NHS WASTES MONEY ON DUBIOUS TREATMENTS WHILE DENYING PATIENTS PROVEN TREATMENTS

A group of Britain's leading doctors has urged every NHS trust to stop paying for alternative medicine and to use the money for conventional treatments. Their appeal is a direct challenge to the Prince of Wales's outspoken campaign to widen access to complementary therapies. Public funding of "unproven or disproved treatments" such as homoeopathy and reflexology, which are promoted by the Prince, is unacceptable while huge NHS deficits are forcing trusts to sack nurses and limit access to life-saving drugs, the doctors say.

The 13 scientists, who include some of the most eminent names in British medicine, have written to the chief executives of all 476 acute and primary care trusts to demand that only evidence-based therapies are provided free to patients. Their letter, seen by The Times, has been sent as the Prince today steps up his crusade for increased provision of alternative treatments with a controversial speech to the World Health Organisation assembly in Geneva. The Prince, who was yesterday given a lesson in crystal therapy while touring a complementary health unit in Merthyr Tydfil, will ask the WHO to embrace alternative therapies in the fight against serious disease. His views have outraged clinicians and researchers, who claim that many of the therapies that he advocates have been shown to be ineffective in trials or have never been properly tested.

The letter criticises two of his flagship initiatives on complementary medicine: a government-funded patient guide prepared by his Foundation for Integrated Medicine, and the Smallwood report last year, which he commissioned to make a financial case for increasing NHS provision. Both documents, it is claimed, give misleading information about scientific support for therapies such as homoeopathy, described as "an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness". The letter's signatories include Sir James Black, who won the Nobel Prize for Medicine in 1988, and Sir Keith Peters, president of the Academy of Medical Science, which represents Britain's leading clinical researchers.

It was organised by Michael Baum, Emeritus Professor of Surgery at University College London, and other supporters include six Fellows of the Royal Society, Britain's national academy of science, and Professor Edzard Ernst, of the Peninsula Medical School in Exeter, who holds the UK's first chair in complementary medicine. The doctors ask trust chief executives to review their policies so that patients are given accurate information, and not to waste scarce resources on therapies that have not been shown to work by rigorous clinical trials. They conclude: "At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence."

Professor Baum, a cancer specialist, said that he had organised the letter because of his "utter despair" at growing NHS acceptance of alternative treatments while drugs of proven effectiveness are being withheld. "At a time when we are struggling to gain access for our patients to Herceptin, which is absolutely proven to extend survival in breast cancer, I find it appalling that the NHS should be funding a therapy like homoeopathy that is utterly bogus," he said. He said that he was happy for the NHS to offer the treatments once research has proven them effective, such as acupuncture for pain relief, but that very few had reached the required standards "If people want to spend their own money on it, fine, but it shouldn't be NHS money."

The Department of Health does not keep figures on the total NHS spending on alternative medicine, but Britain's total market is estimated at 1.6 billion pounds.

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CARELESS NHS SURGICAL TRAGEDY

What a culture of quotas and minimal accountability produces. In private medicine, doctors are much more likely to listen to patients

A surgeon "in a hurry" removed the wrong kidney from a patient and left her dependent on dialysis because he did not bother to read her medical notes, a disciplinary hearing was told yesterday. The General Medical Council was told how Jerome Blanchard took out his patient's transplant kidney, which was still functioning, instead of her diseased natural kidney.

Although both kidneys were on the patient's right side, she had told the surgeon that it was the painful polycystic organ that was to be removed. The fitness to practise panel was also told that Dr Blanchard did not bother to discuss the operation properly with the woman when obtaining her consent for surgery at the Middlesex Hospital, Central London, in March 2004.

Lydia Barnfather, for the council, said that if Dr Blanchard had discussed the operation sufficiently with the patient it would have become clear what operation needed to be performed. "The impression he gave her was that he was in a hurry," she said. "Dr Blanchard examined her and while he was doing so Patient A told him it was her enlarged polycystic kidney that was to be removed and she demonstrated the region of that."

But it was only when the patient's daughter noticed after surgery that there was no catheter to support the transplant kidney that Dr Blanchard realised that he had taken out the wrong organ, the GMC panel, sitting in London, was told. Although the transplanted kidney, which the patient received in 1994, was going to have to be removed eventually, the patient still had plenty of time before it needed to be taken out.

There were other factors, including confusion on the theatre list, that contributed to the wrong organ being removed, the panel was told. "The mistake would never have been made if Dr Blanchard had been carrying out his own duties with regard to getting an informed consent," Ms Barnfather added.

The patient, a mother of three who is now on dialysis for four hours three times a week, said that her diseased kidney needed to be removed because she was in constant pain and had a swollen stomach. She told the panel that she had been expecting to see Dr Blanchard the evening she went into hospital but did not see him until shortly before the operation the next day, after she attended an outpatient appointment for a thyroid condition.

"He examined my stomach and he kept asking me where is my transplant kidney and I said, `It's here'. I said to him, `You know it's the big polycystic kidney that is coming out'," she said, and added that he did not seem to respond. "My whole stomach was out there. You couldn't miss it," she said.

The GMC was told that an abbreviation for transplant was marked on the consent form that the surgeon gave Patient A to sign. The patient said that she had not noticed the abbreviation, and would not have let the operation go ahead if she had seen it. "I just signed it because I trusted him," she said. "He didn't say anything about what operation he was going to perform." She was now back on the transplant list, but did not know how long it would be before another kidney became available.

Dr Blanchard has admitted to removing the wrong kidney but denies misconduct relating to a failure properly to discuss the procedure with the patient or ensuring that he was performing the appropriate surgery. The hearing continues.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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