Hypnosis should be used widely in the NHS 'to save millions of pounds'
Hypnosis treatments could be used on a range of medical conditions to save the NHS millions of pounds, say medical experts. The Hypnosis and Psychosomatic Medicine Section of the Royal Society of Medicine (RSM) believe the therapies help relieve pain and stress. But it warned patients need to be protected from rogue practitioners, who cause harm and end up costing the NHS more.
Jacky Owens, the president of the RSM's Hypnosis Section, said: 'Conditions such as depression, pain and irritable bowel syndrome affect millions of people in the UK and a great cost to the NHS. 'But hypnosis can often work where other treatments have been unsuccessful.'
Ms Owens, a qualified nurse who uses hypnosis in her work with cancer patients added: 'If doctors were able to refer patients to properly trained hypnotherapists, it would save a cash-strapped NHS a great deal of money.' She said making hypnosis a standard part of the 'NHS toolbox' would lead to the public becoming better informed about the procedure and mean that vulnerable patients would be less likely to turn to 'hypno-cowboys'.
The group fear non-medically trained hypnotists frequently lack the understanding of the diseases their patients have, so can cause real harm. It said many of the quack operators use damaging techniques to treat people with psychological conditions, like inducing 'false memories' as they believe current problems stem from past traumas so terrible that the memory of them has been suppressed.
Dr Peter Naish, the president-elect of the section, said: 'There's very little evidence, either from laboratory research or real life, that we can suppress traumatic memories - people suffering from post-traumatic stress disorder would love to be able to do so.'
The senior lecturer in psychology believes there is a wealth of data showing how easily pseudo-memories can be elicited. 'These so-called therapists induce a completely false memory in a vulnerable patient which is of no therapeutic use whatsoever and can cause very serious harm.
'I've treated patients whose lives - and that of their families - have been devastated by the induction of a false memory of sexual abuse. 'They've paid a lot of money and all they get in return is additional emotional trauma, while still suffering from the condition for which they first sought help.'
Hypnosis is now recognised by the National Institute for Health and Clinical Excellence (Nice) as a possible intervention for IBS where other treatments are not having an effect. Ms Owens added: 'That's a small step but we're confident that with more research, hypnosis will be recognised as an extremely useful tool to be used alongside mainstream medicine.
'What we need are doctors, dentists, nurses, psychologists, physiotherapists, radiotherapists - the whole gamut of people who treat patients - trained in using hypnosis as another tool in their treatment programme.'
She called on the Government to review the issue.
A Department of Health spokesman said: 'We believe in patients being able to make informed choices about their treatment and in clinicians having the freedom to prescribe the treatment they feel most appropriate for that patient after discussing the risks and benefits. 'They should always consider the availability of a suitably qualified practitioner as part of this process. 'Our plans to modernise the NHS will give clinicians more freedom to commission the services that best meet their patients' needs.' 6.6.11
Tiered price scheme for pharmaceuticals giant no value for NHS
Drugs companies must behave "in step with society" by reducing their prices to help improve healthcare in developing countries, according the head of one of the world's biggest pharmaceuticals businesses. Andrew Witty, chief executive of GlaxoSmithKline (GSK), said the industry too often acts "as though it is detached from society" and should start putting people before profits to increase public trust.
He made the comments as his company revealed a change in its business model that will see the implementation of a tiered pricing structure - with drug prices aligned to a country's ability to pay. He told The Times: "To be successful in the long term, we have to operate in a way that is in step with society and its expectations.
"Today public trust in all big institutions, including governments and business, is challenged. "I believe industry, including the pharmaceutical sector, sometimes hasn't helped itself by operating as if we were detached from society."
Mr Witty said GSK would be offering its rotavirus vaccine to developing countries for a fraction of its Western market price. The Rotarix vaccine, which prevents diarrhoeal disease - a deadly bug responsible for killing more than half a million children annually - will be made available to poor nations for £1.50 a dose rather than £30.
Profits made in developed countries will be partly used by GSK to subsidise any losses made in their developing counterparts. "I hope this will enable millions of children to receive this important vaccine, saving countless lives in the future," added the chief executive.
Mr Witty said the move was "not a gimmick or one off philanthropic gesture part of a concerted strategy to change our business model". He added: "Specifically, we are aligning our commercial success with doing what we can to tackle the healthcare needs of people in all countries, including the poorest."
Andrew Mitchell, the International Development Secretary, said the Government and the pharmaceutical industry are "locked together" in providing greater assistance in preventing the spreads of diseases in the world's poorest countries. "I hope that the entire industry will follow the path down which Andrew Witty and GSK is blazing a trail," he told The Times.
Political leaders will meet at the Global Alliance for Vaccines and Immunisation (Gavi) conference in London next Monday to discuss how to generate sufficient funds to ensure children in the world's poorest countries receive the vaccines they need. It is hoped they can raise more than £2.25 billion for immunisation programmes over the next four years, saving the lives of an estimated four million underprivileged children.
Gavi is expected to announce several new commitments from other pharmaceuticals manufacturers to reduce pricing of other vaccines which protect against deadly diseases.
Save the Children chief executive Justin Forsyth said: "GSK's price reduction for its new diarrhoea vaccine is a landmark move, potentially saving the lives of hundreds of thousands of children." Diarrhoea kills more of the world's poorest children than Aids, measles and malaria combined, he said. "We now have the prospect of dramatically cutting those needless deaths, by immunising against the virus which causes so many of them.
"It's important that Gavi now uses this to spur other vaccine producers to reduce prices and work to foster greater competition amongst producers to drive prices down even further and help even more children. The NHS pays £11bn per annum for drugs. " 6.6.11
ADR: Bad reactions to medicines lead to one million people a year being admitted to hospital
Bad reactions to drugs have reached epidemic levels, according to a group of doctors and scientists. Around one in 15 hospital admissions each year, more than a million patients, is due to adverse drug reactions, says the Safer Medicines Trust, based on official figures. They say the current system is failing and animal testing of drugs is exposing patients to ‘dangerous' treatments.
The trust, which campaigns for alternative ways of testing the safety of medicines, said the drug industry is over-dependent on animal testing.
In an open letter to the Prime Minister and Health Secretary, published in The Lancet, it said animal testing has failed to protect patients.
Six young men were left in intensive care by a trial drug in 2006 which was ‘demonstrably safe in monkeys at doses nearly 500 times higher than those that nearly proved fatal to the volunteers', the trust said.
It wants new technologies based on human biology to be used instead, after an official assessment of their fitness for purpose.
A spokesman for the Medicines and Healthcare Product Regulatory Agency said: ‘It is very important to recognise that at present there are no laboratory methods available to totally replace animal testing of medicines.' 4.6.11
Cashing in on the The Big C
Drugs firms are concentrating on developing drugs for cancer because over the next three years, drug companies will watch $50 billion of revenue disappear as drugs lose patent protection. Desperate for new revenue, companies are making a big bet on cancer. Cancer is a devastating, stubborn disease.
It is also a huge business opportunity. Current treatments are inadequate. The market, meanwhile, is enormous—in 2010 America spent $125 billion on cancer treatment. By 2020 that number may rise to $207 billion, according to the National Institutes of Health. Drug companies are scurrying to become leaders in cancer research (see chart).
This month Roche submitted an application to the Food and Drug Administration (FDA) for a new melanoma drug, vemurafenib. Pfizer boasted that the FDA had granted “priority review” for a drug, crizotinib, that treats some types of lung cancer.
Other firms are hawking progress ahead of an important conference in June. Theirs is a risky, two-part strategy. First, create drugs that work. Second, charge a fortune for them. 28.5.11
The costly war on cancer
New cancer drugs are technically impressive. But must they cost so much?
CANCER is not one disease. It is many. Yet oncologists have long used the same blunt weapons to fight different types of cancer: cut the tumour out, zap it with radiation or blast it with chemotherapy that kills good cells as well as bad ones (while ignoring all other alternative cancer treatments).
New cancer drugs are changing this. Scientists are now attacking specific mutations that drive specific forms of cancer. A breakthrough came more than a decade ago when Genentech, a Californian biotech firm, launched a drug that attacks breast-cancer cells with too much of a certain protein, HER2. In 2001 Novartis, a Swiss drugmaker, won approval for Gleevec, which treats chronic myeloid leukaemia by attacking another abnormal protein. Other drugs take different tacks. Avastin, introduced in America in 2004 by Genentech, starves tumours by striking the blood vessels that feed them. (Roche, another Swiss drug giant, bought Genentech and its busy cancer pipeline in 2009.)
These new drugs sell well. Last year Gleevec grossed $4.3 billion. Roche's Herceptin (the HER2 drug) and Avastin did even better: $6 billion and $7.4 billion respectively. Cancer drugs could rescue big drugmakers from a tricky situation: more than $50 billion-worth of wares will lose patent protection in the next three years.
This month Pfizer, an American company, announced that America 's Food and Drug Administration (FDA) would speed up its review of a cancer drug called crizotinib. Roche submitted an FDA application for a new medicine, vemurafenib. The industry is pouring money into clinical trials for cancer drugs (see chart).
This is part of a shift in how big drug firms do business. For years they have relied on blockbusters that treat many people. Now they are investing in more personalised medicine: biotech drugs that treat small groups of patients more effectively.
Last year the FDA approved Provenge, developed by Dendreon of Seattle to train the immune system to fight prostate cancer. In March the FDA approved Yervoy, Bristol-Myers Squibb's drug to treat melanoma. And there are promising drugs in the pipeline. Pfizer's crizotinib attacks a protein encoded by a gene found in fewer than 5% of patients with non-small-cell lung cancer. Roche's vemurafenib attacks advanced melanoma by blocking the mutated form of a gene, B-RAF. Both Pfizer and Roche are developing tests to help doctors identify suitable patients for their drugs.
The snag, from society's point of view, is that all these drugs are horribly expensive. Last year biotech drugs accounted for 70% of the increase in pharmaceutical costs in America , according to Medco, a drug-plan manager. This trend will continue as drug firms develop new ways to treat, for example, multiple sclerosis and rheumatoid arthritis.
Cancer plays a huge role in raising costs. America 's National Institutes of Health predict that spending on all cancer treatment will rise from $125 billion last year to at least $158 billion in 2020. If drugs become pricier, as seems likely, that bill could rise to $207 billion.
Not all these new drugs work. In December the FDA said that Avastin's side effects outweighed its meagre impact on breast cancer. (Genentech will argue otherwise in a hearing in June.) More generally, some people reckon that new cancer drugs offer small benefits at an exorbitant price. Provenge costs $93,000 for a course of treatment and extends life by an average of four months. Yervoy costs $120,000 for three-and-a-half months. Some patients live much longer, which fuels demand for the drugs. But others spend a lot and get little. Otis Brawley, chief medical officer for the American Cancer Society, calls the new treatments “the next frontier”, but adds: “We are not buying a lot of life prolongation with these drugs.”
Britain 's National Institute for Health and Clinical Excellence, a public body that judges whether medicine is cost-effective (ie, what Sarah Palin would call a “death panel”), has rejected several new cancer drugs. That so upset patients and tabloid editors that the British government back-tracked and created a separate fund to pay for expensive oncology drugs. The government now plans to introduce “value-based pricing” by 2014, with a system to price drugs not just for their efficacy but also for their “wider societal benefits”.
America does things differently. The government health programme for the elderly is barred from considering price at all when it decides whether to cover injected drugs under something called Medicare Part B. Under Part B's loopy reimbursement system, the more a drug costs, the more the oncologist who prescribes it is paid. Patients have little reason to demand cheaper drugs. Part B usually covers 80% of a drug's price, and most patients have additional insurance to cover the remainder. Americans hate to be denied any kind of treatment: a delay in Provenge's approval prompted furious talk of rationing.
Private insurers have started to make patients pay a larger share of their drug bills. But drug companies often help to pay the patient's share, which stops the public from getting angry about soaring costs. Even when prices are high, demand for cancer drugs is largely inelastic, says Tomas Philipson of the University of Chicago . Dying patients understandably place a high value on life, so they are willing to pay more for treatment. All this means that firms can charge steep prices. “At some point it's just corporate chutzpah,” says Peter Bach of the Memorial Sloan-Kettering Cancer Centre in New York . “There's no check in the system.”
America 's propensity to pay has one important benefit: it encourages investment in research. Drugmakers recoup their investments in America ; other countries take a free ride. New research may yield better treatments. And today's cancer drugs may prove more effective when tested in combination with others, predicts Todd Golub, director of the cancer programme at the Broad Institute, a genetics research laboratory.
Who will reform this unsustainable system? Private insurers may haggle harder. Patients may grow restive—a recent study found that 10% of cancer patients (not covered by Part B) fail to take prescribed drugs, largely because of the cost. Barack Obama's reforms are supposed to cajole all health-care providers into becoming more cost-effective, but that will require political bravery to enforce, and few politicians are brave enough to do anything that sounds like rationing grandma's cancer drugs. Congress recently authorised more than $1 billion to compare the efficacy of drugs—while explicitly ignoring their cost. 28.5.11
Patients increasingly reluctant to recommend their GP practice on NHS Choices
Appointments and access are dominating patients' complaints on the GP practice-rating website NHS Choices and the proportion of patients willing to recommend their practice has fallen substantially, an official report shows.
An analysis of around 18,000 comments on the Departmen of Health run website, obtained by Pulse, reveals patients have become increasingly critical since the site was launched in October 2009.
Just 45% of patients said they would recommend their GP practice, with 32% saying they would not and 23% expressing no view – a significant decline since an early analysis of the first 1,000 comments, which found 60% recommended their practice and only 17% did not.
The analysis, entitled 'What Patients Think', found a 'preoccupation with appointments and the customer service aspects of GP practice care' in the comments left by patients, with 51% mentioning appointments, 37% reception staff and 27% telephone access.
And GPs are far worse at responding to patients' comments than hospitals - responding to only one in eight comments, compared to hospitals' one in every three.
The report said the lower number of replies and the 'defensive tone' of many showed GPs were still coming to terms with the value of online feedback in helping to improve services.
The analysis names the Cowplain Family Practice in Cowplain, Hampshire, as England's most recommended practice, while six of the bottom ten practices are in London, including two in Tower Hamlets and two in Haringey.
Dr Manpreet Pujara, a GP in Rochester, Kent and a national GP clinical lead for
Connecting for Health said GPs needed to be more pro-active in responding to patients' comments.
'GPs need to think of this as an important mechanism of feedback and ensure they treat it in the same way as more traditional ones,' he said. ‘Practices should set themselves a deadline - a couple of days maximum - to respond.'
Dr Michael Taylor, a GP in Heywood, Lancashire and former chair of the Family Doctor Association, said it was ‘quite astonishing' that so many patients' comments were ignored by practices.
'GPs have got to spend some time and effort responding to patients´ remarks. There´s the old adage that if they like what you do they´ll tell three or four others and if they don´t then they´ll tell 12. GPs need to bear that in mind.' 31.5.11
NHS Pneumonia jabs for pensioners to be scrapped 'as they don't work'
Pneumonia jabs for the over-65s are to be scrapped by the Government because they do not save lives.
Millions of pensioners have been vaccinated with a one-off jab that was supposed to give ten-year protection against an infection that causes pneumonia. The vaccine programme is estimated to have swallowed up £100million – with jabs costing around £20 each including GPs' time – since it was launched in 2005.
As recently as January, the Department of Health was issuing promotional leaflets for the jab despite a number of studies questioning whether it works. But independent experts on the Joint Committee on Vaccination and Immunisation (JCVI), which advises the Government, claim it has had ‘no discernible impact' on rates of pneumococcal disease.
It said the protection provided by the vaccine is poor and not long- lasting in older people. It has told the Government's director of immunisation, Professor David Salisbury, there is little benefit in continuing the programme and it should be stopped.
However, the jab should still be given to children and people with risk factors such as respiratory and heart disease as the evidence is more ‘robust', says the JCVI.
The type of jab for over-65s is pneumococcal polysaccharide vaccine sold under brand names Pneumovax and Pneumovax II. A different type is used in children.
The jab for older people has been linked to 30 deaths and more than 3,300 reported side effects, including heart disorders and joint and muscle pain, according to official figures from the Medicines and Healthcare products Regulatory Agency. It is offered when pensioners get their annual flu jab, with a typical uptake of 70 per cent, suggesting at least 3.8million people have had it.
The jab is meant to work against 23 common types of pneumococcal disease bugs but there has been mounting evidence it does not cut the risk of pneumonia in over-65s. Even in 2005, when the programme in older people started after a majority vote in favour by the JCVI, there were doubts.
Last night Professor Salisbury said: ‘The experts that advise us on vaccine programmes have recently reviewed the pneumococcal vaccination programme for over-65s and concluded the protection it offers is not effective enough and that the programme should cease.'
Charlotte Linacre, of the TaxPayers' Alliance, claimed the programme should have been reviewed earlier. She said: ‘The Department of Health shouldn't just throw money at a project without reviewing its effectiveness.' 31.5.11
Private sector's involvement in the NHS has no limit, says Hewitt
Patricia Hewitt, the Health Secretary, has said there should be no limit to the involvement of the private sector in the NHS.
Ms Hewitt's remarks risk exacerbating a threatened strike by health unions angry over the award of a contract for the delivery of hospital supplies to the private firm, DHL.
She will use a speech to the left-leaning think-tank, the Institute for Public Policy Research (IPPR), tomorrow to make it clear there will be no turning back on thereforms, and that she was "fighting for the soul of the NHS". She said she had reviewed the limit of 15 per cent suggested by her predecessor, John Reid, on the use of the private sector to carry out elective surgery - non-emergency operations - for NHS patients.
"Even after we complete the current private sector procurement it is looking at about 7 or 8 per cent of elective but these decisions, in my view, shouldn't be made by the secretary of state," she said. "They should be made by patients."
Her comments came as a senior Labour figure revealed that Tony Blair would try to use a cabinet meeting on Wednesday to bind Gordon Brown and ministers to a reforming agenda after he leaves office. Mr Blair will set up working parties to report back within three months on the economy, public service reform, security and immigration, terrorism, aid, climate change and reform of the United Nations.
Mrs Hewitt is widely seen to be leading the fight on Mr Blair's behalf but has made it clear Gordon Brown would also deliver the controversial changes to the NHS.
She also made it plain that she would stand up to the critics threatening to protest at the party conference about cuts in hospital accident and emergency units or general surgery wards. "These aren't cuts. This is a better service," she said. "We must take account of modern nursing practices to look after patients in their own homes. For certain types of treatment you need to go to a specialist centre. If you get breast cancer you do not want to be operated on by a surgeon who has done some breast cancer operations but has spent most of his time on general surgery. You want a specialist surgeon. The idea that all this is cuts is simply wrong."
She added: "If this Labour government under Tony Blair or the next prime minister says the change is too difficult and backs down, then we will open the door to top-up payments and the unfairness of the American [insurance] system."
With the big increases in spending on the NHS coming to an end in 2008, Ms Hewitt warned that the NHS would have to live within its means. "We are six years into a 10-year programme which has always been billed as investment and reform," she said. "Everyone loves the investment. Not everyone loves the reform. There is a weariness with change and, because of the financial problems coming on top of the change, there are a lot of people who have real questions about where we are going. We have got to respond to that, perhaps better than we have in the past." 18.6.2006
Hewitt rules out limiting size of private sector role in NHS
· Scale of outside provision will be decided locally
· Health professionals urge pause in 'rush to reform'
Patricia Hewitt set out the government's vision yesterday for permanent revolution in the NHS, with no limit on the role the private sector would play in provision of services to patients.
Two days before a national strike by Unison against contracting out the NHS supply agency, the health secretary said her blueprint did not amount to privatisation. But patients' expectations could not be met unless local NHS commissioners were free to choose private sector providers whenever they offered better value for money.
In a lecture to the Institute for Public Policy Research, she said: "Are we privatising the NHS? Never. Are we changing the NHS? Absolutely." It was not her job to decide which organisations should provide NHS services in five, 10 or 15 years time. The outcome would depend on the ingenuity of rival suppliers and the choices made by patients and doctors.
Her remarks caused anxiety among leaders of the medical professions. James Johnson, chairman of the BMA, said doctors were concerned about "an open door policy to the private sector" that could damage the interests of the most vulnerable patients. Beverly Malone, general secretary of the Royal College of Nursing, pleaded for a pause in the government's "headlong rush into reform" that had left staff disaffected and risked giving people services they did not want.
Further evidence of professional discontent came from a consultant dermatologist at Bedford hospital, who said he would stand for parliament at the next general election in protest at a threat to close it. Barry Monk said he hoped to repeat the success of the independent MP Richard Taylor, a consultant who took the Wyre Forest seat from a junior health minister in 2001 after campaigning against the downgrading of Kidderminster hospital. Mr Monk said he would stand in the Labour marginal Bedford and Kempston, where Labour had a 3,383 majority.
Ms Hewitt said NHS staff were facing a difficult time and there was "a sense that the service no longer knows where it is going". The answer would depend on decisions by primary care trusts (PCTs) and GPs commissioning services for their patients. "We should not try and set arbitrary targets or limits on one provider or another. If independent providers can help the NHS provide even better care and value for patients, we should use them. If they can't we shouldn't," she said.
Ms Hewitt was asked whether this liberalised regime invalidated a forecast by her predecessor, John Reid, who said the private sector would not take more than 15% of the market for elective surgery in his political lifetime.
Ms Hewitt - aware of the rough ride she will get at the Labour conference in Manchester next week - said: "From everything I can see, I would say John's prediction was if anything on the high side."
The government did not want the NHS to become "a glorified insurance system buying services from the private sector" and would not be "just a logo to stick on the front door of a private hospital".
But the government could not say how much it would provide because that was for local commissioners to decide. Ministers would not organise a third wave of national contracts for independent treatment centres because PCTs could band together to buy whatever services they needed.
Ms Hewitt also signalled her support for David Nicholson, the NHS chief executive, who told the Guardian last week that up to 60 district general hospitals may lose A&E departments, paediatric and maternity services. Emergency care practitioners would treat more patients in their own homes or at the scene of an accident. The most serious cases would be handled in hospitals specialising in major trauma. But the NHS would still need A&E departments to handle the bulk of the work.
Ms Hewitt avoided saying how many may have to close. "The exact configuration must be determined locally by clinicians, ambulance staff and patients," she said.20.6.2006
NHS pension millionaires: Health cuts bite, but bosses' retirement pots are still gold-plated
Strategic health authority managers have pension pots between £1.2m and £2.6m
Average private sector worker would have to work 1,720 years to accrue same amount
NHS fat cats are enjoying pension pots worth more than £2.5million, and some chief executives will retire on annual payouts of up to £110,000.
While final salary pension schemes have all but disappeared in the private sector, it is those employees who will end up footing the health service pension bill through their taxes. Details of the gold-plated pensions come after evidence of lucrative payments to health service managers, even though the whole system is under severe financial strain.
It emerged last month that the bonuses of senior executives at the Department of Health had doubled in five years. Some received £27,500 on top of their six-figure salaries. And around 1,600 managers of hospitals and health trusts are now earning in excess of £150,000 a year, more than the Prime Minister's salary of £142,500.
Yet many hospitals are being forced to axe doctors, nurses and midwives to save money, and there are concerns that the cuts are having an effect on patient care. The average NHS worker retires with a pension of just £7,000.
Daniel Poulter, Conservative MP for Central Suffolk and North Ipswich, who is a former hospital doctor, said: ‘It is completely unacceptable that under Labour, senior NHS managers, some of whom were already paid salaries ten times more than hard-working nurses, received annual pay increases of around 7 per cent when front-line NHS staff received only 1.8 per cent.
‘The Government is investing £11.5billion in the NHS over this parliament, but we urgently need to curb this kind of excessive spending on management.' Figures reveal that the chief executives of the ten strategic health authorities in England have gold-plated final salary pension pots of between £1.2million and just under £2.6million.
The biggest belongs to Sir Neil McKay of the East of England authority, and is currently valued at £2.59million. He is on a salary of between £230,000 and £235,000, and can expect to enjoy an annual retirement sum of between £105,000 and £110,000.
Only just behind is Sir Ian Carruthers of the South West strategic health authority, whose pension pot is valued at £2.58million and is expected to pay out between £100,000 and £105,000 when he retires. The chief executives will contribute about 8.5 per cent of their salaries to their pension and the remainder will come out of the NHS budget.
Private sector workers earn an average of just under £24,800 a year, and the majority have no company pension at all.
Those who are lucky enough to have a pension plan contribute an average of 6.1 per cent of their salary, around £1,500 a year. With employer contributions, to accumulate a pension pot of £2.58million they would need to work for 1,720 years.
MP Daniel Poulter added: ‘It is staggering that an average private sector employee would have to work for so long to accrue the kind of pension pot that top NHS managers are sitting on.' Strategic health authorities oversee the work of hospitals and primary care trusts in their area. As part of the Government's controversial health reforms, they are due to be abolished.
But there is currently a great deal of uncertainty over the shake-up, and ministers are re-thinking their plans.
In any case, even if these chief executives were to be made redundant they would keep their pension pot for when they retired.
Charlotte Linacre, campaign manager at the TaxPayers' Alliance, said: ‘It's utterly scandalous that NHS bosses can make an absolute fortune and dump the bill on to future generations of taxpayers. ‘Such generous pensions pots signal that care for senior managers has come before care for taxpayers or front-line services. ‘It's shocking that the value of these bumper pension pots are dramatically more than ordinary taxpayers, who fund their lifestyle, could ever save up themselves.' 31.5.11
NHS lets 4,500 patients leave hospital emaciated in a year
Nearly 4,500 patients were discharged from hospital last year severely malnourished. An average of 12 a day were allowed to leave wards desperately emaciated – the highest number on record. Most were elderly patients who were too frail to feed themselves and regularly missed meals because hospital staff were too busy to help them eat.
The number discharged from hospital severely malnourished – suffering from illnesses associated with famines in poor countries – has doubled in four years. A total of 4,412 were discharged with malnutrition last year, compared with 2,265 in 2005/6 and 2,883 in 2006/7.
In the past year alone the figure has increased by a fifth, with 3,633 having left hospital with malnutrition in 2008/9.
Only yesterday a report disclosed that doctors in some hospitals have resorted to prescribing patients drinking water just to ensure they do not go thirsty. The Care Quality Commission watchdog found that a quarter of hospitals were neglecting the elderly to such an extent they were breaking the law.
Meals are routinely dumped in front of sleeping patients only to be taken away cold and untouched. On some wards the frail and confused are left to pick up food with their hands because nurses are too busy to help feed them.
Figures from the NHS Information Centre show that hundreds of thousands are leaving hospital desperately underweight or suffering some form of nutritional deficiency putting them at risk of illness. Those with malnutrition have illnesses such as kwashiorkor, where the stomach swells up due to lack of protein, or marasmus, where muscles waste away. Both conditions are more commonly seen in famines in Africa.
Another 210,476 were discharged with anaemia – lacking crucial vitamins and minerals to protect against illnesses. But these figures probably represent only a fraction of cases as many will not be recorded.
Michelle Mitchell, of Age UK, said: ‘It is extremely worrying that the number of patients reported as being discharged from hospital malnourished is up. ‘This figure will represent the minimum number of people being discharged with many others going unreported. Being well fed and hydrated is a basic level of care all patients should expect to receive and these figures highlight the scale of this problem.
Recognition of the issue is high but not enough is being done to transfer words into action on the wards.'
It is very difficult to establish how many people become malnourished in hospitals because many patients are not properly checked for signs of it when they are admitted.
Some elderly patients may be very underweight when they are admitted, especially if they have spent long periods in hospital or have been brought in from a care home.
