Introduction
“If liberty means anything at all, it means the right to tell people what they do not want to hear.”
― George Orwell, Animal Farm (1945)
― George Orwell, Animal Farm (1945)
"«It can never happen here» has been the traditional saying in Norway when incidents of scientific dishonesty have been disclosed around the world. In a small country with a limited number of medical researchers, traditions for transparency and a strong belief in honesty, there has been a more or less naïve attitude to fraud and research misconduct." (Source: "Research misconduct: lessons to be learned?" Magne Nylenna. Michael 2007;4:7–9. or see PDF)
LailasCase.com is a work-in-progress, public interest disclosure website of fact-based, verifiable and compelling evidence of long-term, ongoing, well-integrated academic misconduct, research misconduct, publication misconduct, and poly-institutional collusion & corruption which is used to implement and further promote a science-bending, medically & ethically flawed, national medical policy, protocol and ultrasound-based "method" for unilaterally determining gestational age for all pregnancies (including IVF pregnancies; no kidding) and abortions in Norway.
Warning: There is a saying: "never show a fool incomplete work." LailasCase.com is incomplete work with redundancies, some planned others, not so much; and, some content needs to be consolidated, updated or reworked. Admittedly, LailasCase.com is a beast of a website in its current form. That being said, LailasCase.com is being constructed from notes and segments written and dictated at various stages of experiencing, researching, investigating, analyzing and understanding the: ideas, agendas, policies, protocols, methods, publications, communications, academic misconduct, research misconduct, publication misconduct, bending of policy-relevant science, poly-institutional collusion and corruption and flawed thinking implemented as national medical policy via the medically- and ethically-flawed 2014 Recommendation of Norwegian Ministry of Health and Care Services and Norwegian Directorate of Health.
Also, there are incomplete sections, errant paragraphs, and (hopefully minor) mistakes. However, the evidence consolidated within LailasCase.com is fact-based, verifiable and incontrovertible; moreover, the evidence is powerful and compelling.
Consequently, a modicum of intellectual effort in consideration of the inherent constraints of a work-in-progress, public interest disclosure website from a sleep-deprived, husband-and-wife team with a baby (now toddler) is both required and appreciated. [Okay, sure, "sleep-deprived" in the same sentence as "with a baby" is redundant.] Also, there will be additions and changes to content, references, links, navigation etc., again, as time permits. In short, LailasCase.com will improve with time.
[Note: The word "Warning" in red text and the words "never show a fool incomplete work" are attributed to Nassim Nicholas Taleb, SILENT RISK, TECHNICAL INCERTO: LECTURES NOTES ON PROBABILITY, VOL 1 © 2015]
Warning: There is a saying: "never show a fool incomplete work." LailasCase.com is incomplete work with redundancies, some planned others, not so much; and, some content needs to be consolidated, updated or reworked. Admittedly, LailasCase.com is a beast of a website in its current form. That being said, LailasCase.com is being constructed from notes and segments written and dictated at various stages of experiencing, researching, investigating, analyzing and understanding the: ideas, agendas, policies, protocols, methods, publications, communications, academic misconduct, research misconduct, publication misconduct, bending of policy-relevant science, poly-institutional collusion and corruption and flawed thinking implemented as national medical policy via the medically- and ethically-flawed 2014 Recommendation of Norwegian Ministry of Health and Care Services and Norwegian Directorate of Health.
Also, there are incomplete sections, errant paragraphs, and (hopefully minor) mistakes. However, the evidence consolidated within LailasCase.com is fact-based, verifiable and incontrovertible; moreover, the evidence is powerful and compelling.
Consequently, a modicum of intellectual effort in consideration of the inherent constraints of a work-in-progress, public interest disclosure website from a sleep-deprived, husband-and-wife team with a baby (now toddler) is both required and appreciated. [Okay, sure, "sleep-deprived" in the same sentence as "with a baby" is redundant.] Also, there will be additions and changes to content, references, links, navigation etc., again, as time permits. In short, LailasCase.com will improve with time.
- "Brave voices. "Brave criticism is more important than ever," said Per Fugelli over five years ago. It still applies."
(Modige stemmer. — Modig kritikk er viktigere enn noen gang, sa Per Fugelli for over fem år siden. Det gjelder fortsatt.) (Source: "The outrage must take place" ("Ytringsmot bør finne sted") Commentary by Tove Lie, Editor of Khrono. Monday 22 April 2019 - 19:43 Last Updated Monday 22 April 2019- 19:43) [Note: "Per Fugelli was a Norwegian physician and professor of General Practice at the University of Bergen from 1984 to 1992, and social medicine at the University of Oslo from 1992 until his death in 2017." (Source: Wikipedia)] - "Academia, the country's universities and colleges and the knowledge sector as a whole have long been a covered area in Norwegian national media. The journalistic coverage of the knowledge sector has mainly been about kindergarten, primary and secondary education, but has, with some honorable exceptions, stopped when one has approached higher education and research."
"Akademia, landets universiteter og høgskoler og kunnskapssektoren i stort har lenge vært et underdekket område i norske riksdekkende medier. Den journalistiske dekningen av kunnskapssektoren har i all hovedsak dreid seg om barnehage, grunnskole og videregående, men har, med noen hederlige unntak, stoppet opp når man ha nærmet seg høyere utdanning og forskning." (Source: Ibid.)
[Note: The word "Warning" in red text and the words "never show a fool incomplete work" are attributed to Nassim Nicholas Taleb, SILENT RISK, TECHNICAL INCERTO: LECTURES NOTES ON PROBABILITY, VOL 1 © 2015]
"What is the cost of lies?"
Intent to Deceive: Falsification, Fabrication, & Plagiarism (FFP)
"A statement developed by the U.S. Office of Science and Technology Policy, which has been adopted by most researchfunding agencies, defines misconduct as “fabrication, falsification, or plagiarism in proposing, performing, or reviewing research, or in reporting research results.” According to the statement, the three elements of misconduct are defined as follows:
Intent to Deceive: Falsification, Fabrication, & Plagiarism (FFP)
"A statement developed by the U.S. Office of Science and Technology Policy, which has been adopted by most researchfunding agencies, defines misconduct as “fabrication, falsification, or plagiarism in proposing, performing, or reviewing research, or in reporting research results.” According to the statement, the three elements of misconduct are defined as follows:
- Fabrication is “making up data or results.”
- Falsification is “manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record.”
- Plagiarism is “the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit.”
Scientific Fraud: Key Questions
In the wake of the extensive, global media coverage surrounding the scientific fraud cases of Hwang Woo-suk in Korea and Jon Sudbø in Norway, Magne Nylenna of Norwegian Electronic Health Library/Norwegian Knowledge Centre for the Health Services and Richard Horton, Editor -in-Chief of The Lancet, posed the following questions in their 2006 commentary in The Lancet.
In the wake of the extensive, global media coverage surrounding the scientific fraud cases of Hwang Woo-suk in Korea and Jon Sudbø in Norway, Magne Nylenna of Norwegian Electronic Health Library/Norwegian Knowledge Centre for the Health Services and Richard Horton, Editor -in-Chief of The Lancet, posed the following questions in their 2006 commentary in The Lancet.
- “How could this happen?” is normally the main question within the research community. “Why did this happen?” should perhaps be asked more often.
(...)
"What lessons can be learned by the revealed cases of scientific fraud for researchers, research institutions, scientific journals, and other parties? Is a more detailed bureaucratic regulation of research the inevitable consequence? Can misconduct be prevented through information campaigns? And who is really responsible for the quality of published research?" (Source: "Research misconduct: learning the lessons" Magne Nylenna and Richard Horton. The Lancet Vol 368 November 25, 2006. https://doi.org/10.1016/S0140-6736(06)69757-2)
"Make reports of research misconduct public"
"Confronted with bad behaviour, institutions will keep asking the wrong questions until they have to show their [sic] working, says C. K. Gunsalus."
"How to investigate allegations of research misconduct: A checklist"
"Confronted with bad behaviour, institutions will keep asking the wrong questions until they have to show their [sic] working, says C. K. Gunsalus."
- "Even when investigations are exemplary and findings clear, universities rarely report them publicly. That secrecy perpetuates misbehaviour and breeds mistrust..." (Source: "Make reports of research misconduct public" C. K. Gunsalus (Director of the National Center for Professional and Research Ethics at the University of Illinois Urbana–Champaign. e-mail: gunsalus@illinois.edu). Nature VOL 570, 6 JUNE 2019. p.7) [Also see: "“Our current approaches are not working:” Time to make misconduct investigation reports public, says integrity expert" Ivan Oransky. Retraction Watch. June 4, 2019)
- "Science is fast becoming more transparent. So, too, should institutional practice. Open misconduct reports would create a virtuous circle. Institutions would learn from their own and others’ investigations. Leaders would be more likely to pay attention to reports that are subject to scrutiny. Honest researchers could see that although groundbreaking science is often uncertain, it is qualitatively different from the conduct that leads to misconduct reviews." (Source: Ibid.)
- "It’s time to do better. Misconduct investigations will be more effective and potentially even lead to systemic improvements if they are framed in the right way, with questions, such as: ‘Do you want your reputation associated with an institution that countenances dishonest work?’, ‘How might this have been prevented?’, ‘What are our students learning about how to do research?’ and ‘Are other scholars depending on this work?’ Institutional procedures must not only protect the rights of whistle-blowers and those accused, but also protect students, colleagues, scholars and the advancement of knowledge. I propose a three-part approach: a checklist to strengthen investigations; the external peer review of investigatory reports; and the publication of findings." (Source: Ibid.) [See: "Institutional Research Misconduct Reports Need More Credibility" C. K. Gunsalus, JD; Adam R. Marcus, MA; Ivan Oransky, MD. JAMA. 2018;319(13):1315-1316. doi:10.1001/jama.2018.0358] [See: "
- "Even the best guidelines are of limited value without a mechanism for holding investigators accountable. We use peer review for research; we should do so for investigations, too. Consortia of universities could work together to peer review and certify reports before they are finalized. " (Source: Ibid.) [See: "Peer Review Form for Research Integrity Investigation Reports" National Center for Professional Research Ethics (NCPRE); Retraction Watch (RW)]
"How to investigate allegations of research misconduct: A checklist"
- "In preparing The List, we referred to “the Guidelines for Responding to Misconduct in Research” from the Japanese Ministry of Education, Culture, Sports, Science and Technology (effective August 26, 2014) and the article, “Institutional research misconduct reports need more credibility” (Gunsalus et al. JAMA 319: 1315-1316, 2018, published as a statement of the Expert Meeting held in Chicago, Illinois, U.S. in December 2017). This article presents a “Peer Review Form for Research Integrity Investigation Reports” which lists key aspects of investigation reports for quality evaluation. In contrast, The List itemizes critical issues that must be considered when initiating, conducting and reporting the results of investigations." (Source: "How to investigate allegations of research misconduct: A checklist" Iekuni Ichikawa. Retraction Watch January 8, 2019) and (Source: "The List" or "Checklist for Investigating Allegations of Research Misconduct" Association for the Promotion of Research Integrity (APRIN), Japan)
Synopsis of Situation
In Norway, all pregnancies are equal, but some pregnancies are more equal than others.
Strangely, yet tellingly, the only "independent" academic, scientific documentation Norway's health authorities use to justify their selection, implementation and ongoing promotion of NCFM Group's eSnurra EDD estimation "method" was written by NCFM Group themselves. Specifically, Norway's health authorities use the bending of policy-relevant science that is the 2012 NTNU dr.philos thesis of NCFM Group member Inger Økland (since employed by Norwegian Directorate of Health); an articles-based thesis which includes 4 articles supervised and coauthored by the 3 NCFM Group members (Sturla H. Eik-Nes, Per Grøttum & Håkon K. Gjessing) who claim copyright ownership of NCFM Group's eSnurra EDD estimation "method." Unfortunately, and sadly, NCFM Group's eSnurra EDD estimation "method" is an appropriated, plagiarized, misused implementation of Dr. David J. R. Hutchon's original idea and method of Population-based Direct EDD Estimation (PDEE) published in 1998. Consequently, NCFM Group are engaged in long-term, ongoing research misconduct via plagiarism and the bending of policy-relevant science; a combination which is proven to cause increased medical risks, critical medical mistakes and grievous medical harms (including perinatal & neonatal death), unnecessarily, for some of Norway's women and their fetuses/babies.
Moreover, Norway's health authorities use the bending of policy-relevant science, knowingly, to justify national implementation of their medically & ethically flawed national medical policy for obstetric & fetal medicine. Incredulously, Norway's health authorities do this in conscious disregard of the explicit, published warnings of the risks & consequences identified by Norway's obstetric & fetal medicine experts, international practice guidelines and Norway’s epidemiological experts. As a result, a dangerous, harms-causing, national medical policy of authority-based medicine with a government-mandated protocol of evidence-obviated medicine (without patients’ informed consent) ensures unilateral reliance on the appropriated, plagiarized, misused ultrasound-based NCFM eSnurra EDD estimation "method," thereby establishing it as the flawed, de facto temporal foundation of obstetric & fetal medicine for all pregnancies and abortions in Norway, but without the ability to actually estimate the clinically important gestational age for individual pregnancies. Presciently, Dr. David J. R. Hutchon warned of precisely this, 20-years ago.
Consequently, and not surprisingly, this combination of flawed national medical policy, flawed national medical protocol and flawed national medical "method" causes the government-mandated, unilateral reliance on NCFM Group's ultrasound-based eSnurra EDD estimation "method" to systemically misclassify the clinically important gestational age for fetuses that are smaller or larger than accurately average for week 18, with 7% of fetuses misclassified by more than 14 days. Misclassification of gestational age causes suboptimal obstetric & fetal awareness, which causes suboptimal obstetric & fetal management, which causes increased medical risks, critical medical mistakes and grievous medical harms. For example, in Laila's case the misclassification of gestational age caused a critical scheduling mistake for the important, time-limited, medical procedure of turning Laila’s baby from breech to vertex for normal delivery before the onset of labor in order to prevent an unnecessary, unwanted breech delivery or Cesarean-section surgery delivery with a cascade of complications. Unfortunately, Laila had no choice but to endure the latter because the midwife in Laila’s case was instructed to disregard (i.e., to obviate, without Laila’s informed consent) Laila’s accurately documented regular LMP date, date of ovulation, date of intercourse/conception and date of early pregnancy test. Moreover, the midwife who did this confirms today, 19 months later, that given the same scenario she would do the same, according to the instructions she has been given. Furthermore, misclassification of gestational age causes medical, ethical and legal problems for fetal diagnostic testing (trisomy 21, 18 & 13) and abortion adjudications in Norway.
Finally, the pregnancies in Norway which "are more equal than others" are, of course, those pregnancies whose fetuses are in fact of accurately average size in gestational week 18 and therefore, less likely to be misclassified by NCFM Group's unilateral, ultrasound-based eSnurra EDD estimation "method." Again, NCFM Group's unilateral, ultrasound-based eSnurra "method" estimates EDD, not the clinically important gestational age. Consequently, NCFM Group must calculate gestational age by using the equivalent of Naegele's rule, but in reverse, by assuming, erroneously, LMP = EDD – 283 days for all pregnancies. Again, Dr. David J. R. Hutchon warned of precisely this, 20-years ago. Norway's women and their fetuses/babies deserve better. Norway's dedicated medical professionals deserve better. Clearly, Norway can and must do better on behalf of science and the public trust.
View/Download: Synopsis of Situation pdf
In Norway, all pregnancies are equal, but some pregnancies are more equal than others.
- Norway's health authorities (i.e., Norwegian Ministry of Health & Care Services and Norwegian Directorate of Health) assume all fetuses are of accurately average size in gestational week 18. They are not.
- Norway's health authorities assume all gestation periods are 283 days. They are not.
- Norway's health authorities assume the estimation of date of delivery (EDD) and the estimation of gestational age are synonymous (i.e., LMP = EDD – 283 days) for all pregnancies. They are not (i.e., LMP ≠ EDD – 283 days).
- Norway’s health authorities assume EDD (only 4% of pregnant women deliver on their EDD) is clinically more important than gestational age. It is not.
- Norway's health authorities implemented a science-bending, medically & ethically flawed 2014 national medical policy for obstetric & fetal medicine which includes a government-mandated protocol of evidence-obviated medicine (without patients’ informed consent) to ensure unilateral reliance on Norway's National Center for Fetal Medicine (NCFM) Group's ultrasound-based eSnurra EDD estimation "method" to establish the clinically important gestational age for all pregnancies and abortions in Norway. However, this policy is proven to systemically misclassify gestational age, which causes suboptimal obstetric & fetal awareness, which causes suboptimal obstetric & fetal management, unnecessarily.
Strangely, yet tellingly, the only "independent" academic, scientific documentation Norway's health authorities use to justify their selection, implementation and ongoing promotion of NCFM Group's eSnurra EDD estimation "method" was written by NCFM Group themselves. Specifically, Norway's health authorities use the bending of policy-relevant science that is the 2012 NTNU dr.philos thesis of NCFM Group member Inger Økland (since employed by Norwegian Directorate of Health); an articles-based thesis which includes 4 articles supervised and coauthored by the 3 NCFM Group members (Sturla H. Eik-Nes, Per Grøttum & Håkon K. Gjessing) who claim copyright ownership of NCFM Group's eSnurra EDD estimation "method." Unfortunately, and sadly, NCFM Group's eSnurra EDD estimation "method" is an appropriated, plagiarized, misused implementation of Dr. David J. R. Hutchon's original idea and method of Population-based Direct EDD Estimation (PDEE) published in 1998. Consequently, NCFM Group are engaged in long-term, ongoing research misconduct via plagiarism and the bending of policy-relevant science; a combination which is proven to cause increased medical risks, critical medical mistakes and grievous medical harms (including perinatal & neonatal death), unnecessarily, for some of Norway's women and their fetuses/babies.
Moreover, Norway's health authorities use the bending of policy-relevant science, knowingly, to justify national implementation of their medically & ethically flawed national medical policy for obstetric & fetal medicine. Incredulously, Norway's health authorities do this in conscious disregard of the explicit, published warnings of the risks & consequences identified by Norway's obstetric & fetal medicine experts, international practice guidelines and Norway’s epidemiological experts. As a result, a dangerous, harms-causing, national medical policy of authority-based medicine with a government-mandated protocol of evidence-obviated medicine (without patients’ informed consent) ensures unilateral reliance on the appropriated, plagiarized, misused ultrasound-based NCFM eSnurra EDD estimation "method," thereby establishing it as the flawed, de facto temporal foundation of obstetric & fetal medicine for all pregnancies and abortions in Norway, but without the ability to actually estimate the clinically important gestational age for individual pregnancies. Presciently, Dr. David J. R. Hutchon warned of precisely this, 20-years ago.
