I lost ten years of my life as a middle class, NHS sponsored drug addict...
Philip Robinson was 25 when he went to his GP with mild depression. The pills he was prescribed changed his life, turning him into a 'zombie-like' addict — just one of the 1.5 million Britons whose lives have been ruined by prescription drugs. Here, with extraordinary candour, he reveals how he battled to get his life back.
The problem began when I got married. Uncertain about the commitment I had just made and torn between wanting to leave my wife and not wanting to hurt her, I started to drink. I wasn't desperately depressed, nor was I drinking myself to oblivion. In fact, compared with my fellow journalists on the lads' magazine Loaded, where I worked at the time, my drinking wasn't a problem; I was just going through a low point.
It was 1998. I was 25 years old, and had been married for just a year when I went for the doctor's appointment that would drive me to the edge of insanity and rob me of the next ten years of my life. I was told, in the nicest possible way, that I was a depressed alcoholic. I was so shocked I gave up drinking immediately. I have not touched a drop since.
Then the doctor prescribed 90 Valium pills and a bottle of beta blockers to help with stress, and recommended I visit a psychiatrist in Harley Street. I can still remember looking at the bottle in disbelief. I'd seen people thrown out of nightclubs for possessing two of these pills. The doctor had just given me 90!
What I didn't realise at the time was that antidepressants and tranquillisers create long-term users. Thanks to the pills that my doctor had just handed over like Smarties, I was already on the road to what is known as ‘involuntary tranquilliser addiction'. Put simply, this is where people seeking short-term help for anxiety end up hooked on powerful mood-altering drugs, sometimes for life. I had just been turned into a middle-class, NHS- sponsored junkie, one of the 1.5 million Britons addicted to prescribed medication.
It comes at a price for the NHS, too: the health service spends £3 billion a year on tranquillisers and antidepressants alone.
Even back then I was shocked to be given so many drugs by the NHS. I remember one colleague noting the number of pills I was packing away in the course of day and telling me to take half. But, as far as I was concerned, I'd obtained these drugs from the doctor, and doctor knows best.
In Harley Street I was given my first supply of anti- depressants and told that I was simply suffering from anxiety and depression. After a few months I was no better. In fact, I was miserable, and seemed to be experiencing new nervous symptoms. In hindsight I was probably suffering side-effects from the drugs.
Over the next few years, Anna, my wife, became accustomed to my ever-changing personality, which altered according to whichever pills and dosages were being tried out on me by my psychiatrist in Harley Street. Despite the side-effects, Anna and I both trusted the doctors and I tested a host of antidepressants and mood-altering pills, trying to find the right combination that would cure my depression and give me back my life.
I remember these pills mostly for their side-effects. In one instance, I was offered a choice of two pills: one would make me fat, the other would give me a sexual dysfunction. I chose the weight gain. Another course of pills made me vomit violently if I took them on an empty stomach.
Feeling increasingly depressed, dislocated, and paranoid, I was starting to lose sight of who I was. I began to display the symptoms of someone who was genuinely mentally ill and I took to sleeping all day, unable to get out of bed. I left full-time work to recover at home and retreated from all but two or three of my friends. Anna loyally stood by me, even though I was growing more angry, depressed and unstable.
I had also become hooked on Valium. If I ran out of pills and the doctors' surgery was closed, I would go to the hospital for an emergency prescription or face cold turkey. Unlike illegal drugs, pres cription drugs are incredibly convenient. You can unscrew the lid while walking for the bus, take a couple of neatly pressed, official-looking pills — medicine — and slip into a metaphorical side room. Tranquilliser users watch life though a chink in a pharmaceutical curtain, unable to participate in their own existence.
Five years after my first prescription, it seemed there wasn't an antidepressant in the world that worked on my brain, yet my Harley Street doctor seemed determined that there was a pharmaceutical answer to my problem. I was depressed, but Anna and I did have some moments of happiness and normality. We had moved into a new house and Anna was pregnant with our first child. I felt that this was my side of the arrangement, my duty, and that I owed her a child.
I loved her, but I was pretending to be a normal dutiful caring husband when, in reality, I was little more than a waxwork. My state worsened when I was put on a powerful (and expensive) anti-epileptic drug called Depakote. Depakote is so toxic that it requires a blood test to be taken first. I am not epileptic, but the pill is commonly given to severely ill people who are bipolar. As far as I knew, I had not been diagnosed with either illness.
I got my blood tests done and took Depakote alongside Effexor (an antidepressant), Valium (a tranquilliser) and Zopiclone (a sleeping pill). All I required was a pair of baggy trousers and green face paint and I could have doubled up as a zombie. I found myself unable to laugh, or smile, or cry. I was taking more and more Valium to cope with mood swings related to taking Valium. I was by now taking double or triple my original prescribed dose.
An additional problem was that heavy doses of tranquillisers slow your breathing and suppress your gag reflex. One night, after approximately 70mgs and some sleeping pills, I woke up aware that I was about to swallow my tongue, which had lolled back into my throat, almost creating an airtight seal. Fortunately, I had enough air in my lungs to cough it out. I remember not feeling concerned at the time.
As the Depakote established itself in my brain, I became cold and detached. I had ‘decided' to live nocturnally, as this was optimum for my writing. I wanted peace and quiet. I avoided my young family, content with silence and the sound of blood pulsing in my ears.
After a few months of this weird, living death I was incapable of understanding or empathising with other peoples' emotions. None of it seemed relevant. The tipping point came when I visited my GP to speak about my continuing prescriptions. She clicked through my records on her screen and casually noted that I should continue my medication because I was listed as being on my local council's Severe Mental Health Register.
Severe Mental Health Register? I left the appointment consumed by a sense of tragedy. I'd gone to my doctor initially to seek help because I was a young man, overwhelmed and confused by the responsibility of marriage. At what point did I acquire severe mental health issues?
When did I become a threat to myself and others? I'm a threat to an open packet of chocolate biscuits, but not much else. I had found rock bottom. Deep down, I knew that I couldn't be bipolar and I had not been diagnosed as such. I was a happy child from a lovely family. My upbringing was so great that when I described it to psychologists, they seemed to be convinced I was making it up to conceal my inner torment.
I realised the only way to find out who I really was would be to get my brain chemistry back to how it was when I could last remember feeling normal. Back to before I ever saw a doctor or even had a drink. I needed to be a kid again. I went back to see the doctor a couple of weeks later and told her that I had made the decision to come off the pills.
She wasn't so sure and warned that my mental health might well collapse if I stopped taking the drugs and that there was a risk of hospitalisation. I wasn't offered any help or advice. Despite this prophecy of doom hanging over me, I found dropping the bipolar pills to be a slow, but relatively easy process. About a month after I stopped taking them, the world seemed brighter and I started to write again and feel alive.
I filled up notepads with ideas, and Anna noticed that I was more engaged with life, she could see my old self coming back. A couple of months later, only Valium remained. I had now been on these mood-altering tranquillisers for ten years and lowering the dose was an agonising battle. Each milligram I took out of my bloodstream was paid for by huge ebbs and flows in my sanity levels.
Over the next two years, I threw myself into bout after bout of Valium withdrawal, lowering the dose each time and enduring what felt like a three month-long Mad Hatter's tea party in my head. I was also at risk, according to the medical profession, of suffering a convulsion or brain seizure. I was altering the very chemicals in my brain that helped me exist.
Eventually I found some help on the internet: a programme for tapering the doses designed by Professor C. Heather Ashton, Emeritus Professor of Clinical Psychopharmacology at the School of Neurosciences at the University of Newcastle upon Tyne .
Tranquilliser withdrawal is medically accepted to be worse than heroin withdrawal, yet — as the All-Party Parliamentary Group for Involuntary Tranquilliser Addiction concluded only last year — most doctors are unaware of the problem, or have no facility to help those whose lives have been ruined by addiction to prescribed medication. After two years of pain, paranoia, sleeplessness and torment, I successfully completed withdrawal.
I had pushed my relationship with my wife and children past any regular limit and feel as if I will be making up for their memories of my anger and mood swings for the rest of my life.
After it was over, I made an appointment to cancel my Valium prescription. Another GP asked me if I would write down how I did it, so he could use the method with his other patients. I got the impression that most of the people who are prescribed these pills never come off them, content to remain zombies until death.
As of writing, I am 37 and two years clear of my last prescription. I have no mental illness apart from a low hum of depression (partly to do with my situation, as I feel that I have wasted a lot of time). Life has happy and sad days as it does for everybody, and my mood moves up and down with it. I don't drink, but only because I know it makes me miserable for a week after I do it, and I accept that at various stages in our lives some of us are more prone to sad thoughts than others.
I think it is more effective to heal ourselves with counselling than pills. What troubles me is that doctors are still prescribing these drugs to people looking for a cure for temporary anxiety, exposing them to the risk of years of addiction, severe depression plus an increased risk of job loss, marital problems, even suicide. That's quite a list of consequences for someone who begins taking a tranquilliser because their new job is giving them sleepless nights, for example.
These drugs do have a role to play, but only in the most severe life-or-death situations. We do not perform lung surgery on people with chesty coughs, so why do we give drugs of almost unknown power to people with mild, temporary depression? To overcome our problems we have to talk through them, understand them and accept them. Not hide from them behind a chemical curtain. 12.10.10
‘Staggering & Massive' public waste costing millions
Sir Philip Green has identified hundreds of millions of pounds of savings as part of his efficiency review, which lays bare a mountain of Whitehall waste that Francis Maude, the Cabinet Office minister who commissioned the report, described as “staggering”.
The retail billionaire, known within the industry as an expert cost-cutter and tough negotiator, has concluded that the government has failed to make the most of its scale, buying power and credit rating.
“There is no reason why government should not be as efficient as any good business,” Sir Philip said on Monday. “The conclusion of this review is clear – credit rating and scale in virtually every department has not been used to make government spending efficient.”
Mr Maude, who commissioned Sir Philip to carry out the review two months ago, described the scale of waste as “staggering” and said government had become more businesslike. “His review shows that for far too long there has been no coherent strategy to make government operate more efficiently,” Mr Maude said on Monday. “Every pound we can take out of the cost of government is a pound we can protect in the front line.”
Sir Philip has uncovered “massive” amounts of unnecessary spending, according to one official, while his work has also revealed “the poor quality of data relating to where and how the government spends its money.” The retail chief, with his long-standing lieutenant Ian Grabiner, went through the government's books to scrutinise spending ahead of the comprehensive spending review on October 20.
Their main focus was on the procurement of goods and services – travel, office and IT supplies – and the management of the government's property portfolio. It has proved a huge undertaking and this weekend Sir Philip forwent flying back to his family in Monaco to put the report to bed after a frantic two months' work.
The findings, to be revealed on Monday, will show that hundreds of millions of pounds have been wasted on unnecessary rents and poor buying across Whitehall, with different departments failing to come together to push down prices by buying in bulk. Sir Philip has found that different departments pay hugely different prices for the same items. “It is ugly,” said the official. “There is massive waste and huge savings to be found.”
Sir Philip, who runs his own business on tight budgets, is thought to have found easy pickings in government, where public sector bodies are spending more than £20bn in rent alone every year.
As the owner of Arcadia Group, which owns or rent more than 2,000 stores across Britain , he was explicitly asked to assess whether leases and contracts entered into since 2007 offer value for money. Sir Philip has also found that thousands of civil servants have been given mobile phones and BlackBerry devices that they do not need, in the meantime racking up millions of pounds worth of calls funded by the taxpayer.
While those who have worked for Sir Philip in the business world have little doubt about his credentials for the job of identifying substantial savings within government, his appointment caused a political storm because of his tax affairs. His family was able to take a £1.2bn tax-free dividend from Arcadia in 2005 because the business is owned by his wife, Lady Tina, who is a resident of Monaco rather than the UK .
Chris Huhne, the Liberal Democrat energy secretary, said last month that Sir Philip's role as an adviser on waste sent the “wrong message”.
“Philip Green could clearly, if he were to arrange his tax affairs in a different manner, be paying rather a lot more tax. I don't think that the messages sent out by that appointment were the best of messages.” 11.10.10
High-frequency sound speeds up healing of broken bones, study shows
Pulses of high-frequency sound can significantly speed up the healing of broken bones, a study has found. Researchers tested the therapy on patients with fractured shin bones, or tibias, which had not properly healed after more than four months. Half the 100 participants were treated with an ultrasound probe and half with a 'dummy' device.
Over a period of 16 weeks, faster healing in patients receiving the 'real' treatment resulted in 34% greater bone density at the injury site.
The treatment, called LIPUS, (low-intensity pulsed ultrasound) is delivered by a small emitter linked to a handheld controller. Therapy sessions lasting 20 minutes were conducted every day throughout the study period.
The research was conducted by a team of German scientists backed by global medical devices manufacturer Smith and Nephew.
D John Block, a US consultant for the company based in San Francisco, said: 'These findings demonstrate significantly greater progress toward bone healing after LIPUS treatment compared to no LIPUS treatment in subjects with established delayed unions of the tibia. 'This should assist in establishing this non-invasive modality as a viable, effective treatment option for patients suffering these injuries.'
The trial results were reported today in the online journal BMC Musculoskeletal Disorders. The patients taking part in the study had a wide age range from 14 to 70. All had fractures of the shin bone shaft that had failed to heal adequately after a significant amount of time.
Delayed 'union' - the knitting together of broken bones - occurs in around 4.4% of tibial fractures. Sometimes the bones do not mend at all, resulting in functional impairment and loss of quality of life.
Currently 'non-unions' are tackled with complex and costly procedures which involve grafting on extra pieces of bone and the use of growth-promoting chemicals. Ultrasound has been shown to accelerate fracture healing by boosting the activity of osteoblasts, the cells that synthesise bone.8.10.10
Drugs giants cashing in by 'inventing' conditions like ‘low libido' label in women to sell more drugs
Drug companies have invented the ‘problem' of low libido in women and other ‘conditions' so that they can sell new drugs, research claims. The pharmaceutical industry is accused of creating the label of ‘female sexual dysfunction' to cash in on a market that doesn't really exist.
And its employees are paying doctors to talk about this and other conditions as ‘widespread' disorders which need diagnosis and treatment, according to researcher Ray Moynihan. He argues in the British Medical Journal that trials of drugs claiming to increase women's libido have so far failed to provide evidence of any health benefit.
The claims, highlighted this week in an investigation by the Daily Mail's Good Health section, come amid increasing concern about the explosion in labels for new medical conditions.
Doctors warn that some of these are ‘non-diseases' based on diagnoses that treat normal behavioural differences as medical problems, like ADHD. The definition of female sexual dysfunction (FSD) has been criticised as merely exaggeratingwomen's dissatisfaction with their partners.
Other sceptics point to similar ‘conditions' such as hyper-appetite problem – otherwise known as overeating – or Total Allergy Syndrome, in which allergies to ‘modern life' including chemicals and artificial materials trigger multiple symptoms.
Sex, Lies and Pharmaceuticals
But the mixture of science and marketing behind FSD amounts to a ‘corporate sponsorship' of the condition, claims Mr Moynihan in his book Sex, Lies and Pharmaceuticals. The lecturer at the University of Newcastle, Australia, told the BMJ: ‘Drug marketing is merging with medical science in a fascinating and frightening way.
‘Drug companies have not simply sponsored the science of this new condition; on occasion they have helped to construct it.' He quotes a drug company employee saying her firm was interested in ‘expediting the development of a disease' and had funded surveys portraying sexual problems as widespread. Many researchers involved in these activities worked in the drug industry or had financial ties to it.
But scientific studies of thousands of people conducted without industry funding have questioned whether a lack of interest in sex can be described as ‘dysfunctional', with many women saying it was not a serious difficulty.
In June a new libido drug called flibanserin was rejected by advisers to the U.S. drugs watchdog, the Food and Drug Administration because it failed to live up to pre-agreed benefits while carrying the risk of serious side effects. Viagra, made by Pfizer, was also pulled from the race after studies showed it made virtually no difference in women with low libido.
But Mr Moynihan warns a global marketing operation is ready to get behind the next potentially moneyspinning product. ‘The edifice of scientific evidence about the condition remains in place, creating the impression that there is a massive “unmet need” for treatment,' he said. ‘The drug industry shows no signs of abandoning plans to meet the need it has helped to manufacture.'
Mr Moynihan called for a fresh approach towards defining disease. He said: ‘Perhaps it is time to develop new panels without financial ties to those with vested interests in the outcomes of their deliberations and much more broadly representative of the wider public – and to start the slow process of untangling the marketing from the medical science.' 'In that case all the 'conditions' labeled in the Diagnostics and Statistical Manual (DSM) used by psychiatrists to label
'behaviors' as medical conditions
would be a good place to start' said one expert.
However, Dr Sandy Goldbeck-Wood, a specialist in psychosexual medicine, said in a commentary piece in the BMJ that some women have very real difficulties in getting help for sexual problems. She said: ‘Faced with a woman in tears whose libido has disappeared and who is terrified of losing her partner, a doctor can feel immense pressure to provide an immediate, effective solution.'
Pfizer declined to be interviewed for Mr Moynihan's book but in a written statement said it had conducted a ‘number of studies over the past 15 years designed to understand the causes and nature of FSD and its impact on women'. 1.10.10
Also see: How the flimsiest medical data makes the headlines below.
How the flimsiest medical data makes the headlines
New study claims ADHD 'has a genetic link' was the headline repeated on television, newspapers and radio stations around the UK.
The first direct evidence of a genetic link to attention-deficit hyperactivity disorder has been found, a study says or claims.
Scientists from Cardiff University , writing in The Lancet, said the disorder was a brain problem like autism - not due to bad parenting. They analysed stretches of DNA from 366 children who had been diagnosed with the disorder.
But one clinical psychologist argued that what happened in children's early years was more crucial than genetics. At least 2% of children in the UK are thought to have attention-deficit hyperactivity disorder (ADHD).
Affected children are restless and impulsive. They may also have destructive tendencies, and experience serious problems at school and within family life. The researchers compared genetic samples from ADHD children, with DNA from 1,047 people without the condition.
They took blood samples from 100 children in each group and found that 15% of the ADHD group had large and rare variations in their DNA - compared with 7% in the control group.
So 15 out of 100 pupils had similar markers but so 7 did pupils without ADHD. Subtract the 7 from the control group which leaves just 8% who share similar DNA traits, yet this enough medical evidence to claim ADHD is a genetic disorder. One critic said the 'the evidence is so low it's meaningless. 8% is not a sufficient number to make such sweeping statements to the media or medical press, it's a reckless statement and unfounded'.
Professor Anita Thapar said: "We found that, compared with the control group, the children with ADHD have a much higher rate of chunks of DNA that are either duplicated or missing.
"This is really exciting - because it gives us the first direct genetic link to ADHD. "We have looked at lots of potential risk factors in the environment - such as parenting or what happens before birth - but there isn't the evidence to say they're linked to ADHD. "There's a lot of public misunderstanding about ADHD. Some people say it's not a real disorder, or that it's the result of bad parenting. "Finding this direct link should address the issue of stigma."
The researchers stressed that there is no single gene behind ADHD, and the work is at too early a stage to lead to any test for the disorder. But they hope the study will help unravel the biological basis of ADHD. This could eventually lead to new treatments. The work was largely funded by the Wellcome Trust (GSK), with extra support from the Medical Research Council.
The chief executive of a charity and support group ADDIS, Andrea Bilbow, said: "We are very excited. We've always known there was a genetic link - through studies and anecdotally. "This paper will help us deal more confidently with the sceptics, who are always so eager to blame parents or teachers. It shows there is a definite genetic anomaly in children with ADHD."
But the study has been criticised by the clinical child psychologist and broadcaster, Oliver James. He cited studies which looked at the effect of anxiety among pregnant women, and disturbed early relations between mothers and their babies.
He said: "Only 57 out of the 366 children with ADHD had the genetic variant supposed to be a cause of the illness. "That would suggest that other factors are the main cause in the vast majority of cases. "Genes hardly explain at all why some kids have ADHD and not others."
