Time to smash up this broken system
When Labour's Frank Field - who was asked by Tony Blair to 'think the unthinkable' on welfare - heard Gordon Brown planned to put a stop to his reforms, he hurried to No 11 and quoted Gladstone. 'Any fool can give money to the poor,' he told Mr Brown. 'The question is whether money gives them freedom.' But freedom was the last thing that interested Mr Brown. He wanted the poor dependent on the government and voting Labour. Set them free and they might, horror of horrors, turn Conservative.
The results have been catastrophic for this country. We are spending 14 per cent of our national income on welfare. Under Labour the total welfare bill, which is now more than £200 billion including tax credits, has doubled since 1997. Yet what is there to show for it? Eight million adults are not in work. One in five people of working age lack a job. Child poverty has soared. There are families where three generations have never had a job - and we are all paying for it. Britain 's welfare system is well and truly 'bust', points out Iain Duncan Smith.
The new Work and Pensions Secretary is promising to achieve what Frank Field was stopped from doing - a transformation of the benefit system. That means setting people free from a system that penalises work. Only 'a moron', admits Mr Duncan Smith, would bother getting a low-paid job today. Not only would they lose almost all their housing and council tax benefit, but a range of other entitlements as well, such as free school meals and school-trip subsidies.
The poor who get a job face handing 95p over to the state for every extra £1 they earn. Mr Duncan Smith goes on: 'These are tax levels none of the wealthiest bankers are asked to pay.' The benefit system should be helping people in difficulty. Instead, it is trapping people in poverty. Iain Duncan Smith's reforms depend on getting people into jobs. But this assumes the jobs exist and that the unemployed can do them. Both of these are dangerous assumptions as I have recently discovered.
That people are desperate to work but trapped by benefits is something I saw for myself when I recently tried to find employment for a Brixton gang I met while researching the benefits culture. I discovered that the National Skills Academy would offer them £150 a week for work in the sports and leisure industry. Crucially this would not affect benefits. Soon it was not just the gang members I was helping. As word got around, I received phone calls from friends, cousins and uncles of the boys.
'We hear you got jobs. You're the job lady,' they exclaimed. The trouble is the National Skills Academy has been drastically - and let us hope temporarily - cut back under the new government's austerity measures. Yet these are the kind of people - semi-literate, little or no experience of work and often with a criminal record - that Iain Duncan Smith's reforms have to reach if they are to succeed.
The difficulty he faces was summed up by the owner of a group of pubs and restaurants, who said: 'We suffer from a desperate shortage of unskilled labour.' He added: 'I would not dream of employing anyone English - that is anyone who has been through the English state education system.'
Instead of disadvantaged men in South London , he hires immigrants. 'Mexicans are the flavour this month,' he said. Sir Terry Leahy, chief executive of Tesco, put it bluntly. Too many children have been leaving school after 11 or 13 years of compulsory education, 'without the basic skills to get on in life and hold down a job'. He said five million adults were functionally illiterate and 17 million could not add up properly. 'On-the-job training' cannot act as a sticking plaster for the failure of our education system, he added.
A CBI survey revealed literacy and numeracy were not the only problems. More than half of employers complained young people were inarticulate, unable to communicate concisely, interpret written instructions or do simple mental calculations.
That about sums up the young men I have been trying to help and explains why of the 1.7 million new jobs created since 1997, 81 per cent have gone to foreign workers. The gang members took me to a Job Centre in South London to illustrate the problems they faced. It was a revelation. First, even the most menial jobs required a qualification. Temporary retail staff, for example, 'must be numerate'. 'What does that mean,' asked 17-year-old Mash, adjusting his hoodie.
'Every job says you need something,' said Tuggy Tug, the gang leader. 'There's even a special kind of training you need for stacking shelves in Iceland .' In addition, nearly every job was temporary. That meant work was out of the question. 'When the job finishes, you sign back on and your money doesn't come through for three weeks,' the gang explained to me patiently.
'How are you meant to eat?' For those on housing benefits, the consequences are dire - as Crusher, a former armed robber in his thirties and desperate for work, discovered when he started at a job agency. He was startled to discover he was the only English person working there.
Research shows that the majority of immigrants have at least three to five years' more education than the average school leaver such as Crusher. They see low-paid work as a chance to learn English and a stepping stone to a better life. As one Polish girl told me: 'I might be working as a cleaner now. But in five years' time, I will be running my own cleaning company.' Crusher, who can barely add up, has no such hope. Indeed, far from the first step to a better life, the job cost him his housing benefit.
Now it is over, he cannot pay his debts and is in court this week for rent arrears. The prospect of losing his home, has 'fair put me off' ever seeking work again. Even the lowest-level job requires computer skills. Stinger, another man in his thirties, tried working on a station platform.
He said: 'I had to go on to a computer and fill in seven pages online for a poxy job. And I haven't heard back from them.' Crusher and Stinger admitted to being on incapacity benefit. They are not the only ones. About 43 per cent of the unemployed are stuck on some sort of sickness payment.
Iain Duncan Smith says 'people basically get parked on this benefit and forgotten about. If you have been on this benefit for more than two years, you are likely to die on it'. He has promised to move 'a significant number' into work. This is radical welfare reform. Both Crusher and Stinger have been on incapacity benefit for 15 years. Like 40 percent of those claiming the benefit, they put it down to mental health problems.
Crusher laughed: 'It's easy, innit. How can the doctor tell you that you are not depressed?' Stinger shook his head. 'But we are,' he said. 'Our lives are all mashed up.' The question is, can Iain Duncan Smith make sure that does not happen to the next generation. Can he set them free? 28.5.10
This painful price for 13 years of Labours' profligacy
The response to yesterday's announcement from Treasury chief secretary David Laws that he planned some £6billion in spending cuts couldn't have been more predictable – or more pathetic. Liam Byrne, Labour's discredited Treasury spokesman, claimed that the cuts package would plunge Britain back into what he called a ‘double dip' recession.
Meanwhile, a phalanx of trade unionists came forward to warn of economic devastation and a massive loss of public sector jobs. But it is obvious that Mr Byrne does not know what he is talking about.
Britain 's total economic product adds up to well over £1trillion. The idea that the loss of £6billion (scarcely 0.5 per cent of the whole economy) could make the slightest difference is economic illiteracy of a very high order. The horrific truth is that unless this country starts to make cuts now, international markets will lose confidence in our economy and plunge us into the same kind of financial crisis that Greece is enduring.
Moreover, the main problem with the economic package from George Osborne and David Laws is not – as the Labour Party claims – that their cuts have come too soon. It is that – as a result of Labour's delay and defeat – they have come much too late.
The facts are simply terrifying. This year the Government is set to spend approximately £170billion more than it will generate from taxation – that's a phenomenal £500million a day. Our indebtedness is far, far higher than it has ever been before in peacetime – the direct result of Gordon Brown's crass management of the economy.
Indeed, the wretched Mr Byrne admitted as much when he left a cynical note behind to his successor after the election noting that ‘there's no money left'.
However, that infamous letter actually understates the scale of the problem. We actually ran out of our own money, thanks to Labour's profligacy several years ago. Now we have run out of other people's money as well. Thirteen years ago, when Labour took over from the Tories, the national debt stood at a comparatively modest £350billion.
Over the past decade that has doubled to just over £700billion. Tragically, under Treasury projections, that sum is set to double again over the next five years to around £1.4trillion.
Even these unimaginable sums of money hugely underestimate the scale of the problem. It is now dawning on financial experts that Mr Brown hid much of our public debt (such as the giant liabilities incurred by our public sector pension funds) off the national balance sheet. Only urgent, hideous and painful surgery can tackle a problem like this.
The £6billion which Mr Laws and Mr Osborne are planning to wipe from the national spending ledger this year represents only a fraction of the work that needs to be done. Indeed, the scale of what lies ahead can hardly be exaggerated.
The cuts that await us over the next few years are far greater than the so-called ‘savage' cuts imposed by Margaret Thatcher and her Chancellor Geoffrey Howe in the 1980s. In all, at least £80billion – and very likely far more, depending on economic circumstances in the years ahead – need to be slashed from annual national expenditure. Therefore, there is huge pain in the pipeline.
Yesterday's axe was merely for starters. The true scale of cuts will only partly be apparent by the time of Mr Osborne's emergency budget on June 22. And the complete picture will be clear only much later in the year, when he announces the results of his comprehensive spending review of all future departmental expenditure.
Bear in mind that, thanks to the prolifically prudent but cowardly decision to protect spending on the NHS, some departments face cuts on a scale that calls their very existence into question.
Let's take the Ministry of Defence. Currently, Britain is fighting a bloody and terrible war in Afghanistan and has military commitments all over the globe. Yet no less than £7billion – roughly one quarter of all defence expenditure – looks set for the chop.
Major programmes, such as the Eurofighter, may have to go. So will plans to build new aircraft carriers. The idea of Britain as a nation with a defence capacity to police the globe will vanish. In order to understand the monstrous amounts involved in this whole process, it is helpful to contemplate the measures already taken by near bankrupt European countries such as Spain , Greece and Ireland.
Most public programmes have been stopped. Civil service pay has been cut by as much as 20 per cent while the age at which state workers can receive pensions has risen sharply. Unemployment benefits have been slashed, while taxation has risen sharply. Here, it can now be taken for granted that VAT will rise from the present 17.5 per cent to 20 per cent and quite possibly more.
Punitively, the budget changes that are now inevitable over the next five years will change us forever as a nation. The truth is that Britain resembles a profligate and irresponsible family which has long been living way beyond its means. We have enjoyed an exaggerated idea of our international standing, and a standard of living to which we are not entitled. Finally, the bank manager is now calling in his loans – and giving us the unpleasant choice between bankruptcy or a very painful drop in living standards.
By the luxurious standards of the New Labour years, yesterday's cuts – the slashing of several quangos, the loss of tens of thousands of student places and the ending of certain civil service perks – may have sounded very severe. But in comparison to what is to come, they were nothing. Sailors sometimes talk of seeing a ‘cloud no bigger than a man's hands' on the distant horizon. Now we lie in wait for the hurricane. 25.5.10
Statins: The side effects 'are worse than feared'
The side effects of statins can be far worse than previously thought, a study suggests. For the first time, the level of harm posed by the cholesterol-lowering drugs has been quantified by researchers. They found some users are much more likely to suffer liver dysfunction, acute kidney failure, cataracts and muscle damage known as myopathy.
For some patients, the risk is eight times higher than among those not taking statins. Overall, the risk of myopathy - which may be irreversible - is six times higher for men on statins and three times higher for women. The scientists from Nottingham University stressed the benefits of statins in stopping heart disease outweigh the risks for most patients.
However, the study will put the brakes on calls for statins to be given to the healthy for prevention, where there are no classic risk factors or symptoms. Statins are prescribed for six million patients at risk of heart disease, including diabetics and angina sufferers. Although drug information leaflets warn of side effects, there has been little analysis of the relative risks and benefits.
The latest study, in the British Medical Journal, used records of more than two million patients in England and Wales aged 30 to 84. Of these patients, 225,922 were new users of various types of statins. Their health was analysed from 2002 to 2008 to determine risk by gender, ethnicity and other medical conditions.
For example, the risk of myopathy for black male patients was eight times higher than for non- statin users. It was also five times higher for women with type 1 diabetes and double for women with type 2 diabetes.
The results showed statin use was linked to lower risk of oesophageal cancer but increased risk of moderate or serious liver dysfunction, acute renal failure, moderate or serious myopathy and cataracts. The study estimated the number of extra cases of a certain condition that could be expected for each 10,000 patients treated with statins.
For high-risk women, there would be 271 fewer cases of heart disease and eight fewer cases of oesophageal cancer but 74 more of liver dysfuncpatientstion, 23 more of kidney failure, 307 more of cataracts and 39 more of myopathy. The figures for high-risk men were similar, except for myopathy, with an extra 110 cases.
In medium-risk women, there would be 228 fewer cases of heart disease and seven of oesophageal cancer. However, there were 17 extra cases of renal failure, 252 of cataracts, 65 of liver dysfunction and 32 of myopathy. Figures for medium-risk men were again similar except for a higher risk of myopathy.
The higher the dose of a statin, the more at risk a patient was from acute kidney failure and liver dysfunction. Lead researcher Julia Hippisley-Cox, of Nottingham University , said one of the reasons for the study was the lack of hard evidence about the level of side effects.
She added that the results were being fed into a website - www. qintervention.org - where doctors and could assess an individual's risk of certain side effects. She called for doctors to closely monitor those at higher risk through more frequent checks on liver, kidney, muscle and eye health.
June Davison, of the British Heart Foundation, said: 'For people with, or at high risk of heart disease, the benefits of statins far outweigh this risk. 'The good news is that the researchers found no significant link between the use of statins and risk of Parkinson's disease or many cancers.' 21.5.10
NHS Whistleblowing Policies Criticised
Some NHS trusts are still making it difficult for staff to speak out with concerns over patient care, according to an analysis published today. This is the finding from a new investigation published on the website of the British Medical Journal. Assistant editor Deborah Cohen and colleagues put together a spreadsheet of trust policies.
They write: "The ability to raise concerns about a colleague's work is important for patient safety. On paper, whistleblowing is protected by law, written into all NHS trust policies, and supported by various bodies such as Public Concern at Work and the National Patient Safety Agency. "Putting it into practice, however, is a different matter."
The analysis of 118 of the 122 NHS foundation trusts shows "widely differing approaches", they report. Policy documents came from trust websites or requests under the Freedom of Information Act, and were compared against six standards set out in the Whistleblowing Best Practice guide produced by Public Concern at Work.
Twenty-two of the policies do not give examples of types of concerns to be raised, and more than a third (43) put constraints on staff going outside the trust with concerns, such as having to go through management first, only after following internal procedures, or only when raising concerns with management was unsuccessful.
Law expert Dr Peter Gooderham of Manchester University, UK , commented on the policies. He said: "It should be made clear that the finger won't be pointed at them if they take steps to raise a genuine concern. We need some positive recognition for people who have raised concerns and they shouldn't be treated as troublemakers, ostracising them, suspending them from work, and so on." 19.5.10
Course of antibiotics 'can leave a patient resistant to that drug for up to a year'
Taking a single course of antibiotics can leave a patient resistant to that drug for up to a year, a new study has found. Up to 10 million Britons are wrongly given the medications every year, despite a Government drive to stop GPs handing them out for coughs and colds, against which they are useless.
Now a new study has shown that the stark effects of such inappropriate prescribing. Researchers found that giving patients a course of antibiotics doubles the chance they will develop bacterial resistance. The effect can last for up to 12 months. Although doctors can often use another antibiotic to treat a patient's infection, this risks building resistance to that drug, creating a vicious circle.
Overuse of antibiotics has fuelled the development of hospital superbugs, such as MRSA. More than £100 million is wasted every year on the drugs being wrongly prescribed every year. The drugs do not work against viral infections but GPs report that they often feel under pressure from patients to hand them over.
Dr Alastair Hay, from the University of Bristol , who led the study, said that while antibiotic resistance was recognised as a public health problem most people did not see that as a reason to stop using them. He said: “I'm also a GP and I have this conversation all the time with patients. “If you start talking to them about antibiotic resistance it is likely that you will see their eyes glaze over.
“What we all think is that one more course of antibiotics is not going to make any difference. “But if you look at the evidence you see that it does make a difference to the individual.” Resistance to antibiotics is on the increase, and studies suggest that resistance to some of the drugs among the general public is already running at between 20 and 40 per cent.
The findings, published in the British Medical Journal, analysed results from 24 studies on patients given antibiotics. "Effects were strongest in the month directly after prescription but were detectable for up to 12 months,” they write. “This residual effect is likely to be an important driver for the high endemic levels of antibiotic resistance in the community.” They add: "In general practice, there are concerns that some common infections are becoming increasingly difficult to treat and that illnesses due to antibiotic resistant bacteria may take longer to resolve. Some antimicrobial resistance may result from indiscriminate or poor use of antibiotics.
"In response, initiatives at the local, national, and international levels, are trying to promote 'antibiotic stewardship', with the goal of improving the appropriateness of use. "However, such initiatives rely for success on the continuing education of prescribers and patients, which needs to be supported by high quality evidence linking antimicrobial use to the emergence of resistance."
Writing in the same journal, Dr Chantal Morel and Prof Elias Mossialos, from the London School of Economics, who reviewed the study for the journal, called for new antibiotics to tackle multi-drug resistant bacteria. 19.5.10
We've poured billions into the NHS, are pioneers in medical research, so why is Britain the sick woman of Europe?
Women are more likely to die early in Britain than in virtually every other western European country. It's an astonishing fact for a place which has always prided itself in the skill of its clinicians and world-leading research. Yet over the past 40 years there has been an astounding downward spiral in female survival rates in the UK compared with other countries.
According to the respected medical journal The Lancet, British women have fallen from 15th to 20th place in a league of death rates in 22 western European nations (the report investigated deaths from disease as well as fatalities in accidents and childbirth). Overall, fewer women are dying earlier, however, in the UK survival rates are not improving as fast as they are elsewhere. How could this have come to pass - especially when there has been a steady rise in the amount of money spent on health by Government?
The fact is, while the amount spent here has risen from 6.8 per cent of our national income in 1997 to about 8.7 per cent in 2008, other countries such as France and Germany still spend more as a percentage.
Leading cancer specialist Professor Karol Sikora says: 'It's tragic and outrageous that the NHS has tripled its spending over the past decade and yet - due to bloated and unnecessary administration and poor policy such as artificial targets - we still perform so badly.' A lack of resources is partly to blame for our poor results. An extensive study last year found that in Britain there are 8.2 MRI and CT scanners per million people; the European average is 11.
There are also far fewer doctors in Britain : 2.5 per 1,000 population, compared to 3.4 in France , for instance. This causes delays in diagnosis.
Just as significant is NHS rationing of lifesaving drugs - for example, the bowel cancer drug Avastin and Nexavar, the only treatment offering any chance of survival for patients with advanced liver cancer - are routinely used in other European countries. These drugs typically offer three to six months of extra life, but some patients can survive for years. Although the drug-approving body NICE agrees they work, it says the health system cannot afford them.
Despite the much-heralded reduction in waiting times, these patients often wait longer between scanning, diagnosis and treatment than in other European countries. In France, for instance, the investigation for breast cancer - the appointment, scan and diagnosis - is all done within 48 hours, says Professor Sikora.
'Here we have a long, drawn-out appointment system where patients wait to see a doctor, then a specialist, then for the CT scan and then the results. It can all go on for months - allowing time for cancer to spread and become more difficult to treat. 'The Government prides itself with the fact that suspected cancer patients can see a specialist within two weeks of their GP deciding they need a referral.
'It is the curse of the British public sector that everything involves waiting - even though we have a good breast screening programme.' The good news is death rates for most cancers are falling; however, we still lag behind most of Europ. A damning league table, compiled by the highly respected Eurocare-4 study, ranked Britain 14th of 19 European countries in a survey of five-year survival rates for any cancer (that is survival for five years or more from diagnosis).
