How stopping smoking or drinking can help the 'Squeezed middle' offset a £2,800 tax hit
Middle-income families could lose up to £2,800 in the triple whammy of tax changes in the latest Budget. There will be a dramatic cash squeeze for working families who will lose out from changes to income tax, child benefit, tax credits and VAT, research predicts.
One way to offset this loss and get healthier is to stop smoking or drinking, it estimated the average family with one smoker could save £2,190 per annum by stopping smoking and £4,380 if they both smoke. Add to this excessive or regular drinking and the savings could top £3,490 for one person and nearly £7,000 if both drink less often.
A couple with two children and a household income of £42,000 stands to lose £2,800 a year by 2013 under the changes, which will bring a ‘prolonged personal recession' to working households, according to a think-tank report. The phenomenon has led to such taxpayers being labelled the ‘squeezed middle' – who are likely to get poorer in real terms as the changes are implemented over the next few years.
The report also found 700,000 middle-income earners will be dragged into the top rate of tax – doubling what they pay – as part of the changes outlined by the Treasury.
Chancellor George Osborne has vowed to help taxpayers by gradually lifting the threshold at which people start paying income tax to £10,000.
But analysis by the Resolution Foundation think-tank reveals that the £170 gain that this will bring to low-to- middle-income taxpayers this year will be more than offset by other changes already in the pipeline.
In their report, Gavin Kelly and James Plunkett, of the Resolution Foundation, write: ‘The typical working household is now poorer in real terms than it was a year ago.
‘In 2011, it will get poorer still. Even as growth resumes and the nadir of the financial crisis fades into memory, millions of families are living through a prolonged, personal recession.' The report reveals the extent to which the squeezed middle will have to brace for tough times ahead as prices rise and wages are frozen.
The hidden penalty of the changes to income tax will also mean that families with at least one top-rate taxpayer will lose their child benefit when they are sucked into the top rate. This will cost them £1,750 a year for two children, or £1,056 for a family with one child, when these changes are introduced in 2013.
Those earning between £15,000 and £58,000 will also lose an average of £435 a year from 2012 in cuts to the families element of the Child Tax Credit. That figure rises to an average of £600 for families in London . Some families could lose as much as £1,300 a year.
It will more than outweigh the £275 average gain families will make in changes to the child tax credit. Middle-income earners are already being hit by the rise in VAT to 20 per cent, which adds at least £400 to the annual bills of the average family. Those figures do not even include changes to National Insurance contributions, which will rise by 1p in the pound in April.
Mr Kelly and Mr Plunkett said: ‘The Coalition's flagship policy will be the £1,000 increase in the amount that can be earned before paying tax, which will benefit low-to-middle-income earners by roughly £170 a year. ‘In normal times, this would be a significant gain, but in the context of 2011, it is not even enough to offset the rise in VAT, let alone the far larger tax credit cuts. About 700,000 people currently on the 20p tax rate are likely to be shunted into the 40p tax band.
‘Not only will their marginal tax rate double, they will also become unsuspecting victims of the planned removal of child benefit for higher-rate taxpayers. A family with two children on £42,000 will be worse off by £1,750 a year – fanning the smouldering embers of the child benefit row.'
Treasury officials refuse to discuss the contents of the budget but stress that the tax changes are necessary to help plug Britain 's record deficit. They pointed out that the Chancellor has deliberately staggered the changes throughout the next couple of years to prevent families being hit by a series of painful tax rises in one go.
Either way the pain is coming but for those who smoke or drink, they can offset these tax increases by changing their lifestyle and becoming healthier. 22.1.11
NHS board handed sweeping powers over fledgling GP consortia
The Government is to grant huge powers to the NHS Commissioning Board, allowing it to help determine the shape and structure of GP consortia, and parachute in alternative providers, such as private companies, to help run those that are failing.
The health bill lays the foundation for the new board to step in and shut down consortia which have ‘failed to discharge any of [their] functions' or if ‘there is a significant risk that a commissioning consortium will fail to do so'.
The board - headed up by current NHS chief executive Sir David Nicholson - will also be able to intervene to change the size of a consortium, parachute in ‘any person who is a provider of medical services' to help run it, or remove any member of the consortium's management, if it is found to be failing.
The bill, which requires all GPs to be part of a consortium, also says the board will be able to make payments at the end of each financial year to consortia which ‘perform well', by either improving health outcomes or saving money, including the power to make ‘one or more' advanced payments during the year.
However, the board will also have the power to withhold money at the end of the year if advanced payments are made but consortia fail to hit their targets.
Every consortium will be made to prepare a plan at the beginning of each year, setting out how it plans to hit health and financial targets, which must be agreed with new Health and Wellbeing Boards, giving a powerful role for local authorities. Consortia must also prove they have consulted with their patients.
The bill says the board will be able to provide financial assistance to struggling consortia, despite health secretary Andrew Lansley's pledge that there will be ‘no bailouts'. Consortia will also be given powers to merge in the future. 20.1.11
Statins 'may cause loss of memory and depression'
Cholesterol-lowering pills taken by millions of Britons may cause memory loss and depression, researchers warn. They say not enough is known about the level of harm posed by statins, prescribed to prevent heart disease and strokes. Leading doctors say that the drugs should only be taken by patients for whom the benefits of the drug outweigh any potential risks.
More than seven million people in Britain now take statins – as many as one in three adults over the age of 40. They are extremely effective in lowering levels of cholesterol, the fatty substance in the blood that clogs up arteries leading to heart attacks and strokes.
Many people over the age of 45 are routinely prescribed statins by their GPs if they have slightly high blood pressure or cholesterol.
In addition low-dose pills are increasingly bought over the counter without a prescription. Although they have been proven to be extremely effective – saving up to 10,000 lives a year – researchers warn that not enough is known about their risks. They warn statins should only be prescribed to those with heart disease, or who have suffered the condition in the past. Researchers warn that unless a patient is at high risk of suffering a heart attack or stroke, statins may cause more harm than good.
The study, published in the Cochrane Library, which reviews drug trials, also points out that the vast majority of trials have been carried out by drugs companies who may play-down any possible risks. Some patients taking statins have suffered from short-term memory loss, depression and mood swings.
Previous studies have also linked the medication to a greater risk of liver dysfunction, acute kidney failure, cataracts and muscle damage known as myopathy. The researchers examined data from 14 drugs trials involving 34,000 patients.
They found that although the drugs did prevent heart attacks and strokes, there was not enough evidence to prescribe them to patients with no previous history of heart disease.
Professor Shah Ebrahim, from the London School of Hygiene and Tropical Medicine said: ‘When you put the evidence together you certainly find it supports the use of statins. But we found that evidence of potential harm is not being taken seriously.
‘The adverse effects are not included in the trials.'
Lead researcher Dr Fiona Taylor, added: ‘The decision to prescribe statins in this group [who have no history of heart disease] should not be taken lightly.'
Amy Thompson, senior cardiac nurse at the British Heart Foundation, said: ‘This systematic review echoes what we already know – that statins have huge benefits for people with heart and circulatory disease, or those who are high risk – they help to reduce the risk of heart disease including heart attacks.
‘It is still unclear whether statins provide any real benefits for people without heart and circulatory disease and who are at low risk.' 19.1.11
U.S. government launches pharmaceutical division
The U.S. government has decided to enter the pharmaceutical business. Apparently, the drug companies aren't coming out with new "breakthrough" drugs quickly enough, and now the U.S. government plans to spend taxpayer dollars conducting research on drugs which will be turned over to Big Pharma. Those drug companies, in turn, will sell them for a profit. It's yet another clear case where the government is taking over the health care (sick care) industry and funneling profits into the hands of pharmaceutical corporations.
This is all happening because drug companies say they're scaling back their research funding to find new drugs. This terrifies the U.S. government, apparently, which doesn't recognize that scaling back drug company R&D is actually a good thing for America given how much economic damage and personal health damage is caused each year by Big Pharma's dangerous drugs. So instead of letting the failing pharmaceutical market contract on its own, Big Government wants to artificially prop it up with taxpayer dollars in much the same way that the feds bailed out Wall Street's rich banksters with trillions of dollars over the last two years.
The new government drug research center will operate under the National Institutes of Health (NIH) and be called the National Center for Advancing Translational Sciences . Dr. Francis Collins, director of the National Institutes of Health, says he hopes Congress will increase funding of the center to at least $1 billion annually.
The NIH, of course, isa revolving doorfor Big Pharma executives. Dr William Potter, for example, was formerly a researcher at the National Institute of Mental Health, after which he became the vice president of translational neuroscience at Merck. And the government money that goes into these so-called drug "discoveries" will only end up boosting the profits of drug companies rather than fundamentally improving the health of the American people. (More drugs does not equal better health. If anything it's an inverse correlation: More drugs = more degenerative disease !)
The myth of drug research
Of course, the bigger issue here concerns the mythology of drug development. The idea that every disease can be treated with a patented synthetic chemical is increasingly being revealed as absurd from the outset. The highly corrupt cancer industry has been promising a "cure" for cancer since the 1960's... if only they could have another few billion dollars in funding. And yet, year after year, their promises turn out to be yet another fundraising hoax. The whole scheme has now devolved into grotesque absurdity with pink products flooding store shelves backed by the ludicrous idea that "we can all cure cancer by going shopping."
At the same time, the chemical "discoveries" made by the drug companies are so dangerous that they must be approved by the FDA with advisory panels stacked with on-the-take "experts" who are paid by the drug companies, then marketed to the public through extremely manipulative and scientifically dishonest drug advertisements that downplay risks and exaggerate drug benefits. Even the clinical trials conducted in an attempt to prove the safety of drugs are riddled with lies, fraud and outright corruption.
If Big Pharma's drugs actually worked well, they wouldn't need to rely on such dishonest tactics to convince doctors and patients to use them, it would seem.
The truth is that even Big Pharma's "blockbuster" drugs are outright failures from a human health perspective. Statin drugs, for example, have been overhyped to such an extreme that doctors are actually recommending they be dripped into the water supply. Yet a rational look at the drugs reveals that they cause extremely dangerous and even deadly side effects such as kidney failure, liver dysfunction, extreme muscle weakness (among other disastrous effects).
Instead of putting more money into "miracle" synthetic drug chemicals, the U.S. government would be far wiser to spend money researching and documentingthe healing effects of medicinal plants and foods which are readily available without a prescription (and need no FDA approval).
But of course, the U.S. government isn't interests in supporting the health of the American people. If it was, it wouldn't continue to protect Big Pharma with an FDA monopoly that outlaws natural alternatives that work better, safer and more affordably to prevent and even cure degenerative disease.
So get ready for a government-run pharmaceutical companyto enter the picture. I've always said that the U.S. government is merely the marketing branch of Big Pharma. Now it is the research arm, too. Natural News 24.1.11
Trouble for the Pharma industry as they search for new ways to work together
Public–private partnership proposed to develop pharmaceuticals. The early stages of drug development could be freed from the shackles of intellectual property under a proposal to be tabled at a meeting of leading pharmaceutical players this week.
Amid layoffs, drying pipelines and the closure of research centres, many observers have warned that, in its current form, the pharmaceutical industry faces a troubled future. The bleak outlook seems even more so in the wake of this month's announcements by Pfizer of plans to reduce research and development spending by as much as US$2 billion and to lay off hundreds of researchers (see 'Pfizer slashes R&D').
Chas Bountra is trying to find a way forwards.
Bountra, who is head of the Structural Genomics Consortium at the University of Oxford, UK, has been talking to academics, research funders and industry representatives to try to get backing for his plan.
He envisions a global initiative worth about $200 million a year — half from private money and half from public and charitable sources — that would focus solely on new therapeutic targets. The initiative would rush these through to phase II clinical trials — the stage at which drugs are given to larger groups of people, but before the huge phase III trials that represent a drug's final hurdle before reaching the market.
If drug candidates proved successful, they would then be made available for the initiative's commercial sponsors to buy and bring to market. This Wednesday, 30 people, including high-level industry experts and academics, will meet in Toronto, Canada, to try to push the idea forwards.
"We have all this parallel activity and most of it is going to fail. I believe that [intellectual property] is slowing down science," Bountra told a group of journalists at the Science Media Centre in London.
According to his proposal, until a molecule has successfully reached the end of early phase II trials, no intellectual property rights would be asserted and all data would be published. This would hopefully assist other researchers working in similar areas. A key problem with the current system is that companies tend to work in parallel, identifying similar or identical targets and developing their own molecules — unaware of other similar products that have already been tested and discarded.
Bountra cites one example of a target for pain, an receptor called TRPV1. In the late 1990s, "the whole industry jumped on that target" after papers in Nature and Science suggested it could lead to treatments for pain.
A number of companies have worked on drugs to target TRPV1, says Bountra, but many in the pain field now think it unlikely that the work will yield a new analgesic. Much of the company data has not been published, however, and in 2006 there were at least 60 companies working on the same target.
"What we're trying to do is reduce that duplication," Bountra says. "If I had done a clinical study and I'd published it in 2002, I hope it would have stopped 50 other companies doing that study."
In addition to the financial benefit, Bountra adds, "there is an ethical argument; we are exposing patients to molecules other organizations know are going to be ineffective".
At present, many details remain to be ironed out. Bountra hopes that the meeting will establish work streams to deal with these, as well as securing commitments from the players.
He imagines that the collaboration will focus on areas that industry is currently exiting owing to their high risk — for example Alzheimer's disease, for which many promising drugs have failed in clinical trials.
Various public–private partnerships have been mooted for the pharmaceutical industry in recent history, especially in the field of neglected diseases. And, to some extent, pharmaceutical companies are already moving in the direction proposed by Bountra, explicitly outsourcing more and more of the early stages of drug discovery. GlaxoSmithKline, for example, will sign contracts with ten leading academics this year to partner with the company in developing drug candidates, reports the Financial Times.
There are an increasing number of areas that industry is exiting, says Judy Slinn, a business historian who researches the pharma industry at Oxford Brookes University, UK. She points out that the industry is, to a large extent, still focused on blockbuster drugs and it may take some time for people to switch to a new mindset.
There is also a question over whether academe will be willing to forgo the money it gains from spin-out work by its academics. "It's a very interesting idea," says Slinn. "It's going to need a lot of good will" while others said 'it's doomed to fail and will be a non-starter'. 15.2.11
Pfizer's Deep Trouble - Will Pharmaceutical Industry be Able to Change?
Pfizer's new CEO, Jeffrey Kindler, implicitly acknowledged last week, that Pfizer has hit the wall. "Despite the nearly $15 billion it made last year, despite the fact that it still has the best-selling drug in the world, Lipitor, which generates around $13 billion in annual revenue - its reliable business model had begun to break down", is the assessment of Joe Nocera in an article in the New York Times' business section.
"Jeffrey B. Kindler, announced that Pfizer was going to do some serious retrenching. For starters, it would lay off 7,800 people. Along with a previously announced reduction of 2,200 sales representatives, that meant Pfizer was going to cut 10,000 jobs, about 10 percent of its work force", continues the article.
Vera Hassner Sharav of the Alliance for Human Research Protection has a comment about this:
"Oddly, the New York Times seems to buy industry's efforts to gain even longer patent extensions beyond its current 20 year market exclusivity. What the Times doesn't begin to address is that many of the blockbuster drugs have no proven, demonstrable therapeutic value, but rather a perceived benefit that when the adverse events are added up, the perceived benefit disappears.
By checking the initial FDA-approved label and subsequent changes in the labels of blockbuster drugs provides insight about how risky it is to consume a newly approved drug. Take Pfizer's blockbuster antidepressant, Zoloft--whose sales in 2005 reached $3.5 billion. In scientific controlled trials, its benefit (82% of its benefit) was matched by placebo--which carries no risks and no cost.
Pfizer's Zoloft label history shows an incremental acknowledgment of previously undisclosed serious risks of harm. The labels do not reflect any commensurate findings of added benefits for those who are exposed to those increased risks of serious harm.
By the time the latest Zoloft label included a black box warning about suicidality in children and adolescents -- its patent protection had almost run out. Even today, the Zoloft label does not yet reflect the evidence that the drug poses a greater than twofold increased risk of suicidality for adults -- as the FDA's latest reported finding (December 2006) show."
This gradually emerging profile of deadly side effects is by no means unique to Pfizer's Zoloft. Other companies and indeed a number of drugs are suffering similar problems. Merck's Cox-2 inhibitor Vioxx was approved in 1999 but after some years, as thousands of deaths among patients could no longer be covered up, the company decided to remove the drug from the market. In 2001, Bayer withdrew its cholesterol-lowering Baycol after it had been linked to more than 50 deaths, later estimated to have been more than a hundred - an ominous sign for Pfizer's blockbuster Lipitor.
When 13 billion dollars out of your total yearly income of 15 billion are from the sales of one fatally flawed drug like Lipitor, you know you are in trouble, despite the size of your company. Despite its apparent success, Lipitor has an appalling side effect profile, and the philosophy behind it - the drug interferes with the liver's natural ability to produce cholesterol - renders the drug both damaging and ineffective .
A flawed business model
Commentators quoted in the New York Times article fault Pfizer's concentration on what are called blockbuster drugs, those that generate more than a billion dollars in yearly revenues:
The era of the blockbuster - and the blockbuster business model - may well be coming to an end. If you get away from Wall Street, it's not hard to find people who view things that way. "I don't think the model makes sense anymore," said the Harvard economist David Cutler. "The blockbuster model does not work as a business anymore," said Roger Longman, a managing partner at Windhover Information, a health care consulting company.
But that is a very superficial way of looking at things. Pharmaceutical companies generally rely on patentable drugs which they can sell at high prices without having to fear competition as long as the patent holds good. That means, their research - by necessity - has to go further and further away from using natural molecules, those the human body has been exposed to and has learned to live with for millennia.
Instead of searching for better ways to deliver nutrients that help our bodies cope with stress and illness, the pharmaceutical world must look for synthetics, which are patentable but which, more often than not, end up disturbing homeostasis, in an effort to suppress this or that symptom. The real causes of illness are almost never addressed.
While pharmaceutical producers have to make ends meet, there is no reason that our health should be the playground for an investment industry that is yielding insane profits to shareholders. But as long as pharmaceutical companies profit from disease, rather than from health, we will have disease as a major outcome. This puts incredible stresses on national health systems, which not only must pay for the overpriced drugs but end up having to provide hospitals and care for an increasingly sick population.
Pfizer's recent restructuring move only shows the tip of the iceberg. What is at stake is not only the pharmaceutical business model. The real question is: can we allow companies to profit from ill health rather than from good health, and can society continue to foot the bill for the outcome in terms of public health.
Something has to give - sooner or later. Whether Pfizer follows the pharmaceutical blockbuster model is not the question. We need deep reforms to bring the pharmaceutical industry out of the doldrums. And those reforms must bring better health outcomes than patentable synthetic molecules are able to deliver.
You can find the New York Times article here , but below is, for archive purposes, a copy.
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THE NEW YORK TIMES
January 27, 2007
The Dangers of Swinging for the Fences
By JOE NOCERA
There was once a pharmaceutical company that could do no wrong. It had the best-selling drug in the world. It saturated the airwaves with its ads, and swarmed doctors' offices with its army of good-looking sales representatives. It had mastered the art of turning drugs into blockbusters. It made many billions in profits. Wall Street analysts loved it. That company, for those among you with short memories, was Pfizer. And that era when it was the king of the hill wasn't some distant age - it was just maybe three or four years ago. Oh, how the mighty have fallen!
This week, during a meeting with analysts and investors, the company's new chief executive, Jeffrey B. Kindler, announced that Pfizer was going to do some serious retrenching. For starters, it would lay off 7,800 people. Along with a previously announced reduction of 2,200 sales representatives, that meant Pfizer was going to cut 10,000 jobs, about 10 percent of its work force.
He also announced that Pfizer would close some of its manufacturing and research facilities and reconfigure its research capabilities. But most important, Mr. Kindler did something his predecessor, Hank McKinnell, who was shown the door last summer well ahead of his scheduled retirement (and handed an obscene exit package), had never been able to do.
Implicitly at least, Mr. Kindler acknowledged that Pfizer had hit the wall. Despite the nearly $15 billion it made last year it; despite the fact that it still has the best-selling drug in the world, Lipitor, which generates around $13 billion in annual revenue - its reliable business model had begun to break down. Mr. Kindler's essential message to the investment community was that Pfizer was going to try to do the single hardest thing any big company can try, and that is to change.
We in the newspaper business tend to obsess about the wrenching transformation taking place in the media industry. It is easy enough to see. We look at other industries, like the domestic auto business, and we can see that its way of doing business isn't working anymore either.
