Category Archives: Paramedics

Rethinking primary care user fees: is charging a fee for appointments a solution to underfunding? If we don’t keep the gatekeeper role for GPs the system will get constipated.

A recent report in the Times (Not on line) opines “Gatekeeping by GPs called into question. This is not new, as you can see from the debate following Matthew Paris’ article in 2015. The problem is not referrals, but the 90% who do not need a referral. Allowing others, less trained in dealing with uncertainty, will lead to more referrals, longer waits and a constipated system. The useless 111 service where there has seen no reduction in GP workload is another attempt to wriggle off the hook of under capacity and poor manpower planning. In his Imperial College funded report, Geva Greenfield and others report: “Rethinking primary care user fees: is charging a fee for appointments a solution to underfunding?”.

One solution is to make patients pay for their GPs and let them have appointments free with the nurses and paramedics. A two tier system by design. Lets see the comparisons in referral rates, expense and survival!! The result would be anarchy.. (sic) Geva Greenfield says “There is a trade-off that needs to be found between GPs serving as hgatekeepers to secondary care, and at the same time allowing patients to see a consultant when they wish”. We are trying to treat patients, and the governement are treating populations. Money matters, and the services are all rationed. (covertly)

Image result for money and NHS cartoon

Image result for money and NHS cartoon

This is the sort of thinking “outside the box” of current opinion that we have to get to talking about openly.

On November 26th 2018 Chris Smyth reported in the Times: Bypassing GPs could help to diagnose cancer sooner

In Pulse 2015: GPs should give up their Gatekeeping Roles

Matthew Paris on June 16th 2012 reported in the Times: GPs – little more than glorified receptionists

In this age of medical specialisation, if family doctors didn’t exist we wouldn’t feel the need to invent them

Next Thursday, family doctors plan to strike. Striking doesn’t suit the profession’s humanitarian image. Interviewed, doctors’ leaders struggle to insist (on the one hand) that nobody needing medical attention will be denied it, without implying (on the other) that few will suffer if doctors aren’t there.

How much, though, would we suffer? If family doctors had not existed, would we today have found it necessary to invent them?

We pay general practitioners more than we pay airline pilots, but they are becoming glorified gatekeepers: a portal to the more specialist medical care that our health service offers in growing measure. As GPs have receptionists, so the NHS itself uses GPs as its receptionists. Are we investing too much in the citizen’s first port of call, to the detriment of investment in the specialist attention to which, to an increasing degree, surgeries are likely to end up referring the patient?……..

……..Nurse-led primary care, too, is plainly on its way and expanding fast, with (the research is clear) excellent results. Walk-in and appointment clinics are becoming more common, especially evening clinics. Sexually transmitted disease, family planning, coughs and colds, eye, ear nose and throat … in all these fields specialist practices staffed by nurses and pooled doctors, rather than personal GPs, are where we’re going.

The only question is how fast. Let’s hope next Thursday’s strike prompts us to speed this thinking up. Decades ago, at the bookshop Foyles, you had to get a little chitty from a person in a booth before you could get your purchase. One day we’ll remember the GP surgery in the same way, with the same amusement that the archaic practice lingered so long.

The response June 18th 2012:

Sir, Matthew Parris (Opinion, June 16) is not quite correct in describing GPs as “becoming glorified gatekeepers”. We have already had that role (among others) for decades.

It is true that part of this role is to refer to secondary care, but he seems to miss the corollary of this; that we also judge when not to refer, thus saving patients, and the country, the burden of over-investigation and over-treating. The internet has expanded everyone’s access to specialist knowledge, but has not, perhaps, increased our ability to apply that knowledge appropriately. We know more, but understand less.

Mr Parris also fails to acknowledge that GPs have a vital role in the other direction of travel; from specialist care to the community. In this past week I have picked up the care of patients after their discharge from heart by-pass surgery, psychiatric in-patient treatment, dermatology, gynaecology, child autism and palliative care clinics.

In addition, we need to manage patients whose symptoms and conditions cover several specialties, as well as those who have exhausted all secondary care investigation without any diagnosis being reached.

