AHPRA: Public Health Watchdog, Big Pharma Lapdog, or Drug Enabler

AHPRA: Public Health Watchdog, Big Pharma Lapdog, or Drug Enabler
by Ramesh Thakur at Brownstone Institute

A Doctor Dies by Suicide

Mei-Khing Loo is a former practice manager whose 43-year-old obstetrician-gynaecologist husband of 21 years, Dr Yen-Yung Yap, died by suicide in 2020 while under investigation by the Australian Health Practitioner Regulation Agency (AHPRA). He left behind three young children. Another speaker intimately familiar with the case explained how Dr Yap had his livelihood destroyed for having delivered two babies by suction rather than forceps in Adelaide in 2015 and 2019. 

There was no complaint to AHPRA, no litigation, no damage to the babies. In both cases ‘subgaleal haemorrhage’ was suspected but never diagnosed and the babies were discharged and went home within five days. An internal audit resulted in an AHPRA notification.

Four doctors who knew Dr Yap told his legal team that he had done nothing wrong in either birth. But the AHPRA-nominated expert (in gestational diabetes) claimed forceps should have been used and AHPRA imposed restrictions that effectively made it impossible for Dr Yap to continue his practice. ‘The ongoing harassment from AHPRA and the Medical Board will make me mentally and emotionally traumatised and professionally unable to care for my patients, and financially unable to care for our kids,’ he wrote in a letter to his wife shortly before his suicide.

Mei-Khing addressed a full audience in Sydney on 3 May about her grief, pain, and unsated anger, through bouts of sobbing and tears. Her speech was passionate, resonant, and yet also in the end inspiring, with a call to maintain the rage against the callous regulator. Only a change in the culture and institutional setup of the regulator to make it more compassionate can best ensure that Dr Yap did not die in vain, she said. She was the only one of the roughly two dozen speakers at the conference to receive a standing ovation from the audience that had listened rapt in pin-drop silence to her presentation.

It also put in perspective another speaker who referenced an insensitive and ‘flippant’ comment from a former Medical Board of Australia chair: ‘These doctors who are getting all stressed about a clearly frivolous complaint [to AHPRA] should really go and learn how to manage their stress a bit better’ (In the series of podcasts from the Australian Society of Anaesthetists, Episode 84, 4 December 2023, at around the 29:40 mark).

Mei-Khing is the human face of some alarming statistics on health professionals’ lack of confidence in AHPRA. According to Kara Thomas, Secretary of the  Australian Medical Professionals Society, in a survey for AMPS 82.6 percent of healthcare professionals said that AHPRA lacks fairness and transparency in handling complaints and 78.5 percent reported unfair treatment at its hands because of a ‘guilty until proven innocent’ approach to investigating complaints.

This is hardly surprising. In March 2023, AHPRA released the results of its own study on the distressing impacts of Australia’s regulatory complaints process on doctors. The study resulted in a peer-reviewed article on 26 September 2023 in the International Journal for Quality in Health Care, an Oxford University Press journal. It’s worth noting that the study team included Tonkin and AHPRA CEO Martin Fletcher, along with six other AHPRA staff. 

The study covered the four-year period 2018–2021 inclusive. Its major findings included the shocking fact that 20 healthcare practitioners involved in a regulatory process over the four-year period had committed or attempted suicide or self-harm resulting in 16 deaths, of which 12 were confirmed suicides and the other four were deemed likely suicides based on the information available. Few if any of the 20 practitioners were being investigated for a complaint regarding their clinical performance. 

‘The Misdeeds of AHPRA’ Conference

Adapting a popular saying against teachers, Dr Robert Malone wrote recently in Brownstone Journal: ‘Those who can, do. Those who can’t, regulate.’ An impressive number of health practitioners gathered for the day-long conference in Sydney on ‘The Misdeeds of AHPRA’ on 3 May. The conference was oversubscribed, with many late registrants having to be turned away. Surprisingly, or perhaps not, no one from AHPRA seemed to be present although they had been invited.

In Australia, registered health practitioners across 16 professions are regulated by AHPRA and 15 National Boards as part of a national, multi-professional regulatory scheme. The goal is to streamline and standardise the regulatory system to ensure consistency, high quality, and national standards while protecting the public against medical malpractice and misconduct.

Driven by the profit-maximising motive of the pharmaceutical industry and the capture of lawmakers, health bureaucrats, and regulators by lobbyists, the public health sector today is guilty of medicalising ordinary human suffering and pathologising the natural life cycles of human beings, including ageing. The entire system is built to put and keep people on medication, from the cradle to the grave. No one dies of old age anymore. My GP would not accept, because the official form could not code, old age as the cause of death of my parents. I had to mention a specific cause that could be inputted for the computer to accept the answer.