It is a little harder to see that with Big Pharma, which is still rolling in profits. But the pharmaceutical business is, indeed, changing. "I think of the environment as a huge screw that is slowly turning," said Steve Scala, the health care analyst with Cowen & Company. "You can't see it turning if you are in the middle of it, but if you walk away for a while and then come back, you notice how much it's turned." For Pfizer, the very tactics that made it so successful for so long are precisely the ones that have now caused the company to stumble.
Mr. Kindler has noticed that the screw is turning. Whether he can actually do anything about it, retrenchment or not, is another question entirely. THE modern Pfizer was built on blockbusters, which is what the industry calls medicines that generate $1 billion or more in annual revenue. That isn't exactly a news flash: There was Viagra, which it brought to market in the late 1990s and turned into a $1.6 billion drug, and its high-blood-pressure medication Norvasc ($4.8 billion in sales last year). And Lipitor, which, despite competing with a handful of other cholesterol-lowering drugs, is by far the dominant drug in its class.
In the 1980s and 1990s, all the big pharmaceutical companies aimed for blockbusters, of course. But no company was better at it, and no company believed more profoundly in the supremacy of the blockbuster model. Pfizer was in the forefront of the mass marketing of drugs, and of getting its sales force in front of doctors to persuade them to use Pfizer's products instead of a competitor's. And if its research labs weren't exactly prolific - Pfizer hasn't developed a blockbuster on its own since Viagra - it still managed to produce a steady stream of blockbusters by buying up other companies and acquiring their potential blockbusters. Mr. McKinnell used to say that there were plenty of blockbusters out there - Pfizer's job was to go out and find them.
Unlike most industries, Big Pharma can't milk its best-selling "branded" drugs forever. That's because drug patents expire after 17 years. Indeed, because the testing and approval process comes after the patent is filed, a company usually has only 10 to 12 years to reap a high price from its drug once it hits the market. After that, the generic drug industry takes it over, and drains most of the profit out of it.
As a matter of public policy, that's surely a good thing, but it doesn't help companies that are trying to generate ever-increasing profits. For them, there is constant pressure to replenish expiring blockbusters with even bigger and more profitable drugs.
To a number of the analysts I spoke to who follow Pfizer, like Mr. Scala, the company's problem is really pretty simple: it has a number of drugs that have either lost their patent protection or will soon - and it doesn't have anything coming on line, at least in the short term, that will take up the slack. Norvasc, for instance, will lose its patent protection this year. Most ominous of all, Lipitor is coming off patent in 2010. How is the company ever going to make up that $13 billion in revenue?
What's more, Pfizer was banking a great deal on a cholesterol drug it had developed called torcetrapib, the first drug aimed at raising the level of good cholesterol, rather than simply lowering cholesterol levels, the way Lipitor does. It would have been huge. But in early December, the company announced that it had ended its efforts to develop the drug after a clinical trial showed a higher-than-expected number of deaths. The loss of torcetrapib was a crushing blow.
But the patent expiration issue, while very real, is to my mind the symptom of something larger. The era of the blockbuster - and the blockbuster business model - may well be coming to an end. If you get away from Wall Street, it's not hard to find people who view things that way. "I don't think the model makes sense anymore," said the Harvard economist David Cutler.
"The blockbuster model does not work as a business anymore," said Roger Longman, a managing partner at Windhover Information, a health care consulting company.
There are lots of reasons for this. For one, as Pfizer discovered with the failure of torcetrapib, when you live by the blockbuster, you die by the blockbuster - companies simply need to become less reliant on a small handful of big moneymakers that will inevitably go away. "If you go the blockbuster route," said Dr. Una S. Ryan, the chief executive of a small biotech company, Avant Immunotherapeutics, "any setback is going to be catastrophic."
For another, the larger society has become much less tolerant of Big Pharma's tactics. There is a backlash against the kind of direct-to-consumer advertising that has propelled many drugs into blockbuster status. Doctors are less willing to spend time with drug company sales representatives.
The game-playing by many companies to extend the life of their patents is under attack by Congress and the Federal Trade Commission. The Food and Drug Administration is giving tougher scrutiny to drug applications - especially for drugs that are only marginally different from those already on the market.
And as health care costs continue to rise, managed care companies are looking to drugs - and drug companies - to save money. Look, for instance, at Lipitor, which is unlikely to have much more sales growth. Why? Part of the reason is that a competing drug, Merck's Zocor, lost its patent protection and is now available in generic form. Pfizer can argue, as it does, that Lipitor is superior to generic Zocor. But it is not that much better. So a number of managed care companies have begun switching patients to the generic version, thus saving millions of dollars.
"In some ways," said Niko Canner, a consultant with Katzenbach Partners, "Big Pharma is a victim of its own success. There was a tremendous period when they were coming up with drugs for chronic diseases that affected lots of people. There is now a lot of very good generic product on the market. And while there have been significant innovations, there hasn't been a big wave like the last one."
And there's more: the science of drug discovery is changing in ways that favor small, nimble biotech companies. The new discoveries tend to be in areas like cancer, where companies can charge very high prices for small populations - and where the sales force needs to be steeped in the science of the drug. Mr. Cutler believes that drugs are eventually going to be customized for individuals - and the kind of broadly available drugs Big Pharma has been so good at producing, requiring huge clinical trials, simply won't make sense anymore.
Mr. McKinnell, Pfizer's former chief executive, was wedded to the blockbuster model; in retrospect, it seems obvious that that is part of the reason he no longer has his job. (He also had very little credibility on Wall Street, and wasn't well liked within the company.) In his announcement this week, Mr. Kindler talked about needing to make the sales force operate differently, about turning its managed care customers into partners instead of foes, and about getting as good at developing $500 million drugs as in coming up with new blockbusters.
He was speaking in code, but if you were attuned to it, the message was clear. He wants to wean Pfizer from its blockbuster culture. But even with 10,000 fewer employees, Pfizer is still a very big company, and very set in its ways. It had a great deal of success doing things one way. And however much its people may say they want to change and thrive, Mr. Kindler is about to discover the same thing executives in the newspaper and auto industries already know. It's hard to teach an old dog new tricks. 28.7.07
Pfizer Pledges To Cut Research To Maintain Earnings
The world's largest drug company is starting to shrink. Pfizer announced fourth quarter earnings this morning that beat analyst expectations, on an adjusted basis, by a penny, and lowered its 2012 sales forecast by roughly $2 billion, or 3%, bringing it more in line with what Wall Street actually expects.
But the world's largest drug company also promised that its 2012 earnings per share forecast would remain unchanged – and it will get there by further cuts to its already battered research laboratories.
Pfizer said that it would close its research laboratories in Sandwich, U.K. where Viagra was invented. The total R&D budge will be cut from an expected $8.5 billion in 2012 to between $6.5 billion and $7 billion.
New chief executive Ian Read, who ascended to the job after predecessor Jeffrey Kindler quit or was pushed out late last year, is signaling to investors that he will do what it takes to maintain per share earnings, even if that means cutting Pfizer's R&D deeply.
The biggest reason for the drop in sales will be the expiration of the U.S. patent protecting Lipitor, the world's best-selling drug with sales of $10.7 billion. The drug will remain a blockbuster for years thanks to sales in some global markets – it could be Pfizer's second biggest drug in 2015 — but sales are expected to drop by $7 billion or more over the coming years. That will still be among the largest research budgets in the drug business, and a third of the total budget of the National Institutes of Health.
Read has little choice but to punish his labs, which have been famously unproductive. Pfizer has gone a decade spending more than any other company with only a handful of moderate-sized successes, including the pain medicine Lyrica and the cancer drug Sutent. There are a few promising drugs in development, including a new rheumatoid arthritis pill, but none of them are expected to crack the drugmaker's top five in the next five years. The biggest product, the vaccine Prevnar, came from Pfizer's acquisition of Wyeth next year.
On Pfizer's earnings call – beginning soon – Read will start to set priorities for the company going forward. One thing seems certain: The world's largest drug company is not going to get any bigger. 2.2.11
Placebo Effect Regularly Beats Pharmaceutical Drugs
A Wired UK article just told us a dirty little secret that the pharmaceutical drug world would rather keep quiet. That fact is: drugs are having a difficult time beating the placebo effect, and increasingly so. In fact, they're finding the placebo effect is getting stronger in people, making it more difficult for drugs to show any improvement over it. The credit for the increased placebo effect has been attributed to the increase in consumer advertising, which makes many consumers "believe" more in the drugs and their effects.
Because the placebo effect is getting stronger, many widely distributed drugs would have had a hard time getting approval to begin with, if they were tested against today's placebo effect. Many drugs, notably Prozac, have also been shown to falter when compared to placebo - after they're already on the market.
A Saatchi & Saatchi advertising executive explains the key to producing a good pharmaceutical ad: it's in making the association between the drug and other aspects of life that promote peace of mind, like playing with your kids or reading a good book.
It's Madison Avenue type stuff, designed to play on your emotions and specifically, to boost sales. These messages appear to be working because many people keep calling on doctors for more drugs, which is the drug company's number one goal. But, interestingly, the same mechanism also seems to be messing up the new drug approval process for drug companies.
Wired tells us, "The fact that an increasing number of medications are unable to beat alleged 'sugar pills' [see placebo fraud] has thrown the industry into crisis" and that "half of all drugs that fail in late-stage trials drop out because of their inability to beat the control pills." Eli Lilly's next-generation antidepressants haven't been doing better than a placebo in seven out of ten trials. It wasn't long ago that Merck withdrew its "highly anticipated medical breakthrough" antidepressant for the same reason; it didn't beat placebo pill.
It's interesting because placebo pills are often sugar pills, and sugar is known to depress the immune system for hours after it's taken. So, in truth, drug companies are having a difficult time competing against an immune system depressant .
William Potter, psychiatrist turned Eli Lilly drug developer, found himself baffled by the evidence that drugs he'd long been prescribing were now failing against placebos. So, he started digging around in Eli Lilly's trial database, a database that included trials the company didn't make public and preferred to keep quiet.
Inside that database, Potter found there were tremendous differences in the results of drug trials, based on things like the size and color of the pills, and even where in the world the trial was located.
For example, blue tranquilizer pills have better effects than red pills, even with the same stuff inside. This is the case in all but Italian men, which with whom the color blue is associated with their national football team. And Valium often beats the placebo in France and Belgium , but regularly fails in the U.S.
Other research has found that patients do better with a caring doctor who takes time with them, compared to a non-caring doctor who doesn't bother with communication, even if they are both given the same placebo.
These random factors can sway drug trials one way or the other, yet drug companies aren't required to submit for regulatory review all of the tests they run on a particular drug. They can submit just the ones they do well in and keep the ones that they fail to themselves, even if the factors for "doing well" are as esoteric (and non-scientific) as the color of the pill given, the branding of the pill, the price of the pill, or which country the trial was held.
Fabrizio Benedetti studied the placebo effect on his own, because funding couldn't be found to study something the drug industry considers to be getting in the way of profits.
Building on previous research, Benedetti found that when someone is given a pill, the brain expects change to happen. Based on that expectation, the brain often then starts producing its own pain-relieving medicine, which can reduce pain and even regulate heart and respiratory functionality.
Instead of working to understand how the body can heal itself, drug companies see this, the placebo effect, as a nuisance. In fact, these days, daily doses of immune-depressing sugar pills might cause bigger problems for drug companies than their direct competitors do.
It'd be curious to see what would happen if the sugar pills were replaced with a whole foods diet, or supplementation with placebo herbs like cat's claw, garlic, or other known immune system enhancers. Perhaps, this should become the standard for the testing of pharmaceutical drugs, as testing against substances that are known to depress the immune system isn't really a level playing field, even if the drug companies are routinely failing.
Of course, if this were to happen, far fewer drugs would pass the already flimsy approval requirements that allow for the cherry picking of data and hiding of negative results. And this isn't something the drug industry wants. Natural News 30.9.09
Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why
Merck was in trouble. In 2002, the pharmaceutical giant was falling behind its rivals in sales. Even worse, patents on five blockbuster drugs were about to expire, which would allow cheaper generics to flood the market. The company hadn't introduced a truly new product in three years, and its stock price was plummeting.
In interviews with the press, Edward Scolnick, Merck's research director, laid out his battle plan to restore the firm to preeminence. Key to his strategy was expanding the company's reach into the antidepressant market, where Merck had lagged while competitors like Pfizer and GlaxoSmithKline created some of the best-selling drugs in the world. "To remain dominant in the future," he told Forbes , "we need to dominate the central nervous system."
His plan hinged on the success of an experimental antidepressant codenamed MK-869. Still in clinical trials, it looked like every pharma executive's dream: a new kind of medication that exploited brain chemistry in innovative ways to promote feelings of well-being. The drug tested brilliantly early on, with minimal side effects, and Merck touted its game-changing potential at a meeting of 300 securities analysts.
Behind the scenes, however, MK-869 was starting to unravel. True, many test subjects treated with the medication felt their hopelessness and anxiety lift. But so did nearly the same number who took a placebo, a look-alike pill made of milk sugar or another inert substance given to groups of volunteers in clinical trials to gauge how much more effective the real drug is by comparison. The fact that taking a faux drug can powerfully improve some people's health—the so-called placebo effect—has long been considered an embarrassment to the serious practice of pharmacology.
Ultimately, Merck's foray into the antidepressant market failed. In subsequent tests, MK-869 turned out to be no more effective than a placebo. In the jargon of the industry, the trials crossed the futility boundary.
MK-869 wasn't the only highly anticipated medical breakthrough to be undone in recent years by the placebo effect. From 2001 to 2006, the percentage of new products cut from development after Phase II clinical trials, when drugs are first tested against placebo, rose by 20 percent. The failure rate in more extensive Phase III trials increased by 11 percent, mainly due to surprisingly poor showings against placebo. Despite historic levels of industry investment in R&D, the US Food and Drug Administration approved only 19 first-of-their-kind remedies in 2007—the fewest since 1983—and just 24 in 2008. Half of all drugs that fail in late-stage trials drop out of the pipeline due to their inability to beat sugar pills.
The upshot is fewer new medicines available to ailing patients and more financial woes for the beleaguered pharmaceutical industry. Last November, a new type of gene therapy for Parkinson's disease, championed by the Michael J. Fox Foundation, was abruptly withdrawn from Phase II trials after unexpectedly tanking against placebo. A stem-cell startup called Osiris Therapeutics got a drubbing on Wall Street in March, when it suspended trials of its pill for Crohn's disease, an intestinal ailment, citing an "unusually high" response to placebo. Two days later, Eli Lilly broke off testing of a much-touted new drug for schizophrenia when volunteers showed double the expected level of placebo response.
It's not only trials of new drugs that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late '90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.
It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.
The fact that an increasing number of medications are unable to beat sugar pills has thrown the industry into crisis. The stakes could hardly be higher. In today's economy, the fate of a long-established company can hang on the outcome of a handful of tests.
Why are inert pills suddenly overwhelming promising new drugs and established medicines alike? The reasons are only just beginning to be understood. A network of independent researchers is doggedly uncovering the inner workings—and potential therapeutic applications—of the placebo effect. At the same time, drugmakers are realizing they need to fully understand the mechanisms behind it so they can design trials that differentiate more clearly between the beneficial effects of their products and the body's innate ability to heal itself. A special task force of the Foundation for the National Institutes of Health is seeking to stem the crisis by quietly undertaking one of the most ambitious data-sharing efforts in the history of the drug industry. After decades in the jungles of fringe science, the placebo effect has become the elephant in the boardroom.
The roots of the placebo problem can be traced to a lie told by an Army nurse during World War II as Allied forces stormed the beaches of southern Italy. The nurse was assisting an anesthetist named Henry Beecher, who was tending to US troops under heavy German bombardment. When the morphine supply ran low, the nurse assured a wounded soldier that he was getting a shot of potent painkiller, though her syringe contained only salt water. Amazingly, the bogus injection relieved the soldier's agony and prevented the onset of shock.
Returning to his post at Harvard after the war, Beecher became one of the nation's leading medical reformers. Inspired by the nurse's healing act of deception, he launched a crusade to promote a method of testing new medicines to find out whether they were truly effective. At the time, the process for vetting drugs was sloppy at best: Pharmaceutical companies would simply dose volunteers with an experimental agent until the side effects swamped the presumed benefits. Beecher proposed that if test subjects could be compared to a group that received a placebo, health officials would finally have an impartial way to determine whether a medicine was actually responsible for making a patient better.
In a 1955 paper titled "The Powerful Placebo," published in The Journal of the American Medical Association , Beecher described how the placebo effect had undermined the results of more than a dozen trials by causing improvement that was mistakenly attributed to the drugs being tested. He demonstrated that trial volunteers who got real medication were also subject to placebo effects; the act of taking a pill was itself somehow therapeutic, boosting the curative power of the medicine. Only by subtracting the improvement in a placebo control group could the actual value of the drug be calculated.
The article caused a sensation. By 1962, reeling from news of birth defects caused by a drug called thalidomide, Congress amended the Food, Drug, and Cosmetic Act, requiring trials to include enhanced safety testing and placebo control groups. Volunteers would be assigned randomly to receive either medicine or a sugar pill, and neither doctor nor patient would know the difference until the trial was over. Beecher's double-blind, placebo-controlled, randomized clinical trial—or RCT—was enshrined as the gold standard of the emerging pharmaceutical industry. Today, to win FDA approval, a new medication must beat placebo in at least two authenticated trials.
Beecher's prescription helped cure the medical establishment of outright quackery, but it had an insidious side effect. By casting placebo as the villain in RCTs, he ended up stigmatizing one of his most important discoveries. The fact that even dummy capsules can kick-start the body's recovery engine became a problem for drug developers to overcome, rather than a phenomenon that could guide doctors toward a better understanding of the healing process and how to drive it most effectively.
In his eagerness to promote his template for clinical trials, Beecher also overreached by seeing the placebo effect at work in curing ailments like the common cold, which wane with no intervention at all. But the triumph of Beecher's gold standard was a generation of safer medications that worked for nearly everyone. Anthracyclines don't require an oncologist with a genial bedside manner to slow the growth of tumors.
What Beecher didn't foresee, however, was the explosive growth of the pharmaceutical industry. The blockbuster success of mood drugs in the '80s and '90s emboldened Big Pharma to promote remedies for a growing panoply of disorders that are intimately related to higher brain function. By attempting to dominate the central nervous system, Big Pharma gambled its future on treating ailments that have turned out to be particularly susceptible to the placebo effect.
The tall, rusty-haired son of a country doctor, William Potter, 64, has spent most of his life treating mental illness—first as a psychiatrist at the National Institute of Mental Health and then as a drug developer. A decade ago, he took a job at Lilly's neuroscience labs. There, working on new antidepressants and antianxiety meds, he became one of the first researchers to glimpse the approaching storm.
To test products internally, pharmaceutical companies routinely run trials in which a long-established medication and an experimental one compete against each other as well as against a placebo. As head of Lilly's early-stage psychiatric drug development in the late '90s, Potter saw that even durable warhorses like Prozac, which had been on the market for years, were being overtaken by dummy pills in more recent tests. The company's next-generation antidepressants were faring badly, too, doing no better than placebo in seven out of 10 trials.
As a psychiatrist, Potter knew that some patients really do seem to get healthier for reasons that have more to do with a doctor's empathy than with the contents of a pill. But it baffled him that drugs he'd been prescribing for years seemed to be struggling to prove their effectiveness. Thinking that something crucial may have been overlooked, Potter tapped an IT geek named David DeBrota to help him comb through the Lilly database of published and unpublished trials—including those that the company had kept secret because of high placebo response. They aggregated the findings from decades of antidepressant trials, looking for patterns and trying to see what was changing over time. What they found challenged some of the industry's basic assumptions about its drug-vetting process.
Assumption number one was that if a trial were managed correctly, a medication would perform as well or badly in a Phoenix hospital as in a Bangalore clinic. Potter discovered, however, that geographic location alone could determine whether a drug bested placebo or crossed the futility boundary. By the late '90s, for example, the classic antianxiety drug diazepam (also known as Valium) was still beating placebo in France and Belgium. But when the drug was tested in the US, it was likely to fail. Conversely, Prozac performed better in America than it did in western Europe and South Africa. It was an unsettling prospect: FDA approval could hinge on where the company chose to conduct a trial.
Mistaken assumption number two was that the standard tests used to gauge volunteers' improvement in trials yielded consistent results. Potter and his colleagues discovered that ratings by trial observers varied significantly from one testing site to another. It was like finding out that the judges in a tight race each had a different idea about the placement of the finish line.