“A decent grasp of the whole thing” is exactly what GPs need.

Dr Jonathan Knight
GP, Ipswich

Sir, Matthew Parris assumes that his interaction with his GP is typical of the work that GPs do. I have been working in general practice since 1987 and my experience is very different. We spend most of our time managing long-term illness such as high blood pressure, diabetes, kidney disease and asthma. When I was in training in the 1980s these conditions were managed in hospital but are now managed mainly in primary care. Of course I do not profess to be an expert in everything so I may refer to colleagues for opinions about aspects of a patient’s care, but they are then usually discharged to my care.

Allowing less-qualified health professionals to manage patients has never been shown to be more cost effective than using GPs.

It is this system of every patient having a GP, enshrined in Bevan’s original vision for the NHS, that other health systems around the world have strived to emulate. We should not discard it lightly.

Steve Charkin
London NW3

Sir, Matthew Parris says that he believes he could refer himself appropriately to a specialist, but he is not our typical patient. GPs’ time is predominantly taken up with the very young and the elderly, particularly those with chronic, complex and multifaceted medical conditions. For these folk, it is their GP who sees the “big picture”, the context and impact on the individual and their family, while each specialist focuses in on his own area of expertise. Approximately 90 per cent of healthcare needs are met in the community, by GPs and their practice nurses, with only 10 per cent of care being hospital-based, at far greater expense. It is true that a GP’s role includes “gate keeping” access to expensive specialist opinion, but I would suggest this is essential.

As Mr Parris concedes, most GP consultations do not lead to a referral to a specialist. His vision of a future without GPs to manage the majority of our health concerns would be financially unsustainable and bewildering to many. Would a woman with lower abdominal pain and back ache refer herself to a gynaecologist, urologist, gastroenterologist, oncologist or orthopaedic surgeon? Does she need a specialist at all if it is just a urine infection? How does she know?

While a single day of industrial action will cause no more inconvenience than the extra bank holiday for the Diamond Jubilee, Mr Parris belittles our role at his peril.

Dr Isabel Cook
Reading

Sir, Before getting rid of GPs Matthew Parris might be wise to wait until he is a bit older when he may have to see more than one specialist at the same time. He will find that the treatment for one condition often aggravates another and he will then be grateful for a generalist’s opinion. He will also find it more efficient to keep seeing the same GP so that he does not have to keep repeating his past history.

Dr Richard Stott
Epsom, Surrey

Sir, As a GP I know Matthew Parris is right. A lot of what GPs do is pointless or could be done by others. So there is a simple solution: stop giving us work.

John Booth
Middlesbrough

Sir, There is overwhelming evidence that GPs deliver highly effective, cost-effective care to our patients. Moreover, we do so with the trust of our patients, and with care and kindness.

I invite Mr Parris to sit through a surgery with me at any time, where he will see first hand how GPs care for the elderly, the frail, the disadvantaged and the ill. I’m sure that afterwards his perceptions of general practice will be different.

Professor Clare Gerada
Chair of Council, Royal College of General Practitio

 

Can the NHS be saved? Only with different local and global thinking, and changing the “rules of the game”.

All of us in the caring professions know the answer to this question, and indeed that there is no “N”HS any longer. The Guardian knows the answer….. Iain Robertson Steel, a retired medical director acknowledges the problem (But suggests no answer/solutions), but on 26th April  in the Western Telegraph I suggested a “fourth option” for people in Pembrokeshire.  This last is only for local needs, and a letter suggesting a global rethinking was in the Western Mail 25th Jan 2018 is at the bottom of this post. What can save the 4 health services is not clever reorganisations, but an honest debate on overt rationing, and making it clear to everyone what is not available free, for them. ( Changing the rules of the game )

Image result for rules of the game cartoon

Can the NHS be saved? The Guardian – Dennis Campbell – 

…the Guardian’s health policy editor Denis Campbell spent a day in King’s College hospital in London. He found staff and patients who are devoted to the NHS but who can also clearly see what is needed in order to sustain the service for future generations.

