The blogspot version of this blog is HERE. The Blogroll. My Home Page. Email John Ray here. Other mirror sites: Greenie Watch, Political Correctness Watch, Dissecting Leftism, Australian Politics, Education Watch, Gun Watch, Recipes, Immigration Watch, Tongue Tied and Food & Health Skeptic. The archive for this site is here or here. For a list of backups viewable in China, see here. (Click "Refresh" on your browser if background colour is missing)
************************************************************************************



21 August, 2008

Reform Needed at the Food and Drug Administration

One-Size-Fits-All Mandates Don’t Work for Individual Patients

In order to best serve the interests of the nation’s patients and doctors, the structure of the Food and Drug Administration desperately needs to be systematically reformed, according to a new study published by the Competitive Enterprise Institute.

In FDA’s Bad Medicine: How the Dispersed Knowledge Problem Affects Drug Safety Analysis, authors Jerome Arnett, M.D., and Gregory Conko argue that the very structure of the FDA prevents it from doing its job—making sure safe and effective medical treatments reach patients in need.

“Every day, thousands of physicians and patients make myriad choices from available drug options,” write Conko and Arnett. “They take into account differences in effectiveness, side effects, and drug interactions for each individual patient. FDA scientists may know a lot about the drugs they evaluate and their average effects on thousands of users, but they know nothing about the individualized physiology of each patient. On the other hand, intensively trained clinical physicians, who do have knowledge of individual patients, are best able to advise them if a drug is appropriate.”

Because the FDA uses the blunt tool of completely banning drugs that aren’t safe for all patients, there will almost always be those who lie outside the average, and for whom unapproved treatments are not just appropriate, but medically necessary. The government should be encouraging a more personalized approach to treatment, with physicians utilizing multiple sources of information and guidance in tailoring the best possible strategy for each individual patient.

“A market-based approach to drug safety information, combined with technological advances in diagnostic science, will lead to a more vibrant medical marketplace—and better outcomes for patients,” conclude Arnett and Conko.

Source





20 August, 2008

Hospital Infections: Preventable and Unacceptable

On July 30, a jury awarded over $2.5 million to James Klotz and his wife Mary in a medical malpractice lawsuit against a heart surgeon, his group practice and St. Anthony's Medical Center in St. Louis, Mo. In 2004 Mr. Klotz, now 69, was rushed to the hospital with a heart attack and a pacemaker was surgically implanted. He developed a drug-resistant staph infection called methicillin-resistant Staphylococcus aureus (MRSA). It was so severe that he underwent 15 additional operations, spent 84 days in the hospital and lost his right leg, part of his left foot, a kidney and most of his hearing.

This verdict should send a warning to physicians, hospitals and hospital board members. Until recently, infection was considered an unavoidable risk. But now there is proof that nearly all hospital infections are avoidable when doctors and staff clean their hands and rigorously practice proper hygiene and other preventive measures.

Hospital infections will cause the next wave of class-action lawsuits, bigger than the litigation over asbestos. The germ that Mr. Klotz contracted, hospital-acquired MRSA, infects about 880,000 patients a year and accounts for only 8% of all hospital infections. Hospital infections caused by all kinds of bacteria sicken millions.

The Klotz verdict is not the first sign that hospitals are in a new legal environment. In 2004, Tenet Healthcare Corporation agreed to pay $31 million to settle 106 lawsuits by patients who contracted infections after heart surgery at Palm Beach Gardens Medical Center in Florida. Since then, numerous lawsuits have been filed against hospitals in Florida, Kentucky and elsewhere by infected patients. Hospitals being sued are saying that their infection rates are within national norms. But for most infections, the only acceptable rate is zero.

Medicare calls certain device-related bloodstream infections, urinary tract infections and surgical infections after orthopedic and heart surgery "never events." Starting in October, Medicare will stop reimbursing hospitals for treatment of these infections. Hospitals will be barred from billing patients for what Medicare doesn't pay, forcing them to take a loss. Next year Medicare will add other types of infections to the list of "never events."

The evidence justifying Medicare's new policy is compelling. Central line bloodstream infections, caused by the contamination of certain devices, are preventable. Hospital patients in intensive care are commonly medicated through a tube inserted into a vein. The risk is that bacteria will invade the tube and enter the bloodstream. Rigorous hygiene, including clean hands, sterile drapes, and careful cleaning of the insertion site with chlorhexidine soap, can keep bacteria away from the tube.

Beth Israel Medical Center in New York City reports that it hasn't had a central line bloodstream infection in the cardiac intensive care unit in over 1,000 days. Dr. Brian Koll, chief of infection control there, explains that the key is using a checklist that doctors and nurses must follow. Implementing the checklist cost $30,000 and saved $1.5 million in treatment costs. Lives saved: priceless.

Other hospitals -- from Johns Hopkins Medical Center in Baltimore to Sutter Roseville Medical Center in Sacramento -- have reached the goal of zero central line bloodstream infections. No wonder Medicare calls these infections "never events." Why should jurors reach a different conclusion in a lawsuit?

We have the knowledge to prevent infections. What has been lacking is the will. A recent survey from the patient-safety organization Leapfrog found that 87% of hospitals fail to consistently practice infection prevention measures. Insurance companies that sell liability coverage to hospitals could change that by offering lower premiums to hospitals that rigorously follow infection-prevention protocols.

To be sure, lawsuits are not the best way to improve patient care. Many verdicts are unjustified, and few truly injured patients find a lawyer to take their case. Still, the coming wave of lawsuits, as well as financial incentives from Medicare and insurers, will fight complacency about hospital hygiene.

Source





19 August, 2008

NHS watchdog to tell patients how to buy medicine unavailable on health service

Patients are to be given advice on drugs rejected by the NHS - so they can choose to buy them privately.

The National Institute for Health and Clinical Excellence (NICE) is drawing up plans to provide patients with independent medical guidance on treatments for diseases such as cancer. The advice would include drugs that NICE has ruled the NHS should not use because they are too expensive. For the first time patients would be able to receive impartial guidance on the health benefits of unapproved treatments and compare them with those available on the NHS. They could then decide if they want to pay for them privately rather than opting for the free drugs, which can be less effective.

The development follows growing public anger over the number of drugs and treatments being blocked by the Nice because they are not 'cost effective'. Many are available abroad and can offer people longer life expectancy or health benefits. Last week the watchdog ruled that four kidney cancer drugs costing around o24,000 a year per patient did not represent value for money.

Under current health service rules patients who choose to buy drugs that the NHS deems too expensive are made to pay for the rest of the care. But ministers are expected to end this following a review of the system which is due to report in October. It is expected this will give the green light for patients to 'top up' their treatment. As a result, NICE - which is currently only responsible for deciding which treatments are available free on the NHS - is preparing to publish guidance on drugs they have ruled against.

Speaking to The Daily Telegraph, Andrew Dillon, the chief executive, revealed his organisation was preparing to play a central role if the Department of Health give the go-ahead to so-called "co-payments" in the autumn. He said: "If the Government wants to go in that direction we are absolutely the right organisation to support the process for doing so. "One of the things we think we could do really well would be to provide entirely independent objective information for individuals to make up their own mind. We think we could do that very well and would be happy to do that."

NICE has faced criticism for rejecting a series of drugs widely available in Europe and America - sparking allegations that it is putting financial considerations above medical benefits. The disclosure that it is now preparing to offer advice to patients buying their own drugs will underline concerns that the development of expensive new drugs is leading to the emergence of a "two-tier NHS".

There are also fears that patients unable to afford 'top ups' will be angered at learning they may not be receiving the best treatment available.

It is understood that the information will largely be provided on-line via a new website called "NHS Evidence". The site is being established to offer advice to NHS doctors and hospitals but could be extended to provide patients with clear information on different treatments and drugs available. If co-payments are permitted the medical benefits of privately-available drugs will also be set out. The NHS will also be able to detail the likely costs of a prescription.

Norman Lamb, the Liberal Democrats' health spokesman, welcomed the move. "One of the big dangers of allowing people to top-up their treatment is that consumers aren't informed and they can be susceptible in a moment of crisis to pressure from pharmaceutical companies," he said. "These drugs can be very expensive and I would welcome the provision of a source of independent, reliable advice."

Medical experts and patient groups said the development may also put more pressure on NICE to approve drugs which have medical benefits which are currently unavailable on prescription. Christoph Lees, an NHS consultant and founder member of the Doctors for Reform group, said: "The fact that NICE are preparing to offer advice shows that the realisation is finally filtering through that you can't withhold information on good drugs which are out there and what they can do, even if the NHS can't afford it. "But that has got to be balanced with some sort of mechanism to make sure that people can afford access to these treatments."

Michael Summers, vice chairman of the Patients Association said: "Any information which is available is obviously valuable. But people would have less need to top-up if NICE did not reject cancer drugs available elsewhere."

Andrew Lansley, the shadow Health Secretary, said: "It seems that the Government is intent on pre-empting the outcome of its own consultation on top-up payments and that it wants to assist people to buy their own drugs, rather than have them provided on the NHS. "But Labour are still avoiding two key questions: if patients buy top-up drugs, will that prejudice their access to NHS treatment? Secondly, why is access to new cancer medicines worse in the UK than in the rest of Europe and America?"

NICE is under mounting pressure after barring four kidney cancer drugs available in other countries last week. Charities and patients are preparing to make official complaints about the approval process with one sufferer claiming he was "patronised and bullied" by the process.

Sutent, one of the drugs rejected, can double life expectancy to 28 months for people diagnosed with kidney cancer. A report has claimed that more than 1,000 patients had been turned down for cancer drugs over the past two years because of a "postcode lottery" in treatment.

Patients are also being forced to mount legal action to get hold of drugs that NICE have not yet approved. A grandfather told he only has two months to live has mounted a legal challenge to gain access to a drug that could possibly extend his life expectancy by up to three years. Colin Ross, 55, of Horsham, West Sussex, who has multiple myeloma, a cancer of the blood cells is fighting for the drug Revlimid after being refused it by West Sussex Primary Care Trust because it has not yet been granted approval by NICE.

Source





18 August, 2008

Drug companies fed up with blundering British bureaucracy

So Brits don't get new drugs

One of the world’s leading drug companies is threatening to withdraw some of its new cancer treatments from the process by which they are approved for use in the National Health Service. Cancer patients in Britain will consequently be denied more effective drugs that are available to sufferers in other countries.

Roche, the Swiss pharmaceutical giant, has already refused to supply economic data on its drug Avastin for treatment of lung and breast cancer to the National Institute for Health and Clinical Excellence (Nice), the authority that evaluates the cost-effectiveness of medicines for the NHS. This means Avastin will not be available on the NHS for those diseases. Avastin is said to double the time a breast cancer patient’s condition remains stable when compared with existing treatments. Studies have also shown improved survival rates for lung cancer victims.

