Monthly Archives: April 2014

Antidepressants do more harm than good, research says

Chris Smyth reports April 30th in The Times: Antidepressants do more harm than good, research says This is old news, revisited because Chris Smyth knows we need to ration the resources spent on psychiatric care. We cannot replace the drugs with talking therapies without planning, and being overt. Any change for this one area would imply that the system could be changed throughout.. The fear of being honest by managers, commissioners  and politicians is leading to overuse of drugs, underuse of people, and bad medicine..

Drugs given to millions of people to treat depression do more harm than good and must not be seen as a “quick fix” for psychological problems, a group of researchers will say today.

People with mild depression get little help from drugs such as Prozac and Seroxat but risk sexual problems, thoughts of suicide and debilitating withdrawal symptoms, says one of the world’s leading experts on medical evidence.

Professor Peter Gøtzsche, co-founder of The Cochrane Collaboration, says that “doctors treat patients much too loosely” and many would be better off with talking therapies or exercise. He will today launch an organisation, the Council for Evidence-Based Psychiatry that aims to “start a national debate about the use of psychiatric drugs and treatments, given the mounting evidence of ineffectiveness and harm”.

Other experts conceded there were legitimate questions to be asked about when doctors used antidepressants and whether talking therapies should be more widely available, but insisted drugs should not be demonised…..

Sensible summary of the impending Health Service disaster – Simon Stevens

Chris Smyth in The Times 230th April 2014 reports on : Cookie-cutter tactics hurt NHS, says boss – for Cookie cutter read covert post code rationing. This is as far as the new boss will be allowed to go in moving towards overt rationing, and the next step will need to be taken by a leading (leader?) politician… This is a sensible summary of the impending Health Service disaster, without political honesty and philosophical change as implied in the Belfast Newsletter.

The new head of the NHS has suggested that the health service will need a cash injection after the next election in his first appearance before MPs.

Simon Stevens, chief executive of NHS England, also criticised a “cookie cutter” approach to care as he urged local health chiefs to experiment with different ways of organising services. Appearing before the health select committee, he also suggested more local hospitals could be saved and admitted the NHS had to “get better at listening”.

Accepting predictions that the health service would face a £30 billion funding gap by the end of the decade without reform, Mr Stevens promised to come up with a fundamental review of NHS finances by the autumn. He said: “If it is the case, as hopefully it will be, that strong economic growth returns then I think for medical reasons, for economic reasons, for social reasons, most independent commentators would predict that the nation would probably be spending more in real terms on health care by 2021 than it is now.”

After reports that he plans an expansion of competition within the service, Mr Stevens said he was “pragmatic” about market forces, saying it was sometimes helpful for patients to have a choice but adding: “do I think it’s the answer to what has to be done in the NHS? No I do not.”

Mr Stevens said that care was “not very joined up” around patients and said that the gap between the NHS and social care was too often failing elderly patients. “About 90,000 are admitted from their own home to hospital as an emergency and discharged into a care home, in many cases that might be appropriate but in some I suspect that it is the absence of other alternatives that is driving that. For this group of frail older people the system is not necessarily working terribly well right now and we have got to change that,” he said.

He also held out hope of a reprieve for some local hospitals after a period in which health service leaders have talked of centralising care to improve results and save money. “I believe that when you look at other countries and compare us to them you would say that we already have a fairly centralised hospital system and it may well be if you get really creative about what you do to local hospitals it would not always be a case of closing or merging as some people think,” he said.

See Commissioning and decommissioning..

Belfast Newsletter implies denial of need to ration and lack of political leadership

The Belfast Newsletter 29th April 2014, in a report entitled: Calamities abroad put our problems into perspective, suggests that there is a political denial of the need to ration health care, and no willingness to lead.

….”There are extreme demands on our healthcare as the population ages, yet a general refusal to accept any sort of NHS rationing, such as prescription charges…..

Too true. Sometimes politicians need to lead, and if they fail the situation gets worse. This worsening situation exists not only in out Health Ser vices, but also in our political system (disengagement and disillusion at both national and Regional levels in Wales) and when considering the environment against intensive agriculture and cheap food. If the price of food rises the price of housing probably goes down! If politicians are unwilling to lead, then we may get a press led society… Until social media such as NHSreality gets a hearing..

Rate of repeat abortions is increasing –

Rosemary Bennett in The Times 29th April 2014 reports: Rate of repeat abortions is increasing

One in four women who has an abortion goes on to have another, according to a leading provider of terminations in Britain.

Marie Stopes International said it was very concerned that the opportunity was being missed to help women to choose an effective form of contraception after they have had an abortion to try to make sure they do not end up with another unwanted pregnancy.