A long-term plan designed to secure the future of NHS England has been delayed once again by Brexit. But as Britain’s health service heads into its annual winter beds crisis, the Guardian’s Denis Campbell visits King’s College hospital in London to find out what staff and patients need for the future – and how much it will cost. 

“The Welsh NHS and social care is a shambles and no longer sustainable or fit for purpose.” Dr Iain Robertson Steel in the Western Telegraph 7th December.

Health service needs to be remodelled Western Mail 25th January 2018

From the perspective of west Wales there is no British health service.

I do not have access or choice to anywhere outside my own rural trust (Hywel Dda) unless the service needed is not available here. Even a second opinion has to be within the same trust.

There are four, and possibly five health services if Manchester is included. The WHO has said it will no longer report on an “NHS”.

The lack of choice, the covert rationing, and the unequal access to tertiary centres, primary care, and palliative care threaten to bring on civil unrest.

A Welsh mutual of three million people cannot offer the same quality of healthcare as one of 60 million. Even if the Welsh Government has tax-raising powers, there are not enough taxable earners to rise above the decline.

We seem to have forgotten the power and improved health outcomes in large mutuals. Since the UK’s health service has to be refashioned, now seems a good time to unify again, and re-establish the same rights across the country.

Increasing taxation to pour more into a holed bucket should not appeal to most taxpayers.

We need a new health insurance system (the original NHS was insurance based) and the caring professions will remain cynical until what replaces “in place of fear”, avoids bringing it back.

Dr Roger Burns

Haverfordwest

Pembrokeshire GP urges a “fourth option”. Western Telegraph 26th April 2018

The finances are in such a mess, that local post code and unexpected rationing is everywhere… The “Rules of the game” need to be changed…..

Changing the rules of the game

Image result for rules of the game cartoon

 

Yet another surgery closes. St Clements in Neyland …. How to make a population angry…

Yet another surgery closes.. NHSreality has been told of scores of surgeries closing since the last post on this subject. Neyland has two surgeries, and so one will have to do. Some closures lead to large travelling needs, great inconvenience, and sometimes expense. The idea that “access” should be free and easy is being challenged by a thinning primary care workforce – why? There are just not enough doctors, and this is only the beginning of a ten year decline. A&E departments, particularly in Wales, (Owain Clarke for BBC Wales: A&E safety risks ‘unacceptable’, first minister warned) are imploding, and as NHSreality has pointed out in the past, there may come a day when ambulances ask the patient to choose between state A&E and Private A&E departments. Do the people of Neyland, who have another practice they can attend, prefer a surgery manned by paramedics and nurses, untrained in differential diagnosis or living with uncertainty? Fortunately, Pembrokeshire is benefitting from increasing numbers of Trainee applicants for General Practice, mainly due to financial inducements, and will be relatively better off in 5 years time than other regions. In the last 6  months 50,000 patients have lost their surgery.….. over 2 years about 4 million. This becomes a sizeable, angry, voting population….

Image result for surgery closed cartoon

The Western Telegraph reports 17th Jan 2018: Public meeting announced to fight plans to close St Clements Surgery in Neyland.

Neyland looks set to lose one of its two doctor’s surgeries.

Argyle Medical Group is planning to close the St Clement’s Surgery, it announced on Wednesday.

It means Neyland patients will have to pay £1.50 a time to cross the Cleddau Bridge to attend appointments in Pembroke Dock’s Argyle Street surgery.

Argyle Street itself is already under major pressure with photographs over recent months showing patients in large queues trying to get appointments.

In a statement posted on Facebook on Wednesday evening, Argyle Medical Group, said: “Argyle Medical Group has submitted an application to Hywel Dda Local Health Board to close the Branch Surgery at St. Clements Neyland.

“The reason for this application is to consolidate & maintain patient care services at a time of reduced GP numbers at the practice.

“Despite concerted attempts at GP recruitment over recent years the practice has been unsuccessful. The practice has been successful in recruiting a further Nurse & Pharmacy practitioner & is continuing to try to recruit further such practitioners.

