SNP MSP Alex Neil asks if the conclusions of the final report ignore some or all of the evidence.

Dr Wael Agur says: "We could all look at the same thing and see it differently."

He says he was keen to publish the table as it was.

The clinician says he would not be fulfilling his duty as a doctor to reduce harm if he followed the recommendations of the report..

Image source, bbc

Mr Neil asks if recommendations seven and eight in the review maximise patient safety.

Dr Agur says; "I believe these conclusions could have done more to ensure safety of women considering these procedures."

Mr Neil asks if members of the review group were "nobbled" and Dr Agur says no.

The clinician says further studies have backed the interim report's finding

SNP MSP Rona Mackay asks if he is surprised that this procedure was given to 400 people since the government moratorium was put in place.

Dr Wael Agur says some healthboards followed the government suspension in full and some did not.

Dr Agur says he advised his board to partially suspended the procedure.

He says the healthboard managers did not take his advice and suspended in full and they were right and he was wrong.

Ms Mackay asks if healthboards have autonomy when the government request a suspension.

Dr Agur says healthboards do.

Image source, bbc

SNP MSP Rona Mackay asks who made the calls to delete the tables from the final report.

Dr Wael Agur says there were calls to delete the tables but he says the figures were verified beyond a doubt.

Dr Agur says members of the group decided by a majority to remove the table, but he says does not know why.

He says he told the group doing a u-turn on methodology and risking consistency was not good for the group.

Dr Wael Agur, consultant gynaecologist and obstetrician, says consistency has been important to him even if the figures questioned his own beliefs.

Dr Agur says there were no disagreements following the original outcome but, because of the publication of another review, the outcomes were reconsidered.

He says some of the figures challenged his own beliefs and he could have brushed this off but he decided to reflect on it properly and research further along with colleagues.

Image source, bbc

Committee convener Johann Lamont asks if the review was independent.

Dr Wael Agur says as the clinical member of the group he did not look at the independence of the group.

Dr Agur says he has heard the criticism that an independent review group is only independent if the chair is independent, but he says he is not a politician and leaves it ther.

He says he does not know why Chapter Six was left out of the final report.

Dr Agur says the minister believed a review of the process is necessary which is good.

He says a parallel review on the outcome of this report is necessary.

"If the stakes are high and there are lives at risk of being ruined then a review is important."

Dr Agur says there are lessons to be learned for future reviews and that the report should be opened to a public consultation.

Image source, bbc

Dr Wael Agur says randomised control trials are not the best for looking at harm.

The consultant gynaecologist and obstetrician says it is better to look at a study of 300 summaries commissioned by Nature looking at mesh adverse events.

He says the risk of a negative outcome was 15%.

The clinician says the study was circulated to the review group twice but was not included in the agenda.

Dr Wael Agur, consultant gynaecologist and obstetrician, says evidence required more scrutiny.

Labour MSP Neil Findlay asks if the mesh implant operation is a cheaper option.

Dr Agur says "yes" it is and that this procedure saves the NHS money.

Image source, bbc

SNP MSP Angus Macdonald asks about the concerns about the use of best available evidence.

Dr Wael Agur says there are several resources available to the review group and chapter five of the report summarised the studies and government reviews from all over the world.

He says the evidence can sometimes be conflicting and the review group had to agree on what was the most likely outcomes and then bring the patients on board

The clinician says: "I believe more could have been done in this respect, mainly in relation to safety."

Dr Agur says some would understand the conclusion suggests to remove the procedure all together and some would not, therefore there is an ambiguous message.

He says, in chapter 6 of the final report, the advantages of mesh implants were covered but the adverse events were not.

Dr Agur says the adverse effects were contained within interim reports.

Image source, bbc

Labour MSP Johann Lamont asks what the difference was between the interim report and the final report

Dr Wael Agur says the differences were in chapter six and in the conclusion.

He says the difference is in the way the data was presented.

The consultant gynaecologist and obstetrician says the conclusion was unusual and he says the review group was the first in the world to express concerns about a gold standard procedure.

He says other institutions have followed the review groups path in October 2015.

Dr Agur says unfortunately this concerns were removed from the final report.

Labour MSP Neil Findlay asks about the clinicians register of interests.

Mr Findlay asks what the issue was around accuracy and integrity with the pilot SIMS study in 2010

Dr Wael Agur says he wants to be absolutely clear about all the figures before publication.

The SIMS trial: adjustable anchored single-incision mini-slings versus standard tension-free midurethral slings in the surgical management of female stress urinary incontinence.