Roche said last week it will consider withdrawing from other evaluations rather than submit products only for them to be rejected by Nice as too expensive. The statement is the latest twist in the growing row over decisions by Nice. Earlier this month Nice caused an outcry in a preliminary decision when it rejected the use of Avastin (also known as bevacizumab), Sutent (sunitinib), Nexavar (sorafenib) and Torisel (temsirolimus) as too expensive to treat kidney cancer.

“The alternative to these drugs for many patients is death,” said Jonathan Waxman, professor of oncology at Imperial College, London. “Nice is making terrible mistakes.” The survival rates for cancer in Britain are already among the lowest in Europe — on a par with Poland, Slovenia and the Czech Republic, according to data published last year. However, cancer charities acknowledge there has been significant improvement in rates since the government made the issue a priority with its NHS Cancer Plan, first launched in 2000. Some consultants argue, however, that Britain already spends less on cancer drugs than many other European countries and that it is “crazy” to reject drugs proven to prolong life.

Richard Barker, director- general of the Association of the British Pharmaceutical Industry, which represents the drug companies, said: “Nice does a tough and necessary job, but is making errors because of a very mechanistic approach. It relies too much on arithmetic and not enough on clinical judgment.”

Nice was created in 1999 with the aim of ensuring that decisions on the best and most cost-effective drugs for the NHS were made at a national level, were transparent and could be challenged. When the drug companies scrutinised the economic modelling used by Nice, they realised that the estimated costs of their drugs and effectiveness could vary widely. Even more seriously, some of the calculations were wrong. There was an outcry in the medical community in February 2006 when Nice stated that Temodal (temozolomide) — declared as the biggest breakthrough in treating brain tumours for decades — did not offer value for money. Temodal had won approval from the European regulator in 2004, but many British patients were denied treatment as Nice wrangled over costs.

Peter Davison, 48, a manager for Cambridge University Press, was among the few British patients who received the drug — because he was diagnosed with a brain tumour while working in Singapore. “I was lucky to be abroad,” said Davison, who is now in remission. “Four months after I had the operation to remove the tumour, I was running and climbing mountains.” When Schering-Plough — the pharmaceutical company which markets Temodal — prepared its appeal against the Nice decision, it identified an error in the modelling. Once corrected, the model showed the drug was cost-effective — and as a result it was ultimately approved for NHS use.

Not surprisingly, the drugs companies now want full access to the economic models, with the chance to check the accuracy of the calculations. In May, the High Court ruled that Pfizer and Esai, the companies which market the Alzheimer drug Aricept, should be given full access to these models. “We believe this modelling might not be fit for purpose and we want to check it,” said a Pfizer spokesman last week. Nice said it was seeking leave to appeal to the House of Lords after the High Court decision.

Even where the models are correct, consultants and patients’ groups say Nice fails to give proper weight to the evidence from clinicians and patients’ groups. The Sunday Times has highlighted the fact that NHS patients do not even have the option of paying for the drugs privately because of government ban on “co-payments”. The government has said it will review the issue.

Professor Sir Michael Rawlins, chairman of Nice, said the evaluation process was recognised internationally and Nice had been commended by the World Health Organisation for the quality of its work. He said: “We have a finite amount of money to spend on healthcare and we have to divide it up in as fair and as equitable a way as we can. We can’t say to yes to everything. It’s awkward, it’s difficult, it’s unpleasant.”

Source




Arrogant Australian drug regulator to cause taxpayers MORE pain

And the crooked bitch mainly responsible is still in her job! Australia's version of the FDA shows how badly such organizations can go off the rails

A class action against the federal Government is set to be launched next week after the $55million payout to Pan Pharmaceuticals founder Jim Selim. The Government could be liable for another multi-million-dollar payout because of the action taken by the Therapeutic Goods Administration in 2003 to cancel Pan's licence. The Weekend Australian has also uncovered further evidence of what occurred in the lead-up to the decision to cancel Pan's licence - including a senior TGA officer shredding notes taken at a crucial meeting.

Mr Selim claimed the government had breached its duty and abused its power of public office, and his Federal Court case was settled on Thursday in his favour. More than 300 people lost their jobs, shareholders lost tens of millions of dollars and hundreds of businesses were affected by Pan's closure in 2003.

In January that year, people reported hallucinations and vomiting as a result of taking travel sickness drug Travacalm. The TGA then investigated Pan and meetings were held to decide what action to take. On April 23, 2003, the TGA organised for an expert advisory group to decide whether the public was at "imminent risk" of death, serious injury or serious illness from Pan's products. It was a statutory requirement that the government believed this "imminent risk" existed before it could take the action to cancel Pan's licence. The EAG was later to report back to the TGA that there was no "imminent risk", although it did find there was a lack of confidence in the quality of Pan's products.

Pages of notes taken by the members of the EAG were later taken by the TGA and destroyed at the direction of senior bureaucrat Fiona Cumming. Dr Cumming is the director of the office of complementary medicines. At the same time, the EAG was meeting at the Qantas Club at Sydney Airport to discuss the risks of Pan's products, media officer Kay McNeice was in the TGA's Canberra office putting the finishing touches to a media release - announcing the cancellation of Pan's licence.

Although the notes of the EAG's deliberations were destroyed, lawyers were able to unearth a transcript of the meeting, which had been recorded at the behest of the TGA. "We don't have much evidence do we," one member noted. "We're having trouble getting to 'imminent risk'," said another. The findings of the EAG did not justify an immediate suspension of Pan's licence, a proposition agreed to in court by the TGA's director of the office of devices, blood and tissues Rita Maclachlan, who spent several days being cross-examined by Mr Selim's barristers. Immediate suspension meant Pan could not dispute the issue in the courts, a fact the TGA was aware of.

Ms Maclachlan, second in command at the TGA, was also present when then health minister Kay Patterson and prime minister John Howard were briefed in late April. "Why didn't you speak up and say, 'Look, even though it's not my call ... we are about to implement the largest recall in the history of the Western world, unlawfully, because we are going to deny the company its statutory requirement to natural justice'. Why didn't you say that?" Mr Selim's barrister, Justin Gleeson SC, asked. "I don't have a recollection, Mr Gleeson" Ms Maclachlan replied.

When Ms Maclachlan gave evidence that she was concerned that one batch of Pan products - manufactured in August 2000 and not part of the 2003 recall - could cause severe allergic reactions in the public, the judge hearing the case, Arthur Emmett asked a few questions of his own. "You weren't prepared to recall this product back then but that was the reason you were going to call the other 6000 products back (in 2003)?" "I don't have a particular recollection as to what happened with this product," Ms Maclachlan replied.

"But you've just told me ... that you were concerned that this product was still out in the community," Justice Emmett said. "You didn't take any steps to have it recalled? I just find that quite unbelievable." Ms Maclachlan declined to comment yesterday.

Source





17 August, 2008

HEALTH WOES IN TROPICAL AUSTRALIA

Cairns is the centre of one of Australia's major resort areas. There is a constant stream of planes landing with loads of tourists at Cairns International airport. The planes seem to roar in every ten minutes or so during the day. So you would think that health services there would be at a standard to create a good impression of Australia. Sadly, it is not so. And note that Cairns Base Hospital serves an area approximately the size of England -- in addition to treating tourist mishaps. Four current articles below

Paramedics dangerously overworked in Cairns

Twenty-four hour shifts and bullying are among a rash of new complaints outlined by stressed ambulance officers. Following a series of exclusive reports by The Cairns Post, more Queensland Ambulance Service paramedics yesterday came forward to detail the staffing shortfalls and other problems plaguing the service across the Far North.

They said overworked staff were sometimes too tired to even fill in their time-sheets properly at the end of shifts that extended to 24-hours in smaller centres with an overnight on-call component. "Everyone's being flogged to death but what choice do you have when there aren't enough staff and you've got a moral obligation to the community?" one paramedic said. Others told of a culture of bullying when complaints were made to management.

The paramedics who rang The Cairns Post yesterday said they felt compelled to speak out before a patient's life was "put on the line". Their complaints come after revelations this week that a student paramedic was left in charge of the entire Cardwell region for seven hours on Monday. The nearest qualified paramedic was more than 40km away in Tully.

Their concerns also follow the death last month of a Cairns World War II Digger who waited more than two hours for an ambulance to come from Kuranda the day he died. One paramedic described that situation as a "regular problem", saying he knew of a recent case where a Code 1 job outside the Cairns casino needed to be responded to by Kuranda and another less serious case where Gordonvale's unit had to be sent to Yorkeys Knob.

Queensland Ambulance Service's new Far Northern assistant commissioner Peter Cahill denied there was a shortage of ambulance officers and said he had not been briefed on any bullying issues. Mr Cahill said he would look into incidents if he had firm evidence. But he said the Far North region had a good record for response rates, with 50 per cent of Cairns and coastal region cases being responded to in 7.4 minutes, which was under the state average. He conceded 24-hour shifts were a long-standing practice for smaller stations but said staff were only on-call overnight for emergencies.

Opposition spokesman Ted Malone called on Emergency Services Minister Neil Roberts to "stop covering up staff shortages".

Source

Cairns paramedics told to put names to complaints

Given the well-known bullying of paramedics by management, this is just stonewalling

The Queensland Ambulance Service will only investigate allegations by paramedics that they are being overworked and bullied by superiors if staff are willing to come forward. The bosses say they will also only investigate alleged unsafe work practices where students were put into positions alone without trained paramedics to back them up if officers will put their names to the complaints.

The response comes after revelations that a student paramedic was left in charge of the Cardwell region for several hours earlier this week. The Weekend Post has since been inundated with calls from paramedics, students and people in senior QAS roles, voicing concerns over practices they believe are "putting lives at risk". But all fear being named, saying they will be sacked or moved on.

"If we are given instances where people felt intimidated or they believe they are going to be sacked I would like to know about them," QAS deputy commissioner Russell Bowles said. "Apart from gross misconduct I have never seen anyone sacked.'' But one highly placed person in the service said there were often directives from the State Government banning staff from speaking out. QAS assistant commissioner Peter Cahill said he would investigate any incident raised through formal channels

Source

Cairns ambulance bosses say sorry for wrongful and fatal delay

Ambulance bosses admit a series of blunders may have contributed to the death of World War II digger Bob Mutton and have apologised to his family. An investigation into the circumstances surrounding the Changi prison camp survivor's death found a series of "operational deficiencies", including an unacceptable response time. Staff involved will be officially counselled.

The inquiry was launched after an exclusive report in The Cairns Post revealed Mr Mutton waited more than two hours for an ambulance. Releasing the outcome of the investigation yesterday, Queensland Ambulance Service deputy commissioner Russell Bowles told The Weekend Post: "It is very unfortunate and I am sorry that it happened and my heartfelt condolences go out to Mr Mutton's family."

