Public Health

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

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

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.

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

Margaret McCartney

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.

Read the FT 2010 Combating Tuberculosis report: http://www.ft.com/reports/tb-2010

Watch videos: Andrew Jack, FT pharmaceuticals correspondent, talks to experts

And post your comments here

Margaret McCartney

Maybe I’m not imagining it: maybe we are all getting a bit more attuned to the problems with screening, even in the US.

But when the doctor who discovered prostate specific antigen (PSA) -  which is commonly used to try to detect prostate cancer – writes in an article in the New York Times The Great Prostate Mistake, that “ I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of PSA screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments” hope is definitely in the air.

By Rebecca Knight

Should we treat foods high in sugar and saturated fat – such as French fries and soda – like cigarettes and liquor, and subject them to a “sin” tax?
 
Some health advocates think so, and this week a study that appears in the Archives of Internal Medicine, one of the JAMA/Archives journals, provides some pretty persuasive scientific evidence to support such a measure. The study, conducted by researchers at the University of North Carolina at Chapel Hill, found that if junk foods were subjected to a “fat tax” people would eat them less and lose weight as a result. 
 

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?

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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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