Thursday, July 31, 2008

The Price of RomneyCare

Gearing up for 2009, liberals are eager to claim Massachusetts as a Valhalla of health reform. Their enthusiasm is apparently evidence-proof. Even Mitt Romney, who should know better, took to these pages recently to proclaim, "Health-care reform is working in Massachusetts." Shortly after Mr. Romney's self-tribute, Governor Deval Patrick wheeled out a new $129 million tax plan to make up for this year's health spending shortfalls. Yet partisans are cheering the cost overruns as a sign of success.

Supporters are exultant because 350,000 people are newly covered since former Governor Romney's parley with Beacon Hill Democrats in 2006; this cuts the state's uninsured rate by about half. That's not the promised "universal" system, but never mind. The ominous news is that only about 18,000 people -- or 5% of the newly insured -- have taken advantage of the "connector," which was supposed to be the plan's free-market innovation linking individuals to private insurers.

Most of this growth in coverage has instead come via a new state entitlement called Commonwealth Care. This provides subsidized insurance to those under 300% of the poverty level, or about $63,000 for a family of four. About 174,000 have joined this low- or no-cost program, a trend that is likely to speed up.

As this public option gets overwhelmed, budget gaskets are blowing everywhere. Mr. Patrick had already bumped up this year's spending to $869 million, $144 million over its original estimate. Liberals duly noted that these tax hikes are necessary because enrollment in Commonwealth Care is much higher than anticipated. But of course more people will have coverage if government gives it to them for free. The problem is that someone has to pay for it.

Thus the extra tab of $129 million, which may need to go higher because it relies on uncertain federal funds from Medicaid. For now, Mr. Patrick wants one-time (yeah, right) charges of $33 million on insurers and $28 million on providers, plus some shuffling of state funds. The balance comes from an estimated $33 million boost in the state's "pay or play" tax: If businesses don't offer "fair and reasonable" insurance to their employees, they get hit.

This is a textbook example of how business taxes evolve into "pay or pay," the first recourse of state-funded health systems. Politicians love levies on business because they disguise the overall bill from voters. But such taxes are merely passed along to workers in the form of reduced take-home pay, since all health costs are part of compensation.

The main reason people are uninsured is because coverage is too expensive. Massachusetts didn't have many options for reforming the way health dollars are laundered in the third-party payment system created by the federal tax code. But it could have helped make insurance cheaper by reforming its private market before defaulting to public programs.

The Bay State has long served up coverage-specific insurance mandates, such as for fertility treatments, which raise costs. Yet in a just-deserts twist, Massachusetts health planners are now reviewing ways to trim mandates because the state is footing more of the bill, even if they didn't care when imposing them on individuals and small business. A state-sponsored study shows that total spending on mandates was $1.32 billion in 2005, or 12% of premiums. The study is devastating despite its pro-mandate slant.

Not that such practical lessons have stopped liberals from joining the Massachusetts parade. They have to gussy up the state's model because the extravagant claim that led to its creation -- that health care will be less expensive if everyone is covered -- is being relentlessly discredited. It's the same claim they want to make when they try to pass a similar plan for the whole country in next year's Congress.


Poor NHS nutrition 'harming patients'

The number of errors relating to poor nutrition in NHS hospitals has almost doubled in two years, figures obtained by the Tories show. The number of incidents rose 88% between 2005 and 2007, from 15,473 to 29,138 across England. Such errors are reported by NHS staff to the National Patient Safety Agency and relate to incidents "which could have or did lead to harm for one or more patients receiving NHS care".

The figures showed big regional variations, with a 248% rise in the North East Strategic Health Authority (SHA) and a 178% jump in the West Midlands SHA. The rise was lower at 46% in the North West SHA and 63% in the Yorkshire and the Humber SHA.

A poll last year from the Royal College of Nursing found that patients are at risk of malnutrition because there are not enough nurses to make sure they are properly fed. Almost half (46%) of nurses said there were not enough staff to help patients who may need help with eating and drinking. A similar number (42%) said they do not have enough time to make sure patients ate properly.

A report in 2006 from the charity Age Concern revealed that 60% of older patients - who occupy two thirds of general hospital beds - are at risk of becoming malnourished or seeing their health get worse. Those aged over 80 are particularly at risk, having a five-times higher rate than the under-50s.

The figures were released in a parliamentary answer to the Conservatives by health minister Ann Keen. Shadow health minister Stephen O'Brien said: "This is a further disgraceful statistic from a Government which has failed patients and the public. "People go to hospital expecting to get better, yet in 2007, 29,000 people suffered unnecessary and completely avoidable harm from poor nutritional care."


Wednesday, July 30, 2008

British doctors criticise surgery bonuses

Doctors' leaders have warned that plans to pay bonuses to surgeons based on the outcomes of operations could discourage doctors from treating high-risk patients. The country's largest hospital trust, Imperial College Healthcare Trust in London, is discussing a pilot scheme in which doctors would be rewarded financially for operations that are particularly successful.

But the British Medical Association, the professional association which represents doctors, warned that this could deter doctors from carrying out complex surgery or operations on frail and elderly patients. It added its voice to other critics of proposals to extend NHS cash reward schemes to reflect performance against a number of quality indicators such as mobility after surgery. Dr Jonathan Fielden, chairman of the BMA's consultants committee, said: "The outcome of an operation is based on multiple factors ... Other members of the medical team would also have fundamental roles in the care a patient receives and the outcome achieved."

A spokesman for the Imperial College trust would not say which operation the scheme would apply to, but he added: "It's about rewarding excellence." Katherine Murphy, from the charity the Patients Association, said: "Patients will be horrified."


Australia: Public hospital bungle covered up

A whistleblower was bullied and information was covered up when a crucial cancer treatment went wrong, critics say. On Friday, SA Health revealed a radiation machine at the Royal Adelaide Hospital, used to treat 720 people between July, 2004, and July, 2006, was delivering the wrong dose.

Yesterday, the hospital was accused of bullying and harassing an employee who tried to expose the error, and of covering up the mistake, which only came to light last week. While working as the Employee Ombudsman, Gary Collis said he dealt with a hospital employee who was bullied after taking his concerns to management. The whistleblower also said up to three machines were not working properly. Mr Collis said whistleblowers in this situation had "very little protection". "Until there is genuine protection the individuals are going to think more about their own survival careerwise rather than just keep on banging their heads against the wall," he said.

SA Health chief executive Dr Tony Sherbon said RAH management discovered the error in 2006 through a quality assurance check but chose not to inform the department, prompting accusations of a coverup from the State Opposition. Dr Sherbon was only made aware of the problem on July 16 this year after someone filed a formal complaint.

"In 2007, the Central Northern Adelaide Health Service completed an investigation of an allegation of bullying and harassment," he said. "It found there was no bullying. This person suffered no retribution." He added that as far as he knew only one machine was affected.

The calibration error meant people received a dose up to 5 per cent lower than prescribed by their doctor. It is not clear what effect, if any, this would have on their survival. SA Health has launched a review into the error and has contacted all patients affected.


Tuesday, July 29, 2008

California Legislature: More Uninsured, Please

Californians struggling to provide for their family's healthcare needs share a common frustration: it's very expensive. Unfortunately, one of the bills making its way through the California legislature will add frustration -- and expense -- to their struggle.

For some, finding health insurance coverage can be as simple as participating in an employer-sponsored plan bought in California's group insurance market. Older Americans receive coverage from Medicare, while those with disabilities and few resources use a state program like Medicaid. But for workers in companies that can't afford to provide coverage, for self-employed and small business owners, for people working part-time or who stay at home to care for children or an ailing parent, health insurance is available through California's individual insurance market.

The individual market allows people to pay monthly premiums, just like employer-sponsored group coverage. The difference is that individual plan premiums are much lower than group plan premiums.

California has imposed so many regulations on the group market that its premiums are often twice as expensive as those of individual plans. For families, group plans now average nearly $12,000 per year, compared with about $3,900 for families buying coverage on the individual market. As much as $2.59 of wages for every hour worked pays for employer-sponsored health plans (2007 California Healthcare Foundation). Higher pay for workers is sacrificed to fund a form of health coverage that is expensive and over-regulated.

In contrast, individual plans in California are far less regulated and-not surprisingly-far more affordable. As of March 2008, individual health plans in California are among the least expensive in the U.S. Health insurance premiums in states that heavily regulate the individual market have predictably skyrocketed-like in Massachusetts, in which much-heralded recent "reforms" contributes to Boston residents paying TRIPLE what San Franciscans do for identical coverage.

That difference in affordability may be disappearing. AB 1962 would impose a mandate for every individual health insurance policy to cover maternity benefits regardless of whether the person needs, wants or can afford this coverage. The bill would force the following Californians to pay for comprehensive pregnancy coverage:

Women who have had a hysterectomy


Post-menopausal women

Couples who can't have children

Men after vasectomy

Women after tubal surgery to prevent pregnancy

If AB 1962 were enacted, it would become illegal in California for an insurer to try to sell an individual health insurance policy without obstetrical coverage. This mandate was examined by the independent California Health Benefits Review Program. Its analysis revealed that forcing these policies to cover pregnancy will add $74.5 million to the premiums paid by those trying to buy individual health insurance.

