General Health News

Some anti-depressants are no more effective than a dummy pill, and yet we're taking more than ever. Why? Professor RICHARD BENTALL, a leading psychologist, blames the drug companies. Here, he explains his views...

Without a doubt, the 20th century saw fantastic improvements in the ability of doctors to treat physical illnesses. From the discovery of penicillin to the use of stem cell transplants, there have been remarkable breakthroughs in the treatment of physical disease. But when we look at mental illness, the picture is very different. For despite the many new remedies that have become available over recent decades, patient outcomes have not improved.

In fact, studies have shown that people in developing countries do better than patients in countries with well-resourced psychiatric services. How could this be? The answer lies largely with the drug companies and the medical profession's growing reliance on their products. Critics argue this due to over prescribing and the medicalising of life's conditions. Between 1991 and 2001, prescriptions for antidepressants alone rose by 173 per cent in Britain. We had entered the Prozac age - an era when drugs were seen as a magic bullet for all mental ills.

Yet I have found that many of the drugs given to patients are nowhere near as powerful as is often believed, and their effects have been exaggerated by skilful pharmaceutical industry marketing. As a result, many patients have ended up receiving treatments that are either ineffective or which have unexpected harmful results.

When considering the role of the pharmaceutical industry, it's important to recognise that the industry's main purpose is to make money for its shareholders. Drug companies are no more driven by the desire to do good than the manufacturers of automobiles, canned soup or other household products.

Profit pull
Of course, they hope that consumers will buy their products because they are effective and (like the manufacturers of cars and fast food) they also hope to avoid being sued for selling products that are dangerous to the consumer. However, within these limitations, they are willing to use any and every method to promote their products to turn a profit.

That they have been successful is evident from the fact that the pharmaceutical industry is the most profitable in the world. By the beginning of the 21st century, the top drug companies were making an 18.5 per cent return on sales, compared to an average return for other industries of 3.3 per cent.

Industry leaders often try to justify these vast profits by pointing to the high costs involved in developing their products, and the substantial risks involved in investing in research which, depending on how clinical trials finally work out, might prove to be a dead end.

However, by far the majority of the research conducted by the industry is not targeted at the discovery of novel medications, but on the development of 'me too' drugs which are as similar as possible to the existing products of rival companies, but sufficiently different to allow fresh patents to be issued.

Second, much of the research that leads to the development of truly innovative treatments is funded by public bodies such as the Medical Research Council in Britain and the National Institutes of Health in the United States.

Finally, and most importantly, only about 11 per cent of pharmaceutical industry revenues are spent on research, whereas a staggering 36 per cent is spent on marketing - it is this marketing that helps explain why much psychiatric care is ineffective. The marketing takes a variety of forms, some of which are more obvious than others. One way the pharmaceutical industry promotes its wares is by sending representatives to hospitals and clinics, where they often fund academic meetings in exchange for the opportunity to say a few words about their products.

Sweetening the pill
The end of these meetings, the representatives (often attractively dressed young men and women) will usually present a few slides extolling the virtue of their particular medicine in comparison with a similar drug sold by another company. Sometimes the representative will distribute free trinkets such as cups or pens bearing company logos. Many, perhaps even most, NHS clinicians drink their morning coffee out of cups adorned with the names of widely used drugs, and write their reports with pens bearing drug company logos.

Trinkets are also prominent at large psychiatric conferences. However, these pale into insignificance compared to the largesse available to some doctors, promtional events, cars,cash, holidays and jewerly.

After flying economy class to give a talk at an American Psychiatric Association meeting in Chicago several years ago, I was bemused to find that some of my psychiatrist friends (most of whom were not even presenting papers) had been flown out business class by a leading drug company and were being accommodated, free of charge, in a magnificent hotel. The floor they occupied had a free bar, so that they would have a convivial environment in which to discuss the latest pharmacological research.

When my friends invited me to join their party for the evening, I found myself being wined and dined at the smartest restaurant in town, before being taken on a pub crawl, accompanied by a drug company representative, who bought all the drinks. Sometimes drug companies sponsor entire conferences in this way.

