Politics

Margaret McCartney

The last couple of days have spawned a few emails of the political campaigning variety. I understand that evidence-based social policy has the potential to exist – but what I’m really interested in is evidence based health policy.

Being on the receiving end of yet another badly thought out initiative on the basis of policy, not evidence, is dreary never mind bad for patient care. (I have even witnessed a DoH representative accept that her evidence for providing a service showed it expensively didn’t work, only to be told, that it was policy so it was happening regardless.)

So in the red corner, we have Mr Brown saying that if the next election is his, then all cancer patients can have one-to-one nursing at home. This is devoid of reason. Are heart failure patients, bronchitis patients, stroke patients, people with end stage Aids, or renal failure, or dementia somehow less worthy of care?

Margaret McCartney

In 2005, and quietly, chloramphenicol eye drops started to become available for sale by pharmacists and without a doctor’s prescription. This was heralded at the time as a great advance for patients, who could get treatment for conjunctivitis faster, and for pharmacists, who could be more autonomous.

What is far less clear is whether or not this is actually good for patients. In the same year as the drops were made available, several pieces of research came out questioning whether or not they did much good: they seemed to shorten the time of infection slightly, but overall the usefulness of them as a routine treatment was rightly questioned.

What conclusions can we now draw? A study, by the Department of Primary Health Care at Oxford University reports in this month’s British Journal of General Practice.

Margaret McCartney

The UK Home Secretary, Alan Johnson, fired Professor Alan Nutt – former chief drugs advisor – at the end of last week after he criticised the government for reclassifying cannabis for political, rather than science-based reasons. This sacking is a disaster.

Prof Nutt’s government post was unpaid and, by the sounds of things, demanding of time and energy. You can read about some of his university work and research: biography and research interests of proff Nutt. His approach is rooted in evidence. He clearly saw his job as making sure the government understood and were updated, on what is known about the harms of illegal drugs.

Prof Nutt was accused of “lobbying for change in policy” about the classification of cannabis. He felt that there was no evidence to make cannabis a class B drug, and should have been made class C. But the government disagreed and discharged him of his duties.

Prof Nutt’s sacking is a disaster because it implies, firstly, that debate is unhealthy. If you look in any medical journal, or attend any lecture at a conference, you will find people noisily going on about what the degrees of certainty are and what isn’t known.  This is good: this is what can cause progress.

Second, it means that independent experts may only be appointed in future if it is felt they will keep quiet where there is disagreement between evidence and politicians, or will only interpret evidence to suit political masters.

Ultimately, this leads to a loss of confidence in the “independent” evidence government is exposed to. And lastly, it is a disaster for science. There will be incidences where government does not wish to take up the advice of experts for various reasons, and sometimes this might be warranted.

But that gulf should be visible to us, the electorate, as a means to judge our elected representatives. This debacle, frankly, does not do the Labour government any favours.

By Ross Tieman

France’s vociferous Committees for the Defence of local Hospital and Maternity Units are getting their marching boots back on after the country’s Health Ministry confirmed it will announce a raft of hospital operating theatre closures by the year end.

The Ministry says the decree will target about 180 theatres which each carry out fewer than 1,500 operations a year. Theatres that carry out fewer than 100 gynaecological operations a year are also thought to be threatened, though the Ministry wouldn’t confirm it.

National opposition to closures of this sort began back in 2004, at the instigation of defenders of my “local” hospital in Saint-Affrique, southern Aveyron. Although it’s not much bigger than a cottage hospital, it still seems to be functioning, five years on, though I’d never dream of going there.

Margaret McCartney

So Gordon Brown has “two minor tears” in his retina, the findings of a routine follow up on his vision has revealed. Mr Brown, who has sight in one eye only, is said not to be unduly concerned about this development.

This comes not long after Andrew Marr  – a well-known journalist and political commentator – harangued him, during an interview, about his use (or not) of medication in order to help manage his job. Mental illness was most definitely implied.

What double standards. We are supposedly in more enlightened times, and should know that disability does not mean no ability. David Blunkett – a labour politician and former home secretary who has been blind from birth  – and his guide dog managed perfectly well. Mental health problems should not automatically preclude high office either.

There would be nothing worse for this country than to have only people with unmarked medical records who thought themselves worthy of scrutiny about their health, standing for parliament.