On the day Mr Mutton died in late July, it took almost an hour for the first ambulance to be dispatched to his Cairns home after his doctor called to report the 88-year-old was struggling for breath. That ambulance was diverted four minutes into the job. After another 71 minutes, an ambulance arrived from Kuranda before taking him to Cairns Base Hospital where he later died. At the time, ambulance bosses blamed delays in reaching the war veteran on the number of ambulances delivering patients to Cairns Base Hospital. But the investigation found crews were in fact available to respond to Mr Mutton.

The investigation found the initial call was classified correctly but it was not actioned correctly. It also found there was an unacceptable initial response time and diversion, and that standard procedures were not followed when responding to calls made by Mr Mutton's doctor. "Standard operating procedure required a response to this case within 20 minutes," Mr Bowles said. "This did not occur as it took paramedics two hours and five minutes to respond.''

Mr Bowles added: "While some crews were waiting to admit patients at CBH, there were other resources available that should have been redirected. "Mr Mutton's case was urgent enough to require the attendance of one of those crews."

Mr Bowles said while some of the staff involved had been debriefed on the incident, others would soon be and they would be "officially counselled regarding this matter''. "We are human. We do 60,000 cases a year and now what we have to do as these cases come up is - and we don't always get it as right as we want - is not to have a witch-hunt," he said. Mr Bowles said as a result of the incident he had also directed the assistant commissioner Peter Cahill to reiterate to all staff the importance of following QAS policy and procedures. He said the QAS was trying to contact Mr Mutton's family to take them step-by-step through what happened on that fateful day.

Source

Two-day emergency department stay in Cairns public hospital

Cairns Base Hospital is again at bursting point, with patients being kept overnight in the emergency department because of bed shortages. Cairns Private Hospital has also been near capacity for the past two weeks, and has been forced to turn away some patients transferred from state facilities. Both hospitals have blamed the flu season and an ageing population for the capacity problems.

Victorian grandmother Lynette Thompson, who is visiting family in Cairns, said she was kept in the emergency department at Cairns Base for two days because staff were unable to find her a bed. The 72-year-old said while she had nothing but praise for hospital staff, she "did not dream the doctors could not find me a bed" in the main part of the hospital. Despite having private health cover, and the best efforts of doctors at Cairns Base, she said no bed could be found at the private hospital either. "I was absolutely horrified there was nowhere to go," Ms Thompson said.

Ms Thompson, who is from Ballarat and spends about two months in Cairns each year visiting her three sons, said she was "appalled" by the situation. "We would never consider living here permanently as we have such good health care in Ballarat and Melbourne."

Both Queensland Health and Ramsay Health said the reasons for the ongoing capacity problems were the ageing population [And that could not be planned for??] and the flu season. Ramsay Health boss Mark Page said Cairns Private had not turned away any booked patients but there had been cases in the past few weeks when it had been unable to accept some transfer patients. "All five operating theatres are also operating at capacity," he said.

A Queensland Health spokesman said no patients requiring admission had been turned away from Cairns Base Hospital. "However, once admitted to the emergency department, some patients may experience a delay in being transferred to a ward due to a shortage of beds in the main hospital at the time they are admitted," he said.

Cairns Base Hospital executive director of medical services Dr Kathleen Atkinson said the hospital had implemented a number of strategies to cope with the rush. She said those strategies included more efficient discharging of patients who were ready to go home and the transfer of patients who were no longer acutely ill, but still needed to be in hospital, to a smaller, rural health facility. Dr Atkinson also urged people to consider if a visit to their general practitioner was more appropriate for their condition than presenting at the emergency department and to undertake health precautions such as having a flu vaccination.

Source





16 August, 2008

NHS discriminates against the old

i.e. those who need medical care most. Great system!

Hospitals have been accused of age discrimination after a study found that they failed to provide basic standards of care to many patients aged 50 and over. Health experts found shortfalls in the quality of care offered to patients with conditions such as osteoarthritis, incontinence and osteoporosis. They also found that doctors paid particular attention to assessments that earned them extra money, including heart disease, diabetes and high blood pressure.

Nick Steel, senior lecturer in primary care at the University of East Anglia, who led the study, said: "One of the conditions that came out worst was osteoarthritis, where we asked people if they'd received basic advice such as doing exercises to control the condition, and whether they had effective pain relief. "At the more severe end of the scale, for those with severe osteoarthritis, we asked if they had been given the opportunity to see a specialist to talk about joint replacement. There were also issues around whether elderly patients had been asked the reason for their falls. These types of areas did not fare so well in the study."

The research, published in the British Medical Journal, found that the quality of healthcare for people with common health conditions "varied substantially by condition". The researchers quantified what treatments for 13 different conditions - including heart disease, diabetes, stroke, depression and osteoarthritis - could be expected. In total, these numbered more than 19,000 different opportunities for care to be delivered to people, but actual care was given only in 11,900 (62 per cent) of those cases. Scores on the quality of care ranged from 83 per cent for heart disease to 29 per cent for osteoarthritis.

The researchers found that substantially more care was provided for general medical conditions (74 per cent) than for geriatric conditions (57 per cent), including falls, osteoarthritis, urinary incontinence, cataract problems, hearing problems and osteoporosis.

Campaigners said that patients with arthritis were often being "fobbed off" by GPs and accused the NHS being guilty of a degree of ageism. Gordon Lishman, director-general of Age Concern, said: "These figures show that age discrimination within the NHS is still rife. "The rewards system for GPs to treat particular conditions has worked - but this hasn't included health problems older people particularly suffer from like depression, falls and vision and hearing problems. The system is therefore clearly failing thousands of older people."

The study involved a series of questionnaires and face-to-face interviews with 8,688 people.

Kate Jopling, head of public affairs at Help the Aged, called the results depressing. "This is extremely shortsighted in an increasingly ageing society," she said. "This kind of ageist treatment is precisely why legislation against age discrimination is needed."

Source





15 August, 2008

Amazing: Patients 'should not expect NHS to save their life if it costs too much'

The NHS should not always attempt to save someone's life if the cost is too much, the medical regulator has ruled. The National Institute for Health and Clinical Guidelines (Nice) has ruled for the first time that saving a life cannot be justified at any cost, in a review of its ethical guidelines.

The ruling - made by the board of the controversial organisation - contradicts advice it received from its own 'Citizens Council' which offers advice from a representative sample of the general public. Nice is facing growing criticism over the number of drugs it is now rejecting which are available throughout Europe and in America. Last week, it refused to sanction four kidney cancer drugs which can double life expectancy.

It has now rejected the so-called "rule of rescue" which stipulates that people facing death should be treated regardless of the costs. The rule is based on the natural impulse to aid individuals in trouble.

In a report on "social values judgement" the regulator says: "There is a powerful human impulse, known as the 'rule of rescue', to attempt to help an identifiable person whose life is in danger, no matter how much it costs. When there are limited resources for healthcare, applying the 'rule of rescue' may mean that other people will not be able to have the care or treatment they need.

"Nice recognises that when it is making its decisions it should consider the needs of present and future patients of the NHS who are anonymous and who do not necessarily have people to argue their case on their behalf.The Institute has not therefore adopted an additional 'rule of rescue'."

The ruling contradicts the advice of Nice's Citizens Council, which said that a rule of rescue was an essential mark of a humane society. The report said that where individuals are in "desperate and exceptional circumstances" they should sometimes receive greater help than can be justified by a "purely utilitarian approach".

Doctors have also criticised the ruling. Tony Calland, chairman of the ethics committee of the British Medical Association, said: "We would be opposed to ignoring a rule of rescue when it introduces a degree of flexibility around extreme cases. So what if you waste a few pounds if you are doing your best for humanity?"

Nice defended its ruling last night saying that the Citizens Council provided useful input to its decisions but that the organisation's role was to determine how best to allocate the health service's limited resources.

Nice is facing increasing accusations that it is giving undue weight to financial considerations - rather than medical benefits - when making decisions on whether to allow drugs or other treatments on the NHS. Doctors and patients have alleged that they are treated with contempt by the organisation and that life-saving drugs are being unfairly denied.

The Daily Telegraph disclosed yesterday that Nice is preparing to offer patients advice on the medical benefits of drugs that are not available on the NHS. The disclosure is likely to anger patients who face paying tens of thousands of pounds for expensive drugs which may prolong their lives.

Source




MEDICAL TOURISM: HEALTH CARE FREE TRADE

Global competition in health care is allowing more patients from developed countries to travel for medical reasons to regions once characterized as "third world." Many of these "medical tourists" are not wealthy, but are seeking high quality medical care at affordable prices. To meet the growing demand, entrepreneurs are building technologically advanced facilities in India, Thailand, Latin America and elsewhere, and are hiring physicians, technicians and nurses trained to American and European standards to run them, says Devon Herrick, a senior fellow at the National Center for Policy Analysis.

Fees for treatments abroad range from one-half to as little as one-fifth the price in the United States, depending upon the destination country and type of procedure performed. For example:

Apollo Hospital in New Delhi, India, charges $4,000 for cardiac surgery, compared to about $30,000 in the United States.

A rhinoplasty (nose reconstruction) procedure that costs only $850 in India would cost $4,500 in the United States. [See the figure.]

An MRI in Brazil, Costa Rica, India, Mexico, Singapore or Thailand costs from $200 to $300, compared to more than $1,000 in the United States.

One reason why medical costs are lower abroad is that labor costs are cheaper, says Herrick:

In the United States, labor costs equal more than half of hospital operating revenue, on the average.

Yet, Indian physicians often earn only 40 percent as much, and many Indian nurses earn only one-tenth as much, as their American counterparts.

As more insured patients begin to travel abroad for low-cost medical procedures, medical tourism will result in sorely needed competition in the American health care industry, says Herrick.

Source





14 August, 2008

Ambulance insanity in Australia: Paperwork more important than patients

Up to eight paramedics were doing office jobs in Cairns' regional headquarters on Monday when a student paramedic was left in charge of the entire Cardwell area, a Queensland Ambulance source has said. The source told The Cairns Post an increasingly "top-heavy" ambulance service was to blame for causing a "potentially life-threatening" situation.

Queensland Ambulance Service Far Northern assistant commissioner Peter Cahill yesterday described Monday's rostering of an unqualified paramedic to a seven-hour solo shift in the Cardwell district south of Tully as "not ideal". "But our regular officer called in sick 20 minutes before the shift and it put us in a situation where we needed to find someone very quickly, we tried a number of staff members and the officer available to assist us was the student paramedic," Mr Cahill said after receiving a briefing on the incident.

The worried Queensland Ambulance source, who did not want to be named, said there were "any number" of qualified paramedics working in off-road jobs from management to training on Monday. The source said several were officers-in-charge whose positions had included on-road duties until about six months ago. "We're short-staffed but we're also top-heavy and for one-off occasions qualified people could cover a position," the source said.