The net result of making individual health insurance less affordable? 2,300 more Californians will become uninsured when they lose the ability to buy any coverage at all when the only policies sold are priced to include maternity benefits. Increasing the number of uninsured Californians isn't what our state needs. If you oppose making insurance MORE expensive, please ask your state representatives to vote no on AB 1962.


Australia: NSW Ambulance staff dread return of boss

Vicious "Health" bureaucrats at work again. They seem to be as bad in NSW as they are in Qld.

The former boss of an ambulance station in western NSW is being returned there as an officer despite an external investigation largely substantiating more than 50 allegations of bullying and harassment made against him over the past 10 years. Several former officers at Wellington station have either resigned, transferred or gone on stress leave, saying they could no longer work there while Rodney Althofer, 63, was manager. The Herald understands a six-month external investigation by Kamira Stacey Consulting found more than 50 allegations against him were mostly substantiated.

Today marks the final hearing day of a parliamentary inquiry into the NSW Ambulance Service, which has been inundated with submissions on bullying and harassment and complaints about poor handling of grievances. Investigators interviewed about a dozen officers who had worked at Wellington for the report, which was completed midway through last year. However, the service has kept that report secret and did not act on the matter until last week. The chief executive of the service, Greg Rochford, has also refused to release to staff the service's response to the report.

The Herald spoke to seven former and serving Wellington ambulance officers, as well as the partners of two others, all of whom alleged bullying by Mr Althofer. Three alleged that he told them not to bother buying property in the area because he would run them out of town. The officers described Mr Althofer, a warrant officer in the navy for 20 years, as a "military-style", micromanaging authoritarian who screamed at, and publicly humiliated, staff. They are also furious at management for failing to deal with the problem for so long.

They were devastated to learn at a staff meeting on Tuesday that Mr Althofer would be returning within two weeks - although as an ambulance officer and not in his original job as station manager. They were told an external mediator would be available to work through any problems. One ambulance officer immediately went on stress leave upon hearing the news and another is seeking a transfer. There are only six full-time ambulance officers at the station.

An email from a former western division officer, sent to the parliamentary inquiry last month, said it was "one of the most investigated and documented accounts of bullying and harassment that I have seen in my experience". The email, which has been seen by the Herald, said "[The manager] has previously been stood down for harassment of staff over the years and has also been sent to anger management courses, this you will find in the [Kamira] report". The Herald understands the Kamira investigation was prompted after the service received three formal complaints of bullying in one week in late 2006 - two from Wellington officers and one from a doctor at the local hospital.

A former officer, who worked there for 18 months until mid-2000, said he went on workers' compensation due to stress from being bullied by Mr Althofer. The final straw was when Mr Althofer "chased me across the road yelling at me . in the main street of Wellington", he said. "They found that he needed to attend an anger management course and he refused to do it." Another former Wellington officer said Mr Althofer would hide behind trees near the station on his days off and check what time staff turned up for work.

Mr Althofer denies any bullying and harassment of staff. "I've always tried to get ambulance officers to do what they are supposed to do and because of the culture of the ambulance service they simply don't do what they're supposed to do. "They breach the code of conduct on a daily basis and all I ever did was to try and get people to do what they're supposed to do," he told the Herald. He said he offered to return as an ambulance officer, and not the manager, because of "all the stress of trying to manage people who don't want to do their job". "I was bullied and harassed," Mr Althofer said.

The service would not comment except to confirm there had been an investigation at Wellington "involving interpersonal dealings between colleagues".


Monday, July 28, 2008

American Cancer Care Beats the Rest

You don't want socialized medicine if you're really sick

"Your accomplishment of [universal access] is the envy of every U.S. citizen who understands what you've done," Sen. Edward Kennedy (D., Mass.) told a Canadian audience in 1996. This week, a major international study confirms that Mr. Kennedy is right to stay at home for his own cancer care: U.S. medicine bests the cancer treatment available to people in 30 other countries.

The Concord study compares five-year cancer survival rates for several malignancies: breast cancer in women; prostate cancer; colon and rectal cancer in women and men. Combining the efforts of some 100 researchers, drawing data from almost two million cancer patients in 31 countries, the study, to be published in the August issue of The Lancet, is groundbreaking.

Who's on top? Arguably Cuba, which records the best overall outcomes for breast cancer and colorectal cancer (in women), and seems to beat U.S. health care in three out of the four categories. The study's authors -- who apparently hold higher standards than filmmaker Michael Moore -- disregard these results owing to data quality issues.

The study finds that the U.S. leads in the field of breast and prostate cancer. France excelled in women's colorectal cancer and Japan in men's colorectal cancer. The news isn't all good here: great discrepancies exist between white and African-Americans. That said, the United States clearly leads other nations in overall survival.

These results aren't completely surprising. Though international comparisons are hard to make, Lancet Oncology published last August a comparison of American and European care, and the U.S. fared better in 13 of the 16 cancers studied.

Americans don't usually hear good news stories about health care. Mr. Moore favorably reviewed British, French and even Cuban health care in the movie "Sicko," showing satisfied patients and happy, chic docs. Paul Krugman wrote last year in the New York Times that: "there's very little evidence that Americans get better health care than the British." Cancer care there is different than here. Take for instance the country whose health-care system Mr. Krugman likes so much. The Lancet Oncology study finds that five-year survival rates for cancer in men, for example, are 45% in England (slightly higher in Wales, lower in Scotland) but 66% in the U.S.

Why do the British lag behind American survival rates? Screening standards are different. In the United States, internists recommend that men 50 and older get screened for colon cancer; in the National Health Service in the United Kingdom, screening begins at 75. And British patients wait much longer to see specialists. A Clinical Oncology study of British lung cancer treatment found in 2000 that 20% "of potentially curable patients became incurable on the waiting list." Novel drugs offered here often aren't available there; for instance, Avastin, a drug for advanced colon cancer, is prescribed more often in the U.S. than in the UK, by some estimates as much as ten-fold more.

A drug called Temodal is the U.S. standard of care for Sen. Kennedy's type of brain cancer. In Britain, a government body charged with funding decisions -- the euphemistically named NICE, or National Institute for Health and Clinical Excellence -- ruled in 2001 that Temodal wasn't worth the money as a first-line treatment; in 2007, they partially lifted the prohibition. Patients can still get the drug, they just need to pay out of pocket -- for all their cancer care. The National Health Service recently ruled that if patients opt out of one type of care (say by getting Temodal), they opt out of all publicly funded care.

Two cheers, then, for American health care and better cancer outcomes. Rising costs, however, threaten to undermine the economy. Not surprisingly, our debate is shifting to a discussion of getting better value from our health dollars. Just last week, the U.S. House of Representatives held hearings on this topic (full disclosure, I was a witness). Former Sen. Tom Daschle and his co-authors speak at length about "value" in their new book, "Critical: What We Can Do About the Health-Care Crisis." Given his potential role in a future Democratic administration, the book may lay out the first outline of ObamaCare.

What's to be done? Mr. Daschle talks up the idea of a federal health-care board charged with "recommending coverage of those drugs and procedures backed by solid evidence. It would exert influence by ranking services and therapies by their health and cost impacts." The inspiration? Mr. Daschle cites Britain's NICE. The Congressional Budget Office is slated to release a paper on this topic later this year.

Given the Concord results, the CBO may want to hold off on that effort. Value -- like in the other five-sixths of the economy -- will come from competition and choice, not a government committee. But the federal government can take a leadership role in promoting competition. How? By creating greater transparency of prices, releasing more Medicare information on complications and outcomes, encouraging hospitals and clinics to standardize their health records, and slashing regulations that discourage competition. Together, these efforts would make it easier for American patients to seek out excellence. And that seems as American as apple pie and good cancer care.


British hip and knee patients face delays due to emphasis on cheap cataract surgery

Thousands of patients could be facing unnecessary delays for hip and knee operations because the NHS is concentrating too much on cataract surgery, an expert has warned. More fiddling in response to targets. Cost instead of clinical need becomes the criterion for doing a procedure

The eye surgery has made up almost one fifth of all "extra" operations carried out using the additional cash ministers have pumped into the health service in recent years, figures show. As a result there has been a significant fall in waiting times for the procedure. But recent evidence suggests that surgeons could be carrying out cataract operations unnecessarily early on some patients, according to The King's Fund, the independent health think tank which collated the statistics.

Waiting times for other operations, in particular hip and knee replacements, have not fallen so fast, said John Appleby, the organisation's chief economist. "In reducing these waiting times we have done the easier operations and left the more difficult ones to last," he said.

The King's Fund calculates that of an estimated 605,000 "extra" operations carried out between 1998 and 2005, 115,000 were for cataracts. "I think that if you looked back from 1998 to now that many people would be surprised just how many of these extra procedures have been one operation, cataracts," Mr Appleby said. "Although the number of other operations being performed have increased as well, the figures show they have not risen nearly as much as cataract operations." He added: "There is also evidence that now some people are being admitted with rather good vision who would normally not be admitted for the operation so soon."

The think tank estimates that while a cataract operation costs the NHS around $1200 to $1400, the cost of a hip or a knee replacement is around 10 times that, at between $12,000 and $14,000.

Although cataracts can ultimately cause blindness some patients do not require surgery for months or even years after their initial diagnosis. Ministers have set a target that no patient should wait more than 18 weeks for treatment by the end of this year. Government spending on the NHS has more than doubled to $180 billion since the turn of the century.

