Sunday, August 31, 2008

Why Healthcare is not a Right

By "Daily Danet"

Recently, Oprah, had an episode about healthcare. Oprah, Michael Moore and other guests continued to refer to healthcare as a right. Many people disagree with this fundamental issue, but have difficulty articulating why. So here is my best effort to explain why it is I believe that healthcare is not a "right."

The classic response is that a right is not something someone gives you, but something that no one can take away. This a good bumper sticker, but it is not terribly instructive if you're not already convinced. I don't presume to solve the problem of escalating healthcare costs. Due in part to rapid advances in medical treatments, ordinary people are being forced to choose between lifesaving treatments that didn't exist only a few years ago and bankruptcy. Rampant lawsuits, anti-healthcare provider forces and those evil profit seekers can be left for another time. A more basic question, however, is whether you (and I) have a right to healthcare.

Rights are not unlimited. Rights can be restricted or even taken away. For example, you have the right to liberty (to walk freely wherever you please). But others can restrict that right in certain circumstances. You cannot, for example, walk freely through your neighbors bedroom at night. That would violate their right to privacy. If you commit a crime and are tried and convicted, your liberty can be revoked completely.

Rights really only make sense in the context of a lawful society. Governments are instituted, as a basic matter, to determine where one person's rights end and another's begins. For example, you have a right to free speech, but others have a right against defamation. If you say something untrue and defamatory about someone, the government can determine whose right trumps.

From the perspective of the government, a right is something that can be ensured to one citizen without taxing (in the broadest sense) another citizen. For example, the government can ensure your right to free speech without any cost to anyone else. No one has to listen (you do not, for example, have the right to be listened to). Nor does anyone have to publish your work. You do not, however, have the right to a full-page spread in the Wall Street Journal. If, however, you can afford to, you can purchase one (or the Wall Street Journal) and say pretty much whatever you want. (Subject, of course, to others' rights to be free from defamation and other torts).

In a (mostly) free and (mostly) just society like ours, rights are plentiful. You have, to name a few, the right to bear arms, the right to your life, your liberty, the pursuit of your happiness. To be sure, however, this does not mean the government must buy you a gun. Nor does it mean government must purchase the things that make you happy. It only means that government cannot restrict these rights without due process of law.

This is the crux of the issue: there is a difference between a right and a need. For example, you need food, clothing and shelter. You have a right to pursue these needs; the government will not prevent you from buying a home, buying food or buying a new pair of jeans. The government does not, however, owe you a house, food or clothing. You have no right to housing, no right to food and no right to clothing.

Consider a small society of 100 people, with laws not too dissimilar to ours. Let's assume 2 of these people are unable, for whatever reason, to afford their own home. Among the other people are a carpenter, a logger, a blacksmith, a painter and a plumber. If the government is to provide those two people with housing, it has to either (i) tax everyone to pay the workmen to build the house or (ii) compel the workmen to build the house for free. Either way, the government must take something of value to provide this need to those who cannot obtain it on their own.

So it is with healthcare. You need healthcare. Everyone does. But in order to provide you with that need, the government has to take from someone else. They either have to tax those who can afford it or compel the doctors, pharmacists and hospitals to provide it for free. You may think, as clearly many do, that this is not such an evil thing. Think back to that "free" house, though. Think how hard those workmen would work if they knew that they either weren't being paid for their efforts, or that some nebulous body called "taxpayers" were paying them. Also, consider how many people would voluntarily buy their own house when they knew that others had gotten one for free. Imagine the standard of construction and innovation that would develop if housing were treated as a right; as something the government needed to provide.

Of course, governments do this all the time. They tax one citizen to pay for another's welfare (literally and figuratively). They tax me to pay for your social security. They tax you to pay for my passport. They tax all most of us to provide for our common defense. The point, however, is that that does not make it a right.

Governments have many purposes. The common defense is one that most people agree on as a valid rationale for taxes. Saving the spotted owl, however, is debatable. So too is providing healthcare.


Top doctors slam NHS drug rationing

Britain's top cancer consultants have accused the government's drugs rationing body of ignoring the plight of patients forced to sell their cars and remortgage their houses to pay for cancer treatments freely available in Europe. Twenty-six professors blame the severe restrictions imposed by the National Institute of Health and Clinical Excellence (Nice) on its failure to "get its sums right".

Nice refuses, on grounds of cost, to recommend some drugs for patients with advanced kidney cancer. The consultants, who include the directors of oncology at Britain's two biggest cancer hospitals, the Royal Marsden in London and Christie hospital in Manchester, claim there is enough money in the NHS to pay for the drugs.

Their letter to The Sunday Times states: "We now spend similar amounts to Europe on health generally and cancer care in particular, but less than two thirds of the European average on cancer drugs. It just can't be that everybody else around the world is wrong about access to innovative cancer care and the NHS right in rationing it so severely." They say: "The time has come for a radical change in how the NHS makes rationing decisions for cancer."

This weekend Andrew Dillon, the chief executive of Nice, and Sir Michael Rawlins, the chairman, challenged the cancer experts to explain which acutely ill patients should be sacrificed to free resources for cancer sufferers. They said: "There is a finite pot of money for the NHS, which is determined annually by parliament. If one group of patients is provided with cost-ineffective care, other groups - lacking powerful lobbyists - will be denied cost-effective care for miserable conditions like schizophrenia, Crohn's disease or cystic fibrosis."

This week patients from the Kidney Cancer Support Network will demonstrate outside the Nice offices in London against the refusal to fund the kidney cancer drugs Avastin, Sutent, Nexavar and Torisel.


The Real Census Story

Every August, the Census Bureau's release of the latest income and health insurance figures results in a political uproar, but this year the political class seems almost embarrassed by the good news. Median household income rose slightly in 2007, the poverty rate held steady and the number of uninsured even dropped slightly. Even so, a closer inspection of the numbers shows some dark clouds around the silver lining -- though not of the sort that those warning of another Great Depression usually find.

Begin with health insurance coverage. Census found that 45.7 million people, or 15.3% of the population, were uninsured in 2007, down from 47 million or so in 2006. While total enrollment in private insurance remained stable -- due to population growth -- it eroded slightly in percentage terms, continuing a downward trend. The growth in coverage was mostly concentrated in public programs -- partially due to an aging population shifting to Medicare, but especially in Medicaid. Democrats are already claiming vindication of their post-2008 priority of moving even more people onto the federal balance sheet.

Yet the Medicaid increase isn't exactly a shocking revelation. Each year, a significant portion of the uninsured qualifies for government assistance but hasn't signed up. In spite of 2007's uptick, 24.5% still earned under $25,000 and are probably eligible for help. Some 22% made over $50,000, which is hardly rich, but enough to afford coverage in most states. Meanwhile, about 54% are between the ages of 18 and 34, and many of them voluntarily choose (risky as it may be) to forgo coverage. In other words, the latest batch of data shows, again, that the policy problem of the uninsured isn't as large as election-year opportunism would have it.

This isn't to deride the genuine hardships that the fragmented health-care system metes out to many families. Rather, it's that insurance is more expensive than it needs to be thanks to regulation and other market interference. Many get priced out of coverage, while others -- especially the young -- are induced to gamble on going uninsured.

Most of the gaps in coverage owe to the way the tax code creates problems for the insured while shortchanging everyone else. People who are covered through their employers -- 59.3% in 2007 -- pay no taxes on the value of the benefit, encouraging them to launder their health dollars through third-party insurers while burdening business with increasing medical costs. Meanwhile, the size of the subsidies are smaller for lower-wage workers -- who typically have less generous plans as part of their compensation -- and nonexistent for individuals.

In a lot of ways, the new figures probably underestimate the effects of the tax code distortions. The Census counts people who were insured for only part of the year as "insured." But other studies have shown that the number that are uninsured at some point during prior years -- usually because their coverage lapsed while switching jobs -- reaches as high as 69 million. Restoring the tax parity of health dollars would allow individuals to buy policies themselves, rather than rely on their employers, and take those policies with them wherever they work. It would increase access and affordability for everyone.

In 2007, President Bush proposed doing just that. His reward was to receive no thanks or even credit, though John McCain has picked up and amplified some of his best ideas. Since the Census report points to some deterioration of the artificial job-based system we have now, this is a good moment for the Republican candidate to focus on the improvements that his plan would bring to middle-income and working-class families, as he started to do yesterday.


Saturday, August 30, 2008

Britain: Deaths linked to hospital infection Clostridium difficile double in two years

The number of deaths linked to the hospital infection Clostridium difficile has more than doubled in the last two years, official figures show. Last year in England and Wales 8,324 people died either from C. diff or were infected with it when they died from other causes - this is a rise of 28 per cent in just one year. The infection which particularly affects elderly people has increased four times over since 2001 when 1,804 deaths were linked to the superbug, data from the Office of National Statistics shows.

Deaths linked to MRSA rose steadily between 2003 and 2005 but have levelled off. In the last year there has been a slight drop of 3.6 per cent in deaths either directly from MRSA or linked to it to reach 1,593.

Andrew Lansley, the shadow health secretary, said the 'vast majority' of these deaths could have been avoided with better prescribing of antibiotics and proper isolation of infected patients. Critics say Labour's waiting list targets have encouraged hospitals to rush through patients leaving wards overcrowded with time for cleaning patient areas between cases.