Expenditure is an issue - 5 to 6 per cent of NHS expenditure goes on cancer, compared with 7 per cent in France and 9 per cent in Germany .
Another issue is the need for better early diagnosis at GP level, say experts. This is partly a training issue, but it also reflects GPs' reluctance to refer because of costs. The reason that small countries such as Iceland fare better than us, say experts, is that patients are in a progressive healthcare system, looked after by a greater number of doctors.
A flawed health service can only be partly to blame for the UK results, as it seems lifestyle factors - such as smoking and obesity - are also responsible for driving up our incidence rates. But it's not all gloomy news, for in some diseases, such as heart disease, the picture in Britain is improving - indeed there are now fewer women dying younger than ten years ago.
In a unique piece of research, Good Health has trawled the very latest, authoritative pan-European statistics to pinpoint exactly where - and why - the story for British women is so bad. As well as the Eurocare-4, we consulted the European cardiovascular disease statistics project, focusing on the biggest killer diseases.
We then asked leading experts to explain what needs to be improved if we are to start saving more women's lives.
Ovarian cancer is notoriously difficult to treat since symptoms often don't emerge until the disease is quite advanced, as the ovaries are deep in the pelvis, explains Professor Karol Sikora. A tumour can grow to the size of a grapefruit before the cancer becomes obvious.
Late diagnosis is the real issue in the UK , adds Professor Hani Gabra, director of the ovarian cancer action research centre at imperial College in London. 'This is not about lack of drugs - though we have fewer oncologists than in other countries such as Germany and Switzerland, which means patients may get less time with their doctor.'
He says the pressing issue is raising awareness, making GPs and patients aware that symptoms such as constipation and bloating are not necessarily bowel related, but could be a sign of ovarian cancer. 'We then need to fast-track diagnostic tests for women presenting to their GP with symptoms that may suggest ovarian cancer.
'At the moment it's harder for GPs to make referral s when they are unsure of symptoms because PCTs are trying to save money by reducing the number of referrals GPs are allowed to make.
It is bureaucratic madness. Women's chances of surviving ovarian cancer greatly improve if the disease is diagnosed early, so prompt referral by GPs could play a significant role in improving the UK's poor survival rates.' A recent study revealed that GPs are less likely to refer older women with suspected ovarian cancer for investigation - even though four out of five cases are in women over 50.
Our survival rates for cancer generally are among the lowest in Europe , but particularly for older people, and age-bias could explain why we lag behind countries such as Malta and the Czech republic. 'Because we are seeing women at a much later stage of the disease, we need to use chemotherapy more aggressively, like they do in other European countries,' says Professor Sikora.
Cardiovascular disease - heart disease and stroke - is the main cause of death in women in Europe . Strokes are usually treated with anti-clotting drugs within three hours, a technique known as thrombolysis. In most western European countries, up to 30 per cent of patients receive thrombolysis.
Only about 1per cent were receiving it in the UK until recently. Clot-busting drugs 'need to be given by an expert who understands how to administer the medication,' says Dr Tony Rudd, a stroke physician at guys and St Thomas 's Trust, London.
The problem is our lack of specialist stroke centres - these offer specialist care, such as scanning and medication, and rehabilitation. All of which make a difference to survival and recovery. Another issue is a shortage of brain scanners - while patients in most European countries are scanned at the earliest opportunity, many in the UK wait as long as 24 hours.
Improvements are slowly being made to treat patients more effectively, notably the drive to take patients straight to specialist stroke centres rather than their local hospitals, even if they are out of the area. This is already happening in Germany and France (explaining their overall survival rates). 'Stroke treatment is good in this country once the patient receives it, but the vital aspect that still needs pushing is to act quickly,' says Dr Rudd.
'This means training paramedics to do tests to determine whether a person has had a stroke and encouraging patients to forget their GP and call an ambulance straight away.'
The second most common cancer in women after breast cancer, yet many sufferers are overlooked in the more treatable early stages because their symptoms are dismissed as Irritable Bowel Syndrome, says professor William Steward of the University of Leicester. There needs to be what I call a higher index of suspicion in the UK . Doctors need to see the patient and arrange a fixed appointment for three weeks later so that investigations can start.'
Other countries are less inclined to diagnose IBS and investigate much more quickly just in case it is cancer. Treatment for bowel cancer is also affected by the rationing of certain drugs widely prescribed in Europe , particularly Avastin for advanced bowel cancer, which is not available on the NHS.
'Having Avastin would bring new hope to the many patients for whom this offers a proven increased chance of living longer with a better quality of life,' says professor Steward.
Above all, says professor Steward, the national bowel screening programme needs to be lowered to the mid-50s as it already is abroad.
More British women are diagnosed with the disease than in any other country in Europe . This may be linked to lifestyle factors such as weight gain and alcohol consumption - we drink more than other European women. Improvements in early detection through the national screening programme mean breast cancer survival rates are better than lung cancer.
But what holds us back is a slow diagnostic system, says leading cancer specialist Professor Karol Sikora. 'Patients wait to see a doctor, then a specialist, then for the CT scan and then the results. yet in countries such as France , the investigation - the appointment scan and diagnosis - is all done within 48 hours.'
We also use a smaller range of chemotherapy drugs and less aggressively than European oncologists, says Professor Sikora. In Europe they will continue to give patients chemo, even when there are serious side- effects - here, specialists might not.
'We also use radiotherapy less and the quality of our technique isn't as good as many places in Europe where precision radiotherapy targets a cancer without damaging surrounding tissue. This means they are more likely to use more extensive radiotherapy.'
Lung disease is the biggest cancer killer of UK women - not surprising since a quarter of them smoke, more than in other European countries, with smoking on the increase among younger women. Research has shown that women are more vulnerable to lung cancer than men and tend to be diagnosed at a younger age - even though they had smoked fewer cigarettes - possibly because nicotine triggers a gene which drives cancer growth.
Our mortality figures are particularly poor compared with countries such as Scandinavia and France, explains Dr Jesme Fox, medical director of The Roy castle Lung cancer Foundation. 'Late diagnosis is a major factor in our relatively poor lung cancer survival figures.
'A big problem is that patients delay seeing a doctor if they have, say, a persistent cough, a possible symptom of the disease, as they won't associate it with cancer the way they would a breast lump. 'And once they do get in the system, it takes so long to be diagnosed, scanned and treated that it can compromise survival.'
So although French women are also big smokers, their treatment in terms of waiting time as well as the use of chemotherapy is more advanced; so survival rates are better. The National Lung cancer Audit revealed that people get worse treatment for lung cancer in the UK than many areas of Europe.
For example only 10per cent of British patients have surgery, which is the main way of tackling the disease. Rates in Europe vary from 17.5 per cent to 25 per cent. Access to drugs such as Iressa - said to increase the time certain lung cancer patients survive without their disease worsening - have been approved in Europe while NIcE has still to make up its mind.
Coronary heart disease is the UK's biggest killer, with one in every six women dying from the disease.
Over the past ten years there have been improvements in mortality rates thanks to better access to treatment and preventative treatment such as angioplasty, explains Dr Mike Knapton, of the British Heart Foundation. These have halved deaths from 20 per 100,000 to 11. Taking the lead from other European countries, there's now rapid access to a coronary care unit - so no delay in diagnosis and therefore greater chance of survival.
A steady increase in the number of cardiologists as well as an increase in the use of preventative drugs, such as statins has also had an impact.
However, three times as many women still die in Britain compared with France, which Dr Knapton says is driven by the number of people developing heart disease. 'One reason for this is that the UK consumes more energy from fat than the European average.
'This raises cholesterol, blood pressure and the risk of diabetes - all of which can lead to heart disease.' A Mediterranean diet includes more monounsaturated fats, fruit and vegetables. 18.5.10
Trial launched for £1 polypill that the NHS may offer to all over 50s
Hundreds of Britons are to test a cheap one-a-day 'polypill' to see if it will slash the risk of heart attacks and strokes. The Red Heart Pill combines low-dose aspirin, a statin to lower cholesterol and two blood pressure-lowering medicines. It will be 'substantially cheaper' than taking each drug separately and doctors hope patients will stick to their medication because they only have to remember to take it once a day.
A new international trial involving 2,000 volunteers who are at high risk of heart attack or stroke, or have survived one, is recruiting Britons for the first time. The trial, which also includes patients from Ireland and the Netherlands, is likely to be extended to India to confirm whether polypills could work in developing nations.
A similar trial in India in 2009 found such low-cost 'magic bullet' pills could halve rates of heart attacks and strokes. Most poor people in countries like India cannot afford to buy cardiovascular drugs.
It is expected the Red Heart Pill could widely used in low-income countries at a substantially lower cost than drugs currently available, with the potential to save millions of lives across the world. The trial called UMPIRE (Use of a Multidrug Pill In Reducing cardiovascular Events)is being run in the UK by Imperial College London.
Professor Simon Thom, the co-Principal Investigator on the study from the National Heart and Lung Institute at Imperial College London,said the Red Heart Pill might also have benefits here. He said 'The polypill idea is really simple: make it easier for people to get the medication they need by giving them just one polypill to take each day, rather than lots of different pills that may need to be taken at different times.
'It's likely that combining medications in one polypill could enable people in low-income countries to have easy access to cheap preventive medication. 'Polypills are being used successfully to treat other diseases like tuberculosis and HIV, but we don't yet know whether they could be effective in those with cardiovascular problems.
'The UMPIRE trial aims to test whether the polypill does help people take their cardiovascular medicines in the long term and whether there are any unintended problems with this approach' he added. Some doctors have been concerned about the possibility of side effects from the one-size-fits-all approach, especially if the polypill is used for healthy people.
The Government's heart czar has said all older people should 'ideally' be taking a polypill including a statin, although some doctors have questioned such blanket prescribing. A major British study last year found daily aspirin can cut the rate of non-fatal heart attacks by one-fifth - but increases the risk of dangerous internal bleeding by a third. Taking low-dose aspirin routinely could mean the side effects cancel out the heart benefits.
But millions of heart patients and diabetics are currently prescribed aspirin in line with medical guidelines because their doctors consider they are at high risk of heart attack, while millions of others are on statins and blood pressure-lowering drugs. The cost of cardiovascular disease to the British economy is an estimated £29 billion.
Related polypill trials began earlier in the year in New Zealand and Australia and there are plans for further trials in Brazil , Canada , China and South Africa. 17.5.10
Foolish junior doctors condemn homeopathy as ‘witchcraft' and demand ban
Junior doctors have denounced homeopathy as 'witchcraft' which should not be supported by the taxpayer and the National Health Service. Hundreds of members at the British Medical Association's annual conference of junior doctors have passed a motion attacking the alternative medicine and other remedies they claim have no scientific basis to support them.
Critics say 'it just goes to show how quickly doctors get brainwashed, they have
started their careers and are already bias, they should bear in the mind the quote of Dr. Mehmet Oz
'half of what we will teach you in medical school will, by the time you are done practicing, be proved wrong' and retain an open mind.
The BMA has previously expressed scepticism about homeopathy, arguing that the rationing body, the National Institute for Health and Clinical Excellence, should examine the available evidence and make a definitive ruling about the use of the remedies in the NHS. Junior doctors have now gone one step further with a vote last week overwhelmingly supporting a blanket ban and an end to all placements that teach homeopathic principles.
Dr Tom Dolphin, deputy chairman of the BMA's junior doctors committee in England , told the conference: “Homeopathy is witchcraft. It is a disgrace that nestling between the National Hospital for Neurology and Great Ormond Street [in London ] there is a homeopathic hospital paid for by the NHS”.
Gordon Lehany, chairman of the BMA's junior doctors committee in Scotland, said it was wrong that some junior doctors were spending part of their training rotations in homeopathic hospitals, learning principles that had no place in science. He told the conference in London : “At a time, when the NHS is struggling for cash, we should be focusing on treatments that have proven benefit. If people wish to pay for homeopathy that's their choice, but it shouldn't be paid for on the NHS until there is evidence that it works.”
The motion was supported by BMA chairman Dr Hamish Meldrum, although it will only become official policy of the whole organisation if it is agreed by their full conference next month.
Homeopathy, an alternative medicine practice devised in the 18th century by the German physician Samuel Hahnemann, is based on a theory that substances that cause symptoms in a healthy person can, when vastly diluted, cure the same problems in a sick person.
Latest figures show 54,000 patients are treated each year at four NHS homeopathic hospitals in Glasgow , London , Bristol and Liverpool , at an estimated cost of £4 million. A fifth hospital in Tunbridge Wells in Kent was forced to close last year when local NHS funders stopped paying for treatments. In February a report by MPs said public money should no longer be spent on the alternative medicine. The Commons Science and Technology Committee said the idea behind homeopathy, of treating a patient with highly diluted substances to trigger the body's natural system of healing, was implausible.
In evidence to the committee, the Royal Pharmaceutical Society of Great Britain said there was no possible reason why such treatments, marketed by an industry worth £40m in this country, could be effective scientifically.
Advocates of homeopathy include Dr Jan de Vries, who in February called on the Scottish Government to safeguard the future of Scotland 's only homeopathic hospital in Glasgow . De Vries said removing funds from the institution would take away the public's right to make their own choice on healthcare. Crystal Sumner, chief executive of the British Homeopathic Association (BHA), said attempts to stop the NHS funding alternative medicines ignored the views of the public, especially patients with chronic conditions.
“Thousands of people, who are not helped by conventional care, rely on homeopathy in the UK annually, and millions worldwide,” she said. “That this group of junior doctors is willing to vilify something they haven't even broached to understand, I think speaks more about the doctors themselves.
“It says more about them living in some kind of dark age. Homeopathy is not witchcraft, it has been around for 200 years. Millions of people depend on it as their first level of medication, because they don't have conventional medicines available.” 17.5.10
UK doctors demand clinical trials research reform
Cumbersome rules for clinical trials are driving research overseas, medical scientists warn. Medical researchers in the United Kingdom warned today that their work is being damaged by excessive regulation and an obsession with targets in the country's health service. Figures show that the number of trials put forward for ethical approval has dropped sharply in recent years.
At a meeting in London, about 50 leading clinical researchers unanimously backed a motion demanding that the National Health Service (NHS) be reformed to make conducting clinical trials easier. The motion warns that "vital industries [are] threatening to quit the NHS, with one of the main reasons cited being the slowness of the NHS system for clinical trials".
At the British Medical Association's (BMA's) annual Conference of Medical Academic Representatives on 14 May, all researchers present backed the motion in a show of hands. "The number of research proposals going forward to the National Research Ethics [Service], is dropping year on year," Michael Rees, a cardiac specialist at Bangor University and the motion's proposer, told Nature before the conference. Feedback from researchers suggests it is getting more difficult to do research in the NHS, he added.
Data released in April by the National Research Ethics Service shows applications declining by more than a third between 2004–05 and 2009–10 (see graph). All UK clinical trials must be approved by an ethics committee. Rees, who co-chairs the BMA's Medical Academic Staff Committee, says the lack of a national system of research governance has left researchers struggling with a patchwork of local rules, hindering those running trials in multiple locations.
Another problem is clinical targets. Managers may be reluctant to back trials that require, for example, computed-tomography (CT) scans, says Rees, if this will make them less likely to hit government targets on CT scans for patients. Without a central system of research governance and research targets for the NHS, "we will continue to decline as a country for biomedical research", says Rees.
Many UK researchers have previously raised fears about the country's ability to attract clinical trials, especially in the face of increasing competition from India and China. Some say that British enforcement of European rules is too heavy-handed. One researcher at the meeting, who asked not to be named, said that a colleague in Germany had managed to conduct and write up the German part of a collaboration before the UK arm had been approved.
In January this year the UK Academy of Medical Sciences noted that the proportion of the world's clinical trials conducted in the United Kingdom fell from 6% in 2000 to 2% in 2006. It warned that forcing researchers to comply with a plethora of sometimes overlapping requirements from the EU Clinical Trials Directive, the European Medicines Agency, the Medicines and Healthcare Products Regulatory Agency, NHS ethics committees and several other bodies, is driving research overseas.
In March, the government asked the Academy of Medical Sciences to review these issues. "There's a huge amount of hurdle-leaping to be done to get good patient benefit out at the end," says academy vice-president Ronald Laskey. "We are already seeing clinical trial activity moving overseas. That is an issue that needs to be addressed urgently." 17.5.10
NHS nurse victimised for being a whistleblower: Trainee thrown out after exposing abuse at shamed hospital
A student nurse who exposed the appalling neglect of elderly patients at a hospital trust where up to 1,200 people died needlessly has been thrown off her training course. Two years after the Stafford Hospital scandal, Barbara Allatt reported NHS colleagues for leaving patients in soiled sheets, shouting at dementia sufferers and secretly slipping sedatives into a cup of tea.
But the mature student was condemned for having an 'attitude problem' before being withdrawn from her nursing course at Staffordshire University last month. Miss Allatt, 40, now plans to sue over a 'culture of bullying' during placements at Stafford Hospital and Cannock Chase Hospital , both part of the crisis-hit Mid-Staffordshire NHS Trust.
Her experiences come after a damning independent inquiry found the safety of sick and dying patients was 'routinely neglected', leading to between 400 and 1,200 unnecessary deaths at the trust between 2005 and But no officials were disciplined and two years on hospital bosses have apparently failed to tackle the 'inhumane treatment' identified in the report.
Miss Allatt, from Cannock , said: 'The wards were heartbreaking. There were patients crying out for help but the staff would sit chatting. 'Some needed urgent pain relief or a change of sheets and others just needed a bit of reassurance, but they were ignored, shouted at or mocked with cruel names. 'Sick and elderly people were manhandled and abused. 'But when I complained my colleagues told me to mind my own business. They were so pally with each other that they shut me out and I felt helpless.'
Miss Allatt, a mother of one with a long-term partner, left her job as an occupational therapy technician to start a diploma in adult nursing in March last year. She passed her exams and got glowing reports on placements in the community - but was disgusted by what she saw on hospital wards. Over four months at Stafford and Cannock Chase hospitals between May 2009 and January this year, she recorded a catalogue of horrors.
Miss Allatt repeatedly reported her concerns to her university tutors, hospital mentors and senior nurses, but she claims she was fobbed off or attacked for whistleblowing. In January she was suspended for four weeks over her 'behaviour, attitude and fitness to practise'.
She was supported by the Royal College of Nursing, but lost two appeals against her suspension, and a fitness to practise panel permanently withdrew her place on the course last month. Miss Allatt, who suffered stress and depression over her 2008 ordeal, is planning to sue the university for breaching the Public Interest Disclosure Act, which is designed to protect whistleblowers. She will also take legal action against the trust for bullying, she said.
Now back at work as an occupational therapist, she said: 'I still feel horribly traumatised, but at least I can sleep at night knowing I have reported them and been an advocate for the patient.'
Julie Bailey, from the Cure the NHS campaign group set up for victims' families in the wake of the Stafford Hospital scandal, said: 'This is evidence that no lessons have been learnt. 'There are good nurses - Barbara is proof of that - but they are forced out by bullying and victimisation.