“The practice plans to increase its capacity to deal with urgent medical problems by offering increased clinical practitioner appointments. These practitioners will be backed up by a GP to provide immediate advice as needed. It is planned this service will be provided from Argyle Surgery, Pembroke Dock alone.

“Argyle Medical Group will continue to provide the full range General Medical Services to its registered patients in Neyland & the surrounding area. In order to facilitate the enhanced same-day service at Argyle Surgery it is proposed that appointments at St. Oswalds Surgery, Pembroke will change from a same day to a pre-booked appointment system.

“The practice consider this action to be the only option to enable a safe level of clinical care to be offered to all its registered patients at a time when recruitment & retention of clinical staff is extremely challenging.”

The move has sparked anger in the town with patients blasting the decision as ‘absolutely disgraceful.’

Neyland county councillor Simon Hancock said the move cannot be allowed to happen.

He has organised a meeting for Neyland residents.

Cllr Hancock said: “A public meeting will be held at Neyland Athletic Club next Thursday 25 January at 7pm to protest against the proposed closure of St. Clement’s Surgery. It cannot be allowed to happen.

“A campaign committee will be formed. Please come along to show your support for a matter of enormous importance for every person and family registered there.”

Cllr Hancock, who is mayor of Neyland, added: “The proposed closure of the surgery is completely unacceptable and will put patients in Neyland and the surrounding villages at risk.

“A town of the size of Neyland needs good quality medical facilities and the Argylr Medical Group will be breaching their responsibilities in seeking to close their Neyland base.

“People without transport will be disadvantaged, people will have to pay travel costs and the consequences when the Cleddau Bridge is closed to all traffic are  too shocking to contemplate.

“I hope we have an excellent and representative turnout  to the public meeting to fight the proposed closure. Simply this is a battle Neyland cannot afford to lose.”

Fellow Neyland county councillor Paul Miller, said: “‘While I understand recruitment of GP’s is difficult this proposed move is a serious betrayal, by the Argyle Medical Group, of its patients in Neyland.

“I’ll be standing side by side with the people of the town in opposition to what would be a serious backward step in the provision of vital medical care.

“The Health Board must block this request and engage with us in an urgent conversation about providing a sustainable GP service for Neyland.”

Preseli Pembrokeshire MO Stephen Crabb said: “This is hugely disappointing news that St Clements Surgery feel the need to close due to a failure to recruit.

“Pembrokeshire is a fantastic place to live and work and more should have been done by the Hywel Dda University Health Board and the Welsh Government, who hold power over the NHS in Wales, to ensure that St Clements Surgery had staff in place to remain open.

“The Welsh Labour Government have known about recruitment problems in rural practices for a long time and have failed to come up with a strategy.

The decline of General Practice.. Bribes may be too late…

Jeremy Hunt to unveil state-backed GP indemnity deal. Bribery is an admission of perverse recruitment and education processes..

A humanitarian crisis – and the goodwill of staff has disappeared. When will the public ask for private A&E?

Patient died in care of unqualified paramedics

Its more than a thin front line, as half timers take over from deserters…

2,000 foreign GPs needed to tackle growing shortage. How about an apology to 20 years of rejected applicants to medical school?

Jan 27th 2016 – almost 2 years ago: The sick parade – of GP closures. This list heralds the end of the health service as we knew it.

Nick Bostock in GPonline 18th Jan 2018 Practice mergers or closures affect 50000 patients in 6 months.

Image result for surgery closed cartoon

In Wales they really can waste money: £68m unveiled for health and care hubs

BBC News reports 6th December: £68m unveiled for health and care hubs

The profession will not see this as positive. It marks the beginning of the end for self employed GPS. It is probably a waste of money, and it is part of the direction of travel, where fewer and fewer people have access to the expertise needed when they are ill. Differential diagnosis, risk analysis and safety netting are all part of a Drs training, and in the case of GPs, living with uncertainty so that good gatekeeping ensures minimal waste. These GP “Geese” who laid those golden eggs are not here now….

But it may be attractive to part time GPS with families often married to other doctors.

