Bomb shell hits UK’s NHS The largest medical malpractice – negligence fraud in operation and breach of human rights ever. Risk to patient safety exposed . Victims affected growing by 70,000 per year
Fraud [frôd] Etymology: L, fraudare, to cheat (in law) the act of intentionally misleading or deceiving another person by any means so as to cause him or her legal injury, usually the loss of something valuable or the surrender of a legal right resulting from the action of that person on the misrepresentation.
Disclaimer – If your gallbladder is truly diseased and failed, it must come out. However, consider seeking additional medical opinion when conflicting discrepancies between medical opinions, evidence based research and patient testimony exist.
Doctors refusing to disclose likely known complications of removing the gallbladder and its function in order to obtain informed consent (through deception) or blocking post care support to save medical treatment costs or to maintain preferred treatment deception, breaches his/her duty of care and gives a cause for negligence action against the doctor
Cholecystectomy for the treatment of gallstones could be categorized as the largest ongoing medical malpractice surgical frauds in modem medical history, if not the largest breach of the Nuremberg code for patients’ ethical and clinical rights to receive Informed Consent.
The following presents evidence confirming possibly UK largest ongoing medical surgical fraud. Victiums affected growing by 70,000 per year and rising. Every patient consent obtained for Cholecystectomy, the treatment of gallstones, impaired gall-bladder and sphincter of Oddi function is obtained through deception by UK National Health Service. In breach of the law, medical ethics, Universal Declaration of Human Rights 1948.
A 2006 UK published medical studies concluded ’More often than not, patients are not provided with consistent information to make an informed choice’ for Laparoscopic Cholecystectomy. Fraud confirmed ‘when taking consent, do not mention complication’
These statements provided in writing to patients during the legal and ethically required patient informed consent processes on risks and likely consequences are misleading, inaccurate and cannot be backed by any evidence based medical studies. As such EVERY consent for the 66,000 patients annually undergoing Cholecystectomy in the UK is obtained by deception and fraud. Patient safety is blocked. NHS can be held liable for long term heath damage that occurs directly from withheld post car treatment support.
Doctors see no evil – Complete denial of post surgery risk:
Doctors see no evil – Complete denial:” Your search for Postcholecystectomy syndrome returned 0 results with the applied search filters. Repeat the search without filters” This from NHS national institute for Heath and Car Excellence, search for “postcholecystectomy syndrome” . ‘Problem does not exist’ explains why post care support unlikely to be provided when they do.
The truth : after gallbladder surgery, medical studies confirm up to 40% of patients develop problems. The medical term for this condition is postcholecystectomy syndrome (PCS). In order to cover up and maintain the fraud, NHS will then withhold adequate post care of duty diagnosis for treatment support for PCS. The outcome from this fraud in includes reduced quality of life and life span.
Bigger question for NHS : What post care support do you provide for the reported 43% of patients likely to develop post complications of which 10% likely to be chronic , 2 days to 25 years down the track ? OR mitigation care support to monitor, diagnose and prevent ?
Your search for “postcholecystectomy syndrome” returned 0 results with the applied search filters. Repeat the search without filters Bigger question for NHS : What post care support do you provide for the reported up to 43% of patients (female) likely to develop post compilations, 2 days to 25 years down the track and of which 10% likely to be chronic ? OR what post care treatment support to monitor, diagnose, mitigate and prevent Post Cholecystectomy complications ?
Legal concerns: patents must be advised medical studies conclude that due to the chronic nature of post heath problem Patients should be advised the truth about both the risks of surgery and the risk of postoperative persistence of symptoms. Below confirms they are clearly are not.
One of the possible reasons NHS withholds truth or even disclose the direct link between post complication risks and removal of the gallbladder function is because that there is no conventional treatment for Postcholecystectomy syndrome . The patients will be passed around the care of the variety of doctors and medical practitioners with different skills, knowledge, and viewpoint on the Postcholecystectomy syndrome. Likely outcome is diagnosis for post care treatment will never be obtained by patients, but instead lift to suffer for years with some consequences described as ” chronic’
And diagnosis for Postcholecystectomy syndrome complications would lead to the requirement to provide treatment, diagnosis could be presented as evidence in a medical malpractice lawsuit , failure to provide informed consent of likely risks.
In addition, cruel, inhuman, or degrading treatment (AKA torture) can best describes NHS process of when engage in cholecystectomy treatment that knowingly has the outcome or negligently inflicts chronic severe pain or suffering with out justification or with out specific patient informed consent. Withhold post care treatment, support, diagnosis or even help to mitigation of likely post complications (PCS) is a criminal act. in which case both the NHS and consulting surgeon must be held accountable.
The International Covenant on Civil and Political Rights (ICCPR), article 7, “no one shall be subjected to torture or to cruel, inhuman or degrading treatment”
Biggest concern of all
Known medical fraud committed by surgeons carrying out unnecessary surgeries, for income, training all the expense of patients true wellbeing
In the US, estimated 7.5 million unnecessary medical and surgical procedures are performed each year, writes Gary Null, PhD., in Death by Medicine. Rather than reverse the problems they purport to fix, these unwarranted procedures can often lead to greater health problems and even death. A 1995 report by Milliman & Robertson, Inc. concluded that nearly 60 percent of all surgeries performed are medically unnecessary, according to Under The Influence of Modern Medicine by Terry A. Rondberg. Some of the most major and frequently performed unnecessary surgeries include hysterectomies, Cesarean sections and coronary artery bypass surgeries.
One US based studies concluded and Increased rate of cholecystectomies performed with doubtful or no indications gallbladder problems. S
Surgeons incentivized to perform surgical procedures, either for financial gain or even training, the fitter and heather patient the better. Laparoscopic Cholecystectomy even considered the surgeons new cash cow ‘ bread and butter’ income stream.
Republished from Consumer Reports on Health (March 1998) by Quake Watch - Needless Surgery
“But since the advent of laparoscopy (cholecystectomy), the number of gallbladder operations has risen 40 percent. And a study of some 54,000 gallbladder surgeries in Pennsylvania found that the number of procedures done in patients with minimal or no symptoms has risen more than 50 percent. Apparently, the advantages of the new technique have convinced some doctors to try preventing severe attacks before they occur.
