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Thank you to Joseph Hasslberger of for forwarding this letter to us, written by a concerned New Zealand resident to the NZ government.

Open Letter to the Hon Annette King, New Zealand Minister of Health and Minister of Food Safety

Dec 2002

Dear Minister
Research into causes of death in New Zealand presented at the recent NZ Society for Risk Management Conference at Te Papa, stemmed from my membership of the Ministry of Health's Sentinel Events Project Working Group. It quickly became very evident that empirical data exists to give concerns about systemic dysfunction within the Ministry of Health; especially with regard to development of policy and policy advice. It seemed incongruent that on the one hand officials select and rabidly support certain public health policy initiatives that seem insignificant in the context of the big picture, yet quickly reject and even deny, to the point of data stripping, major public health issues.

In this month's column in New Zealand's top "people's" health magazine, Healthy Options, I'm taking the liberty of raising a series of questions and offer you the opportunity to respond via this column. I will donate $150 to a charity of your choice if you take up the offer. Did you know that highly preventable medical injury is the number three cause of death in New Zealand following all-cancer deaths and vascular disease?

Have you been advised that highly preventable medical injury resulted in 43,385 potential years of lost life (PYLL) in 1998 - second only to vascular disease? Traffic related deaths resulted in 23,196 PYLL and meningococcal meningitis deaths 1,000 PYLL. Have your officials explained to you why they removed all reference to medical injury related admissions to hospitals in their policy report "The Burden of Disease and Injury in New Zealand"? (BDINZ) This is really puzzling as in the Ministry's own 306 page publication, "Selected Morbidity Data for Publicly Funded Hospitals 1998/99," (SMDPFH), upon which the BDINZ report was based, 35% of injury related admissions to hospital are due to medical injury - versus 25% for falls, and only 6.6% for traffic accidents.

Have your officials told you that for every hospital bed taken up with a patient with a traffic injury, 5 beds are taken up with medical injury related patients? Can they explain why they stripped such important public health information from a document that claims to provide the basis for policy advice to the government?

This is not only puzzling, but I'm sure you agree it is very concerning. Page 34 of BDINZ refers to "Unintentional injuries and adverse effects of health care" and page 36 notes "Adverse effects (surgical, medical, pharmaceutical)." Yet, despite giving the perception that they are included, officials left all of the data out and adjusted the number of injury related admissions accordingly. I'm sure you agree that if your officials have deliberately stripped the third leading cause of death in New Zealand, the second leading cause of PYLL and the leading cause of death in under forty five year olds, something is terribly wrong. Words like malfeasance, misfeasance, nonfeasance, or simply downright incompetence spring to mind. Either way, do you agree that an inquiry is in order?

Can you explain to the readers of Healthy Options why the Government has committed $200 million to subsidise research and pharmaceutical interests in attempting to develop a vaccine with only a 50% chance of success to reduce about 15 deaths per year due to meningococcal meningitis (MOH estimates) when your own Ministry of Health officials have blocked efforts to get Professor Peter Davis' research team funded to continue their wonderful work on documenting the carnage due to medical injury?

Minister, it simply does not make sense. We are talking about $200 million being championed and committed on a 50/50 chance of reducing 15 deaths per year or 1,000 PYLL, versus apparent deliberate data stripping and rejection of requests for $50 million to target the reduction of more than 1,500 highly preventable medical injury deaths (43,000 PYLL).

We're talking about committing $2.66 million per potential life saved over five years - yet refusing to commit a dime to targeted funds to reduce the highly preventable carnage in our publicly funded health system. Minister, does this make sense to you?

Another example of the Ministry of Health's apparent dysfunctional approach to policy making relates to cot deaths. The British Medical Journal has just published further research pointing out that second hand mattresses have a strong relationship with cot death. This fits with earlier research showing that 2nd, 3rd, 4th born children are at increasing risk of succumbing to cot death. On the other hand, New Zealand research shows that over 25% of all babies are sleeping on thick polyethylene sheets in line with Dr Jim Sprott's recommendations. Not a single cot death has been recorded amongst these babies whereas one would have expected over 100 such deaths.

Simple logic concludes that all cot deaths in New Zealand occur amongst babies not sleeping on thick plastic under sheets. Minister, regardless of the spin that your advisors might put on this evidence, a Ministry that rabidly invokes the 'precautionary principle' when it suits them should be advising all mothers to utilise such a stunningly simple and cheap public health initiative. Why do your officials continue to deny the facts? 100,000 plastic sheets saving 100 lives equates to a few thousand dollars per saved life paid for from private funds. Minister, your advisers' myopic policy advice is perplexing to say the least. It simply defies logic. One could even suggest it is criminal.

There are many other discrepancies that I could document, such as criminal folic acid advice, but space does not permit. Highly preventable medical injury impacts on the economy to the tune of more than $4 billion per year. I would recommend a $50 million capital injection, $5 million of that to go to Professor Peter Davis's research team to monitor progress via annual safety audits of randomly selected patient records.

You'll receive howls of protest from your advisors; such a strategy would not fit with their fashion-based approach to setting policy which includes systematically stripping unwanted data from official reports. It would, however, go a long way toward reducing the 1,500 plus extra empty seats at the Christmas dinner table each year and might even stave off a Royal Commission of Inquiry. After all, Cave Creek only resulted in 14 deaths and the Gisborne debacle in a similar number. Quality Ministers can only make quality decisions it they are provided with quality advice.

Healthy Option readers look forward to your response in the New Year.

Have an enjoyable festive season.
Ron Law