Image result for skilled people cartoon

ITV News 6th December covers the initial reaction of the profession: Plans for 19 new health and care centres…..

…Dr Charlotte Jones, chair of the BMA’s General Practitioners Committee says she’s concerned about the lack of involvement of local clinicians:

Whilst we welcome improving access to services closer to people’s homes, it’s difficult to assess the impact this will have without knowing the intricacies of how it will work. It’s concerning to us that the initial reaction from LMC members suggests that they haven’t been involved in the design of the scheme.

It’s vital that local clinicians, who understand the needs of the local community, are involved in service design to ensure that patients receive the services they deserve.

As part of the work to improve access to local services, investment is desperately needed to ensure the GP estate is fit for purpose. Robust premises strategies must be developed, with the full involvement of LMCs. – Dr Charlotte Jones, Chair GPC Wales

Dr Ian Lewis reports 26th November in Walesonline another money spend, mostly from charitable fund raising, which will cut out the GP. By deskilling the GP how does society gain? This is the opposite of utilitarianism. (Greatest good for the smallest number) and brings back the suggestion of the Court Report in the 1970s#; A child health centre in West Wales could be created 20 years after it was proposed – The venture has been in the pipeline for almost 20 years and is estimated to be worth £2.5million

Just as there wont be enough Doctors, there won’t be enough care homes. There are many opinions, but NHSreality fears that Wales is pouring money into a number of buckets which have holes in them. There are just not enough trained people: GPs, Nurses, Physiotherapists, Psychologists, OTs, Psychotherapists, Radiologists, Anaesthetists, you name them…

Mark Smith reports in Walesonline 4th December: The Welsh care homes under threat for not meeting standards – Care homes in Wales are under threat of being suspended or de-registered

BBC News 21st September: NHS reform can cut costs, says local council leader

BBC News 4th December: Cash ‘ploughed into NHS’ preventing change, AMs warn

BBC News 5th December: Welsh Government ‘sticking plaster’ on health services

Image result for not enough skilled people cartoon

 

 

Worried there may be an epidemic – of deaths, many alone at home… A precarious health service..

Niall Dickson opines in the Times 9th October 2017: This will be one of the NHS’s toughest winters and flu is not the only epidemic professionals fear. Mental health (Elderly, middle aged and teenagers), Diabetes from Obesity, staff bullying, staff attacks, drug addiction  and almost any other service you like to name.. The future of the whole NHS is precarious..

Image result for cartoon epidemic

It is becoming hard to overstate the perilous state of the health and care system in England. We have just polled our members — 92 per cent of healthcare leaders are “concerned” about their ability to cope this winter and 62 per cent of those are “extremely concerned”.
Last year the NHS managed well in difficult circumstances. Yet the impact on patients was evident. In early winter, waiting times in the big emergency departments rose sharply, with nearly one in five patients waiting longer than the four hours that is supposed to be the maximum. And there were ten hospitals in which less than 70 per cent of patients were seen within four hours.
This year there is an even greater sense of foreboding. There is much activity in central NHS bodies and an understanding of the political sensitivity of this issue — in part this is because of the obvious damage and distress that such delays cause patients and their families, but it is also because emergency departments are seen as a litmus test for the rest of the system. If the health service cannot cope at its front door, what lies behind it will also be struggling.
The causes are well known — we have a rising population. We have not invested enough in the services in the community that take pressure off hospitals, and we have a problem recruiting skilled staff. Emergency admissions are continuing to rise — in the first quarter of this year there was a 25.9 per cent jump in responses to life-threatening ambulance calls — so the ambulance service too is under increasing strain.

Image result for cartoon epidemic
The current levels of concern are heightened by fears that we may not escape a flu epidemic this year. Simon Stevens, CEO of NHS England, has pointed out that hospitals in Australia and New Zealand have been hit by the worst flu season in years; there is a good chance the same H3 strain is heading our way. A lot of work is underway not just to improve the flow of patients through hospitals but to relieve pressures elsewhere in the system. At the heart of all this will be effective planning and good co-operation across the entire health and social care system, but there is only so much that can be done.