Consequently, and not surprisingly, this combination of flawed national medical policy, flawed national medical protocol and flawed national medical "method" causes the government-mandated, unilateral reliance on NCFM Group's ultrasound-based eSnurra EDD estimation "method" to systemically misclassify the clinically important gestational age for fetuses that are smaller or larger than accurately average for week 18, with 7% of fetuses misclassified by more than 14 days. Misclassification of gestational age causes suboptimal obstetric & fetal awareness, which causes suboptimal obstetric & fetal management, which causes increased medical risks, critical medical mistakes and grievous medical harms. For example, in Laila's case the misclassification of gestational age caused a critical scheduling mistake for the important, time-limited, medical procedure of turning Laila’s baby from breech to vertex for normal delivery before the onset of labor in order to prevent an unnecessary, unwanted breech delivery or Cesarean-section surgery delivery with a cascade of complications. Unfortunately, Laila had no choice but to endure the latter because the midwife in Laila’s case was instructed to disregard (i.e., to obviate, without Laila’s informed consent) Laila’s accurately documented regular LMP date, date of ovulation, date of intercourse/conception and date of early pregnancy test. Moreover, the midwife who did this confirms today, 19 months later, that given the same scenario she would do the same, according to the instructions she has been given. Furthermore, misclassification of gestational age causes medical, ethical and legal problems for fetal diagnostic testing (trisomy 21, 18 & 13) and abortion adjudications in Norway.
Finally, the pregnancies in Norway which "are more equal than others" are, of course, those pregnancies whose fetuses are in fact of accurately average size in gestational week 18 and therefore, less likely to be misclassified by NCFM Group's unilateral, ultrasound-based eSnurra EDD estimation "method." Again, NCFM Group's unilateral, ultrasound-based eSnurra "method" estimates EDD, not the clinically important gestational age. Consequently, NCFM Group must calculate gestational age by using the equivalent of Naegele's rule, but in reverse, by assuming, erroneously, LMP = EDD – 283 days for all pregnancies. Again, Dr. David J. R. Hutchon warned of precisely this, 20-years ago. Norway's women and their fetuses/babies deserve better. Norway's dedicated medical professionals deserve better. Clearly, Norway can and must do better on behalf of science and the public trust.
View/Download: Synopsis of Situation pdf
Events Synopsis: the big-picture
Research Misconduct via Plagiarism of Published Medical Method > Plagiarism Published in International Medical Journal > Repeated Formal Reports of Plagiarism Ignored by International Medical Journal > Plagiarism-based Medical Journal Publications From a 2012 NTNU dr.philos. NTNU Thesis Used by Norwegian Government's Health Authorities to Justify Knowledge-obviated, Science-bending, Medically & Ethically Flawed National Medical Policy for Obstetric & Fetal Medicine > Health Technology Assessment Process Bypassed > Systematic Review Process Bypassed > National Medical Policy Implemented a Government-mandated Protocol of Evidence-obviated Medicine Against Explicit, Warnings of Risks & Consequences by Medical Experts > Precautionary Principle Ignored > Plagiarists Commissioned by Norwegian Government's Health Authorities as Exclusive National Provider of Plagiarism-based Medical Method Used with Medical Protocol > Plagiarism-based Medical Method Intentionally Misused by Plagiarists in National Medical Policy > Suboptimal Obstetric & Fetal Awareness > Suboptimal Obstetric & Fetal Mismanagement > Increased Medical Risks, Critical Medical Mistakes & Grievous Medical Harms > LailasCase.com > Public Interest Disclosure > ?
Research Misconduct via Plagiarism of Published Medical Method > Plagiarism Published in International Medical Journal > Repeated Formal Reports of Plagiarism Ignored by International Medical Journal > Plagiarism-based Medical Journal Publications From a 2012 NTNU dr.philos. NTNU Thesis Used by Norwegian Government's Health Authorities to Justify Knowledge-obviated, Science-bending, Medically & Ethically Flawed National Medical Policy for Obstetric & Fetal Medicine > Health Technology Assessment Process Bypassed > Systematic Review Process Bypassed > National Medical Policy Implemented a Government-mandated Protocol of Evidence-obviated Medicine Against Explicit, Warnings of Risks & Consequences by Medical Experts > Precautionary Principle Ignored > Plagiarists Commissioned by Norwegian Government's Health Authorities as Exclusive National Provider of Plagiarism-based Medical Method Used with Medical Protocol > Plagiarism-based Medical Method Intentionally Misused by Plagiarists in National Medical Policy > Suboptimal Obstetric & Fetal Awareness > Suboptimal Obstetric & Fetal Mismanagement > Increased Medical Risks, Critical Medical Mistakes & Grievous Medical Harms > LailasCase.com > Public Interest Disclosure > ?
Research Misconduct to Effect the Bending of Policy-relevant Science, to Ill Effect
The public trust is beyond the point of being bent; the public trust has been breached, systemically and egregiously.
- Bending science is scientific misconduct.
- Bending policy-relevant science is a form of tyranny.
- Bending policy-relevant science to implement a science-bending, medically & ethically flawed national medical policy of authority-based medicine for obstetric & fetal medicine which is proven to cause systemic misclassification of gestational age, which causes suboptimal obstetric & fetal awareness, which causes suboptimal obstetric & fetal management, which causes increased medical risks, critical medical mistakes and grievous medical harms (including perinatal & neonatal death), unnecessarily, for some of Norway's women and their fetuses/babies, in conscious disregard of the explicit, published warnings of the risks & consequences identified by Norway's obstetric & fetal medicine experts, international practice guidelines and Norway's epidemiological experts, is arguably a malice aforethought criminal act.
The public trust is beyond the point of being bent; the public trust has been breached, systemically and egregiously.
Warnings of Risks & Consequences: Ignored
Directorate of Health, in conscious disregard of the explicit, published warnings of the risks and consequences identified by Norway's obstetric and fetal medicine experts, international practice guidelines and Norway's epidemiological experts in order to implement their knowledge-obviated, science-bending, medically & ethically flawed 2014 Recommendation (i.e., national medical policy) with a protocol of evidence-obviated medicine (i.e., completely excluding (or obviating) a woman's key pregnancy dates, the medical evidence of her pregnancy's beginning). The purpose of Directorate of Health's flawed policy, flawed protocol and flawed "method" is to ensure unilateral reliance on NCFM eSnurra Group's EDD estimation "method" (i.e., a plagiarized, intentionally misused implementation of the Hutchon Method of PDEE).
- "Uncertainty, risk, and the precautionary principle Research may have far-reaching consequences for health, society, or the environment. It is therefore important that the uncertainty and risk that are often accompanying factors when research becomes practical and concrete, are not neglected, and that decision-makers who use scientific knowledge have a thorough understanding of this knowledge and the context." (Source: "Uncertainty, risk, and the precautionary principle" from "Guidelines for research ethics in science and technology" Issued by The Norwegian National Committee for Research Ethics in Science and Technology (2016), p. 10. Text: The Norwegian National Committees for Research Ethics, Last updated: Tuesday, June 28, 2016. ISBN 978-82-7682-075-1)
Informed Consent Requirement: Ignored
Prior, informed, voluntary, explicit consent is not secured from pregnant women in Norway at their routine 18-week ultrasound exam before their key pregnancy dates, which help to establish the start of pregnancy, are obviated from all medical evidence and, thereby, obviated from all medical thinking, medical decision-making and medical actions for the duration of pregnancy. This is Directorate of Health's knowledge-obviated, science-bending, medially & ethically flawed 2014 Recommendation. Moreover, and unfortunately, this 2014 Recommendation is a national medical policy which implements the suboptimal, unilateral ultrasound-based NCFM eSnurra pregnancy-dating "method" (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) within a government-mandated protocol of evidence-obviated medicine that causes suboptimal classification of fetal and gestational age, which causes suboptimal obstetric & fetal awareness, which causes suboptimal obstetric & fetal management, which causes increased medical risks, critical medical mistakes and grievous medical harms (including perinatal death), unnecessarily, for some of Norway's women and their fetuses/babies.
Specifically, no rational, informed pregnant woman in Norway would consent to the unnecessary risks and consequences of the suboptimal, unilateral ultrasound-base NCFM eSnurra pregnancy-dating "method" for herself and her fetus/baby if she were in ownership possession of a factual last-menstrual-period date (LMPD), a factual ovulation-test-positive date (OTPD) and/or a factual single-coitus-insemination date (SCID).
With respect to the routine 18-week ultrasound exam, Norway's pregnant women are not informed of:
Specifically, no rational, informed pregnant woman in Norway would consent to the unnecessary risks and consequences of the suboptimal, unilateral ultrasound-base NCFM eSnurra pregnancy-dating "method" for herself and her fetus/baby if she were in ownership possession of a factual last-menstrual-period date (LMPD), a factual ovulation-test-positive date (OTPD) and/or a factual single-coitus-insemination date (SCID).
With respect to the routine 18-week ultrasound exam, Norway's pregnant women are not informed of:
- the fact the routine 18-week ultrasound exam is completely optional, voluntary and not required in Norway's standard pregnancy care guidelines
- the undisclosed condition of the government-mandated protocol of evidence-obviated medicine to ensure unilateral reliance on the suboptimal, unilateral ultrasound-based NCFM eSnurra Group's pregnancy dating "method" to estimate EDD and, therefrom, calculate fetal age & GA for her pregnancy
- the known, published risks and consequences of the NCFM eSnurra pregnancy dating "method" being grossly and dangerously inaccurate
- the known, proven efficacy of the medical evidence that is a woman's key pregnancy dates, such as for example, a combined, fully corroborating, factual LMPD/OTPD/SCID or just a SCID or OTPD or LMPD.
Clinical Relevance & Consequences
Clinical consequences of Directorate of Health's government-mandated protocol of evidence-obviated medicine to ensure unilateral reliance on ultrasound estimations (or calculations) of gestational age include misclassifications of gestational age, which cause suboptimal obstetric & fetal awareness, which causes suboptimal obstetric & fetal management, which cause increased medical risks, critical medical mistakes and grievous medical harms for some of Norway's women and their fetuses/babies. All of this is due to Directorate of Health's biased selection of NCFM eSnurra Group's suboptimal, unilateral ultrasound-based pregnancy dating "method" (i.e., a plagiarized, intentionally misused Hutchon Method of PDEE) as the exclusive implementation vehicle for their knowledge-obviated, science-bending, medically & ethically flawed national medical policy with a protocol of evidence-obviated medicine in conscious disregard of the identified, published warnings of the risks and consequences by Norway's obstetric & fetal medicine experts. A conscious disregard of risks and consequences identified and made known by experts is intentional recklessness and willful negligence; willful negligence which causes harm is a criminal act. Finally, the evidence of increased medical risks, critical medical mistakes and grievous medical harms is silently and invisibly written off, unattributed, undocumented and unreported, as acceptable collateral damage to Directorate of Health's medically and ethically flawed national medical policy with their protocol of evidence-obviated medicine used in conjunction with NCFM eSnurra Group's method (i.e., a plagiarized, intentionally misused method) with respect to obstetric medicine, fetal medicine and obstetric clinical care.
An Apt Analogy
Included below is an apt analogy regarding the risks and consequences of Directorate of Health's knowledge-obviated, medically & ethically flawed 2014 Recommendation with their government-mandated protocol of evidence-obviated medicine.
- "A. Crossing the road (the paralysis fallacy)
Many have countered the invocation of the PP [Precautionary Principle] with “nothing is ever totally safe.” “I take risks crossing the road every day, so according to you I should stay home in a state of paralysis.” The answer is that we don’t cross the street blindfolded, we use sensory information to mitigate risks and reduce exposure to extreme shocks." (Source: "The Precautionary Principle (with Application to the Genetic Modification of Organisms)" p. 11. Nassim Nicholas Taleb, Rupert Read, Raphael Douady, Joseph Norman, Yaneer Bar-Yam. EXTREME RISK INITIATIVE —NYU SCHOOL OF ENGINEERING WORKING PAPER SERIES. https://arxiv.org/pdf/1410.5787.pdf) - "There are many reasons a previous action may not have led to ruin while still having the potential to do so. If you attempt to cross the street with a blindfold and earmuffs on, you may make it across, but this is not evidence that such an action carries no risk." (Source: ibid., p. 12)
The Precautionary Principle: Ignored
The Precautionary Principle states if a policy or action has an identified or suspected risk of causing harm to the public or to the environment, in the absence of firm, objective evidence and scientific consensus establishing the policy or action is not harmful, the burden of proof to establish the policy or action is not harmful is the responsibility of those who seek to implement the policy or take the action. (Source: paraphrase of: "The Precautionary Principle (with Application to the Genetic Modification of Organisms)" p. 11. Nassim Nicholas Taleb, Rupert Read, Raphael Douady, Joseph Norman, Yaneer Bar-Yam. EXTREME RISK INITIATIVE —NYU SCHOOL OF ENGINEERING WORKING PAPER SERIES. https://arxiv.org/pdf/1410.5787.pdf and the Wikipedia entry: Precautionary principle)
Primum non nocere, the historical Latin aphorism of first, do no harm is recognized as the origin of the non-maleficence principle of modern medical ethics.
- "The principle implies that there is a social responsibility to protect the public from exposure to harm, when scientific investigation has found a plausible risk. These protections can be relaxed only if further scientific findings emerge that provide sound evidence that no harm will result." (Source: Wikipedia entry: Precautionary principle)
- "The precautionary principle is defined here as follows: "When human activities may lead to morally unacceptable harm that is scientifically plausible but uncertain, actions shall be taken to avoid or diminish that harm." This principle is important for a large part of science and technology research, and researchers have a shared responsibility for ensuring that evaluations are based on the precautionary principle and contribute to avoiding or diminishing harm." (Source: "Guidelines for research ethics in science and technology" Issued by The Norwegian National Committee for Research Ethics in Science and Technology (2016). Text: The Norwegian National Committees for Research Ethics, Last updated: Tuesday, June 28, 2016)
Primum non nocere, the historical Latin aphorism of first, do no harm is recognized as the origin of the non-maleficence principle of modern medical ethics.
Health Technology Assessment: Ignored
The Health Technology Assessment (HTA) process, which has been in place in Norway for the past 20 years, was ignored by Directorate of Health. Included below are relevant excerpts from "The National system for the introduction of new health technologies within the specialist health service – For better and safer patient care" or "Nasjonalt system for innføring av nye metoder i spesialisthelsetjenesten – for bedre og tryggere pasientbehandling." (Source: "The National system for the introduction of new health technologies within the specialist health service – For better and safer patient care" or Norwegian version: "Nasjonalt system for innføring av nye metoder i spesialisthelsetjenesten – for bedre og tryggere pasientbehandling" A working document from: The Regional Health Authorities, The Norwegian Medicines Agency, The Norwegian Knowledge Centre for Health Services, The Norwegian Directorate of Health. Version: 1.0 Date: 11 June 2013 / 23 January 2014. PROJECT NUMBER: 9928, PROJECT MANAGER: Brynjar Fure, PARTICIPANT: FHI, ESTIMATED END DATE: Ongoing project, RESPONSIBLE DEPARTMENT: Kunnskapsoppsummering)
"5.0 Introduction
HTA was formally established in Norway in 1997 with the creation of the Norwegian Centre for Health Technology Assessment [9], and has a long history in many other countries, including the USA, Canada, Australia, England, Scotland, Germany, France and Sweden [10-14]. (Source: ibid., p. 13)
"The purpose of the system (p. 14)
Systematic use of health technology assessments (HTA) to inform decision-making was the main ambition behind the establishment.
(...) "HTAs have been used for many years in numerous countries, including the USA, Canada, Australia, Sweden, England and Scotland, in addition to Norway. What is new in the Norwegian context is that HTAs are now being integrated into a holistic system with predictable and transparent processes for introducing new health technologies into the specialist health service. HTAs will be a tool for supporting appropriate prioritisation and decisions making in order to ensure that introduction of new technologies are proven as safe and effective (Figure 1). It will enable patients, health personnel and society in general to be certain that health technologies used in patient care are both safe and effective. The national system in its entirety will promote the rational use of resources within the health services." (p. 4
1997 Initial HTA Agency in Norway
The Norwegian Centre for Health Technology Assessment (Senter for medisinsk metodevurdering) (SMM), was established in 1997, as the initial HTA agency in Norway.
"5.0 Introduction
HTA was formally established in Norway in 1997 with the creation of the Norwegian Centre for Health Technology Assessment [9], and has a long history in many other countries, including the USA, Canada, Australia, England, Scotland, Germany, France and Sweden [10-14]. (Source: ibid., p. 13)
"The purpose of the system (p. 14)
Systematic use of health technology assessments (HTA) to inform decision-making was the main ambition behind the establishment.
- Improve patient safety
- Ensure that patients gain equal access quickly to new methods that have proved to be effective and fulfill safety and cost-effective requirements
- Ensure that new methods that are ineffective and/or harmful are not introduced and that obsolete health technologies are disinvested
- Provide an appropriate decision-making platform for priority setting based on HTAs
- Ensure rational use of resources
- Establish a systematic and predictable process for the introduction of new methods"
(...) "HTAs have been used for many years in numerous countries, including the USA, Canada, Australia, Sweden, England and Scotland, in addition to Norway. What is new in the Norwegian context is that HTAs are now being integrated into a holistic system with predictable and transparent processes for introducing new health technologies into the specialist health service. HTAs will be a tool for supporting appropriate prioritisation and decisions making in order to ensure that introduction of new technologies are proven as safe and effective (Figure 1). It will enable patients, health personnel and society in general to be certain that health technologies used in patient care are both safe and effective. The national system in its entirety will promote the rational use of resources within the health services." (p. 4
1997 Initial HTA Agency in Norway
The Norwegian Centre for Health Technology Assessment (Senter for medisinsk metodevurdering) (SMM), was established in 1997, as the initial HTA agency in Norway.
- "Objectives: The aim of this study was to describe the Norwegian contribution to the broad picture of our international health technology assessment (HTA) history"
"Conclusions: During the 10 years’ time, HTA has become a well-established activity in Norway." (Source: "The history of health technology assessment in Norway" Berit Mørland, The Norwegian Knowledge Centre for the Health Services. International Journal of Technology Assessment in Health Care, 25:Supplement 1 (2009), 148–155. doi:10.1017/S0266462309090576)
"If you see fraud and don't shout fraud, you are a fraud."
Motto of Nassim Nicholas Taleb (Source: his Home Page)
LailasCase.com is the shout.
The Home Page is The Scream.
“It's easier to fool people than to convince them that they have been fooled.”
--Mark Twain
Motto of Nassim Nicholas Taleb (Source: his Home Page)
LailasCase.com is the shout.
The Home Page is The Scream.
“It's easier to fool people than to convince them that they have been fooled.”
