I posted a link to a Daily Mail article by Dr Ben Goldacre a couple of days ago. A couple of months ago the TED Blog published this
post with more comment on the issue of selective publishing of medical trials, along with a video of Goldacre’s talk to TEDMed 2012.
It is well worth watching, but at the same time is pretty terrifying when you consider the implications of what is going on. Most people wouldn’t buy a car for example purely on the sales patter of the car salesman, or the information in the brochure – we know it is going to be biased and selective, we look for independent tests, maybe in the motoring press. That’s not what happens with drugs. Drugs are tested by the manufacturers, and they choose whether or not to publish the results. If the results are positive they publish, negative they’re less likely to. Medical practitioners therefore do not have a full picture when prescribing drugs that could potentially be life or death to a patient…
“People will do lots and lots of studies and on the occasions that it works, they’ll publish. On the ones it doesn’t, they won’t,” says Goldacre in his talk. “This is a problem because it sends us all down blind alleys.”
It was quite a surprise to find out this morning that Dr Ben Goldacre had an article running in the Mail on Sunday. He is more usually found writing his column on Bad Science in the Guardian and certainly the quality of science reporting in papers like the Daily Mail has been a big subject of comment on his part, but it is indeed the same Dr Ben Goldacre writing for a tabloid!
The subject for his article is an important one, picking up themes from his latest book . In this case he is talking about Tamiflu, the drug that the UK government spent £500,000,000 on stockpiling in the wake of the bird-flu epidemic and which the manufacturers are surprisingly unwilling to publish any data on the success of. Essentially GP’s are prescribing this, and a number of other drugs on nothing more than sales patter, with no detailed evidence of whether the drug actually works. Shocking stuff…
Tamiflu is supposed to be the miracle flu drug. Patients across the UK rely on it. In medicine cupboards everywhere patients have eagerly stockpiled it, and in some winters there has even been talk of rationing.
The Government itself has spent £500?million on stockpiling the drug to keep the country from collapse in the wake of a bird-flu epidemic, since it’s supposed to reduce the risk of pneumonia and death.
And yet for all we know, Tamiflu might be no better than paracetamol: because
Roche, the company making it, still withholds vital information on the risks and benefits from researchers, doctors and patients.
Click here to view original web page at www.dailymail.co.uk
We had an interesting debate this morning as a result of a speech local MP Dr Phillip Lee made to a think-tank last night calling for patients who lived unhealthy lifestyles to be forced to pay for their treatment.
Dr Lee said some evidence suggested diabetes treatments could account for a quarter of the NHS budget by 2025.
“This clearly isn’t a sustainable position,” he said in a speech to the right-leaning think tank.
would suggest one way of perhaps trying to move that locus of responsibility for health care from the state to the individual would be in making it that you pay for your drugs at cost, in that way you would be attaching a consequences to lifestyle choice.”.
The idea seems pretty straightforward, if you choose to eat unhealthily others shouldn’t subsidise you, if you smoke, similarly others shouldn’t subsidise your treatment. But where do you draw the line?
One of my colleagues rides a mountain bike, whilst this could be seen as healthy, why should I as someone who doesn’t ride a mountain bike subsidise his hospital treatment if he falls off and injures himself? Similarly why should people who have chosen not to have children subsidise maternity care for those who do, or indeed subsidise healthcare for the children?
Also who decides whether somebodies illness is the result of an unhealthy lifestyle or something else – will it be the GP’s themselves, or do we hand it to some independent group like ATOS, who as we all know are currently doing a superb job at assessing disability claimants…
Click here to view original web page at www.bbc.co.uk
Just came across this article from a local paper in Surrey: Councillor defends two-tier NHS proposal (From Your Local Guardian). It seems a local councillor has come up with a grand plan to rid Surrey of all the overweight people, smokers and drinkers by introducing a two tier NHS. The idea is that in this new Utopia the overweight people, smokers and drinkers, frustrated by the poor service they are receiving will move away, to be replaced by lean, fit, fruit juice drinkers keen to move into the area because of the improved health service they will be receiving. This will also boost house prices…
Basically a modern day eugenics programme using the remains of the “Marxist” NHS. Remember it’s safe in their hands folks!
During his time as Tory leader in opposition, David Cameron has been at pains to portray his party as the party of the NHS pledging to protect and increase spending on the British health service. Alongside that he highlights how he is a proud user of the service – his most recent child being born at an NHS hospital, his other children having been treated by the NHS. Coming into government, the talk so far has been of saving money by cutting back on bureaucracy, reducing management but leaving front line services in tact. However the inadvertent leak and subsequent official confirmation of the scrapping of NHS Direct calls that promise into question, or at least the Tory definition of a front line service. The Liberal Democrats similarly made a commitment not to cut front line services, so again, is this Nick Clegg (@nick_clegg) breaking a promise, or again do the Liberal Democrats have a different definition of a front line service?
What is even more galling about the whole announcement is that when you read the detail, they aren’t phasing out the nurse led medical helpline across the whole country. NHS24 and NHS Direct Wales the Scottish and Welsh versions of NHS Direct are continuing, it’s only in England that the nurse led helpline is being dropped in favour of the new NHS 111 service, a service where the staff on the phone will have sixty hours of training rather than nurses who have been through the same degree and level training as any other nurse working in the country. Essentially the English are being palmed off with a cut price imitation, whilst other parts of the UK continue with the full service.
It’s not as if this isn’t a popular service, it handles calls from 14,000 people a day and has been estimated to have saved other parts of the service hundreds of millions of pounds. Certainly on the occasions we’ve used it the choice was to phone NHS Direct, or pack the kids into the car for a trip to the local Accident and Emergency department. We have an out of hours GP service, but that is run by one person and when we have called it we have often had to wait a good while for a call to be returned. NHS Direct have always been a lot quicker in responding, and in a couple of situations where in the early hours of the morning we have been worried about a sick child have given us clear advice and saved us a trip to casualty. They’ve also given Beth advice when she was concerned over drug combinations when she has both been pregnant and also breast feeding – all advice that a telephonist with sixty hours training would not be allowed or qualified to give, and that the out of hours GP would just be too busy to provide. It seems doubtful if a call centre of primarily operators with a much reduced number of professional medical staff will be able to give the same level of service and support that for over ten years the English public have been getting, and the Scottish and Welsh public will continue to receive.
Following the announcement, discussion on Twitter has been taking place under the #savenhsdirect hash tag, and there is already a petition launched at http://www.savenhsdirect.co.uk/ – and there is already speculation that this change might go the way of the abolition of free school milk which was announced and then swiftly U-turned. It’s pretty clear that the axing of NHS Direct wasn’t intended to be announced just yet, so maybe we’ll have Andrew Lansley to thank in a few months for making another goof in letting the cat out of the bag so soon, and giving the Save NHS Direct campaign a chance to get going sooner rather than later!