NHS patients are cheated by £100m a year extra for their dental work
Patients are being ripped off by more than £100million a year thanks to the Government's 'botched' reforms to NHS dentistry, figures suggest. Loopholes in a new contract for dentists are being exploited so that patients are effectively being charged twice for what should be one course of treatment, critics say. Dentists are accused of recalling healthy patients for checkups and splitting up courses of treatment unnecessarily. The Department of Health admits there is evidence that the tactic has become widespread since the introduction of the contract in April 2006. Now data obtained from every primary care trust shows patients could have saved up to £109million in incorrect charges – almost a quarter of the £475million paid every year. And without the loophole, up to 6.5million appointments could have been freed up for people who currently do not have a Health Service dentist.
The Tories have calculated that the overcharging works out at an average of £7.77 a year per patient, almost a quarter of the average annual charge of £33.80. A deal drawn up by the Government means dentists can claim twice as much by spreading treatments across different appointments or calling patients back for unnecessary check-ups.
NHS guidance, stating that no patients should be called back to their dentist for a check-up or have courses of treatment split up within a three-month period, appears to be being widely ignored. Shadow Health Secretary Andrew Lansley, who obtained the figures, said: 'Labour's management of NHS dentistry has been appalling. Not only have millions been left without a dentist, but now we learn that those who do have one are often being charged more money than they should be.
'The blame here lies with Labour's botched dental contract, which incentivises dentists to increase the number of charges to patients and has led to such drastic cuts in the number of people being able to find an NHS dentist. 'The Government urgently needs to admit that the dental contract has been a monumental failure, get a grip and put an end to these practices immediately.' Dentists' leaders insist there is no evidence that anyone is playing the system.
But last week, the Government effectively admitted that its reforms have backfired when it announced an independent review of access to treatment. Health Secretary Alan Johnson appointed a team to investigate why 1.2million people have lost their NHS dentist since the changes were implemented. Average dentists' earnings stood at just over £96,000 in the first year of the deal – a rise from £87,000 from the year before. For the top-earning dentists who own their own practice, income rose by a third to £172,494.
A decade ago, the Government pledged that all patients would have access to treatment on the Health Service within two years. But surveys suggest one in 20 patients is resorting to DIY treatment, in some cases pulling out their own teeth. And one in five says they have gone without treatment because they could not meet the cost. 16.12.08
________________________ Insane: Professor risks fury with call for healthy adults to use Ritalin
Healthy adults could benefit from taking Ritalin to boost their brainpower, say academics. They called for the controversial anti-hyperactivity drug to be made widely available to improve memory and attention in the workplace. The Alzheimer's drug Aricept is among others which could bring huge benefits to healthy adults ranging from factory workers to surgeons, said Professor Barbara Sahakian, of Cambridge University, and six other academics.
The drugs, which have side-effects varying from appetite loss to heart problems, should be seen as no different to a good night's sleep or the latest laptop as aids to staying on top of the hectic working day, they said. We should 'welcome' new ways of boosting brainpower. The views will horrify those who believe such performance-enhancing drugs can be dangerous, and raise concern that they will be seen as an endorsement from the medical world.
Ritalin and similar drugs have been linked to 12 deaths in the UK. Some victims died of heart problems, others of strokes, tumours or swelling of the brain. Three of the deaths were suicides. Writing in the journal Nature, the academics argue that the prescription-only drugs are already increasingly being used to enhance memory, attention span and wakefulness.
Studies show that up to a quarter of students at some U.S. universities have used them in the past year, while in Britain, doctors have warned that pushyparents are using internet-bought drugs to boost their children's exam performance. The academics said that although more research was needed into the use of the drugs on healthy people, cognitive 'enhancement' should not be viewed as a 'dirty word'. The authors believe it would be wrong to dismiss the use of the drugs on the grounds they are unnatural.
They said: 'The lives of almost all human beings are deeply unnatural; our homes, our clothes and our food - to say nothing of the medical care we enjoy - bear little relation to our "natural" state. 'Given the many cognitive-enhancing tools we accept already, from writing to laptop computers, why draw the line here?'
But others cautioned about the health risks associated with the drugs. Dr Tim Kendall, a consultant psychiatrist from Sheffield, said healthy adults taking Ritalin would be misusing the drug. He said: 'I would ask, do they want to take the risks this drug has simply to help them get through a long day at work?'
Dr Sami Timimi, a consultant psychiatrist in Lincolnshire, said: 'Just as we are comfortable with using surgery to enhance appearance, we are starting to drift towards using drugs to enhance living experiences.' Professor Sahakian said healthy adults should not take Ritalin and other 'smart drugs' until their long-term safety has been proved. She said: 'The major reason for writing this paper is to call on the regulatory authorities to allow pharmaceutical companies to market cognitive enhancers to adults, provided they have provided the necessary data on safety and efficacy. 'It would be much safer if people were able to access these drugs through the normal means than to buy them off the internet.' But critics argue this would lead to mass doping and the authors are clearly insane. 9.12.08
_______________________________________________________ GPs 'are focusing on patients who bring in bonuses', claims Civitas report
Family doctors are playing the system at the expense of patients' lives to earn performance bonuses, a report claims. It says that GPs are putting more effort into treating conditions that attract points towards their results-based pay scheme. The report by the Civitas thinktank found they are ignoring elements of care such as compassion because they do not get extra cash for being nice to patients.
And the elderly are suffering as treating dementia and osteoarthritis are not worth points, nor is dealing with the risk of old people injuring themselves in falls at home. The bonus scheme - the 'quality and outcomes framework' - was introduced as part of a lucrative contract, which was introduced in 2004 and has seen pay rocket by 55 per cent to £107,664. There are 1,000 points available every year with each one worth up to £124 - depending on its size, location and disease prevalence - for a practice, which may consist of more than one GP. The performance element makes up around one third of a doctor's salary.
But experts say it is too easy for GPs to gain the maximum number of points. Last year, 96.8 per cent did so, and more than 600 practices achieved 100 per cent of the points available. Now the Civitas report claims that QOF is distorting priorities because doctors are neglecting to treat illnesses for which they do not receive a bonus.
One study found that achievement across six indicators on asthma and high blood pressure, which are in the QOF, significantly improved between 2003 and 2005. Meanwhile, only 41 per cent of GP practices reached acceptable standards on falls management, and 29 per cent on osteoarthritis, neither of which are in the QOF.
The report also found that some doctors were 'gaming' the system in a number of ways, such as delaying reporting a patient with a 'QOF' illness until the following financial year to get more points. Another ruse is to mark difficult patients as an 'exception' - meaning they do not adversely affect the QOF score. A recent survey of practice nurses found that 76 per cent believed performance pay was undermining the patient focus of the NHS.
Dr Laurence Buckman, chairman of the British Medical Association's GP committee, said: 'The assertions in this report are based on anecdotes that are without evidence.' however a spokesman for the Department of Health said: 'Manipulating data is completely unacceptable and the NHS will and does take action where this is found to have happened, so critics argue 'Dr Buckman is buring his head in the sand'. 19.11.08
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GPs 'waste' £100m NHS fund set aside for local care, study finds Family doctors are failing to provide improved services for patients, despite being paid tens of millions of pounds to do so, a report claims. Cash handed to thousands of GPs to commission services including X-rays, blood tests, eye tests and services for diabetics simply ends up in practice coffers, it was found. The Government had hoped the new GP powers would cut hospital referrals, give patients more local treatment and save the NHS money.
But the King's Fund think-tank found that in many cases this has not happened. The report also found many GPs simply chose themselves to provide services without considering others who could do it more efficiently - raising the prospect of a huge conflict of interest and reducing patient choice.
The practice-based commissioning scheme, introduced in 2005, gave GPs a power that used to belong to primary care trusts. Almost £100million has been paid to commissioning GPs in 2006/07 alone. The report also noted many of these services were being provided by practices anyway.
Other examples of conflicts of interest uncovered include a GP who had formed a partnership with colleagues to tender a bid to take on work from the PCT, and yet sits on the PCT committee that decides which bid wins. The report concludes the initiative has 'the potential to deliver better services and NHS savings, but progress has been painfully slow'.
Matthew Elliott, chief executive of the Tax-Payers' Alliance, said: 'Taxpayers have been short-changed. 'Spending £100million for almost no benefit is appalling. This failure has let down taxpayers and patients alike.' The Department of Health said: 'We have identified areas where practice-based commissioning can be strengthened.' 20.11.08
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Our health service is now worse than Estonia's
Healthcare in Britain is worse than in Estonia even though we spend four times as much on each person, according to a Europe-wide league table. And despite the billions poured into the NHS by Labour, the standard of care is on a par with the former Communist states of the CzechRepublic and Hungary, which spend far less on health. Long waiting times and slow access to new cancer drugs were highlighted as major reasons for Britain's ‘mediocre' placing of 13th out of 31 countries. Britain came out near the bottom on cancer survival rates, waiting times, MRSA infections and the speed of access to new drugs.
The Euro Health Consumer Index report found that when the cost-efficiency of the health service was taken into account, the UK came 17th. Johan Hjertqvist, of the Health Consumer Powerhouse think-tank which compiled the report, said Britain had mproved since last year on patients' rights and providing patients with information on their health. ‘However access for both waiting times for treatment and uptake of modern drugs, remains a problem,' he added. The report concludes: ‘The NHS shares some fundamental problems with other centrally planned healthcare systems. It would require some really top class management for that giant system. Superbug problems are improving, but they are still bad.'
Government health spending has doubled since 2002. This year, £96billion is going into the NHS – almost four times 'the amount spent in the former Soviet republic of Estonia per head of population. The report backs up a recent Italian study, which put Britain near the bottom of a European table for the chances of its patients still being alive five years after being diagnosed with cancer.
Matthew Sinclair, of the TaxPayers' Alliance, said: ‘For all the central initiatives and health drives launched in Whitehall, we are still lagging behind much poorer countries like Estonia. ‘That should teach the politicians that this centralised, micromanaged and monopolistic approach does not work.'
The index rates healthcare systems on 34 indicators before working out a total score out of 1,000. The UK scored 650 points, way behind the Netherlands in first place on 839 points.
Britain was rated ‘poor' on nine indicators, including direct access to a specialist, quick access to operations and MRI scans, five-year cancer survival rates, MRSA infections and quick access to cancer drugs. It was rated ‘intermediate' on 16 indicators, such as the ability to see GPs on the same day, quick access to cancer therapy and heart attack survival rates.
Only on the remaining nine indicators was it rated ‘good'. These include NHS Direct, the quality of hospital rating systems and IT.
The study concluded that countries with a social insurance system, in which patients take out cover with companies but receive healthcare from separate bodies, fared better than those with centrally driven systems such as the UK. LibDem health spokesman Norman Lamb said: ‘We have got to attack the waste and bureaucracy that drives clinicians and the public crazy. We need to make sure that all available resources are focused on patient care.'
Tory health spokesman Stephen O'Brien said: ‘This is further evidence of the incompetence of ministers when it comes to running the NHS.'
