German government doctors to step up strike

Up to 20,000 doctors in Germany have said they are escalating industrial action by going on indefinite strike. The dispute is over pay and working conditions at state-run hospitals as well as at 40 university clinics. Some of the hospitals are in cities staging the World Cup, including Cologne, Munich and Leipzig. Thousands of doctors have already stopped work, delaying some operations. The doctors began their industrial action three months ago.

Their union says they work on average 60 to 80 hours a week - double the number in their contract. The doctors are also demanding a 30% pay rise. Many German doctors have moved abroad to work, the BBC's Tristana Moore reports from Berlin. In the UK, for example, they can earn about twice as much and work fewer hours.

The doctors' union held talks with the employers' association on Saturday. Union leaders are meeting in Frankfurt later on Monday to discuss a new offer that is on the table.

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Lawyers could kill off computerized medical consultations

The number of doctors and hospitals making virtual house calls has exploded in recent years, which has lawyers cautioning the medical community about the legal dangers of treating and monitoring patients via the Internet. Attorneys warn that virtual medicine -- which has popped up in hospitals and clinics in more than a dozen states in the last two years -- could open the floodgates to malpractice claims, privacy disputes and licensure problems. "My concern is that this would open up lawsuits," said attorney Brett C. Powell of Hicks & Kneale in Miami, who handles malpractice appeals for doctors and plaintiffs. "I can foresee a claim down the road where the patients are claiming negligence for failing to recognize a situation. With these virtual house calls ... you could say not only did he not have an adequate examination, but he didn't even see me."

Lawyers' concerns stem not only from the increase in doctors participating in virtual medicine, but by the growing number of insurance carriers that have been willing to pay for online visits. For example, this July, some Cigna HealthCare members in California will be able to conduct online doctor's visits, a service that will also be available next year to members in New York, Florida and Arizona. And some insurers have already started remimbursing doctors for online visits. In Georgia and New York, children are being diagnosed for ear or throat infections by pediatricians via the Internet and high-tech video equipment. In Texas, Pennsylvania and Illinois, nurses are taking digital pictures of hospitalized patients and e-mailing them to doctors, who e-mail instructions on what to do if the person looks too pale or a sore looks infected. In Hawaii and Pennsylvania, homebound patients are holding videoconference calls with their doctors, and transmitting vital signs through devices hooked to computers.

Lawyers, meanwhile, are ambivalent about what they're seeing on the medical front. "I've seen a burst of activity in the last 18 months," said Sharon Klein, a partner at Philadelphia's Pepper Hamilton who specializes in health care law. The nation's legal system, however, has not kept pace with the technological advances regarding virtual house calls, cautioned Klein, who notes that remote caregiving raises concerns about malpractice claims, privacy, confidentiality and security-of-communication claims, as well as about the practice of medicine across state lines. In the last 18 months, Klein has counseled many hospitals in the practice of "virtual rounding," where doctors and specialists check on their patients from remote locations with the help of digital images displayed on computers. She said that it has become a particularly popular practice in children's hospitals.

In helping hospitals use virtual rounding, Klein has drafted hundreds of confidentiality agreements in recent years, in which everyone from doctors and nurses to technology installers and pay groups sign disclaimers promising to keep patient information confidential. Klein also has offered a number of tips on avoiding litigation to health care providers that use virtual medicine. They include making sure patient information is encrypted and being aware of medical-license barriers. In the event something goes wrong and a lawsuit is filed, jurisdictional issues may arise. If physicians prescribe telemedicine services in states in which they are not licensed, malpractice insurance claims could be denied.

Avoiding licensing problems is a top priority for attorney Jane Arnold, whose advice regarding virtual medicine has been sought out in recent years by a growing number of specialists. Arnold's clients include radiologists who read films in the middle of the night from their homes, obstetricians who use fetal monitors to check on pregnant women through secure Web sites on the Internet, and a Phoenix oncologist who does video conferencing with cancer patients in small towns. "Doctors who have been in practice for years and years and years are coming to embrace the convenience and the quality of data that is available," said Arnold of the St. Louis office of Bryan Cave.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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LOTS OF IRISH DOCTORS SOON

A senior Trinity College professor has condemned Bank of Ireland for providing interest-free loans to students in traditional professions who are likely to become high earners. The bank is targeting undergraduates in medicine, dentistry, pharmacology and veterinary, saying 0% interest loans to these students are a guaranteed investment. “There is an extremely competitive market out there,” said Mary Brennan, a bank spokeswoman. “Studies show that 80% of people are unlikely to change banks. Students who become veterinarians or pharmacologists are strong business customers for us.” Other students taking out Bank of Ireland loans are charged 9.2%.

Sean Barrett, economics professor at Trinity College, said preferential treatment by Bank of Ireland was subsidising traditional professions. “Because courses like medicine have until recently restricted the numbers allowed into their courses, they have enhanced their earnings. It is not defensible economic practice. The bank needs to encourage those doing commerce, business, art or history as they are the real engine of the Celtic tiger, not these old-style restrictive professions.”

Ulster Bank offers larger loans — up to 15,000 euros more than the standard maximum — exclusively to students in nine “professional” subjects such as trainee solicitors and student doctors. AIB said it occasionally engages in tactical pricing to recruit students but that “all students are equal in the eyes of the bank”. Aoife McArdle, welfare officer at National College of Ireland student union, said: “ Just because someone does medicine doesn’t mean they will be good at repaying their loans.”

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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U.K.: A BILLION POUNDS SPENT ON "ADVISERS" BUT NO MONEY FOR MORE DOCTORS, NURSES AND DENTISTS

The cost of hiring management consultants to advise on cutting NHS budgets was condemned yesterday by a leading union which said that some consultancy contracts were now reaching 150,000 pounds. Amicus, the country’s largest manufacturing union, said that consultants were being paid 1,200 pounds a day to give advice on how trusts could save money. The union said that contracts usually ended up with hundreds of health jobs being axed.

The so-called “turn-around teams” have been hired to alleviate the financial crises in a number of NHS trusts across the country which are blamed for most of the health service’s 512 million deficit last year.

Derek Simpson, the general secretary of Amicus, said that hiring private consultants was “political dogma gone mad”. He added: “We have to combat the philosophy that private is best. Not only is private provision detrimental to patients, it is costing taxpayers millions of pounds. As the so-called ‘turnaround’ experience demonstrates so vividly, privatisation does not provide value for money.”

Hospital doctors called last week for an end to NHS spending on management consultants, who cost an estimated 1 billon last year. They also accused the Government of “short-sighted” staff planning over fears for the future employment prospects for junior doctors. Paul Miller, the chairman of the British Medical Association consultants committee, said that ministers risked destroying the NHS if they continued to waste money.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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Huge Legal Win for Compounding Pharmacists

It is a welcome outcome when the judicial system issues a ruling that helps solve a medical problem rather than compounding or creating a new one. An Association of American Physicians and Surgeons' "News of the Day in Perspective" release on May 28, 2006 notes such an occurrence.

Tens of millions of Americans take customized preparations prescribed by physicians and mixed by compounding pharmacies instead of mass-produced, FDA-regulated drugs. These include hormones, topical creams for nausea, dermatologic and ophthalmologic preparations, and pain medication.

In a landmark ruling, U.S. District Judge Rob Junell in Midland, Texas, ruled that customized compounds created by compounding pharmacies are not new, unapproved drugs that must be sanctioned by the U.S. Food and Drug Administration. AAPS assisted by filing two amicus briefs in support of the compounding pharmacies in the case 'Medical Center Pharmacy v. DOJ, HHS, FDA.'

Austin lawyer Terry Scarborough, who filed the lawsuit against the FDA on behalf of 10 pharmacists, praised the decision: "We are pleased the court ruled from the bench on the most important issue - that compounds don't create 'new' drugs as the FDA suggested." Scarborough said that Judge Junell indicated he would issue an injunction barring FDA inspections that exceed its authority. Kristie Zamrazil, a spokeswoman for the Texas Pharmacy Association, said the decision preserves the roots of pharmacy. "Compounding has been part of pharmacy practice since its origins. Judge Junell's ruling is a win for patients and recognizes the important health-care service that pharmacists have provided through the ages." (Lavlan Copelin, Austin American-Statesman 5/27/06)

Ken McLain is a pharmacist for the Sav-On pharmacies in Orange County, Calif. While the drugstore he serves in Newport Beach no longer does much compounding, he notes that a ruling against compounding would have had significant detrimental effects upon patients and health care. "There are a number of pharmacies that specialize in compounding that provide needed medicines for many patients. Often patients have specialized needs such as requiring higher/lower doses of a medication or have allergies to filler materials or certain drugs. "Pharmaceutical companies are not able to provide or manufacture pills, tablets, lotions or creams for every known disease, illness or injury. Many patients are extremely dependent on the skills of the pharmacist."