Other critics said 'the study is to promote the use of drugs as ADHD is not even a medical condition, it was voted into the DSM by a show of hands by psychiatrists. They have taken a trait, turned it into a medical condition and are now trying to suggest it has a genetic cause. The whole story surrounding ADHD is a myth, which has become part of popular culture and illustrates how imaginary conditions are turned into medical conditions on the flimsiest of evidence' 30.9.10
Patients suffer as NHS operates a 'closed-shop' market to block the private sector
Patients have to put up with longer waits and poor service because surgeons and managers are "freezing out" private firms from the NHS, a think-tank says. The Civitas report paints a picture of a "closed shop" NHS in which hospital staff are vehemently opposed to an open market.
They routinely awards contracts to in-house-providers rather than commercial operators - even if it means patients or tax payers get a worse deal, found James Gubb, head of the health unit at Civitas.
He interviewed NHS and private contractor staff for his report 'Refusing Treatment'.
In it he argued: "Existing NHS providers use their muscle and connections to keep providing services even when faster, higher quality care is on offer elsewhere. "The results are that the benefits of a decentralised and innovative NHS are being denied to patients who have to wait longer for treatment and fail to access the most appropriate services."
Mr Gubb found many staff believed extra competition would inevitably lead to the break-up of the health service.
One NHS executive told him: "I do not believe many people have bought into the idea that the NHS is the organisation that procures health care for the public and where that health care is delivered should not matter." For this reason the report concluded: "There remains a culture of supporting local NHS providers, often regardless of the quality of other organisations: NHS, voluntary or private."
Tactics included "predatory pricing" by hospital trusts in areas that were open to competition, by off-loading overheads on to other services. The anti-market bias also fostered low productivity and high absenteeism, according to Mr Gubb's evidence.
One private provider told him: "I know for a fact that a surgeon in an unnamed NHS trust takes 2½ hours to do a hip replacement that he does in 45 minutes at [one of our hospitals]."
Another executive said: "It's a question of having the will. Four surgeons didn't turn up for work here yesterday, blaming the snow. In the private sector they'd all turn up... In the health service there just isn't the will to work too hard, because you won't get fired and you've got your pension."
With the Coalition pushing to open up the NHS to greater competition, Mr Gubb - an advocate of greater private sector involvement - warned internal resistance would hinder progress.
He said: "The Coalition Government has put a lot of faith in the power of the market to meet the NHS's unnerving productivity challenge. The problem is the Coalition isn't addressing the real issues as to why the market currently isn't delivering: the overwhelming power of hospitals and the closed-shop 'we can do it alone because we're the NHS' attitude so prevalent across the organisation."
His position is almost the polar opposite of that taken by the British Medical Association, which warned last week that increasing competition would damage the health service. The BMA believes private firms "cherry-pick" the most profitable services, like providing routine operations in independent sector treatment centres, leaving the NHS to carry the can for more expensive ones.
Dr Hamish Meldrum, its chairman of council, said that while he was not "ideologically against" markets, the BMA thought competition cost the NHS more in terms of cash leaving the service, than it saved in terms of increased efficiencies. Other crtics acused the BMA of 'protectionism'. 4.10.10
The British Medical Association needs to stop its scare stories as the private market can help the NHS
The British Medical Association needs to stop its scare stories about the private sector, because the evidence isn't there.
The British Medical Association (BMA) has pulled few punches in campaigning for an end to the use of markets in the NHS. Number one headline: all of those nasty commercial healthcare companies out. The NHS should be "publicly funded, publicly provided and publicly accountable".
Last Friday, the campaign was extended to patients. Leaflets will be distributed to BMA reps in GP surgeries and hospitals to hand out to patients, with scare stories such as a 70-year-old lady who is forced to go to a treatment centre run by a private provider and suffers "complications".
We should be concerned. Aside from the questionable ethics of politicising points of contact between doctors and patients, the evidence-base for what the BMA are proposing simply isn't there.
First, the BMA is guilty of cherry-picking its evidence. Let's take its campaign briefing on Independent Sector Treatment Centres (ISTCs) – surgical centres procured from the private sector to provide for the NHS.
The BMA expresses concerns over quality of care. It cites a study showing sub-standard care in an ISTC at Weston-super-Mare . But this isn't an ISTC. What the BMA fails to cite is the one clinical audit comparing standards in ISTCs with the NHS, which found quality to be at least as good, if not better. No mention either of the Healthcare Commission's study of ISTCs, which found length of stay and rates of re-admission to hospital consistently and significantly better than in the NHS. Nor the fact that patient satisfaction is better (96% rate their care as "excellent" or "very good", compared with 78% in NHS hospitals).
The BMA also expresses concerns over value for money. Here, it has a point. Contract utilisation for ISTCs averages 85%, yet the providers will get paid the full whack anyway. But a lot of this has to do with the fact the contracts were negotiated centrally – and poorly – by the Department of Health. Not quantified is the competitive impact ISTCs have had on the NHS, which is some cases has spurred revolutionary improvement. Take the views of the chief executive of Southampton University Hospitals NHS Trust , Mark Hackett, for example.
Second, the wider principle: ending the market in the NHS. Superficially, it's an easy argument to make. Markets mean profits and privatisation; and that means an end to the NHS. But the market, as it is currently set up, does not question the NHS's underlying ideals: to provide universal, comprehensive care, free at the point of use.
The market is a market for the right to provide NHS care. It asks NHS organisations to keep proving to patients that they are good enough; challenges them to innovate; and allows primary care trusts – the organisations that buy, or "commission", care for the NHS – to look elsewhere and harness the best of what the private and voluntary sectors can offer. In doing so, it confers accountability to patients, and means taxpayers' money can be spent on the providers – NHS or non-NHS – that can offer the best deal on quality and cost.
Our soon-to-be published review of the evidence suggests this is starting to bring benefits. But instead, the BMA wants to get rid of it all. It wants the monopoly back to dictate the terms of play. With a financial storm approaching, this is not the way forward. 4.10.10
GPs stage revolt over NHS shake-up
Doctors went to war with the Government last night, claiming reforms to the NHS risk undermining the future of the Health Service. They say that proposed changes, which will see family doctors take charge of billions of pounds in budgets, is ‘potentially damaging' for patients and will create ‘instability'.
Ministers want GPs to take over from managers decisions about how money should be spent on treatment and services. Many managers are likely to lose their jobs as a result. The proposals, outlined by Health Secretary Andrew Lansley in July, have been hailed as the biggest shake-up of the NHS in 60 years. GPs will form groups, or consortia, to replace Primary Care Trusts, which will be abolished by 2013, along with tens of thousands of managerial and administrative jobs.
But the British Medical Association claims that such a radical overhaul threatens to undermine the ‘stability and long-term future' of the Health Service. It warned that although the Government hopes it will save millions of pounds by cutting management spending, the plans will cost ‘a large amount of money' to put in place.
In an open statement responding to the plans, BMA chairman Dr Hamish Meldrum urged ministers to re-think their ‘slash-and-burn' approach with ‘arbitrary' cuts and ‘poorly considered policies'. ‘There are proposals in the White Paper that doctors can support and want to work with,' he said.
‘But there is also much that would be potentially damaging. The BMA has consistently argued that clinicians should have more autonomy to shape services for their patients, but pitting them against each other in a market-based system creates waste, bureaucracy and inefficiency.
‘Doctors want to build on the founding principles of the NHS, and to maintain and improve services despite the hugely challenging financial climate. ‘However, they can only succeed if they can work in partnership with others in a co-operative environment.' He added that the BMA has not supported the direction taken in the NHS in England in recent years.
This direction would be ‘accelerated' by the proposals, ‘despite evidence showing that increased commercialisation has not been beneficial for the NHS or patients'. Dr Meldrum added: ‘We urge the Government and NHS to focus on those areas where they can truly eliminate waste and achieve genuine efficiency savings rather than adopt a slash-and-burn approach to health care with arbitrary cuts and poorly considered policies.'
But Health Secretary Mr Lansley insisted the Government was right to go ahead with the reforms. ‘There are many GPs . . . who are keen to make the transition quickly,' he said. ‘Others want to know more about how it's going to work before they implement it. ‘This is what the consultation is about: everyone coming forward to say how we can make this work.' The plans were aimed at making care better for patients, he added.
Critics have said ‘the GP revolt is based upon them losing their patient monopoly and blocking private treatment options to improve services and reduce costs. Some GP's are earning up to £500,000 per annum from the NHS and the reform jeopardise their income potential'.3.10.10
Why some GP's, the BMA and Labour are against reforming the NHS
There is a lot of political posturing and rhetoric being voice at the moment from the medical profession, their union and the their political arm the Labour party over plans to reform the NHS and end the monumental waste and bureaucracy which snowballed under Labour over the last 13 years, costing the tax payer £115bn per annum.
Patients don't care who provides their treatment so long as it is professional, suitable and effective. So why are these bodies against reforming the NHS and involving more private companies who can offer better care and treatments for a cheaper price?
The answer is due to ‘protectionism and safe guarding vested interests' rather than serving the patient, who is overlooked by these vested interests.
These bodies see the private sector as a threat, once a private clinic has proven it can do a better job for less, who would want an inferior NHS service?
This would mean the scaling back of the NHS into a commissioning service, getting the best deal for the public purse and the best treatment for the patient at competitive rates, compared to the current system were NHS services are usually the least effective but cost the most.
The private sector are akin to a 100 meter athlete, stripped down, primed, no waste and 100% efficient compared to the bloated NHS couch potato, sluggish and wasteful.
In all their posturing patient treatment and outcomes are rarely mentioned, the fact is, the medical profession, their union and the labour party see the private sector as a threat to their monopoly and dominance within the NHS which they wish to retain. 1.10.10
Private clinic provides better service and proves cheaper for NHS patients
When Peter Aylott, 67, needed a scan for a heart condition he expected it would mean a trip to his local hospital in Kent, not in an exclusive private clinic in London. But Peter and half a dozen other patients were picked up from their homes in Bexley and taken to the home of private medicine, Harley Street.
"We were transported to and from our doorstep to Harley Street, taken into this salubrious place and really treated as if we were a paying patient." With its varnished wooden floors and plush sofas the European Scanning Centre looks more like a boutique hotel than somewhere to scan your heart. But it is the first in the country to have a CT scanner that can produce a three-dimensional picture of a patient's heart with a very low radiation dose.
Dr Chris Harvey, consultant radiologist at the European Scanning Centre is proud of the £1.5m machine, ‘I think this is the way forward, more GP referrals to specialist centres' said Dr Harvey.
The bill for this bespoke service is picked up by Peter Aylott's local primary care trust in Bexley. In the past eight months it has sent more than 80 patients to Harley Street for these scans.
The alternative for Peter was yet another invasive angiogram at the NHS hospital in Sidcup, Kent. "You go in for full surgery, they are putting tubes up your leg - there's always a risk, I'd much sooner have the CT scan, no argument."
Having a CT scan is much safer than an angiogram, where one in every 500 patients suffers a heart attack or stroke.
The scan is also cheaper, says Dr Kostas Manis, a GP in Bexley. "The angiogram is £1,300 in the NHS, and the private clinic scanner is £900 and we're negotiating to bring the figure down to £600."
Dr Manis has helped to develop the new scheme, which has saved the NHS in Bexley £300,000 in the past eight months.
Faced with a £20m deficit in 2007, the primary care trust decided to hand over the bulk of commissioning power to GPs. They now control 70% of the £150m budget for Bexley. Dr Manis was convinced they could improve the service for patients and cut costs. "The cardiology bill we were receiving from hospitals was astronomical," he says.
So he helped to introduce a community cardiology scheme. Every week David Brennand-Roper, emeritus consultant cardiologist at Guys and St Thomas ' hospital, London , sees patients at GP surgeries in Bexley.
Before he arrived 95% of patients with cardiovascular problems were referred for tests at the local hospital: "The PCT was seeing a lot of money spent at hospital on patients who turned out to be remarkably normal."
The solution was longer consultations. Rather than the normal five or 10 minutes, patients see Dr Brennand-Roper for half an hour. "It does seem to work remarkably well and the referral rates have come down to probably around 10%."
Local hospital loses out
That means the GPs get to keep more of the money but the big loser is the local Queen Mary's hospital in Sidcup. David Brennand-Roper is aware that schemes like the one in Bexley, which use specialist hospitals and the private sector, could pose problems for small district hospitals.
He says: "If we see patients in the community there will be a problem for hospitals. The difficulty for the hospital in the long term is the shortfall in income." The South London Healthcare Trust, which is responsible for the Queen Mary's hospital, did not have anyone available to comment.
Dr Kostas Manis says his experience from Bexley is that the introduction of GP commissioning will mean hospitals and consultants have to radically change. "District hospitals have too many managers and too many consultants. GPs are in the driving seat and GPs will decide where patients go." 29.9.10
GP's ignore Ministerial advice as 7% rise in use of Anti-Depressant drugs
Data has shown that the use of anti-depressants is on the rise. It seems like the Ministerial goal to cut down on anti-depressants usage has been ignored by GP's.
The Scottish Government wanted to cap the use of anti-depressants by 2009-10 and prepare the ground for a 10% reduction. But the latest statistics showed a 7% increase between April 2009 and March 2010, compared with the previous year.
The number of defined daily doses for the 12-month period increased in NHS Grampian from 14.16million to 14.52million, while the total in NHS Highland went up from 8.16million to 8.32million. NHS Tayside had a similar increase, up from 12.6million to 12.85million. A similar situation was reported by the island health boards.
At the 2007 Holyrood elections, the SNP manifesto had vowed to decrease the increasing prescribing of anti-depressants. And the party in authority had said that it would cut down the drug prescriptions by 10%. The figures showed that between April 2009 and March this year, there was a surge in the "daily dose per capita" to 38.17 from 35.66.
Official data revealed a 7% boost from the year before. It is the second consecutive rise in the prescription of anti-depressant drugs despite evidence they don't actually work.
Scottish Government officers said that the figures were equivalent to 105 doses per 1,000 people a day, in contrast to 98 per 1,000 in the year before.
Scottish Labour Health Spokesman, Dr. Richard Simpson said, "These figures are extremely worrying. The SNP Government promised to stabilise the prescription of anti-depressants, but they have failed to do so and numbers continue to rise".
A top Labour MSP and veteran physician said that anti-depressant drugs should only be recommended for majority of the patients, when there is no other option left. Simpson said that other treatments like cognitive behavioural therapy that is a kind of structured counselling, should be used more often. 29.9.10
Number of official warnings given to doctors rises by almost 50% in just two years
A growing number of doctors are being handed warnings for offences such as drink-driving and disorderly behaviour. The General Medical Council issued 262 ‘reprimands' to GPs, specialists and hospital consultants last year – an increase of 50 per cent in the last two years.
Such warnings are given out for offences including assault and breach of the peace.
Although they happen out of work and do not endanger patients, they are deemed to be ‘bringing the medical profession into disrepute', and the individual is given a slap on the wrist. The most common offence was drink-driving, which accounted for 37 of all warnings issued – or one in seven.
Many other cases, such as disorderly behaviour and assault were also likely to have been triggered by alcohol – prompting concerns that excessive drinking is becoming an increasing problem among doctors. Earlier this year a report warned that as many as 15,000 doctors had been addicted to alcohol or drugs at some point in their careers.
The report, written by a working group appointed by the Department of Health, said many doctors were increasingly becoming stressed and overworked due to overcrowded wards and excessive Whitehall targets. These latest figures, revealed following a Freedom of Information request by the BBC , show that two years ago the GMC handed out just 172 reprimands.
The watchdog has admitted it is concerned at the rise and will investigate possible causes. 29.9.10
Antipsychotics drugs cause greater risk of blood clots
The safety of antipsychotics [psychotropic] is in the spotlight again after research published in the British Medical Journal showed a link between their use and a risk of venous thromboembolism (VTE).
The study, which looked at more than 25,000 patients with a first deep vein thrombosis or pulmonary embolism and nearly 90,000 controls between 1996 and 2007, found that those prescribed antipsychotic drugs in the previous 24 months had a 32% greater risk of VTE than non-users, despite adjusting data for potential risk factors.
The results also showed that patients who had started therapy with a new drug in the previous three months had around twice the risk of VTE, and that the danger was also greater for atypical rather than conventional and low potency rather than high potency drugs.
The researchers said their data show that there is a link between the use of antipsychotic drugs - which are used to treated illnesses such as schizophrenia as well as other conditions such as dementia-associated agitation - and the risk of venous VTE in a large primary care population.
“Our study adds to the accumulating evidence of adverse health events associated with antipsychotic drugs,” the researchers noted, with recent evidence confirming significantly higher risks of serious events and mortality in dementia patients who are treated for behavioural problems with such medicines.
And while the absolute risks of VTE were low, if replicated in further research the findings could have significant implications for the use of antipyschotics in primary care, particularly as the majority of their use in this setting is for milder conditions such as nausea, vomiting and vertigo.
In an accompanying BMJ editorial, Professor Giovanni Gambassi and Dr Rosa Liperoti, from the Centro di Medicina dell'Invecchiamento in Rome, Italy, stressed that treatment with antipsychotics should be tailored to individual risk factors.25.9.10
Avandia diabetes drug 'that raises risk of heart disease' is finally banned
A diabetes drug taken by up to 100,000 Britons has been banned after it was found to raise the risk of heart disease. European safety chiefs yesterday took Avandia off the market, three months after the committee responsible for drug safety in the UK called for it to be withdrawn.
Avandia was launched ten years ago as a new way to reduce blood sugar in patients with type 2 diabetes, the form that usually strikes in middle and old age. But there has been mounting concern over its safety record, with many critics claiming watchdogs should have acted much faster in banning the drug.
The European Medicines Agency yesterday announced it was suspending the drug's licence after a safety review, which effectively means doctors can no longer prescribe it. Patients on Avandia are being advised to see their doctor, but also to continue taking the drug until they have been switched to another type of medication. The EMA's decision, taken after consultation with drug safety committees from all its members, claims the benefits of the drug ‘no longer outweigh the risks'.
In the U.S., the Food and Drug Administration, which does not have the legal power to suspend the drug, has also slapped further restrictions on its use. Avandia was once one of the best-selling drugs in the world, with annual sales peaking at £3billion in 2006 – UK doctors wrote a million prescriptions last year at a cost of around £30million.
But manufacturer GlaxoSmithKline saw sales of the drug, also called rosiglitazone, slump to £321million for the first half of this year. Pressure was stepped up earlier this month when the British Medical Journal called for Avandia's withdrawal on safety grounds. It said the drug should never have been licensed.
However, EMA's senior medical officer Dr Hans-Georg Eichler denied the safety agency had acted too slowly, saying evidence against the drug had eventually ‘accumulated'. He said the biggest problem was that heart risks are already very common in diabetes patients, and attributing the cause to a drug was extremely tricky. ‘We struggled with it, and colleagues in other jurisdictions struggled with it as well,' he said.
A recent clinical study found Avandia increased the risk of heart attacks by between 20 and 40 per cent. One UK expert has calculated the drug may cause as many as 1,000 extra heart attacks a year in Britain , but the EMA said it was impossible to give an official figure. Patient groups blamed drug safety systems here and in Europe for delays in withdrawing Avandia and failure to put patients first.
Peter Walsh, chief executive of the patient safety charity Action Against Medical Accidents, said: ‘Medical experts have been warning for months about the dangers of this drug, which have been well documented. It should not take this long to come to a decision when there is evidence that people's lives may be at risk. We need a review of how medicines are regulated in the UK and Europe as a whole. We fear that pharmaceutical companies have far more influence than they should have.'
In July the Commission on Human Medicines, an advisory body to the UK's Medicines and Healthcare products Regulatory Agency, stated the ‘risks of rosiglitazone outweigh its benefits, that it no longer has a place on the UK market' and called for prompt action.
Dr Ellen Strahlman of GSK said: ‘Our primary concern continues to be patients with type 2 diabetes and we are making every effort to ensure that physicians in Europe and the U.S. have all the information they need to help them understand how these regulatory decisions affect them and their patients.' 24.9.10
How drug companies keep pushing their drugs
Every day without fail there is a story in the media about how a particular drug ‘could' and the emphasis is on ‘could be used' to treat another condition.