--Mark Twain
Introduction
Laila's pregnancy was planned, by the numbers, with a spreadsheet pregnancy calendar to record and track key events and dates, such as Laila's last-menstrual-period date (LMPD), ovulation-test-positive date (OTPD), single-coitus-insemination date (SCID) etc. And, with a prime contribution from Edward, the numbers added up and Laila became pregnant, as planned. Consequently, Laila's combined, fully corroborating, factual LMPD/OTPD/SCID had very accurately established:
Evidence-Obviated Medicine Without Prior, Informed, Voluntary, Explicit Consent
However, at the scheduling of Laila's routine 18-week ultrasound exam (18wUSE) all of Laila's factual key pregnancy dates (i.e., LMPD/OTPD/SCID) were summarily obviated, without Laila's prior, informed, voluntary, explicit consent, and then replaced with an ultrasound-based estimated date of delivery (EDD) and, therefrom, a calculated gestational age (GA) using the equivalent of Naegele's rule, in reverse, by National Center for Fetal Medicine (NCFM) eSnurra Group's "method." Unfortunately, the "official" EDD & GA assigned to Laila's pregnancy, again, without Laila's prior, informed, voluntary, explicit consent, were grossly inaccurate, lagging Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based EDD & GA by 14 days and 12 days, respectively. Moreover, Laila was breech her entire pregnancy and when it came time for the routine manual turning of Laila's baby from breech to vertex for normal delivery, before the onset of labor, the ultrasound exam required to confirm breech for the routine turning had been scheduled much too late despite repeated, specific, early warnings by Laila & Edward. Not surprisingly (i.e., to Laila & Edward), 15 hours after the ultrasound exam and 2 days before the scheduled routine turning procedure, Laila went into labor, underneath the umbrella of normal variance for her LMPD/OTPD/SCID-based EDD & GA, still breech. A required Hospital CT-scan confirmed Laila's pelvis met all the criteria for a safe, normal, vertex delivery, but did not meet all the criteria for a safe, breech delivery (breech safe?). Consequently, Laila had been denied a normal delivery and had been forced to endure an unnecessary, unwanted Cesarean section surgery delivery. Moreover, Laila's baby was delivered with a dolichocephalic head (i.e., more commonly "long head" or "breech head"). A dolichocephalic fetal head is a symptom of pathology; a symptom which had been masked by the grossly inaccurate NCFM eSnurra BPD-based EDD & GA and, consequently, Laila's baby endured an unidentified, prolonged, undiagnosed and untreated fetal growth restriction/malformation of her head. [Note: BPD = biparietal diameter, i.e., ear-to-ear fetal skull diameter measurement]. Additionally, Laila & Edward had warned fetal pathology could explain the gross discrepancies between Laila's factual LMPD/OTPD/SCID-based EDD & GA and NCFM eSnurra BPD-based EDD & GA. However, because of the government-mandated protocol of evidence-obviated medicine, NCFM eSnurra BPD-based EDD & GA could neither be questioned nor tested for reasonableness, accuracy, errors or efficacy, no matter what! And, by government mandate, all medical thinking, medical decision-making and medical actions (e.g., scheduling the routine turning from breech to vertex, before the onset of labor) were mandated to be based on the grossly inaccurate NCFM eSnurra BPD-based EDD & GA, again, no matter what! At this point, it is important to reiterate Laila's combined, fully corroborating LMPD/OTPD/SCID had established the accurate beginning of her pregnancy, and the only method which could have been more accurate is if Laila were to have had an in vitro fertilization date (IVFD), which could have been more accurate in terms of hours, not weeks and days. The NCFM eSnurra BPD-based EDD prediction/estimation error for Laila's pregnancy was -24 days (prediction error = predicted - actual), just 4 days shy of a full menstrual cycle/period. All of this was a direct result of Directorate of Health's knowledge-obviated, medically & ethically flawed, intentionally reckless, willfully negligent 2014 Recommendation with their exclusive implementation of NCFM eSnurra Group's "method" (i.e., the appropriated, plagiarized, intentionally misused Hutchon Method of Population-based Direct Estimation of EDD (PDEE)) within a government-mandated protocol of evidence-obviated medicine with respect to obstetric medicine, fetal medicine and obstetric clinical care; a protocol proven to cause increased medical risks, critical medical mistakes and grievous medical harms to some of Norway's women and their fetuses/babies, Laila and her baby among them, obviously.
Acceptable Collateral Damage
Moreover, these increased medical risks, critical medical mistakes and grievous medical harms are silently and invisibly written off, unattributed, undocumented and unreported, as acceptable collateral damage of Norwegian Directorate of Health's knowledge-obviated, medically & ethically flawed, intentionally reckless, willfully negligent 2014 Recommendation (i.e., national medical policy). The evidence of the medical consequences (i.e., increased medical risks, critical medical mistakes & grievous medical harms) are termed "adverse events" with the abbreviation "AE" in Ministry of Health and Care Services' Norwegian Patient Safety Programme: In Safe Hands." However, in Laila's case, and other women's cases, the grievous medical harms were neither designated as "adverse events" nor as grievous medical harms because Laila's unnecessary, unwanted Cesarean section surgery delivery, with a cascade of complications, and her baby delivered with a fetal growth restriction/malformation of her head which should have been identified at the first trimester scan, were never recognized as being the result of a problem, much less an insidious, systemic, institutionalized problem. Instead, Laila's case, and other women's cases, were summarily obviated from all medical evidence, just as Laila's factual, key pregnancy dates had been obviated form all medical evidence without her prior, informed, voluntary, explicit consent. In fact, the graphs from Laila's ultrasound reports, the fetal metric measurements (i.e, BPD, FL & MAD) plotted against NCFM eSnurra BPD-based GA (i.e., calculated using the equivalent of Naegele's rule, in reverse, from BPD-based EDD) were confiscated or purloined from Laila's personal medical file folder, the medical file folder she brought with her to the hospital, while Laila was in hospital, and which were never returned despite multiple requests. All of the above was, and remains, downright Orwellian, if not criminal.
It is important to note Lailas case is evidence of just one type of increased medical risks, critical medical mistakes and grievous medical harms which are caused by Directorate of Health's knowledge-obviated, medically & ethically flawed 2014 Recommendation. Not surprisingly, and, as explained above, there are other types of unnecessary increased medical risks, critical medical mistakes and grievous medical harms, such as unnecessary perinatal/neonatal mortality and morbidity for small for gestational age (SGA) fetuses/babies which result from sub-optimal obstetric and fetal awareness and sub-optimal obstetric and fetal management due to Directorate of Health's knowledge-obviated, medically & ethically flawed policy with their government-mandated protocol of evidence-obviated medicine.
- the beginning of Laila's pregnancy (insemination & conception)
- the gestational age (GA) of Laila's pregnancy
- Laila's baby's fetal age
- Laila's estimated date of delivery (EDD)
Evidence-Obviated Medicine Without Prior, Informed, Voluntary, Explicit Consent
However, at the scheduling of Laila's routine 18-week ultrasound exam (18wUSE) all of Laila's factual key pregnancy dates (i.e., LMPD/OTPD/SCID) were summarily obviated, without Laila's prior, informed, voluntary, explicit consent, and then replaced with an ultrasound-based estimated date of delivery (EDD) and, therefrom, a calculated gestational age (GA) using the equivalent of Naegele's rule, in reverse, by National Center for Fetal Medicine (NCFM) eSnurra Group's "method." Unfortunately, the "official" EDD & GA assigned to Laila's pregnancy, again, without Laila's prior, informed, voluntary, explicit consent, were grossly inaccurate, lagging Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based EDD & GA by 14 days and 12 days, respectively. Moreover, Laila was breech her entire pregnancy and when it came time for the routine manual turning of Laila's baby from breech to vertex for normal delivery, before the onset of labor, the ultrasound exam required to confirm breech for the routine turning had been scheduled much too late despite repeated, specific, early warnings by Laila & Edward. Not surprisingly (i.e., to Laila & Edward), 15 hours after the ultrasound exam and 2 days before the scheduled routine turning procedure, Laila went into labor, underneath the umbrella of normal variance for her LMPD/OTPD/SCID-based EDD & GA, still breech. A required Hospital CT-scan confirmed Laila's pelvis met all the criteria for a safe, normal, vertex delivery, but did not meet all the criteria for a safe, breech delivery (breech safe?). Consequently, Laila had been denied a normal delivery and had been forced to endure an unnecessary, unwanted Cesarean section surgery delivery. Moreover, Laila's baby was delivered with a dolichocephalic head (i.e., more commonly "long head" or "breech head"). A dolichocephalic fetal head is a symptom of pathology; a symptom which had been masked by the grossly inaccurate NCFM eSnurra BPD-based EDD & GA and, consequently, Laila's baby endured an unidentified, prolonged, undiagnosed and untreated fetal growth restriction/malformation of her head. [Note: BPD = biparietal diameter, i.e., ear-to-ear fetal skull diameter measurement]. Additionally, Laila & Edward had warned fetal pathology could explain the gross discrepancies between Laila's factual LMPD/OTPD/SCID-based EDD & GA and NCFM eSnurra BPD-based EDD & GA. However, because of the government-mandated protocol of evidence-obviated medicine, NCFM eSnurra BPD-based EDD & GA could neither be questioned nor tested for reasonableness, accuracy, errors or efficacy, no matter what! And, by government mandate, all medical thinking, medical decision-making and medical actions (e.g., scheduling the routine turning from breech to vertex, before the onset of labor) were mandated to be based on the grossly inaccurate NCFM eSnurra BPD-based EDD & GA, again, no matter what! At this point, it is important to reiterate Laila's combined, fully corroborating LMPD/OTPD/SCID had established the accurate beginning of her pregnancy, and the only method which could have been more accurate is if Laila were to have had an in vitro fertilization date (IVFD), which could have been more accurate in terms of hours, not weeks and days. The NCFM eSnurra BPD-based EDD prediction/estimation error for Laila's pregnancy was -24 days (prediction error = predicted - actual), just 4 days shy of a full menstrual cycle/period. All of this was a direct result of Directorate of Health's knowledge-obviated, medically & ethically flawed, intentionally reckless, willfully negligent 2014 Recommendation with their exclusive implementation of NCFM eSnurra Group's "method" (i.e., the appropriated, plagiarized, intentionally misused Hutchon Method of Population-based Direct Estimation of EDD (PDEE)) within a government-mandated protocol of evidence-obviated medicine with respect to obstetric medicine, fetal medicine and obstetric clinical care; a protocol proven to cause increased medical risks, critical medical mistakes and grievous medical harms to some of Norway's women and their fetuses/babies, Laila and her baby among them, obviously.
Acceptable Collateral Damage
Moreover, these increased medical risks, critical medical mistakes and grievous medical harms are silently and invisibly written off, unattributed, undocumented and unreported, as acceptable collateral damage of Norwegian Directorate of Health's knowledge-obviated, medically & ethically flawed, intentionally reckless, willfully negligent 2014 Recommendation (i.e., national medical policy). The evidence of the medical consequences (i.e., increased medical risks, critical medical mistakes & grievous medical harms) are termed "adverse events" with the abbreviation "AE" in Ministry of Health and Care Services' Norwegian Patient Safety Programme: In Safe Hands." However, in Laila's case, and other women's cases, the grievous medical harms were neither designated as "adverse events" nor as grievous medical harms because Laila's unnecessary, unwanted Cesarean section surgery delivery, with a cascade of complications, and her baby delivered with a fetal growth restriction/malformation of her head which should have been identified at the first trimester scan, were never recognized as being the result of a problem, much less an insidious, systemic, institutionalized problem. Instead, Laila's case, and other women's cases, were summarily obviated from all medical evidence, just as Laila's factual, key pregnancy dates had been obviated form all medical evidence without her prior, informed, voluntary, explicit consent. In fact, the graphs from Laila's ultrasound reports, the fetal metric measurements (i.e, BPD, FL & MAD) plotted against NCFM eSnurra BPD-based GA (i.e., calculated using the equivalent of Naegele's rule, in reverse, from BPD-based EDD) were confiscated or purloined from Laila's personal medical file folder, the medical file folder she brought with her to the hospital, while Laila was in hospital, and which were never returned despite multiple requests. All of the above was, and remains, downright Orwellian, if not criminal.
It is important to note Lailas case is evidence of just one type of increased medical risks, critical medical mistakes and grievous medical harms which are caused by Directorate of Health's knowledge-obviated, medically & ethically flawed 2014 Recommendation. Not surprisingly, and, as explained above, there are other types of unnecessary increased medical risks, critical medical mistakes and grievous medical harms, such as unnecessary perinatal/neonatal mortality and morbidity for small for gestational age (SGA) fetuses/babies which result from sub-optimal obstetric and fetal awareness and sub-optimal obstetric and fetal management due to Directorate of Health's knowledge-obviated, medically & ethically flawed policy with their government-mandated protocol of evidence-obviated medicine.
NCFM eSnurra Group's Protocol: Evidence-obviated Medicine
For the NCFM eSnurra Group's EDD estimation "method" all time and all information for a pregnancy begin on the ultrasound exam date; nothing, whatsoever, prior to the date of the ultrasound exam exists when gestational age is established by NCFM Group's unilateral, ultrasound-based eSnurra EDD estimation "method." Dr. Hutchon made this clear in his Hutchon 1998.
In Laila's case, her baby's BPD = 41 mm on 23.09.2016 was mapped to an EDD of 28.02.2017 (grossly inaccurate) and, therefrom, using the equivalent of Naegele's rule, but in reverse, NCFM Group calculated a virtual LMPD of 21.05.2016 (also grossly inaccurate), lagging Laila's factual, accurately documented LMPD of 09.05.2016 by 12 days because NCFM Group's eSnurra EDD estimation "method" assumed Laila's fetus/baby was accurately average in size for a BPD = 41 mm (not true due to small, SGA, pathology etc.) with no questions asked and no testing for reasonableness, accuracy, errors or efficacy against Laila's combined, fully corroborating LMPD/OTPD/SCID-based GA & EDD. Remember, Laila's LMPD/OTPD/SCID had been obviated from all medical evidence and any and all consideration in medical thinking, medical decision-making and medical actions at the scheduling of her routine 18wUSE obviated, without Laila's informed consent, according to Directorate of Health's government-mandated protocol of evidence-obviated medicine. Clearly, this was, and remains, dangerous, as the assignment of Laila's "official," grossly inaccurate NCMF eSnurra BPD-based EDD & GA was a completely unnecessary, preventable (at no cost), critical medical mistake which increased medical risks, caused subsequent critical medical mistakes which resulted in grievous medical harms (and increased costs). The official term (or euphemism) for this is, "adverse events" or AEs.
Bergen Group's Protocol: Evidence-based Medicine Using All Available Information
In stark contrast to NCFM Group, Bergen Group estimate GA from fetal metric measurements and, therefrom, calculate EDD using the equivalent of Naegele's rule, of which Bergen Group is quite clear, i.e., they do no claim this to be an actual estimate of EDD. However, Bergen Group's focus is not EDD, it is obstetric and fetal medicine and, consequently, Bergen Group considers all available information when determining fetal age and GA, including LMPD, OTPD, SCID, PTPD, IVFD, etc., and all corroborating combinations thereof. However, when ultrasound data become available, Bergen Group consider ultrasound data in conjunction with all available information to establish the best possible GA for individual pregnancies to ensure optimal obstetric & fetal awareness and optimal obstetric & fetal management of individual pregnancies. This is in stark contrast with NCFM Group who obviate all available information that is not provided by NCFM Group's unilateral, ultrasound-based eSnurra EDD estimation "method." At this point it may be helpful to refresh memories: Actual birth/delivery date varies, naturally, over a range of 35+ days (or 5 weeks) even when measured exactly from IVF or time of ovulation. This is why only 4% of women actually give birth (or deliver) on their EDD. Again, Bergen Group's focus is not on estimation of pregnancy term (EDD), but on the best possible GA for optimal obstetric & fetal awareness and optimal obstetric & fetal management of individual pregnancies; a GA determined from the beginning of pregnancy with consideration of all the natural, identifiable, resolvable variances, rather than from the estimated end of pregnancy. Bergen Group implements an individual approach to pregnancies for fetal and maternal health, with individual gestation duration as a function of fetal growth velocity and fetal size which, simultaneously, facilitates identification of fetal development, growth and pathology issues.
Norway is Alone
Included below are excerpts from Bergen Group's 2014 article in Aftenposten.
Flawed Recommendation
Included below are 3 relevant excerpts from Bergen Group's 2015 article in Tidsskrift for Den Norske Legeforening to summarize the key points made above.
Publications for Background Information
The articles identified below provide important background information. It is Bergen Group's "Flawed recommendation..." article that catalyzed Laila & Edward (while Laila was still in hospital) to investigate, research, analyze and understand the insidious, systemic problem that is Directorate of Health's 2014 Recommendation with their exclusive implementation of NCFM eSnurra Group's "method" using a government-mandated protocol of evidence-obviated medicine. The results of Laila & Edward's efforts are presented within the public interest disclosure website, LailasCase.com. The articles identified below (among others) serve as evidence to document the fact Directorate of Health were clearly and explicitly warned of the risks and consequences of their knowledge-obviated, medically & ethically flawed 2014 Recommendation or policy; a national medical policy which Directorate of Health implemented with conscious disregard of the published risks and consequences which had been clearly and explicitly identified by Norway's medical experts. This was willful recklessness and gross negligence by Directorate of Health. Moreover, because Directorate of Health's conscious disregard of the known risks and consequences caused grievous medical harms, Directorate of Health's implementation of their 2014 Recommendation was, and remains, stone-cold criminal.
Background Information
"The most difficult problem in dating a pregnancy is..."
...obviating all the biological evidence of a pregnancy's beginning via government mandate.
The excerpt below is the beginning of the "DISCUSSION" section of NCFM eSnurra Group's Gjessing et al. 2007 (which appropriated, plagiarized and enabled the misuse of the Hutchon Method of Population-based Direct Estimation of EDD (PDEE)) regarding "the most difficult problem in dating a pregnancy." Laila had been aware of the "problem" in dating a pregnancy because the supposed "problem" is one of the natural variations taught and discussed in human biology and health classes in most high schools, if not earlier. It is because of these known, natural variations Laila & Edward, like millions of others, planned to have a baby "by the numbers" with the assistance of a highly accurate & reliable, over-the-counter, home-use, digital, urinary ovulation test.