A new drug is subject to the FDA's onerous new drug application process, stated AAPS General Counsel Andrew Schlafly, who filed an amicus brief for the pharmacists.

According to this ruling, "Compounded drugs are fully legal and not subject to the requirements and prohibitions imposed on new drugs by the 1938 Food, Drug and Cosmetic Act," Schlafly further notes. Adds AAPS Executive Director Jane Orient, M.D., who has a way of cutting through the camouflage: "Compounding pharmacies could not possibly meet the onerous, expensive and time-consuming FDA requirements. "They make prescriptions one at a time. The FDA requirements are designed for manufacturers who make pills by the billions. Ophthalmologists and dermatologists - and their patients - would be especially hard hit. The products their patients need are not available except from compounding pharmacies."

In an era of mass impersonal medical care controlled by insurance companies and government, and with professional relationships worsened by trolling trial lawyers, patients are crying out for some personal care. Ideally, specialized care should be the goal of the future. Why take the art out of the art and science of pharmacology? Pharmacists are well trained professionals who significantly add to health care in a one-on-one relationship.

An unwise judicial ruling would have relegated them to pouring pills from many large white bottles to smaller clear ones. It is indeed a rare day in June when a legal or judicial man makes a decision that contributes to better health care. So kudos to Texas Judge Rob Junell. A written order to make this wise ruling binding will be issued in late July.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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Massachusetts owes $86.6m to the US, audit says

And these bureaucratic bunglers think they are the light on the hill!

State Medicaid officials repeatedly violated federal laws and regulations and must return $86.6 million to the US government, a new federal audit has found. The audit, by the inspector general for the US Department of Health and Human Services, found that from 2001 to the first quarter of 2004, state Medicaid officials overcharged the federal government for services provided by the state Department of Social Services. The audit found that the violations did not involve willful misconduct, but resulted instead from lax oversight.

In all of the reported violations, state Medicaid officials billed the federal government for care that was not directly related to arranging medical services. The audit documented hundreds of thousands of instances of those improper claims over the period studied, times when the state overcharged Medicaid by amounts ranging from $209 to $295. State Medicaid officials labeled the audit ``seriously flawed and erroneous" and said they would contest the findings in a reply to the federal government that they plan to submit at the end of the month.

In one example cited by Inspector General Daniel R. Levinson, the state billed federal Medicaid officials for a social worker who called a child's school, asking that the child be allowed to return to class. In another reported violation, the state billed Medicaid for a social worker who accompanied a child to court. ``We attribute these unallowable costs to the state agency's lack of procedures for ensuring compliance with Medicaid requirements," Levinson wrote in his 13-page report, a copy of which was obtained by the Globe. ``The state must comply with all federal requirements."

Beth Waldman, the state Medicaid director, said the federal government had reached an agreement with the state in 1994 to allow Massachusetts to bill for such services. ``We believe that they are allowable under the regulations that [the federal government] worked with us to put in place and that they understood that at the time," Waldman said in an interview yesterday. ``So, if they want to change them, that's fine, but you can't do it retrospectively, and you can't do it through an audit."

Waldman sounded a skeptical note, saying she ``would not be surprised" if the federal government brushed aside the state's reply and demanded return of the $86.6 million. It would then be up to the Legislature to decide how to handle the hit to the state budget, she said. ``Eighty-six million dollars is a lot of money; there's no doubt about that, but there's not going to be an impact on the kids," because the services under review have already been provided, Waldman said. ``It would be a hit to the General Fund".

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THE NEW YORK MESS

It makes even the dubious Massachusetts initiative look good

For years this nation has sought a way to provide every American with affordable health-care coverage. Now the problem is coming to a head. Small businesses and the self-employed are multiplying by the day-yet they cannot access affordable health insurance. Today, the fastest-growing group of uninsured are small-business owners and independent contractors. They are shut out of buying insurance at group rates.

The choice is clear: We can set aside special-interest politics in order to expand coverage for all. Or we can continue utilizing the power of government to exclude some-namely small businesses and the self-employed-while rewarding others. Massachusetts has chosen the first path, while New York seems intent on catering to special interests. The Massachusetts legislature recently passed a bipartisan bill that seeks to insure every resident. It requires able-bodied people to obtain coverage at group-health rates. It gives the self-employed the same buying power and tax breaks enjoyed by large corporations when purchasing health care. Finally, it provides subsidies, scaled to income and family size, that allow people to buy insurance though groups formed by religious, civic, and community organizations. The Bay State health proposal uses a combination of market innovations, quality improvements, and government support to provide fair care for all.

The Massachusetts approach is not perfect. But it stands in stark contrast to the so-called "Fair Share Health Program" bill being pushed by New York Assemblyman Daniel O'Donnell. The New York bill is a typical example of the quick-fix solution that misguided legislators and labor organizations are proposing in states all around the country. Modeled after legislation that passed in Maryland, the bill would force companies-Wal-Mart in particular-to pay an arbitrary amount of their payroll toward health benefits. Specifically, it would require companies with over 10,000 employees in the state to contribute 8 percent of their payroll to health-care coverage.

Troublingly, it was introduced without any serious study of the long-term effect of these massive health obligations-whether they would result in the same unfunded liabilities that are now pushing our auto and steel companies toward bankruptcy. Nor was there any evaluation of whether such a bill would encourage companies to pare back benefits to minimize coverage. Or whether the bill would simply shift costs from state-subsidized programs to private businesses.

Because this type of legislation is driven by politics and not facts, it fails to address the real issue: More people have to find health insurance on their own. Indeed, the proposed New York legislation is a triumph of special-interest politics. It completely ignores the urgent needs of small businesses and the self-employed to access affordable care. According to the Kaiser Family Foundation, last year only 59 percent of firms with fewer than 200 employees offered health insurance, compared to 98 percent of firms with 200 or more employees. Additionally, the Employment Policies Institute reported that a full 45 percent of the uninsured work in firms with fewer than 25 employees.

New York's legislators should be able to work together with our business and community leaders to provide health care for all without resorting to political ploys like "Fair Share Health Care." The problems facing our health-care system are bigger than any one business or group of citizens, and we must continue to seek solutions that include everyone, instead of attacking one group or benefiting a privileged few.

As Massachusetts has shown, it is possible for a broad coalition to come up with a real solution that provides affordable and fair health care for all. It's a great model for the Empire State-perhaps even the starting point for a New York health-care revolution.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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Personal injury lawyers and unharmed plaintiffs abuse the system

Personal injury lawyers often recruit unharmed plaintiffs in an attempt to win big money. These unharmed plaintiffs take compensation away from those patients who have truly been harmed

* Personal injury lawyers have found attacking our healthcare system to be a gold mine. From 2003 to 2004, personal injury lawyers received more than $18 million from medical malpractice lawsuits alone. ("Trial Lawyer Investment Pays Dividends," PRNewswire, May 8, 2006)

* In a scandal that has rocked the U.S. legal system, Dr. Ray Harron made more than $5 million for his work as an "expert-for-hire" in diagnosing many fraudulent silicosis and asbestosis claims. Harron is one of several doctors who contributed diagnoses for more than 20,000 lawsuits. In one day alone, Harron diagnosed 515 people - meaning he had less than one minute a piece to read X-rays and make diagnoses if he worked an eight-hour day. Harron and others were paid significantly more by screening companies for making positive diagnoses. ("Beware the B-Readers," The Wall Street Journal, January 23, 2006)

* Millions of dollars in compensation that should be going to critically ill and dying victims of asbestos exposure is being paid to people who are not sick.

* A study by Academic Radiology had a board of independent doctors reviewchest X-rays that had been entered as evidence by trial lawyers in asbestos lawsuits. In the original trials, doctors paid by trial lawyers to serve as "expert" witnesses concluded that 96 percent of the X-rays showed asbestos-related abnormalities. Doctors conducting the study found that fewer than 5 percent of the X-rays showed such damage. ("The Great Asbestos Deception," San Diego Union-Tribune, August 13, 2004).