A spokesman for the Department of Health said: "In England, by the end of December 2008, no patient will have to wait more than 18 weeks from the time they are referred by their GP for any treatment unless they choose to do so, or it is clinically appropriate. "Latest figures show the majority of patients are already being seen within 18 weeks and that the NHS nationally has achieved its milestones for March 2008.

"The increase in supply of cataract services has enabled the NHS to massively reduce waits for cataract surgery. Average waiting times for cataract operations 10 years ago were as long as 2 years, now it is around 3 months. The number of cataract operations have also nearly doubled in the last ten years. Ultimately, commissioning decisions are a matter for local primary care trusts."


Sunday, July 27, 2008


Two articles below:

Surgeons pulling out of pennypinching public hospital system

SURGEONS are pulling out of public hospitals' on-call rosters because of the "pathetic" pay - leaving patients waiting days for operations. Royal Australasian College of Surgeons president Ian Gough, himself a Queenslander, said Queensland surgeons were increasingly reluctant to be on-call because they felt under-valued - and that included pay issues.

Queensland surgeons say the issue is putting increasing pressure on public hospital beds and nursing staff because some patients, particularly those with trauma-related injuries, are having to wait longer for operations.

Professor Gough said that under Queensland Health's visiting medical officer agreement, the hourly on-call rate was between $7 and $11, depending on the frequency of on-call rostering. "During that time you may receive lots of telephone calls and have interrupted sleep. It has an effect on your family and social life," he said. "There has been a great deal of disenchantment among some surgeons and as a consequence, an unwillingness to continue to be on-call."

If a surgeon in Brisbane is called back to the hospital, the hourly rate increases to between $186 and $212 and relates to a doctor's seniority. Those working outside Brisbane receiver higher rates.

Professor Gough conceded that on-call surgeons were remunerated "reasonably well" when they were called back to hospital. However he said the overall on-call rates were insufficient incentive for many surgeons and called for a fee-for-service system to be considered. He said Queensland Health was relying on surgeons' altruism to be part of on-call rosters. "Surgeons don't have any incentive to be on-call other than their goodwill and wanting to care for the patients," Professor Gough said. "The money that's offered is actually very poor."

His comments were echoed by Royal Brisbane and Women's Hospital trauma services director Cliff Pollard, who said that not paying surgeons sufficiently for being on-call was a false economy. "It's a big cost in terms of beds," he said. "Surgery can be delayed and patients spend longer in hospital. "We're not talking about time-critical patients, they get treated in Australia very well. "But with things like single limb fractures, you may have to wait sometimes a few days (to be operated on)."

An RACS spokeswoman said about 60 per cent of all surgeons in Australia operated only in the private sector. "The more who leave the public sector, the more pressure there is on the people who stay," she said.

Professor Gough raised the issue with Queensland Health reform and development division executive director Stephen Duckett at the RACS's annual Queensland branch meeting at Coolum recently. Professor Duckett accepted at the Sunshine Coast meeting that public hospital surgeons had "punishing" on-call rosters and said the pay issue was being examined. He said yesterday that Queensland Health did not have central data that reflected whether senior surgeons were pulling out of on-call work at public hospitals. Professor Duckett said Queensland Health was about to enter into enterprise bargaining with public hospital medical staff over pay rates. "Details of Queensland Health's position are not yet finalised," he said.


Some patients have to wait just to get on a hospital waiting list

More than 33,000 sick Victorians are waiting just to get on an official waiting list for treatment at public hospitals, the Opposition claims. They are in addition to almost 40,000 people already waiting for elective surgery on the State Government's official waiting lists. Documents obtained by the Opposition under Freedom of Information, and seen by the Herald Sun, show that in December last year 33,869 Victorians were waiting for an outpatient appointment. People must be assessed in hospital outpatient clinics before they can be put on a waiting list for surgery - meaning those who are yet to be assessed do not show up on the official elective-surgery waiting lists.

Liberal health spokeswoman Helen Shardey said public hospitals were being forced to manipulate waiting lists to avoid being penalised by the Government. "There are literally tens of thousands of patients languishing on the Government's secret outpatient waiting lists and thousands more who don't have appointments who are waiting to get on to these lists to see a doctor," she said. "We are now in the unconscionable position of having people waiting to get on to these lists in order to join the queue for elective surgery. In many cases these people are waiting years." The documents show that the "secret waiting list" grew by 8722 patients in just three months leading up to December 2007.


Saturday, July 26, 2008

Qualified British GPs forced to drive taxis due to lack of work as doctors

Socialist Britain sure knows how to manage its health workforce. This amid frequent claims of a doctor shortage and long waits to see a doctor

One fully qualified GP is driving a taxi because he cannot find enough work as a doctor despite Government pledges to increase access to primary care and extend surgery opening hours. Next week 2,500 doctors will qualify as GPs and the vast majority have not found full time jobs and will have to live 'hand to mouth', the British Medical Association has warned.

It costs the taxpayer around $500,000 to train each graduate to junior doctor level and many are considering travelling abroad or working in another speciality even though there is predicted to be shortage of GPs.

Dr Alex Smallwood, chairman of the GP trainees sub-committee at the British Medical Association said the problem was rife and was a 'huge betrayal' of junior doctors who had been encouraged into general practice. He said: "Doctors will be stacking shelves, cleaning and driving taxis to make ends meet. If they can't get work as a doctor they have got to do something."

Dr Smallwood said the general perception of GPs earning anything from $200,000 to $500,000 was nowhere near reality for many. He said there are huge numbers of under-employed GPs who can only get one and half or two days work a week. Under the new GP contract there is little incentive for a partner in a practice to take on another partner to expand the practice or replace one who leaves. Instead, in order to maintain their own income and that of the practice, the partners take on a salaried doctor on around $100,000 to $120,000 full time, but most are employed only part-time and earn significantly less. Other practices are based in such old premises that they physically do not have the room for more doctors. The problem is risking the future of general practice as the best and brightest candidates either enter other specialisms or leave to work as a GP abroad, he said.

Some areas of the country are worse than others, with virtually no partnerships on offer in London whereas the situation is not so bad in poorer areas in the North of England.

Dr Smallwood said: "I can't say it is greed but there is an element of being unfair to younger colleagues. There is a certain amount of protectionism from some doctors. "There are vast numbers of people who can't get full time work and it is not just about getting a partnership it is about getting any job. There is a panic." He said the trend of taking on salaried part-time GPs will affect patient care as it will mean they are less likely to see the same doctor with whom they can build up a trusting relationship. Dr Smallwood said it is vital that a scheme where the upfront costs of taking on a partner are paid is reinstated.


Australia: War hero's tragic wait

Insufficient capacity for emergencies set aside. Cairns has lots of ambulances but most were acting as glorified taxis. Sending one down the mountain range from far-away Kuranda is absurd

A World War II Digger had to wait more than two hours for an ambulance the day he died this week. Changi prison camp survivor Bob Mutton, who lived in the city on Sheridan St, endured a two-hour-and-five-minute wait on Monday while he struggled to breathe. He died hours after finally arriving at Cairns Base Hospital.

Stretched to the limit, the Queensland Ambulance Service dispatched a vehicle from Kuranda, 25km northwest of Cairns, after Mr Mutton's first ambulance was diverted to a "higher priority case" of a man having a seizure. It took 54 minutes for the first ambulance to be dispatched to 88-year-old Mr Mutton. The crew was then diverted four minutes into the job. After another 71 minutes, the nearest available ambulance arrived from Kuranda.

"We're appalled . to have to wait more than two hours for an ambulance can't be acceptable," an upset friend, who did not want to be named, said yesterday. "The sort of duress Bob would have been under waiting all that time doesn't bear thinking about. "This man served his country (and) spent three and half years in Changi prisoner of war camp. He paid his taxes right up to the end and he gets treated like this."

Queensland Ambulance Service assistant commissioner Peter Cahill yesterday confirmed the long wait, blaming it on the number of ambulances delivering patients to Cairns Base Hospital on Monday morning. "The remaining ambulances in the region were dealing with higher priority call-outs," Mr Cahill said. "An ambulance was unable to be dispatched until 11.38am. However, four minutes later this ambulance was diverted to a higher priority case."

Mr Mutton's doctor rang the Far Northern Ambulance's communications centre on a patient transport line at 10.44am, saying Mr Mutton was "frail, delirious, with laboured breathing". A worried friend rang the ambulance about 45 minutes later, saying Mr Mutton still had "rather rattly breathing" and asking when help would come. Mr Cahill said the Kuranda ambulance had to be stood down from another job to finally get to Mr Mutton.

Disgusted friends said their mate had been "pretty crook". "We'll never know whether a quicker ambulance would have saved him," one friend said. "But we know he wasn't treated right. And we'd hate for someone else and someone else's friends and family to go through that." Cairns RSL sub-branch president Peter Turner described the long wait as unacceptable. "It upsets me that this would happen to anyone, veteran or no veteran," Mr Turner said. "Delays like that are a huge concern."


Friday, July 25, 2008


Articles from two States below

The NSW ambulance disgrace continues

Government bureaucrats running a health service are not only a disaster; Some of them are downright nasty -- as we see below:

Some ambulance officers had resorted to getting apprehended violence orders against colleagues because management had dealt so poorly with allegations of bullying and harassment, a parliamentary inquiry was told yesterday. Officials of the Health Services Union said members had no confidence in how the NSW Ambulance Service handled grievances. Some even accused it of being so aggressive towards complainants that it was itself harassing them.

