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As of today, I will be making my FT blog posts to the FT Health blog at http://blogs.ft.com/healthblog/
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.

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.

In the event of a pandemic flu, word was that medical students and all kinds of healthcare professionals (who don’t normally do diagnosis and prescribing) would be mobilised to take care of the ill populace.

Lots of doctors now work part time because of their children and family life. If a pandemic arises such that schools and nurseries are all closed, there will be a large number of people without childcare. But there will be lots of teachers who are not working because their school is closed. And I’d guess that there would be fair numbers of doctors who normally work part time who would be prepared to work more hours in an emergency – as long as their children were safe and being looked after.

I suspect that organising childcare might be a very important part of planning.

I’m glad to see that this public consultation by the Nuffield Council has been launched today, asking questions about the ethical issues involved in whole-body CT scanning and genetic screening done in private clinics for people with no current health problems. It’s very good that these issues are being raised and debated. But I’m a bit concerned that some of the questions they ask of potential contributors are not quite pointed enough. I’m concerned about both evidence-based medicine and screening tests, mainly because of the potential for harm these have and the lack of balanced information the latter may come with.

By going outside the NHS, these tests certainly have potential for fragmenting care, duplicating results and creating communication problems, all things the Nuffield Council are rightly concerned about. But it isn’t really these that worry me.  It might be worthwhile risking all these things if the potential for benefit from testing could outweigh the problems. But the tests the consultation is concerned about come with no evidence to justify them. There are enormous misunderstandings about the limitations of these tests - for example, the document says that CT scans for the well “provide a person-specific disease risk profile”. I’d disagree: for a cardiovascular risk profile, a discussion, a set of weighing scales, a blood pressure and possibly a blood test or two will sort that out – and all that can be got for free on the NHS. A CT scan will not tell you an awful lot of important things. Isn’t it regulation of these “services” that is primarily needed? But these thoughts are contained in the last pages of the Nuffield’s document: I’d prefer that that was the first question in a very necessary debate.

Of particular concern to me about the latest political scandal is the idea that the leader of the Conservative party was to be invited to publish his “full financial and medical records” apparently as a way to reassure the public that he had not had a sexually transmitted disease.

It is difficult to see how a political class offering sympathy to a recently bereaved father a few weeks ago can turn nasty so quickly. It is also rather disappointing to see that STIs are still as wearily ”embarrassing” as ever. But one thing is clear to me - no politician should ever be allowed to make his medical records public. It would only make political stupidity seem reasonable, and in any case, it is no one’s business but the person who the record is about.

Margaret McCartney’s Blog

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

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