Mr Cahill confirmed the student paramedic usually worked under supervision. He said other ambulance officers would have "been doing their roles at their stations". "We have certain numbers of staff to meet demand at certain stations. When these staff are busy doing their work, it is sometimes a bit tricky to relocate them," he said.

Ambulance Employers Association's Bob Lackey described Monday's situation as risky for both the student paramedic and the public with the nearest paramedics 44km from Cardwell at Tully. Emergency Services defended the student as one who has worked with the QAS for more than two years and is expected to be an advanced care paramedic by December.

Source




South Australian public hospital 'to refuse' referred patients

Patients referred to specialist clinics at Flinders Medical Centre will be denied appointments unless they are classified as high priority under a plan to reduce staff workloads, the Public Service Association says. Under the proposal that the PSA yesterday said was being considered by hospital management, only the most urgent cases would be booked into outpatient consulting clinics. To make an appointment, patients need a referral from an emergency department or their GP or medical specialist. Those referrals are then triaged by senior medical staff.

The PSA's chief industrial officer, Peter Christopher, said clerical staff had been told the hospital was examining "how to manage the workloads" because an internal funding request for two extra administration workers was still being negotiated. "Patients who don't fit the highest priority category simply won't get booked into any of the clinics to see the specialists they've been referred to when they present," he said.

Southern Health chief executive Cathy Miller said it was not an official policy but advice to staff from some hospital managers on how to cope with increased demand. "That's one way of categorising patients, but there are other interventions and approaches you can use in managing the workload," she said.

The clinics' administration staff, including ward clerks, last month introduced work bans in protest over "extraordinary" workloads. The work bans and limitations were suspended after a fortnight, but Mr Christopher said they could be "back on within a week or so". But Ms Miller said an extra staff member had been temporarily assigned to the clinics.

Opposition health spokeswoman Vickie Chapman said PSA members were frustrated because the long-running dispute had not been resolved. But a spokeswoman for Acting Health Minister Jay Weatherill said demand for services was rising across every city hospital.

Source





13 August, 2008

Australia: A great emergency call system

This woman is lucky to have received treatment after two 000 calls for help were directed to the wrong cities. Manunda worker Lance Laverty saw the woman lying beside Anderson St with her head in the gutter about 11.45am on Saturday. He called 000 twice but still had to flag down passing police to get the woman help.

The "stuff up" comes just weeks after a World War II Digger died after waiting more than two hours for an ambulance. "She (the woman) had now been laying in the sun for about 40 minutes," Mr Laverty said. "Imagine if that lady was elderly and having a heart attack or a stroke, what the consequences may have been."

Mr Laverty said he tried to phone Cairns police but eventually hung up and called 000, which transferred his call to Beenleigh police [about 1,000 miles South of Cairns].

"I observed what appeared to be three young men hovering around another person lying on the ground," he said. Mr Laverty said he was reluctant to approach the men, fearing a confrontation, so decided the best action was to call police. After waiting 15 minutes for police to arrive, Mr Laverty again called 000 but was this time transferred to Townsville. [about 200 miles South of Cairns].

"I do not blame the police or QAS, all praise on these people and all other emergency service workers at the coal face, but I blame the system that we keep being told is the best in the world," Mr Laverty said.

A police spokesman last night said when a 000 call was received at a police communication centre experiencing a high volume of emergency calls it was transferred to an available call-taker at another police communications centre. This was the reason calls were diverted from Cairns. The woman was taken to Cairns Base Hospital but her condition is not known.

Source





12 August, 2008

Over 1,000 cancer patients refused drugs by NHS managers

More than 1,000 patients been turned down for cancer drugs in the last two years because NHS managers judged they were not "exceptional" cases, according to a new report. The Rarer Cancers Forum, which compiled the data, called on ministers to intervene to end a "bizarre and demeaning" postcode lottery, which it said was leaving patients to die. Their analysis shows that almost all patients in some areas were given the often expensive drugs, while in other areas no patient received them.

The call comes just days after patients groups and doctors reacted angrily to a decision that four kidney cancer drugs were not cost effective enough to be provided on the NHS. The National Institute for Health and Clinical Excellence (Nice) judged that the drugs, which can prolong the average sufferers life for around five or six months, did not provide enough benefits for their cost of up to $48,000.

Primary Care Trusts have a duty to make the drugs available if they have been approved by the watchdog. But NHS managers can also choose to fund drugs which have yet to be approved or have been turned down by Nice if they think a patient's case is "exceptional". The report shows that while the majority of the 5,000 requests to be exceptional cases were approved, 1,300 were turned down. It also reveals wide variations in how some trusts judge what is "exceptional", for example some take into account a patient's wider family situation, whereas others look only at their medical case. Earlier this year a High Court judge ordered an NHS panel to reconsider its decision to refuse one of the kidney cancer drugs, called Sutent, to a woman who is the sole carer of her seriously ill husband, claiming it had not looked at her circumstances "in the round".

The figures, obtained under the Freedom of Information Act, show that more than 5,000 patients asked for their cases to be considered by their local healthcare authorities, since October 2006. While 96 per cent of patients in living in Mid Essex had their requests approved, all those in South West Essex who asked to be considered "exceptional" cases were turned down.

The committees who made the decisions were often controlled by NHS managers rather than doctors, the charity, which received detailed answers from 104 of the 152 PCTs across the country, a total of 68 per cent, claims. The Forum plans to submit the report, Taking Exception, to the Department of Health. Penny Wilson-Webb, from the charity, said: "The NHS should be available to all who need it. "Yet 1,300 cancer patients were denied the treatment that could have made all the difference to them. This audit shows that the exceptional cases process is in chaos and patients are suffering. In the last 20 months, 5,000 cancer patients have been forced to plead for their lives. There has to be a better way. We urge the Government to ... end this bizarre and demeaning lottery."

A spokesman for the Department of Health said: "We have heard from patients that one of their major concerns is the perceived "postcode lottery" in access to drugs – that there are too many variations around who gets access to prescribed drugs and that these variations are a lottery depending on where you live. "The draft NHS Constitution will address this by making it explicit that patients have the right to NICE-approved drugs if clinically appropriate. We will also speed up the national process for appraising new drugs and make more transparent and consistent the process for local funding of drugs not appraised by NICE or where NICE has yet to issue guidance."

Roche, the pharmaceutical company, provided funding for the new research, but the charity insisted it retained editorial control.

Source



11 August, 2008

Another desperate attempt to get NHS computers working

A confectionery and soft drinks executive and the man in charge of programming the nation's pensions have been appointed to take charge of the largest civilian IT project in the world, the Government has announced (David Rose writes).

The Department of Health has named Christine Connelly, formerly of Cadbury-Schweppes, and Martin Bellamy, of the Department for Work and Pensions, jointly to head the mammoth $24.9 BILLION overhaul of NHS computer systems, formerly the highest-paid job in Whitehall. As The Times reported in April, the previous head of the project, Richard Granger, earned $540,000 to $570,000 a year.

Mr Granger, the former director-general of NHS IT, resigned last year after five years. The Government has split his job into two - each advertised for around $400,000 - costing the taxpayer potentially 40 per cent more in managerial wage bills for the project.

The NHS National Programme for IT, designed to link 300 hospitals with thousands of GP surgeries, is running up to two years late in parts and has been repeatedly criticised by auditors, doctors and patients.

Source




Australia: Old lady waits 40 hours in public hospital corridor for surgery

A 40-hour wait for emergency surgery has made health the most important West Australian election issue for pensioners Cathy and Arthur Wardle. Mrs Wardle, 73, arrived at Royal Perth Hospital's emergency department with gallstone pains at noon last Saturday. She did not have surgery until Monday afternoon.

Most of her time was spent waiting on a trolley in a hospital corridor. "I was calm and collected until a nursing co-ordinator told me I was privileged to be lying in a corridor," Mrs Wardle said. "It's not good enough what is happening to people in our hospitals."

Source





10 August, 2008

A bipartisan horror future for medicine coming up

Senators Bob Bennett (R-UT) and Ron Wyden (D-OR) might be calling for "bipartisan" health care in a May 22 letter to the Wall Street Journal, along with lots of others in many forums. As if doubling a bad idea could somehow make it right!

Since well before the massive 1993 Clinton effort to "re-design" American "health care," we have had many Democratic, Republican, and bipartisan schemes-including the piecemeal enactment of an enormous chunk of the Clinton Plan: the criminalization of medicine; the State Children's Health Insurance Program (SCHIP), and "administrative simplification." Nobody dares to suggest that things have gotten any better.

The reformers are all supposed to have good intentions of "fixing" or "transforming" our "broken health-care system." What they are actually doing is trying to break up the working institutions and relationships that we have and force them into a monolithic, centrally engineered system. "Systemness" is the new primary virtue-not competence or compassion, and certainly not ingenuity or inventiveness.

What will the new system look like? I saw a photograph of it recently. There were no faces in the picture, and no suffering, sick patients. Instead, there were the backs of six uniformed "health care workers," possibly once called "nurses," lined up along a wall, faces buried in a row of portable computer monitors. They were presumably interacting with the interactive electronic medical record (EMR) or computerized physician order entry system (CPOE). Who, if anyone, was attending to patients? Answering call buttons, puzzling over symptoms, holding hands, observing response to treatment-all that is mere reality. It is being replaced by the virtual reality of documentation. If it wasn't documented, it didn't happen, and if it is in the record, it stays forever.

The computer is the key piece in all those bipartisan or unipartisan proposals. It is the net that ties everything into one giant interoperable virtual system. The mere human beings who make diagnoses, prescribe or administer treatment, or make the thousands of split-second clinical decisions that occur every day are the ones who have "broken the system." They make errors. They do too little, or else too much. They treat some patients differently than others (that's called "disparity"). They spend too much of "our precious resources" on the seriously sick and the injured-relieving pain, binding wounds, removing tumors, curing infections, staunching hemorrhage, dissolving clots. That's called practicing medicine, and it's what is (or was) taught in medical school.

What all this medicine is breaking is the bank. Neither party is willing to admit that the federal government has made promises that cannot possibly be kept, and incurred debts that cannot possibly be paid. That's not the fault of either party, both of which promised to just pay the bills and not interfere. It must therefore be the fault of those sending the bills. Accordingly, it is they who must be "fixed." The system must "contain" costs, and that means it must control everything. And that means it must know everything; hence, those ubiquitous computers.

The bipartisan fix is to impose a centrally determined order on all that chaos of trying to fix broken human beings. An elite committee will determine "best practices" for each and every situation, "suggest" the proper action to the workers, and monitor compliance. The desired outcome is the optimal health of the system, or population. That's why it's called "health care." And why it gives a higher priority to the healthy taxpayer over the sick or disabled, and to "health maintenance" as opposed to healing. The bipartisan systems engineers don't lay hands on patients-that would be a distraction. Anything with "partisan" in it is about money and control. Its "fix" for medicine is a wrecking ball. Patients (and noncompliant or "disruptive" doctors and nurses) just get in their way.