While laparoscopy is generally less traumatic than the old approach, it’s still major surgery with major potential risks. In fact, accidental severing of the bile duct, which can cause permanent liver damage, occurs in 1 to 2 percent of laparoscopies—three times more often than in open (cholecystectomy) surgery.
Doctors own medical studies confirming fraud, like unnecessary surgery treatments for the benefit of surgeons training requirements
Cannizzaro Hospital (Italy) Ethics Committee commissioned this study to investigate why laparoscopic cholecystectomies had dramatically increased and whether unnecessary overtreatment was taking place. The study found:
- 9.38% underwent surgery due only to the presence of gallstones being diagnosed and no other symptoms present.
- over 20% presented vague symptoms again after the cholecystectomy, demonstrating that the symptoms that led to the diagnosis for cholecystectomy surgery were not related to the presence of the gallbladder stones, determining the need of further exams to identify their source.
The study considered first of its kind ( ethical driven ) concluded reason for (FAKE) diagnoses leading to unnecessary cholecystectomies surgery procedures was most likely due to surgeons perceived training requirements for introduction of different devices and new (laparoscopic) approaches. Surgeons lie to obtain informed consent.
Pulvirenti, E., Toro, A., Gagner, M., Mannino, M., & Di Carlo, I. (2013). Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience. BMC Surgery, 13, 17. http://doi.org/10.1186/1471-2482-13-17
Numbers Don’t lie
More evidence confirming Increased rate of cholecystectomies performed with doubtful or no indications gallbladder problems – incorrect or unjustified (FAKE) diagnosis for treatment
Submission: A Rapid rise in cholecystectomies seen following development of laparoscopic technique becoming main stream
NHS own Statistics – Recorded cholecystectomies
2003-2004 50,000 aprox
- “Approximately 70,000 cholecystectomies were performed in the UK in 2011–2012, a substantial rise from 50,000 in 2003–2004″ nearly 34 per cent from 2004 to 2011, according to NHS statistics. https://www.sciencedirect.com/science/article/pii/S1743919114002088#bib8
- “60,315 cholecystectomies were performed in 2009″https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsbull.2015.e17
- A 2013 study for Organisation for Economic Co-operation and Development. Health care utilisation: surgical procedures (shortlist) identified the rate of laparoscopic cholecystectomy per 100,000 people in the UK was 125. This now consecrate rate at 2017 would indicated 81,500 laparoscopic cholecystectomy procedures per annual are taking place.
And now Laparoscopic Cholecystectomies is the most common elective surgery in the UK.
Unnecessary surgeries confirmed gain
One Scottish showed Cholecystectomies decreasing 1% per year, and then bam, Laparoscopic Cholecystectomies came onto the market for patient services
This survey determined the effect of the introduction of laparoscopic cholecystectomy on the rates of cholecystectomy (total and laparoscopic) in Scotland. From 1977 to 1990, the Scottish cholecystectomy rate fell by an average of almost 1% per annum. With the advent of laparoscopic cholecystectomy, the total cholecystectomy rate (open and laparoscopic) rose considerably–by 18.7% from 1989-93 (p < 0.05). The largest increase (25%) was observed in the 45-64 years age group but it was also particularly evident (19%) in elderly patients (65-74 years). Subjects were more likely to undergo laparoscopic cholecystectomy than open cholecystectomy if they were young and female. The increased cholecystectomy rate observed merits careful scrutiny and health economic evaluation.
Study noted ” The total cholecystectomy rates in two states in the USA have increased since the introduction of LC, with estimates of the increase varying from 28-60%. The reasons for this apparent worldwide change are not known. The increased cholecystectomy rate may reflect a lowered surgical threshold (over alternative treatment) but other factors may be operative
IN OTHER WORDS – SURGEONS TARGETING YOUNG HEALTHY UNSUSPECTING WOMAN FOR PRACTICE AND ENTREPRENEURIAL EXPLOITATION
One US Private practice studies Cholecystectomies increased 159% following the introduction of laparoscopic cholecystectomy. Went on to say:
“It seems that the use of laparoscopic cholecystectomy, a new technology touted as reducing health care costs, may result in an increased consumption of health care resources due to changes in the indications for gallbladder surgery.(JAMA. 1993;270:1429-1432″
IN OTHER WORDS CHANGES IN HOW A DIAGNOSIS FOR PROBLEM REQUIRING SURGERY TOOK PLACE
Fake NHS Informed Consent patient handouts (Deception)
Fake informed consent patient handouts through Selective referencing – by excluding relevant information needed by a patient to make an informed consent decision on treatment options
The Truth - Informed consent obtained by deception, put patients long term heath safety at risk by omitting the following (evidence based) risks options found elsewhere – never disclosed by NHS: Gall bladder removal has increased by nearly 34 per cent from 2004 to 2011, according to NHS statistics. And now the most common elective surgery in the UK.
NHS medical malpractice fraud – Informed consent for gallbladder surgery obtained by deception
Fake informed consent patient handouts through Selective referencing – by excluding relevant information needed by a patient to make an informed consent decision on treatment options
Top 8 non truths NHS tells patients in order to obtain informed consent for Gallbladder Surgery Claims presented to NHS patients in informed consent forms, patient handouts which cannot be backed up by any evidence based medical study.
 ‘You don’t need a gallbladder’. ‘So surgery to take it out is often recommended’
 ‘You can lead a perfectly normal life without a gallbladder’.
 ‘Your liver will still make enough bile to digest your food but, instead of being stored in the gallbladder, it drips continuously into your digestive system’
False / Deception: Surgeons will even advise their patient the Gallbladder is a ‘ vestigial organ made redundant by evolution in order to provide the patient assurance they are doing the right thing to remove. The gallbladder in fact is a very important function and can be described as a protector of the liver and colon. It is essential for:
- Enables fat digestion, fat will be poorly digested. Many people experience diarrhea, bloating, nausea or indigestion.
- Enables absorption of fat soluble antioxidants and vitamins A, E, D and K.
