180 investigators considering complaints. Of those, 42 have some health background, 23 have nursing backgrounds and only four have some degree of medical background. The rest are community workers.”

    For a regulatory authority employing community workers handling and issuing regulatory matters involving board registered professionals is a time bomb waiting to explode.

    The Chairman, CEO and board members of APHRA all appeared to be not “very wise”, if they are wise enough that “Ban on Gary Fettke” would not have been issued three hours after Gary had testified to the Senate! Effectively challenging parliamentary immunity on such a high profile case.

    These supposedly “wise men” who were selected for leadership positions in AHPRA are either negligent/not interested or worse unable to effectively lead and control APHRA.

    Similar to Tim Noakes “trial” where Russ Greene uncovered “Big Sugar and Big Food” invisible hands, one cannot help but wonder whether there are invisible forces joining hands in Gary Fettke’s case.

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