Department of Health statistics show that while the overall number of abortions is going down, the proportion of repeat abortions is rising. In 2012, 37 per cent of women who had abortions had had one previously, compared with 31 per cent in 2001 and 34 per cent in 2010.

Marie Stopes, which carried out 65,000 of the 185,000 abortions that took place in England and Wales last year, interviewed patients who had had more than one to try to see why they were getting pregnant again….

In my own practice in West Wales we found that many of the abortion requests came from older women. We obviously had a different image than the cities where most are younger. The problems around limiting the number of abortions ( to one or possibly two in exceptional circumstances)  is that this form of “deserts based rationing” ends up punishing the unwanted and yet-to-be-born child.

Cancer no longer a death sentence as half of victims survive a decade

 

Chris Smyth in The Times 29th April 2014 reports the good news: Cancer no longer a death sentence as half of victims survive a decade 

This improvement is in most G8 countries, and in comparison the UK lags. The main outcome indicator is how soon a patient gets referred and imaged or biopsied. Waiting times for tests and out patient appointments are important, and must be speedier if we are to match other countries. At the moment we just don’t have the imaging and radiology capacity..

Half of people with cancer will now survive in the long term, according to figures that mark a “tipping point” in the fight against the disease.

Cancer should no longer be seen as a death sentence and is on its way to becoming a chronic condition that people can live with for decades, Cancer Research UK said as it published figures revealing huge improvements in care in the past 40 years.

Fifty per cent of those told they have cancer today are likely to live for at least a decade, compared with just a quarter in the 1970s, according to analysis of data on seven million patients. Many patients who live for ten years after diagnosis will be effectively cured, with no greater chance of dying of cancer than anyone else.

Yet there are huge variations between different types of cancer, with just five per cent of lung cancer patients projected to live more than ten years and just one per cent of people with pancreatic cancer likely to do so, unchanged from the 1970s. By contrast prostate cancer has shown huge improvements, with 84 per cent living more than ten years, up from 25 per cent in the 1970s…

23.7%

Cancer survival rates

The chart below shows the percentage of people who have survived for at least 10 years after diagnosis. Use the buttons to see survival rates from 1971 to 2007. For further graphic look here

Placebo – is a cheap and useful option for doctors and patients

Alan J Bennett writing in a letter to The Times 25th April says:

In tests of a new migraine drug around half the control-group guineapigs fared better with the placebo

Sir, The results achieved by the two migraine drugs you report (Apr 23) will be welcomed by sufferers. You do not comment on the results achieved by the control groups, who were given placebo treatments.

In the first study the migraines were reduced by 52 per cent; in the second control group migraines were reduced by 42 per cent over 12 weeks. Had these placebo treatments been the main subject of the researches, the results would have been trumpeted from the rooftops.

Any medications developed from these researches will, as you say, need extensive testing, and are unlikely to be available on the NHS for several years. The placebo treatments, however, are available now.

Is it not time the NHS put the placebo effect to work? Pain clinics would seem to be one obvious setting. The extra costs would be virtually nil. The implication of “deceit”, a possible moral hazard for staff, must surely be confronted: the benefits for patients demand it.

Alan J Bennett

Bexhill-on-Sea, E Sussex

I agree. Placebo is a cheap and useful option for doctors and patients

Dental Training – There is no control

Dr Josie A Beeley of Glasgow University writes in The Times 25th April 2014:

The General Dental Council has no control over 17% of the dentists on its register – and more are coming

Sir, Amid the discussions about the qualifications of doctors who trained outside the EU, little attention was paid to EU/EEA-qualified dentists.

Of dentists registered with the General Dental Council (GDC) 72 per cent are UK qualified, 17 per cent are EU/EEA qualified, and 11 per cent are from overseas. Overseas graduates have to pass an overseas registration exam which is of the same standard as the final examination in UK dental schools, and also includes basic science.

However, there is no such requirement for non-UK, EU/EEA- qualified dentists. Moreover, while UK graduates also have to complete a period of supervised practice to be able to practise in the NHS, this is not required of other EU/EEA graduates.

The Association for Dental Education in Europe is trying to achieve harmony in dental education throughout the EU/EEA, but these standards are variable.

The GDC validates training in the UK, but such a national supervisory body is not the EU norm.

Currently the GDC has had no control over the qualifications of 17 per cent of dentists on its register, despite having been set up by Act of Parliament for this purpose. With the proposed reduction in the number of UK dental school places and countries such as Romania producing five times as many dentists as they have employment for, this figure seems likely to rise.

Dr Josie A Beeley

Association of Basic Science Teachers in Dentistry, University of Glasgow