* Of the money paid out to date from the largest asbestos trust fund, 60 percent of those payouts have gone to non-injured plaintiffs - each of whom have received an estimated $60,000 despite their lack of injury. ("Diagnosing for Dollars," Fortune, June 13, 2005)

* The legitimacy of evidence used in Fen-Phen class action lawsuits across the nation has been called into question in light of the arrests of former class action plaintiffs in Jefferson County, Mississippi. The former plaintiffs allegedly faked prescriptions of the diet drug in order to collect $250,000 from the $400 million settlement. ("Fen-Phen Arrest Revive Rap on County," Jackson Clarion Ledger, August 7, 2004)

* Since its widely used cholesterol-lowering drug Baycol was withdrawn from the market, Bayer is facing more than 8,000 lawsuits. The New York Times notes that at least 6,000 of those lawsuits, however, are being filed by people who did not suffer any side effects whatsoever. (Scott Gotlieb, M.D., The New York Times, February 26, 2003)

Outrageous personal injury lawyer advertising frightens doctors and patients

* Almost 80 percent of Americans believe advertising by personal injury lawyers encourages people to sue even if they have not been injured. (Sick of Lawsuits National Survey, Conducted by Public Opinion Strategies, August 16-18, 2005)

* Twenty-five percent of patients said they would immediately stop taking a prescribed drug if they saw an ad for a lawsuit involving that drug. (Pharmaceutical Liability Survey, Harris Interactive, July 15, 2003)

* Nine mental health patients in South Mississippi stopped taking their prescribed medications after seeing personal injury lawyer advertising regarding Zyprexa and Risperdal - drugs used to treat patients with schizophrenia and bipolar mania. "People see these ads and they think that they're bad for them, so they quit taking them," said Teri Breister, executive director of the National Alliance for the Mentally Ill in Mississippi. "But these patients' lives have come apart again. Every time they stop taking their medications, the episodes become worse." ("Tort Advertisements Worry Some Health Advocates," Biloxi Sun Herald, March 21, 2004)

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THE GERMAN MELTDOWN

In the past few months, hordes of white-coated doctors have made regular - and noisy - appearances on the streets of German big cities. More than 12,000 employees of university and state hospitals in nine German states have protested long hours and pay levels far below that of their colleagues in the rest of Europe. "The working conditions at the clinics are getting worse and worse," says Athanasios Drougias, of the Marburger Bund, Germany's biggest doctors' union with nearly 105,000 members. And the head of that union, Frank Ulrich Montgomery, recently told German radio that 1 in 3 doctors are now seeking work outside of Germany because of poor working conditions.

The high-profile strikes at about 40 hospitals over the past few months are drawing attention to the difficult working conditions faced by the nation's primary caregivers. But they're also revealing something else: the troubles facing Germany's over-extended social-welfare model, and the long road Angela Merkel's government faces in correcting it. Germany is suffering from rocketing public spending costs and an inflexible labor market that critics say has scared off investors and contributed to the fact that 4.5 million Germans are out of work.

Though still a world-beater in exports, Germany hasn't shown the fervor that economists say is needed to trim social services and battle unemployment. As a result, Europe's traditional economic engine has faltered as countries with more dynamic labor-market policies - such as Britain and Sweden - thrive. The jobless rates of the two economies, at 4.7 and 6.4 percent respectively, are well below that of Germany, which is hovering around 11 percent. More flexibility in their hiring and firing laws, and a willingness to pay top money for high- quality labor, has made Sweden and Britain serious competitors for German medical talent.

In the past three years, doctors have been "fleeing the country," says Mr. Drougias. According to one German doctors' association, 12,000 German doctors are working abroad. Most are on short assignment in the US, says Roland Ilzhoefer, the organization's spokesman. But at last count, 2,600 were registered in Great Britain. More than 1,000 others are in Scandinavian countries, he adds. "We know that doctors here are unhappy with working conditions and the large amount of bureaucracy," he says. "But ... it also has a lot to do with money. They can earn double or triple the amount abroad."

A 2004 comparative study of doctors' wages, conducted by the London-based National Economic Research Associates for the British Department of Health, confirms the claim. Considered by German experts to be the latest and most viable such study, the report acknowledges the difficulty of drawing exact comparisons because of the disparate ways in which countries and research institutes calculate and collect data. Nevertheless, a general trend is clear: Estimates of hospital doctors' average annual earnings in 2002 ranged from $35,000 to $56,000 in Germany; $127,285 in Britain; and $165,000 to $268,000 in the US. Swedish hospital doctor salaries were estimated at only $56,000 a year - similar to the German figures.

The departure of young doctors, coupled with a decreasing number of medical students, has already had an impact on Germany's hospitals, where 3,000 positions are unfilled at the moment, says Mr. Ilzhoefer. The German government seems well aware of this new reality. Chancellor Angela Merkel has called healthcare reform "more difficult than any other" that Germany is being forced to undertake.

The system, which provides patients comprehensive coverage for low monthly payments, currently costs the government 143 euros ($183) billion a year, says Jochen Pimpertz at the Institute for German Economy in Cologne. But employers also shoulder considerable economic burden for the plan. As it stands, they must pay an additional 6.5 percent of an employee's salary toward healthcare. Mr. Pimpertz says the number is already among the highest in Europe, and says that it will only rise in the coming years. As it rises, hiring new workers will become more expensive - and thus less likely to happen, making Germany's labor market less competitive, he says. "Increasing healthcare payments lead to increasing labor costs for companies," says Pimpertz. "That is surely one of the biggest disadvantages to investing in Germany, and it's a major problem for our labor market." The more an employer has to pay for his employee's coverage, the more he is likely to pull up stakes and move on.

"Climbing healthcare costs mean climbing labor costs," says Max Hoefer, director of the German Institute for Health Economics. "This makes products more expensive and leads to automation and, eventually, job cuts." Government proposals for healthcare reform have been stalled by political bickering. The migration abroad, meanwhile, shows no signs of stopping, says Ilzhoefer. In addition, those who do stay are increasingly eyeing other options. "They're no longer going into patient care," he says. "They're becoming medical journalists or working for pharmaceutical companies and consultancy groups."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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ANOTHER TRIUMPH OF SOCIALIZED MEDICINE

A Queensland farmhand was forced to deliver his dead baby in a car beside the road after his wife - having her first child - was turned away from their local hospital and told to drive to another facility three hours away. An investigation has been ordered into why 34-week pregnant Sharon Walker, 35, was not provided with an ambulance for the 270km journey from Emerald to Rockhampton, in central Queensland, and why she was turned away when the hospital knew she was in labour. The examining doctor had warned her that it would probably be a breech birth because the baby had turned in the womb.

Two hours into the trip, the mother's waters broke and the baby's father, Steven Walker, had no option but to deliver the baby son he knew was dead. "Sharon was in pain and was pushing, and I was just there gripping this little baby tight and the thought came over me that this was my son I was pulling out," Mr Walker said yesterday. My panic was starting to rise. When I looked down and I was holding his foot, and he just looked like a really good little baby - it just gutted me. "But most of all I knew that I should not be there, that Sharon should not be going through this."

Mrs Walker said she was feeling pains on the morning of May 16 and rang the nearby Emerald hospital. The midwife told her to come in straight away. She was examined and told there was no heartbeat. The hospital rang her husband and informed him, and said Mrs Walker had to be driven the three hours to Rockhampton because she was "high risk". The doctor gave her a letter for the Rockhampton medical staff in which he said Mrs Walker had dilated 2cm and that it would probably be a breech birth.

State Opposition frontbencher Vaughan Johnson raised the issue yesterday in Parliament, asking Health Minister Stephen Robinson if this was the sort of treatment women could expect under his Government. Mr Robinson said an investigation had been ordered, but later issued a press release in which he said a decision was made by clinical staff at Emerald for the patient to travel to Rockhampton, and that labour commenced in transit. Mrs Walker denied that yesterday, saying she was having pains seven minutes apart at Emerald, and the doctor had said in his referral letter that she was already dilating. "What I don't understand is why an ambulance was not ordered when they knew I was giving birth," she said. "I knew we couldn't make it and I yelled at Steven to pull over because I could feel the baby coming. "He stopped at a little store, raced in and screamed to call an ambulance, came out, tore my clothes off and he could see the feet already."

