Thursday, June 14, 2007


It's much more important to pay the vast army of NHS bureaucrats. The NHS has 1.3 million employees, of whom less than 70,000 are doctors. Bureaucrats don't heal the sick but the latest medications might. So what is the NHS for, exactly?

Tens of thousands of patients crippled by rheumatoid arthritis can expect dramatic improvements in their treatment with the arrival of a new class of “smart” drugs, scientists said today. A study of three medications has shown that they can reduce the symptoms of rheumatoid arthritis, the debilitating joint disease, by about 50 per cent. Experts say the drugs will help liberate many sufferers with severe disease from pain and allow them to lead a near-normal life.

However, doubts remain over patients’ chances of getting the new drugs, which have yet to be approved by the National Institute for Health and Clinical Excellence (NICE), the government watchdog, and could add around 250 million pounds a year to the NHS drugs bill. Britain lags behind other European countries and the US in introducing new medicines. Drugs launched in the past five years, including this new class, make up 27 per cent of the bill for medicines in the US, 24 per cent in Spain, 22 per cent in France, but 17 per cent in the UK.

Trials have shown that the three drugs – MabThera (rituximab), Orencia (abatacept), and tocilizumab – can have a marked impact on symptoms of rheumatoid arthritis, which include joint pain, stiffness and swelling. The disease, which occurs when the immune system attacks the joints, affects an estimated 400,000 people in the UK, 4,000 seriously. Each new drug consists of molecules that target different parts of the immune system.

MabThera and Orencia are licensed in the UK; the latter was launched this month, while tocilizumab is undergoing later-stage clinical trials. Professor Paul Emery, a leading British specialist and co-au-thor of the review in today’s online edition of The Lancet, said: “They are strikingly effective and they work on different targets from the existing drugs, that’s the joy of it .”

The research showed that all three slowed progression of the disease and reduced its symptoms. All achieved the best results when used in combination with the standard treatment, methotrexate. Not all patients respond, and there can be serious side-effects in some, but 30 to 40 per cent of patients do see big improvements. Drugs that do not work for one patient may do so for another, enabling rheumatologists to tailor the treatment to the patient.

Scientists said that the new drugs would raise the chances further of patients finding an effective treatment. “A new era has started in the treatment of rheumatoid arthritis,” Professor Josef Smolen, who led the team, said. Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society, said: “It means that we have some choices, and that’s very important if you are 22 and facing a lifetime of the disease.” Traditional treatments include nonsteroidal antiinflammatory drugs, glucocorticoid steroids, and disease-modifying antirheumatic drugs. All have limited effectiveness, but treatment has greatly improved by the introduction of drugs that target tumour necrosis factor (TNF), a major source of the inflammation at the heart of the disease. Three antiTNF drugs are already licensed and approved by NICE for patients with severe disease.

The Lancet review focuses on the next generation of antibody medicines, which home in on targets other than TNF. MabThera targets immune system cells called B cells, which are known to be involved in the development of the disease. In trials it reduced symptoms by more that 50 per cent in more than a third of patients. Oren-cia targets immune system T cells and, when combined with methotrexate, also reduced symptoms by 50 per cent, in 40 per cent of patients. Tocilixumab targets inter-leukin-6, a cytokine (signalling compound) that activates the T-cells. It is not yet licensed but in trials has shown similar benefits to the other two drugs. With annual treatment costs per patient likely to be between 3,000 and 10,000 pounds, the cost of treating 40,000 patients (the number who have the disease sufficiently severely to get antiTNF drugs) is likely to be about 250 million.


Australia: Staff crisis hits public hospital CT scans

MAJOR Queensland hospitals could be forced to sideline one of their key diagnostic tools because of chronic staff shortages. The Government's failure to retain and attract radiographers is impacting heavily on the ability of some hospitals to conduct CT scans on patients. The scanners, operated by radiographers, help doctors to diagnose ailments from cancers to the internal injuries of accident victims. A leaked email obtained by The Courier-Mail has exposed the dire situation faced by one of the state's biggest health facilities, Royal Brisbane and Women's Hospital. In the email to Queensland Health's radiology steering committee, RBWH director of medical imaging Peter Scally warns the hospital is struggling to maintain CT scanning of patients. "We are experiencing difficulties keeping the CTs functioning because of the numbers of trained radiographers. Have lost two lately," he said.

A Queensland Health spokesman said options were being considered to ensure CT scans continued. "All urgent patients and inpatients will continue to take priority," he said. [Big deal! Don't they anyway?] The spokesman said the shortage of radiographers was not unique to RBWH or Queensland Health. The revelation comes after The Courier-Mail exposed how cancer victims are being forced to wait more than three times longer than recommended for radiation treatment.

Premier Peter Beattie yesterday said the Government was addressing the problems. Mr Beattie said millions of dollars was being invested in extra cancer-fighting equipment, a new pay deal was being negotiated and Queensland Health was "aggressively recruiting" new staff. "We are also recruiting within Australia and overseas for more doctors, nurses and medical radiation staff," he said.

But an internal Queensland Health document shows the so-called "Work for Us" campaign has attracted few new staff. By January 25, Queensland Health had received 5224 expressions of interest but appointed fewer than 300 new staff. Only two of these were medical imaging professionals. The QH spokesman said the internal report was misleading because it did not include radiographers appointed directly by each district.



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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