Monthly Archives: July 2009

By Rebecca Knight

Have you ever worked for a boss who rarely took a vacation, and wouldn’t dream of leaving the office early to take her mother to the doctor, or see her son’s school recital?

I have. It was miserable. It was one of my first jobs out of university. I felt like I wasn’t entitled to a holiday; after all, if my superior wasn’t taking time away from the office, I didn’t deserve to either. And God forbid I have any personal obligations outside of
my professional ones: my boss didn’t have them, and neither should I.

Margaret McCartney

I won’t bore readers with all my usual concerns about screening programmes in the UK: the tendency to supply unbalanced information, the overselling of the plus points of screening, and, too often, the quiet hush about the negatives. I’m not against screening per se – I’m just very concerned about the potential of it to do more harm than good, and the need for healthcare professionals to give enough good quality information to allow people to make properly informed and free choices.I was just about to go on holiday a few weeks ago when this press release landed in my email, which I have copied below.

Women in England Remain at Increased Risk of Undiagnosed Cervical Cancer Compared to Rest of UK

- Marie Stopes International Reinstates Call for Uniform Cervical Screening Programme throughout the United Kingdom -

According to news reports, the Department of Health have today announced that women under the age of 25 will not be routinely screened for cervical cancer. Leading sexual health agency Marie Stopes International (MSI) makes the following statement:

“We are extremely disappointed that the Department of Health has today announced the decision not to offer routine cervical screening for under 25s. Cervical screening currently begins at age 20 for women in Scotland, Wales and Northern Ireland, but women in England have to wait until they are 25.

“Since the beginning of this year, Marie Stopes International has been calling for cervical screening to be standardised across the UK, so that all women start testing at the age of 20. We are today reinstating this call to action.

“The sad and high profile case of Jade Goody has shown that cervical cancer, whilst extremely rare among women under 30, does nevertheless represent a potential threat to their lives and wellbeing. In the UK, more than 1,000 women die from cervical cancer each year. However, early detection and treatment can prevent around 75 per cent of cervical cancers developing in women, so an about-turn from the Government to offer screening from a younger age could save lives.

“The recent introduction of a cervical cancer vaccination programme ironically makes screening all the more important. The vaccine is not a bullet-proof shield against cervical cancer, but there is concern that once vaccinated some young girls may think they are ‘safe’. It is therefore vital to encourage girls to start thinking about their own cervical health as early as possible, and to develop a screening culture amongst young women to ensure as many cases of this preventable form of cancer are detected as possible.

“The Department of Health concerns itself with the provision of standardised high-quality care for all, and with promoting a culture of prevention rather than cure. It is therefore nonsensical that English women have to wait for a preventative cancer screening service that is provided five years earlier to women living in the rest of the UK.”

All quotes above are attributable to Liz Davies, Director for UK and Europe, Marie Stopes International Spokesperson.

- Ends -

I think this is very interesting for a number of reasons.

The release doesn’t relate any of their points to clinical evidence. The chances of any women benefiting from cervical smears between 20-24 are minimal, as a study in the BMJ shows: Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data.

In fact, there has been no clear evidence for benefit up till now. Why is this important? Women in this age group are at risk of “false positives”, ie the smear detecting an abnormality when the cellular changes are not dangerous and would not have led to invasive cancer. They might receive treatments for these changes – but treatments they will not benefit from, because these changes would never have led to a life-threatening cancer.

Is cervical cancer “preventable”? The authors analysed the histories of the women who had developed cervical cancer in the 20-24 age group – of these 73, only five had not been screened in the past five years. Neither vaccination nor regular smears can guarantee to prevent cervical cancer. Furthermore, what about the stigma? There is a line being taken that women with cervical cancer have somehow themselves to blame for not having had the necessary “preventative” treatment: utter rot, of course.

It would be far more sensible for the rest of the UK to change their smear progammes to start at age 25, in line with the more evidence-based practice in England. It’s a great pity Marie Stopes does not seem to have considered the lack of evidence for what they favour, and the potential harms of the screening that they advocate.

Margaret McCartney

So how exactly do we know that there are – as the Health Protection Agency says -around  55,000 new cases of H1N1 “swine” flu each week – especially now that we are no longer swabbing patients before prescribing for it?
 