Potter and DeBrota's data-mining also revealed that even superbly managed trials were subject to runaway placebo effects. But exactly why any of this was happening remained elusive. "We were able to identify many of the core issues in play," Potter says. "But there was no clear answer to the problem." Convinced that what Lilly was facing was too complex for any one pharmaceutical house to unravel on its own, he came up with a plan to break down the firewalls between researchers across the industry, enabling them to share data in "pre-competitive space."
After prodding by Potter and others, the NIH focused on the issue in 2000, hosting a three-day conference in Washington. For the first time in medical history, more than 500 drug developers, doctors, academics, and trial designers put their heads together to examine the role of the placebo effect in clinical trials and healing in general.
Potter's ambitious plan for a collaborative approach to the problem eventually ran into its own futility boundary: No one would pay for it. And drug companies don't share data, they hoard it. But the NIH conference launched a new wave of placebo research in academic labs in the US and Italy that would make significant progress toward solving the mystery of what was happening in clinical trials.
Visitors to Fabrizio Benedetti's clinic at the University of Turin are asked never to say the P-word around the med students who sign up for his experiments. For all the volunteers know, the trim, soft-spoken neuroscientist is hard at work concocting analgesic skin creams and methods for enhancing athletic performance.
One recent afternoon in his lab, a young soccer player grimaced with exertion while doing leg curls on a weight machine. Benedetti and his colleagues were exploring the potential of using Pavlovian conditioning to give athletes a competitive edge undetectable by anti-doping authorities. A player would receive doses of a performance-enhancing drug for weeks and then a jolt of placebo just before competition.
Benedetti, 53, first became interested in placebos in the mid-'90s, while researching pain. He was surprised that some of the test subjects in his placebo groups seemed to suffer less than those on active drugs. But scientific interest in this phenomenon, and the money to research it, were hard to come by. "The placebo effect was considered little more than a nuisance," he recalls. "Drug companies, physicians, and clinicians were not interested in understanding its mechanisms. They were concerned only with figuring out whether their drugs worked better."
Part of the problem was that response to placebo was considered a psychological trait related to neurosis and gullibility rather than a physiological phenomenon that could be scrutinized in the lab and manipulated for therapeutic benefit. But then Benedetti came across a study, done years earlier, that suggested the placebo effect had a neurological foundation. US scientists had found that a drug called naloxone blocks the pain-relieving power of placebo treatments. The brain produces its own analgesic compounds called opioids, released under conditions of stress, and naloxone blocks the action of these natural painkillers and their synthetic analogs. The study gave Benedetti the lead he needed to pursue his own research while running small clinical trials for drug companies.
Now, after 15 years of experimentation, he has succeeded in mapping many of the biochemical reactions responsible for the placebo effect, uncovering a broad repertoire of self-healing responses. Placebo-activated opioids, for example, not only relieve pain; they also modulate heart rate and respiration. The neurotransmitter dopamine, when released by placebo treatment, helps improve motor function in Parkinson's patients. Mechanisms like these can elevate mood, sharpen cognitive ability, alleviate digestive disorders, relieve insomnia, and limit the secretion of stress-related hormones like insulin and cortisol.
In one study, Benedetti found that Alzheimer's patients with impaired cognitive function get less pain relief from analgesic drugs than normal volunteers do. Using advanced methods of EEG analysis, he discovered that the connections between the patients' prefrontal lobes and their opioid systems had been damaged. Healthy volunteers feel the benefit of medication plus a placebo boost. Patients who are unable to formulate ideas about the future because of cortical deficits, however, feel only the effect of the drug itself. The experiment suggests that because Alzheimer's patients don't get the benefits of anticipating the treatment, they require higher doses of painkillers to experience normal levels of relief.
Benedetti often uses the phrase "placebo response" instead of placebo effect. By definition, inert pills have no effect, but under the right conditions they can act as a catalyst for what he calls the body's "endogenous health care system." Like any other internal network, the placebo response has limits. It can ease the discomfort of chemotherapy, but it won't stop the growth of tumors. It also works in reverse to produce the placebo's evil twin, the nocebo effect. For example, men taking a commonly prescribed prostate drug who were informed that the medication may cause sexual dysfunction were twice as likely to become impotent.
Further research by Benedetti and others showed that the promise of treatment activates areas of the brain involved in weighing the significance of events and the seriousness of threats. "If a fire alarm goes off and you see smoke, you know something bad is going to happen and you get ready to escape," explains Tor Wager, a neuroscientist at Columbia University. "Expectations about pain and pain relief work in a similar way. Placebo treatments tap into this system and orchestrate the responses in your brain and body accordingly."
In other words, one way that placebo aids recovery is by hacking the mind's ability to predict the future. We are constantly parsing the reactions of those around us—such as the tone a doctor uses to deliver a diagnosis—to generate more-accurate estimations of our fate. One of the most powerful placebogenic triggers is watching someone else experience the benefits of an alleged drug. Researchers call these social aspects of medicine the therapeutic ritual.
In a study last year, Harvard Medical School researcher Ted Kaptchuk devised a clever strategy for testing his volunteers' response to varying levels of therapeutic ritual. The study focused on irritable bowel syndrome, a painful disorder that costs more than $40 billion a year worldwide to treat. First the volunteers were placed randomly in one of three groups. One group was simply put on a waiting list; researchers know that some patients get better just because they sign up for a trial. Another group received placebo treatment from a clinician who declined to engage in small talk. Volunteers in the third group got the same sham treatment from a clinician who asked them questions about symptoms, outlined the causes of IBS, and displayed optimism about their condition.
Not surprisingly, the health of those in the third group improved most. In fact, just by participating in the trial, volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS. And the benefits of their bogus treatment persisted for weeks afterward, contrary to the belief—widespread in the pharmaceutical industry—that the placebo response is short-lived.
Studies like this open the door to hybrid treatment strategies that exploit the placebo effect to make real drugs safer and more effective. Cancer patients undergoing rounds of chemotherapy often suffer from debilitating nocebo effects—such as anticipatory nausea—conditioned by their past experiences with the drugs. A team of German researchers has shown that these associations can be unlearned through the administration of placebo, making chemo easier to bear.
Meanwhile, the classic use of placebos in medicine—to boost the confidence of anxious patients—has been employed tacitly for ages. Nearly half of the doctors polled in a 2007 survey in Chicago admitted to prescribing medications they knew were ineffective for a patient's condition—or prescribing effective drugs in doses too low to produce actual benefit—in order to provoke a placebo response.
The main objections to more widespread placebo use in clinical practice are ethical, but the solutions to these conundrums can be surprisingly simple. Investigators told volunteers in one placebo study that the pills they were taking were "known to significantly reduce pain in some patients." The researchers weren't lying.
These new findings tell us that the body's response to certain types of medication is in constant flux, affected by expectations of treatment, conditioning, beliefs, and social cues.
For instance, the geographic variations in trial outcome that Potter uncovered begin to make sense in light of discoveries that the placebo response is highly sensitive to cultural differences. Anthropologist Daniel Moerman found that Germans are high placebo reactors in trials of ulcer drugs but low in trials of drugs for hypertension—an undertreated condition in Germany, where many people pop pills for herzinsuffizienz , or low blood pressure. Moreover, a pill's shape, size, branding, and price all influence its effects on the body. Soothing blue capsules make more effective tranquilizers than angry red ones, except among Italian men, for whom the color blue is associated with their national soccer team— Forza Azzurri!
But why would the placebo effect seem to be getting stronger worldwide? Part of the answer may be found in the drug industry's own success in marketing its products.
Potential trial volunteers in the US have been deluged with ads for prescription medications since 1997, when the FDA amended its policy on direct-to-consumer advertising. The secret of running an effective campaign, Saatchi & Saatchi's Jim Joseph told a trade journal last year, is associating a particular brand-name medication with other aspects of life that promote peace of mind: "Is it time with your children? Is it a good book curled up on the couch? Is it your favorite television show? Is it a little purple pill that helps you get rid of acid reflux?" By evoking such uplifting associations, researchers say, the ads set up the kind of expectations that induce a formidable placebo response.
The success of those ads in selling blockbuster drugs like antidepressants and statins also pushed trials offshore as therapeutic virgins—potential volunteers who were not already medicated with one or another drug—became harder to find. The contractors that manage trials for Big Pharma have moved aggressively into Africa, India, China, and the former Soviet Union. In these places, however, cultural dynamics can boost the placebo response in other ways. Doctors in these countries are paid to fill up trial rosters quickly, which may motivate them to recruit patients with milder forms of illness that yield more readily to placebo treatment. Furthermore, a patient's hope of getting better and expectation of expert care—the primary placebo triggers in the brain—are particularly acute in societies where volunteers are clamoring to gain access to the most basic forms of medicine. "The quality of care that placebo patients get in trials is far superior to the best insurance you get in America," says psychiatrist Arif Khan, principal investigator in hundreds of trials for companies like Pfizer and Bristol-Myers Squibb. "It's basically luxury care."
Big Pharma faces additional problems in beating placebo when it comes to psychiatric drugs. One is to accurately define the nature of mental illness. The litmus test of drug efficacy in antidepressant trials is a questionnaire called the Hamilton Depression Rating Scale. The HAM-D was created nearly 50 years ago based on a study of major depressive disorder in patients confined to asylums. Few trial volunteers now suffer from that level of illness. In fact, many experts are starting to wonder if what drug companies now call depression is even the same disease that the HAM-D was designed to diagnose.
Existing tests also may not be appropriate for diagnosing disorders like social anxiety and premenstrual dysphoria—the very types of chronic, fuzzily defined conditions that the drug industry started targeting in the '90s, when the placebo problem began escalating. The neurological foundation of these illnesses is still being debated, making it even harder for drug companies to come up with effective treatments.
What all of these disorders have in common, however, is that they engage the higher cortical centers that generate beliefs and expectations, interpret social cues, and anticipate rewards. So do chronic pain, sexual dysfunction, Parkinson's, and many other ailments that respond robustly to placebo treatment. To avoid investing in failure, researchers say, pharmaceutical companies will need to adopt new ways of vetting drugs that route around the brain's own centralized network for healing.
Ten years and billions of R&D dollars after William Potter first sounded the alarm about the placebo effect, his message has finally gotten through. In the spring, Potter, who is now a VP at Merck, helped rev up a massive data-gathering effort called the Placebo Response Drug Trials Survey.
Under the auspices of the FNIH 1 , Potter and his colleagues are acquiring decades of trial data—including blood and DNA samples—to determine which variables are responsible for the apparent rise in the placebo effect. Merck, Lilly, Pfizer, AstraZeneca, GlaxoSmithKline, Sanofi-Aventis, Johnson & Johnson, and other major firms are funding the study, and the process of scrubbing volunteers' names and other personal information from the database is about to begin.
In typically secretive industry fashion, the existence of the project itself is being kept under wraps. FNIH staffers 2 are willing to talk about it only anonymously, concerned about offending the companies paying for it.
For Potter, who used to ride along with his father on house calls in Indiana, the significance of the survey goes beyond Big Pharma's finally admitting it has a placebo problem. It also marks the twilight of an era when the drug industry was confident that its products were strong enough to cure illness by themselves.
"Before I routinely prescribed antidepressants, I would do more psychotherapy for mildly depressed patients," says the veteran of hundreds of drug trials. "Today we would say I was trying to engage components of the placebo response—and those patients got better. To really do the best for your patients, you want the best placebo response plus the best drug response."
The pharma crisis has also finally brought together the two parallel streams of placebo research—academic and industrial. Pfizer has asked Fabrizio Benedetti to help the company figure out why two of its pain drugs keep failing. Ted Kaptchuk is developing ways to distinguish drug response more clearly from placebo response for another pharma house that he declines to name. Both are exploring innovative trial models that treat the placebo effect as more than just statistical noise competing with the active drug.
Benedetti has helped design a protocol for minimizing volunteers' expectations that he calls "open/hidden." In standard trials, the act of taking a pill or receiving an injection activates the placebo response. In open/hidden trials, drugs and placebos are given to some test subjects in the usual way and to others at random intervals through an IV line controlled by a concealed computer. Drugs that work only when the patient knows they're being administered are placebos themselves.
Ironically, Big Pharma's attempt to dominate the central nervous system has ended up revealing how powerful the brain really is. The placebo response doesn't care if the catalyst for healing is a triumph of pharmacology, a compassionate therapist, or a syringe of salt water. All it requires is a reasonable expectation of getting better. That's potent medicine. 24.8.09
The Truth About Drug Companies
The author calls the pharmaceutical industry a vast marketing machine that thrives on monopoly rights and public-sponsored research but produces few innovative drugs.
The high price of prescription drugs has put -- and kept -- U.S. pharmaceutical companies in the news recently, but Dr. Marcia Angell argues that problems with the industry run even deeper. In her new book, The Truth About Drug Companies: How They Deceive Us and What to Do About It the former editor of the New England Journal of Medicine contends that the industry has become a marketing machine that produces few innovative drugs and is dependent on monopoly rights and public-sponsored research.
Angell disputes the industry's reputation as an “engine of innovation,” arguing that the top U.S. drug makers spend 2.5 times as much on marketing and administration as they do on research. At least a third of the drugs marketed by industry leaders were discovered by universities or small biotech companies, writes Angell, but they're sold to the public at inflated prices. She cites Taxol, the cancer drug discovered by the National Institutes of Health, but sold by Bristol-Myers Squibb for $20,000 a year, reportedly 20 times the manufacturing cost. The company agreed to pay the NIH only 0.5 percent in royalties for the drug.
The majority of the new products the industry puts out, says Angell, are “me-too” drugs, which are almost identical to current treatments but “no better than drugs already on the market to treat the same condition.” Around 75 percent of new drugs approved by the FDA are me-too drugs. They can be less effective than current drugs, but as long as they're more effective than a placebo, they can get the regulatory green light.
Finally, Angell attacks major pharmaceutical industry -- whose top ten companies make more in profits than the rest of the Fortune 500 combined -- for using “free market” rhetoric while opposing competition at all costs. She discusses Prilosec maker Astra-Zeneca, which filed multiple lawsuits against generic drug makers to prevent them from entering the market when the company's exclusive marketing rights expired. The company “obtained a patent on the idea of combining Prilosec with antibiotics, then argued that a generic drug would infringe on that patent because doctors might prescribe it with an antibiotic.”
Angell, who is a doctor and a lecturer at Harvard Medical School , wants to see the industry reformed. She recently sat down with MotherJones.com to talk about how to “ensure that we have access to good drugs at reasonable prices and that the reality of this industry is finally brought into line with its rhetoric.”
MotherJones.com: Pharmaceutical companies say higher prices are necessary to pay for heavy R&D investment.
Marcia Angell: These companies are justifying extremely high prices by saying they need this money to cover their high R&D costs, and they're very innovative, and that we should be willing to spend the money in return for the innovation. In the book, I question those premises. I say that, yes, they spend a lot on R&D, but still they make more in profits, and they spend two to two-and-a-half times as much on what they call “marketing and administration.” If you want to argue that they need the high prices to cover R&D, it would make more sense to argue that they need the high prices even more to cover their marketing costs. I just want to put that in perspective. Also, their profits are enormously high. Until last year, [they were] the number one industry in the U.S. in terms of profits. In 2002, the top 10 American [pharmaceutical] companies in the Fortune 500 made 17 percent of their sales in profits, whereas they spent only 14 percent on R&D. The median for the other Fortune 500 companies was between 3 percent of sales. So, you can't make an argument that they're just eking out a living, just managing to cover their R&D costs.
MJ.com: Your numbers for how much companies spend to bring drugs to market are very different from the industry's. How come?
MA: The industry arrives at that $802 million [per drug] figure by looking at a tiny handful of the most costly drugs. Those are drugs that were developed entirely in-house, and that are new molecular entities. That's a very tiny handful of the drugs that come to market each year. They're the most expensive drugs. Second, even for those drugs, they come up with a figure of $403 million per highly selected drug. They then double that to $802 million simply by adding in what they call the “opportunity costs” — what they could have made if they'd spent the same money on investments. Third, the figure is inflated by not including the tax deductions and tax credits. They get very large tax deductions and credits. So the figure is highly inflated. That gets buried in the reporting of it. When you hear the figure, you hear it given with the implication that for any random new drug, that's what it costs to develop it. And that's just simply not so.
MJ.com: In your book, you charge that even some of what the industry calls R&D is actually marketing. Can you elaborate on that?
MA: Well, no one knows for sure what goes into the R&D budget, because the companies aren't telling. It's been estimated that about a quarter of it is spent on Phase IV clinical trials, many of which are just excuses to pay doctors to prescribe the drug. They don't yield any real scientific information. But no one knows for sure.
MJ.com: So should the pharmaceutical industry be making its books public?
MA: Yes, because it's an industry that is so dependent on the public for special favors. This industry, despite its free-market rhetoric, is on welfare big-time. It lives on taxpayer-funded research to a very great extent, and it lives on government-granted monopoly rights in the form of patents and FDA-conferred exclusivity. An industry that is so beholden to the public has some obligation in return. That includes opening their books. We ought to know more about their business. We ought to know whether the claims they make can really be justified.
MJ.com: Why should the industry have to open its books — or be asked to charge less for its products, for that matter — when other industries aren't held to those standards?
MA: The public is absolutely dependent on this industry for drugs that people need to take for their health and even their lives. So, I think there are some special obligations.
MJ.com: In the past you've written that “there can be no better example of something that does not belong in the market [than prescription drugs],” but you don't address that in the current book. Do you still think so?
MA: I don't think I've ever said that they should come off the market, but there need to be reforms that accomplish several things. [Pharmaceutical companies] have too much influence over the education of physicians in this country. They have too much control over the evaluation of their own products, and that's a conflict of interest. I think the industry needs to be regulated, but I've never suggested taking it out of the market altogether. It's now a funny mix of free enterprise and welfare. On the one hand, it is free to choose to make whatever drugs it wants to make. If it wants to make one more me-too drug, it's free to do that instead of making an antibiotic that may really be needed. It's free to charge whatever the market will bear in this country. And at the same time, it claims all sorts of special favors. It claims that Americans should not be allowed to purchase drugs in any other country. It claims the right to license taxpayer-funded research. It not only claims the right to very long patents, but extends them in all kinds of quite dubious ways. Now, this is hardly free enterprise.
MJ.com: In terms of licensing drugs from publicly-funded institutions, how much do companies generally pay? Is it relative to how much they charge?
MA: I don't know. I know in the case of Taxol, it was very little. In general, when companies license a drug from universities, it's not all that much compared with the profits. They're licensing now from small biotechs as well. The industry likes to portray itself as the engine of innovation, but in fact its major products are me-too drugs—minor variations of drugs already on the market. For example, we have six cholesterol-lowering statins on the market right now; we have five SSRI anti-depressants; we have nine ACE inhibitors to treat high blood pressure. If you look at the top-selling drugs on the market right now, most of them are me-too drugs, and the original of these drugs came on the market back in the ‘80s, or even earlier. The companies have been stringing out variations on the themes ever since. The original drugs were usually based on government university research.
MJ.com: Regarding me-too drugs, can't one make the argument that there should be as many different variations of a drug as possible on the market? Shouldn't the market decide?
MA: We have an FDA because what drugs to sell isn't something for the markets alone to decide. It's also a technical decision that requires scientific evidence. The companies don't want to provide that evidence. They don't test their me-too drugs against other me-too drugs at comparable doses for the same conditions. The companies also make the case that there need to be several me-too drugs on the market because if one doesn't work, maybe another one will. But until they test that, it's just an assertion. They don't test their me-too drugs in people who have not done well with an earlier drug of the same class. They have to do that in order to prove that assertion. I suspect that in most cases, a second drug will not work any better, since me-too drugs are so similar, but no one can know until it's tested.
MJ.com: Speaking of the FDA, you characterize the agency as one that facilitates new drugs, rather than regulating them. To what degree is the agency controlled by the industry it's supposed to regulate?
MA: Too much. The FDA now gets “user fees” from drug companies—about a half a million dollars for any drug that the FDA reviews. Those user fees are small for the companies, but it's a substantial part of the FDA budget. In fact, it's more than half [the budget for] the Center for Disease Evaluation and Research, which is responsible for approving new drugs. In return, the FDA is supposed to review drugs faster.
MJ.com: So you would propose getting rid of those user fees?
MA: Absolutely. I think that the FDA should be funded adequately by taxpayers, and it should see taxpayers as the “users.” It should not be funded by the industry it's supposed to be regulating.
