Tuesday, March 31, 2009

Prohibitionists threaten to force pain patients to live in agony

A Southern Nevada lawyer told the Nevada Supreme Court this month that pharmacists, at the least, had a duty to call physicians to voice their concerns before dispensing a narcotic painkiller to a woman who killed a man in a 2004 vehicle crash in Las Vegas. Lawyer Phil Aurbach told justices that Nevada pharmacists continued to fill prescriptions for Patricia Copening even after being warned by a state task force that she might be a prescription drug abuser. Copening killed 21-year-old Gregory Sanchez Jr. in a June 4, 2004, crash on U.S. Highway 95.

Aurbach asked justices to reinstate the wrongful death case he seeks to file against seven chain-store pharmacies that filled Copening's prescriptions. District Judge Douglas Herndon earlier threw out the case on the grounds that the pharmacies were not legally liable in the crash -- pretty much a no-brainer.

The Supreme Court made no decision, though Justices Mark Gibbons and Jim Hardesty made comments seemingly in support of Aurbach's position. Justice Gibbons, for instance, offered a hypothetical in which a doctor mistakenly prescribes strychnine that would kill the user. He then posed the questions: "Does the pharmacist just fill it and let someone die? Or does the pharmacist call the doctor to see if that is what you intended?"

Sanchez had pulled his vehicle off U.S. 95 after it had a flat tire. His vehicle was struck by a vehicle driven by Copening, who was found to be under the influence of hydrocodone, a narcotic pain reliever. Another motorist, who had stopped to help Sanchez, was seriously injured. Copening spent nine months in jail.

An investigation found many different pharmacies had filled prescriptions for 4,800 tablets of the drug for Copening in the 13 months before the crash. Aurbach said the pharmacies continued to fill her prescriptions even though the Nevada Prescription Controlled Substance Abuse Task Force notified them that Copening was "taking an unusual amount of these narcotics." Aurbach wants to sue Wal-Mart, Longs Drugs, Walgreen Co., CVS Pharmacy, Rite-Aid, Sav-On and Lam's Pharmacy.

Defending the pharmacies, lawyer Mike Wall said Aurbach had been shopping around for "deep pockets" to sue. Wall said the pharmacists have the same protection as bartenders. Under court decisions and the state "dram shop" law, bartenders are not liable if the people to whom they serve drinks are later involved in crashes in which others are injured or killed, he pointed out. Wall said a pharmacist is not there to "second-guess a registered physician."

Judge Herndon's initial decision -- that the pharmacies are not liable -- was correct both in law and in common sense. It's understandable that Aurbach would seek to go after the deepest available pockets on his clients' behalf, but for the courts to adopt his reasoning would be both dangerous and absurd.

Presume the state Liquor Control Board has notified a local supermarket chain that one of their liquor customers has also been buying bottles of wine at other groceries and liquor stores. What should the manager do? Make sure every one of his cashiers, on every shift, can recognize the perpetrator? At which point they should do what, precisely, the next time Mrs. Jones -- not visibly inebriated -- tries to buy a perfectly legal bottle of wine? Quiz her on how many she's bought elsewhere this week? Refuse to sell to her?

If grocery stores were to be held liable for traffic accidents caused by customers who buy their wine or liquor, their accountants' and lawyers' advice is not hard to guess: stop selling alcohol, entirely. ("But painkillers are a more serious problem on the highways than alcohol!" someone will doubtless object. Wrong, Budzilla.)

Similarly, the main job of a pharmacist is to make sure we're sold the actual drug or medicine requested, in the proper dose and at proper purity. (Sponsors of the Harrison Narcotics Act of 1914 insisted that's all the federals wanted to control -- dose and purity -- and that they would never try to actually restrict what we could buy.)

The American Cancer Society reports chronic cancer pain is already substantially under-medicated in this country, due to the fear of doctors and pharmacists that they could well lose their license or even be thrown in jail should they stand accused of writing "too many" painkiller prescriptions. (The former actually happened to Las Vegas' own pain specialist Dr. Dietrich Stoermer, a fine man and a fine doctor, despite the fact his jury unanimously acquitted him on all charges.)

How is a pharmacy clerk supposed to know which customer "looks like she might get stoned and drive"? The person responsible for driving after consuming excessive quantities of drugs that come in little bottles labeled "Warning: May cause drowsiness; do not operate heavy machinery" is the adult consumer, no one else.

What magic confers on a 24-year-old, newly handed his or her M.D. or pharmacy license, the wisdom to play "mommy" or "daddy" to a 50-year-old patient, treated in this model as a willful and irresponsible infant -- instructing us as to how much analgesic plant extract we should be "allowed" to buy and use?

We would be better off getting rid of this whole "doctor's prescription" rigmarole, entirely -- freeing physician from the parade of patients demanding scrips for the latest drug to be written up in Reader's Digest or advertised on TV, allowing them instead to go back to what they do best, which is diagnostic consultation.

But yes, so long as the "prescription" bureaucracy remains in place, pharmacists are also bound by law to determine to the best of their ability that a prescription has actually been written by a legitimate, licensed doctor. Beyond that, leave it alone.

In case you haven't noticed, the "small-town corner pharmacy" has just about given up the ghost. Today, the industry is concentrated in fewer and fewer hands. Threatened with legal liability for traffic deaths caused by those taking prescription drugs, what if one and then more major pharmacy and grocery chains simply told their pharmacists to stop selling any prescription pain-killers, at all? What would that do to the already pathetic -- even tragic -- struggles of small-town sufferers of chronic pain to get the analgesics they need to live out their lives free of suicide-inducing agony?


Australia: Logan Hospital staff quit after government ignores complaints

ONE of Queensland's busiest public hospitals has lost five of its most senior doctors and managers, with no signs of them being replaced. Logan Hospital has been seconding staff from other public hospitals in Brisbane to cover the shortfall of experienced medical staff.

Deputy Premier and new Health Minister Paul Lucas confirmed the worrying turnover, but noted that three of the staff remained within Queensland Health at other hospitals.

Mr Lucas will today begin a two-month "health listening tour" across the state to "see first-hand the challenges facing the health network". Acknowledging major problems at Logan Hospital, Mr Lucas said the Government had to do more - something it promised during and after its successful election campaign. "Senior doctors are often harder to recruit and retain, and I'll be listening to the thoughts of medical professionals about how best to retain expert staff on my statewide listening tour," he said yesterday.

The Sunday Mail first highlighted problems at Logan Hospital last May in a frank open letter from Dr Michael Cameron, then the senior staff specialist in emergency medicine at Logan Hospital. Five months after being asked to talk to Premier Anna Bligh and then health minister Stephen Robertson about the issues Dr Cameron left Logan, saying it was "too dangerous and too dysfunctional". "Everyone is overworked and overwhelmed ... the pressure definitely got on top of me," Dr Cameron said last September.

He stayed with Queensland Health, but took his emergency skills to the newer Redland Hospital in January. Dr Cameron's position at Logan Hospital had not been filled as of last week. Sources said the director of emergency services had also left Logan Hospital last month to take up an identical position at Royal Brisbane and Women's Hospital. Three other senior staff had resigned in the past year because of the workload and pressure. Sources said Queensland Health had moved doctors in from around southeast Queensland hospitals to fill the gaps.

"Logan has degenerated even further," a senior public hospital doctor told The Sunday Mail last week. "They have got major problems there. Lucas has got an uphill battle."

The Minister - handed the poisoned chalice by Ms Bligh last week - said more people would be put into frontline services. "Queensland Health tells me that since 2005, we've hired an extra 100 doctors for Logan Hospital and almost 220 extra nurses - an increase of 66 per cent and 41 per cent respectively in less than four years," said Mr Lucas, who kicks off his tour with a visit to Dr Cameron's Redland Hospital.

"I know Dr Cameron is very highly thought of and I am very keen to meet him and to understand his perspectives on the health system. "Dr Cameron is one of more than 6600 doctors employed by Queensland Health, and I'm undertaking this tour to see what's happening on the ground, and speak to professionals like him and others right across the health network."

Mr Lucas said he would visit hospitals in Cairns, Townsville and southeast Queensland this week. He also promised to visit health facilities on the Torres Strait islands to ensure repair work on sub-standard nursing accommodation had been completed. Mr Robertson was stripped of his responsibilities during the election campaign after it emerged that the housing had not been fixed. He was ultimately banished from the Health portfolio.

"I want to see every part of our health system at work - from the kitchens, to the wards, to our emergency departments and doctors out there delivering services in the community," Mr Lucas said. "Health impacts on many aspects of people's lives and I'm determined to see what's happening on the frontline and how we can improve the services Queensland Health delivers." Mr Lucas said he would also visit a hospital emergency department in action during a peak period.

Dr Cameron said he would be keen to help the new Bligh Government health regime. He said he was enjoying work under different conditions in Redland Hospital.


Monday, March 30, 2009

Bungling NHS hospital overdose leaves girl, 3, fighting for her life

A girl of three is fighting for her life after doctors allegedly gave her a massive overdose by accident. Renee Healey was given double the prescribed dose of drugs by doctors treating her kidney condition at the Royal Manchester Children’s Hospital in Pendlebury, her family claims.

Renee, from Wythenshawe, in south Manchester, was transferred to the intensive care ward on Wednesday and is now in a critical condition after her kidneys failed and she was put on dialysis. Her parents, Tina and Clive, are staying with her in the hospital, where she is on a life-support machine to help her breathe.

Renee was diagnosed 18 months ago with a condition in which tiny filtering units in the kidneys are damaged. Renee’s grandmother, June McKerrall, said her granddaughter was given an overdose of a drug that helps purify the blood, causing her lungs to fill up with fluid which nearly killed her. She said: ‘We can’t understand how someone could make a mistake like that with a child’s life.’

A spokeswoman for the hospital said that the incident was being investigated.


UK: NHS told to curb staff sickness

The NHS should be doing more to tackle staff sickness and promote workplace health, a think tank says. Reform, a right-of-centre group, said the health service was "shooting itself in the foot" by not making more use of the expertise it has in its workforce. Figures show NHS staff take on average nearly 12 days off sick a year, while the rate is 7.2 in the private sector.