A cash injection at this stage is unlikely to solve the winter pressures, but the chancellor must revisit the pencilled-in figures for 2018-19 and 2019-20, which if left as they are would guarantee more crises ahead and further delays to the reforms that are needed. For the longer term, the budget in November will be an opportunity for the government to underline its support for the NHS and to make sure it is deternot preside over a deteriorating service.

Niall Dickson CBE is chief executive of the NHS Confederation, a membership body for NHS health and social care organisations

Kat Lay reports: NHS straining at the seams as our bad habits add to pressure and Cash boost can’t save NHS from another winter crisis and Mental health staff attacked ‘on daily basis’

Chris Smyth: NHS is given six weeks to empty beds in flu alert

and Financially the lunatics running the asylum have run out of ideas in reigning in the cost of locums. Experience is very valuable in medicine and the most experienced radiologists, anaesthetists ans surgeons command high prices in their market, one created by politicians.

A perverse incentive epidemic, especially in mental health – both for GP’s pay/workload in UK and increased organ donors in the US, or dying, means that the systems are likely to get worse ..

An epidemic of nationwide bullying. In most dictatorships this precedes dissolution or breakdown….

Rosemary Bennett 10th October : Half of expelled pupils are mentally ill

Image result for cartoon epidemic

BBC News reports “peanuts” spending: Scottish government announces mental health funding boost

Nick Triggle for BBC News: NHS future precarious, says regulator

Hearing loss and dementia: more research is needed. Patients with hearing aids in hospital need special consideration, and for over 70s, that’s over 60% of us …

More research is needed into the relationship between hearing loss and dementia. Patients with hearing aids in hospital need special consideration, and for over 70s, that’s over 60% of us … The rationing of hearing aids is patently perverse, and the outcome could be more long term dementia care demand on the state. And of course the politicians making the decisions today will not be those addressing the future problem.

Image result for hearing loss and dementia cartoon

A letter from Dr Ted Leverton in the JRCGP October 2017 reads: 

Iliffe and Manthorpe’s editorial in the August issue1 is apposite in view of the publication in July of the Lancet Commissions’ report Dementia prevention, intervention, and care, which expands on several of the themes raised.2 In particular, the editorial’s focus on the role of general practice in prevention and research is to be welcomed. However they do not mention hearing loss, to which the Lancet report devotes considerable space and ascribes a significant potential preventive role. Hearing loss is independently associated with developing dementia in about one-third of cases.

Recent research has suggested that use of hearing aids may reduce or prevent the increased prevalence of dementia seen in adults with hearing loss.3,4 This needs confirmation, as current evidence is weak due to the large number of confounding factors. General practice is ideally suited to carry out this research thanks to our large-scale and long-duration databases. In the meanwhile, GPs are likely to see increasing numbers of patients asking for referral for hearing aids, as some in the commercial sector are stating this benefit of hearing aids as fact. Such referral should be expedited; GPs are sometimes accused of minimising hearing loss and delaying referral, but early users of hearing aids are more likely to use aids successfully over a longer timescale as they can be difficult to use. Hearing loss is associated with depression and social isolation;5 denial of the disability is common, as is irritability and interference with relationships. By the age of 70 years, 70% of GP patients have hearing loss. If in doubt, or if the patient is reluctant, a simple validated screening test is available over the phone or online.6

REFERENCES

  1. (2013) Hearing loss and cognitive decline in older adults. JAMA Intern Med 173(4):293299. Lin FR, Yaffe K, Xia J,et al.
  2. (2015) Hearing loss and cognition: the role of hearing aids, social isolation and depression. PLoS One 10(3):e0119616, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356542/ (accessed 5 Sep 2017). Dawes P, Emsley R, Cruickshanks KJ, et al.
  3. Action on Hearing Loss. Check your hearing. https://www.actiononhearingloss.org.uk/your-hearing/look-after-your-hearing/check-your-hearing/take-the-check.aspx (accessed 5 Sep 2017).

The evidence basis of all practice(s) needs to be challenged – continuously. There are perverse Incentives in private systems, but why do the UK health services still overtreat?