Over the next few months the care commission will be naming and shaming the hospitals which are failing to ensure the elderly are fed or properly cared for. Those not up to scratch could face fines unless they improve. 27.5.11
GPs with fat patients 'should send them to Weight Watchers'
Weight Watchers really does work – and it's better and cheaper than diet advice from your GP, researchers say. A study of hundreds of British slimmers found those who went to a commercial slimming group for three months lost twice as much weight as those who were given diet advice by their family doctor.
Paul Aveyard, a GP and a professor of behavioural medicine, said rather than trying to treat fat patients themselves, GPs should send them to commercial sessions, paid for by the NHS.
Dismissing slimming advice from family doctors as ‘ineffective', he said groups such as Weight Watchers, Slimming World and Rosemary Conley offered the best hope for fighting obesity.
What is more, they are significantly cheaper, with a course of 12 one-hour group sessions costing around £55 – just slightly more than one 12-minute GP appointment. In the NHS-funded study, Professor Aveyard, of Birmingham University , tracked 140 obese men and women as they tried different weight-loss strategies.
These included one-to-one sessions with their GP, practice nurse or pharmacist, attending the Health Service's own slimming group, and joining commercial slimming clubs for three months. Others simply tried to lose weight under their own steam.
All of those taking part shed some pounds – but those treated by NHS employees did no better than those who tried to go it alone.
In contrast, those who attended group sessions run by companies lost a little more than 9lb on average – almost twice as much as the others, the European Congress on Obesity conference, in Istanbul , heard.
After a year, all of those taking part had regained some weight – but those who went to Weight Watchers kept off the most. Professor Aveyard believes patients benefit from the support of the group and the approval of others. Consistency may also be key. Commercial groups hold weekly meetings at regular times, making it easier for people to plan their lives round their diet.
The professor said teasing apart the secrets of commercial groups' success could help improve the services offered by doctors, nurses and pharmacists. But, in the meantime, GPs would be better off referring their patients elsewhere. ‘If we're to tackle the obesity epidemic in straitened financial times, the weight management services we commission must be both effective and cost effective,' he said. ‘This independent study represents a significant step forward in assessing various weight management services' relative quality and value.'
Around two-thirds of Primary Care Trusts in England and Wales already pay for patients to attend Weight Watchers courses. However, most GPs restrict them to those who are dangerously obese – often referring only a handful each year.
A recent study by the Medical Research Council found that those who attend weekly Weight Watchers sessions, paid for by the Health Service, lost an average of 15lb a year – twice as much as those who received weight-loss advice from a GP.
Weekly sessions begin with a weigh-in. Members learn about healthy eating including the points-based system which scores food. Weight Watchers said it works hard to distil the latest scientific knowledge into messages that are easy to put into practice. 25.5.11
Competition will keep NHS on its toes
The plans in the health bill to increase competition won't lead to 'privatisation', but will unlock innovation and help GPs offer their patients better care, says Dr Paul Charlson
The BMA has said that the NHS should not be run like a ‘privatised industry' and that competition is potentially damaging to providing comprehensive, high-quality healthcare. But as Alan Milburn, a former Labour health secretary, wrote in the Health Service Journal recently: ‘Monopolies in any walk of life rarely deliver either operational efficiency or customer responsiveness. That's why there should be no preferred providers.'
The debate about competition has exploded as the Health and Social Care Bill makes its way through Parliament, but the discussion has polarised opinion and generated more heat than light.
Competition and privatisation are often linked, and the words are used interchangeably – yet the two concepts are quite different. There is a difference between private medicine where the patient pays directly and private providing services free at the point of use funded by the taxpayer.
GPs are private, profit-making businesses offering a mix of taxation and non-taxation funded services, but many GPs who are against ‘privatisation' seem to have conveniently forgotten this. Many alternative providers run successful, high-quality services using the same clinicians who work in the local hospital trust or surgery.
Similarly, hospital trusts compete for patients just like a private company. The fact is that the NHS is already a hotch-potch of providers all competing for a bigger slice of the £110bn in tax that you and I stump up each year.
Patients are not concerned about who provides their care so long as it is free, of good quality and offers continuity of care, short wait-times, easy parking and ideally convenient opening hours.
Nobody, least of all this Government, is suggesting that patients should pay for services that have previously been free. The NHS is not being privatised – the new bill is seeking to extend the concept of competing providers started in the 1990s and developed significantly under the last government.
Healthcare is complicated and there is no simple answer as to whether competition is a good thing, but logically we all know that competition makes people up their game and that's often true in the NHS.
If you have two local services – one opening at weekends with high-quality clinicians operating from modern premises and another that has chaotic, weekday-only appointments, with stressed clinicians working from a scruffy building where you get lost and can't park – which would you choose?
Either the second service changes or it will close. The first service sounds like many new community services, and the second like some hospital outpatients departments. This is competition in action.
There is evidence that competition on price generally reduces standards, but fixed-price competition raises them.
The London School of Economics concluded in its 2010 report Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms : ‘Our results suggest that hospital competition in markets with fixed prices can lead to improvements in clinical quality.'
Professor Chris Ham, chief executive of the King's Fund, recently stated that competition is much more likely to benefit primary care, elective and planned care than emergency, unplanned and complex care, where collaboration and integration is far more important.
We also know that the system of pricing of services has to prevent cherry picking by reflecting the complexity of care. A proper competition framework focused in the right areas will unlock innovation, raise quality and ultimately provide better care. This is what the health bill seeks to achieve and the NHS is about.
A pause is sensible to ensure that everything is right – but it would be a grave mistake to dump the competition element completely. Dr Paul Charlson is a chair of Conservative Health and a GP in east Yorkshire 25.5.11
'I'm more excited than ever about the NHS healthcare marketplace'
Despite sustained criticism of the Health Bill's private sector and price competition focus, HSJ's Crispin Dowler finds out why General Healthcare Group chief executive Adrian Fawcett believes now is a time for private healthcare providers to look forward to the future.
From any point of view overlooking Westminster , it's been a rocky few months for the private healthcare industry. The political row over the private sector-friendly elements of the Health and Social Care Bill has escalated to near-crisis level, the bill has stalled, and heavyweights on both sides of the Commons are queueing up to condemn private sector “cherry picking” of NHS patients.
So you might expect Adrian Fawcett, chief executive of the biggest private healthcare provider in the UK , to feel less than optimistic about his company's prospects for business with the NHS. If so, he hides it well.
“At a macro level,” the General Healthcare Group chief executive officer tells Health Service Journal, “I'm more excited than ever about what the healthcare marketplace – and healthcare reforms – mean for the future.”
His main reasons for his confidence are economic, not political. He believes the unprecedented savings targets the Department of Health has set for the NHS – 4 per cent per year, or £20bn by 2015 – are a “massive understatement”, and that to keep pace with demand the service will actually need annual savings “nearer 8 per cent”.
For the next few years, he expects the service's known cost pressures – a growing and ageing population and demand driven by medical advances – to be compounded by high global commodity prices. He suggests high oil prices will have a disproportionate effect on the healthcare industry, which is dependent on both plastics and imports, and that high cotton prices will drive up the cost of bandages and other medical consumables.
The QIPP agenda is about making efficiency savings to neutralise these pressures, but he doubts that NHS productivity can rise sufficiently to do this: “If you look at the healthcare system in the UK , there's no recent history or evidence of efficiency being absolutely delivered.”
Healthcare in the UK must either see an increase in private provision and funding, or accept unsatisfied demand, he concludes. “What better marketplace could you be in as a healthcare provider, [than one] where – ignoring the economy – the demand and need for your product and service is rising irrespective of what you do?
“We're now only arguing how best to configure to deliver it, and how that's paid for. And it is almost untenable to find a 10-year programme that satisfies this demand… out of tax-take alone.
“Therefore we need to increase our sources of funding, and I think these reforms are the starting point [for] making that happen.”
He is not the only private healthcare chief executive who has remained confident his sector will benefit from the reforms, despite the government “pausing” the passage of the health bill, and promising private sector involvement will not be allowed to destabilise NHS services. As HSJ reported last week , in a survey of 20 private sector chief executives polled between March and May, 70 per cent expected the government to partially or completely follow through on its reform commitments.
For his part, Mr Fawcett thinks the government's current “listening exercise” to consider changes to the bill may put the brakes on a produce a slower reform timetable but he does not expect them to stall altogether. Those aspects of the bill which are most important to private providers – namely, the opening up of a large number of NHS services to competition from “any qualified provider”, and the transformation of Monitor to an economic regulator – he expect to come through relatively unscathed. “You will see,” he insists, “with the advent of an empowered sector regulator, competition opening up to deliver higher standards of patient care.”
He rejects arguments that this competition could undermine the viability of hospitals providing essential services like accident and emergency, by allowing private providers to “cherry pick” routine elective work. There is “definitely an argument to make sure that competition allows for essential services, and the quality of those essential services, to be supported,” he says.
But he continues: “I don't think that, in any of the areas where long-term private investment would consider going in, it is actually in danger of damaging core services and facilities offered by the NHS.
“If you look at London, I think there is plenty of capacity for the private sector to be part of the London mix without damaging core services, because the demand on the existing facilities in many areas is greater than [the amount of service they] can actually provide.”
Part of Monitor's role in areas like capital should be to ensure “that the [Accident and Emergency] infrastructure is supported by good general surgery and theatre wards behind it, and that the level of competition in the marketplace doesn't end up disrupting that”, he says.
He maintains, controversially, that where competition is introduced providers must be allowed to compete on price, not just service. Health economist critics of price competition say it has been shown to drive down healthcare standards, and the government has already removed all reference to “maximum tariff” prices from the bill, in an effort to prove that it will not introduce competition on price.
Mr Fawcett says he can understand why, in the early stages of reform, providers would be allowed only to compete on service quality, but says it would be “madness not to end up where price became part of the equation”. For some medical procedures, he argues, there is no way for providers to differentiate themselves except cost, and, when the cost of providing healthcare varies so much across the country, “why would you insist on having only one price?”
So, if the NHS reforms do deliver the opportunities Mr Fawcett anticipates for the private sector, what will be his strategy for taking advantage of them? The first two steps, he says, would focus on mobilising GHG's share of the estimated 30-40 per cent spare capacity in the English private healthcare sector to target NHS patients.
First, he anticipates, this spare capacity would “increasingly be promoted directly to the general public and [NHS] commissioners as available”.
Second, he says: “Private companies, including ourselves, will invest behind NHS funded patients directly”. At this stage GHG would invest in everything from communications materials, to equipment, to consultant training, to beds and wards, with the direct intention they be used to win and treat NHS patients.
That third step – investing in new facilities – would only come when GHG could be certain that the NHS was set for a long-term relationship with private providers. “Once it's formalised and we've got some experience and we've got confidence that there's stability in the system, private companies like my own would have no hesitation in investing in long-term capital assets specifically for NHS service provision,” he says.
Even with up to 40 per cent spare capacity in private hospitals? “[That spare capacity] is such a small proportion of the demand growth that's going to be coming through, it's an irrelevance,” he answers. That investment could mean buying or building hospitals, he says, or his “big passion” for GHG: going “on site with the NHS”.
“The NHS has got a large estate of facilities already,” he explains. “What would stop us, in that scenario, not investing in new swanky facilities down the road, but going onto site and reconfiguring or investing on the same sites as the NHS and creating real medical hubs? That would be a full unison of the private sector with the NHS.”
And would GHG be interested in a Hinchingbrooke-style takeover of a financially struggling NHS trust? “We would have to look at each one of them on its own merits,” he replies.
He would have to be certain that the company was not “trying to take on something which is unfixable”, but, he emphasises, it was “certainly something we would like to discuss with the Department of Health and the NHS directly, to see if there was the opportunity for a stronger partnership as a result”.
While Mr Fawcett remains bullish about the reforms, he has, he says, slowed his investment decisions while the bill is “paused”. “There is enough nervousness, and there is enough political agenda, behind this reform, that I wouldn't be investing further at this stage, when I'm hoping to be so much better informed in 12 weeks time.”
Whether you listen to McKinsey, David Nicholson, or Nick Clegg, he concludes, everybody is looking at the NHS as an asset.
“We mustn't look at it as a treasure, because treasures go up in value as a result of becoming obsolete and [gaining] rarity value. Assets go up in value because they become more interesting and useful.” 25.5.11
Labour wasted £500m in private treatment centres for NHS
Almost £500million of taxpayers' money has been squandered in a Labour flagship scheme to treat NHS patients in private centres. Private firms were paid millions for operations that never took place in overly generous contracts drawn up by the Department of Health, in a Labour plan to cut waiting times and improve choice.
The independent providers received more cash for their buildings when contracts came to an end, and were even paid compensation when a second wave of clinics was cut back, a study by the Bureau of Investigative Journalism has found.
Another part of the £1.5billion scheme intended to allow busy workers to see doctors near offices, but the new walk-in centres were under-used and most are closing down.
As controversial reforms to the NHS will provide even greater opportunities for private providers, it is feared that more public money will be wasted on similar projects to the doomed Independent Sector Treatment Centre initiative.
Allyson Pollock, professor of public health research and policy at Queen Mary, University of London, said that if the reforms go ahead, “the poor value for money of ISTCs will be multiplied one hundred times over”.
“In a time of economic austerity this will be a catastrophe for the NHS if more private providers are brought in.”
Derek Machin, chairman of the British Medical Association's private practice committee, was a member of the Department of Health's Commercial Directorate set up to scrutinise ISTCs but said that the scheme's commercially sensitive nature made the contracts impossible to examine.
He warned that the scheme is a canary in the mine for the current reforms, which force GPs to consider sending patients to be treated by “any qualified provider” rather than just the local NHS hospital.
Mr Machin said: “The private sector is very clever at extracting money from governments, but commercial sensitivity can hide this for years.”
Labour introduced the ISTC scheme as a way to reduce waiting times for treatment at busy NHS hospitals while increasing patient choice, by letting private companies carry out planned, straightforward procedures such as hip replacements and cataract operations.
The first centre opened in 2003, but only 12 of the original 31 contracts, worth at least £1.47bn in total, are still operating.
The bulk of the waste stems from an arrangement called “take or pay”, whereby the NHS allotted the private provider a set sum at the beginning of each year, in order to complete a fixed number of operations.
But the Bureau, a not-for-profit organisation based at City University, found that of the 31 first wave treatment centres, just four performed all contracted operations. In contrast, nine performed less than 75 percent. In total, the government paid £217m for operations that never happened.
The worst performer was the Greater Manchester Surgical Centre, run by South African group Netcare. There, only 56 per cent of contracted procedures were carried out. Netcare received nearly £38m for “phantom” operations.
Onerous contract provisions also forced the Government to buy back ISTCs after five years. This means that despite massive taxpayer investment, nine of the 31 centres initially set up have been forced to close, and others will go the same way as contracts end.
In 14 cases, the previous government agreed to repurchase the centres at the end of the contracts under a “Residual Value agreement”. The government has already paid out £70.1m under these contracts, and is obliged to buy back another six at a cost of £116.1m.
The Bureau has also discovered that a further £59.8m in compensation was given to six private companies when plans for a second wave of ISTCs were reduced from 24 schemes to 10.
The current Government insists the same mistakes will not be repeated, however.
Simon Burns, a Health Minister, said: “The NHS Bill puts safeguards in place to ensure that the waste seen under the previous Government's ISTC contracts doesn't happen again. “Under any qualified provider, the best providers would deliver services, money would follow the patient and all providers would be paid, at NHS prices, with no income guarantees. This is the exact opposite of the take or pay arrangements included in the ISTC contracts.” 21.5.11
'Patients to suffer' as NHS trusts in London face £100m debt crisis
NHS trusts in London are facing a £100 million debt crisis despite being bailed out by health bosses.
At least half a dozen hospital and primary care trusts have overspent, according to new figures. Campaigners warn that patients will suffer as cash-strapped trusts struggle to make further savings in the year ahead.
South London Healthcare NHS trust tops the list of over-spenders with a forecast £45 million deficit. The trust, which includes Queen Mary's Hospital in Sidcup, blames its overspend on a drop in income for patient care. Last year it ran up a £37.7 million debt. Barking, Havering and Redbridge University Hospitals NHS trust has also ended the financial year with an estimated overspend of £34 million.
Finance chiefs describe its financial position as "extremely difficult" in board papers seen by the Standard.
Its debt is up from £19.7 million last year. John Lister from campaign group Health Emergency said the figures on trust deficits were "just the tip of the iceberg". He said: "These are only the figures the trusts will admit to - the real situation is even worse. I don't think more savings can be taken out of the backroom or management.
"So the danger is patients are going to suffer and face misery ahead with lives put at risk." Some trusts have only balanced their books at the end of the financial year because they have been bailed out by the NHS.
NHS Sutton and Merton for example has received more than £20 million in handouts from the Challenged Trust Board. Haringey Primary Care trust was also given £28 million cash to balance the books. The Challenged Trust Board was set up three years ago to wipe out historic NHS debt in London.
But campaigners have warned the financial crisis would deepen even further over the coming year. Trusts are already reducing costs by cutting frontline posts, including nursing jobs.
Epsom and St Helier University Hospitals NHS trust has ended the year with a cash surplus but admits it faces a £38 million deficit by next April.
Imperial College Healthcare NHS trust has confirmed it faces a £100 million "financial challenge" in the year ahead and has drawn up a cost improvement programme to save £70 million. 20.5.11
NHS rapped by MPs for inefficient procurement
Public account committee reproves NHS trusts for wasting money on poor purchasing while making cuts elsewhere.
Parliament's public accounts committee has warned that NHS trusts risk wasting money on inefficient procurement, while they are making cuts elsewhere to achieve savings, according to the Guardian Healthcare Network.
In a report published on 20 May, the committee says the NHS lacks a "culture of efficient procurement". It points to a lack of data which makes it difficult for trust boards to challenge managers on the efficiency of procurement. It also says there is poor control over procurement practices.
"At a time when all trusts are required to make efficiency savings - 4% in 2011-12 alone - they should seek to achieve as much of these as possible from improvements in procurement," the committee says.
According to the findings, England's 165 acute and foundation NHS trusts spend £4.6bn each year on consumables. Typically they purchase these by dealing directly with suppliers; through the national supplies organisation NHS Supply Chain; through regional collaborative procurement hubs; or through direct arrangements with other trusts.
A National Audit Office sample of 61 trusts found they bought 21 different types of A4 paper, 652 different types of surgical and examination glove and 1,751 different cannulas. The committee's report points out that product standardisation combined with commitments to buy in large volumes, something of which the NHS is capable, can produce significant savings.
About half the products available through NHS Supply Chain are more expensive than through other outlets, according to the committee. It calls for a review of the organisation and a possible revision of its contract.
The report calls on the Department of Health to require NHS purchasers and suppliers to use a standard bar-coding system so that price comparisons can be made and savings identified.
It says that this should be in place by April 2014, when all trusts are expected to have foundation status and accompanying greater freedoms.
Margaret Hodge, chair of the public accounts committee, said: "The Department of Health needs to be clear how, when trusts are independent of its control, it will achieve the essential savings it should enjoy from the joint, bulk buying of medical supplies and other consumables in NHS hospitals.
"When resources are so tight it is simply unacceptable that money is being wasted by paying more than necessary on everyday products, from paper to surgical gloves." 20.5.11
Government urged not to turn its back on NHS competition
The Government must not lose its nerve by turning its back on competition or watering down the role of Monitor, according to the head of the NHS Confederation's private companies network.
David Worsket, director of the NHS Partners Network, which represents private companies such as Assura Medical and Care UK, urged the NHS not to turn its back on choice and competition despite the adverse publicity surrounding the Government's NHS reforms, and warned that scaling back the role of Monitor as an economic regulator would simply lead to more cases going through the courts.
Speaking today at a Westminster Health Forum conference this week, Mr Worskett added that he felt the Government had treated the private sector 'shabbily' by excluding them from the Future Forum discussion panel overseeing the listening exercise on health secretary Andrew Lansley 's controversial reforms.
The intervention comes as deputy Prime Minister Nick Clegg set himself on a collision course with Mr Lansley by signaling his intent to push for Monitor's role as an economic regulator to be removed, and that it should instead promote collaboration and protect the interests of patients.
But Mr Worskett said well-managed competition was essential if the NHS was to respond to the huge demographic and financial challenges it faced. He said: 'There is now a danger that if the NHS turns its back on competition, it may be depriving itself of one of the levers it needs to help it adapt and respond to the huge demographic and financial challenges it faces in the next 20 years, whilst maintaining and improving patient care.'
He added: 'Good economic and competition regulation can promote the integration of services. Integration and competition are not fundamentally incompatible. But to manage them constructively together you need a strong specialist economic regulator, which is why watering down the role of Monitor could have exactly the opposite effect to the one desired.'
'We need to grasp the fact that Monitor is the answer to concerns about the role of competition, not the cause of them. A specialist competition regulator is vastly preferable to having the application of competition law developed by the courts.'
Responding to a question from the floor on the Government's listening exercise, Mr Worskett said it was 'a great shame' that the private sector had been excluded from the Future Forum panel.
He said: 'It's a shabby way of treating a collection of providers who we have been trying to co-operate with for almost a decade. We have an awful lot to offer.' 19.5.11
One in three GPs ignore guidelines on 'alternative' therapies to patients suffering back pain
One in three GPs do not offer 'alternative' therapies to patients suffering back pain - despite NHS guidelines sanctioning their use. A new survey reveals a big gaps in availability of therapies like acupuncture, massage and manipulation for NHS patients.
It found 34 per cent of family doctors did not prescribe complementary therapies for patients most seriously disabled by back pain.
But guidelines from the National Institute for Health and Clinical Excellence (Nice) - which were the first to endorse widespread use of 'alternative' therapies - have been in force for two years.
Back pain sufferers in England and Wales are supposed to be able to opt for a three-month course of acupuncture, spinal manipulation or exercise - and try something different if the first treatment fails to work. Treatment can be provided by physiotherapists, chiropractors, osteopaths or other qualified specialists.
The guidelines were described as a 'sea-change' for back pain sufferers, yet the latest survey of almost 500 GPs and patients shows little has changed.
Two out of five patients would like massage offered free on the NHS, but only three per cent of GPs said the service was available locally.
Acupuncture was the most available treatment, with 60 per cent of GPs saying they could prescribe it for patients with long term back pain.
Just five per cent of GPs can prescribe manipulation on the NHS.
Altogether 82 per cent of patients polled would like to receive some form of complementary medicine on the NHS.
When the Nice guidelines were introduced, experts said they would not add to the £1.6 billion bill for NHS treatment of back pain because useless therapies will be dropped.
Dr Michael Dixon, chairman of the College of Medicine, who will release the figures at the College's conference in London tomorrow (thurs) (must credit college and the conference), said the UK could not afford to neglect back pain. He said 'Back pain affects seven out of ten people in middle age - that is, between the ages of 35 and 50 - when we are at our most industrious.
'Absenteeism costs this country millions if not billions every year. By employing accredited techniques, GPs could help reduce these statistics and that is vital, particularly at a time when the nation itself is on its knees because of the financial crisis.'
The Conference says the failure to integrate accredited complementary medicines, both at grassroots and higher levels, is limiting the success of patient care.
Dr Dixon said 'We keep being told that it's the management systems that need an overhaul. They certainly play their part, but what's really needed is a health service where prevention is as important, if not more important, than cure.' 18.5.11
Greater competition will benefit the NHS – not 'unravel' it
All the evidence points to market approaches working better than central planning, argues Stephen Black of PA Consulting.
The forces of opposition seem united in their dislike of more competition in the NHS. TheRoyal College of GPs has warned that more competition could "unravel" the NHS, and Nick Clegg has stated that his party will not support the healthcare bill without further amendment .
But there are both good arguments and good evidence that more competition could benefit NHS patients. For example, recent evidence from groups at LSE, Imperial College and Bristol University suggests competition generates both quality improvement for patients and better control of costs.
The media debate has ignored the most obvious evidence: the fact that almost everywhere where they have been tried, market approaches work better than centrally planned government ways of running the same activity. Not all markets work well, but even the bad ones seem to do better than central planning.
Many arguments against competition in the NHS seem stuck in a 1930s time warp and ignore 80 years of world history that have taught even the Chinese Communist Party that planned economies are a failure – and this is true even when compared to very imperfect market ones.
It would be wrong, though, to pretend that some concerns about the NHS reform are not real. The first worry – that the changes will damage the NHS ethos – initially sounds like a powerful objection, except that large parts of NHS services are already provided by the private sector. Most GPs do not seem to be diverted from their public duty because they are private contractors, not employees, and can make profits. Many other services in the NHS – for example, in mental health – are often provided by independent organisations.
The second concern – about fragmented care – does highlight a potential problem. However, the NHS performance on joined-up care is poor. GPs often refuse to share data with either commissioners or hospitals; hospitals guard their data carefully if it is ever accessible in the first place.
The volume of paper-based notes means they are not easy to share with others in the NHS. Real markets have no problem sharing information if that sharing leads to mutual benefits, and they are a lot better than the NHS at spotting where those benefits might be.
The third concern – about the reforms leading to organisations putting profits before patient care – is wrong for a number of reasons. Most providers in the market will be NHS hospitals or not-for-profit bodies. Even those that are not, can make profits only if they attract patients by offering better care at the same price. Profits can come only because they do the job well. If a provider skimps on quality to make a profit this year, they will attract no patients next year.
This brings us to the final objection: that competition will destabilise a carefully planned NHS, leading to some services closing. It is certainly possible, but that might be a good thing, though even Andrew Lansley, the secretary of state for health, does not want to admit it. One of the most persistent problems of the NHS has been a failure to evolve services as needs and technology change. The broad balance of current investment is wrong: we spend too much on hospital care and too little keeping people out of hospitals. We find it almost impossible to shut services even when demand changes, which is why an unaffordable amount of money is being poured into the rebuild of hospitals despite there being far better ways to spend that money.
What markets do is bring change and evolution – as well as productivity and quality improvements that force incumbents to improve or leave the market. Protecting the incumbents just makes productivity and quality harder to achieve – to the detriment of patients. Markets let us choose an iPod; planners insist we keep buying the Walkman.
Indeed, it is worth reflecting on why always protecting existing services can be bad for patients and taxpayers.This can be seen in a scenario where new technology became available for non-invasive cardiac diagnostics that is safer than traditional approaches, but which requires expensive equipment. The old technique involves an invasive procedure that requires a catheter to be inserted into the heart, which requires skilled staff and is risky. Yet a typical NHS hospital will not rush to use the new kit because it requires investment and would seem to waste money already spent on equipment and training.
A hospital facing competition will see it differently. Faster, safer and cheaper techniques bring big benefits to commissioners and patients, so hospitals that do not adopt the new technology will lose work to those who do (so quality and efficiency will both improve).
This is not only a real situation, but clear evidence of why the lack of competition between providers holds back improvement in the NHS and why competition can bring real benefits to patients. Dr Stephen Black is a health management expert at PA Consulting. 18.5.11
Brushing aside failure King's Fund report calls for new style of NHS management
The NHS in urgent need of a new style of leadership to overcome unprecedented financial pressures and adapt to future challenges, a nine month inquiry by The King's Fund's Commission on NHS Leadership and Management finds.
The report from the Commission emphasises the crucial role excellent general and clinical managers can play in delivering the productivity improvements and service transformation that the NHS requires.
The Commission finds high-quality, stable management to be key to high-performing health services. Yet across the NHS, the average chief executive spends just 700 days in post. In part, this reflects a culture where ‘heroic' leaders grapple with problems only from the top of the organisation, or are ‘parachuted in' to replace individual managers and ‘turn around' troubled NHS services.