Unions said services could be improved, but there were valid reasons why NHS workers took more time off. A spokeswoman for Unison said: "Occupational health is certainly lacking in places, but the NHS is a unique workplace. "For example, we can't have staff going on the wards after they have had things like vomiting bugs."

But Reform said there was still a lot more the health service could be doing. The group highlighted the work done by private firms such as BT which has introduced 24-hour counselling services, lunchtime exercise classes and workplace health advisers. Over the past four years, sickness rates have fallen by a sixth among its 100,000-strong workforce. The think-tank said if the NHS followed the lead of private firms it could reduce its £3bn annual sickness bill by a third.

Reform's report said as the biggest employer in Europe the NHS should be taking a lead and helping its 1.3m staff get back into work when they are ill. But instead it has one of the worst records in the public sector and has long-term absence rates that were two-thirds higher than the private sector.

The report comes after the annual NHS staff survey found nearly half felt they were overstretched and unable to do their jobs properly. Helen Rainbow, one of the co-authors of the study, said: "Stress is a big factor in NHS sickness. There is a lot more it could be doing to help its staff and this in turn will improve its productivity. "The problem is the culture in the NHS is quite reactive, it is shooting itself in the foot when you think of the kind of people it employs."

A Department of Health spokesman said: "The government takes the health of NHS staff seriously. "In January, we announced a review to examine the health of NHS staff and gather evidence to start delivering improvements across the board."


Sunday, March 29, 2009

NHS bosses award themselves inflation-busting 7.5pc rises (but nurses get just 1.9pc)

The socialist version of Wall St.?

Top NHS managers awarded themselves inflation-busting pay rises last year, as private sector staff faced a pay freeze. Average pay for trust chief executives soared by 7.5 per cent in just one year to £142,450, while nurses are having to make do with just 1.9 per cent. And this was despite guidance from the Department of Health that raises for senior managers should be no higher than 1.3 per cent.

The best-paid hospital boss is on £230,000 - enough to pay for more than ten nurses, while two saw their pay rise by more than 30 per cent. Since Labour came to power, Health Service chief executive pay has almost doubled (up 98 per cent).

The shocking details of pay hikes given to senior bureaucrats in the NHS between 2007 and 2008 comes a day after it was revealed that the number of managers has soared quicker than the number of nurses. There are now 39,900 managers in the NHS - up 9.4 per cent in one year. But there are 6,000 fewer GPs and 15,00 fewer midwives than managers. Meanwhile the number of health visitors and nursing assistants also fell.

Michael Summers, of the Patients Association, said: 'The news keeps getting worse. Yesterday we found out there are an ever increasing number of managers and today we find out their pay is climbing. The NHS needs pay increases for nurses, not managers.'

Conservative health spokesman Stephen O'Brien said: 'Why is it that NHS bosses think it is acceptable to award themselves generous perks and inflation-busting pay rises while hard-working nurses are being forced to take what is effectively a pay cut?' 'Labour needs to think again whether now is really an appropriate time for them to be playing fast and loose with taxpayers' money.'

LibDem health spokesman Norman Lamb said: 'Those at the top who have benefited in the past have got to lead from the front. There has to be a sharing of the pain.'

The salaries were revealed in the NHS Boardroom Pay report from research group Incomes Data Services. Average chief executive pay is £142,450, up from £132,500 the year before and £72,000 in 1997. Elite foundation trust chief executives earn even more - £157,000 on average. Other directors on NHS trust boards have seen their pay go up by 6.4 per cent. Finance directors earned £102,850 on average, while medical directors were on £165,000.

The report also found that pay increases in England were much higher than in Scotland or Wales. The highest paid chief executive was Robert Naylor at University College Hospital trust in London. His pay soared to £230,000 - a rise of 30 per cent in a year. Other high earners were the chief executives of the Heart of England trust's Birmingham hospital and Newcastle upon Tyne hospital, on £227,500 and £222,500 respectively. The biggest rise was seen at the Airedale trust in West Yorkshire, where chief executive Adam Cairns' pay soared 33 per cent to £137,000.

Steve Tatton, editor of the report, said: 'The earnings of NHS trust directors are continuing to move ahead at a faster pace than the rest of the economy. 'In the current climate the remuneration of NHS directors, like any top executives working in the public sector, is subject to intense public scrutiny, particularly when unease about the widening gap between senior executives and the rest of the workforce is growing in both the public and private sector.'


Australia: Fraud and loathing in disastrous NSW public hospitals

Patients sent to imaginary beds and a doctor who complained about it gets persecuted!

ON APRIL 28, 2006, Shellharbour Hospital boss, Michael Brodnik, distributed an email. A decision had been made, he wrote, to set up a new unit within the emergency department. "The unit will be … four beds, conceptually down the right hand wall of ED but using the concept of 'virtual beds'," he told colleagues. Patients who arrived at emergency and needed admission would be assigned a virtual bed if no official in-patient bed was available, remaining physically in emergency. Brodnik said he had no control over the change, reassuring staff: "It really is a paper exercise."

The rationale was to get patients off the emergency department's books within eight hours of arrival - a watershed imposed by government as a so-called "key performance indicator" or KPI, amid political pressure over backed-up hospitals and ambulances unable to offload patients.

At Shellharbour Hospital, an outpost serving the cookie-cutter sprawl that straggles down the coast from Wollongong, that target was hard to achieve, because some patients had to be transferred for diagnostic tests.

By May, Shellharbour was still processing emergency patients too slowly, and emails were flying. The head of the hospital's emergency department, Dr Simon Leslie, sent a measured one to Sue Browbank, Brodnik's boss: "We are being asked to run our health service on the basis of the need to treat one statistic," he wrote. "Doctors have not been ignorant or uncaring of the need to manage our resources appropriately … but are driven firstly by patient care and community needs."

For a while, Leslie continued a vocal opposition to the imaginary beds. The directive to reclassify patients "according to any objective look at it was fraudulent", he told the Herald last week. "It required staff in my emergency department to write down records that were incorrect." Later he tired of battling the fait accompli and settled back to running front-line health care in the hard-to-staff hospital.

That could have been the end of it, but then Peter Garling, SC, came to town. On April 14 last year, at one of the inquiry's 34 public hearings, "Dr Leslie told me the 'virtual ward' was a fiction to compensate for the fact that Shellharbour Hospital does not have a short stay unit," Garling recounted in his report. Leslie's evidence resulted - finally - in the ward's abrupt termination, though this, as he had previously observed to Browbank, was, "easy because it doesn't actually exist".

Three weeks later, Browbank informed Leslie of the appointment of a Southern Hospitals Network Director of Emergency Medicine - which, according to Garling's later deconstruction, "both technically and in reality … effected the abolition of Dr Leslie's position". Leslie was ordered to stop calling himself director of the emergency department and told he could instead apply for a part-time position. "How is it possible," he asked a human resources manager, "to remove me from the role for which I have a contract and in which I have been acknowledged and satisfactorily functioning for over two years?"

The vaporisation of his job and claim it had never really existed were normal practice during "amalgamations and clinical reviews," the manager soothingly responded. "In many cases roles and responsibilities have changed, staff displaced and new position descriptions written."

Leslie's was a story Garling could not resist. A microcosm of the poisonous malaise he had observed on a statewide road-trip to 61 public hospitals, it comprised four elements the senior counsel had noticed repeatedly: a bottleneck between emergency and in-patient beds; inflexible performance criteria imposed from on high, then middle-management sleights-of-hand to meet those demands; and a yawning gulf of alienation between clinicians and administrators.

So when Leslie updated the inquiry on the personal fallout from his testimony, Garling in late September 2008 ordered five people as well as Leslie to four gruelling days of extra hearings, devoted to the doctor's treatment. They included Debora Picone - in 2006, chief executive of the South Eastern Sydney Illawarra Area Health Service, but elevated in 2007 to director general of NSW Health.

That won Leslie no respite. On the contrary, shortly after Garling's summonses landed on managers' desks, Leslie was cut out of meetings and told to hand back his pager and vacate his office - though ultimately he did not do so, successfully arguing both were essential to his work.

In her sworn evidence, Browbank acknowledged Leslie's job description was signed by a doctor expressly delegated to work out his role and title. Yet she maintained the position could not exist, because the doctor had no authority to create it. Garling rejected the semantic contortion. Browbank's stance "flies in the face of the obvious facts revealed by the evidence and is wholly untenable," he concluded. Because Leslie's treatment was "unreasonable, repeated, unwelcome, unsolicited, offensive, intimidating, humiliating and threatening," Garling wrote, "I find it amounted to bullying and harassment in accordance with NSW Health's own guidelines."

Leslie is an unlikely poster boy for victimhood. Affable and easygoing, it is hard to imagine him having the sleep disruptions and obsessive thoughts he says beset him at the time. He simply carried on going in to work. "At heart," said the 52-year-old, "I'm a doctor who likes to look after patients."

Doctors who like to look after patients are the backbone of the health system, but are massively disenfranchised. Re-engaging them would be the most critical step in reforming NSW Health, Garling said, proposing a Clinical Innovation and Enhancement Agency - under which clinicians would determine protocols for patient care. As well, he proposes an independent Bureau of Health Information to monitor hospital performance, freeing doctors like Leslie from political pressure to fudge the loathed KPIs.

The toughest challenge is how to make hospitals gentler. "The workplace culture in NSW public hospitals is characterised by lack of respect and trust, absence of empathy and compassion, inability to celebrate the success of others, failure to communicate, and a lack of collaboration," was Garling's damning verdict after his journey to the heart of the health system. Its anti-bullying policy had failed, dissent was quashed and persecution was rife.

Garling recommends making individual employees - all 118,000 of them - more directly responsible for their behaviour, reorienting the system away from blame towards constructive criticism and strengthening complaints procedures.