Pharmaceutical companies are being neither irrational nor altruistic when sponsoring these kinds of event - studies have shown that doctors often change their prescribing habits after attending industry-sponsored meetings. In the United States and in Britain, physicians might also be able to inflate their incomes by acting as paid consultants to the pharmaceutical industry.

The kind of work undertaken might vary, from attending 'educational meetings' (I once declined £1,000 for merely attending an informal dinner at which I was expected to offer my opinions about the treatment of patients with bipolar disorder), to presenting talks in favour of particular medications at industry-sponsored conferences, or providing advice and assistance in the conduct of pharmaceutical trials.

I was recently told by an industry insider that a small number of British academic psychiatrists earn more than £100,000 per year on top of their university salaries for these kinds of activity. Aside from direct payments from drug companies, some U.S. doctors have found that they can make fortunes by setting up private contract research organisations, which carry out clinical trials for the industry.

It is not uncommon for these U.S. organisations to receive fees of up to £6,000 for each patient they successfully recruit into a trial. With such huge sums to be made, it is difficult to have confidence in the data obtained.

And then there is the naked manipulation of data by drug companies. The serotonin reuptake inhibitors (SSRIs) are a prime example. These antidepressants first became available in the late 1980s and were marketed with enormous hype with dramatic claims about their superior efficacy compared to the older tricyclic antidepressants.

Completely unjustified
That these efforts were successful is evident from the number of antidepressant prescriptions written by family doctors. The hype extended beyond the medical profession to the public. Indeed, Prozac achieved almost iconic status, as reflected by the titles of popular books such as Elizabeth Wurtzel's Prozac Nation and Lauren Slater's Prozac Diary.

When the actual evidence in support of the new drugs is carefully examined, it becomes clear that this almost terrifying impression of their effectiveness is completely unjustified.

As early as 1993, a systematic review could find no evidence that the new drugs were better than the old ones. Indeed, subsequent analyses have found that nearly all of the response to both the old and new antidepressants can be attributed to the placebo effect. So how did such drugs get licensed? This is because a drug company doesn't have to show that a drug is better than existing alternatives, but that it is safe and more effective than a placebo in two 'pivotal' trials. And what is 'pivotal' has never been defined, so the manufacturer can do as many studies as it wants until it gets two that meet the criteria.

The pharmaceutical industry's ruthless manipulation of data goes a long way to explain why some of the drugs in wide use today are not nearly as effective as is commonly supposed. But that doesn't mean drugs have no place in modern mental health care. However, they must be used to support psychological and social treatments rather than as a substitute for them.

For as research shows, the two most effective tools available to the clinician are kindness and empathy. Adpated from Doctoring The Mind by Richard P. Bentall 30.6.09

Two men with inoperable prostate cancer have made dramatic recoveries after being given a single dose of an experimental drug. Both men are now cancer-free and their doctors say their progress has exceeded all their expectations. Dr Eugene Kwon, of the respected Mayo Clinic in Minnesota, said: 'This is one of the Holy Grails of prostate cancer research. We have been looking for this for many years.'

Prostate cancer is the most common cancer in British men, with nearly 35,000 cases a year, 10,000 deaths and few treatments for advanced disease. The two patients were taking part in a trial involving a drug called ipilimumab, a specially-engineered antibody that boosts the immune system's ability to fight cancer.

Both had late-stage cancer, that had spread beyond the prostate, with one blighted by a tumour the size of a golf ball. Patients in such a condition may only have months to live and are usually offered only palliative care. The pair were given conventional drugs to mop up the male hormones that fuel the growth of prostate cancer, followed by a single dose of ipilimumab.

So many cancer cells were killed off that the men were able to undergo surgery, and both have gone back to their normal lives. Dr Michael Bute, the surgeon who operated on the men, said: 'The tumours had shrunk dramatically. 'I have never seen anything like this before. I had a hard time finding the cancer. 'At one point the pathologist (who was working during surgery) asked if we had samples from the same patient.'

Dr Kwon, a urologist, said: 'The candidates for this study were people who didn't have a lot of other options. 'However, we were startled to see responses that far exceeded any of our expectations. 'We had thought we might get some incremental delay in the progression of the cancer. 'It had not dawned on us that we might go from an inoperable tumour to an operable one. That just doesn't happen.'