The data is collected from death certificates where doctors note down one underlying cause of death and can mention any number of other factors that may have contributed. In recent years doctors have been encouraged by Sir Liam Donaldson, the Chief Medical Officer, to mention hospital infections on death certificates where patients have them even if it was not the underlying cause of death. The figures show of the 8,324 death certificates that mentioned C.diff, around half noted it as the underlying cause of death.

C.diff is mainly a disease that affects the elderly who have been in hospital for other reasons and who have received broad spectrum antibiotics. These drugs cut the natural flora in the stomach allowing C.diff to multiply and produce a toxin which causes diarrhoea. The ONS figures there was one death per million people aged under 45 but 2,000 deaths per million people aged 85 and over. The number of actual cases of reported cases of C difficile in the over-65s - the main age group affected - fell by nine per cent from 55,635 in 2006 to 50,392 in 2007.

The Clostridium difficile bacteria is a major cause of antibiotic-associated diarrhoea and the intenstinal infection colitis. In most cases the infection is mild and a full recovery is made. Although elderly and vulnerable patients may become seriously ill through dehydration caused by severe diarrhoea. The more serious symptoms include ulceration and intenstinal bleeding and it can be life-threatening.


The tragedies that prompted `our massive wake-up call'

Bacteria will be present in hospitals as long as people are, but vital lessons in infection control have been learnt since outbreaks of Clostridium difficile caused the death of at least 90 patients at Maidstone and Tunbridge Wells NHS Trust in Kent.

Sara Mumford, formerly of the Health Protection Agency, the watchdog for infectious diseases, helped to bring attention to how much bad hygiene and poor staffing had contributed to hundreds of infections during the outbreaks of 2005 and 2006, which were later the subject of a high-profile investigation by the Healthcare Commission.

Now the director of infection control at the trust, Dr Mumford has an array of tools and procedures to keep superbugs at bay, she told The Times yesterday. "Unlike MRSA, there is no way of screening for C. difficile, so the most important thing to get right is cleanliness," she said. "Patients, staff and visitors can carry the bacteria into a hospital without knowing it, or become infected in the community. That's why handwashing is so important."

After an infection had been identified, soap and water were not enough, she said. "We use chlorine-based cleaners and have antimicrobial disposable curtains that we remove after an infected patient has been in a ward. During the `deep clean' we evacuated every ward and subjected everything to ultra-sonic baths or other cleaning. "It was so thorough that afterwards the wheels on the beds seized up - they would not run properly because they'd been cleaned of oil. "The most important thing when you suspect an infection is to isolate the patient quickly - even before you get the test results back from the lab," she said.

The isolation facility at Maidstone - introduced only after the notorious outbreaks - is a dedicated 12-bed ward. Dr Mumford said it helped recovery if patients with the same condition could talk to each other. Patients with a C. difficile infection required specialist nursing and treatment, she said, because other factors could also cause avoidable illness. "Antibiotic use in particular is really, really important," Dr Mumford said. "If you give patients broad-spectrum antibiotics designed to kill all bacteria, they get rid of even the types that help keep C. difficile at bay."

The three hospitals run by Maidstone and Tunbridge Wells Trust are now reporting rates of C. difficile that are below the national average. "Maidstone has had a tragic wake-up call and had to undertake a crash-course in infection control, but some trusts still have work to do - it's something that they ignore at their peril," Dr Mumford said.


Australia: Surgery freeze call over public hospital beds crisis

A ban on elective surgery is being called for as a desperate solution to the chronic shortages of public hospital beds in Queensland's health system. Frustrated emergency specialists have called for a two-week statewide ban on surgery to free up beds. The situation is so critical at hospital emergency departments some patients are forced to sit in waiting rooms for more than 24 hours before being admitted.

Australasian College for Emergency Medicine Queensland chairwoman Sylvia Andrew-Starkey said: "We try really hard not to put elderly people in chairs ... but we've had a situation recently where we've had to put elderly people with pneumonia in chairs for 12 hours or so because we didn't have a bed. "It's awful. It's the worst it's been for years. We're powerless to do anything."

In the past fortnight, some of the state's largest public hospitals - including the Royal Brisbane and Women's Hospital, the Princess Alexandra and Logan - have been forced to go on bypass and redirect ambulances to other facilities because they could not cope with the numbers of patients needing a bed.

In the state's north, a backlog of trolleys and people filled the corridors at Townsville Hospital yesterday as 23 patients waited to be transferred from the emergency ward to beds. Australian Medical Association North Queensland president Dr Sam Baker said Townsville Hospital was overcrowded and in "meltdown" and backed calls for a suspension of elective surgery. "We've got no beds," Dr Baker said. "Staff are being pushed to the limits. It is a bottleneck. It is a shambles. And it is only going to get worse."

Queensland hospitals are so overcrowded that private facilities have also been redirecting patients. "We haven't been able to get a private patient into a private hospital for weeks - they're full too," said Dr Andrew-Starkey, who is based at the RBWH. Freezing elective surgery for a period would free up beds for other patients, taking pressure off emergency departments which are stretched during the traditional winter flu season. "The system needs resetting," Dr Andrew-Starkey said. "I'm not sure suspending elective surgery for a week would be enough. It might take two."

Specialists admit a freeze on elective surgery is a radical step, given lengthy public hospital waiting lists. Queensland Health Minister Stephen Robertson said an elective surgery freeze was unnecessary, but individual hospitals might need to suspend elective surgery from time to time to cope with emergency department demand. "What I do expect is hospital management to make decisions on a daily basis about what is in the best interests of providing safe patient care," Mr Robertson said. "If that means they've got to temporarily suspend elective surgery, then unfortunately, if that decision is made in the interests of patient safety, I support that. I would rather that not be the case, but that's the reality of the very busy times we are experiencing at the moment."

Townsville Hospital staff were yesterday forced to set up makeshift wards in X-ray waiting rooms and lounges. Ten operations were postponed, feeder hospitals at Ingham and Ayr were full, and every nursing home bed in the north Queensland city was occupied. It is the fourth "code yellow" - a complete lack of beds - activated by the hospital in the past two months. Townsville Hospital Acting Director of Medical Services Dr Isaac Seidl said they were working to reduce the likelihood of "ramping" where patients wait outside in ambulances.

Mr Robertson said the situation in Townsville had been exacerbated by 22 nurses calling in sick with "flu-like symptoms", with another 49 off on sick or family leave the day before.



PATIENTS have fallen off trolleys in overcrowded hospital emergency wards which overworked doctors describe as the worst they have experienced. The Royal Brisbane and Women's Hospital's emergency department was in "gridlock" yesterday, forcing hospital administrators to redirect ambulances to other facilities for more than two hours, The Courier-Mail reports. As the bypass was declared, 22 patients were sitting in chairs in an overcrowded corridor. Some had been waiting more than 24 hours to be admitted, with no guarantee when a bed would become available.

Australasian College for Emergency Medicine Queensland chairwoman Sylvia Andrew-Starkey said hospital emergency departments were at crisis point. "People don't get fed properly, people get sleep deprived. The staff get frustrated as well. It leads to a whole snowball effect," she said. "I can give you three instances of elderly people falling out of trolleys because they were confused. They should never have been on trolleys in the emergency department." "Increasing the amount of time that patients spend in an emergency department leads to deaths," she said. "The number of long-stay patients in Queensland emergency departments has skyrocketed in the last couple of months."

Health Minister Stephen Robertson said the State Government was moving towards "quarantining" hospital emergency departments from elective surgery to alleviate problems. Opposition Leader Lawrence Springborg said the "entire health system in Queensland is in danger of collapse".


Friday, August 29, 2008

Kindly old NHS decides not to let people go blind after all

Thousands have gone blind while the authorities spent over two years dithering, though

For the first time a drugs company will pay to top up patients' treatment where the level of care paid for by the Health Service is not enough. In a decision that marks a climbdown for the National Institute for health and Clinical Excellence (NICE), the first 14 injections of the sight-saving drug Lucentis will be paid for by the NHS. If the patient still needs further treatment then Novartis, the manufacturer, will pay for any additional doses.

The ruling overturns previous draft guidance that patients would have to go blind in one eye before receiving treatment with Lucentis, which costs more than $20,000 per eye, on the second. It also paves the way for other new drugs for which top-up doses may be required to be funded in the same way in future.

Richard Barker, director general of the Association of British Pharmaceutical Industry suggested other medicines the NHS cannot afford to pay for in full could be provided through cost sharing schemes between the NHS and the drugs industry. A similar approach has been suggested for kidney cancer drug Sutent, which costs $48,000 a year, and three other drugs after Nice issued draft guidance saying that they were not "cost effective" despite extending life by two months.

NICE has been severely criticised in recent months by health campaigners, who have accused them of condemning patients to "an early grave" by denying them the drugs. It has also been at the centre of a previous controversy over its decision to deny the $5-a-day drug Aricept to victims of Alzheimer's in the early stages of the disease.

Lucentis can stop the deterioration in sight caused by the condition wet age related macular degeneration (AMD), which affects about 250,000 people in the UK including 26,000 new cases each year. It can cause blindness within three months. Up until now around 40 per cent of primary care trusts have refused to fund the drug while others have approved its use only in 'exceptional cases' although the drug was approved in Scotland last year.

