Monthly Archives: May 2009

As of today, I will be making my FT blog posts to the FT Health blog at
where readers can read about and comment on the science, policy, management, technology, business and delivery of healthcare.

I will also be posting entries to my personal blog, which is currently under construction (rumours that my webmaster has first to finish organising a cocktail party in LA are being denied.)

I’ll supply the address on the Health blog when I have it.

Over the past few weeks, I have been offered massages, gym visits, vitamin supplements, make-up tips and consultations with cosmetic surgeons. All these generous invitations came from PR companies keen to create a media glow for their clients’ products. Since an awful lot of column inches seem to be devoted to genome testing at the moment, I began to wonder if this was the latest thing being dangled under journalists’ noses.

There are numerous reports in the British media of how marvellous and easy it is to undergo genetic screening. You simply give a sample of your DNA (a swipe of your cheek on a swab will do) and hand over your cash (anything from hundreds to thousands of pounds, depending on the company). Voilà, by return of post, you are told your “genetic risk profile”.

Two themes emerge from the articles written by these journalists staring, rapt in wonder, at their own genetic code. First, they see this as a part of the information revolution: at last we are in charge of our destiny; no longer are paternalistic doctors preventing us from discovering what we have the right to know. Second, doctors better get themselves trained up on how to use this information; if they don’t, the service the consumer pays for won’t represent value for money. It’s doctors’ responsibility to help us use this information appropriately.

The remainder of the article can be read here. Please post comments below.

…and his Foundation for Integrated Health. An excellent analysis of a recent meeting held at the King’s Fund in London at David Colquhoun’s website .

I may not have seen a pharmaceutical rep for over five years, but still the branded pens they gift to medics continue to infiltrate my house and my handbag. I conciously throw out the drug company pens I find, but they just seep back in: every time I lose my own plain biro, there is another pen somewhere near, in a ravishing colour or with streamlined design, beckoning to take its place.

The reasons why I don’t like seeing drug reps are several. But mainly they come down to this: time is precious, and unbiased appraisals of evidence are better delivered elsewhere. Reps are there to sell, and fair evidence should not need ‘sold’.

But this may not be quite enough. An interesting paper in the Archives of Internal Medicine has examined the effect of exposing medical students exposure to brand logos on equipment – stickers on clipboards or branded notepaper – prior to being asked about the implicit attitudes towards these drugs. The students who had been exposed to the promotional material held higher implicit values for the promoted drug compared with the control group.

There are obvious limitations to this study - it is a single study performed with one cohort of students, and it does not necessarily mean that prescribing is going to vary with the presence of promotional gifts. Yet we don’t know that it doesn’t. Here is a report in Pharmaceutical Field magazine calling on reps to find those ‘rare but lovely creatures’ – GPs who see reps daily. We now have the internet and excellent sources of information. I do not think that pharmaceutical sales reps are needed, or advantageous to patient care. 

A couple of other potential harms bother me. First, pharmaceutical reps are usually highly qualified and very able individuals. They are utterly wasted in being drug reps.  And second, do people seeing their doctor feel any differently for the presence of branded goods in the consulting room?

Squeamishness is relative. I am unfazed by childbirth, urinary catheters and vomit. I am less good with injuries to the ends of fingers or toes, which always make me want to look away. My biggest fear, however, is of eyes.

Operative ophthalmology, in particular, sets me on edge – the eyelid clamped back, the surrounds of the eye draped to keep the area clean and, all the while, the conscious eye watching the approach of the surgeon’s hand. But not everyone is troubled by this prospect. Indeed, a number of FT readers have asked me about laser eye surgery – whether it really works, and what, if any, are the complications?

The information about laser eye surgery on the Royal College of Ophthalmologists’ website gives a useful overview. Laser eye surgery is not suitable for all spectacle-wearers, and some may still have to wear glasses either post-op or at a later stage. Surgery is also expensive – the bill can run to many thousands of pounds.

The remainder of the article can be read here. Please post comments below.

The ritual of weekly baby weighing clinics is unlikely to end anytime soon, and so I am delighted to learn that – at last- the old World Health Organisation baby weight charts are being ditched in favour of more evidence-based ones.  Previously, the charts “smoothed over” the differences in normal childrens’ weight gain in the first two weeks of life: now, the fact that “all infants show different patterns of weight gain” in these two weeks is accepted and instead the weight gain relative to birth weight is more important. Additionally, there are now charts specifically for pre-term infants.

I am sorry to say that I never knew the old infant weight charts to be contentious until I (or my child) was on the wrong side of them. The old charts were based on forumula-fed babies. Breast-fed babies, having a different pattern of weight gain, tended to look malnourished on the old charts rather than thriving.

The charts are free to download from the Royal College of Paediatrics website.

We are living in uncertain times. Circumstances will probably have changed by the time this column appears, but whatever happens, swine flu will probably still be making headlines.

