Margaret McCartney

I am a GP in Glasgow and write the Second Opinion column in the FT magazine, available here; www.ft.com/mccartney

Margaret McCartney

Hurrah – sense sees through the day.

The British Chiropractic Association have evidently decided enough is enough from their statement BCA vs Simon Singh and have dropped their case against him.

Margaret McCartney

I do love the internet: at home and also at work, where I can find things faster, often, than searching through a textbook (filing not being my strong point.)

The pros and cons of using the internet for diagnosis have been noted and an interesting recent perspective in the New England Journal of Medicine  – Untangling the Web – Patients, Doctors, and the Internet – makes the point well. Information has to be good.

Margaret McCartney

I’m pleased to see the WHO acknowledging that there was not enough admission of the “uncertainties” about swine flu.WHO admits shortcomings in handling flu pandemic

If we learn one thing from the experience, surely it should be that we should absolutely accept the unknowns and then start to reduce them – with well-designed, clinical trials.

Margaret McCartney

Most couples are aware of the potential hazards of putting off “trying for a baby” – and rightly so. As less than 2.2 per cent of women over 43 who undergo IVF are successful, it’s not as if there is an easy solution on hand for couples who fail to conceive naturally.

But now a host of fertility tests is piggybacking on to this fear that women (and, yes, men) may be leaving it too late. The most established test measures a woman’s follicle stimulating hormone, or FSH. This fluctuates slightly through the menstrual cycle, but rises in the menopause. However, this test is not useful for everyone, as it may not give much more meaningful information beyond what a woman already knows about her body.

Continue reading “The stork knows best”

Margaret McCartney

Over the past couple of decades, chlamydia screening has been discussed, started, changed, discussed, evaluated, disagreed with, and discussed again.

One thing I think has been missing is large scale Randomised Controlled Trials performed early on, and used to make cost-effective decisions.

Instead decisions have been made on trials that have now been decided as flawed, and last year the National Audit Office - Chlamydia testing ‘wasting money’ – concluded that millions have been wasted.

And this week the BMJ reports that screening for chlamydia with a single test doesn’t prevent pelvic inflammatory disease.  – Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial

Obtaining more information will be nearly impossible – now that screening kits in GP surgeries are endemic, any more “pure” trials – where people are either screened as part of a study, or aren’t screened as part of a study, are going to be much harder to do.

Margaret McCartney

Shall we? The vegetable tide is turning. For those of us forcing vegetables into our children in the belief that they are essential to health, the news, from the Journal of the National Cancer Institute: Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition reporting a very large study, is that vegetables don’t cut the risk of cancer in the way some analyses had found: Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence

All those UK Department of Health ’5 a day’ campaigns, and attempts to wean us off chocolate bars and onto bananas may have wasted their efforts.

Margaret McCartney

this set of modules is rather good: and Angela Raffle, the public health consultant narrating, has a lovely voice. Quite impressive that it was sponsored by the NHS – if only the same common sense would filter into the actual screening programmes. And here’s another thing of interest to people who are sceptical about screening – a paper co-authored by UK surgeon Mike Baum on the possible hazards of surgery for breast abnormalities. This paper is interesting for a number of reasons. It explores a potential harm that may not have been known, or thought about, when screening programmes were being set up for breast cancer. What makes a good scientist I think has something to do with careful observation, and then challenging oneself and others when the results are unexpected or unexplained.

Margaret McCartney

I’ve just received the forms through for speaking at the Cheltenham Science Festival this summer. I have to say what kind of equipment I plan to use, including chemicals or naked flames. I wasn’t intending to, but now I know it’s an option……

Margaret McCartney

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.

Margaret McCartney

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.

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.

This blog is no longer active but it remains open as an archive.
Follow on twitter

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

The Health blog: a guide

Comment: To comment, please register with FT.com, which you can do for free here. Please also read our comments policy here.
Contact: You can write to Ursula Milton, the blog's editor, using this email format: firstname.surname@ft.com
Time: UK time is shown on posts.
Follow: Links to the blog's Twitter and RSS feeds are at the top of the page. You can also read the Health blog on your mobile device, by going to www.ft.com/healthblog
FT blogs: See the full range of the FT's blogs here.