Indeed, people who have understood what it means for them or family members to be unwell may have much to contribute to politics. Even if we did have a society where disclosure of health problems meant nothing except understanding, we should still accept that privacy is an entitlement. Politics does not negate this.

Andrew Jack

At a gathering of European health policymakers, one delegation with a high profile at this week’s Gastein forum rather stands out: Taiwan. Ministers and officials are in attendance, and have even sponsored one of the main sessions, on the sustainability of health systems.Just over the border in Switzerland, the World Health Organisation in the past has had to rebuff Taiwan’s requests to attend its annual world health assembly because of pressure from China. Under a truce brokered by Margaret Chan, the agency’s Hong Kong head, it is now able to attend.

Diplomatic rapprochement is obviously spreading but there is no sign of the Chinese at Gastein.

Taiwan may have some lessons for Europe. It has used the crisis as an excuse to redouble investment in electronic medical records. And it is helping guarantee medical care for the poor with a tobacco tax and money from the national lottery fund – simultaneously dampening and using the proceeds of two vices.

Margaret McCartney

Do read a post on the Health Care Blog -  How to Rein in Medical Costs, RIGHT NOW - a fantastic down-to-earth summary of what the US is wasting healthcare resources on appears on this US blog. In this area the NHS can feel rather proud  – America on the case of the NHS – in having realised already that evidence based medicine is good medicine, as well as being more cost effective. For example, here’s a quote from a US website reporting in the past few days on the two New England Journal of Medicine trials on PSA [prostate specific antigen] screening

“We must put this controversy into perspective together with our patients before embarking on a screening protocol. In practice, many men with a history of borderline or high PSA levels do not recall having had a conversation with their physician about the pros and cons of prostate cancer screening. This includes men without health insurance who then face either further testing that can cost thousands of dollars or continued confusion and concern about their cancer status.These situations are unfair to the individual. A frank discussion about the relevance of screening results, including the potential benefits and harms associated with testing, should precede any screening test for prostate cancer. To attempt this conversation after a PSA test or DRE biases an honest assessment of each individual’s beliefs and preferences”.

This has been standard practice in the UK for some time. Sometimes the NHS is actually pretty good.

Margaret McCartney

I’m following the US/NHS debate with a kind of bewildered fascination: all those politicians wanting to pledge allegiance to the ethos of the NHS with one hand - but continuing political meddling with the other.

What I haven’t heard acknowledged properly is the fact that the US wastes an immense amount of time, energy and money on tests and treatments that don’t actually improve health outcomes. Most of the massive screening industry selling check ups to ‘customers’ is the ultimate outcome of healthcare where sales techniques are allowed to subvert clinical need and ignore evidence based medicine. And then we come to the massive inefficiency created by a system where funding follows tests: and leads to more and more and more tests, many of which would not be done in the UK simply because they are not needed.

And nor does there seem to be much acknowledgement of the political interference with clinical decision making via the GP contract, or waiting list manipulations, or the waste of money on things like Choose and Book – which would facilitate the market based system of delivering healthcare, except that it has been unreliable for doctors and not wanted much by patients.

I apologise for linking to the Jeremy Vine show, but an excellent interview with Professor Allyson Pollock says it all. (It’s only online till 17/8/9 and is about half way through.)

Margaret McCartney

My eldest and I have been giggling at a book “F in Exams: The Funniest Test Paper Blunders”, which includes such gems as:

Q: Name two religions.

A: The Force (Jedi) and Football.

This amused us greatly.

What’s the difference with this next multiple choice one?.

Q: Which of the following explain(s) the physiological relationships between qi and blood/xue. 

A: Qi is the source of all material in the body and blood carries the energy

B: Blood is the source of all material in the body including Qi

C: Qi drives blood moving and blood carries Qi

D: Qi flows in the channels and blood is stored in organs

E: Qi produce blood and blood is the mother of Qi

Well, this is a real exam paper, and it isn’t funny. It is an exam paper from Salford University’s Traditional Chinese Medicine course. The wonderful David Colquhoun gives access to the full paper plus the story behind the Pittilo report

This report would, if implemented, create lots more nonsense exam papers funded by a lot more public money  – and would produce practitioners without the absolutely crucial skill of how to assess evidence and reject or use it appropriatly. 

As a GP, this makes me very concerned – after all, if someone has a degree, and is “regulated” by the government, surely you’d think the “treatment” on offer works? Sadly, and worryingly, no.

The public may now respond to the Pittilo report.  Please do.

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”

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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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