David Epstein in propublica (Atlantic) on 22nd Feb 2017 writes/asks: When Evidence Says No, but Doctors Say Yes = Long after research contradicts common medical practices, patients continue to demand them and physicians continue to deliver. The result is an epidemic of unnecessary and unhelpful treatments. (Such as Bisphosphonates)

Image result for bad pharma cartoon

You can listen to the article  HERE, and the importance of evidence based medicine, study replication and critique becomes vital. In the UK we see the over prescribing of anti-depressants to elderly people (BMJ 2011;343:d4551 ) when over 90% don’t work and 7% cause side effects (At present unpublished data). In orthopaedics we were given the solution to cross infections and waiting lists in 1983, but have moved in the opposite direction, closing cold orthopaedic hospitals or denying them as choice options to patients. In addition, clips closing skin wounds have been shown to increase infections by 300% but are still used because they are faster! The article covers heart disease, hypertension, knee injuries and other conditions that need systematic evidence review. What has never been measured is morbidity and mortality for patients who wait longer for operations (Hips and Knees especially) as there is no public database, and big pharma are not concerned. Indeed, waiting lists mean more drugs, prescriptions and side effects. Proposed legislation to reduce efficacy thresholds (USA) could increase the influence of “pharma” when the opposite is needed…

For a summary read from this link. When Evidence Says No, But Doctors Say Yes

Summarising:

Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all.

Atenolol did not reduce heart attacks or deaths—patients on atenolol just had better blood-pressure numbers when they died.

The consultants approach: “Just do the surgery. None of us are going to be upset with you for doing the surgery. Your bank account’s not going to be upset with you for doing the surgery.”

When looking at cross-over trials for cancer: “If the treatment were Pixy Stix, you’d have a similar effect. One group gets Pixy Stix, and when their cancer progresses, they get a real treatment.”

When distinguishing between relative and absolute risk: “Relative risk is just another way of lying.”

The article ends:

In 2014, two researchers at Brigham Young University surveyed Americans and found that typical adults attributed about 80 percent of the increase in life expectancy since the mid-1800s to modern medicine. “The public grossly overestimates how much of our increased life expectancy should be attributed to medical care,” they wrote, “and is largely unaware of the critical role played by public health and improved social conditions determinants.” This perception, they continued, might hinder funding for public health, and it “may also contribute to overfunding the medical sector of the economy and impede efforts to contain health care costs.”

It is a loaded claim. But consider the $6.3 billion 21st Century Cures Act, which recently passed Congress to widespread acclaim. Who can argue with a law created in part to bolster cancer research? Among others, the heads of the American Academy of Family Physicians and the American Public Health Association. They argue against the new law because it will take $3.5 billion away from public-health efforts in order to fund research on new medical technology and drugs, including former Vice President Joe Biden’s “cancer moonshot.” The new law takes money from programs—like vaccination and smoking-cessation efforts—that are known to prevent disease and moves it to work that might, eventually, treat disease. The bill will also allow the FDA to approve new uses for drugs based on observational studies or even “summary-level reviews” of data submitted by pharmaceutical companies. Prasad has been a particularly trenchant and public critic, tweeting that “the only people who don’t like the bill are people who study drug approval, safety, and who aren’t paid by Pharma.”

Perhaps that’s social-media hyperbole. Medical research is, by nature, an incremental quest for knowledge; initially exploring avenues that quickly become dead ends are a feature, not a bug, in the process. Hopefully the new law will in fact help speed into existence cures that are effective and long-lived. But one lesson of modern medicine should by now be clear: Ineffective cures can be long-lived, too.

NHS rationing: hip-replacement patients needlessly suffering in pain on operation waiting lists

The physiotherapists research: Toby Smith & Debbie Sexton, and two consultants (Donell and Mann) in 2010:  Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis (BMJ 2010;340:c1199 ) – found a 3 fold or 300% increase in infections

Blunders. Iatrogenesis continues to be very important – for us all. It may become more so…

The nation hooked on prescription medicines – no more than many others actually..