‘Prozac could help with relieve PMS' or ‘Arthritis drug could help with dementia' and so.
Drug manufacturers are desperate to find new markets for failing drugs and so dream up new scenarios where the drug could be used next. In most cases the evidence is extremely weak hence the term ‘could be used' but the facts never get in the way of pushing drugs on new customers.
The pharmaceutical industry is worth $750 billion a year and they settle thousand of law suits each year for damages caused by their use of their products, just a cost of doing business for some.
Their huge PR machines roll on pushing products with little or no benefit, so the next time you read a story about how a drug could be used, it's more PR spin than medical fact. 22.9.10
Cosmetic surgery industry in UK 'has key weaknesses'
Up to three-quarters of cosmetic surgery clinics are unregulated and potentially harming patients, according to a watchdog's report published today. Many of those carrying out treatments such as face lifts, breast enlargement and liposuction are not following basic safety guidelines.
The majority – 56 per cent – use poorly-equipped operating theatres – with some not even having resuscitation ‘crash' trolleys needed if a patient suddenly has a heart attack. A fifth of clinics offering breast enlargement surgery carry out fewer than ten such procedures a year – which is far too infrequent for the complex operation to be carried out safely, according to the report.
Similarly 55 per cent of centres offering the less-common breast reduction treatment undertake fewer than ten operations a year. A quarter of clinics try to entice women with supermarket-style offers, such as ‘three for two' on liposuction treatments. Experts warn that such discounts are unethical as they encourage patients to undergo potentially dangerous, life-changing operations.
The report, carried out by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), an independent, Whitehall-funded body which aims to improve medical care, also found that a third of clinics do not have high-dependency units able to deliver life-saving care in case anything goes wrong during surgery.
More than 70 per cent of the 550 high street clinics approached by NCEPOD refused to take part in the investigation, meaning they are effectively unregulated. Cosmetic surgeons warn that women's safety is being put at risk.
Nigel Mercer, president of the British Association of Plastic Surgeons, said: ‘These figures present a distressing picture, but one which is sadly not surprising to us as they only confirm what we have been saying for years – that there is an absolute need for statutory regulation in this sector.
‘Aesthetic surgery needs to be recognised as the multi-million pound specialty it is and not just a fragmented “cottage industry”. ‘The association has long been calling for enforceable regulation of this sector of medicine. ‘Just as someone eating in a restaurant wouldn't have to personally inspect the kitchen, the public should have the right to expect providers of aesthetic surgery to be properly overseen and regulated on their behalf by our Government.'
The cosmetic surgery industry is worth an estimated £1.2billion a year and procedures such as weight-loss treatment and face-lifts are becoming increasingly popular among women, as well as a growing proportion of men. But the number of complaints is also rising. In 2008 there were 173 complaints about botched breast operations to the Medicines and Healthcare Products Regulatory Agency, up from 135 in 2007. 17.9.10
Aspirin stops bowel cancer
An aspirin a day can slash the risk of bowel cancer, it is revealed today. Just one 75mg pill could cut the chance of getting the deadly disease by more than 30 per cent. The new research is further evidence of the health benefits of the wonder drug.
Doctors already know aspirin can reduce the chance of a heart attack or stroke for those at high risk – and may even protect against dementia.
Now, for the first time, they have quantified the amount that patients need to take to protect them from bowel tumours. Previous studies suggested that a high dosage was required. The new study, by a team in Edinburgh , shows that one low-dose 75mg pill is enough.
Last night medical experts welcomed the study and hailed the results as encouraging. Bowel cancer claims more than 16,000 lives a year in Britain and is the third most common form of cancer.
Almost 40,000 new cases are diagnosed annually. The risk of getting the disease increases for people who have a poor diet, drink too much alcohol, are obese and take no exercise. Although bowel cancer responds well to the latest drugs if caught early, many patients are too embarrassed to go to the doctor when they start to experience problems.
The new research, published in the journal Gut, studied almost 6,000 patients, many of whom had suffered bowel cancer. 16.9.10
Thousands of GPs earn more than the PM... and as much as £500,000 a year
More than 4,000 GPs are now earning more than the Prime Minister, figures show. Many self employed family doctors are on salaries well in excess of £250,000 with some taking home more than £500,000 a year.
The most recent figures show that up to 4,230 GPs have annual earnings higher than £150,000 - more than David Cameron, who earns £142,500. Of these, 950 are on salaries of more than £200,000, with 250 GPs - almost one per cent - earning more than £250,000.
Family doctors' pay has soared since the introduction of a 'bungled' new contract in 2004 by the then Labour government, which actually resulted in them working fewer hours a week. The system enables them to earn points for treating or referring patients to NHS services with certain conditions which translate into bonuses on their final salary.
But as part of the contract they were also able to opt-out of working evenings and weekends, resulting in the average GP working seven fewer hours a week. The widely condemned system has resulted many GPs earning well in excess of £100,000 a year, compared with £70,000 six years ago, a 42% increase.
Figures published by the NHS Information Centre also show that family doctors earn an average of £105,300, a slight fall compared with previous years. But it has recently emerged that many are on lucrative pay deals with some are taking home as much as £500,000 a year.
One family doctor who owns two practices in the West London borough of Hillingdon declared annual earnings from the NHS of £507,241.
Another of the highest paid GPs in the country is believed to be Dr Shiverdorayi Raghavan, who runs two surgeries in Birmingham , earning more than £1million from the NHS in just two years.
Campaigners warned that their escalating pay could not be sustained.
The NHS has been ordered to make £20 billion of cuts by 2014 and thousands of frontline staff including doctors and nurses are facing the sack.
In addition, many health trusts have started to cut back on what they regard as 'low-priorty treatment', such as IVF, varicose vein operations and surgery to remove unsightly skin moles. Fiona McEvoy, from the TaxPayers' Alliance , said: 'Though GPs do an important job, their salaries have increased at an astonishing rate over the last decade, despite the fact they're working fewer hours.
'These salaries show the folly of ring-fencing the NHS budget. We need to ensure value throughout the NHS, and that means we can't afford to sustain this rate of escalation. Though doctors deserve a decent wage, we should be careful not to over- compensate them for the work they do.'
The 2004 contract has been widely criticised by MPs and other campaigners who claim it is too easy for GPs to increase their salaries. Under the points system, they can earn more money by monitoring asthma patients and those with coronary heart disease, testing and diagnosing diabetes and checking blood pressure, all of which they get extra payments for.
But critics say it is too easy for GPs to gain maximum points and accuse them of ignoring patients like dementia victims who are not included in the points scheme or holding on to patients rather than referring them on for specialist care or treatment.
A Department of Health spokesman said: 'While there has been an overall decrease in GPs' earnings, we must ensure better value for money from the overall investment in the GP contract, and make sure resources are used to the greatest benefits of patients and the taxpayer. 'The Coalition Government recently announced a two year pay freeze for all NHS staff earning more than £21,000 a year.
'We are currently considering how best to apply this pay freeze to groups such as GPs and dentists whose NHS income covers both their personal pay and practice expenses. 'The NHS White Paper published in July, set out our proposals to pay GPs according to the outcomes they achieve for patients and how effectively they use resources.' 16.9.10
Public sector riddled with the bone idle
The public services are riddled with ‘bone idle people' who have damaged the productivity of the state sector, a leading fire chief has claimed. In a withering attack on the malaise gripping the public sector, Tony McGuirk has warned that unless bosses are prepared to sack lazy workers, they will never make the kind of savings necessary to put the economy back on course.
Mr McGuirk, chief fire officer of Merseyside, sparked outrage at the TUC conference yesterday by saying that he has been able to slash staff numbers by 40 per cent and actually provide a better service. He advised other public sector bosses to show ‘muscle, sack some people'.
‘We've got some bone idle people in the public sector. There, I said it – bone idle people.' Mr McGuirk said he had slashed the number of firefighters from 1,550 to 850 during the past decade.
‘There is no need to close a fire station, we haven't touched a single fire station. ‘Frontline is fire engines and fire stations, not firefighters. We provide a far better service with those 850 – more with less.' He claimed that lazy workers had led to an ‘epidemic of sickness leave' which had damaged productivity. ‘Here's one of the things we did, get a grip on sickness. It is deficit reduction plans need not hurt public services epidemic in the public sector.'
Mr McGuirk spoke out at a seminar organised by the centre-right think tank Reform – a transcript of which was circulated at the TUC yesterday.
His claim that it is possible to maintain frontline services with fewer staff will boost the Government's case that its Mr McGuirk said bosses should ‘manage performance, reward good performance, develop people with poor performance or ultimately sack them. ‘If they are not doing their job you have got to get rid of some people.'
The fire chief said that his cuts had led to personal abuse. ‘There were 2,000 people walking through Liverpool wearing shirts saying on the back “I hate McGuirk”,' he said. The Fire Brigades Union last night condemned his view.
General Secretary Matt Wrack said: ‘It's very easy for people who do not risk their lives fighting fires to sneer at people who do. ‘Mr McGuirk is among the highest paid fire chiefs in the country, getting more than £200,000 a year. He is massively overpaid. ‘For that money we could get six fully trained firefighters, which would be a much better use of scarce resources.' 15.9.10
The great public and private pay gulf - state workers get a lot more
State workers get £136 a week more than private employees in pay and pensions. The widening gulf between earnings in the private and public sectors was laid bare yesterday. State workers receive an average of £7,000 a year more in pay and pension contributions than their counterparts in private companies, official figures showed.
The calculation will pile pressure on the Coalition to rein in the cost of the public sector – fattened by 13 years of Labour government – through pay freezes, job cuts and reform of the pension system. State employees earn an average of £615 a week when their pension provision is taken into account, the Office for National Statistics said.
That compares with an average of only £479 a week in the private sector, where many workers do not enjoy such generous retirement packages, a difference of £136 a week. It means that the ‘total reward' of pay plus pension contributions for public sector workers is an average of £31,980 a year.
This is more than £7,000 above the £24,908 earned in the private sector. Despite the gap, union barons last night repeated their warning that public spending cuts will hit front-line services.
But Mark Littlewood, director general of the Institute of Economic Affairs , said: ‘The TUC 's idea that there will be a wave of public support for poor, repressed public sector workers is woefully misplaced. ‘The generous packages enjoyed by public sector workers are paid for by the private sector. ‘They are living in a parallel universe to the rest of us who are paying their salaries.'
The ONS figures showed that public sector workers earn considerably more than their private sector counterparts even in terms of basic pay, but the gap becomes much wider when pension payments are included. Average pay in the public sector was £539 a week before employers' pension contributions were taken into account.
That compared with £465 a week in the private sector. Pension contributions by the state pushed total public sector earnings up £76 a week to £615 whereas average pay in the private sector rose by a mere £14 to £479 a week. More than half of full-time workers in the private sector do not save for their retirement compared with only one tenth in the public sector, the ONS said.
In addition, many private companies have closed final salary pension schemes and cut back on payments for employees in the wake of the financial crisis and the recession.
The Office for Budget Responsibility, the public finances watchdog, forecasts the Treasury will spend £4billion this year topping up public sector pensions. In four years' time this will have more than doubled to £9.4billion.
The TUC said workers in the public sector are increasingly well educated, and that many of the lowest-grade blue collar jobs, such as cleaning and maintenance, have been outsourced to the private sector.
Adam Lent, head of economics at the TUC , said: ‘You can't make direct comparisons-between the public and private sector workforce. ‘The public sector has many more professional and highly skilled workers within it than the private sector. ‘Averages simply do not tell us anything useful, whatever Right-wing think tanks say.'
But critics blamed years of lavish spending by the previous Labour Government which saw an explosion in the number of workers paid by the taxpayer. The public sector workforce continued to grow during the recession despite one million job losses in the private sector.
Emma Boon of the TaxPayers' Alliance said: ‘The public sector effectively hasn't had a recession with staff numbers increasing consistently. With Government spending cuts on the way, it's time they took some of the pain.' Patrick Nolan, chief economist at free market think tank Reform, called for restraint in the public sector. ‘It is not fair that the private sector has borne the brunt of the adjustment from the recession when the public sector has been largely protected,' he said.
‘We hear from the unions that public sector workers shouldn't have to pay, but the private sector has already paid. It is time for public sector workers to share some of the costs of the recession.'
Deputy Prime Minister Nick Clegg recently said that it is ‘unfair' to keep asking private sector workers to pay their taxes into ‘unreformed gold-plated public sector pension pots'. Chancellor George Osborne said the projected rise in the cost to taxpayers of public sector pensions was ‘unsustainable' and must be tackled.
Ex-Labour cabinet member John Hutton has been appointed by the Tory-Lib Dem coalition to head a commission into public pensions. The former Work and Pensions minister is due to publish an interim report this month. A Treasury spokesman said: ‘The Budget announced a two-year pay freeze for the public sector.' 15.9.10
Welsh bid to save £50m in wasted pills and medicines
THE Assembly Government was last night standing by its policy of free prescriptions for all despite evidence that at least 250 tonnes of medicine is wasted each year. Medicine worth £50m is returned unused to pharmacies and GP surgeries, and much more may be binned each year with the household waste.
In one case a single patient was found to have returned medicine worth £2,000.
The Assembly Government is today launching a campaign to reduce this waste and the chief medical officer for Wales , Dr Tony Jewell, is writing to health professionals to urge them to only prescribe the necessary amounts. Welsh Conservatives yesterday said the time had come to end free prescriptions for high earners.
Shadow Health Minister Andrew RT Davies described a recent visit to a pharmacy in Rhyl, saying: “Piled as high as you can imagine were drugs that had been returned, many in boxes that hadn't been opened that had to be incinerated.” He believes pharmacists can play a key role in assessing whether patients on repeat prescriptions are receiving the correct medicines.
But he was also adamant that the prescriptions system needed to change, saying: “It's a problem that's gone on far, far too long and the Assembly Government really needs to up its game.” He continued: “If you're a City banker on £1m a year you'd qualify for a free prescription... We believe, frankly, that's not social justice and someone on the 40% tax band should be paying for their prescription.”
However, the Assembly Government said academic analysis had shown that the introduction of free prescriptions had not resulted in an increase in medicines prescribed. However, the Health Minister Edwina Hart was adamant that more effective use of medicines must be made.
She said: “Millions of poundsworth of waste medicines are being burnt every year. This is money that could be better spent elsewhere in the NHS.
“Not only is there a significant cost associated with wasted medicines, if people have out-of-date medicines, they are risking their health. If we all adhere to the clear and simple guidelines in this campaign and patients only order what they need, and GPs prescribe effectively, the safety and benefits of such medicine management will be felt directly by all in Wales . We all have a duty to play our part in reducing the amount of unnecessary prescribing of medicines.”
Veronica German, Liberal Democrat health spokeswoman, said: “The issue of wasted medicines is not a new one and it should have been addressed a long time ago. “£50m is a huge amount of money to be wasting every year, this is money that the NHS in Wales desperately needs. It is disappointing that only now the Labour Plaid Government is taking action.”
Russell Goodway, chief executive of Community Pharmacy Wales, hoped the campaign would lead to a change in behaviour. He said: “Community pharmacists deal with waste medicines on a daily basis and are specifically qualified and well placed to help tackle the problem. Patients who are not sure if they need to take all the medicines they have at home can ask their local community pharmacy for a free medicines check-up. “It is not safe to keep medicines at home that are not going to be used or are no longer needed. People should bring any such surplus medicines to their local community pharmacy for safe disposal.”
An Assembly Government spokesman said: “There are no plans to scrap free prescriptions. “We see free prescriptions as a long-term investment in improving health and by providing people with the medications they need, it will help to keep them out of hospitals through reduced emergency admissions and therefore reduce the cost to the NHS. “In Wales , we have a higher proportion of older people and people with chronic conditions, and therefore we would expect more prescriptions to be dispensed every year as the number of older people and people with chronic conditions increases.”
We all have a duty to play our part in reducing the amount of unnecessary prescribing of medicines. 14.9.10
Royal College of GP urges Government to delay start of commissioning to delay private sector
The RCGP has urged Andrew Lansley to put back his plans for GP commissioning, after the biggest survey of GPs to date showed fierce opposition. In a major blow to the health secretary, a college report said its consultation of members, which will result in a formal response to the Government, had unearthed ‘major concerns' and called for the time frame for the reforms to be extended.
It warned plans for GP consortia to replace PCTs risked destabilising the NHS, and could swamp practices with extra workload and take clinicians away from the front line, while opening the door to the private sector.
While the RCGP said the consultation had seen GPs recognise opportunities to increase their leadership role in the NHS and that it was sure ‘GPs will rise to the challenges', it called for a more considered approach. There were, it said, widespread fears the moves to set up commissioning groups across the country would increase health inequalities. The report said there had been ‘a significant number of comments on the risks of these reforms to the NHS in England.
‘GPs will be seen as the purse-holders: this could reduce public trust and decrease their ability to advocate for patients, and they will be blamed for failures and cuts in services,' it said.
Many GPs felt they lacked the time, skills and capacity for commissioning and felt ‘the reforms open a door to increased involvement of the for-profit private sector' and could even lead to the ‘break-up of the NHS'. ‘We believe GPs can assist in the efficient use of NHS resources, and wish to play an active role in reducing waste and duplicated effort,' it concludes. ‘However, some of our members are not convinced the scale of the changes proposed is justifiable, especially in the context of cost reductions.'
At meetings across the country, Mr Lansley's plans have met with a similar mixture of enthusiasm and trepidation. Dr Nigel Watson, chief executive of Wessex LMCs, said after a meeting with Mr Lansley that while GPs were up for the challenge there were ‘many areas of uncertainty'.
Dr Ben Milton, a GP in Matlock, Derbyshire, said: 'We can't engage people if they don't truly understand both the carrot and the sticks that are going to be put in place here.' GPs at a Birmingham meeting called for a legal challenge to the white paper due to what they claimed was the threat to single-handed practices.
But critics said the RCGP were 'scare mongering', the real objection was the involvement of the private sector and increased competition. Many people don't realise most GP's are self employed and have a monopoly, they receive funding for making referrals to NHS services, with some GP'S earning up to £500,000 per annum. They see the private sector as a ‘threat' and not as an opportunity to improve treatment and patient care as the government do'. 14.9.10
The nightmare of giving up sleeping pills: One woman reveals her addiction battle
Paula Wynne had always been a solid sleeper until two years ago. Then she was made redundant from her job as a marketing manager, and soon afterwards underwent a minor operation on her shoulder.
What should have been a simple procedure went wrong, and the mother-of-one ended up needing two corrective operations over the next nine months. The crippling pain and anxiety made it difficult to sleep and her GP prescribed the sleeping pill zopiclone until the pain subsided.
Paula, then 44, took the pills every night for six months, but when she began working again, helping her partner Ken in his business, she found giving up the tablets very difficult. Whenever she tried, her insomnia became worse than ever before.
'It was horrible - I'd go to bed at the normal time, but just lie in bed wide awake for hours,' she recalls, two years later. 'I felt depressed. I had no energy in the morning to do anything. It was the darkest year of my life. I was only getting a few hours' sleep a night. 'I was behaving out of character, and over-reacting to even the slightest upset. I couldn't make decisions and needed my partner, Ken, to do everything for me.
'I hated not being able to sleep without the aid of medication - but giving it up only made the insomnia even worse.' Paula was suffering from 'rebound insomnia', caused specifically when you give up the pills.
Dr Cosmo Hallstrom, of the Royal College of Psychiatrists, explains: 'Rebound insomnia is like having a double dose of insomnia. The body - which couldn't sleep in the first place - adapts to needing a sleeping pill to sleep; and when it is then taken away, the insomnia is compounded.'
Sleeping pills are both physically and psychologically addictive, he says. Other withdrawal symptoms include anxiety and depression. And while most patients will suffer mild withdrawal symptoms, many suffer more extreme reactions. Sleeping pills are a commonly prescribed drug - around nine million Britons take them occasionally, with an estimated million using them regularly, and long-term.
Many long-term users are elderly, says Dr Hallstrom. 'If you start taking them and you are in the older age group, there is a one-in- three chance of becoming a long-term user. 'And once you are a long-term user, you will stay on them indefinitely, because they are so difficult to give up. There are people who have been on sleeping pills for 10 to 20 years.'
