Left-leaning doctors promote sweeping social meddling

The American Medical Association, meeting in Chicago this week, will consider a controversial proposal to fight obesity by taxing soda pop. A committee of the influential doctors' group is recommending the AMA lobby for a "small" federal tax on sugar-sweetened soft drinks, with proceeds going to anti-obesity efforts such as physical activity programs and healthier school meals. The committee did not specify how high the tax should be. But a consumer group, Center for Science in the Public Interest, estimates that a 1 cent a can tax would raise $1.5 billion a year. That's more than the advertising budget of McDonald's.

These are among the proposals the American Medical Association will consider this week during its annual meeting at the Hilton Chicago: Support a 50 percent reduction in salt in processed foods, fast foods and restaurant meals over the next decade. Urge health insurance plans to cover stomach-stapling surgery for weight loss. Oppose beer ads on college sports broadcasts. Prepare a report summarizing video game research, including emotional and behavioral effects and addictive potential. Push to ban smoking in all public places and workplaces. Urge school health classes to "discuss the importance of routine pap smears in the prevention of cervical cancer." Support mandatory school instruction on the dangers of Internet pornography.

During its five-day meeting, the AMA's governing House of Delegates can accept, reject, amend or table these and dozens of other proposals. A 12-ounce can of Pepsi contains 150 calories of sugar or high fructose corn syrup -- the equivalent of 10 teaspoons of sugar or a 3.2-ounce reduced-fat ice cream cone at McDonald's.

In the late 1970s, teens drank nearly twice as much milk as soft drinks; now they drink twice as much soft drinks as milk. Pop is "devoid of nutritional value" and contributes to increasing obesity rates, the AMA committee said. The committee cited one study that found the odds of a child becoming obese increases 60 percent for each additional can of pop consumed each day. However, the committee report noted that other studies have found no link between soft drinks and obesity. The AMA committee also endorsed soda pop taxes imposed by state and local governments. Diet pop, flavored milk and sugary fruit drinks should be exempt, the committee said.

More than a dozen states have passed soft-drink taxes, but in recent years several states have repealed such taxes. States typically use soft-drink taxes for general purposes, rather than for obesity programs. Taxing soft drinks is "misguided," said Kevin Keane of the American Beverage Association. "It will not move the needle one ounce in addressing health and wellness issues." Doctors should know better than to target a single food, Keane said. "People consume a lot of calories every day. Why pick on one particular product?"

Of course, soda pop is not the only cause of the obesity epidemic. But pop makes an easy target because it has no redeeming nutritional value, said Michael Jacobson of the Center for Science in the Public Interest. "It's a simply defined category of food that's pure junk." The AMA's House of Delegates can accept, reject, amend or table the committee's recommendation. An AMA endorsement of a soft drink tax could be "extremely useful" to legislators who push such measures, Jacobson said. However, he added that a federal soda pop tax is unlikely. "Tax increases are not popular with this administration or Congress," Jacobson said. "It would be dead on arrival."

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Bloated NHS to get the Tesco treatment

Health chiefs want to use 'lean thinking' management techniques to remedy an inefficient service

Hospitals and surgeries need to adopt the "lean" management techniques used by companies such as Tesco and Toyota to reduce the inefficiency and hold-ups experienced by patients in the NHS. Health service leaders want hospitals to improve their service by better understanding how patient demand varies and identifying and removing the valueless activities that create bottlenecks in the system.

These include getting patients from accident and emergency to the operating theatre more quickly by removing unnecessary paperwork and reducing the number of different staff involved. It also involves improving the layout of hospitals, so that waiting rooms and items such as diagnostic machines are where they are needed most, to save time and money and reduce patient and staff stress.

One hospital trying the "lean" approach, a production methodology first developed about 60 years ago by Toyota, found that processing a routine blood sample involved 309 separate steps, which it reduced to 57 with simple changes. They also found that under the current system more than 250 different interactions took place to discharge a patient with complex health problems. A report commissioned by the NHS Confederation, Lean Thinking for the NHS, concludes that the lean system, which is also used by the Royal Navy and Royal Air Force, could revolutionise health care and dramatically improve quality and efficiency.

The key is to remove activities that do not add value to the customer, or patient, by redesigning how services work. Early results of a study by Bolton Hospitals NHS Trust, with the assistance of the RAF, showed that the lean method helped to cut by a third death rates for patients having hip operations; reduced paperwork in the trauma unit by 42 per cent; and halved the amount of space needed by the pathology department.

Nigel Edwards, policy director of the NHS Confederation, which represents health service managers, said: "Many ideas about the organisation of work are deeply held and often wrong." Australian health chiefs at Flinders Medical Centre in Adelaide, who redesigned their care based on the lean model, found that it allowed them to do about 20 per cent more work and offer a safer service on the same budget and using the same infrastructure, staff and technology. Gill Morgan, the NHS Confederation's chief executive, said that more was needed to improve frontline services. "The NHS can learn from the latest thinking as adopted by the Royal Navy, RAF, Tesco and Toyota. NHS managers want to be at the vanguard of modern techniques to improve patient care." She said that the pioneering work done at Bolton and Wirral, which had also adopted the method, showed what could be done. David Fillingham, chief executive of Bolton Hospitals NHS Trust, added: "When we started out, some people were very sceptical. But I've never seen anything that energises staff in this way."

Results of a survey of 203 NHS chief executives, released by the confederation at its annual conference yesterday, showed that 95 per cent accepted that the NHS must increase productivity and cut waste before they could justify more government funding. Tony Blair has also called for trusts to improve efficiency. In an interview with Health Service Journal, published today, he says that the principles of quality healthcare provided equitably and free would remain abstract concepts without good NHS management. The Royal Navy adopted the lean method after it felt pressure to reduce its aircraft support costs by 20 per cent. It managed to reduce the number of aircraft repair bases and saved millions of pounds on its Sea King and Lynx helicopter operations.

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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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