Nice has taken over two and a half years to issue its final guidance on the drug in which time many thousands of people have already gone blind as a result of the condition. The drug has no effect on the condition once the patient has gone blind.

Andrew Dillon, NICE Chief Executive, said the decision would be justified by both the improved quality of life for patients and cost savings in the long run. "Lucentis is an expensive drug, costing more than $20,000 for each eye treated," he said. "But that cost needs to be balanced against the likely cost savings. AMD results in reduced quality of life and increased risks of illness, particularly in relation to accidents - especially falls - and psychological ill-health. "Studies have also demonstrated that patients with visual impairment tend to have longer hospitalisations, make greater use of health and community care services and are more likely to be admitted to nursing homes.

"It has been estimated that the costs related to sight impairment for patients treated with Lucentis are around $16,000 cheaper than for patients who receive best supportive care over a 10 year period. Our guidance means that patients who are suitable for this treatment will have the same access to it, irrespective of where they live."

Steve Winyard, Head of Campaigns at Royal National Institute for the Blind, said: "We've been waiting for this for over two years. It is a victory for thousands, bringing overwhelming relief to desperate people across the country. Finally the torment faced by elderly people forced to either spend their life savings on private treatment or go blind, is over. "NICE's guidance will finally bring an end to a cruel postcode lottery." Primary care trusts in England and Wales now have three months to fund the treatment for all eligible patients....

The ABPI's Mr Barker said drug companies were being flexible and suggesting cost sharing schemes but Nice had to be flexible also.

The decision comes after Health Secretary Alan Johnson ordered an investigation into the policy of denying NHS services to patients in England who top up their care with private treatment. Currently, anyone who pays for any private care can be barred from receiving the normal package of NHS care but the review will look at whether such co-payments should be allowed in future.

In July, RNIB also backed three pensioners in landmark High Court action against Warwickshire PCT for denying them treatment. Tom Bremridge, chief executive of The Macular Disease Society said: "Those responsible for NICE should be aware that during the cumbersome two year review process 152 PCTs have individually had the power to decide whether to let patients go blind or to save their sight. The resulting stress and suffering has been cruel and unnecessary. "Many hundreds of vulnerable patients have been subjected to an appalling emotional rollercoaster ride for the past two years - during which many of them have lost their remaining sight."

He called for Nice to speed up drug appraisals in order to avoid primary care trusts around the country making different decisions on funding drugs that have not yet been through Nice....

Dr Rafiq Hasan, Director of Market Access and Ophthalmics at Novartis said the new agreement was "an innovative approach which shows how pharmaceutical companies can work together with Nice and the Department of Health to ensure patients do get access to treatments on the NHS." He said: "Wet AMD is a debilitating eye condition that can result in a rapid loss of sight if left untreated. Lucentis is a treatment for a key unmet medical need and it has the potential to save many peoples' sight. "Rapid implementation of the guidance is now needed to ensure that patients receive the treatment they need as soon as possible."


FOI investigation into Sydney public hospital conditions

A Seven News investigation has revealed hospital blunders have led to dozens of serious injuries or deaths. Secret internal documents detail the errors in Western Sydney hospitals, and outline a two year review of investigations into blunders that can mean the difference between life and death. 61 people have died following serious mistakes over the past two years. The reasons for these deaths have until now been kept under wraps, because the information is not made public. Those reasons include surgical material or instruments left inside patients, procedures performed on the wrong patient or wrong body part, and incorrect diagnosis.

Furthermore, a report in 2006 led to a raft of recommendations, but 40 percent of them were ignored, and 20 percent were implemented after serious delays.

Warren Anderson's 16 year old daughter died after a bungled treatment for a fractured skull. "Vanessa should have been walking out of that hospital totally healthy," he said. He added, "Change the system that killed my daughter to make it a safe system. That's the apology I want from Reba Meagher." Health Minister Reba Meagher wouldn't comment, but she apologised to Mr Anderson.

Shadow Health Minister Jillian Skinner said, "I'm shocked with the extent of these deaths, given the government has denied them, is not reporting them, is failing to come clean with the extent of problems in our hospitals."


Tasmanian hospitals festering, warns doctors' boss

ACUTE staff shortage in the Launceston General Hospital's emergency department is part of a problem festering across the entire hospital system, the Australian Medical Association says. Outgoing AMA state president Haydn Walters said hospitals appeared likely to suffer across-the-board staff shortages, making them extremely expensive to run - and warned that the state's health bureaucracy needed to become more doctor friendly.

Prof Walters said the department was about 10 years late in realising that doctors were not ratbags who needed to be kept in line. He said the LGH risked following the Mersey and Burnie hospitals, reliant on $2500 a day specialist locums and overseas-trained doctors - and parts of the Royal Hobart Hospital were also at risk. Prof Walters said doctors were voting with their feet.

His criticism of the department's "can't-do culture" was rejected by Health and Human Services Department secretary David Roberts. Mr Roberts, who was lured to Tasmania from the UK in January, said he was impressed by the department's innovative "can-do culture". He said he had witnessed a long hard slog of reform in the UK that enabled its hospitals to get a grip on similar emergency department problems. He said a key innovation in emergency departments - already embraced by LGH doctors - was a new acute physician's role where doctors were trained to deal with a broad range of medical problems, not unlike a general practitioner.

Mr Roberts said he had an open door policy, regularly meeting with doctors and nurses: "Doctors are coming with ideas on how we can reform ... I'm pleased to back them." Mr Roberts said Prof Walters' gloom and doom scenario - and his view that North-West hospitals had become dependant on locums - was wrong, but conceded the Mersey hospital had struggled. "It will pick up," he said.

Mr Roberts said apart from some hard-to-fill posts, Tasmanian hospitals were not having major difficulties recruiting doctors. "Our doctor shortage is not as severe as some of the mainland states," he said. [THAT'S a consolation!]

Prof Walters said the ranks of doctors who were committed to living and working in Tasmania for the long term, continued to thin. He said among those bearing the brunt of the LGH crisis were interns - doctors just out of medical school who were feeling exposed and vulnerable - as a growing number of experienced professionals who supervised them voted with their feet. Prof Walters, also from the UK, said he had nothing against overseas-trained doctors, but for the sake of stability and cost control, they needed to be balanced by local doctors.

He will step down in two weeks to begin a sabbatical.


Thursday, August 28, 2008

Thousands Go Blind with National Health Care

(Great Britain) Due to delays in getting approval for distribution of the drug Lucentis, which by the way is readily available in other countries, thousands of Brit citizens are negligently, or intentionally, allowed to go blind due to a condition called wet age-related macular degeneration.

Although the drug Lucentis has been available since 2006, the bureaucracy of the National Health Service (NHS), along with the National Institute for Health and Clinical Excellence (NICE), has denied necessary distribution of the drug to over 50,000 patients in that period. Instead, NICE stated that the drug could only be prescribed after a patient went blind in one eye.

Apparently, the bureaucrats at NICE hoped to save sight in the other eye but, unfortunately, the disease progresses rapidly and patients lost sight in both eyes before being allowed treatment.

Over 50,000 blind people can blame the government bureaucracy, up and down, for the lack of proper drugs. Whenever the government is involved with health care, you can expect literally thousands of people taking an inordinate amount of time making decisions directly affecting patients. People went blind not because of waiting lists, the usual complaint, or clinical trials. They went blind because the bureaucrats at NICE and within the NHS couldn't make a decision.

And, if Obama is elected President of the United States and gets his national health care scheme through Congress, be prepared to go blind (metaphorically) in America.

By the way, the head of NICE, Andrew Dillon, said that he is "genuinely sorry" that delays have caused thousands of people to go blind. Sadly, though, blindness is life-altering, Andrew Dillon's sorrow isn't.
Health care: Unions lie; choice dies

Who would support a self-serving political agenda at the expense of your health, wealth, and job mobility? AFL-CIO president John Sweeney and Colorado executive director Mike Cerbo. In a recent Denver Post commentary, they perpetuate the big lie behind politician-controlled medicine: "that the free market is not working," and that consequently, "costs have been spiraling out of control." But costs have been increasing largely because of what unions defend: a tax code that favors employer-sponsored insurance. It penalizes buying an individual or group policy through a membership organization like AAA.

In a free market, government respects your right to buy and sell according to your own judgment. Not so with medical insurance in America. If your company buys you a $10,000 policy, it pays no tax on those dollars. But you'd face a stiff tax penalty for buying your own policy with that money. Rather than using your own judgment of what's best for you and your family, politicians punish you for not choosing employer-sponsored insurance.

Because politicians favor employer-sponsored insurance, you have companies who are not invested in pleasing you, fewer choices of plans and jobs, lower pay, and escalating medical and insurance costs. Employer-sponsored insurance coddles insurance companies. They need not compete for our business as they would in a truly free market. You aren't their customer, your employer is. So why should they please you?

Insurers know you're essentially stuck with the one or two plans most employers offer. To buy a competitor's product you must change jobs or pay a stiff tax penalty. Economists call this "job lock." Business Week reports that "fear of losing coverage keeps people at jobs . many workers will keep hanging on to jobs they hate." "Single-payer" government-controlled insurance is not the answer. If you don't like the government's insurance plans, changing jobs is not enough. You must move to another state or country!