Last week, it was reported that sleeping pills raise the risk of early death by a third.
This was true whether the pills were used long term or just occasionally, Canadian scientists found. One theory is the drugs affect alertness and co-ordination, making patients more prone to falls and other accidents. It could also be that they interfere with the breathing system and worsen any breathing problems as the person sleeps.
Although British experts questioned the numbers affected, many patients, shocked by the findings, will want to quit the drugs. But as Paula discovered, this is far easier said than done.
The most commonly used sleeping pills are benzodiazepines and newer drugs known as the 'z-drugs' (including zaleplon, zolpidem and zopiclone). They all act in a similar way. They are sedatives that depress brain chemicals in the central nervous system, making you feel relaxed.
While the newer drugs produce less of a 'hangover effect' the next day, all the drugs are potentially addictive, according to the National Institute for Health and Clinical Excellence (NICE).
'To stop people becoming addicted, they should be used only for a short period of time,' says Dr Hallstrom. Indeed, NICE recommends sleeping pills should be prescribed for a maximum of only one month.
The Royal College of Psychiatrists goes even further, advising that only when a patient is so distressed they cannot sleep at all should the pills be prescribed - and then only for less than two weeks. In fact, Paula's GP prescribed zopiclone for weeks on end. 'At first,' says Paula, 'the pills were wonderful. I went from lying in bed all night in agony to being able to drift off at 10pm .'
When one didn't do the job because the pain was particularly bad, she'd pop two at a time. And if she woke up in the night through pain, she'd pop another to get back to sleep. 'I did it because it was such an easy way to get a good night's sleep, something so many of us take for granted,' she explains.
One key concern with sleeping pills is that the body can quickly become tolerant to them, so they work less well at their recommended dose. Then - like Paula - many patients often end up taking more than they should to have an effect.
Determined to end her reliance on the sleeping tablets, for three months Paula repeatedly tried to give them up. Every time she ended up taking the pills again because the withdrawal symptoms were so bad. Without them, she would lie awake all night. Ken couldn't sleep when she did not sleep, so eventually she'd sneak off to the spare room so at least one of them would get a decent night.
'Apart from worse insomnia than ever if I didn't take the pills, I was very anxious and depressed,' says Paula. 'I lost all interest in things. I had no energy to go out and meet friends, or anything. Moping was the only thing I could do.'
Paula talked to her GP about weaning herself off by gradually reducing the dose. She tried taking the pills on alternate nights - but that didn't work. Finally her GP started her on painkillers again, with a sedative.
Almost six months after first trying to quit, she finally took her last pill. 'My sleep patterns have been erratic, but I'm thrilled to be free of the tablets at last,' she says. 'I now appreciate every wink.'
There is no easy way to quit, Dr Hallstrom warns. Patients have to be prepared to suffer some worsening of their sleep for at least a few weeks. 'They need maybe to take the pills on alternate nights, or they could try alternative medication suggested by their GP.'
The potentially addictive nature of the drugs is why the Royal College of Psychiatrists suggests trying other approaches before even thinking of talking to your GP about sleeping problems.
It recommends self-help methods such as exercising during the day, and getting up if you cannot sleep and doing something relaxing. But that advice came too late for Paula, who warns: 'People think the pills will help - but in fact they can make things worse. I don't believe everyone is told how addictive they can be. Avoid them if you can.' 14.9.10
Up to 750,000 'special needs' pupils are just badly taught
Schools have wrongly labelled as many as 750,000 children as having special needs to cover up poor teaching, a damning report warns today.
They are diagnosing conditions such as 'behavioural , emotional and social problems' to massage unfavourable league table ratings, according to inspectors. They found that 1.7million pupils in England were classed as having special educational needs in January, just over one in five.
But, declares Ofsted, almost half of these have simply been poorly taught. In some schools, a 'culture of excuses' means that pupils making slow progress are automatically classed as having special needs. In other cases, pupils have ended up with learning or behavioural problems after being failed by poor literacy and numeracy teaching early in their school career.
Inspectors also visited a school where pupils were categorised as having special needs simply because their fathers were away fighting in Afghanistan. Inspectors found that some local authorities appear to offer incentives to give such labels to children as some types of educational need bring in extra funds.
Exam results are also adjusted to take account of the number of pupils with special needs. This can have a 'positive influence' on their league table rankings, Ofsted found.
Schools are, meanwhile, under pressure from 'articulate middle-class parents' who lobby for such diagnoses to ensure extra support for their children, such as personal tuition and extra time in exams. The term "special educational needs" is used too widely,' said the report. 'Around half the schools and early years provision visited used low attainment and relatively slow progress as their principal indicators.
'Inspectors saw schools that identified pupils as having special needs when, in fact, their needs were no different from most other pupils. 'They were under-achieving but this was sometimes simply because teaching was not good enough and expectations of pupil were too low.
'A conclusion that may be drawn is that some pupils are being wrongly identified as having special needs and that relatively expensive additional provision is being used to make up for poor teaching and pastoral support.'
Christine Gilbert, the chief inspector of schools, said: 'Schools are identifying children and young people as having special needs when they need essentially better teaching and better pastoral support.' In contrast, parents of children with the greatest needs or disabilities must endure the troublesome 'statementing' process.
Statements are legal documents outlining the support to which children are entitled. But Ofsted found that, even when parents succeed in obtaining one, there was no guarantee of appropriate or good provision. Those with the severest needs - 2.7 per cent of all primary and secondary pupils - have written statements. This is down slightly from 3 per cent in 2003.
But the proportion of all pupils classed as having special needs without statements rose from 14 per cent in 2003 to 18.2 per cent this year.
As many as half of these, or approximately 750,000, 'would not be identified as having special educational needs if schools focused on improving teaching and learning for all, with individual goals for improvement,' Ofsted suggested. Pupils from poor backgrounds or who regularly play truant or who were disruptive were more likely to be given the label.
In one case, 14 and 15-year-olds who were 'demotivated' about taking their GCSEs were put on the special needs register so the school could justify bringing in 'mentors' to help them. Janet Thompson, an Ofsted inspector and the report's author, said: 'Too much is being identified as being additional and different, rather than "this is the group of youngsters we are providing education for and this is the wide range of needs that we can meet".
'We did find examples of young people identified as having behavioural, emotional and social difficulties who, if you unpicked the reasons for that, were actually around inability to read and write.' 14.9.10
Also see: New mental health 'bible' will lead to almost everyone having a disorder, warn experts
GP's prescribe one-to-one surfing therapy for mental health patients
Patients suffering from depression are being given free surfing lessons paid for by the NHS. The pilot project is offering one-to-one tutorials by professional surfers to young people who have been diagnosed with mental health issues, which could be just about everyone according to the new mental health bible.
Health chiefs hope the ‘therapy' will help them build confidence while learning a new skill. The patients aged between 12 and 25 were referred to the scheme by mental health charities and it is being paid for by the Cornwall Primary Care Trust.
They decided to spend £5,000 on the project after watching a similar surfing session run by the same company in Polzeath for soldiers suffering from post-traumatic stress disorder after serving in Iraq and Afghanistan .
But critics say the activity is a waste of the NHS's money and it would be better spent on medicine and staff during the economic downturn. It comes as health trusts have been ordered to tighten their belts to make the NHS more efficient.
Conservative MP Philip Davies said: ‘This PCT seems to have far too much money if it can afford to provide jollies like this. ‘It's ridiculous that at a time when some drugs are being restricted from patients because of the cost that this can go on. They are not accountable and do not need permission to hold these activities and just do it. That seems wrong.'
TaxPayer's Alliance spokesman Fiona McEvoy said: ‘This is a highly questionable use of NHS funds at a time when doctors are having to deny cancer patients drugs. ‘It's important that the NHS uses its funds for medicine and equipment rather than watersports.'
Depression and anxiety cost the national economy £17billion a year. Forty per cent of those claiming disability allowance do so as a result of mental illness. Joe McEvoy, who commissioned the service for the PCT, said: ‘I think it will offer excellent value. ‘It's a long-established body of evidence which shows that when you organise therapeutic activities around particular tasks, people benefit not just from social interaction but also build confidence.
“That's been one of the tenets of occupational therapy which has been an established therapeutic discipline in all sections of health care for many decades.' ‘The coast is one of our greatest assets and it makes sense to use it to improve the health and well-being of our patients.
‘There are many positive health benefits that flow from physical activity and people who are suffering from poor mental health can also gain from improved self-esteem and doing things which are enjoyable.'
A spokesman for Era Adventuresm which is providing the lessons, said: ‘This is a really exciting opportunity and a great way of using surfing in the community.' Unruly pupils were given foot massages in the classroom as a therapy to calm them down paid for by the taxpayer.
Despite medical experts say there is little evidence that such treatment can improve the behaviour of young tearaways, Labour-run Lambeth Council in South London spent £90,000 sending reflexologists into its schools. However Lambeth's PCT does not provide reflexology sessions for the wider public. 16.9.10
Doctors prescribe 'fresh air and farm work' for patients with depression
Doctors are prescribing a novel treatment for depression - a day out on a farm. A scheme in Suffolk encourages patients to work in the outdoors - mucking out pigs, growing vegetables and tinkering with tractors.
Known as care farms, the initiative is designed to offer therapeutic help to people with a wide range of problems from mental health and autism to recovering stroke victims.
Doctors who support the farm link programme, which have been successfully run in Norway and Holland, can now refer patients to the Clink Care Farm in Tofts Monk, near Beccles, Suffolk. The 143-acre farm received its first helpers in June and is run by Doeke Dobma, 47 from The Netherlands.
He said: 'This is a very exciting project and we hope it will inspire others. We have had a lot of very positive feedback from doctors who would rather see their patients working on a farm that just sitting at home on medication and trapped by four walls. 'We hope to have up to eight people a day here helping and it will improve their bodies as well as their minds. We are sure it will inspire and motivate people.'
In the Netherlands a network of care farms, backed by Government funds, now takes more than 10,000 people each week.
The plan is also backed by Suffolk County Council and adult community services boss Colin Noble said: 'We are always looking at innovative ways to help people overcome difficulties that they face in every-day life by encouraging new activities. 'There are strong agricultural traditions in Suffolk and clear benefits in drawing on that heritage and combining the care of the land with the care of people.
'It is also an alternative to traditional day and residential care so that disadvantaged people can do meaningful work, learn new skills, develop a sense of achievement and feel valued.' 11.9.10
Vitamin B halts memory loss in breakthrough British trial
A simple vitamin pill could prevent millions from suffering the agony of Alzheimer's. The tablet, costing as little as 10p a day and made up of three vitamin B supplements, cut brain shrinkage linked to memory loss by up to 500 per cent.
Oxford University researchers behind the landmark study said it offered the 'first glimmer of hope' in the battle to find a drug that slows or stops the development of Alzheimer's. It and other forms of dementia blight the lives of more than 800,000 Britons, and the number of cases is expected to double within a generation.
No previous drug trials have been successful and, with around 500 new cases of Alzheimer's diagnosed every day in the UK alone, anything that delays the development of the disease could improve the lives of millions.
The breakthrough centres on a compound called homocysteine which is naturally made in the body and, at high levels, has been linked to memory loss and Alzheimer's. Vitamin B is known to break down homocysteine, so the researchers decided to look at whether giving patients the vitamin would be good for memory.
Working with colleagues in Norway , the Oxford team recruited 270 pensioners suffering from slight memory lapses that can be a precursor to Alzheimer's. Known as mild cognitive impairment, or MCI, it affects one in six aged 70-plus, or 1.5million Britons.
Half of those with MCI will develop dementia within five years of diagnosis. Half of those taking part in the trial took a vitamin B tablet a day for two years. The tablets contained extremely high doses of vitamins B6, 9 and 12.
For instance, the amount of B12 was up to 300 times higher than could be obtained by simply eating bananas, meat, wholegrains, beans and other foods rich in the vitamin.
The others took a daily dummy pill with no active ingredients. Brain scans were carried out to check if the pill reduced the shrinkage of the brain that happens naturally as we age and speeds up in memory loss. Vitamin B cut the amount of shrinkage by 30 per cent, on average, the journal PLoS ONE reports.
In those with the highest amounts of homocysteine in their bloodstream at the start of the study, it halved the shrinkage and in one extreme case, it cut it five-fold. Those with the slowest rate of shrinkage did best in memory tests and in some cases their ability to recall lists was as good at the end of the trial as it was at the start.
Professor David Smith, one of the study leaders, said: 'This is a very striking, dramatic result. It is our hope this simple and safe treatment will delay the development of Alzheimer's in many who suffer from mild memory problems.'
Co-researcher Professor Helga Refsum added: 'Here we have a very simple solution: you give some vitamins and you seem to protect the brain.'
The results suggest that a basic cocktail of vitamins can achieve results that have evaded pharmaceutical companies, despite billions of pounds being spent on experimental dementia drugs.
Professor Smith said: 'This was a disease-modifying study. All other disease modifying trials have failed. What we can say is that this is the first one that shows a glimmer of hope and success.' The professor plans to run a larger trial which will look at whether the vitamin cocktail actually affects the onset of Alzheimer's.
If the trial is successful, high dose vitamin B could be widely prescribed to those with mild memory loss in as little as five years. Those who do not want to wait can make their own vitamin cocktail with supplements on sale at health food stores.
But the researchers stress that people should not do this without speaking to their doctor first. High dose vitamins may trigger cancer and are known to fuel existing cancers. They may also react with medicines including arthritis and psoriasis drugs.
Despite this, Professor Smith says he ‘would not hesitate' to take the cocktail of 20mg of vitamin B6, 0.8mg of vitamin B9, or folate, and 0.5mg of vitamin B12, himself, if he were diagnosed with MCI.
The Alzheimer's Research Trust, which part-funded the study, said that delaying the onset of Alzheimer's by five years could halve the number of those who die with the condition. Rebecca Wood, the charity's chief executive, said: ‘These are very important results.'
The Alzheimer's Society gave the research a cautious welcome. Professor Clive Ballard said: ‘This could change the lives of thousands of people at risk of dementia. However, previous studies looking at B vitamins have been very disappointing and we wouldn't want to raise people's expectations yet.'
● A drug that may combat the sticky deposits that clog up the brains of Alzheimer's patients has been created by U.S. scientists. In tests on mice it cut levels of a compound key to plaque formation, without any side-effects, the journal Neuron reports. 9.9.10
One in four young doctors quit the NHS over EU rules on hours
Up to a quarter of junior doctors are dropping out just two years into their training, figures show. Many are becoming disillusioned with new rules that have forced them to work more and more night shifts without senior supervision. The exodus means that almost 1,400 junior doctors leave the NHS after foundation training rather than go on to the next stage of more specialised learning.
Campaigners blame this on the introduction last summer of the European Working Time Directive. Designed to improve the work-life balance of junior doctors, it states that they can do no more than 48 hours a week. This forced hospitals to shake up rota systems, leaving junior doctors to work a majority of night shifts and weekends. So - although the trainees are working fewer hours - these are mainly during busy and stressful times when few senior medics are around to supervise and guide.
There are also fears that the young doctors are left to carry out menial tasks. Although some of the doctors who drop out are taking gap years, many are leaving the health service completely to take up posts in English-speaking countries. The figures come from the Medical Program Board, which oversees doctors' training.
Of the medics who wanted to carry on and specialise, 22 per cent were turned down by hospitals because they lacked skills or experience.
Matthew Shaw, founder of Remedy UK , which campaigns to change doctors' training, said: 'The European Working Time Directive has completely changed the shift patterns of junior doctors and they no longer feel part of a team, under the guidance of a senior consultant. 'In the past, consultants would play a bigger role in their trainees' development but under the new shift pattern they barely see them. 'Junior doctors are working a majority of night shifts and even though they are working fewer hours it has adversely affected their quality of life.'
Gordon Fletcher, of the British Medical Association, said: 'There have been problems round the country with shift patterns brought in by the EU Working Time Directive which has led to junior doctors working more night shifts. 'They also often have to carry out a lot of bureaucratic and admin tasks such as chasing up results from the lab as the staff who would normally do this aren't around.'
There have already been warnings that lives are being put at risk by a system that puts junior doctors in charge of wards at nights and weekends. A report by the Royal College of Physicians also warned that the 48-hour week rule had led to doctors caring for an average of 400 patients a night, rather than just 60 during the day.
Health Secretary Andrew Lansley said: 'We will support the Secretary of State for Business, Innovation and Skills in taking a robust approach to future negotiations on the revision of the European Working Time Directive, including maintenance of the opt-out. 'We will not go back to the past with tired doctors working excessive hours, but the way the directive now applies is clearly unsatisfactory and is causing great problems for health services across Europe. 7.9.10
Experts call for diabetes drug Avandia to be withdrawn due to heart attack risk
A diabetes drug taken by up to 100,000 patients increases the risk of heart attacks and should be withdrawn on safety grounds, senior doctors say today. A report by the British Medical Journal says Avandia should never have been licensed in Britain because its risks outweigh its benefits.
One UK expert has calculated that the drug may cause as many as 1,000 extra heart attacks a year in Britain. The warning - which raises concerns about the way drugs are tested and regulated - comes three months after the committee responsible for drug safety in the UK called for the drug to be withdrawn.
But despite it writing to GPs to alert them to the dangers, patients were not informed and tens of thousands of people are still taking the drug.
Experts stressed that patients should not stop taking medication without first seeing their doctor - but urged GPs to review the way they treated diabetes. Avandia was approved by the European Medicines Agency in 2000 to help reduce blood sugar in patients with type 2 diabetes, the form that usually strikes in middle and old age.
It became one of the best-selling drugs in the world, with global sales of more than £1.5billion. Here, doctors wrote out more than a million prescriptions for it last year at a cost of around £30million. Its manufacturer, GlaxoSmithKline, said 'extensive research' showed the drug was 'safe and effective'.
The drug, which is also called rosiglitazone, has long been known to increase the risk of heart failure. However, recent studies have shown it may also lead to a small increase in the risk of heart attacks.
A BMJ investigation with the BBC's Panorama has revealed that concerns about Avandia were raised in July by the Commission on Human Medicines, an advisory body to the Medicines and Healthcare products Regulatory Agency (MRHA). The commission said the 'risks of rosiglitazone outweigh its benefits, that it no longer has a place on the UK market' and called for prompt action.
At the time, the MRHA wrote to GPs, warning them to look out for dangerous side-effects and to consider alternatives. But doctors were told to carry on prescribing Avandia while a European probe into its safety was under way. The results are due later this month.
Diabetes expert Professor Edwin Gale told Panorama the drug should already have been withdrawn. 'How long do you wait, how important is it to be absolutely certain and at what point do you start saying this game isn't worth it, people's lives may be at risk,' he said.
Clinical pharmacologist Dr Yoon Loke, of the University of East Anglia , estimated that the drug causes around 1,000 extra heart attacks and another 600 extra cases of heart failure a year. 'Even if you restricted it to patients who don't have heart failure you will still get patients who newly develop heart failure,' he said.
Yesterday the BMJ said no new patients should be started on Avandia and called on doctors to consider alternatives. In July a U.S. safety committee recommended that the drug was safe enough to stay on the market.
The drug's manufacturer, GSK, said in response to Panorama that 'patient safety is our priority'. 'We have carried out an extensive research programme, involving more than 50,000 patients, and continue to believe it is safe and effective when it is prescribed appropriately,' it said.
GlaxoSmithKline, the British drug maker, is to take a £1.57bn charge to cover settlements and legal actions relating to its diabetes pill Avandia and antidepressant Paxil. Glaxo, the U.K. 's biggest drugmaker, agreed to settle about 10,000 suits for an average of at least $46,000 apiece. The company had been facing more than 13,000 suits alleging Glaxo hid the drug's heart-attack risk, according to a UBS AG analyst. The settlements come as Glaxo is set to face its first Avandia trial in federal court in Philadelphia in October.
“This is exceptionally good news given the market has discounted $6 billion liability,” for Avandia litigation, Gbola Amusa, an analyst at UBS in London, said in an interview. “We had outlined an absolute worst-case scenario where $500,000 per case would have to be paid.” 6.9.10
GP’s ‘hoover up patients and payments’ many earning more than £200k to £500k a year
More than 160 GPs are better paid than the Prime Minister and at least two earns more than £500,000 a year, NHS trusts have admitted.
The doctors, many of whom are self employed, were the main winners of Labour’s controversial shake-up of healthcare, which saw the average GP’s salary rise to £106,000. The figures, disclosed under Freedom of Information laws, reveal that 161 GPs had annual earnings of £200,000 or more in the tax year 2008-09, the most recent for which figures are available. Their wages dwarf the £142,500 earned by David Cameron.
Pay for family doctors has hit previously unheard of levels since 2004, when Labour introduced lucrative new contracts and a system that allows GPs to compete with private companies by selling ‘top-up' services to the NHS. As a result a number of GPs have achieved huge salary boosts by capitalising on the chance to become entrepreneurs.
The British Medical Assocation, which represents doctors, said that large pay packets were a proper reward for GPs who had achieved entrepreneurial success while maintaining patient care but critics said 'patients were been retained in the NHS rather than referred to private
to maintain profits' as the BMA has also told GP's 'to use their commissioning powers to freeze the independent sector out of the NHS by wherever possible to ensure that NHS providers, rather than private or voluntary sector ones, are “the providers of choice”.
The disclosure that so many doctors are earning so much has shocked and surprised colleagues and will lead to fresh demands for an overhaul of the payment system and the payment of bonuses, having increased on average by an eye-watering 58 percent since 2003. The highest-paid GP, who is a senior partner and owner of two practices in the London borough of Hillingdon, has declared annual earnings fro m the NHS of £507,241.
The same doctor earned in excess of £400,000 in each of the previous three financial years. It is not known whether the income relates solely to the GP practices or whether he or she had carried out other work for the NHS. NHS Hillingdon, the local primary care trust, said that it was unable to provide a breakdown of the earnings.
But another Hillingdon GP, who asked not to be named, said: ‘It is extraordinary that a single GP could earn so much money. I am at a loss to explain how they have done it.’Another added: ‘I work seven days a week and I take home a salary of just under £100,000. It is very difficult to see what is going on here.’
The figures reveal that six other GPs – one each in Bradford, Shropshire, Brighton and Hove, Derbyshire and the London boroughs of Westminster and Hounslow – earned £300,000 a year or more. The Mail on Sunday obtained the pay details from 71 of England’s 152 primary care trusts.Fifty-five trusts had at least one GP earning £200,000 or more. Cambridgeshire NHS Trust had 13 and trusts in Derbyshire, Sunderland and Hounslow each had eight.
Critics of the system blame the spiralling pay on a controversial series of changes introduced by Labour in 2004, which allowed GPs to boost their incomes if they met clinical and administrative targets.
The biggest beneficiaries have been doctors who own more than one practice and have been able to ‘hoover up’ patients and payments.
Dr Richard Vautrey, deputy chairman of the BMA’s GP Committee, accepted that some entrepreneurial doctors were earning huge sums.
But he said: ‘We are talking about a very small number of high earners.
‘The figures relate to a minority of GPs who have become entrepreneurs and businessmen and often run several practices.’
Dr Vautrey said that the earnings were not a cause for concern if they were a reward for success and were not being achieved at the expense of patient care.
The Government has already announced a pay freeze for doctors and other public servants and pledged to ensure there is more of a direct link between payments and patient outcomes. A Government spokesman said: ‘In our White Paper we have proposed to establish GP consortia, which would be paid according to the outcomes they achieve for patients and how effectively they use resources.
We will be discussing with the BMA how the full range of payments to practices and consortia can be focused to deliver quality outcomes.’
Earlier this year it was revealed that a GP in Birmingham had earned £528,000 in the financial year 2007-08. Sources identified Dr Shiverdorayi Raghavan as the GP but he declined to comment. 5.9.10
How vested interest blocked Thorium which could kill fossil fuels overnight
If Barack Obama were to marshal America 's vast scientific and strategic resources behind a new Manhattan Project, he might reasonably hope to reinvent the global energy landscape and sketch an end to our dependence on fossil fuels within three to five years. We could then stop arguing about wind mills, deepwater drilling, IPCC hockey sticks, or strategic reliance on the Kremlin. History will move on fast.
Muddling on with the status quo is not a grown-up policy. The International Energy Agency says the world must invest $26 trillion (£16.7 trillion) over the next 20 years to avert an energy shock. The scramble for scarce fuel is already leading to friction between China , India , and the West.
There is no certain bet in nuclear physics but work by Nobel laureate Carlo Rubbia at CERN (European Organization for Nuclear Research) on the use of thorium as a cheap, clean and safe alternative to uranium in reactors may be the magic bullet we have all been hoping for, though we have barely begun to crack the potential of solar power.
Dr Rubbia says a tonne of Thorium - the silvery metal – named after the Norse god of thunder, who also gave us Thor's day or Thursday - produces as much energy as 200 tonnes of uranium, or 3,500,000 tonnes of coal. A mere fistful would light London for a week. Thorium eats its own hazardous waste. It can even scavenge the plutonium left by uranium reactors, acting as an eco-cleaner. "It's the Big One," said Kirk Sorensen, a former NASA rocket engineer and now chief nuclear technologist at Teledyne Brown Engineering.
"Once you start looking more closely, it blows your mind away. You can run civilisation on thorium for hundreds of thousands of years, and it's essentially free. You don't have to deal with uranium cartels," he said. Thorium is so common that miners treat it as a nuisance, a radioactive by-product if they try to dig up rare earth metals. The US and Australia are full of the stuff. So are the granite rocks of Cornwall . You do not need much: all is potentially usable as fuel, compared to just 0.7pc for uranium.
After the Manhattan Project, US physicists in the late 1940s were tempted by thorium for use in civil reactors. It has a higher neutron yield per neutron absorbed. It does not require isotope separation, a big cost saving. But by then America needed the plutonium residue from uranium to build bombs.
"They were really going after the weapons," said Professor Egil Lillestol, a world authority on the thorium fuel-cycle at CERN . "It is almost impossible make nuclear weapons out of thorium because it is too difficult to handle. It wouldn't be worth trying." It emits too many high gamma rays.
You might have thought that thorium reactors were the answer to every dream but when CERN went to the European Commission for development funds in 1999-2000, they were rebuffed. Brussels turned to its technical experts, who happened to be French because the French dominate the EU's nuclear industry. "They didn't want competition because they had made a huge investment in the old technology," he said.
Another decade was lost. It was a sad triumph of vested interests over scientific progress. "We have very little time to waste because the world is running out of fossil fuels. Renewables can't replace them. Nuclear fusion is not going work for a century, if ever," he said.
The Norwegian group Aker Solutions has bought Dr Rubbia's patent for the thorium fuel-cycle, and is working on his design for a proton accelerator at its UK operation. Victoria Ashley, the project manager, said it could lead to a network of pint-sized 600MW reactors that are lodged underground, can supply small grids, and do not require a safety citadel. It will take £2bn to build the first one, and Aker needs £100mn for the next test phase.
The UK has shown little appetite for what it regards as a "huge paradigm shift to a new technology". Too much work and sunk cost has already gone into the next generation of reactors, which have another 60 years of life.
So Aker is looking for tie-ups with the US, Russia, or China. The Indians have their own projects - none yet built - dating from days when they switched to thorium because their weapons programme prompted a uranium ban.
America should have fewer inhibitions than Europe in creating a leapfrog technology. The US allowed its nuclear industry to stagnate after Three Mile Island in 1979. Anti-nuclear neorosis is at last ebbing. The White House has approved $8bn in loan guarantees for new reactors, yet America has been strangely passive. Where is the superb confidence that put a man on the moon?
A few US pioneers are exploring a truly radical shift to a liquid fuel based on molten-fluoride salts, an idea once pursued by US physicist Alvin Weinberg at Oak Ridge National Lab in Tennessee in the 1960s. The original documents were retrieved by Mr Sorensen.
Moving away from solid fuel may overcome some of thorium's "idiosyncracies". "You have to use the right machine. You don't use diesel in a petrol car: you build a diesel engine," said Mr Sorensen. Thorium-fluoride reactors can operate at atmospheric temperature. "The plants would be much smaller and less expensive. You wouldn't need those huge containment domes because there's no pressurized water in the reactor. It's close-fitting," he said.
Nuclear power could become routine and unthreatening. But first there is the barrier of establishment prejudice.
When Hungarian scientists led by Leo Szilard tried to alert Washington in late 1939 that the Nazis were working on an atomic bomb, they were brushed off with disbelief. Albert Einstein interceded through the Belgian queen mother, eventually getting a personal envoy into the Oval Office.
Roosevelt initially fobbed him off. He listened more closely at a second meeting over breakfast the next day, then made up his mind within minutes. "This needs action," he told his military aide. It was the birth of the Manhattan Project. As a result, the US had an atomic weapon early enough to deter Stalin from going too far in Europe .
The global energy crunch needs equal "action". If it works, Manhattan II could restore American optimism and strategic leadership at a stroke: if not, it is a boost for US science and surely a more fruitful way to pull the US out of perma-slump than scattershot stimulus.
Even better, team up with China and do it together, for all our sakes. 2.9.10
China bets on Thorium - brand new nuclear programme within 20 years
China has committed itself to establishing an entirely new nuclear energy programme using thorium as a fuel, within 20 years. The LFTR (Liquid Fluoride Thorium Reactor) is a 4G reactor that uses liquid salt as both fuel and coolant. China uses the more general term TMSR (Thorium Molten-Salt Reactor).
The thorium fuel cycles produce almost no plutonium, and fewer higher-isotope nasties, the long-lived minor actinides. Thorium is much more abundant than uranium, and the reduced plutonium output eases proliferation concerns. The energy output per tonne is also attractive, even though thorium isn't itself a fissile material.
Thorium reactors are also safer, with the fuel contained in a low-pressure reactor vessel, which means smaller (sub-500MWe) reactors may be worth building. The first Molten-Salt Breeder prototype was built at Oak Ridge in 1950, with an operational reactor running from 1965 to 1969. Six heavy-water thorium reactors are planned in India, which has the world's largest thorium deposits.
The design has also had its champions in Europe, but planning restrictions and a continent-wide policy obsession with conservation and renewables have seen little commercial action. But that might change.
A private company founded by Kazuo Furukawa, designer of the Fuju reactor, called International Thorium Energy & Molen-Salt Technology Inc aims to produce a small (10KW) reactor within five years. Furukawa is aiming for a retail price of 11 US cents per kWh (6.8p per kWh).
Just to put that into perspective, the UK's feed-in tariff ranges from 34.5p/kWh for a small wind turbine to 41.3p/kWh for a retro-fitted solar installation, making a personal LFTR much more attractive than an additional garage. Just tell them you've got an enormous solar panel.
There's a good 15-minute introduction to LFTR, here. WARNING: contains technical terms and scientific concepts. Renewable energy supporters may wish to meditate before and after viewing. 1.2.11
No way to dispense public money
The NTA's poor and unfair practices mean it cannot be trusted. This £19million+ a year public-health authority should be wound down now, not in two years' time.
It is bad enough when we find that huge sums of public money have been wasted, as in the case of the NTA's management of the last government's damaging mass methadone prescribing exercise. (The latest UK drug death figures published this week revealed that drug deaths involving methadone rose by another 8% this year and that methadone is now the second highest cause of drugs deaths after heroin and morphine). It is outrageous when we find basic standards of procedure over allocation of capital sums have been ignored.
This appears to be the case with a particularly shoddy process the National Treatment Agency has just overseen. On July 22nd, Drug Action Teams were sent an invitation to bid for £8million of capital – a potential lifeline for rehabilitation centres which have been disinvested in, to the point of closure, over the last 12 years. These are the centres on which the success of government's new treatment approach will largely depend. But here comes the catch...
They were given less than a week to submit their bids for money on which their survival might depend. In some cases, DATs did not even invite providers to take part in the bidding. The closing date for bids was July 29th so any bids had to be drafted - and the support of one or more statutory bodies to the DAT partnership secured - between July 22nd and July 29th (which included a weekend and was the start of the school summer holiday).
On the basis of the NTA's past performance, services guiding addicts to drug-free lives would be forgiven for believing that being an abstinence service had a lot to do with their rejection.
For the NTA's past form on capital allocations does not give comfort. Last time round in the bidding for a capital pot of £54million, the majority of small abstinence rehabilitation providers did not even get a look in, regardless of their track records of getting at least 65% of their clientele totally drug free, into education and training and on the way to employment. For details of how deeply unsatisfactory this past process was, see Addiction Today' s report at the time.
It is not clear why the Department of Health decided to give this deeply unsatisfactory body a two-year life extension, especially given the Public Accounts Committee's recent devastating critique. Ministers may come to rue this decision.
The decision has left the NTA operating as usual, with control over spending by Drugs Action Teams and Primary Care Trusts. For both are still required to submit their drugs treatment budget/spending and care plans for approval to the NTA in January 2011. These plans are due to be passed in March, yes by the NTA, for the year to come. This will most likely block any real change till the end of 2012. By then, as one concerned colleague commented to me last week, “no doubt the NTA hierarchy will have embedded themselves in the DH and still be able to destroy and wreck lives by putting whatever spanners in the works of treatment reform they disagree with.” Kathy Gyngell Chair - Prisons and Addictions Forum Centre for Policy Studies 27.8.10
In B&Q they cost 20p. So why does the NHS spend £99 for a screw to put in your hip?
Every year, the NHS spends £500 million on orthopaedic equipment, but according to one insider they are being completely ripped off. In a damning expose, a medical sales rep, under the cover of anonymity, talks to VICTORIA LAMB ERT about the used-car-sales tactics of companies which make millions from the NHS.
The NHS needs to save £20 billion in the next four years, according to the British Medical Association — yet in all the debate over which operations are at risk and whether we can afford new cancer drugs such as Avastin, there is one solution which could save the health service millions of pounds without costing a job or delaying treatment.
What could be so simple that politicians, doctors, managers and the public haven't already considered it? Well, just this: the NHS needs to learn smarter shopping. At the moment, most health trusts squander a fortune paying deliberately over-inflated prices for surgical supplies, each trust spending between £3million and £4million a year on orthopaedic supplies alone — money that could be saved overnight if managers just got together and agreed to flex their vast purchasing power and demand lower prices from the companies which produce the goods they need, or by being more rigorous in their decisions over which product to buy.
Unfortunately, most don't seem even to realise the situation exists, let alone how to change it.
How do I know this financial black hole exists? I'm on the other side: an anonymous sales rep for one of the orthopaedic supplies companies which currently make millions each year from the NHS.
How overpriced are the supplies we sell? Well think of the small surgical screws that get used in lots of orthopaedic work, such as attaching a metal plate to a fractured bone. We sell screws that are barely any different from the ones you see in B&Q, priced five for £1. Yet ours cost between £30 and £40 — each. And while they cost us, at most, £10 to make, we justify the mark-up because they are slightly finer. Oh, and sterile.
The cost of our screws can actually go up to £99 each for the basic ones. A screw with a hole down the middle for inserting a wire is a staggering £148.
So how do we get away with selling such expensive products? We use standard sales techniques — the same type that have been practised by double-glazing men and people who go door-to-door selling conservatories.
Although some staff have a medical background, such as a science degree or experience nursing, these days your ability to sell is more important than your special education, so fewer come from that profession. These days they are more likely to come from car sales, and after a few weeks' training are as easy with medical patter as formerly they were with torque and braking.
To begin with, we make friends with the staff. There is a compliance act which officially prevents surgeons accepting gifts in return for using a particular brand. But we build up great relationships with doctors, inviting them to conferences all over Europe , where they stay in top hotels and are wined and dined.
Sometimes we offer them specialised advanced training courses in countries across the world. They are the sort of opportunities doctors don't want to miss, as the NHS can't afford to offer extra training.
But the closeness of our relationships doesn't end there.
How shocked would you be if I told you that in many operating theatres, standing next to the surgeon — wearing his own scrubs and clogs — is a sales rep? He or she is not wielding the scalpel, but they are leaning in and offering advice.
Say, it's your elderly mother having hip replacement surgery. Did you ever consider that her highly trained consultant would be taking advice about just how many millimetres of bone to shave off the femur joint from a guy who six months ago was flogging BMWs or conservatories?
Some senior surgeons are often so unfamiliar with the instrumentation they are using that they will cancel the operation if the rep cannot attend, sometimes on the day of the procedure.
How do I know all this? Because I've been that sales rep. I've popped into hospitals (like most of my colleagues) where I am well known and signed in with the receptionist (often no need for special permission), before nipping into the scrubs room and getting into my ‘blues' so that I can join the theatre staff. It's such common practice that no one even questions why I'm there.
I'm no would-be doctor, and I'm not going to take over the op from the surgeon. Your mother is in no danger from me; I'm hygienic and careful not to get in the way.
But going into theatre is one of our favourite techniques to persuade healthcare professionals that our products are the best. Once there, we can subtly discuss how our product beats the competition and why this or that design is so superior in its results. Practical demonstration and the personal touch beats a leaflet any day. And the doctors don't mind —they seem to enjoy our company.
In fact, going into theatre is one of our favourite techniques to persuade and influence healthcare professionals that our products are the best. We want the doctors then to request our screws or hip joints from the purchasing department, which they usually do. Of course, the managers should then look at the cost of our product and its results compared to its rivals and make an informed choice. But often they are in thrall to the consultants who have years of training and experience, while they, the managers, may have worked in hospital procurement for only a year or two. There is an imbalance of power. No contest.
And once we've made the sale, we get a signature on 12-month or two-year contracts for our products, and everyone — except the NHS accountant and the taxpayer — is happy.
Ironically, Bupa and other private healthcare providers get their products cheaper because they have central procurement departments, and cheaper products mean better profit margins per procedure for them.
Should we reps feel guilty? Actually, our profession is not evil. But the pressures on us to succeed are huge, as are the rewards when we do.
I've lost count of the exotic locations my company has held conferences where the top salesmen can expect to be singled out for high praise and win fabulous family holidays — from Caribbean cruises to luxury city breaks and glamorous spas. Do well and you'll get a fabulous car; executive cars are an industry standard.
And then there is the bonus. Commission is typically 5 per cent on target sales. So the top earners, who are shifting in excess of £2 million worth of goods to the two or three hospitals they service, can receive staggering £100,000 annual bonus cheques. (Reps do not cover larger areas because the smaller the number of hospitals they service, the more intensive and intimate their relationships with the surgeons.)
So why would I want to blow the whistle on the practices my profession follows? I'm writing this anonymously, so it is not like I want to leave my job. And I'm good at it. I may not be in the £100,000 club, but I am well rewarded. I even like my boss.
But a few weeks ago, I was browsing a website which held suggestions for cost-cutting in the NHS, and it really came home to me how my industry had lost touch with the rest of the UK. I had already begun to feel sickened by the bonus culture, watching my fellow reps being encouraged to make more and more over-priced sales at a time when we should all be economising — so ordinary patients can get their hands on that Avastin if they need it.
I'm not saying I have a problem with anyone making a good living or companies making a fair profit. This is commerce and I'm not naïve. But it hit me that my industry needs to clean up its act. While the rest of the country tightens its belt, it is unreasonable for it to be business as usual in medical supplies.
So, what should be done? The NHS needs to examine its purchasing chain and realise its huge bargaining power.
Individual hospitals don't have the leverage to bargain us down — we don't need one hospital's order; we'd stop supplying them if they started to negotiate — but ten hospitals, a region, a whole country? We couldn't afford to walk away from those orders.
Scottish NHS teams are already beginning to adopt this strategy. But in England and Wales there is no appetite to truly centralise the process. They have to learn to purchase more intelligently.
We talk of partnerships in our sales literature, but it is meaningless. Some medical suppliers have long seen the NHS as a cash cow. We need to reconsider our attitudes — and the health service needs to refuse to be milked. 3.9.10
Swine flu vaccine safety probed over link to rare sleep disorder
The safety of a swine flu vaccine is to be investigated by European drugs regulators after it was linked to a rare condition that causes people to fall asleep suddenly. The investigation has been prompted after health officials in Finland announced they were suspending the vaccination programme there following reports of narcolepsy in people who had received the jab.
