Friday, October 06, 2006


But will the NHS be able to afford it? Note a previous story here

A condition that causes thousands of Britons to go blind every year can be halted and even reversed with a monthly injection. Trials into a treatment for age-related macular degeneration (AMD), which is diagnosed in more than 20,000 elderly people a year and is the commonest cause of blindness, have shown dramatic results for almost all who use it. Patients given Lucentis did not only have the gradual deterioration of their sight halted, but even regained vision lost to the disease. For decades, patients with the condition, which leaves 10 per cent of sufferers blind, have been told there is little or nothing that can be done to slow the disease, let alone reverse it. But in a new trial Lucentis reversed sight damage in more than a third of participants with "wet" AMD, the most damaging form of the disease. It also prevented further loss of vision in almost all who were treated with it.

About 24,000 patients a year have wet AMD diagnosed. It is responsible for 90 per cent of cases where people lose their sight entirely: loss of vision is caused by the growth of new blood vessels behind the retina, which cause bleeding and scarring.

Lucentis, developed by the Californian company Genentech, does not yet have a British licence. At 1,000 pounds a treatment, it will raise serious funding questions for the NHS if recommended for use by the National Institute for Health and Clinical Excellence (NICE), which is conducting an appraisal. Costs for treating all newly diagnosed cases to a course of monthly injections - the regime used in the trial - are put at 400 million pounds.

Steve Winyard, head of campaigns at the Royal National Institute of the Blind, said that the results were very exciting. "These results show that the drug is just as good as we thought it was going to be. About 30 per cent of these patients got a significant gain in sight, which shows that the drug also offers improvements as well as preventing sight loss." John Blake, 75, one of the few patients in Britain to have been treated with Lucentis, said that the drug had improved his sight sufficiently for him to be able to take up golf again. "Everything had gone, 80 per cent of my life had gone", he said. "I couldn't drive or watch TV," he said. "Within three days my sight had improved. It cost me nearly 5,000 pounds, but I'm very pleased."

The two trials published today in The New England Journal of Medicine compared Lucentis with a placebo and Visudyne, the only treatment hitherto available on the NHS. In the placebo-controlled trial, 716 US patients were randomly given Lucentis at two dose levels, or a placebo. Over two years, a third of patients given the higher dose of Lucentis gained in visual acuity, compared with only 4 per cent given the placebo. On average, Lucentis patients were able to read about six more letters on the optician's chart after two years of treatment than at the start, while those given a placebo could read fifteen fewer letters.

In the second trial, Lucentis was compared with Visudyne. Over two years, between 35 and 40 per cent of those given Lucentis improved by an average of 15 letters, while fewer than 6 per cent of the Visudyne group did this well. Yit Yang, a consultant ophthalmologist from Wolverhampton, described the results as very striking. "These results mean that potentially people with wet AMD can become independent again and return to activities such as reading, shopping and hobbies."


NHS-speak 'demeaning to patients'

Terms such as "frequent flyers" and "bed-blockers", used by ministers and NHS staff to describe patients, are demeaning, the patients' tsar says. Harry Cayton said such negative words shifted blame to patients and should be avoided, the Royal Society of Medicine journal said. Frequent flyers - patients who are in and out of hospital - and bed-blockers are common phrases in the NHS. The Department of Health said it would take the comments on board.

Mr Cayton, the national director for patients and the public, said of the term frequent flyers: "It implies that somehow these people want regular trips to hospital, that they are collecting points, that they enjoy the health and life-threatening roundabout of continual admission, treatment and discharge." Other phrases, such as bed-blockers, shifted the blame from the NHS to the patient, and further examples of labels included referring to those who do not turn up for appointments as "DNAs".

He also attacked the use of words like "dement" to describe somebody with Alzheimer's disease. He added: "Labelling people in this way is the most common way in which the NHS dehumanises those it is supposed to care for." He said most of the language was used to describe elderly people, possibly reflecting an ageist culture. "Older people generally use the health service most often but they are also sometimes the least able to speak up for themselves, the most vulnerable."

Mr Cayton said he understood that health workers needed to create distance due to the stresses of the job, but added they should find other ways of achieving that distance. A Department of Health spokesman said: "It is important that we are sensitive to the terms patients do not find acceptable. "Harry Cayton is one of our very valued National Directors and an incredibly experienced champion for patients' rights. "We welcome his views and will take this feedback on board."



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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