Health Secretary Alan Johnson said: ‘The European Health Consumer Index report is not anchored in any reputable academic or international organisation. It uses flawed methodology and old data.' 14.11.08
_________________________________________________ Chemotherapy can do more harm than good, study suggests
Doctors have been urged to be more cautious in offering cancer treatment to terminally-ill patients as chemotherapy can often do more harm than good, a study suggests. Patients with incurable cancers were promised much greater access to the latest drugs which could offer them extra months or years of life by a Department of Health review last week. Such medicines are often taken or injected as part of a “cocktail” of chemotherapy drugs. But the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found that more than four in ten patients who received chemotherapy towards the end of life suffered potentially fatal effects from the drugs, and treatment was “inappropriate” in nearly a fifth of cases. About 300,000 patients now receive chemotherapy in the UK each year, a 60 per cent increase compared to 2004.
But in a study of more than 600 cancer patients who died within 30 days of receiving treatment, chemotherapy probably caused or hastened death in 27 per cent of cases, the inquiry found. In only 35 per cent of these cases was care judged to have been good by the inquiry's advisors, with 49 per cent having room for improvement and 8 per cent receiving less than satisfactory care.
More than one fifth of patients were already severely debilitated at the time the decision to treat with chemotherapy was taken, while that many could not make an informed consent to treatment, the report said. Mark Lansdown, surgical oncologist at Leeds General Infirmary, and a co-author of the report, said that it is usual for patients to suffer some side-effects following chemotherapy, but that very few patients die as a consequence.
“The majority of patients in this study were receiving palliative treatment where the aim is to alleviate symptoms of cancer with the minimum of side effects,” which represented a small proportion (2 per cent) of all patients receiving the treatment, he said. “Yet 43 per cent of all patients in the study suffered significant treatment-related toxicity.”
The proportion of deaths attributed to chemotherapy “is of particular concern for the 14 per cent of patients for whom [it] was intended to cure them of their cancer,” he added. Co-author Diana Mort, of Velindre NHS Trust, Cardiff, said that treatment can also result in life-threatening infections or patients may simply die of their cancer.
“[But] patients must be made aware of the risks and side effects of chemotherapy as well as the potential benefits. They should be given time to reflect on their decision and must always be free to change their minds.” The Government's national cancer director, Professor Mike Richards, said that he was “very concerned” by the report's findings.
The National Chemotherapy Advisory Group will publish a full response to the NCEPOD report today, “to bring about a step change in the quality and safety of chemotherapy services for adult patients,” he added. “I am asking all chemotherapy service providers to consider these reports urgently and to reassess their own services immediately against the measures we have set nationally.”
Katherine Murphy, director of the Patients Association, commented: “too many clinicians have a cavalier attitude to providing information on cancer outcomes, when they should be doing everything in their power to raise standards and give full information to their patients.”
Jane Maher, Chief Medical Officer at Macmillan Cancer Support added: “Doctors and nurses need to be much better at helping patients understand the pros and cons of such powerful treatments in the last year of life. “Some patients may not be getting the right information and support before deciding whether to start chemotherapy and even more importantly, when enough is enough. “Something clearly needs to be done - I welcome a prompt response by the National Chemotherapy Advisory Group.” 12.11.08
_____________________________________________ Hope for other treatments as NHS rips up drug rules to give dying patients better final weeks of life
Dying patients are to get faster access to new treatments under Government plans to tear up the NHS rulebook. Ministers want to allow patients to 'die with dignity' by adjusting the way a drug's effectiveness is measured, giving greater value to the final weeks of life. The deal is being drawn up as part of a review of a controversial ban on patients paying privately for life-extending treatments while receiving NHS care.
The Government has been forced into a rethink by the outcry over the death earlier this year of Linda O'Boyle, a grandmother who was denied free treatment after buying a drug to treat her bowel cancer. A senior source told the Daily Mail that a compromise being considered would see the drugs rationing body, the National Institute for Clinical Excellence, fundamentally alter the way it assesses which treatments are available on the NHS. It would be made to give far greater weight to the final stages of a patient's life when deciding whether a new drug should get the green light.
Treatments currently banned from the NHS on cost grounds could become more quickly availabe while other treatments currently not available might stand a better chance of gaining NHS approval as the culture moves away from many 'useless and expensive drugs' to cheaper and better complementary treatments.
NICE currently uses complex formulas to calculate so-called 'quality-adjusted life years' - a measure of the quality and quantity of life that a particular drug can bring a patient. But the way it makes its calculations and dithering over the evaluation process has been heavily criticised. In several cases, it has taken several years for it to approve the use of some drugs. Adjusting the way NICE assesses new drugs would mean many more of the top-up treatments being paid for by patients becoming available on the NHS, ministers say.
However, their cost would still be taken into account. Money to pay for faster access to treatments would come, they say, from savings being made in the NHS drugs budget by purchasing cheaper generic products and renegotiating deals with pharmaceutical firms. Ministers are, however, preparing to allow some patients to pay for some extra drugs that remain unavailable - a move that Left-wing Labour MPs, unions and some doctors claim will lead to a two-tier system based on ability to pay.
Dozens of health service trusts have told cancer patients they cannot buy private drugs while receiving NHS care. But many others have been allowing top-up payments. A Government source said: 'The issue of top-up payments is massively controversial, but a lot of it could be resolved by changing the way we measure the effectiveness of drugs. 'Those final stages of a life are so important to people - whether it's being around for an important family event, seeing a grandchild born or whatever - so it's right that we look at recognising them better.'
Professor John Harris, an ethics expert at Manchester University, said Nice's current methods for deciding on a drug's availability were less fair than 'tossing a coin'. He said that whether a drug extends life by a short period is 'quite irrelevant' because 'your life does not diminish in value with diminishing life expectancy'.
The Rules
NICE - nicknamed Nasty by its many critics - has come under fierce attack for the way it chooses which life-saving drugs should be available on the NHS. Under the current system, it uses something called a 'quality adjusted life year' or QALY. This determines the cost of a new treatment by working out how much it improves and extends a person's life compared to existing treatments.
One QALY equals one year of perfect health, or two years of 50 per cent perfect health or four years of 25 per cent perfect health. Generally, if the cost per QALY is below £20,000 the treatment is deemed cost effective and approved. If it falls between £20,000 and £30,000 NICE will need 'persuasion' to give it the go-ahead and above £30,000 the decision is normally to refuse the drug, although exceptions have been made.
Effectively, this means NICE values a year of quality life at between £20,000 and £30,000. Critics say the figure it uses has remained the same for nearly a decade, ignoring inflation and rises in NHS spending. The body has also been attacked for the level of secrecy it attaches to its calculations for each drug. 25.10.08
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Three NHS trusts to be sued by cancer sufferers who have had to pay for their own life-saving drugs Cancer sufferers forced to buy their own drugs are planning to sue the NHS for compensation. Hundreds of patients had to pay for treatment after NHS chiefs ruled that new pills that might improve or extend their lives were not 'cost effective'. But many are now demanding refunds from the health service after spending tens of thousands of pounds. At least three London trusts have been targeted by patients making compensation claims, an investigation by the Evening Standard has found.
In the first known case of its kind, one trust has been forced to refund a patient for a drug it initially refused to buy. Experts warn the NHS is facing a series of legal battles as families fight to recover the huge sums they have spent on buying drugs privately. The move comes amid a growing row over access to life-enhancing treatment and anger over the Government's policy of denying 'top-up' treatments.
Current rules mean patients cannot mix NHS care with private care even with drugs not available on the NHS.
Health Secretary Alan Johnson this weekend signalled he may reverse the policy within weeks. But the Uturn comes too late for many who have paid for private treatment, and raises the prospect they will seek to recover their money. Patients in Bromley, Hillingdon and Wandsworth have already requested refunds. A course of Avastin for colon cancer costs up to £70,000 a year per patient, while Erbitux, used to treat bowel cancer, can cost up to £60,000.
Bromley PCT has compensated one patient for drugs which it originally refused to fund. Other claims include a kidney cancer patient who asked for a refund from Hillingdon PCT. The claimant personally funded a cycle of treatment with the lifeextending drug Sorafenib.
The PCT has refused the request, but could face other claims as a number of patients have made 'inquiries' about refunds. Wandsworth PCT has also received a written request for a refund. It comes after the PCT admitted court action is inevitable from patients who have been denied cancer drugs.
Ian Reynolds, chairman of Wandsworth PCT, said: 'We're being sent bills by people turned down by exceptional treatment panels and who have then gone private. We're not liable to pay but the reality is that these claims will now end up in court.' Katherine Murphy from the Patients' Association said: 'It's quite unforgivable to deny someone their right to a treatment which a clinician says could save their life.'
£55,000, BUT ADAM DIDN'T SURVIVE
When Adam Griffin was diagnosed with bowel cancer at the age of 29 health bosses would not pay for his life-extending medication, telling him he was not an 'exceptional' case. Instead, the graphic designer and his friends and family embarked on a fund-raising drive to raise £55,000 to pay for the drug Erbitux.
They raised £80,000, but Adam, who lived in Twickenham, took the drug for two months before he died in December last year. His sister Amy, 30, of Dulwich Village, said: 'We had to give the NHS £55,000 before they gave him the medication. They will not start treatment until you have given them the full amount. 'Adam didn't want his family to have to pay because it would have meant remortgaging the house. The only way he was happy to pay was through fund-raising,' she added. 'The drugs do not cost that much, but patients then have to pay for everything else privately.' 27.10.08
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'Inefficient & bureaucratic' NHS blamed for cancer drug bans PATIENTS should not have to pay privately for life-extending treatment, Britain 's leading cancer expert said today. Professor Karol Sikora blamed "bureaucrats" for denying people expensive medication banned on the NHS but freely available on the Continent. He said cancer specialists must be involved in making decisions on the benefits of drugs even if they are costly.
The oncologist from London 's Imperial College said: "The real tragedy is the inefficiency of the NHS which has led to many cancer drugs routinely available in European countries simply not being used here. "It just can't be that the NHS is right and every other western European country is wrong. There should be no need to top-up for cancer. We have to change the way we assess treatment benefits and get cancer specialists, not bureaucrats, involved in decision-making."
Health Secretary Alan Johnson is today expected to lift a lift a ban on cancer patients buying drugs privately. Currently, patients lose their right to free treatment if they pay extra for life-extending drug not available on the NHS. Mr Johnson will, however, tell doctors that such patients must be treated on a separate ward.
Ministers are also expected to announce they are working with pharmaceutical companies to ensure fewer cancer drugs are rejected by rationing body the National Institute of Clinical Excellence on cost grounds. Nigel Edwards, director of policy at the NHS Confederation, warned the new rules could undermine the core principles of the health service. He also called for changes to how Nice operates.
He said: "This change in policy is welcome and helps deal with a situation which had become unsupportable. "But allowing private payments alongside NHS care cannot be allowed to become the thin end of the wedge no one wants a two-speed health service. "Most importantly Nice's procedures need to be speeded up so decisions about useful new drugs are made as quickly as possible." King's Fund chief executive Niall Dickson said: "Patients who decide to pay for an additional drug should also pay for any extra costs to the NHS of administering that drug." 4.11.08
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Biotech cash crunch threatens new medicines: UK expert The global credit crunch, which has already pushed some small biotechnology companies to the wall, could seriously delay the discovery of new life-saving medicines, a British expert warned on Monday. David Wield, director of the Economic and Social Research Council's Edinburgh-based Innogen Center , said the cash crisis now looming for many firms had wider implications for society. "Drug discovery depends on long-term finance with high risk of failure -- and lots of it," he said in remarks prepared for a conference in London".