The report advocates a new type of ‘shared leadership' involving leaders at different levels of the workforce working collaboratively with all those involved in patient care to lead change and improve services, rather than only tackling problems inside specific institutions.
The Commission examined evidence from UK and international health care and other sectors, finding that given its size and complexity, the NHS is under-managed, but over-administered. Key issues were that:
no assessment of the future needs of the NHS has been made, yet the coalition government has imposed a 45% cut in NHS management posts and 33% cut in administration costs
a large cohort of NHS administrators has developed over time to respond to extensive and often duplicated requirements from multiple regulators and performance managers; an urgent assessment of the information demands placed on the NHS is needed
each NHS organisation should take responsibility for its own leadership development and quality of management, including dealing with failing managers
the work that has started to strengthen leadership and leadership development should be taken forward through the creation of an NHS Leadership Centre.
Professor Chris Ham, chair of the Commission on NHS Leadership and Management and chief executive of The King's Fund, said of the findings: "We know there is public support for reducing the number of NHS managers. But given the immense challenges facing the NHS, politicians of all parties must resist the temptation to denigrate the value of management in delivering excellent and efficient services.
"The priority for the future NHS must be to deliver the best care possible to those with chronic and long-term conditions. That needs a new style of NHS leader, as adept at building partnerships to deliver care across boundaries as they are at managing their own services."
Managers ‘vital' to care
Commenting on the report, NHS Confederation chief executive Mike Farrar said: "This report makes the vital point that high quality health services simply do not happen without skilled management. As the NHS enters a period of huge financial challenge and organisational upheaval, stable and effective leadership will be the difference between success and failure."
Farrar highlighted that good management is "just as vital" to the care that the NHS provides as the hands that deliver it. "There is consensus across the service that good leadership will be key to the integrated efficient services the NHS needs...
"With funding so tight and services needing to change to meet the demands of modern healthcare, difficult decisions will need to be made on how services are configured," he continued. "Local NHS leaders will need support to make these decisions, based on the evidence."
On an accreditation body for NHS managers, Farrar added: "We also share some of the concerns in the report about an accreditation body for managers and agree that as health services look to forge links across social care and local authorities, new leadership styles will need to be developed and brought to the fore."
But a leading surgeon today said red tape, EU directives, paperwork and government targets has meant NHS hospitals are being 'run as factories.' David Sandilands, 64, hit out as he retired from his post after a 40 year career in medicine - 22 years of which he was consultant surgeon at Burnley General Hospital.
'The job is unrecognisable now to when I first started because it's being destroyed by bureaucracy - it's tragic,' he said. 'Hospitals are run more like factories now with patients being rushed through. 'Targets have become priorities and as such patient care has suffered. Morale among staff has suffered too because of the way they are being treated by management and it has caused a lot of insecurity. 'I find it depressing that there's a culture of not saying anything to the outside world. Everyone working in the NHS feels the same way as me.
A spokesman for the Burnley General said: 'We cannot say anything as we consider his criticisms to be directed to the broader NHS.' 18.5.11
NHS IT system is a farce 'has cost billions without delivering ANY benefits'
Health Minister damns project as 'expensive farce and utter waste of money'.
The NHS' controversial project to computerise all patient records has cost billions of pounds without delivering any benefits, according to a damning report. It warns the project is running years behind schedule and will probably never happen.
The £11 billion scheme, launched under Labour in 2002, was meant to create a central computer database of all patient records which could be easily be accessed by GPs and hospitals. But from the outset it has been hit with technical glitches and arguments between the companies installing the systems.
The scheme has also been heavily criticised by leading doctors and privacy campaigners who warned patients' personal details would be vulnerable if stored on a database that could be easily accessed by thousands of NHS staff.
The report by the National Audit Office concludes that the £2.7 billion so far spent creating a database of medical records had not been “value for money”. It said it had no confidence that the £4.3 billion which will be invested over the next few years will be “any different.”
The project was meant to be completed last year but the report warned that it was unlikely to be finished even by 2016, when the contract with one of the main firms installing the system expires.
So far only a few hospitals across the country have installed the new system – and there have been widespread problems. Doctors have said it is too slow to use during busy clinics and other staff have reported the system suddenly crashing.
Ministers last night described the project as an “expensive farce” and demanded it was scrapped immediately. It is expected to cost £11.4 billion - £7 billion spent setting up the database of patient records and the remaining £4.4 billion incurred installing the system in hospitals and surgeries.
But its future is now uncertain. Only last week Prime Minister David Cameron said the Government was considering terminating the contract of one of the main companies CSC which is meant to be installing the system in the North, Midlands and East Anglia. And next week it will be reviewed by the Government's Major Projects' Authority, a new department set up earlier this year to ensure all Government schemes are value for money.
Health Minister Simon Burns said: 'In the North, the Midlands and the East only four per cent of hospital records systems have actually been installed. 'A decade on and £6.4 billion down, all Labour managed to deliver was a patchy IT system that experts now confirm has failed its core objectives. This has been an expensive farce from the beginning.
'Labour's box-ticking bureaucracy tied doctors and nurses up in red tape and stopped resources getting to where they were really needed. We are changing all that by putting doctors and nurses back in charge to deliver better care for patients.'
Richard Bacon Conservative MP who has followed the program since it was launched said: 'It is perfectly clear that throwing more money at the problem will not work. 'This turkey will never fly and it is time the Department of Health faced reality and channelled the remaining funds into something useful that will actually benefit patients. The largest civilian I.T. project in the world has failed.'
A Department of Health spokesperson said: 'Improving information technology is a fundamental part of delivering a modern, world-class health service. 'This report from the NAO highlights major concerns with the pace and scale of delivery of information systems under the National Programme for IT. 'We agree change is needed and that the original vision was flawed.' 18.5.11
'Corruption risk' of ex-ministers walking straight into top jobs warns damning report
Weak rules policing the way former ministers take up lucrative jobs in the private sector put Britain at ‘high risk of corruption', a damning report warned yesterday. The study criticises the cosy system that is supposed to monitor the so-called ‘revolving door' between government and big business.
It claims the rules – which have allowed a string of lucrative jobs for former ministers such as Tony Blair and Peter Mandelson to be simply rubberstamped – are so lax that they ‘undermine trust in government'.
In addition, it shows more than half of all leading civil servants now take up well-paid jobs in the private sector after leaving Whitehall.
The report, by the respected campaign group Transparency International, warns that only a lifetime ban on lobbying might be enough to ease public concerns about the way ministers and officials in ‘high risk' areas such as defence and health move seamlessly into top jobs.
Chandrashekhar Krishnan, of Transparency International, said: ‘The revolving door between government and business is spinning out of control.
‘There have been far too many cases of officials moving between the two in circumstances which suggest a serious conflict of interest. This has created an environment in which corruption risks are high. ‘We need a more robust system with greater transparency and tighter rules which can be properly enforced.'
The study highlights a string of cases where former ministers and civil servants have taken jobs in industries they were previously in charge of. 'Cabs for hire': Former transport secretary Stephen Byers, former health secretary Patricia Hewitt and former defence secretary Geoff Hoon were suspended from the Parliamentary Labour Party for 'bringing it into disrepute'.
It says there are real risks that a senior official or minister might favour a company ‘with a view to ingratiating himself or herself with that company and thus opening up a path to future employment'.
It also warns that former ministers might be able to benefit commercially from information gained in public office. The findings were welcomed last night by Labour MP Paul Flynn, a member of the Commons public administration committee. He said: ‘The system of policing the revolving door is a scandal that is potentially worse than the expenses scandal – and certainly more damaging to the country.'
Under the existing rules, ministers and top civil servants have to notify the Advisory Committee on Business Appointments (Acoba) of any new jobs taken up within two years of leaving office.
The committee, which comprises four knights, two peers and a dame, then advises on any restrictions that should apply – such as preventing former ministers from lobbying their departments for a set period. But it has never banned a minister from taking a job, and its recommendations are not binding.
Last year a string of former ministers were filmed by Channel 4's Dispatches apparently offering to work for a fictitious lobbying firm in return for cash.
Former transport secretary Stephen Byers, former health secretary Patricia Hewitt and former defence secretary Geoff Hoon were suspended from the Parliamentary Labour Party for ‘bringing it into disrepute'.
Mr Byers had boasted that he was like a ‘cab for hire'. A spokesman for Acoba said: ‘Some of the changes called for in this report are already in place.'
The former health secretary, took a job with private equity firm Bridgepoint Capital, whose subsidiary won a £16million NHS contract six months after he joined.
The former health secretary took several lucrative jobs with health firms after leaving office in 2007. The Labour MP landed a £45,000-a-year post with healthcare giant Boots, as well as a £55,000 job with Cinven, which bought 25 private hospitals.
The former Labour defence minister has faced criticism for joining the defence firm Thales, which is involved in the £1.5billion project to supply two new aircraft carriers. She is thought to have had frequent contact with Thales in office.
The former transport minister joined the traffic information firm ITIS Holdings seven months after leaving office in 2007. It emerged that a Department for Transport contract with the firm had been extended while he was in office.
SIR KEVIN TEBBIT
Former permanent secretary at the Ministry of Defence. Joined the board of Italian defence firm Finmeccania shortly after a £1.9billion deal with a subsidiary of the firm was signed. The deal was announced in March 2005 and Sir Kevin left the MoD in November that year. 17.5.11
How NHS patients are being used like guinea pigs as faulty implants put thousands of patients' lives at risk
Thousands of patients are being put at risk by faulty medical devices including hip replacements, breast implants and pacemakers, an investigation has found. Equipment which is routinely implanted during surgery has been linked to serious health complications and death.
Experts say many devices do not have to undergo strict safety checks before being used, so patients are ‘acting like guinea pigs'. In one case a metal hip replacement was inserted in hundreds of elderly patients even though the company knew it had caused infections and serious groin pain.
Several patients reported difficulty walking and when doctors investigated they found that the device, which replaces the hip joint surface, had destroyed some of their muscle tissue.
But the manufacturer did not take the device off the market until last year – three years after patients first reported problems. In another example a retired businessman had to be taken to hospital after his pacemaker mistakenly gave him 30 electric shocks in a day.
Chris Pitt, who is in his 60s and lives in Andover, Hampshire, had the device fitted following a long history of heart problems. But less than a year later it suddenly began giving him electric shocks as if to restart his heart – even though the organ was functioning normally.
Mr Pitt had the device removed and replaced with another pacemaker. He has recovered from the effect of the shocks but is not sure whether they have caused any long-term damage.
The investigation, by the British Medical Journal and Channel 4's Dispatches programme, also reveals that last year a breast implant that had been used on 40,000 women in the UK was recalled after it emerged it was prone to leaking, and had never undergone safety tests.
Experts say manufacturers are not properly monitoring the safety of their devices and are relying on patients to report any faults.
Dr Carl Heneghan, director of Oxford University's Centre for Evidence-based Medicine, said patients ‘were acting like guinea pigs'.
He added: ‘The true extent of medical device recalls in the UK is unknown. It is likely that hundreds if not thousands of patients each year are suffering and/or dying.' Dispatches: The Truth About Going Under The Knife. 16.5.11
That's rich - GPs threatened by vested interests
GPs must be involved equally with hospital doctors in debates on the Health and Social Care Bill, without “sniping from the sides or threats of destabilisation from many vested interests who are opposed to clinical leadership” urges Michael Dixon, chair of the NHS Alliance.
Dr Dixon told GPs that if clinical leadership is to succeed, clinical commissioning leads must be allowed to get on with the job without the interference of red tape or being “seen as puppets by their peers”.
He warned GP Commissioning Pathfinder leaders at a King's Fund/NHS Alliance conference yesterday: “GP Consortia and GP consortia leaders have got a serious job to do, which is not helped by sniping from the sides or threats of destabilisation of many vested interests who are opposed to clinical leadership, primary care or decentralisation.
“Everyone agrees that the NHS needs to change and improve; dumbing down GP commissioning and straitjacketing its leaders is not the way forward.”
He pointed out that unless the health reforms truly have clinical commissioning and leadership at their heart, they will fail in their aim to deliver better health for better value during one of the most severe financial crises in NHS history.
He warned: “Clinical commissioning leaders have been out to bat three times already – as locality commissioners/fundholders, leaders within primary care groups and practice based commissioners. Each time, clinical leadership has been strangled by the dead hand of centralism, bureaucracy and red tape. Don't let this happen again.”
Dr Dixon emphasised that clinical leaders are prepared to face the challenges ahead. “Contrary to some impressions given on high, clinical leaders know what they are doing.
“They know about governance processes and, throughout the country, consortia are making sure that they have good systems, which include primary care clinicians and specialists and which are truly ‘owned' by local people,” he said.
Critics said ‘GP's know all about vested interests as they have been told by their union the BMA to block any private treatment to safeguard NHS services even when they are worse'. 12.5.11
Hundreds of herbal remedies now outlawed across Europe
Live in Europe ? Get your herbs while they last. New rules put forth by the European Union (EU) will ban the sale of certain herbal remedies that have been used for centuries.
Traditional herbs such a St. John's Wort or Echinacea must now meet strict licensing guidelines in order to be sold, while other lesser-known herbs that haven't been "traditionally" used in the last 30 years won't even make the cut to reach consumer shelves. Only those products that have been "assessed" by the Medicine and Healthcare products Regulatory Agency (MHRA) will be available for purchase. The real kicker? Even approved products will only be recommended for minor ailments such as the common cold, which means that product labeling may no longer be allowed to convey the potent health benefits of widely-used herbal remedies.
According the the EU, the laws were put in place to protect consumers from the "damaging" effects of traditional herbal remedies. The subtext of that statement, of course, is that herbal remedies can sometimes have dangerous interactions when taken with prescription drugs .
Used alone, however, herbal supplements rarely pose a problem. With so many people taking prescription drugs, it's clear that the EU's move to ban herbal products is a monopolistic attack on the alternative health movement, strange then as pharmaceutical drug kill far more people than any herbal medication.
While they can't admit the dangerous and deadly side effects of manufactured drugs, they can shift the blame to herbs.
Richard Woodfield, MHRA head of herbal medicine policy, claims that the new regulations empower the consumer: "The current signs are that the [herbal remedy] market will be lively and competitive. The key difference for consumers is that in the future they will be in the driving seat and able to make an informed choice when they wish to use these medicine."
Banning widely-used natural substances that may help cure or prevent illness promotes "informed" choices?
Paul Gimson, director of the Royal Pharmaceutical Society in Wales , also claims that herbal remedies may not be safe because they have not been put through clinical trials in the same way drugs are tested. Isn't this a tad obvious, however, since drug companies would never even consider testing or promoting a natural herb as a medicinal cure? Clearly, herbal remedies are not widely used because doctors or health care professionals recommend them. They are used because people know they work.
The most disturbing part? These regulations point to a movement toward complete restriction of herbal products and the idea that pharmaceutical companies may someday have patents on herbal remedies. Consider a possible scenario: A woman who has been taking Chasteberry supplements to regulate a gynecological condition may now need a prescription for it. She goes to her doctor and, instead of giving her the herb, he recommends a drug . She can no longer buy Chasteberry supplements unless she scours the Internet in search of a reputable company that sells safe herbal products. As we all know, these companies can be hard to find.
Not only do these laws threaten the livelihood of nutritionists, herbalists and holistic healthcare providers across Europe, but they put consumers in a lose-lose situation: go without herbal remedies or run the risk of purchasing them online.
Vicky Perks, clinical nutritionist at The Health Diva and health food store, Beanfreaks, notes that the regulations are "poorly thought out" and are driven by money : "Licensing is just a way of generating extra money for the government. It costs €50,000 to license one product."
Herbal products still on shelves will be for sale until their expiration dates. Stock up while you can. Natural News 13.5.11
GPs cannot assess the benefits and side-effects of drugs - drug data ‘should be made publicly available'
GPs cannot choose the best drugs for their patients because medicines regulators are withholding unpublished drugs trial data, due to concerns over 'commercial confidentiality', claim researchers.
The Danish researchers – writing in the British Medical Journal this week – say drugs regulators are putting drug company profits ahead of the lives and welfare of patients, and argue that this could have and has had fatal consequences.
The academics argue for full access to published and unpublished reports so that the benefits and side-effects of drugs can be independently assessed by the scientific community.
'Drug agencies should get rid of the huge paper mountains and require electronic submissions from the drug companies, including the raw data, which should also be made publicly available,' say the authors of the BMJ article, Professor Peter Gøtzsche and Dr Anders Jørgensen.
'There is something fundamentally wrong with our priorities in healthcare if commercial success depends on withholding data that are important for rational decision making by doctors and patients.'
The researchers, from the Nordic Cochrane Centre in Denmark, claim they endured a three-year struggle to access unpublished trial reports for two anti-obesity drugs, but the EMA refused access to them, arguing it would undermine commercial interests and that there was no overriding public interest in disclosure.
They appealed to the European ombudsman, P Nikiforos Diamandouros, who criticised the EMA 's refusal to grant access. But it was only after the ombudsman accused EMA of 'maladministration' that they agreed to increase public access to documents, said the academics. They finally received their information in February. 13.5.11
1,600 NHS bosses earn more than PM: Big pay rises handed out as front-line staff face axe
At least 1,600 NHS chief executives and managers are paid more than the Prime Minister, according to figures published today. Average salaries for chief executives have soared by five per cent in the last year, nearly twice the pay rise given to nurses, a report says.
The increases have been handed out despite the fact that thousands of doctors, nurses and midwives' posts face the axe to save the NHS billions of pounds. The figures show the average pay for a hospital chief executive is now £158,800 a year, up from £150,000 last year. David Cameron earns £142,000.
At least 125 of the chief executives earn more than £150,000. At the top of the scale is Ron Kerr, who runs Guy's and St Thomas ' hospitals in London and earns £274,000 a year. In addition to the chief executives are hundreds of doctors who have taken on senior managerial roles.
Around 1,500 of these medical directors earn more than £150,000. Their average salary is £175,000. Their main role is to advise health trusts on medical issues and many cut back on seeing patients to concentrate on their managerial duties.
The report, by researchers Income Data Services, looked at figures for 195 chief executives and 2,141 medical directors from hospitals and ambulance trusts in England. It shows that chief executives from foundation trusts – the ‘elite' hospitals – typically earn £164,500, while those in the others earn £152,500.
Many medical directors are former consultants, who would have already been earning well in excess £100,000. Hospitals say they have to offer them lucrative packages to entice them into their new roles. The report shows trusts have flouted Government orders not to award pay rises of more than 1.5 per cent.
Over the last five years chief executives' salaries have risen by 27 per cent, up from around £125,000 in 2006, it says. NHS trusts are meant to be making combined savings of £20billion over the next four years and many are axing front-line posts and restricting treatments for patients.
Latest estimates show 40,000 posts could be at risk – half of them front-line workers including doctors, nurses and midwives. Commenting on the report, Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: ‘This is yet another example of some trust chief executives showing extremely poor judgment and leadership at a time when the NHS is facing huge financial challenges.
‘It also sends an extremely poor message to hard-working nurses and other health workers, many of whom are worried about their jobs.'
David Stout, deputy chief executive of the NHS Confederation, which represents Health Service bodies, said: ‘A large city hospital could have a budget of between £500million and £1billion and employ as many as 10,000 staff – comparable to many FTSE 250 companies. ‘Because of the challenging nature of a chief executive's role, NHS boards must consider a range of factors, including pay, to encourage the best candidates.' 11.5.11
Why the NHS needs competition
The NHS row is not about Andrew Lansley's future or even slowing down the reckless pace of the administrative restructuring he was planning. The battle lines are now drawn between monopoly NHS insiders and the champions of the consumer.
The monopolists want to suppress competition from alternative suppliers and hide behind their professed love of the NHS as their excuse. On the other side are critics who argue that the best way to encourage high standards and value for money is to promote pluralism so that the best ideas can emerge from comparison of one provider with another.
No doubt in every walk of life the insiders would like to be "preferred providers" with no irritating rivals compelling them to raise their game. But we all know as consumers that, unless we have alternatives, producer interests come to dominate.
GPs notoriously seized on Mr Blair's reforms of 2004 to advance their own narrow interests. In the first year of their new pay deal, called the Quality and Outcomes Framework, they increased their average pay by about 30 per cent. In many cases they stopped providing an out-of-hours service, when no doctor who truly cared about his patients would hand over the out-of-hours service to subcontractors who, in some cases, employed inexperienced locums and even foreign doctors with inadequate grasp of English.
In recent years some hospitals have been found guilty of extreme negligence. The Healthcare Commission's report in 2009 found complete failure at "virtually every stage" in the care of emergency admissions at Stafford Hospital . According to Sir Ian Kennedy, the commission's chairman, "There is no doubt that patients will have suffered and some of them will have died as a result."
The investigation found that there were "too few doctors and nurses, vital equipment was not available when needed, patients did not receive the care they deserved and the trust had no system in place to spot when things were going wrong." Some wards were filthy, with blood and excrement caked on surfaces; and some nurses were unable to operate cardiac monitors or intravenous drips, which meant patients were not receiving the correct amount of fluid.
When these events were occurring, a survey of NHS staff found that many would not want to be treated in their own hospital, suggesting that Stafford was not unique. The Healthcare Commission asked employees of all acute NHS trusts in 2006 if they agreed with this statement: "As a patient of this trust, I would be happy with the standard of care provided." Only 42 per cent agreed, 25 per cent disagreed and 32 per cent said they neither agreed nor disagreed. In "large acute" trusts only 34 per cent agreed. In 2007 staff in all acute trusts were asked whether, "Care of patients/service users is my trust's top priority.' Only 48 per cent agreed, 23 per cent disagreed and 28 per cent sat on the fence, neither agreeing nor disagreeing.
So far the main critics of the planned NHS reforms have been arguing that the scrapping of primary care trusts and their replacement by GP commissioners was moving at a reckless speed that might do more harm than good. The Government has wisely paused for reflection but now a new line of attack has emerged. The Royal College of General Practitioners is keen on plans to transfer power to GPs but is hostile to any increase in competition from the private sector. Of course, it claims that its doubts are driven by concern for patients but in truth it is defending old-fashioned monopoly.
If the Royal College gets its way we will be back to the era before Tony Blair declared war on the "forces of conservatism and reaction" in the public sector. Creating a Patient-Led NHS said in 2005: "At its worst, the NHS has a very hierarchical tradition with professional divides and bureaucratic systems and inflexible processes. These can get in the way of good patient care".
As a result there was a big push for "contestability" and patients were told that they were now consumers with choices that put them "in the driving seat". The NHS Improvement Plan of 2004 specifically denounced monopoly: There would be "contestability … so that patients and the public, rather than monopoly institutions, can make choices about where, when and how care is delivered." Giving people greater personal choice would give them "control … allowing patients to call the shots about the time and place of their care, and empowering them to personalise their care to ensure the quality and convenience that they want."
Since that time there has been a steady increase in the involvement of the private sector. Provision of diagnostic services has been vastly improved and the Independent Sector Treatment Centres have been a great success.
The Government was right to slow down the imposition of GP commissioners in place of primary care trusts (PCTs). At worst PCT employees would have faced a year or two of uncertainty while they re-applied for their old jobs under the new structures.
When the NHS needs to make substantial efficiency savings just to stand still, creating widespread job insecurity among the key workers made no sense. But the Government also planned to push ahead with a steady increase in private provision to raise standards and encourage better value for money through the trial and error of the marketplace. The case for competition is as strong as it was when Tony Blair urged a reluctant Labour party to embrace "contestability". On competition, the Government should stand its ground. 11.5.11
European Medicines Agency (EMA) accused of putting pharma profits before patients
Regulators are "protecting drug company profits rather than the lives and welfare of patients by withholding unpublished trial data", according to researchers in articles published by the BMJ.
They call for full access to full trial reports, both published and unpublished, "to allow the true benefits and harms of treatments to be independently assessed by the scientific community." Professor Peter Gotzsche and Dr Anders Jorgensen from the Nordic Cochrane Centre in Denmark write that despite the existence of hundreds of thousands of clinical trials, "doctors are unable to choose the best treatments because research results are being reported selectively".
They claim that selective reporting can have "disastrous consequences". For example, they say Merck & Co's now-withdrawn painkiller Vioxx (rofecoxib) has "probably caused about 100,000 unnecessary heart attacks in the USA alone, while anti-arrhythmic drugs have probably caused the premature death of about 50,000 Americans each year in the 1980s".
Three-year 'struggle' to get unpublished data
The authors go on to describe what they call a three-year struggle to access unpublished trial reports for two anti-obesity drugs, Sanofi-Aventis now-withdrawn Acomplia (rimonabant) and Roche's Xenical (orlistat), submitted by the manufacturers to the European Medicines Agency.
This information "was important for patients because anti-obesity pills are controversial,” they say, and "people have died from cardiac and pulmonary complications or have experienced psychiatric disturbances, including suicidal events, and most of the drugs have been de-registered for safety reasons".
However, Prof Gotzsche and Dr Jorgensen claim the EMA refused access, arguing that this would undermine "commercial interests and that there was no overriding public interest in disclosure". They also cited the "administrative burden involved and the worthlessness of the data after they had edited them". The authors appealed to the European ombudsman, who criticised the EMA 's refusal to grant access. But only after the ombudsman accused the agency of maladministration did the regulator agree to widen public access to documents.
“There is something fundamentally wrong with our priorities in healthcare if commercial success depends on withholding data that are important for rational decision making by doctors and patients,” say Prof Gotzsche and Dr Jorgensen. They call on other drug regulatory agencies to follow suit and suggest that access should be prompt and that documents should be provided in a useful format to allow for independent scrutiny.
“Drug agencies should get rid of the huge paper mountains and require electronic submissions from the drug companies, including the raw data, which should also be made publicly available,” they conclude.
In an accompanying editorial, researcher Andrew Vickers of the Memorial Sloan-Kettering Cancer Center, New York says "the system is broken and needs fixing". He describes a new initiative by the Wellcome Trust to tackle the problem by developing principles for funders with regard to data sharing, and suggests that the medical research community “get used to it.”
He argues that once medical researchers start publishing their data, and depositing it in data archives, "they will discover not only that it is painless, but that it affords huge advantages to medical science, and to patients present and future." The BMJ added that it believes "systematic efforts are needed to assess this largely unexamined threat to the integrity of evidence-based medicine". 11.5.11
Opening up data at the European Medicines Agency
Widespread selective reporting of research results means we don't know the true benefits and harms of prescribed drugs. Peter Gøtzsche and Anders Jørgensen describe their efforts to get access to unpublished trial reports from the European Medicines Agency
Doctors cannot choose the best treatments for their patients despite the existence of hundreds of thousands of randomised trials. The main reason is that research results are being reported selectively. Comparisons of published drug trials with unpublished data available at drug regulatory agencies have shown that the benefits of drugs have been much over-rated and the harms under-rated. Comparisons of trial protocols with published papers have also shown widespread selective reporting of favourable results.
Selective reporting can have disastrous consequences. Rofecoxib (Vioxx) has probably caused about 100 000 unnecessary heart attacks in the United States alone, and class 1 antiarrhythmic drugs probably caused the premature death of about 50 000 Americans each year in the 1980s. An early trial found nine deaths among patients taking the antiarrhythmic drug and only one among those taking placebo, but it was never published because the company abandoned the drug for commercial reasons.
Allowing researchers access to unpublished trial reports submitted to drug regulatory agencies is important for public health. Such reports are very detailed and provide more reliable data than published papers,but it has been virtually impossible to get access to them. We eventually succeeded in getting access to reports held by the European Medicines Agency ( EMA ) after three years of trying. Our case has set an important precedent, and we summarise here the process and the arguments.