So far there have been 27 reports of suspected narcolepsy in people across Europe who had previously been vaccinated with Pandemrix, the H1N1 swine flu vaccine made by GlaxoSmithKline. No cases have been reported in Britain .
In total more than 30m people in the European Union have been vaccinated with Pandemrix.
Narcolepsy is a rare condition and its causes are unknown. It can be dangerous if sufferers fall asleep while driving or operating machinery. It is thought there are 25,000 people with the condition in Britain but experts have estimated that 80 per cent of sufferers have not been diagnosed.
Once diagnosed with the condition, which is long-term and has no cure, people are not allowed to drive. The investigation will examine if Pandemrix was the likely trigger for the condition or whether it was a coincidence.
Finland suspended its national vaccination programme on Tuesday after eight suspected cases of narcolepsy following administration of the jab. A further ten cases have been reported in Sweden , six in France , and one each in Germany and Norway.
The European Medicines Agency will now investigate if there is any link, including how many people would normally be expected to suffer narcolepsy so this 'background rate' can be compared to with the number of cases observed after vaccination.
The Agency is also liaising with the European Centre for Disease Prevention and Control, other drugs regulators and the World Health Organisation.
A spokesman for GlaxoSmithKline said: "Information surrounding the reported cases remains limited at the current time. GSK is conducting its own investigation in an effort to gather as much additional data as possible regarding the observed cases and is working closely with the regulatory authorities, including the European Medicines Agency (EMA)
"Global experience with previous large-scale immunisation programmes has shown that it is likely that a certain level of adverse events will be reported. The adverse events that are reported may be the result of underlying conditions, or new conditions that occur in temporal association with the vaccination, and some events may be related to the vaccine.
"Having reviewed the currently available data and information regarding the reported cases of narcolepsy, which remains limited at this time, as well as GSK's own safety database, the Company has concluded that the currently available information is insufficient to assess the likelihood of a causal relationship between Pandemrix and narcolepsy." 28.8.10
Coalition's £200m cancer drugs pledge is no more than an 'aspiration'
The Cancer Drugs Fund promised by the Government to cover life-extending treatments for thousands of patients is under threat, it has emerged. Ministers had pledged to set aside £200million a year to pay for any medicine recommended by a doctor or specialist - even if it had been banned by NICE, the NHS rationing body.
But the Department of Health now admits the figure is only 'aspirational', prompting one leading charity to write to Chancellor George Osborne to beg him to stick to the pledge. Campaigners fear the fund will be slashed, leaving thousands of cancer sufferers to die early.
There are also concerns that the pot will be wiped out by demand for Avastin, the 'miracle' bowel cancer drug deemed too expensive for the NHS by the National Institute for health and Clinical Excellence. NICE provoked outrage earlier this week when it ruled Avastin was not 'cost effective', despite doctors' advice that it could enable patients to live for several years.
The drug could be used to help around 6,500 with advanced bowel cancer every year, at a cost of £20,800 per patient. But if the drugs fund were to cover this cost, it would use up £135million, leaving just £65million for other cancer victims, if the original pledge is honoured. But even that is in doubt, with fears growing that the £200million figure will be slashed as part of the Comprehensive Spending Review announced by the Chancellor on October 20.
So far ministers have only confirmed £50million of 'interim funding', which will be available from the six months between October and April 2011.
This will be reviewed, but if it is not increased for the following six months, it will add up to £100million a year - half the original pledge.
Earlier this month, junior health minister Earl Howe admitted that £200million was an 'aspirational figure', a position that has been confirmed by the Department of Health.
This contradicts the promise made by David Cameron a few days before he became Prime Minister when he said he would 'create a £200million Cancer Drugs Fund, and reform the way the NHS buys drugs, so that every patient has access to the treatments they need'. Campaigners last night accused ministers of 'backtracking'. The Rarer Cancer Foundation said that by halving the cancer fund to £100million a year, up to 3,600 patients will be denied life-prolonging treatment.
The charity's chief executive Andrew Wilson has written to Mr Osborne urging him not to slash the amount. Last night Mr Wilson said: 'The Prime Minister made the £200million Cancer Drugs Fund a centrepiece of his health policy, but it appears as though the Government is backtracking on this commitment. 'Our figures show that, without the £200million of funding, thousands of cancer patients will be denied the treatment their clinicians feel they need. We are calling on the PM and the Chancellor to urgently clarify the funding that will be available.'
Ian Beaumont, of Bowel Cancer UK , said: 'We would be very disappointed if the figures were reduced. We accept this is a financially difficult period but cancer patients should be prioritised. They have certainly not been prioritised in the past.'
Ministers claim the fund will be paid for by a reduction in the planned rise in National Insurance, which they estimate will save the NHS around £200million a year in staff costs. A Department of Health spokesman said the amount set aside for the drugs fund would be 'scrutinised' along with other public spending.
He added: 'Thousands of cancer patients will benefit from the £50million of funding we have already announced for this year, but we recognise that there is more to do. 'We will work with the NHS, clinicians, patient groups and manufacturers in the design of the full Cancer Drugs Fund to operate from April 2011, to ensure we achieve the maximum possible benefits for patients.
'To ensure that effective drugs for all conditions are affordable, the Government will introduce a new, more cost-effective, system of paying drugs companies according to the value of new medicines, from the end of 2013 when the current pricing scheme expires.'
Shadow health secretary and Labour leadership candidate Andy Burnham said: 'Yet another Tory manifesto commitment on the NHS turns out to be completely worthless. 'Ripping up their promise to stop top-down reorganisations is already set to cost the NHS billions - it's no surprise that they can no longer afford their expensive pledge.'
Supports of the proposed plan said 'the drug companies should make these drug cheaper'. 26.8.10
Number of NHS complaints soars to record high of 100,000 in a single year
The number of complaints about NHS hospitals and community health services in England is at a record high, figures showed today. The sector has also seen the biggest annual rise in complaints since records began 12 years ago, according to data from the NHS Information Centre.
Between 2008/09 and 2009/10, the number of written complaints rose from 89,139 to 101,077 - a 13.4 per cent rise and the biggest year-on-year increase since 1997/98. Previously, the biggest yearly rise was 10.6 per cent between 1999/2000 and 2000/01.
The head of The Patients Association said the figures were 'worrying' and reflected the 'appalling stories of neglect and misdiagnosis' they regularly received.
Today's report showed that last year nearly half the complaints (44.2 per cent) related to the medical profession. The second highest proportion related to nurses, midwives and health visitors at 22 per cent. NHS trust administrative staff accounted for nine per cent.
When broken down by topic, the biggest percentage of complaints (42 per cent) related to 'all aspects of clinical treatment.' This was followed by staff attitude at 12 per cent and delays or cancellations to outpatient appointments at 10.6 per cent. All NHS trusts and community services are required to supply data for the report but it is not compulsory for foundation trusts to do so.
There are 130 foundation trusts, of which 18 did not supply any data for the study. Separate figures showed a 4.4 per cent rise in annual complaints about GP services and dentistry, reaching 50,755 in 2009/10.
Katherine Murphy, Chief Executive at The Patients Association told the Mail Online: 'The rise in complaints is very worrying and is reflected in an increase in the number of people contacting our helpline to tell us of problems they are having with NHS services. 'On our Helpline we hear absolutely appalling stories of neglect, misdiagnosis and a distinct lack of care and compassion. We know many people receive good care but that doesn't excuse the poor care received by others.
'Keep in mind many people want to complain but don't and these figures will certainly massively underestimate the number of people that actually want to complain. The rise might actually reflect greater awareness of the complaints process.' She added: 'It is absolutely outrageous that 18 Foundation Trusts did not participate in the report. The local communities of those Trusts deserve to know how their services compare and at a time when the new Health Secretary is urging the NHS to become more open and transparent it is completely unacceptable for these 18 Trusts to be acting in a way completely contrary to that ethos. They should be forced to share their data.'
NHS Information Centre chief executive Tim Straughan said: 'This report shows the biggest annual rise in written complaints about NHS hospitals and community services for 12 years. 'However, it is important to bear in mind that there has been a substantial increase in NHS activity in England over time.
'For example, information from two of our other data collections show that hospital admissions increased by 28 per cent between 1998/99 and 2008/09, while GP consultations increased by an estimated 44 per cent between 1998 and 2008.' 25.8.10
Aspirin during pregnancy could prevent pre-eclampsia in thousands of women, says NHS
Taking aspirin in pregnancy could save thousands of women from developing a condition that can threaten the lives of both mother and baby, say new NHS guidelines. The painkiller cuts the risk of pre-eclampsia which raises blood pressure, leading to strokes and even death.
It is more common in first-time pregnancies and can lead to premature birth, stillbirth and babies being born smaller than average. As many as one in 20 first-time mothers develops pre-eclampsia, while around 20 women die each year from conditions linked to high blood pressure.
It is thought to claim the lives of 600 babies a year. The only treatment is to deliver the baby early with an emergency Caesarean.
Guidance from the National Institute for Health and Clinical Excellence recommends women with high blood pressure at moderate to high risk of pre-eclampsia take a low dose (75mg) of aspirin. This should be taken every day from the 12th week of pregnancy, according to the guidelines for the NHS in England and Wales .
It is not routinely prescribed to pregnant women at risk and NICE hopes the advice will ensure consistent standards. But experts warn that women should not self-medicate because there may be risks if they are asthmatic or have stomach problems.25.8.10
NHS Trust spent £270,000 covering surgeon who was suspended on full pay
A hospital trust spent £270,000 employing a locum after a breast cancer surgeon was suspended for botching operations. Puvaneswary Markandoo was suspended on full pay for more than two years after 35 women came forward to complain about problems after their breast surgery.
The General Medical Council eventually ruled she could work in the NHS only under supervision.
It cost Barnsley Hospital NHS Foundation Trust £270,000 for a stand-in surgeon while the doctor was suspended on full pay of £122,000 a year from July 2006 to October 2008 until she left the trust, it emerged in figures just released. The total compensation bill for 27 female patients has topped £1million and two cases are still to be settled.
They all had reconstructive operations carried out by Miss Markandoo after receiving treatment for breast cancer at Barnsley Hospital.
A spokesman for campaign group Patient Concern said: 'It is a disgrace that someone can injure numbers of patients then sit at home for two years on an enormous salary meanwhile costing the NHS large amounts in compensation then get a slap on the wrist from the GMC and be allowed to go back to work.
'We have to wonder just who is protecting patients.'
In 2008 the GMC found the doctor to be deficient in 11 areas including basic and specialist surgery, arranging treatment, referring patients, relationships with colleagues and working within laws and regulations. Her case was never referred to a fitness to practise panel as the working conditions she was given were deemed sufficient.
Barnsley Council Tory councillor Paul Hart-Davis said the Government needed to closely monitor money spent by the NHS. He said: 'We have to look at NHS spending more closely and be aware of any mismanagement.' 24.8.10
Peony could ease side-effects for patients enduring chemotherapy
It is already a perennial favourite of gardeners the country over. But the peony may soon be giving fresh hope to cancer patients. Its beautiful blossoms could help ease the distressing side-effects of chemotherapy, such as nausea, vomiting, diarrhoea, stomach cramps and weight loss.
Given in combination with three other plants, it also cuts tumour growth, research from the Yale University School of Medicine in the U.S. suggests. Chemotherapy works by killing cells that are rapidly growing and dividing - a hallmark of cancers.
But fast-growing cells in other parts of the body are also attacked, causing unpleasant side-effects that cannot always be controlled. The research centres on a centuries-old Chinese traditional medicine put into drug form. Known as PHY906, the drug is made up of four plants: the peony, liquorice, extracts of date and extracts of the skullcap plant.
When the drug was given to mice being treated for bowel cancer, their tumours shrunk more quickly and they did not lose any weight, the journal Science Translational Medicine reports.
'This combination of chemotherapy and herbs represents a marriage of Western and Eastern approaches to the treatment of cancer,' said researcher Dr Yung-Chi Cheng.
He added that use of the drug in cancer patients is still preliminary and people should not try to source their own online. 20.8.10
Drugs don't work: Top professor claims five in six new medicines have 'little benefit' to patients
Drug companies have been accused of conning the public by hyping up patented medicines with little new to offer while downplaying their potentially harmful side-effects.
A new study estimates that 85 per cent of new drugs offer few if any new benefits while having the potential to cause serious harm due to toxicity or misuse.
The author of the research delivered a damning attack on 'Big Pharma' at a meeting of sociology experts in the US.
Professor Donald Light described the pharmaceutical industry as a 'market for lemons' - one in which the seller knows much more than the buyer about the product, and takes advantage of this fact.
'Sometimes drug companies hide or downplay information about serious side-effects of new drugs and overstate the drugs' benefits,' said Prof Light, a professor of comparative health policy at the University of Medicine and Dentistry in New Jersey, US. 'Then, they spend two to three times more on marketing than on research to persuade doctors to prescribe these new drugs'.
'Doctors may get misleading information and then misinform patients about the risks of a new drug. It's really a two-tier market for lemons.'
He alleged that the pharmaceutical industry owned companies in charge of drug testing and provided 'firewalls' of legal protection behind which information about dangers or lack of effectiveness could be be hidden.
Companies were assisted by the 'relatively low bar' for effectiveness that had to be crossed to get a new drug approved, he claimed.
Prof Light presented his paper, entitled 'Pharmaceuticals: A Two-Tier Market for Producing 'Lemons' and Serious Harm' at the American Sociological Association's annual meeting in Atlanta, Georgia. 18.8.10
India rejects UK scientists' 'superbug' claim
India has rejected a claim by British scientists that a new superbug, resistant to even the most powerful antibiotics, has entered UK from India.
The health ministry said it was unfair to link the bug to India and officials described it as "malicious propaganda". Several Indian MPs raised the issue in parliament, calling it a conspiracy.
Scientists say patients who went to India and Pakistan for treatments such as cosmetic surgery have come back with bacteria that make NDM-1 enzyme. Health experts say NDM-1 can exist inside different bacteria, like E.coli, and it makes them resistant to most antibiotics. About 50 cases have been identified in the UK so far, but scientists said it could spread globally, medical publication Lancet Infectious Diseases said.
The Indian health ministry has described the report as "sensational".
An official told the BBC it was "unfair" to link the bug to India and create a scare. The "plasmid", associated with drug resistance to antibiotics, is present "in the environment, may be in the intestines of humans and animals universally", the health ministry said in a press release.
Officials said a person could become infected with the drug-resistant bacteria anywhere in the world and it was "preventable by sound infection-prevention strategies which are followed in any good hospital".
"We strongly refute the naming of this enzyme as New Delhi metallo beta lactamase," the ministry said.
"We also refute that hospitals in India are not safe for treatment, including medical tourism," it added.
The issue was also raised in India 's parliament, with angry MPs questioning the Lancet study, saying it was funded by pharmaceutical multi-national companies. "When India is emerging as a medical tourism destination, this type of news is unfortunate and may be a sinister design of multi-national companies," MP SS Ahluwalia of the opposition Bharatiya Janata Party said.
Congress party's Jayanthi Natarajan said the report of the superbug was a "wrong propaganda against the country". Indian medical tourism industry is growing rapidly and is estimated to be worth hundreds of millions of dollars.
Critic have said 'the story is another swine flu scandal, using government scientists to whip up a frenzy to sell more pharmaceutical products'. 13.8.10
Swine flu advisers' ties to drug firms: Five WHO experts linked with vaccine producers
A third of the experts advising the World Health Organisation about the swine flu pandemic had ties to drugs firms, it has emerged. Five of the 15 specialists who sat on the emergency committee had received funding from pharmaceutical giants, or were linked to them through their research.
The revelation will prompt speculation that the 'pandemic' was wildly overestimated and largely fuelled by the drugs industry who stood to benefit from the panic. Last month it emerged that the Government had squandered more than £1.2 billion tackling swine flu - most of it going towards vaccines following experts' dire predictions that as many as 65,000 Britons would die.
In fact the virus claimed just 457 lives - a third of those killed every year by ordinary seasonal flu.
But today it emerged that many of the scientists on the WHO's emergency panel had links with firms including GlaxoSmithKline, who made millions manufacturing swine flu vaccines. It follows revelations by the Daily Mail earlier this year that more than half of the scientists advising the British Government's own taskforce on the pandemic had links to drugs giants.
One of the 15 scientists advising the WHO was British professor Neil Ferguson - who last year warned the pandemic would be so bad all schools would need to close. It has since emerged that Professor Ferguson had acted as a consultant for Roche, who makes Tamiflu, as well as GSK Biologicals until 2007.
Professor Maria Zambon, who was also on the panel, from UK Health Protection Agency's Centre for Infection, said she received funding from several vaccine makers, including Sanofi, Novartis, CSL, Baxter and GSK. During the outbreak last year Professor Zambon warned that up to a third of school children in Britain had the virus without knowing as they did not have symptoms.
Meanwhile US professor Arnold Monto admitted he had done research for GlaxoSmithKline, Baxter, the two firms contracted to make the jabs, as well as Roche, which makes Tamiflu. He had also done work for two other large firms Novartis and Sanofi Pasteur.
Critics warned that there was serious conflict of interest amongst these experts whose advice had led to the waste of vast sums of taxpayer's money. Labour MP Paul Flynn said: 'A year ago, these experts told us the world was facing a grave health emergency.
'On this occasion, regrettably, they got it wrong: their advice led WHO, the EU and national governments to vastly overrate the seriousness of the H1N1 epidemic, wasting large sums of public money and scaring the world unnecessarily. 'With such conflicting pressures, we need to be absolutely certain that the advice of such experts is based on solid scientific evidence and is driven solely by the need to protect public health. The only way to do that is through total transparency.
'When a future pandemic is declared, the public has a right to know, from the outset, who is recommending such a drastic step – as well as any links they may have to the pharmaceutical industry, which stands to profit from such a recommendation.'
Another expert Nancy Cox, from the US Centers for Disease Control, admitted she had received funding from the drugs industry group, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) for flu vaccine research and work on viruses.
British scientist John Wood admitted that his research unit at Britain 's National Institute for Biological Standards and Control (NIBSC), had undertaken work for Sanofi Pasteur, CSL, IFPMA, Novartis and Powdermed on influenza vaccine. The panel were instrumental in advising the WHO to officially declare swine flu as the first pandemic in 40 years last June.
Earlier this year it emerged that 11 of the 20 members of the Scientific Advisory Group for Emergencies, which advised the British Government on swine flu, had done work for the pharmaceutical industry or were linked to it through their universities.
A spokesman for the WHO denied that the experts' work gave rise to a conflict of interest but critics have said 'this is not realistic and shows that even though a conflict of interests clearly exist, they chose to ignore it'. 13.8.10
Doctors want statins served with fast food
Fast-Food outlets should dish out cholesterol pills with their high-calorie meals, researchers claimed yesterday. They want customers to be given ‘McStatins' to offset the harm that fatty foods do to the heart. The apparently serious suggestion comes from British doctors who believe fast-food junkies need to be saved from themselves.
A single statin pill could offset the increased risk to the heart caused by the fat in a 7oz cheeseburger and milkshake, they said. The cost of the cholesterol-lowering medication would be less than 5p per customer – roughly the price of a sachet of ketchup.
Although statins have side effects, which can be serious including: muscle pain and damage, gastro-intestinal problems, headaches, joint pains and peripheral neuropathy (nerve damage and loss of feeling in the hands and feet), memory loss, depression, sleep disturbance, sexual dysfunction and a rare lung diseasel, the Imperial College London researchers believe the benefits are worth it.
But Dr Malcolm Kendrick – GP and author of The Great Cholesterol Con says, 'these drugs not only cause terrible side effects such as muscle problems, hair loss, depression and impotence, they will actually have no impact on whether you succumb to heart disease'.
Darrel Francis and colleagues at ICL claim that most types of statin would be able to counteract the increased risk caused by eating an extra 36g of total fat or 2.8g of trans fats a day – the equivalent to a quarter pounder with cheese and a small milkshake. Those eating an unhealthy meal only once a year – and one pill – would see minimal benefit, they conceded in a report in the American Journal of Cardiology.