Employer-sponsored insurance also contributes to high medical costs. Tax-discounted insurance encourages us to buy more costly coverage than we probably need, hence penalizing savings for future medical expenses.

We consume medical care like a business traveler dining on the company's expense account: Since someone else pays the bill (insurance companies), patients need not shop around, so providers don't compete on price. "Yeah," you say, "but my company is paying for it," so isn't it better than buying it myself?" No. As a Cato Institute study summarizes: "an employer that does not offer health benefits must offer higher cash wages to compete for workers. Workers who choose the job with health coverage bear the cost of that benefit in the form of higher cash wages forgone."

But the AFL-CIO defends subsidizing employer-sponsored insurance. A union-backed Colorado ballot initiative pushes further. The "employer mandate" would empower government to punish companies for not offering insurance to their employees.

Given its harmful consequences, why do unions support employer-sponsored insurance? Shouldn't they also support buying, say, our auto insurance and cell phone plan through our employers? Imagine how much negotiating power unions would have then!

Labor unions of course back politicians who support employer-sponsored insurance and politically-controlled health care. Sweeney and Cerbo write that Obama is correct to be "skeptical of the idea that the market is the right entity to put in charge."

But what is "the market"? It's when you choose what's best for you and peacefully trade with others doing them same. Both parties win. For union bosses, politicians are the "right entity to put in charge" of your medical choices - not you. But you should be in charge. Politicians should not dictate whether you buy insurance on your own, through a membership group, or through your employer. Legislators should eliminate the tax break and lower tax rates commensurately.

Second-best would be to extend the tax break to all medical insurance and expenses. Health Savings Accounts are a step in this direction, but they should be eligible to everyone regardless of their insurance plan. Such "Large HSAs" would allow consumers to buy medical care and insurance with tax-free earnings. McCain's tax-credit proposal, though convoluted, is also on the right track.

Unions should be ashamed of promoting self-serving policies that make medical care and insurance so expensive.


Senior British doctor accuses Government of destroying NHS

One of Britain's most senior doctors has criticised the Government for leading the NHS into "catastrophic meltdown". Professor Paul Goddard, a former president of the Royal Society of Medicine, said Labour's obsession with bureaucracy and political correctness had resulted in dire care for patients. The radiology specialist also hit out at the National Institute for Clinical Excellence, NICE, claiming the organisation put finances first.

Prof Goddard, 58, said: "If they think a patient will gain an extra year of life, but it will cost more than $40,000 they think it is not cost-effective. Yet if the patient wants to pay for it themselves they are denied NHS treatment. It's an outrage."

The senior doctor, who has quit the NHS, claimed the Government had lost sight of the basic principles of a national health service. "The NHS was built on the foundation of caring for the community. It was designed to help those who needed help, care for those who needed care and treat those who needed treatment. "Those basic principles have been lost as the Government takes us down a dangerous path that can only be a catastrophic meltdown of the system."

But a spokesman for the NHS said record levels of investment had led to dramatic improvements in areas like waiting times. "Ten years ago waits of 18 months were not uncommon, but by the end of this year no-one should wait longer than 18 weeks. None of this would have been possible without the hard work and dedication of everyone working into he NHS."

It comes after a group of 26 professors wrote to a Sunday newspaper claiming NICE had "poorly" assessed a decision to deny patients four kidney cancer drugs. Earlier this month Nice issued guidance rejecting the drugs Sutent, Avastin, Nexavar and Torisel even though trials found the treatments could prolong life in kidney cancer patients by up to two years. Nice said the drugs were too expensive and would mean the health service was less able to afford more cost-effective drugs for other illnesses.

But the professors, who include directors of oncology at Britain's two biggest cancer hospitals, said the latest guidance would force patients to re mortgage their homes, give up pensions and sell cars to fund their own treatment


Wednesday, August 27, 2008

British cancer patients kept in dark about `too expensive' drugs

Doctors are deciding against telling cancer patients about expensive new treatments to avoid causing distress when they find out that the NHS is unwilling to pay for them. A quarter of specialists questioned in a survey admitted to hiding the facts about new drugs for bone marrow cancer that may be difficult to obtain on the NHS. According to the poll, nearly all the doctors who chose not to mention such expensive drugs said that they did so because it might "distress, upset or confuse" their patients.

Three quarters said that cost issues were a consideration, 40 per cent cited "lack of evidence" and 29 per cent argued that there was "no point" discussing treatments that their patients were unlikely to receive.

It is believed that thousands of patients with various types of cancer could gain extra months or years of life from the latest, most effective drugs. In many cases they are being denied the treatments on the NHS because of a lack of approval by the National Institute for Health and Clinical Excellence (NICE), which assesses the cost-effectiveness of new medicines in England and Wales.

The poll, by the charity Myeloma UK, comes after patients with advanced kidney cancer were denied four treatments on the NHS under guidelines issued by NICE. These and other new drugs for cancers of the lung, pancreas, colon and breast, and for multiple myeloma, are available widely throughout Western Europe, and in some cases in Scotland, but campaigners say that patients in England are being "left to die" if they cannot persuade their local trusts to fund treatment.

A total of 103 myeloma specialists in England, Wales and Scotland took part in the survey, with a quarter admitting that they avoided telling patients about licensed drugs that were still awaiting approval by NICE, which local health authorities were reluctant to pay for. Myeloma affects about 3,800 people each year in Britain and, of these, 2,600 are likely to die from it. NICE is reviewing treatments for the disease, including the drug Revlimid, which in clinical trials was found to be able to extend the life of some patients by up to three years.

The drug obtained its UK licence in June last year and is available across Europe, but NICE is not expected to make a final decision on whether it should receive NHS funding in England and Wales until early next year. The drug, which costs $72,000 for one year of treatment, has been rejected as not cost-effective by the Scottish Medicines Consortium, NICE's counterpart north of the Border.

NHS trusts have a legal obligation to provide treatments that are approved by NICE. In the absence of such approval, if a doctor thinks someone would benefit from a new medication, the patient can appeal to a committee at the local trust. Those who are refused must settle for less effective treatments or pay for the drugs.

In a statement, the Department of Health said that it had "issued guidance to the NHS which makes it clear that funding for a treatment should not be withheld simply because NICE guidance does not exist".


Treatment blocked despite years of pain: Case study

Colin Ross, 55, of Horsham, West Sussex, found that he had multiple myeloma, a cancer of the blood cells, in May 2004, and has been told that unless he is given the drug Revlimid he will not survive beyond the autumn. Mr Ross, a former engineer in the oil and gas industry, has suffered years of pain and disability because of the disease, which has been slowly eating away at his vertebrae and other bones, making them brittle.

Despite the exhortations of doctors treating him at the Royal Marsden Hospital in London, Britain's leading cancer hospital, Mr Ross's local NHS primary care trust in West Sussex has refused repeatedly to fund the treatment, even though patients in East Sussex and elsewhere have access to the drug on the NHS. "I've broken bones several times, feeling very weak and tired all the time. It's got to the point where my bone structure can't support my own weight, it takes ten minutes just to get out of bed and I can't stand unsupported in front of the mirror to clean my teeth," he told The Times yesterday. "I was told from the start that it was incurable, that treatment could only hold it at bay, but it now seems that Revlimid is my last resort."

Although the drug is readily available to patients across Europe and in the United States, it has not yet been granted approval for use throughout the NHS in England and so is being provided only by some NHS trusts in "exceptional circumstances".


Australia: Storm over 'ghost' public hospital wards

VICTORIAN Health Minister Daniel Andrews is at the centre of a growing political storm over claims that hospitals have been falsifying patient records to win government funding. The State Opposition, the Australian Medical Association and an independent health policy institute have expressed dismay at Mr Andrews' refusal to investigate the claims, which are believed to involve some of the state's leading public hospitals. "This is an unconscionable state of affairs and must be investigated," Australian Health Policy Institute director Stephen Leeder said.

Federal Health Minister Nicola Roxon last night intervened in the row, warning that evidence of "fudged" patient data would be of serious concern to the Government as it negotiates new funding agreements with the states and territories. Mr Andrews last night was refusing to launch an investigation, repeating that he did not believe the allegations.

The row erupted after The Age revealed that Victorian hospitals had been accused of manipulating patient data, creating "phantom wards" and inconsistently measuring waiting times to meet State Government benchmarks for bonus payments. A survey of 19 emergency department directors by the Australasian College for Emergency Medicine found almost 40% of hospitals had been "admitting" patients when they were, in fact, still languishing in emergency department waiting rooms, corridors or on trolleys. The "virtual wards" were used purely for "creative accounting", the doctors said.

Similar allegations about NSW hospitals falsifying patient data to rort funding were investigated by the NSW Health Department last year and have been referred to the state's Independent Commission Against Corruption.

Australian Medical Association president Rosanna Capolingua said allegations of hospitals acting fraudulently should be investigated to ensure new health care agreements were not rorted in the same way. Dr Capolingua said benchmarks should not encourage rorting that would undermine efforts to improve the health system. ''We need to make sure there is transparency, honesty and no perverse incentives in the benchmarks," she said.

Professor Leeder of the Health Policy Institute said the Victorian emergency doctors' claims could be more widespread than thought and must be investigated by the State Government. "If you do not have a person going around checking on what people are doing when they are recording and coding information, all evidence suggests there will be errors, random, systematic and perverse," he said.