'Managers at the hospital and the university knew she was a conscientious student who wanted to uphold nursing standards and reject disturbing, illegal practices, but labelled her with an attitude problem.'
The Royal College of Nursing said it did not comment on individual cases, but in a statement prepared for an appeal hearing, a representative said: 'There is nothing . . . that would suggest anything other than Barbara being a knowledgeable, intelligent, enthusiastic student who performs well and questions appropriately. 'She was unfairly tagged as a troublemaker when she raised concerns on her first placement. This bad name followed her to her next placement.
'I would suggest collusion between several nurses, and that the decision has been made at some level that it is easier to remove Barbara from her training than pursue her allegations.' Mid-Staffordshire NHS Trust said an investigation into her complaints found them to be 'without foundation'. A Staffordshire University spokesman said: 'Our nursing students get a lot of input about how to report any issues, and are supported to do so.'
The Daily Mail has consistently highlighted appalling treatment as part of our Dignity for the Elderly campaign. 15.5.10
NHS consultant suspended from working for EIGHT YEARS for daring to speak out about high death rates
A leading heart consultant who blew the whistle on high death rates at his hospital has been banned from working for eight years - at a cost of £6million to the NHS. Dr Raj Mattu was suspended in 2002 after he blew the whistle on dangerous clincial practicies and high death rates at Walsgrave Hospital in Coventry.
The top practionner was stopped from working and hauled before a High Court judge, the General Medical Council and now, when found innocent of all charges, is being disciplined for asking for his old job back. Hospital bosses have reportedly spent as much as £6million blocking his return.
Almost a decade after he first spoke out, the hospital has been found to have one of the highest death rates in the country. Yet he is battling to resume his career as a cardiologist.
Last night, the defeated Labour Government stood accused of repeatedly breaking their 1997 election promise to protect doctors and nurses who spoke out to protect patients. Dr Mattu's supporters claim Labour health ministers were aware of his situation, but refused to intervene.
Hospital bosses suspended high-flying specialist Dr Mattu on allegations of bulling a junior doctor. But the 48-year-old, who was found innocent in a £500,000 independent inquiry, was still not allowed to return to his job - even though a High Court judge ruled he should go back to work.
After the QC-led independent inquiry, University Hospitals Coventry and Warwickshire then reported Dr Mattu to the GMC, which also rejected the charges. He was told he could return last year and began 18 months of retraining. But now he has been told by hospital bosses that he will face further allegations at a new disciplinary hearing.
Dr Mattu, who was hired to raise standards in cardiology at the hospital, is being disciplined for asking for his old job back - which included pioneering heart research. He has been forced to abandon his refresher training at two leading London hospitals by the hospital trust, which had organised the course. Dr Mattu, who earned £110,000 as a specialist, last night said the saga has destroyed his career.
'This has taken an enormous toll on me psychologically,' he said. 'To have been barred from doing the job I love for eight years has been a tremendous blow. 'I never believed that this could go on for so long. I have been hung out to dry by the hospital and I have had no backing or support from the Department of Health.
'Labour was pledged to protect people like me who spoke out on behalf of patients but I've been badly let down. Now that the trust has started new disciplinary action I have no idea where this will end. 'It's an absolute nightmare. I thought when they finally agreed that I could go back to work that it was all over. But the hospital is continuing to persecute me. 'It has had a terrible effect on my mental and physical health and affected my relationships with family.'
Ted Needham, a research scientist who worked with the doctor, said: 'Dr Mattu has not done anything wrong clinically. His only crime was to speak up on behalf of patients and report things he saw were wrong that were costing lives.' He added: 'He has been left in limbo. Without retraining he can't go back to work. It's the same as being suspended. He can't organise his own retraining. That has to be sponsored by the trust.
'He has every right in law to go back to his old job which involved treating patients and doing vital heart research. But they want to take away his research work and he quite rightly wants to carry on. 'It is almost unbelievable that someone could be kept from their job for eight years and yet the Labour Party health team in Whitehall chose to ignore his plight and allow his persecution to continue. His friends and supporters were shocked by Labour's indifference to his plight.'
Norman Lamb, Liberal Democrat health spokesman until the election, said: 'It is frankly scandalous that a hospital consultant can be kept away from his job for eight years when he is completely innocent of any offence. 'Labour's Health Secretary, Andy Burnhan really should have intervened and told Dr Mattu's trust that it could not carry on in this way.
'If Dr Mattu is innocent then he should be allowed to carry on with his retraining. You cannot discipline someone simply because they ask to return to their old job.' Department of Health guidelines state that long term suspensions should be avoided and suspensions should be dealt with speedily within six months.
Hospitals are also directed to avoid suspensions for non clinical reasons. Tory Peter Bone, a member of the House of Commons Health Select Committee until the General Election, said: 'It is outrageous that a doctor can be kept away from his job for so long without good cause. 'What on earth is going on for the Department of Health to allow a hospital trust to behave in this way?'
A former colleague of Dr Mattu said: 'We had terrible death rates here according to the national statistics and Raj was brave enough to point out where mistakes were being made.' Walsgrave Hospital is one of 25 hospitals singled out in a report by Professor Brian Jarman for having higher than average death rates. He urged that all the hospitals should be subject to immediate investigation by the Care Quality Commission.
A University Hospitals Coventry and Warwickshire NHS Trust spokesman said: 'We are aware of the information being put into the public domain by Dr Mattu's supporters. Much of the information being published is, in our view, inaccurate and misleading. 'We have however, being a responsible employer, made a commitment to keep matters between any of our employees and ourselves strictly confidential.'
Legal experts said the matter was a disgrace, 'the GMC have too much power and act above the law of the land, an urgent review is required to stop this from happening again'. 14.5.10
NHS doctors afraid to blow whistle about concerns
More than 60% of Scotland 's hospital doctors have had serious concerns about standards of patient care or staff behaviour – but many were afraid to blow the whistle. A survey by the British Medical Association Scotland found hundreds of medics have encountered problems they thought ought to be raised with managers.
However, more than one-third said they had not reported the issue, with fears that doing so would damage their careers and little hope that speaking up would make a difference among the top excuses for failing to act. Many of those who had spoken out reported it had been a bad experience.
One in 10 said their health board had warned them that raising the matter could have a negative impact on their employment.
In a report on their findings, published yesterday, BMA Scotland says the culture in the Scottish health service is completely wrong and demands health boards and the Scottish Government take action to improve the situation. Dr Sue Robertson, chairman of the BMA's Scottish Staff and Associate Specialists Committee, said: “Most doctors know and understand that they have a contractual right and an ethical duty to speak out, but many NHS employers make speaking out difficult or dangerous for an individual doctor.
“Ultimately this will result in staff failing to raise concerns. That is why we are calling for a concerted effort by the NHS to improve on the awareness and implementation of whistle-blowing policies.”
Nearly 400 doctors working in Scottish hospitals took part in the BMA research. Of these 239 said they had at some point had important concerns relating to everything from patient safety to staff bullying. Some 44% of the issues were to do with patient care, 37% to do with staff behaviour and 19% about their health board's targets or policies. Just over 60% reported the problem and almost half said they were not aware of any action being taken as a result.
One-fifth said they would not be prepared to report concerns again. Almost 80% of the doctors who took part in the BMA survey said they were not aware their health board had a whistle-blowing policy.
Ross Finnie MSP, Scottish health spokesman for the Liberal Democrats, said: “It is concerning that many health care professionals don't know how to blow the whistle. “When a complaint is made it must be handled appropriately and must be brought to a conclusion. “Health care professionals should feel confident that when they express their concerns they are addressed properly.”
A Scottish Government spokesperson said: “Any doctor who is concerned about patient care or the behaviour of other staff has the duty to speak up. Their primary responsibility is always to patients – and every health board in the country has procedures to protect staff who raise concerns.
“Indeed, the Freedom of Speech policy that boards have to follow states that boards will not tolerate harassment or victimisation of any member of staff who raises a concern – and that includes informal pressure. Any example of that kind of behaviour would be treated as a serious disciplinary offence.”
Interruptions ‘hit care'
Doctors who are regularly interrupted by other staff could be offering poorer care to patients, researchers have said.They have less time overall to spend on their work and face being interrupted by colleagues 6.6 times an hour on average.
Being pulled in different directions means doctors fail to return to 19% of their jobs while 11% of all tasks are interrupted – 3.3% more than once. Doctors multi-task for 13% of the time, while the average time spent on a job is 1.26 minutes, research found. When doctors do go back to tasks after an interruption, they spend less time on them than if they had never been stopped.
And when colleagues stop doctors to ask a question, the doctor then completes the task in about half the time they would have spent otherwise. Experts from the University of Sydney followed 40 doctors in the A&E department of a large hospital for the research. They examined the group for 210 hours in total spread over 131 weekday sessions, recording 9,588 tasks. 13.5.10
Special Investigation: Why ARE so many doctors addicted to drink or drugs?
Disturbing new research reveals that one in six doctors has been hooked on alcohol or drugs. How has this happened - and what are the implications? The patients were waiting dutifully. But their young female doctor seemed reluctant to attend to their ailments at morning surgery. As the minutes ticked by, her door remained firmly shut.
The reason for her absence soon became apparent. When staff finally went to investigate, Emily Heinzman was found slumped unconscious over her desk at Oulton Medical Centre, near Leeds. The room reeked of alcohol; the dishevelled doctor was snoring loudly and oblivious to the world. Clearly, Heinzman had not been taking her medicine properly. For this bright, intelligent 31-year-old usually tried to ensure she wouldn't suffer any ill-effects from the previous night's drinking - by taking a cocktail of drugs.
Using all the pharmaceutical skills she had learned during an expensive university education, Heinzman would mix herself 'magic elixirs' to deal with the raging headaches and trembling hands that always followed when she had too much to drink - an occurrence which, as the years went by, had become a nightly event.
At her upmarket docklands apartment in Leeds , she kept thousands of tablets in dozens of bottles. There was codeine, temazepam, diazepam and co-codamol - all highly addictive substances that are often used as a temporary treatment for drug addicts. And there was another problem: the drugs had been stolen. Heinzman had obtained them by writing fake prescriptions for non-existent patients.
Although she claimed she drank and took drugs to ease the pain of a break-up, Heinzman also liked getting high - and she was in the perfect position to exploit a never- ending supply of pharmaceuticals. But prescription drugs weren't her only addictions. She was also a heavy cocaine user. And she was handing out stolen drugs to her friends and holding late-night parties at her flat in Leeds ,where drink and narcotics flowed.
Indeed, when the law finally caught up with her, cocaine - along with countless other substances - was found to be coursing through her veins. Finally arrested and brought to court last year, it transpired that she'd been living this secret lifestyle for several years, treating patients at the same time as she was bingeing on drugs and alcohol. Heinzman was given an eight-month jail term - suspended for 18 months - and ordered to carry out 100 hours' Community Service after she admitted 16 charges of fraud relating to her fake prescriptions. Not surprisingly, she also feared losing her job.
But this month, three years after her drug-taking spiralled out of control, Heinzman was cleared to resume her medical career after serving a 12-month suspension imposed by the General Medical Council hearing into her potentially life-threatening behaviour. Before she was cleared to return to work - on condition she remained 'clean' - Peter Atherton, a lawyer for the General Medical Council, outlined the full scale of her abuse of the system, revealing that she had used a number of cunning schemes to ensure her supply of drugs.
'She used many different names, and multiple addresses for the same patient,' he said. 'Prescriptions have been presented in many different large pharmacies, where staff were less likely to remember her. The efforts and preparation appear to have been a way of covering her tracks.' But, in truth, the only really surprising thing about this sordid tale of abuse is how commonplace it has become in the medical profession.
One in Six
According to shocking new figures, up to one in six doctors will have been addicted to drink or drugs - or both - at some stage in their medical career, raising the horrifying prospect that these highly-paid carers may have your life in their trembling hands. And that's not all. Surveys of hospital trusts also found that a third of male junior doctors and almost one in five of their female peers have used cannabis, ecstasy, cocaine and other hallucinogenic drugs.
'The problems will become more acute in future, as drug and alcohol dependency is becoming more common in the population as a whole,' say the authors of Invisible Patients, a government-funded study into the scale of the crisis. 'It may be easy to spot a health professional who is obviously under the influence of drugs or alcohol, but persistent and long-term substance misuse can be harder to pick up and the consequences for quality and safety of care harder to predict.
'Working while under the influence of drugs or alcohol increases the chances that healthcare workers will make mistakes and communicate poorly with colleagues and patients,' say the authors, revealing that more than 15,000 British doctors suffer from drink and drug addictions. In other words, while medical staff are dealing with the growing carnage caused by drunks in chaotic Accident and Emergency wards, these same professionals are themselves increasingly intoxicated.
That was certainly the case for Dr Michael Wilks, a general practitioner who was downing a bottle of whisky a day between examining patients. 'I was in a bit of a mess after several years of denial about the scale of the problem,' he told me. 'I thought I could handle it because I was a doctor. I don't think I was a good doctor, but I don't think I was a dangerous doctor. 'I was certainly deeply unhappy. I finally realised I couldn't go on drinking, but I also knew that I couldn't stop. I approached a patient I'd helped with an alcohol problem 15 years earlier and asked him for help. He told me what he'd done to get sober and for the first time in my life I listened.'
Now sober for 20 years and deputy chairman of the Sick Doctors Trust, a charity established to help medics addicted to booze and drugs, Dr Wilks says the medical profession is in deep denial about the scale of its alcohol problem. 'Doctors are taught to be decisive and they are treated with respect,' he says. 'So to ask for help, you have to climb down off your pedestal and admit you have a problem. Doctors don't want to reach out for that help - because they don't understand that a real alcoholic cannot help themselves.'
Such is the stigma among alcoholic doctors that few are willing to be named. But many interviewed by the Mail, on conditions of anonymity, revealed harrowing details of how their drink-sodden lives as medical students did not stop when they became full-time professional medics.
Incredibly, doctors told me how they hook themselves up to saline drips before going to bed to combat the effects of alcohol, and how they and their friends self-prescribe drugs to ease their symptoms. One even said his recollections of carrying out medical procedures after drinking were 'vague'. The most striking example of this growing scourge emerged last year when it was revealed that one doctor drank three bottles of vodka a day, and was often so drunk on duty that he didn't know his own name, let alone how to carry out correct medical procedures.
Dr Ramasankerpersad Jairam, who worked at Coventry 's Walsgrave Hospital , left his hospital accommodation in such a squalid state that the bedding and curtains had to be burned and the carpets steam cleaned. For more than a year, other staff covered up his drink problem, with hospital security helping him to bed most nights. He was even seen propped up against a hospital wall, clearly drunk.
Concerned colleagues took a blood sample from Dr Jairam when he fell unconscious. Fearing he may die of acute alcohol poisoning, it transpired he was almost five times over the drink- drive limit when dealing with patients. Disturbingly, however, a General Medical Council disciplinary inquiry heard from fellow medical specialists that there was no evidence that his drinking had caused 'any direct harm' to patients.
In fact, as well as the obvious risk posed to patients, this superior attitude to drink and drug abuse is also killing doctors. Studies have shown they are three times more likely to die as a result of alcohol related cirrhosis of the liver. But many are in denial, believing the normal rules don't apply to them. Indeed, surveys have shown that even school pupils know more about safe drinking levels than medical students.
This is a problem for doctors - but it also has profound implications for patients. One doctor, who asked to remain anonymous, revealed that he drank himself senseless at least four nights a week - with what he called 'definite health implications' for himself and his patients when he was on duty.
Describing the medical profession as 'hypocritical' in its attitudes to alcohol, the doctor added: 'This dependence on alcohol for social interaction and relaxation should be worrying to all medical students and perhaps we should strive to live by example.' Yet, astonishingly, there are no country-wide rules preventing doctors from drinking. Nor is there a policy of random blood tests for drink and drugs - something that many other professions, including bus and train drivers, must submit to.
Indeed, there are huge disparities between the policies of individual NHS trusts - some doctors are even allowed to drink while on call. Yet some doctors insist the scale of the problem is exaggerated.
Prizzi Zarsadias, a trainee doctor and editor of the British Medical Journal's magazine for students, said: 'I've heard of people using saline drips to rehydrate themselves while they sleep off the drink - but as far as I'm concerned, it's an urban myth.' She also dismissed suggestions that, as doctors, she and her colleagues believe they are impervious to the problems faced by 'ordinary' people.
'It's got nothing to do with feeling superior,' she said. 'My view is that it's down to the long hours that doctors have to put in - the sheer volume of work. They just use their free time to the max. 'The types of people who become doctors are often extrovert and when they celebrate, they really go for it. We know what's on the line if we fail - there' s a lot of stress and that makes certain people drink more as a release.'
Yet many older doctors scoff at the 'stress' argument, pointing out that doctors' hours have never been shorter and the rewards greater. But as alcohol claims 40,000 lives a year in the UK , doctors are falling prey to Britain 's binge- drinking culture.
Hannah Barton, a first-year medical student at Barts and The London School of Medicine, blames student unions offering cut-price drinks and tequila shots for £1 a pop. 'I remember being told when I began my degree that gone were the days when I could take the chance of getting on a bus or train without paying; these were the sorts of seemingly innocuous transgressions that would damage my reputation and possibly my future career. 'But excessive drinking is still promoted. We are all aware of the health risks and downsides of excessive drinking - not least the morning after - but for many of us, it is part of our student social life.
'Undoubtedly, alcohol will continue to be one of the most important public health problems of our time. But that won't stop many people, including me, from going down the pub tonight.'
But with so many doctors drinking themselves silly, while being charged with advising others against alcohol abuse, it seems that in alcohol-soaked Britain, it's now very much a case of the blind leading the blind. 13.4.10
Psychiatrist who 'prescribed fatal cocktail of drugs profited by £1.2m from former debutante's will when she died'
A psychiatric who prescribed a 'vulnerable' wealthy patient a potentially fatal cocktail of drugs profited by £1.2m from her will when she died, a General Medical Council tribunal heard. Dr Peter Rowan treated former debutante and actress Patricia May for anorexia for 16 years, giving her 'excessive dosages' of powerful drugs - but never telling her NHS GP or her respiratory specialist, it was claimed.
He also accepted huge cash 'gifts' from her, first one of £50,000, then one of £100,000, and then ultimately a bequest of £1.2m when she died aged 66 the day after a fall in the bath of her home in Mayfair, London. Only then was a stash of more than 1,000 tranquilizers, sleeping pills and anti-depressants found in the £1m flat where she lived alone.
That discovery, and a resulting inquest, delayed payment of the £1.2m - but Dr Rowan, who had tracked down the will on the internet, and told her executors 'Miss May told me she was leaving something to me', eventually received it.
Speaking for the GMC, Andrew Hurst told the tribunal: 'There are no excuses, clinically, professionally, socially or otherwise for this catalogue of errors and this misjudgement after misjudgement. 'Dr Rowan lost sight of professional boundaries, maintaining dual roles of doctor and friend, a role that had become blurred and secretive. ''This case is about the management of a frail, vulnerable, physically ill psychotic patient.'
