Thursday, December 03, 2009

Lack of treatment for British cancer sufferers uncovered

No wonder British cancer survival rates are only a fraction of America's. Pain relief only seems to be the British idea of treatment

Just one in 20 cancer sufferers have surgery in an attempt to clear their cancer in some parts of the country, an audit has found. The proportion of lung cancer patients receiving treatment varies widely across the country, NHS figures have revealed. It comes just one day after a report by Prof Mike Richards, the national director for cancer services, admitted England lags behind the best in Europe on cancer survival rates. Just 15 trusts in England can match the best rates in Europe for either breast, lung or colorectal cancer, it said.

New data now shows the likelihood of being treated for lung cancer also varies widely with some patients six times more likely to be offered surgery than others. In some areas only one in ten patients are given any active treatment for lung cancer, meaning treatment that is aimed at curing the disease rather than just relieving symptoms until they die.

At Hinchingbrooke Healthcare NHS Trust in Cambridgeshire, just under one quarter of lung cancer patients receive active treatment compared with 88 per cent at Guy's and St Thomas' NHS Trust in central London. The proportion of patients having surgery in an attempt to clear their cancer varies from less than one in ten in some places to one in four in others. At North Middlesex Universities Hospital NHS Trust, in north London only 4.2 per cent receive surgery but at University College London NHS Trust, less than seven miles away in central London, over 30.2 per cent have surgery.

One third of patients do not receive chemotherapy, the report from the NHS Information Centre said, despite some forms of the disease responding well to this treatment. The National Lung Cancer Audit Report 2009, is based on data from 32,447 patients with lung cancer first seen in the NHS 2008.

Tim Straughan, chief executive of the NHS Information Centre, said: “Overall, it is clear that quality of care is improving slowly, however there remain wide variations in care which differences in casemix do not explain. “Trusts should examine this report closely to see if their approach to lung cancer treatment varies from the recommendations or national averages and, if it does, to ask themselves the reasons why. They should also use the audit as a tool for comparing themselves with trusts delivering the best outcomes and to see where they can improve the care they offer to their cancer patients.”

Dr Jesme Fox, Medical director of the Roy Castle Lung Cancer Foundation, said: ''The information in this audit is vital in assessing how lung cancer patients are treated in the NHS. "We applaud the high quality of the data. However, the massive geographical variation in access to active anti cancer treatment, especially surgery, is very worrying. Patients deserve better. "These differences urgently need to be explored and rectified. Next year's audit, we hope, will show a marked improvement'.

A Department of Health spokesman said: "This year we have seen a further fall in cancer mortality with the latest data showing a drop of almost 20 per cent since 1997 [Why not compare it with 1907? That would tell us as much]. The challenge now is to keep up this momentum and this year we have identified tackling local variations as a top priority. "We have published data today that shows that cancer survival rates vary across the country, including for lung cancer. We are challenging the NHS to use this data to tackle the variations across the country, to improve the experience and outcomes for cancer patients."


British woman died after drug side effects were ignored by NHS hospital staff

And hospital staff have covered up their negligence -- even to the point of shredding relevant documents. So the same rogue staff are still there and could well do the same again next time they are feeling a bit lazy. NHS hospitals are good at killing people -- usually the elderly but no-one is safe

Eileen Downing's life could have been saved, if she had been taken to hospital when her husband, Terence, first raised the alarm, an inquest heard. But despite his increasingly desperate phone calls to the hospitals oncology unit, when he told them of her deteriorating health, she was not brought in for treatment.

Mrs Downing, 66, began to suffer serious nausea, diarrhoea and delirium and died at the couple's home in Burrough-on-the-Hill, near Melton, Leicestershire on April 12.

An inquest into Mrs Downing's death, held at Loughborough Magistrates heard her husband's concerns were not passed on to senior doctors at Leicester Royal Infirmary who would have brought her in for urgent care. Mr Downing contacted the unit on Wednesday, April 9 last year after his wife, who had had an operation to remove cancerous cells from her left breast, became weak and dehydrated after her fourth cycle of chemotherapy.