The two men were among 108 taking part in the trial, which is ongoing. A third 'inoperable' patient underwent surgery last week and 20 more are showing improvements and are being monitored by the surgeons. A second trial, using higher doses, is planned, but the researchers cautioned that the results would have to be confirmed in further, large-scale studies.

British experts described the results as 'extremely encouraging' - but cautioned the work is still at an early stage. John Neate, chief executive of The Prostate Cancer Charity, said: 'The reported results of the experimental treatment of these two patients showed dramatic shrinkage of the tumour, allowing surgery to take place. 'If these early and small-scale results are replicated in larger trials, this represents a potentially very exciting development.

'We urgently need a wider range of treatment options for prostate cancer which has spread outside the prostate gland and this research is a welcome indication of potential progress in this area. 'It must be remembered that this is a small trial, however, and the findings are preliminary results.

'The Prostate Cancer Charity eagerly awaits further research and looks forward with anticipation to exploring the results.' Professor Malcolm Mason, Cancer Research UK's prostate cancer expert, said: 'These case reports are extremely interesting and encouraging. 'But caution is needed, as earlier trials with this drug in other types of cancer were less successful than reported here. 'The other cautionary note its that both men received hormone therapy, which in some instances causes dramatic reductions in tumour size by itself.' 22.6.09

Damning report reveals NHS Agenda For Change that cost tens of billions hasn't resulted in better productivity

A flagship pay deal for more than a million NHS staff has not resulted in promised savings or better productivity, says a damning official report.

Instead productivity levels fell by 2.5 per cent on average a year between 2001 and 2005, according to the Commons Public Accounts Committee. Its report claims there is no evidence that the changes in working have been implemented. Agenda for Change was brought in as a pay modernisation programme for 1.1 million NHS staff in England between 2004 and 2006.

It covers all staff, except doctors, dentists and senior managers and promised a streamlined pay system as well as a boost to staff training and development. But the PAC found no evidence that £1.3 billion of savings predicted by the Government have been achieved or that system-wide changes in how staff work have been implemented.

A National Audit Office report in January also found no evidence of better working or increased productivity. The Department of Health estimated cumulative savings from Agenda for Change of between £1.1 billion and £2.2 billion after giving a figure of £1.3 billion in its business case to the Treasury.

The Department calculated these savings on the assumption that new roles and ways of working had been implemented across the NHS. "There is, however, no evidence that Agenda for Change has led to systemic changes to the way that NHS staff are working' says the report.

The NHS pay bill for Agenda for Change staff rose by 5.2 per cent a year on average since 2004/05 reaching £28 billion last year. But productivity fell by 2.5 per cent a year on average between 2001 and 2005, although there have been signs of improvement since then.

Tory MP Edward Leigh, chairman of the public accounts committee, said 'It is not known whether the Agenda for Change programme has generated the predicted £1.3 billion savings. 'That makes it all the more incumbent on the Department to explain to us how the programme is going to support the £15 billion of efficiency improvements in the NHS planned for the next three years.'

Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), said 'Transferring over a million staff to a new pay system in such a short time is no mean feat. NHS staff and employers have worked closely together to achieve this. 'Critics are wrong to speak out after so little time to say the changes have not brought about improvements. 'There is plenty of evidence to show Agenda for Change has made the NHS a better place for patients and for staff.' Critics argue Dr Carter is 'out of touch and in deial'. 18.6.09

The NHS is on the verge of the biggest financial shortfall in its history and cannot survive without major changes, according to an influential report. In the next 10 years the NHS Confederation predicted the health service is facing a £15billion shortfall in funding.

They said the next two years were 'tough but manageable' but explained 'the position beyond 2010/11 is very different and extremely challenging'. Its report - Dealing with the downturn: The greatest ever leadership challenge for the NHS? - said the service should expect the huge deficit due to the impact of the recession and rising costs.

'With little or no cash increase, from 2011/12 the NHS will need to plan for real terms funding to fall by 2.5-3 per cent per annum,' the study said. 'This is equivalent to a cut of between £8-10 billion over the next Comprehensive Spending Review and up to £15 billion over five years.'

