EMERGENCY ROOM BLUNDERING IN THE NHS

Patients admitted to accident and emergency departments with serious injuries are treated routinely with untested therapies that may kill them, one of Britain's leading public health experts said yesterday. Hardly any treatments used in emergency trauma care have been subjected to proper clinical trials, according to Ian Roberts, Professor of Public Health at the London School of Hygiene and Tropical Medicine.

Professor Roberts led the first important study in the specialty, which has shown that drugs commonly used for 30 years to treat head injuries actually increase the chances of death and disability. An "evidential black hole" means that doctors have no way of knowing whether other therapies are similarly dangerous.

Though injury is among the biggest causes of death, it receives a fraction of the research funding given to other killers, such as cancer and heart disease. This is because pharmaceutical companies have no interest in evaluating the effectiveness of widely used but untested drugs, and because injury disproportionately affects the poor, Professor Roberts said. "It is a worrying fact that injury is a major cause of death worldwide, but most of the treatments used in its management are untested," he told the festival conference in Norwich. In the UK, injuries account for 6.6 per cent of the burden of disease, but less than 1 per cent of research spending. This compares with 27 per cent for cancer, 16 per cent for neurology, 12 per cent for infectious disease and 9 per cent for cardiovascular disease.

The biggest random controlled trial of a trauma treatment - the Crash study into corticosteroids for head injury - was stopped early in 2004 after finding that the drugs raised the risk of death by 3 per cent. The Lancet, the medical journal, estimated that at least 10,000 patients had died from the untested drugs. "I very much hope these treatments do more good than harm, but we don't know and I think we should," Professor Roberts said.

Soldiers also suffer from the lack of research, he said, and the Ministry of Defence should devote more funding to trials for treating trauma. "You would have thought the MoD has a duty of care towards soldiers," he said. "Not at all. I think they should show a little interest in evaluating treatment of trauma."

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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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