Monthly Archives: May 2009

Margaret McCartney

Britain’s backs are in terrible shape. We spend more time off work because of back pain than for any other ailment, according to the NHS. So it’s not surprising that we are keen to relieve our suffering. A new study on acupuncture and back pain tries to do just this, though in truth it is as confusing as it is informative.

Published in the Archives of Internal Medicine and performed in the US, the study compared 638 patients with chronic back pain. Each person was randomly ascribed to one of four treatments.

One group received “usual care”. The others were given either “individualised”, “standardised”, or “sham” acupuncture. Individualised meant that the therapist prescribed “distinct points” for that person’s particular problems. Standardised meant that the needles were inserted into points which are “considered effective by experts for chronic low back pain”. Sham acupuncture consisted of a series of movements with a toothpick and cotton wool, designed to make the person feel as though they were having needles inserted into the skin, when in fact there was no penetration at all.

The remainder of the article can be read here. Please post comments below.

By Julian Le Grand

In a Financial Times poll of economists published on January 1, I was one of just two who was relatively optimistic about the likely course of the recession. Although it is of course far too early to be sure, it now seems just possible that the prophets of economic doom were indeed mistaken, and that, just as in the previous recessions of the early 1980s and 1990s, recovery will be swift and relatively long-lasting.

However, one consequence of recent events that will take a long time to dissipate, if indeed it ever does, is a revival of belief in the role and importance of the state. Few would now deny that individuals operating in unregulated financial markets do make mistakes, and systematic ones at that. Moreover, most would agree that shrewd interventions by the state in this area can save individuals from the worst consequences of their own poor decisions, and can thereby make things better both for themselves and for others affected.

Financial markets have peculiar pathologies, and too much should not be made of the current situation concerning market behaviour in other areas. However, the shift in the view of the state that is implied in much of the reactions to the recession could have implications for public health.

The spectre of the nanny state has always haunted public health pronouncements. Everyone accepts that the state has a right to interfere in an individual’s actions if those actions are harming a third party. But, ever since excessive state paternalism was denounced by John Stuart Mill in the 19th century, the idea that the government should try to control or even influence well-informed individuals’ decisions over, say, their own smoking, drinking or eating, when only they themselves are affected, has always been much more contentious.

Continue reading ‘Need for a nudge’

Julian Le Grand is Richard Titmuss Professor of Social Policy at the London School of Economics and chair of Health England: The National Reference Group for Health and Wellbeing for the UK Department of Health

Today’s edition of the Financial Times contained issue two of FT Health, our ongoing magazine series.

In this issue, we examine ageing.

Andrew Jack looks at the challenges posed to healthcare systems by increased life expectancy and examines the state of research into Alzheimer’s disease, while Nicholas Timmins questions why the task of creating accessible electronic medical records has proved so difficult. Nicholas also asks whether the growing number of women doctors could be changing the way medicine is practiced. 

All the articles in the FT Health series can be read online at

By Nicholas Timmins

To their advocates, electronic medical records are the Holy Grail. Something not just desirable but essential for the practice of modern medicine. To the sceptics, they remain an expensive, potentially dangerous and unproven set of technologies.

Across the world, however, healthcare systems and governments are investing in electronic medical records – even if getting them up and running is proving a struggle everywhere.

That they are needed is not in question. Don Detmer, chief executive of the American Medical Informatics Association, says medicine is fracturing, with doctors becoming ever more specialised. The pace of research is such that no individual doctor can keep up. Patients are no longer treated just in primary care settings or hospitals but in a wider range of environments, by a wider range of clinicians, and for a wider range of illnesses as patients live longer, often with multiple chronic conditions.

“It used to be that medicine was pretty safe because it was mostly pretty ineffective,” says Mr Detmer. “Today it is both effective and potentially dangerous.” The record, in effect, becomes the glue that holds a patient’s treatment together: sophisticated electronic records provide decision support tools to help with diagnosis and reduce the chances of dangerous drug interactions, while providing the basis for a good medical audit of the outcome of treatment.”

But while electronic records have been around in one form or another for well over 20 years, not even the most advanced country has them operating everywhere yet – and this in a world that routinely banks, orders books, music and many other goods online and, for those with the money and technological sophistication, runs its pensions, investment and other complex financial products electronically.

Continue reading ‘System upgrade’

By Alicia Clegg

Is the size of an employee’s waistline any business of the employer?

The notion of companies concerning themselves with their employees’ lifestyles once seemed strange. But in the light of broader societal concerns about health, the role of employers in the provision of healthcare is more relevant than ever.

The economist Julian Le Grand has even proposed that large employers should be legally required to “automatically enrol their employees in a weekly exercise hour, unless the employee chose to opt out”.

Two years ago, Unilever invited its UK staff to undergo confidential health screening to assess their fitness. Now the company has launched “Fit Business”, a year-long pilot programme to encourage its people – more than half of whom were revealed to be overweight – to eat healthily, become physically active and monitor their blood pressure, body fat and cholesterol levels.