The union officials were giving evidence at the inquiry into the management and operations of the service, which has been inundated with submissions about bullying, harassment and inadequate handling of complaints. The union's industrial manager, Dennis Ravlich, told the inquiry that some officers had been "reduced to seeking AVOs on an ambulance station".

Outside the inquiry, Mr Ravlich told the Herald he knew of "at least three or four" officers who had taken out AVOs against colleagues at their stations in the past five years because they felt so frustrated by a lack of action by management. "It's difficult to comprehend that the workplace had become that dysfunctional," he said. Another union official, Raymond Tait, told the inquiry that an eight-year complaint had only just been concluded but was now the subject of an unfair dismissal action before the Industrial Relations Commission. He told the Herald a complainant had been unfairly sacked last month over an unrelated matter.

Mr Tait said the service had kept secret its 2006 report into the eight-year-old complaint of alleged bullying. The complainant could only read the document but not keep a copy of it. And there was a condition that the person did not reveal its contents.

Mr Tait had told the inquiry earlier that the service's professional standards and conduct unit was "judge, jury and executioner" and rejected too many complaints, hoping they would just go away. The inquiry has received several submissions criticising the unit. It has been called an "absolute joke", likened to the NSW Supreme Court in terms of time delays, and referred to as "pathetic standards and cover up".

Mr Ravlich told the inquiry he was unsure whether bullying and harassment were more prevalent than in other comparable organisations. But he said that in dealing with complainants, the unit took "a rather aggressive approach towards staff . almost to the point of being harassing itself". In other evidence, the union told the inquiry it was not unusual for ambulance officers to work up to 14 hours without a meal break.

The officers' appearance before the committee followed a mass demonstration of more than 200 ambulance staff and paramedics who marched through Martin Place to Parliament House. The protesters demanded the State Government employ another 300 paramedics to ease pressure on staff. One officer at the rally, Warren Boon, of Camden station, said that in 2006-07, NSW ambulance staff had dealt with 1,052,000 cases. "The workload has gone from intense to nigh impossible," he said. "Fatigue is a chronic problem for staff and the shortage is affecting services to the public." He cited a recent incident in which he narrowly saved a cardiac arrest patient. "But if it had occurred any time in the previous six weeks, he would have probably died because of a lack of resources," Mr Boon said.

Ambulance officers were also having to work overtime to boost their modest salaries, he said, which were between $900 and $1000 a week for staff with 15 years' service.


Qld.: Fire engines sent to cover for ambulances on many occasions

FIRE engines are being forced to respond almost daily to ambulance call-outs with 250 assigned in the past year, according to Emergency Services. Emergency Services Minister Neil Roberts said 250 fire-engines were sent to triple-0 ambulance calls last financial year. Firefighters provided first aid or CPR at 208 of the cases while the remaining 42 cases involved assisting invalids.

Mr Roberts said fire service crews were not used as automatic first responders in ambulance call-outs. He said the cases represented only 0.4 per cent of all fire call-outs. "The reality is, however, that they are very often the first on scene where people have been injured," he said.

The figures were revealed in a parliamentary estimates hearing under questioning from Opposition emergency services spokesman Ted Malone. Mr Malone said every Queenslander paying the $100-a-year ambulance levy deserved to see a Queensland Ambulance Service staffer if they called for medical assistance.


Thursday, July 24, 2008

No antibiotics for cough, colds and ear infections in Britain

Patients are to be refused antibiotics for coughs, colds and ear infections, under strict new guidance to doctors. This is right in theory but will undoubtedly lead to deaths among patients with meningococcal infections.

The drugs are not necessary in most cases, do not work against many of the infections and contribute to the spread of lethal hospital superbugs like MRSA, experts said. Family doctors routinely prescribe antibiotics for common respiratory infections such as sore throats. But GPs claim they often feel under pressure from patients who are angered if they are refused treatment.

Now the NHS drugs rationing body, the National Institute for Health and Clinical Excellence (NICE), has issued new guidance to doctors telling them not to prescribe antibiotics to patients who are suffering from minor illneses such as an ear infection, sore throat, tonsillitis, a cold, sinus infection, cough or bronchitis. Instead, doctors will advise them to stay at home and rest while taking painkillers. The move comes after Health Secretary Alan Johnson launched a $540 million advertising campaign earlier this year telling patients that the drugs will not help with a cough or cold.

Sir Liam Donaldson, the Chief Medical Officer, said inappropriate use of antibiotics was fuelling superbug infections as it encourages infections to become resistant to the drugs. Treatment with antibiotics also leaves people vulnerable to gut infections like Clostridium difficile, which can also be fatal particularly in the elderly. Last year 38 million prescriptions for antibiotics were written by GPs at a cost to the NHS of $350 million. Prescriptions to treat respiratory illnesses currently accounting for almost two thirds of all antibiotic prescribing in GP surgeries

The new guidance - which may dismay those who have grown to expect treatment for routine illnesses - says patients should be reassured that antibiotics are not needed immediately because they will "make little difference to symptoms and may have side-effects". They should be told to return to the doctor if they get worse or it does not clear up on its own. Alternatively doctors could issue a prescription for the patient to cash in at a later date if their symptoms get worse or go on for more than a week. Experts say this 'delayed prescribing' works well and doctors say few of the prescriptions are cashed in showing that patients do follow the instructions.

The guidance was welcomed by Professor Steve Field, chairman of the Royal College of GPs, who have been campaigning on the issue. He said: "It costs an absolute fortune. I have always said there is no shortage of money in the NHS - we just need to spend the money on things that are useful. "It can be very difficult being a GP having a consultation with a patient who expects antibiotics. It has become ingrained in them but because the infection gets better anyway, people think it was the antibiotics."

The guidance says doctors should consider giving antibiotics to children under the age of two who have an ear infection in both ears, children who have discharge from the ears and patients who have tonsillitis along with other problems. Antibiotics or further testing should be offered immediately to patients who have symptoms that suggest a serious illness or complications such as pneumonia, or if they are at high risk of complications. This would apply to those who already have a serious condition such as cystic fibrosis, severe heart, lung, kidney or liver disease or whose immune system is compromised.

Patients who are aged over 65 and have a cough should immediately be prescribed antibiotics or sent for further testing if they also fulfill two of the following criteria - having been admitted to hospital in the last year, having diabetes, suffering heart failure or using certain medications. Patients over the age of 80 with a cough need only fulfil one of the other criteria.

Dr Gillian Leng, who was in charge of developing the guidelines and is Deputy Chief Executive of NICE, said: "This is the first practical guideline which will help all healthcare professionals to assess adults and children with respiratory tract infections to decide whether their condition will improve by taking antibiotics. The guidance will also ensure that they can be followed up by the right people, at the right time and within the right healthcare setting."

Mike Sharland, a consultant paediatrician who helped develop the guidelines, said: "Every year, over five million antibiotics are prescribed for children in the community - the great majority for upper respiratory tract infections which are nearly always viral. This guideline describes the evidence base for prescribing antibiotics in children with an upper respiratory tract infection and gives clear and concise recommendations for their use."

Anne Joshua, Associate Director of Pharmacy at NHS Direct, who also helped draw up the guidelines, added: "This short clinical guideline brings together everything we know on targeting antibiotics to those who really need them. It sets out very clearly the information that should be provided by healthcare professionals when they are assessing children and adults presenting with respiratory tract infection symptoms in order to reassure them that they are receiving the most effective course of treatment, based on the most up-to-date evidence."


Australia: Public hospital emergency power fails

This is pretty disgraceful. Emergency systems should be tested regularly. This one obviously was not

Doctors and nurses had to ventilate patients by hand during a Sydney hospital blackout but its manager says no patients were at risk. Concord Hospital, in Sydney's inner-west, lost power for over an hour on Saturday and emergency generators for the intensive care unit and emergency department failed to kick in. However, the hospital's general manager Danny O'Connor said no patient treatment was compromised.

"Concord Hospital has a comprehensive emergency power supply system. Unfortunately in this instance a component of the system failed," Mr O'Connor said in a statement. "This led to power being interrupted to several wards for about one hour. "Patient treatment was not compromised while the interruption was resolved." Mr O'Connor said the faulty component had been replaced following the incident and the system had been retested and was functioning correctly.

Opposition Leader Barry O'Farrell said Health Minister Reba Meagher needed to explain how such a "catastrophic failure" could occur in one of NSW's largest hospitals. "How is it possible for a contingency electricity supply to fail in the most crucial parts of the hospital - the intensive care unit and the emergency department," Mr O'Farrell said in a statement. "It's a tribute to the outstanding staff that no one died during this major failure."

The NSW opposition wants the government to review all emergency back-up electricity generator systems in public hospitals statewide. NSW Health declined to make any comment saying the statement from Mr O'Connor should explain what happened.


Wednesday, July 23, 2008

Outcry at British drug watchdog's plan to cut arthritis treatments

Tens of thousands of arthritis sufferers will be denied powerful drugs on the NHS under a controversial decision by the Government's rationing body

Patients' groups have reacted angrily to new guidelines which will mean 40,000 people with rheumatoid arthritis will have possible treatments withdrawn. Without the drugs the patients will suffer more pain, the possibility of more surgery and long-term disability, it is claimed. The decision amounted to a "prescription for pain", experts warned.