Last July, Leslie lodged a formal complaint about his treatment. Eight months later he has not been told how it will be resolved. Terry Clout, the area health service's chief executive, told the Herald he was seeking more information and would consider "any actions that may be required". He declined to comment further, citing, "procedural fairness" in the "personnel matter".

Leslie said the delay was "a process to wear me down". He understands deliberations will not privilege Garling's account of events - despite the evidence the commissioner collected under unmatched statutory powers.

Perhaps that is unsurprising. Garling said Leslie's situation went unresolved because Shellharbour managers "did not demonstrate … the slightest knowledge of what constituted bullying and unacceptable behaviour".

When is a bed not a bed? Leslie has paid a price for trying to reconcile the internal logic of NSW Health's storytelling with empirical reality, and no one has ever apologised. He will now take his case to the NSW Industrial Relations Commission. If Leslie - with the inquiry's weight behind him - cannot bring NSW Health managers to account, possibly nobody can. "Mr Garling's put a fairly heavy burden on me," he said. "I feel an obligation not to let that go to waste."


Saturday, March 28, 2009

More NHS incompetence

IVF mother died during caesarian birth after 'doctors starved her brain of oxygen'. The NHS relies heavily on overseas doctors who are often poorly trained. "Prasad" is an Indian surname

A mother who spent years undergoing IVF treatment died after a bungled birth and never saw the baby she longed for, an inquest was told yesterday. Joanne Lockham had a Caesarean operation to deliver baby Finn but her brain was starved of oxygen for up to 30 minutes, it was claimed. Within moments of the birth she suffered a heart attack and she died two days later after sustaining massive irreversible brain damage. Her husband Peter is now bringing up Finn on his own.

The inquest jury heard that Mrs Lockham, a 45-year-old nurse from Wendover, Buckinghamshire, had been through countless rounds of failed IVF treatment when she finally became pregnant. Her baby was six days overdue when she went into Stoke Mandeville Hospital to have her labour induced on October 9, 2007.

Because doctors were concerned about the slow progress of the labour, they decided to perform a Caesarean with the assistance of an epidural anaesthetic. But later Mrs Lockham was told that further complications involving foetal distress meant she needed a general anaesthetic. She sobbed as she was told of the change of plan but midwives assured her that she would soon be holding her first child.

Jacqueline Hall, a consultant in obstetrics and gynaecology, said she did not anticipate any complications when she 'strongly' advised the Caesarean at 6pm. However, problems arose in the operating theatre. The jury heard that three attempts were made by anaesthetist Dr Prasad to insert a tube to give Mrs Lockham oxygen before it was eventually believed to have been successful.

Dr Prasad broke down in the witness box as he told how he repeatedly tried to intubate Mrs Lockham. He told the jury that on the first occasion on which he tried to provide a tube to get air to her lungs, he was unable to do it sufficiently. On the second try, the equipment was not working as he believed it should. Dr Prasad then made a third attempt to insert a tube using a mask and thought he was successful. Dr Prasad said: 'I was doing my job, but I was in a complete state of shock, I couldn't think, I was trying to be useful in anything I could. 'I went in at that point in time with a particular plan and it didn't happen. 'It was completely out of the blue and the equipment was not giving way, so I didn't know what to do, it completely numbed me, it was not what I was expecting.'

The inquest was told that just before 7pm the obstetrician started the operation and the baby was delivered. Then Mrs Lockham went into cardiac arrest. When consultant anesthetist Dr Bogdanov arrived at the hospital at 7.30pm after being paged because of the complication, he was unhappy with the placement of the intubation tube and removed it. He used the same piece of equipment that Dr Prasad believed was faulty to re-intubate Mrs Lockham.

When Dr Prasad was asked if he was blaming the equipment for his own inadequacy, he replied: 'No, I am not.' Mrs Lockham was transferred to intensive care but following brain stem tests, the decision was made to switch off her life support machine.


National Health Preview

The Massachusetts debacle, coming soon to your neighborhood

Praise Mitt Romney. Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country. It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.

In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls. As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget. The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic. The state's overall costs on health programs have increased by 42% (!) since 2006.

Like gamblers doubling down on their losses, Democrats have already hiked the fines for people who don't obtain insurance under the "individual mandate," already increased business penalties, taxed insurers and hospitals, raised premiums, and pumped up the state tobacco levy. That's still not enough money.

So earlier this year, Mr. Patrick appointed a state commission to figure out how to control costs and preserve "this grand experiment." One objective is to change the incentives for preventative care and treatments for chronic disease, but everyone says that. It sometimes results in better health but always more spending. So-called "pay for performance" financing models, on the other hand, would do away with fee for service -- but they also tend to reward process, not the better results implied.

What are the alternatives? If health planners won't accept the prices set by the marketplace -- thus putting themselves out of work -- the only other choice is limiting care via politics, much as Canada and most of Europe do today. The Patrick panel is considering one option to "exclude coverage of services of low priority/low value." Another would "limit coverage to services that produce the highest value when considering both clinical effectiveness and cost." (Guess who would determine what is high or low value? Not patients or doctors.) Yet another is "a limitation on the total amount of money available for health care services," i.e., an overall spending cap.

The Institute for America's Future -- which is providing the intellectual horsepower (we use the term loosely) for reforms like those in Massachusetts -- argues that the cost overruns prove the state must cap how much insurers are allowed to charge consumers and regulate their profits. If Mr. Patrick doesn't get there first, that is. He reportedly told insurers and hospitals at a closed meeting this month that if they didn't take steps to hold down the rate of medical inflation, he would.

Even the single-payer cheerleaders at the New York Times have caught on to this rolling catastrophe. In a page-one story this month, the paper reported on the "expedient choice" that Mr. Romney and Democrats made to defer "until another day any serious effort to control the state's runaway health costs. . . . Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls. The very stakeholders who were coaxed into the tent -- doctors, hospitals, insurers and consumer groups -- would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said."

Now they tell us. What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered. But reducing costs while increasing access are irreconcilable issues. Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional. Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers.

Which brings us to Washington, where Mr. Obama and Congressional Democrats are about to try their own Bay State bait and switch: First create vast new entitlements that can never be repealed, then later take the less popular step of rationing care when it's their last hope to save the federal fisc.

The consequences of that deception will be far worse than those in Massachusetts, however, given that prior to 2006 the state already had a far smaller percentage of its population uninsured than the national average. The real lesson of Massachusetts is that reform proponents won't tell Americans the truth about what "universal" coverage really means: Runaway costs followed by price controls and bureaucratic rationing.


Friday, March 27, 2009

FDA - ending the atrocities

They block badly needed drugs and approve dangerous ones. They are a sort of public medicine Mafia, judging from their behaviour

A startling number of reports reveal the FDA is in far worse shape than originally thought. Few people comprehend that they are likely to suffer and die prematurely as a result of FDA’s failures.

The media does a decent job reporting on FDA disasters. The apathetic public, however, often forgets what they read the next day. That is, until they are diagnosed with a serious illness. Then they go into a panic mode to find an effective treatment. All too often, however, the cure does not exist because of FDA bureaucratic roadblocks. In other cases, the FDA-approved drugs available induce horrific side effects.

It is our mission to memorialize these tragedies to demonstrate the urgent need to radically reform the FDA. This “state-sponsored” carnage of the American citizenry must be stopped!

FDA Disseminates Fraudulent Safety Data

Ketek (telithromycin) is a drug the FDA approved to treat mild-to-moderate pneumonia. Ketek can also cause sudden and serious liver damage. In some cases, complete liver failure develops necessitating the need for a liver transplant. Some patients die before a liver transplant can be performed.1-5. The risks of liver failure (and other toxic side effects) were known before the FDA approved Ketek. In order to convince an outside scientific advisory committee to recommend that Ketek be approved, the FDA knowingly allowed a fraudulent safety study to be presented. Here is what the Senate Investigative Committee uncovered:6

* FDA accepted the resubmission of a new drug application, which included safety data that were fraudulent, in whole or in part.

* FDA employees presented the fraudulent study data to the advisory committee that was tasked with recommending Ketek’s approval or disapproval.

* FDA instructed its employees preparing to appear before the advisory committee that they should present these fraudulent safety data.

* FDA approved a pediatric clinical trial of Ketek, involving infants as young as six months old, despite concerns related to known toxicities affecting the heart, eyes, liver, and vascular system.

* FDA continued to knowingly cite the fraudulent study data in publically released safety information on Ketek.

How fraudulent were these data? While the FDA was presenting these fake data, a criminal investigation was simultaneously being conducted that found the clinic where the “safety” study allegedly occurred was closed during the time the study was supposed to have taken place. It was also determined that documents relating to the safety study had date modifications and signature inconsistencies.

Shortly after the advisory committee meeting where the fake safety data were presented by FDA employees, the person who conducted the study was criminally indicted, pled guilty, and was sentenced to almost five years in jail.

It is even more shocking that the FDA continued to cite this safety study long after the principal investigator admitted it was fraudulent. While the perpetrator of this “safety” study was in prison for falsifying the data, the FDA used the very same study to issue a Public Health Announcement stating:

“Based on the pre-marketing clinical data it appeared that the risk of liver injury with telithromycin [Ketek] was similar to that of other marketed antibiotics.”7

The “pre-marketing clinical data” FDA cited to mislead the public about Ketek was the fraudulent study, a study that may never have actually occurred. According to the Senate Investigative Committee report, “it defies explanation why the FDA would continue to cite” this fraudulent study to the American public to imply that Ketek is safe.8

The Senate Committee report concluded by stating that, “Retaliation against these individuals, or any other FDA employees who communicate with the committee with reference to Ketek will not be tolerated.”8 Based on the tone of the Senate investigative report, it would appear that the FDA functioned as a continuous criminal enterprise in this instance.8,9

The Revolving Door

You may wonder why certain officials in the FDA would go to such extreme lengths to get a lethal drug like Ketek approved. Look no further than the gargantuan economic benefits drug companies reap when a patented compound like Ketek receives the FDA seal of approval. When we first exposed the revolving door of FDA employees going to work for companies they regulate, virtually no one believed us. Back in the 1980s, most Americans were deceived by FDA propaganda stating that the agency “is responsible for protecting the public health by assuring the safety…of human drugs.”12

The harsh reality is that the FDA functions primarily to protect the financial interests of the pharmaceutical industry, not the public’s health. If anyone ever questioned this, look no further than the FDA’s attempts last year to ban the safest form of estrogen (estriol). The FDA has no qualms about publically stating that its ban on estriol was based on a petition filed by Wyeth, the maker of dangerous estrogen drugs like Premarin and Prempro.