Dr Rowan, who ran the eating disorders clinic at the celebrated private hospital, The Priory, in Roehampton, south west London, faces being struck off if the hearing at the GMC in London rules against him. The psychiatrist, of west London , who is married and has two children, denies misconduct.
Elegant Miss May suffered from a serious respiratory illness and regularly saw both her NHS GP and a lung specialist. But neither knew anything of the drugs she received on her regular visits to the clinic of Dr Rowan, 65, in Sloane Street , central London. Those drugs included powerful anti-depressants which could have dangerously affected her already limited breathing.
The GMC heard that because she was not only physically frail, but also elderly and had a low weight, Dr Rowan was arguably giving her up to eight-times the advisable dose of drugs. Mr Hurst said: 'This was simply too high. She was being heavily over-medicated. The risk of falls can be increased.'
Miss May's NHS GP Gordon Atkinson told the GMC he was aware she was seeing the psychiatrist, but the former actress refused to discuss him. The GP added that he never saw any evidence Miss May was suffering from anorexia, nor that she was depressed. And if he had known of the cocktail of drugs she was receiving from her psychiatrist he would have immediately requested a detailed report on her prescriptions, complete with justifications for why she required the anti-depressants.
Dr Atkinson added: 'She was very frail and fragile and vulnerable.' Miss May's consultant in respiratory medicine, John Costello, then told the tribunal that he too had never had any contact with Dr Rowan, and had never been told of the sedatives she was being given.
Dr Costello, who works at the Cromwell Hospital in London , said of his late patient: 'She had a very advanced lung disease. She was very slightly blue in appearance, showing how severe her condition was. 'I am very reluctant to prescribe drugs with sedative effects to someone with a lung disease like this because they depress breathing.
'The patient is already on a respiratory knife-edge - and sedatives can lead to heart failure and be fatal, within a few hours.' Dr Costello went on to say that although Miss May was 'very thin', he was not aware of her having an eating disorder. 'She was in the wrong age group for that,' he said. Miss Mays' friend and lawyer Julie Frances told the tribunal the retired actress kept changing her will to leave ever more to Dr Rowan, who she assumed was a boyfriend.
Mrs Frances said: 'I didn't say "Is he a boyfriend" because I felt that it was, just by her body language. She gave no indication ever that Dr Rowan was her psychiatrist.' Mrs Frances added that she found an official letter about an appointment on Dr Rowan's headed paper in the dead woman's flat - and he had signed it 'Love P'. The lawyer contacted the authorities after finding the haul of drugs too.
Dr Rowan, now the medical director of the Cygnet Hospital in Ealing, west London , accepts that he in 1996 accepted £50,000 from Miss May and the following year another £100,000. He says there was nothing inappropriate about receiving the gifts or the bequest. Dr Rowan further claims that Miss May banned him from discussing her treatment with other doctors.
An inquest into Miss May's 2003 death was ordered by Home Office four years ago - although she was cremated before tests could be carried out - and heard that she was 'infatuated' by Dr Rowan. The coroner, who was told the psychiatrist took his two daughters on a skiing holiday paid for by Miss May, returned an open verdict on the death.
Many experts now think Psychiatrist's should lose their prescribing rights to stop this from happening again as their 'diagnosis have no basis in medicine or science'. 12.5.10
NHS spending on 'chemical cosh' child-calming drugs soars by 60% to £31m
NHS spending on 'chemical cosh' drugs to treat hyperactivity has soared by two-thirds to £31million in just four years, new figures revealed yesterday. Nearly 750,000 prescriptions are now being doled out every year for Ritalin and similar drugs - most of them to children.
The surge triggered concerns that children are being unnecessarily drugged as poor discipline is increasingly seen as a medical issue.
Teachers warned today that prescribing calming drugs was often cheaper and easier than 'talking cures' and parenting support. Three drugs are now routinely used to treat Attention Deficit Hyperactivity Disorder (ADHD), which is characterised by disruptive behaviour, impulsiveness and difficulties focusing on specific tasks. These are drugs based on methylphenidate (Ritalin), atomoxetine (Strattera) and dexamfetamine (Dexedrine).
Critics blame the 'Diagnostic and Statistical Manual of Mental Disorders' (DSM) which is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders and disease but has no basis in science or medicine whatsoever. Psychiatry admits 'it has not proven the cause or source of a single mental illness it has classifed and the theory of a chemical imbalance in the brain causes mental illness has been thoroughly discredited by the psychiatric industry itself' mainly because critics pointed out 'there isn't even a test for a chemical imbalance, it's complete nonsense'. They say psychiatry is the 'original pseudoscience, medical fraud and completely made up'.
Figures released under the Freedom of Information Act show that NHS spending on the three drugs in England alone rose from £18.97million in 2005 to £31.14million in 2009.
An increase in the cost of the drugs partly accounts for increase. But statistics also show that, over the same period, the number of prescriptions issued by doctors surged, from 486,536 to 744,078. The figures may underestimate the true scale of spending since private prescriptions and those handed out by in-house hospital pharmacies are excluded from the data, which was issued to The Guardian by the NHS Business Services Authority.
Official NHS guidelines recommend drug treatment for the most severely affected but some doctors take this more literally than others. Figures published in 2008 showed that doctors in the Wirral dispensed one Ritalin prescription for every seven children under 16, although this did not equate to one in seven children taking Ritalin - since one child could have repeat prescriptions.
Across England , the average was one for every 23 children, while Stoke-on-Trent doled out just one prescription for every 159 children. Experts warned that some doctors and teachers are too keen to pin medical labels on what would previously have been branded poor discipline.
Dr Gwynedd Lloyd, an education researcher at the University of Edinburgh , said: 'You can't do a blood test to check whether you've got ADHD - it's diagnosed through a behavioural checklist. 'Getting out of your seat and running about is an example - half the kids in a school could qualify under that criterion. 'I know a lot of children have genuine difficulties, and some of these are biological, but most are social and cultural.'
Meanwhile teachers warned that funding pressures on schools could lead to an increase in prescribing in future. Mental health programmes to help children through counselling and parental support were labour-intensive, they said.
Tim Bown, assistant head of Queen's Park Community School , North London , said: 'Ideally, schools would prefer to offer intensive one-to-one support, but if the resources are limited - which they usually are - then we're pushed into a choice between medication or exclusion. 'Hearing a student say that a drug "takes away his soul" doesn't sit comfortably with us as a school, but permanent exclusion doesn't either.'
He warned that therapists, counsellors and mentors could be sacrificed as schools fought to keep teachers. Professor Frank Furedi, a sociology expert from Kent University and author of Therapy Culture, said: 'Parents are ambitious for their children and teachers are at a loss about how to manage classroom behaviour, so they medicalise it.'
Since ADHD was first recognised as a medical condition in the mid-1980s, debate has raged over the use of drugs to treat it. Side-effects can include stunted growth and cardiovascular problems, as well as insomnia, lethargy and headaches. But research also shows that youngsters treated with Ritalin and similar drugs do better in tests. 12.5.10
Feds found Pfizer too big to nail for fraud so cut a deal
CNN's Special Investigations Unit reveals internal company documents on Bextra and Pfizer's health care fraud. Imagine being charged with a crime, but an imaginary friend takes the rap for you. That is essentially what happened when Pfizer, the world's largest pharmaceutical company, was caught illegally marketing Bextra, a painkiller that was taken off the market in 2005 because of safety concerns.
When the criminal case was announced last fall, federal officials touted their prosecution as a model for tough, effective enforcement. "It sends a clear message" to the pharmaceutical industry, said Kevin Perkins, assistant director of the FBI's Criminal Investigative Division. But beyond the fanfare, a CNN Special Investigation found another story, one that officials downplayed when they declared victory. It's a story about the power major pharmaceutical companies have even when they break the laws intended to protect patients.
Big plans for Bextra
The story begins in 2001, when Bextra was about to hit the market. The drug was part of a revolutionary class of painkillers known as Cox-2 inhibitors that were supposed to be safer than generic drugs, but at 20 times the price of ibuprofen. Pfizer and its marketing partner, Pharmacia, planned to sell Bextra as a treatment for acute pain, the kind you have after surgery.
But in November 2001, the U.S. Food and Drug Administration said Bextra was not safe for patients at high risk of heart attacks and strokes. The FDA approved Bextra only for arthritis and menstrual cramps. It rejected the drug in higher doses for acute, surgical pain.
Promoting drugs for unapproved uses can put patients at risk by circumventing the FDA's judgment over which products are safe and effective. For that reason, "off-label" promotion is against the law. But with billions of dollars of profits at stake, marketing and sales managers across the country nonetheless targeted anesthesiologists, foot surgeons, orthopedic surgeons and oral surgeons. "Anyone that use[d] a scalpel for a living," one district manager advised in a document prosecutors would later cite.
A manager in Florida e-mailed his sales reps a scripted sales pitch that claimed -- falsely -- that the FDA had given Bextra "a clean bill of health" all the way up to a 40 mg dose, which is twice what the FDA actually said was safe.
Doctors as pitchmen
Internal company documents show that Pfizer and Pharmacia (which Pfizer later bought) used a 'multimillion-dollar medical education budget' to pay hundreds of doctors as speakers and consultants to tout Bextra. Pfizer said in court that "the company's intent was pure": to foster a legal exchange of scientific information among doctors.
But an internal marketing plan called for training physicians "to serve as public relations spokespeople."
According to Lewis Morris, chief counsel to the inspector general at the U.S. Department of Health and Human Services, "They pushed the envelope so far past any reasonable interpretation of the law that it's simply outrageous." Pfizer's chief compliance officer, Doug Lanker, said that "in a large sales force, successful sales techniques spread quickly," but that top Pfizer executives were not aware of the "significant mis-promotion issue with Bextra" until federal prosecutors began to show them the evidence.
By April 2005, when Bextra was taken off the market, more than half of its $1.7 billion in profits had come from prescriptions written for uses the FDA had rejected.
Too big to nail
But when it came to prosecuting Pfizer for its fraudulent marketing, the pharmaceutical giant had a trump card: Just as the giant banks on Wall Street were deemed too big to fail, Pfizer was considered too big to nail.
Why? Because any company convicted of a major health care fraud is automatically excluded from Medicare and Medicaid. Convicting Pfizer on Bextra would prevent the company from billing federal health programs for any of its products. It would be a corporate death sentence.
Prosecutors said that excluding Pfizer would most likely lead to Pfizer's collapse, with collateral consequences: disrupting the flow of Pfizer products to Medicare and Medicaid recipients, causing the loss of jobs including those of Pfizer employees who were not involved in the fraud, and causing significant losses for Pfizer shareholders.
"We have to ask whether by excluding the company [from Medicare and Medicaid], are we harming our patients," said Lewis Morris of the Department of Health and Human Services. So Pfizer and the feds cut a deal. Instead of charging Pfizer with a crime, prosecutors would charge a Pfizer subsidiary, Pharmacia & Upjohn Co. Inc.
The CNN Special Investigation found that the subsidiary is nothing more than a shell company whose only function is to plead guilty.
According to court documents, Pfizer Inc. owns (a) Pharmacia Corp., which owns (b) Pharmacia & Upjohn LLC, which owns (c) Pharmacia & Upjohn Co. LLC, which in turn owns (d) Pharmacia & Upjohn Co. Inc. It is the great-great-grandson of the parent company.
Public records show that the subsidiary was incorporated in Delaware on March 27, 2007 , the same day Pfizer lawyers and federal prosecutors agreed that the company would plead guilty in a kickback case against a company Pfizer had acquired a few years earlier.
As a result, Pharmacia & Upjohn Co. Inc., the subsidiary, was excluded from Medicare without ever having sold so much as a single pill. And Pfizer was free to sell its products to federally funded health programs.
An imaginary friend
Two years later, with Bextra, the shell company once again pleaded guilty. It was, in effect, Pfizer's imaginary friend stepping up to take the rap.
"It is true that if a company is created to take a criminal plea, but it's just a shell, the impact of an exclusion is minimal or nonexistent," Morris said. Prosecutors say there was no viable alternative.
"If we prosecute Pfizer, they get excluded," said Mike Loucks, the federal prosecutor who oversaw the investigation. "A lot of the people who work for the company who haven't engaged in criminal activity would get hurt." Did the punishment fit the crime? Pfizer says yes.
It paid nearly $1.2 billion in a criminal fine for Bextra, the largest fine the federal government has ever collected. It paid a billion dollars more to settle a batch of civil suits -- although it denied wrongdoing -- on allegations that it illegally promoted 12 other drugs.
In all, Pfizer lost the equivalent of three months' profit.
It maintained its ability to do business with the federal government.
Pfizer says it takes responsibility for the illegal promotion of Bextra. "I can tell you, unequivocally, that Pfizer perceived the Bextra matter as an incredibly serious one," said Doug Lankler, Pfizer's chief compliance officer. To prevent it from happening again, Pfizer has set up what it calls "leading-edge" systems to spot signs of illegal promotion by closely monitoring sales reps and tracking prescription sales.
It's not entirely voluntary. Pfizer had to sign a corporate integrity agreement with the Department of Health and Human Services. For the next five years, it requires Pfizer to disclose future payments to doctors and top executives to sign off personally that the company is obeying the law.
Pfizer says the company has learned its lesson. But after years of overseeing similar cases against other major drug companies, even Loucks, isn't sure $2 billion in penalties is a deterrent when the profits from illegal promotion can be so large. "I worry that the money is so great," he said, that dealing with the Department of Justice may be "just of a cost of doing business." 2.4.10
Pain specialists warn that drugs are often over-prescribed and not helping in the long term
Eight million people live with chronic pain. After four years of chronic pain Amanda Duffy was desperate. Doctors had tried everything - steroids, opiate painkillers, anti-depressants, anti-epilespy drugs, bone grafts, spinal injections and even a full body cast - yet nothing could relieve her terrible lower back and leg pain.
Personal assistant Amanda doubted she would ever live a normal life again. When she stood up it was as if a hot pin was piercing her feet and legs. The pain radiated down from her hips in a burning sensation. 'I struggled to sit up for more than ten minutes at a time and was unable to work for two and a half years,' recalls the 34-year-old from Bexleyheath , Kent. 'I felt very low and couldn't see when things would improve.' Frustratingly, her pain had been caused by the simplest of events.
Amanda was walking up a staircase when she was knocked backwards by a heavy piece of equipment that had been dropped. 'Instinctively, I tried to protect myself, but got knocked off balance. Fortunately, I managed to stop myself from falling, but I still leant backwards in an awkward twist.'
In that moment, Amanda joined the eight million people in the UK who suffer from chronic pain - pain that has lasted more than three months and not improved. Four years on, she was one of the lucky ones, benefiting from a new multi-disciplinary approach to pain management.
This has meant she is now able to lead a normal life, unlike the majority of sufferers, who will be forced to rely on a cocktail of strong painkillers usually prescribed by their GPs - just 2 per cent will ever see a pain specialist. It has been estimated that in 22 per cent of cases, chronic pain leads to depression.
Just why pain occurs is not always understood - but what is known is that once pain has been switched on, the longer it continues for, the more difficult it becomes to treat. Experts say chronic pain is not taken seriously enough, pointing in particular to NICE guidelines issued last year, which banned anti-inflammatory injections of steroids for patients with recurring lower back pain when the cause is unknown. Specialists fear the new guidelines mean that tens of thousands of people, mainly the elderly and frail, will be left to suffer excruciating levels of pain.
Medicine consultant and anaesthetist Dr Neal Evans, who runs a pain medicine clinic at Spire Thames Valley Hospital , finds one of his first tasks with many patients is to reduce or rationalise their medication before he can begin to work on the pain. 'Recently a patient aged just 20 came to me - he was on six different drugs for pain. He didn't know how to take them or when one would cancel another out, which some did. It was chaotic. I had to get him down to one drug before I could start treating him.'
Dr Evans adds: 'Many people have already seen two or three well-meaning GPs before they get to me and often they end up adding to previous prescriptions. 'While you do need something pharmaceutical to deal with acute pain, once it is long term you need to consider other options.'
The rapid growth in prescriptions of opiate-based painkillers has not helped sufferers of the condition. The number of prescriptions for opioids dispensed in England from 1999 to 2008 increased from 6.2 million to a 14.8 million.
Pain specialists warn that these drugs are often over-prescribed, bringing unpleasant side effects, such as severe constipation, long term dependency or in some cases addiction. 'Chosen wisely, opioid drugs are a valuable tool when managing pain,' says Dr Dalvina Hanu-Cernat, a consultant in pain medicine and anaesthesia at University Hospital Birmingham.
'But chronic pain is so complex, you have to address all the problem, not just the bit you can fix with a drug. And patients ought to know what you are letting yourself in for if you go down the medication pathway.' ‘These drugs do have a potential for addiction and other ways of dealing with pain should have been considered before they are prescribed.' Not afterwards, as often happens at the moment.
Amanda Duffy was one of the lucky ones, benefiting from a new approach to pain. Six months after her treatment she was back at work and able to walk, even dance again. This new approach brings together a team from various disciplines, including psychologists, surgeons, neurologists and GPs. This idea is to work on the psychological and the practical elements of chronic pain - it is not a 'cure' but helps patients to cope with chronic pain, without medication.
Amanda was treated at the Pain Management & Neuromodulation Centre, at Guy's & St Thomas ' Hospital. It is run by Dr Adnan Al-Kaisy, one of the leading exponents of this new approach, and is the first and largest pain management centre in the world.
At the clinic - which takes referrals from all over the country and abroad - patients are offered a range of treatments such as cognitive behaviour therapy (which teaches new ways to cope with pain by breaking old habits and patterns of behaviour) to physiotherapy and surgical implants that stimulate the spinal cord to alter the pain messages sent to the brain.
If appropriate, pharmaceutical pain relief may be offered initially – although staff try to avoid this route. But where Dr Al-Kaisy's approach is ground-breaking is that the clinic now offers a four-week residential programme for adults who've suffered chronic pain that is not responding to other forms of treatment.
These are the most difficult cases, says Dr Al-Kaisy. They may already have been to other pain management clinics without success - the average patient referred to the unit has had pain for 10 years and has tried around six different treatments without finding a solution. When Amanda arrived at the clinic it was, she says, 'a last resort'. Following her accident she was diagnosed with a prolapsed disc in her in her lower back.
She had a variety of treatments, including injections of steroids and painkillers directly into the area - when none of this worked, two years after her fall she underwent two operations to remove and replace the disc. Unfortunately, part of the bone graft to replace the disc became loose, and went astray inside her body. A fragment of bone lodged in the root of a nerve. This was removed in a third operation; she then underwent a fourth with a new bone graft.
But the bone fragment had caused scar tissue on the nerve and she woke up from the operation 'screaming in pain', says Amanda Her problems worsened and she ended up in a full body cast to prevent her spine moving too much to allow healing. She took heavy painkillers, but they ‘zonked me out'. She freely admits that by this stage she was at the end of her tether – emotionally as well as physically.