One speaker listed the big criminal fines on Big Pharma that total $123 billion (unspecified but probably US currency) in just this century. Internal pharma documents confirm that they retain ownership and control of studies that they sponsor and that the purpose of the data collected is to support marketing of their product. They suppress adverse events data, cherry-pick data on benefits, remunerate researchers generously but don’t permit them to control use of data, draw up plans to influence regulatory agencies and health bureaucrats, liaise with media, and expand the market for their product through ‘disease-mongering’ strategies. In this context, too many medical and scientific journals, especially those sponsored by the industry, are tainted and in effect an extension of the marketing arm of the pharmaceutical industry.

Over the course of the day, it became clear that we were in the midst of a roomful of people who had paid a price – some a small price, others a heavier price, and a few the ultimate price: financial, professional, and personal (strain on family, suspicions on the part of friends and colleagues, deteriorating health, toll on mental health). Yet all they had tried to do, in their opinion, was to stand up for patient safety and welfare as their primary, indeed overriding duty of care.

The conference was convened by AMPS and the Australian Doctors Federation. The discussions ranged widely over just what had happened, how it had all been possible, and what institutional safeguards can be recreated to avoid a repetition of the horrors of unscientific, unethical, and deeply corrosive health policy and practices.

An outsider to the healthcare profession is struck by the extraordinary complexity of the public healthcare provider and regulatory system. Little wonder that it’s become a broken system in need of urgent repair or replacement. There has been a slow but steady shift from patient-centric care based on physicians’ judgment and informed patient consent to protocol-governed compliance with rules and regulations set by bureaucrats. This has had the consequence and may indeed have been motivated by the desire to protect politicians and health bureaucrats, not the patients and certainly not the doctors.

The Covid Legacy Hangs Heavy

The organisers in their introduction emphasised the importance of engaging in the conversation in a spirit of open dialogue in the hope of effecting positive change. But they did note that this would be in contrast to the behaviour of the regulator during the pandemic. The broad consensus among speakers and participants was that patient care suffered during the Covid years. Principles of good medical practice (non-maleficence or first do no harm, beneficence or do good, justice meaning equitable access to healthcare, individual autonomy, and personal agency as the basis for informed patient consent) were violated. 

During the Covid years the cadre of public health technocrats deployed a lethal combination of fear and moralism to foment mass hysteria that overrode existing checks on their authority and rode roughshod over safeguards and liberties to gather in even more power to themselves. Yet, many official claims were either known from the start or subsequently shown to be at odds with the scientific evidence:

• Covid-19 could only have started in the Wuhan wet markets v. plausibility of Wuhan lab origin;
• Covid-19 kills healthy children, adolescents, and young v. negligible mortality of these cohorts;
• mRNA is broken down in minutes and doesn’t pose long-term safety issues v. mRNA and spike protein detected in blood months and possibly years after injection;
• mRNA and adenoviral vectors are not gene therapies and required only the usual levels of regulatory scrutiny v. they were developed as gene therapies and should have received more rigorous scrutiny;
• mRNA vaccines contain minimal DNA contamination v. they were heavily contaminated and had potentially lethal side effects;
• Covid-19 vaccines prevent infection and community transmission v. they prevent neither infection nor transmission.

How many of us experienced being otherised while walking outdoors sans mask, with passersby crossing to the lighted side of the street to escape from the vector of disease spread that any uncovered face symbolised? The arrival and mandating of Covid vaccines crystallised the moral landscape with even sharper clarity and bled over into a class bias that persists to this day.

For children especially the risk of severe illness or death from Covid is very slight. The risks of serious reactions to vaccines are higher. Protection against risk of reinfection is at least as robust and may last significantly longer for children who are infected but not vaccinated compared to the Covid-naïve who are vaccinated. The long-term effects of Covid vaccines are unknown. In the absence of other known treatments, existing antiviral inflammatory drugs with established safety profiles could and should have been repurposed to treat Covid-19.

Every one of these statements is contestable and subject to revision as the databank grows and more studies are published, but not one is so implausible as to be summarily dismissed.

In these circumstances, for health bureaucrats and regulators to claim a monopoly on scientific truth is just not good enough. The effort to shut down legitimate debates on pain of excommunication from the medical profession represents a clear and present danger to public health. I certainly have more confidence in my consultant’s professional advice based on training, qualifications, experience, and knowledge of my medical history, free of pressures to conform to the zeitgeist from bureaucrats and regulators, the latter often with questionable links to industry. Those of us without medical credentials arouse understandable scepticism towards our critiques. This makes it all the more imperative not to silence medical professionals but to welcome and encourage contestable policy recommendations from them.