MJ.com: One of the changes you propose in this book is that the NIH -- and not drug companies -- be responsible for clinical research. But you propose that drug companies help pay the NIH to do this. Couldn't this lead to a similar problem?
MA: No, because instead of paying user fees by drug , companies would be levied a very small percentage of their revenues. It wouldn't be tied to research on any particular drug. This would be only for clinical trials, not the early development stage. The NIH would put out contracts to universities and medical centers to actually design and carry out the clinical trials, but the NIH would have oversight.
MJ.com: FDA commissioner Lester Crawford recently warned against buying drugs from Canada , citing potential terrorist threat if drugs are tampered with. Is there a valid concern there?
MA: There's no reason to think that drugs that are imported from Canada are any more likely to be unsafe than drugs that one gets right here. In fact, the cases of counterfeiting that I know of have all occurred in this country. So there's some reason to think that maybe it's safer to get your drugs from Canada [laughs]. The drugs that an American would purchase from Canada are going to be the drugs that they ordinarily pay much more for here—that is, FDA-approved drugs. They're not going to be buying just something in a bottle; they're going to be buying FDA-approved drugs that were shipped to Canada from European and American companies which have manufacturing plants all over the world. We have to remember that drugs are crossing borders all the time. Pfizer, for example, said on its website last year that it had 60 manufacturing plants in 32 countries. That right there constitutes a lot of borders. There's nothing about the Canadian border that's going to render these drugs poison. It's a scare tactic. What the industry does not want people to realize is the great price disparities between the United States and every other advanced country.
MJ.com: In the past, you've criticized the U.S. health care system, saying that “if we had set out to design the worst system we could imagine, we couldn't have imagined one as bad as this.” Do you still believe that?
MA: The market-based pharmaceutical industry is one problem in the larger problem of a market-based health care system. We spend twice as much per person on health care as the average of all the other advanced countries, and that gap is growing. Yet, we get less for our money. We have over 40 million people with no insurance at all. Most of the rest of us are under-insured. The usual indices of health, like life expectancy and infant mortality, are toward the bottom in the U.S. compared with other advanced countries. So, something's wrong, and it's the system. A market-based system distributes health care as a commodity according to the ability to pay, instead of as a social service distributed according to need. Yet, there's an inverse relationship between one's ability to pay for health care and one's medical needs. The situation gets crazier when you allow competing, investor-owned insurance companies to insure Americans, because they have learned that the best way to compete is to keep costs down by skimping on health services. We have the only health care system on the world that's based on dodging sick people. [Insurers] do everything they can to avoid covering people at high risk of getting ill, and when they do get ill, [companies] fight paying for it. They exclude certain expensive conditions as much as possible. They pass those costs back to the patient or another insurer. And that takes a lot of paperwork, and a lot of overhead.
MJ.com: In the book, you mention that every other developed nation regulates prescription drug prices—
MA: Yes, but they have different ways of doing it. If you look at Canada , it's a very mild form of regulation, really. They have a national board, and when a me-too drug comes on the market, they say it can't be priced any higher than the highest-priced drug for that condition already on the market. Nor can it be priced any higher than the median in seven advanced countries, and these countries include the U.S. Then they say the prices cannot rise any faster than the inflation rate. So, that's not too onerous. Drug companies make profits in Canada .
MJ.com: Is that an example of a system you'd like to see in the U.S. ?
MA: Yes. Importing drugs from Canada is not a very sensible solution, because Canada can't possibly supply the U.S. , and the drug companies are now retaliating against Canada and squeezing their supplies. So, importation is not a long-term solution. It's just a symptom of the real problem of price-gouging in this country. We should be looking at the Canadian system, and maybe import that rather than importing the drugs.
MJ.com: Realistically, do you think a system of price controls like that could ever be instituted in the U.S. ?MA: Well, something's going to have to happen, because there's no one around any longer who can afford the drug company prices. Not only are individuals having problems, but states are having problems. They feel these prices through the Medicaid system. The federal government is going to find that this fairly open-ended Medicare drug benefit is going to be completely outpaced by the rising prices.
MJ.com: If pharmaceutical manufacturers were forced to lower prices, couldn't it backfire if they cut back on research as a result, rather than marketing?
MA: Well, they might choose to do that, but they wouldn't have to. They could cut their marketing instead, or they could cut into their profits. Their R&D very often comes from the NIH or other publicly sponsored research. Most of their R&D expenditures go for clinical testing after the creative work is already done. This is true for the most innovative drugs, as well as for cancer and HIV/AIDS drugs.
MJ.com: You say that there's “palpable” discontent among seniors and others about drug prices. Do you see this as having an effect on the problems you described in the book?MA: I think that there are political effects, and I think that's what you're seeing right now with the importation issue. Congress has passed a law saying that you can import drugs from Canada , but that the administration must certify that it not add any risks. Both the Clinton and Bush administrations have refused to do that. It's giving Congress an opportunity to play both sides of the street.
MJ.com: Given that Congress is torn between seniors and the pharmaceutical lobby, do you think change will ever occur?
MA: I think that the public doesn't seem to be buying the argument that drugs from Canada are dangerous. If it comes down to choosing between the money that drug companies provide and the votes that citizens provide, I think members of Congress are going to go with votes. That's what I hope will happen.
MJ.com: In the conclusion of the book, you stress that citizens should grill their doctors regarding drugs they're prescribing. Why do you recommend that type of action most heavily?
MA: The other reforms will take time, but in the meantime, doctors are too willing to provide drugs for very minor conditions. Those drugs are too often the very most expensive, heavily advertised, me-too drugs. I think that patients have to get a little savvier about that. Instead of just grabbing that sample and thinking they've gotten something for free, they ought to think about what it means. Nearly every drug has side effects. I do think that we are an overmedicated society. 14.1.11
Health Advocacy Groups Take Drug Company Cash—Often Without Full Disclosures
We've reported extensively on the ties between pharmaceutical companies and the physicians they fund to speak, consult and do research. But doctors aren't the only ones taking money from drug companies—and they're not the only stakeholders in the field of health whose public disclosures aren't complete.
According to a new study in the American Journal of Public Health, not-for-profit health advocacy groups like the American Diabetes Association and the National Alliance on Mental Illness also get money from drug companies in the form of grants that—more often than not—aren't disclosed by those groups.
The study examined more than 160 health advocacy organizations that received funding from Eli Lilly in the first half of 2007. (Lilly was the first company to make its grant registry public.) Here's what the analysis found:
As an aggregate, only 25% of HAOs acknowledged Lilly funding anywhere on their Web site. Eighteen percent acknowledged Lilly in their 2007 annual report, 1% acknowledged Lilly on a corporate sponsors page, and 10% acknowledged Lilly as the sponsor of the grant event reported in the [Lilly Grant Registry.]
Health advocacy groups often advocate for research and the approval of new drugs on top of promoting public awareness. According to the study, their reputation as a trusted resource for information on specific diseases and their treatments should prompt “far more detailed” disclosure of their corporate grants and industry relationships.
This report isn't the first time such ties have been spotlighted.
The National Alliance on Mental Illness, or NAMI, came under similar scrutiny back in 2009 when Sen. Charles Grassley, a top Republican, began making inquiries.
From 2006 to 2008, the group took in nearly $23 million in drug company donations—about three-quarters of its fund-raising. At the time, NAMI's executive director told The New York Times that “the percentage of money from pharma has been higher than we have wanted it to be” and promised greater disclosures.
Following the revelations about NAMI, Sen. Charles Grassley sent letters to 33 health advocacy groups asking them to disclose details about their financial ties to drug and device makers. He has not released the responses he received from the groups.
Today's report, however, highlighted continued concerns about the degree to which a group's funding influences its advocacy and helps boost sales for drug companies making donations. Here's an example from the report, involving NAMI:
This lack of transparency is disappointing because, either by design or through a convergence of interests, the HAOs in the current study pursued activities that promoted the sale of Lilly products.
In the area of neurosciences, Lilly gave NAMI $450,000 for its Campaign for the Mind of America. NAMI has advocated that cost should not be a consideration when prescribing for patients. ‘‘For the most severely disabled,'' insisted NAMI, ‘‘effective treatment often means access to the newest medications such as atypical anti-psychotic and anti-depressive agents. . . . Doctors must be allowed to utilize the latest breakthrough in medical science . . . without bureaucratic restrictions to the access for life-saving medications.''To the degree that NAMI's campaign succeeded, the market for Lilly's neuroscience drugs expanded.
As we've noted, the health care law contains a provision requiring greater disclosure of drug company payments to physicians by 2013, but it does not include company payments to health advocacy organizations. Propublica 14.1.11
NHS patients to be offered free private treatment... as long as it doesn't cost any more
NHS patients will be able to get free treatment almost anywhere they want – public or private – under radical reforms unveiled today. Health Secretary Andrew Lansley will change the law to allow the public to choose where they would like to be treated, as long as it meets NHS standards and doesn't cost the taxpayer more.
Patients will even be able to pick their GP and decide which clinical team treats them in hospital, while communities will get greater powers to stop the closure of maternity and A&E departments. No closure will go ahead unless local GPs and councillors on new 'health and wellbeing boards' sign off hospital plans.
The changes are part of the Health and Social Care Bill, to be introduced to the Commons today by Mr Lansley. Patients can already access private treatment paid for by the NHS if they have waited almost 18 weeks, but the coalition wants to remove the time limit and increase the number of NHS-funded services carried out by the private and charity sectors.
The Bill will demand the abolition of all 152 primary care trusts – the NHS bodies run by managers who currently decide how Health Service money is spent. This power will be transferred to GPs in around 300 consortia across the country, who will have control of the bulk of the £100 billion health budget.
The NHS will also be encouraged to buy care from the charity and private sectors, rather than relying solely on state services.
The Government claims that the changes will save £5billion by 2015 – equivalent to 40,000 extra nurses or 17,000 extra doctors.
Mr Lansley said: ‘This Bill will modernise the NHS to give every patient the best chance of surviving an illness like cancer, and the best quality of life if they have a long-term condition like diabetes.'
The controversial legislation will also remove the Health Secretary's powers to intervene in the day-to-day running of the NHS. Instead the health service will be run by a new quango, the NHS Commissioning Board. Mr Lansley and future secretaries will be confined to setting the national strategy of the NHS and laying down national priorities.
Unions have criticised the reforms saying they are 'too much too soon.' And doctors' and nurses' leaders warned that creating greater commercial competition between the NHS and private firms could be 'potentially disastrous.'
On Monday, Prime Minister David Cameron defended the Government's reforms of public services. 'Pretending that there is some 'easy option' of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction,' he said. 'Put another way: it's not that we can't afford to modernise; it's that we can't afford not to modernise.'
A report released yesterday by the cross-party Commons Health Committee said ministers had failed to show the plans represent the most 'efficient' way of delivering good patient care. While supporting the overall direction of the reforms, MPs said they were 'surprised' by the 'significant policy shift' between coalition promises made in May and the plans set out in the health white paper in July. They added that the proposals for a 'disruptive reorganisation' of the NHS had been made with little prior discussion. 19.1.11
Competition is good for the NHS
The health secretary is right to bring competition into the health service, but he should give more control to patients and citizens.
While tuition fees may have grabbed the headlines, Andrew Lansley, the secretary of State for health, has faced fire from almost every quarter over his plans for the NHS. There is little clear narrative behind the opposition, but concern typically has focused on moves to introduce greater competition.
Such unease is wide of the mark. Yes, the effectiveness of competition, particularly in a field such as healthcare, depends significantly on getting the "rules of the game" right. But this can be achieved: recent academic evidence suggests that what competition there has been in the NHS has driven clinical quality, improved management and reduced waiting times.
The fact is that, in its current form, the NHS is failing as a progressive means for providing high-quality healthcare. Inequalities in health, far from narrowing, actually widened over Labour's time in office: travel from Kensington to Tottenham and life expectancy drops by as much as 17 years.
The root of the problem is that the NHS has too easily become a bureaucratic, centralised and self-gratifying machine, disconnected from the people and communities it is supposed to provide for; apparently either unable or unwilling to believe in the power of people and harness the goodwill of society.
One symptom of this is how perilously hard it is for people, communities, voluntary organisations and companies to get new ideas, that could bring benefit to patients, into the NHS. Just speak to Circle, now the largest partnership of doctors in Europe.
Another is the number of organisations providing poor quality care that are allowed to continue, as the recently published NHS Atlas reveals only too clearly. Foundation trust hospitals, the supposed vanguard for public membership of NHS organisations, have in many places become self-serving monopolies.
This is why competition is needed in the NHS; not on the basis of neoliberal dogma, but because competition, more than any other system, permits the pluralism for new ideas to flourish; new ideas the NHS so badly needs if it is to find a way out of the overarching difficulty it currently faces: getting greater value for every pound of taxpayer funding.
On competition, Lansley has got it right.
Where he has got it horribly wrong, however, is in commissioning. Here, he has plumbed for the archetype failed "market state" solution: reorganise to "liberalise". By 2013, all primary care trusts (PCTs) – the geographically based organisations charged with commissioning (ie buying) appropriate healthcare for their local populations – will be abolished, replaced with "consortiums" of general practice.
Lansley says this will bring the commissioning of healthcare closer to patients and empower healthcare professionals. In some areas the move will, no doubt, bring benefits. The reality, however, is that GP consortiums will be statutory bodies placed in the same hierarchical framework as PCTs, only this time reporting first and foremost to the latest Whitehall-based quango, the NHS commissioning board, and then to ministers.
There is also no guarantee that GPs will rise above the commercial interests they have as providers, and use commissioning to expand their own service offerings. And this is to say nothing of the risks involved in universally transferring £80bn of taxpayer resource from organisations (PCTs) that have built systems, processes and relationships supporting the commissioning of healthcare, to new organisations starting largely from scratch. A field day for management consultants is in the offing.
Of course, all is not well with PCTs – too many are simply mediocre. But Lansley has missed a trick. For one, there is much that could be done to improve their effectiveness without structural reform, not least by giving them the same political support and competitive tools now being given to GP consortiums.
More fundamentally, the secretary of state has missed the opportunity to truly turn accountability over to the people who the NHS is there to serve: you and I, patients and citizens. By putting in place a permissive and flexible framework by which PCTs could be mutualised rather than eradicated, Lansley could have found a cause that could unite right and left.
PCTs, controlling the purse strings in the NHS, could be owned by the populations they serve and run by boards representing them, with the possibility, also, of being supplemented or supplanted by local groups (including local citizens and GPs), depending on their performance.
These bodies could become new civic institutions, strengthening and nurturing local communities – the means by which people could really become involved in their health, with responsibilities as well as rights. It is not, yet, too late. 17.1.11
We cannot afford not to reform NHS, says David Cameron
The Government cannot afford to delay essential reform of Britain 's public services, David Cameron warned today. As ministers prepared to publish legislation to radically overhaul the NHS, the Prime Minister said that failure to modernise was draining resources away from the public sector.
In a keynote speech at the Royal Society of Arts in London, he dismissed suggestions that services could carry on as they were as "a complete fiction". The Government's plans for the NHS were denounced today by six health service unions - including the British Medical Association and the Royal College of Nursing - as "potentially disastrous".
But Mr Cameron insisted that change was essential.
"Every year without modernisation the costs of our public services escalate. Demand rises, the chains of commands can grow, costs may go up, inefficiencies become more entrenched. "Pretending that there is some 'easy option' of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction.
"We need modernisation, on both sides of the equation. Modernisation to do something about the demand for healthcare, which is about public health. And modernisation to make the supply of healthcare more efficient, which is about opening up the system, being competitive and cutting out waste and bureaucracy.
"Put another way: it's not that we can't afford to modernise; it's that we can't afford not to modernise." 17.1.11
The third sector could help the NHS to flourish
Britain 's charities and social enterprises are an untapped resource when it comes to health care, writes Stephen Bubb.
Andrew Lansley's health reforms – arguably the biggest shake-up of the NHS since its foundation in 1948 – go before Parliament for the first time next week, when the Coalition introduces its Health Bill into the Commons. Such a far-reaching upheaval, taking place against the background of the deepest cuts in public spending for 30 years, is undoubtedly a gamble. But the prize is worth the risk.
As someone who represents the leaders of charities and voluntary organisations up and down the country, the most exciting aspect of these changes to me is the opportunity for the so-called Third Sector to play a far greater role in delivering health care. There was a time before the state took over when all hospitals were run by charities; and while no one wants to return to those days, there is great potential for the creation of new employee-owned organisations and social enterprises.
In 2007/08, the NHS spent just 0.05 per cent of its healthcare budget on voluntary organisations. It is, in other words, a virtually untapped resource waiting to be used. Voluntary groups can compete against the private and statutory sectors, thereby freeing up NHS staff and delivering better care for the public. If we really want a “Big Society” then the NHS should – and can – be part of it.
But there are many vested interests – principally the health service unions – that will have none of this. They say the reforms are ideologically driven, essentially privatisation by another name. Competition, their argument goes, will benefit the shareholders of multinational private companies and should be opposed by anyone who cares about NHS patients and staff. They will try to dissuade NHS staff from playing a part in these reforms by calling them “a leap in the dark”. They will say that third sector organisations should not be competing with NHS providers, but should merely continue to provide optional extras, while leaving the bulk of care in the hands of the people who have always done it.
But this is a short-sighted approach. To me, competition in the NHS means British Red Cross volunteers being able to help more people adapt to life back at home after a lengthy spell in hospital, so preventing the need for readmission. Those who are supported in this way are often aged over 65 and have experienced a fall. Volunteers bring them home, settle them in, advise neighbours or relatives of their return, check on pets, help prepare a meal and make a further home visit the next day to ensure they are safe and well. Such schemes can save the typical NHS commissioner up to £1 million a year.
Competition in the NHS also means an environmental charity like BTCV running more "Green Gyms", which give people a physical work-out while taking part in environmental projects. So far, more than 10,000 people – often referred by their GPs – have taken part in this activity. An evaluation found that the positive impact on mental and physical health, not to mention the acquisition of new skills, means the state saves £153 for every £100 it invests. On top of that, it has a positive impact on local communities and the environment. Do we want less of this, or more? To me – and I suspect most of us – the answer is obvious. The people who rely most on the NHS are the vulnerable, the very people, indeed, who charities were set up to help precisely because they were let down by the status quo.
So if third sector organisations like the Red Cross and BTCV can do a better job than the NHS then we should let them. We also need charities to work more closely with GPs – who will be taking over responsibility for commissioning services - to ensure that they use the third sector more and are aware of what it can offer. These reforms could herald a new and dynamic relationship between local GPs and charities that both deliver good services and act as a powerful voice for patients.
We have in this country one of the most successful charity sectors in the world. It employs more people than banking and has a higher turnover than the car industry or farming. It can represent the people who rely on public services, especially those whose voices are not otherwise heard – the elderly and isolated, the mentally ill, ethnic minority communities - and ensure that the NHS responds to their needs and not just those with sharp elbows.
Moreover, as a provider of services, third sector organisations can promote innovation and quality. The health service unions are on the wrong side of this argument; but to make the most of the opportunities Lansley must commit himself to bold and practical reform, He has outlined his plans for more competition to deliver NHS services; now he needs to make that competition fair, tackling hard issues like the distortions created by the tax and pensions systems. Furthermore, he needs to make sure that when GPs take over the commissioning of NHS care, they understand the enormous potential offered by the country's charities and social enterprises.
These are the issues we need to deal with now to make the NHS properly responsive to the needs of the citizen. The obsession with “privatisation” is yesterday's debate. 14.1.11
GP's fear competition in the health service
GP commissioning is the bait which Howard Stoate has swallowed. There are good arguments for greater involvement of GPs in designing healthcare pathways, which is why a quarter of us are already nibbling at the idea. But he fails to mention all the accompanying reforms which cleverly reinforce each other to create the conditions for the marketisation of the NHS, with its attendant profit motive and explosion in transaction costs but also better care.
No mention is made of abolition of the fixed national tariff for provision of each service. This will lead to a race to the bottom, where competitive tenders will be won by the cheapest bids, as quality is so difficult to measure. The current fixed tariffs ensure competition on quality alone. No mention of Monitor, the body which will ensure awarding of all contracts is subject to European competition law, so preventing GPs from "anti-competitively" supporting their local hospital, if there is an alternative cheaper private provider.
