Monthly Archives: June 2009

Margaret McCartney

Work is appreciably busier. I am very happy to be busy if I am doing something useful or good. I am unhappy if neither is the case. Having previously been keen to be a good team worker who would do her best to play along in the face of any increased NHS pressure, after reading the flood of H1N1 documents arriving electronically every day, I have reached the point of rebellion.

When things started out, “containment” was the policy. This meant that confirmed H1N1 cases and their contacts were treated with osteltamivir, no matter how well or ill.

By Jonathan Soble in Tokyo

In rapidly aging Japan, a bit of black humour has it that the only profitable businesses will soon be mortuaries and nursing homes. Dark as it sounds, that formulation may be too sunny in one respect: the latter of those businesses, nursing care, is looking like a bust.

According to Teikoku Databank, a research firm, 26 operators of nursing homes or in-home nursing services went bankrupt last year, up from four in 2004 and the highest number on record. In spite of soaring demand – there are now 4.5m elderly Japanese who need at least some help taking care of themselves, against 2.6m in 2000 – providers are having trouble making a go of it.

Margaret McCartney

Wonder drugs are rare. Applying the criteria of effectiveness, usefulness and cost, I’d put paracetamol, morphine and penicillin high on my list. The number one position, however, would go to aspirin. Not only is it good for pain relief, as an anti-inflammatory and to reduce fever, it also works as a blood-thinning agent, to decrease the stickiness of platelets and reduce blood-clotting.

A few years ago two researchers argued that what we really needed was a “polypill”. This, a tablet containing several drugs which could be given to many people at low cost, was to be the mother of all wonder drugs. The researchers who proposed it, and who are now studying it, are Nicholas Wald and Malcolm Law from London’s Wolfson Institute of Preventive Medicine.

They set out a brave vision for their creation in the British Medical Journal in 2003: “The polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the western world than any other single intervention.”

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

By Rebecca Knight

A study by the Archives of Internal Medicine, has found that total knee replacement (arthroplasty) appears to be a cost-effective procedure for older adults with advanced osteoarthritis.

This study caught my eye because, like 12 per cent of the over-60 population, I have bad knees. Well, one bad knee at least. The difference between the rest of those folks and me is that I am in my early 30s.

Margaret McCartney

A rather disappointing debate recorded in Hansard on the subject of screening for cancer in men.

Unfortunately the extremely important issues of effectiveness, evidence, and potential harms seem to have become lost, e.g. “the government is committed to introducing screening for prostate cancer” – but since the evidence is mixed but much of it shows that it does more harm than good – (a large trial is ongoing in the UK at present), it seems premature to make any sort of commitment.

President Obama yesterday took part in a White House town hall meeting televised on ABC. During the meeting, he answered questions from audience members chosen by ABC News.

From the ABC new health care forum:
President Obama struggled to explain today whether his health care reform proposals would force normal Americans to make sacrifices that wealthier, more powerful people — like the president himself — wouldn’t face. President Obama Defends Right to Choose Best Care

A lively imaginary debate from The Health Care Blog:

Will health care Reform Improve Our Health?

“When government entered the markets for workers compensation insurance, crop and flood insurance, and disaster insurance, it often completely crowded out private options. Do you expect a new government health insurance program would do the same?

I hope so because the current private options are lousy at keeping down health care costs, or satisfying their customers. Oops, Obama can’t say that, can he.”

And from the Health Business Blog:

A public plan private plans can live with?
“From where I sit, the most exciting aspect of the healthcare reform debate is the discussion around a public plan that would compete with private plans. So I was interested to read that Senate Finance Committee members Olympia Snow (R-ME) and Charles Schumer (D-NY) appear to be negotiating a compromise bipartisan agreement that would establish a public plan -but do so in a way that would be less frightening for private insurance companies.”

 

Margaret McCartney

An interesting survey has been published by the Foundation for Mental Health. It’s called “Death of the smoking den, The initial impact of no smoking legislation in psychiatric units in England in 2008.”

In the introduction to the report, Louis Appleby, the National Director for Mental Health is quoted as having said in 2007 “The rest of the NHS is going smokefree. What message would an exemption for mental health wards send out about the importance of the lives of mental health patients?”

However, the survey uncovered widespread problems with the implementation of a smoking ban in psychiatric units in England. Most respondents indicated the ban had been only partially effective, with only 15.6% of responding units claiming complete effectiveness.

It’s an interesting area, and one deserving of more research. I’d like to know what patients think of the ban. Part of the problem is that some patients are admitted on an involuntary basis to psychiatric wards.

It is easy to see why the stress of being very unwell paired with that of not being allowed to leave, never mind smoke could end up seeming like both an intolerable violation of personal liberty and an immediate difficulty in trying to build therapeutic relationships with staff. In short. this would not seem the ideal time to stop smoking.

In many other areas of challenging behaviour, compromises are made, for example methadone substitution for heroin, the supply of clean needles for intravenous drug use or sterilised equipment for people who are driven to cut or harm themselves.

Without necessarily agreeing with any of these, I think it’s crucial that nurses should be able to use their professional judgement as regards smoking cessation for their psychiatric inpatients.

By Rhymer Rigby

At Wheeler Interests, a Virginia-based property development company, plans are under way to get employees canoeing.

“We’re building a dock and pier and I’d like to get six kayaks and canoes,” says chief executive Jon Wheeler. The company is committed to providing the “right type of culture and environment for employees and this includes physical exercise”.

The company headquarters, explains Mr Wheeler, sits on a tributary of the Lynnhaven River and the idea is to let staff go canoeing and kayaking at lunchtime.

Andrew Jack

Efforts to make newer and more costly vaccines widely available to the poorest in Africa are being hampered by a long-standing system that makes vaccines affordable to middle-income Latin American countries.The board of the Pan American Health Organ-isation will this week discuss its “revolving fund” for vaccine purchases as concerns mount that it deters manufacturers from offering deeper discounts on such products to the world’s least developed countries.

By Tom Braithwaite

President Barack Obama’s plans for health reform received a double boost over the weekend, with drugmakers agreeing to cut prescription charges and an opinion poll showing a significant majority of Americans want the option of public health insurance.

Pharmaceuticals companies agreed to cut about $80bn over the next decade in charges for prescription drug users aged 65 and over, the Obama administration announced on Saturday. These users of the Medicare government-backed scheme currently have to pay the full price of medicines that cost between $2,700 and $6,153 a year.

Continue reading “Obama health plan gets boost from drugmakers”

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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.

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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: www.margaretmccartney.com/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

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