But those who ate fast food all the time would ‘neutralise' the extra risk with the statins. Even taking the drugs now and again cuts the risk of dying from heart disease, says Dr Francis. ‘Statins don't cut out all of the unhealthy effects of burgers and fries – it's better to avoid fatty food altogether,' he added.
‘But we've worked out that in terms of your likelihood of having a heart attack, taking a statin can reduce your risk to more or less the same degree as a fast food meal increases it.' One generic statin, simvastatin, is available at a low 10mg dose over the counter without a prescription and millions of patients are prescribed them to cut the risk of heart attacks and strokes.
Dr Francis said: ‘It's ironic that people are free to take as many unhealthy condiments in fast-food outlets as they like, but statins, which are beneficial to heart health, have to be prescribed.
‘Everybody knows that fast food is bad for you, but people continue to eat it because it tastes good. ‘We're genetically programmed to prefer high-calorie foods and, sadly, fast-food chains will continue to sell unhealthy foods because it earns them a living. ‘It makes sense to make risk-reducing supplements available just as easily as the unhealthy condiments that are provided free of charge.
‘When people engage in risky behaviours like driving or smoking, they're encouraged to take measures that minimise their risk, like wearing a seatbelt or choosing cigarettes with filters. ‘Taking a statin is a rational way of lowering some of the risks of a fatty meal.'
However, statins interact with some other drugs and have side effects, including abdominal pain, diarrhoea and nausea, with serious muscle weakness. Some studies show other problems, for example a higher risk of diabetes, which has led doctors to reconsider the idea that healthy people would be better off taking statins.
Professor Peter Weissberg, medical director of the British Heart Foundation, said: ‘The suggestion that the harmful effects of a junk food meal might be erased by taking a cholesterol-lowering statin tablet should not be taken literally. ‘A junk food diet has a wealth of unhealthy consequences beyond raising cholesterol. ‘It can cause high blood pressure through too much salt, or obesity through eating meals loaded with calories. ‘These are all risk factors for life-threatening health problems such as heart disease, Type 2 diabetes and stroke. ‘Statins are a vital medicine for some people with – or at high risk of developing – heart disease. They are not a magic bullet.'
Mike Knapton, associate medical director of the British Heart Foundation, also rejected the suggestion. "Risk reduction has a place in tobacco addiction. But the risk of eating burgers goes beyond the cholesterol raising effects. It can cause high blood pressure through too much salt, or obesity through eating meals loaded with calories. Adding a statin could do more harm than good by increasing consumption."
Critics have said the advice is 'irresponsible'. 13.8.10
Deadly toll of NHS painkiller blunders as hospitals make 1,300 errors
Three patients have died in the past year because of errors involving the administering of strong painkillers by NHS staff. A further two were seriously harmed in 1,300 recorded mistakes by medical workers. A Freedom of Information Act request showed that almost one in five dosage errors involved morphine, diamorphine and similar opiate medicines.
The revelation comes a year after pensioner David Gray, 70, died at his Cambridgeshire home when he was injected with a ten-fold overdose of diamorphine by Daniel Ubani, a locum GP who had flown in from Germany that day.
An official report into the death last month revealed that two GPs who had been hired with Ubani by Take Care Now – a now-defunct company that was then providing some out of hours services for the NHS – had been involved in non-fatal diamorphine overdoses the year before.
One of David Gray's sons, Rory, called the figures highlighting medical staff errors as ‘unbelievable.' He told The Guardian: ‘Taken at face value [they] suggest nothing has been made safer with regards to opiate medicine. ‘Whilst there is no accountability then it seems there will continue to be no effective measures put in place to stop these unnecessary and avoidable deaths.'
The charity Action against Medical Accidents said the statistics were shocking and ‘confirm our worst fears about not implementing patient safety alerts'. The organisation has also accused hospitals and other care providers of killing and injuring patients by not complying with official directives from the National Patient Safety Agency intended to protect patients.
Both the NPSA, established in 2003 to help the NHS learn from its mistakes, and the Care Quality Commission, the Health Service regulator, insisted the number of mistakes was getting lower. But it is not clear how many dosage mistakes have been made as notifying the two bodes over drug and other errors that resulted in death or severe harm only became mandatory from April 1 this year.
The NPSA received a total of 4,223 cases involving opiate drugs between November 2004 and June 2008. Of these, 3,338 were recorded as causing no harm, 629 low harm, 242 moderate harm and four severe harm. Five patients died.
There was insufficient data on five other cases of dosage mistakes with patients. Figures from May 2009 to April this year show 1,329 cases, 1,078 said to have resulted in no harm, 179 low harm, 67 moderate, and two severe. Three patients died. Linda Hutchinson, CQC director, said: ‘Unfortunately we will never be able to eliminate human error from healthcare, but the risks can be minimised.
‘That is why it is so important that NHS trusts and other health providers report incidents, thoroughly investigate them and make changes to stop the same mistakes happening again. ‘They should also implement changes as a result of safety alerts. Had Take Care Now done this, it is possible that Mr Gray would still be alive today.' 13.8.10
The European Medicines Agency forced to reveal secret data on drug side-effects
The European Medicines Agency (EMA) has reversed its long-held stance on releasing studies on drug side effects after pressure from the European Ombudsman.
A spokesman for the European Medicines Agency (EMEA) said the move would improve transparency and accountability. Some experts believe it will also make it easier for consumers to sue pharmaceutical companies for adverse drug reactions (ADR's). One expert said, 'patients should have easy access to drug side-effects and know the risks of the medications they are taking, which can be very serious, these risks are often played down or just ignored by the medical profession'.
Information on the side effects of Accutane, Roche's acne drug, will be published "within the next few weeks", the agency said, following complaints from an Irish woman whose son committed suicide while on the medication and is currently suing Roche over the drug, Accutane which has had a controversial history since being launched in 1982. While good at clearing acne, the drug has been linked to birth defects and other psychological problems.
The EMEA had argued that concerns over patient confidentiality meant it did not have to obey EU disclosure rules but the 2001 EU transparency law did not apply to "adverse reaction reports."
In April this year, the European Ombudsman, Nikiforos Diamandouros, warned the agency that it was not adhering to EU regulations and "must react to requests for access to documents."
The agency has since decided to put out side-effect reports once personal data has been removed and will do so voluntarily without the need for citizens to make requests. The new system ensures personal data is deleted before reports are published.
Roche, which has always rejected such claims, stopped selling the drug last year, blaming generic competition. Drug companies will be watching the development closely as it potentially could make it much easier for citizens to launch lawsuits against them. 12.8.10
Aspirin 'cuts prostate cancer risk by 30%': A tablet a day helps stop killer tumours forming
Men who take a low dose of aspirin every day could cut their risk of developing prostate cancer by almost 30 per cent, research shows. A 75mg tablet taken on a daily basis has a powerful protective effect against the disease, according to scientists. The painkiller appears to work by blocking the effect of enzymes which cause inf lammation thought to be a key factor in the development of prostate cancer.
The study, by specialists at the Fred Hutchinson Cancer Research Centre in Seattle, is the latest in long line of investigations into whether aspirin can help prevent prostate tumours from forming. It examined and compared two groups of men – 1,001 prostate cancer sufferers and 942 cancerfree volunteers of a similar age.
When the experts looked at how often men in both groups took aspirin, they found higher usage among the cancer-free volunteers.
Men who had used aspirin at any point in the previous 12 months were 21 per cent less likely to develop a tumour. Those who had taken aspirin frequently for five years or more saw a 24 per cent decline in risk. But the biggest benef its appeared to be among those regularly taking a low daily dose of 75mg.
Among this group, the chances of developing prostate cancer dropped by 29 per cent. Other pain-killing medications similar to aspirin, which are known as non- steroidal antiinflammatory drugs, did not have the same effect.
Prostate cancer kills 10,000 men each year in the UK – the equivalent of more than one an hour. Nearly 32,000 cases a year are diagnosed. The risks increase with age, with men aged over 50 more likely to develop a prostate tumour, and there is also a strong genetic link.
The results of previous studies on aspirin and the disease have been mixed. Some have found that the drug can reduce risk, others that it has no effect at all, while other studies suggest it could even increase the risk. Reporting on the latest study in the American Journal of Epidemiology, the Seattle researchers said that aspirin appears to dampen the effects of two particular enzymes that stimulate inflammation in the prostate.
They wrote: ‘The anti-cancer effects are thought to occur primarily-through the direct inhibition-of enzymes called PTGS1 and PTGS2.' They added: ‘Aspirin is a widely used and inexpensive medication. The potential public health implications of an effective preventive agent for prostate cancer are considerable.'
Their findings are likely to be controversial because of ongoing concerns that frequent aspirin use can increase risk of life- threatening stomach bleeding. Although doctors often recommend a low daily dose to heart disease patients to help thin the blood and reduce the risk of clots, some studies suggest that even taking small amounts can increase the chances of stomach bleeding.
Regular use of aspirin has already been linked to a lower risk of other types of cancers. A 2007 study at the Mayo Clinic in Minnesota found that, as well as prostate cancer, the risk of developing breast, ovarian and lung cancer was slashed by taking aspirin several times a week.
A common skin cancer was 90 per cent less likely among regular aspirin users, it found. 12.8.10
Study debunks myth about delaying pregnancy after miscarriage
A miscarriage should not deter you from planning your next pregnancy immedietely. In fact, a study has now confirmed that women who conceive within six months of their initial miscarriage have the best chance of a healthy pregnancy with the lowest complication rates.
Researchers from the University of Aberdeen reviewed the data of over 30,000 women, who visited Scottish hospitals between 1981 and 2000, to come to this conclusion. All the participants had a miscarriage in their first pregnancy, and subsequently conceived again.
According to the study, among those who got pregnant within six months of their initial miscarriage, 85% delivered a healthy baby. While, the ones who waited for more than two years to get pregnant again, the rate was 73%.
The results confirmed that those who conceived again within six months were less likely to have another miscarriage, termination of pregnancy or ectopic pregnancy as compared the ones who conceived between six and 12 months after their initial miscarriage.
Besides, the women who conceived within six months were less likely to undergo a Caesarean section, deliver prematurely or have underweight babies. The findings debunk the guidelines issued by the World Health Organization, which recommends women delay getting pregnant for at least six months after a miscarriage.
Miscarriage or spontaneous pregnancy loss before 24 completed weeks of gestation affects one in five pregnancies.
Lead researcher Dr Sohinee Bhattacharya from the University of Aberdeen explained the broad contours of the research. "Our research shows that it is unnecessary for women to delay conception after a miscarriage. The current WHO guidelines may need to be reconsidered. As per our results, women wanting to become pregnant soon after a miscarriage should not be discouraged. There may be cases where a delay is desirable, for example if there are signs of infection."
Dr Sunita Mittal, who heads the gynecology department at AIIMS, told TOI "I agree with of suffering a micarriage once she recovers physically. A woman, who suffers a miscarriage, experiences severe mental strain, and would naturally love to have a proper pregnancy and child birth at the earliest. However, if the would-be mother is very young, we ask her to wait for the second pregnancy as she has a lot of time at hand."
According to Dr Bhattacharya, after a miscarriage, women should also be counselled about how to take care of their own health before and during pregnancy in preparation for subsequent conception.
"The potential negative effects of delaying the next pregnancy for more than 18-24 months should also be discussed with couples, allowing them to make a fully informed decision about future pregnancy," she added.
Gynecologists say women, who have suffered an initial miscarriage, are at a greater risk not only of a second miscarriage but also of complications in subsequent pregnancy. They are more likely to experience threatened miscarriage, pre-term birth, induced labour, and postpartum haemorrhage in the next pregnancy. 5.8.10
Secrets of the GSK drug trials
Secret emails reveal that the UK 's biggest drug company distorted trial results of an anti-depressant, covering up a link with suicide in teenagers.
Panorama reveals that GlaxoSmithKline (GSK) attempted to show that Seroxat worked for depressed children despite failed clinical trials. And that GSK-employed ghostwriters influenced 'independent' academics. GSK told Panorama: "GSK utterly rejects any suggestion that it has improperly withheld drug trial information."
GSK faces action in the US where bereaved families have joined together to sue the company. As a result, GSK has been forced to open its confidential internal archive.
Karen Barth Menzies is a partner in one of the firms representing many of the families. She has examined thousands of the documents which are stored, box upon box, in an apartment in Malibu , California. She said: "Even when they have negative studies that show that this drug Seroxat is going to harm some kids they still spin that study as remarkably effective and safe for children."
GSK's biggest clinical trial of Seroxat on children was held in the US in the 1990s and called Study 329. Child psychiatrist Dr Neal Ryan of the University of Pittsburgh was paid by GSK as a co-author of Study 329. In 2002 he also gave a talk on childhood depression at a medical conference sponsored by GSK.
He said that Seroxat could be a suitable treatment for children and later told Panorama reporter Shelley Jofre that it probably lowered rather than raised suicide rates. In amongst the archive of emails in Malibu, Shelley was surprised to find that her own emails to Dr Ryan from 2002 asking questions about the safety of Seroxat had been forwarded to GSK asking for advice on how to respond to her.
She also found an email from a public relations executive working for GSK which said: "Originally we had planned to do extensive media relations surrounding this study until we actually viewed the results. "Essentially the study did not really show it was effective in treating adolescent depression, which is not something we want to publicise."
But the article was published in the Journal of the American Academy of Child and Adolescent Psychiatry which says it ranks as number one in child mental health in the world.
The editor in chief of the British Medical Journal, Fiona Godlee, said that what she calls the "blind-eye culture of medicine" should be exposed by professionals. She has written in response to the Panorama film: "We shouldn't have to rely on investigative journalists to ask the difficult questions. "Reputations for sale are reputations at risk. We need to make that risk so high it's not worth taking."
The Medicine and Healthcare Products Regulatory Authority (MHRA) began a criminal investigation into GSK three years ago but no action has been taken yet. A spokesperson told Panorama that the investigation has been given substantial additional resources and remains a high priority.
Seroxat was banned for under 18s in 2003 after the MHRA, revealed that GSK's own studies showed the drug actually trebles the risk of suicidal thoughts and behaviour in depressed children. 29.7.09
Drug safety crackdown revs up
FDA's strengthened powers to assess drugs already on the market will soon be put to the test.
It's not easy to quit smoking, but when some people became violent while taking a drug to help them beat their addiction, the US Food and Drug Administration (FDA) took notice. Since its approval in 2006, a popular prescription drug called Chantix (varenicline) has helped smokers curb their cigarette cravings. But the drug has also produced more reports of psychiatric side effects than any other drug on the market, according to the Institute for Safe Medication Practices in Horsham , Pennsylvania.
A paper published on 20 July in The Annals of Pharmacotherapy highlighted 26 instances in which Chantix users became violent in thought or action. In one case, a woman hit her 17-year-old daughter while the girl was driving a car. In another, a man on the drug had his front teeth knocked out after punching a stranger at a bowling alley.
Although every drug bears some risk, those risks can lurk undetected until the drug hits pharmacy shelves — an uncomfortable truth highlighted by the once-popular diabetes drug Avandia (rosiglitazone), which has been linked to heart attacks. In a close decision, an FDA-appointed committee last month voted to allow Avandia to remain on the market with tighter guidelines for how it is prescribed. "Avandia is not an exception or an aberration," says Brian Strom, an epidemiologist at the University of Pennsylvania in Philadelphia . "We'll certainly see more cases like it."
Chantix is one of a growing number of drugs that could soon face similar attention. In 2008, the FDA required Pfizer, the New York-based manufacturer of Chantix, to perform additional safety studies on the drug. In doing so, the agency was flexing new muscle. The Food and Drug Administration Amendments Act, passed in 2007, gives the agency authority to demand clinical trials even after a drug is on the market. Since then, the FDA has ordered further studies on 132 approved drug applications, some of them well-known pharmaceuticals (see Table 1). The agency also has the power to issue fines if those trials are not completed within an agreed time. All of this suggests that further approved drugs will be thrust into the spotlight over adverse reactions.
But some remain sceptical about whether the act will have its intended effect. "The FDA has a little bit more power, but it has to develop the courage to use that power," says Curt Furberg, a physician with the Division of Public Health Sciences at the Wake Forest University School of Medicine in Winston-Salem , North Carolina , and a co-author on the latest Chantix paper1. Furberg and others have expressed concern that the FDA's post-marketing watchdogs work under regulators who may be reluctant to question a drug's safety, having approved the drug in the first place.
By the time a drug such as Chantix hits the market, it has typically been through clinical trials that can involve several hundred to a few thousand subjects. That's enough to uncover common side effects, or even infrequent events, such as liver failure, that are uncommon in the population at large. But small increases in relatively common ailments can easily slip through. For example, some studies found that Avandia increased the risk of heart attack by 40% — considered a relatively subtle effect. But given that diabetes patients are already at high risk of cardiovascular disease, that subtle effect could translate into thousands of heart attacks.
To pick up on those effects, the FDA is also constructing a network called the Sentinel Initiative. Still in early development, the network will eventually link together the nation's largest insurance databases. With those data to hand, FDA watchdogs will increasingly be able to perform studies such as the recent analysis of more than 200,000 Avandia users, performed by FDA epidemiologist David Graham with data collected from patients on Medicare, a government-sponsored health-insurance programme. Graham's analysis figured prominently in the decision to further restrict Avandia. Large data sets will give regulators more power to identify smaller increases in risk than they have in the past, says Strom. This could, in turn, mark out further drugs for investigation.
But inclusion on the FDA's watch list should not automatically condemn a drug, cautions Steven Nissen, a cardiologist at the Cleveland Clinic in Ohio who published the first meta-analysis of Avandia clinical trials. "Not every drug that raises concern turns out to be a bad drug," says Nissen.
In fact, most drugs are not pulled from the market because they are too risky to be of any use, but rather because they are misused. The painkiller Vioxx (rofecoxib), which was withdrawn from the market in 2004 for causing heart attacks and strokes, was a valuable drug for the few patients who failed to respond to other anti-inflammatory drugs. But thanks to aggressive marketing, the drug was overprescribed, says Strom, and reached patients with a relatively high risk of heart attack.
Such advertising-fuelled haste to embrace new drugs will ensure a steady supply of post-marketing scandals, he says. "It isn't necessarily that the drugs don't have a benefit or have too many risks," he adds. "The issue is that we haven't precisely quantified those risks, and then we start using the drugs too widely." 5.8.10
Costly £100m for NHS websites which confuse patients
The NHS spends close to £100m a year on thousands of websites that are often hard to find, badly designed and not wanted by the public, according to government reports leaked to Nursing Times' sister publication HSJ. The NHS Digital Communications Review, published internally by the Department of Health in June, says there are 2,873 NHS websites in use.
Research for the DH review, also leaked to HSJ, found that - despite the huge number of sites - the public “struggled to locate the NHS online with a Google search”. When they did find it, “the scale and depth of information on offer was daunting to many”.
The research, carried out by communications agency Precedent, states there are “over 2,000 NHS organisations all trying to get the attention of the public”. It identified 4,121 NHS websites - but noted that more than 1,000 are no longer accessible. The research report says around 30 per cent of the “live” sites had “at least one notable deficit in standards”, including confusing navigation and/or poor quality content.
“GP surgeries were the weakest of all the website types in the sparse offering of features and functionality,” it says. Sites maintained by primary care trusts, foundation trusts and strategic health authorities received “almost no recognition” from the public. “The question is raised why these sites were developed in the first instance - ie due to a genuine need or if they were developed without evidence, on a perceived need only,” it says.
On accessibility, it found: “Some basic web standards were not followed… vulnerable members of the public are often not being properly catered for.” Only half the websites provided email addresses. “The NHS is not making itself easy to do business with,” it says.
The research report also found: “It is possible that where problems are found across the [NHS digital] estate, the confidence of the public in the NHS brand may be diminished, especially in the current climate where the public have high expectations and demands online.”
Interviews with users revealed the public wanted to see “one NHS” online. “The public expected NHS websites to represent the ‘one NHS' that they see providing their treatment.”