Mr Walker said he was "operating on adrenalin but was unable to pull the baby's head out. "I was afraid I would lose Sharon. We knew the baby was dead, but I didn't want to lose them both," he said. The ambulance arrived and officers helped deliver the baby. "We were put in the ambulance and the baby was wrapped in a blanket and put in with us," Mrs Walker said. "He was a beautiful, fully formed little boy. We named him Marshall Henry Walker, and held a funeral service for him in Rockhampton two days later. "I never want this to happen to anybody else."

Source






HUGE INCREASE IN SPENDING ON NHS STILL NOT ENOUGH

Bureaucracy is a bottomless pit

The NHS deficit more than doubled last year to 512 million pounds, the Government announced yesterday. This is more than twice the target of 200 million set at the start of the year and makes it the second successive year in which the NHS has failed in its statutory duty to break even. At least 15,000 jobs are to go in the attempt to cut costs.

However, such was the expectation of an even bigger deficit that Patricia Hewitt, the Health Secretary, was able to announce the figure with a sense of relief. It is less than the 620 million predicted at the half-year and hundreds of millions less than some expected. Ms Hewitt said that the deficit was concentrated in a relatively small number of organisations, was not the fault of reforms and that she would be “held accountable” if the NHS did not return to overall financial balance by next April.

Sir Ian Carruthers, acting chief executive of the NHS, said that patient care was improving, in some cases dramatically, but admitted the deficits were a “blot on the landscape”. Andrew Lansley, the Shadow Health Secretary, said that the figures would deepen “the crisis of confidence in the Government’s stewardship of the NHS”. He added: “The gross deficit — the figure for NHS trusts and primary care trusts — is 1.27 billion pounds. It is this vast sum that directly gives rise to the serious consequences in cuts in services and frontline posts. “The Health Secretary is living in a parallel universe, in which everything gets better and nothing is wrong. Hard-working NHS staff are in the real world, where they deliver in spite of the Government’s policy failures.”

A breakdown of figures shows that in 2005-06, primary care trusts (303 organisations) were in deficit by 476 million pounds, compared with 272 million in 2004-05. Acute trusts had a deficit of 545 million (246 million), while teaching trusts’ deficit was 62 million (78 million). The overall figures would have been much worse if strategic health authorities (SHAs) had not managed to save money, underspending by 524 million. That surplus, set against the overall NHS deficit, halved the total overspend. Overall, 31 per cent of the 566 NHS organisations failed to break even in the year 2005-06, compared with 28 per cent the year before.

Niall Dickson, chief executive of the King’s Fund think-tank, said that the figures masked the true scale of the financial problems. “The gross deficit has increased throughout the NHS to 1.27 billion and has been reduced to a net of 512 million only by using increased surpluses from other parts of the service” he said. “In fact, more NHS organisations are in deficit than predicted, while the net deficits for primary care trusts and hospitals are worse than last year.” Sir Ian also released his annual report on the NHS yesterday, which highlighted how waiting times have fallen to the lowest level recorded. The NHS was on target for a 20 per cent drop in cancer deaths in under-75s by 2010, and a 40 per cent reduction in heart and stroke deaths.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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BRITISH DOCTORS NOW TO BE REWARDED FOR BEING GOOD BULL-ARTISTS

Every doctors' surgery is to be inspected and awarded Michelin-style stars so that patients can tell the quality of care offered by their GP at a glance, The Times has learnt. Expert panels will give family doctors one of three gradings in a move backed by ministers desperate to show that patients are getting value for money from huge GP pay rises. The scheme, being drawn up by the Royal College of General Practitioners, will run alongside government plans to publish detailed patient surveys of each surgery's performance.

Ministers want to increase the pressure on GPs to perform after salary rises last year took average annual pay to 94,000 pounds. Critics believe that the GP contract was bungled and won too little in return for the NHS. The new GP ratings will be reviewed - with the possibility of upgrade or demotion - every three years after a two-day assessment by a panel including a doctor, nurse, surgery manager and patient representative, The Times understands. Britain's 10,500 GPs will be encouraged to display their rating on a plaque outside their surgery and also on letterheads. Practices that repeatedly fail to achieve the basic level can expect to be replaced.

The scheme should be in place by next April. Around 2,000 surgeries have so far signed up to a forerunner scheme called practice accreditation. Mayur Lakhani, chairman of the college, said that the rating system would improve standards and make the system more "customer-focused".

Dr Lakhani, who is also visiting professor in the Department of Health Sciences at the University of Leicester, said that it would provide patients with a clear indication of qua-lity, not dissimilar to the Corgi rating given to plumbers. It will apply to all providers and help patients to choose between the growing number of private health firms looking to move into the family doctor sector. "This would be the most important advance in general practice in a generation," Dr Lakhani said. "At the moment we don't really know what the accreditation is, what it represents. As a result you get a small number of practices that aren't up to scratch and we have no mechanism, no handle, on how to get things to improve."

The minimum standard - a Level 1 rating - will require GPs to pass a wide range of assessments. These include opening hours, prompt telephone answering and flexible booking to fit in with patients' busy lives as well as the standard of facilities and quality of care from doctors and nurses. Levels 2 and 3 will be judged on similar but higher standards, with the top grade requiring extra measures such as research into patient needs and greater responsiveness to community needs.

The Times can also reveal that six million patients will be asked to assess their GPs over the next year after complaints about problems in booking appointments embarrassed Tony Blair on live television during the general election. Anonymous results will appear on primary care trusts' websites so that the public can compare surgeries. Sources at the Department of Health confirmed that Patricia Hewitt, the Health Secretary, strongly supported the ratings as a way to regulate general practice and inform patients better.

The drive for more information was given extra impetus when Mr Blair admitted during the election that he was "astonished" after an audience member said that she could not book a GP appointment. Surgeries were refusing to book ahead so that they met government targets to see everyone within 48 hours of an appointment being made.

Dr Lakhani added that failure to reach Level 1 would put the surgery at risk of being dropped by the local primary care trust. He said that GPs would require considerable support to assist with regulation and reform, which the college would help to provide. He will outline the broader changes to the profession in a conference speech this week.

Source






Public hospital negligence in Victoria, Australia

A top Victorian surgeon has blamed communication and system failures at the Royal Children's Hospital for a medical disaster that left a baby brain-damaged. Prof Paddy Dewan told a medical inquiry yesterday he was astounded not only that a toxic glucose dose was put in the boy's drip, but also that the treatment continued unchecked. The pediatric surgeon labelled the child's case an "unbelievable scenario" compounded by an overlap of medical and surgical unit care.

The Medical Practitioners' Board of Victoria is investigating unprofessional conduct claims against three doctors in the wake of the tragedy. Dr Lea Lee Foo, Dr Shobha Iyer and Dr David Tickell face potential penalties ranging from counselling to deregistration if found guilty. Dr Foo is accused of ordering the wrong intravenous drip fluid solution. The two others are accused of failing to properly examine the child and check his fluid treatment. The doctors deny being unprofessional.

The disciplinary hearing has been told the baby, who cannot be identified, suffered permanent brain damage after he was given a glucose solution 10 times stronger than advised. The boy was admitted suffering vomiting and was diagnosed with an abdominal problem that needed routine surgery. The drip was inserted in the early hours of September 19, 2001.

Prof Dewan said he had discussed the baby's condition and treatment with the boy's father, Dr Foo, registrar Dr Gehan Roberts and at least one nurse for up to an hour. It was agreed 50 per cent glucose would be added to an intravenous drip mix to make up a 5 per cent solution. Instead, the baby was given a 50 per cent glucose concentration. "To give an infusion of 50 per cent dextrose is a toxic solution and that was not the order that I gave," Prof Dewan said. He believed the registrar clearly understood the instruction, but conceded the junior doctor may have been confused.

Asked about a program the hospital had brought in to encourage staff to speak up about concerns, Prof Dewan replied: "Junior staff and nurses are not going to speak up if they see a professor getting fired for doing so." The hospital sacked Prof Dewan three years ago after the board decided his relationship with surgeons had deteriorated beyond repair. Before his sacking, he aired allegations about patient safety risks.

Nurse Jayne Morrison told yesterday's inquiry she held up a piece of paper to Dr Foo to confirm it was the right order, but did not discuss it.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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THE NHS GOOFS AGAIN

They tried their best to condemn a large group of people to death

A cancere drug that the Government value-for-money watchdog wanted to deny to NHS patients has celebrated five years of use with stunning results. Glivec, the biggest breakthrough in cancer therapy for a generation, has kept alive 90 per cent of the patients with chronic myeloid leukaemia (CML) who have been taking it in those five years.