In recent times American and British authorities have admitted to the lack of any scientific basis for such mandatory lockdown-era measures as the two metre/six foot distance rule and school closures. Why did the Australian authorities adopt the rule? Did they have independent scientific advice to justify it or were they guilty of herd behaviour in mimicking what Europe, Britain, and America were doing?

We looked in vain for the emergence of an Australian equivalent of Anders Tegnell. Sweden’s state epidemiologist showed remarkable courage of scientific convictions in standing against the herd and provided the world with the most instructive control group of all against the anti-scientific idiocy of lockdowns. In an interview with Nature early in the pandemic on 21 April 2020, Tegnell explained that the sole basis for the tough love of lockdowns was epidemiological modelling:

Closedown, lockdown, closing borders — nothing has a historical scientific basis …. We have looked at a number of European Union countries to see whether they have published any analysis of the effects of these measures before they were started and we saw almost none.

AHPRA also has structural and operational links with the World Health Organisation (WHO). As a designated Collaborating Centre, AHPRA partners with the WHO to promote best practice in health workforce regulation and promote access to quality health care, including by capacity building in other countries. More concerningly, AHPRA supports global regulatory capacity, implements WHO programs, and aligns with international (that is, not just national) priorities. Yet, whenever challenged, both the WHO and AHPRA reject the claim that this dilutes national autonomy. 

Practitioner Concerns about AHPRA

The protracted crisis in Australia’s medical regulatory system has developed over more than a decade. Every Australian is directly affected, either as a consumer of healthcare and/or as one of the 900,000 healthcare professionals. Practitioners have concerns regarding the judgment, consistency, proportionality, accountability, and independence of AHPRA as Australia’s medical regulator. They believe its flaws and failures put at risk the integrity of Australia’s healthcare system and the medical autonomy of doctors.

Two-tier justice meted out by AHPRA is indicated in several examples where serious misconduct or bad practice that harmed patients resulted in a mild slap of the wrist, whereas conduct that departs from the approved narrative, even when no patient has suffered harm, entangles the doctor in a costly and high-stress investigation that can involve suspension of the right to practice medicine for extended periods while the investigation proceeds at a leisurely pace.

In the complaints-driven system, AHPRA’s KPI effectively seems to be not patient safety and welfare, but the number of doctors taken down. They demand moral purity of doctors, but exempt themselves from the same requirement. Ditto transparency and independent external scrutiny. They are meant to protect patient safety and promote patient welfare, but destroy the doctors on whom patients rely for safe medical care. ‘Independence’ of the regulator in practice has been corrupted into meaning that they are not answerable to anyone else. They review and clear themselves whenever accused of overreach and responsibility for harming doctors. The system is durable and resilient because it allows governments to disclaim responsibility for the regulator’s decisions, washing their hands Pontius Pilate-like for the fate of doctors harmed by their aloofness and callousness.

Notifications to alert AHPRA and the Boards to concerns about a registered health practitioner’s performance, conduct, or health are central to the public protection objective. However, practitioners have many concerns about the prevalence and management of ‘vexatious’ notifications that are disproportionately stressful and distressing. In particular, said one speaker, ‘AHPRA has weaponised anonymous complaints, to allow the process to be the punishment, without the need for proof.’ Several pointed to the potential for targeting doctors without supporting evidence by an AHPRA that takes an adversarial stance against practitioners under investigation, the virtually unlimited scope for investigations, the silencing of practitioners, and the fear-based compliance by practitioners.

Sometimes AHPRA tries to have it both ways. One speaker put up a slide that quoted a position paper from AHPRA and National Boards on 9 March 2021. It warned doctors, on pain of prosecution by AHPRA, not to promote anti-vaccination statements and health advice, and not to advise patients against Covid vaccination. Yet, the same guidance also required all health practitioners ‘to use their professional judgment and the best available evidence’ in their practice of medicine. Another speaker cited examples of the medical literature often publishing contradictory conclusions drawn on vaccine safety and efficacy from study of the same data, for example in the New England Journal of Medicine and Vaccine.

Health practitioners particularly resent the two-tier justice which doesn’t deploy the same process and standards of evidence for complaints levelled at AHPRA and the Boards. Given the undeniable reality that AHPRA investigations can cause harms that range from minor to serious, a key question is: How to hold regulatory bodies like AHPRA accountable for their actions? Who will watch the watchdogs?