Our application for access
On 29 June 2007 we applied for access to the clinical study reports and corresponding protocols for 15 placebo controlled trials of two anti-obesity drugs, rimonabant and orlistat. The manufacturers had submitted the reports to the EMA to obtain marketing approval in the European Union. We explained that we wanted to explore the robustness of the results by adjusting for the many missing data on weight loss and to study selective publication by comparing protocols and unpublished results with those in published reports.
The information was important for patients because anti-obesity pills are controversial. The effect on weight loss in the published trials is small, and the harms are substantial. People have died from cardiac and pulmonary complications or have experienced psychiatric disturbances, including suicidal events, and most of the drugs have been deregistered for safety reasons.
A basic principle in the European Union is to allow its citizens the widest possible access to the documents its agencies possess (box 1). But there are exemptions, and the EMA refuses access if disclosure would threaten commercial interests unless there is an over-riding public interest. We argued in our first letter to the EMA that secrecy was not in the best interests of the patients because biased reporting of drug trials is common. Furthermore, we hadn't found any information that could compromise commercial interests in 44 trial protocols of industry initiated trials we had reviewed previously.
Box 1 : Basic principles on citizens' access to EU documents
“Any citizen of the Union, and any natural or legal person residing or having its registered office in a Member State, has a right of access to documents of the institutions, subject to the principles, conditions and limits defined in this Regulation.”
“Openness enables citizens to participate more closely in the decision-making process and guarantees that the administration enjoys greater legitimacy and is more effective and more accountable to the citizen in a democratic system. Openness contributes to strengthening the principles of democracy and respect for fundamental rights as laid down in Article 6 of the EU Treaty and in the Charter of Fundamental Rights of the European Union.”
Without any comment on our arguments, the EMA replied that the documents could not be released because it would undermine commercial interests. We appealed to the EMA 's executive director, Thomas Lönngren, and asked him to explain why the EMA considered that the commercial interests of the drug industry should over-ride the welfare of patients. We argued that the EMA 's attitude increased the risk of patients dying because their doctors prescribed drugs for them without knowing what the true benefits and harms were. He sent us a similar letter to the EMA 's first letter, ignoring our request for clarification, and told us we could lodge a complaint with the European ombudsman, which we did.
Over the following three years the EMA put forward several arguments to avoid disclosing the documents: protection of commercial interests, no over-riding public interest, the administrative burden involved, or the worthlessness of the data to us after the EMA had redacted them ( box 2 ). It also did not respond to the ombudsman's letters before his rather generous deadlines had run out.
Box 2 : The path to the data
The delays on our part amounted to 130 days (11% of the time); we awaited replies for 1028 days.
29 Jun 2007 : We asked the EMA to provide access to the clinical study reports and their corresponding protocols on rimonabant and sibutramine
20 Aug 2007 : The EMA replied that the documents could not be released because they came under the exception of commercial interests
24 Aug 2007 : We explained that the EMA 's lack of transparency violated basic principles in the EU treaty and that it leads to suboptimal treatment of patients
17 Sept 2007 : With no comment on our arguments, the EMA referred again to commercial interests and noted we could institute court proceedings against the EMA or complain to the European ombudsman
8 Oct 2007 : We appealed to the ombudsman, noting that the published literature on drugs is flawed and arguing that protocols and study reports did not disclose anything that could undermine commercial interests
30 Jan 2008 : The EMA replied to two letters from the ombudsman, referred to protection of commercial interests and mentioned that it could not identify any over-riding public interest that could justify disclosure of the requested documents
26 Feb 2008 : We told the ombudsman that the EMA had failed to explain why commercial interests would be undermined
28 Apr 2008 : The EMA replied to the ombudsman that it needed to protect the data against unfair commercial use; that evaluating the balance between benefits and risks of medicines is the EMA 's job; and that redaction of personal data would cause disproportionate effort
17 Jun 2008 : In our reply to the ombudsman, we argued against this and noted that if commercial success depends on withholding data that are important for rational decision making by doctors and patients, there is something fundamentally wrong with our priorities in healthcare
22 Jan 2009 : The ombudsman proposes a friendly solution to the EMA and asks it to grant us access to the documents or provide a convincing explanation why such access cannot be granted
26 Feb 2009 : The EMA restates the commercial interests; claims that we have not given evidence of an over-riding public interest; and refers to the workload involved in redacting the documents
10 Mar 2009 : The ombudsman again proposes a friendly solution to the EMA and asks it to clarify its reasoning
7 Apr 2009 : The EMA repeats its previous arguments.
19 May 2009: We again counter the EMA 's arguments: the EMA has provided no evidence that the documents are commercially sensitive; many patients had been harmed by selective publication of trial data on COX 2 inhibitors; and redacting the documents should be quick and easy
31 Aug 2009 : We tell the ombudsman that we have received trial data from the Danish Medical Agency on a third anti-obesity drug, sibutramine
6 Oct 2009 : The ombudsman goes to the EMA to inspect the documents we had requested
19 May 2010: The ombudsman issues a draft recommendation that the EMA should grant us access to the documents or provide a convincing explanation as to why not
7 Jun 2010 : In a press release the ombudsman accuses the EMA of maladministration because of its refusal to grant access
31 Aug 2010 : The EMA informs the ombudsman that it will provide access
1 Feb 2011 : We receive the data
Protection of commercial interests
Protection of commercial interests was the EMA 's over-riding argument. It would undermine the protection of commercial interests to allow us access, it said, as the documents represented the full details of the clinical development programme and the most substantial part of the applicant's investment. Competitors could use them as a basis for developing the same or a similar drug and gather valuable information on the long term clinical development strategy of the company to their own economic advantage.
We explained that the clinical study reports and protocols are based on well known principles that can be applied to any drug trial; that the clinical study reports describe the clinical effects of drugs; and that nothing in the EMA 's guidelines for preparation of such reports indicates that any information included in them can be considered a trade secret. The trial protocols are always sent to the clinical investigators, and it is unlikely that companies would have left in any information that could be of commercial value (such as a description of the drug synthesis).
We also noted that the clinical study reports and trial protocols represent the last phase of drug development, which has been preceded by many years of preclinical development. Other companies could hardly use them as a basis for developing similar drugs. In fact, unpublished trial data are generally less positive than published ones, and competitors would therefore be less likely to start drug development if they had access to the unpublished results. Other companies are more likely to be interested in in vitro, animal, and early human studies, and drug companies have no problems with publishing such studies because the results may attract investors.
The European ombudsman, P Nikiforos Diamandouros, considered that commercial interests might be at stake but noted that the risk of an interest being undermined must be reasonably foreseeable and not purely hypothetical. He could not see that access would “specifically and actually” undermine commercial interests. He inspected the relevant reports and protocols at the EMA and concluded that the documents did not contain commercially confidential information. He therefore criticised the EMA 's refusal to grant us access.
Over-riding public interest in disclosure
Even if commercial interests were undermined by disclosure, access would still have to be granted if there was an over-riding public interest. The EMA argued that it could not identify any over-riding public interest and remarked that the evaluation of safety and efficacy of drugs is its responsibility—the EMA constantly monitors drugs and updates its assessment reports and requires changes in product information as appropriate.
We considered this insufficient. Monitoring adverse effects reported by doctors to drug agencies would not have revealed that rofecoxib causes heart attacks. Few such events are reported, and heart attacks are common in people with arthritis. Postmarketing passive surveillance systems can therefore usually not detect whether a drug leads to more heart attacks than expected; randomised trials are needed for this.
We provided more evidence of the detrimental effects of selective publication but to no avail. The EMA continued to claim that we had not documented the existence of an over-riding public interest. We noted that we could not prove this in this specific case because we were denied access to the data, but we drew attention to the fact that the total number of patients in the main clinical studies of orlistat differed according to the source of the information: published reports, the EMA 's website, and the website of the US Food and Drug Administration.
The ombudsman indicated that we had established an over-riding public interest, but he did not take a definitive stance on whether an over-riding public interest existed because this question needed answering only if disclosure undermined commercial interests. He asked the EMA to justify its position that there wasn't an over-riding public interest, but the EMA avoided replying by saying that we had not given evidence of the existence of such an interest. We believe that we had. Furthermore, the EMA 's argument was irrelevant. A suspect asked for his alibi on the day of the crime doesn't get off the hook by asking for someone else's alibi.
According to the EMA , the redaction of (unspecified) “personal data” would cause the EMA a disproportionate effort that would divert attention from its core business, as it would mean redacting 300 000-400 000 pages. This was surprising. The Danish Drug Agency had not seen the workload as a problem when it granted us access to the reports for the anti-obesity drug sibutramine, which was locally approved in Denmark . The 56 study reports we received comprised 14 309 pages in total, and we requested only 15 study reports from the EMA (the pivotal studies described in the European Public Assessment Reports (EPARs) on rimonabant and orlistat). The ombudsman declared that the EMA had overestimated the administrative burden involved.
Worthlessness of data after redaction
The EMA argued that, “as a result of the redaction exercise, the documents will be deprived of all the relevant information and the remaining parts of them will be worthless for the interest of the complainant.”
From what we know of clinical trial reports and protocols it struck us as odd that they would contain so much personal data that the documents became worthless. The ombudsman noted that the requested documents do not identify patients by name but by their identification and test centre numbers, and he concluded that the only personal data are those identifying the study authors and principal investigators and to redact this information would be quick and easy.
The EMA also remarked that a possible future release of the assessment reports of the EMA 's Committee for Medicinal Products for Human Use and the (co)rapporteur assessment reports “could satisfy the request of the complainants.” These reports were not available and they would have been worthless to us because they are merely summaries used for regulatory decisions.
The EMA was completely resistant to our arguments and those from the ombudsman. However, after the ombudsman accused the EMA of maladministration in a press release on 7 June 2010 , three years after our request, the EMA reversed its stance. The EMA now gave the impression that it had favoured disclosure all the time, agreed with the ombudsman's reasoning, and noted that the same principles would be applied for future requests for access but that it would consider the need to redact part of the documents.
The EMA 's last letter was unclear: “The Agency will do its utmost to implement its decision as quickly as possible, in any case within the next 3 months at the latest. The Agency will keep the European Ombudsman promptly informed of the exact implementation date.”
It was not clear whether the three months was the deadline for sending the reports to us, for implementing its new policy, or both. We received the data we requested from the EMA on 1 February 2011 , which in some cases included individual patient data in anonymised format, identified by individual and test centre numbers.
According to the EMA 's responses to the ombudsman, the EMA put protecting the profits of the drug companies ahead of protecting the lives and welfare of patients. Moreover the EMA 's position is inconsistent because it resisted requests to give access to trial data on adult patients while providing access to data on paediatric trials, in accordance with EU legislation.
The Declaration of Helsinki gives authors the duty to make publicly available the results of their research on humans. The declaration also says that, “Medical research involving human subjects must . . . be based on a thorough knowledge of the scientific literature.” If the knowledge base is incomplete, patients may suffer and cannot give fully informed consent and research resources are wasted. The EMA should be promoting access to full information that will aid rational decision making, not impede it.
Our case sets an important precedent. On 30 November 2010 the EMA declared it would widen public access to documents, including trial reports and protocols. We recommend that the FDA and other drug regulatory agencies should follow suit. Access should be prompt—for example, within three months of the regulator's decision—and documents should be provided in a useful format. Drug agencies should get rid of the huge paper mountains and require electronic submissions from the drug companies, including the raw data, which should also be made publicly available. 11.5.11
Who's saving the NHS from who?
As you listen to Liberal Democrats declare that they are riding to the rescue of the NHS I can't help recalling a story I heard a while ago. It relates to Nick Clegg's reaction to attending a service at Westminster Abbey to celebrate the 60th anniversary of the NHS.
As well as prayers and blessings the service on 2 July 2008 included a speech by Prime Minister Gordon Brown and the reverential playing of a sound recording of a speech by the founder of the NHS, Labour's Aneurin Bevan. Clegg complained to friends that only in Britain would they turn an organisational structure into a cause for a religious service.
But any constituency MP in Britain is also acutely aware of the weaknesses and failings of the NHS - huge numbers of people waiting unacceptably long for operations and diagnostic tests; bed shortages; cancelled operations; over-stretched staff; the collapse of NHS dentistry; buildings that often date back to before the Second World War; micro-management from Whitehall; poor standards of customer care and frequent problems with standards of cleanliness in hospitals
The NHS is a system that fails to allow for the disciplines of choice, diversity and competition which can help to ratchet up standards. Most of my elderly constituents, given appointments for vital diagnostic tests and consultations which may be months or years in the future, have no alternative to the NHS if they need faster treatment. The only option for the wealthier minority is to buy treatment in the private sector - which usually means seeing privately in a week the same consultant who could not be seen for six months or a year on the NHS.
Clegg, you see, is rather more radical than some have recognised. In part, that's because of his strong European roots - he was brought up by a Dutch mother, worked in Brussels for the European Commission and then became an MEP. British affection for the NHS stems partly from memories passed down the generations of what health care was like before it was created and in large part from a comparison with American healthcare. From a European perspective the NHS doesn't look that special. After all you're not asked for your credit card before going to hospital in France or Holland.
No wonder then that Clegg signed up to the Orange Book - published in September 2004 - which proposed that the UK should adopt a Euro style health insurance model. His ally David Laws - who'll be back in the spotlight this week - wrote the chapter which observed that:
"The NHS is a system that fails to allow for the disciplines of choice, diversity and competition which can help to ratchet up standards"
The current NHS proposals were drawn up not just by the Tory Andrew Lansley but by his Lib Dem Deputy Paul Burstow. They were reviewed and approved not just by the Conservative Oliver Letwin but by Clegg's soulmate Danny Alexander. The foreword to them was signed not just by David Cameron but by Nick Clegg too.
So they are, to coin a phrase, all in it together when it comes to the NHS.
Both Cameron and Clegg realised too late the political danger of the reforms they'd agreed to. Both are now trying to reassure voters that they are not planning to privatise the NHS and to assuage the anger of hospital consultants and nurses who fear that GPs will not fund them as generously as politicians who, down the years, have found campaigns to keep hospitals open hard to resist. Both know NHS reforms that go wrong could destroy their personal as well as political reputations.
The battle is on for the credit for changes which - in broad outline if not all detail - have, I'm told, been agreed. After staging 100 meetings in which 10,000 NHS staff have been engaged I am told by a Tory source that it is a statement of the obvious that "no bill is better than a bad bill" but that "everyone expects to improve and not dump" the NHS plan.
Lest anyone read this blog as me suggesting that the Lib Dems are a threat to the NHS or that both Coalition partners are equally a threat let me be clear. I am not. Indeed, choice, diversity and competition are words that were used by previous Labour Health Secretaries who allowed private companies to provide not just cleaning or pharmaceutical but clinical services.
Ever since the NHS became a national religion politicians have competed to say that they love it more or can be trusted to save it. However, for more than two decades - ever since Margaret Thatcher decided to keep the health service and not to dismantle it - debate has been about how much choice, diversity and competition it is possible and desirable to have within the NHS. 7.5.11
Public sector staff 'are 43% better off' than private workers - and the pay gap is widening
Earnings boosted by premium salaries and gold-plated pensions
Public sector workers are 43 per cent better off per year than people with private sector jobs, a report shows. On pay alone, they are more than 20 per cent better off per year than their private sector equivalents in Scotland, the North East, the North West and Wales – and the gap is widening.
But in the South East, public wages are only four per cent higher than those of private sector workers, according to centre-right think-tank Policy Exchange. The report found the gap between the sectors' pay rose throughout last year, despite unions' complaints that state workers were hard done by.
The findings are even more stark when hourly pay rates are compared. The public sector ‘premium' - the additional pay a public sector worker receives – is up to 35 per cent when calculated on hourly pay, the report shows. Nationwide, the average hourly premium is 24 per cent.
When gold-plated public sector pensions are taken into account, those on the state payroll are 43 per cent better off.
Even when factors such as the differences in age, experience and qualifications are considered, the hourly pay premium for a public sector worker was 8.8 per cent in December. This almost doubled from 4.3 per cent two years earlier.
And the gap was growing despite widespread pay restraint in the public sector. Ministers have put in place a two-year pay freeze on public sector incomes – sparking claims by unions that state workers are being unfairly punished. But the report shows that it is the private sector staff and firms that have borne the brunt of the recession.
Pay shrank for the bottom 30 per cent of private sector workers last year. Crucially, the researchers found: ‘Even if the public sector pay freeze were extended beyond April 2013, the public sector pay premium would not be eliminated until 2016. ‘Including the superior value of public sector pensions, it would not disappear until 2018.'
Only the highest paid workers in the private sector – those earning at least £47,000 – continue to be paid more than their public sector counterparts, but even there the gap is shrinking.
The report said: ‘Public sector workers are paid more than private sector workers whether measured annually, by typical wage or raw average. 'For all these measures, the gap between public and private increased between 2009 and 2010.'
Policy Exchange director Neil O'Brien said: ‘It is unreasonable and unfair to expect private sector workers to make all the sacrifices. ‘We need a much better-balanced system of public pay, with organisations like the NHS and schools given greater freedom to vary pay so they can attract staff but also get value for the taxpayer.'
TUC general secretary Brendan Barber accused the think tank of ‘stirring up divisions', saying: ‘The truth is that both [sectors] are having a terrible time. ‘Public sector workers are facing a pay freeze, job losses and have seen the value of their pensions cut by 25 per cent. ‘In the private sector, pay freezes are still common, and public spending cuts are doing just as much damage as they are in the public sector.' 9.5.11
More Conflicting Medical Advice as Low-Salt Diet Ineffective, Study Finds. Disagreement Abounds.
A new study found that low-salt diets increase the risk of death from heart attacks and strokes and do not prevent high blood pressure, but the research's limitations mean the debate over the effects of salt in the diet is far from over.
In fact, officials at the Centers for Disease Control and Prevention felt so strongly that the study was flawed because of how the data was manipulated as in ALL studies that they criticized it in an interview, something they normally do not do.
ALL studies manipulate their data to support the findings they want, Dr. Peter Briss, a medical director at the centers, said that the study was small; that its subjects were relatively young, with an average age of 40 at the start; and that with few cardiovascular events, it was hard to draw conclusions. And the study, Dr. Briss and others say, flies in the face of a body of evidence indicating that higher sodium consumption can increase the risk of cardiovascular disease.
“At the moment, this study might need to be taken with a grain of salt,” he said.
The study is published in the May 4 issue of The Journal of the American Medical Association. It involved only those without high blood pressure at the start, was observational, considered at best suggestive and not conclusive. It included 3,681 middle-aged Europeans who did not have high blood pressure or cardiovascular disease and followed them for an average of 7.9 years. It was a clear example of 'loading' the study with certain demographics which would produce more favourable data, something the pharmaceutical industry do all the time, its the 'norm' said one expert.
The researchers assessed the participants' sodium consumption at the study's start and at its conclusion by measuring the amount of sodium excreted in urine over a 24-hour period. All the sodium that is consumed is excreted in urine within a day, so this method is the most precise way to determine sodium consumption.
The investigators found that the less salt people ate, the more likely they were to die of heart disease — 50 people in the lowest third of salt consumption (2.5 grams of sodium per day) died during the study as compared with 24 in the medium group (3.9 grams of sodium per day) and 10 in the highest salt consumption group (6.0 grams of sodium per day). And while those eating the most salt had, on average, a slight increase in systolic blood pressure — a 1.71-millimeter increase in pressure for each 2.5-gram increase in sodium per day — they were no more likely to develop hypertension.
“If the goal is to prevent hypertension” with lower sodium consumption, said the lead author, Dr. Jan A. Staessen, a professor of medicine at the University of Leuven, in Belgium, “this study shows it does not work.”
But among the study's other problems, Dr. Briss said, its subjects who seemed to consume the smallest amount of sodium also provided less urine than those consuming more, an indication that they might not have collected all of their urine in an 24-hour period.
Dr. Frank Sacks of the Harvard School of Public Health agreed and also said the study was flawed. “It's a problematic study,” Dr. Sacks said. “We shouldn't be guiding any kind of public health decisions on it.”
Dr. Michael Alderman, a blood pressure researcher at Albert Einstein College of Medicine and editor of the American Journal of Hypertension, said medical literature on salt and health effects was inconsistent. But, Dr. Alderman said, the new study is not the only one to find adverse effects of low-sodium diets. His own study, with people who had high blood pressure, found that those who ate the least salt were most likely to die.
Another problem in all studies is 'vested interests' with doctors working for certain industries to
a positive result, Dr. Alderman said that he once was an unpaid consultant for the Salt Institute but that he now did no consulting for it or for the food industry and did not receive any support or take any money from industry groups.
Lowering salt consumption, Dr. Alderman said, has consequences beyond blood pressure. It also, for example, increases insulin resistance, which can increase the risk of heart disease. “Diet is a complicated business,” he said. “There are going to be unintended consequences.”
One problem with the salt debates, Dr. Alderman said, is that all the studies are inadequate. Either they are short-term intervention studies in which people are given huge amounts of salt and then deprived of salt to see effects on blood pressure or they are studies, like this one, that observe populations and ask if those who happen to consume less salt are healthier.
“Observational studies tell you what people will experience if they select a diet,” Dr. Alderman said. “They do not tell you what will happen if you change peoples' sodium intake.”
What is needed, Dr. Alderman said, is a large study in which people are randomly assigned to follow a low-sodium diet or not and followed for years to see if eating less salt improves health and reduces the death rate from cardiovascular disease.
But that study, others say, will never happen.
“This is one of those really interesting situations,” said Dr. Lawrence Appel, a professor of medicine, epidemiology and international health at Johns Hopkins Medical Institutions. “You can say, ‘O.K., let's dismiss the observational studies because they have all these problems.' ” But, he said, despite the virtues of a randomized controlled clinical trial, such a study “will never ever be done.” It would be impossible to keep people on a low-sodium diet for years with so much sodium added to prepared foods.
Dr. Briss adds that it would not be prudent to defer public health actions while researchers wait for results of a clinical trial that might not even be feasible.
Dr. Alderman disagrees. “The low-salt advocates suggest that all 300 million Americans be subjected to a low-salt diet. But if they can't get people on a low-salt diet for a clinical trial, what are they talking about?” He added: “It will cost money, but that's why we do science. It will also cost money to change the composition of food.”
Critics said this study 'illustrates all the flaws in making up medical data to fir the purpose. All trials and studies are compromised from placebo fraud to vested interested to manipulating the data, what is does show is that the scientific community and medical profession cannot be trusted' 7.5.11
Breast cancer prevention drug 'only works in less than half of high risk women'
Only half of women at high risk of breast cancer appear to benefit from taking a hormone therapy called tamoxifen as a preventative medicine, a study suggests. In March Prof Jack Cuzick, a Cancer Research UK epidemiologist at Queen Mary University of London, said that up to 10 per cent of all women could benefit from taking drugs before they even start to develop the first signs of breast cancer.
The idea is to mirror the approach used in managing heart disease, where high risk individuals are prescribed statins both have been criticised for just selling more drugs and seeking to medicate people for no medical purpose.
Certain groups of women are known to be at much higher risk of developing breast cancer, including those with a family history of disease and those with high density breast tissue.
A previous analysis of a trial called IBIS1 found that high risk women who took tamoxifen were a third less likely to develop breast cancer than those who took a placebo, although no one knows the contents of the placebo pill which are often designed to make the drug group appear more successful.
Tamoxifen interferes with the hormone oestrogen, which helps trigger the most common form of the disease, called oestrogen receptor positive (ER) breast cancer.
However, a new analysis of the same data, published in the Journal of the National Cancer Institute , has found that tamoxifen only appears to work in half of those given it, which is the problem with medical data it is manipulated to support whatever facts the drug companies want.
In the study of almost 1,000 high risk women, half were given tamoxifen and half a placebo.
In those given tamoxifen, 46 per cent saw their breast density drop by 10 per cent of more over a 12 to 18 month period, while 54 per cent did not. The 46 per cent group were two-thirds less likely to develop breast cancer than the placebo group.
Breast density appears to be a key indicator of the likelihood of developing tumours.
But the 54 per cent of those given tamoxifen whose breast density fell by less than 10 per cent did not see their chances of developing cancer reduced.
Prof Cuzick said this did not mean tamoxifen should be written off as a preventative drug, but that if women showed no reduction in tissue density after 12 to 18 months they should be switched to something else rather than "hoping for the best".
The finding applied both to using tamoxifen as a treatment for breast cancer and as a preventative medicine, he said. Tamoxifen is currently licensed to be used to treat breast cancer in the UK, but not as a preventative medicine. The National Institute for Health and Clinical Excellence is due to discuss widening its use later this year. 6.5.11
Prescribe statins to ALL over-55s, declares professor
Everyone over 55 should be offered statins to cut their risk of heart attacks and strokes, no matter how high their cholesterol or blood pressure readings, a leading doctor said last night.
Professor Sir Nicholas Wald said prescribing cholesterol-busting statins and blood pressure pills based on age alone would be much easier and quicker than the current system. This takes into account a range of factors and requires GPs to carry out various tests.
Patients would not be taking the drugs needlessly because almost everyone of a certain age could benefit from having lower blood pressure or cholesterol, no matter what level it is to begin with, Sir Nicholas said.
However, concerns about the side-effects of the drugs mean that the proposal would be controversial. It is also unclear whether people would be willing to take tablets when they have not had an examination to show there is anything wrong with them.
Critics said the idea was ‘ridiculous, statins have very serious side effects including muscle pain and damage, gastro-intestinal problems, headaches, joint pains and peripheral neuropathy (nerve damage and loss of feeling in the hands and feet) memory loss, depression, sleep disturbance, sexual dysfunction and a rare lung disease to name but a few'.
And according to a study published in the British Medical Journal in 2010, for every heart attack allegedly prevented by statins, two people suffer liver damage, kidney failure, cataracts or extreme muscle weakness from taking the drug. And statistically, less than three percent of people experience any benefit at all from taking statins.
Currently, everyone over 40 is entitled to undergo a battery of tests and questions designed to work out their odds of suffering a heart attack or stroke. Age, sex, blood pressure and cholesterol readings are factored in, as are diabetes and whether a person smokes.
Those judged to have a 20 per cent risk of a heart attack or stroke in the next ten years are advised to take drugs such as cholesterol-lowering statins rather than changing their diet or increasing their exercise regime which would be much more beneficial.
But calculations by Sir Nicholas, of Barts and The London Medical School, show that age is by far the most important factor. He worked out that using the age of 55 alone as the trigger for prescribing statins and blood pressure pills would be 84 per cent accurate at spotting those at risk of heart problems.
This is just as good a rate as with the current technique, meaning as many lives would be saved, the journal PLoS ONE reports. Using age alone would lead to slightly more people taking the pills unnecessarily, but the figure would be small, and outweighed by the benefits of streamlining the process.
Sir Nicholas said: ‘This study shows that age screening for future cardiovascular disease is simpler than current assessments, with a similar screening performance and cost effectiveness. ‘It also avoids the need for blood tests and medical examinations. ‘Prevention is better than measurement. Identifying people at high risk of cardiovascular disease needs to be greatly simplified, enabling people to obtain easy access to preventive treatment.'
However, many of those prescribed tablets for high blood pressure don't take them because they don't feel ill enough, while persuading healthy people to take a pill for life could prove even trickier. Others may stop taking their tablets because of side effects, some of which can be serious.
There are also worries that over-reliance on pills would lead to people neglecting other aspects of their health, such as diet and exercise.
Addressing the concerns, Sir Nicholas said the benefits would easily outweigh the risks. But he cautioned that the policy would not be a panacea and that other health drives, including anti-obesity initiatives, would have to continue in parallel.