"What will happen to investment in biotech research if finance cannot even be found for relatively everyday expenses, which are increasingly becoming more of a struggle?"
Many biotech companies are desperate to find new funds as investors shun the notoriously risky sector, leading to severe financial problems on both sides of the Atlantic.
In addition to the impact on the basic research performed at biotech companies, development of drugs by large pharmaceutical firms has also been hit by the credit crunch, with several having laid off staff or closed research units, Wield said. But critics argue this may not be such a bad thing, ‘as the big pharmaceutical companies lose their grip over treatments options this may encourage the use of more alternative and complementary medicine by the mainstream medical profession'.
Recent articles in the media have been encouraging the use of more complementary medicines which have been proven to be better than the pharmaceutical option in many cases. 27.10.08 ___________________________________________________
Brain stimulator treats depression by beaming magnetic pulses through the skull
The U.S. government has approved the first non-invasive brain stimulator to treat depression - a device that beams magnetic pulses through the skull. The pulses trigger small electrical charges that spark brain cells to fire. The stimulator, called 'Transcranial magnetic stimulation' or TMS, causes less risk than other methods such as surgically implanted electrodes or the last resort of shock therapy.
The Food and Drug Administration (FDA) approved the therapy, made by NeuroStar, specifically for patients who had no relief from their first anti-depressant, offering them a different option than trying pill after pill. 'We're opening up a whole new area of medicine,' says Dr Mark George of the Medical University of South Carolina in Charleston, who helped pioneer use of TMS in depression.
While there is a big need for innovative approaches - at least one in five depression patients is treatment-resistant - the question is just how much benefit TMS offers. The FDA cleared the prescription-only therapy based on data that found patients did better when treated with TMS than when they unknowingly received a sham treatment that mimicked the magnet. But the study was fraught with statistical questions that concerned the agency's own scientific advisers.
For a clearer answer, the National Institute of Health has set up an independent study that is tracking 260 patients and may have initial results as early as next year. TMS is expected to cost £3,500-£6,000, depending on how many treatments a patient needs, says Dr Philip Janicak of Rush University Medical Center in Chicago, who helped lead the study.
Neuroscientists have been using TMS for years as a research tool in brain studies. The question was how to harness that activity in a way that might improve disease. TMS is also being studied in stroke rehabilitation and other brain disorders. 'Nobody thought this would work; it was a crazy idea. I had to do it at 6am in the morning before the real scientists came in,' South Carolina's George laughs as he recalls work he began in 1993.
But, 'the brain is an electrical organ,' George adds, explaining the rationale. 'Electricity is the currency of the brain. It's how the brain does what it does.' For depression, psychiatrists aim the magnet at the left front of the head, the prefrontal cortex. Since everyone's brain is different, they first zap the top of the head to find a patient's motor-control region, and then carefully move five centimeters forward. Then, the NeuroStar beams about 3,000 pulses a minute during a 40-minute treatment, done about five times a week for up to six weeks.
The theory: Stimulating brain cells in the prefrontal cortex triggers a chain reaction that also stimulates deeper brain regions involved with mood. TMS did prove to be very safe: Patients in the NeuroStar study suffered no seizures or memory problems like shock therapy can cause, or other reactions throughout the body. The chief complaint from the sessions was headaches.
The FDA cleared the device after focusing just on a subset of the patients initially enrolled - 164 who had failed one antidepressant during their current bout of depression, not those who were more severely treatment-resistant. What's a modest benefit? About 24 percent who got TMS scored significantly better on standard depression measures after six weeks, compared with 12 per cent who got the sham, says Janicak. That's about as well as patients respond to a single antidepressant, he says. Some reported remarkable improvement.
'One day it was like a light switch went off,' says Steve Newman, 60, of Washington, D.C., who enrolled in the NeuroStar study at the University of Pennsylvania in 2005. Newman had suffered repeated bouts of depression since he was a teenager, and drug after drug barely blunted it. He was considering shock therapy when he heard about TMS. After two weeks of treatment, Newman was wondering if he was getting the sham - when suddenly, he started feeling lots better, and doctors spotted a corresponding major improvement in his depression measurements. 'I was awake. I was there,' says Newman who said he still gets what he calls a 'maintenance dose' of TMS about once a month. 21.10.08
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Drug companies 'bankrolling charity campaigns for NHS cancer & other treatments'
Healthcare charities protesting against the NHS for refusing to provide expensive drugs for cancer patients are being funded by pharmaceutical companies, it has been revealed. Groups including the National Kidney Foundation, Beating Bowel Cancer, and the Alzheimer's Society received six figure sums from drug companies last year.
These charities have been among the most critical in attacking the National Institute for Excellence over its decision to restrict access to drugs on the NHS. An investigation by The Independent has also found other charities including the Arthritis and Musculo-Skeletal Alliance, and the Royal National Institute for the Blind also received funding from drug companies. It found Beating Bowel Cancer received 10 per cent of its income from drug companies.
The NFK and the National Rheumatoid Arthritis Society also received half of their £300,000 funding from pharmaceutical and renal industries in 2007, it has been found. Tim Kendall, director of research at the Royal College of Psychiatrists said the pharmaceutical industry reached into 'every corner of the health service' to gain influence.
'Drug companies will try to do anything to align their interest with those of patients. They do things at every level of the health service and we know they do it with patient groups,' he said. 'It is a multi-pronged approach to persuade patients that their drug is the one.'
Despite the ferocious attacks on the NHS, none of the charities has criticised the expensive prices which the pharmaceutical companies charge for the drugs. The Association of the British Pharmaceutical Industry has tightened its code on drug company funding of patients groups, which requires transparency with grants.
Both the RNIB and the Alzheimer's Society declare funding from drug companies on their websites, but many smaller charities do not reveal such information. One source claimed 'This is another clear example of how drug companies operate, under-handed and willing to exploit any avenue, the whole system is corrupt'. 1.10.08
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Charities lobby NICE over cancer drug A charity coalition is urging the medicines watchdog to rethink its decision on a life-prolonging cancer drug deemed too expensive for the NHS.
New drug Revlimid has been found to lengthen the lives of patients with multiple myeloma, a deadly bone cancer, by up to three years. But medicines watchdog the National Institute for Health and Clinical Excellence (Nice) has ruled that the drug is not cost effective. A month's supply of Revlimid, a once-a-day capsule, costs £4,368 and a year's treatment can cost between £36,000 and £69,000.
Professor Peter Littlejohns, the clinical and public health director at Nice, said: "Nice has to decide what treatments represent best value for the NHS. If these treatments were provided on the NHS, other patients would lose out on treatments that are both clinically and cost effective."
The Department of Health said: "We are already doing much to secure best value for money from the £10bn a year spent on medicines in the NHS in England. We are in advanced negotiations with the pharmaceutical industry on a new pharmaceutical price regulation scheme.
"The outline package agreed so far recognises the importance of achieving value for money for the taxpayer whilst also ensuring that patients continue to benefit from innovative products at a reasonable price."
Three cancer charities have this week launched a campaign urging Nice, the department and Revlimid's manufacturer, Celgene, to find a way to make the treatment available on the NHS.
Eric Low, the chief executive of charity Myeloma UK, said: "This is yet another instance of patients losing out because Nice and the pharmaceutical company have failed to effectively interpret an impressive set in what is no more than a game of professional one-upmanship."
A spokesman for Celgene said: "Celgene is disappointed that the preliminary recommendation from Nice does not recommend Revlimid for the treatment of multiple myeloma. "Although devastating for patients, this is only a preliminary recommendation and Celgene is committed to working with Nice, the Department of Health and the myeloma community to ensure that the final Nice guidance will be positive and patients with myeloma can have the opportunity to live longer with their cancer controlled." Nice is to continue consultations on Revlimid before making its final recommendation in January. 29.10.08
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How sick! GPs paid bonus to NOT send you to hospital
Family doctors are receiving cash bonuses not to send patients to hospital despite National Health Service research that suggests incentive payments can reduce the quality of care. GPs are paid £1 per patient to spend time reviewing their decision to send someone to hospital and a further £1 for every name on their surgeries' list if they reduce their previous year's referral rate. An average surgery with 10,000 patients will receive up to £20,000 for taking part in the scheme.
The scheme which pays bonuses to GPs for not sending patients to hospital has been branded 'unethical'. Patients' groups and MPs warned that the policy - introduced as a way of cutting NHS budgets - could prevent people receiving the urgent care they need. Under the scheme, a typical doctors' practice can earn up to £20,000 a year from its local health authority if it cuts the number of patients sent for expensive hospital treatment rather than being treated by GPs, practice nurses or physiotherapists.
Primary care trusts around the country have introduced the payments this year, and many more are expected to follow in the next few months. The bonus money will be paid into practice coffers, from which GPs draw their income, giving them a direct financial incentive to refuse further treatment for patients. Tory health spokesman Andrew Lansley said: 'It is inefficient and unethical to pay GPs to refer fewer patients to hospital.
'It would be so much better if GPs, not bureaucrats, had responsibility for their patients' budgets. 'It is GPs who should be making the decisions about the best use of resources and how best to meet the needs of their patients. 'If patients find out that their local health bureaucracy is paying their GP not to refer them to hospital they will be rightly outraged.'
In Oxfordshire, the number of patients referred by GPs to hospital is rising by eight per cent a year. Now the PCT is giving surgeries with 10,000 patients or more £10,000 to review their referral procedures and another £10,000 if they reduce their referral rates.
If doctors hit their targets the PCT will be left with a bill of £1.2million. But it believes the expense is justified because the increasing number of patients being sent to hospital is estimated to cost £6million a year. Eighty out of 82 Oxfordshire practices have signed up to the scheme, which was introduced on October 1.
A spokesman for Oxfordshire PCT said: 'We have got significantly increasing rates of referral to secondary care providers. We're not sure why, so we're trying to understand why. 'We're asking them to look at the referrals they're making. That will take clinical time to do. We're offering to pay for the time it will take them to review the referrals they're doing.' Surgeries would get an extra bonus if they then cut their referral rates, she said.
But Sue Woollacott, chairman of the Patient Support Group at Nuffield Orthopaedic Centre in Oxford, said: 'It seems to imply that GPs aren't presently making good judgments and need financial incentives in order to do that. 'If I were a GP and getting payments for the practice it would seem like some sort of bribe to me.
'To delay patients, who are often elderly, from getting necessary care can often complicate the procedures that they then eventually have to have.' Dr Laurence Buckman, chairman of the British Medical Association's GP Committee, said: 'I don't think that patients' services should be treated as a commodity.
'A large number of patients are referred to hospital for investigation. If you don't know what's wrong with the patient you cannot know how to handle the problem.' Dr Buckman described the policy as 'money that is being given for me to not behave appropriately. I think that is not good.' Practices in London, Essex, Devon and Wiltshire also run incentive schemes for reducing referrals. 20.10.08
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NHS to let patients self-refer for therapy care Patients will be able to refer themselves directly for NHS services such as physiotherapy and podiatry without first going to a family doctor, Health Secretary Alan Johnson will announce on Tuesday.