Then nearly four years after her accident, Amanda's consultant referred her to Guy's and Tommy's INPUT programme. ‘It suited me very well,' she says simply. 'We were taught to challenge our attitudes to pain – that if you are feeling pain it does not mean you are experiencing damage.
'When you are used to chronic pain that is a huge thing to get your head around: that hurt does not equal damage. It took the fear away. ‘We also learned how to reduce our medication, and simple strategies such as stretching for up to 30 minutes a day. That may sound like nothing, but you have to remember, I had not moved for three and a half years – I had been in agony every day.'
She also learnt to pace herself and plan her days so that she could get on with life again, without wearing her body out. ‘For example, on a long car journey, I add extra time for stopping and getting out of the car for breaks as I can't sit in the same position for too long. I plan for lifts, stairs, I think things through.' 'This has absolutely turned my life around.
While this clinic was the first of its kind, pain medicine is now a rapidly growing specialty around the country. 'It used to be true that we wouldn't see patients until they had been through failed investigations and treatment elsewhere; but now many GPs are referring straight for pain management,' says Dr Neal Evans.
‘However I still see patients who may have to wait two years between getting referred to the clinic and beginning treatment. It doesn't make me happy, because the faster you can intervene, the better your chances of recovery.' Amanda says she knows she is not 'cured'. 'In fact physically I have deteriorated having developed arthritis in my back . But mentally I continue to improve – I am really positive and cheerful. I rarely take any painkillers at all – just the odd paracetamol.
‘I lead a very active life these days and I am due to get married this year to my fiancé and I can't wait. I will be able to walk down the aisle and even dance at my wedding. 'Things I never dreamt would be possible. Now, as long as I pace myself, there is nothing I can't do.' 11.4.10
Side-effect risk to millions who take unnecessary stomach drugs
Millions of patients are being unnecessarily treated with expensive indigestion drugs that can cause serious side-effects, researchers warn.
The prescription drugs - proton pump inhibitors - stop the backflow of acid from the stomach and are used to treat ulcers and to prevent heartburn and gastric reflux. But an analysis of research into the side-effects of PPIs has found between half (50%) and two-thirds (75%) of such prescriptions are 'inappropriate'.
PPIs increase the risk of pneumonia, osteoporosis, broken bones, kidney problems and infection with C.difficile, the superbug that afflicts thousands of older hospital patients every year.
The report found that while PPIs were effective in several conditions, there was evidence they are excessively used to treat indigestion when other prescription medicines costing half as much would work just as well, without such severe side-effects. There were 36million prescriptions written for PPIs in the UK last year - a threefold rise since 2000.
Doctors have previously warned the NHS is spending £100 million unnecessarily each year over-treating indigestion patients with PPIs - around one-quarter of the total expenditure on the drugs.
A report in the British Medical Journal found overuse of the drugs flouted NHS guidelines, because doctors were reaching for the 'top weapon in the armoury' to treat even mild cases of indigestion.
Dr Mitchell Katz, of the San Francisco Department of Public Health, writing in the journal Archives of Internal Medicine, said overuse of PPIs was a major problem. He said: 'That proton pump inhibitors relieve dyspepsia is without question but at what cost - and I do not mean financial.'
The U.S. report looked at a series of studies highlighting the side-effects of PPIs.
An eight-year study involving 162,000 women aged 50 to 79 showed the drugs raised the risk of fractures, particularly in the spine and wrist.
It is thought that when PPIs reduce acid secretion by the stomach, it results in less calcium being absorbed by the body, leading to weakened bones. An analysis of 100,000 patients discharged from hospitals over five years found PPIs caused a 74 per cent increase in infection with C.diff. Another study looked at 1,200 patients being treated for C.diff and found a 42 per cent increased risk of recurrence if PPIs were being used.
With C.diff, doctors say that when PPIs reduce stomach acid it allows the superbug to survive more easily. The bug produces toxins which damage the bowel's lining, resulting in severe diarrhoea. It is usually spread by the hands of healthcare staff and via contaminated surfaces.
Other research has found that PPIs are linked with higher levels of bacterial pneumonia. Archives editor Dr Rita Redberg said: 'Harm will result if these commonly used medications are prescribed for conditions for which there is no benefit, such as non-ulcer dyspepsia.' 11.5.10
Lifestyle interventions first step in treating childhood obesity (and other conditions)
Doctors have warned that surgery and drug treatment for obese children should be a "last resort". Obese children should be targeted with lifestyle interventions, such as a focus on improving diet and exercise, before the use of drugs or surgery are considered. The paper, published online by the Lancet, was written by doctors and academics from the UK and the US .
They recommend that doctors should take a "very conservative approach to drug therapy" and use such methods only for children in the highest five per cent of BMI. It appears present treatment methods are wrong as they point out that antipsychotics, anticonvulsants, blood-pressure drugs and antihistamines should also be considered as a possible cause of recent excessive weight gain in a child.
For treating children who are already obese, the authors stress: “Non-pharmacological approaches should be the foundation of all obesity treatments, especially in children, and should always be considered as first-line therapy.”
But the authors warn: “Treatment with these drugs is associated with more adverse effects than is lifestyle intervention alone.” They suggest that drug therapy is appropriate only for children in the highest 5% of BMI, who have substantial complications of obesity, and in whom lifestyle interventions have failed.
The data suggests that 90 per cent of cases of childhood obesity can be attributed to an imbalance between calories consumed and used.
Other groups have welcomed the disclosure saying ‘this model is also applicable to many other conditions were the use of drugs should be last resort and not the first'. 8.5.10
Drug side effects "neglected, restricted, distorted and silenced" by drug companies
New research shows that information on potentially lethal side effects of the blockbuster painkiller Vioxx was "neglected, restricted, distorted and silenced" by pharmaceutical giant Merck, writes London-based physician and author John Briffa in The Epoch Times .
Vioxx was first approved for sale in 1999 and quickly became a top seller. Yet according to an analysis published in the Archives of Internal Medicine , clear evidence existed by 2001 that the drug increased the risk of cardiovascular thrombotic events, including heart attack, stroke and death. This evidence was contained in studies conducted by and for Merck.
"Most of the information we are using in this study was never published, or if it was published, they never included the key safety data," co-author Harlan Krumholz said.
It has been proven Merck promoted Vioxx through the popular industry practice of ghostwriting articles and scientific studies for publication in respected medical journals. In addition, a recent article in the British Medical Journal shows that the company employed tactics designed to "neutralize" and "discredit" doctors who tried to raise concerns about Vioxx.
Yet Merck still insists that it did not know about the heart risks of Vioxx until 2004, when it voluntarily withdrew the drug from the market.
Practices like those Merck used to promote Vioxx are widespread in the drug industry, as revealed by numerous recent lawsuits against companies for concealing drug side effects, illegally promoting drugs for off-label uses, and using questionable marketing techniques.
Briffa notes that Merck may now be engaged in an attempt to save the image of the cholesterol-reducing drug ezetimibe (also marketed as Vytorin), which does not appear to reduce the risk of heart attacks but may actually increase the risk of cancer death.
"Never mind, though, because it appears Merck has managed to find some scientists who claim that this association is likely to be due to chance, even though the stats show it's very unlikely to be due to chance," Briffa writes. "Let's hope history isn't repeating itself." 7.5.10
NHS slashes services to meet costs of fake swine flu scare
The NHS is being forced to cut services because of the huge costs of the swine flu scare that proved unfounded. A survey has found that as many as one in six health trusts may have to slash services - or already have done so - to recoup costs. The cuts required to pay for swine flu preparations are on top of the cuts needed after the election as the NHS adjusts to a post-credit crunch world.
And, for the first time, it has emerged that the average cost of the swine flu scare to primary care trusts was £340,000 - enough to pay the salaries of 17 nurses. The huge amounts were spent on setting up antiviral collection points, storing and distributing vaccines, staff vaccination sessions and advertising to encourage people to have the jab.
The news comes just a month after ministers revealed that up to £300million of taxpayers' money was wasted on swine flu jabs that were never needed. The Government ordered 90million doses of a vaccine last year as panic over the illness gripped the country - but when the pandemic failed to materialise, it soon became clear the order was far too large.
At the height of the scare, the chief medical officer, Sir Liam Donaldson, said as many as 65,000 people could die from the disease. In fact, the toll has been less than 500 - a fraction of the number who died from ordinary flu. The survey of 107 Primary Care Trusts in GP magazine - which submitted a Freedom of Information request - has laid bare the full cost to local health services.
Five out of 31 PCTs which gave full details to the magazine said they had made cuts or were considering them, while others said they had used contingency funds to meet costs. None of the PCTs would say where the axe would fall.
Dr Richard Vautrey, deputy chairman of the British Medical Association's GP Committee, said individual trusts should not have had to foot the bill. 'I think a pandemic should be seen as an exceptional circumstance and a PCT should be fully supported by central government,' he said.
'The whole nature of a national health service is that one area should be able to support another, and the unusual financial burden of this episode should be borne centrally.'
Critics say 'the scare was exaggerates by 'pharmaceutical stooges' who abused their positions and influence to mislead the media, create unrest and sell more vaccines'. 6.5.10
Deceit and sham: what history's verdict will be on 13 years of New Labour
Let there be no mistake. Today's vote will be a referendum on New Labour's 13-year record in government. New Labour - especially the Blairite wing - constantly brags about winning three successive general elections, as if simply gaining and holding on to office was the main purpose of politics. But how will history judge the Blair and Brown Years?
First and foremost, it will pronounce that New Labour was not just another administration of the traditional British kind - but instead a regime. For they came to power in 1997 with a mission to build an ever-more powerful state, whose interfering apparatchiks would stop individual citizens from having responsibility for their own lives.
They would also introduce endless bureaucratic diktats, or 'guidelines' - with bossy instructions for everything, such as even telling families what they ought to eat. History will note that the regime's totalitarian purpose was brilliantly served by Blair's close crony and director of communications - a master of propaganda and media manipulation called Alastair Campbell.
Yet, eventually, a surfeit of staged photos, rigged interviews and re-heated policy announcements led to a deep distrust of what became known as spin. The public came to know the truth about New Labour: Whitehall 's mismanagement of the NHS and of state education, the ballooning of the national debt, the uncontrolled borders that led to record levels of immigration and the insidious encroachments of the Nanny State.
The contrast between the spin and gloss and the self-evident truth of what was really happening to this country shook the public's faith in their political system, breeding cynicism and apathy. History will therefore pronounce that the New Labour regime was culpable of institutionalised falsity.
This was manifested on the regime's very first day in power in May 1997. In a PR stunt masterminded by Campbell for the benefit of the TV cameras, Tony Blair entered Downing Street amid the adulation of countless well-wishers - who were, in fact, a mob of bussed-in New Labour 'groupies'. The new Prime Minister then delivered a few inspiring 'catch-in-the-throat' words from the steps of No 10.
And what, indeed, could have been more symbolic of New Labour's falsity than the charismatic Fuhrer of the new regime himself, actor Blair - then as pretty as a pop star and almost as youthful? Nevertheless, tragically, it would take years before the nation saw through the sham and the shallowness.
Yes, shallowness. For history will find that New Labour's idea of a well-devised policy was one which led to headlines on that night's TV news and the next day's news papers' front pages. For example, recorded in history's footnotes will be such headline-grabbers as Blair's brilliant wheeze that litterbugs would be marched off to the nearest cash-point to withdraw money in order to pay a fine.
But, typically, this idea lasted no longer than it takes a cigarette butt to fall from a lout's fingertips to the pavement. The truth is, however, that history will arraign the New Labour regime on much more serious charges than mere shallow opportunism.
It will find them guilty of adopting a novel kind of moral code, in which what was judged as moral was simply that which best served the interests of the Party and the regime. Under New Labour, from No10 downwards, it was no sin to dissemble or unscrupulously manipulate statistics - or even to tell flat-out lies. For these people, the sin lay in being found out.
Only last month, Gordon Brown had to apologise to the Commons for falsely claiming to the Chilcot Inquiry into the Iraq war that, when he was Chancellor, defence expenditure had increased every year. In fact, as he had to admit after being found out, it had actually dropped in four of those years. He was similarly exposed for spouting false statistics on immigration - having presided over increases in the number of foreigners moving to this country that are unsustainable.
However, history will surely conclude that the most criminal of all of New Labour's lies were the dodgy dossiers on Saddam Hussein's military capabilities, drawn up in September 2002 and February 2003, which were used to justify the needless - and illegal - war in Iraq. In the first dossier, the very scanty evidence about Saddam's suspected (but, in fact, nonexistent) weapons of mass destruction was deliberately 'sexed up' on the instructions of Alastair Campbell. The second dossier was concocted by Campbell from a student thesis found on the internet.
The New Labour regime will be further indicted by history for its almost Mafia-like methods of crushing opponents by means of character assassination. Why bother to answer a critic's well-argued case if you can damage him or her personally by a crude slander whispered in a tame journalist's ear? This shameful technique was not only employed against Labour's political enemies, but also against innocent members of the public.
For example, no one can forget how Labour's attack dogs tried to smear as a racist a 94-year-old woman who had complained about her NHS treatment. Then there was the odious case when the Government was forced to apologise for questioning the political motivations of Pam Warren and the other survivors of the tragic Paddington rail crash.
Of course, such amoral tactics were also employed during bitter quarrels within the regime itself - above all in the long-running feud between Blair and Brown, where each man's band of thugs did their best to wound the hated rival.
Still more dangerously reminiscent of the Mafia's way of doing business - or, for that matter, reminiscent of fascist or communist tyrannies - was the New Labour regime's scorn for constitutional procedure and the orderly transaction of government business. Even in the case of such supreme issues as war and peace - such as in Iraq and Afghanistan - the full Cabinet never held thorough debates informed by weighty departmental reports and minuted in detail afterwards.
History will know this because of the testimony to the Chilcot Inquiry by former Defence Secretary Geoff Hoon, Clare Short (who resigned from the Cabinet) and other witnesses regarding the run-up to the attack on Iraq in 2003. Instead, Tony Blair and a few unelected confederates made the key decisions during conversations on a Downing Street sofa.
A historian like myself cannot help but be reminded of Adolf Hitler's similar distaste for formal procedures of government - and his preference for deciding national policy in one-to-one meetings with cronies such as Goebbels and Himmler over cream cakes in his home. Did the New Labour leadership likewise wish to veil its decisions from history's scrutiny? Or was this style of doing business just a sign of the regime's slovenly amateurism?
Here, history will detect a gruesome paradox.
While New Labour promoted the ever-greater empowerment of the State, it entrusted the running of this super-state to a crew of amateurs - politicians learning their jobs on the trot as they shifted from one ministerial desk to another. It was almost as if amateurs obtained their naive faith in 'targets' from a 'Teach Yourself Management' course downloaded from the internet.
History will therefore find that it was all this incompetent meddling that caused the regime's across-the-board failures of policy and execution. Take, for example, the basic economic and financial record. In 1997, Britain was the seventh most competitive economy in the world, but today it has dropped to 13th.
The public sector - paid for by taxpayers out of borrowed money - now accounts for 53.4 per cent of Gross National Product, as against 40 per cent in 1997, and only 36 per cent at the end of the Thatcher era. Government debt stood at £6 billion when Gordon Brown took over as Chancellor in 1997, but today stands at the unimaginable total of £167 billion.
As a result, interest payments to our international creditors now come to more than the national defence budget and more than the education budget. Gordon Brown contends that New Labour chose to incur this colossal debt in order to prevent the financial crisis of 2008 spiralling down into a 1930s-style slump.
He contends that, in any case, this crisis was none of his doing, either as Prime Minister or Chancellor - it was all the fault of the global panic sparked by the collapse of the American subprime mortgage market. Until then, so Brown alleges, Britain mightily prospered thanks to his wise economic stewardship. But the truth is that history will pronounce all of this to be just yet another lie. Yes, there was a decade of economic growth during Brown's stint as Chancellor. However, it was a bubble blown up by a consumer spending spree and a parallel expansion of state expenditure - both on borrowed money.
Gordon Brown has just admitted that as Chancellor he did not do enough to regulate the banks. Official figures show that annual Treasury debt rose from £15 billion in 1997 to £41 billion - even before the banking crisis struck. Brown lavished the Treasury's borrowed money on projects dear to the regime's essentially socialist heart, such as welfare handouts designed to increase the poorer citizen's dependence on the state.
Yet the audit of history will reveal that these huge public expenditures failed to buy proportionate improvements in the nation's life. Far from it.
Take education. In the ten years since the New Labour regime came to power, the state education budget was increased by 52 per cent. Certainly, brand spanking new schools were built. Yet in the final year of that decade, one in five teenagers failed to get a single good GCSE, while only a quarter gained good GCSEs in the four core subjects of English, maths, science and a modern language.
Moreover, the number of 'Neets' (Young people who are not in education, employment or training) rose by a third. According to available figures (from 2005), 9 per cent of 16 to 24-year-olds were unemployed - compared with 4.6 per cent in Germany and only 3.4 per cent in France.
Meanwhile, employers prefer to hire eastern European workers rather than British, on the basis that they are better educated, better trained and better motivated. No wonder. Whereas in 1997 the UK ranked 14th in international comparisons of adult literacy, we had dropped to 33rd place by 2009. So where has all the money gone? Answer: down the drain of amateurish top-down ministerial attempts at micro-management of the education system.
Just as damning will be history's audit of New Labour's record over the nation's health.
Since 2002, expenditure on the NHS has doubled in real terms, and yet, even though splendid new hospitals have been opened and waiting times for operations much shortened, Britain now ranks 14th out of the 20 countries in the EU (according to the Eurohealth Index) in terms of patient rights, waiting times, range of services and the outcomes of treatment.
Although infant mortality has certainly improved (from 5.7 per 1,000 births in 1997 to 4.9 in 2009), this still makes a grim enough comparison with Germany 's 3.7 per 1,000 and France 's 3.3. Moreover, productivity in the NHS has been falling. So once again, where did all the money go?
Answer: on higher wages and on the layer upon layer of managers needed to transmit Whitehall diktats down to the frontline medical staff and return to Whitehall all the 'target report forms' with boxes duly ticked. It is a sombre fact that the number of desk-wallahs in the NHS has doubled to nearly 45,000 under New Labour - while the number of nurses has only risen by a quarter.
Yet in judging New Labour's record, we must never forget - and nor should we - the regime's foreign wars in Iraq and Afghanistan, both of them crimes against international law motivated by the swollen vanity of Tony Blair and by his subservience to the American President of the day, George W Bush. And history will not forget that Gordon Brown, as Chancellor, refused to sanction the extra defence spending required by these wars.
This shameful betrayal of our men and women in uniform serves as a grim supplement to all New Labour's costly blunderings over economic and social policy at home. Only in the past three years has Gordon Brown, as Prime Minister, begun to provide all the kit our Armed Forces need.
