Change Agents PART 2 - Australian Nursing & Midwifery Federation - Belinda Fettke

Part 2

I was honoured to be invited to present as one of the Keynote Speakers at the recent Australian Nursing & Midwifery Federation Tasmania Branch Annual Conference 2018, in Launceston.

The conference topic; ‘Change Agents - Inspiring Change by Challenging the Norms’ is one that has become very dear to my heart. 

In Part 2 of my presentation I challenge the role of Vested Interests in shaping our dietary and health guidelines and point out that even if Tasmania isn't making changes to help reduce sugary drinks and junk food from hospital and healthcare settings plenty of other states are!

If you missed Part 1 the link is here.

Gary didn’t really question his medical, or continuing education, despite regularly challenging paradigms when new science was presented on things like infection risks, DVT prophylaxis, and smoking on surgery outcomes, until his own health became compromised again in 2011/12.

He had to find another way to stop his cancer from being active. The chemo wasn’t holding it and he didn’t think he couldn’t go through surgery again.

Giving up sugar, processed carbohydrates and reintroducing healthy fats back into his diet has stopped his cancer in its tracks. It is our miracle and our biggest reward!

Unfortunately, when you begin to question long-held beliefs in medicine, the unshakable paradigms and the Associations that fiercely guard the dietary and health ‘RULE-Books’ it is tough. 

Admitting he was sorry was a big step. There is no doubt in my mind that Gary felt grief as he came to terms with what he was learning. He became angry with the system for not listening and considering the health benefits of LCHF.

Elizabeth Kubler Ross describes "The five stages of grieving as denial, anger, bargaining, depression and acceptance are a part of the framework that makes up our learning." 

To work through grief takes time. Over the last 8 years Gary has well and truly reached the acceptance stage and is confident to practice the medicine he knows improves health outcomes. I love that he spends time mentoring other healthcare professionals who may be going through their own stages of grief as they are either embroiled in AHPRA investigations or simply coming to terms with the possibility that they too, may have been prescribing harm following guidelines that promote 'band-aiding sick-care'.

I can’t believe that AHPRA pursued a two-and-a-half year investigation into Gary’s qualifications as a medical doctor to give nutritional advice and to speak on the science of what we eat and its central role in our health when Dietetics isn't even under the AHPRA Framework ... Apparently, it was deemed too low a risk to public safety to warrant the expense! Yet, Gary was investigated, and given a life-long non-appellable ruling against recommending real food. 

AHPRA came down with their final ruling 'silencing' him 2 hours after he presented at a Senate Inquiry into the failed AHPRA process.

The Medical Board of Tasmania, under the umbrella of the Australian Health Practitioners Regulation Agency, advised him in November 2016; ”In particular, that he does not provide specific advice or recommendations on the subject of nutrition and how it relates to the management of diabetes or the treatment and/or prevention of cancer.”

Gary is not allowed to comment on the central role of nutrition in preventative health, nor in the management of chronic illness on any social media platform.

AHPRA states “There is nothing associated with your medical training or education that makes you an expert or authority in the field of nutrition, diabetes or cancer. Even if, in the future, your views on the benefits of the LCHF lifestyle become the accepted best medical practice this does not change the fundamental fact that you are not suitably trained or educated as a medical practitioner to be providing advice or recommendations on this topic.”   

Did the AHPRA investigation begin simply because Gary raised issues of Quality Assurance and Patient Safety in the workplace? 

He was advocating a review of junk food and sugary drink sales publicly by 2013 and questioning the sugary/processed carbohydrate menu given to his patients with diabetes complications and uncontrolled blood glucose levels which still includes 3 desserts per day!

It makes me happy to think how many different countries, and closer to home, how many Health Services in city and regional areas, and various community groups around Australia, are now sounding alarm bells on junk foods and sugary drinks.

Tasmania could have been the leader in this area … instead we look we will be the last to adopt any of these changes. Is it simply to save face? Can you imagine the THS or AHPRA admitting Gary may have been right after all?

Since 2010, The Alfred Hospital in Melbourne began reducing sugary drink sales simply by removing them from display and placing them under the counter with their #RethinkSugaryDrink Campaign - Making Healthy Choices the Easy Choices.