People don’t like uncertainty, either as patients or doctors. It would be easier if we could predict the spread of disease reliably, or the effect of medications accurately. The prospect of a swine flu pandemic has triggered a million questions and concerns – and the answers to a substantial proportion of them remain unclear.

This is not stopping many people from trying to make a fast buck. Companies are selling alternative and complementary medicines – which will, so they say, reduce the chances of flu – and expensive hand washes, insisting they are essential in pandemics. These products parade all manner of claims, yet few admit they are untested. Conversely, people who are honest about the uncertainty of the evolving flu situation have been misquoted or have had their estimates pushed to the edges of reason by an anxious media.

The remainder of the article can be read here. Please post comments below.

This starts in the Royal Courts of Justice today. There are restrictions on what can be reported currently.  I am reliably informed that this legal blog  will have updates.

Best wishes, Simon.

Boots the chemist are making much of research just published in the British Journal of Dermatology. It involves their Protect and Perfect product, which is on sale in my local store, where there are signs saying that customers are allowed to buy only 6 bottles. Clearly they are anticipating great demand.

In 2007, the BBC program Horizon revealed results of a test of Protect and Perfect. They used it on 15 people over 12 days, applying the cream to the forearm and then assaying skin samples for fibrillin, which – say Boots may ”perhaps clinically improve photoaged skin”. 

Rightly, this experiment was criticised, and it was announced that proper trials were going to be done, and here, in the BJD, they are.

This is what Boots says about it:

“The trial was an independent study of 60 volunteers over an initial period of six months. Half the volunteers used No7 Protect & Perfect Intense Beauty Serum and the other half used a placebo product (the same formula, but without the anti-ageing ingredients). Neither group knew which product they had been given.

The results for No7 Protect & Perfect Intense Beauty Serum were astounding. After the initial six months were over, skin on the volunteers using the real No7 Protect & Perfect Intense Beauty Serum showed some repair of the damage caused by sun exposure. No changes were seen for the group using the placebo product.

Use of the No7 Protect & Perfect Intense Beauty Serum for an additional six months led to clinical reduction in the appearance of wrinkles, assessed by an independent dermatologist. Seventy per cent of people perceived a marked improvement in their skin, thus proving that the skin looks better the longer you use No7 Protect & Perfect Intense.”

I don’t think that’s quite how I’d put it. Certainly, it was an RCT, and that’s good. The 60 participants were blinded to either the placebo cream or the test cream for six months. After six months the groups were unblinded and they all used the test cream. However the study used linear regression analysis to “extrapolate the vehicle response to 12 months, thus allowing comparisons with the test product”. This seems like a bad idea to me: this technique is not as true to life as doing the comparative test in real life would be.  The assessments of skin changes were made by two dermatologists, and I am not convinced that we know this is a reliable and reproducible tool. But very interestingly, in the abstract summary it says “at six months, the test product produced statistically significant improvement in facial wrinkles as compared to baseline assessment (p=0.013) whereas vehicle-treated skin was not significantly improved (p=0.11).” A p value of less than 0.05 is usually treated as being statistically significant in medical papers. However, in the discussion section, please note (and my caps):

“Compared to the baseline, the test product did lead to a noticeable clinical improvement in facial wrinkles (P=0.013) in 43 per cent of treated individuals after six months, compared with only 22 per cent of those treated with the vehicle where there was no significant improvement in appearance (p=0.11). In a comparison between groups THIS IMPROVEMENT WAS NOT STATISTICALLY SIGNIFICANT but does indicate that larger clinical trials of cosmetic products might be expected to show useful clinical improvement after six months’ use.”

I interpret that as bit of a wish-list. I’m not astounded either.

I live with an Irishman, which means that at home we drink Barry’s Tea. In my early married life I was “not allowed” this Irish brand, as apparently I did not appreciate it enough. Now, there is a supplier in Glasgow and we no longer have to import boxes of the elusive blend from Dublin. I am still not allowed to make it, however, as there is a very specific brewing time – at least five minutes, so I’m told.

This method of preparation may be a good thing, for in the process of brewing, then adding milk, the tea is never piping hot. According to a recent study in the British Medical Journal, the temperature of tea could be a risk factor for cancer. The habit of drinking of hot tea in Iran, where the study was conducted, seemed to increase the likelihood of developing oesophageal cancer.

More than 80 per cent of oesophageal cancers are diagnosed in the developing world; men, too, are at increased risk, accounting for almost two-thirds of sufferers. In Iran, there are 17.6 cases per 100,000 of the male population; in China, the rate is 24; and in England, it is 14.

The remainder of the article can be read here. Please post comments below.

Margaret McCartney’s Blog

This blog is no longer updated but it remains open as an archive.

A forum on healthcare policy and professional issues, by Glasgow-based GP and FT Weekend columnist Margaret McCartney.