- Assists the removal of cholesterol from your body
- Assists the removal of toxins that have been broken down by the liver
Truth is you are 99% likely to survive removal but cannot live healthy without a gallbladder. The body cannot ever property extract nutrients from food again normally, the liver becomes over worked trying to produce move bile needed to process food where the gallbladder function once stored, concentrated and delivered on demand. Food is toxic to the body if not processed correctly. End result based on the long list of bad outcomes (see below medical studies) and sadly is reduced life span. I.e. elevated risk of colon cancer, cardiovascular disease, type 2 diabetes mellitus, high blood pressure, and high cholesterol levels once removed. Heath professionals agree the top two ROOT CAUSES of chronic and degenerative diseases in modern times are:
- Nutritional Deficiency
 ‘Surgery side effects are temporary. (bloating, flatulence and diarrhea – this can last a few weeks)’
False: The side effects listed are generally accessed as being lifelong. The human body digestive system is permanently disabled once the gallbladder is removed.
 Eat a normal diet straight away – you can return to a normal diet
False: It is the greatest disservice your doctor can do to send you home and pretend you can process food normally. A personalized post-surgery diet plan is recommended as well as a long term diet change.
 Some people experience symptoms similar to those caused by gallstones after surgery (tummy pain, indigestion, diarrhoea).
 his is known as post-cholecystectomy syndrome (PCS) and it’s thought to be caused by bile leaking into areas such as the stomach or by gallstones being left in the bile ducts.
 In most cases symptoms are mild and short-lived
False and Misleading: to advise post-cholecystectomy syndrome as having low grade issues. Excluded are major issues such as “Bile Reflux, gastritis, pancreatitis, Irritable Bowel Syndrome and Sphincter of Oddi Dysfunction are just a few heath issues that reduced quality of life.
Deceptive to use the words ‘Some’ and ‘mild’ and ‘short lived’ , a breach of duty by fail to warn of true likely risks associated with removing gallbladder and its function.
Medical studies confirm the incidence of postcholecystectomy syndrome has been reported to be as high as 40% and the onset of symptoms may range from 2 days to 25 years. Symptoms occur and can be transient, persistent or lifelong. The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases. For some patients, PCS makes life miserable and result in reduced quality of life
One medical study concludes the incidence of Bile Duct Injury during laparoscopic cholecystectomy remains as high as 1.4% and has a great impact on the patient’s physical and mental quality of life, even at long-term follow-up.
Patents are never advised treatment or post care support will NEVER be provided to help mitigate or postpone complications and progression of the postcholecystectomy syndrome and other symptoms, which are very far from stomach such as depression, anxiety, low memory, skin dryness or itchiness, yellowish skin, blurred vision, bruises, tingling and numbness, often colds and more And seen also in other NHS hospital consent forms
Very rarely, patients notice that their bowels are a little looser (diarrhea) than before the operation.
You will be able to eat a normal diet after your operation
Unfortunately there is no non-surgical alternative; the only successful treatment is to remove (the gall bladder and) gallstones completely.
False and Intentionally Misleading:: Possibly the best well-crafted and deceptive statement invented by Surgeons, effectively misleading patients into thinking the only option to remove gallstones completely is to remove the gallbladder and no alternate non surgery treatment option is available .
Fact: Following the advent of laparoscopic cholecystectomy – removal of gallbladders for treatment of gallstones and gallbladder problems increase dramatically in the UK. Nonsurgical methods of gallstone removal, including pharmacologic dissolution, shock wave lithotripsy, and endoscopic laser ablation, were once considered alternatives to the traditional surgical approach are almost never advised to clients during the informed consent process
40% over traditional alternative treatment options such as. This is never disclosed by the NHS.
Cholecystectomies performed, with over a 40% increase in cholecystectomy for acute acalculous cholecystitis, and 300% increase for biliary dyskinesia.
Although nonsurgical methods of gallstone removal, including pharmacologic dissolution, shock wave lithotripsy, and endoscopic laser ablation, were once considered alternatives to the traditional open surgical approach, widespread use of laparoscopic cholecystectomy with its increased patient acceptance, has generally lead to the limitation of these treatments as alternatives.
Can I manage without my Gall Bladder? Yes. The gall bladder is a reservoir for bile and we are able to manage without it. Rarely patients notice that their bowels are a little looser than before the operation but this is uncommon
Definition of uncommon: out of the ordinary; unusual. adjective - unusual, abnormal, rare, atypical, uncustomary, unconventional, unexpected, unfamiliar, strange, odd, curious, out of the ordinary, extraordinary, out of the way, outlandish, offbeat, irregular, deviant, novel, singular, peculiar, queer, bizarre, freakish, quirky, alien;
False and deceptive to advise risks post-cholecystectomy diarrhoea as being rare or uncommon: Evidence based medical studies report up to 20% report diarrhoea as a troublesome problem. Bile acid malabsorption (BAM) was seen in 65.5% patients with PCD
- “Generally once the gall bladder is removed the symptoms you have had will resolve. In some instances they persist for a short time and then get better”
- “Removal of the gall bladder does not usually impair the digestive system”
- “There are no other effective, safe, durable and widely accepted alternatives to surgery”. “The other alternative is to have no treatment.”
- “you may experience some diarrhoea after surgery. This should settle within three or four weeks. If the diarrhoea is bothersome your local chemist can advice you on over-the-counter remedies.”
- “Your gall bladder is not an essential organ. If it is removed, bile flows to your intestines directly from your liver and digestion continues as normal.”
Proof – Here’s an extract from an Informed Consent handout which confirmed all the above being dishonest
- “Are there any alternative treatments?: In very occasional cases, your gallstones may be suitable for treatment with medicines that allow your stones to dissolve. Your doctor will explain this if it applies to you”
FAKE PATIENT HANDOUTS continued
Strategically missing key info needed for a patient to make an informed consent decision for treatment options. Surgeons and hospitals will avoid advising patients alternative treatment option due to personal revenue income steam. This is informed consent fraud. Fundamental breach of human rights and the law. The most blatant fraudulent deception present to patients by NHS Cambridge university hospital in order to obtain patient consent can be see here. A NHS hospital that prides its self for:
“We believe in being transparent and accountable about the care and treatment we provide.”……… “Unfortunately there is no non-surgical alternative; the only successful treatment is to remove (the gall bladder and) gallstones completely. The results of this operation are very good and most patients can then return to eating a normal diet”
American College of Gastroenterology – Gallstones in Women
Treatment option - Dissolution of Gallstones: ursodeoxycholic acid, Actigal®, is a medicine that can be given as a pill to dissolve gallstones. Therapy requires at least 6 to 12 months and is successful in dissolving stones in 40-80% of cases. When surgery is too risky, the symptoms are mild, the stones are small, and rich in cholesterol, dissolution of gallstones is a reasonable alternative.
Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management actually states the following:
During the 1990s, there was a 29% increase in the number of cholecystectomies performed, with over a 100% increase in cholecystectomy for acute acalculous cholecystitis and 300% increase for biliary dyskinesia. Although nonsurgical methods of gallstone removal, including pharmacologic dissolution, shock wave lithotripsy, and endoscopic laser ablation, were once considered alternatives to the traditional open surgical approach, widespread use of laparoscopic cholecystectomy with its increased patient acceptance, has generally lead to the limination of these treatments as alternatives.
Therapy of gallstone disease: What it was, what it is, what it will be. Portincasa P1, Ciaula AD, Bonfrate L, Wang DQ. https://www.ncbi.nlm.nih.gov/pubmed/22577615?dopt=Abstract
Cholesterol gallstone disease is a common clinical condition influenced by genetic factors, increasing age, female gender, and metabolic factors. Although laparoscopic cholecystectomy is currently considered the gold standard in treating patients with symptomatic gallstones, new perspectives regarding medical therapy of cholelithiasis are currently under discussion, also taking into account the pathogenesis of gallstones, the natural history of the disease and the analysis of the overall costs of therapy. A careful selection of patients may lead to successful non-surgical therapy in symptomatic subjects with a functioning gallbladder harboring small radiolucent stones. The classical oral litholysis by ursodeoxycholic acid has been recently paralleled by new experimental observations, suggesting that cholesterol-lowering agents which inhibit cholesterol synthesis (statins) or intestinal cholesterol absorption (ezetimibe), or drugs acting on specific nuclear receptors involved in cholesterol and bile acid homeostasis, might be proposed as additional approaches for treating cholesterol gallstones. In this review we discuss old, recent and future perspectives on medical treatment of cholesterol cholelithiasis.
The Fraud in more detail
Informed Consent: An Ethical Obligation (AND) or Legal Compulsion
Informed consent must be preceded by disclosure of sufficient information. Therefore, accurate, adequate and relevant information must be provided truthfully in a form (using non-scientific terms) and language that the patient can understand. It cannot be a patient’s signature on a dotted line obtained routinely by a staff member.
DISCLOSURE OF INFORMATION
The information disclosed should include:
- The condition/disorder/disease that the patient is having/suffering from
- Necessity for further testing
- Natural course of the condition and possible complications
- Consequences of non-treatment
- Treatment options available ( including
- Potential risks and benefits of treatment options (lifelong risks of developing Postcholecystectomy syndrome (PCS )
- Duration and approximate cost of treatment
- Expected outcome
- Follow-up required (lifelong support needed)
ETHICAL – Violations
The concept of consent arises from the ethical principle of patient autonomy and basic human rights. Patient’s has all the freedom to decide what should or should not happen to his/her body and to gather information before undergoing a test/procedure/surgery. No one else has the right to coerce the patient to act in a particular way.
LEGAL – Violations
No one has the right to even touch, let alone treat another person. Any such act, done without permission (as a result of making informed consent), is classified as “battery” – physical assault and is punishable. The issue: Non-disclosure for the following risks post removal of gallbladder and function. False information putting patient safety at risk What the law says
What the law says
UK Law : ” The legal position regarding the provision of information needed to make an informed consent derives from the 1985 case of Sidaway v Board of Governors Bethlem Royal Hospital (Sidaway v Board of Governors Bethlem Royal and the Maudsley Hospital  2 WLR 480), where the House of Lords held that the legal standard to be used in deciding whether adequate information had been given to a patient would be the same as that in judging whether a doctor had been negligent in their care”
US Law ” What constitutes a material risk is at the heart of the controversy surrounding the informed consent doctrine. Generally, the patient should be informed of all serious risks, even if unusual or rare. In one court case, a 1% risk of hearing loss required disclosure (Scott v. Wilson, 396 S.W.2d 532 [Tex. Civ. App. 1965]) In Canterbury, a young man was advised by his physician to undergo a laminectomy in an effort to alleviate back pain. The physician, aware that 1 percent of laminectomies resulted in paralysis, did not advise the patient of the risk because he believed this might cause the patient to reject the useful treatment. Following the procedure, the patient fell from his hospital bed and was paralyzed. It remained uncertain whether the laminectomy procedure or the patient’s fall caused the paralysis. The patient sued, alleging that the physician failed to inform him of the risks associated with the procedure. The court held that “the standard measuring [physician] performance…is conduct which is reasonable under the circumstances”. In other words, the court held that, instead of adhering to the community disclosure standard, physicians are now required to disclose information if it is reasonable to do so. Essentially, to establish true informed consent, a physician is now required to disclose all risks that might affect a patient’s treatment decisions. In Canterbury, the decision outlined key pieces of information that a physician must disclose:
- condition being treated;
- nature and character of the proposed treatment or surgical procedure;
- anticipated results; (4) recognized possible alternative forms of treatment; and
- recognized serious possible risks, complications, and anticipated benefits involved in the treatment or surgical procedure, as well as the recognized possible alternative forms of treatment, including non-treatment.
HUMAN RIGHTS – Violation
The International Human Rights law including the Universal Declaration of Human Rights (1948) proclaims the right for all human beings to live in conditions that enable them to enjoy good health and health care.
Article 5: No one shall be subjected to cruel, inhuman or degrading treatment
Article 8: everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law.
Article 25: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, or other lack of livelihood in circumstances beyond his control.
The problem also associated with this procedures (carried out mainly to woman) often have brutal consequences for a woman’s physical and mental health. And likely in breach of The Convention on the Elimination of All Forms of Discrimination against Women (1979), the Convention against Torture, and other Cruel, Inhuman or Degrading Treatment or Punishment, prohibits the infliction of physical or mental pain or suffering on women.