The National Institute for Health and Clinical Excellence (Nice), today issues a final appraisal document - the last draft before definitive guidance is issued - stating that patients who do not respond to one powerful drug cannot try another of the same type. Currently doctors are able to try patients on three variants of a drug type which work by blocking the action of a chemical. If one does not work or its effectiveness wears out over time, sufferers can switch to another, prolonging the period they can remain fit and active. But the drugs are very expensive, with even the cheapest costing around $200 a week per patient.

Many rheumatoid arthritis patients live with the disease for decades. They argue that cutting down the options will leave them needlessly living in agony for years. Cutting access to the drugs will speed their decline, meaning they are less able to work for a living and will have to rely more on benefits and care, campaigners say. Ailsa Bosworth, Chief Executive of the National Rheumatoid Arthritis Society, said: "This decision is another nail in the coffin for the treatment of rheumatoid arthritis in England and Wales. "Nice is re-writing the rules of rheumatoid arthritis treatment in this country ignoring the clinical effectiveness of drugs and ignoring the views of patients and clinicians."

Rheumatoid arthritis, which differs from osteoarthritis, is an auto-immune disease in which a person's joints are attacked by their body's own defences. It affects 400,000 people of all ages in the UK. Most suffer with a mild form that can be controlled with ordinary painkillers. However, tens of thousands needed the stronger drugs, called anti-TNFs as they block the action of a chemical called tumour necrosis factor (TNF). Between 20,000 and 40,000 people in England and Wales are taking an anti-TNF at any time, and 50 per cent have needed to switch treatments at least once. The anti-TNF drugs currently available on the NHS are Enbrel (its generic name being etanercept), Humira (adalimumab) and Remicade (infliximab).

Scientists are not sure why one anti-TNF drug might stop working over time but doctors and patients agree being able to switch between them can be highly beneficial. Once arthritis patients have exhausted the anti-TNF options, under NHS rules they can move on to another drug called rituximab, a 'biologic' which works by modifying the immune system. Until recently they would have then been able to try a separate drug called abatacept, but in April Nice quashed that option, saying it was not cost effective. Consequently campaigners say Nice has reduced the treatment options for people with the disease from five to two.

Professor Rob Moots, Professor of Rheumatology at Liverpool University, said: "It's almost impossible to know which anti-TNF will work for a patient at the outset. Before this decision we could try patients on each of the three treatments in turn to find one that was effective for them - now we only have one shot at success. "This flies in the face of clinical judgment. Many patients will be left in astonishing pain, while knowing we haven't explored all the options for them."

Ros Meek, Director of the Arthritis and Musculoskeletal Alliance, added: "Rheumatoid arthritis is a debilitating disease and living with it is an extremely painful experience. Nice's decision takes away access to a normal and independent life for the many thousands of people battling with the condition. It also totally contradicts Lord Darzi's pronouncements in his recent review of the NHS - in particular his focus on patient choice and patient empowerment. It's a prescription for pain."

A spokesman for Nice said: "Having taken all the available evidence of clinical and cost effectiveness into consideration, together with the views of patients and clinicians, the independent Appraisal Committee was not persuaded that TNF -? inhibitors, when used after the failure of a previous TNF - inhibitor, would be an appropriate use of NHS resources. "However, the Committee agreed on the importance of further research that examines the comparative effectiveness of all possible options for treating people with Rheumatoid Arthritis". "People currently receiving adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis after the failure of a previous TNF -alpha inhibitor should have the option to continue therapy until they and their clinician consider it appropriate to stop."

Nice's final guidance is expected in September but campaigners hope their appeals will lead to a last minute U-turn. In April, following public outcry, Nice changed its prescription guidance for Lucentis, a drug which slows down onset of the severe eye condition macular degeneration. And in May the Court of Appeal ruled that Nice must explain how it reaches its decisions on whether or not to recommend drugs, in an ongoing battle over the Alzheimer's treatment Aricept. However, it has never lost a case regarding its guidance in court.


Tuesday, July 22, 2008

Nasty British health bureaucrats refuse to treat dying patient

Bosses in the National Health Service have refused to administer a drug to a patient with advanced kidney cancer even though the medicine is being provided free.

Barrie Clark, 61, was told in May that he could receive a free supply of a new kidney cancer drug on compassionate grounds from the pharmaceuticals company that makes it. Clark was then astonished to be told by the NHS that he could not take up the offer at his local hospital because it was against management policy. He could receive the drug, which has been approved as safe, only by paying for nurses to administer it privately.

Clark is in a similar predicament to patients being denied NHS care if they choose to pay for drugs that the health service does not fund. Campaigners are outraged that the ban on allowing NHS patients to pay for private drugs has now extended to letting them receive additional medicines for free.

In a letter of complaint to NHS Grampian, which runs Aberdeen Royal Infirmary where Clark is being treated, the father of four said: "I have been denied a free drug for a long time when there was no alternative treatment. "We find this appalling and demand that the drug be offered free of charge immediately. How many other people has this happened to? You have jeopardised my life and caused great anguish to me and my family. That is disgraceful."

The medicine, temsirolimus, which has the brand name Torisel, was granted a licence for the European Union in November. The European Medicines Agency (EMEA) has ruled that its benefits outweigh the risks. Dozens of NHS patients have received it on compassionate grounds from Wyeth, the manufacturer, in advance of its commercial launch in Britain. The National Institute of Health and Clinical Excellence (Nice) is assessing whether Torisel is cost-effective enough to be prescribed on the NHS.

Managers at NHS Grampian told Clark that he could not receive it because it was not yet on its list of prescribed drugs, known as the hospital formulary. The trust says it will not be placed on the formulary until it is assessed by Nice or the Scottish Medicines Consortium.

Clark, a manager in the oil industry, has been helped by Kate Spall, a cancer drugs campaigner with the Pamela Northcott Fund. Spall said: "I have never heard such rubbish. They are saying this medicine cannot be given because it is not on a drug list, but patients elsewhere across the country are getting it. Are we now in a position where a terminally ill patient is denied a free medication?"

Cancer professors dismissed the explanation as "bureaucratic nonsense". Will Steward, a consultant oncologist at Leicester Royal Infirmary, said: "I really do not understand the decision not to allow a free drug to be administered from the hospital. We do this frequently. "Many trusts have allowed this in the past and this decision is perverse."

Jonathan Waxman, a consultant oncologist at the Hammersmith hospital in London, added: "This is an effective treatment. This shows the mess we are now in." After Clark told the hospital he was going to speak to the media, managers said he could pay to have the drug administered privately. He would need to pay about œ1,000 a month as it is taken intravenously.

Clark said that, although appalled at his treatment by the NHS, his own oncologist had done his best. NHS Grampian declined to comment on the individual case. The Sunday Times has been campaigning to end the ban on NHS patients paying for private drugs that the state does not fund. Last week two patients won appeals to receive cancer drugs on the NHS after they featured in the Sunday Times Right to Pay campaign.

Sheila Norrington, 59, a cancer patient from Maidstone, Kent, was denied NHS care after paying privately for Erbitux, which costs about œ3,000 a month. After the paper highlighted her case, the Peggy Wood Foundation, a charity, agreed to pick up the bills, but last week West Kent Primary Care Trust reversed its decision.

Barry Humphrey, 59, from North Walsham, Norfolk, was told that if he paid for Nexavar, the only available treatment for his advanced liver cancer, he would be billed for his NHS care. His local trust refused to fund the drug but neighbouring Suffolk Primary Care Trust has recommended that the NHS should provide it.

The British Medical Association and the NHS Confederation, which represents hospital managers, support a patient's right to co-pay for cancer drugs without losing NHS care.


Monday, July 21, 2008

Australia: Queensland hospitals administration turns lawyers on its staff

This organization is never out of trouble. It is clearly totally out of control. It should be abolished and started again with none of the old administrative staff rehired

QUEENSLAND Health is spending hundreds of thousands of taxpayers' dollars for law firms to fight complaints by hospital staff. State Government sources said high-powered barristers and solicitors were engaged in an attempt to get "intimidated and bullied" employees to back down. Some legal eagles cost up to $5000 a day to appear in courts and tribunals.

It was also revealed in Parliament last week that Queensland Health had spent more than $8 million on legal fees and settling claims made by staff and patients during the past two years. Another 274 claims were outstanding.

The department insider said staff who lodged complaints about minor matters, mainly related to pay and conditions, found themselves on the end of an expensive legal battle. Brisbane lawyer Susan Moriarty obtained documents under Freedom of Information that showed Queensland Health had paid almost $115,000 in legal fees in three recent cases. Ms Moriarty, who has represented several Royal Brisbane Hospital staff with claims or complaints, said Queensland Health was hiring private law firms to deal with complaints that should be dealt with by staff. "There are plaintive cries for more and more funding for hospitals, yet they have plenty of funding to go after their own employees," she said.

Leading law firm Corrs Chambers Westgarth was paid $53,000 to represent Royal Brisbane Hospital Health Services District against a female hospital cleaner who was claiming $3500 in an impairment discrimination case. Ms Moriarty said the woman was seeking to cover the economic loss of losing weekend penalty shifts when she returned to work after surgery. After failed attempts at conciliation, the case was referred to the Anti-Discrimination Tribunal, before settling confidentially.