A two-year review of the notifications framework by the National Health Practitioner Ombudsman Richelle McCausland on 9 December 2024 noted the tension between the function of AHPRA and Boards to ensure patient safety while also ensuring that practitioners ‘are treated fairly and not placed under undue stress.’ Her report acknowledged concerns that the complaints notifications process can be vexatious and ‘is being “weaponised” to harm practitioners.’ She made 17 recommendations to better resolve the tension between patient safety concerns and practitioners’ rights to due process and their welfare.

A Queensland Supreme Court judgment on 13 December 2024 held that an extraordinary pandemic such as Covid-19 does not abrogate doctors’ rights to ‘procedural fairness’ before ‘an unbiassed tribunal,’ nor extend the Medical Board’s ‘regulatory role to include protection of government and regulatory agencies from political criticism.’

Quo Vadis? The Government, Our Enemy

There seemed to be broad agreement among the speakers and participants that the ‘subjugation’ of the medical profession under AHPRA is failing both society at large as well as the healthcare professionals who come under its jurisdiction. It seems structurally and operationally unable to lift safety standards and health outcomes. To this end, doctors owe a duty to patients to overcome fear, become strong, and unite against the budding tyranny of AHPRA.

To reverse the loss of proportionality and independence, AHPRA should be returned to being a registration and accreditation body. It should terminate its status as a WHO collaborating centre. Doctors must unite to defend informed consent, clinical discretion, and the sanctity of  the doctor-patient relationship. This can only come about if and when doctors, patients, and the public join forces to push back government intrusions into the clinic.

Many speakers and members of the audience raised important questions on where we go from where we are. Should Australia revert to state-based regulators or stay with a national regulator? In the US the system is chiefly state-based. In Canada, it operates mainly at the national level. This may be a false binary choice. The principle of subsidiarity would embrace both levels of regulation.

A question that arises with respect to any institution or bureaucracy that gradually descends into dysfunctionality is should it be reformed or abolished and replaced? Whatever the answer, advocates must understand the importance of framing the issue. In particular, their remarks and recommendations have to be patient-centric, and not focus on doctors’ privileges and perks. Equally, they must articulate the key foundational principles like integrity, independence, professionalism, competence, transparency, informed consent, and scientific accountability. In addition, they need to explain why these matter for the health and integrity of the registration and accreditation system so that it can ensure the highest level of patient care.

The pathology of regulatory excess is more widespread and generalised than just the medical sector. Because the conference was focussed narrowly on the misdeeds of AHPRA, there was no linkage made to the broader societal and political trends that have resulted in the growth of the administrative, surveillance, and regulatory state. Quasi-autonomous NGOs (Quangos) are supposedly independent bodies that are nevertheless set up, wholly or partly funded, and appointed by governments. They have been delegated some legislative and some judicial functions that circumvent the formal machinery of government and end up exercising de facto governmental powers without any responsibility for the consequences of their actions, no clear lines of accountability, and seemingly unanswerable to anyone.

Elected politicians and unelected judges alike have seen their powers shift to unelected and unaccountable technocrats. AHPRA is part of that institutional landscape. Australian doctors as a class are among the victims of that power grab. Many – but not nearly enough – brave souls who stood up to it and other organisations in the brotherhood of medical regulators paid a heavy price in the form of censure, deregistration, and loss of professional jobs and status.

The uncontrolled proliferation of Quangos has unmoored the state from its democratic anchor and made it distant from the people. Increasingly, the state neither reflects our needs and aspirations nor responds to our concerns. More and more people are waking up to the reality of the administrative state that has slowly but surely captured almost all key institutions and is stealthily strangulating democracy. This is a major explanation for the success of Nigel Farage’s Reform UK party in England’s local elections on 1 May.

Key to the reforms will be rebalancing the doctor-regulator relationship in the boardroom, on the one hand, and re-sacralising the doctor-patient relationship in the clinic, on the other. And establishing a better balance between patient safety, doctors’ rights and welfare, and regulatory reach. If the Leviathan is to be defeated, the resistance will have to be much more broad-based than each sector taking on bits of the state apparatus piecemeal.

The question addressed in this article to Australia’s medical regulator, as to whether the public health watchdog has been corrupted into a Big Pharma lapdog and drug enabler, is relevant for most countries. As in most areas in the current era, the United States has the heaviest normative weight and strongest gravitational pull of any country in the world. For better or worse, the presence of the likes of Robert F Kennedy, Jr, Jay Bhattacharya, Marty Makary, and Vinay Prasad in the top echelons of public health decision-making in Washington, DC is bound to have ripple effects in other countries in recalibrating the normative settling point of public health policy.

AHPRA: Public Health Watchdog, Big Pharma Lapdog, or Drug Enabler
by Ramesh Thakur at Brownstone Institute – Daily Economics, Policy, Public Health, Society