Choice is an illusion to foster the market for competing providers. As a GP, I am uncertain of quality differences between my local hospital consultants, let alone those from multiple providers. Patients stand little chance of making rational choices when outcome data is so easy to manipulate. They always ask for one good local hospital. GPs will inevitably be guided by health management professionals in their commissioning decisions, which the private sector is eager to exploit. Why didn't the white paper just put a few keen GPs in charge of the existing PCTs and save the £3bn being used to create the conditions for an insidious private takeover of our NHS?
Critics said ‘GP's have had it their own way for too long the gravy train is over. The government wants to break the medical monopoly and introduce competition within the NHS to drive up standards, care, increase productivity and get a better deal for the tax-payer. Monolithic bureaucracy within the NHS needs to be tackled and the only way to do this is to make it competitive'. 14.1.11
Nearly 1,000 GPs earning £200,000: Ministers fail in effort to rein in doctors' pay
The number of GPs taking home more than £200,000 a year has risen – despite repeated promises by ministers to get to grips with doctors' pay.
Taxpayers funded these high salaries for no fewer than 950 family doctors in 2008/09 - up from 910 the year before. Critics expressed disbelief that the number of high-earning GPs has risen at a time of supposed financial austerity, even though ministers have tried to clamp down on pay.
Overall, the average salary has fallen slightly to £105,300. But this is still more than 40 per cent higher than before the lucrative 2004 contract which saw the vast majority withdraw out-of-hours care. And more than 4,000 earned more than the Prime Minister's salary of £152,500.
Doctors are semi-private operators who are given a lump sum every year by the Government to pay for their practices, including rent of buildings, equipment and wages for staff. What is left over goes into doctors' pockets as profit. On top of that they receive a referal fee from other NHS services.
Over the past few years, the Treasury has frozen the amount of money given to GP practices. While pay for the average doctor has fallen marginally, the rise in the numbers earning more than £200,000 indicates that some are taking a greater proportion in profit – and spending less on their practices – than during the previous year.
The figures, from the NHS Information Centre, show that one in eight GPs – a total of 4,230 – earned more than £150,000 in 2008/09.
The average income before tax for a GP was £105,300 in 2008/09, down 0.7 per cent from the previous year. However, at the top of the income scale, the number of super-high earning GPs went up, with 950 pocketing more than £200,000. Almost 3 per cent of GPs now earn more than £200,000 and 250 GPs are on more than £250,000.
Charlotte Linacre, of the Taxpayers' Alliance, said it was appalling that some doctors were continuing to do so well out of the GP contract, despite the recession. ‘It is infuriating that under current rules almost 1,000 GPs now have these inflated salaries which have to be covered by cash-strapped taxpayers,' she said. ‘This is another reminder of what an expensive mistake the new GP contract was that saw us paying much more for exactly the same job.
‘Taxpayers want to be reassured that they are getting value for money and that services are being provided to a high standard without wasting funds – but doctors have outsmarted the politicians and now we have to fund this spiralling wage bill.
While people appreciate that GPs need to be paid well, it's unfortunate that they can take painfully high pay packets because of government officials who lost control by gambling with our money.'
The statistics also show that family doctors who work in solo practices earn far more than those who work with other GPs. Some take 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. 13.1.11
GP's fear patient revolt as NHS reforms set to end their monopoly and self interest
Lucrative NHS overtime payments for consultants questioned
Some consultants are making more than £100,000 a year in overtime payments from the NHS, the BBC has learnt. The sums - paid on top of basic salaries and bonuses - have been criticised at a time when the health service is trying to save money.
Consultants have been accused of playing the system, but doctors said poor planning by managers was to blame. Overtime rates vary, but are often about £600 for four hours - treble what senior medics get for contracted work. Basic pay for consultants stands at just under £90,000 a year on average. For full-time consultants, this pays for 10 separate four-hour blocks a week.
Consultants who do private work are also obliged to do an extra four-hour session paid at their basic rate if their NHS trust needs them. Any extra work beyond that is then done at a higher rate under a system known as waiting list initiative payments (WLIs). These are negotiated individually by each trust so there are no figures for how much is spent nationally.
The Department of Health stressed the need for the efficient use of money in the current climate.
However, the BBC has learnt that many trusts pay between £500 and £700 for the four-hour sessions. Depending on what speciality they are in, consultants can earn tens of thousands of pounds on top of their basic pay. Figures seen by the BBC show that, in some cases, consultants are making more than £100,000 a year.
Consultants involved in common forms of surgery, such as ear, nose and throat and hip and knees, tend to do the most overtime alongside anaesthetists. Others, working in areas such as geriatrics, are likely to get very little. In Coventry and Warwickshire NHS Trust, one ear, nose and throat specialist made more than £105,000 in 2009-2010 in overtime. Another three consultants from other areas made in excess of £80,000. Similar figures were also seen in the previous years.
Ed Burns, from Newton Europe, a consultancy which has carried out work for NHS trusts to improve productivity, said figures in excess of £60,000, including those above £100,000, would not be seen in every trust but were "not unusual" either.
He said poor job planning was the most common cause of high overtime payments, but added sometimes consultants fought against giving them up by employing tactics such as under-booking theatre sessions to make sure there was a need for overtime. "Consultants work hard to provide the best possible patient care, and by volunteering for WLIs they help keep waiting times down. However, for a few, WLI payments can serve as a disincentive to working more efficiently because they face a loss of earnings."
His claims are supported by the experience of some NHS trusts.
Managers at Mid Staffordshire NHS Trust tried to reduce the rate for overtime for orthopaedic surgeons from £1,000 to £500 for a four-hour session. But minutes from official meetings showed consultants would be "downing tools" if they did so. In the end, managers had to compromise on a fee of £750.
Paul Flynn, from the British Medical Association, admitted some of the higher sums "sounded unhealthy", but pointed out research by the union also suggested consultants were doing six hours a week extra for free. He also rejected suggestions that consultants were blocking moves to make hospitals more productive.
"WLI is a quick fix and consultants certainly would not want to come to rely on the payments as they are unpredictable."
He said hospitals could reduce the reliance on overtime by easing the load on consultants by recruiting extra staff or giving admin tasks and duties such as routine follow-ups to other staff.
But Professor Alan Maynard, an expert in health policy from York University and former chairman of a hospital, said NHS trusts often faced a "challenge" managing consultants. "They don't always keep to their job plans and then get to do the overtime. I think there needs to be much more transparency about consultants pay.
"The public are just not aware of the sums they can earn. If the data was published it would put pressure on them and reduce some of the figures we are seeing."
News of the overtime payments comes after the BBC reported at the end of last year that doctors were getting bonuses of up to £75,000 a year. It means overall pay, once basic salary, bonus and overtime are totted up, can be well in excess of £200,000 a year.
The Department of Health said it did not want to comment on individual payments. But a spokeswoman said: "We expect the NHS to increase productivity and improve health outcomes - this includes making effective use of consultants' time. "Consultants and managers should work together to ensure that clinicians' time is planned cost effectively whilst delivering high quality patient care." 13.1.11
Depression In Women Rampant - Most Feel Doctors Over-Prescribe Drugs
Sixty three percent of women with mental health issues feel that doctors too readily prescribe drugs to treat low level mental health problems.
What are classified as "low level" mental health concerns, depression, stress and low self-esteem impact women's lives significantly and thus society in general. Problems are triggered by relationship breakdown, changing school, bereavement or debt effects 63% of all women, and in particular are impacting work attendance and personal relationships.
Platform 51, the operating name of YWCA England & Wales, played a large part in the 24-page research document. Penny Newman, Platform 51's chief executive states:
"Policy-makers need to act now to address this unseen crisis in women's mental health and provide a range of effective interventions. We must put an end to the dependency culture that has built up around prescription drugs, giving women more choice and control over the support they receive. Too often women's opinions about what matters to them are not heard."
Many women often turn to including promiscuity, drug taking and crime to relieve these low feelings of anxiety, self esteem and societal acceptance. Some of the women studied claimed to have slept with three or more persons in a week's time seeking love, attention and acceptance.
Mental health problems can be triggered by emotional or physical abuse, bullying, changing school, getting into debt, relationship breakdown, bereavement, redundancy, leaving home or getting pregnant. For many it is a combination of these which can cause the onset of mental health problems; the cumulative effect makes it harder to cope with each new challenge.
Other impacts of women's mental health on self and society were uncovered. Forty four percent of women with mental health problems took time off work, with 25% of these taking at least one week off per year outside of granted vacation time.
Almost a third of women reported losing friends and drinking regularly with the intent to get drunk. One in five build up excessive debt and 35% of women 18 to 24 attempted self-harm.
Millions of women with mental health problems are not getting the right kind of help. It is reported that nearly 30% how sufferers had never even sought professional help.
"Millions of girls and women are not getting the support they need. Women are often the linchpins of their families and their communities, and if three in five of them aren't functioning at their best they lose out, their family and friends lose out and so does wider society. Working with girls and women every day for over 150 years we have seen time and time again how often mental health can hold women back." 12.1.11
Strong painkillers increase risk of heart or stroke death: research
Large regular doses of ibuprofen and similar painkillers could treble the risk of strokes and increase the likelihood of heart attacks, researchers are warning. Scientists have found high doses of ibuprofen may carry a similar health risk to painkillers that were withdrawn from the market several years ago on safety grounds. Scientists have undertaken one of the most comprehensive studies on the cardiovascular effects of powerful painkillers and have concluded there is little evidence they are safe for the heart.
Up to eight million Britons are prescribed so-called anti-inflammatory drugs every year, usually to combat arthritis or back pain.
They stressed that while the overall numbers of people suffering heart attacks or strokes while on the drugs is small, there are important risks associated with taking them. The drugs include ibuprofen which is available over the counter, without prescription and the authors have questioned if this should be allowed to continue.
A total of11m prescriptions were written for the seven drugs included in the trial in England in 2009, costing around £76.7m.
The drugs, called non-steroidal anti-inflammatory drugs (NSAIDS) and a subgroup of newer ones called COX -2 inhibitors, are known to affect the heart and one of them, Vioxx, was removed from sale in 2004 because of the increased risk of heart attacks. Since then some doctors have questioned the safety of the whole class of similar drugs.
The analysis, conducted by a team at Bern University , evaluated 31 studies involving over 116,000 patients who took the painkillers regularly, mostly for arthritis pain.
The drugs were naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib and two others not used in England , called rofecoxib or Vioxx, and lumiracoxib. It was found that compared with placebo, rofecoxib and lumiracoxib were associated with twice the risk of heart attack, while ibuprofen was associated with more than three times the risk of stroke.
Etoricoxib and diclofenac were associated a fourfold risk of death from a heart attack or stroke. Naproxen appeared least harmful in terms of cardiovascular safety of the seven, the researchers said.
The study only looked at people taking the drugs continuously and not those taking the odd painkiller for a headache or other minor ailment.
The findings were published online by the British Medical Journal. Co-author Professor Peter Jüni, of the Institute of Social and Preventive Medicine at the University of Bern in Switzerland, said: "The use of other non-steroidal anti-inflammatory drugs not covered by our analysis should be reconsidered, as well as the over the counter availability of non-steroidal anti-inflammatory drugs such as diclofenac or ibuprofen.
"In conclusion, the options for the treatment of chronic musculoskeletal pain are limited and patients and clinicians need to be aware that cardiovascular risk needs to be taken into account when prescribing." An accompanying editorial by Prof Wayne Ray, of the Department of Preventive Medicine at Vanderbilt University in Nashville , America , said: "What does this all mean when prescribing NSAIDs for patients at high risk of cardiovascular disease? Current data suggest that selective cyclo-oxygenase-2 inhibitors, particularly in higher doses, should be avoided.
"The controversy and confusion about the cardiovascular safety of drugs to relieve chronic musculoskeletal symptoms provides an important lesson. "Drugs for symptomatic relief must be evaluated with regard to the target symptoms as well as less frequent yet serious adverse effects. NSAIDs are not an ideal treatment with respect to efficacy or safety. Perhaps it is time for a larger more systematic evaluation of a broader range of alternatives."
Professor Peter Weissberg, Medical Director at the British Heart Foundation, said: “This confirms what has been known for some years now – taking non-steroidal, anti-inflammatory drugs on a regular basis increases heart attack or stroke risk. “However, some patients with debilitating joint pains may consider the small increased risk worthwhile when set against the improvement in their quality of life that these drugs bring.
“Anyone who needs regular painkillers should talk to their doctor about which drug is the most appropriate for them. There is lots than can be done to mitigate any potential risks.”
Medical director of Arthritis Research UK Professor Alan Silman, said: "Far fewer GPs are now prescribing NSAIDs and Cox-2 to their arthritis patients, particularly those with cardio-vascular problems, because of the potential risks, yet for many people who are not at high risk of heart attacks and strokes they remain a highly effective means of combating pain.
"Naproxen, in particular, is probably very safe. We concur with medical advice that people should take the smallest dose for the shortest length of time possible, although this isn't very practical if you have a long-term condition such as arthritis. “We would advise people with arthritis to seek an annual review of their painkillers with the GP so their risk of cardio-vascular risk can be regularly checked, and so that they can seek advice about alternatives to NSAIDs.”
The Proprietary Association of Great Britain (PAGB) is the UK trade association representing manufacturers of over-the-counter (OTC) medicines.
Its chief executive, Sheila Kelly, said: "The studies that the researchers looked at involved people taking high doses of NSAIDs on a long-term basis, for chronic conditions such as osteoarthritis. "Patients with such conditions will have their medicines prescribed by the doctor who will decide on the most appropriate treatment for them, taking into account any other risk factors.
"People who buy over-the-counter medicines containing ibuprofen, naproxen or diclofenac to treat the occasional headache, sprain or period pain should not be alarmed at these findings. "At the dosage levels available over-the-counter, for short-term use and used according to the instructions on pack, these medicines are extremely safe." 12.1.11
Cases dropped against malaria homeopaths
Officials have dropped charges against pharmacies alleged to have advised people to take homeopathic remedies to protect them against malaria instead of anti-malarial drugs. The General Pharmaceutical Council's decision has been described as "shabby and irresponsible" by some who helped bring the case against the pharmacies.
Charges were bought after an undercover investigation by campaigning group Sense about Science and BBC Newsnight. Drug experts advocate anti-malaria drugs. Speaking about the latest decision, Tracey Brown, director of Sense about Science who are funded by the drug industry said "we may as well have no regulation of pharmacists at all".
It comes days after the Royal Pharmaceutical Society said they were "shocked" that one of the pharmacies involved, Ainsworths in London , is still suggesting taking homoeopathic remedies to prevent serious diseases such as typhoid, polio and malaria instead of proven drugs and vaccinations.
'I am shocked that a regulatory body would ignore its responsibility to protect patients” said Dr Simon Singh Science writer and broadcaster.
The 2006 undercover investigation showed that homeopathic pharmacies were recommending homeopathic pills instead of drugs and vaccinations for travellers to countries where malaria is endemic. At the time the head of the Royal London Homeopathic Hospital Dr Peter Fisher told Newsnight "there is absolutely no reason to think that homeopathy works to prevent malaria… people may even die of malaria if they follow this advice".
The government's Chief Scientist, Professor Sir John Beddington, recently told BBC News that "there is no scientific evidence to indicate that homeopathic remedies are efficacious and the fundamental underpinning of homeopathy seems to me to be scientific nonsense". Critics said, 'its an old argument, it's about time the government funded trials to access homeopathy to stop this accusation'.
The pharmacists from three practices including Ainsworths were set to face fitness to practice hearings which could have resulted in them being struck off or other penalties. Now the General Pharmaceutical Council (GPhC) has written to Sense about Science to say that it has dropped the action. It gives two reasons.
First the GPhC says that Ainsworths' pharmacist Anthony Pinkus has taken "remedial action" to prevent what happened in 2006 ever happening ever again.
However last week Newsnight showed a leaflet they were given by the pharmacy in 2010 to the Royal Pharmaceutical Society (RPS). The leaflet advertised Ainsworths' homeopathic remedies for serious diseases and said there was anecdotal evidence that they were a successful treatment.
The RPS said: "We would be very concerned if a patient took a homeopathic preparation to travel to an area where there may be yellow fever, typhoid, malaria, believing they were safe when in fact they wouldn't be safe".
The second point the GPhC makes is that the allegation about Ainsworths "would fall below the current threshold criteria for referral to the investigating committee". The test is now whether a pharmacist is being "reckless with the safety and wellbeing of others".
Ms Brown from Sense about Science says that if the regulator doesn't think "continuing to market useless homeopathic travel 'vaccinations' for diphtheria, malaria, polio, typhoid and encephalitis" and potentially putting lives at risk is not reckless then there's little point having regulation.
Former Liberal Democrat science spokesman Evan Harris, who is now the director of the Campaign for Evidence Based Policy, said that it was "hard to imagine cases where so many professional standards had been breached". "If a doctor or a nurse had done this their respective professional bodies would have instigated a full investigation for professional misconduct," he told BBC News.
Dr Simon Singh, who writes critically of some so-called alternative medicine, said: "The evidence was served to the GPhC on a plate. I am shocked that as a regulatory body it would ignore its responsibility to protect patients."
The Nightingale Collaboration, which campaigns for evidence-based medicine, will submit a new complaint to the General Pharmaceutical Council on the basis of last week's Newsnight report. Its director Alan Henness said: "This is a disgraceful state of affairs.
"Statutory regulation is there to protect the public. By taking so long to investigate and by dropping these complaints, the GPhC cannot be seen to be fulfilling this vital role."
The GPhC said that in the cases it investigated it did not consider that the individuals' fitness for registration was "impaired such that it ought to be removed or restricted". "Although the cases are now closed," it told BBC News "the information gathered as part of the (recent Newsnight) investigation including the original complaint may be taken into account if we receive any further complaints about the pharmacy professional in the future." BBC News contacted Ainsworths for a response. A spokesman said: "We do not make comments to the media." 12.1.11
More Incompetence - Shadow Chancellor Alan Johnson makes another gaffe on live TV as he blunders over National Insurance rate
If it wasn't enough that Labour's mismanagement of the economy and an inability to run a budget lead to the UK recession, Alan Johnson blundered into another embarrassing gaffe on live television today when he was unable to explain the details of Labour's main tax policy.
The Shadow Chancellor, whose shaky grasp of economics has alarmed some senior colleagues in recent weeks, was unable to state the current rate of national insurance – despite wanting to raise it.
In a humiliating appearance on Sky News the former postman initially dismissed claims that he remains an economic ‘novice', saying: ‘The accusation of economic novice is that when you take over a new job, you have to ensure that you bone up on these things.'
Seconds later the 60-year-old was left squirming when presenter Dermot Murnaghan asked him to identify the current rate of employers' national insurance. Mr Johnson, who took up the job three months ago, initially ducked the question, before saying it was rising by one per cent from 20 per cent to 21.
Mr Murnaghan then informed him that the rate currently stands at just 12.8 per cent. The error is all the more embarrassing because national insurance is one of the few taxes that Labour admits to wanting to raise.
Mr Johnson was a surprise choice to be Shadow Chancellor. Many observers believe he was chosen in part to keep Ed Miliband's former leadership rival Ed Balls out of the key economic role. But a string of gaffes has led to mounting concerns about whether Mr Johnson is up to the job of convincing the public that Labour has a credible economic alternative.
Firstly he wrongly suggested that the Government's VAT rise would hit family food bills. And last week he got into a tangle over when Labour would clear the budget deficit, initially saying the target was 2015, before saying he ‘probably' meant 2016. He also appeared confused about when Labour's planned cuts would have kicked in.
Some senior Labour figures are urging Mr Miliband to ‘read the riot act' to his Shadow Chancellor, who has openly defied him over issues like the 50p tax rate and university tuition fees.
Labour sources today insisted Mr Miliband was content with his overall performance. In a jibe at the Coalition's own problems in explaining the impact of the VAT rise, a Labour source said: ‘We would rather have a Chancellor who knows the difference between a regressive and progressive tax and who knows about real life than get involved in a Westminster parlour game.'
But political opponents seized on the latest gaffe as evidence that Labour lacks credibility on the economy. Liberal Democrat MP Stephen Williams said Mr Johnson was becoming ‘an embarrassment'. He added: 'For Alan Johnson, the man who Labour wants to run Britain's economy, to be plucking the rate of employers' national insurance contributions out of thin air is utterly incredible.
‘Continuing to advocate a jobs tax when he appears not to understand its basic facts smacks of economic illiteracy and incompetence. 'Instead of being a powerful asset to Ed Miliband, Alan Johnson is fast becoming an embarrassment.'
