Monthly Archives: February 2010

Margaret McCartney

In one of my most enduring memories of childhood, I can see my little brother sneaking up to a glass of Guinness on Christmas Day and taking a furtive sip. He turned to reveal a cream moustache – and a nauseated grimace.

This Christmas, I saw that same look of horror when my seven-year-old daughter asked me if she could have a taste of fizzy wine. I said yes – but only a tiny drop. She tried it and promptly made a disgusted face that said, do adults actually drink this? I admit I was pleased: by satisfying her curiosity and denting alcohol’s glamour, I hoped I’d done a good thing.

Continue reading “Mother’s ruin”

Clive Cookson

Margaret McCartney wrote about the placebo effect on this blog earlier in the week, in the context of the Commons Science committee recommending that the NHS should not pay for homeopathy.

Coincidentally The Lancet has a fascinating long review of placebos, looking at the clinical evidence and ethical considerations.

The authors, led by Damien Finniss of the University of Sydney, point out that placebo effects are “genuine psychobiological events” which can be produced in both laboratory and clinical settings.

A key conclusion is that there are many different placebo effects, depending on circumstances.

Margaret McCartney

Ever bought one of these? …Its an electronic gadget claiming to be able to repel mosquitoes by emitting a low frequency noise. Tempting, I suppose, since it seems quick and easy – no tablets to remember.

However a cochrane review - Electronic mosquito repellents for preventing mosquito bites and malaria infection – have found categorically that these devices don’t work. Regardless, they have been on sale widely including on board several major airlines.

Dr Bart Knols, who edits the MalariaWorld website decided to get busy and write to the airlines expressing his concern. Success: KLM have pledged to no longer sell them from March 2010 – KLM: An airline that acts responsibly – and responses are awaited from BA and Singapore Airlines.

A victory for evidence.

Margaret McCartney

I am confused. The Robert Francis inquiry is a the response to the Healthcare Commission’s investigation into the higher than expected mortality rate at the Mid Staffordshire NHS Foundation Trust.

The enquiry says “many staff” expressed concerns, but were “ignored”. Nurses complained there were not enough beds to cope with the demands placed on the service, and that they were expected to deal with a workload far above what could be safely managed.

Pressures to meet waiting time targets compromised care – for example patients were moved out of A&E regardless of their clinical state and how much monitoring they needed.

There were not enough senior and skilled nurses.

Wards were made more mixed to contain more different types of cases, despite objections from clinical staff that it would compromise care.

Trained staff numbers were reduced in ward reorganisations which went ahead despite opposition from clinical staff.

Why were the savings being made? The hospital was in debt, and this is what drove staff cuts.

Alan Johnson, then health secretary, has said there was a ”a complete failure of management to address serious problems and monitor performance”. But management had in fact been doing an awful lot of what they had been told to do: sort out the financial problems, meet the targets.

We are now coming round to thinking that it isn’t just individual mistakes that should be seen as problems, but the system, which allowed them to occur.

Blaming the managers is an easy option. Isn’t it the case that the system that managed this Trust – the political structure that told it what ‘good outcomes’ were – is the one to blame?

By Rebecca Knight

Anyone who has ever spent considerable time with a young child who’s learning to talk -not just baby babble, but learning how to pronounce words, string phrases, and put sentences together – knows that it’s a fascinating thing to watch.

I have a two year-old daughter who every day is figuring out how to express herself with language. (She expresses herself in other ways too, she is a toddler, after all, but for the purposes of this blog, I’ll stick to language.) It started with basic words: ball, kitty, yellow, mama, daddy. Then phrases: “mo wawa pease” – that’s: “more water please” for the uninitiated. And now she repeats everything I say. Every. Little. Thing.
 
Perhaps what’s been most exciting, however, is the fact that she, unlike me, speaks two languages. At home, we speak English, but she also spends a lot of time with her Brazilian nanny who speaks to her almost exclusively in Portuguese. My daughter understands most everything her nanny says, and answers her, accordingly, in Portuguese. It’s true, what they say, small children are like sponges.
 