The practice is already well established in Australia and the Department of Health officials said the move follows successful pilot schemes in several district in the UK. But doctors' leaders said the change could increase waiting times for services in areas where provision is already stretched. Local health authorities in England will be encouraged to allow patients to refer themselves for treatment with a range of so-called allied health professionals.
As well as physiotherapists, these include chiropodists, speech and language therapists, art and drama therapists, podiatrists and radiographers, a health department spokeswoman said. "Self referral will help both vulnerable members of society and those with busy lives by providing quicker access without the unnecessary hoop-jumping of going to see a doctor first," she added.
The department said trials had shown that patients who referred themselves to physiotherapy for musculoskeletal problems were able to access services quicker, were more likely to complete the treatment and to turn up for follow-up appointments.
It said the move is part of the government's aim to increase patient choice and provide easier access to services, as outlined in Health Minister Lord Darzi's Next Stage Review of the NHS this summer. But the British Medical Association, which represents doctors, called for additional health funding if extra demand puts pressure on services in places where waiting lists are already long.
"In some areas, physiotherapy services are already quite overstretched and some patients go private to make sure they are seen in a reasonable time," a BMA spokeswoman said. The Chartered Society of Physiotherapy said the experience of the trials was that self-referral did not increase demand or waiting times.
"If you have a problem where physiotherapy is what you need, it's a lot more empowering for the patient to be able to request that service straightaway, rather than having the added hassle of making a GP appointment and hoping that they will refer you," a spokeswoman said. 21.10.08 ____________________________________________________
Drug giants spending millions on doctors perks to influence treatment options Free flights, meals, holidays and match tickets can damage patient care, say critics. Drug companies are spending millions of pounds every year on all-expenses-paid trips to conferences around the world for doctors and other hospital staff, in what critics say is a massive marketing exercise dressed up as medical education.
The Guardian can reveal the scale of pharmaceutical company sponsorship following an examination of the registers of gifts and donations to doctors that all hospitals are required to keep. They show considerable largesse - from drug companies regularly picking up hefty bills for travel to international conferences in Europe, Asia and America, to specialist nurses' salaries, and weekly sandwich lunches for hospital staff training sessions.
All-expenses-paid trips to conferences in the US, Vietnam or Hungary are a regular feature of the registers, costing the companies up to £5,000 per doctor. Many of the declarations by doctors do not put a price on the trip. The total amounts received by staff at individual hospital trusts with complete registers are substantial - Sheffield's staff received funding of more than £105,000 from pharmaceutical and medical devices companies in the 12 months to last June.
Examples of the firms' hospitality include:
Astra Zeneca paid £2,500 for a doctor at the Royal Bournemouth trust and £1,500 for a doctor at Sheffield teaching hospital to attend a cancer conference in Texas.
Sanofi-Aventis, the world's fourth biggest pharmaceutical company, paid for doctors at the Countess of Chester trust to go to conferences in Cape Town, New Orleans and Barcelona. At Gateshead trust, their reps gave a breakfast for 30 staff "to discuss drugs for the treatment of breast cancer". The trust's register records that "the donor was seeking to secure business".
Roche spent £2,000 for an oncology consultant at Addenbrooke's hospital in Cambridge to go to a conference in May last year. GSK, the biggest British pharmaceutical company, paid £1,200 for a consultant at Sheffield teaching hospital to attend the 11th international congress of Parkinson's disease and movement disorders in Turkey last June. Companies have also been taking hospital staff to top football and rugby matches. Carillion, a public sector construction firm, spent £180 taking a senior manager at Milton Keynes trust to lunch and then a rugby match at Twickenham last August.
Most doctors deny that their reliance on drug company cash makes them biased. The pharmaceutical companies argue that they are helping doctors acquire further medical education by funding their trips to conferences in foreign cities, but they refuse to reveal how much they pay out. However, the health select committee warned in a report in 2005 that the industry's sponsorship of doctors and other medical staff had drug promotion as its motive and could lead to unsafe prescribing of drugs such as Vioxx, the arthritis drug which was found to cause heart attacks.
Joe Collier, the recently retired professor of medicines policy at St George's hospital, London, a former member of the Medicines Commission and an adviser to the select committee, said: "Through its orchestrated campaigns affecting all those involved in the use of medicines, the pharmaceutical industry enormously influences what patients are prescribed. On the whole these influences are detrimental to best practice."
Payments to doctors are far from transparent. The Department of Health requires NHS trusts to compile registers of their medical staff's and directors' possible conflicts of interest and to make them available to the public. Only a minority do so. The Guardian requested the registers for 90 hospital trusts under freedom of information legislation. Only around a quarter returned data that included the names of the doctors and the sponsoring companies and the amounts of money received. Some refused to give any information at all.
Collier said this was unacceptable. "Declarations of interest are a key way to help break the pharmaceutical industry's stranglehold. It is not a trivial issue. Public declarations by doctors are essential if prescribing is to be sensible and appropriate and according to patients' needs."
Consumers International (CI) said the lack of transparency was unacceptable. "When a medical professional speaks on a health issue, we assume that they are putting patients' interests first. If that person has a conflict of interest because they or their organisation are receiving funding from a drug company the least we should demand is the right to know about it," said Justin Macmullan, head of campaigns. "Pharmaceutical companies will tell you that what they are funding is medical education. But our concern is that this is really highly effective, well-targeted marketing. This throws any notion of impartiality out of the window and jeopardises a doctor's ability to make an informed, balanced decision about the most appropriate treatments."
CI wants drug companies to declare how much they give to doctors. "Countries such as the US and Australia have woken up to this issue and are now requiring pharmaceutical companies to disclose their funding of medical organisations and medical education. European regulators have been sleeping on the job," he said.
Labour MP Paul Flynn described as "codswallop" the companies' claim that their only intention was to help educate doctors. "It's not true. It's part of a huge marketing budget. It's all about maximising their profits, not helping people in life-threatening situations," he said. "The influence of these companies is enormous."
Doctors who receive funding believe they are not influenced by it. Robert Storey, a consultant cardiologist at Sheffield involved in drug trials, took four trips to conferences in the year to June 2007 courtesy of Astra Zeneca at a total cost of £12,000. However, he regards these as business trips because he is asked to disseminate research findings and are funded from the R&D budget. More junior doctors have their funding arranged through the drug rep and must fly economy class under Association of the British Pharmaceutical Industry (ABPI) rules.
"If it is done through the local rep, who may expect some sort of favour in exchange for that sponsorship, there is more stringent regulation," said Dr Storey. "[Those doctors] are seeing reps on a regular basis and although it is explicitly stated in the ABPI rules that there shouldn't be any conflict or conditions [on the funding], it probably does influence doctors' behaviour because they are unsure whether they will get further sponsorship for going to further meetings, so it is useful to them to engender good relationships with different reps.
"One has to be careful how one judges oneself, but when you get to my level where you are getting a lot of interest from different companies, you can pick and choose to a certain extent. If you feel uncomfortable about any particular request or association, you can very easily walk away. If I'm asked to put certain points across in a talk which I think are biased, I won't do it in the best interests of patient care."
Storey, who makes a fuller declaration than most doctors, would prefer to see a different system. "I certainly think it would be preferable if sponsorship or money for travelling to meetings was independent from the pharmaceutical companies but there is no pot of money for providing that," he said.
Dr Willy Notcutt, an expert in pain relief at James Paget hospital in Great Yarmouth, has recently returned from a big conference in Glasgow. Two companies, Eli Lilly and Boehringer, paid £800 for his travel, accommodation and registration fee. He says he has been prescribing a drug sold jointly by the two companies but was not "brainwashed" into it by their hospitality. He made his own independent evaluation of the merits of the drug. "I don't give a toss what the drug company rep says. I prescribe drugs which give benefit to my patients," he said. The ABPI said doctors would not be able to attend conferences where they hear from experts in their field without sponsorship, but it was important this was transparent. 23.8.08
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MPs attack doctors' pay rises for less work Doctors have raked in "eye-watering" pay rises while doing less work thanks to a new government contract designed to improve patient care, an influential group of MPs said in a report on Thursday. The Public Accounts Committee said the reforms sent budgets soaring, but failed to improve services in deprived areas and did not lead to longer opening hours at surgeries.
"Partners in GP practices are now putting in less time and their productivity has decreased," said Committee Chairman Edward Leigh. "Only their pay is burgeoning, having increased on average by an eye-watering 58 percent since 2003." The government negotiated new contracts with family doctors to try to stop GPs leaving the system and to improve access for patients as part of a key Labour pledge to improve the NHS.
However, the changes have cost far more than expected. Over the first three years, the bill was 1.8 billion pounds higher than originally planned. Average salaries for GPs rose from 73,000 pounds in 2002-03 to 114,000 pounds in 2005-06, the report said. Hours worked each week dropped by seven hours during the same period.
Morale has also fallen due to critical media coverage and an emphasis on cost-cutting and targets, rather than quality of care, the MPs said, citing the British Medical Association. However, the new contracts have succeed in raising the number of doctors in the system and have improved the consistency of care for long-term illnesses, the MPs noted.
The committee recommended that NHS bosses do more to measure doctors' work. They should demand more annual feedback from GPs on how they have been more productive. The BMA said the report was "based on an out-of-date understanding of the current situation."
"GP practices have taken on additional work since the original contract was agreed, practice income has been frozen," said Dr Laurence Buckman, chairman of the BMA's GP Committee. "The measure of productivity quoted is crude and doesn't accurately reflect how GPs' work has changed in recent years." 9.10.08
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Drug Company Funding of Drug Trials Greatly Influences Outcome University of California, San Francisco - In head-to-head trials of two drugs, the one deemed better appears to depend largely on who is funding the study, according to an analysis of nearly 200 statin-drug comparisons carried out between 1999 and 2005. UCSF researchers examined 192 published results of trials comparing one cholesterol-lowering statin drug to another, or to a non-statin drug.
Their findings found that two links stood out. If the reported results favored the test drug, the trial was about 20 times more likely to be funded by the maker of the statin rather than the comparison drug company. Even more striking, they say, if the conclusions or interpretation of the drug trial - which reflect the impressions of the trial investigators - favored the test drug, the trial was about 35 times more likely to be funded by the maker of that drug rather than the comparison drug.
"Many people are concerned about the growing proportion of drug trials funded by the drug's manufacturers," says Lisa Bero, PhD, UCSF professor of clinical pharmacy and health policy studies. "Results of drug trials affect what drugs are covered by medical plans, and so what drugs physicians will prescribe. If drug trial outcomes are largely determined by who pays for the trial, we don't really know what the best drug is." Bero is senior author on the PLoS paper.
The UCSF study examined the links between reported outcomes of the statin trials and many factors, including study design, sample size, thoroughness and type of analysis, as well as funding source. They examined only published randomized controlled trials. The trials involved seven different statins overall, all studied in head-to-head drug comparisons.