NUREMBERG CODE Code – breached
Just like the Nuremberg trials defendants, we assume doctors never aspired to bring evil into medicine but rather they over-identified with an ideological providing healing through the sacrifice of innocent trusting patients’ lives. Lacking empathy they couldn’t fully appreciate the human consequences of their career-motivated decisions.
Leo Alexander, a Viennese-born American physician gave a memorandum entitled “Ethical and Non-Ethical Experimentation on Human Beings,” in which he identified three ethical, legal, and scientific requirements for the conduct of human experimentation. The second point is key which focused on the duty of physicians as expressed in the Hippocratic Oath, which Alexander restated in research terms:
“the medical Hippocratic attitude prohibits an experiment if the foregone conclusion, probability or a priori reason to believe exists that death or disabling injury of the experimental subject will occur”
Source : FIFTY YEARS LATER: THE SIGNIFICANCE OF THE NUREMBERG CODE. EVELYNE SHUSTER, PH.D.
From the Nuremberg trails emerged principles, the Nuremberg Code, that guide us today. These include, as regards medical interventions,
- The voluntary consent of the human subject is absolutely essential
- Exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion…
- Should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him/her to make an understanding and enlightened decision.
The last one is key. For consent to be valid, the person, or patient, must know everything. Consent, in this context, is a corollary of autonomy, probably the stoutest pillar in the ethical framework that doctors refer to on a day to day basis. Tom Beauchamp and James Childress, working in Healy Hall, Georgetown University, Washington, wrote Principles Of Biomedical Ethics, containing the now familiar touchstones:
Autonomy: The right for an individual to make his or her own choice.
Beneficence: The principle of acting with the best interest of the other in mind.
Non-maleficence: The principle that “above all, do no harm,” as stated in the Hippocratic Oath.
Justice: A concept that emphasizes fairness and equality among individuals.
Are doctors above the law?
The United States chief prosecutor for the Nuremberg trials, Telford Taylor opening statement pointed out this was “no mere murder trial,” because the defendants were physicians who had sworn to “do no harm” and to abide by the Hippocratic Oath. “ the trial was a murder trial and murder had been identified as a crime against humanity”
The true risks NHS never discloses to patients
Informed consent obtained by deception, puts patients long term heath safety at risk by omitting the following (evidence based) risks opinion never disclosed to patients.
Not disclosed to patients, specialist medical opinion and studies list the following expected risks, side effects, diseases, syndromes and conditions after the removal of the gallbladder and its function (Cholecystectomy). The majority of these problems are not accepted by surgeons, heath service providers, public or private hospitals, as a risks to disclose and blocked from the informed consent process, nor advised during post-operative follow-ups. NHS may want to consider the following as being true and honest disclose of long term outcome risk . And consider the law, your risk of liability for risk not disclosed . And consider medical ethics under Nurburgring trials code of ethics.
Note: The main reasoning behind not including Post Cholecystectomy risk in patient consent forms is because Doctors are required by law and medical ethics to ensure each patients has understand all content information of the consent form before obtaining signed consent and proceeding with treatment. The Helsinki Declaration : Informed Consent obtained , ‘After ensuring that the potential subject has understood the information’
They are but not exclusive to:
|Biliary track||Biliary injury Cholangitis Choledochoduodenal fistula Choledocholithiasis Clip migration / Inaccurate clip placement Dyskinesia Nonspecific dilatation or hypertension Obstruction Strictures Stump cholelithiasis Adhesions Cyst Dilation without obstruction Fistula Hypertension or nonspecific dilation Malignancy and cholangiocarcinoma Trauma|
|Colon||Adhesions; incisional hernia; irritable bowel diseaseConstipationDiarrhoea Incisional hernia|
|Duodenum||AdhesionsDuodenal diverticulaIrritable bowel disease Peptic ulcer disease Perforation|
|Esophagus||AchalasiaAerophagiaDiaphragmatic hernia Esophagitis Hiatal hernia|
|Gallbladder and cystic Duct remnant||InflammationLeakMirizzi’s syndrome Mucocele Neuroma (Amputation ), suture granuloma Residual or reformed gallbladder Stump cholelithiasis|
|Liver||Chronic idiopathic jaundiceCirrhosisCyst Dubin-Johnson syndrome Fatty liver; hepatitis; cirrhosis; idiopathic jaundice Gilbert disease Hepatitis Hydrohepatosis Liver abscess Sclerosing cholangitis|
|Nerve||Intercostal lesionsIntercostal neuralgiaNeuroma Neurosis Psychic tension or anxiety Spinal nerve lesions Sympathetic imbalance|
|Pancreas||Benign tumorsFunctional pancreatic sphincter disorderPancreatic cysts Pancreatic stone Pancreatitis Stone Tumors|
|Periampullary||PapillomaSphincter of Oddi dysfunction (Functional biliary sphincter disorder); spasm; hypertrophyspasm; hypertrophySphincter of Oddi stricture Stricture|
|Small bowel||AdhesionsAdhesions; incisional hernia; irritable bowel diseaseIncisional hernia Irritable bowel disease|
|Stomach||Bile gastritisPeptic ulcer disease|
|Vascular||Coronary anginaInjury to hepatic artery, portal vein (pseudoaneurysm, portal vein thrombosis)Intestinal angina Mesenteric ischemia|
|Miscellaneous||Dropped GallstonesParasitic infestation (Ascariasis)Thermal injury Trocar site hernia|
|Other||AnxietyBacteria overgrowth in the stomachBarrett’s oesophagusBezoars Bile Acid Malabsorption Bile Reflux Bloating Celiac Disease Cramps Decrease in bile secretion Depression Diabetes Dumping of bile Syndrome Foreign bodies, including gallstones and surgical clips Gas Gastroparesis GERD Reflux Heartburn Irritable Bowel Syndrome Nausea Pain – right upper abdomen Pain – shoulders and abdomen Thyrotoxicosis Weight gain Weight loss|
Evidence based medical studies confirming statistically significant increased risk of cancer following cholecystectomy, required by law but never disclosed by doctors during the informed consent process listed as:
|Other Biliary tract Liver Colon Esophagus Stomach Liver Liver Pancreas Periampullary Other||Adrenal cancer Ampulla of Vater cancer Cholangiocarcinoma cancer Colorectal cancer (Colon / Bowl) Esophageal cancer Gastric cancer Hepatocellular carcinoma cancer Liver cancers Pancreatic cancer Periampullary cancer Smallintestine carcinoid cancer|
“Postcholecystectomy Syndrome (PCS) describes the presence of abdominal symptoms after surgical removal of the gallbladder (cholecystectomy). Symptoms of Postcholecystectomy Syndrome may include: Upset stomach, nausea, and vomiting, gas, bloating, and diarrhoea. Persistent pain in the upper right abdomen.
Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy, and can be transient, persistent or lifelong. The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases.”
“Biliary Diseases Laparoscopic Cholecystectomy. Postcholecystectomy Syndrome Dr. Jacob L. Turumin (Iakov L. Tyuryumin), MD, PhD, DMSci”
“The absence of the gallbladder leads to functional biliary hypertension and increased hepatic and common bile duct . 3-5 years after cholecystectomy increases right and left hepatic ducts equity.
Functional hypertension in the common bile duct contributes to the appearance of functional and hypertension in Wirsung’s pancreatic duct with the development of the phenomena of chronic pancreatitis . At the same time period in some patients this is accompanied by the progression of chronic pancreatitis, sphincter of Oddi dysfunction and duodenogastric (Biliary / bile ) reflux.
Duodenogastric reflux of mixture of bile with pancreatic juice promotes atrophic gastritis in the antral part of stomach.
From 40% to 60% of patients after cholecystectomy dyspeptic suffering from various disorders, from 20% to 40% of pains of different localization .
Up to 70% of patients after cholecystectomy have chronic effects of “bland” cholestasis, chronic cholestatic hepatitis and chronic compensatory bile acid-dependent apoptosis of hepatocytes.
Patients undergoing cholecystectomy had an increased prevalence of metabolic risk factors for cardiovascular disease, including type 2 diabetes mellitus, high blood pressure, and high cholesterol levels.
Part of patients after cholecystectomy with increased concentration of hydrophobic hepatotoxic co-carcinogenic deoxicholic bile acid in serum and/or feces with increased risk of colon cancer”
Postcholecystectomy syndrome (PCS), S. Mohandas, L.M. Almond, Department of General Surgery, Worcestershire Royal Hospital, Worcester, UK
“The incidence of postcholecystectomy syndrome has been reported to be as high as 40% in one study, and the onset of symptoms may range from 2 days to 25 years. There may also be gender-specific risk factors for developing symptoms after cholecystectomy. In one study, the incidence of recurrent symptoms among female patients was 43%, compared to 28% of male patients.”
“cholecystectomy is associated with several physiological changes in the upper gastrointestinal tract which may account for the persistence of symptoms or the development of new symptoms after gallbladder removal. The cholecyst sphincter of Oddi reflex, cholecyst-antral reflex, and cholecyst-oesophagal reflexes are all disrupted and some local upper gastrointestinal hormonal changes also occur after cholecystectomy. Thus, there is an increased incidence of gastritis, alkaline duodene gastric reflux and gastro-oesophageal reflux after cholecystectomy, all of which may be the basis for postcholecystectomy symptoms.”
The postcholecystectomy syndrome: A review, Khalid R Murshid, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
Instance of Post Cholecystectomy Syndrome sustainably increased when patients followed for 5-9 years vs. only two years’ follow-up
Cholecystectomy and Clinical Presentations of Gastroparesis, the NIDDK Gastroparesis Clinical Research Consortium (GpCRC)*
Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization and had a worse quality of life.
Jacob L. Turumin, Victor A. Shanturov, Helena E. Turumina Irkutsk Institute of Surgery, Irkutsk Regional Hospital, Irkutsk 664079, Russia
The basic role of the gallbladder in a human is a protective. The gallbladder decreases the formation of the secondary hydrophobic toxic bile acids (deoxycholic and lithocholic acids) by accumulating the primary bile acids (cholic and chenodeoxycholate acids) in the gallbladder, thus reducing their concentration in gallbladder-independent enterohepatic circulation and protecting the liver, the mucosa of the stomach, the gallbladder, and the colon from their effect
- Wikipedia, Postcholecystectomy syndrome. https://en.wikipedia.org/wiki/Postcholecystectomy_syndrome
- Steen W Jensen, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF Postcholecystectomy Syndrome [medscape.com]
- S.S.JaunooS MohandasL.M.Almond. Postcholecystectomy syndrome (PCS) [ScienceDirect]
- Sureka B, Mukund A. Review of imaging in post-laparoscopy cholecystectomy complications. Indian J Radiol Imaging 2017;27:470-81 [Indian Journal of Radiology and Imaging]
- Murshid KR. The postcholecystectomy syndrome: A review. Saudi J Gastroenterol [serial online] 1996 [cited 2018 Jan 15];2:124-37. Available from: http://www.saudijgastro.com/text.asp?1996/2/3/124/34017
- Girometti, R., Brondani, G., Cereser, L., Como, G., Del Pin, M., Bazzocchi, M., & Zuiani, C. (2010). Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. [The British Journal of Radiology, 83(988), 351–361]
- Jacob L. Turumin, Victor A. Shanturov, Helena E. Turumina. Irkutsk Institute of Surgery, Irkutsk Regional Hospital, Irkutsk 664079. The role of the gallbladder in human [ScienceDirect]
- Dr. Jacob L. Turumin, MD, PhD, DMSci Biliary Diseases Laparoscopic Cholecystectomy. Postcholecystectomy Syndrome. http://www.drturumin.com/en/index.html#sthash.Y35Uey8C.dpuf
- Martin, Walton. “RECENT CONTROVERSIAL QUESTIONS IN GALL-BLADDER SURGERY.” Annals of Surgery 79.3 (1924): 424–443. Print. [PMC]
- Donato F. Altomare*, Maria T. Rotelli, Nicola Palasciano. Diet After Cholecystectomy . Current Medicinal Chemistry Volume 24 , 201 http://www.eurekaselect.com/node/152535/article
- The NIDDK Gastroparesis Clinical Research Consortium (GpCRC). “Cholecystectomy and Clinical Presentations of Gastroparesis.” Digestive diseases and sciences 58.4 (2013): 1062–1073. [PMC]
- Yong Zhang , Hao Liu , Li Li , Min Ai , Zheng Gong, Yong He, Yunlong Dong, Shuanglan Xu, Jun Wang , Bo Jin, Jianping Liu, Zhaowei Teng Cholecystectomy can increase the risk of colorectal cancer: A meta-analysis of 10 cohort studies Published: August 3, 2017 https://doi.org/10.1371/journal.pone.0181852
- Mearin, F., De Ribot, X., Balboa, A. Duodenogastric bile reflux and gastrointestinal motility in pathogenesis of functional dyspepsia. Role of cholecystectomy. Digest Dis Sci (1995) 40: 1703. https://doi.org/10.1007/BF02212691
- Simona Manea, Georgeta & Carol, Stanciu. (2008). DUODENOGASTROESOPHAGEAL REFLUX AFTER CHOLECYSTECTOMY. Jurnalul de Chirurgie. 4 [Researchgate]
More honest truth and transparent opinion
Heath risks not accepted Doctors, Surgeons, hospital intervention consultants and not never presented to patients during informed consent process:
The body is permanently damaged and cannot be healthy without a gallbladder and its function. You can live, but in many cases you will be miserable. Some common side effects of gallbladder removal are an upset stomach, nausea, and vomiting. Gas, bloating, and diarrhoea. Persistent pain in the upper right abdomen.