Another leading law firm, Clayton Utz, was paid $44,000 to investigate several allegations by a junior nurse who claimed she had been bullied by Royal Brisbane Hospital supervisors. Ms Moriarty said the woman's union advised her to lodge a complaint after she was asked to do work she was not trained to do. "Instead of conducting an internal investigation, they initiated an external investigation conducted by a private law firm," Ms Moriarty said. The six-week investigation ran to 18 months. Queensland Health eventually sacked the nurse.

In the third case, a Royal Brisbane Hospital cleaner, who had studied medicine overseas and had worked as a theatre wardsman interstate, claimed race and age discrimination after his applications for permanent theatre positions were rejected. Queensland Health has paid Corrs Chambers Westgarth $18,000 so far, with the matter still to be heard in the Anti-Discrimination Tribunal. "The big law firms have become nothing other than de facto human resources advisers to Queensland Health, at about $400 an hour," Ms Moriarty said.

Opposition health spokesman John-Paul Langbroek said he was aware of cases where Queensland Health had become heavy-handed with its own staff. "It's Big Brother . . . a lot of issues could be resolved by normal staff negotiations and relationships," he said.


Australia: Moronic response to overstretched hospitals in NSW

What about paring down the army of health bureaucrats and using the money saved to hire more medical staff? Does anyone NOT already know about GPs? People don't go to GPs because it is generally dearer and not available after hours

The New South Wales State Government has launched an advertising campaign aimed at reducing the pressure placed on hospital emergency departments. The Government says the initiative has been designed in consultation with emergency department staff.

They hope the program will encourage people to seek treatment from their GP, for non-urgent medical conditions, so hospitals can give priority to people needing emergency care. They have cited figures which show an 8 per cent rise in emergency department admissions with 2.3 million people attending emergency department in the past year. Only 34 per cent of those attending believed they really needed hospital care.

The Government hopes the initiative will help people consider how serious their condition is, and make the right decision about where to find treatment.


Sunday, July 20, 2008

Counterproductive NHS pennypinching

When you've got an army of clerks to feed day in and day out, you cannot do your best for the patients

The Department of Health may have saved more than $36 million a year by choosing a cervical cancer vaccine that does not protect against genital warts. The decision to use GlaxoSmithKline's Cervarix rather than Merck's Gardasil for the vaccination campaign for 12-year-old girls was announced last month. It was criticised by experts who said that Gardasil was a better vaccine. Dr Colm O'Mahony, a consultant in sexual health at Chester Foundation Trust, said: "All the clinical evidence pointed to Gardasil and instead they have chosen a vaccine suitable for the Third World."

A new analysis published in the British Medical Journal says that a vaccine that does not protect against genital warts needs to be $26-$42 cheaper per dose to be as cost-effective. The study, by health economists at the Health Protection Agency, used the economic model employed in the tendering process. The agreed price is confidential, but if the department saved less than this it made a poor choice.

In an editorial accompanying the study, Professor Jane Kim, from the Harvard School of Public Health, said that the Department of Health seemed willing to forgo health benefits in return for the lower cost of Cervarix. "Assuming 80 per cent coverage of current 12-year-old girls in the UK with the full three-dose vaccine series, this price differential translates to savings of $23 million to $37.2 million from the vaccine price alone in the first year of the programme."

A spokeswoman for GlaxoSmithKline said that the Health Protection Agency's model assumed that the human papilloma virus (HPV) vaccines were equal in quality and duration of protection against HPV strains 16 and 18. It also assumed that protection must last ten years or longer. There were no data for either vaccine over such a long period, but data on GlaxoSmithKline's vaccine had demonstrated prevention of pre-cancerous lesions and strong immune response for 6.4 years. "This is the longest duration of protection reported for any vaccine against HPV 16 and 18," she said.

Natika Halil, director of information at the FPA, said the charity was disappointed that Gardasil had not been chosen. Choosing Cervarix, she said, "has cost the UK a rare opportunity to protect an entire generation of its young women against genital warts. "Genital warts is very common, easily transmitted, but can be stubborn to treat and young women are in a high risk group for this infection. We reiterate our disappointment that Gardasil wasn't chosen. "Genital warts has its own financial cost to the NHS which spends $44 million a year treating it, so it will be interesting to see how this has been factored into the cost analysis."

Lisa Power, of the Terrence Higgins Trust, said: "The Government has made a decision which appears to be cost-effective but not health-effective. They think it's cheaper to let people get genital warts and treat them than to prevent them. The cost of human misery has not been considered."


Saturday, July 19, 2008

NHS chasing its tail over superbugs

They beat down one problem and another pops up

A big drop in MRSA infection has brought the NHS within reach of the Government's target of halving rates by this year - but infections caused by Clostridium difficile have risen . In 2007-08 the number of MRSA cases fell to 4,438 - 588 above the target, Health Protection Agency data show. However, in the first quarter of this year a trend of falls in C. difficile bloodstream infections was reversed, with a 6 per cent rise: there were 10,586 cases of C. difficile blood infections in patients aged 65 and over.

A total of 966 cases of MRSA were reported - an 11 per cent drop on the previous quarter and an average of 322 cases a month. In 2004 John Reid, as the Health Secretary, said that infections of methicillin-resistant Staphyloccocus aureus should be cut to a monthly average of 321. At the time that was said to be unachievable. Even within the Department of Health, leaked documents last year showed there was serious concern it would not be met. But the recent fall in cases suggests that high-profile initiatives such as the "deep clean" of all hospitals and introduction of a mandatory "hygiene code" may have had the desired [temporary] effect.

MRSA and C. difficile are carried by some healthy people, but the bacteria can cause illness when they grow unchecked, elderly hospital patients being particularly at risk. Annual figures showed a decline for both infections.

Alan Johnson, the Health Secretary, described the decreases as a remarkable achievement. "Our strategy is clearly having an impact, with our challenging target now within touching distance, but this is not an issue we can be complacent about and we will continue to focus our efforts on reducing infections further," he said.

Graham Tanner, chairman of National Concern for Healthcare Infections, said: "It should be remembered that over four years, more than 20,000 patients have suffered an MRSA infection, and in excess of 200,000 contracted C. difficile."

Andrew Lansley, the Conservative Shadow Health Secretary, said that the Government would not have met its MRSA target had it measured the yearly rates to March. To achieve half of the 7,700 MRSA infections in 2003-04, the NHS would have had to limit rates to just 3,850 cases this financial year, he said. "Every case of a hospital infection is one too many, but in four years Labour hasn't even been able to halve MRSA rates, he said. "They have only got round to admitting they have missed the target by moving the goalposts. This shows just how much they've dithered and delayed over tackling hospital infections."

Murray Devine, Safety Advisor for the Healthcare Commission, the NHS regulator, added: "This is great news for patients. There's no question that there has been a very significant turn around, but the challenge isn't over. This improvement has got to be sustained and infection rates brought down further."


Huge public medicine failure in Australia: Children wait years for ear, nose and throat procedures

HUNDREDS of Queensland children are waiting up to four years for ear, nose and throat surgery, surgeons say. ENT specialists say the long wait puts them at serious risk of behavioural and learning problems. Specialists say the wait for an outpatient's appointment at Mater Children's and Royal Children's hospitals in Brisbane is about two years. Queensland Health's own figures show that as of April 1 this year, 400 children were waiting for category 3 ENT surgery at the two hospitals.

Research has found children who have untreated ear infections in their early years are at risk of becoming truants and doing badly at school. Yet they can be easily treated by inserting grommets - tiny tubes that give the middle ear a chance to recover from recurrent infection. Other children require operations to remove tonsils or adenoids to improve sleeping and concentration at school.

ENT surgeon Chris Perry conceded the State Government had started to make inroads into elective surgery waiting lists for children through its Surgery Connect program public operations performed in private hospitals. Queensland Health figures reveal Surgery Connect has cut the waiting list by about 10 per cent. The Government expects the program to be able to treat about 45 children with ENT problems each month.

However Associate Professor Perry said Surgery Connect was only a BandAid solution. "I don't want to embarrass the Government," he said. "I think they're trying to do something about it. "But we think Surgery Connect is counter-productive to the development of public hospitals. "They should be spending the money to fix up public hospitals."

Professor Perry said he had a "duty to help these kids" by operating on them via Surgery Connect but he hoped Queensland Health did not intend to make the program permanent. "It's work that needs to be done at night time, when everybody's tired, including surgeons, or on weekends, and that cuts into family time," he said. Surgeons would prefer to see the Government set up elective surgery theatres in public hospitals to "quarantine" non-urgent cases from emergencies. Because of the huge increase in demand on public hospital emergency departments, elective surgery lists are sometimes cancelled because of the more urgent cases.

Specialists raised the issue with Queensland Health Minister Stephen Robertson at the Royal Australasian College of Surgeons' annual state meeting at Coolum, on the Sunshine Coast, at the weekend. Mr Robertson acknowledged the Government needed to do better by treating children in a more timely manner. "I want to see an improvement in wait times for children," he said. He said he would consider creating elective surgery only theatres for children but he said Surgery Connect was probably here to stay. "My personal view is that it would be irresponsible ... where we can identify capacity in the private sector, not to use that capacity if it means that we increase our throughput," Mr Robertson said.