The next question is always: So you're complaining about the sorcerer's apprentice, but what's your plan for fixing medicine? The question itself is a symptom-socialist central planning is so ingrained in our consciousness that we aren't even aware of it. The American answer-try freedom!-doesn't seem to ring any more.

In medicine, if you have a desperately sick patient, doing nothing is better than radical surgery that you know will fail. Better still-try stopping some of the poisonous drugs he has been taking. Let's make a list of some toxic laws, and repeal them. If surgery is indicated, let's identify the tumor (big government) and work on that instead of cutting off the patient's healthy legs (doctors and nurses attending patients).

Source





9 August, 2008

Scottish government hospital faces criminal charges over 18 superbug deaths

Sad that patients have to die before negligence is noted

Criminal charges could be lodged over "appalling and completely unacceptable" conditions at a hospital where there were 18 deaths linked to Clostridium difficile after a damning independent report was passed to the Procurator Fiscal, the public prosecutor in Scotland. The report into infection control at the Vale of Leven hospital, Dunbartonshire, ordered by the Scottish government and published yesterday, describes inadequate facilities, poor practice and lack of leadership. Fifty-five patients contracted C.difficile at the hospital between last December and June and the bug was recorded as the underlying or contributory cause of death in 18 cases.

The hospital had insufficient handwashing facilities or single rooms, beds were too close together, patients were transferred frequently between wards and the building was rundown. The report also found a lack of leadership and supervision with regard to infection control, and a lack of clarity of roles and responsibilities. It noted that the hospital, which had been under threat of closure for ten years, had a lower priority than others in implementation of policies, surveillance systems and staff development.

Cairns Smith, Professor of Public Health at Aberdeen University, led the independent review team that visited the hospital five times last month and, on one occasion, walked round the wards affected by the outbreak.

Nicola Sturgeon, the Health Minister at Holyrood, said that she had passed the report to the Lord Advocate, who had in turn asked the area Procurator Fiscal for Argyll and Clyde to consider any further action.

Ms Sturgeon said: "Let me be absolutely clear that the picture painted by the review team report is appalling and completely unacceptable. The absence of clear lines of professional responsibility has fostered an environment where there was an inadequate management of a cluster of cases at ward level, or awareness at higher levels. There were also inadequacies and inconsistencies in advice to relatives and in management of patients."

Ms Sturgeon said that she had apologised to families of the victims when she met them yesterday morning and that the health board at NHS Greater Glasgow and Clyde owed them "a direct and unconditional apology for the serious failings on its part". The minister demanded "a clear and unequivocal commitment" to the future of the Vale of Leven hospital and the sustainability of its services. Ms Sturgeon pointed to a "history of neglect" at the hospital. The debate must no longer be about what services were to be withdrawn, she said, but about how the board could create a "modern, fit-for-purpose hospital".

A report from Health Protection Scotland yesterday into levels of C.difficile across the country from last December to June found that there were 3,174 cases, of which 285 patients died with the bacterium an underlying cause or a contributory factor. There were no clusters or outbreaks that had not been identified or reported.

Tom Divers, chief executive of Greater Glasgow and Clyde Health Board, apologised to patients and families. He said: "I recognise the concerns of relatives of patients that they were not properly informed every step of the way of the infection and how to help protect themselves and others from the risk of infection." Mr Divers said that he had ordered immediate improvements to, among other things, hand-washing facilities and bed spacing. A system of infection surveillance across all hospitals had been introduced. "As a result of today's recommendations we will take forward further actions to reinforce leadership, accountability and empowerment both at the ward and hospital level and ensure clear lines of communication and responsibility to the board's medical and nurse directors," he said.

"The uncertainty over the future of this local hospital has undoubtedly been a factor in the lack of major modernisation investments. I can give a commitment that this board will bring forward proposals in August and September that will set out a clear vision for the future of the site."

Syed Ahmed, Consultant in Public Health Medicine at NHS Greater Glasgow and Clyde, said: "The Vale of Leven certainly had more cases of C.difficile than one would expect during the first six months of 2008. Sadly, C.difficile is a germ that is in the community and there will always be sick and vulnerable patients, especially among the elderly, who will develop C.difficile-associated diseases."

Richard Simpson, the Labour public health spokesman, and Jackie Baillie, the local Labour MSP, called for a public inquiry into the deaths. They were joined by Ross Finnie, the Scottish Liberal Democrat health spokesman, while Jackson Carlaw, of the Scottish Conservatives, said that NHS Greater Glasgow and Clyde could not avoid responsibility for the "appalling" loss of life.

Source




Australian health boss caught misrepresenting hospital waiting lists

Nice to have such a bright spark running public hospitals

HEALTH Minister Stephen Robertson has been caught massaging hospital waiting list figures as his department fails to treat the sickest patients in time. Mr Robertson bungled his attempt to laud the latest quarterly public hospital report card for elective surgery waiting lists as a significant achievement. The report showed Queensland Health treated a record 33,732 patients during the June quarter, up from 28,416 for the same period last year. However, the number of patients stuck waiting on lists grew from 34,454 to 34,703.

Having used the annual change to show the record numbers treated, Mr Robertson then moved the goal posts and used the quarterly change for category breakdowns. The number of category one patients not receiving surgery within 30 days had blown out by 35 per cent, from 188 to 254 patients, over the year.

Mr Robertson repeatedly claimed the list was decreasing but was eventually forced into an embarrassing backdown. "Oh, I beg your pardon. There has been a slight increase in cat ones," Mr Robertson said of the 35 per cent rise. "Yes, it has slightly gone up."

The report also showed the Princess Alexandra Hospital and Royal Children's Hospital as among the most under pressure with list backlogs. Opposition health spokesman John-Paul Langbroek said it was not good enough for the sickest patients to wait for more than two weeks longer than they should. "Queensland Health is continually failing to meet these (doctors') time recommendations for surgery," he said.

Source





8 August, 2008

British public hospitals infested with rats, fleas and bed bugs

Hygiene standards in NHS hospitals have been called into question after it emerged they are routinely dealing with infestations of vermin

Outbreaks have included rats in maternity wards, wasps and fleas in neo-natal units, bed bug infestations, flies in operating theatres and maggots found in patients' slippers. The data, uncovered using Freedom of Information rules, include hospitals with maggots, "over-run" with ants and mice "all over" wards; cockroaches in a urology unit and a store for sterile materials infested with mice. The figures raise questions over standards of cleanliness and hygiene in hospitals although the healthcare regulator said complaints about pests were 'negligible'.

The Conservatives asked all 171 hospital trusts in England for details of pest control incidents for the last two years. Of those, 127 Trusts responded and almost all had experienced problems and 100 of them collected detailed information about pest infestations. In total there were almost 20,000 reports of pest problems and seven out of 10 trusts that responded reported they had called in pest control officers more than 50 times since January 2006 - an average of once a fortnight.

Maidstone and Tunbridge Wells Hospital Trust, the trust at the centre of Britain's biggest superbug scandal when more than 300 patient deaths were linked to Clostridium difficile, reported more than 50 pest incidents in two years. A spokesman for Maidstone and Tunbridge Wells NHS Trust said: "Most incidents relate to old buildings which have now been demolished at Pembury Hospital. There is no specific problem."

Of the trusts that collected detailed information 80 per cent had problems with ants, 66 per cent had rats, 77 per cent had mice, 59 per cent had problems with cockroaches, 65 per cent had biting insects or fleas, 24 per cent had problems with bed bugs and 6 per cent had maggots.

Shadow health secretary Andrew Lansley said: "Labour have said over and over again that they will improve cleanliness in our hospitals but these figures clearly show that they are failing. It is difficult for health service estates to maintain a completely pest free environment but the level and variety of these infestations is concerning. "We need greater transparency in NHS infection control, and publishing data like this is one way in which we can drive up overall hygiene standards."

Eight hospitals trusts called in pest control officers more than 500 times, with Nottingham University Hospitals NHS Trust having the most severe problem with 1,070 incidents in two years.

The healthcare watchdog inspects hospital trusts against a strict hygiene code and has the power to shut down wards, departments or even a whole hospital if there is a risk to patients. Christine Braithwaite, head of healthcare associated infection programme at the Healthcare Commission said: "We receive a wide range of information on hygiene from different sources. However, concerns around pest control have, to date, been negligible. "Clearly, it may be necessary to take action against pests in these large public buildings from time to time. "However, it is important for hospital trusts to have robust procedures in place to deal with any pest problems and if they persist, trusts should question whether they have the right systems in place. "If we were concerned that the safety of patients was at risk, through poor hygiene standards or in any other way, we would take immediate action."

Health Minister Ivan Lewis said: "Hospitals must be responsible for ensuring their buildings are clean and that patient safety is not compromised. The Hygiene Code requires NHS bodies to have a pest control policy that anticipates and manages this issue. "Trusts should take rapid action and follow through with surveillance in place to avoid pest incidents and minimize hazards. Use of pest control is a sign of good proactive management. "The claim that insects spread hospital acquired infections is entirely unproven. There is no evidence of their carriage of antibiotic resistant bacteria being a hazard to patients. Despite this we expect hospitals to take continued action to tackle pest problems"

Nottingham University Hospital had the most pest control incidents of any that responded to the Conservatives' request for information. John Simpson, Director of Estates and Facilities Management at Nottingham University Hospitals, said: "These figures must be put into context. It goes without saying that as the fourth largest trust in the country, our hospitals are bigger than most others around the country and therefore our figures should be compared with trusts with similar-sized estates rather than smaller acute trusts. "It is also worth bearing in mind that trusts are likely to have recorded and reported figures differently and therefore the table may not be comparing like-for-like data."

Source





7 August, 2008

A wonderful story about a very good man -- and a big failure of socialized medicine

Only the extraordinary personal efforts of a dedicated doctor saved the life of a baby

A newborn baby was saved from kidney failure after a paediatrician built a dialysis machine for her in his garage. Millie Kelly was given little chance of surviving her first weeks when she suffered kidney failure after a lifesaving operation. At 6lb 2oz (3.3kg), she was too small to use the NHS dialysis machine that would do the work of her failed kidneys. It was not until Malcolm Coulthard, a paediatrician at the Royal Victoria Infirmary, Newcastle, built the machine that she began to recover. Millie is now a fit two-year-old and her mother is supporting Dr Coulthard's campaign for hospitals across the country to have dialysis machines for small babies.

Rebecca Kelly, a 21-year-old student, admitted to misgivings the first time she saw the machine that represented her child's last chance of survival. "It looked handmade in the garage," she said. "It did not look like it was a professional NHS thing. He had made it out of metal and there were a few paint splodges on it. "I did not know what to think really, but I knew it was the only hope. It was touch and go and I went along with it."