Yet, if the National Institute for Health and Clinical Excellence had had its way, many would never have received the drug. Its initial advice, in May 2002, staggered patients and specialists involved in the trials as well as the maker, Novartis. But after an outcry it reconsidered its advice, making the drug available to more patients.

Yesterday, at a meeting in London, survivors gathered to hear the latest data. Sandy Craine said: "When Glivec became available five years ago, I would never have believed I would be standing here today. "I was diagnosed in 1999 in the accelerated phase of CML and was told that, without invasive chemotherapy, followed by a stem cell transplant, I had about 12 months to live." Ms Craine travelled to the United States to get on to a trial of the drug. "Glivec saved my life," she said.

There are between 600 and 800 cases of CML diagnosed in the UK each year. It is a cancer of the bone marrow, caused by an unusual rearrangement of chromosomes 9 and 22, generating a new chromosome that in turn produces a protein that drives the disease. Professor Charles Craddock, of the University of Birmingham, said that before Glivec the outlook for such patients was "pretty gloomy". A bone marrow transplant could cure a minority. Some found the drug interferon alpha effective, but at the cost of permanently feeling that they had flu.

Glivec was fast-tracked by the US Food and Drug Administration and licensed in record time, on June 5, 2001. Since then, more than 1,000 patients have been followed. In 90 per cent of those on Glivec, the aberrant chromosome was eliminated. "There was major scepticism that a single drug would give a prolonged response, but it has," Professor Craddock said. "In 10, 15 or 20 years' time, we could have treatments based on the Glivec experience that knock out the cells that cause the problems."

The side-effects of Glivec are not negligible, but they are less than those of interferon alpha. The drug also works well for a rarer cancer: gastro-intestinal stromal tumours (GIST), which form in the digestive system. Before Glivec, there was no treatment for GIST except surgery, and the tumours often returned. The drug has greatly extended the survival of GIST patients and in many the tumours have disappeared.

The drug costs 14,000 pounds per patient per year, and for some patients with CML a bone marrow transplant may still be preferred, but for GIST patients there is no alternative. Thalidomide, notorious for causing birth defects in thousands of children in the 1960s, significantly increases survival in patients with multiple myeloma, a study shows. The results were reported to the American Society of Clinical Oncology yesterday.

Source






A NHS DEATH SENTENCE AVOIDED VIA PRIVATE MEDICINE

A delivery driver's life was saved when his colleagues paid for a brain scan that revealed a life-threatening tumour. Gary Harris, 38, had been put on a three-month waiting list for an NHS scan but was later told by doctors that he would have died within two weeks had he not had an emergency operation to remove the tumour.

All 60 employees at Park Furnishers, Bristol, paid 12 pounds each - a total of 720 pounds - to cover the cost of having the scan done privately because Mr Harris was convinced that there was something seriously wrong. Mr Harris, a keen cyclist, said: "My workmates made sure I could live. How can I ever repay or thank them for such unimaginable kindness?" He had experienced dizziness and vomiting over five months, and went to his GP several times. He said: "I could count on one hand the number of times I had visited the doctor before all this. So in November last year, when I started experiencing dizziness and vomiting, I knew something was seriously wrong."

During the next four months GPs from The Crest Family Practice in Bedminster, Bristol, diagnosed winter vomiting sickness, vertigo, stress and possible eye strain. After one attack of vomiting and numbness he visited an accident and emergency department, where he says that he was told to take ibuprofen and paracetemol. He said: "Eventually they agreed for me to see a neurologist at the beginning of April. He thought it was neck arthritis from the cycling but said he would put me on the list for a CT scan as a precaution. That wasn't going to be until July. "He could have sent me straight away for an emergency scan, but decided not to. "Then my warehouse manager came and told me to get a private scan and not to worry about the cost. It took my breath away."

The scan took place on April 27, and revealed a large tumour that had started attaching itself to his brain stem. The next day he was admitted to Frenchay Hospital, where he underwent more tests and had a drain inserted to remove fluid on his brain before undergoing 13 hours of surgery a week later. Mr Harris said: "The neurosurgeon at Frenchay, Mr Porter, told me without an operation I would have two weeks to live. It would have been a painful and unpleasant death. "He told me my brain would have been crushed as the tumour was so big. If I had relied on the NHS I would have died seven weeks before the scan they offered me."

Mr Harris was discharged from hospital on May 17. The surgeon told him that his recovery was remarkable. Mr Harris's wife, Kim, 28, with whom he has a daughter, Gracie, 4, has given up her job to look after him. She said: "For months our lives were on hold. We couldn't do anything and we just didn't know what was wrong. When the scan showed up the problem it was almost relief that it had a name. "Then reality set in that we could be about to lose him. We can't describe how grateful we are."

Last week staff at Park Furnishers were handed a note with their payslips from Deryn Coller, the company director. At the top was written: "Last month you saved someone's life." He also added 20 pounds to everyone's pay to thank them. Alfie Dibble, Mr Harris's manager, said: "Gary is a great bloke and it was never an option not to help him. Everyone feels very emotional about what he's been through and proud to have been able to help." Mr Harris intends to pursue complaints against the doctors he consulted. The GP surgery declined to comment.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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Analysis: Massachusetts Health Care Plan Intrusive, Expensive

The new Massachusetts health plan has dominated the policy conversation recently, causing more division among conservatives than liberals. The law, designed to make the state the first in the nation to achieve universal health coverage, was signed April 12 by Gov. Mitt Romney (R). He was flanked at the by-invitation-only signing ceremony by the Democratic leaders of the Massachusetts legislature and by U.S. Sen. Ted Kennedy (D-MA), a longtime advocate of universal health coverage. The biggest concern among conservatives is the requirement that every individual in the state must purchase health insurance or face financial penalties. Such mandates are almost impossible to enforce, even with the fines and other enforcement provisions in the law. Further, the state must specify what kind of insurance people are required to buy and how much they should pay, taking away the ability of markets to compete freely and for people to purchase the coverage of their choice.

Market-oriented analysts are also concerned about the back-door employer mandate. The Massachusetts legislature wanted to force employers with 11 or more employees to pay a $295 annual fine for each employee without health insurance. The governor vetoed the provision, but leaders of the heavily Democratic House and Senate have said they will override.

House Speaker Salvatore DiMasi (D-Suffolk) called the veto disingenuous, saying the law was crafted with concessions and compromise. "To change anything will disturb the delicate balance that made this law possible," DiMasi said. Note to employers: $295 is only the beginning.

While many free-market groups--such as the Pacific Research Institute, Cato Institute, and Council for Affordable Health Insurance--have been highly critical of the Massachusetts plan, the conservative bellwether Heritage Foundation was very involved in helping the governor craft the legislation. The governor credits Heritage with creating the new Federal Employees Health Benefits Program-like insurance connector to offer insurance options and collect and distribute premiums. Bob Moffit of Heritage stood behind the governor at the signing ceremony.

An integral provision in the new plan is the requirement that every employer with more than 10 employees, such as your local automotive garage, must offer a Section 125 cafeteria plan so employees can use pre-tax money for their insurance premium contributions. And that's only the beginning of the reporting requirement, mandates, penalties, and other enforcement provisions in the new law. For example:

* The law requires every employer and employee in the state to sign "under oath" a Health Insurance Responsibility Disclosure form, testifying to whether the employer has offered insurance and whether the employee has accepted or declined.

* It creates at least 10 new boards and commissions to create and run the new health system, such as the Health Care Quality and Cost Council, Payment Policy Advisory Board, and Health Access Bureau.

* New and existing state agencies will be checking on individuals' insurance status, monitoring their income to see whether they qualify for subsidies, and tracking individual health habits (such as smoking and wellness activities) to determine their insurance rating category.

The plan also includes a major expansion of Medicaid and the State Children's Health Insurance Program to cover children in families with incomes up to 300 percent of the poverty level. The state has made it clear it is doing all it can to maximize collection of federal matching funds to help finance the new plan.

My biggest concern is over the financing. The state says it is just moving money around--redirecting about $1 billion in uncompensated care money to subsidize health insurance for those under 300 percent of the poverty level (about $50,000 a year for a family of four). But there is nothing in the law to keep health insurance costs from soaring. Policies offered through the new health insurance connector must have first-dollar coverage and include all of the 40 coverage mandates on the books, with none of the provisions that are working in the private sector to engage consumers as partners in managing health costs. Estimated premiums are unrealistically low and will quickly lead to higher taxes and "assessments" on individuals and employers.