She had been switched to the drug Taxotere, which gave her much more severe side effects than those she experienced with her previous anti-cancer medication.

Assistant deputy coroner Olivia Davison asked Mr Downing what advice he had received when he called. He replied: "Hang on in there. Let's wait and see. It might not have been those words exactly." Mr Downing said his wife became more poorly and asked to go to hospital on April 12, so he called the unit at 12.05pm. He said: "They said they would go away and think about it. "They asked me to carry on looking after her." He said he called again at 2.49pm. He said: "I said it was absolutely essential she come in and they said there were some difficulties with bed availability. "I called again at 4.40pm and demanded they call an ambulance and that's what I thought they had done.

The call came back after she had died. "They rang back when I was trying to resuscitate her. I had to dial 999 to get an ambulance."

Ms Davison asked breast cancer specialist Dr Stephen Chan, of City Hospital, Nottingham, if Mrs Downing's death could have been prevented if she had been admitted on April 9. He said: "I believe so." Asked if there was a chance she could have been saved on April 12, he said: "There might have been a chance."

Dr Chan said the Infirmary had a very good system for dealing with such calls, but it had not been followed on either day because senior staff were not informed. Michelle Wain, University Hospitals of Leicester NHS Trust clinical governance manager, said an internal investigation was unable to establish who took Mr Downing's calls because no staff on duty at the time recalled taking them. She said she was alarmed the call records appeared to have been shredded by clerical staff without authorisation.

She said: "As soon as this was discovered, in October, it was raised as an incident that must never happen again. "The advice on the call on April 9 should have been to come into the unit for medical assessment. "On April 12, the patient should have been brought in for immediate medical review."

She told Mr Downing: "We are very sorry for what happened to your wife and please accept our apologies and condolences."

Ms Davison recorded a narrative verdict of death caused by neutropenic sepsis the lowering of white blood cells increasing the risk of infection. She said: "The trust has done an awful lot of work to get to the bottom of this. "It is not as if the trust has come before me indifferent and has made no changes. "It said it is changing things to ensure this cannot happen again. "It is one of the saddest inquests I have had to conduct but I am heartened by the trust's response to it.


Senate health debate begins

The Senate, after almost a year of maneuvering over policies and politics, began debate yesterday on the landmark legislation to overhaul the nation's health-care system. But it remains uncertain how long the deliberations will last or how much the bill will change before it comes to a vote.

With Republicans united in opposition, and conservative Democrats and the Senate's two independents expressing reservations, Majority Leader Harry Reid (D., Nev.) faced a daunting challenge in building the filibuster-proof majority needed for final passage. He promised to keep the Senate working through weekends on the 2,074-page, $849 billion bill in hopes of bringing it to a vote by Christmas and landing a measure on President Obama's desk before the end of January. And he sought to remind Democrats that, after investing so much time and political capital on the health-care issue, the price of failure could be high. "While each of us may not say yes to each word in this bill as it currently reads, let us at least admit that simply saying no is not enough," Reid said.

The legislation marks the most ambitious effort in decades to provide near-universal health coverage, slap new regulations on insurance companies, and curb skyrocketing health costs.

Republicans have considerable power to extend the debate into the new year. Minority Leader Mitch McConnell (R., Ky.) has indicated he would like at least six weeks of discussion on the bill. "Kentuckians want to know how spending trillions of dollars we don't have on a plan that raises health-insurance premiums and taxes on families and small businesses is good for health care or for jobs or for the economy, for that matter," McConnell said as he returned from a Thanksgiving trip to his home state.

But just as debate began, the nonpartisan Congressional Budget Office issued a report challenging Republican assertions that the bill would drive the cost of insurance through the roof. The CBO, the arm of Congress that analyzes federal budget and spending proposals, found that under the Senate bill, premiums for most people - those in group plans provided by their employers - would remain unchanged or even drop.