The British Heart Foundation said the approach would not help those under 55. Natasha Stewart, a senior cardiac nurse at the charity, said: ‘Vitally it would miss younger people in higher risk groups such as those with a family history of heart disease, people of South Asian origin and people with diabetes. ‘Because this model is cheaper it may be useful for a widespread screening programme. But it's essential that we continue full risk assessments for younger people who may be at significant risk of getting heart and circulatory disease.'
Malcolm Kendrick – GP and author of The Great Cholesterol Con says, 'these drugs not only cause terrible side effects such as muscle problems, hair loss, depression and impotence, they will actually have no impact on whether you succumb to heart disease'. This example is typical of most drugs, the side effects are far worse than the condition they are meant to be helping.
Critics also questioned 'conflicting medical advice from unreliable trials', in 2 years time they could be telling you not to take statins because of the side-effects' said one expert. 5.5.11
Big Pharma lies about statin drugs finally exposed in British Medical Journal
To hear Big Pharma tell it, statin drugs are "miracle" medicines that have prevented millions of heart attacks and strokes. But a recent study published in the British Medical Journal tells a completely different story: For every heart attack prevented by the drug, two or more people suffered liver damage, kidney failure, cataracts or extreme muscle weakness as a result of taking the drug.
Statin drugs, in other words, harm far more people than they help.
Julia Hippisley-Cox and Carol Coupland led the study which examined data from over two million patients, including over 225,000 patients who were new statin drug users.
They found that for every 10,000 women being treated with statins, there were only 271 fewer cases of heart disease.
And yet, at the same time, the statin drugs caused 74 cases of liver damage, 23 cases of acute kidney failure, 39 cases of extreme muscle weakness and 307 cases of cataracts.
Statin drugs, in other words, helped 271 people but harmed 443 people. This demonstrates how they are wreaking havoc with the health of those who take them, causing damage that far outweighs any benefit they might offer.
Big Pharma's highly deceptive advertising implies that statin drugs help everyone who takes them . So if 10,000 people took the drugs, we're promised, heart attacks would be prevented in all 10,000 people. That's the implied message in the drug ads, anyway.
But this is just a wild exaggeration and distortion of the facts. Most drugs don't work on most people, and statin drugs only "work" on about 2.7% of those who take them. Yet they cause serious damage in about 4.4% of those who take them.
So if you take statin drugs, your odds of benefiting from them is less than 3 out of 100. But your odds of being harmed by them are more than 4 out of 100. For 96 out of 100 people, statin drugs do nothing except make the drug companies rich.
Keep the pharma profits rolling
From the point of view of Big Pharma, they have the added benefit of causing other diseases that often result in yet more drugs or medical procedures being prescribed. Kidney dialysis makes big money for hospitals, by the way. It's a multi-billion-dollar business all by itself. Statin drugs are therefore a way for the sick-care industry to recruit new patients into kidney dialysis, knowing that some percentage of statin drug users are going to end up with full-blown kidney failure.
What's really interesting about all this is how easy it is to fool doctors into prescribing statin drugs. Doctors mistakenly think these are miracle drugs, but they're never read the research. They've been convinced by drug reps, misleading medical journal articles and Big Pharma advertising -- and they bought it!
Mainstream doctors, you see, are perhaps the most gullible people on the planet. They'll gladly prescribe a drug that harms more people than it helps -- by the millions -- because they can be almost effortlessly swayed into pushing poison pills through " science babble" language used by drug companies to promote their pills.
Doctors are literally walking around today thinking statin drugs are such miracle lifesavers that some doctors openly talked about dripping the drug into the public water supply! That's how convinced they are about the drug's benefits. They think everyone should be taking statins whether they need them or not!
It's downright loony. But that's characteristic of western medicine, isn't it? Proclaim your poison to be "miracle medicine" while utterly ignoring the truth that those drugs harm far more people than they help (and they simply don't work on more than 90% of people who take them).
The statin scam
Statin drugs are a scam, plain and simple, and the doctors who prescribe them are puppets used by Big Pharma to sell high-profit drugs to people who for the most part won't even benefit from them. That this research exposing the truth about statin drugs even appeared in the British Medical Journal is a minor miracle all by itself, by the way. But it does indicate that the wall of lies constructed about statins by Big Pharma is starting to crack.
If the truth about statins were openly known, the drugs wouldn't be prescribed to anyone, and drug companies would be sued for billions of dollars for their false advertising and marketing manipulations.
Until that happens, just remember this: Any doctor who recommends a statin drug is a con man drug pusher. If they don't have the honesty to research the truth about these drugs and stop prescribing them, they certainly cannot be trusted with your health. If they're pushing statin drugs on you, they're really just working for Big Pharma, not for you, and they're not interested in real science and the real impacts of drugs on patients.
It brings up another hugely important question in modern medicine: Why don't doctors have the capability to question the false beliefs of their own industry? As you might have guessed, that's the topic of another story altogether. Natural News 14.6.10
FDA approved Big Pharma drugs without effectiveness data
Consumers constantly are told how complicated it is to get a new drug on the market. After all, researchers have to jump through all sorts of hoops to assure safety before new therapies are approved for the public, right?
It turns out they may be missing some of those hoops or not jumping through some of the most important ones.
In fact, huge red flags are being raised about how drugs are tested and approved in two new studies, including one just published in the May 4th issue of the Journal of the American Medical Association.
A case in point: it turns out that only about half of the new prescription medications pushed onto the market over the last decade had the proper data together for the U.S. Food and Drug Administration - yet the FDA approved them anyhow.
The information in question is known specifically as comparative effectiveness data . And it is - or should be - a very big deal when it comes to deciding whether a drug should be approved and sold to the public.
According to the Institute of Medicine, comparative effectiveness data is defined as the "generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care."
In other words, how does a new drug stack up against other treatments - is it more beneficial, safer, or does it have more potential dangers?
Comparative effectiveness information on drugs is especially important when doctors are making decisions about whether to prescribe a med, and to whom, soon after a drug is approved. That's because when Big Pharma medications first hit the market, physicians are relying on what drug companies and the FDA tell them about a medication. It takes a while for real life reports to come in as people report reactions, side effects (including deaths related to a drug) to become clearer.
Also, there are usually not data from large head-to-head trials comparing multiple treatments available when a medication first hits the marketplace. "Comparative effectiveness is taking on an increasingly important role in U.S. health care, yet little is known about the availability of comparative efficacy data for drugs at the time of their approval in the United States," according to background information in the new JAMA study.
It's not like there's not money to come up with this information, either. In 2009, Congress allocated $1.1 billion of taxpayers' money to comparative effectiveness research.
For the JAMA study, researcher Nikolas H. Goldberg and colleagues from Brigham and Women's Hospital and Harvard Medical School, Boston, investigated the proportion of recently approved drugs that had comparative efficacy data available at the time they were authorized by the FDA to be sold in the U.S. They also examined the availability of this information over time and by therapeutic indication by checking out approval packages publicly available through the online database of drug products (dubbed new molecular entities, NMEs, for short) approved by FDA between 2000 and 2010.
The researchers found that only about half of 197 eligible approved NMEs between 2000 and 2010 had comparative efficacy data available at the time they were approved to be marketed.
Meanwhile, another recent study throws needed light on the limited data behind the safety and effectiveness of some Big Pharma drugs.
Research led jointly by Alexander Tsai of Harvard University and Nicholas Rosenlicht of the University of California San Francisco just published in PLoS Medicine zeroed in on the medication aripiprazole, which is prescribed treating bipolar disorder.
How was this powerful drug deemed safe and effective? Amazingly, the research team found the only evidence for the use of this medication came from a single trial. And, as they described in their paper, the scientists found key limitations of the drug study that clearly skewed the findings so they appear to support the use of aripiprazole for bipolar disorder.
Did this stop the FDA from approving the drug? No way. And neither did the fact that this single, poorly designed trial was sponsored by the drug manufacturer who produces aripiprazole. Natural News 4.5.11
No longer an illness or disease - Depression could be good for you - sometimes it leaves you more resilient and creative
Eleven years ago, Helen McNallen suffered an episode of depression so severe she attempted to take her own life. So it may seem extraordinary that the 43-year-old former city trader now devotes most of her time to running a website she has started up called www.depressioncanbefun.com.
Despite the somewhat flippant name — designed to reduce stigma around the subject — it has the serious purpose of trying to help others cope in similar circumstances. She set it up because she is convinced that her mental health crisis, which was triggered by the pressures of her job, has, in the long-run, transformed her life for the better.
‘I'm glad I had depression,' says Helen, from Sheffield in South Yorkshire. ‘At one time, I thought I would be working in the City of London for the rest of my days, even though it was incredibly stressful and I was very unhappy. ‘Now, I feel very lucky to be able to spend my time helping other people. It was a turning point in my life.'
Depression has become something of a modern-day epidemic.
One in four people in the UK suffers with it at some point in their lives and GPs now issue record numbers of prescriptions for anti-depressants — more than 30 million a year. Economists say it costs Britain around £17 billion in sick leave and lost productivity.
Causes range from having a family history of the problem or suffering a major trauma, to chronic stress and money worries.
But now some experts are arguing that these negative effects of Britain's depression ‘crisis' hide the fact that, for some people like Helen, it can be a positive life-changing experience that leaves them tougher, more resilient and more creative.
Some even argue that depression may not be a disease or illness at all, but an evolutionary survival mechanism that helps us cope with life's crises by forcing us to reassess our priorities. ‘Nobody would choose to have depression because it can be a really unpleasant experience,' says Dr Paul Keedwell, a psychologist and psychiatrist based at Cardiff University. ‘But you have to wonder why it is such a common condition and why it has not been bred out through evolution. Perhaps it's because we need something that makes us put the brakes on every now and then and reassess our goals and strategies.
‘We need to meet our own needs in order to thrive and be loved and be part of a social group. Sometimes we can learn to do that through the pain of depression.'
This controversial idea, that depression might do some of us good in the long run, is backed up by a recent study carried out in the Netherlands.
It analysed the effects of depression on 165 people by looking at how well they coped with life's stresses and strains before and after their mental breakdown. The researchers expected to find patients were left chronically disabled by their experience, struggling to cope in their domestic and working lives.
In fact, the majority had more vitality, improved social lives and were performing better at work. The evolutionary theory raises another key question — are too many people with mild to moderate depression being encouraged to rely on antidepressants to make them feel better, rather than confront the issues underlying their mental state and become stronger as a result?
Moreover, Professor Peter Kinderman, a member of the British Psychological Society, says mild to moderate depression can have a positive effect and should not be regarded as a medical complaint but a normal reaction to life's ups and downs.
‘We know that when someone is profoundly depressed it is completely different from their normal state of being,' he says. ‘But that does not mean it's abnormal. It's part of being alive.'
But if suffering mental health problems really can be beneficial, experts agree it's only likely to apply to those with mild to moderate depression — the majority of cases. Where the cause is fairly obvious — such as bereavement or relationship break-up — it can act as a catalyst to re-evaluate what is important in life.
‘For example, if you don't get the grades at university you might get upset and that's completely normal,' Professor Kinderman says. ‘Then you reflect on the choices and mistakes you made and you come out of it with a different sense of motivation. We need this evolutionary system to allow us to cope with rejection and disappointment, and the normal ups and downs of life.'
But when there is no apparent reason for a slump in mental wellbeing, it's much less likely to have any benefit.
This is a state of mind that doctors call anhedonia: the kind of clinical depression where things that used to bring great joy — prized possessions, favourite places and loving relationships — no longer do.
When sufferers fall this low, it can be hard for them to focus on the problems that have caused their decline, or make changes that might get them out of it. Helen had been struggling with stress at work as a high-flying City trader for several years before she finally broke down and was sectioned under the Mental Health Act.
‘It had been coming on for a while,' says Helen, who has no children and is separated from her husband. ‘I was very unhappy in my job, but kept going. I refused to stop work because I'd have been seen as a failure. ‘I became very withdrawn and wanted to be on my own all the time. I stayed in bed for whole weekends and felt I wanted to die. It went on for two years before I suffered a breakdown. I tried to commit suicide by jumping off a building. But I'd also swallowed huge quantities of Valium and passed out on the roof. I woke up in hospital and ended up in a psychiatric unit for three months on suicide watch.'
Helen was treated with a range of anti-depressants, counselling and even electric shock therapy, with mixed results. Over five years or so, she abandoned them all for her own regime of healthy eating, regular exercise and frequent laughter — hence the website.
She works with the NHS on providing support for depression sufferers, is training to be a mental health counsellor and has more than 125,000 registered users on her website.
Helen believes depression made her stronger, by teaching her not to be afraid to seek help when she really needs it and to place more emphasis on quality of life, rather material wealth. ‘Once I realised there was a reason for how I was feeling, I knew I could do something about it.'
But Dr Eva Cyhlarova, head of research at the Mental Health Foundation, cautions against deliberately allowing depressive symptoms to worsen in the hope of it doing some good. ‘People should not wait until they have a diagnosis of mild depression before doing something about it. Instead, they should try to recognise the symptoms of stress, anxiety or depression early on and take steps to address the problem before it deteriorates.
‘These steps might include taking more exercise, eating more healthily, talking to a friend or family member or addressing any concerns with work or personal relationships.'
Marjorie Wallace, founder of the mental health charity SANE, says depression is a form of ‘malignant sadness' that can be ‘agonising and destructive'. ‘Everybody experiences sadness. But there comes a point where that becomes malignant. That's when it becomes an illness and can be dangerous. ‘But for some people, depression can be a wake-up call. They peer over the edge and say to themselves “I can't give in to this — I have got to survive.” That's the point where they accept they have depression and seek help.' 3.5.11
Anger as ten million patients ripped off by GPs' 40p-a-minute phone lines & £8.00 calls
Ten million patients are being ripped off by GPs who are flouting guidelines on the use of premium line phone numbers. More than 1,000 surgeries are still charging patients more than 40p a minute to make a call, a month after they were told to stop.
Doctors should no longer use the high cost 0844 or 0845 lines under guidelines that came into force at the beginning of last month.
Calls to these numbers can cost as much as 41p a minute from a mobile phone, with GPs keeping part of the income. Campaigners say that some patients phoning to book an appointment or chase up test results are sometimes kept waiting on the line for 20 minutes, working out at £8 for a single call.
The clampdown followed a Government review which heard complaints from more than 3,000 members of the public. In September 2009 the Department of Health announced that GPs would be banned from using the high rate numbers, and the guidelines came into force on April 1.
Primary Care Trusts have been instructed to amend GP contracts to ensure that the cost of calls made to surgeries is no higher than calling a local number from a landline, which is around 4p a minute. But even though family doctors have had more than 18 months to comply with the new rules, many have not done so.
Campaigner David Hickson has identified at least 1,115 surgeries using the 0844 or 0845 numbers, around one in eight of all practices in England and Wales, and covering ten million patients. The worst affected areas are South Yorkshire, the West Midlands, Birmingham and Leicestershire.
Mr Hickson said: ‘People tell me they have been kept on the phone for 20 minutes. That’s more than £8 for a single call. It’s the elderly who will be hardest hit, or their relatives acting on their behalf. ‘This is a case where the NHS’s principle of “free at the point of need” is being breached at present.’
The Department of Health first issued guidance in 2005 telling doctors not to use 0870 numbers, which are even costlier. Many then switched over to 0845 or 0844 numbers, which still cost between 20 and 41p per minute from a mobile phone. Surgeries receive some of the income generated by the calls, although doctors insist they do not make a profit and the revenue is spent on installing and operating the systems.
Many other organisations including PCTs, hospitals and even NHS Direct also use 0845 numbers. A Department of Health spokesman said: ‘NHS organisations remain free to use non-geographical number ranges such as 0844, providing that patients are not charged more than the equivalent cost of calling a geographical number to do so. ‘It is up to PCTs to ensure that GP practices comply with this in line with their standard contract.’
More than 600 NHS bureaucrats are earning more than David Cameron thanks to huge pay rises under Labour. A report by Income Data Services revealed that earnings for NHS trust chief executives soared by 121 per cent under the last government, outstripping pay rises for all other groups of health workers. Nurses’ earnings, for instance, rose by 68 per cent. At least 650 NHS managers earn in excess of the Prime Minister’s salary of £142,500, including 46 with an income of at least £200,000 in 2009/10.
Mr Hickson said: ‘People tell me they have been kept on the phone for 20 minutes. That’s more than £8 for a single call. It’s the elderly who will be hardest hit, or their relatives acting on their behalf. ‘This is a case where the NHS’s principle of “free at the point of need” is being breached at present.’
The Department of Health first issued guidance in 2005 telling doctors not to use 0870 numbers, which are even costlier. Many then switched over to 0845 or 0844 numbers, which still cost between 20 and 41p per minute from a mobile phone. Surgeries receive some of the income generated by the calls, although doctors insist they do not make a profit and the revenue is spent on installing and operating the systems.
Many other organisations including PCTs, hospitals and even NHS Direct also use 0845 numbers. A Department of Health spokesman said: ‘NHS organisations remain free to use non-geographical number ranges such as 0844, providing that patients are not charged more than the equivalent cost of calling a geographical number to do so.
‘It is up to PCTs to ensure that GP practices comply with this in line with their standard contract.’
Too many failures see developers pursuing new strategies to improve trial efficiency
Drug developers are pursuing new strategies to help improve the operational efficiency of their clinical trials, according to a panel of industry leaders recently convened by the Tufts Centre for the Study of Drug Development (CSDD) in Boston , US. The panel, whose members were drawn exclusively from research-based companies, said they had begun collaborating with investigative sites in developing protocols and educating patients about trials before they agree to participate, in an attempt to streamline the trial process.
“The pharmaceutical and biotech industry is facing a crisis in that it needs to develop new drugs more quickly and control expenses,” said Tufts CSDD senior research fellow, Ken Getz.
“Developers understand that substantial operational improvements will more likely flow from new approaches that increase the probability of success, rather than from actions which merely seek to reduce or prevent failures.”
According to Tufts CSDD, more than two-thirds of trial sites fail to meet their patient enrolment targets. And, whereas in 2001 nearly half of all screened patients completed trials, in 2010 that figure plummeted to less than one in four.
Getz says some of the blame may lie in the ever increasing number of procedures patients are subjected to, with the median number per trial sky rocketing by 49 per cent between 2000-03 and 2004-07.
“Improving patient enrolment and controlling the number of procedures could provide substantial benefits,” he said.
The industry leaders convened by Tufts also agreed that communication between sponsors and investigative sites – before, during and after trials – remains critical to the development of good relations.
In addition, medical advisors to help sites better understand trial goals, testing protocols with patients prior to trials, and using electronic medical records to help define and manage data flow, were all agreed by the panel to be of paramount importance to a trial's success. 27.4.11
Anger as NHS chiefs run up £13m bill on wining, dining and lavish away days
NHS bureaucrats have blown £13million on lavish dinners and hospitality for themselves, it emerged last night. Freedom of Information requests reveal strategic health authority staff are enjoying away days which cost more than a luxury meal at the Ritz.
It comes at a time when NHS managers are claiming they are so short of funds that thousands of nurses and doctors will lose their jobs. Strategic Health Authorities – which face the axe under controversial NHS reforms – have squandered the extraordinary sums over the past four years.
Last year alone, the average spending by SHA chiefs on ‘hospitality for conferences, meetings and staff away days' was £361,113 each.
The estimated £3.6million bill for wining and dining by the ten SHAs last year is the equivalent of 120 nurses, 600 hip operations or more than 16,000 hospital bed days. Some of the staff development days have included events held by the East of England SHA at a stately home in Cambridgeshire.
The most expensive event held by the SHA was at Chilford Hall, with a bill of £25,000 for 285 employees. At £85 per head, it cost almost twice as much as dinner at the Ritz Hotel in London .
The most expensive reported event was a staff development day held by NHS North West in October 2008 at a cost of £49,248.
Health Secretary Andrew Lansley is proposing to abolish SHAs, which set financial controls on NHS trusts and decide the 'strategic direction' of the health service. However, the reforms have come under threat from a revolt by Lib Dem members of the coalition and plans are on hold while ministers consider the views of medics and other professionals.
Last night Dr Daniel Poulter, who sits on the Health and Social Care Bill Committee, said: 'People will feel rightly outraged that Labour allowed NHS bureaucrats to be wined and dined at taxpayers' expense. 'Wasting such huge amounts of money on staff away days, meetings and hospitality is completely unacceptable.
'And it is proof of why our NHS needs urgent modernisation. We need an NHS that works for patients, not bureaucrats. 'That is why we are scrapping £5billion of NHS management costs and reinvesting every penny into frontline patient care.
'By restoring power to doctors and nurses, increasing investment in the frontline and giving patients real choice and better information, we can drive up standards across the board and make sure we are getting value for money.'
There are other examples of staggering waste among SHAs. Earlier this week, it emerged that dozens of NHS desk workers are driving top-of-the-range rental cars funded by the taxpayer – including a Jaguar XF, Mercedes CLS , Audi A5 Coupe and BMW 330.
The ten SHAs have spent £1million every year since 2007 on the luxury cars for staff. One SHA, Yorkshire and the Humber , splashed out £400,000 in a year on 95 luxury motors. Extravagances: Dozens of NHS desk workers are driving top-of-the-range rental cars funded by the taxpayer such as Jaguar XF, pictured, Mercedes, Audi and BMW. 27.4.11
NHS £1million luxury car scandal as desk worker gets £37k Porsche Boxster sports car funded by the taxpayer
Dozens of NHS desk workers are driving top-of-the-range rental cars that are funded by the taxpayer, it emerged today. Strategic Health Authorities around the country have spent a staggering £1,000,000 every year since 2007 on the luxury cars.
They included a Jaguar XF, Mercedes CLS , Audi A5 Coupe and BMW 330 for staff who needed the vehicles to get around. Shockingly, one 'pen pusher' was allowed to hire a £37,000 Porshe Boxster - costing taxpayers thousands of pounds. The details emerged as the NHS faces biting cuts around the country, with many patients complaining of appalling care.
One SHA, Yorkshire and the Humber, splashed out £400,000 a year on 95 luxury motors, according to The Sun. The worker who was handed a Porsche is employed by the second biggest spender, North West, which pays £4,500 towards each manager's annual rental costs. The figure amounts to £120,000 a year.
Across the country, the total bill for England 's ten SHAs since 2007 came to £2,995,181. The figure amounts to almost £1,000,000 a year.
Spending on bureaucracy has soared 50 per cent since Gordon Brown became Prime Minister in 2007. But spending on cancer has increased by just 30 per cent.
Tory MP and Health Select Committee member Chris Skidmore said that taxpayers would be 'angry they're funding luxury cars'. London is the only authority that does not allow managers to rent cars.
The Conservatives have vowed to 'root out' NHS waste but critics have complained that their cost-cutting could lead to a privatisation of the health service. Health Secretary Andrew Lansley has said in the past that primary care trusts and strategic health authorities which cover a range of NHS trusts and supervise local NHS services are exerting too much control.
Under Tory reforms, primary care trusts will not be scrapped immediately, but will be phased out as power is passed to doctors. Mr Lansley will point to the joint Tory-Lib Dem document which states: 'We will strengthen the power of GPs as patients' expert guides through the health system by enabling them to commission care on their behalf.' 26.4.11
Study: Statins cause memory loss, depression
The growing list of serious negative side effects caused by statin drugs now includes memory loss and depression, according to a new study published in the Cochrane Library. Researchers discovered that the vast majority of drug trials allegedly showing statins to be safe have been conducted by drug companies, and that way too many people are being prescribed the dangerous medications as a result.
Researchers pulled data from 14 drug trials involving 34,000 patients and found that, while statins appeared to help prevent heart attacks and strokes in some patients, there was simply not enough evidence to prove that people with no history of heart disease can safely take the drugs. And yet millions of healthy people needlessly taking statins every day at the direction of their doctors.
"[W]e found that evidence of potential harm is not being taken seriously," said Professor Shah Ebrahim, from the London School of Hygiene and Tropical Medicine. "The adverse effects are not included in the trials."
Amy Thompson, a senior cardiac nurse at the British Heart Foundation, added that "[i]t is still unclear whether statins provide any real benefits for people without heart and circulatory disease and who are at low risk." She and others are thus advising people without any history of heart disease to avoid statins altogether.
But do statin drugs actually provide any real benefit for anyone? According to a study published in the British Medical Journal in 2010, for every heart attack allegedly prevented by statins, two people suffer liver damage, kidney failure, cataracts or extreme muscle weakness from taking the drug. And statistically, less than three percent of people experience any benefit at all from taking statins. Natural News 21.4.11
Chris Grayling pledges incapacity benefit 'revolution'
Employment minister unveils payment by result scheme to treat addiction as figures show more than 80,000 claiming benefit for obesity, alcohol or drugs. The employment minister, Chris Grayling, has said the government will launch a "revolution" to help people "turn their lives around" as figures revealed that more than 80,000 people are claiming incapacity benefit for obesity and addiction to alcohol and drugs.
According to figures released by the DWP on Thursday, in August 2010 there were 42,360 claimants with alcohol addiction, 37,480 with drug dependency and 1,800 who were obese. Grayling said the figures – which also show that 12,880 alcoholics and 9,200 drug abusers have been dependent on the benefit for more than 10 years – told a "pretty sorry tale".
He told BBC Radio 4's Today programme the conditions were treatable and "able to be overcome" if people were given the "right support", and unveiled plans to launch a payment by result scheme to treat addiction. "I don't think you can simply say because you're a drug addict or you're an alcoholic we should pay you benefits for the rest of your life, that we should consign you to the fringes of society," he said.
"We should actually, in my view, be helping those people overcome their problems and get back into the workplace, which surely is a better option. "We are launching a revolution, a financial revolution, to try and help people turn their lives around."
Grayling said that, as part of the government's welfare strategy, it would extend the delivery of payment by result schemes for the work programme being launched in June to one specifically tailored to people with addictions.
The treatment will be delivered by specialist organisations, who will be paid on the basis of their success in helping people to overcome addictions to the point where they can return to the workplace. Grayling said this would be funded by the money saved from getting people off benefits and into work and would move away from the idea that politicians know best about how to deal with drug addiction.
In a separate interview on BBC Radio 5 Live, he said: "We'll pay them [specialist organisations] when they succeed to move people off drugs and help overcome some of these addictions problems.
"That in itself will get way from the situation where we say 'we know best when it comes to drug treatment', it will ensure that the best treatments, the ones that succeed, come forward."
Grayling said people with addictions and on incapacity benefit had been left on the "fringes" of the welfare system for years "unquestioned, unchallenged". "This is all about saving lives, not saving money – it's about trying to work out who has the potential to make more of their lives and deliver specialist help to help them do so," he said.
"Very often, it's a self-fulfilling prophecy – you end up in a position where you are out of work, where you are on benefits, actually you end up sinking into something of a rut. "Your situation gets worse, you get depressed, some problems like alcohol addiction can actually be accentuated by that situation."
The benefit figures, released by the Department for Work and Pensions (DWP), provide a snapshot of incapacity benefit claimants in August 2010. Incapacity benefit is paid at three weekly rates – £68.95 for the first 28 weeks, £81.60 from weeks 29 to 52 and £91.40 from week 53.
Since February, no new incapacity benefit claims have been accepted. Existing claimants are being reassessed to see whether they are fit to work straight away or need help first through the Employment and Support Allowance (ESA). The figures show that a total of 81,670 claimants are not working, either because they are obese (1,830) or suffering from drug (37,480) or alcohol problems (42,360).
In total, there are 2.1 million claimants, and the total yearly incapacity benefit bill is £7bn.