Despite its rough-and-ready appearance, it was the product of hours of painstaking work by Dr Coulthard. Millie was attached to the machine for seven days before she began to show signs of recovery. She had suffered kidney failure after an emergency operation for gastroschisis, a condition that causes the intestines to protrude from an opening near the umbilical cord.

Ms Kelly, from Middlesbrough, was convinced that her daughter would survive. "When she was ill, I knew she wouldn't give in. I was devastated when they said she wouldn't make it, but she's a fighter and I knew she would pull through," she said. "If it was not for that machine then she would not be here today. Words cannot describe how grateful my family are to Dr Coulthard. Not only is he a great consultant but now also a great friend and inspiration to Millie, my family and I. "Afterwards, the doctors and nurses didn't know if she would make a full recovery, but she's just turned 2 and she's a normal, happy baby now."

Ms Kelly is calling for more funding to build new machines, as the baby dialysis machine in Newcastle is the only one in the country. "It saved my daughter's life and other babies should have the same chance," she said.

Dr Coulthard, who designed the machine with Jean Crosier, the senior children's kidney nurse, also hopes to build on the success. "This machine is only being used on the tiniest, earliest babies where there is nothing else that can be done," he said. "But if we had a machine that we could use much more freely, then we would be able to deal with many more babies and have a much greater chance of saving lives." The machine allows haemodialysis, the process that cleans the blood through an artificial kidney, to be carried out on babies with renal failure. Underweight newborn babies usually cannot undergo the treatment.

Source





6 August, 2008

Australia: More on another dangerous public hospital doctor

Hundreds of patient files are being reviewed after a damning report into a foreign-trained doctor found he performed surgery beyond his capabilities. The Health Quality and Complaints Commission report found Egyptian-trained doctor Abdalla Khalafalla was allowed to operate on patients at the Mackay Base Hospital without supervision despite "red flags" over many years about his competence.

Dr Khalafalla worked in Mackay from April 2004 to August 2006. An audit of 1000 unsupervised surgical procedures he performed between 2001 and 2006 has been launched in the wake of the HQCC probe. Queensland Health said the audit would include operations he performed in Townsville, Mount Isa, Proserpine and Mackay.

Dr Khalafalla's contract was terminated in August 2006 after the Medical Board of Queensland deregistered him, but the board acted only after former Nationals MP De-Anne Kelly raised the matter in Federal Parliament.

Health Minister Stephen Robertson said Dr Khalafalla, believed to be living in Victoria, was unlikely to face criminal charges. But he admitted the case raised similar questions about clinical practices to that of Indian-trained surgeon Jayant Patel. "There have been incidents where clinicians have not reported where they have witnessed harm to a patient as a result of another surgeon conducting his or her work," Mr Robertson said.

Cabinet meanwhile endorsed a plan yesterday to introduce mandatory reporting by doctors if they saw patients being harmed by colleagues. "We cannot allow these circumstances to keep going on where doctors witness harm, serious harm on some occasions, and not have it reported," he said. The two-year HQCC investigation found the Royal Australasian College of Surgeons supported Dr Khalafalla's appointment in Mackay despite receiving notifications about his competence dating back to 2002.

It said a review of his surgical performance at the Mackay hospital in September 2005 found six out of 26 cases involved a "potentially dangerous technique". The review found two of the patients could have died if action had not been taken and recommended a national reporting system for tracking the performance of registered health professionals.

Source




Incompetent doctor report 'like reliving nightmare'

THE former head of an inquiry into former surgeon Jayant Patel says a report handed down yesterday into another Queensland surgeon was like "reliving a bad nightmare". Barrister Tony Morris, QC, headed the initial 2005 inquiry into Dr Patel, the former director of surgery at Bundaberg Base Hospital now on manslaughter charges, before stepping down five months later over claims of bias.

Queensland's Health Quality and Complaints Commission (HQCC) yesterday released the results of a two-year investigation into surgeon Abdalla Khalafalla, who allegedly performed at least 27 major operations beyond his credentialled level of skill. Egyptian-trained Dr Khalafalla, who has previously worked in Townsville and Victoria, worked at Mackay Base Hospital from 2004 to 2006. In August 2006, former Nationals MP De-Anne Kelly outlined to Federal Parliament four cases where Queenslanders allegedly were injured in operations conducted by the unsupervised doctor and the HQCC began its investigation.

Mr Morris said today he had read the report and found it "absolutely terrifying". "It's like reliving a bad nightmare," Mr Morris told ABC radio. "You read the report and it's almost a complete replication of what happened in Bundaberg. "And the really terrifying part is it's still the same attempt by the bureaucracy to say 'It's not our fault - let's blame the doctors'. "But Queensland Health are to blame and the only change I've seen is that the bureaucrats are now smarter about how they get back at whistleblowers." He said the health department needed to be rebuilt from scratch.

Health Minister Stephen Robertson said the commission's report dealt with issues that occurred two to three years ago and improvements had been made. "They (the commission) do make the observation that the changes made would have gone a long way to stop this thing that happened in Mackay from occurring again," Mr Robertson said. He said it was unfair to blame health bureaucrats. "What occurred in Mackay was a doctor not being properly supervised by who? Not a bureaucrat, a senior doctor," Mr Robertson said. "That senior doctor was reporting to another senior doctor."

An audit is under way into all cases of major surgery performed by Dr Khalafalla at Mackay Base Hospital without direct supervision. The Government is also proposing new laws to force doctors to report cases of patient harm by colleagues. Dr Khalafalla is living in Victoria but is no longer registered to practise. The commission report has been passed on to Victorian and other authorities around Australia.

Source

Comment from a political reporter:

QUEENSLAND Health Minister Stephen Robertson has put in a woeful performance in the wake of the damning Health Quality and Complaints Commission report into how the department handled allegations of incompetence against surgeon Abdalla Khalafalla. Yesterday I wondered how the Government was going to spin its way out of trouble on this one. Robertson has provided the answer _ blame the doctors. Surely with an 69-strong army of PR flacks at Queensland Health, he could have come up with a better line.





5 August, 2008

Huge monetary costs of NHS negligence

Despite the fact that most Brits are effectively discouraged from claiming and despite the fact that awards in Britain are usually only a tiny fraction of the equivalent in the USA

For Dr Spencer at his Norfolk surgery, the whoops-a-daisy moment came when he dosed a woman with bismuth. Startled by her dyspeptic response, and eager to reassure her increasingly agitated husband, he swallowed a spoonful of the stuff himself. "See? Perfectly safe!" Two things then happened: Dr Spencer vomited, fell down and lay writhing on the floor. His patient died.

The explanation was simple. As the doctor explained to the coroner, bismuth and strychnine look remarkably similar in the bottle and, well, mistakes do happen. At the subsequent trial for manslaughter, Mr Justice Willes agreed. A simple blunder, he said, was not in itself a criminal act. To secure a conviction, the crown would have to prove that the doctor's medicines were in such chaotic disorder that it was impossible for him to know which was which. Not guilty, said the jury.

That was in 1867. Legal actions against clinical killers then were exceedingly rare, and would remain so. By 1989 only six more doctors had been fingered for manslaughter - an average of one every 20 years. Then something changed. In the 1990s, 17 were prosecuted, and since 2000 there have been 11 more. One or two of them, like the Spencer case, were tales of startling improbability. A woman under anaesthetic was connected to an oxygen cylinder instead of to a ventilator and inflated like a balloon (the anaesthetist got six months' jail, suspended for 18 months). Mostly, however, they were mundane tragedies of misread notes, wrong drugs or lethal doses administered by exhausted, inexperienced or occasionally negligent practitioners who failed in the most basic of their responsibilities.

This relatively small number of headline cases, however, was only the tiny tip of a legal iceberg. It wasn't just the police and Crown Prosecution Service who were taking a more critical look at wards and clinics - it was the patients themselves. In England between 1990 and 1998, the rate of civil negligence claims against hospitals doubled, reaching a peak in 1998-9 of 6,168. If we didn't know them to be true, the numbers would strain credibility. The cost to the NHS of claims settled in 2006-7 was 579.3m pounds. In the same year it was hit by 5,426 new cases. The NHS Litigation Authority (NHSLA) estimates that the combined cost of settling all outstanding claims, including incidents so far unreported, will be 9.09 billion pounds.

Some of the settlements are whoppers - the actress Leslie Ash made headlines in January this year when she was awarded 5m pounds for the paralysing effects of the hospital "superbug" MRSA. The all-time record is the 12.4m paid last year to a professional dancer, Kerstin Parkin, who suffered brain damage from a heart attack during childbirth. Others by comparison are trifling - "a few hundred pounds for someone scratched during an operation" is one example offered by the NHSLA. But there is an important common factor, and it affects us all.

Paralysing tentacles of fear are now putting the squeeze on medical practice, and changing the way we are treated. Type the words "clinical negligence" or "no win, no fee" into Google and you'll see why - a clamorous pack of legal agencies and law firms who trade on the idea that every accident must be someone's fault. Some websites even provide interactive body maps showing the value of everything from an injured finger (1,000 to 75,000 pounds) to serious brain damage (millions). The come-on to patients is the promise of "no win, no fee". If the lawyer wins your case for you, he collects his fee in costs from the other side and you walk away with your damages in full. If he loses, he charges nothing. So, come on! What are you waiting for? Sue the doc!

Many cases in the past have been the medical equivalents of the time-honoured "slips and trips" actions against local authorities with bumpy pavements. Anyone coming out of hospital with a bruise or a sore eye they didn't go in with was encouraged to call a solicitor. The result was that lawyers' fees were often higher than the damages they won, and these in turn could be eroded by extra costs - medical reports by independent experts, for example - so that even successful litigants wound up out of pocket. According to the National Audit Office, legal and administrative costs exceed money paid to victims in most claims under 45,000. This is why Citizens Advice in 2004 published a 59-page report on personal-injury compensation under the title No Win, No Fee, No Chance.

As so often with the NHS, vice is the bastard child of virtue. "No win, no fee" deals, known in law as conditional-fee arrangements, were introduced by an amendment to the Courts and Legal Services Act in 1995. It was meant to be a double benefit. The courts would be opened up to those in the income trap who were ineligible for legal aid but unable to afford lawyers. The government itself would save money by effectively privatising legal aid. On the surface it looked like the long-overdue democratisation of civil justice.

But law firms are not charities. Working for nothing - pro bono - is not unknown, but it hardly stands as an ideal business model. If lawyers were to drop their fees when they lost, then they would need a bonus when they won. Recognising this, the law allows a "success fee" of up to double the normal scale. In clinical- negligence cases, when judgment favours the patient, this must be paid by the NHS, otherwise known as the taxpayer.

Given all this, the one surprise is that the number of cases each year is actually going down, albeit very slowly. The cost to the NHS nevertheless continues to rise. How can this be? Ironically, it is due in part to improvements in medicine that allow seriously damaged people - especially children - to survive for near-normal life spans. For this reason, courts are awarding much higher damages. Thirty years ago, for example, children suffering cerebral palsy in birth accidents might be expected to die. Now they can reach late middle age. Damages in such cases, which account for 60% of all claims the NHSLA faces, can run to 5m or more....