Tory MP Matthew Hancock said: ‘Labour's threadbare credibility took another dive today as Alan Johnson admitted he didn't know the level of national insurance, the very tax he wants to put up. 'Every time Labour speak on the economy they show they have no credibility, no ideas, and no plan to deal with the historic mess they did so much to create.'
Meanwhile, Mr Miliband was reported to be having difficulties in his own attempt to recruit a Blairite chief of staff. Former Pensions Secretary James Purnell is said to have turned down the job last week, while the former Lord Chancellor Lord Falconer is also said to have rejected approaches. A Labour source insisted that neither man had been formally offered the job.
Critics said ‘Johnson is clearly out of his depth', ‘ sooner or later everyone gets promoted to their level of incompetence...Johnson got there when he was a post man' and ‘anyone who wants a former postman to be in charge of the economy has a very different view to economics to me, no wonder Labour made such a mess of things'. 10.1.11
Also see: Incompetant Ministers - Jacqui Smith: I'd never run a thing before the Home Office
Device 'cancels out the sound of the dentist's drill'
An invention which cancels out the noise of a dentist's drill could help people overcome their fear of a check-up, researchers say. For many, the sound of the drill is a big cause of anxiety when it comes to visiting the dentist. The device has been developed by experts at King's College London, Brunel University and London South Bank University.
This new device allows patients to listen to music on an MP3 player, while the sound of the drill is blanked out. Patients are, though, still able to hear the dentist's voice because not all sounds are filtered out. Carmakers Lotus develop a similar system in the 1980's to remove unpleasant 'engine and road noise' by using the car's stereo to 'cancel-out' the unwanted sound waves.
The device is similar to noise cancelling headphones. It works by turning the sounds of the dental consulting room into a digital signal. A special chip called a digital signal processor analyses the incoming sound from microphones placed close to the dental drill. It produces an inverted sound wave to cancel out unwanted noise in the headphone signal.
It also uses "adaptive filtering" technology, where electronic filters lock onto sound waves and remove them, even if the wave's amplitude and frequency change as the drill is being used.
But this also allows other noises like the dentist's voice to come though. So a patient could simply plug the device into their MP3 player and then, via their headphones, listen to their own music without being disturbed by the noise of the drill but still be able to hear the dentist.
'No extra cost'
Developed by experts at King's College London, Brunel University and London South Bank University , it was originally the idea of Professor Brian Millar of King's Dental Institute. He was inspired initially by the efforts of car-maker Lotus who were trying to develop a system that removed unpleasant road noise, while still allowing drivers to hear emergency sirens.
After more than 10 years of research and collaboration with engineers, Professor Millar and his team have developed a prototype.
"Many people are put off going to the dentist because of anxiety associated with the noise of the dentist's drill, but this device has the potential to make fear of the drill a thing of the past. "The beauty of this gadget is that it would be fairly cost-effective for dentists to buy, and any patient with an MP3 player would be able to benefit from it, at no extra cost."
Dr Mark Atherton of Brunel University 's School of Engineering and Design said allowing the patient to still hear the dentist was a key theme throughout the project. "You can't switch the patient off. They want to have a conversation with the dentist, so they can't just put a pair of ear-muffs on, they still want to hear a voice."
But Dr Atherton said the designers found that just reducing the noise of the drill, by putting on ear defenders for example, was not enough. "The dental drill noise is so distinctive the brain still recognises it and people still hear it, such is the anxiety. "It's such a distinctive sound, the pitch is probably recognised around the globe. Most people have heard it and, sadly for some, they dread it."
The team are now looking for investors to make the device commercially available. Professor Millar said it has the potential to help people overcome their fear. "What we need now is an investor to develop the product further, to enable us to bring this device to as many dental surgeries as possible, and help people whose fear of visiting the dentist stops them from seeking the oral healthcare they need." 10.1.11
Weather control is no myth: Scientists engineer thunderstorms over Abu Dhabi
Discussions of weather control technology or weather weapon used to be limited to the hushed gossip of conspiracy theorists, but it turns out the conspiracy theorists were right (again). Today in Abu Dhabi , scientists have successfully manipulated entire weather systems, causing up to fifty downpours of rain across the Al Ain region the desert nation over the last year.
It's all being accomplished by a team of scientists working for Sheikh Khalifa bin Zayed Al Nahyan, the president of United Arab Emirates . They have erected entire fields of giant ionizers to generate waves of negative ions which rise into the lower atmosphere and attract dust particles. The dust particles, in turn, attract condensation from the ambient air, and when enough condensation is achieved, the clouds can't hold the water anymore and a downpour of rain is unleashed. The whole system was devices by a Swiss company named Metro Systems International.
This last year saw huge rainstorms over Abu Dhabi during July and August -- months that are normally bone dry in the desert. The success of the project astonished even the Max Planck Institute for Meteorology , whose former director reportedly said, "Maybe this is a most important point for mankind."
Where are the skeptics now?
What I find really interesting in all this is that, for decades, the so-called "skeptics" have insisted that all this talk about weather control is pure conspiracy theory. If you tell a typical conventional doctor that "weather control technology can make it rain in the desert," they'll look at you as if you were some kind of nut.
But it turns out the skeptics are getting soaked over this issue, as usual. This technology is up and running right now, bringing rain to Abu Dhabi at a fraction of the cost of desalination plants. The conspiracy theorists were right yet again about the existence of weather control technology. Jesse Ventura even did a show on it last year on his Conspiracy Theory series: Remember the episode about HAARP? (High Frequency Active Auroral Research Program.) Watch that episode on NaturalNews .TV right now
HAARP appears to be an experimental weather control technology being operated by the U.S. government right now, shrouded in secrecy. The field of HAARP ionizers looks eerily similar to those set up in Abu Dhabi and the entire project is understood by those who have really looked into it as a "weather weapon" capable of "potentially triggering floods, droughts, hurricanes and earthquakes" and might explain the recent rise in natural disaters.
Today we know that weather control technology works. It's up and running right now in Abu Dhabi, and there's little question that controlling the weather has many applications, including military and economic applications. So for those who raise their eyebrows when you say "weather control," just answer them with "Abu Dhabi". Fifty thunderstorms prove it already works. Natural News 13.1.11
The NHS needs a radical explosion
GP commissioning may lead to fierce commercial competition – and privatization which will be good for the NHS and patients with improved services and care. As private companies step in to run commissioning for GPs, they may "turn to private providers at the expense of NHS providers". Some GPs are eager to run the £80bn NHS budget and become the chief rationers but some are not.
The government has sold this as a homely notion whereby your well-respected family doctor will commission the services you need – and who better to make those decisions? It seems to make sense that those who spend the money by referring their patients should control those budgets.
For the first time the entire NHS has been put under competition law. The financial and clinical safety of NHS foundation trusts used to be the responsibility of the regulator, Monitor. Now its website proclaims: "The first of Monitor's three core functions is to promote competition." That means "enforcing competition law" and "removing anti-competitive behaviour".
Few yet understand the nuclear nature of this. It compels every NHS activity to be privately tendered. If the NHS is the preferred provider, that can be challenged in the courts or referred to the Competition Commission. Red-in-tooth-and-claw commercial competition breaks all partnerships.
This makes NHS contracts subject to EU competition law. The NHS was exempt as an essentially state-run service, but GP consortiums will no longer be allowed to use a local hospital without tendering first, for fear that a private company could take them to court.
This may not be a slow and stealthy change, but an immediate and radical explosion. Take the huge new Great Western Commissioning Consortium, amalgamating Hounslow, Hillingdon and Ealing primary care trusts – now considerably more distant from patients. GPs there have hired the US company United Healthcare to run their "referral facilitation service", taking over next month. It will guide and arm-twist, if not quite order, local GPs' referral habits. It will even step in where one hospital consultant directly refers a patient to another specialist and the PCT picks up the bill. Some predict such commercial commissioners may break old NHS ties and bring in fellow private providers which are desperately needed.
The British Medical Association is alarmed. In tomorrow's British Medical Journal Dr Laurence Buckman, who chairs the BMA's GP committee, says: "I am very disappointed that people are coming to financial arrangements with commercial organisations. If you give someone a toehold, they'll take a foothold. I hope this will not be repeated elsewhere" – but he thinks that it will be.
Dr Clare Gerada, who heads the Royal College of General Practitioners, has already voiced her concern, pointing out that only a quarter of GPs are enthusiastic about a system that supposedly puts them at the helm – hardly surprising if they face lawsuits for staying with trusted NHS hospital partners. Don't assume most doctors have yet got their heads around the full implications; most tend not to bother until something impedes their everyday practice – but then they will kick up a huge fuss.
However reform is urgently needed, the NHS costs the tax-payer £115bn per annum and much of that money is spent on bureaucracy, waste and mismanagement, something private companies don't have. 3.1.11
More Psychology and less Psychiatry - How the Government wants to change the way we think
The secret Whitehall policy unit dreaming up psychological tricks to alter our behaviour.
Shame, vanity, laziness and the desire to fit in are all to be used as tools of Government policy by ministers acting on the advice of a new psychology unit in Whitehall .
The first glimpse into the confidential work of the Cabinet Office's Behavioural Insight Team came on Tuesday when ministers suggested members of the public should be able to make small charitable donations when using cashpoints and their credit cards. On Friday, the Cabinet Office again followed the unit's advice in proposing that learner drivers be opted in to an organ donation scheme when they apply for a licence, and also floated the idea of creating a lottery to encourage people to take tests to prove they have quit smoking.
These initiatives are examples of the application of mental techniques which, while seemingly paradoxical to the Coalition's goal of a smaller state, are likely to become a common feature of Government policy.
The public will have "social norms" heavily emphasised to them in an attempt to increase healthy eating, voluntary work and tax gathering. Appeals will be made to "egotism" in a bid to foster individual support for the Big Society, while much greater use will be made of default options to select benevolent outcomes for passive citizens – exemplified by the organ donation scheme.
A clue to the new approach came early in the life of the Coalition Government, in a sentence from its May agreement: "Our Government will be a much smarter one, shunning the bureaucratic levers of the past and finding intelligent ways to encourage, support and enable people to make better choices for themselves," it read.
The Prime Minister, David Cameron, established the seven-strong unit in July, since when the Government has declined to divulge all its members and the full extent of its work. However, The Independent has learnt its guiding principles and some of the projects that have used its favoured techniques.
One experiment involved Her Majesty's Revenue and Customs (HMRC) secretly changing the wording of tens of thousands of tax letters, leading to the collection of an extra £200m in income tax. Other ideas tried elsewhere that have been studied by the unit include reducing recidivism by changing public perception of ex-prisoners, and cutting health costs by encouraging relatives to look after family members in "patient hotels".
The unit draws inspiration from the Chicago University professor Richard H Thaler and his colleague Cass Sunstein, whose book Nudge: Improving Decisions About Health, Wealth and Happiness is required reading for Conservative frontbenchers.
Professor Thaler, who advises the UK team, suggests that instead of forcing people to behave more virtuously through legislation, governments can guide them in the right direction using psychology. Ministers should become, in his jargon, "choice architects", making virtuous choices more attractive than unvirtuous ones. In his books he quotes the example of automatically opting workers into company pensions to raise the amount saved for old age, which will come into force in the UK in 2012 having been enacted by Labour. Another is from Amsterdam 's Schiphol airport, where flies were etched on to urinals to give men something to aim at, reducing spillages in the gent's toilets.
Mr Cameron embraced nudge theory two years ago in a speech about "Broken Britain", but has subsequently placed more emphasis on his own idea of the Big Society, where individuals and charities play a much greater role ias the state shrinks.
Both ideas, however, fit neatly into the work of the insight team, which reports to key Government figures including Jeremy Heywood, the Prime Minister's Permanent Secretary, Steve Hilton, Mr Cameron's director of strategy, and Sir Gus O'Donnell, the Cabinet Secretary.
Central to this is limiting regulation and cost, according to the unit's director, Dr David Halpern, a former Cambridge University social psychology lecturer. In comments to policymakers and businesspeople in Brussels recorded by The Independent last month, Dr Halpern said: "One of the policies of this new administration is essentially a 'one in, one out' approach to regulation, so departments wanting to introduce a new form of regulation have to get rid one at the same time. One of the fashionable things to say is: 'Well, what are the alternatives to regulatory instruments?' – spending money – which they're not very keen on. So it tends to support this shift towards behavioural economics."
Dr Halpern has experience of seeking unconventional solutions to policy problems via his role as chief analyst at Tony Blair's Strategy Unit, which looked into ways of increase happiness in the UK that – in common with other western countries – have not kept pace with economic growth.
Dr Halpern's approach, carried over from his days with Mr Blair, centres on his favourite term, "Mindspace," an acronym that stands for: Messenger (i.e. he who communicates information affects its impact); Incentives; Norms (what others do influences individuals); Defaults (pre-set options tend to be accepted); Salience (revelance and novelty attract attention); Priming (sub-conscious cues); Affect (the power of emotional associations); Commitments (keeping public promises); and Ego (the stroking of which encourage positive action).
Seeking to explain Messenger he told his Brussels audience: "It matters who tells you. If you are go to say something about vaccination, you are much better off having the Chief Medical Officer say it than a Cabinet minister ... if you want anybody to follow the advice."
Similarly, tax officials who reinforce "norms" dramatically increase their collection rates. The authorities tend to be "quite aggressive and assertive" when chasing late payers, Dr Halpern said. "We will send you a rude letter and say: 'We're going to come and find you and break down your door and take away your children.' So [HMRC] officials had been reading a bit of [nudge] literature and they changed letters on just one block of letters [chasing] £600m in unpaid tax.
"The normal repayment rate is about 50 per cent. The [new] letter says: '94 per cent of people pay their tax on time', so now you emphasis the underlying social norm – and then: 'Even if one person doesn't it has a significant impact'. The repayment rate went up to 85 per cent, [collecting] £200m just in that experiment."
Intriguingly, closer co-operation between the unit and HMRC was referred to in passing by the Cabinet Office on Friday. At the centre of the unit's work, though, are its priorities: well-being, public health, the environment and philanthropy.
While there are few details so far on how the unit will tackle happiness, plans for public health are more advanced. Britons have one of the worst records in Europe when it comes to rates of obesity, drug use, and sexually transmitted diseases (STDs). The Health Secretary, Andrew Lansley favours nudging rather than legislation and has controversially recruited food and drink multinationals, who profit from unhealthy behaviour, to devise appropriate strategies.
One is likely to see signs placed at supermarket checkouts reinforcing social norms about the amount of fruit and vegetables bought by the average shopper. Another is the idea of "patient hotels", a Continental innovation where relatives can sleep alongside patients, cutting costs and improving outcomes. This has the added attraction of reducing health spending at a time when the NHS budget will come under increasing pressure from rising demand.
Public health campaigns on STDs are likely to replace factual warnings with questions designed to emphasise social norms. So, instead of advising people of the likelihood of sexual partners having an STD, posters would ask: "What would your girlfriend think of you if you say you don't want to use a condom?"
Some professional health organisations, such as the British Medical Association, are concerned that nudges will be used at the expense of new legislation on tobacco advertising, tax on junk food and other issues. But Nick Chater, Professor of Behavioural Science at Warwick Business School , who is not involved with the unit, welcomed the new emphasis on psychology. "Broadly speaking, I think it's a valid approach," he said.
"If you are interested in changing people's behaviour for their own or the collective good, then regulation is often a blunt tool and it often doesn't harness goodwill. But it's misleading to think with a few nudges consumer behaviour will head off in another direction. [Behavioural economics] is definitely an additional tool, [but] I don't see it as a way to eliminate regulation or redistribution."
The nudge unit's priorities
Public health is a priority for the unit, because half of UK health spending goes on treating the consequences of unhealthy behaviour such as drinking, smoking and having unprotected sex. Yet only one half of one per cent of NHS spending goes on promoting healthy behaviour. The unit suggests using respected medical figures to give health warnings and reinforcing social norms about other people's behaviour, to spur consumption of fresh produce and condom use.
The unit has been drafted in to help the Coalition achieve its aim of being the greenest Government ever. While investing in new sources of low-carbon energy generation should limit greenhouse gas emissions, individuals will also need to make greener choices.
Creating a band of active citizens who contribute to public life is central to the Big Society. The Coalition wants to create a "culture change" to increase time and money for good causes. Its green paper Giving last week noted that the average UK citizen spends 16 hours a week watching TV, but only one hour doing voluntary work. But telling people that volunteering increases life satisfaction is unlikely to be enough, it warns. As Dr Halpern explains: "Evolution has endowed us with a social brain that predisposes us to reciprocate acts of kindness, not to just blindly help anyone and everyone, regardless of how they treat us."
* Social networks
The unit believes that individuals' social contacts and connections are vital to their health and welfare, and are an untapped resource for the whole of society. "Harnessing the capacity of social networks and affecting the behaviour of the individual" is one of its aims. The Giving green paper said it wanted to do more to support community groups, charities and social enterprises.
Monthly polls by Ipsos-Mori show that the UK is a fearful place. Despite being among the wealthiest in Europe, Britons are less happy than others in Europe, particularly in Scandinavia. We are also less trusting of our fellow citizens. The unit is looking towards Denmark, which studies suggest is the happiest nation in Europe. The most important thing to Danes is "love". By contrast, the least happy people, Bulgarians, are "much more worried about jobs and money", Dr Halpern told an EU conference in Brussels. 7.1.11
Leading medics challenge GPs to fight Andrew Lansley over NHS reforms to improve care
More than 100 doctors, including 20 professors, sign open letter criticising British Medical Association leaders. Doctors leaders are facing a challenge from senior medics who claim they have been too quick to accept the government's NHS shakeup and should instead "mobilise" to thwart it.
More than 100 doctors, including 20 professors, have signed an open letter in the British Medical Journal, criticising the leadership of the British Medical Association, the doctors' union.
They claim the BMA should abandon its "failed" policy of "critical engagement" with ministers over plans that will "destroy" their monopoly and instead withdraw from discussions with health secretary Andrew Lansley to fight his reforms.
They write: "The NHS really is in your hands. We understand the pressures you are under, but now is the time to mobilise the profession and stop these damaging reforms, which will not only destroy the NHS but also profoundly affect the social fabric of our nation."
Fighting the changes is "a great opportunity for the BMA to achieve redemption for its opposition to the inception of the NHS in 1948," they add. The letter is addressed to BMA chairman Dr Hamish Meldrum, a GP; Dr Laurence Buckman, who heads its influential GPs' committee; and the other members of it.
Among the signatories are three members of the BMA council, its 33-strong ruling body, and leading doctors in fields such as cancer, children's health and emergency medicine. They also include GPs, whom Lansley insists will benefit from his plan to hand £80bn of NHS funding to family doctors in England so that they can commission services on their patients' behalf.
The letter was organised by Dr Clive Peedell, a consultant clinical oncologist at the James Cook university hospital in Middlesbrough , who is on the BMA council, as are co-signatories Jacky Davis, co-chair of the NHS consultants' association, and men's health expert Professor Ian Banks.
The doctors add that it is "remarkable" that the BMA had decided not to hold a special meeting to allow its full membership to air their views, despite Lansley's proposals being what the King's Fund health thinktank has called "the most radical restructuring of the NHS since its inception".
As a result, they say: "The BMA has no mandate from the wider membership to continue with the 'critical engagement' policy … The association has effectively sent a message to the profession that the [government's NHS reform] white paper is a done deal."
Meldrum rejected the criticisms, saying that the BMA, after several debates in its council, had welcomed some key aspects of Lansley's plans but had "real concerns" about others, "including the speed at which the changes are being rushed through and the dangers of market-based competition in the NHS".
The BMA plans to increase its lobbying ahead of the publication of the health bill, expected later this month, and will "continue to forcefully represent members' concerns as the government's proposals move to the next stage".
John Healey, the shadow health secretary, said the letter was "evidence of the pressure mounting on Lansley, and the growing criticism of his plans for a high-risk internal reorganisation of the NHS".
Critics said 'this illustrates why the NHS is in such a mess as attempts to reform it and break up the medical monopoly are always thwarted, as a result patients suffer. This letter is all about protecting their own interests which are under threat from plans to introduce the private sector to reduce costs and improve care'. 6.1.11
Scottish NHS spends £11m leasing cars
Scottish health boards and NHS bodies spent almost £11million on leasing more than 7000 vehicles, including Jaguars, Mercedes and BMWs last year. NHS Greater Glasgow and Clyde has the biggest bill, spending £3.4m on 2460 vehicles for staff.