Dr Wael Agur, consultant gynaecologist and obstetrician,calls for a review of the final report decisions which, he says, will restore faith in the process and protect women in the future.

Dr Agur says the committee has heard from a range of witnesses since this petition was lodged on May 2014.

The clinician says this is the first time it has heard from a physician.

He says all the views he will give are his own and based on professional research, experience and morals.

Image source, bbc

Dr Wael Agur is a consultant gynaecologist and obstetrician and was a member of the review group of mesh implants before resigning.

Dr Agur says he would like to thank Elaine Holmes and Olive Mcllroy for bringing this important petition to Holyrood.

He says resigned before the publication of the final report as he believes the government report could have done more.

The clinician says more needs to be done to bring the report up to standard.

He wants the final report to be opened up to consultation to allow officials to publish the feedback of stakeholders.

The Public Petitions Committee begins taking evidence on PE1517, external by Elaine Holmes and Olive McIIRoy on behalf of Scottish Mesh Survivors - "Hear Our Voice" campaign on polypropylene mesh medical devices.

Committee convener Johann Lamont introduces:

• Dr Wael Agur, consultant gynaecologist and obstetrician

Scotland's Chief Medical Officer, Dr Catherine Calderwood, said she had "fully accepted" the recommendations made by the independent review and had been clear that the suspension of the use of mesh implants should remain in place until she was satisfied they had been implemented.

She added: "The cabinet secretary met with the chair of the independent review, who informed us that some evidence has been presented in a different format to that of the interim report, but that no evidence has been deleted or hidden."

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Dr Claderwood said: "The interim report is available to read on the independent review's website and the final report builds on that.

"The clinician who resigned from the review group drafted an alternative version of one chapter which was not agreed by the rest of the group, but in the interests of transparency was published on the Scottish government website.

"A review is being carried out into the process of the independent Review, which will make recommendations about the conduct of future similar reviews and will report back next year."‎

In his written submission, he stated: "The report did not adequately warn surgeons and patients against the serious risks with the transobturator mesh tape (the type most commonly used in Scotland).

"The report ignored the best evidence on mesh-related adverse events that described the prevalence of a negative outcome to be as frequent as 15% (1 in 7).

"On interpreting the evidence tables comparing safety of surgical procedures, I came to the following conclusions: Non-mesh procedures are safer than mesh procedures for incontinence. Transobturator tape is too risky to be offered, except in very rare circumstances. Prolapse mesh has no benefit and is too risky to be offered."

His submission to MSPs added: "As the chapter was deleted, its evidence did not inform the recommendations of the final report."

Image source, bbc

Dr Wael Agur said he reviewed the most up-to-date research in the UK and internationally and concluded that non-mesh surgical procedures were safer, but said that such conclusions were removed or changed.

He told BBC Scotland: "It was so important that we got this right. Not just for women in Scotland but for women around the world. Scotland was the only country where an independent review was running to look at the benefits and risks of these procedures.

"I believe the report has left the door slightly open for some procedures to be performed and that should not have happened."

Dr Agur said he believed mesh use should be avoided in future in all but the rarest circumstances because of the risks of "acute" and "irreversible" damage.

Asked if he believed the final report by the review group was a whitewash, he said: "Whitewash is a political term and I am not a politician. I'm a clinician and a researcher and a surgeon and I can tell you that I looked into the evidence that compares all these procedures and I concluded that they should either not be performed at all or restricted to clearly defined situations where not a single surgeon but a group of surgeons nationally should decide."

Based on the evidence gathered, he said he expected the review group to conclude that mesh use should not continue and that the suspension should remain in place.

He said that ultimately the report gives surgeons in Scotland and globally the impression that its use should continue.

Over the past 20 years, more than 100,000 women across the UK have had transvaginal mesh implants - including more than 20,000 in Scotland.

• What's the issue with mesh implants?

But some have suffered painful and debilitating complications.

There are more than 400 women currently taking legal action against Scottish health boards and manufacturers as a result of mesh implant surgery.

In 2014, former Scottish Health Secretary Alex Neil called for the suspension of such procedures, and an independent review group was set up to look at safety issues.

Dr Agur, a consultant urogynecologist, was a member of the review group but said he was forced to step down earlier this year after an entire chapter of the final report was removed and put in the appendices.

It followed the resignation of two patient representatives on the group who claimed the report had been "watered down" and that it was ultimately "a whitewash".

At the time, Health Secretary Shona Robison said no evidence would be hidden in the group's final report.