Opposition health spokeswoman Helen Shardey said the allegations must be investigated to ensure Victoria's health system was measured properly and did not jeopardise its position under the new health care agreements. "It's extraordinary that a health minister would not want to investigate this immediately," she said. "It displays ignorance and it says he does not trust the people running our hospitals."


Tuesday, August 26, 2008

Government experiments in health care

Back in January 2007, I wrote a column taking Colorado legislators to task for sponsoring a bill that would have forced parents of girls 12 and older to either vaccinate their daughters with a HPV "vaccine" or "opt out." Social conservatives argued that the bill would lead to promiscuous behavior in children. My concerns were different.
Not only is this bill an invasion of privacy and an implicit endorsement of the vaccine, the law has the potential to encourage many parents to give the vaccine to their children without educating themselves properly beforehand. After all, shouldn't parents "opt in" instead of being forced to "opt out"? Trust me, if in 10 years we learn that the HPV vaccine causes toe cancer, not a single lawmaker will be held responsible.

The same bill had been peddled in states across the nation. The reason I mention my column (which isn't online anymore), is that I remember receiving a rather large number of angry emails and calls. One nurse practitioner, in an agitated letter that ran in the Denver Post, scolded me: "We have the potential to drastically reduce the incidence of cancer with the introduction of the HPV vaccine. To cloak this discussion in the "government forcefeeding parents" debate is an affront to the health and well-being of the public."

How could I oppose the HPV drug? Did I hate children? (Well, some children.) Was I willing to put the lives of these poor creatures at risk for an ideology? The answer, of course, is yes. Freedom and choice is an ideology worth risking lives over. But, even more than that, there was no convincing proof that HPV vaccines were effective. Nor did we know enough about the side effects. Individuals, I argued, with detailed knowledge of their own situation, will, on the whole, make smarter and healthier choices for their children than detached government officials.

Now, the New York Times runs a story titles "Researchers Question Wide Use of HPV Vaccines." The article quotes two New England Journal of Medicine articles that conclude, the "Two vaccines against cervical cancer are being widely used without sufficient evidence about whether they are worth their high cost or even whether they will effectively stop women from getting the disease ."

So will all those states that endorsed these vaccines through legislation now "educate" parents about the potential pitfalls? Highly unlikely.


Prominent Australian surgeon accused of botched work

Only 12 years late. Those good ol' "regulators" and government "watchdogs" were asleep as usual

A PROMINENT surgeon accused of performing botched, incompetent and unethical operations over more than a decade could face disciplinary action. Toowoomba surgeon Darryl Wayne Bates is also accused of engaging in dishonest behaviour. The Medical Board of Queensland has referred Dr Bates to the Health Practitioners Tribunal alleging a pattern of misconduct by him.

Board documents filed in the District Court of Queensland reveal Dr Bates, who is on the Toowoomba and Darling Downs Medical Association executive committee, was found in an audit of patients by St Vincent's Hospital, Toowoomba, and the Royal Australasian College of Surgeons to have performed "suboptimal" surgery as far back as 1996.

In one operation it is alleged "a loop of intestine was mobilised from the pelvis and left without blood supply and attachment to the gut". The patient, who deteriorated and required further treatment at the Toowoomba Base Hospital, was found to have a 1cm-wide cut in their mid-small bowel by another surgeon.

Further incompetence allegedly took place between August 2003 and September 2005 in four cases at Toowoomba's St Andrew's Hospital, which filed a complaint against Dr Bates to the medical board. On August 14, 2006, he signed an undertaking to have restrictions placed on him by the medical board and later that month was told his conduct was being referred to a Professional Conduct Review panel. He is then alleged to have carried out four operations in January and February this year, contrary to his agreed restrictions.

When contacted by The Courier-Mail, Dr Bates deferred comment to his solicitor Harry McCay. Mr McCay chose not to provide a statement to The Courier-Mail. A directions hearing into Dr Bates's case has been set down for September 1 in the Health Practitioners Tribunal.


Monday, August 25, 2008

Stark Revelation

So government auditors have uncovered evidence of fraud in Medicare. Or rather, more fraud. The politicos lingering around Washington can barely keep a straight face as they claim to be shocked.

A draft report by the inspector general of Health and Human Services -- circulating on Capitol Hill and leaked this week -- determines that Medicare may have paid $2.8 billion in improper or fake claims for medical equipment in 2006. That's an error rate of 31.5%, in a single corner of this colossal entitlement. "This report doesn't surprise me," fumed Democrat Pete Stark.

Glad to hear the Congressman is catching on, given that dozens of studies have come to similar conclusions. But he aims his real outrage at the Bush Administration, which says it has stepped up its efforts to combat fraud and reined it in more than the inspector general alleges. "To look better to the public, you cook the books," Mr. Stark continued. "This agency is incompetent."

We're speechless. Mr. Stark and his ilk consistently claim that Medicare is a model for government-run "universal" health care because it spends less on overhead than the private sector. True, Medicare's administrative costs are just 3% of total spending, while the private sector hits 11% to 14%.

But insurance companies spend money to screen their claims for fraud. Medicare automatically pays more than 95% of the bills it receives. This lack of scrutiny reduces overhead, but it makes the program highly vulnerable to abuse. In June, a high-school dropout pleaded guilty to conning Medicare out of $105 million by submitting over 140,000 bogus claims before auditors noticed. It was the biggest health-care fraud in American history.

The real reason liberals like Mr. Stark are outraged is because they want to claim one of Medicare's vices as a virtue, to help along their health-care ambitions. The inspector general's report makes their argument poorer politically. It also shows that taxpayers will be literally poorer if Mr. Stark gets his way.


Deadbeat public hospitals in Australia

But their army of clerks and "administrators" still get their pay on time, of course. Clerking is the one ESSENTIAL activity in all public hospitals

Public hospitals are threatening the livelihood of small businesses across New South Wales by failing to pay their bills. Suppliers have been forced to suspend services or pursue legal action until tens of thousands of dollars worth of outstanding invoices are paid. Companies struggling to recoup unpaid bills range from a bakery, hardware store, taxi service and dairy supplier to fuel stations, a tyre dealer, software supplier, grower's market and confectioners. Medical providers - including pharmacists, physiotherapists and psychiatrists - have also been left as much as $40,000 each out of pocket.

Hospitals in the Greater Southern, Greater Western, South Eastern Sydney Illawarra and North Coast areas have among the biggest debts. "Most hospitals never pay their bills for months and most of the suppliers are too scared to create problems because they are threatened with losing their contracts," a NSW Health source said.

Belinda and Wayne Morrison, owners of Bels Gordon St Bakery in Port Macquarie, have supplied the town's hospital for nine years. But, in the past six months, the hospital's unpaid invoices have mounted to as much as $7000. "We are a small business and we do need cash flow," Mrs Morrison said. "It's frustrating having to chase money - especially when I give them goods and they get money back on the same day." The buns and cakes that her bakery supplies are sold at a profit by the hospital's cafeteria. "They sell them for quite a healthy profit." she said.

NSW Opposition health spokeswoman Jillian Skinner said the Government had an obligation to pay bills on time. "It's the lowest of the low for a big government agency to make suppliers hold out for payment of services and goods that they have supplied," she said. "It's mean and it's jeopardising some of those small businesses that have to pay their bills and staff on time - they struggle to stay afloat."

The Sunday Telegraph has learned of a case in which a fuel station refused to fill up area health service vehicles in the South Eastern Sydney Illawarra area because of unpaid hospital bills. Colin Richardson, managing director of Global Direction software suppliers, suspended services to Dubbo Base Hospital's pathology service in May after accounts of more than $22,500 were unpaid. "Now we have put them on pre-pay so they pay in advance," Mr Richardson said.


Sunday, August 24, 2008

Infertile couples to be priority for NHS IVF treatment

A complete turnaround. Up until now there has been a pervasive attitude in the NHS that infertility is not a "real" problem. I suspect that Britain's socialists have decided that they need to breed all the little future taxpayers that they can

Infertile couples could soon be offered wider and more consistent treatment on the NHS under the first proposals from the government panel that has the task of ending the IVF postcode lottery. NHS trusts should give IVF a much higher importance when drawing up spending plans, by taking into account the effects of infertility on mental health and general wellbeing, the influential group will say today.

The advice from the Expert Group on Commissioning NHS Infertility Provision, which was convened by health ministers this year, will put fresh pressure on the 95 per cent of primary care trusts (PCTs) that do not offer the three cycles of IVF recommended by the National Institute for Health and Clinical Excellence (NICE).

Its interim report, which suggests several measures designed to improve access to IVF, comes as an NHS regional health authority has agreed for the first time to implement the NICE guidelines across all 14 of its trusts. The decision by NHS East of England means that infertile couples in Essex, Suffolk, Norfolk, Cambridgeshire, Hertfordshire and Bedfordshire will be entitled to three cycles of treatment from next April, provided that they meet eligibility criteria.