When historians complete their final audit, they will undoubtedly conclude that this was the most deceitful government of modern times. And the most disastrous for the British nation. Yet we voters already know this and have lived through more than enough to convince us that when we vote today, it will be our duty to bring an end to this regime. Correlli Barnett is a fellow of Churchill College , Cambridge , and the author of The Audit Of War. 6.5.10
Magnets could be new drug-free treatment for depression: research
Magnets could hold the key to a treatment for depression in people who have not responded to drugs, research has suggested. A study has found that people who had magnets applied to their head to activate certain parts of the brain were more likely to report their depression lifting than those treated with a similar device without a magnet.
The research conducted by a team at the Medical University of South Carolina, in America , involved 190 people who were depressed and who had not responded to medication. Just under half were randomly assigned to receive the transcranial magnetic stimulation therapy which involved wearing a helmet like device that applied a magnetic current to the front section of brain for around 37 minutes a day for three weeks.
The others wore the same helmet for the same duration but the magnetic field was blocked. The study was published in the Archives of General Psychiatry.
Afterwards depression lifted in 14 per cent of those who received the real magnetic treatment compared with five per cent who received the sham treatment. It mean the transcranial magnetic stimulation was four times more likely to successfully treat depression.
It was calculated that 12 people needed to be treated with the device for one to be cured of their depression.
Lead author Dr Mark George, said: "The results of this study suggest that prefrontal repetitive transcranial magnetic stimulation is a monotherapy with few adverse effects and significant antidepressant effects for unipolar depressed patients who do not respond to medications or who cannot tolerate them." 5.5.10
The NHS investigated: keep the politicians out of it
The NHS investigated: Professor Karol Sikora says courage and competition will let our talent flourish.
What's the most important thing in your life? Of course it's your health. It's something you take for granted until it goes wrong. This week we've been treated to a fantastic collection of articles in The Daily Telegraph, brimming with ideas, stimulating, informative and sometimes entertaining. But with notable exceptions, they stuck to the good, self-righteous, quasi-religious feel of those three magic letters – NHS. Our politicians will do the same over the next two months for they are too scared to tell us the real truth.
The current crisis in health care goes beyond borders, politics and society. This truly global storm has been created by the alignment of ageing populations (a good thing caused by better social fabric as well as medical care), innovative but expensive technology and, most importantly, the rampant, informed demand by increasingly sophisticated consumers.
The internet is the great leveller, despite its faults. I now openly go on to the web in front of patients in the clinic. There's no point trying to hide it any more. It's difficult to imagine that when I started in the cancer business we rarely told patients their diagnosis. So, looking forward, I suspect we have to be more radical than most of the week's suggestions and go for a far bolder vision.
Free markets deliver value through choice and competition driving down costs. Change abounds in the high street, supermarket, insurance world and even banking. Our health system is in a cul-de-sac; a Galapagos Island of evolution, where the vestigial remains of previous ages abound. As Sophia Christie, chief executive of a PCT, put it, “we are operating a lot of 19th-century health care alongside that of the 21st”. GP Dr Agnelo Fernandes hit the nail on the head when he said “innovators and innovations are often suppressed by the notion that there has to be equity”.
We clearly have to take more drastic action than creating a few nurse co-operatives or more clunky websites offering impersonal advice before telling you to see your doctor.
I see three problems, but there is a solution to each. The first is politicians. They are not good at telling the truth. They know it's a vote loser to suggest anything that could threaten the concept of universal free health care. But we have a problem. Purely tax-based systems are doomed, simply because the old, who consume the majority of care, pay far less tax than those working. Sure, they paid it in the past but not at rates for tomorrow's technology. This means that the young need to be taxed until the system collapses.
So we need to define a core package from tax and look at insurance and savings plans linked to pensions for the rest. Many spend large amounts of money on holidays and cars but regard health care as a free good handed down by the state. Politicians start squirming here so the solution is simply to take them out of the equation. Supermarkets seem to manage without them, so why not hospitals and GPs? Sure, we need regulators, arbitrators and patient rights but not a political football match every time a bedpan falls to the ground.
The second problem is that governments run poor services. So take health care away from governments; that's happening all over the world. Merge the 152 NHS Primary Care Trusts into 20 large purchasers linked to commercial insurers and make them compete for our business. Make such insurance mandatory, as in Europe .
We need to allow primary and secondary care structures to evolve into competitive providers actually wanting our custom. Some will succeed; some will disappear – that's the nature of competition. It's inevitable that hospitals will close as we reconfigure services to be delivered in clinics, at home and in pharmacies. Nobody ties themselves to the railings in protest when a shop shuts. Why do so for a hospital?
The third key issue is that the concepts of universality and equity that we all love are a utopian dream. Even in our supposedly completely free health system, patients from lower socio-economic groups have a 15 per cent less chance of cure from breast cancer, far greater infant mortality and a life expectancy up to four years shorter. This is scandalous. Cosy committees of the good and the great deliberating with sanctimonious intensity do not produce. And fairness can be delivered as efficiently by private as well as public providers. The front end needs to be in charge of the ship; professionals plotting the course forward.
The art of medicine is being able to sort out the important from the trivial rapidly and cheaply. Maintaining health – physical, psychological and spiritual – in what many perceive to be a toxic world is a major challenge. So let's use all the weapons we have; end destructive arguments about complementary medicine, internecine disputes between professional groups and the endless expansion of bureaucracy chasing elusive and often irrelevant targets. Outcomes are the only key to success.
Above all, we have to get the humanity back into medicine – retaining the ethos of the cottage hospital, the wise GP and the kindly nurse in an age of technological miracles. We have people with the talent, education and skills to deliver the best care in the world. All we need now is the infrastructure in which to do it and the courage to be honest about the challenges ahead.
By Professor Karol Sikora. Karol Sikora is Medical Director of CancerPartnersUK, a private sector cancer service provider, and Dean of the new medical school at the University of Buckingham. 5.5.10
What do we want from the NHS?
We keep pouring money into the NHS, but failing to address the challenges of the 21st century has left it lagging behind other countries, says Jeremy Warner.
If you Google the French health service, you will immediately be hit by a wall of laudatory articles explaining why it is the best in the world. The World Health Organisation regularly ranks it number one, though in recent years it has been closely challenged by the Netherlands .
Yet read a bit further, and you will find a series of less flattering appraisals. "French health system on verge of collapse as deficit mounts", reads one headline, while other stories relate how the service has reduced France to a nation of pill-popping hypochondriacs who put health concerns, however trivial, before any consideration of economic cost. Still others describe how French health professionals are among the lowest paid, and thus the most dissatisfied, in the Western world.
It just goes to show that however perfectly a health system is designed, funded and organised, it is always going to have its problems. Right now, the health services of all advanced economies – good, bad, and ugly together – face a common challenge. The demographic time-bomb of baby-boomers about to hit the age of maximum health care cost has pretty much made all of them fiscally unsustainable. Either we are going to have to pay a whole lot more for our health care, or it will have to be rationed.
Here in Britain, the taxpayer will this year spend around £1,800 per head of population on health, but this is just an average; the older people become, the more they cost and, by extension, the more a society ages, the more money it will have to spend on its health system.
'GP federations' are the future of the NHS
Over the past decade, the British Government has dramatically increased spending on health. In the eight years since the Wanless review, real spending on the NHS has risen by more than 50 per cent and the proportion of the GDP devoted to spending on the NHS is now close to the EU average of about 10 per cent.
We can argue about how efficiently that extra money has been spent; plainly there have been improvements in waiting times, access, equipment, infrastructure and some standards of care. There are more staff, and a notable improvement in outcomes has been achieved; survival rates for cancer, heart disease and stroke have all been raised, though admittedly by no more than the European average.
Unfortunately, that's not the whole story. A large amount of the additional funding seems to have been eaten up by higher salaries that have failed to make a significant difference to productivity. Crude targeting and relentless reorganisation of systems, some of which seems to have done a great deal more harm than good, has further compounded the sense of waste.
A King's Fund review a few years back on the future of the NHS, coauthored by Derek Wanless, the man who lit the fuse on the current surge in health spending, makes for alarming reading. "Even higher funding will be needed over the next two decades," it concludes, "to deliver the high-quality services envisaged in the 2002 Wanless Review". Ominously, it warns that "such an expensive service could undermine the current widespread political support for the NHS and raise questions about its long-term future."
You can say that again. The curiosity of the political debate over the future of the NHS is how little of it there is. As Barack Obama has discovered to his cost, any politician who embarks on health care reform does so at his peril. Politicians, therefore, tend to leave well alone. Twenty years down the line, a funding shortfall will be someone else's problem.
In Britain , the difficulties are made worse by sentimental and idealistic attachment to the founding principles of the NHS, a system of health care free to all at the point of delivery that was once the envy of the world. The NHS is a sacred cow that no politician who values a future in government dares touch. Thus it is that whatever sacrifices other departments are expected to make in the coming spending squeeze, health will remain ring fenced.
The rise of 'co-operative PCTs'
In fact, the NHS has always struggled to live up to its founding principles and as the years have given way to decades, it has found the service it provides surpassed by different systems in other countries.
Significantly increasing the percentage of the tax base devoted to health care has failed to correct the problem. The NHS has become like a leviathan that threatens to swamp all other calls on the government's money. Although the NHS perennially overspends, even on its inflated budgets, the politicians promise to spend still more. Yet they daren't explain where the money will come from.
Can anything be done to correct these problems, or do we just trundle on regardless until financial and operational crises brutally impose unwanted solutions? The starting point for any serious debate on the future of the NHS must be the realisation that there are limits to what publicly funded health care can and should be expected to provide.
Many of the treatments and services now routinely expected of the NHS are beyond the imagination of the service's founding fathers, and certainly beyond what they would have regarded as an appropriate claim on taxpayer funds.
In allowing the leviathan to grow, governments of all hue have closed their eyes to the costs of changed demographics and the relentless march of technological and medical advancement. Unbelievably, there are still no long-term government forecasts around these issues. The problem is being swept under the carpet.
The next stage of the debate needs to be the realisation that if people want better health care, they must be prepared to pay more towards it. Yes of course much could be done to improve productivity. A relatively recent report by management consultants McKinsey suggested that the NHS workforce in England could be cut by 10 per cent, saving £20 billion by 2014, without affecting the quality of service. Needless to say, the report was suppressed and when it was leaked its findings were rejected.
But there is only so far you can go with cost-cutting before eating into the fabric of the service, and it won't remove the relentless pressures of ageing populations and technological advancement. Similarly, initiatives to introduce elements of the free market into publicly funded health care, such as providing patients with a greater element of choice, are no doubt well intentioned but don't address the underlying problem of rising costs – and will lead to a form of health care apartheid, where the well informed and pushy triumph over the weak-willed and feeble.
Health care systems in other countries have been generally better at grafting on additional sources of funding to meet these rising costs than we have in the UK – in particular, co-payment, user charges and voluntary as well as compulsory forms of insurance. One clear funding advantage of the French system, for example, is that most treatment outside chronic illness requires some form of co-payment, but the vast bulk of people are able to insure themselves privately through regulated schemes against these costs.
In Britain , by contrast, most forms of health treatment are seen as an entitlement of the tax system. People think nothing of spending £1,000 on a second foreign holiday, or indeed of spending even more on cosmetic surgery, yet there would be a revolution if they were required to spend the money instead on better health care.
Sadly, it is just such a revolution in outlook that has to take place if a looming catastrophe in disappointed expectations is to be averted. As with so much else, people are going to have to learn to prioritise their long-term health needs over the rampant consumerism of the recent past. 5.5.10
NHS investigated: the Dutch health service
Juul Zilvold, 40, a translator, whose father is a doctor, lives in Amsterdam with her husband, Kieran, and two children Kyo, six, and Keeva, 10. Like most Dutch people, Mrs Zilvold pays a compulsory base level of insurance, basisverzekering , as well as additional health insurance.
"We pay 124 euros per month, but whatever package you have there is an annual threshold of 165 euros, which you might have to pay at the end of the year, depending on what care you have had. Certain costs for what are considered basic needs – such as visits to your GP – are always reimbursed," she says.
Health care in the Netherlands is free at point of use after presentation of ID and a health-insurance chip card. Basic insurance covers general medical care, hospital stays, dental care up to age 22 and prescription medicine. Costs start at approximately 100 euros a month, depending on income.
"You have different basic packages from low to the very best. We take the medium and we take an extra module for dental care but that is only nine euros a month," says Mrs Zilvold.
All Dutch residents are registered with a nearby huisarts , or family doctor – the idea is that the GP is no more than 10 minutes away in case of house calls. Dutch doctors are renowned for an old-fashioned approach and a reluctance to hand out medication as a quick fix.
"I know some French and Spanish people who complain that they do not get enough pills when they go to the doctor," Mrs Zilvold says. "It is much less medicalised than other European health services. Doctors won't give you antidepressants if you are a bit depressed, they will try to do something about the causes.
"My dad is a rehabilitation doctor, so unless your arm is hanging off he would think nothing is wrong with you. I am used to the no-nonsense approach."
Coverage for children is free and good quality, but Mrs Zilvold, a supporter of "no nonsense" medicine, says "we don't use the doctor a lot". But, as in Britain , the GP service is also criticised. "Because of opening hours and secretaries acting as a buffer, it is not always easy to get to speak to your GP. So hospitals are complaining that people just bypass them and go straight to the emergency room for things that they should officially first go and see their GP for."
As a mother, Mrs Zilvold praises the Dutch system for encouraging home births, and a third of Dutch women have their babies at home. "There are well-trained midwives and because the Netherlands is densely populated, there's always a hospital nearby, just in case of complications. I had both my children at home and was happy that this was possible," she says.
"For people who go to hospital, it seems that it is often busy so there is less time to let things take their course. There is considerably more intervention, like forceps, in hospital deliveries. In order to preserve the system, we will need to maintain the number of midwives, though."
Mrs Zilvold's main concern is the lack of accountability in hospitals where consultancy work is outsourced. "Specialists are often not employed by hospitals, but basically work as contractors within the hospitals, which means that hospitals have less control over them. In case of mistakes, it is not easy to call them to account, even though there has been a National Complaints Board since 2001." 5.5.10
Now Goldman Sachs faces U.S. criminal investigation into $1bn mortgage securities fraud
Goldman Sachs came under fresh pressure this morning after it was revealed the Wall Street powerhouse faces a criminal investigation into mortgage security deals it arranged. The inquiry follows civil fraud charges filed by the government against Goldman two weeks ago.
The U.S. attorney's office in Manhattan opened the investigation following a criminal referral by America 's financial watchdog, the Securities and Exchange Commission. The SEC brought civil fraud charges against Goldman and a trader in connection with the transactions in 2006 and 2007.
The agency alleged the firm misled investors by failing to tell them the subprime mortgage securities had been chosen with help from a Goldman hedge fund client, Paulson & Co., that was betting the investments would fail. Goldman and the trader, Fabrice Tourre, have denied the charges and said they will contest them in court. The Justice Department move came a day after a group of 62 congressmen, including Democratic Judiciary Committee Chairman John Conyers, asked Justice to conduct a criminal probe of Goldman.
'On the face of the SEC filing, criminal fraud on a historic scale seems to have occurred in this instance,' the group said in a letter to Attorney General Eric Holder. Goldman spokesman Lucas van Praag said: 'Given the recent focus on the firm, we're not surprised by the report of an inquiry. We would cooperate fully with any request for information.'
Several thousand demonstrators marched through the New York financial district on Thursday in a protest led by labour unions, saying Wall Street's biggest banks must account for record profits while average Americans still suffer financially. Spearheaded by the AFL -CIO (America's Union Movement), the march made its way through the downtown Manhattan financial district with signs saying 'Wall Street overdrafted our economy' and 'Reclaim America, hold banks accountable.'
The march featured a variety of organisations and labour unions with grievances about the economy and jobs. Union member Kurt Hallman, an electrician who was marching in the rally, said the big banks 'let everybody here sink to the bottom.' He added: 'They tightened up all the loaning. Now there's no money. These guys who gave themselves billion dollar bonuses.'
The Justice Department move was the latest in a dramatic series of turns in the Goldman Sachs saga, which has pitted the culture of Wall Street against angry politicians in an election year, in the wake of the financial crisis that plunged the country into the most severe recession since the Great Depression of the 1930s. The Senate yesterday lurched into action on sweeping legislation backed by the Obama administration that would clamp down on Wall Street and the sort of high-risk investments that nearly brought down the economy in 2008.
And two days earlier, a day-long showdown before a Senate investigative panel put Goldman's defence of its conduct in the run-up to the financial crisis on display before indignant lawmakers and a national audience. The panel, which investigated Goldman's activities for 18 months, alleges that the Wall Street powerhouse bet against its clients - and the housing market - by taking short positions on mortgage securities.
The bank then failed to tell them that the securities it was selling were at very high risk of default. Goldman CEO Lloyd Blankfein testily told the investigative subcommittee that clients who bought the subprime mortgage securities from the firm in 2006 and 2007 came looking for risk 'and that's what they got'. Blankfein said the company didn't bet against its clients - and can't survive without their trust.
He repeated the company's assertion that it lost $1.2billion in the residential mortgage meltdown in 2007 and 2008. He also argued that Goldman wasn't making an aggressive negative bet - or short - on the mortgage market's slide.
In addition to the $2billion so-called collateralised debt obligation that is the focus of the SEC 's charges against Goldman, the subcommittee analysed five other such transactions, totaling around $4.5billion. All told, they formed a 'Goldman Sachs conveyor belt' that dumped toxic mortgage securities into the bloodstream of the financial system, the panel said.
A collateralised debt obligation or CDO is a pool of securities, tied to mortgages or other types of debt, that Wall Street firms packaged and sold to investors at the height of the housing boom.
Buyers of CDOs, mostly banks, pension funds and other big investors, made money off the investments if the underlying debt was paid off. But as U.S. homeowners started falling behind on their mortgages and defaulted in droves in 2007, CDO buyers - inclusing the Royal Bank of Scotland - lost billions.
It wasn't immediately known whether the Justice Department's inquiry also encompasses the five other transactions. The investigation, even though at a preliminary stage, opens a momentous new front in the legal aftermath of the near-meltdown of the financial system. The Justice Department and the SEC have previously launched wide-ranging investigations of companies across the financial services industry.
But a year after the crisis struck, charges haven't yet come in most of the probes. In addition to fallen mortgage lender Countrywide Financial Corporation and bailed-out insurance giant AIG , the investigations also have targeted government-owned mortgage lenders Fannie Mae and Freddie Mac and crisis casualty Lehman Brothers.
Last August, a federal jury in New York convicted former Credit Suisse broker Eric Butler of conspiracy and securities fraud in connection with a $1billion subprime mortgage fraud. But the swift acquittal in November of two former Bear Stearns executives in the government's criminal case tied to the financial meltdown showed how tough it can be to prove that investment bank executives committed fraud by lying to investors.
The SEC sued the two executives in a civil suit, and that case is still pending. The government must show that executives were actually committing fraud and not simply doing their best to manage the worst financial crisis in decades, some legal experts say.