In a sign of how high the stakes are for Obama, White House chief of staff Rahm Emanuel and other senior administration officials traveled to Capitol Hill yesterday to plot strategy with Senate leaders. Democratic leaders acknowledge that major provisions may have to be changed to win the 60 votes needed to break an expected GOP filibuster and pass the bill.

Republicans began their attack with an amendment to strip out provisions that would curb the growth of Medicare spending by nearly $500 billion over 10 years. Democrats said the savings would come from squeezing excessive subsidies and inefficient practices. Sen. John McCain (R., Ariz.) said they would curb benefits to the elderly and cater to special interests that lobbied the White House.

McCain also sought to tap into anxiety unleashed by a recent recommendation from a federal advisory panel that women in their 40s should no longer get annual mammograms. McCain argued it was a window onto the kind of government intervention into medical decisions that the bill would encourage. Democrats' first amendment was designed to allay those concerns. The amendment, introduced by Sen. Barbara A. Mikulski (D., Md.), would guarantee women's access to preventive health care, including mammograms, that their doctors consider necessary.

The CBO report was produced at the request of Sen. Evan Bayh of Indiana and other wavering centrist Democrats whose support for the bill is crucial to passage. Bayh said he was reassured by the report's conclusion that people insured through their employers - 83 percent of the nonelderly population with coverage - would see little or no difference in their premiums by 2016.

The report found that for the 17 percent who buy individual policies, premiums could rise 10 to 13 percent by 2016, mostly because the policies would provide more generous benefits than now. For half of those affected, the CBO said, their costs would go down because they would receive federal premium subsidies.


Reid bidding up votes for Obamacare

Senate Majority Leader Harry Reid of Nevada is doing this week what he always does when he needs votes to pass a bill that President Obama favors but that the public opposes. Reid goes behind closed doors to cut deals and buys senators' votes. For example, to get to the 60 votes needed to pass the motion to proceed to debate Obamacare, Reid came up with arcane legislative language that netted $300 million in federal assistance tailored for Louisiana. That sweetener temporarily bought Reid custody of Sen. Mary Landrieu's vote, but she quickly made it clear that he will have to raise the ante to get her vote for final passage. That is business as usual on the road to Obamacare.

This week, Reid goes back behind closed doors in search of more deals in the quest for final passage of the Senate version of Obamacare. Reid's problem is twofold: First, a handful of Senate Democrats say they unalterably oppose something in the bill, but going too far in satisfying them risks alienating other Senate Democrats who unalterably favor whatever it is they oppose. The logical assumption is that Reid prefers to operate behind closed doors because he doesn't want the public to see the ugly reality behind Senate Democrats' support for Obamacare. Or maybe he just prefers the world not see him pull his hair out as one proposed vote-buying deal after another falls through.

Second, public opposition grows as this Obamacare vote-buying process drags on and people know more about the bill. The latest data from Gallup finds more respondents saying they would advise their congressman to vote against Obamacare than saying they would encourage a vote for it, 49-44 percent. Obamacare support has been declining among Republicans, Democrats and independents, according to Gallup, "falling by 6 points among Democrats, 8 among independents, and 12 among Republicans." That data was produced between Nov. 20 and 22, meaning the heavy lobbying earlier in the month by the White House and its special interest allies like AARP and the AMA made no dent in public opposition.

Reid's frantic vote buying only fuels this growing opposition as his numerous deals are exposed. As the National Center for Policy Analysis's John Goodman points out, it didn't have to be this way. This unsavory vote-buying spectacle became inevitable at the outset when Obama, Reid and House Speaker Nancy Pelosi ignored Republicans in crafting health care reform. That made every potential recalcitrant Democrat's vote ever more valuable. Just ask the $300-million lady from Louisiana.