Nevertheless, Laila was assigned, without her prior, informed, voluntary, explicit consent, an estimated EDD and, therefrom, a calculated GA using the equivalent of Naegele's rule, in reverse, by Norway's National Center for Fetal Medicine (NCFM) eSnurra Group's "method" (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) which used Laila's fetus/baby's ultrasound-based biparietal diameter (BPD) measurement (or ear-to-ear skull diameter) of 41 mm to estimate Laila's EDD and, therefrom, calculate Laila's gestational age (GA) on the ultrasound dated using the equivalent of Naegele's rule, in reverse. However, the BPD measurement is known, internationally, to be a problematic and unreliable predictor/estimator of EDD and GA because it is not insensitive to fetal head shape. See Warnings > BPD IS PROBLEMATIC
See The Warnings > BPD IS PROBLEMATIC
Nevertheless, in Laila's case the BPD measurement of 41 mm was used, without HC to test for reasonableness, by NCFM eSnurra, without Laila's prior, informed, voluntary, explicit consent, to establish Laila's "official," NCFM eSnurra BPD-based EDD & GA, which could neither be questioned nor tested for reasonableness, accuracy or efficacy by government mandate, no matter what!
Insidious, Systemic, Institutionalized, Government-mandated Problem
Following is a summary of this insidious, systemic, institutionalized, government-mandated problem and most of the integrated, component causes discovered during Laila & Edward's investigation and research, which are covered in detail elsewhere in LailasCase.com. This is where LailasCase.com becomes truly strange and more systemic than either Laila or Edward could have imagined, yet it is included in LailasCase.com with all the fact-based evidence.
For the NCFM eSnurra Group's EDD estimation "method" all time and all information for a pregnancy begin on the ultrasound exam date; nothing, whatsoever, prior to the date of the ultrasound exam exists when gestational age is established by NCFM Group's unilateral, ultrasound-based eSnurra EDD estimation "method." Dr. Hutchon made this clear in his Hutchon 1998.
- "The approach mimics, in modern terms, the method originally formulated by Boerhaave. By adopting this approach we do not need to concern ourselves about the length of the cycle nor the certainty of the dates. Provided the fetus can be assessed as normal using other criteria, this chart can be used to provide the best estimate of the date of delivery (EDD)."
- "The chart is only for estimating the date of delivery. "
- "Just as Boerhaave was not actually measuring the length of pregnancy, and the word "gestation" is used to describe the measurement of time from the last menstrual period to reflect this, so also there is no pretence that this method is determining fetal age."
- "The approach mimics, in modern terms, the method originally formulated by Boerhaave. By adopting this approach we do not need to concern ourselves about the length of the cycle nor the certainty of the dates. Provided the fetus can be assessed as normal using other criteria, this chart can be used to provide the best estimate of the date of delivery (EDD)."
In Laila's case, her baby's BPD = 41 mm on 23.09.2016 was mapped to an EDD of 28.02.2017 (grossly inaccurate) and, therefrom, using the equivalent of Naegele's rule, but in reverse, NCFM Group calculated a virtual LMPD of 21.05.2016 (also grossly inaccurate), lagging Laila's factual, accurately documented LMPD of 09.05.2016 by 12 days because NCFM Group's eSnurra EDD estimation "method" assumed Laila's fetus/baby was accurately average in size for a BPD = 41 mm (not true due to small, SGA, pathology etc.) with no questions asked and no testing for reasonableness, accuracy, errors or efficacy against Laila's combined, fully corroborating LMPD/OTPD/SCID-based GA & EDD. Remember, Laila's LMPD/OTPD/SCID had been obviated from all medical evidence and any and all consideration in medical thinking, medical decision-making and medical actions at the scheduling of her routine 18wUSE obviated, without Laila's informed consent, according to Directorate of Health's government-mandated protocol of evidence-obviated medicine. Clearly, this was, and remains, dangerous, as the assignment of Laila's "official," grossly inaccurate NCMF eSnurra BPD-based EDD & GA was a completely unnecessary, preventable (at no cost), critical medical mistake which increased medical risks, caused subsequent critical medical mistakes which resulted in grievous medical harms (and increased costs). The official term (or euphemism) for this is, "adverse events" or AEs.
Bergen Group's Protocol: Evidence-based Medicine Using All Available Information
In stark contrast to NCFM Group, Bergen Group estimate GA from fetal metric measurements and, therefrom, calculate EDD using the equivalent of Naegele's rule, of which Bergen Group is quite clear, i.e., they do no claim this to be an actual estimate of EDD. However, Bergen Group's focus is not EDD, it is obstetric and fetal medicine and, consequently, Bergen Group considers all available information when determining fetal age and GA, including LMPD, OTPD, SCID, PTPD, IVFD, etc., and all corroborating combinations thereof. However, when ultrasound data become available, Bergen Group consider ultrasound data in conjunction with all available information to establish the best possible GA for individual pregnancies to ensure optimal obstetric & fetal awareness and optimal obstetric & fetal management of individual pregnancies. This is in stark contrast with NCFM Group who obviate all available information that is not provided by NCFM Group's unilateral, ultrasound-based eSnurra EDD estimation "method." At this point it may be helpful to refresh memories: Actual birth/delivery date varies, naturally, over a range of 35+ days (or 5 weeks) even when measured exactly from IVF or time of ovulation. This is why only 4% of women actually give birth (or deliver) on their EDD. Again, Bergen Group's focus is not on estimation of pregnancy term (EDD), but on the best possible GA for optimal obstetric & fetal awareness and optimal obstetric & fetal management of individual pregnancies; a GA determined from the beginning of pregnancy with consideration of all the natural, identifiable, resolvable variances, rather than from the estimated end of pregnancy. Bergen Group implements an individual approach to pregnancies for fetal and maternal health, with individual gestation duration as a function of fetal growth velocity and fetal size which, simultaneously, facilitates identification of fetal development, growth and pathology issues.
- Fetal size in the second trimester is a determinant of birth weight and pregnancy duration, small fetuses having lower birth weights and longer pregnancies (up to 13 days compared with large fetuses). Our results support a concept of individually assigned pregnancy duration according to growth rates rather than imposing a standard of 280–282 days on all pregnancies. (Source: "Fetal size in the second trimester is associated with the duration of pregnancy, small fetuses having longer pregnancies" Synnøve L Johnsen, Tom Wilsgaard, Svein Rasmussen, Mark A Hanson, Keith M Godfrey and Torvid Kiserud. BMC Pregnancy and Childbirth 2008, 8:25., p. 1. doi:10.1186/1471-2393-8-25. Received: 22 November 2007, Accepted: 16 July 2008, Published: 16 July 2008)
- To accommodate biological variation in fetal growth, customized [29] and conditional [30] models have been developed to individualize growth assessment. We believe that by accepting a greater biological variation of pregnancy duration than is imposed by the current ultrasound dating method, our clinical assessments may be founded on sounder biological principles. (Source: ibid., p. 6).
- Bergen Group would have included Laila's combined, fully corroborating, factual LMPD/OTPD/SCID as medical evidence of the beginning of her pregnancy for consideration in their practice of evidence-based medicine.
- Bergen Group would have compared their Terminhjulet HC-based GA with their Terminhjulet BPD-based GA and identified the large GA discrepancy. [Note: HC = head circumference]
- Bergen Group would have compared Terminhjulet FL-based GA with their Terminhjulet BPD-based GA and identified the large GA discrepancy, confirming the above. [Note: FL = femur length]
- Bergen Group would have calculated a cephalic index (CI) to quantify the degree of Laila's baby's apparent dolichocephalic head and would have used Laila's baby's dolichocephalic head and CI as evidence of fetal pathology and actively investigated same.
- Bergen Group might have put Laila on bed rest to arrest or reduce the apparent pressure-induced malformation of Laila's baby's head due to breech and Laila's short stature and, to lower Laila's blood pressure, as Laila was hypertensive when not recumbent on her left side, indicating pressure on her vena cava.
- Bergen Group would have cross-checked Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based GA with Bergen Group's Terminhjulet HC-based GA and Terminhjulet FL-based GA for reasonableness.
- Bergen Group would not have assigned a grossly inaccurate BPD-based GA & EDD to Laila's pregnancy to cause her Symphysis-fundus height (SFH) plots to appear above the 97.5 centile for erroneous interpretation as an excess amount of amniotic fluid (polyhydramnios) requiring a separate ultrasound exam to confirm otherwise.
- Bergen Group would have scheduled the turning of Laila's baby from breech to vertex in time to ensure Laila had every possible opportunity to have the normal delivery she had always wanted and for which she had planned.
- Bergen Group would have prevented an unnecessary, unwanted Cesarean section surgery delivery and a cascade of complications resulting in 11-nights in hospital.
- Bergen Group would not have had to listen to Laila & Edward's repeated warnings of a grossly inaccurate BPD-based GA & EDD because Bergen Group were well aware, from their own 2004 study, BPD is a problematic, unreliable predictor/estimator of EDD or GA when used without the more robust HC to keep BPD measurements in check during routine ultrasound exams.
- To summarize what is now obvious: Bergen Group consider all available information to establish the best possible fetal age and GA in their practice of evidence-based medicine for optimal medical awareness and medical management of individual pregnancies.
- Evidence-obviated Medicine (NCFM eSnurra Group)
a government-mandated protocol of evidence-obviated medicine which establishes fetal age and GA from the end of pregnancy (i.e., the wrong end) via a GA calculated, exclusively, from a direct estimation of EDD using the equivalent of Naegele's rule, in reverse, which, by government-mandate can neither be questioned nor tested for reasonableness against other evidence of known, proven efficacy, no matter what! - Evidence-based Medicine (Bergen Group)
a protocol which includes all available information, including a woman's factual, key pregnancy dates, in the practice of evidence-based medicine to establish the best possible fetal age and GA from the beginning of pregnancy via direct GA estimation for each individual pregnancy.
Norway is Alone
Included below are excerpts from Bergen Group's 2014 article in Aftenposten.
- Life or Death
"Assigning the correct fetal age can determine life or death. Therefore, all available sources should be used - not only ultrasound, which is standard practice today."
"Å angi riktig alder på et foster kan handle om liv eller død. Derfor bør alle tilgjengelige kilder brukes – ikke bare ultralyd, slik vanlig praksis er i dag."
"Correct fetal age acts in the difficult cases of life or death. We expect all available information to be used to arrive at the safest or most likely age of the fetus, and it can not be based on routine ultrasound alone."
"Riktig fosteralder handler i de vanskelige tilfellene om liv eller død. Vi vil forvente at all tilgjengelig informasjon tas i bruk for å komme frem til den sikreste eller mest sannsynlige alderen for fosteret, og det kan ikke være basert på rutineultralyd alene." - "Norway is alone in its practice
The Norwegian Gynecological Association has recommended in the Guide to Childbirth, that the age stipulations made first in pregnancy will not be altered on the basis of subsequent measurements. It is also recommended that the pregnancy age be determined from the date of fertilization, with accurate knowledge of this.
These recommendations are in line with international evidence-based guidelines. However, in Norway it is a common practice to use routine ultrasound as the sole basis for age determination. It can have significant consequences for diagnosis and treatment, both at lower limits for viability, time for lung-type syringe and overtime." (Source: "Abort: Ultralyd er ikke nok for å bestemme fosterets alder" Cathrine Ebbing, Synnøve Lian Johnsen, Jørg Kessler, Torvid Kiserud. Aftenposten Kronikk, Published: 16.okt.2014 14:28 updated: 17.okt.2014 11:49.) [Note: Source of "Guide to Childbirth" : "Veileder i fødselshjelp (2014)" Norsk gynekologisk forening, Den Norske Legeforening)]
"Norge er alene om sin praksis
Norsk gynekologisk forening har i Veileder i fødselshjelp anbefalt at aldersbestemmelsen som er gjort først i svangerskapet, ikke blir endret på bakgrunn av senere målinger. Her anbefales også at svangerskapsalderen bestemmes ut fra befruktningstidspunkt, ved nøyaktig kjennskap til dette.
Disse anbefalingene er i tråd med internasjonale, evidensbaserte retningslinjer. Men i Norge er det en utbredt praksis å bruke rutine-ultralyd som eneste grunnlag for aldersbestemmelsen. Det kan ha betydelige konsekvenser for diagnostikk og behandling, både ved nedre grense for levedyktighet, tid for lungemodningssprøyte og ved overtidighet." (Source: "Abort: Ultralyd er ikke nok for å bestemme fosterets alder" Cathrine Ebbing, Synnøve Lian Johnsen, Jørg Kessler, Torvid Kiserud. Aftenposten Kronikk, Published: 16.okt.2014 14:28 updated: 17.okt.2014 11:49.) [Note: Source of "Veileder i fødselshjelp" : "Veileder i fødselshjelp (2014)" Norsk gynekologisk forening, Den Norske Legeforening)]
Flawed Recommendation
Included below are 3 relevant excerpts from Bergen Group's 2015 article in Tidsskrift for Den Norske Legeforening to summarize the key points made above.
- "We argue that critical mistakes may follow from the failure to include all available information when fetal age is assessed."
"Vi mener det kan føre til kritiske feil om ikke all tilgjengelig informasjon tas med i vurderingen av fosterets alder."
(Source: "Flawed recommendation issued by the Norwegian Directorate of Health concerning the determination of fetal age" or "Helsedirektoratet gir feil anbefaling om bestemmelse av fosteralder" Cathrine Ebbing, MD, PhD, Synnøve Lian Johnsen MD, PhD, Jørg Kessler, MD, PhD, Torvid Kiserud, MD, PhD, Svein Rasmussen, MD, PhD., Nr. 8, 5 mai 2015, Tidsskr Nor Legeforen, 2015; 135:7401, DOI: 10.4045/tidsskr.15.0093) - "However, the issue at stake is not the accuracy of the predicted date of a normal delivery, it is the accuracy of the fetal age, which is an essential factor in clinical situations throughout the pregnancy."
"Men spørsmålet i debatten var ikke hvor bra man kunne beregne forventet tidspunkt for normal fødsel, det var å bestemme nøyaktig fosteralder, noe som er avgjørende i kliniske situasjoner gjennom hele svangerskapet." (Source: ibid.) - "However, the basis for determining gestational age is not the end of the pregnancy, but its beginning."
"Men alderen bestemmes ikke ut fra svangerskapets slutt, men når det begynner." (Source: ibid.)
Publications for Background Information
The articles identified below provide important background information. It is Bergen Group's "Flawed recommendation..." article that catalyzed Laila & Edward (while Laila was still in hospital) to investigate, research, analyze and understand the insidious, systemic problem that is Directorate of Health's 2014 Recommendation with their exclusive implementation of NCFM eSnurra Group's "method" using a government-mandated protocol of evidence-obviated medicine. The results of Laila & Edward's efforts are presented within the public interest disclosure website, LailasCase.com. The articles identified below (among others) serve as evidence to document the fact Directorate of Health were clearly and explicitly warned of the risks and consequences of their knowledge-obviated, medically & ethically flawed 2014 Recommendation or policy; a national medical policy which Directorate of Health implemented with conscious disregard of the published risks and consequences which had been clearly and explicitly identified by Norway's medical experts. This was willful recklessness and gross negligence by Directorate of Health. Moreover, because Directorate of Health's conscious disregard of the known risks and consequences caused grievous medical harms, Directorate of Health's implementation of their 2014 Recommendation was, and remains, stone-cold criminal.
Background Information
- 2012: "How Long Does a Pregnancy Last?" (Source "How Long Does a Pregnancy Last?" Torvid Kiserud. Tidsskrift for Den norske legeforening nr. 1, 2012; 132. Published: 10 January 2012. HTML version)
- 2014: "Term Determination: Will require everyone to use the same method" Norwegian: "Terminfastsettelse: Vil kreve at alle bruker samme metode" (Source: "Terminfastsettelse: Vil kreve at alle bruker samme metode" Anne Grete Storvik. Dagens Medisin. Published: 2014-09-19 16.02)
- 2014: "- Late abortion threshold is a "leather solution" Norwegian: "– Senabortgrensen er en «skinnløsning»" (Source: "– Senabortgrensen er en «skinnløsning»" Anne Grete Storvik. Dagens Medisin. Published: 2014-09-19 11.54)
- 2014: "Abortion: Ultrasound is not enough to determine the age of the fetus" Norwegian: "Abort: Ultralyd er ikke nok for å bestemme fosterets alder" (Source: "Abort: Ultralyd er ikke nok for å bestemme fosterets alder" Cathrine Ebbing, Synnøve Lian Johnsen, Jørg Kessler, Torvid Kiserud. Aftenposten Kronikk, Published: 16.okt.2014 14:28 updated: 17.okt.2014 11:49.)
- 2014: "Obstetricians: - Directorate of Health does not understand the difference between term and age" Norwegian: "Fødselsleger: – Helsedirektoratet forstår ikke forskjell på termin og alder" (Source: "Fødselsleger: – Hdir forstår ikke forskjell på termin og alder" Anne Grete Storvik. Dagens Medisin. Published: 2014-10-22 13.19)
- 2014: Formal Request to Norwegian Knowledge Centre for the Health Services (Nasjonalt kunnskapssenter for helsetjenesten) : "Age Determination of Pregnancy" Norwegian: "Aldersbestemmelse av svangerskapet" by Synnøve Lian Johnsen, MD, PhD (Bergen Group) (Source: "Age Determination of Pregnancy" ("Aldersbestemmelse av svangerskapet") Synnøve Lian Johnsen. 01.11.2014 Request to The Knowledge Center, Forslagsnr: 2015_005. [Note: The Knowledge Center (NOKC) reported to Directorate of Health until 01.01.2016 when NOKC was transferred to Norwegian Institute of Public Health (NIPH) (Folkehelseinstituttet (FHI))]
- 2014: "Not trustworthy from the Directorate of Health" Norwegian: "Ikke tillitvekkende fra Helsedirektoratet" (Source: "Ikke tillitvekkende fra Helsedirektoratet" Dagens Medisin Published: 2014-12-01 12.29, Posted by: Ebbing, Lian Johnsen, Kessler, Kiserud, Everyone at the Women's Clinic, Haukeland University Hospital)
- 2014: "NGF disagrees with Directorate of Health's recommendation for the determination of gestational length and term" Norwegian: "NGF tar avstand fra Helsedirektoratets anbefaling for fastsetting av svangerskapslengde og termin" (Source: "NGF tar avstand fra Helsedirektoratets anbefaling for fastsetting av svangerskapslengde og termin" Jone Trovik, Rolf Kirschner, Pål Øian. Bergen, Oslo, Tromsø 03.12.14. Norsk gynekologisk forening, Den Norske Legeforening Nyheter, 2014
- 2014: "Gynecologists are raging against the Directorate of Health" Norwegian: "Gynekologer raser mot Helsedirektoratet" (Source: "Gynekologer raser mot Helsedirektoratet" Anne Grete Storvik. Dagens Medisin Published: 2014-12-08 14.04)
- 2015: "Directorate of Health's role - and eSnurra" Norwegian: "Helsedirektoratets rolle – og eSnurra" (Source: "Helsedirektoratets rolle – og eSnurra" Dagens Medisin. Skrevet av: Johan Torgersen, divisjonsdirektør i Helsedirektoratet and Torunn Janbu, avdelingsdirektør i Helsedirektoratet. Published: 2015-04-13 11.49)
- 2015: Bergen Group's "Flawed recommendation issued by the Norwegian Directorate of Health concerning the determination of fetal age" Norwegian: "Helsedirektoratet gir feil anbefaling om bestemmelse av fosteralder" (Source: "Flawed recommendation issued by the Norwegian Directorate of Health concerning the determination of fetal age" or "Helsedirektoratet gir feil anbefaling om bestemmelse av fosteralder" Cathrine Ebbing, MD, PhD, Synnøve Lian Johnsen MD, PhD, Jørg Kessler, MD, PhD, Torvid Kiserud, MD, PhD, Svein Rasmussen, MD, PhD., Nr. 8, 5 mai 2015, Tidsskr Nor Legeforen, 2015; 135:7401, DOI: 10.4045/tidsskr.15.0. HTML versions: English or Norwegian)
- 2016: Norwegian Directorate of Health's 2014 Recommendation "One Norwegian national tool for estimating date of delivery and fetal age" Norwegian: "Nasjonalt verktøy for bestemmelse av termin og fosteralder" by Torunn Janbu, MD, PhD, Head of the Department of Hospital Services, Norwegian Directorate of Health. (Source: "One Norwegian national tool for estimating date of delivery and fetal age" or "Nasjonalt verktøy for bestemmelse av termin og fosteralder" Torunn Janbu, MD, PhD, Head of the Department of Hospital Services, Norwegian Directorate of Health. Tidsskr Nor Legeforen nr. 9, 2016; 136: 790 – 1.)