The analysis found that about half of the trials were funded by industry, and about a third did not disclose any funding source. Among those declaring industry funding, about one fifth explained the role of the sponsor, such as data analysis, or writing and preparing the manuscript. Trials with no disclosed funding sources were less likely to have conclusions favoring the test drug, compared to trials with industry funding, the researchers report.
The researchers note that a number of factors can result in the drug trial results favoring the trial drug's sponsor. Drug companies could selectively fund trials on drugs that are likely to produce a statistically significant result, the researchers explain. This can be accomplished, they say, by selecting non-equivalent doses of drugs for testing.
Also, sponsors may choose not to report results that don't favor the drugs they sell. Or, they may report positive results in more than one journal, skewing the number of positive articles about their drug.
In addition, almost half of the trials lacked adequate blinding - assuring that study scientists don't know which drug the patients were taking until the end of the trial. Blinding is considered of paramount importance in clinical trials. The researchers found that those studies with adequate blinding were less likely to report results favoring the test drug. This finding was independent of who funded the study - in other words, funding source was a stronger predictor of outcome than blinding, but both had independent effects on outcome.
The most important weakness found in most of the trials was a lack of clinical measures of outcome, such as heart attacks or mortality - considered better indicators in trial design than less direct measures such as lipid levels. "The lack of true clinical outcome measures in these direct head-to-head comparisons of drugs is disappointing because the studies don't give us the best information we need to choose one statin over another," Bero says.
The analysis is one of the first large studies examining the influence of funding source on the outcomes of head-to-head drug comparisons, rather than comparing the effectiveness of one statin with no drug at all. The market for statins is competitive, so it is important to have valid information to choose one statin versus another, Bero explained. For policy makers, the relevant choice is not to select a statin versus a placebo, but to select one statin compared to another.
The study also differed from most other assessments of influences on drug trials by examining 11 different factors, and how they may interact to affect trial results. Most previous studies examined the link of results to one factor alone, such as funding source. But this analysis adjusted for "confounders" - study aspects that can influence the results, such as study design, including randomization, blinding, sample size, even choice of comparison drug in the study.
Inclusion of the confounders still pointed to industry sponsorship as the most influential factor related to positive results and conclusions.
The study examined trials by all funding sources, as well as a subset of studies that were only industry funded. Favorable results and conclusions were associated not so much with industry sponsorship, but with the specific company that funded the study, Bero points out.
"The data available on choosing between statins based on head-to-head drug comparisons appears to be influenced by financial conflicts of interest," Bero concludes. "So decision makers - those choosing drugs for a formulary or insurance plan - should be skeptical about these kinds of trials. We need to know if a newer, more expensive drug is really better compared to older, less expensive drugs." 5.6.07 ______________________________________________________
Drug firms' lobby tactics revealed
A lobbyist is an individual who is paid to represent a special interest group whose function is to urge support for or opposition to legislative matters. Documents show how drug companies try to get new medicines fast-tracked. Multinational drug companies have been lobbying ministers in an attempt to subvert the independent appraisal process and get their expensive new medicines approved for large-scale use in the NHS, the Guardian can reveal.
Over the eight months from October to May this year, senior executives from 10 drug companies met ministers to press for favourable decisions on their products. The executives were highly critical of the National Institute for Clinical Excellence (Nice), an independent expert body set up to decide which drugs are cost-effective for use in the NHS.
Documents obtained by the Guardian under Freedom of Information legislation reveal that:
The world's biggest drug company, Pfizer, warned ministers that it could take its business elsewhere. "Pfizer ... noted that there is complacency in some quarters of Whitehall regarding their continued investment in the UK," the minutes of the meeting record. Ministers later agreed to a special meeting where six companies could lobby for their drugs for Alzheimer's disease.
Two companies lobbied ministers for wider access by patients to their drugs, both of which were later turned down by Nice on the grounds that they were not effective enough and too expensive. The pharmaceutical industry is a major contributor to the UK economy. Its total investment in research and development was more than £3.4bn in 2004, which, a Whitehall briefing note points out, "represents around a quarter of the UK's total manufacturing industry expenditure".
Decisions by Nice, set up seven years ago, are crucial for the companies. It decides whether a drug should be universally available to patients in the NHS. Chaired by Prof Sir Michael Rawlings, Nice draws on scientific experts and consults doctors, patients, drug companies and the Department of Health. The government invariably accepts its final recommendations. Although ministers say they cannot influence Nice, the documents reveal a constant stream of high-level visitors from drug companies.
Manufacturers, led by Pfizer, have been complaining to ministers about Nice's position on their controversial Alzheimer's drugs. Originally Nice decided to allow them, then it reversed its position, saying they should be used only for a minority of patients with moderate disease.
At a meeting in October with the minister, Pfizer executives made it clear they "were unhappy with the Nice decision ... and thought their processes were flawed". They requested a special meeting with ministers where all the companies making Alzheimer's drugs could put their case. The documents prepared by civil servants for the Pfizer meeting outline the wealth and scale of the US company, which in 2004 had revenue of $52.5bn (£28bn) and a net income of over $11bn.
But, Pfizer executives warn the minister, it could always take its business elsewhere. "Pfizer ... noted that there is complacency in some quarters of Whitehall regarding their continued investment in the UK," the minutes record. "Pfizer asked for more public support from the government for a robust pharmaceutical industry in the UK and more consultation/dialogue with the government."
The subsequent meeting with all the companies took place in December. The minister, Jane Kennedy, was confronted by eight managing directors, vice-presidents and senior executives from six drug companies. The executives lobbied hard for the Nice ruling to be overturned by the government. A memo reports the summing-up of Johnson & Johnson's vice-president David Brickwood: "Nice should take into account what the companies see as the overwhelming views of patients, carers and clinicians on the efficacy of the drugs."
In a statement, Pfizer said it "regularly meets with key stakeholders, including government ministers, to keep them up to date with issues relating to our business". A variety of topics were discussed, it said. "Nice and health technology assessment remains a topical issue coupled with the proposed ban on medicines for mild Alzheimer's disease. We believe this is the wrong decision and have appealed along with other manufacturers of anti-dementia medicines."
In February, Eli Lilly lobbied hard for its drug Alimta, designed to treat the asbestos-linked cancer mesothelioma. Its executives gave a presentation to Ms Kennedy, incorporating newspaper cuttings claiming that cancer victims were dying for want of the drug. The minister agreed that there should be a high-level meeting between her ministry and the Department for Work and Pensions.
But in June, Nice said there was insufficient evidence to show that Alimta was better than other cheaper treatments, recommending that the NHS should not use it. A Lilly spokesman said it was legitimate for the company to make representations to the DoH but it was not seeking to undermine Nice. "We are fully engaged and committed to the Nice process," he said
Pressure was brought to bear on ministers by another company, Johnson & Johnson, over its bone cancer drug Velcade. A briefing for Ms Kennedy before a meeting with the company's executives in November says: "Johnson & Johnson have written to the Department of Health numerous times over the past 12 months about Velcade." The company wanted its drug fast-tracked for approval by Nice. Velcade was one of the five drugs Nice was asked by ministers to handle through its new fast-track procedure. But Nice's appraisal committee has given a preliminary opinion that it is not suitable for use in the NHS.
A Johnson and Johnson spokesman said the company was not trying to "unduly influence" Nice but it was legitimate to seek to persuade ministers to speed up the appraisal of Velcade. The company did not want to comment on its lobbying over Alzheimer's drugs. In May, the health minister Andy Burnham met Peter Dolan, then chief executive of Bristol-Myers Squibb and chairman of the Pharmaceutical Research and Manufacturers of America (PhRMA), the powerful industry body in the US, which has been highly critical of Nice.
Richard Marsh, director of external affairs at Bristol-Myers Squibb, who also attended the meeting, told the Guardian that his company had wanted to raise a number of issues, including Nice, with the minister.
"Companies have a legitimate interest in getting the best for their products and getting a positive appraisal by Nice. Where they have an opportunity to raise issues with ministers, they can do that ... It may be that Nice has genuinely got a blind spot about something and a legitimate point can be made to ministers. I don't think the Nice process is necessarily undermined. It is up to the minister what they do with that information." He added that companies wanted to invest in countries with a "favourable environment". 28.9.06
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Addiction Today Survey: Doctors speak out on the scale of the alcohol & drug problem
A survey of all doctors in private practice across the UK makes heartbreaking reading when it comes to treating people with alcohol and drug problems. Of the first 114+ doctors who responded:
- 96.5% are currently treating patients with alcohol problems
- 90.4% have seen patients die from alcohol problems
- 88.6% see these patients presenting with co-occurring mental issues.
- 72.8% treat heavy-drinking patients who also present with tobacco-related problems
- 83.3% see patients with illicit-drug problems.
The Addiction Recovery Foundation - the charity which publishes Addiction Today - commissioned Freedom Corporate Consults to undertake the survey. The full results, and some steps forward, are detailed in the September 2008 issue of Addiction Today journal.
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Demand For Clinical Trials To Check Drugs Against Natural Remedies & Placebo's John Bremner and Anna Sawkins, partners in the UK-based innovative alternative health company, Sweet Cures of York , are leading a call for clinical trials of new drugs to also test the drugs against natural remedies, both new and traditional. This, Anna says, "Would solve at a stroke the appalling situation where a drug is accepted and brought into use just by virtue of having been 'trialled' even though its performance was barely better than placebo, and is then the preferred choice for treating whatever disorder it is aimed against."
She makes the point that if the new drug and its side effects had been tested against one or more natural remedies, as well as against placebo, the trial would put the drug in its true perspective. "You could well find that a new drug is more effective and has less side effects than treating the problem naturally," he says, "but the opposite could also be discovered, and wouldn't that be a great thing to know?"
Testing new drugs against natural remedies would also, at a stroke, solve the problems of the providers of natural health solutions not being able to afford the huge costs of well-run clinical trials. The information revealed would be invaluable to our sum of knowledge about natural remedies, not only about what works, but about what doesn't work.
John Bremner reinforces the point, "The public really want this. There is a huge need for people to know what works and what doesn't work, and traditional, natural and food-based remedies don't have the evidence-base needed for people, therapists, and doctors to be able to determine the best way to treat particular problems."
They suggest that trials could also include nutrition and lifestyle change treatment options. So for example, if a new drug to slow or reverse the progress of colon cancer is being proposed, wouldn't it be great to know if doing 10 minutes exercise a day, going on an organic diet and taking high doses of flax-seed oil achieved a result that equalled or bettered the drug being tested?
What if just taking a plate of porridge in the morning worked better than the proposed new drug? Or what if taking a tablespoon of olive oil proved as effective?
The idea behind their proposal is to uncover these possibilities. As John Bremner continues, "To compare a new drug to placebo is great, but let's compare proposed new drugs to our huge legacy of natural health cures. The pharmaceutical industry is barely a hundred years old and does not have all the answers - which is one reason they are busy trying to harvest and patent the active ingredients of natural ingredients that they already know to be effective. Natural remedies and lifestyle answers to health problems are based on a legacy of thousands of years of trial and error, finding out what works and what doesn't work."