The Ayrshire & Arran health board spent more than £1.5m on 680 cars, while Grampian spent over £1.1m on 474 vehicles, including an Alfa Romeo and an Audi A3 1.6 Sport. NHS National Services spent £655,621 leasing 274 vehicles including a Jaguar X-Type and a Lexus IS 220 SE.
Dumbarton MSP Jackie Baillie, Labour's Scottish health spokeswoman, said the figures were “astonishing”. She said: “Of course, staff like district nurses need to be provided with a car so they can do their job and visit patients. “But it doesn't make sense to spend nearly £11m subsidising senior managers to drive BMWs and Mercedes when health boards are being forced by budget cuts to reduce the number of nurses.
“If Labour forms the next Government in Scotland we will review this scheme to ensure NHS resources are spent on improving patient care and not on perks for executives.”
The total amount spent on car leasing was £10,889,607, with 7318 vehicles rented. This included vehicles leased by the Scottish Ambulance Service, the State Hospital at Carstairs, Golden Jubilee Hospital in Clydebank, NHS Quality Improvement Scotland and NHS Education for Scotland.
Not all health boards provided figures for the amount they spent. Of those that did, NHS Orkney paid the least, renting three vehicles at a cost of £6770.
A Scottish Government spokeswoman said: “It is up to NHS boards to manage their own budgets and to ensure frontline services are delivered as efficiently and cost-effectively as possible. “Patient care is our priority and health boards, like all public bodies, are expected to get the very best value for money.” 4.1.11
The £10,000-a-week celebrity rehab clinic a judge said would shame the Third World
- Retreat run by former male nurse 'scandalously negligent'
- Drunken woman tied to a boat as she was ferried to clinic
- Staff 'too busy' to help patient threatening to slash wrists
- Did clinic fail C4 executive who killed herself after leaving?
Even the world of celebrity rehabilitation is subject to the vagaries of fashion. For a while it seemed no clinic was more hip than The Causeway Retreat. It was the centre of choice for, among others, Amy Winehouse, Take That star Mark Owen, actor Jonathan Rhys Meyers and members of some of Britain's most aristocratic families.
But the £10,000-a-week 'dream retreat' on a remote island was too good to be true. It was closed down in May after an investigation by health watchdogs, who then launched a criminal prosecution against the company running the clinic. In November, the firm was taken to court and admitted running an unregistered service and the judge said its standards 'would really shame a Third World country'.
Now former staff and patients have come forward to describe a shambolic ' Fawlty Towers regime' in which vulnerable patients were at risk.
They allege that:
- A patient signed for a weekly delivery of medication from a drug company because 'no one else was available'.
- Staff tied a drunken patient to a boat as she was ferried to the island.
- A patient attempted to swim back to the island and was 'lucky not to have drowned'.
- Staff were too busy to help a suicidal woman who was threatening to slash her wrists with nail clippers.
- Medicine was dispensed in a way that let patients 'stockpile pills'.
The rehab clinic's appeal to the rich and famous had been obvious. It was hidden among woods on 400-acre Osea Island , which is linked to the Essex coast at low tide by an ancient stone causeway that snakes for a mile across mud flats. Based around an Edwardian manor, it offered 'discreet accommodation' although some celebrities chose to arrive indiscreetly - by helicopter.
After checking into the well-appointed rooms, they would slip into the Mulberry dressing gowns provided and submit to 'world-class' therapy - while no doubt convincing themselves that the weekly cost (significantly more than its better-known rival, The Priory) was worth it.
But it did not live up to its own hype and was shut down in May. Then, in November, District Judge Cooper, sitting at Chelmsford Magistrates' Court, fined the company behind the clinic, 27 Management, £8,000 with £30,000 costs for running an unregistered hospital. He described 27 Management - run by ex-nurse Brendan Quinn - as 'atrocious' and said it had been 'scandalously negligent if not downright misleading and fraudulent'. He urged the Government to review the 'ludicrously low' penalties for the offences.
The clinic housed mainly alcohol and drug addicts but also took in patients with mental health problems - and treated them illegally, beyond the scrutiny of the health regulator, the Care Quality Commission. 'A very clear picture emerged of a service being run of significant danger to the public,' said prosecuting barrister Paul Spencer. 'In particular to those who spent huge sums of money to enter there for treatment.'
He added that one of the many disturbing aspects of the case was 'the death of a young lady discharged from the Causeway without any proper assessment because she was considered a difficult patient'. She was known to be at risk of suicide and 'took her life' within months of leaving.
The woman referred to was 34-year-old Channel 4 executive and highly regarded producer Sarah Mulvey, who was found dead at her flat in North London in January last year. Intriguingly, the inquest into her death was postponed by the coroner because he wanted to await the outcome of the Causeway prosecution. Expected to be 'exhaustive', the inquest will now begin later this month.
The Causeway Retreat opened in 2006. Its chief executive was 35-year-old Quinn, a man with an eye for the main chance or, as he put it, a desire to 'de-stigmatise people's experiences of being treated in mental health facilities'.
He had previously worked as a nurse in London hospitals, dealing primarily with addiction, and was well aware of the success of clinics such as The Priory. Quite how he decided on Osea Island as a base for his vision is unclear. However, the clinic quickly gained a reputation among aristocratic families.
Count Gottfried von Bismarck, the great-great-grandson of Prince Otto, Germany 's Iron Chan cellor, spent six weeks on the island before he died in July 2007. Others who sought help for drug addiction include Nicholas Knatchbull, the great-grandson of Lord Mountbatten, godson of Prince Charles and a friend of Prince William at Eton.
But the majority of patients were ordinary people who often struggled to pay the crippling fees. A former nurse at the retreat, who asked not to be named, said: 'The fee structure was such that if you paid £10,000 you stayed in the best accommodation at the manor and were entitled to five one-to-one therapy sessions a week.
'If you were in the £5,000 accommodation you were entitled to two sessions a week. It would be a bit like going into a private clinic with pneumonia and being told that "if you pay £10,000 we'll give you an antibiotic that will probably make you better. But if you give us £5,000 we can give you one that might get you better".'
The nurse, whose complaints triggered the investigation into the clinic by the Care Quality Commission, got to know Sarah Mulvey well during his four months working there in 2009. He said the Oxford graduate, who made programmes such as Ten Years Younger, Brat Camp and How To Look Good Naked, was deeply troubled.
'She was paying the lowest rate - £5,000-a-week - but needed the daily one-to-one sessions. She was desperate to get more therapy sessions but didn't have the money. 'She had a meeting with the general manager, who didn't have medical experience and had been a hotel manager prior to joining the clinic.
'He told her she could only have what she could afford. At the time, Sarah was in a hell of a state and when she came out of his office she disappeared. 'After about an hour I rang Brendan Quinn and I said, "I'm dialling 999 for the police," and he said, "No you can't do that." I said, "Brendan I haven't rung you to ask your permission, I'm just telling you what I'm doing." 'But just at that moment I saw Sarah sitting on a rock on the beach. I had never been so scared, I was sure she was going to be found washed up.'
Dorothy King, 35, is a respected archaeologist and historian who spent several weeks at the clinic in the summer of 2009. She suffered from post-traumatic stress and, in particular, appalling nightmares. 'I needed a rest more than anything, and at least I got that, but nothing prepared me for what went on at the Causeway,' she said. 'The place was a shambles. The first therapist I saw was Brazilian, couldn't speak English very well and wore a hearing aid. It was pointless.
'I was OK but it was people such as Sarah and others who suffered more. One girl tried to slash her wrists with nail clippers. We rang several members of staff for help but kept being told that everyone was busy checking in new guests. In the end we had to deal with the situation ourselves. 'There was a real problem with staff shortages, or rather staff retention. No one stayed for very long once they realised the type of place it was.
'The clinic had a contract with a company that provided all the medication and one day, when a guy turned up in a van to deliver it, there was no one around so I ended up having to sign for it. It was a great big box - enough to open a market stall. I took it up to the main house and handed it over.
'There was group therapy every day but much of the time was spent sitting around chatting on the terrace outside our cottages. At any one time there was never more than about 18 patients, five nurses and four therapists. I never saw Quinn, although I spoke to him on the phone.' She said the clinic's two consultant psychiatrists only came to the island twice a week, 'which was woefully inadequate'.
What Ms King didn't know was the clinic had been deceiving the Care Quality Commission about the services it provided. In order to treat mental health patients, it had to be registered, which would have meant submitting to regular monitoring. But when CQC staff visited in February 2007 'staff were not given an accurate picture by Mr Quinn of what was being provided'.
A CQC spokesman added: 'The following year he [Quinn] also wrongly informed a major health insurer that we had registered The Causeway service in 2007.' During the court case, the CQC's counsel said that as a result of this deception BUPA sent a 'great deal of patients' to the retreat.
He added: 'Many complaints were received, particularly from patients and families who borrowed money or raised money. One family from the West Midlands paid £20,000 for four weeks' treatment.'Having being given the promise that the lady would be given specialist treatment for depression, none of the services she had been promised were available.'Her husband had secured that money by virtue of a loan against his property. There were a number of well-known clients and others who were in difficult financial situations and were effectively duped into thinking that they could access specialist treatment.'
Staff asked Mr Quinn on a number of occasions to ensure patients were admitted properly with appropriate paperwork. 'This frequently didn't happen,' said the nurse. 'He [Quinn] would just call and tell us to expect so and so. The patients would ring Quinn and as long as they had a credit card to pay the first week's fees they were accepted. 'We had no risk assessment or medical reports, which was crazy.'
He added: 'One Saturday a woman in her 50s was being admitted and she came over on the boat heavily intoxicated and aggressive. Staff went over on the boat to bring her over. They ended up tying her to the inside of the boat because they were worried about her jumping into the water.
'The lady spent the whole night withdrawing from alcohol without sedatives, which is dangerous as she could have suffered a fit. 'I phoned Quinn and told him that I was going to dial 999 for an ambulance. He told me not to dial 999 and to wait for the doctor who didn't arrive until later that day. 'One patient in his 60s tried to swim back to the island after hitching a lift to the mainland on a boat.'
There was also concern about the way medicine was dispensed. In court, barrister Paul Spencer said: 'Medication was kept in a suitcase in a small cupboard. Medication has to be totally controlled in a locked cupboard and it is a criminal offence if it is not so kept.'
Another former patient, a nurse herself who also asked not to be named, told The Mail on Sunday: 'The way it was administered was very unsafe. 'Medication should normally be brought to the patient on a trolley and the nurse should sign it off once she has seen you take it. But they didn't check and I know that Sarah Mulvey, for instance, was stockpiling hers.
'It was the wrong place for Sarah, she was very sick and they couldn't keep her safe. They didn't understand her and treated her appallingly.
'She was self-harming, burning herself with matches and cigarettes. She told me that the nurses said she had to dress her wounds herself. That's not how you treat people who are self-harming. 'Sarah could also behave in a childlike manner, hugging her pillow and sucking her thumb, and the staff would tut at her and raise their eyes. 'She was an absolutely lovely person, kind and compassionate, particularly kind and understanding to those with mental health problems. 'She used her intellect to talk them out of suicide. She couldn't do that for herself, unfortunately.'
Mr Quinn has been suspended for 18 months by the Nursing and Midwifery Council for offering unlicensed treatments for addiction and depression - including to children. He declined to answer a series of detailed questions about the clinic put to him by The Mail on Sunday.
Speaking at his £800,000 five-bedroom home in Lewes, East Sussex , he said: 'It was not a Third World operation. An awful lot of people were treated very well and had a fantastic experience. 'I never gave drugs to any patient out of a suitcase. We always had the correct equipment in place.' He suggested that he should not be blamed as he was simply a businessman. 'I could not treat patients and run a company,' he said. 2.1.11
Why taking statins might be pointless - and even bad for you
A few years ago many people would never have heard of statins. Now more than five million Britons take the cholesterol-lowering drugs every day to prevent heart attacks and strokes. But do they actually work for many of us? A new study has raised serious questions about whether they do — meanwhile, other new evidence has linked statins with severe depression and suicide.
Statins have been hailed as ‘wonder pills' by doctors and drug companies. They are prescribed to anyone in Britain who is believed to have more than a 20 per cent chance of having a heart attack or stroke over the next ten years. It is hoped that, by lowering their cholesterol, the patients' death risk will drop significantly.
The trend for believing that any cholesterol at all is automatically bad has intensified to the point where growing numbers of patients are being prescribed statins even if their cholesterol levels come into the traditional categories of ‘normal' or even ‘low'.
A new study by a prestigious U.S. university calls all this into question. The research suggests a great many people may not get any benefit from taking statins — that's because it's our calcium levels, not cholesterol, that really matter, claim the researchers. The study of 950 men and women found that statins may only help patients if they have a calcium build-up — calcification — in their blood vessels. Calcium makes arteries harden and increases the risk of high blood pressure, heart attack and stroke.
Scientists believe calcification is primarily caused by a combination of genes and ageing, along with poor lifestyle such as lack of exercise, bad diet and smoking. It's not clear why these cause a build-up of the mineral — though calcium in the diet is not to blame.
The researchers from Johns Hopkins University, Maryland, found that in the group of 950 healthy people, half had calcium build-up; they suffered 95 per cent of all the heart attacks, strokes or heart-related deaths seen in the five-year study. The other half of the group did not have any calcium build-up and, tellingly, they suffered only 5 per cent of the heart problems that occurred. If calcium, not cholesterol, is the real issue, this might explain why 75 per cent of people who suffer heart attacks have normal cholesterol levels.
But the more immediate message, says Dr Michael Blaha, who led the study, is that patients with no calcium build-up would be very unlikely to get any benefit from swallowing preventative statins. ‘Our results tell us that only those with calcium build-up in their arteries have a clear benefit from statin therapy,' he told a conference of the American Heart Association earlier this month.
He says instead of handing out statins to increasing numbers of patients, doctors should first measure patients' coronary artery calcium deposits using a CT scanner (a kind of X-ray machine) and give the drugs only to those with high levels.
There are compelling reasons why we should be wary of swallowing ever more statins — as many as 5 per cent of people develop serious side effects. Numerous studies have suggested we need a certain level of cholesterol in our bodies to remain healthy. People with low cholesterol levels have higher risk of suicide, Parkinson's disease and some forms of stroke.
Why suicide? A new Swedish study of 42 people who had attempted to kill themselves suggests that when our level of blood cholesterol drops, so, too, does our level of the ‘feel good' brain chemical, serotonin.
There are other ‘new' side-effects that have been added to the warning lists published with the packaging on statins. These include muscle problems, sleep disturbance, memory loss, sexual dysfunction, depression and a potentially lethal lung disease.
Overall, the rate of side-effects is low but, given the huge number of users, this adds up to many thousands of patients being affected.
Nevertheless, drug companies are intent on selling ever more statins, which are already the world's top-selling prescribed drugs. The drug makers would like statins to be prescribed more widely to people with normal and even low cholesterol.
Their case seems to be backed by results of a study called Jupiter, which involved more than 2,000 UK patients. The research, paid for by AstraZeneca, claimed that the statin rosuvastatin significantly cut deaths from heart attacks and strokes in men and women who had normal cholesterol levels. The trial was scheduled to run for four years, but after nearly two years, the scientists running it declared that the early results were so strongly positive that they should stop testing and move on to publicising the good news so that everyone could benefit.
The study, published in 2008, is being seen as a good reason for giving statins to a wider group of people, not just those deemed at 20 per cent risk of heart attack.
Statins should even be put in the water supply, according to one of Britain 's leading heart experts, Dr Mahendra Varma, who is vice-chairman of the Northern Ireland Chest, Heart and Stroke Association. But a big scientific row has broken out this year over the Jupiter study. According to three expert articles in the journal, Archives of Internal Medicine, the Jupiter trial was deeply flawed.
Close analysis of the figures by French doctors found that statins did not actually achieve any real reduction in deaths, and the figures had been warped by commercial interference. Nine of the 14 Jupiter researchers had financial ties with AstraZeneca.
Cambridge University doctors who examined the study said the fact that it had been stopped early meant the results could be cherry-picked to make them look favourable before any longer-term problems emerged. The journal's experts added that, overall, the best evidence shows that statins do not, in fact, help people who have no evidence of heart disease.
Despite this, the British Heart Foundation says it continues to support the widespread use of statins. Judy O'Sullivan, Senior Cardiac Nurse at the BHF, says: ‘It is unusual in this country for statins to be given preventatively to people with normal cholesterol levels. We think that statin drugs are useful for the vast majority of people taking them.'
And she adds: ‘We don't think that screening patients for calcium build-up before prescribing them statins would be helpful, as the test would be expensive and expose people to radiation.'
But some doctors are sceptical of preventive statin treatment. Dr Matt Hughes, a GP and hospital practitioner in cardiology in Cardiff , said recently doctors should be very cautious about prescribing statins for people as ‘treatment for a disease they don't have yet'.
Writing in the GPs' newspaper, Pulse, he said the best scientific evidence shows statins do not even benefit people who are considered at high risk of developing heart disease.
Dr Malcolm Kendrick, a Cheshire GP and outspoken critic of widespread statin use, says despite all the negative clinical evidence, prescription levels of statins are still rising considerably, so most people over 65 are taking them. ‘Such widespread use is a tribute to the persuasiveness of the drug companies. It does not mean statins work preventively — they don't,' he adds. 21.12.10
NHS must focus on improving health not meeting time limits: Andrew Lansley
The NHS will be judged in future on improvements it makes to life expectancy, cancer deaths and patients' feedback on care, Andrew Lansley, Health Secretary has said. Dozens of indicators of health will be collected to measure how effectively the NHS is treating patients, the Department of Health has said.
These include hospital superbugs, medicine errors causing harm, emergency admissions for asthma, infant mortality and five year survival rates in a range of cancers. Most of the information is already being collected and by measuring factors that affect patients' health the NHS will focus more on outcomes and less on time limits and 'process targets', ministers have said.
The details of the exactly how much the NHS should improve by on each of the measures will be negotiated next year. A similar set of measures is being drawn up on public health.
The Coalition pledged to remove 'process driven' targets in the health service and are scrapping the four-hour waiting time target in A&E and the 18-week target from GP referral to specialist treatment.
Doctors had warned the target distorted priorities and that they were encouraged to treat less urgent cases ahead of seriously ill people because they were in danger of breaching the target. The new regime aims to prevent that.
Mr Lansley said: “Our ambition is to achieve health outcomes at least as good as any in the world. To achieve this, we need to focus on outcomes and their robust, continuing measurement. "Our focus on improving health outcomes will give the NHS, public health organisations and local government a benchmark for what the public expects to see from their health services.
“The NHS Outcomes Framework will provide patients with a clear national indication of how the NHS is working to improve the quality of service it already gives, and address the inequalities seen in health outcomes. “Public Health is everyone's business and through the consultation on the Public Health Outcomes Framework, people will have the chance to comment on our plans for how success will be judged.
“These are important changes that will be far reaching and I urge everyone who has a view to take part.” 21.12.10
Top doctors' pay up £50,000 - for less work: How our overpaid consultants are dragging down the NHS
Senior doctors earn £50,000 more than they did a decade ago, but their workload has fallen, a damning report revealed yesterday. Hospital consultants now take home £120,000 a year, despite the fact that on average they carry out fewer treatments than ten years ago when they earned less.
The report by the National Audit Office estimates the NHS could save up to £1.6billion a year if hospitals became more efficient and spent less on over-inflated salaries. The average consultant has seen their earnings leap by 70 per cent since the introduction of a new contract by Labour in 2003, designed to reward them for improving the quality of NHS care.
But the Government spending watchdog found their productivity has fallen by 3 per cent.
At the same time, the workload of other staff such as nurses and midwives has steadily increased, even though their pay rises have been far smaller. The report also warned hospitals were not doing enough to curb consultants' ‘lifetime' bonuses, which can see them earning up to £76,000 a year on top of their salary.
These payouts, known as clinical excellence awards, are paid out every year even if they no longer carry out the work for which the money was initially paid.
The NAO found total productivity of hospitals, measured by comparing numbers of patients treated with costs of staff, drugs and equipment, has fallen by 11 per cent in the past decade. It warned NHS spending has almost doubled in a decade to a predicted £102billion for the next financial year. 17.12.10
Changing 'expert' advice, now sunbathing can be good for you, say health charities
Experts have overturned decades of advice by other ‘experts' urging people to go out in the midday sun without sunblock – because the dangers of missing out on Vitamin D can outweigh the risk of cancer. After years of ordering us to cover up to avoid skin cancer, a leading group of charities are now telling us to go out in the midday sun unprotected – at least for the first few minutes.