Walsh does not buy into the idea that avaricious lawyers alone are to blame for the escalating costs of clinical negligence, or even that the costs are excessive. "They come to well under 1% of the NHS budget," he says, "so the notion that claims are bleeding the NHS dry doesn't hold water." Furthermore, it's entirely reasonable for claimants' solicitors to charge more than their opponents do.

Apil's Amanda Stevens agrees. "It's much more costly to prepare evidence to prove a claim than it is to assemble evidence to knock it down," she says. The British public, too, is very far from the writ-happy mob of gold-diggers that the headlines often suggest. "They do not like making a claim." Every year, she says, around 800,000 "adverse clinical events" are recorded in the NHS, and many more - at least 20% - go unreported. Yet only 1% of the victims make a claim, and only 10% of these - ie, 0.1% of the total - get damages.

Thus if the NHSLA believes it is shelling out too much in costs, the remedy is in its own hands. It is a legal catch-22. The NHSLA is duty-bound to keep expense to a minimum, and therefore to challenge costs awarded against it. This means that more cases go to appeal and legal costs escalate. Peter Walsh invites the NHSLA to draw the obvious conclusion. "Stop arguing, admit fault and settle earlier without drawn-out legal wrangling," he says. "That alone would save millions of pounds."

Of all the ways to cut the costs of medical negligence, one stands out way above the others: avoid being negligent in the first place. The NHS needs literally to clean up its act. Here are some figures reported by Sir Liam Donaldson in 2003: 10% of hospital admissions may result in something going wrong; 5% of the entire population report "some adverse effects" of medical care; 18% of patients say they have been victims of "medication error" within the past two years. On top of all the traditional foul-ups - missed diagnoses, poor or inadequate treatment, slipped scalpels and lethal drug doses - now looms the utterly modern phenomenon of the drug-resistant hospital infection. As recently as February, the Department of Health thought it necessary to launch a national campaign against the over-prescription of antibiotics. "The more we take antibiotics when they are not necessary," said Donaldson, "the more bacteria will become resistant to them." Yet patients with runny noses still think they can be cured by them, and - for all that they know better - some doctors still go on doling them out.

The other thing that bacteria love is filth, and the ideal place to look for it is in an NHS hospital. The result is that there are now law firms claiming to specialise in hospital "superbug" cases, and the number of claims is multiplying like bacteria on a Petri dish. One of the most notorious cases involved the three hospitals administered by the Maidstone and Tunbridge Wells NHS Trust where, between April 2004 and September 2006, more than 1,170 patients were infected with Clostridium difficile. According to the Healthcare Commission's official report, about 90 people "definitely or probably died as a result of the infection". The commission's inspectors found that the hospitals were epidemics waiting to happen. Supposedly clean bedpans were contaminated with excrement. Nurses were not washing their hands, emptying commodes, cleaning mattresses and equipment, or wearing aprons and gloves. If there was a parlour game called "pass the bacteria", this is how you'd play it. The health secretary, Alan Johnson, described the episode as "scandalous", and Kent police are still weighing the possibility of prosecution.

Another NHS trust in trouble was Bromley, against which the commission issued an "improvement notice" in February. Inspectors found an absence of routine cleaning around beds in the wards; sterilising equipment not being properly used; dirty commodes marked clean and ready for use; a blood-culture bottle trolley thickly covered in dust, and more. One is always wary of generalising from the particular, but there is no reason to suppose that these two trusts are wholly out of the ordinary. In fact, there is every reason to think otherwise. In June the Healthcare Commission reported that 103 of the 391 primary-care and hospital trusts in England were not meeting statutory hygiene standards - a failure rate of over 25%. The nurses might not be washing their hands, but the lawyers sure as hell are rubbing theirs.

More here





4 August, 2008

Shock! Some NHS hospitals do allow patients to buy expensive drugs that the NHS is too mean to give them

The government’s ban on NHS patients paying for medicines the health service does not fund is in disarray. Figures obtained under freedom of information legislation show that NHS hospitals were allowing dozens of patients to top up with private drugs before the government warned them it was not allowed under NHS rules in July last year. The evidence that top-up payments have previously been allowed, apparently without difficulties, undermines the government’s claim they are contrary to the fundamental principles of the NHS.

At one trust, the Royal Cornwall Hospitals NHS Trust, 20 patients were allowed to co-pay for cancer drugs that the health service refused to fund before the government ban was introduced.

The figures also provide further evidence that many trusts are allowing patients to top up with additional drugs without removing the remainder of their NHS care. Freedom of information data shows that Nottingham University Hospitals NHS Trust has allowed patients to pay for drugs their consultant has recommended without losing the rest of their NHS treatment. John Baron, MP for Billericay, who obtained the figures, said: “This undermines the case of those who argue co-payments cannot exist within the NHS.”

Other trusts that have allowed co-payments include the University Hospital Birmingham NHS Foundation Trust, ABM University NHS Trust in Bridgend, south Wales, and Weston Area Health NHS Trust in Somerset.

Source




Another disastrous foreign doctor in Australia

There have been some appalling cases of doctors trained in India and in Muslim countries. There should be more testing of them before they are hired

Health Minister Stephen Robertson will receive a report tomorrow into an Egyptian- trained surgeon who allegedly bungled operations he performed without supervision. Abdalla Khalifallah, who worked at Mackay Base Hospital, had his contract terminated in August 2006 after he was deregistered by the Medical Board of Queensland.

The report, by the Health Quality and Complaints Commission, is based on almost two years of investigation. The matter was raised in Federal Parliament in August 2006 by former Nationals MP De-Anne Kelly, who outlined the cases of four people she said were injured during unsuccessful operations at Mackay Base Hospital.

Mrs Kelly told Parliament Dr Khalifallah had undertaken three major operations that he was unqualified for without supervision, resulting in complications. One case. to remove a bowel tumour, resulted in fecal matter entering the intestinal cavity, she said.

"This operation was carried out in direct contravention of the decision of the (hospital's) credentials committee," she said. "In July 2005, the hospital's credentials committee determined that Dr Khalifallah must be supervised during major surgery."

Dr Khalifallah became a staff specialist at the hospital in 2004. A spokeswoman for Mr Roberston said the Minister had called for a report into the matter in 2006. "We cannot comment any further until the Minister sees what the report says," she said.

The above article by Suellen Hinde appeared in the Brisbane "Sunday Mail" on 3 August, 2008. The spelling of the name of the fool seems to vary. In this report, it was Abdalla Khalafalla





3 August, 2008

17 NHS patients with cancer wrongly get the all-clear

Seventeen cancer patients were wrongly given the allclear by a hospital after test results were misinterpreted, it was revealed yesterday. The men and women may have missed out on months of potentially life-saving treatment because of the blunders at Hereford County Hospital. In some cases the delay could have been more than two years. They have now received the devastating news that their initial diagnosis was wrong and have begun treatment. In addition 14 people were told they had cancer when they did not. Some may have needlessly undergone debilitating treatment.

The scandal came to light after concerns were raised about a consultant who examined tissue samples at the hospital. Six months ago a review of his work between May 2006 and August 2007 was started, and is now complete. The consultant, who has not been named, has been suspended and is facing disciplinary action. Legal experts said the hospital may be sued by patients.

Paul Keetch, Liberal Democrat MP for Hereford, has sent a letter to Health Secretary Alan Johnson asking him to ensure resources are made available for treating the wrongly diagnosed patients. Mr Keetch said: 'These people have not just been failed by Hereford, they have been failed by the NHS. 'Obviously there will be some patients who are undergoing speeded-up treatment for cancer, and we will be looking for other hospitals in the region to help. 'We must make sure none of the patients suffers as a result of this.'

Dr Lesley Walker of Cancer Research UK said: 'This is extremely unfortunate and distressing news. It's vital that robust systems are put in place at Hereford County Hospital to stop this happening again.'

Caroline Klage, from national medical legal firm Bolt Burden Kemp, said the NHS trust faces being sued by many of the patients. She said: 'In the very worst scenario, where someone has lost the opportunity to be given effective treatment for cancer, the outlook is now bleak and they have a number of dependents, a compensation claim is likely to be significant.'

The review looked at 5,404 tissue samples from 4,654 patients which had been worked on by the consultant in the hospital's histopathology department. Not all the cases involved cancer patients. It found the diagnosis of 102 patients was wrong and their treatment needed altering. The situation of 40 was 'more serious' than at first thought, while the remaining 62 were less serious or 'not materially different'.

Around a quarter of the department's work concerns cancer patients. It also examines samples taken from patients with other conditions, such as the bowel disease Crohn's.

Hereford Hospitals NHS Trust chief executive Martin Woodford said he wanted to apologise 'personally and on behalf of the trust' to all the patients affected. He said: 'We have acted as quickly as possible to make sure that the review was carried out thoroughly and effectively. 'I can confirm that 17 patients were initially informed, incorrectly, that they did not have a malignancy such as cancer. 'However we must emphasise that a number of these patients would have undergone precautionary treatment anyway or been subject to clinical review. 'Furthermore we can give an absolute assurance that all patients are now following the correct course of treatment.'

Source




Are the "minute clinics" about to be swallowed up?

Well, now they've done it! Now they want to insulate the danged "minute clinics"! According to a Boston Globe news story, the recent rise in low-cost walk-in clinics, sponsored by various chain-stores (Walgreen's, CVS, et alia), has attracted the interest of the HMO world, at least in Massachusetts. As the story, "Insurers to cover drugstore clinic visits," reports, both Harvard Pilgrim Health Care and Tufts Health Plan have signed contracts with CVS Caremark, and are in negotiation with Walgreen's, seeking to "cover" most of the costs of patient visits to CVS and similar "minute clinics," by offering reduced "co-pays" to those under their umbrellas who seek care at the clinics.

To some, this might seem a good thing, since the programs call for much lower co-payments from the patients than those exacted for more conventional healthcare visits (doctor's offices or emergency rooms). Instead of the $75-150 customary for ER drop-ins, the patients will likely be paying only $15-25 for a clinic appearance. The problem is, the wider effect of this could be the perpetuation of the very thing that got us into the healthcare mess in the first place: the "employee benefit," third-party payor, institutionalized model for maintaining wellness.

Arnold Kling of the Cato Institute has labeled this the "insurance as insulation" premise, and I see no reason to reinvent the terminology here. This "insulating" concept takes the position that ALL costs for health and wellness should somehow be paid for by third parties, either as "insurance coverage" or via tax deductions (for the copayments). As a result, we've come to see healthcare, not as a personal-responsibility issue (do what you can to stay well, get checkups regularly to detect problems early on . thereby minimizing the costs and even the likelihood of critical aftercare), but as a matter of "public policy."