Extrapolation. The HPA does give a range, between 30,000 and 85,000 cases. There are about 100 general practices in England that work with the HPA to track how many consultations about “flu-like” illnesses there are each week. These “surveillance” practices were set up long before the current outbreak, and have been quietly providing flu data for many years. HPA weekly pandemic flu update

Margaret McCartney

To be a “guinea pig” in a clinical trial is not an experience people volunteer for lightly. We need only think of the dramatic side-effects of the so-called Elephant Man drug trial at Northwick Park in 2006 to be reminded that volunteers can end up worse off. In that case, there was financial reward for the unfortunate guinea pigs, though most trials do not offer cash incentives. Either way, the prospect of being given drugs or operated on is daunting when we suspect a lack of emotional care and consultation.

Even the term guinea pig has outmoded and unethical connotations. People taking part in clinical experiments should not be seen as unknowing animals. Indeed, a number of recent experiences have convinced me that we need to redefine the term human guinea pig to mean an active, able and knowledgeable person, who agrees to participate in research. In order to make this happen, patients need to be involved as much as medical experts.

Not long ago I attended the launch of a new service on healthtalkonline, the website of the research charity Dipex. Founded by GP Ann McPherson, who at the time had breast cancer, and Andrew Herxheimer, who had undergone a knee replacement, the website provides an archive of videos in which people talk about their medical experiences.

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

Glitches hit swine flu phone helpline 

  • Cases nearly double in a week to 100,000
  • Small businesses ask for specail measures 

Ill wind yields sales dividend

While many companies worry about swine flu-related absences hampering their activities, for others it has proved an unexpected boon as public concern about the pandemic boosts demand for their products. 

For full coverage of the swine flu pandemic, visit http://www.ft.com/indepth/swine-flu

In recent days the momentum of Barack Obama’s drive to reform US healthcare - see US health reform Q and A has seemed to fade. Congressional committees have produced bills which broadly follow White House specification. Yet these proposals remain unfinished work because the crucial questions – who pays, and how? – await answers. Raising the stakes of his own personal commitment to the project, the president went on television this week to persuade the country that the reform was needed, and still on track.

Contine reading “Healthcare reform needs bolder action”

By Rebecca Knight

It was a Friday from hell. I had two big stories due in the morning, my daughter’s 18-month checkup at the pediatrician in the afternoon, and I needed to pick up my car from the shop before the weekend arrived. While I managed to get it all done, I woke up the next morning feeling achy and rundown.

It’s a familiar pattern: stressful time at work, school or home, followed by a crippling cold. Is this merely coincidence, or is it possible that stress is what makes me sick?

Andrew Jack

With the UK government warning employers to prepare for up to an eighth of their employees to be absent from work because of swine flu in the coming weeks, some businesses could be stretched to the limit.

There again, things could get worse still if current discussions lead to recommendations to keep schools closed after the summer holidays until a swine flu vaccine is prepared and given to children. That would mean more staff staying at home to look after them - just when business is picking up after the break.

So how is your business coping with the swine flu outbreak? Is it a serious threat to the recovery of the UK economy? What is the impact of the on the workplace, and your ability to operate? Share your views by clicking here or on the link below.

Andrew Jack

An awkward dilemma today for Labour parliamentary candidate Chris Ostrowski, as the ruling party tries to hold its seat in the Norwich North byelection this week. it has been confirmed that Mr Ostrowski has contracted swine flu, and as a representative of the UK government, he will surely feel obliged to follow official advice to stay at home to recover and avoid further spread of the virus.

While wishing him a swift recovery, party leaders might also be grateful for the cover his illness provides, given the odds suggest a Conservative victory.

Margaret McCartney

To have a baby or not? The National Childbirth Trust, a hardworking parenting charity, have been criticised for offering advice (now withdrawn) that women may wish to delay pregnancy until the swine flu pandemic is over. Various other agencies, including the Royal College of General Practitioners and the Department of Health, were quick to respond by saying that this was an over-reaction. And probably, it was.
 
The problem is that pregnant women and babies seem to have been amongst those most affected by the H1N1 influenza strain. So how are people meant to react? You can’t say that no risk to a baby or pregnant woman exists, only that the risk is, overall, very small. From what I can gather, the NCT did not say that women should delay pregnancy, rather that it was an option.
 
It seems that we have an ongoing problem with the way risk is viewed and managed, and it is this, rather than the thing we are meant to be afraid of, which is causing significant problems at the moment. Listening to the radio today, I was interested to find out more about developments in the influenza infection rate. Instead, there were back-to-back interviews about who was right and who was wrong.

Can we not just agree that there are quite a lot of things we are not sure about at the moment, some of which can be tested, some which can’t be quite so easily, and we are going to have to give people enough information to allow them to make reasonable decisions for themselves at present?

Health and science blog




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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