The report called for immediate action if the service is to continue to keep to its founding principles of providing free care to everyone at the point of need. It warned against 'diluting' the quality of patient care and extending waiting lists like in the past, or making cuts to training budgets. A solution to this crisis lies in NHS leaders embracing innovation, change and improving efficiency, it said.

The shortfall means a cut in staff numbers is unavoidable and it may be time for a cap on the budget for new drugs to be considered. Steve Barnett, chief executive of the NHS Confederation - which represents 90 per cent of all NHS organisations - said: 'With little or no cash increase from 2011/12 the NHS has to prepare itself for real-terms reductions in what it can afford to do and needs to make the hard decisions about which programmes to fund, how to reward staff and how to reorganise services now.

'If it does not, then the mistakes of the past could be repeated and shortages in funding will translate to the kind of across-the-board cuts which could see waiting lists lengthen, standards fall and dissatisfaction with the service grow among patients and staff. 'The NHS needs to take the opportunity to find efficiencies and savings - I believe it has the people, the ideas and the capacity to meet this challenge but we should be under no illusions of the size of the task ahead.'

Director of policy, Nigel Edwards, who wrote the report, added: 'It is really important that the significant improvements that have been made in the NHS are not lost through short-term cuts and crude approaches to cost control. 'Quality improvements through greater efficiency and redesigning services can provide the budget savings necessary to navigate this crisis.'

The NHS budget in 2009/10 stands at £102.7 billion - a 7.5 per cent real terms increase on the previous year, according to the Department of Health. Next year, the budget will be £105.8 billion, which it said was a 1.6 per cent increase in real terms.

Health Secretary Andy Burnham said NHS funding had tripled since 1997, putting it on a strong financial footing. He admitted the NHS would face a 'challenge' over the next five to 10 years but that raising concerns of closures and job cuts was 'completely premature'. The NHS Confederation was right to forecast a dip in spending growth over the next decade and to say 'let us plan', the minister said.

But trying to allay concerns, he added: 'I think it would be wrong to scare people, that there are big changes coming, that there are cuts and closures, that is not the case with this Government. 'We have always looked after the NHS. We have said, and the Prime Minister has said, we will carry on increasing health spending.'

Dr Hamish Meldrum, chairman of the BMA, said: 'The imminent funding crisis could be very dangerous for the NHS, and has the potential to seriously threaten patient services. 'We agree with the NHS Confederation that difficult choices will have to be made. 'But we also believe that one of the most effective ways to reduce the adverse impact on NHS funding would be to reverse the policy of encouraging a market in healthcare in the English NHS.

'Too much money that could have been spent on frontline patient care has been wasted on poor value deals with commercial providers and the bureaucratic costs of administering the market in the NHS.' 10.06.09

How the humble hydrangea shrub could hold the key to curing MS, diabetes and arthritis

It's bright and beautiful flowers bring a splash of colour to gardens all over Britain. But it seems the hydrangea is more than just a pretty bloom. A drug made from its roots could be used to treat a raft of common diseases, researchers say.

The colourful shrub - a staple of Chinese medicine - has the power to 'revolutionise' the treatment of multiple sclerosis, psoriasis and some forms of diabetes and arthritis, scientists claimed yesterday. These diseases occur when the immune system attacks the body.

Existing treatments are expensive, have to be injected, and do not address the biological cause of the problem. Powerful drugs which suppress the immune system can be used as a last resort but leave patients at risk of infections and other serious side-effects. Now it appears that a medicine derived from the hydrangea's root could offer an alternative. Experiments found that it blocked the formation of a type of white blood cell involved in autoimmune disease.

Crucially, the drug does not seem to affect other kinds of cell vital to the body's defences - meaning it does not otherwise inhibit the immune system. Mice with a multiple sclerosis-like disease were far less severely affected when given low doses of the hydrangea-based drug, which is called halofuginone, the journal Science reported.

Halofuginone is already used to treat a rare autoimmune disease which affects the skin and internal organs. Much more research would be needed for it to be given the green light to treat other conditions such as rheumatoid arthritis and diabetes. However, scientists say it is a promising avenue of research.

