Immoral Science (and research) – e.g. NHS to ban ‘toxic’ metal-on-metal hip implants

Research has changed – it is now driven by pharmaceutical companies looking for lifestyle drugs to treat the elderly and obese in the first world…. It is not aimed at the world population. Much of it is questionable, and Universities and academic institutions don’t help by insisting on regular publication in order to stay in post or advance. Teaching has been subsumed by research and governments conspire in this by their award of grants linked to publication.

What suffers is the “truth”.

Two papers in The Economist 19th October 2013 should make all Scientists and Doctors think about what they read.

How Science Goes Wrong – Economist19102013

Unreliable research – Economist19102013

An example: The Times staff 26th October report NHS to ban ‘toxic’ metal-on-metal hip implants

“Fitting “toxic” metal-on-metal hip replacements will be banned at NHS  hospitals after an unacceptably high failure rate was found among 17,000  patients. 

The guidance was issued by a health watchdog after research found failure  rates as high as 43% among some of the implants, reports said.

Surgeons are concerned that joints are wearing away and failing far too early  and there are fears that some can leak toxic metal.

Orthopaedic surgeon Martyn Porter said seeing the failure rates was like  “watching a car crash in slow motion – at first, you just don’t know how bad  it is going to be”.

New guidelines from regulators say the NHS should stop using any hip implants  with failure rates higher than 5% at five years.

This would mean that almost every metal-on-metal implant, including five still in use, would have to be banned. Traditional implants use a metal ball in a plastic socket.

Research of all hip surgery in England, Wales and Northern Ireland found most  metal-on-metal implants had unacceptable failure levels, falling below  standards set by the National Institute for Health and Care Excellence  (Nice).

One implant, the DePuy ASR required secondary surgery in almost a quarter of  cases during the first five years, the Daily Telegraph said.

Manufacturers admitted to failure rates of 13% in that time, and the device  was withdrawn.

Nice found that after nine years failure rates were estimated at 43%.

Six metal-on-metal models and a ceramic-on-metal model implanted in more than  11,000 patients having hip resurfacing procedures had five-year failure  rates of 5% or worse. Some rose to 16% within nine years, figures show.

Just two types of metal-on-metal implant fall within the proposed national  standard, the study found.

Stephen Cannon, an honorary consultant surgeon for the Royal National  Orthopaedic Hospital, welcomed the report.

He said: “I think there is a question about whether it goes far enough, but  this is definitely a step in the right direction – it amounts to a ban on  most of them.

“The figures speak for themselves – even the best metal-on-metals have four  times the failure rate of the rest. This is a really significant problem  because these were given to an awful lot of people.”

Mr Porter, past president of the British Hip Society, said the full scale of  the failings was only now becoming clear and that the scale of the problem  was “extremely disappointing”.

He said: “These devices, which were supposed to be innovative, had such poor  results.”

Some senior surgeons have called for all types of the implant to be removed  from the market.”

One wonders how much criticism and repetition of the work was done by unbiased parties when considering the licensing of these hips? I happen to have one but it has been no trouble!

Update 1st November 2013 from The Times Letters November 1 2013:

The draft guidance does not say anything about prostheses being ‘toxic’, and this document does not change NHS practice for now

Sir, Your headline “NHS to ban ‘toxic’ metal-on-metal hip implants” (Oct 26) misrepresents the NICE draft guidance on hip replacements.

NICE is updating its existing guidance on provision of hip replacement prostheses, based on medical evidence about how long artificial joints can last. The recommendations include a stricter benchmark for the quality of hip prostheses, proposing that those prostheses should be used for which there is evidence that they need replacing only in 5 per cent of people within 10 years, instead of the current 10 per cent. The NHS is not to “ban” use of the devices. The draft guidance does not say anything about prostheses being “toxic”, and this document, which is currently open for public consultation, does not change NHS practice until final guidance is issued. Professor Carole Longson Director of the Centre for Health Technology Evaluation at NICE

Update 30th October 2013 Charles Bankhead , Staff Writer, in MedPage Today and correspondence reports a meta analysis from 2010, and recently corroborated by the BMJ: Should people at low risk of cardiovascular disease take a statin? BMJ2013;347:f6123 (Who sponsors medpage I wonder? Could it be the drug companies?)

Should Healthy People Take Statins? New Studies Say No Published: Jun 28, 2010 followed by

BBC news May 2012 NHS ‘should consider giving statins to healthy people’ By James Gallagher

Pharmcy news in Australia comments: ABC under fire for airing controversial statin and cholesterol views 29 October, 2013

Whilst all the research on statins is done by the companies themselves it has never been verified independantly. Lifestyle drugs for great profits…

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This entry was posted in A Personal View, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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