But there's plenty of money for the health bureaucracy

QUEENSLAND Health bureaucrats have spent more than $800,000 travelling the world over the past two years, a budget estimates committee heard. The hearing was today told non-clinical staff made 69 overseas trips in 2006-07 at a cost of $364,546, and 67 trips between July 1, 2007 and May 31, 2008, at a cost of $464,809. The trips included five senior bureaucrats taking an $80,000 two-week visit to US and UK hospitals in November 2006, and a $50,000 trip for two senior bureaucrats to join Health Minister Stephen Robertson on a tour of facilities in the US and Canada in August 2007.

Opposition health spokesman John-Paul Langbroek said Queenslanders on hospital waiting lists were entitled to ask why they didn't come first. "With such an urgent need for new hospital beds to be delivered and for waiting lists to be tackled, Queenslanders will be wondering why senior health bureaucrats are spending so much time touring hospitals in other countries," Mr Langbroek said in a statement.

Mr Robertson said overseas travel arrangements were under review to ensure taxpayers got value for money from health staff attending conferences and recruitment fairs. "I think it's appropriate every now and then to review that travel budget to ensure it is being used appropriately," he told reporters in Brisbane today. "I'm always worried when I see expenditure going into areas that don't have a direct effect on good patient outcomes. "Just as I look at travel every now and then, I look at other areas of administration to see if there are ways that we can save money and redirect those funds into front-end services."


Friday, July 18, 2008

Bigoted Leftist hater of drug companies

A comment on "Side Effects" by Alison Bass

Prozac improved the nation's mood when it came on the market in 1987. Earlier antidepressants had caused many side effects and were potentially lethal in overdose. Prozac appeared to be both a godsend and a blockbuster. It was effective, easy to administer and less likely to be used by depressed patients as a means to commit suicide. It was a boon to the bottom line of its manufacturer, Eli Lilly, but it also became a cautionary tale for the drug industry—of pharmaceutical success inspiring suspicion, controversy and backlash.

Soon enough a Harvard professor, Martin Teicher, published reports of six patients who developed suicidal thinking while taking Prozac, and the Church of Scientology campaigned against it. By 1990 stories about the purported dangers of Prozac screamed from the headlines and fell from the lips of Hugh Downs on "20/20." Was Prozac causing patients to commit suicide?

In 1991, the Food and Drug Administration convened a committee of experts to study the matter. As it turned out, Mr. Teicher's six patients had been deeply depressed for years, medicated with multiple drugs and in several cases had attempted suicide before they first ingested Prozac. The Scientologists rested their arguments on anecdotes, not data. The committee concluded that Prozac did not trigger suicides in adults.

But the matter was not put to rest. For nearly two decades a worry over the "hidden" effects of antidepressants—and not just Prozac—have become a kind of cultural reflex. Thus the FDA has convened more committees and analyzed more data. The facts are not easily resolved, because the underlying illness (depression) is itself a risk factor for the adverse event (suicide), and the adverse event is mercifully rare. The latest evidence suggests that, for adults age 25 and older, antidepressant use is not associated with increased suicidality. A pooled analysis of nearly 100,000 patients, conducted by the FDA in 2006, showed no increased suicidality for adults ages 25 to 64.

In "Side Effects," Alison Bass recasts this history of debate and analysis as one of corporate greed. She extends the "lessons" of Prozac to the antidepressant Paxil, lambasting GlaxoSmithKline, its manufacturer, for supposedly concealing inconvenient information. Her narrative is filled with you-are-there moments, in which heroic researchers challenge Paxil's efficacy and safety and heroic prosecutors from the office of Eliot Spitzer, New York's attorney general, prepare a 2004 lawsuit against the company.

In the event, GlaxoSmithKline settled out of court and, as soon as the matter of transparency was raised, published online all of the studies of Paxil that had been submitted to the FDA, including those that showed no significant difference between the effects of Paxil and a placebo. The question of study-publishing is a fraught one: Most companies leave it to the FDA and its populous staff to subject their studies to scrutiny, determining which ones are significant, which inconclusive—that is, to weigh the totality of the results. Ms. Bass, like other crusaders against Big Pharma, assumes that a manufacturer is trying to mislead doctors and defraud the public if some of its studies are not published in the scientific literature.

It is a question of point of view. For Ms. Bass the judgment of researchers, together with their data and claims, are untrustworthy if they have received money from drug companies to finance clinical trials. She is particularly hard on a professor of psychiatry from Brown University who has defended Paxil. But if the drug companies didn't pay for such trials, who would? And why shouldn't companies seek advice from the best scientific minds and pay them for their efforts?

Most odd of all, Ms. Bass treats the FDA as a shill for industry—despite its having thoroughly reviewed the suicide matter and required warnings on products labels where it saw fit. She makes the usual complaint that the FDA has reduced its time frame for approving new drugs: "That sprint came with a price tag. A flood of questionable drugs was unleashed on the market, many of which," like Vioxx, "would later have to be recalled."

But she says not a word about how society suffers when the FDA approves new drugs too slowly, depriving patients of life-improving and life-saving medicines. Nor does she mention the studies showing that more rapid drug approval timelines in the European Union have not led to more drug-safety withdrawals. There are two sides to this story; Ms. Bass tells only one.

That tendency is on display elsewhere in "Side Effects." In a matter as hard to determine as the effect of an antidepressant on the suicidal tendencies of depressed patients, Ms. Bass nowhere mentions the exculpatory adult data. As for pediatric patients: In April 2007 the Journal of the American Medical Association published an analysis of more than two dozen studies. It found that for children and adolescents on antidepressants, as The Wall Street Journal reported, "the risk of suicidal thinking or behavior is smaller than previously thought" and that "antidepressants were more effective than placebos in treating children and teens for major depression" and other disorders.

"Side Effects" belongs to a genre of investigative journalism that involves talking to plaintiffs, their lawyers and their expert witnesses, taking their stories as gospel and denigrating the opposing view because corporate money (apparently less pure than money from the plaintiffs' side) supposedly has a corrupting effect. Ms. Bass admires David Healy, for example, a British psychiatrist and expert witness whom the drug companies have been "unable to discredit." Surely a more even-handed account—since corporate fees are routinely cited—would mention the fees that Dr. Healy has collected for testifying for a dozen or more plaintiffs. She does not mention either that a court in 2002 rejected his testimony because of "glaring, overwhelming and unexplained" errors in his analysis.

"Side Effects" is lively and well-written, but readers should be warned that they may have an adverse reaction: a deep disquiet that only half the story has been told.


Thursday, July 17, 2008

Government Funded Science Inherently Politicized: Chinese Herbal Remedy Edition

Over in the Science Based Medicine blog, Wallace Sampson is expresses outrage that the National Institutes of Health has announced an initiative to fund “research” into Traditional Chinese Medicine:
I have pointed out that scientific characteristics were never a part of TCM. It lacked objective observation, consistency of observation, classification of observed phenomena, information storage, rationality and logic, consistent written transmission, objectively descriptive language, and a method for analysis or for interpretation. The system of elements , q’i, and yin/yang did not include a method for developing theories or independent natural conepts. TCM depended on empiricism, unreliable observation, was plagued by post hoc reasoning and causality error. It lacked a concept of error and a system for self-analysis to correct error. In fact, the culture discouraged analysis and criticism, considered to be bad form and disrespectful. TCM depended on individuals who rarely communicated in a formal, direct, manner. Add to that a system that accepted manipulation to suit the mood and concept of the observer or authority. I conclude that there is nothing in TCM to study scientifically. So now they want to develop scientific criteria to apply to their observations? Proteomics? On what? Actions of herbs? Words again fail me at the glaring presumptuousness and ignorance required to conceive such a project....

nothing but a jangling confusion of borderline and conflicting findings will result from further study. Unless they appoint people with critical analysis experience, a wide reading knowledge of the history and use of TCM, and a scientific view, their research conclusions will be indeterminate over the next 10 years or more. They will continue to rely on ideologues, advocates, self-deluded practitioners, and politically correct academics for advice and pronouncements.

They will probably exclude scientific or skeptical analysts, so there is no way they will develop a credible commentary on how best to integrate TCM and improve the health of the American and Chinese people. Well, they got it backwards again. It’s China that has to integrate scientific medicine over there. Their scientists and physicians clamor for it. The Chinese can begin with public health principles like inhibiting spitting in the streets, cleaning up their air (finally but it took the Olympics) personal hygiene, cleaning their toilets, improving their food handling methods, and other systematic changes...

What is HHS doing, using a cover of medical science and for what? The government doesn’t do such things without pressure from some group or perceived self-interest in negotiation. In this case, what are the respective interests? There could be several.

For China, the most apparent is awakening the American population to the hidden miracles of TCM - and the marketing of supplements. Ka Kit Hui, a practitioner in Santa Monica, Calif., been promoting TCM herbs for several decades. I debated him on the subject at Stanford in 1995 or so at which time he extolled the undiscovered miracles in TC herbal medicine. Again in a letter to the editor to JAMA in 1997 he predicted that TCM herbals would be the prime economic product of the 21st century. I dismissed the statement in a response, but here we are, nearly 1/10th the way through the century, and here is TCM herbalism making inroads. China must see a large market, a population at least a third of their’s, and in view of the differences in income, living standard, and disposable income, a market that is at least as large in dollars/yuens as China has at home - probably greater.