Sugary drinks have already been banned in Sydney's Northern Beaches hospitals and the NSW government became the first state in Australia to apply a blanket ban on its hospital cafes, staff kiosks, vending machines and catering services from selling sugar-sweetened beverages with no nutritional value.

New Zealand has had a government-enforced ban on the sale of sugar-sweetened drinks at healthcare sites since 2015 and Britain's National Health Service will ban sugary drinks from July this year."

Last month, Western Australia’s HEALTH Minister, Roger Cook ordered hospitals to crack down on the availability of junk food on their premises and wants all State Government buildings to adhere to the same standard and the WIDE Bay Hospital and Health Service in Bundaberg (yes … we are talking about the sugar capital of Australia) have also decided to phase out the sale of sugary drinks from its health facilities.

I wonder when the Tasmanian Health Service will decide to reduce junk food and sugary drinks from the hospital setting and put the health of our community first?

I am not sure if you are aware but there has been a call to arms this last week. AHPRA will be linking all complaints against health professionals on a public register even if they are unfounded and even if cleared.

“A finding made many years before, that has no relation to the doctor’s current practice or conditions, will remain linked to the AHPRA register in perpetuity,”

I am not sure if the new system will affect nurses, but the medical profession is in trouble.

HPARA – the Health Professionals Australia Reform Association, is the only organisation that recognises the serious problems in the regulation of health professionals.

The 2016 and 2017 Senate Inquiries identified many of the issues, but the political system has failed to act and rectify them.

Let’s take a look at one of Gary’s slides from his HPARA presentation with some facts and figures on Medical Board of AHPRA.

Board members are not skilled in Health and Law. The commitment is 1 day per month, but preparation time includes reading approximately 1,000 pages for each meeting! This would suggest that the board members rely on the summaries of the investigators. At the time of Gary's investigation there were 180 investigators for over 10,000 complaints per year and only 4 of the investigators Australia-wide had a medical background! 

Considering War and Peace is 1,200 pages long, that is a serious board commitment for such a small amount of remuneration ($627 per month) which includes travel expenses. Makes me wonder why would someone choose to be a board member for AHPRA? 

What if the guidelines, which appear to have become strict Rule-Books fiercely protected by Associations and Regulatory Bodies that have ties to food and pharmaceutical companies, have been causing harm?

Imagine the harms that have occurred since the 70’s when the guidelines for the management of diabetes changed from low sugar and carbs to the high-carb low-fat dietary advice we still have in place now.

The numbers of people with type 1 diabetes, type 2 diabetes, gestational diabetes and even Alzheimer’s, which is being considered Type 3 diabetes - have escalated significantly and so have the complications...    

Not since thalidomide may doctors have inadvertently, and unintentionally, prescribed harm of this scale. Thalidomide use in the late 50s and early 60s caused some 10,000 children worldwide to be born with significant birth deformities. 

How many deformities is diabetes claiming? 

Type 2 diabetes isn’t just an old person’s disease anymore. Children as young as 3 have been diagnosed with a preventable and reversible disease. Devastatingly, Type 2 diabetes is in our schools, not just our retirement homes. 

Because of the early age of onset and longer diabetes duration, children and adolescents are at risk for developing diabetes-related complications at a much younger age which will profoundly affect their productivity, quality of life, and their life expectancy. 

When will these kids lose their eyesight, end up on kidney dialysis and begin the debridement of rotting flesh from ulcers that won’t heal and could lead to amputation? 

Gary is already seeing people with non healing ulcers as a result of peripheral neuropathy (a major complication of Type 2 diabetes) in people in their early 40's. It is only a matter of time before people in their 30's are affected, too.

Diabetes is recognised as the world’s fastest growing chronic condition

In 2015, the 7th edition of the International Diabetes Federation’s Diabetes Atlas estimated that: 

Every six seconds a person dies from diabetes. 

One in 11 adults has diabetes (415 million) with a global expenditure cost of $673 billion US. 

“Once you've got type 2 diabetes, it's with you for life.” Greg Johnson CEO of Diabetes Australia was quoted as saying on ABC’s 7.30 report earlier this year. It seems that Diabetes Australia has significant ties to the pharmaceutical industries including Roche, Astra Zeneca, Abbot, Bayer, Lilly, Pharmaco, Sanofi and Medtronic. Their corporate partners have a lot to lose if their ‘product’ is no longer required.

How out of touch is Diabetes Australia to continue the myth of Type 2 being a chronic progressive disease? How long before they are made accountable for this advice?  People with Type 2 diabetes may still remain insulin resistant living an #LCHF lifestyle, but the diagnosis is reversible based on criteria of blood glucose control & HbA1c testing.

The RACGP General practice management of type 2 diabetes 2016 - 18 acknowledges AstraZeneca and Sanofi (pharmaceutical companies that supply diabetes medications) on the back cover as 'supporting the education programs of Diabetes Australia'.

Interestingly, a study carried out by a group of researchers (with funding disclosures to the pharmaceutical industry in Australia) came to the conclusion that:- 

"A peer-to-peer, interactive GP education program reduced GPs’ perceptions of the difficulties of starting insulin in T2D and achieved changes in attendees’ clinical practice. This education program offers an effective approach to overcome the therapeutic inertia that is too common in diabetes management." The program was initiated in 2008 by a number of the authors in conjunction with the sponsor (Sanofi - Sydney, Australia). 

Is it any wonder that 'medicating' is a priority in diabetes management guidelines and that Low Carb management isn't even discussed in the RACGP General practice management of type 2 diabetes until page 133, and even then only in a short paragraph under the heading Issues under debate?

I can't help but continue to question "Who is 'Silencing' Gary?" after we recently uncovered The Australian Dietitians Guide to Diabetes was sponsored by the Australian Sugar Industry - an alliance with Diabetes Australia, circa 1993. 

I just don't understand why women diagnosed with Gestational Diabetes are encouraged to eat 8 ½ serves of carbohydrates every day to stabilise blood glucose levels. It doesn't make sense.

What causes Gestational Diabetes?

According to Diabetes Australia "In pregnancy, the placenta produces hormones that help the baby grow and develop. These hormones also block the action of the woman’s insulin. This is called insulin resistance. Because of this insulin resistance, the need for insulin in pregnancy is 2 to 3 times higher than normal. If you already have insulin resistance, then your body may not be able to cope with the extra demand for insulin production and the blood glucose levels will be higher resulting in gestational diabetes being diagnosed.

"When the pregnancy is over and blood glucose levels usually return to normal and the gestational diabetes disappears, however this insulin resistance increases the risk of developing type 2 diabetes in later life."

Loading the dietary recommendations from Victoria's Baker IDI for Gestational Diabetes into the FOODWORKS app it showed that carbohydrate consumption can easily reach 346 grams when women eat 8 1/2 serves of carbohydrates PLUS a serve of legumes/lentils from the 'vegetable food group' and another as 'a protein alternative'. 346 grams of carbohydrate per day is equal to 88 1/2 teaspoons of glucose sugars. At a minimum, 8 1/2 serves of carbohydrate appears to be around 42 teaspoons of glucose sugars. 

How is anyone supposed to have control of their blood glucose with that much glucose sugar circulating, let alone a pregnant woman with insulin resistance? 

For information on Low Carb Healthy Fat principles to prevent and manage GD, I highly recommend reading Lily Nichols book Real Food for Gestational Diabetes.

I think it is time to make health care about the people and not the process anymore. Strict Rule-Books, ticking boxes and band-aiding sick care simply isn’t working.   

I often wonder how different the last 8 years would have been if people had not been so closed to debate and insistent on following guidelines. How many lives could have changed for the better?

I also look back and think how enriched our lives have become because of the road blocks. They have led Gary to research and network with the most amazing people and there is no doubt ... amongst people who want to be Change Agents we have found 'our people’.

I hope I have planted some 'food for thought' with you today. 

Part one can be found here if you missed it.

Remember to go forward with the perspective of a patient, the spirit of an activist, and the heart of a healer.

Thank you.