- 2018: Bergen Group's "Estimated date of delivery based on second trimester fetal head circumference; a population based validation of 21451 deliveries" by Jörg Kessler, Synnøve Lian Johnsen, Cathrine Ebbing, Henriette Odland Karlsen, Svein Rasmussen & Torvid Kiserud. (Source: "Estimated date of delivery based on second trimester fetal head circumference; a population based validation of 21451 deliveries" Jörg Kessler, Synnøve Lian Johnsen, Cathrine Ebbing, Henriette Odland Karlsen, Svein Rasmussen & Torvid Kiserud. Acta Obstetrica et Gynecologica Scandinavica (AOGS), Volume 98, Issue 1, January 2019. Pages 101-105 https://doi.org/10.1111/aogs.13454 First published: 31 August 2018, Publication history: Accepted manuscript online: 31 August 2018)
"The most difficult problem in dating a pregnancy is..."
...obviating all the biological evidence of a pregnancy's beginning via government mandate.
The excerpt below is the beginning of the "DISCUSSION" section of NCFM eSnurra Group's Gjessing et al. 2007 (which appropriated, plagiarized and enabled the misuse of the Hutchon Method of Population-based Direct Estimation of EDD (PDEE)) regarding "the most difficult problem in dating a pregnancy." Laila had been aware of the "problem" in dating a pregnancy because the supposed "problem" is one of the natural variations taught and discussed in human biology and health classes in most high schools, if not earlier. It is because of these known, natural variations Laila & Edward, like millions of others, planned to have a baby "by the numbers" with the assistance of a highly accurate & reliable, over-the-counter, home-use, digital, urinary ovulation test.
- "The most difficult problem in dating a pregnancy is the almost universally missing knowledge about the exact time of conception. The date of the LMP has been used as the basis for almost all prediction models. Even ultrasound prediction models have been constructed from ‘reliable’ LMP dates. However, the LMP date can at best be regarded only as a proxy for the true start of the pregnancy, in particular owing to imperfect recall and variable menstrual cycle, such as variable length of the follicular phase 21" (Source: Gjessing et al. 2007 or "A direct method for ultrasound prediction of day of delivery: a new, population-based approach," H. K. GJESSING, P. GRØTTUM and S. H. EIK-NES; Ultrasound Obstet Gynecol 2007: 30: 19–27, p.23)
- "almost universally missing knowledge about the exact time of conception"
This information was not missing in Laila's case, as it was fact-based evidence provided by the combination of Laila's single-coitus-insemination date (SCID) and Laila's factual ovulation-test-positive date (OTPD) with the knowledge that an unfertilized human ovum/egg's mean survival time is just 17 hours. Moreover, home-use, urinary ovulation tests entered the mass market in 1989, almost 30 years ago; and, these tests, like pregnancy tests, are highly accurate (i.e., high sensitivity (low false positives) & high specificity (low false negatives)) and reliable. - "the LMP date can at best be regarded only as a proxy for the true start of the pregnancy"
Last-menstrual-period date (first day) (LMPD) is most definitely "a proxy for the true start of the pregnancy." Moreover, LMPD has always been a proxy, ever since Boerhaave established LMPD "as a proxy for the true start of pregnancy" some 200+ years ago with his algorithm for calculating EDD, which Naegele subsequently popularized (while giving full credit and formal attribution to Boerhaave) and became popularly known as Naegele's rule. - "in particular owing to imperfect recall and variable menstrual cycle"
Laila's LMPD was factual and recorded on the day it presented in Laila's pregnancy spreadsheet and her smartphone to guard against "imperfect recall" and to track her by-the-numbers effort to become pregnant, just as millions of others do with smartphone pregnancy apps, web-based pregnancy apps, spreadsheets, pocket calendars, wall calendars, pencil & paper or in their heads, as Norway's women are well-educated and resourceful. - "and variable menstrual cycle"
Laila had been tracking her menstrual cycle which had always been regular, 28 days, like clockwork, textbook in fact; and, Laila entered her LMPD in her pregnancy spreadsheet and smartphone when it presented. - "such as variable length of the follicular phase"
Laila had eliminated otherwise unknown ovulation variance due to "variable length of the follicular phase" with the results of a highly reliable and highly accurate urinary, digital Clearblue ovulation test; a testing system which tracked Laila's estrogen hormone ramp-up and signaled both rising and peak Luteinizing hormone (LH) surge using monoclonal antibodies with lab-on-a-chip technology to establish Laila's ovulation-test-positive date (OTPD), day 14 (LMPD + 14 days or 2w+0), again, textbook; a test which not only signaled Laila's pending ovulation (i.e., ovulation generally occurs, 36 hours after first LH rise and 17 hours after LH peak) and her peak fertility, but also served to isolate and eliminate ovulation (or follicular phase) variance from her pregnancy, as ovulation variance is widely reported to account for up to 50% of total gestational variance in pregnancies. Moreover, over-the-counter, home-use, urinary ovulation tests entered the mass market in 1989, a few years after home-use pregnancy tests, almost 30 years ago; therefore, an ovulation test was not new biochemical evidence of Laila's OTPD. And, as was the case with her LMPD, Laila had entered her OTPD in her pregnancy spreadsheet and smartphone when it presented.
- LMPD = 0w+0 = 05.09.2016
- OTPD = 2w+0 = 05.23.2016; day 14, textbook
- SCID = 2w+1 = 05.24.2016; effective, but not textbook
- (LMPD + 15 days) = (OTPD + 1 day) = SCID = 05.24.2016 = "the exact time [date] of conception"
[Note: an unfertilized human ovum/egg is widely reported to have a mean survival time of 17 hours]
- LMPD/OTPD/SCID-based GA = 2w+1 on 05.24.2016, "the exact time [date] of conception"
- LMPD/OTPD/SCID-based EDD = (05.24.2016 + 266 days) = 02.14.2017, Valentine's Day!
Or, using the equivalent of Naegele's rule: (LMPD-based GA = 0w+0 on 05.09.2017); (05.09.2016 + 280 days) = 02.13.2017, close enough, but not Valentine's Day
Nevertheless, Laila was assigned, without her prior, informed, voluntary, explicit consent, an estimated EDD and, therefrom, a calculated GA using the equivalent of Naegele's rule, in reverse, by Norway's National Center for Fetal Medicine (NCFM) eSnurra Group's "method" (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) which used Laila's fetus/baby's ultrasound-based biparietal diameter (BPD) measurement (or ear-to-ear skull diameter) of 41 mm to estimate Laila's EDD and, therefrom, calculate Laila's gestational age (GA) on the ultrasound dated using the equivalent of Naegele's rule, in reverse. However, the BPD measurement is known, internationally, to be a problematic and unreliable predictor/estimator of EDD and GA because it is not insensitive to fetal head shape. See Warnings > BPD IS PROBLEMATIC
- The BPD fetal head measurement is known, internationally, to be a problematic, unreliable estimator of GA and EDD during routine ultrasound exams and, therefore, the more robust head circumference (HC) measurement should be used instead, or HC should be used with BPD to keep BPD in check and to test BPD-based GA for reasonableness, but BPD should not be used alone. This makes perfect sense, intuitively, because HC contains information of 2 spacial dimensions (i.e., 2 diameters perpendicular to each other) while BPD contains information of only 1 spacial dimension (i.e., 1 diameter), thus enabling the HC measurement to contain more information of fetal head size for reliable estimation of GA or EDD (depending on the method) while being nearly insensitive to fetal head shape. See Warnings > BPD IS PROBLEMATIC
See The Warnings > BPD IS PROBLEMATIC
Nevertheless, in Laila's case the BPD measurement of 41 mm was used, without HC to test for reasonableness, by NCFM eSnurra, without Laila's prior, informed, voluntary, explicit consent, to establish Laila's "official," NCFM eSnurra BPD-based EDD & GA, which could neither be questioned nor tested for reasonableness, accuracy or efficacy by government mandate, no matter what!
- NCFM eSnurra BPD-based EDD = 28.02.2016 (for which Laila's LMPD/OTPD/SCID-based GA = 42w+1, which, in reality put Laila's EDD into post-term by 2-weeks, erroneously), Lagging Laila's factual LMPD/OTPD/SCID-based EDD = 14.02.2017 (Laila's LMPD/OTPD/SCID-based GA = 40w+1) by 14 days
Lagging Laila's LMPD-based EDD = (Laila's LMPD-based GA = 40w+0) 13.02.2017 by 15 days - NCFM eSnurra BPD-based GA (calculated from EDD (the estimated end of pregnancy; the wrong end) via the equivalent of Naegele's rule, in reverse) = 17w+6 on ultrasound date = 23.09.2016
Lagging Laila's LMPD/OTPD/SCID-based GA = 19w+4 on ultrasound date = 23.09.2016 by 12 days
- Laila & Edward estimated Laila's baby's cephalic index (CI) (i.e., BPD/OFD x 100 or (ear-to-ear diameter) / (back-to-front diameter) x 100) to be 62, which is defined as extreme dolichocephaly (i.e., on the date of the ultrasound exam 23.09.2016). However, this evidence, too, was obviated because it relied on Laila's LMPD/OTPD/SCID-based GA and the use of a non-NCFM eSnurra Group published HC reference chart; a chart of known, proven efficacy. See Warnings > BPD IS PROBLEMATIC
Insidious, Systemic, Institutionalized, Government-mandated Problem
Following is a summary of this insidious, systemic, institutionalized, government-mandated problem and most of the integrated, component causes discovered during Laila & Edward's investigation and research, which are covered in detail elsewhere in LailasCase.com. This is where LailasCase.com becomes truly strange and more systemic than either Laila or Edward could have imagined, yet it is included in LailasCase.com with all the fact-based evidence.
- Corrupted decision-making by Norwegian Directorate of Health from within and by special interests which resulted in the formulation of a medically & ethically flawed national medical policy with respect to obstetric medicine, fetal medicine and obstetric clinical care.
- Intentional recklessness and willful negligence by Directorate of Health by implementing their medically & ethically flawed 2014 national medical policy against the clear, explicit, published warnings of the risks and consequences by Norway's foremost medical experts of obstetric medicine, fetal medicine and obstetric clinical care, including Norsk gynekologisk forening (NGF) (Norwegian Society of Gynecology & Obstetrics), Oslo, Norway and Bergen Group of Haukeland University Hospital, Bergen, Norway, among others. Directorate of Health's willful negligence was stone-cold criminal.
- Subversion of the doctoral degree regulations and requirements of Norwegian University of Science and Technology (Norges teknisk-naturvitenskapelige universitet) (NTNU) combined with academic misconduct and fraud by a doctoral candidate, her coauthors, her thesis supervisors and members of her doctoral thesis Assessment Committee which resulted in an NTNU doctoral thesis which fell well outside the boundaries of the ethos of scholarship, academic integrity and independence required of an NTNU doctoral degree; a doctoral thesis subsequently used as independent, academic justification by Directorate of Health for their medically & ethically flawed, intentionally reckless, willfully negligent 2014 Recommendation, i.e., national medical policy; a policy which included a government-mandated protocol of evidence-obviated medicine proven to cause increase medical risks, critical medical mistakes and grievous medical harms to some of Norway's pregnant women and their babies, Laila and her baby among them.
- Research misconduct and scientific misconduct by National Center for Fetal Medicine (NCFM) eSnurra Group via their appropriation, plagiarism and misuse of Dr. David J. R. Hutchon's original idea and method, the Hutchon Method of Population-based Direct Estimation of EDD (PDEE), developed at Memorial Hospital, Darlington, U.K., beginning in 1995 and published 19.07.1998, Hutchon 1998 and presented on Dr. Hutchon's copyrighted website, hutchon.net.
- Research Misconduct via plagiarism by authors of the publications listed below with their self-identified institutional affiliations which are identified within their respective publications:
Taipale & Hiilesmaa 2001 in collaboration with National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway
Authors: Pekka Taipale, Vilho Hiilesmaa
1) Department of Obstetrics and Gynecology, Jorvi Hospital, Espoo, Finland
2) Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
3) National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway
4) Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Eik-Nes et al. 2005 and Gjessing et al. 2007
Authors: Strurla H. Eik-Nes, Per Grøttum, Håkon K. Gjessing, Harm-Gerd Karl Blaas
1) Norway's National Center for Fetal Medicine (Nasjonalt senter for fostermedisin) (NCFM or NSFM) Trondheim, Norway;
2) Department of Medical Informatics of University of Oslo (UiO), Oslo, Norway;
3) Norwegian Institute of Public Health (Folkehelseinstituttet) (FHI), Oslo, Norway;
[Note: Harm-Gerd Karl Blaas was not an author of Gjessing et al. 2007]
Salomon et al. 2010
Authors: Laurent J. Salomon, Costanza Pizzi, Antonio Gasparrini, Jean-Pierre Bernard, Yves Ville
1) CHU Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
2) Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
3) Public and Environmental Health Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK - Identified plagiarism of Dr. David J. R. Hutchon's original idea and method, the Hutchon Method of Population-based Direct Estimation of EDD (PDEE), Hutchon 1998, was formally reported on 4 separate occasions to the international, academic medical journal Ultrasound in Obstetrics & Gynecology (UOG) also known as The White Journal, the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), published by John Wiley & Sons, Inc., were ignored; and, 2 of the principal plagiarists are authors published in UOG, members of ISUOG and each a former President of ISUOG, one of whom was Editor-in-Chief of UOG at the the time the appropriation and plagiarism were first reported on 26.07.2007 to Ultrasound in Obstetrics & Gynecology
- Multiple breaches of medical ethics, professional misconduct, conflicts of interest and breaches of the public trust
Cascade of Critical Medical Mistakes
Following is a summary of the unnecessary, preventable cascade of critical medical mistakes; critical medical mistakes which would not have been made if Laila's pregnancy were to have been under the care and supervision of Bergen Group's protocol of including all available information in the practice of evidence-based medicine to determine the best possible fetal age and gestational age (GA) for Laila's pregnancy.
Despite the fact Directorate of Health had been clearly and explicitly warned of these exact risks and consequences by NGF and Bergen Group, Directorate of Health, nevertheless, enacted their government-mandated protocol of evidence-obviated medicine with conscious disregard of the identified risks and consequences for which they had been so clearly, explicitly and publicly warned by Norway's foremost, venerated medical experts. Moreover, and according to Directorate of Health, their national medical policy with their exclusive implementation of NCFM eSnurra Group's method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE), along with their government-mandated protocol of evidence-obviated medicine must be implemented and used by all of Norway's medical institutions and medical professionals with respect to obstetric medicine, fetal medicine and obstetric clinical care, without question and without exception. In the economy of words that are Bergen Group and NGF this is "medically flawed" and "can be directly dangerous," respectively. Moreover, and in the words of Laila, this is "downright Orwellian!"
The Resistance
Apparently, Directorate of Health's medically & ethically flawed 2014 Recommendation collided with medical knowledge outside the bubble of confirmation bias and doublethink, thus impeding full implementation of their medically & ethically flawed 2014 Recommendation throughout all of Norway. Unfortunately, Laila's pregnancy was not handled by those medical professionals among the knowledge-based resistance. On the other hand, and as Laila readily pointed out, LailasCase.com would then not exist to join and support the knowledge-based resistance.
Critical Mistakes Require Critical Questions & Answers
All this can be summed up by answering the following question: When all of one's medical professionals and all the medical specialists from a national center for fetal medicine and a nation's government's healthcare authorities and representatives intransigently insist: 2 + 2 = 5, does one conclude:
Increased Medical Risks, Critical Medical Mistakes and Grievous Medical Harms
The increased medical risks, critical medical mistakes and grievous medical harms side of Laila's case is not complicated, although there is some gestational mathematics which any average 4th-grade student could handle, and there is some basic human biology which any average 6th-grade student could handle; and, there will be no test. However, there are very specific causes of the risks, mistakes and harms which are deeply rooted in corruption, academic misconduct, research misconduct and institutionalized confirmation bias and doublethink, and not something similar to doublethink, but the actual, literal definition of doublethink, precisely as written by George Orwell, right out of his novel "1984." Included below is an excerpt to refresh memories, as doublethink in Laila's case was very real, deeply institutionalized and proven dangerous.
Research Misconduct: Appropriation, Plagiarism & Misuse of Hutchon Method of PDEE
The research misconduct via plagiarism side of LailasCase.com was discovered while investigating the origin of the idea, method and associated publications used by NCFM eSnurra Group to predict/estimate the day/date of delivery (EDD) and, therefrom, calculate gestational age (GA) using the equivalent of Naegele's rule, in reverse. The method used by NCFM eSnurra Group is the Hutchon Method of Population-based Direct Estimation of EDD (PDEE), developed by Dr. David J. R. Hutchon (Darlington, UK) from his original idea, the first ultrasound fetal biometry method of direct prediction/estimation of date of delivery (EDD), Hutchon 1998, 29-years after Stuart Campbell's original ultrasound fetal biometry method of prediction/estimation of gestational age (GA), Campbell 1969. The appropriation, plagiarism and misuse of Dr. David J. R. Hutchon's original idea and method, the Hutchon Method of PDEE, is a story unto itself, but it is tied directly to the increased medical risks, critical medical mistakes and grievous medical harms inflicted upon Laila and her baby, and other women and their fetuses/babies, as a direct result of Norwegian Directorate of Health's medically & ethically flawed 2014 Recommendation with their exclusive NCFM eSnurra Group's "method" (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) within a government-mandated protocol of evidence-obviated medicine.