There are a number of estrogen drugs that have not been shown to increase stroke or breast cancer risk.13 The FDA, however, has done nothing to remove Premarin or Prempro. Instead, the FDA openly seeks to protect Wyeth’s market share by denying American women access to natural estriol. According to the FDA, “bioidentical hormone products are unsupported by medical evidence and are considered false and misleading by the agency.”14 The truth is that bioidentical hormones are far less expensive and pose a major competitive threat to Wyeth, ergo the FDA’s aggressive attempts to disallow them.

In a report issued by the Associated Press just last year, it was revealed that a record number of FDA employees are leaving the agency to go to work for pharmaceutical companies. According to the Associated Press, these FDA staffers are resigning in order to go into “the more lucrative side of the business…”15

The FDA’s Brain Drain

As experienced FDA scientists leave the agency to work for Big Pharma, the remaining staff is leaner and less competent to approve new life-saving medications. As reported by the Associated Press, a consequence of FDA employees going to work for pharmaceutical companies is a clogging of the drug approval pipeline.

As long time Life Extension members know, the FDA drug approval process has always been a bureaucratic quagmire, where life-saving medications languish for years, decades, and sometimes forever. The drug pipeline has been “clogged” for almost 50 years. We are deeply disturbed that it is now taking even longer for life-saving medications to become available to those in need.

The Wall Street Journal continues to support our position with blistering exposes describing human beings who suffer horrendously and die while potential life-saving therapies languish at the FDA. An article published last year titled “Sick Patients Need Cutting-Edge Drugs” disclosed heart-wrenching reports of young cancer patients who were denied compassionate-use access to experimental drugs. The Wall Street Journal article raised the logical questions: “Why do terminally ill patients have to wait so long to get access to the only treatments that hold any promise of saving their lives? And why is it not their right to decide?”16

These very issues have been discussed in Life Extension’s publications for nearly 30 years. We have analogized in previous articles how it is perfectly legal to engage in all kinds of risky activities, such as parachuting from high bridges, but it is illegal to make experimental medications available to terminally ill people without the FDA’s permission.

According to the Wall Street Journal, the drug delay problem is getting much worse. The problem has been magnified in recent years as the number of new drug approvals has fallen dramatically. The FDA approved just 16 new drugs in 2007 and 24 in 2008.17,18 That’s down from 139 in 1996.

With the approval of life-saving drugs grinding to a snail’s pace, the moronic cruelty of denying experimental drugs to terminal patients must stop. Each day a life-saving drug is delayed, human beings perish. The case for radical reform of the Food, Drug, and Cosmetic Act and the FDA itself has never been stronger.


Negligent NHS hospital nearly gets healthy baby aborted

Baby Deacon Lewis is a lively, healthy baby who sleeps right through the night and is a joy to his proud parents. But Deacon, who is now six months old, was almost aborted after doctors told his mother he almost certainly suffered from a chromosome disorder that would eventually kill him.

Dawn Lewis, 26, says she was advised to have an abortion when a routine 12-week scan showed her child had Edward's syndrome. The condition causes serious heart and kidney problems with less than half of babies surviving beyond eight weeks.

After four years of trying for a baby, Miss Lewis and her partner Jonathan Blemmings, 26, a construction worker, were devastated. But Miss Lewis, a childminder, refused to have an abortion and decided to seek a second opinion on her baby's condition. She was referred to the specialist maternity hospital where a more sophisticated test found no evidence of the disorder. She said: 'I was absolutely delighted to find my baby was healthy but also horrified that I could have had him aborted. 'I was shocked that I had been advised to have a termination without first being offered a second scan and further tests. 'Thankfully we decided to pursue a second opinion because if we hadn't then Deacon may not have been here today.'

The couple have now made an official complaint to Rochdale Infirmary in Greater Manchester over the severe distress caused by the alleged mistake. They also want to warn other prospective parents that medical advice to terminate a pregnancy may not always be correct.

Miss Lewis, who has a six-year-old daughter Ayla, said: 'Many people would have taken the doctors' advice and never have known they had aborted a healthy child. It is only because of our determination to have another child that our son is with us today. 'We are really shocked that the experts we trusted got this so badly wrong and we think it's important to let other people know they don't always get things right.'

The saga began in March last year when Miss Lewis, of Rochdale, went to the hospital for a routine 12-week scan. As well as checking the baby's heartbeat and size, the scan also measures the amount of fluid at the back of the baby’s neck. Known as the nuchal translucency test, the measurement, along with the mother's age, the age of the baby and the presence or absence of the baby's nasal bone, can calculate the likelihood of the baby having a chromosomal abnormality.

'The doctor told me he was 99 per cent sure my baby had a chromosome 18 abnormality which was Edward's syndrome,' Miss Lewis said. 'He told me there would be absolutely no quality of life for my baby and told me the best thing to do would be to have a termination. 'But Jonathan and I had been trying for a baby for four years and we were not going to have an abortion so we sought a second opinion.'

A scan at St Mary's Hospital in Manchester followed four days later. She added: 'Because my pregnancy was too early for a amniocentesis test, doctors tested a tiny sample of tissue from the placenta. After a nail-biting two days the results came back that my baby did not suffer from the abnormality.'

The boy was born in Rochdale in September without complications and is now doing well

Edward's syndrome is a genetic disorder caused by the presence of all or part of an extra chromosome resulting in heart abnormalities, kidney malformations, and other internal organ disorders. It affects around one in around 3,000 babies with less than 10 per cent of sufferers surviving beyond their first year.

Mr Blemmings said: 'Even after the tests at St Mary's it was always in the back of our minds that our baby might be seriously ill, even when he was born we were really anxious. It took me a few weeks to accept he was really okay.' Deacon was born at Rochdale Infirmary and the couple have no complaints about their treatment during the birth.

A spokesman for Pennine Acute Hospitals, which runs Rochdale Infirmary, said: 'We will be conducting a full investigation into this complaint. We will make a formal response to Miss Lewis when our investigation is completed.'


Thursday, March 26, 2009

Six die as vulnerable patients 'failed' by 'appalling' NHS

Six vulnerable people died in NHS care in a system which has demonstrated a litany of "significant and distressing failures", an official report has concluded. One man died as a result of failings in his care and it is likely that a second man's death could have been avoided, the Health Service and Local Government Ombudsmen ruled. Patients with learning difficulties were treated less favourably than others, resulting in "prolonged suffering and inappropriate care", their report said.

When their relatives complained about the care given to their loved ones, they were left "drained and demoralised and with a feeling of hopelessness".

The charity Mencap said the conclusions were a "damning indictment" that confirmed an "appalling catalogue of neglect". The investigation was launched after Mencap made a complaint on behalf of the families of six vulnerable people who died in NHS or local authority care between 2003 and 2005.

The two ombudsmen called for an urgent review of health and social care for those with learning disabilities. They found that Mark Cannon, 30, died as a consequence of public service failure by the Barking, Havering and Redbridge Hospitals NHS Trust and Havering Council in east London. Mr Cannon, of Romford, Essex, was epileptic and had a severe learning difficulty which meant he had very little speech. In June 2003 he broke his leg at a council care home and, despite receiving hospital treatment, died eight weeks later.

The ombudsmen concluded that he had been left in severe pain and great distress for prolonged periods, and was twice discharged from hospital without due concern for his safety. They also upheld a complaint against the Healthcare Commission, finding that the regulator's review of a complaint by Mr Cannon's parents was "unreliable and unsafe".

The report - entitled Six Lives - found it was "likely" that the death of Martin Ryan, 43, another patient with learning disabilities, could have been avoided had his care and treatment not fallen so far below the required standard. Mr Ryan, of Richmond, south west London, who had Down's syndrome and epilepsy, went without food for 26 days while in hospital after suffering a stroke in November 2005.

The Health Service Ombudsman, Ann Abraham, concluded that Kingston Hospital NHS Trust gave him less favourable care because of his disability. She found the failure to feed Mr Ryan for nearly four weeks "undoubtedly placed him at considerable risk of harm".

The investigation also looked at the care given to four other people with learning disabilities whose cases were highlighted in a March 2007 Mencap report called Death By Indifference. Ms Abraham said: "The recurrence of complaints across different agencies leads us to believe that the quality of care in the NHS and social services for people with learning disabilities is at best patchy and at worst an indictment of our society. "Six Lives has highlighted distressing failures in the quality of health and social care services for people with learning disabilities.

Local Government Ombudsman Jerry White added: "Six Lives shows that on many occasions basic policy and guidance were not observed, the needs of people with learning disabilities were not accommodated and services were unco-ordinated."

Mark Goldring, chief executive of Mencap, said: "The ombudsman's reports are a damning indictment of NHS care for people with a learning disability. "They confirm the findings in Mencap's Death by Indifference report of the widespread failure by health professionals to provide the proper level of care and highlight an appalling catalogue of neglect of people with a learning disability."

Care Services Minister Phil Hope said: "Preventable deaths of people with learning disabilities are absolutely unacceptable. "We are taking action to ensure that people with learning disabilities get the equal access to the health care that they deserve."

David Rogers, chairman of the Local Government Association's community wellbeing board, said: "There must be no room for complacency and a relentless focus on attempting to continually improve the services we provide to some of the most vulnerable members of society. "Health and social care organisations are already reviewing the services for those with learning difficulties because they are determined to ensure the needs of these people are put first."


NHS lets down injured solier

Albert Thomson was only six days into the war in Iraq when he lost his left leg after a Warrior armoured vehicle accidentally opened fire on him. He was treated in an NHS hospital in Roehampton and, though he praises the care he receives, he says that the civilian system did not have the right resources. "I was in the same queue as everybody else," he said. "The NHS couldn't supply what I needed."

Eventually he went private, buying a 25,000 pound state-of-the-art prosthetic limb with his insurance money.

He remains self-conscious about his injury, saying: "I wouldn't wear shorts in the UK." He still doesn't like having to exercise in a civilian environment, where he can't hide his amputation. "I wouldn't go to the gym. I feel uncomfortable about it."

He left the Army in 2005, and started a company, Action Amps, that uses amputees in role play to train medics, soldiers and emergency services in how to respond to serious accidents. In January, he won the Radar Disabled Entrepreneur of the Year award.

Mr Thomson, who received compensation from the Ministry of Defence, feels no sense of bitterness. He said: "If it's going to happen to you, it's going to happen."


Australia: Single-sex hospital wards return in NSW

HOSPITALS are to be radically reformed in New South Wales, with single gender wards returning, under major changes to be announced by the State Government. The Daily Telegraph can reveal the Government will restructure hospitals - with some services possibly shutting - when it officially responds next Monday to the Garling inquiry, held last year into NSW hospitals. Mixed-gender wards will be wiped out where possible, with men and women returning to single-sex rooms or separate ward bays.

It follows Commissioner Peter Garling SC's disgust at men and women sharing wards when he handed down his 1100-page report last November. The move back to gender wards will cost $12 million over four years and was approved by Cabinet last night. Health Minister John Della Bosca said public hospitals needed to have greater resources to place men and women in separate rooms.

Under the new plans, elderly patients would be treated in their homes rather than in hospitals in order to alleviate pressure on the system. In his report, Mr Garling said hospitals were not a suitable environment for the elderly. "My recommendations are designed to encourage models which deliver as much care as possible in the home and not in the hospital, which is a very alienating place for older citizens," Mr Garling said. Other reforms include:

* THE sacking of doctors who repeatedly fail to wash their hands;

* BEDSIDE briefings by doctors and formal shift handovers;

* BETTER supervision of junior doctors; and

* EMERGENCY response teams within hospitals.

The Garling inquiry began a year ago and was aimed at restoring the ailing health system. The landmark 10-month investigation followed a string of mishaps and the death of teenager Vanessa Anderson. The 15-year-old died at Royal North Shore Hospital in November 2005 after being given the wrong medication for a brain injury after she was struck in the head by a golf ball.

Mr Garling's controversial report made 139 recommendations, some of them regarded as radical. At least 10 hospital emergency departments were deemed "unsafe" or unnecessary. The Government has been considering whether to endorse Mr Garling's recommendation to close Manly, Ryde, Sydney, Mt Druitt, Auburn, Camden, Bulli and Kurri Kurri's emergency departments.


Wednesday, March 25, 2009

Children's lives put at risk by poor care at specialist British hospital

Children's lives were put at risk by the poor standard of care at a specialist hospital, according to the second damning report into health provision to be published this week.

An investigation by the Healthcare Commission found that there was a shortage of beds at Birmingham Children's Hospital NHS Foundation Trust as managers "struggled" to meet rising demand for treatment. This meant that seriously ill young people were admitted late while others were sent to different hospitals miles away from their families. Surgeons warned that theatre staff were poorly trained, handed them the wrong instruments and even knocked their hands during critical operations.

In addition, managers failed to act when they were warned of the dangers by consultants, the report said. Paul O'Connor, the hospital's chief executive, resigned two weeks ago.

It comes just days after another report by the watchdog found that as many as 1,200 patients may have died needlessly at Mid-Staffordshire NHS Foundation Trust, as managers put targets and cost-cutting ahead of care.

Describing the situation in Birmingham, Anna Walker, the chief executive of the Healthcare Commission, said: "While we have no evidence of serious incidents causing harm to patients, the standard of care has not been as good as it should have been in some cases. "The response to safety concerns has been slower than ideal. It is deeply concerning that serious issues were raised but not properly or rapidly addressed over several months. While I would not say there were 'third-world' conditions, there were serious potential risks in the way care was provided."

Birmingham Children's Hospital is one of only four specialist hospitals for young people in England, caring for 140,000 patients in 2007-8. Last year it was rated "excellent" for use of resources by the Healthcare Commission although only "fair" in terms of quality of services.

Senior staff at nearby University Hospital Birmingham NHS Foundation Trust met managers from the children's hospital last June to discuss their concerns about standards of care. They then wrote a highly critical report that was obtained by a Sunday newspaper under the Freedom of Information Act before it had even been seen by the children's hospital, prompting the Government to order an official investigation in December.

The Healthcare Commission found that because of increasing demand for treatment at the hospital, average bed occupancy was running at more than 98 per cent. This led to 28 per cent of admissions being cancelled on the day and 70 children a month being sent to other hospitals for treatment because there was no room for them in Birmingham. The report said this is a "special concern" for patients with liver problems, who need to be seen urgently.

Many members of staff also warned it was "very challenging" to get access to operating theatres for urgent but not life-threatening cases. There are only two days on which neurosurgery sessions take place, meaning that children admitted after Wednesday have to wait until the following Monday for treatment unless they are put on the emergency list. This situation was said to have led to several "near misses" and was a risk to patients.

The watchdog found that "almost all" consultants were worried that they could not use interventional radiology to diagnose patients because demand was so high. Surgeons said theatre staff did not always know what instruments were required for operations, and sometimes consultants brought their own equipment because the hospital did not have it. Leadership of the neurosurgical ward was said to be inadequate, driving nurses to resign.

The watchdog concluded that it was "deeply concerning" that serious concerns had been raised but not dealt with properly, causing "alarm and anxiety" among patients and their families. It made 12 recommendations about how the children's hospital can improve, including monitoring demand better and working on its relationships with consultants.


More NHS authoritarianism

SOME NHS hospitals are banning mothers from collecting umbilical cord blood from their babies to use as a possible source for their future medical treatment. Parents seeking to reserve the blood for themselves so that they can derive stems cells from it in the future are being told they must instead donate it to public blood banks.

The alternative is to give birth in private hospitals, which are prepared to reserve it for the child's or family's own use. A family's chance of a successful treatment with the stem cells is much higher if there is a personal match. Doctors have already used such cells to treat children with leukaemia and believe they could cure many common conditions in the future.

The row highlights the growing tension between individuals' desire to pay for advanced treatment for their own families and the state's duty to provide free healthcare for all.

King's College hospital in south London and Watford General in Hertfordshire have banned parents from collecting stem cells from the umbilical cord blood even if they hire a private technician to carry out the procedure. Watford General asks women to give to the NHS cord blood bank and King's College encourages women to give the blood to the Anthony Nolan Trust. Other trusts, such as Wirral University teaching hospital and University College London hospital, ban personal collection of stem cells but do not donate to public banks. If the women donate to the public banks, the stem cells become available for whoever is a suitable match.

Shamshad Ahmed, managing director of Smart Cells, a commercial stem cell bank storing families' personal supplies, said: "It is an injustice that certain hospitals will participate in the collection of umbilical cord blood if parents agree to give it away to a public bank but not for their own use. "It is clear these hospitals believe in the technology but are denying individuals this important opportunity to store their own baby's stem cells."

The NHS cord blood bank website compares the advantages and disadvantages of private versus public cord blood storage but it suggests women have a choice. It says: "A public donation is made as a purely altruistic act, solely for the benefit of others. It has the potential to save the life of any person for whom the unit is a good match, including the person who donated it, if it is still available. Private cord banks store a unit solely for use by the donor or their family."

Sophie Isachen, 37, from southeast London, has a history of illness in her family and her younger sister, Rosalind, died aged 26 from a rare blood disorder. Her parents offered to pay 1,600 pounds to store the umbilical cord blood stem cells from her daughter, Freya, when she was born in December. King's College hospital refused to allow the collection. Isachen said: "We decided to go down the private route because of a family history of illness. My parents were going to pay for this because, tragically, my sister died at an early age. "We are in the fortunate position that we can afford it but the unfortunate position that we have a medical history that would make us think it is something that could help us."

A spokesman for King's College hospital said: "At King's, all donations of cord blood are made on an altruistic basis. We are committed to the scheme and the potential it has to help save the lives of thousands of people in need of stem-cell transplants."


Tuesday, March 24, 2009

The Trouble with Embryonic Stem Cells

President Obama's reversal of President Bush's executive order banning federal funding of embryonic stem cell (ESC) research ultimately could cost American lives.
What most people are unaware of is that there are three types of stem cell research: there is embryonic stem cell research (ESC), there is induced pluripotent (IPSC) research, and adult stem cell research (ASC).

When Barack Obama rescinded George Bush’s ban on federal funding on certain types of embryonic stem cell research he also rescinded Bush’s Executive Order 13435 which had provided federal funding for induced pluripotent stem cell research using harmless adult stem cells manipulated into mimicking embryonic stem cells without the risk ESC cells entail.

This is where 72 different diseases are now being remedied or cured.

There are no embryonic stem cells being used anywhere in the world on humans, with one tragic exception. A boy treated with embryonic stem cells for a rare genetic disease developed benign tumors, casting doubt on claims of the therapy's safety and effectiveness.

According to media reports, the boy, now 17, received the ESC stem cells in 2001 at a Moscow hospital and four years later scans showed brain and spinal tumors. Israeli doctors removed the abnormal growth from his spine and their tests show it most probably was caused by the stem cells.

The Moscow doctors should have known better. It is well known that lab animals given embryonic stem cells routinely develop tumors and other malignant growths that eventually kill them. There is a 100 percent mortality rate among lab animals that develop these tumors.
That's why President Bush didn't want the federal government paying for the research. Likewise, major drug companies are not funding ESC research because they can foresee massive class action lawsuits. That's telling. If major drug companies are steering clear of a supposed gold mine in medicine, they must suspect danger.

All the while, Obama's reversal has de-funded induced pluripotent stem cell research (IPSC), an area that has shown considerable promise.
NHS hospital scandal: missed warnings

The shocking extent of the failures at an NHS hospital where hundreds of patients died unnecessarily can be disclosed today. Senior managers at Stafford Hospital were told repeatedly that the standard of care they were delivering was not good enough but each time the warnings were ignored. The disclosures follow the publication last week of a damning report by the NHS regulator, the Healthcare Commission, that found that hundreds of patients died at the hospital because of the "appalling" treatment they received.

Today, The Sunday Telegraph can disclose that executives at Stafford Hospital were warned as early as 2002 by the commission's predecessor that it had problems with the standard of its emergency care services and that it was not adequately staffed. However, they failed to act on the warnings. In 2006, a former government adviser warned the hospital about the standards of hygiene in A&E. Again, the warning was ignored. It was only when alerts were issued over the high mortality rate at the hospital that alarm bells rang.

At that stage an investigation by the Healthcare Commission began, resulting in the publication of last week's report and the suspension on full pay of Mid Staffordshire NHS Foundation Trust's chief executive, Martin Yeates, and the resignation of its chairman, Toni Brisby.

The Sunday Telegraph launches a campaign today for a series of measures to ensure that the crisis in Staffordshire is never repeated in the NHS. The Heal Our Hospitals campaign demands the establishment of an independent inquiry into the regulation and supervision of NHS hospitals. This has been endorsed by the Patients Association and the Cure the NHS campaign group, which worked to expose the crisis at Stafford Hospital. The two groups today launch a petition demanding an inquiry.

Richard Branson, the vice-president of the Patients Association, said: "The most important thing is that patients are happy and safe. I've signed the petition because I think patients need to have confidence that they will be. Inquiries are not about laying blame, they are about finding answers to important questions." This newspaper is also calling for:

* A review of hospital targets to ensure that they work to improve quality of care.

* Nurses to focus on patient care - not form-filling - as their central duty.

* Routine publication of comprehensive death rates for hospitals.

* Patients to be given a stronger voice in the running of hospitals.

* Assurance that senior hospital staff will not be rewarded for failure.

In an interview with The Sunday Telegraph yesterday, the chairman of the Healthcare Commission condemned the board at Mid Staffordshire NHS Foundation Trust and bosses at the strategic health authority for failing to act. Sir Ian Kennedy said it was clear that serious problems at the hospital were evident as far back as 2002, yet no action was taken by managers. Sir Ian said board members and managers who had not already left should "examine their consciences". "Anybody who had any responsibility for leadership and management must ask how they allowed this place to get into the state where patients were dying," he said.

Terry Deighton, an expert in risk assessment who carried out the inspection of A&E in February 2006 that led to another warning for Stafford Hospital, described the conditions as "absolutely disgusting". He found blood encrusted on seats, puddles of urine on the lavatory floors and doctors and nurses washing their hands in sinks encrusted with grime. Mr Deighton's report said standards of cleanliness risked placing patients in danger of infection but Mr Yeates insisted that Stafford Hospital was "very clean" and refused to meet Mr Deighton for over a year.

The commission has also criticised standards of care at Birmingham Children's Hospital NHS Foundation Trust (BCH) after it struggled to meet rising demands.

The commission is also investigating allegations that West London Mental Health Trust did not do enough to prevent patients harming themselves and other people.

The disclosures have led to concern about standards of care in the NHS and calls for a change in the target-driven culture that many emergency care specialists believe is distorting clinical priorities within A&E departments.

The Sunday Telegraph's campaign has received the backing of health experts and practitioners. Claire Rayner, the president of the Patients Association, said: "The target culture has led to a dreadful waste of professional time and extra layers of management." John Heyworth, the president of the College of Emergency Medicine, said: "The lack of doctors and nurses identified in Stafford is a dramatic example of what can happen when the focus on care in departments is lifted." Dr Peter Carter, the chief executive of the Royal College of Nursing, said: "Many of the catastrophic failings identified at the Mid Staffordshire trust could have been avoided if there were simply enough nurses to care for patients."

The Conservatives will set out their own plan to put patient safety first this week. It includes giving patients power to hold failing hospitals to account, an end to the target culture and tougher inspections to root out failure. Andrew Lansley, the shadow health secretary, said: "I welcome The Sunday Telegraph's campaign. We need to make sure that patients are listened to and give responsibility to doctors and nurses."

A survey for Channel 4's Dispatches programme to be broadcast tomorrow indicates that many nurses believe that the lives of patients were being placed in danger by a lack of training, staff shortages and long hours. It also indicates that more than a third (37 per cent) think that patient care in the NHS has become worse in the past five years. Mr Yeates refused to comment but his replacement, Eric Morton, said: "Care standards fell below those that our patients had a right to expect of their hospital and we regret this. We would like to offer our very sincere apology. "We would like to reassure the local community that our focus is, and will remain, on providing high-quality, efficient and safe health care for the people of Staffordshire. "We have put in place effective governance structures to address the key issues."

The Department of Health responded to the launch of The Sunday Telegraph campaign by insisting that the problems in Mid Staffordshire were down to "a complete failure of management" at a local level, which had been revealed through a "meticulous" inquiry by the Healthcare Commission.

A spokesman said the system of regulation and management would be reviewed; trusts were expected to monitor mortality rates, and there was no secrecy over the figures; and the system of targets set minimum standards which patients would expect.


Just move on: What boss of careless NHS hospital told boy's parents after missing fatal injury

The boss of Stafford Hospital, where appalling treatment may have killed hundreds of patients, sent a `callous and arrogant' letter to the grieving family of one victim. Chief executive Martin Yeates told the parents of 20-year-old John Moore-Robinson it was time to `move on'.

Mr Moore- Robinson died because doctors at the hospital failed to discover he had ruptured his spleen in a cycling accident. They sent him home with painkillers - and he bled to death. A year later, an inquest told the hospital to improve its standard of care. But it was another nine months before Mr Yeates wrote to the family. He told them: `I hope that the way the matters have been resolved speedily will go some way to help and your family feel that it's time to put the matter behind you and move on. `Please accept my apologies and regret for the death of your son.'

Mr Yeates is suspended on full pay - 15,000 pounds a month - after a damning report from the Healthcare Commission found that his NHS Trust board prioritised Government targets over basic patient care. An inquiry has been launched into his role in the scandal. Last night, Frank and Janet Robinson, both 57, branded his words ` despicable' and `insulting'. Mr Robinson said: `It makes my blood boil to think that Martin Yeates has got away with it and he's living it up it on full pay. `We can't possibly start to move on when we know that John lost his life needlessly. We've lost our boy and he thinks he can make everything OK with a letter. 'The arrogance of it is despicable. The letter is an insult. I don't for one minute think that he's truly sorry. `He was in charge of the hospital and he's at least partly responsible.'

Mr Moore-Robinson, a telecommunications worker, was thrown over the handlebars of his mountain bike on a day trip to Cannock Chase, Staffordshire, with friends in April 2006. He was taken to Stafford Hospital A&E department where an X-ray revealed broken ribs. He was vomiting and in agony but doctors prescribed pain medication and discharged him, his family said.

Friends drove him back to his home in Coalville, Leicestershire, but within hours his family called 999 because he was still in severe pain. He died minutes before paramedics arrived. His father said last night: `It's every parent's worst nightmare to lose their child but when somebody's incompetence is to blame it becomes worse. `John's treatment was shambolic and I am demanding that senior management be brought to account for the shocking waste of life.' Mr and Mrs Moore-Robinson plan to join other grieving families in suing the Mid-Staffordshire NHS Trust.

Health Commission investigators uncovered a shocking series of failings between 2005 and 2008, including staff shortages and unqualified receptionists carrying out initial checks on A&E patients. More than 100 people told them that patients were ignored as they called for help on filthy wards covered in blood and excrement. Staff showed a general lack of compassion, dignity and respect, the commission's report said. As many as 1,200 patients may have died as a result of the appalling treatment they received.


U.S. health care overhaul may cost about $1.5 trillion

Your lungs may work just fine, but the estimated price for universal health care could take your breath away. Health policy experts say guaranteeing coverage for all Americans may cost about $1.5 trillion over the next decade. That would be more than double the $634 billion 'down payment' President Barack Obama set aside for health reform in his budget. About 48 million people are uninsured, and the problem is only expected to get worse because the cost of coverage keeps rising.

Still, administration officials have pointedly avoided providing a ballpark estimate for Obama's fix, saying it depends on details to be worked out with Congress. "It's impossible to put a price tag on the plan before even the basics have been finalized," said White House spokesman Reid Cherlin. "Here's what we do know: The reserve fund in the president's budget is fully paid for and provides a substantial down payment on the cost of the reforming our health care system."

The potential for runaway costs is raising concerns among Republicans and some Democrats as Congress prepares to draft next year's budget. The U.S. spends $2.4 trillion a year on health care, more than any other advanced country. And some experts estimate that a third or more of that goes for tests and procedures, rather than prevention and treatment. "We shouldn't just be throwing more money on top of the present system, because the present system is so wasteful," said Sen. Judd Gregg of New Hampshire, the ranking Republican on the Budget Committee.

The health care plan Obama offered as a candidate would have cost nearly $1.2 trillion over ten years, according to a detailed estimate last fall by the Lewin Group, a leading consulting and policy analysis firm. The campaign plan would not have covered all the uninsured, as most Democrats in Congress want to do. But it is a starting point for lawmakers.

John Sheils, a senior vice president of the Lewin Group, said about $1.5 trillion to $1.7 trillion would be a credible estimate for a plan that commits the nation to covering all its citizens. That would amount to around 4 percent of projected health care costs over the next 10 years, he added. The cost of covering the uninsured is "a difficult hurdle to get over," Sheils said in an interview. "I don't know where the rest of the money is going to come from," he added.

Some of the leading advocates of coverage for all use cost estimates around $1.5 trillion. "Honestly ... we can't do it for the $634 billion the president put in the reserve fund," John Rother, public policy director for AARP, told an insurance industry meeting in Washington last week. "In all likelihood, it will be over $1 trillion," he added, citing his own estimate of $1.5 trillion.