Infertility is a problem for between one in six and one in seven couples. Almost 45,000 cycles of IVF are performed in Britain each year, but limited NHS provision means that about 75 per cent of these are conducted privately, at an average cost of o2,000 per cycle. NICE, the value-for-money watchdog, recommended in 2004 that PCTs should provide three cycles to infertile couples in which the woman is aged between 23 and 39. It added that these should be full cycles, including the replacement of frozen embryos, should a couple fail to conceive with fresh ones.

A Department of Health survey published in June found, however, that just 9 out of 151 PCTs in England meet this standard. About two thirds offer only one cycle, and half of these do not replace frozen embryos. Three trusts offer no IVF at all.

In March, Dawn Primarolo, the Health Minister, asked an expert group to recommend ways of encouraging more trusts to implement the NICE guidance in full. Its first advice, seen by The Times, will be published today. It found that the main barrier to wider provision was the low priority that many trusts give to IVF. This needed to be reassessed in the light of evidence about links between infertility and depression, stress, relationship breakdown and quality of life. "The provision of infertility treatment has not been seen as a traditional NHS service and, therefore, is often viewed as a relatively low priority compared to more visible conditions whose impact is well established," the report will say.

"The group's final report will seek to consider the often unseen consequences of infertility, including the impact on mental health and general wellbeing, which may draw on other NHS services for treatment, as well as the positive benefits of IVF." The group has also identified a "lack of knowledge and understanding of infertility and its treatment" among commissioning managers, and a poor grasp of what the NICE guidelines actually mean.

In the light of the group's advice, Ms Primarolo will write today to all PCTs to clarify that NHS IVF cycles should include the replacement of frozen embryos as well as fresh ones. If trusts acted on this, it would significantly improve some infertile couples' chances of a baby.

Ms Primarolo's letter will also confirm that NICE will not review its guidance until 2010-11. Many trusts had been holding off from offering three cycles, as NICE had been due to reassess its policy as early as this year.

The expert group, made up of five NHS commissioning experts and a patient representative, will also recommend that the NHS set a fixed price that PCTs would pay for IVF. Such national tariffs already exist for dozens of medical procedures, such as heart bypasses, and help managers to plan their spending. A spokesman for the Department of Health said that it was receptive to this idea. "It is appropriate for IVF to be considered carefully for inclusion on the national tariff," he said.

Mark Hamilton, chairman of the British Fertility Society, which represents medical professionals in the field, said that it was right for PCTs to consider the wider health impact of infertility. "This is a positive development," he said. "Clinicians and practitioners involved in infertility services are all aware that we are not just dealing with a physical pathology. "Infertility is a disease, but it also has fallout beyond that for a significant proportion of couples, causing mental health problems, depression, stress-related illnesses and so on."

Dr Hamilton welcomed the East of England decision, though he questioned whether other parts of the country would match it unless the Department of Health provided more dedicated funds. "It is a tremendous step forward that a region has seen the value of doing this, and I would hope that others will do the same. But there is certainly a view in the sector that central funding would solve an awful lot of problems."


Nod for 'top-up' drugs

Dozens of NHS hospitals are allowing patients to "top up" their treatment with medicines bought privately. These are often expensive cancer drugs the health authority refuses to fund.

Topping up or "co-pay" is against NHS regulations, according to the Department of Health. But there is nothing in NHS regulations that prohibits patients buying in treatment if they wish, according to senior legal opinion obtained by health insurer Western Provident Association.

John Barron, Conservative MP for Billericay, discovered the hospitals' "top-up" figures through freedom of information laws.

The subject is relevant to expats returning to the UK seeking to switch from NHS to private care, or the other way round, because under many policies cover is capped at certain cash levels.


Saturday, August 23, 2008

Obama's Health-Care Tipoff

'If I were designing a system from scratch, I would probably go ahead with a single-payer system," Barack Obama told an audience in Albuquerque on Monday. He was lauding the idea of a health-care market -- or nonmarket -- entirely run by the government.

Most liberals support single payer, aka "Medicare for All," because it would eliminate the profit motive, which by their lights is the reason Americans are uninsured. The Democratic Presidential candidate takes a more moderate campaign line, though we suppose just about everything is "moderate" compared to a total government takeover. While preferring that option in theory, Mr. Obama continued, his health-care plan is designed to "build up the system we got," and over time, "we may . . . decide that there are other ways for us to provide care more effectively."

The Senator has expressed similar sentiments before, including throughout his combat with Hillary Clinton. But repetition doesn't make it any less telling, especially about his political instincts and the breadth of his ambitions. Mr. Obama's health-care plan includes a taxpayer-funded insurance program, much like Medicare but open to everyone. The goal, like HillaryCare in the 1990s, is to displace current private coverage and switch people to the default government option. What's new is Mr. Obama's smoother political packaging.

With good reason, critics often call this a back-door route to a centrally planned health-care bureaucracy. For all his lawyerly qualifications, Mr. Obama has essentially admitted that his proposal is really the front door.


Disorganized British paramedics kill woman

A Midland widower whose wife died after alleged delays by paramedics in getting her to hospital has criticised the ambulance service for not apologising four years after her death. Roger Bereza, who lives in Coventry, spoke out after West Midlands Ambulance Service (WMAS) paid an undisclosed six-figure-sum in an out of court settlement earlier this month.

His 41-year-old wife Tracey had suffered asthma since childhood but on April 11, 2004 she had an acute attack and her condition continued to worsen, so Mr Bereza dialled 999 for an ambulance.

As well as complaints about the way the ambulance crew treated his wife at the scene, he said they had to ask him for directions to the nearest hospital and went the wrong way. A crew of two paramedics arrived at the family home at just after 9.20pm but, he said, it took more than 75 minutes to take his wife to hospital during which time she went into respiratory arrest.

Mr Bereza, a 47-year-old RAC patrolman, claimed there was a series of shortcomings in the way his wife's care was handled and once in the ambulance she suffered a respiratory arrest. He said he could only watch as his wife vomited blood, turned blue and arrested in front of him, as his three daughters looked on from the house. "By now I knew I had to do something, so I started doing chest compressions on Tracey's chest while one of the paramedics tried to get the defibrilator to work. Monitors were showing her pulse was at zero, and we were still on the driveway. I couldn't give up on her, even though I realised it was the beginning of the end."

They arrived at Coventry & Warwickshire A&E at 10.35pm. Mrs Bereza never regained consciousness and died four days later after her family took the difficult decision to turn off her life support machine. The couple, who had three daughters aged 20, 19 and nine, were due to celebrate their 21st wedding anniversary in June 2004.

Despite the pay-out from WMAS, the family said they had yet to receive a formal apology or admission of liability. A trust spokesman said: "WMAS first became involved in the treatment of Mrs Bereza on the evening April 11, 2004 when her husband called for an ambulance. Mrs Bereza had suffered an asthma attack after inhaling polish fumes. "The trust wrote to Mr Bereza on July 22, 2008 in regard to his claims about the level of care given to his wife and expressed its `sincere regret'. "WMAS is always learning from its experiences and strives constantly to find ways of improving patient care. "In light of this case, further inquiries into the trust's protocols were undertaken to ensure that the training and actions of staff are appropriate at all times."

Mr Bereza added: "I am still extremely angry. This tragedy should never have happened. "Although Tracey had suffered from asthma since childhood, it was controlled most of the time. We knew that if she had a severe attack we had to get her to hospital as soon as possible. Even though we live just 10 minutes from the nearest A&E, I had always been told to call an ambulance and not to attempt to drive there myself in case we got stuck in traffic or Tracey required emergency oxygen for her nebuliser. "I wish I'd ignored this advice and taken Tracey to hospital myself."

Lindsay Gibb, a medical negligence expert with Birmingham-based law firm Irwin Mitchell, said: "This is a hollow victory for the family because despite agreeing to pay a significant sum by way of compensation, the trust has not apologised to the family or accepted that its paramedics were negligent in any way. "The relevant guidelines state that: .'in a life threatening or acute severe asthma attack - do not delay transportation. Load and go to nearest suitable receiving hospital and provide nebulisation en route'. "This clearly was not the case on this occasion and the evidence suggests these delays were responsible for the fatal outcome."


Friday, August 22, 2008

Thousands of NHS operations cancelled

Thousands of NHS operations were cancelled last year, many because of shortages of staff, beds or equipment, figures suggest. One in three hospital trusts cancelled surgery for the same patient at least three times, and up to 7,014 patients had operations cancelled or rescheduled more than once, data obtained by the Conservatives shows.

The most common reported reason for cancellation was problems with theatre bookings, responsible for 16,617 cases. Other causes included: 400 operations cancelled because the patient's notes had been lost, more than 10,000 cancelled because of bed shortages, nearly 4,000 because of equipment failure and more than 11,000 because of staffing shortages.

Data from 124 trusts - more than three quarters of those in England - responding to requests under the Freedom of Information Act, suggested that 77,302 operations were cancelled for "non-clinical reasons" in 2007-08. However, the trusts with the highest reported cases of cancelled surgery apologised yesterday for providing inaccurate data.

Kingston Hospital NHS Trust, which reported 10,351 operations cancelled last year, said that this figure was incorrect. "This was an error on our part and we apologise for any confusion this mistake has caused," the trust said, adding that only 190 operations were cancelled in 2007-08. Other trusts reporting more than 3,000 cancellations included hospitals in York and Brighton and Great Ormond Street Hospital for Children in London. They also said that the figures were erroneous or had been misinterpreted.

