Evidence basis is needed for all treatments – and confirmation by independent third party. Hospitals and pysicians collude to waste money.

The Crick Institute, with buildings at Mill Hill and in Central London, could be a useful tool in health rationing once rationing is overt. It’s evidence could be an additional source for NICE. However, the incentive for government keen to reduce costs is on questioning too much, and delaying, and the incentive for big Pharma is to sell more. The evidence for many drugs in common use should have been questioned more, and the alternative use of funds which might have been used on Pharma products needs more consideration. Only overt rationing can do this. Bisphosphonates such as Alendronate cost money, and it might be better spent elsewhere. The advertising and the sale pitch is on fear of fractures, and the misconception that X ray improvement of bone density correlates with less risk. Hospitals think they will reduce costs, and physicians want to do good, so they conspire/collude to waste money. Knowing this, Big Pharma is willing to pay us when it’s arm is twisted.. (Drug companies propped up NHS with £250m after cabinet’s threat)

Tom Feliden reports in the Times 1st March 2017: Osteoporosis drugs may make bones weaker

Drugs used to treat weak bones in elderly patients suffering from osteoporosis may actually make them weaker, research suggests.

Scientists at Imperial College London examined the bone structure of hip-fracture patients who had been treated with bisphosphonates.

They found evidence the drugs were linked to microscopic cracks, making bones more fragile and prone to break.

Osteoporosis affects three million people in the UK.

What is osteoporosis?

Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures.

Bisphosphonates – the main treatment for osteoporosis – are an extremely successful and commonly prescribed class of drugs that slow down the natural processes by which the body removes ageing or damaged bone.

But doctors have raised concerns about the number of fractures occurring among elderly patients who have been taking the drugs for a long time.

To find out why, the team led by Dr Richie Abel took samples of bone from 16 hip-fracture patients and studied them at the Diamond Light Source – the massive doughnut-shaped Syncatron or particle accelerator at the Harwell campus in south Oxfordshire.

“What we wanted to see was whether the bone from bisphosphonate patients was weaker or stronger than bone from untreated controls,” Dr Abel explained.

“Rather startlingly, we found the bone from the bisphosphonate patients was weaker. That’s a conundrum because the bone should be stronger.”

By bombarding the samples with X-rays 10 billion times brighter than the Sun, the team were able to generate images of the internal structure of the bones in unprecedented detail.

These showed microscopic cracks building up in the bones of patients treated with bisphosphonates.

Dr Abel said: “The drug is clearly working, but it also leads to the build-up of micro-cracks in the bone and that could increase the likelihood of a fracture.”

It’s a surprising result, but the study was small and the work is at an early stage.

Even so, Prof Justin Cobb, a co-author on the paper, says the discovery raises important questions about how we prescribe bisphosphonates for long-term conditions such as osteoporosis.

“There’s no hurry, but we should think about how long people are taking them for, and how we might monitor the development of these micro-cracks,” he said.

In the meantime the researchers say people should continue to take medications prescribed by their doctor.


Osteoporosis: Are you at risk?

If you answered: “Yes,” to more than one of these questions, then you may be more at risk of developing osteoporosis:

•Has anyone in your family ever been diagnosed with osteoporosis?

•Have you ever broken a bone after a minor bump or fall?

•Are you female and aged over 50?

•Do you drink more than three units of alcohol a day?

•Do you miss out on summer sunlight (through being housebound, avoiding the sun, always covering your skin or wearing sunscreen)?

•Do you miss out on doing at least 30 minutes of activity five times a week?

Source: National Osteoporosis Society

Medline Evidence on Osteoporosis

NICE pathways to Osteoporosis treatments

(Drug companies propped up NHS with £250m after cabinet’s threat)

No party is offering a credible alternative….. the future of the 4 UK Health Services may lie in social media

 

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This entry was posted in A Personal View, NHS managers, Rationing, Stories in the Media, Trust Board Directors 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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