Nonetheless, newspapers around the country are falling over each other in their effusive praise of a Blue state, led by a Republican governor, building a bridge across the political chasm to go where no state has gone before. Romney's term ends this year, and he is likely to be spending a lot more time in Iowa and New Hampshire than in Massachusetts as this plan gets up and running. The worry is that he has laid the foundation for what can become a very intrusive, onerous, and expensive health plan for Massachusetts. Other states, which are firing up their photocopiers now, should wait to see how this works out before rushing to follow the Bay State's lead.

Source






More stupid and self-defeating government penny-pinching

Queensland taxpayers are paying millions extra for costly open-heart surgery because of restrictions on more cost-effective preventative heart operations. In its latest Australian hospital statistics 2004-05 report released last week, the Australian Institute for Health and Welfare said Queensland hospitals were performing 20 per cent fewer operations to prevent heart attacks and 17 per cent more operations to treat heart attacks compared with other states.

Historical under-funding and quotas placed on hospitals and doctors from performing less-expensive coronary angioplasty operations have been blamed by medical groups for what they say is a "backward" situation. They say patients prevented from having an angioplasty often end up needing more expensive coronary bypass operations which also have greater risks. Cardiac Society of Australia Queensland president Con Aroney said his group had been warning about the imbalance for years. He said there were significant differences between the two operations.

Dr Aroney said coronary angioplasty was a less expensive and less invasive form of surgery done through keyhole-type incisions in the groin rather than opening the chest. "It involves unblocking arteries using a catheter procedure rather than using open-heart surgery to do a bypass," he said. "The costs are very different - from several thousand dollars for an angioplasty compared with tens of thousands for open heart."

"Angioplasties are recognised around the world as the most contemporary and effective form of treatment for heart disease," Queensland Health chief health officer Dr Jeannette Young said. Australian Medical Association Queensland president Zelle Hodge said it was fair to say that patients that "need an angioplasty and don't have it, will be more likely to need a bypass". "It is very important that people who could be treated by angioplasty are done so," Dr Hodge said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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NHS refuses to fund new prostate therapy for men

Hundreds of men are being denied an alternative to radical surgery for prostate cancer because the National Health Service is refusing to pay for it. Hard-up primary care trusts across England have stopped funding brachytherapy, a new form of radiotherapy, although it has been approved by the National Institute for Health and Clinical Excellence (Nice).

Doctors and patient groups have accused the NHS of discriminating against men. John Neate, chief executive of the Prostate Cancer Charity, said: "Nobody should have to battle bureaucracy when they need all their energy to come to terms with a diagnosis."

Brachytherapy has fewer side effects than removing the prostate or giving radiotherapy for five days a week over seven weeks. Only 10%- 15% of men are left impotent after brachytherapy, compared with about 50% of men who undergo surgery.

The 9,000 pound treatment takes just one day. The patient has radioactive pellets implanted into the prostate gland. These target and kill the cancer.

Brachytherapy is not suitable for all prostate cancer sufferers but doctors believe that it is the best treatment for patients who have small tumours which have been caught at an early stage. Stephen Langley, a consultant at the Royal Surrey County hospital in Guildford, one of about 10 in England offering brachytherapy, said: "A similar number of men die from prostate cancer every year as women who die from breast cancer, but there is a fraction of the money going into prostate cancer."

The issue will be raised this week at the British Medical Association's staff and associate specialists conference. The Department of Health said: "With devolved decision-making, trusts can make different choices. The principle of local autonomy is important."

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VAST NHS COMPUTER BUNGLE

Evidence that the government's troubled 20 billion pound National Health Service computer system has lengthened waiting times for patients has emerged for the first time. It was hoped that a pilot scheme for the technology at the Nuffield Orthopaedic Centre NHS Trust in Oxford would show the benefits of the delayed system. Instead, when it went "live", the computers crashed, data could not be found and some patients found that they were facing among the longest waits for operations in the country.

In December 2005, just 12 people were waiting more than six months for an operation in England. But in the same month the Connecting for Health computer systems were launched at the Nuffield and the number of people waiting longer than six months started to rise. Within a few weeks more than 100 people in England were waiting longer than six months, most of them at the Nuffield, which insists that the problem is now resolved.

Staff who were instructed to sort out the problem could not even establish from the malfunctioning computers which patients had been waiting the longest and the numbers kept climbing. Details of the waiting list problems at the Nuffield, released under the Freedom of Information Act, will increase pressure on the government for an independent review of the scheme.

Lord Warner, the health minister, confirmed last week that the system was already delayed and would cost up to 20 billion pounds. The figure originally given by the government for the project was 6.2 billion.

The problems at the Nuffield were so severe that hospital managers could not even compile accurate data for the Department of Health on patients waiting to be treated. Figures now released by the hospital show that it repeatedly breached the government's key target of keeping no patient waiting longer than six months for an operation. On March 31 the number of patients waiting longer than six months for an operation was 123, out of a national total of 199 patients. This meant that the hospital, in most areas one of the best performers, had temporarily fallen to the bottom of the national league table for patients waiting longer than six months.

Leon Price, 31, who had to wait longer than six months for a back operation, said: "You have to wait long enough to be seen without problems like this. It's ridiculous that people were waiting even longer because of a faulty computer system."

The hospital is now confident that it has addressed the problems and that no patients are breaching the government's key six-month waiting target. Computer experts say the problems at the Nuffield highlight the need for a national review of the programme.

Ross Anderson, a professor in security engineering at the University of Cambridge, warned that the new system was likely to cause "chaos and disaster" in the NHS. "They're ripping out the old systems but they're not replacing them with anything better," he said.

The Connecting for Health scheme is intended to create centralised medical record systems for 50m patients and link more than 30,000 GPs in England to 300 hospitals by 2012. Many doctors and IT experts are concerned that a centralised system will make the NHS even more vulnerable to damage from computer failures. Connecting for Health said that the old computer systems at the Nuffield were in a state of near collapse and the new ones would improve patient care, although there had been initial problems. "It did cause disruptions to some patients, for which we are sorry," said a spokesman.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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MORE NHS PENNY-PINCHING

But there's plenty of money to pay hundreds of thousands of bureaucrats

Cancer charities reacted with anger and disappointment yesterday to new recommendations from the health watchdog not to make two new treatments for bowel cancer available on the NHS. In draft guidance, the National Institute for Health and Clinical Excellence (NICE), said it did not believe that the treatments bevacizumab (Avastin) and cetuximab (Erbitux) were cost effective. The guidance, which is not final and is open to consultation, said that Avastin should not be recommended for use as the primary treatment for somebody with advanced bowel cancer. Erbitux is not recommended for any second line treatment, after other treatments have failed, of advanced bowel cancer.

Ian Beaumont, of Bowel Cancer UK, said the charity was very disappointed at the decision, given the proven efficacy of the drugs and that the UK had been in the forefront of their development. “It looks as if we will, once again, be at the very back of the queue when it comes to being able to make them available to patients. “It is also very hard not to be angry and cynical when NICE appears to be making its decisions on the basis of financial expediency rather than clinical efficacy,” he said.

Joanne Rule, chief executive of the charity Cancerbackup said that the new treatments were already widely available in the private health care sector. The charity Beating Bowel Cancer said that all bowel cancer patients should be entitled to the best course of treatments available to each of them, regardless of their ability to pay.

Andrea Sutcliffe, deputy chief executive of NICE, conceded that Avastin does show some increased benefit over the standard treatment for bowel cancer, but said it did not justify the cost. NICE had been unable to say whether Erbitux was better than any other existing treatments. “Neither of these drugs represents a good use of scarce NHS resources,” she said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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Is the U.S. stealing health care workers from abroad?

It's become a stock image in the immigration debates: the flooded emergency room, halls packed with sick illegals seeking subsidized care. But now that image's negative is at the heart of a far smaller battle-not over the immigrants awaiting care in the E.R., but the immigrants providing it.