Dr Anjana Rao, of the Children's Hospital in Boston in the U.S., said: 'Halofuginone may herald a revolution in the treatment of certain types of auto-immune and inflammatory diseases.' Her fellow researcher Dr Mark Sundrud added: 'This is really the first description of a small molecule that interferes with auto-immune pathology but is not a general immune suppressant.'

Hydrangea root has traditionally been used to relieve inflammation and 'cleanse' the joints. It is one of the 50 staple herbs of Chinese medicine and is also a traditional medicine of north American Cherokee Indians. An extract of hydrangea leaf is also said to have anti-malarial properties.
5.6.09

The BBC is facing a legal bill of well over £1million after settling a libel battle with top IVF doctor Mohamed Taranissi. Mr Taranissi, who is said to have helped mothers give birth to 2,300 babies in seven years, had accused the Panorama programme of making defamatory allegations.

Yesterday it emerged that the BBC has come to a settlement with the Egyptian-born doctor, with the corporation paying both sides' legal bills. Legal experts said this could cost up to £6million, but the BBC said Mr Taranissi's costs were around £900,000. The Corporation's own costs have not been revealed but they are likely to be a sizeable six-figure sum.

It was unclear if Mr Taranissi has received any damages. Last October the High Court ordered the BBC to pay him an estimated £500,000 costs after it 'threw in the towel' over one part of its defence. But BBC bosses decided to fight on in what became one of the most bruising legal battles in its history.

The decision to settle with Mr Taranissi comes just over a week after the broadcaster offered to pay £30,000 and apologise to the Muslim Council of Britain over claims that it encouraged the killing of British troops. Mr Taranissi, who has been described as one of the country's richest doctors, launched his action after the Panorama broadcast in January 2007 suggested that one of his central London clinics, the Assisted Reproduction and Gynaecology Centre, offered 'unnecessary and unproven' treatment to an undercover reporter posing as a patient.

The show also alleged that a 26-year-old journalist was offered IVF treatment costing thousands of pounds despite neither she nor her partner having a history of fertility problems. One of the therapies involved a blood transfusion that an independent expert suggested could harm an unborn child.

The programme also claimed that Mr Taranissi was running a second clinic, the Reproductive Genetics Institute, without a licence and was sending his older and harder-to-treat patients there to maintain higher success rates at the ARGC. The IVF investigation was used to relaunch Panorama on a new Monday night slot on BBC1.

Mr Taranissi, who was represented by top libel lawyers Carter-Ruck, called the programme 'biased and irresponsible'. He said producers had information that showed 'a different side and a different argument', but chose not to use it. He has said Panorama sent at least two other undercover reporters to his clinics and they were given legitimate advice - but this was left out of the show. There have also been claims that the show's researchers used fake GP referral letters to target Mr Taranissi.

The programme generated 150 complaints to the BBC, a sizeable number of them said to have come from Mr Taranissi's former patients. His supporters claimed that the Human Fertilisation and Embryology Authority, the fertility watchdog, had colluded with Panorama as part of a 'witch hunt' against the doctor. Leading fertility expert Lord Winston later wrote to Panorama accusing it of trial by television and letting the HFEA 'off the hook'. Last night a BBC source said: 'Both parties have agreed to settle the case and consider the matter now closed.'

But critics of the Corporation are astonished that it let the case run on so long, increasing the costs, and are angry that such an extraordinary amount of licence fee cash is being spent on legal costs rather than on TV shows at a time when money is short. 8..6.09

Sedatives and sleeping pills raise suicide risk in the elderly FOUR fold, researchers warn

Vulnerable elderly people prescribed sedatives or sleeping pills may be more likely to take their own life, a study suggests. The drugs, which are prescribed to ease depression, anxiety and problems with sleep, raise the risk of suicide among the elderly fourfold , the Swedish researchers found. ‘Clinicians need to be aware of this as these drugs are widely prescribed to the elderly,' the researchers warn.

The team reviewed figures for the Swedish city of Gothenburg along with two nearby counties and found that older people taking antidepressants, antipsychotics, sedatives or hypnotics were all more likely than others to commit suicide. While research has linked use of these drugs to suicides among younger people, there had also been evidence the pills may reduce the risk in the elderly, Anders Carlsten and Margda Waern of Gothenburg University reported in the journal BMC Geriatrics.