It is gross medical misconduct to send a patient home and pretend you don’t need a gallbladder, and due to the considerable numbers of affected patients, Under Article 32 of the 1949 Geneva Convention IV, an ongoing crime against humanity.
Most patients suffer permanent impairments of the digestive system as a consequence of cholecystectomy, and develop various disorders as a result of poor digestion. The gall bladder is a vital organ with a crucial role in the absorption of fat and fat-soluble vitamins A, D, E and K and in essential fatty acids (omega-3 and omega-6), and poor cholesterol metabolism. In the long run, this may contribute to fatty liver. The absence of the gall bladder affects not only the process of food digestion but a wide range of other internal processes as well. In time, patients who have suffered cholecystectomy are also exposed to a high risk of developing heart disease, diabetes and disorders of the nervous system. This is due to inappropriate synthesis and assimilation of vital nutrients, vitamins and minerals.
Symptoms and Conditions
|Vitamin A deficiency signs include||Dry eyes Drying, scaling, and follicular thickening of the skin Night blindness Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks) Respiratory infections|
|Vitamin D deficiency linked to a strikingly diverse array of common chronic diseases, including:||Alzheimer’s disease Asthma Autism Cancer Cavities Cold and fly Crohn’s disease Cystic fibrosis Diabetes 1 and 2 Dementia Depression Eczema & Psoriasis Hearing loss Hypertension Heart disease Infertility Inflammatory Bowel Disease Insomnia Macular degeneration Migraines Multiple Sclerosis Muscle pain Obesity Osteoporosis Periodontal disease Preeclampsia Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks) Rheumatoid arthritis Septicemia Seizures Schizophrenia Signs of aging Tuberculosis|
|Vitamin E deficiency signs include:||asthma and allergies brain damage cancer cognitive decline high oxidized LDL cholesterol levels hot flashes menstrual pain poor circulation prostate and breast cancers|
|Vitamin K deficiency can lead to:||Arterial calcification Cardiovascular disease Dementia Infectious diseases such as pneumonia Leukemia Liver cancer Lung cancer Osteoporosis Prostate cancer Tooth decay Varicose veins|
|Deficiencies in essential fatty acids||Allergies Alzheimer’s disease Asthma Bone weakness Brittle or soft nails Cancer Cracked skin on heals or fingertips Dandruff or dry hair Dry eyes Dry Eye Syndrome Dry, flaky skin, alligator skin, or “chicken skin” on backs of arms Fatigue Frequent urination or excessive thirst Gallstones Heart disease Lowered immunity, frequent infections Lupus erythematosus and other autoimmune diseases Multiple sclerosis Parkinson’s disease Peripheral artery disease Poor attention span, hyperactivity, or irritability Poor mood Poor wound healing Postpartum depression Premature birth Problems learning Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks) Rheumatoid arthritis Schizophrenia Tissues and organ inflammation Ulcerative colitis Vascular complications from type 2 diabetes|
National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. https://doi.org/10.17226/1222. https://www.nap.edu/read/1222/chapter/14#317
Why Doctors (Surgeons) lie about cholecystectomy risks
Why would a reasonable surgeon consider performing unneeded surgical procedures?” From a surgeon’s perspective, two distinct answers appear intuitive:
1. We perform surgery because we have been trained to do so and because “we have always done it this way” or we simply do not know any better. In German psychology, this behaviour is analogous to a historic entity termed “Funktionslust”
2. We are incentivized to perform surgical procedures, either for financial gain, renown, or both
Philip F. StahelEmail author, Todd F. VanderHeiden and Fernando J. Kim. Why do surgeons continue to perform unnecessary surgery? https://doi.org/10.1186/s13037-016-0117-6
History – Surgeons have always lied about Laparoscopic Cholecystectomy
Despite of the formal recognition and endorsement of ethical principles set forth in the Nuremberg Code and Declaration of Helsinki by Doctors, the institutionalized development of laparoscopic cholecystectomy through leaning on ‘test subjects’ breach ethical, moral and legal standards. This infringement breaching all basic human right were deemed acceptable outcomes in a surgeon’s quest for the entrepreneurial exploration of the procedure, so too were the resulting deaths and injuries that followed.
Early in the national experience with laparoscopic cholecystectomy it became apparent that some surgeons who were in the early phases of their training would misidentify the anatomy and inadvertently clip and divide the common bile duct thinking it to be the cystic duct. In many instances this would result in complete obstruction of the common bile duct which would require a second operation to correct. Often these injuries were not noted at the time of the initial procedure and therefore a delay in the diagnosis of the problem often resulted.
Other problems of much less consequence have also been identified to occur following laparoscopic cholecystectomy. This includes entering the gall bladder and spilling stones and bile into the peritoneal cavity, failure to diagnose stones in the common bile duct, cystic duct clips falling off leading to bile peritonitis, holes being poked in the cystic dust while doing x-rays of the biliary tree (cholangiography), holes poked into the intestine or mesentery by either the needle used to fill the peritoneum with CO2 (Verness needle) or one of the trocars used to introduce the ports.
