Monthly Archives: November 2009

Margaret McCartney

I’m amazed by the coverage of the newly-officially-recognised fact that screening can do harm. This article, for example, from this week’s New England Journal of Medicine: Screening Mammography and the “R” Word seems to get all flustered about the potential for women who might benefit from screening mammography ending up not having it, under new age guidelines.

For example: “The most controversial recommendation of the (US Preventative) Task Force is to delay the onset of routine screening mammography from 40 to 50 years of age. Many observers were concerned that this move away from intensive screening might signal a shift away from the war on cancer…But at a deeper level, the recommendations raise concerns about access to potentially lifesaving care. ”

Margaret McCartney

It used to be seen as embarrassing, extravagant, foolish. But improving your looks under the surgeon’s knife has now passed the stage of social unorthodoxy to become something acceptable, appealing – even fun. Just think of the rise of Botox parties, where a nurse wielding the syringe will come to you (and the host gets a discount).

In Los Angeles, studies of women found that more than two-thirds of respondents were interested in having cosmetic surgery. In the UK, a study of female university students showed that low body mass index, lack of body appreciation and media influence were predictors of a desire for cosmetic surgery. Indeed, one US study links watching TV makeover shows with a more favourable attitude towards cosmetic surgery, as well as an increased pressure to try it. This does not necessarily prove cause and effect, but it does raise the question of how people acquire enthusiasm for these procedures.

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

What are the prospects for improving prevention and treatment of HIV, what more needs to be done and how can we balance efforts to tackle the infection with other health and development priorities?

Email a question now to ask@ft.com for

Michel Kazatchkine, executive director of the Global Fund to fight Aids, TB and Malaria, a doctor and France’s former Aids ambassador and
Peter Piot, head of the Institute for Global Health at Imperial College, London, and former executive director of UNAids, the United Nations’ Aids agency

They will post answers to your questions on this page:

www.ft.com/q&a/aids

On Tuesday December 1, betweeen 17:00 and 18:00 GMT

By Rebecca Knight

Have you ever read a newspaper article about cancer risk and felt anxious that something you do – or neglect to do – puts you in danger of developing a terrible disease? Or have you ever watched a television news report about a new cancer drug and felt optimistic – perhaps too optimistic – about a promising breakthrough?
 
It happens every day, according to an editorial published earlier this month in the Journal of the National Cancer Institute. The editorial, written by the editor and researchers at the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire, discusses the exaggerated fears and hopes that often appear in news coverage of cancer research. Promoting Healthy Skepticism in the News: Helping Journalists Get It Right 

Margaret McCartney

Boris Johnson isn’t just endlessly entertaining, intelligent and amusing, but he is actually, as Mayor of London, in a position of power.

So it was amusing to read his newspaper column about how his private medical examination (“my feeling from the female doctors and nurses was that I was doing better than I ever thought possible … the general ego-boost was what I imagine it must be like to be in a South-East Asian massage parlour and receive a series of extravagant and wholly warranted compliments on one’s physique.”)

However Mr Johnson’s check-up did not go to plan, because he received the results not of his own blood and other tests, but of some other unfortunate person with leukaemia. Boris laughs this off and gets his real results couriered round.

Apparently the Mayor of London’s annual exam has to be done for “insurance purposes”. But what a waste of time and money!

Margaret McCartney

Yes, because evidence is the only way medicine gets better. Yes, because people have sometimes died, or had risky procedures, or endured more suffering, because of the application of opinion-based, fashion-set meandering through all the medical interventions that imagination has to offer. Yes, because time, money and effort is wasted when people are given non evidence based treatments by healthcare practitioners.

Nevertheless, the careers section of the British Medical Journal website devotes some uncritical space to careers advice about osteopathy. The doctor describing his decision to pursue a qualification in the discipline – he now combines medicine with osteopathy – says that since the UK National Institute for Health and Clinical Excellence recommend it, it should be done.

But this isn’t, I don’t think, good enough: mainly because the evidence for treating back pain, which is the specific Nice recommendation he refers to, is complicated by the fact that the great bulk of back pain will get better no matter what doctors do or don’t do.

More importantly, a systematic review of systematic reviews of spinal manipulation a review of systematic  suggests that  ”Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.”

There remains the concept that doing more in medicine is always better. In truth, doing can be far more evidence based.

Margaret McCartney

In September this year, a young woman fell ill and died, hours after she was injected with Cervarix, the vaccine intended to prevent cervical cancer.

Several media reports questioned the safety of the vaccine and called for the schools vaccination programme to be scrapped. The batch of vaccine was quarantined until investigations could be completed, but after a postmortem concluded that the schoolgirl had died of a previously unknown tumour, the vaccination programme continued.

I am no great fan of Cervarix, but not for safety reasons. Rather, I am not convinced that doubts about its performance have been adequately addressed by research. The management of this unexpected fatality, however, was faultless. The possible link to the vaccine was instantly spotted and properly reacted to. Deaths in young schoolgirls are uncommon, so the potential danger was easier to identify, and in this case it was relatively easy to rule out.

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

Margaret McCartney

And so, to my mail box this morning.

“Dear Doctor

We are writing to brief you about the British Heart Foundation’s forthcoming Atrial Fibrillation campaign [when the upper chambers of the heart beat in an unco-ordinated fashion].

The campaign aims to increase people’s awareness of asymptomatic AF and encourages them to check their pulse for an irregular rhythm…The campaign will be starting on 16th November 2009 and will run across the following weeks. We will be directing people to visit our website or call a bespoke telephone line which will provide information about AF, how to check their pulse, and the difference between a regular and an irregular pulse…We would value your assistance in communicating the above information with your own patients, colleagues and networks.”

The picture at the top of the BHF website is of someone checking his pulse and the ominous message “An irregular pulse can kill. Don’t leave it to chance.”

So, a nice little campaign that should see us clutching our wrists, taking our pulse, and saving our lives?

Margaret McCartney

It seems that people like enticements. Take the shimmering lures at make-up counters, where if you buy enough of one brand’s products, you’re promised a “gift”.

Of course, these deals rarely look so good on closer inspection. Buying one and getting one free, for example, often applies to goods where buying large quantities is impractical. And I don’t really want another make-up bag full of travel-sized cosmetics, even if not boosting my spending just a bit to get that freebie seems like a waste.

So what happens when you incentivise patients to do what is “best” for their health – lose weight, stop smoking, eat more vegetables? Over the past few years, the catalogue of research on health-related incentives has thickened.

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

Margaret McCartney

Last Saturday, How To Spend It ran an interview with Professor Susan Greenfield, who is famous as a neuroscientist and a life peer. And she says that one of the “grooming staples I’m never without [is] Boots No 7 Protect and Perfect Intense Beauty Serum (£19.75) – it is, they tell us, clinically proven to reduce wrinkles. And I believe it.”

If Baroness Greenfield is having trouble sorting the science from the spin….oh dear. I wrote about this face cream earlier this year. Since the conclusions of the scientists studying this cream were that the improvement in appearances between the placebo cream and the No 7 cream were “not statistically significant”, I felt it wasn’t the breakthrough it was being touted as.

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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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