The SEC civil fraud case against Goldman - even with the lower required burden of proof than in a criminal case - also could be difficult and faces pitfalls, in the view of some experts. To prove it, they say, the agency must show that Goldman misled investors or failed to tell them facts that would have affected their financial decisions.
The greatest challenge, the experts say, will be boiling the case down to a simple matter of fraud: the issues involved are so complex that Goldman may be able to introduce enough complicating factors to shed some doubt on the SEC 's claims. Political intrigue has swirled around the SEC suit, meanwhile, as some Republicans have accused the agency of timing the April 16 announcement of fraud charges against Goldman to bolster prospects for the financial overhaul legislation while it was at a critical stage in the Senate.
The speculation was heightened by the revelation that the SEC commissioners approved filing of the charges on a 3-2 vote, along party lines, with both Republicans opposing the move. SEC Chairman Mary Schapiro has insisted there was no connection between the timing of the agency lawsuit, which followed a monthslong investigation of the firm, and the push for the legislation in the Senate. Last week, President Barack Obama denied any White House involvement in the timing of the SEC case.
'We don't time our enforcement actions by the legislative calendar or by anybody else's wishes,' Schapiro told a Senate Appropriations subcommittee on Wednesday. 'We bring our cases when we have the law and the facts we believe support bringing our cases.'
Last week President Barack Obama delivered a speech in New York in which he scolded Wall Street for fighting tighter regulation and said legislation was needed to avoid future crises. But Tanya Gallo, an education at the rally on Thursday, said: 'I am very disappointed Obama didn't come down stronger. 'If there is ever a time to be mad as hell, it's now.' 30.4.10
WHO issues warning about corruption of pharmaceutical industry
The World Health Organization (WHO) recently issued a fact sheet warning about the corruption and unethical practices that are endemic to every step of the pharmaceuticals business.
"Corruption in the pharmaceutical sector occurs throughout all stages of the medicine chain, from research and development to dispensing and promotion," the fact sheet reads.
The medicine chain refers to each step involved in getting drugs into the hands of patients, including drug creation, regulation, management and consumption. According to WHO data, unethical practices such as bribery, falsification of evidence, and mismanagement of conflicts of interest are "common throughout the medicine chain."
The fact sheet also highlights other forms of corruption specific to particular steps in the chain. For example, clinical trials may be conducted without proper regulatory approval, royalties may be collected through manipulation or disregard of the patent system, and products may be registered with incorrect or insufficient information. Drugs may be produced through substandard or counterfeit methods, leading to products that are less effective at best, and hazardous at worst. Corruption can also occur during the drug inspection process, allowing such shoddy products to be given a government seal of approval.
Once drugs have been produced for the market, corruption can occur via the selection of non-essential drugs for different governments' lists of "essential" medications. Unethical marketing strategies -- both legal and illegal -- are common throughout the drug business. Vendors may collaborate with pharmaceutical companies and doctors might be unduly influenced to dispense drugs to gain the greatest profit rather than to produce the greatest benefit for the patient.
This corruption can have serious consequences, the WHO warns. "Medicines are only beneficial when they are safe, of high quality, and properly distributed and used by patients," the fact sheet says.
Most obviously, corruption in the drug business can divert medicines away from where they are most needed, while the production of substandard pharmaceutical products can be dangerous to patients' health. "Diverted, counterfeit and substandard medicines have been identified in markets of both rich and poor countries," the fact sheet says. "Such practices lead to patient suffering and have direct life or death consequences."
Corruption in the drug business also wastes public resources and "[erodes] public and donor confidence in public institutions." In Third World countries, as much as 89 percent of health care spending is lost to corruption, while unethical practices cost First World countries an estimated $12 billion to $23 billion a year. Worldwide, this amounts to a loss of 10 to 25 percent of all drug procurement spending, or nearly $190 billion.
The WHO notes that corruption is so widespread in part because medicines pass through a large number of intermediaries before they reach the patients who need them. Each extra step provides an opportunity for corruption to take place, ultimately driving up the cost of the medicine or diverting it toward the wrong recipients.
Corruption is especially hard to fight because most cases go unreported. The WHO attributes this both to fear of retaliation on the part of whistleblowers, and also the institutionalization of corruption "to the point where people feel powerless to influence change in their countries."
According to the WHO, countries most likely to be plagued with corruption in the pharmaceutical industry are those without "appropriate legislation or regulation of medicines; enforcement mechanisms for laws, regulations and administrative procedures; [or] conflict of interest management."
"A lack of transparency and accountability within the medicines chain can also contribute to unethical practices and corruption."
Corruption has real health impacts, the fact sheet emphasizes. For example, countries with more corruption have higher child mortality rates than other countries with similar health standards.
As part of its efforts to reduce unethical practices in the medicines chain, the WHO launched the Good Governance for Medicines program in 2004. This program helps countries evaluate their vulnerability to corruption, then plan and implement programs to reduce it. 30.4.10
Is the new gene test just playing the averages? Scientist has every gene screened to show risk of catching disease
For many of us, being told how likely we are to be hit by a range of fatal diseases is something we would rather not know. But a scientist has been given the first ever prediction of his risk of future disease after his DNA was completely decoded and he has a 50% chance of catching just about everything.
He was prescribed anti-cholesterol drugs to tackle his heart disease risk after colleagues at a leading university sequenced his genetic code. The American researchers who uncovered Professor Stephen Quake's future risk predict everyone could be offered such testing within a decade for a few hundred pounds.
They claim he is the first person to have a clinical 'diagnosis' made about his risk of suffering a range of illnesses. The results revealed heightened risks of heart disease, cardiac arrest, diabetes and prostate cancer, as well as his likely responses to certain medicines.
Prof Quake, 40, made headlines last year when he used new technology to sequence his own genome, or genetic code, for less than $50,000 (£33,000). The latest study, published today in The Lancet medical journal, used his personal genetic data to make predictions about his health.
Prof Quake said: 'We're at the dawn of a new age of genomics. Information like this will enable doctors to deliver personalised health care like never before. It's certainly been interesting. I was curious to see what would show up. 'But not everyone will want to know the intimate details of their genome, and it's entirely possible that this group will be the majority.'
Colleagues at Stanford University School of Medicine near San Francisco , examined the scientist's genetic profile and combined the results with research information from studies about the genetic causes of different diseases. Aspects of his family history were also taken into account, including the sudden death of a distant relative in his sleep at the age of 19.
Prof Quake, professor of bioengineering at Stanford's medical school, was screened for 55 conditions, ranging from obesity and Type 2 diabetes to schizophrenia and gum disease. In some cases the normal risk of developing a certain condition for a man of his age was scaled down, and in other cases up.
For instance, he entered the study with a 16 per cent chance of developing prostate cancer in his lifetime. But after incorporating information about 18 separate genetic variants from 54 studies, Prof Quake's personal risk of prostate cancer was put at 23 per cent.
The worst news was on obesity, type-2 diabetes and coronary artery disease. Prof Quake - described as a 'seemingly healthy' man - was found to have a more than 50 per cent chance of developing any of these conditions.
The screening also showed how his body is likely to react to certain drugs. Several genetic variants were associated with a good response to cholesterol-reducing statins, which he has now been prescribed to deal with higher-than-average levels of blood fats.
Already, tests are commercially available that read part of a person's genome - starting at around £300 - and giving a verdict on the risk of 50 common diseases for $2,000 (around £1,300). Cardiologist Euan Ashley, one of the Stanford scientists, said the falling cost of genome sequencing would soon put screening of the full code within reach of the general public.
'The $1,000 (£657) genome is coming fast,' he said. 'The challenge lies in knowing what to do with all that information.' Professor Henry Greely, from Stanford Law School , said patients, doctors and geneticists are about to be hit by a 'tsunami' of genetic data. 'We predict that an average person might need information about roughly 100 genetic risks,' he said.
He warned that it would take at least five hours to counsel the average patient about their genetic risks of disease, in addition to many hours of analysis to assess the nature of the risks.
But critics said 'it's just a prediction and taking a test which states you have a 50% of chance of contracting any condition is a waste of medical resources. From the results Prof Quake has as much chance of contracting MS as he does lung cancer, they may as well screen every known condition as I'm sure there is chance you 'could' get something'. 30.4.10
Hospitals are killing too many patients
A hospital is no place to be if you're sick, and new studies just released confirm this view. A review of practices in hospitals in the UK has found that 850,000 errors occur every year, resulting in 40,000 deaths, although the rate could be as high as 72,000 deaths a year.
This gloomy picture is just from those incidents that hospitals and staff admit to, and the situation could be many times worse. Overall, the figures suggest an error rate of 2.2 per cent, whereas other studies have reported rates from as high as 3.6 per cent. An Australian study, thought to be one of the most accurate and reliable yet produced, reported an error rate of 4.75 per cent, which, if so, would suggest that the situation in UK hospitals is twice as bad as that reported.
The study doesn't reveal how the patients got into hospital in the first place, but a What Doctors Don't Tell You report estimated that up to 1.1 million Britons are admitted every year following an adverse reaction to a drug or medical therapy, or from a prescribing error. So once medicine has got you into a hospital bed, it has a pretty good chance of finishing you off.
Not that the situation is any better in the USA . Around 195,000 patients die in an American hospital every year as the result of a medical error, one study has concluded.
The health insurance group Healthgrades Inc produced the new figures, which double those reported by the Institute of Medicine in 1999. It was based on a review of 45 per cent of hospital admissions from 2000 to 2002, and includes failures to rescue dying patients and deaths from infection of low-risk patients, neither of which were included in the Institute of Medicine 's report.
In addition to the deaths, 1.14 million patients also suffered a 'safety incident', which represents one in four Medicare patients admitted from 2000 to 2002. (Sources: British Medical Journal, 2004; 329: 369).
Woman GP faces being struck off after 'getting hooked on DIY hangover cure she devised to combat drink problem'
A family doctor became hooked on a cocktail of drugs she prescribed to cure her dreadful hangovers, a tribunal heard yesterday. Dr Emily Heinzman, 31, began drinking heavily after she split from her boyfriend following an unhappy relationship. But the effects the mornings after her drinking sessions were so bad she allegedly devised a DIY hangover cure.
Heinzman issued prescriptions to a number of pharmacists for drugs such as tamazepam, diazepam, codeine and co-codamol, becoming addicted to strong codeine painkiller tablets. Sometimes she would write out prescriptions in friends' names but collect the drugs herself from the chemist.
Yesterday she faced a General Medical Council disciplinary panel in Manchester charged with misconduct. The hearing was told that Heinzman began working as a GP at the Thornton Medical Centre in Leeds in August 2006, shortly after her relationship broke down. She began drinking to excess and suffered from raging hangovers.
At first she took codeine tablets given to her by a friend with chronic back pain who was prescribed them lawfully by another doctor. When they ran out Heinzman is alleged to have written out prescriptions herself for more. She was caught out when she went to collect a prescription for 230g of codeine tablets and a pharmacist queried one of the notes with a doctor's surgery.
The chemist challenged her and she said she was collecting pills for her brother's girlfriend. But she was refused the drugs and left the store. Another pharmacy in Leeds contacted the doctor's practice with concerns about a prescription for 100 codeine tablets.
Having written prescriptions in her own name, eventually Heinzman used a variety of false names and addresses, some of them belonging to genpendeduine patients, to obtain about 4,000 codeine tablets between July 2007 and April 2008. The police were called in and an investigation of Heinzman's records showed she had prescribed herself drugs on several occasions.
She also tested positive for taking cocaine.
In April last year Heinzman, who is from Leeds, was given an eight-month jail term suspended for 18 months and ordered to complete 100 hours unpaid work after she admitted 16 charges of fraud. Yesterday Peter Atherton, for the GMC, told the tribunal: '[The drugs] were obtained for her own use.
'She was not involved in the selling of drugs. 'She used a variety of prescribing techniques. These included using the computer handwritten prescription, using the names of both patients and people who were known to her. She would create prescriptions and then delete them.
'She used many different names, friends, family and genuine patients. Multiple addresses have been used for the same patient. 'Prescriptions have been presented in many different large pharmacies, where staff were less likely to remember her. 'The efforts and preparation appear to have been a way of covering her tracks.'
During her sentencing at Leeds Crown Court in April 2009, Anthony Sugare, defending, said: 'Her problems stemmed from a relationship breakdown. 'She started to drink heavily and she found in the morning she required assistance to get to work and started taking these tablets. She started to use it and found it relaxing.' 29.4.10
Complementary flower remedy could revolutionise treatment of leukemia and other cancers
A common white flower could revolutionise the treatment of leukemia and save thousands of lives, scientists have claimed. An extract from the white flower commonly known as Baby's Breath can boost the efficiency of anti-cancer drugs by a million times, according to experts.
They found that molecules called saponins, extracted from the Gypsophila paniculata plant, appear to break down the membrane of cancer cells. This makes it much easier for antibody-based drugs, known as immunotoxins, to attack the cancerous cells. As a result, immunotherapy used to treat certain types of leukaemia and lymphoma is increased in potency by 'over one million-fold'.
The discovery has been made by scientists working for the charity Leukemia Busters, based in Southampton, Hants. The charity is run by David and Bee Flavell whose son Simon Flavell died with an incurable form of childhood leukemia in 1990, aged ten. Scientists carried out the work at the newly refurbished Simon Flavell Leukemia Research Laboratory at Southampton General Hospital .
Dr David Flavell said: "I am usually careful about the words I use with things like this but this discovery could truly revolutionise the way these antibody-based drugs work and it will save lives. "And this doesn't just apply to leukemia, there is a really big possibility this can be used for many cancers too. "This is a potentially very important discovery that could allow us to kill leukemia cells in the patient much more effectively with much lower doses of immunotoxin.
"The challenge now is to establish how best to apply this laboratory discovery to the treatment of patients. "We are all excited at the major advance this could represent for immunotoxin treatments for leukemia."
The next step is to take the findings from the test tube and into clinical trials to turn it into a treatment that can be made available to patients. If that is successful - a process that could take between three to five years - then thousands of leukemia patients could benefit from lower doses of drugs. The breakthrough has come as a result of 12 months of research and testing in collaboration with scientists based in the German capital Berlin.
Dr Flavell added: "We still need to do laboratory-based work to further develop this discovery into a practical and safe treatment for patients and money is the key to achieving this. "Leukemia Busters scientists and doctors have worked tirelessly day and night over many years and have relied on the generosity of donations to fund a great deal of its work. The name Leukemia Busters and its logo were both devised by Simon Flavell before he died. The youngster was a great fan of Ghost Busters.
Critics say the claim although welcomed is not new and alternative health practitioners have known for some time and being using saponins for cancer benefits. Studies have shown that saponins have antitumor and anti-mutagenic activities and can lower the risk of human cancers, by preventing cancer cells from growing. Saponins seem to react with the cholesterol rich membranes of cancer cells, thereby limiting their growth and viability. Researchers found that saponins may help to prevent colon cancer and as shown in their article "Saponins as anti-carcinogens" published in The Journal of Nutrition (1995, 125, 717s-724S). Other studies have already shown that saponins can cause apoptosis of leukemia cells by inducing mitotic arrest.
Saponins have many other health benefits. Studies have illustrated the beneficial effects on blood cholesterol levels, cancer, bone health and stimulation of the immune system to fight disease and cancer cells. 29.4.10
Broccoli could stop breast cancer spreading by targeting stem cells
Broccoli could help stop breast cancer spreading, scientists have discovered. Researchers found that a component of broccoli called sulforaphane targeted and killed cancer stem cells and prevented new tumours from growing. Study author Professor Duxin Sun from the University of Michigan , said: 'Sulforaphane has been studied previously for its effects on cancer, but this study shows that its benefit is in inhibiting the breast cancer stem cells. 'This new insight suggests the potential of sulforaphane or broccoli extract to prevent or treat cancer by targeting the critical cancer stem cells.'
Results of the study on mice and cell cultures appear in the May 1 issue of Clinical Cancer Research. Current chemotherapies do not work against cancer stem cells, which is why cancer recurs and spreads. Researchers believe that eliminating the cancer stem cells is key to controlling cancer.
In the current study, researchers took mice with breast cancer and injected varying concentrations of sulforaphane from the broccoli extract.
Researchers then studied how many cancer stem cells were in the tumours. These measures showed a marked decrease in the cancer stem cell population after treatment with sulforaphane, with little effect on the normal cells.
Further, cancer cells from mice treated with sulforaphane were unable to generate new tumours.The researchers then tested sulforaphane on human breast cancer cell cultures in the lab, finding similar decreases in the cancer stem cells.
Co-author Dr Max Wicha said: 'This research suggests a potential new treatment that could be combined with other compounds to target breast cancer stem cells. 'Developing treatments that effectively target the cancer stem cell population is essential for improving outcomes.'
The concentrations of sulforaphane used in the study were higher than what can be achieved by eating broccoli or broccoli sprouts.
Prior research suggests the concentrations needed to impact cancer can be absorbed by the body from the broccoli extract, but side effects are not known. While the extract is already available in capsule form as a supplement, concentrations are unregulated and will vary.
This work has not been tested in patients, and patients are not encouraged to add sulforaphane supplements to their diet at this time. Researchers are currently developing a method to extract and preserve sulforaphane and will be developing a clinical trial to test sulforaphane as a prevention and treatment for breast cancer. 4.5.10
The breakthrough 5-minute test to halt bowel cancer that could save thousands of lives
A five-minute screening test at the age of 55 could save thousands from dying of bowel cancer, a study shows. Experts say the one- off investigation would be the biggest breakthrough in beating bowel cancer for a generation – and called for the NHS to fund it. The test would prevent 5,000 cases of the disease from developing and cut 3,000 deaths a year.
Professor Wendy Atkin, from Imperial College London, who led the research, said: ‘No other bowel cancer screening technique has ever been shown to prevent the disease.' It is hoped the test could be offered nationally within three years. Although earlier diagnosis and drugs have reduced death from the disease, there has been little change in the number of cases.
The study shows for the first time the life-saving benefits of a quick examination using a sigmoidoscope – a thin flexible tube used to check for abnormalities in the lower bowel. Dubbed the Flexi-Scope test, researchers found it cut the death rate for bowel cancer by 43 per cent and reduced the number of cases by a third.
It works by detecting and removing tiny polyps, fleshy growths inside the bowel, which if left untreated can develop into cancer some years later. The findings involving 170,432 men and women who were followed for 11 years are published online in The Lancet journal.
Harpal Kumar, chief executive of Cancer Research UK charity, called for any incoming Government to back Flexi-Scope screening as a ‘matter of urgency'. He said: ‘Cancer Research UK does not often use the word “breakthrough” but this is one of those rare occasions when I am going to.
‘It is extremely rare to see the results of a clinical trial which are quite as compelling as this.'
At present, screening for bowel cancer uses a test which looks for traces of blood in stools and identifies cancer at an early stage. It is offered every two years to those in their 60s and 70s and cuts the death rate by 25 per cent.