There were important, specific capabilities and limitations identified by Dr. Hutchon for his Hutchon Method of PDEE which NCFM eSnurra Group ignored when they appropriated, plagiarized and then misused the Hutchon Method of PDEE. Specifically, Dr. Hutchon made 2 specific points decidedly clear and explicit in his seminal Hutchon 1998.
Medical Consequences of Plagiarisim
When NCFM eSnurra Group appropriate and plagiarized Dr. Hutchon's original idea and method over the last 12-years, they prevented those who read NCFM eSnurra Group's many publications based, entirely, on the Hutchon Method of PDEE from knowing about Dr. Hutchon and what Dr. Hutchon had made clear in his seminal Hutchon 1998 and other publications about using the Hutchon Method of PDEE beyond its capabilities. Again, Dr. Hutchon could not have been more clear (excerpts above). Consequently, and by not considering all available information (i.e., key pregnancy dates including LMPD, OTPD, SCID, etc.) when establishing GA & EDD with the Hutchon Method of PDEE, some of Norway's women and their babies endured increased medical risks, critical medical mistakes and grievous medical harms as a direct consequence of grossly inaccurate NCFM eSnurra estimations of EDD and, thereby, calculated grossly inaccurate GA values using the equivalent of Naegele's rule, in reverse, that were not checked for reasonableness, errors or efficacy against all available evidence i.e., the pregnant woman's key pregnancy dates including LMPT, OTPD, SCID, etc.. Again, Dr. Hutchon could not have been more clear in his seminal Hutchon 1998 when he stated, "...there is no pretence that this method is determining fetal age."
Publishers & Plagiarism
Additionally, Ultrasound in Obstetrics & Gynecology (UOG) and ISUOG ignored Dr. Hutchon's 4 separate attempts to seek a by-the-book investigation and redress of the appropriation and plagiarism of his original idea and method, the Hutchon Method of PDEE, in NCFM eSnurra Group's Gjessing et al. 2007. By ignoring Dr. Hutchon and the reported plagiarism, UOG and ISUOG enabled the Norwegian Directorate of Health and NCFM eSnurra Group to use NCFM eSnurra Group's plagiarism-based publications; publications based, entirely, on the Hutchon Method of PDEE, as justification of their medically & ethically flawed 2014 Recommendation with their exclusive implementation of the NCFM eSnurra Group method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) within a government-mandated protocol of evidence-obviated medicine that caused increased medical risks, critical medical mistakes and grievous medical harms to some of Norway's women and their babies, Laila and her baby among them.
Following is a summary of the unnecessary, preventable cascade of critical medical mistakes; critical medical mistakes which would not have been made if Laila's pregnancy were to have been under the care and supervision of Bergen Group's protocol of including all available information in the practice of evidence-based medicine to determine the best possible fetal age and gestational age (GA) for Laila's pregnancy.
- The Directorate of Health's medically & ethically flawed, intentionally reckless, willfully negligent 2014 Recommendation with their exclusive implementation of NCFM eSnurra Group's method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) within a government-mandated protocol of evidence-obviated medicine, obviated Laila's key medical evidence (i.e., Laila's factual, key pregnancy dates), including her combined, fully corroborating, factual LMPD/OTPD/SCID, from medical evidence and from any and all consideration in medical thinking, medical decision-making and medical actions to ensure NCFM eSnurra Group's "method" (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) maintained complete, exclusive control of assigning ultrasound-based estimated date of delivery (EDD) and, therefrom, a calculated gestational age (GA), using the equivalent of Naegele's rule, in reverse, for all pregnancies and abortions in Norway, without testing these NCFM eSnurra EDD & GA values for reasonableness, errors or efficacy against any other medical evidence, whatsoever. Consequently, Directorate of Health's implementation of their medially & ethically flawed 2014 Recommendation (i.e., national medical policy) against the clear, explicit, published warnings of the risks and consequence by Norway's foremost medical experts was, and remains, a critical medical mistake; an intentionally reckless, willfully negligent critical medical mistake; a criminal mistake.
- At Laila's first ultrasound exam on 10.08.2016 for a nuchal translucency (NT) measurement (screen for trisomy 13, 18 & 21) the CRL, BPD & FL fetal metrics were measured to establish NCFM eSnurra EDD & GA values (below), which lagged Laila's LMPD/OTPD/SCID-based GA & EDD, significantly, and should have indicated a potential fetal pathology, such as small for gestational age (SGA), but these clearly obvious lags were either ignored or attributed to a later ovulation date, which could make sense for other pregnancies, but since Laila had an OTPD, her factual LMPD/OTPD/SCID-based GA & EDD should have been used as a cross-reference check for reasonableness. Consequently, the NT scan of 1.4 mm and the blood tests (beta-hCG & PAPP-A) were compared to reference curves/charts using a CRL measurement of 54 mm with an NCFM eSnurra BPD-based EDD which was factually inaccurate by -8 days (or 1w+1) which begs the question: Why combine a CRL measurement with a BPD-based EDD estimate in an NT test; why not use the CRL-based EDD with a CRL measurement? Nevertheless, ignoring the EDD & GA lags or discrepancies was a critical medical mistake which was made before Laila's LMPD/OTPD/SCID-based GA & EDD had been obviated, which makes the point, obviated or not, Laila's key pregnancy dates were never considered as evidence for cross-reference checking ultrasound estimated dates of GA with Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based GA.
- NCFM eSnurra CRL-based EDD = 25.02.2017, which lagged Laila's factual LMPD/OTPD/SCID-based EDD by 11 days
NCFM eSnurra CRL-based GA = 12w+0, which lagged Laila's factual LMPD/OTPD/SCID-based GA by 9 days - NCFM eSnurra BPD-based EDD = 22.02.2017, which lagged Laila's factual LMPD/OTPD/SCID-based EDD by 8 days
NCFM eSnurra BPD-based GA= 12w+3, which lagged Laila's factual LMPD/OTPD/SCID-based GA by 6 days
[Note: NCFM eSnurra FL-based EDD & GA were not included in Laila's first-trimester ultrasound report.]
- NCFM eSnurra CRL-based EDD = 25.02.2017, which lagged Laila's factual LMPD/OTPD/SCID-based EDD by 11 days
- Laila was not informed the routine 18-week ultrasound exam (18wUSE) was an optional, voluntary exam, nor was she informed the exam's primary purpose was to obviate her factual key pregnancy dates and then replace them with ultrasound estimates of EDD and, therefrom, calculations of GA using the equivalent of Naegele's rule, in reverse, via NCFM eSnurra Group's method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE). Laila's obviated key pregnancy dates which were replaced with ultrasound estimated dates had been "corrected," the euphemism used by Laila's medical professionals to imply there was something incorrect with her factual, key pregnancy dates. Other than their apparently inconvenient existence, there was nothing incorrect with Laila's factual, key pregnancy dates. The routine 18-week ultrasound exam was used by Directorate of Health and NCFM eSnurra Group as a Trojan horse of fetal health assessment, but with deceptive, hidden conditions; conditions which were forced upon Laila, without her prior, informed, voluntary, explicit consent. These deceptive, hidden conditions included:
- a government-mandated protocol of evidence-obviated medicine which would obviate all of Laila's key pregnancy dates and Laila's combined, fully corroborating factual dates (i.e., LMPD/OTPD/SCID) from all medical evidence at the scheduling of the "routine" 18wUSE,
- Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based GA & EDD used to schedule the routine 18wUSE would be replaced with the ultrasound-based EDD & GA values from NCFM eSnurra Group's method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE), despite the fact Laila's key pregnancy dates did not need to be "corrected" or replaced because Laila's key pregnancy dates were spreadsheet-recorded as they presented and were stone-cold factual
- Laila's first-trimester ultrasound GA & EDD values would be replaced by the less accurate second-trimester GA & EDD values established at the18wUSE when fetal metrics and their measurements present increased random growth velocity variances or higher random error (SD, precision) from NCFM eSnurra Group's accurately average assumption for all fetal metric measurements
- Laila's factual, key pregnancy dates, her medical evidence, were obviated from any and all consideration as medical evidence at the scheduling of her routine 18-week ultrasound exam (18wUSE), without Laila's prior, informed, voluntary, explicit consent; again, Laila's factual, key pregnancy dates, her medical evidence of known, proven efficacy were all obviated from all medical evidence and any and all consideration in medical thinking, medical decision-making and medical actions without Laila's prior, informed, voluntary, explicit consent. Redundant, yes, but important.
- Laila was forced to assume an unnecessary 12.8% risk of a grossly inaccurate NCFM eSnurra BPD-based EDD and, therefrom a calculated, grossly inaccurate GA using the equivalent of Naegele's rule, in reverse, as her "official" EDD & GA for herself and her fetus/baby to be used, exclusively, in all medical thinking, medical decision-making and medical actions even though she was in ownership possession of a combined, fully corroborating, factual LMPD/OTPD/SCID-based GA & EDD; of which, the only more accurate evidence for the beginning of Laila's pregnancy would have been if Laila were to have had an in vitro fertilization date (IVFD).
- NCFM eSnurra Group's eSnura method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) is almost exclusively reliant upon the ultrasound-based fetal biparietal diameter (BPD) measurement (i.e., the ear-to-ear head/skull diameter), which is know, internationally, as a problematic, unreliable fetal metric measurement for estimating GA or EDD, depending on the method, during routine ultrasound exams and, consequently, the more robust head circumference (HC) should be used instead, or BPD should only be used in conjunction with a corroborating HC measurement to establish GA & EDD at routine ultrasound exams. Also, this is intuitive, as BPD is a diameter measurement in 1 spacial dimension whereas HC is a measurement in 2 perpendicular spacial dimensions which makes it highly insensitive to head shape while containing more information on fetal size.
- The decision to establish Laila's EDD & GA using NCFM eSnurra BPD-based EDD & GA was compromised by confirmation bias and doublethink given that contradictory evidence from NCFM eSnurra Group's own EDD & GA values derived from the 2 other fetal metric measurements (i.e., femur length (FL) and mean abdominal diameter (MAD)) corroborated each other 100% in signaling the NCFM eSnurra BPD-based EDD & GA values assigned to Laila's pregnancy were grossly inaccurate and should have been interpreted as obvious evidence of potential fetal pathology and not as evidence of accurate EDD & GA values.
- NCFM eSnurra Group's eSnurra method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) assigned an NCFM eSnurra BPD-based EDD & GA to Laila's pregnancy that lagged Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based EDD & GA by 14-days and 12-days, respectively, thereby signalling: 1) grossly inaccurate NCFM eSnurra BPD-based EDD & GA values and 2) potential fetal pathology. Consequently, all of Laila's medical professionals' medical thinking, medical decision-making and medical actions which related to her pregnancy were based on the grossly inaccurate NCFM eSnurra BPD-based EDD & GA by government mandate.
- Directorate of Health's government-mandated protocol of evidence-obviated medicine would not allow Laila's medical professionals to compare the EDD & GA values from NCFM eSnurra Group's eSnurra method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) against Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based EDD & GA values for reasonableness, errors or efficacy.
- NCFM eSnurra Group's eSnurra method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) assigned Laila's pregnancy an NCFM eSnurra BPD-based EDD that lagged Laila's factual LMPD-based EDD by 15-days which, according to NCFM eSnurra Group's publications should have trigger an automatic anomaly scan, but this 15-day EDD discrepancy was ignored, likely because acting on Laila's 15-day EDD discrepancy would have violated the government-mandated protocol of evidence-obviated medicine.
- Laila & Edward's repeated, insistent warnings the EDD & GA values assigned to Laila's pregnancy by NCFM eSnurra Group's eSnurra method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) were grossly inaccurate relative to Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based GA & EDD were ignored.
- Laila & Edward's repeated warnings that the BPD-based EDD assigned to Laila's pregnancy by NCFM eSnurra Group's eSnurra method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) was lagging NCFM eSnurra's own FL-based EDD and the NCFM eSnurra's own MAD-based EDD by 8-days were ignored.
- Laila's midwife measured Laila's Symphysis-fundus height (SFH) at each appointment beginning 27.10.2016 (Laila's GA = 24+3) for a total of 6 measurements which were plotted against the grossly inaccurate NCFM eSnurra BPD-based GA. Not surprisingly, Laila's GA vs. SFH plots were tracking above the 90th centile, with 2 measurements above the 97.5 centile, evidence of a grossly inaccurate NCFM eSnurra BPD-based GA. Nevertheless, it was decided Laila had to be an anomaly, so Laila had an ultrasound exam on 23.12.2016 to confirm an excess amount of amniotic fluid (polyhydramnios) was causing Laila's anomalous GA vs. SFH plots, despite Laila & Edward's repeated, insistent warnings the NCFM eSnurra BPD-based EDD & GA were grossly inaccurate, lagging by 14 day and 12 days, respectively. Not surprisingly, the ultrasound exam showed Laila's amniotic fluid volume to be normal, and still, the grossly inaccurate NCFM eSnurra BPD-based EDD & GA could neither be questioned nor tested for reasonableness against Laila's anomalous GA vs. SFH plots or Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based GA & EDD. Again, this was due to a government-mandated protocol of evidence-obviated medicine which necessitated government-mandated, institutionalized confirmation bias and doublethink.
- Laila & Edward's repeated warnings that the grossly inaccurate GA & EDD values assigned to Laila's pregnancy by NCFM eSnurra Group's eSnurra method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) were masking a potential fetal pathology, when compared to Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based GA & EDD were ignored.
- Laila & Edward's repeated warnings that the grossly inaccurate GA & EDD values assigned to Laila's pregnancy by NCFM eSnurra Group's eSnurra method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) were masking a potential fetal pathology, when compared to NCFM eSnurra's own FL-based EDD and the NCFM eSnurra's own MAD-based EDD by 8 days were ignored.
- Laila & Edward's warnings that the scheduling of the ultrasound exam to confirm breech and then schedule the routine, manual turning of Laila's baby from breech to vertex for normal delivery had been scheduled too late and the scheduled date fell under the normal umbrella of variance (+/- 14 days) of Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based EDD were ignored.
- Laila's medical professionals scheduled the ultrasound exam to confirm breech, which had already been known, to then schedule the routine, manual turning of Laila's baby from breech to vertex for normal delivery much too late; consequently, Laila went into labor 15-hours after the ultrasound exam to confirm breech and 2-days before Laila's baby was scheduled for the routine turning from breech to vertex for normal delivery; and, a baby cannot be turned from breech to vertex for normal delivery after the onset of labor.
- A hospital CT-scan confirmed Laila's pelvis measurements met all the criteria for a safe, vertex delivery, but did not meet all the criteria for a safe, breech delivery (breech safe?); ergo, this cascade of critical medical mistakes forced Laila into an unnecessary, unwanted Cesarean section surgery delivery, thus denying Laila and her baby their respective natural medical benefits, of which there are many, of a normal, vertex, delivery. Also, Laila's baby was born with a dolochocephalic head (i.e., commonly "long head" or "breech head"), the fetal pathology masked by the grossly inaccurate NCFM eSnurra BPD-based EDD & GA values, which Laila & Edward had identified by comparing Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based GA & EDD against the NCFM eSnurra BPD-based EDD & GA values, but this was not allowed to be considered as medical evidence by the government-mandated protocol of evidence-obviated medicine; consequently, all of Laila & Edward's repeated, insistent warnings were ignored.
- Laila's baby was officially recorded as GA = 37w+0 at delivery, which was grossly inaccurate relative to Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based GA which established Laila's baby's GA = 38w+5 at delivery. NCFM eSnurra Group's eSnurra method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) resulted in a prediction error (predicted (set to 0) - actual) = -24 days; 4 days shy of a full menstrual period.
- Laila's baby's official birth/delivery record registered at the Norwegian National Birth Registry was recorded as 37w+0 at delivery, which was grossly inaccurate, of course, but serves to make the point that these insidious, systemic increased medical risks, critical medical mistakes and grievous medical harms are silently and invisibly written off, unattributed, undocumented and unreported, as acceptable collateral damage of Directorate of Health's medically & ethically flawed, intentionally reckless, willfully negligent 2014 Recommendation (i.e., national medical policy) with with their exclusive NCFM eSnurra Group's eSnurra method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) and their government-mandated protocol of evidence-obviated medicine with respect to obstetric medicine, fetal medicine and obstetric clinical care. This insidious, systemic, institutionalized problem was, and remains, a breach of the public trust of which Norway's women and their babies are among the most vulnerable.
Despite the fact Directorate of Health had been clearly and explicitly warned of these exact risks and consequences by NGF and Bergen Group, Directorate of Health, nevertheless, enacted their government-mandated protocol of evidence-obviated medicine with conscious disregard of the identified risks and consequences for which they had been so clearly, explicitly and publicly warned by Norway's foremost, venerated medical experts. Moreover, and according to Directorate of Health, their national medical policy with their exclusive implementation of NCFM eSnurra Group's method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE), along with their government-mandated protocol of evidence-obviated medicine must be implemented and used by all of Norway's medical institutions and medical professionals with respect to obstetric medicine, fetal medicine and obstetric clinical care, without question and without exception. In the economy of words that are Bergen Group and NGF this is "medically flawed" and "can be directly dangerous," respectively. Moreover, and in the words of Laila, this is "downright Orwellian!"
The Resistance
Apparently, Directorate of Health's medically & ethically flawed 2014 Recommendation collided with medical knowledge outside the bubble of confirmation bias and doublethink, thus impeding full implementation of their medically & ethically flawed 2014 Recommendation throughout all of Norway. Unfortunately, Laila's pregnancy was not handled by those medical professionals among the knowledge-based resistance. On the other hand, and as Laila readily pointed out, LailasCase.com would then not exist to join and support the knowledge-based resistance.
Critical Mistakes Require Critical Questions & Answers
All this can be summed up by answering the following question: When all of one's medical professionals and all the medical specialists from a national center for fetal medicine and a nation's government's healthcare authorities and representatives intransigently insist: 2 + 2 = 5, does one conclude:
- their competences are exceeded by simple mathematics or
- they are using alternative mathematics with alternative facts or
- something truly Orwellian is afoot and needs to be investigated?
Increased Medical Risks, Critical Medical Mistakes and Grievous Medical Harms
The increased medical risks, critical medical mistakes and grievous medical harms side of Laila's case is not complicated, although there is some gestational mathematics which any average 4th-grade student could handle, and there is some basic human biology which any average 6th-grade student could handle; and, there will be no test. However, there are very specific causes of the risks, mistakes and harms which are deeply rooted in corruption, academic misconduct, research misconduct and institutionalized confirmation bias and doublethink, and not something similar to doublethink, but the actual, literal definition of doublethink, precisely as written by George Orwell, right out of his novel "1984." Included below is an excerpt to refresh memories, as doublethink in Laila's case was very real, deeply institutionalized and proven dangerous.