The shadow work and pensions secretary, Liam Byrne, hit out at the coalition for cutting "too far and too fast". He said: "It was Labour that changed the law to start testing people on incapacity benefit to see who was fit for work. "But the real problem now is that the Tories' decision to cut too far and too fast has meant that unemployment is set to increase every year, by up to 200,000 more people, helping push the benefits bill up by a massive £12bn, or £500 for every household in Britain.
"With five people now chasing every job, what we need to get people off benefits and paying tax is more jobs." 21.4.11
Benefit applicants - '75% fit to work or drop claims'
Three-quarters of people who apply for sickness benefit are found fit to work or drop their claims before they are completed, official figures show. Department for Work and Pensions figures showed 887,300 of 1,175,700 employment and support allowance ( ESA ) applicants over a 22-month period failed to qualify for assistance.
Of those 39% were judged fit to work, while 36% abandoned their claim.
Employment Minister Chris Grayling said the welfare system needed changing. He said the figures underlined the need to reassess people still on the old incapacity benefit - a process which the government began rolling out last month. "Once again we have clear evidence of the need for change in our welfare system.
"We now know very clearly that the vast majority of new claimants for sickness benefits are in fact able to return to work. "That's why we are turning our attention to existing claimants, who were simply abandoned on benefits. "That's why we are reassessing all of those claimants, and launching the work programme to provide specialist back to work support," he said. "We will, of course, carry on providing unconditional support to those who cannot work, but for those who can it's right and proper that they start back on the road to employment," Mr Grayling added.
The DWP figures cover the period from 27 October 2008 - when ESA was introduced by the former Labour government - to 31 August 2010 .
Norman Smith Chief political correspondent, BBC Radio 4
The real significance of today's figures - showing three-quarters of new claims for sickness benefit are rejected - is how far they are replicated as the government tests those already on employment support allowance ( ESA ).
The view in government circles is that, given the right support, many of the more than two million claimants on ESA can work, and that in an era of computers and modern technology there should be jobs which people with minor disabilities can perform.
Ministers argue this is not just about saving money, it's also about trying to tackle inter-generational poverty by ensuring families are not abandoned on sickness benefits but helped back into work. And yet successive governments have tried and failed.
Indeed the number of claimants on sickness benefits has hardly fallen over the past 20 years - even when the economy was booming.
Ministers hope this time it will be different. The real challenge they face though is that they're trying to move people off ESA and back into work when there just aren't many jobs around. 28.4.11
Failed NHS treatments means addicts on sick benefits for decade
If any more proof were needed that the addiction services have failed it is the fact more than 21,000 drug addicts and alcoholics have been claiming sickness benefits for longer than 10 years, it has been disclosed.
The taxpayer-funded handouts form part of the £7 billion a year paid in incapacity benefit. New figures from the Department for Work and Pensions show that 80,000 people are claiming incapacity benefit for being an alcoholic, a drug addict or too obese to work. Of these, 12,000 alcoholics and 9,200 drug addicts have been drawing the benefit for more than a decade at a cost estimated at around £1 billion. Each claimant has been able to claim an average £4,700 a year.
Thousands of others can claim for conditions such as headaches, acne, coughs and eating disorders. Short-term IB is £69 a week for the first 28 weeks, from weeks 29-52 at £81 a week with longer-term IB, paid after a year, £91.40 a week.
Chris Grayling, the employment minister, said: “It's not fair on anyone for this situation to continue. Far from being the safety net it should be the benefits system has trapped thousands in a cycle of addiction and welfare dependency with no prospect of getting back to work.
“We are putting an end to this, we won't allow people to be left on benefits and forgotten about, that's why we have already started reassessing everyone on incapacity benefit [IB] and will support people with addictions to help them back into work.”
Ministers are angry that claimants have been left on IB, with the state washing its hands of responsibility to get them over their addictions and into work. Under plans from the Department for Work and Pensions, everyone on IB will be reassessed to see whether they are capable of some work, and what help they might need to return to employment.
The tests began this month. Assessors will determine whether people on IB can start looking for work straight away or if they will initially need the employment and support allowance. Mr Grayling said 10,000 people a week will be asked to take part to look at “what they can do, and what they can't do”.
He said those with “complex barriers” will be helped through the new Work Programme, which begins this summer. It has been described by Iain Duncan Smith, the Work and Pensions Secretary, as the biggest “welfare to work” programme attempted in Britain. Private and voluntary sector organisations will be asked to get people back to work, with rewards for their success rates. 21.4.11
Cutbacks council spends £1.2m on free phones for two thirds of staff
One of the country's most controversial councils has handed out free mobile phones to nearly two out of every three of its own workers, it was revealed yesterday. More than 7,000 town hall staff in Manchester have been given mobiles, with the bill of more than £1.2million a year paid by the taxpayer.
The number of mobiles for council workers went up by nearly a third last year and the cost of providing them rose by more than ten per cent, according to details released under freedom of information rules.
The wide distribution of phones to the authority's 96 councillors and the majority of its 11,500 staff came in the depths of the recession and just before it launched a programme of large-scale cutbacks in its services to the public.
Labour-run Manchester is currently cutting back lollipop patrols, swimming pools, leisure centres, homes for the disabled, libraries and public toilets as part of an attempt to deal with £170million in reductions in grants from the Treasury. Its leaders have piled the blame entirely on the Coalition and cuts. Ministers, however, say the city could maintain its service if it improved efficiency and spent less on wasteful bureaucracy.
But at the weekend its leaders were revealed to have £95.2 million sitting untouched as cash reserves. The council spent more than £1.2million on mobile phones for its staff in the financial year that ended in April 2010, according to the figures obtained by the council tax protest group Is It Fair?
The bill was 10.6 per cent up on the £1,095,734 paid for staff mobiles the year before. It supplied workers with 7,032 mobile phones and 232 BlackBerry devices, up from 5,451 mobiles and 111 BlackBerries in the previous year. The authority was the most generous provider of phones to its staff among a number asked for information by the pressure group.
While other councils supply mobiles to councillors, managers and staff who need to stay in touch, numbers are generally smaller.
Manchester's near neighbour in the North West, Liverpool, for example, provided 2,431 staff with phones and 710 with BlackBerries last year at a cost of just under £814,000. Numbers in Liverpool fell compared to the previous year. Hackney in London spent £442,490 last year on 1,552 mobiles and 590 smartphones.
The generosity with mobiles brought a wave of criticism yesterday. Christine Melsom of Is It Fair? said: ‘People have to remember that it is their taxes that are paying for mobile phones for council workers. ‘We have to ask if they really need them. I was incredulous when I saw the numbers, and I think there are no excuses.'
She added: ‘They are pretending the Government is treating them badly, and then we find out they are spreading phones around like this. People need to understand that they are being ripped off.'
Local Government Minister Grant Shapps said: 'There is a very good case in some instances for council employees to have phones. 'However given Manchester's carefree attitude to spending public money without a second thought, it's highly questionable as to why the number of phones handed out rocketed so dramatically in the recession when there was a pressing need to rein in public spending.'
Manchester said mobiles were necessary for anyone routinely working out of hours or away from their office, and staff equipped with them include social workers, school liaison staff, highways staff, events promotions staff, neighbourhood wardens, parks and leisure staff, and senior managers.
A spokesman for the council said: ‘Our mobile charges are about £14 per unit per month, which is good value for money. Mobile devices allow staff to work flexibly and efficiently.' 19.4.11
Should NHS give patients anti-depressants to help them talk to strangers?
The NHS drugs rationing body is to investigate whether anti-depressants should be given to those suffering from acute shyness, it emerged yesterday. The Department of Health has ordered a review into treatments available for ‘social anxiety disorder' – a condition that leaves sufferers terrified at the prospect of public speaking, talking to strangers or even going to parties.
In extreme cases, victims suffer panic attacks, blushing and sweats in any social situation. The National Institute for Health and Clinical Excellence, which is heading the review, claims that one in eight will suffer from the disorder during their lifetime.
The body has previously come under fire for advising health authorities that they should not fund drugs for a range of patients including those suffering from the early stages of Alzheimer's disease. The growing use of drugs to treat extreme shyness has alarmed some experts who say pharmaceutical companies and doctors are ‘medicalising' normal human behaviour.
The concept of ‘social anxiety disorder' or ‘social phobia' has entered mainstream medicine in the last couple of decades after the drugs industry began to promote it.
In the late 1990s and early 2000s, the amount of money spent on social anxiety drugs doubled, while in the last decade around £1.5billion has been spent on the condition. Around 200 people a year who suffer from excessive blushing or sweating are given surgery on the NHS to sever the nerves which supply sweat glands on the face, hands and armpits. Doctors also recommend cognitive behavioural therapy.
Dr Joanna Moncrieff, a consultant psychiatrist and lecturer at University College London, told The Sunday Telegraph: ‘Some people will find parties and public speaking more difficult than others, but it can be extremely damaging to label them with a medical disorder that needs treatment. 'Effectively that is telling people that they can't deal with things themselves.'
NICE will look at the effectiveness of all treatments offered for social phobia on the NHS – including drugs, counselling and surgery. It will also look at the use of the anti-wrinkle jab Botox to suppress underarm sweating.
A spokesman said: ‘It's been referred to us by the Department of Health and it is still very early days. 'This condition is already being treated by doctors on the NHS and what we will do is find out which treatments are the most effective.'
Dr Tim Kendall, consultant psychiatrist at Sheffield Health and Social Care Trust, said: ‘For people who suffer from serious anxiety disorder, it can ruin their life. 'This isn't about common shyness, this is about a level of anxiety that can prevent people from establishing relationships.'
But Dr Louise Foxcroft, author of Hot Flushes, Cold Science, said: ‘You have to question the role of the pharmaceutical industry and the influence they hold over the medicalisation of so many behaviours and emotions which are common to us. This is big business.'
In the last few years NICE has come under fire for advising health authorities that they should not fund drugs for the early stages of Alzheimer's disease. Last year, after a Daily Mail campaign, the body reversed its decision and allowed the drugs to be used at any stage. 18.4.11
NHS bosses see their bonus pot double in 5 years ... as staff face cuts
NHS chiefs have seen their bonuses double in the last five years even though tens of thousands of frontline workers face the axe to save money. Some officials at the Department of Health on six-figure salaries are receiving performance-related awards that exceed the average nurse's wage.
The payments are being dished out despite the fact that up to 40,000 posts in hospitals and health trusts will go over the next year as part of attempts to save billions. Last year 1,162 senior officials at the Department of Health shared £2.5million in bonuses, taking home an average of about £2,150.
One civil servant was paid £27,500 on top of their six-figure salary; the average nurse earns just over £26,000 a year. The pot has more than doubled since 2004/5, when just £1.15million was handed out.
The bonuses are usually only given to the most senior staff on the highest salaries, and are typically awarded if the department believes it has met certain targets, such as keeping waiting times down, reducing superbug infections, or making efficiency savings.
The department refuses to name the recipients of its top bonuses, but two of its highest-paid employees who may benefit from performance-related pay are Sir David Nicholson, NHS chief executive, and Clare Chapman, its director general of workforce. Sir David earns between £255,000 and £259,000 – over £100,000 more than the Prime Minister. His pay package includes up to £50,000 for a rented flat in London and living expenses.
Two years ago he instructed the NHS to make £20billion of efficiency savings by 2014. Hospitals have resorted to scrapping thousands of posts to meet the targets.
Mrs Chapman earns around £245,000. She has seen her pay increase by up to a fifth since her appointment in 2006. The revelations will further anger frontline workers who say they are being stretched to the limit.
Nurses made their discontent clear earlier this week when they backed a vote of no confidence in Health Secretary Andrew Lansley at the annual Royal College of Nursing conference.
Many say that because of cuts they are too busy to assist elderly people with their food or help them to the toilet.
Despite the strains being placed on the NHS, figures from April to October last year show that almost £1.8million has already been given out, meaning bonuses for 2010/11 are on target to be higher still.
The payments, condemned by critics as ‘indefensible', are only a fraction of the bonuses handed out across the health service among various quangos and local health trusts.
Dr Peter Carter, chief executive and general secretary for the Royal College of Nursing, said: ‘The inexorable rise in bonus payouts will leave frontline staff reeling, especially the news that the Department of Health is paying out bonuses higher than a nurse's starting salary.
‘At a time when those earning above £21,000 are being subjected to a pay freeze, frontline nurses and others will feel that there is one rule for them and another for us. This appears at best insensitive and at worst, during a time of financial austerity, indefensible.
‘We need to know what improvements those receiving bonuses have made to health services and patient care.'
Conservative MP Priti Patel, who obtained the figures, added: ‘The levels of pay and bonuses overseen by the previous Labour government showed utter contempt for Britain 's hard-pressed taxpayers and those who work on the frontline in the NHS.'
A Department of Health spokesperson said: ‘The Coalition Government has announced that in light of the financial difficulties facing public services, the number of performance-related payments made to senior civil servants overall will be significantly reduced.' 15.4.11
Mind can be used to help treat arthritis
Arthritis pain in some patients could be soothed by an experimental drug-free treatment, a small study by a group of scientists suggests. Researchers say that computer-generated image technology may be able to trick some arthritis patients brain into feeling less pain in their fingers.
The mind trick, called Mirage, works by having patients place their hands inside a box containing a camera. The patient then watches as a real time image of their hands is projected in front of them. The technology then manipulates the image to make it look like their fingers are being stretched and shrunk.
The research, which is still in its early stages, found that the treatment halved the pain of a small sample of test subjects with arthritis in 85% of cases.
Scientists at the University of Nottingham 's Psychology department created the mind trick, which was tested on subjects who had all been clinically diagnosed with arthritic pain in their hands and fingers and were an average of 70 years old.
Many of those being tested said they felt less pain in their hands and fingers when the image appeared to show them being stretched while others said the pain reduced when the image showed them shrinking. Some reported reduced pain for both.
The research found that a third of those taking part in the trial said the treatment stopped them feeling pain completely. It was found that the illusion only worked when painful parts of the hand were manipulated.
The study, which will be published in the medical journal Rheumatology, found that anecdotally, some volunteers said they experienced a wider range of movement in their hands following the treatment. 14.4.11
PDT: Me and my operation: The beam of light that can kill lung cancer in 15 minutes
Lung cancer kills 35,000 Britons a year. Don Moulden, 79, a retired machine tools sales manager from Hertfordshire, was one of the first to undergo a new procedure that effectively cured him.
Years ago, I started coughing up blood once or twice a week. After three weeks, I saw my GP, who prescribed antibiotics. But they didn't help. So two months later he sent me to the local hospital for X-rays and then a bronchoscopy, where they put a flexible tube into my lungs to take a sample of the cells.
The doctors told me I had pre-cancerous changes in my right lung, which could grow into a tumour. I was devastated. Six years earlier, I'd had cancer in my left lung and had to have it removed. It was a horrendous ten-hour operation in which they had to break my ribs, so I was in terrible pain. I'd smoked in my 40s, but had given up after five years — that was enough to trigger cancer.
The doctors said that this time, since I had only one lung, they couldn't operate or treat the tumour with radiotherapy, for fear of damaging the lung so badly it would kill me. They estimated I had 12 months to live and handed me palliative care leaflets. My wife, Jean, and I left the hospital in shock.
I was then referred to a chest specialist, Dr Jeremy George, at University College Hospital London. When I saw Dr George three weeks later, in June 2006, he did another bronchoscopy and told me that since the changes were small, they would simply keep an eye on me. I saw him every three months for a bronchoscopy. I felt well, so in 2007 we booked a holiday to the U.S. to see our daughter and three grandchildren, who live there.
But just before we went I had another appointment with Dr George — it was bad news: my tests showed the cells had changed into early cancer.
Then he told me about a trial they were running for early lung cancer patients. They could inject a light-sensitive dye into me.
I'd then have a laser put down my throat and this would be switched on when it reached the diseased part of my lung. The dye would release a type of oxygen that would destroy the tumour. He said I wouldn't need a long recovery and could be home within a few days. Suddenly I was being offered this wonder cure that would save my life.
When Dr George said they wanted me in the following Sunday, we cancelled the holiday. On the day itself, I was given an injection of dye in my arm. Because it made me very sensitive to direct light — even a few rays would give me sunburn — I had to stay in the dark for two days so the dye could get to the tumour. On the Tuesday, they wheeled me to theatre. The op took only about 15 minutes and when I woke from the general anaesthetic I felt fine. I went home that Friday.
For two months I had to wear a hat, gloves and mufflers because I was still light sensitive. When I went back for tests four months later, Dr George said the tumour had gone. Jean and I were delighted. And while I go back for a bronchoscopy every six months, the tumour hasn't come back. I'm still going strong years later, despite having been given just 12 months to live. Dr George and his team are wonderful.
Dr Jeremy George is consultant chest physician at University College Hospital London . He says: While lung cancer is not the most common cancer in Britain , it is the most lethal, killing 35,000 each year. This is because it is often detected late, as there may be no early symptoms.
For early stage lung cancers, surgery is the best treatment — we remove the tumour or the lung.
However, losing a lung leaves patients breathless, and so for some this isn't an option. Since 90 per cent of these patients are smokers, they might have other conditions such as emphysema or heart disease, meaning they wouldn't survive surgery.
In Mr Moulden's case, he'd already had one lung removed. Radiotherapy also has drawbacks, including the risk of damaging healthy tissue.
However, in the Eighties, doctors in the U.S. found that the body naturally produces a reddish- purple dye called porphyrin, which is attracted to cancerous tumours and is sensitive to light. They found that by shining a bright light on this dye, they could make it produce a toxic kind of oxygen that killed the cancerous cells, while leaving the surrounding tissue healthy.
Over the years, doctors worked out that you could also inject patients with this dye, so there was such high levels in the body that shining a light on the tumour would destroy it.
My colleague Professor Stephen Bown at University College London was among those who pioneered the treatment, which we call Photodynamic Therapy (PDT). It's really exciting — it's a new way to help patients who aren't suitable for surgery, and they heal quickly with limited damage to surrounding tissue.
PDT is being used at just a few centres in Britain to treat early cancers, including skin, mouth and oesophageal cancers.
Studies show it has a 70 per cent success rate for early lung cancer. First, we inject the dye porphyrin into the patient's arm as one slow intravenous injection. The porphyrin makes the skin more sensitive to light, but it's also particularly attracted to cancer cells.
Two days later, we wheel the patient into the treatment room covered by a blanket. We use only side lights to light the room. The procedure takes half an hour under general anaesthetic. First, I feed a bronchoscope through the mouth, into the airways — it has a tiny camera attached, which relays images on to a screen so we can see the tumour.
Then I slide an optical fibre — a thin flexible cable that carries light — through the bronchoscope and hold it against the tumour for ten to 15 minutes. When I switch on its laser beam, it emits a cylinder of red light, and the dye in the cells of the tumour produces toxic oxygen that kills cancerous cells.
Then we take out everything and wake the patient. We keep a close eye on them, with a bronchoscopy two days later to check for a scab on the airways as the tissue heals — this could block their breathing.
Once everything is clear, they go home and have to avoid bright light for at least a month. The dye is excreted naturally by the body.
The tumour should have gone completely, but we keep monitoring patients. There is a risk that another tumour will start to grow, but as long as it's in an accessible place we can treat that, too. We are hoping to develop drugs that make patients sensitive to light for shorter times, so that PDT can be offered at more centres. The cost of treatment to the NHS is £4,000 — this procedure is not available privately. 13.4.11
This is not a new story see: Why are cancer patients been told a proven treatment is ‘experimental or doesn't work'? 16.10.09
Rehashed study - Diet drug Qnexa: Don't get too carried away by old data
A study in the journal the Lancet trumpets the diet drug Qnexa, but this study is not so new. It was done before the FDA denied approval of the drug, asking for further research.
The diet drug Qnexa claims to help obese people with weight-related medical conditions to lose more weight than those who take a dummy pill and could allow some to scale back on medications for diabetes, high blood pressure or cholesterol, according to a new study published online in the Lancet.
Only this study is not so new -- and its findings may be less weighty than might be concluded with its publication in this respected medical journal. Qnexa -- an investigational weight-loss drug that combines the anticonvulsant topiramate with the short-term diet drug phentermine -- was denied FDA approval last October. At that time, the FDA asked Vivus, the company sponsoring Qnexa's application for market approval, to conduct further research on the drug's safety.
This 'newly published' article details only one of two clinical trials that were submitted for evaluation by the FDA before the agency decided to deny approval for Qnexa in October 2010. When the FDA's staff scientists combined the results of this study with a second study (both funded by Vivus, of Mountain View, Calif ) -- they concluded that the weight-loss difference between those taking Qnexa and those taking a placebo was "of nominal statistical significance".
In both the Lancet article and the accompanying press release, the secondary effects of subjects' weight loss with Qnexa were highly touted: "The findings published Online First in the Lancet ... suggest that this promising new treatment has additional metabolic benefits," the press release describing the study says. The authors write: "Most importantly, weight loss achieved with phentermine and topiramate was sustained during 56 weeks with improvements in blood pressure, lipids, glycaemia, and inflammatory markers."
In its assessment of those improvements in a June 17 memorandum last year, the FDA's scientists were not quite as breathless: The groups treated with Qnexa, they wrote, "had the expected improvements in blood pressure, lipids and glycemia."
The Lancet study does have some additional data not reviewed by the FDA - - and not entirely typical for such an article: comparisons between Qnexa's effectiveness for weight loss and that of two other drugs vying for the potentially vast U.S. market for weight-loss drugs.
These other weight-loss-drug candidates, commercially known as Lorcaserin and Contrave, haven't won FDA approval either, but both remain under consideration. In a box labeled "research in context," the authors offer a comparison that is certainly not apples to apples but which may give Qnexa some competitive edge: In studies performed by other researchers using different populations of subjects under different circumstances, the authors of the Lancet study note, Qnexa promoted greater weight-loss than Contrave, Lorcaserin or Orlistat (a fat-blocking drug long on the market).
The study described in the Lancet was funded by Vivus. Three of its seven authors are employees of Vivus, a fourth was an employee of the contract research organization that coordinated the study for Vivus. The lead author has served as a consultant to Vivus, and the second author acknowledged receiving donations, honoraria, consulting fees or grants from Vivus (as well as several other pharmaceutical firms with interests in weight-loss drugs).
In denying Vivus approval to market Qnexa in October, the FDA asked the company to extend the trial described in the Lancet article and to submit further findings on Qnexa's effect on subjects' heart function, as well as on its safety for use in women who might become pregnant.
Critics said 'this illustrates the 'pharmaceutical process' of marketing drugs with little benefit based upon data supplied by trials funded by the company and written up by employees or person funded by the company, clearly bias and not independent'. 11.4.11
Pharmaceutical drugs causing spike in diseases they supposedly treat
A recent U.S. News & World Report piece highlights new studies that point to serious problems down the road for the over-medicated population. According to reports, more than 60 percent of American adults now take at least one drug every day for a chronic health problem, and more than half of seniors take at least three medications every day. But the end result is more diseases like diabetes, heart disease, obesity, arthritis and cancer.
While some disease rates have declined over the years, many others have rapidly increased in their place, even though a lot more people take pharmaceutical drugs than they used to. The cause, say many, is the drugs themselves. And experts fear that millions of people are being over-diagnosed and over-medicated due to aggressive, uncontrolled marketing by drug companies, which is exacerbating the problem even more.
Most of the approved drugs on the market today are backed by studies very limited in scope. Besides having been manipulated to show favorable results, most studies evaluate the effects of drugs on a very limited cross-section of people with isolated illness symptoms, and for a very short period of time. Little, if any, consideration is given to the long-term effects of such drugs on a wide spectrum of diverse people.
Another major problem is off-label prescription practices in which doctors prescribe drugs for conditions the drugs were not meant to treat. And drug companies themselves play a major role in making this happen by literally paying doctors to recommend certain drugs to their patients, even if the drugs are unnecessary. A great example of this was identified in a government report back in March that found that 22 percent of Massachusetts nursing home residents had been prescribed antipsychotic medications for conditions they did not have.
Some experts are calling on regulatory reform to end the cozy relationship between agencies like the U.S. Food and Drug Administration (FDA) and drug companies, which many now recognize as a primary cause of the problem. Natural News 11.4.11
Doctor pursues career exposing lies, quackery and fraud in "medical science"
Greek doctor John Ioannidis has based his career on exposing the untrustworthy nature of medical research, and it has made him one of the most celebrated medical scientists in the world. Indeed, Ioannidis worries that the medical research system is so broken that it cannot ever be fixed.
Ioannidis first became aware of the problems in medical science as a young researcher, when he realized that even for well-researched diseases, doctors tended to make their treatment decisions based on intuition and basic guidelines rather than solid research. He became involved in the "evidence-based medicine" movement, searching for reliable data to help doctors make these decisions -- and discovered that there isn't any.
Medical scientists ask the wrong research questions, set up studies to deliver certain results, recruit the wrong research populations, take the wrong measurements, analyze their data poorly and present their results inaccurately, he concluded. Researchers want to achieve specific results, Ioannidis says, and either consciously or unconsciously, they make sure to get them.
"At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded," says Ioannidis. "There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded."
In part, Ioannidis blames a system that makes researchers dependent on publishing studies in influential journals in order to receive and keep tenured positions. Such journals are more likely to publish sensational research findings, even if those findings are less accurate.
To prove his point, Ioannidis published two highly influential papers in 2005. In the first, he used a mathematical proof to show that with only small levels of researcher bias, less than ideal research methods, and a tendency to focus on exciting rather than likely theories, as many as 80 percent of non-randomized studies, 25 percent of randomized studies and 10 percent of non-randomized studies will be wrong. And indeed, these figures match the rates at which studies are later disproven. In his second paper, Ioannidis showed that of the 49 most influential studies of the last 30 years that were later retested, 41 percent were eventually proven wrong.
These papers included the one that led to hormone replacement therapy as a treatment for menopause symptoms, and the one that led doctors to recommend that patients take an aspirin pill daily to prevent heart attacks. 6.4.11
Lies, Damned Lies, and Medical Science - Exposing Bad Science
Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.
I N 2001, RUMORS were circulating in Greek hospitals that surgery residents, eager to rack up scalpel time, were falsely diagnosing hapless Albanian immigrants with appendicitis. At the University of Ioannina medical school's teaching hospital, a newly minted doctor named Athina Tatsioni was discussing the rumors with colleagues when a professor who had overheard asked her if she'd like to try to prove whether they were true—he seemed to be almost daring her. She accepted the challenge and, with the professor's and other colleagues' help, eventually produced a formal study showing that, for whatever reason, the appendices removed from patients with Albanian names in six Greek hospitals were more than three times as likely to be perfectly healthy as those removed from patients with Greek names. “It was hard to find a journal willing to publish it, but we did,” recalls Tatsioni. “I also discovered that I really liked research.” Good thing, because the study had actually been a sort of audition. The professor, it turned out, had been putting together a team of exceptionally brash and curious young clinicians and Ph.D.s to join him in tackling an unusual and controversial agenda.
Last spring, I sat in on one of the team's weekly meetings on the medical school's campus, which is plunked crazily across a series of sharp hills. The building in which we met, like most at the school, had the look of a barracks and was festooned with political graffiti. But the group convened in a spacious conference room that would have been at home at a Silicon Valley start-up. Sprawled around a large table were Tatsioni and eight other youngish Greek researchers and physicians who, in contrast to the pasty younger staff frequently seen in U.S. hospitals, looked like the casually glamorous cast of a television medical drama. The professor, a dapper and soft-spoken man named John Ioannidis, loosely presided.