The immigration bill passed by the Senate last week includes a provision that would allow unlimited entry to foreign-trained nurses until 2014, and as a committee attempts to reconcile that bill with the less permissive House version, an open door policy for foreign nurses has a shot at becoming law. A free flow of RNs may seem like sound policy for a country in the midst of a severe nursing shortage, but opponents claim it's parasitic, emblematic of a ruinous American practice of stealing skilled labor from poor countries that can ill afford to export their most educated workers. The Philippines, in particular, seems to be hemorrhaging nurses, while the U.S. soaks up thousands of Filipino-trained RNs annually. Last week, a New York Times article, headlined "U.S. Plan to Lure Nurses May Hurt Poor Nations," implied that the Philippines' health system risks collapse if the U.S. keeps it up. Talking Points Memo Blogger Nathan Newman excoriated supporters of the Senate provision, complaining that " The U.S. refuses to invest in training and education of our own population, then instead leeches off the tiny investments in education done by developing countries."

The vision of American hospital administrators prowling the streets of Manila poaching nurses from Filipino hospitals presupposes that the number of Filipino RNs is fixed, completely independent of U.S. demand. But that hasn't been true for at least half a century. According to Catherine Ceniza Choy's 2003 book Empire of Care, Americans began training Filipino nurses in 1907, and the first wave of Filipino-trained nurses arrived in the United States between 1956 and 1969 as part of an Exchange Visitor Program. The Philippines has since become the world's largest exporter of trained nurses according to the World Health Organization. Filipino nurses trained in Americanized schools in English have been showing up in the U.S. for decades and in droves, and a nursing education has long been seen as a ticket out.

The government of the Philippines clearly thinks it gains something when America "leeches" off its investment. The government has consistently lobbied for more, not fewer, nursing visas in the United States and United Kingdom, with an eye on the massive remittances nurses send back to families still at home. The Philippines is heavily dependent on money sent from abroad; the government is famous for encouraging its citizens to leave, and eight percent of its population resides abroad as domestic workers in Malaysia, English teachers in China, and nurses all over the developed world. According to the Philippines Central Bank, large scale labor migration brought home remittances totaling $9.7 billion last year, and nurses have historically been among the most stable earners.

If the United States agreed to take in fewer nurses, would Filipino hospitals suddenly be flush with staff? Not likely. According to a 2005 report by the International Council of Nurses, new Filipino graduates "report that they can't find jobs in nursing." It's true that the Philippines suffers from a nursing shortage, but it doesn't suffer from a lack of trained nurses. Its hospitals are simply too poor to employ adequate numbers of them. That's a tragedy, but it won't be solved by slamming the gates at the U.S. border. Underfunded health care programs are a symptom of poverty, not of poaching. If the United States were to turn away nurses seeking placement, they would simply fill vacancies in every other developed country-the current nurse dearth is a global phenomenon affecting every region on Earth. U.S. demand has created supply in the Philippines: The medical professionals leaving now-at least some of whom will eventually return-would have been far less likely to invest years in study and training without the prospect of high pay abroad.

The Philippines won't suffer for the opportunities America offers its citizens. But it's not for well-meaning Westerners to decide where a health care worker would be "better off" anyway. Workers are not the property of countries that train them, and any policy that seeks to limit their options will prove cruelly restrictive. After all, stemming the flow of skilled labor doesn't just mean locking workers out of wealthy nations. It means locking them into poor ones.

Source





Australian Medical School biases to be investigated

There are four generations of doctors in Lucy Verco's family and yet, despite recieving 99.9 in her academic results, she was rejected by the University of Adelaide's school of medicine. Ms Verco said she felt "insulted" after being told she had not made the grade following an interview. The 20-year-old is now studying medicine at the University of Melbourne.

Federal Education Minister Julie Bishop has ordered medical experts to investigate methods for selecting medical undergraduates, after The Australian reported concerns that students applying for medical school places were being subjected to "personality assessments".

Ms Verco received the near-perfect results in her Tertiary Admissions when she finished Year 12 in 2003. "I thought the point of the interview was to show that students didn't have any psychological issues or anything like that," Ms Verco told The Australian. "If I'd been tripped up on my marks I could have thought I could have worked harder but it wasn't my fault. "It was quite personally insulting to find that a 30-minute interview could determine that I was a bad person or that I wouldn't go through."

The concerns about "personality assessments" include claims that medical schools were asking students their views on the Iraq war and gay marriage. Adelaide University's former deputy chancellor Harry Medlin has also criticised the institution's medical school for an unwritten discrimination policy against private-school students and the children of doctors. The Australian understands at least six children from prominent medical families have been rejected during the Adelaide University interview process in the past three years.

But the interview process has been defended by eminent educators including professors Peter Smith and Richard Henry of NSW University's faculty of medicine. It is argued the structured interview leads to a selection of a "better cohort of medical students who make better doctors". They argue knowledge and skills form only part of what makes a good doctor.

Ms Verco was educated at Adelaide's exclusive girls' school Wilderness and is the daughter of highly regarded Adelaide obstetrician Christopher Verco. Her grandfathers and great-grandfather were specialist doctors. Her great-great-uncle was dean of the university's faculty of medicine. Ms Verco's mother is Judith Sloan, an economist whose credentials include being a commissioner with the Fair Pay and Productivity commissions and a director of Santos.

Ms Verco said the interview process was fraught with problems as students were asked different questions in each interview. Apart from the usual questions about teamwork, difficult situations she had faced and her strengths and weaknesses, Ms Verco was asked how she would deal with the family of a deceased cancer patient who had found a cure overseas via the internet. "I think it's a difficult question to ask a 17-year-old. Even if you're a 45-year-old oncologist it would still be very hard," she said. She was not specifically asked about her family history.

Professor Sloan has pursued the university since her daughter's rejection in early 2004 in the hope of effecting change for future students. "(The interview process) is supposed to be the great leveller but people spend a lot of money on preparations for the (exams) and people lie (in the interview)," Professor Sloan said. The university's Health Sciences faculty executive dean, Justin Beilby, said the process had been validated and that there were set questions.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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BRITISH COMPUTER BLOWOUT

Doctors are cautioning that a failure to consult staff and patients over the new multibillion-pound NHS computer system will add to a 2½-year delay announced by ministers. The British Medical Association (BMA) said that patients should be asked for consent before their details were put on the national electronic database. But the Government, which is planning to presume patient consent, said that this would take up extra time for doctors on a system already suffering serious delays.

The price of an electronic system to keep records is set to rise from 6.2 billion pounds to about £20 billion, Lord Warner, the Health Minister, said yesterday. The system, which will computerise records for 50 million patients, will not be ready until 2008, and is likely to be criticised in a National Audit Office report next month.

Hamish Meldrum, chairman of the BMA’s GPs Committee, said: “Family doctors are concerned that this scheme . . . is trying to do too much too quickly and could threaten patient confidentiality.” The program, Connecting for Health, has four main projects: online booking; centralised, electronic medical records; e-prescriptions; and fast network links between NHS organisations. A spokesman for the Department of Health said: “The NHS IT program is one of the largest IT projects in the world and will revolutionise patient care. As with any large, complex program there will be difficulties.”

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U.K.: Patient surgery choice extended

Surprise! A choice between a dirty State-run tweedledum and a dirty State-run tweedledee is not attractive to patients

Patients are to be given a choice of hospitals across England for operations as a key NHS reform is expanded. Ministers will announce later that the 32 foundation trusts will be added to the list of local hospitals patients currently choose from. From the start of this year, people have been able to choose from at least four hospitals for elective surgery. But patient groups said people tended to want to stay local so the extra choice would not mean a great deal. Patient choice has been one of the government's key reforms to make the NHS more patient-friendly.

Since January, patients have had a choice of at least four hospitals for treatment, one of which can be a private centre. Many primary care trusts included more than the minimum of four on their lists, to which they will now add the 32 foundation trusts, top performing hospitals which have been given more autonomy than other hospitals. By 2008 patients will be able to choose any hospital in the country.

But despite the government's enthusiasm for the reforms, opinion polls have consistently rated it as a low priority for patients. The Department of Health's own research published at the launch of patient choice in January found that eight out of 10 knew little about it. And only 14% would be prepared to travel outside their area for treatment.

The roll-out has also been hampered by delays to the 6.2 billion pound IT upgrade. As part of the project, a system called choose and book was meant to set up to allow appointments to be made online. But only a quarter of GP surgeries had the system in place at the beginning of the year and a fifth still do not have it, the latest figures suggest.