According to a new study, they’re sponges in the womb, too. The research, which appears in the latest issue of the journal Psychological Science, found that infants born to bilingual mothers who spoke both languages during pregnancy show signs of different language preferences than babies born to mothers who spoke only one language. 

Margaret McCartney

Simon Singh goes to the UK courts today (Tuesday 23rd February) in an appeal against a preliminary ruling in a libel action raised by the British Chiropractic Association. I wish him well.

Another libel action is ongoing on in the UK against cardiologist Peter Wilmshurst, who is being sued after comments made about results in connection with research done by US company NMT Medical.

There is an unsettling feeling in the UK about libel law: many scientists and doctors are speaking out about it as a bad way to judge scientific proof and evidence.

The potential cost puts many people off even pursuing debate and many choose to settle before a case knowing they may not be able to afford it.

You can read about Dr Wilmshurst’s case here and he is also interviewed on Radio 4 for a programme Science on Trial.

I would urge you to consider signing the petition if you have not done so already. Sense about science: National petition for libel law reform

Margaret McCartney

On February 22nd the UK government Science and Technology Committee published Evidence Check 2: Homeopathy and concluded that “the NHS should cease funding homeopathy”. Hurrah! 

It also noted that ”the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. As they are not medicines, homeopathic products should no longer be licensed by the MHRA.” Hurrah again. 

But this is the really really interesting bit. “In the Committee’s view,
homeopathy is a placebo treatment and the government  should have a policy on prescribing placebos.”. They go on to say that placebos involve deception, and are not consistent with informed consent.

To which I say: no, no, you miss the point.

Margaret McCartney

Is it an unsightly freckle – or a deadly melanoma? To find out, many people now visit private or high-street clinics offering mole checks. Some people say they just want a quick consultation; others seem reluctant to “bother” their doctor. These services have proliferated recently, but how reliable are they?

Dermatology is one of the few medical specialities that still rely, to a great extent, on pattern recognition. Indeed, being able to make a diagnosis from a glance – the role of the consultant during a traditional dermatological assessment – is, I am told, what makes it so satisfying.

Continue reading “Of moles and men”

Margaret McCartney

I am the first to accept that modern medicine is not always good: lots of it is still unproven, or weakly proven, and in general use: and it has taken a very long time for doctors to realise that good intentions are not enough.

One has to have evidence of benefit and knowledge of harms: and to inform the patient of these and the uncertainties connected with treatment.

But – this only applies, it seems, if you are a regulated doctor. If you are dealing in unproven medicine, and your intentions are good, then it doesn’t really seem to matter whether your treatments work, or even if they give you cancer or renal failure.

This report on the judgement from the UK Old Bailey on a practitioner of Chinese medicine – Chinese herbal pills destroyed UK woman’s health – quotes the judge as saying “Although the MHRA did their best to try and make sure everybody knew about the dangers and about the regulations, it is not a foolproof system and I am certainly not blaming you for the fact you didn’t know about these regulations”.

This seems really rather a mystery of logic to me. If I set up a shop selling erratically behaving electrical goods which had a habit of giving the odd fatal electric shock, would I not be in some way responsible for my actions?

Clive Cookson

The American Association for the Advancement of Science annual meeting – the world’s biggest and most diverse scientific conference – kicks off tonight in San Diego.
The AAAS president this year, Peter Agre, mixes modesty with humour in his opening question-and-answer session with the world’s science journalists, who always flock to the annual meeting.
He expresses sympathy about the decline in their trade, particularly in the US, as newspapers and broadcasters slim down in a desperate attempt to survive in competition with new web-based media. Science is suffering along with most other journalistic specialities.
“Newsrooms across the US are being gutted,” laments Agre, who won the Nobel chemistry prize in 2003 for discovering how water gets through cell walls. “Visiting a newsroom is sometimes like visiting an empty warehouse.”

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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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