To quote James Duke, PhD, (The Herbal Insider) discusing whether natural remedies work as well as drugs, or better, "Until tamoxifen and raloxifene are compared to standardized bean soup (40 milligrams of isoflavones per cup) and/or to kudzu (our best source of the natural phyto-estrogen, daidzein) no one knows for sure--not you, me or the ACS."
There would seem to also be a case for extending the new guidelines to cover surgical trials. For example, olive oil and lemon juice are traditionally used to get rid of gall stones. Logically it would seem to make sense to test the risks of the operation to remove the gall bladder against this natural method of making them slip out of the body.
And again, isolated rare sugars or combinations of these can reverse antibiotic resistant kidney, urinary tract, bladder, and prostate infections that allopathic treatment finds difficult or impossible to address without causing the individual long-lasting damage. Should alternative remedies not be tried before a kidney is allowed to deteriorate to the point where it needs to be removed?
One of the points John Bremner and Anna Sawkins are making is that the pharmaceutical industry will also benefit from their suggested incorporation of natural remedies rather than just placebo into trials. New drugs are often arrived at by extracting active ingredients from plants that have been traditionally used as remedies. If a pharmaceutical company is successful in deriving a new drug that is more effective than, say, a tea made from the leaf or flower of the plant, then they can prove that point in the clinical trial. It will also show up natural or traditional remedies that don't work better than placebo, adversely affect the condition being treated, or produce significant side effects.
On the other hand, if the pharmaceutical industry is allowed to continue ignoring alternative remedies in its clinical trials, we are in danger of losing them altogether as the industry uses its enormous financial influence and lobbying power to bury all alternative remedies so deep in the mire of complex legislation and regulatory costs, that no provider of alternative remedies or healthcare will be able to survive.
Critics point out that the system would need to be closely monitored as the pharmaceutical companies could not be trusted to compile the true data and may manipulate the results in favour of their drug rather than the natural remedy.
To Take Further Action: In the UK you can write to the Health Minister Dawn Primarolo, and propose that the guidelines for conducting clinical trials should be amended to include trialling of natural remedies alongside placebo. It's exactly the right time, because she is currently working on new legislation to make drug companies more accountable. 3.04.08 ________________________________________________
Wild plants are now being harnessed for new wonder drugs
They're bursting with health benefits, require no prescription and cost nothing. Research shows that Britain's hedgerow plants are full of vitamins and antioxidants. Furthermore, scientists are investigating their uses as medicines for a host of conditions, including cancer and high blood pressure.
ROSEHIPS
Orangey-red, oval berries, sometimes as much as an inch long. They're the fruit of the dog rose and found in hedgerows from August until November. Seeds should not be eaten because they can irritate the mouth and stomach.
Contain: One of the richest sources of vitamin C, but also A, D and E, iron, calcium, antioxidants and fatty acids. Rosehip syrup was given to children during World War II for its vitamin C content. One cup of 30 berries contains as much as 40 oranges.
What's new: Powdered rosehip is three times better at reducing the pain of osteoarthritis than paracetamol, according to research at the University of Copenhagen, though just why is unclear. There were also none of the sideeffects associated with conventional painkillers such as constipation, diarrhoea or drowsiness.
'There is now good evidence for rosehips for osteoarthritis from a series of studies,' says Professor Edzard Ernst, professor of complementary medicine at the Peninsula School of Medicine in Exeter and Plymouth.
At home: Make rosehip tea for a cold. Boil one tablespoon of fresh, ripe rosehips in two cups of water for ten to 15 minutes, and then strain, getting rid of any seeds. Traditionally sweetened with cinnamon. Rosehip can also be used to make jellies and syrup.
Tip: Remove hairs from rosehips before use because they can cause irritation - they were used in joke itching powders.
HAZELNUTS
Grow in large clusters on hazel in the hedgegrow and turn chocolatebrown when ready. Usually harvested in the last week of September.
Contain: Good source of fibre, manganese, potassium, copper, thiamine, B6 and E, folate and antioxidants. Among nuts, they have the highest levels of monounsaturated fats.
What's new: Oleic acid, a monounsaturated fatty acid in hazelnuts, has been shown to lower bad cholesterol, while arginine, an amino acid, widens blood vessels and improves bloodflow.
Scientists at Hacettepe University in Turkey found that 11/2oz of hazelnuts a day lowers the risk of heart disease. Men who consumed hazelnuts twice or more in a week had half the risk of dying of heart attack, according to American research. Hazelnuts may also help fight cancer. Portland University researchers found they contain the chemical paclitaxel, which is the active ingredient in drugs used to treat ovarian and breast cancers.
At home: Can be eaten raw, roasted, fried, boiled or dried. Roasting adds flavour and preserves goodness.
SLOES
The fruit of the blackthorn bush, it is the ancestor of cultivated plums and the same colour, but smaller and more tart. Prolific in hedgerows now and can be picked until November. Usually too bitter to eat raw.
Contain: Vitamin C, antioxidants.
What's new: Sloes may have an anti-bacterial effect, according to a study at the University of Salford. Polish researchers have found the fruit is high in the antioxidants that have been linked to a lower risk of heart disease.
At home: Sloe syrup has traditionally been used as a tonic to fight flu. Put 4lb of sloes in a pan, cover with boiling water, put on a lid and leave for 24 hours. Drain off the liquid, bring it to the boil and put back over the sloes. Repeat this process. Finally, strain the juice, add 11/2 lb sugar and bring to the boil before bottling.
Tip: If you wait to pick until October or November, or even after the first frosts, sloes are sweeter and juicier.
BLACKBERRIES
Hedgebrow berries in fruit from mid August to late September.
Contain: Have one of the highest antioxidant levels of any fruit. Also rich in vitamin C - a half-cup (three handfuls) provides 100 per cent of the recommended daily vitamin C for an adult. The compound that gives blackberries their colour, anthocyanins, is also a potent antioxidant.
What's new: 'Fresh berries are some of the most powerful disease-fighting foods available,' say Oregon
University researchers. Blackberry is being tested for its use against lung cancer in women - scientists have found that the berries could reduce the oestrogen activity which feeds the tumour. Animal studies have shown similar effects.
At home: Best eaten straight off the bramble, but blackberry syrup is a traditional therapy for sore throats.
Bring to the boil three cups of blackberries, one cup of sugar, half a cup of water, grated zest from one lemon, and simmer for 15 minutes while stirring. Strain and cover, and put in the fridge for two weeks.
Tip: The lowest berry, at the tip of the stalk, is the first to ripen and the sweetest and fattest of all.
HAWTHORN
Part of the rose family and a common sight in hedgerows, its small red berries (the size of a pea) taste similar to sweet potato. Can be used to make drinks, syrups and jelly.
Contains: Flavonoids and oligomeric procyanidins, which have antioxidant effects.
What's new: Hawthorn extract (900mg/day) as a supplement taken for two months was as effective as low doses of captropril, a leading heart medication, in improving symptoms of heart failure, say researchers at Maryland University in America.
Hawthorn berries have been shown to combat chest pain in angina sufferers, and lower cholesterol. Hawthorn leaves and fruit have also been found to be effective for high blood pressure in a group of patients with type 2 diabetes. A study at the Institute for Medicinal Plants Research in Belgrade found hawthorn leaves and fruit to be a potent anti-inflammatory.
'There is extremely good evidence for hawthorn and congestive heart failure,' says Professor Ernst. 'You should not self-medicate, but it is an approved medication in Germany.'
At home: Make hawthorn syrup as a tonic. Simmer one part hawthorn fruit in three parts water until the mixture is reduced by half. Add sugar to taste. Great on pancakes.
Tip: The leaves, which have a nutty flavour, can be eaten raw in salads.
BILBERRIES
Small, dark blue fruits (smaller than blackcurrants) found on bushes that grow to around 18 inches on heathland and moors. Related to the blueberry and can be eaten raw.
Contain: High levels of vitamin C and chemicals known as anthocyanosides - plant pigments that work as antioxidants and may help to prevent or reverse damage to cells in conditions such as heart disease, cancer and age-related eye conditions. Also contains tannins - an anti-inflammatory.
What's new: A study at the University of Cincinnati is testing whether a juice made from the berries boosts memory in older people. In research similar to the blackberry study, researchers are also looking at the use of a compound found in bilberries for lung cancer in women.
At home: Bilberry tea is a traditional therapy for sore throats. Pour a cup of boiling water onto three teaspoons of crushed berries, leave for ten minutes, strain and drink.
Tip: Jam could be good for night vision, too. During World War II, British fighter pilots were reported to have improved night-time vision after eating bilberry jam.
NETTLES
Found in, around and under all hedgerows. September is the last month to harvest the leaves, as after this they wither.
Contain: Formic acid, an antibacterial, which is one of the key ingredients responsible for the stinging feeling on contact. Also contain the neurotransmitter serotonin, and histamine, which is involved in the immune system response.
What's new: A study at Exeter and Plymouth universities shows that nettles may ease the pain of osteoarthritis of the knee. Serotonin and histamine in the nettles might block the pain signals.
At home: Make nettle tea for joint problems. Pour boiling water over a handful of fresh leaves in a warm tea pot. Leave for five minutes before straining and drinking.
Tip: A sprig of nettles in the kitchen is a traditional way to keep flies away.
ELDERBERRIES
Also known as the English grape, elderberry is abundant in hedgerows, where the blue-black fruits hang in large clusters in late summer and early autumn.
Contain: Rich in antioxidant compounds called anthocyanins, which have been shown to help treat diabetes and ulcers. May have antiviral and antibacterial effects.
What's new: Anthocyanins in elderberry boost the immune system by increasing levels of cytokines - key compounds in the immune system defences. Anthocyanins may also help prevent obesity and diabetes, according to American research.
A study at the University of Graz in Austria showed that an extract made from elderberry lowers levels of bad cholesterol.
At home: Use elderberry cordial for a cold. Put berries in a saucepan, add a little water and cook until juice runs out. Strain off the juice, add 1lb of sugar for every pint of juice, and then boil until it is thick syrup before bottling.
Tip: When picking elderberries, use a fork to get them off the stalks to stop the fruit breaking up.
HOPS
Plant with heartshaped leaves with serrated edges, and pendant-like whitish flowers.
Contain: Hops are high in bitter substances, known as humulone and lupulone, which stimulate the appetite.
What's new: German researchers found that time spent in total sleep and deep sleep was 10 per cent greater in people taking a mix of hops and the herb valerian. It is thought that the relaxing effects are down to a compound in hops called dimethylvinyl carbinol.
A study at Howard University in America showed that hops also have an antiviral effect, while research at the Chinese Academy of Sciences showed that compounds in hops may work against HIV-1 infection.
At home: Put some hops in a pillow to combat insomnia.
AND A WARNING...
Make sure you have identified the correct plant, berry and leaf. Some are toxic. Do not self-medicate without seeking medical advice, especially if you have a diagnosed condition or are taking medication. 16.9.08
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'St John's Wort as effective as Prozac for treating depression', say scientists It has long been a happy alternative for those reluctant to pop pills for depression. But the herbal extract St John's wort now has more than just cheerful converts to testify to its mood-lifting powers. In what is billed as the most thorough study of the plant, scientists have found it is just as effective as Prozac at treating depression
It also had fewer side effects than many standard drugs used to help those battling despair. Researchers compared the effects of the plant hypericum perforatum - popularly known as St John's Wort - with placebos or a wide range of old and new antidepressants, including those from the new generation of SSRI drugs, such as Prozac and Seroxat. The findings could prompt more GPs to prescribe St John's wort. In Germany, it is commonly given to children and teenagers.