One of the researchers, a biostatistician named Georgia Salanti, fired up a laptop and projector and started to take the group through a study she and a few colleagues were completing that asked this question: were drug companies manipulating published research to make their drugs look good? Salanti ticked off data that seemed to indicate they were, but the other team members almost immediately started interrupting. One noted that Salanti's study didn't address the fact that drug-company research wasn't measuring critically important “hard” outcomes for patients, such as survival versus death, and instead tended to measure “softer” outcomes, such as self-reported symptoms (“my chest doesn't hurt as much today”). Another pointed out that Salanti's study ignored the fact that when drug-company data seemed to show patients' health improving, the data often failed to show that the drug was responsible, or that the improvement was more than marginal.
Salanti remained poised, as if the grilling were par for the course, and gamely acknowledged that the suggestions were all good—but a single study can't prove everything, she said. Just as I was getting the sense that the data in drug studies were endlessly malleable, Ioannidis, who had mostly been listening, delivered what felt like a coup de grâce: wasn't it possible, he asked, that drug companies were carefully selecting the topics of their studies—for example, comparing their new drugs against those already known to be inferior to others on the market—so that they were ahead of the game even before the data juggling began? “Maybe sometimes it's the questions that are biased, not the answers,” he said, flashing a friendly smile. Everyone nodded. Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all. Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted?
That question has been central to Ioannidis's career. He's what's known as a meta-researcher, and he's become one of the world's foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field's top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else's work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there's a problem.
THE CITY OF IOANNINA is a big college town a short drive from the ruins of a 20,000-seat amphitheater and a Zeusian sanctuary built at the site of the Dodona oracle. The oracle was said to have issued pronouncements to priests through the rustling of a sacred oak tree. Today, a different oak tree at the site provides visitors with a chance to try their own hands at extracting a prophecy. “I take all the researchers who visit me here, and almost every single one of them asks the tree the same question,” Ioannidis tells me, as we contemplate the tree the day after the team's meeting. “‘Will my research grant be approved?'” He chuckles, but Ioannidis (pronounced yo-NEE-dees) tends to laugh not so much in mirth as to soften the sting of his attack. And sure enough, he goes on to suggest that an obsession with winning funding has gone a long way toward weakening the reliability of medical research.
He first stumbled on the sorts of problems plaguing the field, he explains, as a young physician-researcher in the early 1990s at Harvard. At the time, he was interested in diagnosing rare diseases, for which a lack of case data can leave doctors with little to go on other than intuition and rules of thumb. But he noticed that doctors seemed to proceed in much the same manner even when it came to cancer, heart disease, and other common ailments. Where were the hard data that would back up their treatment decisions? There was plenty of published research, but much of it was remarkably unscientific, based largely on observations of a small number of cases. A new “evidence-based medicine” movement was just starting to gather force, and Ioannidis decided to throw himself into it, working first with prominent researchers at Tufts University and then taking positions at Johns Hopkins University and the National Institutes of Health. He was unusually well armed: he had been a math prodigy of near-celebrity status in high school in Greece, and had followed his parents, who were both physician-researchers, into medicine. Now he'd have a chance to combine math and medicine by applying rigorous statistical analysis to what seemed a surprisingly sloppy field. “I assumed that everything we physicians did was basically right, but now I was going to help verify it,” he says. “All we'd have to do was systematically review the evidence, trust what it told us, and then everything would be perfect.”
It didn't turn out that way. In poring over medical journals, he was struck by how many findings of all types were refuted by later findings. Of course, medical-science “never minds” are hardly secret. And they sometimes make headlines, as when in recent years large studies or growing consensuses of researchers concluded that mammograms, colonoscopies, and PSA tests are far less useful cancer-detection tools than we had been told; or when widely prescribed antidepressants such as Prozac, Zoloft, and Paxil were revealed to be no more effective than a placebo for most cases of depression; or when we learned that staying out of the sun entirely can actually increase cancer risks; or when we were told that the advice to drink lots of water during intense exercise was potentially fatal; or when, last April, we were informed that taking fish oil, exercising, and doing puzzles doesn't really help fend off Alzheimer's disease, as long claimed. Peer-reviewed studies have come to opposite conclusions on whether using cell phones can cause brain cancer, whether sleeping more than eight hours a night is healthful or dangerous, whether taking aspirin every day is more likely to save your life or cut it short, and whether routine angioplasty works better than pills to unclog heart arteries.
But beyond the headlines, Ioannidis was shocked at the range and reach of the reversals he was seeing in everyday medical research. “Randomized controlled trials,” which compare how one group responds to a treatment against how an identical group fares without the treatment, had long been considered nearly unshakable evidence, but they, too, ended up being wrong some of the time. “I realized even our gold-standard research had a lot of problems,” he says. Baffled, he started looking for the specific ways in which studies were going wrong. And before long he discovered that the range of errors being committed was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals.
This array suggested a bigger, underlying dysfunction, and Ioannidis thought he knew what it was. “The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” Researchers headed into their studies wanting certain results—and, lo and behold, they were getting them. We think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it's easy to manipulate results, even unintentionally or unconsciously. “At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” says Ioannidis. “There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded.”
Perhaps only a minority of researchers were succumbing to this bias, but their distorted findings were having an outsize effect on published research. To get funding and tenured positions, and often merely to stay afloat, researchers have to get their work published in well-regarded journals, where rejection rates can climb above 90 percent. Not surprisingly, the studies that tend to make the grade are those with eye-catching findings. But while coming up with eye-catching theories is relatively easy, getting reality to bear them out is another matter. The great majority collapse under the weight of contradictory data when studied rigorously. Imagine, though, that five different research teams test an interesting theory that's making the rounds, and four of the groups correctly prove the idea false, while the one less cautious group incorrectly “proves” it true through some combination of error, fluke, and clever selection of data. Guess whose findings your doctor ends up reading about in the journal, and you end up hearing about on the evening news? Researchers can sometimes win attention by refuting a prominent finding, which can help to at least raise doubts about results, but in general it is far more rewarding to add a new insight or exciting-sounding twist to existing research than to retest its basic premises—after all, simply re-proving someone else's results is unlikely to get you published, and attempting to undermine the work of respected colleagues can have ugly professional repercussions.
In the late 1990s, Ioannidis set up a base at the University of Ioannina. He pulled together his team, which remains largely intact today, and started chipping away at the problem in a series of papers that pointed out specific ways certain studies were getting misleading results. Other meta-researchers were also starting to spotlight disturbingly high rates of error in the medical literature. But Ioannidis wanted to get the big picture across, and to do so with solid data, clear reasoning, and good statistical analysis. The project dragged on, until finally he retreated to the tiny island of Sikinos in the Aegean Sea, where he drew inspiration from the relatively primitive surroundings and the intellectual traditions they recalled. “A pervasive theme of ancient Greek literature is that you need to pursue the truth, no matter what the truth might be,” he says. In 2005, he unleashed two papers that challenged the foundations of medical research.
He chose to publish one paper, fittingly, in the online journal PLoS Medicine , which is committed to running any methodologically sound article without regard to how “interesting” the results may be. In the paper, Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time. Simply put, if you're attracted to ideas that have a good chance of being wrong, and if you're motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you'll probably succeed in proving wrong theories right. His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials. The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using the peer-review process—in which journals ask researchers to help decide which studies to publish—to suppress opposing views. “You can question some of the details of John's calculations, but it's hard to argue that the essential ideas aren't absolutely correct,” says Doug Altman, an Oxford University researcher who directs the Centre for Statistics in Medicine.
Still, Ioannidis anticipated that the community might shrug off his findings: sure, a lot of dubious research makes it into journals, but we researchers and physicians know to ignore it and focus on the good stuff, so what's the big deal? The other paper headed off that claim. He zoomed in on 49 of the most highly regarded research findings in medicine over the previous 13 years, as judged by the science community's two standard measures: the papers had appeared in the journals most widely cited in research articles, and the 49 articles themselves were the most widely cited articles in these journals. These were articles that helped lead to the widespread popularity of treatments such as the use of hormone-replacement therapy for menopausal women, vitamin E to reduce the risk of heart disease, coronary stents to ward off heart attacks, and daily low-dose aspirin to control blood pressure and prevent heart attacks and strokes. Ioannidis was putting his contentions to the test not against run-of-the-mill research, or even merely well-accepted research, but against the absolute tip of the research pyramid. Of the 49 articles, 45 claimed to have uncovered effective interventions. Thirty-four of these claims had been retested, and 14 of these, or 41 percent, had been convincingly shown to be wrong or significantly exaggerated. If between a third and a half of the most acclaimed research in medicine was proving untrustworthy, the scope and impact of the problem were undeniable. That article was published in the Journal of the American Medical Association .
DRIVING ME BACK to campus in his smallish SUV—after insisting, as he apparently does with all his visitors, on showing me a nearby lake and the six monasteries situated on an islet within it—Ioannidis apologized profusely for running a yellow light, explaining with a laugh that he didn't trust the truck behind him to stop. Considering his willingness, even eagerness, to slap the face of the medical-research community, Ioannidis comes off as thoughtful, upbeat, and deeply civil. He's a careful listener, and his frequent grin and semi-apologetic chuckle can make the sharp prodding of his arguments seem almost good-natured. He is as quick, if not quicker, to question his own motives and competence as anyone else's. A neat and compact 45-year-old with a trim mustache, he presents as a sort of dashing nerd—Giancarlo Giannini with a bit of Mr. Bean.
The humility and graciousness seem to serve him well in getting across a message that is not easy to digest or, for that matter, believe: that even highly regarded researchers at prestigious institutions sometimes churn out attention-grabbing findings rather than findings likely to be right. But Ioannidis points out that obviously questionable findings cram the pages of top medical journals, not to mention the morning headlines. Consider, he says, the endless stream of results from nutritional studies in which researchers follow thousands of people for some number of years, tracking what they eat and what supplements they take, and how their health changes over the course of the study. “Then the researchers start asking, ‘What did vitamin E do? What did vitamin C or D or A do? What changed with calorie intake, or protein or fat intake? What happened to cholesterol levels? Who got what type of cancer?'” he says. “They run everything through the mill, one at a time, and they start finding associations, and eventually conclude that vitamin X lowers the risk of cancer Y, or this food helps with the risk of that disease.” In a single week this fall, Google's news page offered these headlines: “More Omega-3 Fats Didn't Aid Heart Patients”; “Fruits, Vegetables Cut Cancer Risk for Smokers”; “Soy May Ease Sleep Problems in Older Women”; and dozens of similar stories.
When a five-year study of 10,000 people finds that those who take more vitamin X are less likely to get cancer Y, you'd think you have pretty good reason to take more vitamin X, and physicians routinely pass these recommendations on to patients. But these studies often sharply conflict with one another. Studies have gone back and forth on the cancer-preventing powers of vitamins A, D, and E; on the heart-health benefits of eating fat and carbs; and even on the question of whether being overweight is more likely to extend or shorten your life. How should we choose among these dueling, high-profile nutritional findings? Ioannidis suggests a simple approach: ignore them all.
For starters, he explains, the odds are that in any large database of many nutritional and health factors, there will be a few apparent connections that are in fact merely flukes, not real health effects—it's a bit like combing through long, random strings of letters and claiming there's an important message in any words that happen to turn up. But even if a study managed to highlight a genuine health connection to some nutrient, you're unlikely to benefit much from taking more of it, because we consume thousands of nutrients that act together as a sort of network, and changing intake of just one of them is bound to cause ripples throughout the network that are far too complex for these studies to detect, and that may be as likely to harm you as help you. Even if changing that one factor does bring on the claimed improvement, there's still a good chance that it won't do you much good in the long run, because these studies rarely go on long enough to track the decades-long course of disease and ultimately death. Instead, they track easily measurable health “markers” such as cholesterol levels, blood pressure, and blood-sugar levels, and meta-experts have shown that changes in these markers often don't correlate as well with long-term health as we have been led to believe.
On the relatively rare occasions when a study does go on long enough to track mortality, the findings frequently upend those of the shorter studies. (For example, though the vast majority of studies of overweight individuals link excess weight to ill health, the longest of them haven't convincingly shown that overweight people are likely to die sooner, and a few of them have seemingly demonstrated that moderately overweight people are likely to live longer .) And these problems are aside from ubiquitous measurement errors (for example, people habitually misreport their diets in studies), routine misanalysis (researchers rely on complex software capable of juggling results in ways they don't always understand), and the less common, but serious, problem of outright fraud (which has been revealed, in confidential surveys, to be much more widespread than scientists like to acknowledge).
If a study somehow avoids every one of these problems and finds a real connection to long-term changes in health, you're still not guaranteed to benefit, because studies report average results that typically represent a vast range of individual outcomes. Should you be among the lucky minority that stands to benefit, don't expect a noticeable improvement in your health, because studies usually detect only modest effects that merely tend to whittle your chances of succumbing to a particular disease from small to somewhat smaller. “The odds that anything useful will survive from any of these studies are poor,” says Ioannidis—dismissing in a breath a good chunk of the research into which we sink about $100 billion a year in the United States alone.
And so it goes for all medical studies, he says. Indeed, nutritional studies aren't the worst. Drug studies have the added corruptive force of financial conflict of interest. The exciting links between genes and various diseases and traits that are relentlessly hyped in the press for heralding miraculous around-the-corner treatments for everything from colon cancer to schizophrenia have in the past proved so vulnerable to error and distortion, Ioannidis has found, that in some cases you'd have done about as well by throwing darts at a chart of the genome. (These studies seem to have improved somewhat in recent years, but whether they will hold up or be useful in treatment are still open questions.) Vioxx, Zelnorm, and Baycol were among the widely prescribed drugs found to be safe and effective in large randomized controlled trials before the drugs were yanked from the market as unsafe or not so effective, or both.
“Often the claims made by studies are so extravagant that you can immediately cross them out without needing to know much about the specific problems with the studies,” Ioannidis says. But of course it's that very extravagance of claim (one large randomized controlled trial even proved that secret prayer by unknown parties can save the lives of heart-surgery patients, while another proved that secret prayer can harm them) that helps gets these findings into journals and then into our treatments and lifestyles, especially when the claim builds on impressive-sounding evidence. “Even when the evidence shows that a particular research idea is wrong, if you have thousands of scientists who have invested their careers in it, they'll continue to publish papers on it,” he says. “It's like an epidemic, in the sense that they're infected with these wrong ideas, and they're spreading it to other researchers through journals.”
THOUGH SCIENTISTS AND science journalists are constantly talking up the value of the peer-review process, researchers admit among themselves that biased, erroneous, and even blatantly fraudulent studies easily slip through it. Nature , the grande dame of science journals, stated in a 2006 editorial, “Scientists understand that peer review per se provides only a minimal assurance of quality, and that the public conception of peer review as a stamp of authentication is far from the truth.” What's more, the peer-review process often pressures researchers to shy away from striking out in genuinely new directions, and instead to build on the findings of their colleagues (that is, their potential reviewers) in ways that only seem like breakthroughs—as with the exciting-sounding gene linkages (autism genes identified!) and nutritional findings (olive oil lowers blood pressure!) that are really just dubious and conflicting variations on a theme.
Most journal editors don't even claim to protect against the problems that plague these studies. University and government research overseers rarely step in to directly enforce research quality, and when they do, the science community goes ballistic over the outside interference. The ultimate protection against research error and bias is supposed to come from the way scientists constantly retest each other's results—except they don't. Only the most prominent findings are likely to be put to the test, because there's likely to be publication payoff in firming up the proof, or contradicting it.
But even for medicine's most influential studies, the evidence sometimes remains surprisingly narrow. Of those 45 super-cited studies that Ioannidis focused on, 11 had never been retested. Perhaps worse, Ioannidis found that even when a research error is outed, it typically persists for years or even decades. He looked at three prominent health studies from the 1980s and 1990s that were each later soundly refuted, and discovered that researchers continued to cite the original results as correct more often than as flawed—in one case for at least 12 years after the results were discredited.
Doctors may notice that their patients don't seem to fare as well with certain treatments as the literature would lead them to expect, but the field is appropriately conditioned to subjugate such anecdotal evidence to study findings. Yet much, perhaps even most, of what doctors do has never been formally put to the test in credible studies, given that the need to do so became obvious to the field only in the 1990s, leaving it playing catch-up with a century or more of non-evidence-based medicine, and contributing to Ioannidis's shockingly high estimate of the degree to which medical knowledge is flawed. That we're not routinely made seriously ill by this shortfall, he argues, is due largely to the fact that most medical interventions and advice don't address life-and-death situations, but rather aim to leave us marginally healthier or less unhealthy, so we usually neither gain nor risk all that much.
Medical research is not especially plagued with wrongness. Other meta-research experts have confirmed that similar issues distort research in all fields of science, from physics to economics (where the highly regarded economists J. Bradford DeLong and Kevin Lang once showed how a remarkably consistent paucity of strong evidence in published economics studies made it unlikely that any of them were right). And needless to say, things only get worse when it comes to the pop expertise that endlessly spews at us from diet, relationship, investment, and parenting gurus and pundits. But we expect more of scientists, and especially of medical scientists, given that we believe we are staking our lives on their results. The public hardly recognizes how bad a bet this is. The medical community itself might still be largely oblivious to the scope of the problem, if Ioannidis hadn't forced a confrontation when he published his studies in 2005.
Ioannidis initially thought the community might come out fighting. Instead, it seemed relieved, as if it had been guiltily waiting for someone to blow the whistle, and eager to hear more. David Gorski, a surgeon and researcher at Detroit's Barbara Ann Karmanos Cancer Institute, noted in his prominent medical blog that when he presented Ioannidis's paper on highly cited research at a professional meeting, “not a single one of my surgical colleagues was the least bit surprised or disturbed by its findings.” Ioannidis offers a theory for the relatively calm reception. “I think that people didn't feel I was only trying to provoke them, because I showed that it was a community problem, instead of pointing fingers at individual examples of bad research,” he says. In a sense, he gave scientists an opportunity to cluck about the wrongness without having to acknowledge that they themselves succumb to it—it was something everyone else did.
To say that Ioannidis's work has been embraced would be an understatement. His PLoS Medicine paper is the most downloaded in the journal's history, and it's not even Ioannidis's most-cited work—that would be a paper he published in Nature Genetics on the problems with gene-link studies. Other researchers are eager to work with him: he has published papers with 1,328 different co-authors at 538 institutions in 43 countries, he says. Last year he received, by his estimate, invitations to speak at 1,000 conferences and institutions around the world, and he was accepting an average of about five invitations a month until a case last year of excessive-travel-induced vertigo led him to cut back. Even so, in the weeks before I visited him he had addressed an AIDS conference in San Francisco, the European Society for Clinical Investigation, Harvard's School of Public Health, and the medical schools at Stanford and Tufts.
The irony of his having achieved this sort of success by accusing the medical-research community of chasing after success is not lost on him, and he notes that it ought to raise the question of whether he himself might be pumping up his findings. “If I did a study and the results showed that in fact there wasn't really much bias in research, would I be willing to publish it?” he asks. “That would create a real psychological conflict for me.” But his bigger worry, he says, is that while his fellow researchers seem to be getting the message, he hasn't necessarily forced anyone to do a better job. He fears he won't in the end have done much to improve anyone's health. “There may not be fierce objections to what I'm saying,” he explains. “But it's difficult to change the way that everyday doctors, patients, and healthy people think and behave.”
AS HELTER-SKELTER as the University of Ioannina Medical School campus looks, the hospital abutting it looks reassuringly stolid. Athina Tatsioni has offered to take me on a tour of the facility, but we make it only as far as the entrance when she is greeted—accosted, really—by a worried-looking older woman. Tatsioni, normally a bit reserved, is warm and animated with the woman, and the two have a brief but intense conversation before embracing and saying goodbye. Tatsioni explains to me that the woman and her husband were patients of hers years ago; now the husband has been admitted to the hospital with abdominal pains, and Tatsioni has promised she'll stop by his room later to say hello. Recalling the appendicitis story, I prod a bit, and she confesses she plans to do her own exam. She needs to be circumspect, though, so she won't appear to be second-guessing the other doctors.
Tatsioni doesn't so much fear that someone will carve out the man's healthy appendix. Rather, she's concerned that, like many patients, he'll end up with prescriptions for multiple drugs that will do little to help him, and may well harm him. “Usually what happens is that the doctor will ask for a suite of biochemical tests—liver fat, pancreas function, and so on,” she tells me. “The tests could turn up something, but they're probably irrelevant. Just having a good talk with the patient and getting a close history is much more likely to tell me what's wrong.” Of course, the doctors have all been trained to order these tests, she notes, and doing so is a lot quicker than a long bedside chat. They're also trained to ply the patient with whatever drugs might help whack any errant test numbers back into line. What they're not trained to do is to go back and look at the research papers that helped make these drugs the standard of care. “When you look the papers up, you often find the drugs didn't even work better than a placebo. And no one tested how they worked in combination with the other drugs,” she says. “Just taking the patient off everything can improve their health right away.” But not only is checking out the research another time-consuming task, patients often don't even like it when they're taken off their drugs, she explains; they find their prescriptions reassuring.
Later, Ioannidis tells me he makes a point of having several clinicians on his team. “Researchers and physicians often don't understand each other; they speak different languages,” he says. Knowing that some of his researchers are spending more than half their time seeing patients makes him feel the team is better positioned to bridge that gap; their experience informs the team's research with firsthand knowledge, and helps the team shape its papers in a way more likely to hit home with physicians. It's not that he envisions doctors making all their decisions based solely on solid evidence—there's simply too much complexity in patient treatment to pin down every situation with a great study. “Doctors need to rely on instinct and judgment to make choices,” he says. “But these choices should be as informed as possible by the evidence. And if the evidence isn't good, doctors should know that, too. And so should patients.”
In fact, the question of whether the problems with medical research should be broadcast to the public is a sticky one in the meta-research community. Already feeling that they're fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren't eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding. Ioannidis dismisses these concerns. “If we don't tell the public about these problems, then we're no better than nonscientists who falsely claim they can heal,” he says. “If the drugs don't work and we're not sure how to treat something, why should we claim differently? Some fear that there may be less funding because we stop claiming we can prove we have miraculous treatments. But if we can't really provide those miracles, how long will we be able to fool the public anyway? The scientific enterprise is probably the most fantastic achievement in human history, but that doesn't mean we have a right to overstate what we're accomplishing.”
We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That's because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that's dressed up to seem more right than it is, scientists will keep delivering exactly that.
“Science is a noble endeavor, but it's also a low-yield endeavor,” he says. “I'm not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”
David H. Freedman is the author of Wrong: Why Experts Keep Failing Us—And How to Know When Not to Trust Them . He has been an Atlantic contributor since 1998. 6.4.11
GPs can't be trusted: Clegg suggests plans for GP-led commissioning could see 'substantial' change
Nick Clegg today vowed to address concerns over the Government's controversial NHS reforms after they had to be put on 'pause' due to widespread criticism. The Deputy Prime Minister suggested there could be 'substantial' changes to the legislation to reflect public concern about the proposals to hand GPs control of NHS funding.
But he insisted it was 'uncontroversial' to hand doctors more responsibility, despite MPs stressed they should not be solely in charge of commissioning patient services as critics said 'they cannot be trusted to do the right thing'. Unless there were 'significant changes', there would be a danger of conflicts of interests, with GPs able to commission from private services in which they have a stake.
His defence of the measures came hours after Health Secretary Andrew Lansley was dragged to the Commons to announce a pause in the reform plans. Mr Lansley has been forced to slam the brakes on the flagship proposals because of what he admitted were 'genuine concerns' about them.
Mr Clegg said this morning: 'It is a rather good idea to have them in the driving seat, rather than unaccountable officials who are moving money around from one side of the desk to the other. 'But, yes, with responsibility must come more accountability, which is precisely why we will be looking at these concerns, and will be looking to amend the legislation to reflect that.'
The Liberal Democrat leader said the coalition would listen to 'legitimate' concerns about the Bill, currently going through Parliament, and that there could be 'substantial' changes to the legislation. 'The NHS is not the Government's property. We want people to feel comfortable with the changes, which will strengthen, and not weaken, the NHS,' he told the BBC.
Addressing concerns about competition, he said: 'There isn't going to be a bargain-basement rush to the bottom, because there isn't going to be competition based on price. 'We want to be very, very clear - we're not going to allow cherry-picking. We're certainly not going to allow vital parts of the NHS, like A&E, to be suddenly open to competition.'
In the Commons yesterday, Mr Lansley promised changes to make the GP-led commissioning bodies more accountable and transparent - but refused to row back on the broad thrust of the reforms, insisting that they were essential to help the NHS save money. All 152 PCTs in England will be scrapped along with ten health authorities;
- GPs to take over management of 80% of NHS budget;
- Patients allowed to choose where they are treated – including free private care if necessary;
- Councils and public given new powers to stop local A&E and maternity units closing;
- Far more NHS operations and treatments provided by private companies and charities;
- Hit squads of matrons sent into hospitals to check on elderly care;
- Redundancies among 21,000 staff - but up to seven in 10 managers will keep their jobs.
But last night Stephen Dorrell, Health Secretary between 1995 and 1997, demanded that he 'significantly change' his plans, saying mere tinkering would not be enough. Many of Labour's NHS reforms were ‘badly executed', Ed Miliband said yesterday - as he admitted the last government got it wrong on GPs' contracts.
The Labour leader stopped short of apologising for the botched renegotiation of the contracts in 2003, but admitted that it had been badly handled. The deal has seen average GPs' salaries rocket by 40 per cent to £105,000, while cutting their working week by seven hours.
More than 90 per cent also opted out of responsibility for out-of-hours care. Mr Miliband said: ‘Some reforms were badly executed. The GP contract changes, for example, failed precisely because they reduced, rather than enhanced, the accountability of GPs to their patients for evening and weekend opening.' He also admitted that the last government had set too many targets and meddled too often in NHS re-organisation.
Mr Dorrell, who is chairman of the Commons Health Select Committee, warned that reforms were not 'legitimate, effective or accountable'. Mr Lansley's climbdown came amid signs he is being sidelined following opposition to his plans from doctors and the Liberal Democrats.
David Cameron and Mr Clegg are to launch a PR blitz later this week to make the case for change - signalling their concern that Mr Lansley has failed to explain why the changes are necessary. Yesterday, the Health Secretary told the Commons: 'We recognise that this speed of progress has brought with it some substantive concerns. 'Some of those concerns are misplaced or based on misrepresentations but we recognise that some are genuine.
'We want to continue to listen to, engage with and learn from experts, patients and frontline staff within the NHS and beyond and to respond accordingly. 'We propose to take the opportunity to take a natural break in the passage of the Bill - to pause, to listen and to engage with all those who want the NHS to succeed,' he added.
He said the Health and Social Care Bill would be changed to make it clear private firms would not be able to 'cherry pick' the most lucrative NHS procedures. There would be moves to prevent GPs' potential conflicts of interests, and moves to ensure any decisions they make are transparent. And patients would be given a stronger voice in the NHS.
The concessions follow concern that the reforms, which have gone through the Commons, would not pass the Lords. Mr Lansley said: 'No change is not an option. There is a once-in-a-generation opportunity to set the NHS on a more sustainable course.'
But in his committee's report, Mr Dorrell said that only significant changes would do, and added that GPs should not be solely in charge of commissioning services for patients. He said that they should be joined by nurses, hospital doctors, public health experts, social workers and representatives of communities.
Mr Dorrell described sections of the Health and Social Care Bill, which will bring about the changes, as 'misleading and inaccurate'. He added that Mr Lansley's proposals saw consortia which were too secretive and open to conflicts of interests, and called for the boards to meet in public and publish all their papers. Mr Dorrell said that rather than just being a cosy grouping of GPs, the consortia should be full public bodies with a chief executive and a finance director on the board, and an independent chairman.