What motivates the US? For one, TCMers may be behind the effort. They are on a path toward legitimizing the OMD degree and licensing of TCM practice. They already have acupuncture licensure in a plurality of states. They have a dozen or more schools of TCM. The California state legislature several years ago dropped an attempt to standardize teaching in the California schools - a first step to a standard exam and thus an academic standard for licensure. But they will be back. It took naturopaths over 15 years to get their licensure and degree recognition - another history familiar to Kim Atwood and others. The rest of the ulicensed hordes are following through an accompanying though crippled series of Access to Medical Treatment Acts. They persist - getting bits here and there and then, in an alignment of the planets minute, achieving passage of licensure legislation that imprints their initials in gold.

The formation of the NCCAM was a major step for TCMers. Now an HHS officially- sanctioned 2 day conference opens the plausibility of studying more TCM just as acupuncture systematic reviews are showing indeterminacy to ineffectiveness, herbs are being found more dangerous than helpful, and products from the PRC being found adulterated with metals and with standard pharmaceuticals. A fly on the wall of certain congressmen and senators and of HHS director Leavitt could tell us a lot. (Here we go again with a FOI request.)

As for government sourced motives, as Ms. Woeckner suggested, we probably had to pay a price for the stationing of FDA offices in Chinese cities. I still fail to see what they can do about adulteration of products, much of which could be shifted to way stations in Taiwan or in the US.

While insightful, Dr Sampson fails to dig down to the real sources of the problem:

If the NIH wastes money on quackery, its officers do not suffer a loss. They don’t have to justify their spending to donors or shareholders. The money extracted at gunpoint from the citizenry will continue to flow in regardless of the junk science the NIH produces. In fact, inconclusive junk science can benefit NIH officials - larger staff and larger budgets will lead inevitably to higher salaries for managers - with no end in sight to the enterprise.

Furthermore, by having the government license medical treatments and practitioners, the medical industry has fatally undermined the ability of people to have reliable mechanisms to root out quackery. Again, publicly funded licensure boards will continue to be funded regardless of how bad a job they do. Their presence will inhibit the formation of private enterprises that are dependent on donor perceptions of effectiveness to continue operations - just as the creation of the FDA ended the drug testing research of Consumer Union. The public looks at a government license as a mark of quality - and there is no one to tell them otherwise. Suspicions allayed, most people in the market for medical care will accept advertising at face value.

The sad fact is that when the AMA was founded in the late 19th century, most doctors made a deal with the devil. The state licensure boards - which were successful in their mission to keep competition low and prices high - not only created a pool of underserved consumers for quacks to prey upon, it also created traditions and political framework that quacks and junk scientists can use to provide cover for their fraudulent activities.

So long as proponents of quality in medical care continue to pin their hopes on an organization that can extract money by force regardless of how crummy a job it does, they are doomed to failure.


Wednesday, July 16, 2008

From here to (better) maternity: A long road for Britain

The experience of giving birth is getting worse. Mothers need greater choice, not bigger hospitals

In between the tea ceremonies, the cruises and learning to fold kimonos, the wives at the G8 summit in Lake Toya have been campaigning against maternal mortality. It's the perfect choice for the spouses, a subject surely as uncontentious as gazing at waterlilies. No one wants mothers to die in childbirth. Everyone must be shocked that a woman dies every minute giving birth and that there is a global shortage of four million midwives. Yet no one does anything about it.

The British should know. We are increasingly bad at giving birth. In the past ten years spending on maternity services has gone up by a quarter in real terms. Yet the satisfaction rates have plummeted, Britain's maternal death rate is one of the highest in Europe at 7.3 per 100,000 births compared with an average of 6.8, and the free-market think-tank Reform says that maternity care now accounts for more than half of all negligence claims against the NHS.

According to a study into maternal care published by the Healthcare Commission yesterday, most units do not have enough beds or showers and two thirds of trusts still offer no choice of how to deliver baby, leaving women feeling powerless. But the real problem is that the money has been directed at building projects rather than people. The proportion of the NHS workforce represented by midwives has dropped from 2.1 per cent to 1.7 per cent in ten years and some midwives are now in charge of a quarter more births than they were in 2001.

When I had my first child, in 2000, I gave birth in the cramped Queen Charlotte's Hospital in London in the same room where I had been born. The paint was peeling off the radiators, the blinds were stuck in a June heatwave and you had to import your Jaffa cakes from the local garage. Yet the system worked. You had your own midwife who followed your every twinge and came to celebrate your baby's first birthday. “This is not a hotel,” the midwives would say when you asked for more than one piece of toast on the ward, but they had the time to teach mothers how to feed their babies and change their nappies.

When my second baby was born two years later, the hospital had moved to a gleaming new site overlooking Wormwood Scrubs, with cappuccinos in the canteen - but the experience was harrowing. The midwives appeared as exhausted as the patients and rotated faster than the fans. They had to follow a raft of directives rather than their intuition. I got down on my knees just minutes after the birth to clean the floor before my parents arrived because nobody else had time to clear up the mess.

When my fourth child arrived, I brought in a bucket and brush but I didn't need it. The hospital was so overstretched that I was sent home within two hours of giving birth.

The postnatal experience has deteriorated even more rapidly. Terry, my first health visitor, had been looking after new mothers for more than 20 years. While she made us both tea, she was quietly working out whether I was elated or depressed and how many bottles of wine were stacked in the bin. But she had given up by the time I had my second child because she couldn't stand the doubling of her workload. She never saw the same mother twice; instead her job was to collate information on the religion and ethnicity of every baby. Our last health visitor spent an hour filling out forms and never touched our baby, which is presumably why she registered my son as a girl on every document.

Although under Lord Darzi of Denham's plans more money will be spent on building new supersize units, in recent years 41 small maternity units have been closed or are now under threat. Yet Britain already has the biggest maternity units in Europe, and these have shown no improvement on maternal mortality. The bigger the unit, the more impersonal and daunting the service will become. There may be more consultants for emergencies but most women will never see one. The Government has promised it will solve this by returning to one-to-one midwife care but there is already a shortage of 5,000 midwives and there isn't the money to fund such a specialised system.

It's easy to think that pregnant women don't matter: they are not ill (as I was constantly told) and they are not going to come back often. Very few actually die in childbirth or of postnatal complications, so all they need is a building, a nameless face shouting “push” and an ability to cross their legs until they actually make it - sometimes miles away - to their nearest super-hospital.

But for many women this is the first time they have ventured into a hospital since they were born and the weeks after their baby's birth can be crucial in helping them to cope with motherhood. Instead of queueing up to drop their children in supersize baby battery farms, they need to feel that someone cares about this new life. So let women go free-range and choose the type of care they want - whether in smaller units, at home or in a larger hospital with a consultant on hand - and give them a friendly face to guide them through the process.


Insane medical working hours in Australia: One in three medicos risks patients' lives

ONE in three doctors admits they have put patients at risk by working exhaustive hours to prop up Victoria's ailing health system. And more than 80 per cent say medicos in general work too many hours and are under so much stress that the safety of patients and doctors is being compromised. A Herald Sun survey of Victorian doctors also revealed half had considered quitting due mainly to stress, long hours and excessive workloads.

Almost 90 per cent of doctors said there were not enough of them to adequately care for the health needs of Victorians. "We are dangerously tired, overworked and stressed, and patients are suffering and dying from errors borne of pure exhaustion," one doctor said. Another said: "Hours are ridiculous. Working 12 days straight is idiotic and guarantees serious medical errors with fatal consequences." The findings are based on the responses of 1787 doctors who took part in the Herald Sun poll.

The survey also revealed:

MOST doctors believe hospital emergency departments are in crisis.

MORE than 90 per cent say it is unacceptable that more than 45,000 patients were left waiting on hospital trolleys for more than eight hours during the last six months of 2007.

ABOUT 80 per cent say already swollen hospital waiting lists for elective surgery will get longer before they get shorter.

SEVEN out of 10 doctors say patients are losing faith in the public health system.

MORE than 80 per cent say public hospitals will continue to fail their performance targets unless they receive a massive injection of cash from the Government.

The poll showed 47 per cent of Victorian doctors work more than 50 hours a week and 8 per cent work more than 70 hours. Thirty-one per cent of doctors admit they have compromised the care and safety of patients by working excessive hours. And 47 per cent of doctors who work more than 70 hours a week admit to putting their patients at risk.

The strain drove one doctor to write: "I constantly reconsider my options. You asked whether I have considered leaving the medical profession in the last three years - of course. Daily. And unless things change soon, I most likely will."

About 40 per cent of doctors seeking counselling from the Victorian Doctors Health Program are struggling with issues of stress and fatigue. "When you are fatigued, you can't see the wood for the trees to make decisions," director Dr Kym Jenkins said. "I know a significant proportion of the people I see here who are stressed are worried they might have made a mistake. "When people feel they might be compromising patient care it can be anything from not having done their paperwork before the knock-off, to being worried about a major incident."

Australian Medical Association state president Dr Doug Travis said the Herald Sun survey brought to the public's attention the every-day realities encountered by doctors. "We do not have the capacity in our public health-care system to give Victorians the care they need right now, today. That is beds, nurses, doctors and emergency departments," he said.

Health Minister Daniel Andrews said the Government was negotiating a new enterprise bargaining agreement with the AMA to balance increased doctors' pay while leaving enough money to improve the health system. "We value the feedback of our hospital doctors and recognise the vital work they do in making the state's public health system one of the world's best," he said.

Opposition Leader Ted Baillieu said the Government must confront issues raised by the survey. "The huge pressure on our doctors is further proof that Labor has abandoned Victorian public hospitals," he said.