Many cases could have been cancellations by patients themselves or have been logged as changes by hospitals before the patient was notified of a date for surgery, NHS staff said.

A spokesman for Brighton and Sussex University Hospitals Trust said: "Over six hundred of the operations that were `cancelled' were in fact brought forward to an earlier date and around 1,000 were administrative cancellations, which are about how the hospital schedules its work."

Andrew Lansley, the Shadow Health Secretary, said: "Having an operation cancelled can cause huge distress for patients and their families. It's simply unacceptable that these figures are so high."

Government figures show that the number of cancelled operations has increased by 14 per cent since 1997. There were 57,350 cancelled operations in 2007-08, compared with 50,505 in 1997-98, official records state, but they include only operations cancelled 24 hours in advance or less.

Richard Collins, a spokesman for the Royal College of Surgeons, said that the figures would almost certainly relate to elective, planned surgery rather than urgent care. "The shortage of ICU [intensive care unit] beds for major surgery patients is a common problem, especially in winter," he added. "Notes are also lost on a worryingly frequent basis."

A Department of Health spokesman said: "The number of cancelled operations needs to be set against the huge increase in the number of patients that the NHS is treating. "Between 1997 and 2008, the number of elective admissions has increased by over 1.5million while the number of operations cancelled at the last moment remained at less than 1.5 per cent."


Thursday, August 21, 2008

Reform Needed at the Food and Drug Administration

One-Size-Fits-All Mandates Don’t Work for Individual Patients

In order to best serve the interests of the nation’s patients and doctors, the structure of the Food and Drug Administration desperately needs to be systematically reformed, according to a new study published by the Competitive Enterprise Institute.

In FDA’s Bad Medicine: How the Dispersed Knowledge Problem Affects Drug Safety Analysis, authors Jerome Arnett, M.D., and Gregory Conko argue that the very structure of the FDA prevents it from doing its job—making sure safe and effective medical treatments reach patients in need.

“Every day, thousands of physicians and patients make myriad choices from available drug options,” write Conko and Arnett. “They take into account differences in effectiveness, side effects, and drug interactions for each individual patient. FDA scientists may know a lot about the drugs they evaluate and their average effects on thousands of users, but they know nothing about the individualized physiology of each patient. On the other hand, intensively trained clinical physicians, who do have knowledge of individual patients, are best able to advise them if a drug is appropriate.”

Because the FDA uses the blunt tool of completely banning drugs that aren’t safe for all patients, there will almost always be those who lie outside the average, and for whom unapproved treatments are not just appropriate, but medically necessary. The government should be encouraging a more personalized approach to treatment, with physicians utilizing multiple sources of information and guidance in tailoring the best possible strategy for each individual patient.

“A market-based approach to drug safety information, combined with technological advances in diagnostic science, will lead to a more vibrant medical marketplace—and better outcomes for patients,” conclude Arnett and Conko.


Wednesday, August 20, 2008

Hospital Infections: Preventable and Unacceptable

On July 30, a jury awarded over $2.5 million to James Klotz and his wife Mary in a medical malpractice lawsuit against a heart surgeon, his group practice and St. Anthony's Medical Center in St. Louis, Mo. In 2004 Mr. Klotz, now 69, was rushed to the hospital with a heart attack and a pacemaker was surgically implanted. He developed a drug-resistant staph infection called methicillin-resistant Staphylococcus aureus (MRSA). It was so severe that he underwent 15 additional operations, spent 84 days in the hospital and lost his right leg, part of his left foot, a kidney and most of his hearing.

This verdict should send a warning to physicians, hospitals and hospital board members. Until recently, infection was considered an unavoidable risk. But now there is proof that nearly all hospital infections are avoidable when doctors and staff clean their hands and rigorously practice proper hygiene and other preventive measures.

Hospital infections will cause the next wave of class-action lawsuits, bigger than the litigation over asbestos. The germ that Mr. Klotz contracted, hospital-acquired MRSA, infects about 880,000 patients a year and accounts for only 8% of all hospital infections. Hospital infections caused by all kinds of bacteria sicken millions.

The Klotz verdict is not the first sign that hospitals are in a new legal environment. In 2004, Tenet Healthcare Corporation agreed to pay $31 million to settle 106 lawsuits by patients who contracted infections after heart surgery at Palm Beach Gardens Medical Center in Florida. Since then, numerous lawsuits have been filed against hospitals in Florida, Kentucky and elsewhere by infected patients. Hospitals being sued are saying that their infection rates are within national norms. But for most infections, the only acceptable rate is zero.

Medicare calls certain device-related bloodstream infections, urinary tract infections and surgical infections after orthopedic and heart surgery "never events." Starting in October, Medicare will stop reimbursing hospitals for treatment of these infections. Hospitals will be barred from billing patients for what Medicare doesn't pay, forcing them to take a loss. Next year Medicare will add other types of infections to the list of "never events."

The evidence justifying Medicare's new policy is compelling. Central line bloodstream infections, caused by the contamination of certain devices, are preventable. Hospital patients in intensive care are commonly medicated through a tube inserted into a vein. The risk is that bacteria will invade the tube and enter the bloodstream. Rigorous hygiene, including clean hands, sterile drapes, and careful cleaning of the insertion site with chlorhexidine soap, can keep bacteria away from the tube.

Beth Israel Medical Center in New York City reports that it hasn't had a central line bloodstream infection in the cardiac intensive care unit in over 1,000 days. Dr. Brian Koll, chief of infection control there, explains that the key is using a checklist that doctors and nurses must follow. Implementing the checklist cost $30,000 and saved $1.5 million in treatment costs. Lives saved: priceless.

Other hospitals -- from Johns Hopkins Medical Center in Baltimore to Sutter Roseville Medical Center in Sacramento -- have reached the goal of zero central line bloodstream infections. No wonder Medicare calls these infections "never events." Why should jurors reach a different conclusion in a lawsuit?

We have the knowledge to prevent infections. What has been lacking is the will. A recent survey from the patient-safety organization Leapfrog found that 87% of hospitals fail to consistently practice infection prevention measures. Insurance companies that sell liability coverage to hospitals could change that by offering lower premiums to hospitals that rigorously follow infection-prevention protocols.

To be sure, lawsuits are not the best way to improve patient care. Many verdicts are unjustified, and few truly injured patients find a lawyer to take their case. Still, the coming wave of lawsuits, as well as financial incentives from Medicare and insurers, will fight complacency about hospital hygiene.


Tuesday, August 19, 2008

NHS watchdog to tell patients how to buy medicine unavailable on health service

Patients are to be given advice on drugs rejected by the NHS - so they can choose to buy them privately.

The National Institute for Health and Clinical Excellence (NICE) is drawing up plans to provide patients with independent medical guidance on treatments for diseases such as cancer. The advice would include drugs that NICE has ruled the NHS should not use because they are too expensive. For the first time patients would be able to receive impartial guidance on the health benefits of unapproved treatments and compare them with those available on the NHS. They could then decide if they want to pay for them privately rather than opting for the free drugs, which can be less effective.

The development follows growing public anger over the number of drugs and treatments being blocked by the Nice because they are not 'cost effective'. Many are available abroad and can offer people longer life expectancy or health benefits. Last week the watchdog ruled that four kidney cancer drugs costing around o24,000 a year per patient did not represent value for money.

Under current health service rules patients who choose to buy drugs that the NHS deems too expensive are made to pay for the rest of the care. But ministers are expected to end this following a review of the system which is due to report in October. It is expected this will give the green light for patients to 'top up' their treatment. As a result, NICE - which is currently only responsible for deciding which treatments are available free on the NHS - is preparing to publish guidance on drugs they have ruled against.

Speaking to The Daily Telegraph, Andrew Dillon, the chief executive, revealed his organisation was preparing to play a central role if the Department of Health give the go-ahead to so-called "co-payments" in the autumn. He said: "If the Government wants to go in that direction we are absolutely the right organisation to support the process for doing so. "One of the things we think we could do really well would be to provide entirely independent objective information for individuals to make up their own mind. We think we could do that very well and would be happy to do that."

NICE has faced criticism for rejecting a series of drugs widely available in Europe and America - sparking allegations that it is putting financial considerations above medical benefits. The disclosure that it is now preparing to offer advice to patients buying their own drugs will underline concerns that the development of expensive new drugs is leading to the emergence of a "two-tier NHS".

There are also fears that patients unable to afford 'top ups' will be angered at learning they may not be receiving the best treatment available.

It is understood that the information will largely be provided on-line via a new website called "NHS Evidence". The site is being established to offer advice to NHS doctors and hospitals but could be extended to provide patients with clear information on different treatments and drugs available. If co-payments are permitted the medical benefits of privately-available drugs will also be set out. The NHS will also be able to detail the likely costs of a prescription.

Norman Lamb, the Liberal Democrats' health spokesman, welcomed the move. "One of the big dangers of allowing people to top-up their treatment is that consumers aren't informed and they can be susceptible in a moment of crisis to pressure from pharmaceutical companies," he said. "These drugs can be very expensive and I would welcome the provision of a source of independent, reliable advice."