Economist Len Nichols, who heads the health policy project at the New America Foundation, said guaranteed coverage will cost $125 billion to $150 billion a year when fully phased in.

White House budget director Peter Orszag told the House Budget Committee earlier this month that the president's $634 billion fund is "likely to be the majority of the cost." Roughly half of the money would come from spending cuts, and the other half from tax increases. But whether the $634 billion represents 50 percent, 60 percent or 70 percent of the cost "will depend on the details of whatever is finally done ... as we move through the legislative process," Orszag added.

The overall cost matters because the expansion of health coverage is meant to be a permanent reform. That means future generations will have to bear the cost. "We are dealing with huge numbers," said David Walker, a former U.S. comptroller general and now head of the Peter G. Peterson Foundation, a group that promotes fiscal responsibility. "We need to have a much better sense of what we are talking about doing, and whether or not it's affordable and sustainable over time."


Monday, March 23, 2009

Logic problems for the single-payer cabal

Believe it or not, Jay Leno is not the biggest clown with that particular last name. No, really, he’s not. That dubious honor instead falls to my State Senator, Mark Leno. Leno’s latest clown move is again introducing a single-payer health care measure that would impact all Californians:
The new version of the bill, SB 810, would provide medical, dental, vision, hospitalization and prescription drug benefits to every California resident and make state government the single payer of all benefit claims. Both employees and employers would be required to contribute to pay for the coverage.

So, in Leno’s California, every person would be dependent on a single agency to get health care. He sidesteps the issue by saying the following:
“It is not socialized medicine. Your doctor doesn’t change. Your hospital doesn’t change. Your clinic doesn’t change. The only thing that changes is who pays for the health care provision.”

That’s wonderful. It really is. I can choose my doctor, my hospital, my clinic, my medical marijuana club, and anything else. But to actually pay them and get anything in return, I have to crawl to a bureaucrat in Sacramento. That sure sounds like socialized medicine to me. However, I don’t just want to argue semantics about what is and isn’t socialized medicine. I want to take a look at how single-payer health care squares with some other sacred cows of the political left.

First, let’s take a trip back to the late 1990s. The fashionable thing among the left was to bitch about the big, evil corporation Microsoft and their monopolistic behavior with their operating system. I don’t dispute that monopolistic behavior is bad, but it must be remembered that this monopoly dealt with bits in a computer and was never complete. The fact that I’m typing this from Mac OS X is proof enough of that.

In comparison, the Leno bill comes off just a bit worse. Where the maligned Microsoft monopoly allowed other OS players in the space, the Leno bill creates a true, iron-clad monopoly. This brings up logic problem number 1: Why is a quasi-monopoly on computer software evil while a real monopoly on medical services is good?

Next, let’s come back to the present day and talk about the death penalty. Even after all the appeals and reexaminations of the evidence, innocent people still wind up on death row. The left, along with libertarians, argue that systems composed of human beings cannot justly hold the power of life and death in their hands.

However, the Leno bill would require that the State of California to hold the power of life and death in its hands in the form of authorizations and declinations of medical care. Here’s logic problem number 2: Why is it unjust for the courts to decide whether criminal defendants should die but just for a bureaucrat to decide whether an innocent person should die?

Finally, let’s visit a topic rarely touched on the pages of the Liberty Papers–abortion. The left argues that it is a woman’s right to choose what to do with her own body. There are legitimate questions about when a life begins, and that’s part of why the debate continues to rage.

The Leno bill places the choice about what happens to my body in the hands of a bureaucracy in Sacramento. This brings us to logic problem number 3: Why is choice for abortion sacrosanct while choice for all other procedures can be sacrificed for the common good?

How can the left support single-payer health care when it seems to go against their own principles? Discuss.


NHS a goldmine for lawyers

While mistreated patients get peanuts

LAWYERS are earning 800 pounds an hour from the National Health Service and taking “indefensible” fees of tens of millions of pounds in legal disputes. The money is coming from a government scheme intended to compensate patients for medical blunders and inadequate care, an investigation has found.

The compensation lawyers are claiming costs and “success fees” worth about 100m pounds a year out of the scheme. In some cases the payouts claimed are 10 times more than the damages won by the patient. Health professionals warn that it could get much more expensive. There is an estimated backlog of cases against the NHS amounting to 12 billion in claims, of which lawyers could get up to 6 billion.

The NHS Litigation Authority (NHSLA), which operates the compensation scheme, has lambasted the fees in a submission to Lord Justice Jackson, the judge. He is reviewing civil litigation costs. The document warns that some “no-win, no-fee” lawyers are allowed to charge the NHS compensation scheme £804 an hour to pursue patients’ claims. It states: “The whole costs structure is indefensibly expensive in relation to the compensation awarded or agreed. It is difficult to believe that it would be sustained were it not for the lack of motivation to change it.”

Mark Simmonds, the shadow health minister, said the huge fees being earned by the lawyers would be better spent on patient care. “It is unacceptable in some cases that the legal fees are many times higher than the awarded damages,” he said.

Bertie Leigh, a lawyer who defends the NHS in litigation cases, said he regards many of the cases he sees as a “buccaneering attack on the funds of the NHS”.

In one case involving Barking, Havering & Redbridge Hospitals NHS Trust, a legal firm claimed nearly 78,000 in costs and fees, having won just 7,000 for a female patient. A Liverpool firm submitted a legal bill for £4.4m for a single case.

The figures for 2007-8 show that more than one in four NHS trusts are paying out more in legal costs than in damages. The clinical negligence scheme paid 264m in compensation in 2007-8 of which 90m was in claimants’ fees.

Compensation lawyers say the success fees help to cover the cost of fighting cases they lose.


NHS patients ‘died of neglect’

VULNERABLE patients with learning disabilities have died because of neglect in NHS hospitals, an official report is expected to say this week. The report by the parliamentary and health service ombudsman will find widespread failures by doctors and nurses to care properly for people who are mentally handicapped.

The inquiry began after a report by the charity Mencap, Death by Indifference, found six patients had died through neglect while in NHS care.

One man, Martin Ryan, 43, from Surrey, died after he starved for 26 days while in Kingston hospital following a stroke. Staff had failed to use a nasal feeding tube to prevent his condition from deteriorating. This left Ryan too weak to undergo surgery to have a tube inserted into his stomach. Kingston hospital NHS Trust has apologised and says it has improved care for such patients.

Another patient, Emma Kemp, 26, from Buckinghamshire, died from cancer in 2004 after doctors said she had a 50% chance of survival but delayed treatment, the charity claims. Doctors believed Kemp, who had behavioural problems, would not cooperate. Mencap did not say which hospital she was in.

The three other cases the watchdog examined follow similar patterns, with warnings ignored or problems missed until it was too late.

The watchdog is likely to find NHS failings were responsible for some but not all of the six deaths. An earlier independent inquiry by Sir Jonathan Michael, managing director of BT Health, found that although people with learning disabilities had more physical health problems than the general population, they received less effective treatment. Michael found “appalling examples of discrimination, abuse and neglect”.

Mark Goldring, chief executive of Mencap, said: “Mencap’s Death by Indifference report exposed the horrendous deaths of six people with a learning disability who suffered a catalogue of neglect while in NHS care.” Mencap is calling for disciplinary action against the doctors and nurses responsible.

A spokeswoman for the Department of Health said: “Preventable deaths of people with learning disabilities are absolutely unacceptable. We are now taking action that will lead to people with learning disabilities getting equal access to healthcare”


Sunday, March 22, 2009

No privacy for pregnant mothers in an American community hospital?

As the head of obstetrical services at our hospital, I was sitting in a meeting one day when the idea was broached that local obstetricians should routinely perform drug screening on the urine of all pregnant women. We were told that at a community hospital such as ours, 15–20% of women would test positive for illicit drugs. At present, the obstetrical service at our institution identifies drug use in only about 5% of our patient population. Therefore, we must be missing quite a few cases that could be identified by routine maternal drug screening. Furthermore, the hospital down the road was preparing to initiate such a plan. We must, after all, keep up with the competition.

At this point in the meeting, the role of government was introduced. It was suggested that an even better plan would be for our state (Tennessee) to mandate routine maternal drug screening. This, naturally, would mean one more state-sponsored loss of dignity for all expectant mothers. And for some, the effects would be more far reaching. Once women were identified by a positive urine drug screen, the results would go to the appropriate state social service agency. Big Brother, or rather Big Sister, would then come knocking on the door for the euphemistically named “home visit.” The mother would be encouraged to mend her ways. Of course, if she did not mend her ways in a manner satisfactory to the state, her children could be removed and sent to foster care.

Maternal drug use in pregnancy creates many problems for both the infant and mother. In relation to expectant mothers, such terms as “drug problem,” “drug addiction,” and “drug abuse” have much more serious meanings than they may have for other people. Maternal cocaine use in particular results in a wide range of morbidities — low birth weight infants (infants weighing less than 2,500 grams or five and a half pounds), infants admitted to intensive care units, and infant mortality. Amphetamine is probably the next worst drug for expectant mothers, causing many of the same types of problems as cocaine, though on a somewhat reduced scale. Maternal opioid use is most commonly associated with infant withdrawal syndrome. While it is rarely lethal, it is emotionally troubling to those who witness an infant coping with this unjust inheritance. Marijuana, while not as damaging as the other drugs, has been shown to result in smaller infants with smaller head circumferences.

It might be surprising to learn that the majority of infants born to drug-using mothers actually do fairly well. One of the best determinates of neonatal health is whether the newly born infant is admitted to the neonatal intensive care unit (NICU) instead of the regular well-baby nursery. A study from the Minneapolis-St. Paul area looked at the number of NICU admissions among women who tested positive for illicit drugs (cocaine, opioids, and marijuana). This number was then compared to the remainder of mothers, who had negative tests. The results were a 20.7% NICU admission rate for mothers who were drug-test positive versus a 12.3% NICU admission rate for mothers who tested negative. One can argue whether this glass is half full or half empty. Maternal drug use resulted in a 69.7% increase in admissions to the intensive care unit. However, 79.3% of infants born to women who used drugs were admitted to the regular well-baby nursery. Perhaps the best way to look at the data is to say that maternal drug use conferred an additional 8.4% risk of bad outcomes beyond the baseline rate. In considering this drug-induced penalty, one should also note that many babies who are initially admitted to the NICU eventually have a good outcome.