Patients Association chairman Michael Summers said: "We were very much in favour of patient choice when it started. Patients have told us that they appreciate having choice of local hospitals. "However, it also seems they are not all that interested in being able to go to hospitals anywhere in the country. "People don't want to travels miles and miles. There are exceptions where this will not be the case, but on the whole extending the choice does not mean a great deal to many."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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Why Is the Best Sunscreen Blocked by FDA?

We think of July and August as the peak of summer, but when it comes to sunburn, now is the peak. Next Tuesday, June 21st, is the longest day of the year, when the sun is highest in the sky, so it's now that the sun does the most damage. Like most people, you probably think you know what to do about it. You slather on the sunscreen when you're out in the sun.

Our suntan lotions are good at screening out the sun's UVB rays - the ones that cause sunburn and skin cancers - but most people don't realize their sunscreens don't offer much protection against UVA rays, the ones that put wrinkles in your skin. "Ultraviolet A light ages your skin. And the reason it does that, it's a longer wavelength, so it can penetrate deeper into the skin, and instead of attacking the upper layers of the skin where skin cancer often forms, it attacks the layers that give your skin its tone, its elasticity, as we call it. . You get the lines, the wrinkles, all the things associated from aging," said Dr. Darrell Rigel, clinical professor of dermatology at New York University

But there's good news. Lotions that contain the ingredients Oxybenzone, Titanium Dioxide or Parsol 1789 block out some UVA rays. Doctors say a chemical called Mexoryl offers even better protection. "It produces a product which gives us almost perfect protection against sunshine," said Dr. Vincent DeLeo, chairman of dermatology at Columbia University. People are happily protecting themselves with Mexoryl on the beaches of Rio de Janeiro, the streets of Paris, in Canada, Mexico and Australia. Mexoryl "is the No. 1 individual ingredient in terms of protection from Ultraviolet A radiation," Rigel said.

But even though dermatologists say Mexoryl is the best, you cannot legally buy it in the United States. It's illegal, because the Food and Drug Administration won't approve it. They won't even say why. The FDA is charged with making sure no drug is sold unless the government is convinced it's safe and effective. Dermatologists think it's just stuck in the bureaucracy. It routinely takes 12 to 15 years for a drug to get approval. After an approved drug - Vioxx, for example - gets bad publicity as a health risk, the FDA gets particularly cautious.

But is there no common sense here? All drugs have risks as well as benefits. Mexoryl has been in use in other countries for 13 years. It's passed many safety tests. Why won't our FDA even talk about it? Although buying or selling sunscreens with Mexoryl is illegal in the United States, that doesn't mean sunscreens with Mexoryl aren't bought and sold here. We found it at some pharmacies. It was expensive - $30 to $50. "People really want this stuff. People go to pharmacies and they keep it under the counter, like it's a secret ingredient, like prohibition or something and people will still buy it," Rigel said. I don't fault the pharmacies, they're serving their customers.

Everyone is always telling us, protect yourself from the sun, but then the government won't give us permission to have the best sunscreen?

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Theory, Evidence and Examples of FDA Harm

To obtain permission to market a drug, the manufacturer must satisfy the FDA that the drug is both safe and effective. Additional testing often enhances safety and effectiveness, but requiring a lot of testing has at least two negative effects. First, it delays the arrival of superior drugs. During the delay, some people who would have lived end up dying. Second, additional testing requirements raise the costs of bringing a new drug to market; hence, many drugs that would have been developed are not, and all the people who would have been helped, even saved, are not.

In addition, because FDA approval is mandatory, industry and medicine must heed FDA standards regardless of their relevance, efficiency, and appropriateness. Not all testing is equally beneficial. The FDA apparatus mandates testing that, in some cases, is not useful or not appropriately designed. The case against the FDA is not that premarket testing is unnecessary but that the costs and benefits of premarket testing would be better evaluated and the trade-offs better navigated in a voluntary, competitive system of drug development.

Three bodies of evidence indicate that the costs of FDA requirements exceed the benefits. In other words, three bodies of evidence suggest that the FDA kills and harms, on net. First, we compare pre-1962 drug approval times and rates of drug introduction with post-1962 approval times and rates of introduction. Second, we compare drug availability and safety in the United States with the same in other countries. Third, we compare the relatively unregulated market of off-label drug uses in the United States with the on-label market. In the final section, before turning to reform options, we also discuss the evidence showing that the costs of FDA advertising restrictions exceed the benefits.

Comparison of Pre- and Post-1962

Sam Peltzman (1973) wrote the first serious cost-benefit study of the FDA. He focused his attention on the 1962 Kefauver-Harris Amendments to the Food, Drug, and Cosmetics Act of 1938, which significantly enhanced FDA powers. The amendments added a proof-of-efficacy requirement to the existing proof-of-safety requirement, removed time constraints on the FDA disposition of NDAs, and gave the FDA extensive powers over the clinical testing procedures drug companies used to support their applications.

Using data from 1948 to 1962, Peltzman created a statistical model to predict the yearly number of new drug introductions. The model is based on three variables, the most important of which is the size of the prescription drug market, lagged two years. The idea is that if the prescription drug market were large two years ago, manufacturers would invest more money in research and development, which would pay off two years later in a new drug. (Prior to 1962, it took approximately two years to develop a new drug.) Despite the model's simplicity, it tracks the actual number of new drug introductions quite well....

Because Peltzman's model tracks the pre-1962 drug market quite well, we have some confidence that if all else had remained equal, the model also should have roughly tracked the post-1962 drug market. Peltzman's model, in other words, estimates the number of new drugs that would have been produced if the FDA's powers had not been increased in 1962. Thus, by comparing the model results with the actual number of new drugs, we can draw an estimate of the effect of the 1962 amendments. The model predicts a probable post-1962 average of forty-one new chemical entities (NCEs, or new drugs) approved per year.

The average number of new drugs introduced pre-1962 (forty) was also much larger than the post-1962 average (sixteen). Thus, whether one compares pre- and post-1962 averages or compares the results from a forecast with the actual results, the conclusions are the same: the 1962 Amendments caused a significant drop in the introduction of new drugs. Using data of longer span, Wiggins (1981) also found that increased FDA regulations raised costs and reduced the number of new drugs.

Even if FDA regulations have not improved safety, they might be redeemed if they have reduced the proportion of inefficacious drugs on the market. Using a variety of tests, however, Peltzman (1973) found little evidence to suggest a decline in the proportion of inefficacious drugs reaching the market since 1962. Thus, he concluded, "(the) penalties imposed by the marketplace on sellers of ineffective drugs prior to 1962 seem to have been enough of a deterrent to have left little room for improvement by a regulatory agency." (1086) Similarly, in their survey of the literature, Grabowski and Vernon (1983) conclude, "In sum, the hypothesis that the observed decline in new product introductions has largely been concentrated in marginal or ineffective drugs is not generally supported by empirical analyses" (34).

The costs of FDA regulations do not vary with the number of potential users of the drug, so the decline in drug development has been especially important in the treatment of rare diseases. By definition, each rare disease afflicts only a small number of people, but there are thousands of rare diseases. In aggregate, rare diseases afflict millions of Americans: according to an AMA estimate (AMA 1995), as many as 10 percent of the population. Thus, millions of Americans have few or no therapies available to treat their diseases because of increased costs of drug development brought about by stringent FDA "safety and efficacy" requirements. In response to this problem, in 1983 the Orphan Drug Act was passed to provide tax relief and exclusive privileges to firms developing drugs for diseases affecting two hundred thousand or fewer Americans (AMA 1995). It would be better to reduce or eliminate FDA regulations for all drugs and patient populations.

The Grisly Comparison

The delay and large reduction in the total number of new drugs has had terrible consequences. It is difficult to estimate how many lives the post-1962 FDA controls have cost, but the number is likely to be substantial; Gieringer (1985) estimates the loss of life from delay alone to be in the hundreds of thousands (not to mention millions of patients who endured unnecessary morbidity). When we look back to the pre-1962 period, do we find anything like this tragedy? The historical record-decades of a relatively free market up to 1962-shows that voluntary institutions, the tort system, and the pre-1962 FDA succeeded in keeping unsafe drugs to a low level. The Elixir Sulfanilamide tragedy, in which 107 people died, was the worst of those decades. Every life lost is important, but the grisly comparison is necessary. The number of victims of Elixir Sulfanilamide tragedy and of all other drug tragedies prior to 1962 is very small compared to the death toll of the post-1962 FDA.

Much more here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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