Dems call for quick passage of health plan, but voters resist

The Senate began debate on an $848 billion bill to overhaul health care in America, with Democrats declaring the nation cannot wait for reform even as poll numbers signal strong opposition to the plan. Senate Majority Leader Harry Reid, D-Nev., said the chamber would work through every weekend this month to get the bill completed, a task that will involve debating hundreds of amendments that will likely bring significant changes to the legislation before it is ready for a final vote. "There is not an issue more important than finishing this legislation," Reid said. "This crisis, and yes, it is a real crisis, is simply too hazardous to our country and our constituents' health."

But poll numbers show the public has a much more negative view of the proposal, forcing Democrats to race to finish the bill before the end of the year, when lawmakers will return home for the holidays to get an earful from constituents. Two new polls released Monday show Democrats are not winning over the public. A USA Today/Gallup survey taken before Thanksgiving found 49 percent of those responding would tell their member of Congress to vote against the health care bill, while 44 percent said they would recommend a vote in favor it. "Despite the considerable efforts of Congress and the president to pass health insurance reform, the public remains reluctant to endorse that goal," Gallup reported Monday.

The steepest drop in support has been among independent voters. The poll found that just 37 percent supported the health care legislation, down from 48 percent in September.

A Rasmussen Reports poll found 41 percent of voters in favor of the bill and 53 percent opposed to passage, with the favorable rating dropping 10 points since President Obama outlined his health care reform plan in a Sept. 9 speech to Congress. In the days following the speech, 51 percent said they favored the bill and 46 percent opposed it.

Republicans opened the debate with anecdotes from constituents who implored lawmakers to block the bill. "Americans are fed up with big-government solutions that drive up taxes and debt and which only seem to create more problems, more abuse and more fraud," said Senate Minority Leader Mitch McConnell, R-Ky. "In the face of this, our friends on the other side of the aisle appear determined to plow ahead with their plans. They don't seem to care that Americans are telling them to stop and start over and fix the problem, which is health care costs."

The bill is funded through tax increases and $465 billion in cuts to Medicare. Democrats argued the cuts to Medicare would keep the program solvent, but Republicans said it would hurt senior citizens. "Seniors know you can't make these kinds of cuts without jeopardizing the kind of care they receive," said Senate Minority Whip Jon Kyl, R-Ariz.

Sen. John McCain, R-Ariz., announced he would introduce the first GOP amendment Monday calling for the Senate to strip the Medicare cuts from the bill.


Health Care Bombshell: ObamaCare Would Doom Medicaid

Writing for the Heritage Foundation, Dennis Smith and Ed Haislmaier have today exposed a huge political drawback to the liberal health care bill: ObamaCare -- without intending to -- could, almost certainly would, be the death knell of Medicaid, America's health care safety net for the poor.

Smith and Haislmaier convincingly demonstrate that the states can't afford Medicaid under an ObamaCare regime -- costs to the states would reach $725 billion over the 2013-2019 period alone. What's more, staying in Medicaid under ObamaCare effectively puts the federal government in charge of about a quarter of each state's budget, and every state except North Dakota would come out better financially by abandoning Medicaid.

Fiscally and logically, withdrawing from Medicaid would be a no-brainer for the states. It could even be seen as a compassionate choice, as ObamaCare provides subsidies to help low-income people buy health insurance unless they receive Medicaid. So, a state legislature or governor could reason, why not get rid of the burdensome, unaffordable and -- let's be frank, substandard -- Medicaid program? The poor of my state will still get help with their health care bills, because Washington D.C. will provide it!

The Heritage paper explains all this in far greater detail, and it is a must-read for anyone following the health care debate. (The paper is quite readable for people who aren't health care wonks, by the way.) If the mainstream media has any competence at all (I doubt it very strongly), it will cover this heavily, as the repercussions are immense.

A closing thought (from me): When Barack Obama was running for president, I don't recall him promising an end to Medicaid and steep cuts in Medicare, but if he gets ObamaCare through, it looks like that's what he'll be delivering. Surprise!


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