Reduction of the 8.4% increase in infant morbidity among drug-exposed children is a worthy goal. Since drug-abusing mothers often lie about their habits, routine universal drug screening has been increasingly advocated. Routine urine drug screening is often touted as highly accurate and inexpensive. Once women are identified as users of illicit drugs, they can be directed towards comprehensive programs. These programs, which concentrate on drug abstinence counseling and obstetrical care, have shown progress in lessening infant morbidity. While this certainly sounds good, it can be shown that each of the premises is highly problematic.

First, maternal drug testing is not the only way to identify substance abuse. While it is true that over 50% of women who abuse drugs will not admit to doing so, there are other ways of identifying most drug-abusing women. Think of it as a type of profiling.

Several studies have shown that carefully designed questionnaires identify the majority of drug-abusing mothers. In one study from the University of California, Davis, 93% of women whose urine tested positive for drugs had one of the following three characteristics: actual admission of drug use, poor or no prenatal care, and cigarette smoking. By asking the right questions and noting salient patient characteristics, one could identify the women most likely to be using drugs.

Secondly, routine drug screening is neither straightforward nor cheap. Abstaining from cocaine and opioids for a 72-hour period prior to testing often leads to a negative drug test; consequently there is ample opportunity to beat the system. In addition, some drugs, such as amphetamines, have a high false-positive rate; i.e., the urine tests positive even when no amphetamines have been taken. Confirmatory testing with gas and liquid chromaphotography is necessary to confirm a positive drug screen. This sounds expensive, and it is. As an example, the average charge to our office for routine prenatal blood work is $77. The charge for urine drug screening is $19. But adding a confirmatory test for a positive drug screen costs another $70. By this measurement, the cost of drug screening plus confirmation exceeds the cost of routine prenatal lab work.

The most problematic idea, however, is the notion that once drug-using mothers are identified, they can be counseled, supported, and nurtured to the betterment of themselves and their infants. Several studies have been undertaken of this noble cause. The best one, perhaps, is from Brown University, and was published in 2000. This study also showed the most encouraging results. Eighty-seven women were recruited over a three and a half year period. They received extensive support from Project Link, an organization that offers patients individualized therapy, including group and individual psychotherapy, nutritional advice, home visits, and transportation services. The 87-member study group was compared to a control group of 87 substance-abusing women who received the same care but after delivery. Compared to the control group, the study group showed a reduction in the number of premature infants, low birth weight infants, and infant admissions to the intensive care unit.

This appears to provide encouragement, but a closer look at the numbers is more sobering. The obstetrical service involved in the study was delivering approximately 9,000 babies per year. If we assume a 15% rate of maternal substance abuse, the 87 women enrolled in this study represent less than 2% of the substance-abusing women delivering at the hospital. The authors also stated that each of the women in the study group self-reported their addiction and volunteered for the program. This is clearly an unusually dedicated group of women who wanted to do the best for their infants. Unfortunately, it is also a small group of women. The vast majority of substance-abusing mothers would not comply with such a program. The noncompliant mothers were aware that their behavior was harmful to their babies, yet their addiction to the drug was just too strong. Inchoately, they know what the apostle Paul knew: “I do not understand what I do. For what I want to do I do not do, but what I hate I do” (Romans 7:15). No matter how good the intentions of large hospital systems and state government, these entities cannot loosen the grip that addicting drugs have on a mother.

Of course, there is one option for drug-abusing mothers that might prove successful. In a study done through the North Carolina state penal system, pregnant inmates were followed closely throughout their gestations. Their prison-based pregnancies were compared to their other pregnancies. Specifically, infants who were delivered when their mothers were in prison were compared to their siblings, delivered when their mothers were not in prison. Pregnancies that came to term in prison resulted in the birth of larger infants with fewer premature deliveries. It was speculated that the women received more regular prenatal care and better nutrition while in prison. Also, they presumably had forced abstinence from drugs. Still, the authors of this study concluded that the benefits of slightly larger babies were overridden by problems inherent to incarceration, such as familial separation and maternal anxiety. Mercifully, there are no serious voices suggesting this level of governmental intervention.

A final argument is that routine drug screening in pregnant women might keep them from seeking prenatal care. In researching this paper, I identified no studies that quantitated the effect that routine maternal drug screening would have on attendance for prenatal care. It is a well-accepted fact that under the current system, where drug testing is usually not mandated, drug-abusing women show up less often and more sporadically for prenatal care. There is reasonable concern that mandatory drug testing, and the resultant governmental demands for drug abstinence, would still further decrease attendance at obstetrical clinics.

There is, to be sure, a fairly sizable group of women who will not commit to drug abstinence but still show up for prenatal care. Many of these women attend methadone clinics. Methadone can best be viewed as opiate-lite. It should not be viewed as a treatment for all drug-abusing women as it is only prescribed for women with opiate addictions. (Opiates include such well-known drugs as heroin, morphine, oxycodone and hydrocodone.) As an example, methadone would have little benefit for a woman with a crack cocaine problem. In general, however, methadone does seem to have three distinctive advantages over illicitly obtained opiates. First, there seems to be less morbidity for the newborn infant. Second, a user of methadone is less likely to need escalating doses of the medication to get the desired calming effect. Third, withdrawal from methadone is somewhat easier than with other opiates.

But probably the greatest good derived from methadone prescription is that it tends to keep pregnant women within the prenatal care system. There is much evidence to show that women who both receive methadone in a controlled manner and also receive enhanced prenatal care have superior outcomes to women who get their opiates off the street. The prenatal care focuses on fetal growth, which can be followed fairly reliably with ultrasound measurements. It is a general truth that babies who grow well in the womb do well in the nursery. For fetuses who do not grow well, enhanced fetal surveillance is performed. This sometimes allows the delivery of infants prior to the development of fetal compromise.

In my opinion, the way in which we care for mothers who receive methadone should be a model for how we should treat all women at high risk for drug abuse. Pregnant women should be carefully questioned at the beginning of their prenatal care. Women deemed to be at high risk for drug abuse should receive the same type of prenatal care as pregnant women who are taking methadone. The growth of their fetuses should be monitored closely with ultrasound measurements. For infants who do not grow well, more intensive testing and occasionally early delivery should be offered.

This article has outlined two basic arguments against routine maternal drug screening. One is based on human nature. The other is more pragmatic. From a practical standpoint, a positive drug screen is not a secret between a patient and her physician. The test results are routinely reported to hospital social service workers who in turn report them to the appropriate state agency. The more intrusive the state becomes in monitoring drug-using women, the more each allegation of drug use will be challenged. Routine drug testing would invariably result in expensive retesting and confirmatory testing; it would therefore lead to thousands of bitter and costly legal contests. It would also lead many women who need prenatal care to decide not to get it, for fear of the tests and consequent legal involvements.

A drug-abusing woman who discovers that she is pregnant is heavily conflicted. There is the desire to do what is the best for her baby, but there is also the pull of a strong addiction. Only a few, highly motivated, strong-willed individuals are likely to benefit from comprehensive drug abstinence programs. Such women are not waiting to be notified by a hospital or state agency that they have a problem and need help. They sign up without such prompting. But for women who are either untruthful about their drug use or unwilling to commit to drug abstinence, it is unlikely that being notified of a positive drug test will materially change their behavior, unless they are in fact imprisoned.

As mentioned previously, there is an 8.4% increase in intensive-care admissions for infants born to drug-abusing mothers (20.7% versus 12.3%, for women who are not involved with drugs). While this number is not high enough to warrant extraordinary measures (e.g., incarceration) in order to protect the fetus, it is high enough to make some recommendations for closer concern and careful medical monitoring — not for a large, new extension of state power, fraught with its own possibilities of abuse.


End this postcode lottery in British cancer care

The nightmare of NHS bureaucracy needs sorting out

Every person reading this article has a one in three chance of getting cancer. In the most recent year for which there are statistics, 367,000 men and women in England had cancer diagnosed.

The NHS Cancer Plan for England was published in September 2000 with the laudable ambition of reducing cancer deaths. Investment was planned to improve survival through prevention, screening, early diagnosis, better treatment, hospices and cancer networks. Investment in the NHS has risen from 4.8 per cent of GDP in 1997 to 9 per cent today.

Has this money achieved its aims? Partly. Fewer people smoke, more are screened and waiting times are shorter. But bureaucracy has been an obstacle to greater success. The National Institute for Health and Clinical Excellence (NICE) has prevented effective treatment becoming widely available; the weaving of a spider's web of administrative muddle has led to death and misery.

There remains a wide variation in the standard of care and the chances of survival. This is partly because the Government believes in local autonomy - 150 primary care trusts dictate local policy, creating a postcode lottery. Living in Richmond means that you might be prescribed a drug for cancer, while you cannot be effectively treated in the stinking black hole that is Oxford. The annual administrative budget for these trusts is £5 billion.

One of my colleagues has shown that death rates from kidney cancer are solely determined by postcode. In areas where the trusts allow the use of a particularly effective drug the average survival rate is more than two years; in those where it is refused, average survival time is six months. Many readers will know that NICE has changed its mind three times over whether these kidney cancer drugs should be available.

In 2000 the Secretary of State for Health wrote in his introduction to the Cancer Plan that “decades of under-investment alongside outdated practices mean that survival rates lag behind the rest of Europe... too many variations in the quality of care across the country leave patients frustrated by the postcode lottery.” His view is still correct. Presumably his successor now needs a hearing aid as those words ring in his ears.

Secretary of State, please could our wonderful NHS be granted the gift of sanity in prescribing and clarity in administration? The nightmare of bureaucracy needs sorting out. The rationalisation of NICE and the primary care trusts would free up funds that could be used to benefit patients.