Continue reading ’The carrot and stick approach to healthier employees’

By Margaret McCartney

Simon Singh, as mentioned before, was in the High Court last week facing the British Chiropractic Association over an article he wrote for the Guardian (which is no longer available to read on their website.)

In court, the Judge held that the phrase Singh used –  ”happily promotes bogus treatments”  – was capable of bearing the meaning that the BCA was being knowingly dishonest in using treatments (in the article, Singh was referring to the treatment of certain childrens ailments) they knew to be ineffective. The BCA sued for libel over this claim, and in court it was held that Singh would either need to defend, settle or appeal regarding the meaning of his article.

It goes without saying I am disappointed about this. The best way to have a discussion about evidence is transparantly, preferably unthreateningly, and in the public domain. Much of this has been done, quietly, already. For example, the Cochrane Collaboration -an international organisation which searches for evidence on healthcare interventions, assesses it for quality and disseminates its results – has examined some evidence on chiropractic, and other reviews are ongoing:

For example, one review of manipulation and mobilisation for neck pain found that :  

This review of 33 trials did not favour manipulation or mobilisation done alone or in combination with various other physical medicine agents. It was unclear if manipulation and mobilisation performed in combination were beneficial, but when compared to one another, neither was superior.”

Or there’s a review of the evidence for using chiropractic to treat asthma which concludes :

“There is not enough evidence from trials to show whether any of these therapies can improve asthma symptoms.”

 Some large studies suggest some benefit, for example the UK Beam Trial, which looked at the effectiveness of exercise and manipulation for back pain. But there are, I think, also valid criticisms of this trial – for example, the high drop-out rate, and the indices used to measure improvement. 

Thus, we can say that there is some evidence for chiropractic in certain situations. What I am unclear about it whether it is any better than the combination of exercise, physiotherapy and pain relief I will commonly advise. Moreover, a Cochrane review from 1994 concludes that, “There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low-back pain.”

However, yesterday NICE recommended chiropractic treatment for low back pain, as well as acupuncture “needling” (there is a column coming up about this, but briefly: we know that sham and even needle-free acupuncture is as good an intervention as full acupuncture.)

To make it clear, I am no more “against” chiropractic than I am for or against any other kind of medical intervention. The judgement about using or recommending something should be about; the chances of it working, its potential to harm, the cost-effectiveness of the intervention, and how a patient feels about using it. This means using evidence and assessing it for fairness.

You may also be interested in the judgement the ASA made recently about a chiropracter’s clinic . So what is “bogus”? And how are consumers to be helped to sort this out?

By Margaret McCartney

A very good, very interesting paper in PLOS Medicine examines the history of the MMR scare story and why many parents still don’t trust the combined measles, mumps and rubella vaccine – despite the evidence in it’s favour.

One of the problems the Public Library of Science article considers is the fact that media interviews are often set up to offer two opposing points of view. Except in this case, the opinions weren’t representative: a view held by a small minority only gets, in this format, 50% of the coverage.

Some have argued that the key to higher immunisation rates is a better public understanding of science. But while laudable, this is may be difficult to achieve. Science can be counter-intuative and difficult: when I am dealing with subjects I don’t know about, I want to feel I can trust the guide lending me support. 

Ultimately, often the most useful thing I can do is not to discuss a screed of internet files but instead to say that all my children have been fully immunised and I don’t know a doctors’ child that hasn’t been either.

As of Tuesday 26th May, we will be welcoming a new regular contibutor to this blog.

Margaret McCartney is a GP in Glasgow and has written a column for the FT since 2005

By Jonathan Birchall in New York

American consumers are accustomed to being sold everyday food items on the basis of their health benefits.

But this month, the US Food and Drug Administration shook up the food industry by warning General Mills, maker of the best- selling US breakfast cereal, Cheerios, over its assertion on packets that, “in just six weeks, Cheerios can reduce bad cholesterol by an average of 4 per cent”.

Continue reading ‘Taste of a stricter future for health claims on food labels’

By Krishna Guha and Edward Luce in Washington

Controlling costs is emerging as the Obama administration’s top priority in health even as it seeks a reform package that greatly expands coverage of the 47m uninsured Americans.

The White House’s approach is to widen coverage within strict fiscal constraints, rather than increasing coverage at all costs, reflecting the political and economic pressures imposed by record budget deficits, according to healthcare analysts.

Continue reading ‘Cost control emerges as priority in shaping US healthcare reform’

See also ‘Sortfall dictates prescription for health’

Plus Q&A about US healthcare reform

Health and science blog (Archived)

This blog, part of the FT's health series, is a forum for readers interested in the science, policy, management, technology, business and delivery of healthcare.

This blog is no longer active but it remains open as an archive.

About our regular bloggers

Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog:

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow