Ian Powell – Health Minister drops Medical Council in a right political pickle

‘In a pickle’ is an idiom meaning to be in a difficult, tricky, or troublesome situation; one where it is hard to know what to do or how to escape.

It can include everyday things such as losing house or car keys, missing a bus, or forgetting one’s wallet.

In a pickle reportedly first used by William Shakespeare in his play, The Tempest

William Shakespeare is thought to be the first to use the idiom “in a pickle” in The Tempest. Although, in this case, the pickle was in the narrower context of being inebriated.

Pickles can also be political. Think the National Party caucus over the inane unsuccessful coup against Prime Minister Christopher Luxon. Think NZ First cabinet minister Shane Jones often when he opens his mouth.

Medical Council dropped into a right political pickle

Politicians can also drop innocent parties into a political. Minister of Health Simeon Brown has just provided an excellent example of this when he dropped the Medical Council, whose leadership he purged and, in July, controversially appointed some new members, into a right pickle of a mess.

I discussed this purge and its wider dangerous implications for the safety of the public in our health system in an earlier post (2 July): Health Minister’s purge.

What is the Medical Council

For context, the Medical Council is one of 18 regulatory authorities established by the Health Practitioners Competence Assurance Act 2003 whose prime purpose is the protection of the safety of the public in the health system.

These 18 authorities cover the various medical, nursing, dental, allied health professional, and scientific and technical occupations.

Medical Council’s statutory purpose is safety of the public

They are responsible for ensuring that all registered health practitioners are fit to practise and fully competent. This includes issuing annual practising certificates and approving individual ‘scopes of practice’.

Should the authorities fail to fulfil this requirement to a high standard or be obstructed from doing so by political interference, then the safety of the public in the health system is compromised.

Investigative journalist undaunted by sinister attack

Andrea Vance, National Affairs Editor of The Post, has covered the above-mentioned controversy as a good investigative journalist should.

This led to a sinister attack on her which I discussed in my Political Bytes blog (3 August): Investigative journalist attacked for being investigative.

The attack came from the rightwing and selective misnamed Free Speech Union. Subsequently it was revealed that the health minister had appointed two members of the FSU to the Medical Council, one of which (Dr Roderick Mulgan) was a former president and current board member.

This followed an earlier meeting them and the health to discuss their concerns over the Medical Council, including narrow more monocultural approach to cultural competence.

Andrea Vance is not for turning on investigative journalism

But Vance remained undaunted by this sinister intimidatory conduct. On 4 August The Post published an extraordinarily revealing paywalled article under the striking heading ‘Simeon Brown’s Medical Council pick under scrutiny over supplement marketing’:    Brown’s Council pick under scrutiny.

Understanding the pickle

The pickle the Medical Council has been dropped in is that one of the above-mentioned new members appointed by the health minister, general practitioner Dr Mulgan, is founder and executive director of a for-profit company, Lifeguard Health, which sells a range of over-the-counter supplements.

The specific nature of the pickle is that there is a strong persuasive argument that his involvement in marketing his commercial supplement company’s profits conflicts with the Medical Council’s rules on doctor endorsements and testimonials.

Vance comments:

An examination of Lifeguard Health’s website shows repeated use of Mulgan’s medical credentials in its marketing, including claims that products were “designed by Dr Roderick Mulgan, a practising New Zealand GP” and “formulated by a New Zealand GP”.

The website also features a section titled “Why doctor-formulated matters”, which promotes the value of products being developed by a medical professional.

The council’s own advertising standards warn doctors against using their professional status to promote commercial products.

The Medical Council issued its Statement on advertising in April 2022: Advice to doctors on advertising.

The purpose of the Council’s Statement is:

…to protect the public from advertising that is false, misleading or deceptive, and to provide guidance to doctors about the advertising of health-related products and services.

Vance refers to Standard 14 of the Statement:

As a doctor, you should not endorse any medical products or methods of treatment in your advertisement.

Vance then refers to Standard 15:

If you are acting as an agent for, or have a financial or other interest in, a medical product or method of treatment, you should declare your interest within the advertisement in a way that does not endorse the product or method of treatment.

