Monday, July 16, 2007

Don't get breast cancer in Britain

An "alarming" number of patients with suspected breast cancer are waiting too long for a diagnosis, doctors warn. Government targets dictate all suspected breast cancers should be seen by a specialist within two weeks. But a team at Bristol's Frenchay Hospital discovered an increase in the number of positive diagnoses among women deemed to be non-urgent cases. Doctors said the target was failing, but the government said it was looking to improve the situation.

The study published in the British Medical Journal reported that the two-week wait target - from GP referral to consultant appointment - was introduced in 1999 because of long waiting lists for diagnosis and treatment. Doctors at the Breast Care Centre at Frenchay Hospital compared nearly 25,000 urgent and non-urgent referrals - where breast cancer is not suspected but a consultant's opinion is still needed - between 2000 and 2005.

They discovered that the number of women referred urgently by their GP had increased, as expected. But the proportion of cancers detected in those seen within two weeks went down from 12.8% to 7.7%. Meanwhile, the numbers seen as non-urgent cases fell, but the proportion diagnosed with cancer rose from 2.5% to 5.3%.

Lead researcher Simon Cawthorn said the target had been very effective in getting many women seen quickly but that most of the time it was impossible to tell whether a breast lump was cancer or not. "The message is that we need to see everyone within two weeks. "Even though it's only a small number in the routine group, it's a significant number." He added that because the two-week wait rule had improved diagnostic services, GPs were now referring women they would have previously asked to come back to see them in a month or two. "They are having to decide whether it's urgent or not and the thing is you just can't tell."

The team have now invested in two specialist breast nurses and see all patients within two weeks. A Department of Health spokesperson said ministers were looking to improve the situation. "We accept that there will always be some patients who do not come through the two-week wait route, because they do not have obvious symptoms, are detected through screening, or through investigation for other conditions. "In 2005, the government made a manifesto commitment to go further on cancer waits and we are considering proposals to do this as part of the Cancer Reform Strategy due to be published at the end of this year."

Maggie Alexander, director of policy and campaigns at Breakthrough Breast Cancer said all patients should be seen within two weeks. "We have known for some time that many women eventually diagnosed with breast cancer are given a routine referral by their GP, and as a result may endure anxious, long waits to find out if they have breast cancer." Hisham Hamed, Cancer Research UK breast surgeon, said the aim was for all patients to be seen in the shortest possible time and the majority referred did not have breast cancer. "It is important to say that research shows an extra week or two will not compromise the patient's outcome."


The IVF `miracle maker' is vindicated; Nasty British bureaucrats defeated

Three cheers for the High Court's ruling that the HFEA, Britain's fertility regulator, acted unlawfully in its witch-hunt against Dr Taranissi

Last week, the High Court in London ruled that warrants obtained by the UK Human Fertility and Embryology Authority (HFEA) in January to support raids of the London clinics of top IVF doctor Mohamed Taranissi were unlawful, and therefore invalid. The HFEA is ordered to pay legal costs in the case, which are estimated to be in excess of 1million pounds. As a former patient of Mr Taranissi's - whose groundbreaking IVF treatments helped me, and many other women, to become pregnant and give birth to healthy, beautiful children - I am relieved and happy that my doctor has been vindicated. But I remain appalled that the HFEA pursued such an outrageous, sensationalist and expensive campaign against him in the first place.

The timing of the police-accompanied raids of the ARGC and RGI - Mr Taranissi's clinics - appear to have been the result of a cynical move by the HFEA to hit the headlines at the same time that a BBC Panorama `expos,' of Mr Taranissi's fertility methods and practice was due to be aired. The chief executive of the HFEA, Angela McNab, now accepts that the evidence she provided to the courts in order to obtain the warrant was inadequate and incomplete. The judge who granted permission for the review of the warrants said the HFEA's applications were `unfair and highly misleading'. It seems the HFEA acted quickly so that the raids could be included in the Panorama programme broadcast on the same day, 15 January 2007. After last week's judgment, Evan Harris MP, a member of the Science and Technology Select Committee, expressed concern that `the HFEA allowed a media timetable and presentational issues to conquer better judgement and due process'.

The recent legal debacle is just the latest in a series of heavy-handed, misguided or just plain incompetent actions by the HFEA. The fertility regulatory authority was established in 1991 following the passage of the Human Fertilisation and Embryology Act of 1990. Its remit is to licence and regulate IVF and other fertility treatments and to oversee research in the field. Since its inception, it has used its powers to interfere in and obstruct the clinical practice and research agendas of doctors, scientists and other specialists.

From `saviour siblings' to animal hybrids, from sex selection to limiting the number of embryo transfers, the HFEA has either erected ethical or bureaucratic obstructions to IVF breakthroughs, or at best encouraged researchers and doctors to proceed with extreme caution. It has continually dragged its feet and prevented progress in the field. It is little wonder, then, that it has consistently clashed with the most cutting-edge and progressive of reproductive clinicians, Mr Taranissi, who has by far the best IVF success rates in Britain. Some refer to him as the IVF `miracle maker'.

There have been numerous calls - from the press and from fertility specialists - for the resignation of Angela McNab for her part in this shambolic affair, not least because of the massive costs involved. There is also some insinuation that she is pursuing a grudge in her vendetta against Mr Taranissi. No doubt there is now very good reason for Ms McNab to consider her position. Yet a change of personnel, even at the very top, will not alter the character of the unelected and seemingly unaccountable HFEA. What is required is a radical overhaul of the way that fertility treatment and research is regulated.

Although there is strong support in the fertility sector for some level of independent regulation, there is also much discontent about the manner in which the HFEA has conducted itself. The British Fertility Society has called for a full investigation by the Department of Health into the HFEA's recent actions, as it is clear that the authority has lost the trust and confidence of the fertility sector. Regulatory reform is certainly in the pipeline: there are plans to merge the HFEA with the Human Tissue Authority in 2008. It remains to be seen whether this will lead to a more liberal system with a greater degree of accountability.

Clearly, the current state of affairs cannot be allowed to continue. That an appointed quango can dupe a judge to allow it to ride roughshod over the rights of a doctor by strong-arming its way into his clinics, terrifying his patients and absconding with his records and computer files in order to stage a dramatic scene for a TV show is - I hope - not the way we ought to conduct government in this country. The HFEA did not even have the decency to apologise to Mr Taranissi for its unlawful actions against him. Instead, its post-trial statements put as positive a `spin' on its actions as it possibly could, and the HFEA proceeded to remind Mr Taranissi and the rest of us that his clinics are still under investigation for breaches of licensing regulations.

The regulation of the fertility sector should not be the authoritarian Big Brother it is in danger of becoming under the auspices of the HFEA. Important policy decisions affecting the sector should properly be made by our elected and accountable representatives in parliament, while the clinical decisions relating to patient treatment should be made between doctors and patients. It is entirely legitimate to call for Ms McNab to resign - but it might be wise to call for the HFEA to be abolished at the same time.



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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when is playing up, there are mirrors of this site here and here.


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