But experts say the Flexi-Scope procedure would actually prevent cancer. The blood test would still be needed as it picks up some cancers in parts of the bowel the Flexi-Scope cannot reach. The study took place in 14 centres natonally. Around 170,000 people aged between 55 and 64 were offered the Flexi-Scope test or allocated to non-intervention unless they developed symptoms.
Those having the Flexi-Scope test had small polyps removed or were sent for further investigation where necessary. After an average of 11 years follow-up, 2,524 were diagnosed with bowel cancer – comprising 1,818 who did not have a test and 706 who did.
Altogether 727 died of colorectal cancer – 538 of whom had not had the test and 189 who had. Overall, the test cut the death rate by 43 per cent and incidence of the disease by 33 per cent. Researchers say the benefits to individuals will accumulate as bowel cancer affects mostly older people, who will be protected by the cut in lifetime risk. Bowel cancer claims around 16,000 lives a year.
The study will be reviewed by the NHS Cancer Screening Programmes, which will decide whether to back it. 28.4.10
Whitehall 'wastes £9billion a year' on excessive and inefficient bureaucracy
Billions of pounds of taxpayers' money are being blown on taxis, spin doctors and management consultants, figures have revealed. A snapshot of £45billion of Whitehall spending has found that up to £9billion could be being wasted on excessive and inefficient bureaucracy. At a time when public finances are in crisis, the detailed breakdown shows that central government squandered £11million a year on taxis for civil servants alone.
A further £564million was spent on external communications and marketing and £1.6billion on outside management consultants. The Conservatives, who uncovered the official figures in a series of Parliamentary answers, said they showed the 'appalling' extent to which ministers have frittered away public money. They added that the figures were the tip of the iceberg because expenditure across the public sector as a whole is estimated at £220billion.
David Cameron has pledged that a Conservative government would cut £6billion in waste this year by not replacing public sector workers who leave and cutting spending on IT and procurement. But his plans have been criticised by Gordon Brown, who has claimed they would lead to tens of thousands of job losses.
Tory Treasury spokesman Philip Hammond said the figures proved the Conservatives could make £6billion in savings without harming frontline public services. They show that £881million a year is spent on temporary staff, with the Home Office alone spending £161million on temps - enough to pay for the salaries of 33,000 police constables.
The cost of office furniture is £57million a year, with the Ministry of Justice burning through £11million, followed by the Ministry of Defence at £10million. In addition, Government departments are spending £5.8billion a year on databases and computers. The Conservatives admit that not all of the spending can be classified as 'waste'.
But Mr Hammond said: 'No one who has read this report could argue that the Government couldn't save just £1 in every £100 it spends to make a £6billion cut in government waste this year.'
Francis Maude, shadow minister for the Cabinet Office, added: 'Gordon Brown has imposed tax upon tax on hard-working families and local firms, yet he's wasted our money.' 28.4.10
Labour no longer trusted on NHS: New poll shows damning effect on voters of squandered billions
- Nick Clegg called for NHS to be broken up
- New poll condemns Labour health record
- Tories now best placed to run the NHS
Labour has wasted so much money on the NHS that voters no longer believe it is safe in their hands. An exclusive poll for the Daily Mail found that fewer than one in five voters see significant improvements in the service, despite a doubling of budgets. Almost two thirds say out-of-hours GP cover has deteriorated under Labour, and a huge majority call for GPs to be forced to take back responsibility for patient care at evenings and weekends.
Voters believe Labour has squandered billions on bureaucracy and that the Tories are now the party best placed to look after the NHS.
The results of the Harris survey are evidence that David Cameron's decision to put Tory support for the NHS at the heart of his election strategy is paying off. By contrast, it emerged yesterday that Liberal Democrat leader Nick Clegg has called for the NHS to be broken up.
In an interview before he became Lib Dem leader, Mr Clegg said the party should 'break a long-standing taboo' and consider replacing the service with a European-style insurance system that would end the principle that healthcare is free at the point of use. Mr Clegg said: 'We do want to break up the NHS. We don't want to privatise it, we want to break it up.'
Yesterday's poll suggests that Labour's historic claim to be the party of the NHS has been fatally damaged since 1997. Gordon Brown attempted to regain the initiative by launching Labour's health manifesto, promising the right to NHS care at home, including home births and end-of-life care.
But when asked which party would be most effective in managing the NHS, 27 per cent of voters said Conservative, 26 Labour and just 13 LibDem. The remainder said 'none of these' or 'don't know'. Although the Tory lead is marginal, it is hugely symbolic. Voters give Labour some credit, saying they have seen some improvement since the party took power, with 19 per cent calling it 'significant'. But 56 per cent say that while there has been improvement, it is not significant enough to justify the rise in costs.
Another 18 per cent think there has been no improvement at all, meaning 74 per cent do not believe that Labour has secured value for taxpayers' money.
The survey reveals grave concern about changes introduced by Labour, allowing GPs to opt out of responsibility for patients outside office hours. Private companies have taken over cover, sometimes employing foreign doctors with little grasp of English. Of those who said they had used out-of-hours services since 2004, 60 per cent said the service had got worse.
Two thirds - 67 per cent - agree with the Tory and Lib-Dem position that GPs should be forced to take back responsibility for out-of-hours care. Four out of five voters believe the standard of English among NHS doctors and nurses is a problem.
There is also widespread opposition to the work of NICE, the rationing watchdog set up by Labour to decide which drugs are cost-effective and which are not. More than three quarters - 77 per cent - said the health service should give lifeextending drugs to everyone who needs them, regardless of cost. The Tories have pledged to supply cancer drugs that Labour has denied to patients.
The poll revealed that a large majority of voters want to preserve the NHS and are against any cut in the number of doctors and nurses. More than 90 per cent believe major savings can be made without cutting frontline services, mainly by slashing the organisation's bloated bureaucracy.
In a speech to the Royal College of Nursing, Mr Brown sought to convince nurses and voters of his commitment to the health service, speaking about his daughter Jennifer, who died soon after her premature birth, and his son Fraser, who has cystic fibrosis. He said: 'We feel like parents who have been in the presence of angels dressed in nurses' uniforms, performing the most amazing works of mercy and care.'
Mr Brown ducked calls for a nursing pay freeze and pledged to protect nurses' pensions - a move which flies in the face of Labour's pledge to tackle the spiralling cost of gold-plated public sector retirement payouts. But he was unable to guarantee that no front-line workers would lose their jobs after the election.
Clegg called for NHS to be broken up. Nick Clegg has called for the NHS to be 'broken up' and said the Lib Dems should consider replacing it with a European-style insurance system. In a little-noticed interview before he took over as leader, he said the party should consider a social insurance system to replace the present tax-funded Health Service.
It would mean healthcare would no longer be free at the point of use - with patients who can afford to pay more getting better care. The comments raise huge question-marks over the Lib Dems' commitment to such a cherished institution as the NHS. They contrast with the course taken by David Cameron, who has made support for the NHS a key plank of his campaign.
The interview is another serious embarrassment for Mr Clegg as he prepares to face nurses at the Royal College of Nursing conference today. A week ago, the Daily Mail revealed that he had said Britain had a 'more insidious cross to bear' than Germany over World War II.
Opponents said the comments about the NHS, in a 2005 interview in the Independent, showed that Mr Clegg had no understanding of the way the health service works. In the interview, carried out while Charles Kennedy was leader and two years before Mr Clegg took the job, he said: 'I think breaking up the NHS is exactly what you do need to do to make it a more responsive service.'
Asked whether he favoured a Canadian or European-style social insurance system, he said: 'I don't think anything should be ruled out. I do think they deserve to be looked at because frankly the faults of the British health service compared to others still leave much to be desired. 'We will have to provide alternatives about what a different NHS looks like.'
Under a social insurance system, members pay into an insurance scheme, either themselves or through an employer, to guarantee their healthcare. It means that those who pay into a more expensive scheme can get better care. Under the NHS, however, everyone pays into the same scheme through taxes - and is then guaranteed care that is 'free at the point of use'.
In the interview, Mr Clegg said 'defending the status quo' is no longer an option. Instead, he called on his party to 'let its hair down', 'break a long-standing taboo' and be 'reckless' in its thinking. 'We do want to break up the NHS,' he said. 'We don't want to privatise it, we want to break it up. Should the debate be taboo? Of course not, absolutely not.'
A year earlier, Mr Clegg had contributed to the notorious Orange Book in which those on the right of the party discussed how policies should change under Mr Kennedy's leadership. The conclusion of the book outlines in more detail the type of insurance scheme he was outlining. 'The NHS is failing to deliver a health service that meets the needs and expectations of today's population,' it said.
John Lister, of the lobby group Health Emergency, said: 'These comments show Mr Clegg does not understand the NHS. He seems to be ignorant of the fact that social insurance schemes in Europe are far more expensive.' Shadow Health Secretary Andrew Lansley said: 'The NHS is one of Britain 's most loved institutions. People will be worried that Nick Clegg wants to "break it up".'
A spokesman for the Lib Dems told the Daily Mail: 'Under Nick Clegg the Liberal Democrats are totally committed to an NHS free at the point of use and always have been. This can be seen in our NHS policy paper which was adopted when Nick Clegg was party leader.' In the latest of his many flip-flops, Nick Clegg has declared that God might exist after all.
Within days of seizing the Liberal Democrat leadership in December 2007, he became the first British political leader to declare himself an atheist. But in an interview at the weekend he revealed that he now attends church almost every week with his Catholic wife Miriam and their three sons, and sees himself more as an 'agnostic'.27.4.10
Prescribe heroin on NHS, says Royal College of Nursing leader
Heroin should be routinely prescribed on the NHS as a way of weaning drug users off their addiction, the head of the country's top nursing union has said. But critics said Dr Carter must be unfamiliar with methadone which is a heroin substitute and meant to wean addicts off heroin.
Dr Peter Carter, the general secretary of the Royal College of Nursing (RCN), also said he was in favour of “drug consumption rooms” to enable addicts to take drugs safely under medical supervision, and to cut rates of drug-related crime.
Nurses gathering at the RCN's annual congress in Bournemouth had earlier discussed providing heroin to addicts where other attempts at treatment have failed. Results of pilot studies in London, Brighton and Darlington suggest that allowing users to inject themselves with the Class A drug under medical supervision can cut local crime rates by two-thirds over six months. Aberdeen has been considered as a potential future pilot location in Scotland.
But some experts are concerned at the prospect of providing legitimate “shooting galleries” in publically-funded clinics, despite the increasing use of methadone, the heroin-subsitute, and a lack of abstinence-based programmes.
Amid controversy over how to treat chronic drug users, members of the RCN, the country's largest nursing union, discussed the possibility of providing heroin on the NHS today but did not hold a vote for or against the move.
Speaking in a personal capacity after the debate, Dr Carter, the former head of Central and North West London Mental Health NHS Trust, said that he believed in providing drugs, needle exchanges and locations for users to inject substances safely.
“The fact is heroin is very addictive,” he said. “People who are addicted so often resort to crime, to steal to buy the heroin. It obviates the need for them to steal. “It might take a few years but I think people will understand that if you are going to get people off heroin then in the initial stages we have to have proper heroin prescribing services.” Dr Carter added that more research was needed into consumption rooms, which have been tested in Sydney and Amsterdam . Experts found the programme stopped users injecting in school playgrounds and stairwells.
“Critics say you are encouraging drug addiction but the reality is that these people are addicts and they are going to do it anyway,” he added.
Radical proposals for the most chronic drug users were first advocated in 2002 by the then Home Secretary David Blunkett. The gave rise to pilot programmes in England in which users inject themselves with pharmaceutical diamorphine imported from Switzerland , under medical supervision.
Preliminary results suggest that of 127 users involved in the pilots, three-quarters “substantially reduced” their use of street drugs, while their spending on drugs fell from £300 to £50 a week. The number of crimes they committed also fell from 1,731 in three months to 547 in six months. Critics said this was school boy economics, 'if you give people free drugs it is obvious they will buy less street drugs'.
Delegates at the RCN congress Claire Topham-Brown, a nurse from Cambridgeshire proposed the motion for today's debate, saying that that medical heroin could be provided as a means of “harm-reduction” which despite initial resistance by health professionals, “has now become an accepted model of practice”.
But some nurses disagreed. Gayle Brooks, of the union's UK safety representatives committee, said: “Where would this stop, cannabis, cocaine, crack cocaine and other illicit substances? If we do this for heroin, do we have to do this for other substances, and can the NHS afford this?”
All three main political parties in Britain have stressed the importance of alternative treatments for long-term drug addicts in the run-up to the election. While the number of heroin addicts needing treatment has decreased in recent years, almost 200,000 people receive methadone each year. Recent guidance from the Department of Health made clear that prisoners serving sentences of more than six months should be encouraged to become “drug-free” — of prescribed and illegal substances — while in jail.
The Times has highlighted concerns about numbers who may emerge from the criminal justice system with an addiction to methadone; almost 20,000 inmates were put on the drug last year, a rise of 57 per cent since 2008.
Harry Shapiro, a spokesman for the charity Drugscope, said it would support moves towards “a balanced treatment system, with a range of different treatment options”, including providing heroin for a minority of users who met strict criteria for treatment. “These are people who have been using for a long time and where previous attempts including rehabilitation had failed,” he added. “The results can be encouraging in that this can help people engage in treatment and control their chaotic lives.”
Doctors could regularly prescribe reduced heroin and cocaine to recovering drug addicts until 1968, when the practise required a Home Office license. Dr Neil McKechnie, of Glasgow University, said any national programme to increase heroin provision on the NHS was “an extraordinary risky proposal”. “Where it is tightly controlled and prescribed to a very small group of addicts — 1 per cent of users — there may be some who can benefit, but we should be wary of a creeping extension of this, as happened with methadone.
“The vast majority of people on methadone are continuing to use illegal drugs, and by definition they are failing on their treatment. “Most people would say that treatment for drug addiction is about getting people off drugs rather than giving them easy access to drugs.” Full results from the pilots, overseen by the National Addiction Centre at King's College London, will be published with the next couple of months.
Critics say the plan is an admission of failure of the present system and a step backwards, it is also unethical, with no incentive to get off drugs if they are provided free by the state. Methadone is supposed to wean heroin users off the drugs, does this mean methadone is a failure as well? 'We need successful treatment not more wasteful schemes' said one leading expert. 26.4.10
Nurses 'to bear the brunt of NHS cuts' as thousands face the sack after the election
Thousands of doctors and nurses face the sack after the election under devastating cuts being planned by NHS bureaucrats, according to two studies. Despite repeated promises from Labour ministers to safeguard patient care, front-line staff look set to bear the brunt of a Whitehall diktat that the NHS slash its budgets by billions of pounds.
Last night nursing leaders warned the cuts could see the return of Third World wards and long waits for treatment - and could even threaten the lives of patients. A report from the Royal College of Nursing (RCN) has identified 5,600 jobs which are under threat, and that is in just 26 hospital trusts. The union said the figure could rise to more than 36,000 in a 'worst-case scenario', if the data is extrapolated across all 170 trusts.
Separate analysis by the Tories shows hospitals are planning to sack at least 650 doctors and 2,000 nurses in England - while 1,500 beds have been earmarked for closure. They say these figures are likely to be just the tip of the iceberg. The surveys are a severe embarrassment to Gordon Brown on the day he is expected to address nurses at the RCN conference in Bournemouth.
The true scale of the cuts comes just days after Health Secretary Andy Burnham promised that a planned £20billion of 'efficiency savings' by 2014 would not affect the front-line. But union leaders said nurses had been misled by the Government and accused ministers of protecting the jobs of highly paid managers.
Dr Peter Carter, RCN general secretary, said it was 'disingenuous' to suggest £20billion could be removed from the NHS budget and 'nothing changes'. 'Despite assurances that the NHS budget will be protected, the reality is that locally, trusts are making deep and dangerous cuts to staff numbers now, with further cuts planned for the future.'
And Howard Catton, head of policy at the RCN, said: 'There is clear evidence that front-line staff are being targeted by savings. 'It is creating a perception among nurses that they are being pushed to the front of the queue while managers appear to be much further down the line. 'If you take away front-line staff you reduce quality of service. In the very worst case scenario this can cost lives.'
The Conservative analysis revealed that more than half of hospitals are planning to cut the number of doctors they employ. At least 650 jobs are at risk. More than half say they will slash the number of nurses, with around 2,050 nursing jobs at risk.
The NHS in the West Midlands alone plans to cut 900 nurses. Three in five hospitals are planning bed cuts. Tory health spokesman Andrew Lansley said: 'Gordon Brown has promised voters that he would protect the NHS and protect front-line services. But these figures reveal that Labour are actually planning secret cuts.'
A Department of Health spokesman said: 'The 2010 Budget confirmed that funding for front-line NHS services will rise in line with inflation in 2011/12 and 2012/13 and also confirmed that the NHS will deliver annual efficiency savings of £15bn to £20bn by 2013/14.' 25.4.10
Drug firms lose battle to prescribe cheaper drugs
Efforts by drug companies to halt the growing practice of the National Health Service paying doctors to switch prescriptions to cheaper medicines have been rejected by the European court of justice. The ruling is a devastating blow to the UK drug industry, which has tried to block the trend towards the "prescribing incentive schemes" launched around the country in recent years.
The schemes are intended to save the NHS money by paying doctors to substitute cheaper generic medicines for the high-priced patented drugs they would typically have offered patients. The Association of the British Pharmaceutical Industry (ABPI), the trade body, had argued that the NHS should be subject to the same ban that applies under EU law to drug companies in providing incentives to doctors to influence their prescription decisions.
The practice has become widespread as several effective chronic care drugs, such as statins to control blood cholesterol, have gone off-patent, creating a sharp difference in cost between these drugs and similar ones in the same class still protected from competition. However, in a highly unusual decision that contradicted the opinion issued earlier this year by Niilo Jääskinen, the ECJ's own advocate-general, the court drew a distinction between drug companies and health services.
Nigel Jones, co-head of healthcare at Linklaters, the law firm, said: "It is unlikely in the current climate that politicians would be interested in changing the law in favour of the pharmaceutical industry."
The ECJ argued that the relevant existing European legislation primarily concerned promotional activities by drug companies, and when incentives were used by public healthcare agencies they were not seeking to promote commercial products. It added the proviso that public authorities must ensure there is no discrimination in their incentive schemes against drugs produced by companies based in other countries.
The court ruled that health authorities should make public the evaluations they use to support their assessments that the drugs prescribed are medically equivalent to the more expensive variants. Drug companies have come under increasing pressure to reduce payments to prescribers that could be seen to influence their professional objectivity.
They argued there was no reason why the NHS should be exempt from the same rules, and that incentives paid by health trusts could also encourage prescriptions that did not best meet patients' medical needs.
The ABPI said: "It is important that patients can have total confidence that when their doctor is making prescribing decisions, those decisions are, and are seen to be, completely independent of personal financial considerations. "The ECJ interpretation of the legislation risks this being put in doubt." 23.4.10