Where this has gotten us is to the point where the "employee benefit" model has engulfed the whole arena of doctor/patient relationships. The sheer numbers of "covered" individuals, whether as workers or as their spouses and families, have overwhelmed the effect of "market forces" on healthcare costs and accountability. When there is a fairly well-guaranteed demand for something, regardless of its cost (they ain't paying for it) or efficacy (if it doesn't work, try something else as well) of that procedure, it will continue to be offered in spite of its dubious value (cf. the overuse of MRI, CAT, statins, etc.).

So now, just when one segment of private industry (chain drugstores, which have at least a peripheral interest in public wellness) is trying to encourage low-cost solutions for common maladies - catch them early, instead of after significant damage may been done to the person's body, and charge accordingly for the diagnosis - now the "providers" from the orthodox "healing community" want to make sure it's all getting "covered"!

The net effect is obvious: People with even minor ailments will now be "insulated" from even the minimal costs of keeping well, or of monitoring the little things before they grow into something serious. While the short-term good news might be a bigger reliance on such cheap clinics for diagnosis and treatment of simple illnesses (instead of glutting the ERs with their petty issues, or ignoring problems until they become critical), the fact that they'll still be largely subsidized out of "insurance" - instead of operating on an out-of-pocket cash-basis - could easily offset their value in terms of the effects on healthcare cost-reform.

Once again, the analogy can be made to the automobile-insurance game: NOBODY gets car insurance to cover oil-changes, or even routine maintenance. (As this editor recently discovered, even a brake-job can't be paid for, even under an extended maintenance contract. Compare this with "catastrophic health coverage" and you'll still fall short of the reality.) Similarly, the cost of an annual physical exam (were it to be billed only at reasonable, no-overhead rates, with fair-market prices for the 5-10 minutes a physician or NP actually physically examines you?), or a routine visit to see if that scratchy throat is more than s brief attack of the "crud" . these should be considered just part of the "normal wear and tear" of having that physical bag of skin and bones to lug around in this lifetime!

Mark my words, this latest move by the large HMOs will not improve the situation, except insofar as it encourages more people to go to the clinics. Very soon, the basic cost of a visit will go up, as these establishments are forced to spend more time on paperwork, justifying to their third-party corporate benefactors the "actual costs" and validity of the last week's spate of snifflers and sprained ankles. And before we know it, those little cheap "minute clinics" will just be another arm of the Leviathan healthcare state, instead of the good idea they began as.

Were I the paranoid sort, I might consider this an intentional move on the part of the very same AMA-driven, allopathic-only establishment that decried the drugstores' idea in the first place - if you can't squash the bug, you just tame and put a leash on it!

Source





2 August, 2008

'Women must have brittle bone drug', campaigners beg NHS

The Health Secretary must overturn 'farcical' rules that deny thousands of women medicine for thinning bones, campaigners say. In an unprecedented move, the National Osteoporosis Society, of which the Duchess of Cornwall is president, is writing to Alan Johnson asking him to intervene over the 'unfair and clinically unworkable' guidance.

Guidelines set by the Government's drug regulator mean doctors are only able to give women with osteoporosis the cheapest drug available - even though a quarter cannot take it. Those who cannot tolerate alendronate will have to prove that their condition has worsened by up to 60 per cent before they are allowed to have alternative treatment. It is unethical as some women will have to get 'significantly worse' than other patients before receiving a treatment they need, the charity said.

It is likely to affect thousands who experience crippling stomach pains as a side-effect or do not respond to alendronate, which costs $100 a year. Other drugs cost $34 a month. A woman in her early seventies who cannot tolerate alendronate would have to get 20 per cent worse - using a clinical scoring system - to qualify for medication such as risedronate or etidronate. The same woman would have to deteriorate 60 per cent to be eligible for strontium ranelate.

Doctors fear that the restrictions proposed for England by the rationing body, the National Institute for Health and Clinical Excellence, could lead to an epidemic of broken bones among older women. Osteoporosis can affect anyone because of natural bone loss caused by ageing. But women are at greater risk. Up to 14,000 a year die as a result of an osteoporotic hip fracture. Many others experience debilitating pain and disability from fractures.

Last year, the charity won an appeal against even more draconian restrictions put forward by NICE. But it says this has made little difference in practice. It has decided not to appeal again - which would result in the same NICE team reviewing drug treatments for a third time - but it wants a fresh appraisal. In a letter to Mr Johnson, chief executive Claire Severgnini said: 'The recommendations remain unnecessarily restrictive, denying many patients treatment at a point where treatment might make most difference to longterm quality of life. 'Their condition must be allowed to get progressively worse before each alternative treatment will be prescribed. 'Using barriers to limit treatment without regard to clinical or cost effectiveness is not how NICE is meant to appraise treatment options.'

Nick Rijke, of the charity, said the whole process is a 'farce', based on a computer model of pricing options in which the cost of treating hip fractures was grossly under-estimated. NICE had failed to give the charity access to the model despite a legal judgment this year which ruled against similar secrecy used in a drugs ban imposed on thou-with Alzheimer's disease. Mr Rijke said: 'We have been left with no option other than to plead with the Department of Health to secure a fresh, open-minded and fair appraisal.

A Department of Health spokesman said NICE is appraising 'a number of treatments for primary and secondary prevention of osteoporotic fractures. 'Stakeholders have recently had the opportunity to lodge appeals against NICE's revised draft guidance and I understand that NICE has now received an appeal which will be heard in public. NICE will not issue final guidance to the NHS until the appeal has been heard and considered. 'It would be inappropriate for ministers to intervene in the conduct of an ongoing NICE appraisal.'

Source





1 August, 2008

McCain Is the Radical on Health Reform

If you listen only to presidential campaign rhetoric, you might conclude that Hillary Clinton and Barack Obama proposed bold new changes for our health-care system, while John McCain is offering only small improvements. If so, you are in for a surprise. Most health-policy analysts believe that Mr. McCain is proposing the most fundamental health-care reform.

Right now the federal government encourages private health insurance primarily through the tax system -- handing out more than $200 billion in tax subsidies every year. Mr. Obama would leave this system largely intact. Mr. McCain would completely replace it with a fairer, more efficient system with a much better chance of insuring the uninsured and controlling health costs at the same time.

Under the current system, every dollar in health-insurance premiums paid by an employer is excluded from employee income and payroll taxes. Take an employee in the 25% income-tax bracket. Throw in state and local income taxes, add the 15.3% (FICA) payroll tax, and the tax exclusion for a middle-income family is worth almost 50 cents on the dollar. To make things a little better, employees can often pay their share of the premium with pretax dollars as well.

But this system is extremely arbitrary. There is virtually no tax relief for people who work for the 40% of employers who do not provide insurance, for part-time workers or people not in the labor market, or for anyone else who for any reason must buy his own insurance. The self-employed get a slightly better deal: They can deduct 100% of their premiums, but they get no relief from the payroll tax.

According to the Lewin Group, a private health-care consulting firm, families earning $100,000 a year get four times as much tax relief as families earning $25,000. In other words, the biggest subsidy goes to those who least need it, and who probably would have purchased insurance anyway. The system is also wasteful. People can always lower their taxes by spending more on health insurance, and there is no limit to how bloated a health plan can be.

Under the McCain plan, no longer would employers be able to buy insurance with pretax dollars. These payments would be taxable to the employee, just like wages. However, every individual would get a $2,500 credit (and every family would get $5,000) to be applied dollar-for-dollar against taxes owed.

The McCain plan does not raise taxes, nor does it lower them. Instead, it takes the existing system of tax subsidies and treats everyone alike, regardless of income or job status. All health insurance would be sold on a level playing field under the tax law, regardless of how it is purchased.

The impact would be enormous. For the first time, low- and moderate-income families would get just as much tax relief as the very rich when they purchase health insurance. People who must purchase their own insurance would get just as much tax relief as those who obtain it through an employer. Whereas Mr. Obama would continue the current practice of giving the vast bulk of federal help to the rich (through tax subsidies) and the poor (through spending programs), the McCain tax credit would give the most new tax relief to the middle class.

The McCain plan would also encourage all Americans to control costs. The tax credit would subsidize the core insurance that everyone should have. It would not subsidize bells and whistles (marriage counseling, acupuncture, etc.) as the current system does. Since employees and their employers will be paying for additional coverage with aftertax dollars, everyone will have an incentive to compare the value of extra health benefits to the value of other things money can buy. When they eliminate health-care waste, they would get to keep every dollar they save.

The McCain tax credit would be refundable. People could apply $2,500 per person or $5,000 per family to the purchase of health insurance, even if they do not owe any income taxes. Families would not have to wait until April 15 the following year to get their credit. They could obtain the subsidy at the time the insurance is purchased. The credit would also be transferable. Insurance companies and other intermediaries would be able to help families obtain their credit and apply it directly to health-insurance premiums.

The McCain health plan would allow people to buy insurance across state lines -- thus creating a competitive, national market for health insurance. It would provide additional federal money for people who have been denied coverage because of a pre-existing condition, making it easier for people who have lost their insurance to obtain new coverage. It would also encourage Medicare to become a smarter, more efficient buyer of care.

The McCain plan will not solve all our health-care problems. But it has a far better chance of positively reforming the system than any other plan that has been proposed in this campaign season.

Source




Great Moments in Socialized Medicine

Post below lifted from Taranto. See the original for links

Oregon is, according to an editorial in the Oregonian newspaper, "the only state that both allows assisted suicide and tries to ration health care." This embarrassed the state when 64-year-old Barbara Wagner got sick with lung cancer and the state essentially said to her, Have you considered suicide, lady?:

After her oncologist prescribed a cancer drug that would cost $4,000 a month, the newspaper reported, "Wagner was notified that the Oregon Health Plan wouldn't cover the treatment, but that it would cover palliative, or comfort, care, including, if she chose, doctor-assisted suicide."

The Oregonian editorial explains that the decision to deny coverage for the drug was based on a policy of disapproving payment "for treatment that doesn't provide at least a 5 percent chance of survival after five years." The paper does not fault the state for this decision:

In Wagner's case, administrators of the Oregon Health Plan had to make a difficult call. But that's what they do every day in performing the tough, thankless job of rationing government-paid health care to the needy. What's unacceptable, however, is that Wagner's rejection letter included the offer of payment for doctor-assisted death. Such notification creates at least the appearance of an ethical conflict: state encouragement of dying as a cost-saving measure.

The editorial notes that, the rejection of the $4,000-a-month drug notwithstanding, taxpayers have "paid thousands of dollars over the years for Wagner's cancer care, and . . . will continue to do so."

Unless, of course, she chooses suicide instead--an option that would still be open to her whether the state made the point explicitly or not. The Oregonian is troubled by the "appearance of an ethical conflict" when the state spells out the offer, but it seems not to mind the actual ethical conflict posed by the underlying assisted-suicide policy.