Experts do not know exactly how the plant lifts depression, although most believe it probably works by keeping the chemical serotonin, which is linked to positive moods, in the brain for longer. The study's lead author, Dr Klaus Linde, from the Centre for Complementary Medicine in Munich, pooled data from 29 studies involving 5,489 patients with mild to moderately severe depression.
'Overall, the St John's wort extracts tested in the trials were superior to placebo, similarly effective as standard antidepressants, and had fewer side effects than standard antidepressants,' he said. But he pointed out that St John's wort products available in health food shops and chemists differed greatly and some may be more effective than others.
'Using a St John's Wort extract might be justified but products on the market vary considerably, so these results only apply to the preparations tested,' he explained. The findings were published by the Cochrane Library, which specialises in systematic reviews of research studies. A separate study has found St John's wort, available in countless health shops, is the only alternative medicine proven to have an effect.
Others, including ginseng, liquid tonic, cat's claw, gingko biloba and royal jelly, had no firm base in evidence and could be dangerous when taken with other drugs, according to the study by St James' University Hospital in Leeds. Some other studies however have indicated that St John's wort may interfere with the effectiveness of the contraceptive pill.
Other reported effects have included dizziness, tiredness and hair loss. The extract has become a popular alternative to antidepressants such as Prozac and Seroxat in recent years following fears over the safety of SSRI (selective serotonin re-uptake inhibitor) drugs. Doctors have been told not to prescribe most SSRIs to under-18s because of an increased risk of suicide. Experts have also said they could not rule out a suicide risk to older users.
Another study found that pregnant women who take SSRI drugs were at risk of having babies with birth defects such as cleft palates and heart problems. Four out of five GPs have admitted overprescribing Prozac and similar drugs. They blamed a lack of suitable alternatives, including behavioural therapy and social care as well as medicines. 8.10.08
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Forget ADHT - a stroll in the park is as good at calming children as Ritalin, study finds
A stroll in the park could be just as effective for treating hyperactive children as drugs such as Ritalin, a study has revealed. Troubled youngsters showed significant improvements in concentration levels after what researchers called 'a dose of nature'. A 20-minute walk in green surroundings gave improvements on a par with a daily dose of drugs for Attention Deficit Hyperactivity Disorder, or ADHD.
Record levels of medicines are being dished out to hyperactive children on the NHS. Latest figures show GPs wrote more than 535,000 prescriptions for anti-hyperactivity drugs last year - more than 10,000 a week. The figure has doubled since 2002. Critics have accused doctors of using such drugs as a 'chemical cosh' to calm thousands of youngsters thought to have ADHD, a condition that makes them inattentive or boisterous and unable to concentrate at school.
Roughly one child in every classroom is thought to be affected by ADHD. In the latest study, researchers at the University of Illinois took a group of 17 hyperactive children on three walks in a park, town centre and residential area. The children stayed off their medication that day so researchers could be sure any benefit was from the environment alone.
The youngsters were tested on their powers of concentration after each walk. After strolling in green areas, their scores were improved by as much, if not more than, when they took prescription drugs. But the same children did not get any benefit from walking through town centres or residential streets.
Researcher Andrea Faber Taylor said: 'The greenest space was best at improving attention. 'We calculated the size of the effect in our study and compared it with the size of effect in a recent study involving medication. 'We were surprised to see the "dose of nature" had effects the same size or even larger than those of drugs. 'We can't say for sure that two hours of outdoor play will get you this many days of good behaviour. But we can say as little as 20 minutes could potentially buy you an afternoon, or a couple of hours, to get homework done.'
Andrea Bilbow, from the National Attention Deficit Disorder Information and Support Service, said it was a well-known fact that fresh air and exercise could calm down a child. But she stressed: 'You cannot possibly alter the structure of the brain by going out and looking at trees. There is no good evidence that this is as effective as drug treatment.'
Attention aid or chemical cosh?
Ritalin is one of three drugs recommended by the NHS to treat ADHD. Side effects can include hallucinations, insomnia, headaches, mood swings, decreased appetite, bleeding and suicidal thoughts, but critics claim the side-effects are worse than the condition it's meant to be helping. Ritalin and similar medications have been linked to 12 deaths in the UK.
It is a methylphenidate - the same class of drug as cocaine and amphetamines. It works by firing up the brain areas involved in concentration and attention, while decreasing restlessness. Some parents give their children Ritalin bought online to boost their exam results but many claim its just another example of drug companies and doctors medicalising life's problems and putting profits before common sense. 25.10.08
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Lawyers make £3million every week out of NHS blunders
Lawyers are pocketing £1 in every £2 paid out to victims of NHS blunders. Legal firms are bringing in a total of more than £3million every week as the compensation culture booms. Experts say increasing numbers of cases are being taken to court by 'no-win, no-fee' solicitors, who even tout for business in A&E waiting rooms. If they win, these 'ambulance chasing' lawyers ask the court for more in costs than would be paid in legal aid cases. This is to cover their extra risk. Last year, a total of £165million went on legal fees in medical negligence cases, for both defence and prosecution lawyers. This was 25 per cent up on 2006/07. The compensation to injured patients rose by a lower amount, 18 per cent, to £382million, according to the annual report of the NHS Litigation Authority (NHSLA). On top of the £547million paid out to victims and lawyers for medical negligence claims, a further £114million went on other claims not directly linked to doctors' mistakes, such as slipping on a hospital carpet.
Peter Walsh, chief executive of Action Against Medical Accidents, said: 'The amount of money taken up in legal costs rather than the compensation injured patients need and deserve is excessive. 'The state is shooting itself in the foot by the whittling down of legal aid which is now only available to the very poorest in society. People are forced to litigate using "no-win, no-fee" agreements which are much more costly for the NHS to settle. 'We need a bolstering of legal aid and a proper scheme to compensate patients injured by negligence without having to go to court.'
Matthew Elliott of the TaxPayers' Alliance said: 'It's a disgrace that so much of our money is going to ambulance-chasing lawyers. There is a big difference between providing legal advice and excessive billing that is frankly greedy.' The NHSLA provides payouts to people injured by health service treatment. All hospital, ambulance and primary care trusts pay premiums to the organisation for the collective cover it provides.
In total, around 6,000 cases against the NHS go to court every year.The NHSLA said the legal costs payable to victims' lawyers were typically around double the cost of the lawyers the health service instructs to defend the cases.
A spokesman said: 'We continue to seek to have claimants' costs capped where this is appropriate and the authority remains concerned about the high level of costs incurred in relation to clinical negligence cases on both sides.' 13.9.08
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One in 300 NHS patients killed by avoidable blunders One in 300 NHS patients is killed because of avoidable blunders by staff or hospital-acquired infections, Sir Richard Branson warned yesterday. The Virgin Atlantic chief said that this toll was far higher than the risks posed by air travel. Sir Richard, a newly-appointed vice-president of the Patients Association, compared the safety records of his aviation business and the NHS.
He added that the level of harm suffered by patients going into hospital for treatment was ‘unacceptable'. ‘If you fly on a plane you have a one in ten million chance of being killed,' he said. ‘If you go into hospital you have a one in 300 chance of being killed - not from the illness you went in with, but because of mistakes and other unnecessary problems such as hospital-acquired infections.
‘If one in 300 of our passengers died unnecessarily we would rightly be grounded.' He told a Patients Association conference in Harrogate, North Yorkshire, that the NHS record was not good enough. He called for new measures such as routine screening to detect and treat carriers of superbugs.
Around 2,000 NHS patients die each year after errors in treatment - half of which could have been avoided, according to the National Patient Safety Agency. An estimated 5,000 die from superbug infections. 8.10.08 ___________________________________________________________
Drug watchdog NICE 'spends more on 'spin' than tests on new treatments'
The health rationing watchdog has come under attack for spending more money on spin than on evaluating drugs which could save patients' lives. The National Institute for Health and Clinical Excellence (NICE), which has been widely criticised for banning drugs from NHS use as too expensive, squandered £4.5million on 'communications' last year. This was £1.1million more than the £3.4million the controversial organisation spent on assessing new medicines. The money forked out on press officers, marketing executives and consultants included £25,000 on top public relations firm Weber Shandwick to defend NICE's ban on Alzheimer's drugs.
It could have paid for 5,000 Alzheimer's sufferers to get £2.50-a-day drugs for a year. Alternatively it would have funded nearly 200 patients with advanced kidney cancer to have a drug for 12 months that would double their life expectancy. Tens of thousands of people across the country are waiting for NICE to assess drugs and treatments that could extend their lives or alleviate conditions such as rheumatoid arthritis and thinning bones.
MPs, patients groups and medical organisations branded the amount spent on communications as a 'scandalous waste of money'.
Myeloma sufferer Jacky Pickles, one of the 'Velcade Three' - three mothers who launched a campaign after being denied anti-cancer drugs - said: 'It is disgraceful that money which could provide drugs that make the difference between someone living and dying is being spent on communications.' Mrs Pickles, 46, of Keighley, West Yorkshire, added: 'NICE should either use the money to improve their evaluation process, or give it back to the NHS to spend on people who are ill.'
Shadow Health Minister Mark Simmonds, who uncovered the budget breakdown tucked away in NICE's annual report, said: 'These figures typify New Labour's approach to Britain's health service. 'Thousands of patients across the country who are still waiting for NICE to evaluate new treatments will rightly be asking why Labour insists on spending more on spin than on speeding up people's access to lifesaving drugs.'
NICE has an annual budget of £34.4million, and spends £1 in every £8 on communications. In contrast, £1 in every £10 is spent on evaluating new drugs. The rest is spent on such things as salaries - NICE's annual report for 2006/07 revealed that wages accounted for almost 37 per cent of the budget - accommodation (eight per cent) and external contracts. Almost 300 full-time staff are employed in London and Manchester.
The watchdog looks at whether drugs are cost-effective for the NHS, with the annual cost threshold set between £20,000-£30,000, above which they are considered too expensive. The 'value-for-money' calculation, which does not take into account factors such as severity of a disease, means British patients are denied drugs that are freely available abroad. NICE was condemned recently for handing a 'death sentence' to 1,700 patients with advanced kidney disease each year who will be deprived of four life-extending drugs.
One, Sutent, which costs around £24,000 a year, can double the life expectancy of patients to 28 months.
NICE has also been accused of 'dithering' over the evaluation process. It has taken several years for the watchdog to approve the use of some drugs. Chief executive Andrew Dillon was forced to make a grovelling apology last month for a two-year delay in approving a new treatment for blindness during which time many Britons lost their sight. Michael Summers, vice-chairman of the Patients Association, said spending £4.5million on communications was 'immoral and indefensible'.
He said: 'If NICE has reached the situation where it is so unpopular that it has to spend money improving its image, maybe it should be less dilatory and improve its performance.' Nick Rijke, of the National Osteoporosis Society, said: 'I would have thought that an organisation that spends so much on communicating would be rather better at listening to the views of clinical experts and patient societies.'