- "DOUBLETHINK means the power of holding two contradictory beliefs in one’s mind simultaneously, and accepting both of them. The Party intellectual knows in which direction his memories must be altered; he therefore knows that he is playing tricks with reality; but by the exercise of DOUBLETHINK he also satisfies himself that reality is not violated. The process has to be conscious, or it would not be carried out with sufficient precision, but it also has to be unconscious, or it would bring with it a feeling of falsity and hence of guilt" (Source: George Orwell, 1984, Part Two, Chapter 9)
Research Misconduct: Appropriation, Plagiarism & Misuse of Hutchon Method of PDEE
The research misconduct via plagiarism side of LailasCase.com was discovered while investigating the origin of the idea, method and associated publications used by NCFM eSnurra Group to predict/estimate the day/date of delivery (EDD) and, therefrom, calculate gestational age (GA) using the equivalent of Naegele's rule, in reverse. The method used by NCFM eSnurra Group is the Hutchon Method of Population-based Direct Estimation of EDD (PDEE), developed by Dr. David J. R. Hutchon (Darlington, UK) from his original idea, the first ultrasound fetal biometry method of direct prediction/estimation of date of delivery (EDD), Hutchon 1998, 29-years after Stuart Campbell's original ultrasound fetal biometry method of prediction/estimation of gestational age (GA), Campbell 1969. The appropriation, plagiarism and misuse of Dr. David J. R. Hutchon's original idea and method, the Hutchon Method of PDEE, is a story unto itself, but it is tied directly to the increased medical risks, critical medical mistakes and grievous medical harms inflicted upon Laila and her baby, and other women and their fetuses/babies, as a direct result of Norwegian Directorate of Health's medically & ethically flawed 2014 Recommendation with their exclusive NCFM eSnurra Group's "method" (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) within a government-mandated protocol of evidence-obviated medicine.
There were important, specific capabilities and limitations identified by Dr. Hutchon for his Hutchon Method of PDEE which NCFM eSnurra Group ignored when they appropriated, plagiarized and then misused the Hutchon Method of PDEE. Specifically, Dr. Hutchon made 2 specific points decidedly clear and explicit in his seminal Hutchon 1998.
- "By adopting this approach we do not need to concern ourselves about the length of the cycle nor the certainty of the dates. Provided the fetus can be assessed as normal using other criteria, this chart can be used to provide the best estimate of the date of delivery (EDD)."
- "Just as Boerhaave was not actually measuring the length of pregnancy, and the word "gestation" is used to describe the measurement of time from the last menstrual period to reflect this, so also there is no pretence that this method is determining fetal age."
- "However, the issue at stake is not the accuracy of the predicted date of a normal delivery, it is the accuracy of the fetal age, which is an essential factor in clinical situations throughout the pregnancy." (Source: "Flawed recommendation issued by the Norwegian Directorate of Health concerning the determination of fetal age" & ("Helsedirektoratet gir feil anbefaling om bestemmelse av fosteralder") Cathrine Ebbing, MD, PhD, Synnøve Lian Johnsen MD, PhD, Jørg Kessler, MD, PhD, Torvid Kiserud, MD, PhD, Svein Rasmussen, MD, PhD., Nr. 8, 5 mai 2015, Tidsskr Nor Legeforen, 2015; 135:7401, DOI: 10.4045/tidsskr.15.0093)
- "Fetal age, fetal size, length of pregnancy and date of delivery are obviously all related data. However, it is impossible to deduce fetal age routinely from the predicted date of delivery. Only 4 per cent of women give birth at their estimated due date; in order to determine gestational age, it is clearly necessary to take account of the time of conception. The Directorate of Health have demonstrated their lack of understanding of these differences, and they have failed to appreciate that the Trondheim Group looked only at term prediction (3)." (Source: ibid.)
- surprised to learn the Hutchon Method of PDEE had been implemented in Norway's national healthcare system
- distressed to learn Norwegian Directorate of Health's misuse of the Hutchon Method of PDEE caused increased medical risks, critical medical mistakes and grievous medical harms to some of Norway's women and their babies
- incredulous Norwegian Directorate of Health implemented a national medical policy of evidence-obviated medicine in conjunction with the Hutchon Method of PDEE against the explicit, published advice and warnings of the risks and consequences by Norway's foremost obstetric and fetal medicine experts
Medical Consequences of Plagiarisim
When NCFM eSnurra Group appropriate and plagiarized Dr. Hutchon's original idea and method over the last 12-years, they prevented those who read NCFM eSnurra Group's many publications based, entirely, on the Hutchon Method of PDEE from knowing about Dr. Hutchon and what Dr. Hutchon had made clear in his seminal Hutchon 1998 and other publications about using the Hutchon Method of PDEE beyond its capabilities. Again, Dr. Hutchon could not have been more clear (excerpts above). Consequently, and by not considering all available information (i.e., key pregnancy dates including LMPD, OTPD, SCID, etc.) when establishing GA & EDD with the Hutchon Method of PDEE, some of Norway's women and their babies endured increased medical risks, critical medical mistakes and grievous medical harms as a direct consequence of grossly inaccurate NCFM eSnurra estimations of EDD and, thereby, calculated grossly inaccurate GA values using the equivalent of Naegele's rule, in reverse, that were not checked for reasonableness, errors or efficacy against all available evidence i.e., the pregnant woman's key pregnancy dates including LMPT, OTPD, SCID, etc.. Again, Dr. Hutchon could not have been more clear in his seminal Hutchon 1998 when he stated, "...there is no pretence that this method is determining fetal age."
Publishers & Plagiarism
Additionally, Ultrasound in Obstetrics & Gynecology (UOG) and ISUOG ignored Dr. Hutchon's 4 separate attempts to seek a by-the-book investigation and redress of the appropriation and plagiarism of his original idea and method, the Hutchon Method of PDEE, in NCFM eSnurra Group's Gjessing et al. 2007. By ignoring Dr. Hutchon and the reported plagiarism, UOG and ISUOG enabled the Norwegian Directorate of Health and NCFM eSnurra Group to use NCFM eSnurra Group's plagiarism-based publications; publications based, entirely, on the Hutchon Method of PDEE, as justification of their medically & ethically flawed 2014 Recommendation with their exclusive implementation of the NCFM eSnurra Group method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) within a government-mandated protocol of evidence-obviated medicine that caused increased medical risks, critical medical mistakes and grievous medical harms to some of Norway's women and their babies, Laila and her baby among them.
The Principal Plagiarists
Research misconduct via plagiarism was committed by those who knew or reasonably should have known better. But, these people knew precisely what they were doing, what they were not doing, what they had done and what they had not done.
Research misconduct via plagiarism was committed by those who knew or reasonably should have known better. But, these people knew precisely what they were doing, what they were not doing, what they had done and what they had not done.
- Pekka Taipale and Vilho Hiilesmaa of National Center for Fetal Medicine (NCFM), Trondheim University Hospital, Trondheim, Norway and Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland, in a recognized collaboration with NCFM eSnurra Group, who took no authorship credits; a collaboration which resulted in Taipale & Hiilesmaa 2001 entitled: "Predicting Delivery Date by Ultrasound and Last Menstrual Period in Early Gestation" published February 2001 by Obstetrics & Gynecology.
See Hutchon Timeline entry 00.02.2001
- Dr. Sturla H. Eik-Nes: President of ISUOG (1998-2004); Ultrasound in Obstetrics & Gynecology's 1998 Ian Donald Gold Medal awardee; founder and leader of NCFM eSnurra Group and a claimed "copyright owner" of the NCFM eSnurra method (i.e., the appropriated, plagiarized, misused Hutchon Method of Population-based Direct Estimation of EDD (PDEE)). NTNU identifies Sturla H. Eik-Nes as an employee, Department of Clinical and Molecular Medicine (Source: NTNU: http://www.ntnu.edu/employees/sturla.eik-nes).
"Sturla H. Eik-Nes, born 1945. Medical School in Münster 1966 – 1972. Doctoral Thesis at the University of Lund 1980 on “Ultrasound assessment of fetal weight, growth and blood flow”. Specialist in Gynecology and Obstetrics 1981. Post doc at Stanford University 1982 – 1983. Professor Dept. Gynecology and Obstetrics Regional Hospital, Trondheim – later St. Olavs Hospital 1985. Introduced fetal medicine in Norway. Chair National Center for Fetal Medicine, St. Olavs Hospital 1990 – present. Supervisor or cospervisor for 21 PhD Thesis. 128 peer reviewed papers in high ranking journals. President numerous Norwegian societies.President European Society of Ultrasound 1993 – 1996. President International Society of Ultrasound in Gynecology and Obstetrics 1998 – 2002. Ian Donald Gold Medal for outstanding contribution to the development of ultrasound, Edinburgh 1998. Honorary Fellow American Society of Ultrasound 2000, Stuart Campbell Award for Teaching and Training, Vancouver 2005. Commander of the Royal Norwegian Order of St. Olav, 2005, (Knight hood). Haakert Stiftung Gold Medal for Achievements in Perinatal Medicine, Düsseldorf 2007. Honorary member of 8 European societies of medicine. Member WHO Group on Medical Imaging 2000 – present. Started “Outreach Program” International Society of Ultrasound (ISUOG) in 1998 involving Philippines, Thailand, Singapore and South Africa – ongoing." (Source: The 7th Conference on Global Health and Vaccination Research: Innovation for Global Health, 26th-27th September 2012, Clarion Hotel and Conference, Trondheim. The Research Council of Norway and NTNU - Trohdheim, Norwegian University of Science and Technology. p. 16)
"PROFESSOR STURLA EIK-NES NORWAY
Sturla Hall Eik-Nes is a Norwegian gynecologist and obstetrician with ultrasound diagnosis and fetal medicine as a special area. He is a professor of clinical physiology and biomedical technology at the Norwegian University of Science and Technology, NTNU, and senior physician at the National Center for Fetal Medicine (NCFM) at St. Olavs Hospital in Trondheim. Eik-Nes is a world-renowned authority in ultrasound diagnostics and fetal medicine. His pioneering work in Trondheim in 1979-80 includes the development of a duplex unit (imaging and Doppler ultrasound) used as a method to measure blood circulation; this made it possible for the first time to quantify blood flow in human fetal aorta as well as in the umbilical vein. At the same time, he carried out the so-called Ålesund and Trondheim surveys that were randomized controlled studies to assess the value of systematic scanning of all pregnant women as opposed to using ultrasound on a clinical indication only. In the Cochrane Collaboration 2015, these two studies, along with an additional 7 studies emerging from them, were named as the first to present the evidence basis for offering ultrasound to the total population of pregnant women around week 18. Eik-Nes' work in general was central to the decision to introduce such an offer to all pregnant women in Norway in 1986 and many countries around the world.
Eik-Nes became Professor at the University of Trondheim in 1985, later NTNU, and founded the National Center for Fetal Medicine in 1990 at St. Olavs University Hospital in Trondheim. At this center, he initiated fetal medicine in Norway and thus the basis for looking at the fetus as an independent patient. During that time the center was involved in the organization of fetal medicine, and the development of a university-based education for midwives performing ultrasound was started.
In total, 39 people now work at the center. In 2006, Eik-Nes was knighted by the Norwegian King Harald V and appointed Commander of the Royal Norwegian St. Olav's order for his efforts in fetal medicine. In the decision it was emphasized that "Eik-Nes had promoted Norwegian medicine internationally in a very beneficial way". Eik-Nes retired 2015 from his clinical duties at NCFM at the age of 70, but he is still active and is currently involved in three ongoing PhD thesis. He now is Professor emeritus at The Norwegian University of Science and Technology.
Eik-Nes was a founding member of the Norwegian Society of Ultrasound in 1977. He attended his first EUROSON congress in Bologna in 1978 and attended all EUROSON congresses over the next 25 years. As president of EFSUMB during 1993-1996, Eik-Nes started an extensive educational program named “EFUMB East West Collaboration”. The program aimed to reach out a hand to the countries previously behind the “Iron Curtain”. The use of ultrasound in all relevant subject areas was taught along the entire former border to the East: Murmansk, Poland, Czechoslovakia and Hungary. Presidents who succeeded Eik-Nes, starting with Luigi Bolondi, have continued the program.
Eik-Nes took over as President of EFSUMB at a time when the society was losing impact and fewer members attended the congresses. Facing a situation where the EFSUMB would not manage to maintain a EUROSON congress every third year, he managed to pass a new and still active format for the EUROSON congresses at his last Board Meeting in Budapest 1996: In the years to come, the EUROSON congress would be organized annually, but always in conjunction with another member country’s annual conference. Retrospectively seen, this was probably one of the most important decisions in the history of EFSUMB since its initiation.
In 1998, Eik-Nes took over as the second President of the newly established International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) during the period 1998-2002. During his presidency he continued his interest to promote ultrasound in “the third world” and continued his “East West Collaboration” program with ISUOG as the umbrella organization, now called “ISUOG Outreach Program”.
Programs for using ultrasound in the field of pregnancy care were established in the Philippines, Turkey, Hong Kong for further work in China, Thailand and the Middle East and South Africa. This project was fully incorporated by ISUOG in 2008, and has now been continued by his colleagues in ISUOG throughout the developing world.
Using his “home institution”, NCFM, Eik-Nes started teaching centers in Singapore, Cape Town and Durban. From 2001, Eik-Nes responded to Nelson Mandela's former health director’s request for education programs aimed at South African midwives whose work in the resource-poor areas was previously neglected by the Apartheid government. Since then, NCFM has had increased its activity in South Africa, which involves both teaching and developing ultrasonic equipment adapted to be used in the rough, tough areas. As a result of the international activity promoted by Eik-Nes, the National Center for Fetal Medicine in 1996 was offered cooperation with WHO as the "WHO Collaborating Center in Diagnostic Ultrasound in Obstetrics and Gynecology". This cooperation continued and was chaired by Eik-Nes as long as was head of NCFM.
Eik-Nes has mentored 20 PhD theses and has produced 137 peer review papers. His focused research has had a high scientific impact and has over the years been cited close to 8000 times; he has achieved an h-index of 51 and an i10-index of 106. Over the years, he has presented approximately 5000 scientific and teaching lectures worldwide." (Source: "PROFESSOR STURLA EIK-NES NORWAY" Norsk forening for ultralyddiagnostikk (NFUD). Kari Utne, President of NFUD 2017)
(Source: "Hvorfor tar vi ultralyd av gravide kvinner?" ("Why do we use ultrasound on pregnant women?") av NTNUmedicine 2. april 2014. NTNU Medisin og helse - Fagblogg. YouTube Video Published Mar 27, 2014. "Hvorfor gjør man undersøkelse med ultralyd av gravide kvinner? Hva kan man se hos fosteret? Lege og professor Sturla Eik-Nes forklarer hvorfor." ("Why do you examine pregnant women with ultrasound? What can you see of the fetus? Doctor and Professor Sturla Eik-Ness explains why.")
- Dr. Yves Ville: President ISUOG (2012-2014) and Editor-in-Chief Ultrasound in Obstetrics & Gynecology (2006-2010). As reported in the American Journal of Obstetrics and Gynecology website: "Yves Ville is a Professor of Obstetrics and Gynecology at Paris University since 1998 and is head of Obstetrics and Fetal Medicine at Necker Hospital for Sick Children in Paris." "Yves Ville is currently an associate editor of the American Journal of Obstetrics and Gynecology and past-president of ISUOG. He has been the editor-in-chief of Ultrasound in Obstetrics and Gynecology for five years." (Source: American Journal of Obstetrics and Gynecology: http://obstetricsgynecology.eu/about-editors/yves-ville-associate-editor or see: https://web.archive.org/web/20171121205558/http://obstetricsgynecology.eu/about-editors/yves-ville-associate-editor)
- Dr. Yves Ville: As reported by Ian Donald Inter-University School of Medical Ultrasound, France Branch, Yves Ville, Director:
- Education, Training and Degrees
Medical School: Paris-Sud University 1979-1986
Specialist Registrar in Obstetrics and Gynaecology: Paris 1986-1992
Clinical Research Fellow in Fetal Medicine: Harris Birthright Research Centre, King’s College Hospital, London: May 1992- May 1993
MD Thesis. 1993
Senior Registrar in OB/GYN: Paris: May 1993- May 1996
Habilitation to direct Research. University of Paris. 1996: Thesis on treatment of Twinto-twin transfusion syndrome. - Professional Activities
Consultant-Senior Lecturer in Obstetrics and Director of Fetal Medicine Unit: St Georges Hospital & Medical School: July 1996- November 1998
Professor of Obstetrics and Gynaecology at Paris V University and head of department in Poissy Hospital September 1998-September - 2008. National Teaching Duties
Director of the French National Diploma of Ultrasound in Obstetrics and Gynaecology for René Descartes University.
Coordinator of the French National Sub-specialty program in Fetal Medicine for Paris University - Other National Duties
Expert witness près la Court d’Appel since 1998.
Member of the National Committee on Prenatal Ultrasound Screening. In charge of CME.
President of the Société Française d’Application des Ultrasons à la Médecine et à la Biologie (SFAUMB)
Member of the Board of the National Agency for Biomedicine - International Activities
Editor in chief of Ultrasound in Obstetrics and Gynaecology
Fellow of the International Academy of Perinatal Medicine
Member of the International Fetal Medicine and Surgery Society, the Fetoscopy Group and the International Society for Prenatal Diagnosis. (Source: Ian Donald Inter-University School of Medical Ultrasound, France Branch, http://www.iandonaldschools.com, http://www.iandonaldschools.com/admin/uploads/branches/France_Yves%20Ville.pdf)
- Education, Training and Degrees
- Dr. Yves Ville is Director of the Ian Donald Inter-University School of Medical Ultrasound, France Branch for Dr. Asim Kurjak, Director of Ian Donald Inter-University School of Medical Ultrasound. Ironically, Sturla H. Eik-Nes wrote a response to Iain Chalmers' article in "Analysis And Comment, Professional regulation" of BMJ: "Role of systematic reviews in detecting plagiarism: case of Asim Kurjak" in which Eik-Nes stated: "I am writing this letter as President of International Society of Ultrasound of Obstetrics and Gynecology (ISUOG) during the period of 1998 – 2002." See Plagiarism > HUTCHON TIMELINE 01.12.2006
- "Croatian academic is found guilty of plagiarism"
"A Croatian government committee that is investigating a senior academic and obstetrician has ruled unanimously that allegations of plagiarism in his published work are well founded.
In an opinion issued on 15 May the Committee for Ethics in Science and Higher Education declared that Asim Kurjak of Zagreb University Medical School was guilty of “violations of the [committee's] ethics code . . . and of common norms in biomedical publishing.”