Medical experts and patient groups said the development may also put more pressure on NICE to approve drugs which have medical benefits which are currently unavailable on prescription. Christoph Lees, an NHS consultant and founder member of the Doctors for Reform group, said: "The fact that NICE are preparing to offer advice shows that the realisation is finally filtering through that you can't withhold information on good drugs which are out there and what they can do, even if the NHS can't afford it. "But that has got to be balanced with some sort of mechanism to make sure that people can afford access to these treatments."

Michael Summers, vice chairman of the Patients Association said: "Any information which is available is obviously valuable. But people would have less need to top-up if NICE did not reject cancer drugs available elsewhere."

Andrew Lansley, the shadow Health Secretary, said: "It seems that the Government is intent on pre-empting the outcome of its own consultation on top-up payments and that it wants to assist people to buy their own drugs, rather than have them provided on the NHS. "But Labour are still avoiding two key questions: if patients buy top-up drugs, will that prejudice their access to NHS treatment? Secondly, why is access to new cancer medicines worse in the UK than in the rest of Europe and America?"

NICE is under mounting pressure after barring four kidney cancer drugs available in other countries last week. Charities and patients are preparing to make official complaints about the approval process with one sufferer claiming he was "patronised and bullied" by the process.

Sutent, one of the drugs rejected, can double life expectancy to 28 months for people diagnosed with kidney cancer. A report has claimed that more than 1,000 patients had been turned down for cancer drugs over the past two years because of a "postcode lottery" in treatment.

Patients are also being forced to mount legal action to get hold of drugs that NICE have not yet approved. A grandfather told he only has two months to live has mounted a legal challenge to gain access to a drug that could possibly extend his life expectancy by up to three years. Colin Ross, 55, of Horsham, West Sussex, who has multiple myeloma, a cancer of the blood cells is fighting for the drug Revlimid after being refused it by West Sussex Primary Care Trust because it has not yet been granted approval by NICE.


Monday, August 18, 2008

Drug companies fed up with blundering British bureaucracy

So Brits don't get new drugs

One of the world’s leading drug companies is threatening to withdraw some of its new cancer treatments from the process by which they are approved for use in the National Health Service. Cancer patients in Britain will consequently be denied more effective drugs that are available to sufferers in other countries.

Roche, the Swiss pharmaceutical giant, has already refused to supply economic data on its drug Avastin for treatment of lung and breast cancer to the National Institute for Health and Clinical Excellence (Nice), the authority that evaluates the cost-effectiveness of medicines for the NHS. This means Avastin will not be available on the NHS for those diseases. Avastin is said to double the time a breast cancer patient’s condition remains stable when compared with existing treatments. Studies have also shown improved survival rates for lung cancer victims.

Roche said last week it will consider withdrawing from other evaluations rather than submit products only for them to be rejected by Nice as too expensive. The statement is the latest twist in the growing row over decisions by Nice. Earlier this month Nice caused an outcry in a preliminary decision when it rejected the use of Avastin (also known as bevacizumab), Sutent (sunitinib), Nexavar (sorafenib) and Torisel (temsirolimus) as too expensive to treat kidney cancer.

“The alternative to these drugs for many patients is death,” said Jonathan Waxman, professor of oncology at Imperial College, London. “Nice is making terrible mistakes.” The survival rates for cancer in Britain are already among the lowest in Europe — on a par with Poland, Slovenia and the Czech Republic, according to data published last year. However, cancer charities acknowledge there has been significant improvement in rates since the government made the issue a priority with its NHS Cancer Plan, first launched in 2000. Some consultants argue, however, that Britain already spends less on cancer drugs than many other European countries and that it is “crazy” to reject drugs proven to prolong life.

Richard Barker, director- general of the Association of the British Pharmaceutical Industry, which represents the drug companies, said: “Nice does a tough and necessary job, but is making errors because of a very mechanistic approach. It relies too much on arithmetic and not enough on clinical judgment.”

Nice was created in 1999 with the aim of ensuring that decisions on the best and most cost-effective drugs for the NHS were made at a national level, were transparent and could be challenged. When the drug companies scrutinised the economic modelling used by Nice, they realised that the estimated costs of their drugs and effectiveness could vary widely. Even more seriously, some of the calculations were wrong. There was an outcry in the medical community in February 2006 when Nice stated that Temodal (temozolomide) — declared as the biggest breakthrough in treating brain tumours for decades — did not offer value for money. Temodal had won approval from the European regulator in 2004, but many British patients were denied treatment as Nice wrangled over costs.

Peter Davison, 48, a manager for Cambridge University Press, was among the few British patients who received the drug — because he was diagnosed with a brain tumour while working in Singapore. “I was lucky to be abroad,” said Davison, who is now in remission. “Four months after I had the operation to remove the tumour, I was running and climbing mountains.” When Schering-Plough — the pharmaceutical company which markets Temodal — prepared its appeal against the Nice decision, it identified an error in the modelling. Once corrected, the model showed the drug was cost-effective — and as a result it was ultimately approved for NHS use.

Not surprisingly, the drugs companies now want full access to the economic models, with the chance to check the accuracy of the calculations. In May, the High Court ruled that Pfizer and Esai, the companies which market the Alzheimer drug Aricept, should be given full access to these models. “We believe this modelling might not be fit for purpose and we want to check it,” said a Pfizer spokesman last week. Nice said it was seeking leave to appeal to the House of Lords after the High Court decision.

Even where the models are correct, consultants and patients’ groups say Nice fails to give proper weight to the evidence from clinicians and patients’ groups. The Sunday Times has highlighted the fact that NHS patients do not even have the option of paying for the drugs privately because of government ban on “co-payments”. The government has said it will review the issue.

Professor Sir Michael Rawlins, chairman of Nice, said the evaluation process was recognised internationally and Nice had been commended by the World Health Organisation for the quality of its work. He said: “We have a finite amount of money to spend on healthcare and we have to divide it up in as fair and as equitable a way as we can. We can’t say to yes to everything. It’s awkward, it’s difficult, it’s unpleasant.”


Arrogant Australian drug regulator to cause taxpayers MORE pain

And the crooked bitch mainly responsible is still in her job! Australia's version of the FDA shows how badly such organizations can go off the rails

A class action against the federal Government is set to be launched next week after the $55million payout to Pan Pharmaceuticals founder Jim Selim. The Government could be liable for another multi-million-dollar payout because of the action taken by the Therapeutic Goods Administration in 2003 to cancel Pan's licence. The Weekend Australian has also uncovered further evidence of what occurred in the lead-up to the decision to cancel Pan's licence - including a senior TGA officer shredding notes taken at a crucial meeting.

Mr Selim claimed the government had breached its duty and abused its power of public office, and his Federal Court case was settled on Thursday in his favour. More than 300 people lost their jobs, shareholders lost tens of millions of dollars and hundreds of businesses were affected by Pan's closure in 2003.

In January that year, people reported hallucinations and vomiting as a result of taking travel sickness drug Travacalm. The TGA then investigated Pan and meetings were held to decide what action to take. On April 23, 2003, the TGA organised for an expert advisory group to decide whether the public was at "imminent risk" of death, serious injury or serious illness from Pan's products. It was a statutory requirement that the government believed this "imminent risk" existed before it could take the action to cancel Pan's licence. The EAG was later to report back to the TGA that there was no "imminent risk", although it did find there was a lack of confidence in the quality of Pan's products.

Pages of notes taken by the members of the EAG were later taken by the TGA and destroyed at the direction of senior bureaucrat Fiona Cumming. Dr Cumming is the director of the office of complementary medicines. At the same time, the EAG was meeting at the Qantas Club at Sydney Airport to discuss the risks of Pan's products, media officer Kay McNeice was in the TGA's Canberra office putting the finishing touches to a media release - announcing the cancellation of Pan's licence.

Although the notes of the EAG's deliberations were destroyed, lawyers were able to unearth a transcript of the meeting, which had been recorded at the behest of the TGA. "We don't have much evidence do we," one member noted. "We're having trouble getting to 'imminent risk'," said another. The findings of the EAG did not justify an immediate suspension of Pan's licence, a proposition agreed to in court by the TGA's director of the office of devices, blood and tissues Rita Maclachlan, who spent several days being cross-examined by Mr Selim's barristers. Immediate suspension meant Pan could not dispute the issue in the courts, a fact the TGA was aware of.

Ms Maclachlan, second in command at the TGA, was also present when then health minister Kay Patterson and prime minister John Howard were briefed in late April. "Why didn't you speak up and say, 'Look, even though it's not my call ... we are about to implement the largest recall in the history of the Western world, unlawfully, because we are going to deny the company its statutory requirement to natural justice'. Why didn't you say that?" Mr Selim's barrister, Justin Gleeson SC, asked. "I don't have a recollection, Mr Gleeson" Ms Maclachlan replied.

When Ms Maclachlan gave evidence that she was concerned that one batch of Pan products - manufactured in August 2000 and not part of the 2003 recall - could cause severe allergic reactions in the public, the judge hearing the case, Arthur Emmett asked a few questions of his own. "You weren't prepared to recall this product back then but that was the reason you were going to call the other 6000 products back (in 2003)?" "I don't have a particular recollection as to what happened with this product," Ms Maclachlan replied.

"But you've just told me ... that you were concerned that this product was still out in the community," Justice Emmett said. "You didn't take any steps to have it recalled? I just find that quite unbelievable." Ms Maclachlan declined to comment yesterday.