NICE said the majority of its communications budget was spent informing doctors about which drugs had been approved and new guidelines for treatments, although it admitted that it had a 'small' marketing budget. Mr Dillon said: 'The actual cost of assessing new drugs for the NHS includes money spent on NICE's behalf by the Department of Health. When you add them together, the total cost of the NICE technology appraisal programme far outstrips the cost of NICE communications.' 10.9.08
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Dentists 'giving patients pointless check-ups to exploit NHS payouts' Dentists are 'exploiting' the NHS by inviting healthy patients for needless check-ups to maximise their profits, the Government has said. Chief dental officer Dr Barry Cockroft accused dentists of advising patients to return every six months when official guidance says check-ups are only required every two years.
He also said some were routinely splitting up treatment that could be given in one session, in order to receive the NHS appointment payment more times. Dr Cockcroft said unnecessary check-ups were unfairly inflating dentists' salaries - already pushing £100,000 - and were clogging up waiting lists. Officials have ordered a crackdown on the practice, which they say could free up 800,000 appointments a year and hundreds of thousands of pounds for the NHS.
Dentists' pay shot up after a new contract was introduced in 2006, but over the time since then the number of people seeing an NHS dentist has fallen by a million. The average dentist's salary in 2006-07 was £96,135 - an 11 per cent increase on the last year of the old contract. Guidance from NICE, the National Institute for Health and Clinical Excellence, recommends patients have a check-up every two years, unless they are at risk of a life-threatening illness.
A Department of Health spokesman said: 'It is a contractual requirement for dentists to apply the NICE guidance. 'However, it is clear from new data available to primary care trusts that many patients are being seen every six months or so, effectively preventing new patients from getting access to NHS dentistry. 'PCTs now have contract based data to enable them to address this.' Some invitations to check-ups have come in the form of ' threatening' letters, warning that failure to attend could cost a patient their NHS place.
Dr Anthony Halperin, a dentist and a trustee of the Patients' Association, said: 'There is no doubt that some dentists are abusing the system. It is entirely inappropriate to see healthy patients so often.' But Peter Ward, chief executive of the British Dental Association, said there was no evidence to back up the Government claims.
'The interval between patients being recalled by their NHS dentist is, according to NICE guidelines, a matter for the practitioner's clinical judgment in consultation with the patient,' he said. 'The BDA supports this guideline, as we do not believe a one-size-fits-all approach is clinically appropriate. 'Dentists develop treatment plans in conjunction with the patient, ensuring they are clinically appropriate and fit with the individual's wishes.' 14.10.08
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Cash-strapped hospitals paying £1,300 a day for temporary boss
A cash-strapped NHS trust is paying a consultancy firm up to £1,300 a day to hire a temporary deputy chief executive. Worthing and Southlands NHS Trust hired Sue Barnett on a temporary basis this year, paying £65,338 to the company for ten weeks' work. Nine months later she is still employed by the trust - at an even higher rate.
At the same time, figures have revealed that the trust is running a £1million a month overspend on temporary and agency staff. The financial report also shows that the trust was supposed to keep to a target of 12 cases of MRSA this financial year. But it has reached that number after four months. It is also missing its target for cutting the number of clostridium difficile infections.
Initially consultancy firm Odgers Interim was paid at £6,500 a week for Miss Barnett's work. Calculated on a fiveday week, this is £1,300 a day. Since the start of April, that has risen to £6,600 a week. The total works out at just under £350,000 a year, a figure greater than the annual salaries of many hospital chief executives. The hospital's own chief executive, Stephen Cass, is paid £120,000. Miss Barnett was previously deputy chief executive at the troubled Barking, Havering and Redbridge NHS Hospitals Trust. She stepped down shortly after Mark Rees, her boss at the time, had his contract terminated, as the trust struggled with multi-million pound debts.
Last night critics condemned the the high payment. Matthew Sinclair, of the TaxPayers' Alliance, said: ‘With ordinary taxpayers footing such a large bill to support the NHS, and many patients being denied vital drugs, it is shocking to see money being wasted paying such an extravagant wage for an NHS official. ‘Having to use a temporary member of staff for so long is bad for the broader management of the trust and awful value for money.'
The trust said Miss Barnett had joined in January, as interim director of service delivery and deputy chief executive. The employment was through an ‘established recruitment consultancy' and came at a time when the trust was undergoing consultation into the future of health-care provision in West Sussex. ‘At this time the outcome of the Fit For Future consultation was not known, hence the decision by the trust board not to appoint a permanent replacement director,' a spokesman said.
‘In the eight months since her appointment, Sue has delivered on a range of targets and is making a major contribution to the trust's success. It is because of her achievements that the board has agreed to extend her contract. 'That contract runs until October. The question of how much payment went to Miss Barnett was private, the trust added. 3.9.08
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Fed-up senior doctor quits £100,000 NHS job to become a hairdresser
A high-flying hospital consultant got so fed up with NHS red tape he has ditched his doctors coat for a pair of scissors and has become a hairdresser instead. Former clinical director in anaesthesia Roger Tackley has given up a £100,000 salary to realise his dream of opening up his own salon.
The incredibly long hours and frustration of working within suffocating bureaucracy all added up disillusionment as a doctor. And a chance meeting with celebrity stylist Trevor Sorbie further inspired the 56-year-old to quit medicine. He was so fed up with the NHS he even advised his youngest son who is studying to be a doctor not to follow his footsteps. Now the father-of-two is looking forward to being his own boss after 19 years as a consultant.
Mr Tackley went to night school to learn his new trade after purchasing a salon he was working in part-time last year. The former Torbay hospital consultant is delighted to have changed direction after opening his own salon in Paignton, Devon today.
He said: ‘I got fed up with all the red tape and the restrictions on what we were allowed to do. ‘I did not get the opportunity to try out new ideas. 'My hands were tied often waiting for approval from above. ‘The NHS job changed. I would deal with protocol and the finance.
‘But I had very little power to make any changes - I could make recommendations but nothing ever got done. ‘All these things just added up in the end and it was time for a change.
‘For instance when I started as a clinical consultant if a new drug or a new technique in anaesthesia came around I could try it out, using my clinical judgement, obviously not putting patients at risk. ‘But now if anything is a major change from the standard procedure you have to wait for ethical approval or clinical trials to be done.
‘I just thought there's more to life than spending 100 hours a week in a hospital.
‘I always wanted to do something with hair but I never got the encouragement or the opportunity and as a hairdresser I can be much more of an individual,' he added. Mr Tackley, from Torquay in Devon, said everything came to a head in December 1998 while on a four-week family holiday in New Zealand. He decided to go part time and started an evening class in hairdressing.
‘I was very stressed at this point in time and a bungee jump just put me in the right mood to chuck it in - I finished my job as clinical director in 1999,' he said. ‘I studied two nights a week at South Devon College but I was very worried about fitting in as I was older. ‘But I got so much encouragement I knew it was what I wanted to do,' he added.
‘My son is studying medicine at Cardiff and I told him not to do it. But it is a good job with plenty of satisfaction and challenges for him.'
He added that further encouragement came from a chance meeting with Trevor Sorbie on a train in November 2000 when the celebrity hairdresser told him to go for it. 4.9.08
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What alternative medicine has known for 30 years: Vitamin C jabs 'trigger fightback against cancer'
It is usually associated with fighting the sniffles. But vitamin C could prove a powerful weapon against some of the most deadly forms of cancer, scientists said last night. Tests show injections of super-high doses halve the growth of brain, ovarian and pancreatic tumours. It is thought vitamin C triggers the production of hydrogen peroxide inside the body. Commonly used as hair bleach, the chemical also kills cancer cells without harming healthy tissue, meaning the treatment should be free of the pain, nausea and hair loss often associated with cancer drugs.
U.S. government scientists, whose work was published in the Proceedings of the National Academy of Sciences, studied the effects of daily injections of vitamin C in mice with brain, ovarian or pancreatic tumours. Within days, the rate of tumour growth had slowed by up to 53 per cent. In the case of brain tumours, the disease seemed to stop spreading.
In tests on cells in a dish, vitamin C attacked three- quarters of the tumour cells tested but no healthy specimens, suggesting treatment could be side-effect free. The researchers, from the National Institutes of Health in Maryland, said their results should revive interest in the anti-cancer properties of vitamin C when used with other cancer drugs.
Previous poor results could be explained by the vitamin being eliminated from the body when given in tablet form. Injecting it bypasses this natural clearance system. Dr Alison Ross, of Cancer Research UK, said: 'This is encouraging work but it's at a very early stage because it involves cells grown in the lab and mice. Much more research is needed before we'll know whether vitamin C could be a viable cancer treatment.'
Dr Alison Ross continued 'there is currently no evidence from clinical trials in humans that injecting or consuming vitamin C is an effective way to treat cancer. Some research even suggests that high doses of antioxidants can make cancer treatment less effective, reducing the benefits of radiotherapy and chemotherapy'.
But critics accuse Dr Ross of pouring scorn on the findings and her response is typical of the very people who should be excited by such news and as a doctor in her position she should be aware of how this treatment has already been successfully used for some time in real patients and not mice by alternative medicine practitioners worldwide. Cynics argue Cancer Research is more interested in it's own existance with an annual turnover of £468 million and makes more money out of 'researching for a cure' (£315 million in 2007) than by actually finding a cure and hence why Dr Ross is complacent about the findings that vitamin C jabs fight cancer.
Unfortunately, Dr Ross should also know there are no large randomized, placebo-controlled, double blind studies with IV vitamin C, as are done with all new FDA approved drugs because most studies such as these are funded by large pharmaceutical companies. Vitamin C simply has not grabbed the attention of the pharmaceutical industry, because a patent cannot be obtained on vitamins. There is little money to be made from large investments in vitamin research but more concerning is the fact Cancer Research who have an annual income of £468 million and spend £315 million on research have no plans to conduct such trials in the future. Since the 1970s, many cancer patients have been treated with regular infusions of high dose intravenous vitamin C. Some patients have been reported to be cured, while some went on to live many years with their cancer.
One such case is of Bryan Hubbard and his mother Edith from March 2006. 'For you, I have an extraordinary story, and one that gives genuine hope to everyone. It concerns my mother, Edith, who was diagnosed with end-stage breast cancer. Our family doctor gave her just three months to live, and told the family that we should say our good-byes.
We'll never know why Edith had nursed the cancer for several years without telling a soul. Perhaps she hoped that it might just go away, or perhaps it was an exercise in magical thinking that something we don't define doesn't really exist. Whatever the reason, it turned out to be the best thing she could have done, even though the doctor said that her breast was by that stage the most awful thing he had seen in his years of practice.
Of course, as editors of What Doctors Don't Tell You, and knowing what we know, we couldn't accept the death sentence. We asked the doctor if we could take charge of her care. As he had nothing to offer – she was too late for chemotherapy or radiotherapy – he was happy to do so. We immediately contacted one of our editorial panel, an eminent doctor who looks beyond the mainstream for effective treatments. He was confident he could reverse the cancer, even at that late stage, and when we met him with Edith, he explained what he would do.
Central to the treatment was vitamin C ther | 