The allegations were originally made in the BMJ by Iain Chalmers of the James Lind Library in Oxford (BMJ 2006;333:594-7 doi: 10.1136/bmj.38968.611296.F7)." (Source: "Croatian academic is found guilty of plagiarism" Geoff Watts. BMJ. 2007 May 26; 334(7603): 1077. doi: 10.1136/bmj.39223.354178.DB) - Dr. Matko Marusic wrote an interesting article on the Kurjak case in the 10.12.2007 BMJ "Editor's Choice" letter: "The Kurjak plagiarism case: the vicious circle of academic corruption" (Source: "The Kurjak plagiarism case: the vicious circle of academic corruption" Matko Marusic, Editor in Chief, Zagreb University School of Medicine, Salata 3, 10000 Zagreb, Croatia, BMJ 2007;335:0. doi: https://doi.org/10.1136/bmj.39392.602523.47 (Published 08 November 2007)
- Dr. Inge Axelsson, chief physician in pediatrics, Östersund Hospital; associate professor, Mid Sweden University, wrote an interesting article about the Kurjak case which opened with: "Do not base your clinical practice, teaching or research on literature written by Asim Kurjak or Sanja Kupesic. Shame on them! This call is directed by Inge Axelsson to Swedish obstetricians and midwives when he reports here an internationally recognized case of prolonged research fraud in the form of plagiarism and falsification of scientific publications." (Source: "The world-famous professor plagiarized and falsified" ("Den världsberömde professorn plagierade och förfalskade") Inge Axelsson. DEBATE AND LETTERS, LÄKARTIDNINGEN 2006-10-03 issue 40 Volume 103, p. 2929)
- See Plagiarism > HUTCHON TIMELINE 01.12.2006
See Hutchon Timeline entries: 26.07.2007, 17.09.2007, 21.09 2007, 00.11.2007, 29.02.2008, 13.02.2009, 11.12.2009, 00.01.2012
Norway's Medical Professionals Are Victims, Too
Importantly, there are two groups of victims identified in LailasCase.com:
- Norway's women and their fetuses/babies who are among the most vulnerable to breaches of the public trust.
- Norway's medical professionals, the midwives and doctors, especially in the smaller towns, whose education, training and practice of evidence-based medicine has been insidiously, systemically and institutionally compromised by:
- Directorate of Health's medially & ethically flawed 2014 Recommendation with their government-mandated protocol of evidence-obviated medicine with respect to obstetric medicine, fetal medicine and obstetric clinical care and
- their ultrasound-based GA & EDD training developed and delivered by Norway's National Center for Fetal Medicine (Nasjonalt senter for fostermedisin) (NCFM) to promote NCFM eSnurra Group's "method" (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) in conjunction with the Trojan horse-use of the routine 18-week ultrasound exam to obviate a woman's medical evidence i.e., her factual, key pregnancy dates and fully corroborating combinations thereof, without the pregnant woman's prior, informed, voluntary, explicit consent; obviated from all medical evidence and from any and all consideration in medical thinking, medical decision-making and medical actions with respect to obstetric medicine, fetal medicine and obstetric clinical care. In the words of the Bergen Group and NGF, this is "medically flawed" and "can be directly dangerous," respectively.
Directorate of Health's medically & ethically flawed 2014 Recommendation (i.e., national medical policy) created increased medical risks and a cascade of critical medical mistakes; critical mistakes which forced Laila to endure an unwanted, unnecessary Cesarean section surgery delivery with a plethora of complications and, caused Laila's baby to endure an unidentified, prolonged, undiagnosed, untreated fetal growth restriction/malformation of her head, a dolichocephalic head (i.e., commonly "long head" or "breech head") due to and/or exacerbated by known breech orientation throughout Laila's entire pregnancy. By definition, Laila's baby's dolichocephalic head had a smaller/shorter biparietal diameter (BPD), or ear-to-ear head/skull diameter, than a normally shaped head for Laila's baby's true gestational age (GA). Ergo, grossly inaccurate NCFM eSnurra BPD-based EDD & GA values were assigned to Laila's pregnancy; GA & EDD values which grossly underestimated EDD by 15 days relative to Laila's factual LMPD-based EDD and 14 days relative to Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based EDD. This was a critical medical mistake; a completely unnecessary, preventable medical mistake; a critical medical mistake not limited to Laila and her baby.
Again, Directorate of Health had been clearly and explicitly warned by NGF and Bergen Group of this exact risk and consequence. Nevertheless, Directorate of Health enacted their medically & ethically flawed 2014 Recommendation with their exclusive implementation of NCFM eSnurra Group's method (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) within a government-mandated protocol of evidence-obviated medicine in conscious disregard of the consequences. Therefore, Directorate of Health were intentionally recklessness and willfully negligent. This was stone-cold criminal, a matter for Norway's Ministry of Justice and Public Security (Det kongelige justis- og beredskapsdepartement) and Norway's National Police Directorate (Politidirektoratet) (Tips Politiet) to investigate, fully, with subpoena power to compel testimony under penalty of perjury.
It is Laila's hope:
- Laila's Case will create awareness, cooperation and action, preferably in the form of official investigation(s), with subpoena power to compel testimony under the penalty of perjury, of this insidious, systemic, institutionalized problem which causes increased medical risks, critical medical mistakes and grievous medical harms as a direct result of Directorate of Health's medically & ethically flawed, intentionally reckless, willfully negligent 2014 Recommendation (i.e., national medical policy).
- Laila's Case will help to effect the necessary changes, including new law if necessary, to return the practice of evidence-based medicine with respect to obstetric medicine, fetal medicine and obstetric clinical care to the competences of Norway's medical professionals, dedicated doctor-scientists and, especially, Norsk gynekologisk forening (Norwegian Society of Gynecology & Obstetrics), and out of the offices and backrooms of special interests and corrupt administrators at Directorate of Health who have so clearly "acted beyond their competence" in an intentionally reckless, willfully negligent, sub-standard fashion while, simultaneously, abrogating their responsibilities to the public and the public trust.
Information Asymmetry: Pregnant Woman vs. NCFM
There is likely no greater information asymmetry in a transaction than the exchange that takes place between a pregnant woman in her first pregnancy and her obstetric and fetal medicine healthcare providers. A pregnant woman provides a portion of her taxes to pay for Norway's national healthcare system and, more importantly, she provides her trust in exchange for proper, evidence-based obstetric medicine, fetal medicine and obstetric clinical care. However, instead of mitigating the information asymmetry in the exchange, Directorate of Health and NCFM eSnurra Group exploit it, beginning with the scheduling of the "routine" 18wUSE when a pregnant woman's factual, key pregnancy dates are obviated from all medical evidence and from any and all consideration in medical thinking, medical decision-making and medical actions without the pregnant woman's prior, informed, voluntary, explicit consent; medical evidence of know, proven efficacy is obviated in accordance with Directorate of Health's medically & ethically flawed 2014 Recommendation which is proven to cause increased medical risks, critical medical mistakes and grievous medical harms. Laila and her baby, and other women and their fetuses/babies, deserved better; Norway's women and their fetuses/babies deserve better; Norway's medical professionals deserve better. And, Norway can do better for both the public and the public trust.
CONCLUSION
"What is the cost of lies?"
"To be a scientist is to be naive. We are so focused on our search for truth, we fail to consider how few actually want us to find it. But it is always there, whether we see it or not, whether we choose to or not. The truth doesn't care about our needs or wants. It doesn't care about our governments, our ideologies, our religions. It will lie in wait, for all time. And this, at last, is the gift of Chernobyl. Where I once would fear the cost of truth, now I only ask: What is the cost of lies?" (Source: The closing 8 sentences of dialog from the miniseries Chernobyl, created and written by Craig Mazin.)
"To be a scientist is to be naive. We are so focused on our search for truth, we fail to consider how few actually want us to find it. But it is always there, whether we see it or not, whether we choose to or not. The truth doesn't care about our needs or wants. It doesn't care about our governments, our ideologies, our religions. It will lie in wait, for all time. And this, at last, is the gift of Chernobyl. Where I once would fear the cost of truth, now I only ask: What is the cost of lies?" (Source: The closing 8 sentences of dialog from the miniseries Chernobyl, created and written by Craig Mazin.)
Public Awareness, Cooperation & Action
Among the Norwegian public, vehicle drivers are required to obey traffic signals and the rules-of-the road to protect the public and the public's trust in each other; reciprocal trust between strangers; trust with each other's lives while driving, cycling, jogging, walking or standing on a sidewalk. Academicians, doctors, scientists, medical researchers, authors, journal editors, publishers, government administrators and politicians are, similarly, required to follow rules; rules of professional behavior and ethical conduct to protect the public and the public trust. However, there are various intoxicants, be they different, which affect both sides of this analogy; intoxicants which induce aberrant behaviors which violate the public public trust by causing increased risks, critical mistakes and grievous harms. Consequently, and as is the case on a nation's roads, public awareness, cooperation and action are required to protect the public and the integrity of the public trust. LailasCase.com is a public interest disclosure, an effort to increase public awareness to induce action; a public interest disclosure which is motivated by the vigilant actions of NGF and Bergen Group via their publications of clear, explicit warnings of the risks and consequences; publications which spoke truth to power, the Norwegian medical community and the Norwegian public in fulfillment of their professional and ethical responsibilities to the integrity of the public trust. The public trust was, and remains, well served by NGF and Bergen Group, and others. However, public awareness, cooperation and action are the only time-tested ways and means of effecting needed change when the public trust has been violated so blatantly and systemically. Norway's women and their babies are among the most vulnerable to beaches of the public trust; and, consequently, there is a need for public awareness, cooperation and action on their behalf. There are many things for which a nation's people will neither agree nor cooperate, but one must believe the insidious, systemic, institutionalized problem of evidence-obviated medicine with respect to obstetric medicine, fetal medicine and obstetric clinical care, proven to cause increased medical risks, critical medical mistakes and grievous medical harms to Norway's women and their fetuses/babies is not among them.
NGF, Bergen Group and others issued clear, explicit warnings (publication references below); LailasCase.com investigated, researched, documented and reported fact-based evidence of increased medical risks, critical medical mistakes and grievous medical harms with their associated, systemic, institutionalized causes in an effort to increase public awareness and induce action by the public and the public institutions chartered with a responsibility to the public trust.
Wilful and Wanton Conduct Law and Legal Definition
Section 67 of Norway's "Act of 2 July 1999 No. 64 relating to Health Personnel etc." states:
Next-steps efforts require individuals, organizations and institutions to become aware, cooperate and act.
Among the Norwegian public, vehicle drivers are required to obey traffic signals and the rules-of-the road to protect the public and the public's trust in each other; reciprocal trust between strangers; trust with each other's lives while driving, cycling, jogging, walking or standing on a sidewalk. Academicians, doctors, scientists, medical researchers, authors, journal editors, publishers, government administrators and politicians are, similarly, required to follow rules; rules of professional behavior and ethical conduct to protect the public and the public trust. However, there are various intoxicants, be they different, which affect both sides of this analogy; intoxicants which induce aberrant behaviors which violate the public public trust by causing increased risks, critical mistakes and grievous harms. Consequently, and as is the case on a nation's roads, public awareness, cooperation and action are required to protect the public and the integrity of the public trust. LailasCase.com is a public interest disclosure, an effort to increase public awareness to induce action; a public interest disclosure which is motivated by the vigilant actions of NGF and Bergen Group via their publications of clear, explicit warnings of the risks and consequences; publications which spoke truth to power, the Norwegian medical community and the Norwegian public in fulfillment of their professional and ethical responsibilities to the integrity of the public trust. The public trust was, and remains, well served by NGF and Bergen Group, and others. However, public awareness, cooperation and action are the only time-tested ways and means of effecting needed change when the public trust has been violated so blatantly and systemically. Norway's women and their babies are among the most vulnerable to beaches of the public trust; and, consequently, there is a need for public awareness, cooperation and action on their behalf. There are many things for which a nation's people will neither agree nor cooperate, but one must believe the insidious, systemic, institutionalized problem of evidence-obviated medicine with respect to obstetric medicine, fetal medicine and obstetric clinical care, proven to cause increased medical risks, critical medical mistakes and grievous medical harms to Norway's women and their fetuses/babies is not among them.
NGF, Bergen Group and others issued clear, explicit warnings (publication references below); LailasCase.com investigated, researched, documented and reported fact-based evidence of increased medical risks, critical medical mistakes and grievous medical harms with their associated, systemic, institutionalized causes in an effort to increase public awareness and induce action by the public and the public institutions chartered with a responsibility to the public trust.
- Norwegian Society of Gynecology & Obstetrics (Norsk gynekologisk forening) (NGF) article published in Norsk gynekologisk forening, Nyheter, 2014: "NGF dissociates from Directorate of Health's recommendation for the determination of gestational age and term" In Norwegian: ("NGF tar avstand fra Helsedirektoratets anbefaling for fastsetting av svangerskapslengde og termin") (Norsk gynekologisk forening, Den Norske Legeforening Nyheter, 2014) [Note: English translation see: Intro & more > DOCUMENTS
- Bergen Group's article published in the Norwegian Medical Association's Tidsskrift for Den norske legeforening (Tidsskr Nor Legeforen nr. 8, 2015; 135.): "Flawed recommendation issued by the Norwegian Directorate of Health concerning the determination of fetal age" In Norwegian: ("Helsedirektoratet gir feil anbefaling om bestemmelse av fosteralder")
(Source: "Flawed recommendation issued by the Norwegian Directorate of Health concerning the determination of fetal age" & ("Helsedirektoratet gir feil anbefaling om bestemmelse av fosteralder") Cathrine Ebbing, MD, PhD, Synnøve Lian Johnsen MD, PhD, Jørg Kessler, MD, PhD, Torvid Kiserud, MD, PhD, Svein Rasmussen, MD, PhD., Nr. 8, 5 mai 2015, Tidsskr Nor Legeforen, 2015; 135:7401, DOI: 10.4045/tidsskr.15.0093)
Wilful and Wanton Conduct Law and Legal Definition
- "A Willful and Wanton Conduct is a willful or wanton injury that must have been intentional or the act must have been committed under circumstances exhibiting a reckless disregard for the safety of others, such as a failure, after knowledge of impending danger, to exercise ordinary care to prevent it or a failure to discover the danger through recklessness or carelessness when it could have been discovered by the exercise of ordinary care." [Henslee v. Provena Hosps., 369 F. Supp. 2d 970, 977-978 (N.D. Ill. 2005)] " (Source: US Legal, Inc., USLegal.com: Legal Definitions: Willful and Wanton Conduct)
"Willful and wanton conduct means “acting consciously in disregard of or acting with a reckless indifference to the consequences, when the Defendant is aware of her conduct and is also aware, from her knowledge of existing circumstances and conditions, that her conduct would probably result in injury.” [Duncan v. Duncan (In re Duncan), 448 F.3d 725, 729 (4th Cir. Va. 2006)]" (Source: ibid.)
Medical Dictionary: willful negligence Malpractice Provision of health care in an intentionally substandard fashion, the most serious form of negligence, which may carry with it criminal charges. See Malpractice, Negligence. (Source: McGraw-Hill Concise Dictionary of Modern Medicine. S.v. "willful negligence." Retrieved September 17 2017 from http://medical-dictionary.thefreedictionary.com/willful+negligence)
Section 67 of Norway's "Act of 2 July 1999 No. 64 relating to Health Personnel etc." states:
- § 67 Punishment
Anyone who intentionally or by gross negligence contravenes the provisions of this Act, or who aids and abets thereto, shall be punished by fines or a term of imprisonment not exceeding three months.
Public prosecution will be instituted if it is in the public interest or by petition by the Norwegian Board of Health.
(Source: "Act of 2 July 1999 No. 64 relating to Health Personnel etc." Reglement | Dato: 01.07.2002. Refjeringen.no: https://www.regjeringen.no/no/dokumenter/act-of-2-july-1999-no-64-relating-to-hea/id107079/)
Next-steps efforts require individuals, organizations and institutions to become aware, cooperate and act.
- The Ministry of Health and Care Services (HOD)
Helse- og omsorgsdepartementet
Phone: +47 22 24 90 90
E-mail: postmottak@hod.dep.no
URL: (English): https://www.regjeringen.no/en/dep/hod/id421/
URL: (Norsk): https://www.regjeringen.no/no/dep/hod/id421/ - Directorate of Health
Helsedirektoratet
Phone: 810 20 050 +47 24 16 30 00
E-mail: postmottak@helsedir.no
URL: (English): https://helsedirektoratet.no/English
URL: (Norsk): https://helsedirektoratet.no/ - Ministry of Justice and Public Security
Det kongelige justis- og beredskapsdepartement
Phone: +47 22 24 90 90
E-mail: postmottak@jd.dep.no
URL: (English): https://www.regjeringen.no/en/dep/jd/id463/
URL: (Norsk): https://www.regjeringen.no/no/dep/jd/id463/ - National Police Directorate
Politidirektoratet
Phone: +47 23 30 50 00
E-mail: post@pst.politiet.no
URL: (Norsk): http://www.pst.politiet.no
The End of the Beginning
The publications of NGF, Bergen Group and others were the beginning; and, importantly, LailasCase.com is not the end. There is much work to be done to eliminate the unnecessary medical risks, critical medical mistakes and grievous medial harms being inflicted on some of Norway's women and their babies. There is heavy lifting ahead which will require assistance and cooperation among complete strangers, as is the case on a nation's roads during emergencies and natural disasters. LailasCase.com is fact-based evidence of an emergency in progress, but there are no sirens nor flashing lights nor smartphone alerts with maps to signal and direct first responders and volunteers who are able to talk the talk and walk the walk in emergencies; first responders who know how to organize, inspire and lead others into action; into a coordinated response. LailasCase.com is a public interest disclosure with fact-based evidence of an emergency in progress and, hopefully, will serve as an alert to first-responders who are able to talk the talk and walk the walk.
The publications of NGF, Bergen Group and others were the beginning; and, importantly, LailasCase.com is not the end. There is much work to be done to eliminate the unnecessary medical risks, critical medical mistakes and grievous medial harms being inflicted on some of Norway's women and their babies. There is heavy lifting ahead which will require assistance and cooperation among complete strangers, as is the case on a nation's roads during emergencies and natural disasters. LailasCase.com is fact-based evidence of an emergency in progress, but there are no sirens nor flashing lights nor smartphone alerts with maps to signal and direct first responders and volunteers who are able to talk the talk and walk the walk in emergencies; first responders who know how to organize, inspire and lead others into action; into a coordinated response. LailasCase.com is a public interest disclosure with fact-based evidence of an emergency in progress and, hopefully, will serve as an alert to first-responders who are able to talk the talk and walk the walk.
"Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."
-- Winston Churchill
-- Winston Churchill