Doctors own testimonies at the time exposing the medical evil – criminal intent
“There were many who started performing surgery without acquiring adequate training and skills. The result was that there was an explosion of injuries to patients’ biliary systems as well as other parts of their bodies, and many patients were turned into biliary cripples requiring multiple operations and procedures in an effort to effect a repair – a result which was a medical disaster for the patient, who then became another victim of medical negligence”
Complications after laparoscopic cholecystectomy. MD Harvey R. Bernard’Correspondence information about the author MD Harvey R. Bernard1, BA Thomas W. Hartman1 Albany, New York, USA PlumX Metrics DOI : https://doi.org/10.1016/S0002-9610(05)80956-0
“The frequency of cholecystectomy has increased sharply, by 21%, since the advent of laparoscopic cholecystectomy. The serious injury rate may be approximately 15 times that observed after an open cholecystectomy.”
“The New York State department Of Health was alerted to possible problems posed by the largescale introduction of the laparoscopic methodology to general surgery as a treatment for diseases of the gallbladder by Dr. Hiram Polk, Jr., the editor of The American Journal Of Surgery, in May 1990. There were several factor that indicated a danger. These included:
(1) the attractiveness of the method to patients who were informed by the news media of the considerable benefits of minimally invasive surgery without any indication of the possible complications;
(2) the attractiveness of the method to surgeons who saw a ‘bread-and-butter operation threatened by nonsurgical treatment;
(3) the strong influence of instrument manufacturers for whom rapid dissemination of the technology was just good business; and
(4) the absence of the safeguards inherent in traditional surgical education in the numerous abbreviated training courses by which practitioners were introduced to laparoscopic methods.
The Columbus Dispatch June 5, 1995, Health column, New York Times News Service. “Gallbladder Surgery Easier–And Too Common?” By: Jane E. Brody
“In the five years since the technique was introduced, it has prompted a sharp rise in the number of gallbladders removed, in some cases from patients who have no symptoms.”
“Some experts now wonder whether the glamour of the high-tech procedure and the promise of a rapid postoperative recovery are resulting in a lot of needless surgery. Patients, though, forget that every operation has risks, and that the expected benefits from the surgery should justify taking those risks. Such justification may be lacking in most patients with gallstones that cause few or no symptoms.
Pedersen B1, Ellebæk MB, Dorfelt A, Qvist N. Cholecystectomy for uncomplicated gallbladder stones does not follow evidence-based recommendations.Dan Med J 64/11 November 2017 Danish Medical JOURN
CONCLUSIONS: Our results may represent over treatment and/or incorrect selection of patients suitable for surgery. More and larger prospective cohort studies are warranted to elucidate the indications for cholecystectomy in uncomplicated gallbladder stones.
May 1993. “Management Of Major Biliary Complications After Laparoscopic Cholecystectomy” By:G. Branum MD, C. Schmidt MD, J. Baillie Md, P. Suhocki MD, M. Baker MD, A. Davidoff. MD, S. Branch MD, R. Chari MD, G. Cucchiaro MD, E. Murray RN, T. Pappas MD, P. Cotton MD , W.C. Meyers MD.
Dr. E. Armistead Talman: “It is not enough for SAGES to state, and I quote, “New laparoscopic procedures require informed consent, the exercise of sound surgical judgement and documentation of results in an environment designed to meaningfully evaluate safety and efficacy.” This just does not address the assault that marketing and competitive pressures have unleashed (on patients). In many cases this means someone picks up the pieces after the fact as Dr. Meyers has so vividly demonstrated today.”
Dr. David Adams: “…this has led us to believe that bile duct injuries after laparoscopic choleystectomy are more common than previously recognized, a point, I think, that has been underscored by Dr. Meyers report today.”
Variations in Consenting Practice for Laparoscopic Cholecystectomy. AM Chen,* DR Leff,* J Simpson, SJD Chadwick, and PJ McDonald
CONCLUSIONS: More often than not, patients are not provided with consistent information to make an informed choice. We suggest that a preprinted consent form will provide a more uniform approach to consenting practice for laparoscopic cholecystectomy.
TRUTH – Patient testimony
1500+ testimonies of the health complications experienced after cholecystectomy procedures, all of which could be used as affidavits contradicting Doctors medical advise presented during the informed Consent process
Some cholecystectomy victims indicate they would like to sue their surgeon for not disclosing the truth about long-term complications and risks to health.
Challenge your to read 50 patient testimonies :
Go here for another 1500 more:
The following testimony with gallbladder surgery in is not dissimilar to the thousands of victim’s disparately desperately seeking help through online medical support groups. For some, life a has been a sheer living hell.
I’m 17 years old. I had my gallbladder removed when I was 16, I have headaches, nausea, bloating, cramping, pains, insomnia, hard to concentrate…
Now, I’ve been researching the factors of symptoms after the surgery. I am aware that 40% of patients who go through the procedure experience difficulties. I am also aware that there is nothing to be done, that this is the lifetime effect.
I have an incredibly healthy diet…now after surgery. From my research, . Iit seems we should be taking enzymes to help us digest fat and possibly Cholacol, or bile salts. Since, the gallbladder creates bile.
I just want to be normal healthy and well. I fear I cannot be.
I know what’s wrong, I know the side effects of surgery. I do not want to take silly placebos or pain killers. I want to be better.
Is this non-repairable?. Is there no turning back? Can we only ease the pain? … Someone enlighten me. Is there a way to fix it? What have the doctors told you?
Cry for help unanswered. Final words hours before taking the only option to end suffering one year post cholecystectomy.
“ I been sick for a year I feel like I’m getting worse my GI dr pushed of to pain mgmt ….before the surgery I was average joe now if I can get symptoms under control I don’t how much longer I can go on like this everyday. I have to amazing kids and husband. And I can’t be the wife or mother I want to be…”
RIP Ange 2015 , beautiful young mother and loving wife
Examples of NHS Fake fraudulent Informed Consent patient handouts on file (Informed consent obtained by deception) NHS affiliated trust hospitals appear to be producing fake informed consent patient handouts through Selective referencing – by excluding relevant information needed by a patient to make an informed consent decision on treatment options