A PELVIC mesh scandal that has left an unknown number of Australian women with devastating injuries is “an example of poor clinical practice being allowed to somehow gain legitimacy in the healthcare system”, said Newcastle health insurance executive Mark Fitzgibbon.
But health insurers have not challenged the hundreds of millions of taxpayer dollars spent on pelvic mesh devices for more than a decade, the nib head said after a scathing Senate inquiry report on mesh was released last week.
“The ability of insurers to question what we might regard as suspect clinical practice is limited. If we did we’d be howled down by doctors as us crossing the line and challenging their clinical authority,” Mr Fitzgibbon said.
Instead most pelvic mesh devices will join knee arthroscopies and many back pain remedies as examples of expensive, taxpayer-funded treatments used by doctors without evidence of either safety, efficacy or both.
The Senate report recommended that pelvic mesh devices to treat women for complications after childbirth should only be used as a last resort, despite doctors’ groups, including the Australian Medical Association, arguing strongly for a type of mesh device, the midurethral sling, to treat incontinence.
Pharmaceutical giant Johnson & Johnson withdrew its mesh devices from the Australian market in January, including the most commonly used midurethral sling, the TVT, after more than 800 women alleged injuries during a class action against the company in 2017.
Mr Fitzgibbon said health insurers were obliged to pay when items were cleared for funding under Medicare.
The ability of insurers to question what we might regard as suspect clinical practice is limited. If we did we’d be howled down by doctors as us crossing the line and challenging their clinical authority.nib chief executive Mark Fitzgibbon
In a submission to the Senate inquiry nib said of 138 women with mesh implants for incontinence or prolapse between 2011 and 2017, 60 were readmitted with complications ranging from “mechanical failure and other issues affecting nearby organs through to infection”.
The inquiry heard at least 150,000 Australian women are believed to have been implanted with pelvic mesh devices since the first incontinence devices were developed in Western Australia in the late 1980s, with the likelihood that the figure is much higher. The Senate report recommended a national audit of the devices because it was likely the true complication rate is underestimated.
Mr Fitzgibbon said health insurer concerns about approved treatments costing billions of dollars had “always been a tricky subject”.
In 2017 a British Medical Journal expert panel made a “strong recommendation against use of arthroscopy in “nearly all patients with degenerative knee disease” after an extensive review of all research found knee arthroscopy was “no better than exercise therapy”.
In March more than 30 of the world’s leading back specialists said lower back pain was being mistreated on an enormous scale – costing Australian taxpayers $4.8 billion a year – with the “elephant in the room” being the vested interests of clinicians and industry.
The Senate inquiry into pelvic mesh devices recommended a review recommended a review of doctors’ relationships with device manufacturers “to prevent the payment of inducements” to doctors and teaching hospitals.
Mr Fitzgibbon said health insurers had been “paying for knee arthroscopies and spinal fusions for years” despite research questioning their widespread use in Australia.
“Medical practice is littered with treatments which today are seen as complete nonsense, but which in the past were common. There are many examples of procedures and surgeries being performed where there isn’t evidence backing their use,” Mr Fitzgibbon said.
The pressure was on health insurers to manage the situation by helping patients make informed decisions, he said.
“We don’t make it our business to challenge the independent determiners, the government bodies that decide what is to be funded and made available. It’s just not what we’ve done. If we did we’d be accused of crossing the line and challenging doctors.
“Certainly our future direction is drawing upon evidence and publishing it, getting it out to members so that they can make more informed decisions about what is in their best interests.
“We’re very into this whole thing today, about improving people’s health literacy.”
Mr Fitzgibbon said it would be “difficult psychologically” for doctors to accept that treatments and procedures might not only fail at doing what they were supposed to do, but be “outright dangerous”.