The Precedent research attempted to assess the cost of NHS sites but not many organisations could or were willing to provide information when asked. The report estimates the cost of running the sites “could be as high as £86m per year”. However, the figures do not include set-up costs and therefore “underestimate the overall total spend”.
There was also very little information about the use of NHS websites. Precedent stated: “The very fact that collecting basic cost and usage data was problematic underlines an accountability and performance management gap.” The DH concluded “web management is still a relatively immature service area in the NHS”.
The Precedent research also discovered that Google listed 56 million pages within the nhs.uk domain. The vast majority are likely to be hidden to the public and the research concludes that their purpose is unclear.
A DH spokeswoman told HSJ: “As the recent white paper said, the government intends to bring about an NHS information revolution to give people access to comprehensive, trustworthy and easy to understand information from a range of sources on conditions, treatments, lifestyle choices and how to look after their own and their family's health. “The department will set out how it intends to achieve this with the launch of an information strategy in the autumn.”
A total of 4,121 [NHS] websites were reviewed. This is a huge number of individual sites for a single organisation and creates huge challenges in terms of maintaining quality, focus and relevance.” “The ownership of NHS websites was often unclear, with the review process indicating that even trained researchers found it difficult to identify the purpose and ownership of sites.”
“The public are confused by the diversity of sites and content. They think of the NHS as one institution and expect the web presence to reflect this.”
“Poor navigation was found throughout the NHS estate but public-facing websites such as those from GPs and PCTs were most commonly to blame.”
“GP surgeries have by far and away the poorest sites, in that they have the largest percentage of problems identified. GP sites [also] failed to provide the means to allow interaction with users.”
“The public find that the NHS does not always feature in Google search results for many health-related terms. What this means is that people are often drawn to resources from Wikipedia, the charity sector, NetDoctor and Patient UK , for example, rather the NHS.”
“It is possible that where problems are found across the estate, the confidence of the public in the NHS brand may be diminished, especially in the current climate, in which the public have high [online] expectations.”
“From the limited data received, it is clear that the NHS has little in the way of central mechanisms to track the costs and usage of all NHS websites.”
“The majority of returns on these [website traffic] measures informed us organisations were not equipped or used to reporting on these measures.”
- 4,121 Total nhs.uk websites
- 2,000 Approximate “active” sites
- 287,300 Estimated pages accessible
- 56 million Pages indexed by Google
- 30 per cent Number of sites that exhibited at least one “notable deficit in standards” (poor quality content, lack of NHS branding, poor navigation, “not authoritative” or out of date content)
- 50.3 per cent Sites that include email address
- 188 Responses to researchers' request for usage and cost data (of 4,121 sites)
- 33 per cent Sites that include accessibility statement
- 11 per cent Show no sign of NHS branding
- £12,000-£30,000 Estimated average cost per site
- 51,000 Estimated average annual unique users per site
- 400,000 Estimated average annual visits to site - 5.8.10
Why antidepressants are simply a confidence trick: A leading psychologist claims taking sugar pills would work just as well
We spend more than £250 m a year on antidepressants in the UK - and it's a complete waste of money. They are not much better than sugar pills, they have nasty side - effects, such as sexual dysfunction, and they increase young people's risk of suicide. New research shows they don't even work on the brain in the way we thought they did.
For years we were told depression was caused by low levels of a brain chemical called serotonin, and that antidepressants worked by boosting it.
But an Australian study published in the Archives of General Psychiatry shows that rather than low levels, depressed people might have double the normal amount in some parts of their brains. Many people were surprised by these new findings, but I wasn't. I've been studying antidepressants for more than a decade, and I knew that if they worked at all, it wasn't by changing brain chemistry.
The major reason you feel better when taking an antidepressant - maybe the only reason - is the placebo effect.
When I first published a paper back in 1998 saying that antidepressant drugs such as Prozac and Seroxat were not much better than a placebo, almost everyone thought it couldn't be true. There was so much evidence they worked. Thousands of people claimed the drugs had turned their lives round.
My colleagues said that I must have made a mistake: either I had looked at the wrong data, or I hadn't analysed it properly. In fact, what I'd done was to look at the research on antidepressants in a different way from everyone else.
Other researchers were concentrating on how much better the drugs were than a placebo. What I was interested in was finding out how strong the placebo effect was in treating depression.
I compared the placebo effect to having no treatment at all - no one had done that before. We already knew that placebos could have a powerful effect in conditions such as pain, angina, ulcers and asthma. Depression was an obvious next step, because when you are depressed you lose hope, and placebos give you hope.
But I was flabbergasted by just how big the placebo effect was. Patients getting the drug improved: that was not surprising. But patients given the placebo also got better - and by almost the same amount. Most of the drug improvement was really a placebo effect. I decided the best way to convince people that antidepressants were largely placebos was to look at the drug companies' own data.
At the time, I was working at the University of Connecticut, so I used the Freedom of Information Act to force the U.S. Food & Drug Administration, which licenses drugs, to let me see all the trials the drug companies had run to get the most popular antidepressants approved.
That's when I got another shock. More than half of the trials showed no difference at all between the drugs and the placebos - but most of those negative trials had never been published. In other words, the benefits of antidepressants were even smaller than I'd thought, but the drug companies had hidden the data showing this.
No wonder everyone had thought I was wrong.
Information about the best way to treat patients was being hidden from doctors, and so billions of pounds were being wasted and patients were being exposed to dangerous chemicals for no real benefit. My new analysis, published in 2002, found that all antidepressants, including the well-known SSRIs (serotonin selective reuptake inhibitors), had no clinically significant benefit over a placebo.
Other researchers took my findings more seriously this time, but it was still very unpopular with many psychiatrists. I gave a lecture at one top psychiatric clinic and was almost driven out of the building by angry psychiatrists.
'This is outrageous,' they shouted. 'How can you say that our best drugs don't work?'
Everyone now agrees that hiding negative trials is bad.
But back then, the FDA thought it was perfectly all right. Knowing that there is negative data is of 'no practical value' to doctors, they argued, and it scares them away from prescribing antidepressants. Drug firms now have to register all new trials on the web, so it's less easy to lose them, but they still don't have to publish the results.
As I studied the results from trials of antidepressants, something else jumped out. Whatever type of drug was being tested, the amount of benefit patients reported stayed about the same. Now this is odd, because antidepressants work in all sorts of different ways.
The cells in our brain communicate with each other by producing chemicals called neurotransmitters. Most current antidepressants, the SSRIs, are supposed to work by increasing the amount of the neurotransmitter serotonin, which can affect mood.
But other antidepressants are supposed to work by boosting different neurotransmitters, such as norepinephrine and dopamine, that are also linked with mood. There is even an antidepressant that brings the level of serotonin down instead of pushing it up. All these drugs have the same effect. No matter what they do - or don't do - to serotonin, about 60 per cent of patients get better.
This means the serotonin theory must be nonsense.
If the effects of these drugs stay the same whatever chemicals they contain, then they are placebos. Maybe we have been barking up the wrong tree. What happens to you in your life can make you depressed: when someone close to you dies, or when your business goes under, or you lose your job. But you don't need a pill to help you get through the bad times.
Research shows that talking therapies can make people feel better; and if you are helped in that way, then you are much less likely to relapse if the going gets tough later on. The real message of my work is that a pill may help after all - but not the sort of pill you get a prescription for.
If the drugs are no better than a placebo, then why not give a placebo that doesn't have any of the nasty side-effects? The problem is that doctors should not lie to their patients. So I'm now working on ways to produce the placebo effect without telling lies to patients.
The best way to make a placebo work really well is to have a good relationship with your doctor. Recently, I worked on a study at Harvard University that showed this. We divided patients with irritable bowel syndrome into three groups. One lot were put on a waiting list, and the other two groups got pretend acupuncture.
But the treatment was delivered in different ways. With some patients the doctors were warm and encouraging; with others, they were cool and businesslike. All the patients said they felt better - even those on the waiting list. But while 44 per cent of those who saw businesslike doctors improved, 62 per cent treated by the warm ones benefitted.
Placebos don't work for all conditions, but if we could find a way to get those sorts of results without deceiving people, we'd save an awful lot of money and the risk of side-effects would be zero.
Not a great solution for drug company sales, perhaps - but wonderful for the rest of us.
• Irving Kirsch is professor of psychology at the University of Hull. His book, The Emperor's New Drugs: Exploding The Antidepressant Myth, is published by The Bodley Head at £11.99. 3.8.10
Obese? Just call them fat: Plain-speaking doctors will jolt people into losing weight, says minister
Doctors should stop mincing their words and tell the overweight they are fat, the public health minister has said. Anne Milton called on the NHS to ban terms such as 'obese', because they do not have the same emotional impact.
The former nurse said larger people were less likely to bother to try to lose weight if they were told they were obese or overweight than if the doctor was blunt and said they were 'fat'. But health experts argued against such plain speaking because they fear it could stigmatise overweight people.
Around a quarter of adults are obese, meaning they are so fat their health is at risk from heart attacks, stroke, diabetes and cancer. Experts warn that if nothing is done, more than half of the population will be obese in 2050, putting a huge strain on the NHS.
Mrs Milton told the BBC that it was important people took ' personal responsibility' for their lifestyles. Speaking in a personal capacity, the public health minister said: 'If I look in the mirror and think I am obese I think I am less worried than if I think I am fat.'
She said she was worried that too many in the NHS feared using the term when dealing with patients. Yet it could, she said, actually encourage personal responsibility. 'At the end of the day you cannot do it for them,' she said. 'People have to have the information.'
But Professor Lindsey Davies, of the Faculty of Public Health, said using the word 'fat' might not be such a good idea. She added that doctors had originally started using the word obesity to encourage patients to think about the condition in a different way. 'Obesity is something that happens to people rather than something they are. The language you use all depends on the relationship you have with a patient.
'I would probably be more likely to say something like "can we talk about your weight" rather than obesity, but that is a judgment you make patient by patient.'
Harry MacMillan, chief executive of healthy living charity Mend, also disagreed with the use of 'fat'. He said: 'Based on our experience working with and supporting families to manage their weight, we believe that using positive language such as "above a healthy weight" is more likely to make someone take practical action to lose weight and become healthier.'
However, Professor Steve Field, of the Royal College of GPs, agreed with the minister and said he used the term fat as often as he could. 'I think the term obese " medicalises" the state,' he said. 'It makes it a third-person issue. I think we need sometimes to be more brutal and honest. 'You can be popular by saying the things people want to hear and in the NHS we too often do that when we should spell things out clearly.'
Mrs Milton's comments came after she gave a speech to the King's Fund think tank on the Government's vision for public health. Earlier this week, senior doctors accused her boss, Health Secretary Andrew Lansley, of being in hock to the food industry and putting the fight against child obesity at risk.
Signatories including the Royal College of Physicians expressed 'dismay' and 'alarm' over his plans to get the makers of chocolate, crisps and fizzy drinks to fund antiobesity campaigns. In return, food and drink firms would be freed from the 'burden of regulation'. 30.7.10
DoH commits to continue NHS funding of homeopathy
NHS funding for homeopathic treatments will continue, despite a highly critical report published by MPs earlier this year.
MPs on the parliamentary science and technology select committee published a report on homeopathy in February, which urged the government to withdraw NHS funding for such treatments and for the medicines regulator to stop licensing homeopathic products.
Both proposals were rejected this week by the Department of Health as it published its official response to the report. Critics said the report was bias and it only heard oral evidence from those apposed to homeopathy. Homeopathy has been funded on the NHS since the service began in 1948 and there are four homeopathic hospitals in the UK , in London , Bristol , Liverpool and Glasgow.
It is estimated that the NHS spends around £4 million a year on homeopathy.
The select committee's report said there was no conclusive evidence that homeopathic drugs were any more effective than a placebo and given that existing scientific literature showed no good evidence of efficacy, further clinical trials of homeopathy could not be justified. The committee said it believed homeopathy was a placebo treatment.
To prescribe these treatments was damaging the integrity of the doctor-patient relationship and because the effect of homeopathy was unreliable and unpredictable, it should not form the sole basis of any treatment on the NHS.
The MPs also wanted the Medicines and Healthcare products Regulatory Agency (MHRA) to stop licensing homeopathic products because they were allowing these products to make medical claims without evidence of efficacy. The BMA at its annual conference in June voted overwhelmingly for a motion that said homeopathic remedies should be banned on the NHS and taken off pharmacy shelves where they are sold as medicines.
The Department, however, in its response, said the use of homeopathy on the NHS did not amount to a “risk to patient trust, choice or safety”.
In addition, it did not believe the risk was significant enough for the Department to take the unusual step of removing PCTs' flexibility to make their own decisions. Public health minister, Anne Milton said: “We believe in patients being able to make informed choices about their treatment, and in a clinician being able to prescribe the treatment they feel most appropriate in particular circumstances, which includes complementary or alternative treatments such as homeopathy.
“It is the responsibility of clinicians to discuss the risks and benefits of specific treatment options with individual patients; and to take into account safety, clinical and cost-effectiveness and the availability of suitably qualified/regulated practitioners.” 27.7.10
New mental health 'bible' will lead to almost everyone having a 'mental disorder', warn experts
An updated edition of a mental health bible for doctors could mean that soon no-one will be classed as normal, experts warned today. Diagnoses for 'disorders' could be based on symptoms including toddler tantrums, mild mood swings and binge eating.
Sweeping changes are being made to the U.S Diagnostic and Statistical Manual of Mental Disorders (DSM), which influences practitioners around the world. However, leading British mental health experts have warned the revisions could devalue the seriousness of mental illness and label almost everyone as having some kind of disorder.
Critics have long since been apposed to the DSM where 'disorders' are voted in by a show of hand at the annual general meeting and have no basis in science or medicine whatsoever. According to Dr James Howenstine, MD and many others, 'Psychiatry is a Complete Fraud'. Psychiatry itself admits 'it has not proven the 'disease theory' or the cause or source of a single mental illness it has classified 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'.
One suggestion of the American authors is a new diagnosis of 'Psychosis Risk Syndrome' which singles out people thought to be at risk of developing a psychotic illness such as schizophrenia. Individuals falling into this category might experience occasional mood changes, feelings of distress, anxiety or paranoia, or fleeting episodes of hearing voices.
In the past they might have been considered difficult or eccentric. Under the new proposals they could receive a diagnosis that affects their future lives and job prospects. Yet they may never develop 'full blown' psychosis. Other diagnoses under consideration include 'mixed anxiety depression', 'binge eating', and 'temper dysregulation disorder with dysphoria'.
In addition, the bar could be lowered on some common existing disorders, such as depression, so that more people are considered to have symptoms that warrant a diagnosis. Professor Til Wykes from Kings College London, said: 'It's leaking into normality. It is shrinking the pool of what is normal to a puddle.' Professor Wykes edits the Journal of Mental Health which carries a "health warning" about the proposals in its latest issue.
The changes have been put forward for discussion by a powerful group of U.S experts working on the fifth edition of the DSM, which is published by the American Psychiatric Association. The new edition, due to appear in May 2013, will provide the first update of the guidelines in 16 years.
Professor Wykes and other experts fear the draft proposals, now entering a six-month period of public consultation, could have a devastating impact both on individuals and society. They accuse the US authors of racing ahead of scientific progress in mental health, which has made relatively little headway in 16 years.
Many of new diagnostic criteria are based on symptoms that dovetail with normal behaviour and are not sufficiently underpinned by research, it is claimed. Prof Wykes said the "at-risk" diagnosis would lead to unnecessary psychotherapy or even medical treatments. She used the analogy of treating 10 people with common colds for pneumonia because all are considered at risk of developing a serious illness.
'The difficulty is we do not know whether you can prevent one person having a psychosis by treating everybody,' she said. 'Not only is it self defeating, but we think it will have severe consequences from the point of view of stigma, the way people view themselves, and the anxiety they might have. 'We have no test that can say that a person is going to have schizophrenia.'
The Journal of Mental Health editorial, co-authored by Prof Wykes and Dr Felicity Callard, said a diagnosis of "Psychosis Risk Syndrome" would expose many people who were not destined to develop a serious mental illness to the risk of social stigma and discrimination.
Labelling an individual at risk of a disorder 'commonly regarded with great apprehension' could even change an individual's 'sense of personhood', it was claimed.
The editorial adds: 'As well as the distress likely to be experienced by themselves and their families, and the suffering entailed by treatment irrespective of whether it is drug or psychological therapy, the logic entailed by Psychosis Risk Syndrome might also divert attention away from understanding the underlying causes of schizophrenia.'
Dr Callard, from the Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, said: 'If this category were to be introduced the people likely to be given this diagnosis are going to be relatively young. What are the implications of someone receiving a diagnosis that is not a diagnosis of a disorder as such, but a potential disorder?' Both experts spelled out their views at a news conference in London today.
Colleague Professor Nick Craddock, from the University of Cardiff , said it was useful and necessary for practitioners to agree on how they identify symptoms of psychiatric disorders. But it was "highly problematic" to label traits that overlapped with normal behaviour medical symptoms. 'At what point is it right to ask to say that someone has a medical problem?' Professor Craddock asked.
Professor Wykes said the U.S. had a major influence on psychiatry and mental health research partly because most of the "high impact" journals in the field were American. People have used the words 'the Americanisation of mental illness' because you cannot underestimate the dramatic effect it has had,' she said. One factor driving the American approach was the way healthcare was funded in the U.S, said the experts.
The DSM guidelines provided the means by which US psychiatrists were reimbursed by private health insurers for treating patients. A practitioner who offered help to someone who fell outside a defined diagnostic category risked not getting paid hence they are desperate to classified any condition. One expert said, ‘there isn't a single shred of evidence, science or medical expertise behind any condition classified in the DSM, it's completely made up and nonsense however the medications associated to these 'illnessess' cause debilitaing side-effects and an involunutary drug addiction for millions of people, once you're on the drugs, you can't get off which is good business for the pharmaceutical industry'. 28.7.10
Also see: Up to 750,000 'special needs' pupils are just badly taught
Oil firm wins battle to identify chatroom users
Oil company Nighthawk Energy today said it had uncovered the identity of online investment chatroom users it claims have been spreading "defamatory and untrue" rumours.
The group - listed on the Alternative Investment Market (AIM) - went to court to force websites ADVFN and iii to reveal the identities of the anonymous bulletin message posters.
The High Court ruled in late June that the postings could be defamatory and granted the order, according to Nighthawk. It is now considering legal action against the individuals, whom the company alleges made "persistent" postings about the firm's operations and its management "which the board considers to be extremely damaging to the company and its reputation".
Nighthawk added: "The company took steps to identify the posters who try to escape liability for their defamatory postings by hiding behind a cloak of anonymity, using anonymous email, social networking or bulletin board accounts to disseminate those postings.
"In some cases the names and other details used to register these accounts are fictitious and posters also can try to cover their tracks using numerous pseudonyms, but they can be traced through their IP addresses."
Fellow AIM-listed oil stock Nostra Terra Oil and Gas also confirmed it was considering similar action after claims were made about the group's management in bulletin board postings.
Chief executive Matt Lofgran said he and the firm had been the target of postings since just before the start of the year. The firm is also looking at potential legal action after recently seeking a court order to unmask the chatroom users.
Internet bulletin boards attract thousands of postings each day from retail investors discussing stocks and their portfolios.
ADVFN said it receives between 10,000 to 12,000 postings a day and has received several court orders already this year requiring it to reveal the identities of users. The group said its policy was not to police the bulletin boards and does not reveal user identities unless served with a court order. But it said it will remove certain postings if complaints have been received and always complies with court orders.
It has already been served with several court orders this year.
The Financial Services Authority (FSA) said bulletin boards were being looked at closely as part of its efforts to combat market abuse.
It issued a £15,000 fine in March 2005 to investor David Isaacs for internet market abuse, which saw him post dishonestly obtained information on an internet bulletin board to boost a company's share price.
Bulletin board postings are believed to be behind a so-called flash crash in shares of Aim-quoted Falkland Islands oil explorer Rockhopper in June, when shares plunged almost 77% in a session after rumours appeared on bulletin boards questioning the quality of its oil.
One lawyer said, 'it sends a clear message that people can not longer hide behind a faceless internet, if you make false claims against a company or seek to damage their reputation, then you will be traced and could pay damages'.