Digging down further

It should come as no surprise that the intrepid Andrea Vance dug further into Medical Council policies.

She highlighted another relevant Council Statement; this one on doctors and their relationship with health-related commercial organisations issued as recently as February 2023: Ethical issues.

Dr Roderick Mulgan is not supposed to endorse his for-profit company

Vance notes that the Statement allows doctors to disclose financial interests in health-related businesses, adding that disclosures must be made “in a way that does not endorse the product”.

She goes on to directly quote the Statement:

Ethical issues can arise when you promote and sell products to patients. For example, your integrity could be compromised if you have a preference for certain products, or if you have sales targets to meet. Where possible, you should avoid selling products to patients, and only do so if there is a clinical basis for that product.

What an investigative nose reveals

Dr Mulgan’s for-profit company sells a range of over-the-counter dietary supplements, Vance’s investigative nose reports that:

Lifeguard Health’s website also includes a customer review section containing around 20 testimonials. Several describe specific health outcomes, including claims about improvements in arthritis, joint inflammation, tendon injuries and blood pressure.

The council’s advertising standards prohibit doctors from using or quoting testimonials on platforms under their control. Because the website is a business platform Mulgan controls, the guidelines place an active duty on him to regularly monitor it and remove any testimonials posted there, while also banning doctors from encouraging patients to leave reviews.

Under the council’s standards, testimonials “must not be used or quoted in your advertising or on any websites, social media or any other platforms you control.”

Lifeguard Health highlights Roderick Mulgan in sale of its supplements

The Post’s National Affairs Editor also notes that the Council includes reference to platforms under a doctor’s control. Pointedly she quotes:

…it is your [the doctor’s] responsibility to monitor regularly the content of such websites or platforms and to remove any testimonials that are posted there.

Mulgan’s defence, as reported by Vance, was that he had a longstanding interest in nutraceuticals and the role of nutrition in health”.

Further:

All my commercial interests and directorships were disclosed to the Ministry [of Health] and the Medical Council at an early stage when I applied for a position.

“They have been vetted in detail and no issues have been identified. I have confirmed this is the position in response to your enquiry.”

However, he could not confirm whether the Health Ministry had both specifically reviewed his company’s website and determined that it complied with the Medical Council’s advertising standards.

Dropping the Medical Council into this political pickle

When asked the Health Ministry quickly and underwhelmingly passed the buck stating that “any questions about activity being consistent with the Medical Council’s standards are a matter for the Council.”

This is code for suggesting that the Ministry either failed or declined (perhaps due to political connections or synergies between Mulgan and Simeon Brown) to do due diligence.

Alternatively it might be due to the loss of institutional memory over such matters with the Ministry’s restructuring and with less health system experience in its leadership.

Council Chair Dr Ken Clark caught between a political rock and a hard place; the medical profession is fortunate to have his professionalism in this precarious situation

Dropped right in it new Medical Council Chair Dr Ken Clark could only say, when asked by Vance, that whether Mulgan’s marketing activities complied with the regulator’s standards, depended on the “full circumstances” (technically correct but the reported evidence suggests they did not comply).

But Dr Clark, highly respected in the medical profession, said questions about checks undertaken before appointments were matters for the minister and ministry; absolutely correct.

In other words, the Medical Council had been kept out of the loop. Previously the practice over Council appointments was based on a formal consultation relationship between the Council and the Ministry with the latter leading the process.

Further, there was also a longstanding informal relationship between the Council and health ministers (regardless of political flavour) which largely focussed on the skill mix of current and potential Council members.

These formal and informal processes provided a valuable level protection against inappropriate or insufficiently suitable appointments. However, in this case they were ignored either deliberately or inadvertently.

Summarising the pickle

Health Minister Simeon Brown primarily responsible for this political pickle (NZ Herald)

In summary:

• health Minister Simeon Brown dropped his Ministry  into the pickle by stating in Parliament that it was responsible for vetting and recommending appointments;
• the Ministry of Health dropped the Medical Council into the pickle by pointing the responsibility finger to it; and
• the Medical Council, which was sidelined in the process, is left in a right political pickle.

Health system leadership decision-making at its best!!! I think not!