A collection of papers published today in the Journal of Medical Screening affirm that breast screening is a good thing. The first, from the Wolfson Institute of Preventive Medicine, takes two sets of data – one from a randomised trial in Sweden, and the other from England’s Breast Screening Programme (and not, therefore, a randomised controlled trial.) The paper concludes that “between 2 and 2.5 lives are saved for every over-diagnosed case.”
The second paper is regarding the ‘Age’ trial. The women were randomised to either screening from age 40/41 or age 48. They concluded that uptake was “comparable with that in the UK screening programme”. The conclusion I expect to be put out in a small media gale is that breast screening is good, desirable, and that woman want to have it.
I fear that this will not take us to the real argument about breast screening which we do need to have. Given what we know about breast screening (and we could pick holes in this trial, not just about the fact that breast cancer deaths are declining independent of screening) – which is best seen in Cochrane reviews (when all the evidence, not just the bits that fit your argument, are assessed) about breast screening. We know that overdiagnosis, with all the attendant surgery, chemo or radiotherapy, exists. But most women attending for breast screening do not. The real debate needs to be with each woman as she is given properly informed consent so that she can choose to have, or not to have, screening. An independent review of the cost effectiveness of breast screening is sorely needed.
It took 30 years in the planning, 18 months since the last glitch forced an embarrassing deferral, and several strained hours this morning, but scientists at CERN this lunchtime re-created the conditions just after the Big Bang, without destroying the world.
Two proton beams smashed into each other at 7 TeV at around 1pm Central European Time in the Large Hadron Collider, and in less than 30 minutes they had been stabilised and experiments began. Now the hard working of studying and analysing the results begins.
The Royal College of Physicians have just put out a report on smoking: Passive smoking is a major health hazard to children- sudden infant death, asthma, wheeze, meningitis, middle ear disease can all be caused by it and they want more to be done to prevent these problems – particularly in children.
There is an irony in that people in public houses are now better protected against smoke than children who live with smokers. And yes, most smokers want to give up – and most parents who smoke, I find, do so with guilt and out of the back door. Here are a couple of the proposals:
- It is important to promote smoke-free homes through mass media campaigns, advice and support from health professionals to smokers, and new approaches such as substituting cigarettes with medicinal nicotine
- Smoke-free legislation should be extended much more widely, to include public places frequented by children and young people, and to prohibit all smoking in cars and other vehicles; media campaigns are needed to explain the need to avoid exposing children to smoking as well as to smoke
…and while I can see why, it seems a bit illogical to me to stop adults on their own from smoking in their own cars.
Pain is impossible without a mind. The brain is where our neurochemicals tell our conscious being what is happening – and that includes the message that we are feeling pain.
So I was surprised to see a headline in The Daily Telegraph that said “Back pain may be ‘in the mind’”. The story was based on a back pain study published in The Lancet, which itself made no such claims. It is nevertheless an interesting piece of research. Two groups of people with long-term back pain were invited to have either group cognitive behavioural therapy (CBT) or basic care. After a year, the people who underwent CBT had better outcomes, according to questionnaires about such things as the impact of their pain on sleep and mobility.
Continue reading ‘The painful truth’
By Rebecca Knight
The Lancet, last month, retracted its controversial 1998 study that linked the measles, mumps and rubella (MMR) vaccine to autism.
To be clear: the only evidence that showed a connection between vaccinations and the neural development disorder has been formally expunged from the scientific record.
Here is a link to the FT’s article about the now discredited study:
Lancet retracts MMR link to autism
Is making booze more expensive the way to cut binge drinking, abuse of alcohol – and even cut deaths caused by it? The evidence is mounting that this is an efficient way to improve health.
And is does seem illogical, from a health perspective, that soft drinks are not much cheaper than alcohol either in supermarkets or bars. The Lancet publishes a very interesting modelling study - Estimated effect of alcohol pricing policies on health and health economic outcomes in England: an epidemiological model – demonstrating that increasing the price of alcohol could be a feasible and useful public health tool.
If it can be done, then should it? How far should governmental control go? I suppose the government already has substantial influence on tax already: what I’d like to see is more evidence it could work here in the UK.
Researching the FT’s first Combating Tuberculosis report in the last few weeks, I was a little disappointed by the lack of dissonance. HIV and increasingly malaria activists have been important advocates in raising the profile of those killer diseases, and in highlighting important issues of disagreement. The TB community, by contrast, still feels neglected, small and even overly consensual.
Apart from the obvious but difficult demands for more funding, and more effective drugs, diagnostics and vaccines, there are important short term and less costly actions that could be taken. Here are a few thoughts on what more needs to be done. Do reply to disagree or add to them!
Illuminating reading in the Journal of the Royal Society of Medicine this month: Mis investigating alleged research misconduct can cause widespread, unpredictable damage
When investigations into alleged misconduct do not accept the reports commissioned, trouble is afoot. The more I read, the more naive I feel.
The past few years “whistleblowing” in the NHS has been seen as a dramatic act somewhat separate to the common activities of the clinical day.
The truth about how unnecessarily high-risk situations are brought to the attention of management is rather more complex and subtle. You observe that your community child clinic is overworked to dangerous levels, and you note that notes are not arriving: you tell management.
There are meant to be 4 paediatricians in clinic; however, during the period 2006-2008, one was off sick, one was on special leave, and two resigned. Juniors were left to take on tasks that would normally have been done by consultant staff. During this time baby P was seen.
Kim Holt - Support for Baby P clinic whistleblower Dr Kim Holt – a consultant paediatrician, was one doctor who raised these concerns, well before baby Peter was seen.
Her observations were not acted on: instead, cuts were made to the service. Dr Holt was off sick when baby Peter attended - Great Ormond Street Hospital – senior management must take responsibility over Baby Peter – and while it is easy to blame a single doctor for not picking up his problems, it is more realistic to view this failure in the context of more generalised problems within the clinic structure.
Dr Holt remains on full pay but has not been allowed back to her job. A report has recommended that she should be allowed to return: regardless, she remains in an extra-numerary part time position while the shortage of paediatricians remains. A petition to support her is here: Support for Baby P Clinic Whistleblower Dr Kim Holt. Whistleblowing should not need to come at such personal cost.