Monthly Archives: April 2013

Wales Ambulance Service: ‘Big changes needed,’ review says

BBC Wales news reports 30th April 2013:

Major changes are needed in the running of the Welsh Ambulance Service, according to a review commissioned by the Welsh government.

The review also calls for paramedics to be given more training to make decisions about patient care and calls for a revamp of performance targets.

The service failed to meet targets for life-threatening call responses in every local authority area last month.

500,000 to be offered daily breast cancer pill

The Times reports 30th April 2013 (Marin Burrow):

“A daily pill that cuts the risk of breast cancer could soon be available on  the NHS to half a million women.

A study published today suggests that tamoxifen or one of three similar drugs  reduces the incidence of the cancer by almost 40 per cent in women at an  increased risk of the disease.

The National Institute for  Health and Clinical Excellence, the….”

Shingles vaccine to be routine for people in their 70s

News 30th April By Michelle Roberts Health editor, BBC News online reports:

People in their 70s across the UK will be offered a vaccine against shingles from this September.

Experts have been recommending routine immunisation against the disease, which causes a painful rash, for some years.

The government-led programme will target 70, 78 and 79-year-olds in the first instance and should prevent tens of thousands of cases a year

Shingles and the pain afterwards in a significant number of people is important. We have known that the vaccine helps for some years. (BBC News 2005) but for some reason we have not taken this step until now. It is a great announcement.

Shingles is a re-occurrence of Chicken Pox in the nerve root of a particular dermatome (we are all built in caterpillar like segments) and there are some countries who vaccinate against Chicken Pox although it is a relatively minor illness usually…. We have chosen not to for good reasons..BBC News 2010 but we have known about the Shingles Vaccine since 2005 (BBC News)

I would guess that a cost-analysis of the treatments for shingles, which includes drugs, and the pain clinics has only now shown a benefit from vaccination. Is this just a numbers game because there are ore elderly people? What will the attitude be to those who ask for the shingles vaccine before their 70th birthday (choice)? If deemed ineligable (rationing), could they ask for it privately?

Choice in The Information age

In an insightful diagram Richard Smith in the BMJ 2007 tried to look into “The future of Health Care Systems” where patients were allowed to use information to make choices. His diagram is The Information Age. The article and prediction may seem ironic to doctors and patients in Wales, who cannot get choice, and who do not have access to specialist cancer treatment centres.

itfuture with reference

Almost all doctors and nurses would wish to exercise choice for themselves or their family.

Why is this denied to patients in Wales? Listen to Kim Odoherty and Paul Davies WAM in the Audio recordings.

Specialist Treatment Centres

Dr Peter Saul (Associate Dean for General Practice in Wrexham – N Wales) commenting on an article by Dr Simon Chowdhury (Oncologist) and Professor Roger Kirby (Urologist) at The Prostate Centre, Department of Medical Oncology, Guys Hospital, in The Practitioner magazine (published for doctors across the world) covers many subjects and is issued on a monthly basis. One recent article is on

“Advances in the treatment of metastatic prostate cancer 25 Apr 2013

Prostate cancer is the most common cancer in men in the UK. It accounts for nearly a quarter of all male cancer diagnoses and is the second most common cause of male cancer death. Most patients present with localised disease, but there are still many who present with metastatic disease. Medical castration using LHRH analogues has become the gold standard in managing both locally advanced prostate cancer, in combination with radiotherapy, and metastatic disease. Eventually most men with advanced prostate cancer become resistant to ADT. This is now called castrate refractory prostate cancer (CRPC), and is associated with a poor prognosis. There is now hope for patients who progress after chemotherapy with the emergence of several new agents that have been shown to benefit patients.”

The article goes on to summarise:

“The best outcomes for prostatic cancer are in dedicated  centres treating large numbers of patients and where data on treatment outcomes are more readily available. For advanced prostate cancer access to the latest clinical trials and therapies is vital as evidenced by the progress seen with such drugs as abiretone and enzalutamide. The drugs extend life and have significant palliative benefits and until recently, were only available in clinical trials. GPs have a vital role in helping to direct their patients to such centres.”

Science Magasine on 22nd April reports 22ns April on “Why is cancer so common?”:

The text below refers to “The future of cancer research”:

“The field of cancer research is moving away from defining a cancer by where it is in the body, as one type of breast cancer can have more in common with an ovarian cancer than another cancer in the breast.

Instead scientists are looking deeper at what is going wrong inside cancerous cells – a tumour can have 100,000 genetic mutations and these alter over time.

By pinpointing the mutations that can cause certain cancers, doctors hope to personalise treatment – choosing the drug most likely to work on a particular type of tumour.

Scientists are creating targeted cancer therapies using their latest insights into cancer at a molecular level. These treatments block the growth of cancer by interfering with molecules specifically involved in tumour growth and progression.

Clinical trials using gene therapy are also underway. This experimental treatment involves adding genetic material into a person’s cells to fight or prevent disease.”

and then, ironically for people in Wales, For more information and advice, visit NHS Choices

The ability to choose (either by patient or GP) means access to reliable information in order to make the choice. Not much hope for patients in Wales then…. where choice restriction is used as a method of rationing.

We all need the ability to choose specialist treatment centres, not only for prostate, but also for bowel, lung, melanoma skin cancers etc if we are to have a shot at getting the best outcomes.

Fermanagh woman ‘abandoned’ by health service

BBC news reports 29th April 2013:

The family of a Fermanagh pensioner who has been waiting seven months for surgery on her broken arm have said they feel abandoned by the health service.

They said she is in constant pain since the fracture last October. She was told at the time she needed a plate fitted.

Her son said his mother felt let down by a system she had once believed in.

The Western Health and Social Care Trust said it intended to reduce waiting times by renovating wards.

Waiting times are becoming a nightmare across the NHS. They are not published overtly and fed through to GPs. Since Fund Holding, when waiting times interested every GP, there has never been accurate timely information available. In Wales of course the GP has no choice and has to refer locally. Whether choice is or is not available – surely overt information on waiting times and quality should be? When waiting lists are growing, more and more patients will be tempted to go privately, and thus increase inequalities.

Tobacco display ban in large shops comes into force

BBC also reports 29th April 2013:

A ban on the display of cigarettes and other tobacco products in large shops in Scotland has come into force.

Public Health Minister Michael Matheson said the move will help prevent young people from taking up smoking.

Under the Tobacco and Primary Medical Services (Scotland) Act 2010, the sale of cigarettes from vending machines is also banned.