The change of heart comes as it emerges a large proportion of Britons are at risk from vitamin D deficiency which can lead to a host of health problems.
Paranoia about sun exposure has become so great among some parents that doctors are even seeing a return of rickets in children – the bone disease that it was thought died out 80 years ago. The "definitive statement" by seven leading health groups and charities, including Cancer Research UK, the National Osteoporosis Society and Multiple Sclerosis Society, is designed to clarify conflicting messages.
It concluded that surrendering your body to the sun for 10 minutes should take place at midday during the summer months because that is when the sun is strong enough to trigger the body into making vitamin D.
For the whole of winter, and before 10am and after 4pm in summer, the rays are too weak in the UK , to stimulate vitamin D synthesis in the skin.
But they reiterated the message that people should "never be red" at the end of the day and that foreign sun was much stronger. After 10 it is time to go indoors, cover up or slap on the sunscreen, they said.
Safety advice has softened since fear of skin cancer meant everyone was encouraged to avoid the sun, but this has led to confusion. Thursday's guidance is intended to make it clear that "little and frequent" sun exposure is now officially considered a good thing.
Prof Peter Johnson, chief clinician at Cancer Research UK , denied that it was a great "change of position" or that there was an "epidemic of vitamin D deficiency. "A little sun exposure and often is a good way to get optimal vitamin D levels without adding substantially to the real risk of skin cancer," he said. "It is important to strike the right balance with the risk of skin cancer and vitamin D deficiency. This statement is designed to bring some sort of clarity."
The consensus statement represents the views of the British Association of Dermatologists, Cancer Research UK, Diabetes UK, the Multiple Sclerosis Society, the National Heart Forum, the National Osteoporosis Society and the Primary Care Dermatology Society.
Vitamin D can be obtained from diet but is primarily manufactured in the skin by a process that involves ultraviolet B rays from the sun.
Too little vitamin D can lead to rickets in children and brittle bones in adults. It is also linked with MS, heart disease, diabetes and even cancers. It is thought that getting adequate sun exposure is summer allows the body to build up stores.
The charities said that the usefulness of supplements was not proved except for high risk groups such as pregnant women. They warned that there was a danger that stores could build up to toxic levels which could cause other complications. Experts said winter holidays to sunnier climes might also be beneficial – but ruled out skiing trips, even to sunny mountain slopes.
Warmth was needed for maximum vitamin D manufacture and skiers tended to be too covered up. Sunbeds were also not recommended because they mainly generated UVA rays which produced little vitamin D. Although the vitamin is found in some foods, our diet is not sufficiently rich to do more than just top up levels.
Prof Rona Mackie, of the British Association of Dermatologists, said: "The take home message is that total sun protection with high SPF sun cream all the time is not ideal. "Never be red but the general advise is five or 10 minutes of unprotected sun exposure then put the shirt or sunscreen on."
Critics say, ‘this illustrates how medical advice changes all the time, those who thought sun bathing was bad for you and advised everyone not to do it, did not consider the vitamin D deficiency that followed and the return on the Victoria disease rickets. So called 'expert medical advice' changes all the time, for an industry that ‘peach they know best', they get it wrong more than two thirds of the time and should be less dogmatic'. 17.12.10
EU regulator slams drug companies for putting profit before public health
The continued emergence of drug-resistant "superbugs" has created an urgent need for either better antibiotics or an entirely new approach to dealing with infectious diseases. But drug companies hardly seem concerned about investigating any solutions to the problem because they can make more money by devoting their time to creating other, more lucrative drugs, says the head of a prominent medical agency.
Thomas Lonngren, soon-retiring chief of the European Medicines Agency (EMA), recently announced that his organization may need to step up and act as "watchdog" for the pharmaceutical industry to prod it to better meet public health needs. According to Lonngren, there is little incentive for drug companies to work towards creating better antibiotics at this time because the sales of such drugs will only be a fraction of what other potential "blockbuster" drugs will likely be.
"We have more or less a gap of five years without research into new antibiotics," explained Lonngren at a recent EMA conference in London. "This is probably one of the biggest health threats in the world today ... it's an issue where commercial consideration doesn't really match the public health need."
Lonngren explained that drug companies have neglected other important areas of research and development (R&D) as well, including the area of central nervous system disorders, again because of inadequate profit expectations. And with a slew of drug patents ready to expire, drug companies are scrambling to rake in a much new profit as possible, by whatever means possible.
Most currently-used antibiotics are steadily becoming completely ineffective. But there are many natural antibiotic alternatives like garlic, raw honey, coconut oil and bee propolis that will always be safe and effective against harmful pathogens without inciting harmful side effects. Natural News 17.12.10
If given a fair choice, most consumers would choose alternative medicine over conventional health care
As a strong proponent of free market economics, I have long wondered why free markets don't seem to be operating in the health care industry. Today, it finally hit me with great clarity, and I'll share that with you here. But first, a primer on free market economics:
As the free market theory says, "greed is good" because innovators can only get rich by figuring out how to deliver more goods, services and life improvements to consumers who purchase those items. The genius who figures out how to build a better car - or a less expensive car of the same quality -- earns the business of consumers and is financially rewarded as a result. Greed drives innovation, the theory goes, and innovation benefits consumers even as it fills the pockets of corporate CEOs, too.
This model works under one critical assumption, and it turns out that assumption is not true in health care today (for reasons you'll see below). Which assumption is it? That consumers will rationally purchase only those things that are in their own self interest (things that benefit them) and, equally importantly, that consumers have access to the information they need to make an informed decision.
So, for example, if a solar panel manufacturer figures out a way to make a new line of solar panels with twice the current efficiency at the same cost as current solar panels, consumers will rationally choose to purchase those solar panels and will experience a benefit as a result (but only if they have access to accurate information about the improved performance of those solar panels). The CEO who runs the company that figured out how to make the new, improved solar panels will also reap the financial rewards at the same time.
This is called free market theory in a nutshell.
How it all fell apart in health care
But all this falls apart when corporations are selling products that harm consumers under an irrational system protected by government intervention. Many pharmaceuticals, vaccines and treatment services (such as chemotherapy) actually harm consumers far more than they help them. Knowing this, no rational consumer would choose to purchase such products. So the health care system must engage in some rather devious marketing distortions to cajole people into buying their faulty products:
1) People are TRICKED into thinking they need these products that harm them. This is accomplished through disease mongering (pushing fabricated diseases such as ADHD), emotional advertising and bribing physicians in order to influence their drug prescribing behavior.
2) People are LIED TO about the risks of using such products. Drug companies, in particular, routinely lie to consumers by burying negative clinical trials, bribing researchers to produce positive study results, exaggerating claimed benefits in television advertisements and other similar methods.
3) People are ISOLATED from information they need to know in order to make a rational decision about conventional medicine's products. They are not allowed to know the truth about the dangers of drugs as revealed in clinical trials, for example. The FDA even conspires with drug companies to hide this relevant data.
4) People are FORCED into a monopolistic choice by the government outlawing alternative choices such as natural cancer remedies or certain nutritional supplements . Once again, the FDA plays a key role in discrediting natural alternatives. The health insurance industry also enforces this monopolistic approach by covering conventional sick-care therapies (such as heart bypass surgery) while not covering natural therapies that help prevent degenerative disease.
5) People are KEPT IGNORANT of the actual costs of health care through Medicare, Medicaid and health insurance coverage. Consumers have no idea what they're being billed for most medical procedures because they're not footing the bill! So hospitals, clinics and cancer centers bill whatever amount they can get away with.
Why this recipe works for the sick care industry
Remarkably, this recipe of deception has achieved tremendous success, creating a trillion-dollar global market in bad medicine largely based on quack science combined with manipulative marketing.
Of course, it's not really a free market to begin with. This market is a protected, monopolistic market that's propped up through government regulatory action designed to eliminate competition. It only exists under the illusion of a free market, where consumers think they're making a "free choice" about what drugs to take, not knowing they have another option to avoid taking those drugs altogether and do something completely different to protect their health.
Government intervention harms consumers
One conclusion from all this is that when the government gets involved in protecting one particular industry while allowing "greed" to run its course inside that protected industry, the result quickly becomes harmful to consumers even while corporate CEOs (in Big Pharma) accumulate wealth. We see this in Wall Street as much as we do in health care... notice how the trillion-dollar bailouts all went to the wealthiest money criminals even while debasing the currency held by the working masses?
On the Big Pharma side of things, rather than creating better and more innovative products, these companies are in the business of marketing disease first, followed by introducing a chemical pill designed to treat that disease. This is precisely the story behind restless legs syndrome , for example, or the recent push to use drugs to control your uric acid levels.
When governments interfere with free market economics, they inevitably create an unfair playing field that favors one group of companies over another, and that favoritism will always result in financial exploitation that inevitably harms consumers.
The best way out of this would be to deregulate all health care and end the monopoly on medicine currently granted to Big Pharma (and even doctors at the state level). By allowing all providers of health services and health products to compete on a level playing field, without government favoritism, selection or censorship, consumers would quickly learn which products or services work best to protect their health, and they would rapidly shift their purchasing behavior in that direction.
This would cause a windfall of profits in the realm of natural health and alternative medicine, by the way, even while sharply reducing the profits of Big Pharma and the sick-care industry (because it produces virtually no positive results). In fact, this is precisely why the government is not pursuing a free-market approach to health care right now: Because to allow consumers a truly free choice about how to treat their own health would spell the end of some of the wealthiest corporations in the world -- the drug companies whose very existence depends on ignorance, deception and scientific fraud.
Conventional medicine must force consumers to use it!
This is why the FDA continues to censor the truth about nutritional supplements, by the way. It's the reason why Medicare won't cover Traditional Chinese Medicine or homeopathy treatments. This is why the AMA has waged a 100-year war on the chiropractic industry. Conventional medicine works so poorly and is such a total failure in terms of its results that it has to force consumers to use it . Sometimes at gunpoint! (With the forced chemotherapy treatment of teens, for example.)
No other system of medicine in the world is such a total failure that a government has to force its own citizens to use it through a campaign of disinformation, monopolistic controls and active censorship of alternatives.
Today, Americans think they live in a free country. But most do not realize their entire health care system is structured in direct opposition to free markets and free choice. The sick-care industry can't afford for you to have a free choice, because to do so would destroy their entire business model.
Opting out of sickness and into health
You can, of course, opt out of the entire system as I have done. I spend exactly $0 on health insurance, doctor visits and health care. With all the money I save by not writing checks to a system of failed quack medicine, I instead buy superfoods, nutritional supplements, gym memberships and organic fresh produce that I juice and drink every day. This level of personal health commitment combined with true freedom of choice terrifies both the government and the sick care industry which is precisely why Obamacare mandated that all Americans must buy sick-care insurance or be fined by the IRS.
Think about it: If conventional health care really worked, would they have to send IRS agents after people to force them to buy into it? This is "gunpoint health care" where you get to choose any system of medicine you want as long as it's the one the IRS says you have to choose. Sounds a bit like Communist China, doesn't it?
What we really need is a truly free market for health care products and services. ...a level playing field where natural remedies can be honestly marketed with accurate health claims and where healers of all kinds can engage in healing services without being arrested or threatened with imprisonment. State medical licensing boards, in particular, should be completely dissolved. They are the monopolistic power hubs that enforce conventional medicine monopolies at the state level while criminalize alternative cancer doctors.
A truly free market in health care would revolutionize health in America while ending the dark age of Big Pharma dominance over the entire industry. One day soon, let us hope we may have an opportunity to invoke truly free market economics that will unleash a new era of freedom and healthy living while giving the natural side of medicine its well-deserved opportunity to compete against the failed system of conventional sick care.
In a fair competition, 4 out of 5 consumers would choose natural medicine over conventional medicine. That is precisely why they cannot allow such a freedom of choice to exist. Natural News 5.1.10
Drug recalls surge as Big Pharma's dangerous medications are increasingly exposed
The number of drug recalls in the United States has surged in recent years, raising concerns about the overall safety of pharmaceutical products.
"Overall, I am concerned about the quality of drugs," said Prabir Basu of the National Institute for Pharmaceutical Technology and Education.
The number of recalls ballooned from 426 in 2008 to 1,742 in 2009, with more than 1,000 of the recalls from a single company. That company, Advantage Dose, has since gone out of business. Even removing Advantage's recalls from the picture, however, the number of recalls still increased 50 percent from 2008.
"We've seen a trend where the last four years are among the top five for the most number of drug recalls since we began tallying recalls in 1988," said analyst Bowman Cox. "That's a meaningful development."
Already 296 drugs have been recalled in 2010, continuing that trend. "If we continue at this same rate, we could get 600 or more recalls by the end of the year," Cox said. "That's still a very high rate of recalls."
The errors responsible for recalls have included low-quality raw materials, contamination, and faulty labels and packaging. Analysts attribute these errors largely to manufacturers' efforts to be the first to bring generic versions of drugs to market, and the ensuing temptation to cut corners and skimp on testing the product before releasing it.
"So they get the application. They make and market the drug, but they could still have problems down the road if they haven't really understood the optimum way to make that drug," said Cox.
Because competition can be so fierce in the drug business, especially for companies selling generic drugs, manufacturers also seek to cut costs by outsourcing production to potentially unreliable third parties.
"It is very expensive to make drugs," Basu said. "It also costs a lot of money to maintain adequate quality controls." Natural News 16.12.10
Drug giant Johnson & Johnson recalls 13 million boxes of Rolaids
Johnson & Johnson (J&J) has announced its 14th major drug recall this year so far, this time for contaminated Rolaids products. According to an announcement from McNeil Consumer Healthcare, the J&J division that produces Rolaids, the company is voluntarily recalling 13 million packages of Rolaids Extra Strength Plus Gas Softchews and Rolaids Multi-Symptom Plus Anti-Gas Softchews because they contain "metal and wood particles" and other "foreign materials."
The company had been receiving adverse event reports pertaining to the products that include vomiting, gum and tooth injury, and abnormal taste, which prompted it to initiate the recall. Despite this, though, the company still made the seemingly contradictory declaration that the "risk of serious adverse health consequences is remote."
According to an ABC News report on the recall, the two Rolaids products being recalled were produced by a third-party manufacturer, but a McNeil spokeswoman refused to indicate the identity and location of the facility. Since the company operates facilities in developing nations like India , however, it is likely that production of the tainted products took place at such a facility.
The company has ceased production of the two specific recalled products as well as Rolaids Extra Strength Softchews in order to conduct an investigation into the cause of contamination. McNeil has also instructed consumers to stop using the recalled products immediately.
A quick browse of the McNeil Product Recall page ( http://www.mcneilproductrecall.com/... ) indicates that literally hundreds of J&J products have been recalled this year for various problems. Everything from allergy and pain medicines to children's cold and cough formulas have been recalled for improper labeling, foreign materials and alcohol content, among other things. Natural News 16.12.10
Will we ever wake up to the deadly risks of anti-depressants?
As new research reveals antidepressants raise the danger of heart attacks, the disturbing cost of this modern addiction. Just as David Cameron launches his campaign to boost national happiness, along comes grim news for the 12 million Britons taking happy pills. London-based researchers have just announced that antidepressants raise the risk of fatal heart attacks.
This research is only the latest wake-up call for a nation hooked on happy pills. Might we finally heed the warnings and shake ourselves out of our pharmaceutical stupor? It is high time we did: a small mountain of studies shows that antidepressant drugs are largely ineffective. But more than that, they can ruin lives by creating chronic dependency and a grinding hopelessness that sometimes leads to self-neglect and death.
The latest study, by Dr Mark Hamer, a public health researcher at University College London, shows that people on the older drugs — tricyclic antidepressants — are at far higher risk of cardiovascular disease than those taking the newer class of pills, selective serotonin reuptake inhibitors (SSRIs). But if I were taking SSRIs, I would not be cheered by the findings. Tricyclics were discovered in the Forties and it is only now we have identified these dangerous effects.
Moreover, some SSRI drugs are known to cause serious problems such as stomach bleeding. In addition, the withdrawal symptoms can be so severe that patients may become dependent on them.
Dr Hamer says his findings do not only affect people with depression, because antidepressants are also prescribed to people with back pain, headache, anxiety and sleeping problems. Last year, according to Dr Hamer's figures, about 33 million antidepressant prescriptions were dispensed in England.
At some point, surely, there will be no one left to prescribe for. In my view, it's fast becoming one of the greatest medical scandals of our age.
The most worrying thing about these drugs is not their side-effects, but their widespread non-effect: they just don't work for most people with mild to moderate depression.
Two years ago, researchers at Hull University concluded that the pills only benefit people who are most seriously, clinically depressed. In these extreme cases, there is often a physical problem in their brain, a result of genetics or accident. But what of the rest?
There is a growing view that many people are being needlessly drugged because the natural state of feeling unhappy is viewed as an illness, rather than a normal part of life that we should experience and learn from.
An American study of 8,000 people who had been treated for depression found that a quarter of them were not clinically sick, but had just undergone a normal life event such as bereavement. Their symptoms, it said, should be left to pass naturally (that, of course, would be a blow to the drug manufacturers, who profit so handsomely from the mass consumption of their mind-numbing chemicals).
One leading expert, Randolph Nesse, a psychiatry professor at Michigan University, argues that this mild form of depression is beneficial, often interjecting in life to tell us to stop what we are doing and reconsider.
This can help, he says, when something awful happens to us, such as a job loss or relationship break-up, when it makes sense to slow down to grieve, reassess and make changes. But instead, we live in a world that tells us that when we feel out of sorts we need a pill to recover.
It is this belief that creates queues of patients at the doors of hard-pressed GPs, who often feel they have no option but to hand out happy pills as though they were sweeties.
Many patients later claim they couldn't have coped without them. They will swear that ‘the drugs make me feel better, so they must be working'. But often the drugs do not actually work as chemicals. Instead, they merely reassure us — the so-called placebo effect.
In 2008, Professor Irving Kirsch at Hull University found something strange when he took a close look at some figures from drug manufacturers' own trials of four common antidepressants.
The drugs improved patients' sense of wellbeing. So far, so unremarkable. But many of those involved in the trials were given sugar pills instead of antidepressants. And their depression scores improved just as much as those on the real pharmaceuticals. In other words, the placebo patients put so much store by the magical (and much-promoted) power of antidepressants that they lifted their own morale without any genuine chemical intervention. Such is the life-enhancing power of human belief.
But this phenomenon also has a dark side: the opposite of placebo, which is called the ‘nocebo' effect. This occurs when you convince someone that a particular thing will do them harm, and they begin to feel sick. Talk to someone about food poisoning while they are tucking into a hearty meal and you will see the nocebo effect at work.
Something similar is happening in our pill-obsessed world. When we are convinced that we need drugs to get us out of an emotional crisis, we stop doing things to help ourselves.
This was clear from the latest research. Dr Hamer found that tricyclic drugs raise a person's heart attack risk. But that risk was dwarfed by another danger: the people taking the drugs often lost the will to look after themselves properly. They were more likely to smoke, be overweight and not exercise.
Dr Hamer says that if they started living more healthily they would cut their heart attack risk by three times. Exercise and weight loss would also help alleviate their depression and anxiety. But people stuck in the role of helpless drug-munchers often cannot make that change for themselves. They simply sit waiting for their questionable pills to work. And when the pills fail, they become even more demoralised. It's a vicious cycle, and one that's sucking in more and more vulnerable people.
Thankfully, this situation is not entirely hopeless. Such patients may be helped by cognitive behavioural therapy (CBT). Health department guidelines already state that patients on antidepressants should also be given CBT, but many GPs' budgets will not stretch to providing it.
And what is CBT?
It is a form of talking therapy that encourages depressed patients to exchange their self-destructive thoughts for healthier ways of believing and acting. It is the modern equivalent of telling people (gently) to shape up, smarten up and take responsibility for their own lives.
Except that you could not possibly convey that time-honoured message with such stark clarity these days. Apparently, we are all too fragile to hear such sage advice: the shock might send us rushing to the medicine cabinet.
That is a terrible shame. All the antidepressant drugs and therapy-speak in the world cannot take away the simple, honest fact that life for all of us can be dismally hard at times. For most of us, though, the healthiest option is to face our problems vigorously, rather than disappear down a black hole of antidepressant dependency.
That is an especially important message to spread during this economic downturn. Times are getting harder. But instead of grasping for tablets, we would be far better off being encouraged to rely on our own resources — positivity and self-reliance. It is sad news for the millions on antidepressants that their drugs may have lethal effects on the heart. But if such warnings awaken us to the wider damage these pills wreak, they will have done everyone a priceless favour. 14.12.10