Yesterday a think-tank close to Mr Cameron, Policy Exchange, called for the reforms to be delayed. And it also emerged that hundreds of managers made redundant by the NHS in London on Friday could soon be back working for the Health Service if a delay does take place.
Labour leader Ed Miliband condemned the Government's plans as 'ideological and reckless'. 'Going slower isn't the answer to bad policy,' he said. 'It's a bad Bill, built on bad assumptions and dangerous ideology.' Mr Miliband accused ministers of 'horse trading' over the future of the NHS to hold the Coalition together. 'The NHS is too important for its future to be determined in a back-room deal,' he said. 5.4.11
Prostate cancer screening has zero benefit, concludes 20-year study
Don't let anyone from the cancer industry lie to you about PSA screening: The test is completely bogus and offers zero improvement in your lifespan. That's the conclusion from a 20-year study that followed over 9,000 men. After 20 years of follow-up, guess what the results were? No significant difference in the rate of death between those screened for prostate cancer versus those who weren't.
In other words, prostate cancer screening is really a bogus test used to exploit men's fear and recruit them into unnecessary and potentially harmful cancer treatments . That's why the cancer industry uses the PSA test, of course: It's a powerful recruiting tool! It scares men into agreeing to expensive, high-profit treatments which are then billed to their insurance companies, Medicaid or Medicare.
This study, by the way, was published in the British Medical Journal, I don't personally trust the BMJ on most issues, since it seems to so strongly favor vaccines and pharmaceuticals in its selective publication of research. But that's what makes this so remarkable: Even the BMJ is effectively admitting that PSA tests don't work!
Why are hospitals still using a bogus quack test for prostate cancer?
Given that the PSA test simply doesn't work, it makes you wonder: Why are hospitals are cancer centers still using the PSA test? Isn't that quackery to keep using something that doesn't work while marketing it to patients as if it did work? It's not just false advertising -- it's bad medicine! And if it were being done in any other industry, someone would probably get arrested.
If you sold a car that turned out to be a lemon and didn't run, you could be sued. If you sold a financial product but completely misrepresented it to your customers, that would be considered criminal fraud . But why can hospitals and cancer clinics sell PSA prostate cancer tests that are completely bogus while getting away with it?
The answer is because modern medicine has zero accountability . Most of it is simply fabricated quackery. Flu vaccines, for example, are based on completely fabricated quacked-up evidence that has absolutely no connection to scientific reality. ADHD screening programs are absurdly transparent as psychiatric drug marketing tools. Mammograms actually cause breast cancer, and the No. 1 side effect of chemotherapy is -- get this -- cancer itself!
It's all "pretend medicine" in a grand health care fairy tale
Nothing in medicine, you see, has to have any actual scientific evidence behind it at all. The reason PSA tests are so popular is precisely the same reason that flu vaccines are so heavily pushed: Because modern medicine pushers suffer from a deeply-ingrained cult-like irrational belief in everything they were taught in medical school, regardless of whether it has any basis in fact. PSA tests, in other words, are a kind of medical voodoo which works no better than sticking pins in a rag doll.
And as literally dozens of studies have found over the last decades, antidepressant drugs are a kind of "brain chemical voodoo" that works no better than placebo either. Let's face it: Much of modern medicine is based entirely on a virus of the mind -- a contagious yet false idea that somehow disease is caused by a lack of chemicals, radiation or surgery. It's an insane idea, of course, yet it is the foundation of virtually the entire modern system of "health care" (sick care).
A psychic would probably get you better results
If you want to go get screened for all these various diseases, that's your choice, of course. But just know as a scientific fact that most of the medical screening being offered today is no more scientifically valid than a tarot card reading . A tarot card reading might be more valuable, actually, as it would remind you to consider your inner journey and perhaps take responsibility for your life rather than handing it over to a group of utterly incompetent cancer doctors who are still using bogus prostate cancer tests that have been proven utterly useless again and again.
Heck, your cancer doctor might as well use a dousing rod to diagnose your cancer. And even then, if you're told you have cancer, the only rational thing to do anyway is to change your lifestyle and start pursuing anti-cancer activities such as juicing, walking in the sun, avoiding toxic synthetic chemicals and so on. And those things should be pursued whether you have cancer or not!
This is why I never get screened for any disease . I'm in my 40's, and I follow a very healthy lifestyle. I eat massive quantities of anti-cancer superfoods and I completely avoid (to the best of my ability) synthetic chemicals in foods, personal care products, gardening and so on. Why would I even need to get screened for cancer in the first place? There's no valid reason for it.
Cancer isn't something that strikes you like a bolt of lightning, folks. It's something your body can grow over decades until it becomes noticeable -- and it only grows cancer tumors if you let it. The easiest way to stop growing cancer it to boost your vitamin D levels to 70 - 90, eat lots of fresh sprouts, drink fresh juices, get exercise and avoid cancer-causing chemicals. Get plenty of sleep, avoid excessive stress and eat superfoods such as berries (which are loaded with anti-cancer nutrients). And stop eating refined sugars, too, because cancer tumors just love sugar.
It's not a difficult recipe. And when truly followed, it will reduce your risk of cancer to nearly zero. Of course, a stray piece of plutonium from Fukushima could still get inhaled into your lungs and cause cancer, but even in that case, antioxidants help protect you from radiation damage , greatly reducing your risk of cancer even from nuclear fallout radiation.
Nutrition and lifestyle is the answer here, not useless disease screening quackery. Don't fall for the bogus PSA screening and mammography tests. They are designed to scare you into becoming a high-profit cancer patient. They do nothing to improve your health, and they may in fact harm you. Prostate cancer is not a very aggressive cancer in most cases. It can be easily and reliable reversed with the help of any competent naturopathic physician, herbalist or natural medicine practitioner. 4.6.11
'Blinded by Science' explores the power of vibrational energy and water in healing and wellness
The narrow and mechanistic way in which modern science tends to investigate and explain life, the world, and human health has robbed generations of people of a true knowledge of how these things actually work. In an up-and-coming new book Blinded by Science , author Matthew Silverstone explores how vibrational energy, water, magnetism, and plants all play a crucial role in health, and how the Western scientific method as we know it has utterly failed to grasp the critical connection between the natural world and real health.
The field of modern medicine has been largely reduced to nothing more than a type of reactionary, drug-input system where only synthetic chemicals that induce a specific and narrowly-measurable response are considered scientifically valid. Trees, plants, water, sunlight -- these and many other natural features of the world are ignored in favor of a "scientific method" that is not only biased but inherently flawed. And yet, it is the simple things in nature that have everything to do with promoting health.
In his book, Silverstone shares countless hours of research on ideas like vibrational energy, which is found in everything from plants and trees, to the sun and the entire universe. Even at the atomic level, electrons are constantly moving as they spin around nuclei. And understanding this inherent vibrational reality that exists all around us will help explain various unknown phenomena, including inexplicable health conditions, that modern science is incapable of truly explaining.
Building upon the reality of vibrations, Silverstone also explores how vibrational energy affects us and the world around us, including our moods, attitudes, and even our physical health. The vibrational properties of water, he says, make all the difference in how well plants grow, for instance. And the vibrational properties of water affect how beneficial it is in our bodies as well.
Blinded by Science addresses these and many other fascinating concepts that will revolutionize the way you see the world around you. But the even greater thing about the book is that it is part of a "Book 2.0" project where readers can participate in the writing of the final version.
As you download and read one chapter at a time, you will gain access to a forum where you can submit comments and feedback on that chapter, and thus open up access to the other chapters. Not only will your ideas be considered and potentially included in the final release of the book, but you may even earn a co-author spot in the book's credits.
To learn more about Blinded by Science,
From there, you can download the book's introduction for free, and read more about the foundational concepts of the book. You can also register to download any single chapter of the book for free. And if you choose to participate in Book 2.0, you can also begin submitting comments and gaining access to other chapters in the book. 6.4.11
Recession linked to huge rise in use of 'useless' antidepressants
Economic worries are thought to be fuelling a rise in the use of antidepressants after new figures showed prescriptions for the drugs have risen more than 40 per cent over the past four years, despite government plans to reduce their usage and fears of GPs over-prescribing medicines.
The number of prescriptions for drugs such as Prozac has risen from 16 million to 23 million since 2006 with many GPs saying patients are increasingly expressing concern about the recession.
Figures obtained by the BBC under the Freedom of Information Act found the number of prescriptions for the most common group of antidepressants rose by 43 per cent during the period covering the banking crisis and housing crash. Around one in five people in the UK will be affected by depression at some point and the rise in the number of prescriptions is thought to be partly down to better diagnosis.
But Dr Clare Gerada, head of the Royal College of GPs said some of the rise could also be explained by concern over worsening financial conditions. She said: “Of course in times of economic problems we would expect mental health problems to worsen – and GPs are seeing more people coming in with debts racking up, or who have lost their jobs and are cancelling their holidays.
“They feel guilty that they can't provide for their family and these things can often act as a trigger for depression.”
Mental health charities have also reported an increase in the number of people contacting them with money worries. The chief executive of Sane, Marjorie Wallace, said: “It is impossible to say for sure that economic problems are leading to a rise in depression. But we are certainly hearing more from people who are worried where their next meal is coming from, job security and cuts in benefits – many who are getting in touch with us for the first time.
“It's a toxic combination, especially for those who already have darker thoughts and other problems.”
Care services minister Paul Burstow said: “The last recession has left many people facing tough times. If people do experience mental health problems, the NHS is well placed to help. “We're boosting funding for taking therapies by £400 million over the next four years. This will ensure that modern, evidence based therapies are available to all who need them, whether their depression or anxiety are caused by economic worries or anything else.” 7.4.11
Amount of drugs prescribed by GPs triples over 15 years
The amount of drugs prescribed by GPs has more than tripled over the past 15 years due to their financial ties to pharmaceutical giants who push their use, official figures show.
The Office for National Statistics said the steep rise in medication being given to patients was one of the key factors behind increased healthcare activity. Separate figures collected by the National Health Service show that 886million prescriptions are now dispensed every year, at a cost of £8.5billion.
It has renewed concerns that doctors are doling out pills to patients who do not really need them, potentially damaging their health as well as wasting public money.
However medics point out that the population is growing as well as ageing, while new treatments are being developed to help those with chronic conditions. The figures have emerged as Scotland became the latest country to make prescriptions free for patients, while charges for patients in England rose by 20p to £7.40 for each item.
Celia Grandison-Markey, interim chairman of the Patients Association, said: "It is worrying that there has been such a large increase in the number of drugs being prescribed to patients. "Drugs are not always the answer and besides it being potentially dangerous to take medicines that are not needed, over-prescription of drugs can lead to an increase in antibiotic resistant bacteria such as MRSA.
"With prescription charges increasing by 20p across England, not only are patients taking more pills but the cost of getting them has become more expensive to patients. "We are concerned that many doctors are prescribing medicines unnecessarily because they do not have enough time to sit with their patients and talk about options other than taking medication."
The new ONS report on productivity in the NHS said that an increase in medication was one of the main factors that “drove output growth between 1995 and 2009”, with output defined as the health services provided across Britain. It said: “The volume of drugs prescribed by GPs more than tripled over the whole period, with growth averaging 8.6 per cent per year.”
Drugs dispensed by GPs also accounted for a significant proportion of the goods and services purchased by the health sector. Figures produced by the NHS Information Centre provide more detail on the medication prescribed in England.
They show that in 1995, 473.3m prescriptions were written out, at a cost of £3.680bn. This is equivalent to an average cost per item of £7.78, and the average person receiving 9.8 prescriptions. By 2009, the number of prescriptions had almost doubled to reach 886m, at a cost of £8.539bn. This means the average item cost £9.64 and the average number of prescriptions per head of population had reached 17.1 a year.
In recent years, many more adults have begun taking medication for conditions such as obesity and depression, with 39.1m anti-depressants prescribed in England in 2009 and 1.5m prescriptions for weight-loss pills.
Concerns have also been raised about the number of children being prescribed drugs to control their behaviour. Recent figures show that 650,000 children aged between eight and 13 are now taking Ritalin to treat attention deficit hyperactivity disorder (ADHD), a compared with just 9,000 two decades earlier.
As many as 7million people in England, most over 40, take statins to lower their cholesterol despite a lack of evidence that they protect many from heart disease. Four of the five most commonly prescribed drugs are used to treat cardiovascular disease, while the number of medicines used to treat diabetes symptoms have also tripled.
Antibiotics are also routinely handed out to patients with coughs and colds, which scientists fear could be fuelling the number of drug-resistant infections such as MRSA.
Earlier this year the head of the drug safety regulator, the Medicine and Healthcare Products Regulatory Agency, said that NHS patients are being prescribed too many drugs. Prof Sir Alasdair Breckenridge said that pharmacists should be encouraged to challenge the prescriptions that doctors write for their patients, and ask: “Is this really necessary?”
“We have more powerful drugs with more possible adverse effects than in the past,” he warned.
But Dr Laurence Buckman, Chairman of the British Medical Association's GPs Committee, said: ""There are many reasons why prescribing rates have risen. Our population is growing, we can treat more illnesses than ever before, we are all getting older and, as a result, the number of people with multiple long-term conditions is also on the rise. It's not unusual now to find a patient with an array of prescriptions to treat their various conditions."
A Department of Health spokesman added: "It is up to individual clinicians to decide what treatment is most appropriate for their patient, and increased prescribing does not necessarily indicate over prescribing.
"The continued upward trend in the number of prescriptions dispensed in the community in England reflects a number of factors including our increasing and ageing population, increased access to new and more effective medicines, changes in prescription length and the move towards prescribing medicines preventatively, such as low cost statins to reduce deaths from cardiovascular disease." 7.4.11
Antidepressants linked to higher heart disease and stroke risk
People taking antidepressants are more likely at the risk of heart disease and strokes, says study. Though many studies have been done to build any potential association between depression and heart stroke, this is for the first time that a significant association has been revealed between use of antidepressants and risk of heart diseases.
After reviewing the data of 513 middle-aged male twins who were part of the Vietnam Era Twin Registry, the team claimed that antidepressants can increase the thickness of carotid artery, which is known as carotid intima-media thickness, resulting in higher risk of heart stroke.
Responding to the study, the lead researcher of the study, Dr. Amit Shahclaimed, “there is a clear association between increased intima-media thickness and taking an antidepressant, and this trend is even stronger when we look at people who are on these medications and are more depressed”.
Moreover, the team has warned that a small amount of increase in intima-media thickness can raise the risk of heart attack by a significant 1.8%.
The team believes that there is no clear evidence suggesting any possible reason for the strong association between the two, there is high possibility that antidepressant increase the level of brain chemicals serotonin and norepinephrine, which inhibits the flow of blood in human brain and consequently, shoots the blood pressure. 6.4.11
Obesity and alcohol misuse are "preventable health issues" which costs NHS £140m in Wales
Obesity and excessive drinking are 'preventable issues' costing the NHS in Wales more than £140m each year, according to research. The Swansea University study warned the true cost of both could be even higher.
Those at the sharp end dealing with the effects of alcohol and obesity say they are growing problems, and affecting people at a younger age.
Chief medical officer Dr Tony Jewell said both were "preventable health issues" and people had to take responsibility for their own actions. The research, commissioned by the assembly government, put the cost of obesity to the NHS in Wales at £73m and excessive alcohol consumption at between £69.9m and £73.3m.
This works out as between £25 and £29 a person in Wales for obesity and about £24 a person for alcohol.
Prof Ceri Phillips, who was involved in the study, said it was likely about 3% of NHS Wales spending, increasing to 10% if smoking is included, could be "attributed to the additional demands placed on NHS Wales as a result of lifestyle behaviours".
Wales continues to have high levels of alcohol abuse, obesity and other lifestyle behaviours relative to other countries, despite the efforts and successes of organisations to address behaviours that have major implications for people's health," he said. Researchers said excessive drinking and obesity needed to be tackled in a "cost-effective" way at a time of pressure on NHS Wales budgets.
The study looked at factors such as hospital admissions, GP consultations and prescription costs attributable to alcohol misuse and obesity.
Dr Jewell said this was the first time for such an estimate. "In addition to legislation and pricing mechanisms people need to understand the health and social risks that come from the choices they make and take responsibility for their own health and making informed lifestyle choices," he said.
"People rightly expect the NHS to be there when they get ill, but we need to reinforce the message that they also need to help the NHS by taking responsibility for their own actions."
Dr Eamon Jessop, a GP from Prestatyn, said there was a need to educate the public on the issue via the media. But he added: "We can't come down top-heavy, constantly saying to patients: 'We are taking on your problem for you'. "If the patient has a problem and comes to us we'll give them all the help in the world, but ultimately it's they who have got to make that first step."
Specialist dietician Sioned Quirke, who works in the NHS in Wales , said: "It [obesity] is such an overwhelming problem. I see people who are obese but also people who are super-morbidly obese. "We're seeing teenagers with type two diabetes which is normally the late onset diabetes [most common in older people] because they're overweight - their organs can't cope with the fat they're carrying. "We're seeing it younger and younger and it's horrifying."
The Welsh health survey in 2008 said 21% of people in Wales were obese and 57% were either obese or overweight. Excessive drinking has also long been a concern in Wales where about one in four say they binge drink.
Wynford Ellis Owen, chief executive of the Welsh Council on Alcohol and Other Drugs, said: "We have to really look at the underlying problems here." He said drinking culture was about "avoiding the burden of being human" but children had to be taught that life was also about feeling sad sometimes. "I think more money needs to be spend on better parenting - it's about teaching children to grow up... and how to deal with problems," he added. 31.3.11
Whitehall IT chief Ian Watmore attacks Labour's record
Tony Blair's former IT chief has said Labour ministers ordered expensive computer projects because they wanted their policies to "sound sexy". Ian Watmore - who is now in charge of a Whitehall efficiency drive - gave a scathing assessment of the previous government's IT record.
He told the public administration committee Labour's procurement had been over-ambitious and badly-managed.
Critics said 'Labour's record is a disaster of throwing money at ill-conceived and poorly executed projects like health, education, immigration and social welfare. It appointed ministers who were out of their depth like Jacqui Smith who had never running anything before she was appointed Home Secretary and ex-postman Alan Johnson who was appointed Shadow chancellor even though he did not has an interest in economics or a basis grasp of fiscal policy. The problem is, these people have been running the country'.
The coalition has called a halt to big IT projects to save cash.
In a strategy document published by the Cabinet Office, it vowed to move to "smaller more manageable projects" and said no scheme will cost more than £100m.
It has also promised to open up procurement to smaller firms, who have found it difficult in the past to break the grip of giants such as HP, BT and Fujitsu, who together get about a third of central government contracts, worth about £5bn a year.
Mr Watmore, who is permanent secretary at the Cabinet Office, said some of the high profile IT "fiascos" under the previous government had not been down to defective technology but to poor project management and badly-defined policies.
Too often, he told the Commons public administration committee, ministers simply ordered IT as an "after thought... or worse, there were people thinking they needed to have a piece of technology to make their policy sound sexy".
Mr Watmore became the head of Tony Blair's e-Government Unit in 2004 - at the height of Labour's IT procurement strategy - before going on to head the then Prime Minister's Delivery Unit.
He then left government for a brief spell as chief executive of the Football Association, before being brought back to Whitehall last year by Cabinet Office minister Francis Maude - who was also being grilled by the committee - with the task of cutting waste.
But it was Mr Watmore's career before entering government, when he was managing director of IT consultancy giant Accenture, that came under the spotlight most during the two-hour grilling by MPs.
Committee chairman Bernard Jenkin told him: "You come from exactly the large corporate culture which has bedevilled IT procurement in government. Are you part of the cultural change the minister is looking for, or aren't you just part of the problem?"
Mr Watmore replied: "I am certainly not part of the problem and I would contest that the corporate industry of this country has caused the problems."
He said the "so-called IT disasters" of recent years were not down to technical problems but "over-ambitious projects" that were expected to deliver complex changes at a national level on a single day, "the so-called 'Big Bang' implementation".
Mr Jenkin also questioned the government's commitment to "open source" software, asking how many civil servants in charge of making the policy work had a background in the open source community. He pointed out that the previous government's "open source" guru had left to join Microsoft.
Mr Watmore, who claims to have already saved £2bn in Whitehall efficiencies, said he wants to end the UK government's reliance on Microsoft products, which are used by about 90% of civil servants.
He insisted the government was committed to using more "open source" software to save cash - but had to balance this with concerns about how easily it could be "hacked".
His "personal" view, he added, was that Apple products, which he said he used at home, should also be used more in government. "I personally would like to see people move off Microsoft products onto open source or use Apple technology. "I use Apple at home. I know it's not very open but I use it. I love it, it works and I think it is great - I'm Steve Jobs' best customer. 31.3.11
Labours legacy - School leavers unfit for work: 'Firms forced to spend billions on remedial training for victims of education failure'
After been told exam results wer improving every year under Labour it turns out private firms are spending billions on remedial training for school leavers who are not capable of work, a business leader said yesterday. In a scathing attack on Labour's legacy, he said the youngsters are the victims of an ‘education failure', and called for the urgent return of grammar schools.
The comments by David Frost, the outgoing director general of the British Chambers of Commerce, came on the day teachers at one secondary school went on strike in protest over their uncontrollable pupils. At another, a headmistress exasperated with slovenly standards of behaviour and continual fiddling with electronic gadgets, handed out more than 700 detentions in four days.
Both cases highlight a crisis in discipline which many believe has contributed to a drop in attainment by many children.
Mr Frost, who speaks for more than 100,000 British businesses, told the BCC annual conference in London: ‘Despite the billions that have been spent over the last decade, business relentlessly bemoans the lack of skills available. ‘What they are really describing is a failure of the education system. ‘A system where half of all kids fail to get five decent GCSEs simply means that five years later we spend billions offering them remedial training to make them work-ready.'
Mr Frost made an unashamed call for the return of grammars to improve social mobility by giving youngsters from poorer backgrounds greater opportunities. Earlier this week, ministers led by Nick Clegg published their strategy to close the gap between rich and poor, but there was no mention of expanding selective education.
Mr Frost suggested this was a mistake, although he backed the Government's creation of more technical schools. He said: ‘If we really want to focus on social mobility rather than just internships why not re-introduce grammar schools?
‘They provided the escape route for bright working class children. I appear to be a lone voice on this subject, and find little support. ‘But high quality state academic education coupled with high quality vocational education . . . would, I believe, make a major contribution to the future economic performance of the UK.'
Mr Frost joins the growing ranks of business leaders to attack Labour's record on education. Former Tesco boss Sir Terry Leahy described school standards as ‘woeful' in 2009. His comments were echoed in the same year by former Marks & Spencer chief Sir Stuart Rose, who said many school leavers were not ‘fit for work'.
Despite a doubling of spending on education since 2000, from £35.8billion to £71billion, Britain has plummeted down world rankings, according to the respected Organisation for Economic Co-operation and Development. During this period the UK slipped from eighth to 28th in maths, from seventh to 25th in reading and from fourth to 16th in science. It is now behind relatively poor nations such as Estonia, Poland and Slovakia.
Disturbingly, the study found that a fifth of 15-year-olds are ‘functionally illiterate'. Under Labour there was a 3,800 per cent increase in uptake of non-academic GCSE-equivalent courses. In 2005 15,000 were taken. This soared to 575,000 last year.
Education Secretary Michael Gove has signalled that he will scrap the most pointless vocational courses and is encouraging schools to concentrate on the teaching of core subjects including English, maths, science, modern languages, history and geography. Mr Gove is also seeking to encourage leading businesses to open University Technical Colleges to teach students from the age of 14 practical skills alongside academic subjects.
Last night Charlotte Leslie, a Conservative MP and member of the Education Select Committee, agreed with Mr Frost. She said: ‘It's no good former ministers insisting Labour's education legacy is fine. Businesses tell the real story, and it is our young people who are suffering.'
A spokesman for the Department for Education said: ‘Employers are right to demand more from the education system. We're overhauling schools to keep pace with the leading economies in the world.' 7.4.11
NHS too slow to adopt good ideas
How can the NHS speed up the way it spreads good practice? The use of a blood flow monitor during major surgery reduces complications and speeds the recovery of patients. This is not the first time that the monitor has been shown to be effective.
Over the past decade there has been a steady flow of clinical trials and assessments which have demonstrated that it benefits patients and budgets. In a cash-strapped health service it is worrying that the NHS is taking so long to adopt good ideas.
Professor Monty Mythen, from University College Hospital London, which has been using the monitor for 15 years, said it was partly down to what he called "silo-budgeting". He said: "The cost of the probe - about £100 a time - comes out of the anaesthetics budget. That is a big extra cost. It saves £1,000 in the weeks to come but that saving goes to the surgical budget." This suggests a worrying lack of joined-up thinking.
NICE suggests that more than 800,000 patients a year in England could benefit from being monitored using the ultrasound device. Those are patients undergoing major or high-risk surgery. At present fewer than 25,000 patients are monitored using it.
Of course patients have no idea whether they have had their blood flow monitored using the ultrasound machine, because it is introduced into their oesophagus when they are under a general anaesthetic.
But surgical teams and hospital managers have a duty to ensure that proven technologies which benefit patients get used - especially when they also save the NHS a huge amount of money. Perhaps we might one day see patients demanding the use of such medical devices in the same way cancer patients have demonstrated over the refusal to give them new therapies. 31.3.11
Study helps confirm effectiveness of intravenous vitamin C in fighting cancer
New open-access, collaborative study published in the Journal of Translational Medicine provides a credible, scientific rationale for the use of intravenous vitamin C as a treatment for cancer. Citing 246 references and supported by both oncologists and alternative medicine practitioners, the study highlights the scientific successes involving the use of intravenous vitamin C to improve immunity, help prevent cachexia, and boost overall quality of life for cancer patients.
"Currently there is a great divide in the way intravenous vitamin C is viewed," said Thomas Ichim, a board member of the Riordan Clinic and first author of the publication. "On the one hand, you have alternative medicine practitioners who have been claiming very interesting results in practical treatment of cancer patients, but cannot explain any molecular rationale for its use or potential effects. On the other hand you have a great amount of scientific literature supporting possible relevance of this approach in cancer. This paper is a significant step towards closing the divide."
Among its various findings, the study suggests that ascorbic acid, an isolated form of vitamin C, may help to protect endothelial cells from chronic stress. Several sources cited in the study also suggest that cancer patients generally lack adequate vitamin C levels, for which higher levels of disease-causing inflammation are a result. Cited references in the study also showed that high-dose vitamin C is even linked to actually stopping the growth of tumors and causing them to shrink.
The Riordan Clinic-promoted study specifically differentiates between oral and intravenous vitamin C treatments, suggesting that only the latter has been proven effective in cancer treatment. Since the body is only capable of assimilating so much vitamin C at a time orally, it is difficult to consume enough in this manner to effectively treat serious diseases. However, previous studies confirm the effective of high-dose intravenous vitamin C in disease treatment.
A 1935 study out of Columbia University found that high-dose vitamin C helps to prevent polio, while another from the same year showed it helps treat diphtheria. A study published a few years later in the Journal of Southern Medicine and Surgery found that high-dose vitamin C can help cure viral pneumonia. And various other studies have confirmed that high-dose vitamin C is capable of treating kidney stones and heart disease as well.
The US Food and Drug Administration (FDA), meanwhile, has been busy trying to outlaw intravenous vitamin C as a legal disease treatment. Back in January, the Alliance for Natural Health announced that the FDA had begun trying to criminally prosecute manufacturers of intravenous vitamin C therapies. Natural news 6.4.11
Also see: What alternative medicine has known for 30 years: Vitamin C jabs 'trigger fightback against cancer'