To find out, they compared the records of 85 men and women older than 65 who had committed suicide with those of 135 elderly people from the general population who had not. Psychiatrists interviewed people close to the patients about mental problems over the past month and the volunteers were also interviewed in person.

After taking account of the diagnosed psychiatric conditions, the team found that patients who took sedatives and hypnotics for sleeping problems were four times more likely to commit suicide. According to the World Health Organisation, some 877,000 people worldwide kill themselves each year. For every suicide death, anywhere from 10 to 40 attempts are made, the U.N. agency estimates

Scientists have linked sleep disturbances to an increased risk of suicide in people with psychiatric disorders and in adolescents but it is unclear whether the association also exists in the general population. ‘A careful evaluation of the suicide risk should be carried out when an elderly person presents with symptoms of anxiety and sleep disturbance,' the researchers said.

While they do not know exactly why, Carlsten and Waern suggested that the drugs somehow trigger aggressive or impulsive behaviour or provide the means for people to take an overdose. However, disabilities or sleep problems may make people more likely to commit suicide, they added. ‘[People] with these problems might be more likely to seek health care and perhaps more likely to receive prescriptions for psychotropic drugs,' they said.

Sophie Corlett, External Relations Director at mental health charity Mind said: 'Any research that links a drug treatment with increased risk of suicide is alarming, and further research is needed to clarify the role that sedatives might play. 'We know that older people can be routinely over-prescribed or given inappropriate medication for the sake of convenience, and health professionals must act responsibly and be alert to the damage some medications can cause.' 4.6.09

MPs branded liars by 76% of public as Brown is warned of 'lowest ever' support for Labour

Three-quarters of people believe their MPs are liars in the wake of the expenses scandal, with almost half also considered corrupt, a devastating new poll reveals. The scale of public disillusionment with Parliament is laid bare by the Ipsos Mori survey for the BBC.

Only 20 per cent declared they could trust their MP with some 76 per cent believing they do not tell the truth. A huge majority, 85 per cent, of the 1,000 people polled backed the idea of an independent judicial body to make sure MPs are kept in line. It came as a disastrous poll put Labour's support at its lowest ever, with a warning Gordon Brown faces a defeat from which the party might never recover.

Labour peer Lord Desai said the party ran a serious risk of being beaten not only by the Conservatives but also by the Liberal Democrats at the next General Election. The survey, also by Ipsos Mori, showed backing for Labour has crashed by ten points in the last month. It is now running neck and neck with the LibDems on just 18 per cent - the worst figure for any governing party.

The poll suggested the Tories are largely undented by the scandal over MPs' expenses, down only one point on a month ago at 40 per cent.

However, in a sign of wild fluctuations in voting intentions, a separate survey by ComRes for the Independent put the Conservatives on just 30 per cent, Labour on 22 per cent and the Lib Dems on 18 per cent if an election were held now. Labour's desperate standing forms the worst possible backdrop for Mr Brown to Thursday's crucial local and European elections. The Prime Minister again insisted yesterday he would defy any attempt to drive him from Downing Street, no matter how bad the results.

But Lord Desai warned his party is heading for defeat on the scale of the Liberals in 1922, after which they never returned to power. 'It is seriously possible that we will come below the LibDems at the general election,' he said.

The BBC's research showed 7 per cent believe all MPs to be corrupt, 17 per cent that most were and 24 per cent for 'about half' - totalling 48 per cent. Some 62 per cent agreed MPs were pursuing their own interests rather than those of the country and their constituents. A a large majority, 80 per cent, said that the parliamentary system was also to blame and needed reform.

Yet another poll indicated almost one third of voters are not planning to back any of the three main parties in Thursday's elections. The ComRes poll for the Indepent put support for 'others' at 30 per cent, up 18 per cent since before the expenses row. The rating is neck and neck with the Tories - who have plummeted 15 per cent from the equivalent poll last month.

Labour has dropped four points to 22 per cent, while the Liberal Democrats were up one on 18 per cent. The Greens were on 8 per cent, Ukip on 7 per cent, the BNP 3 per cent, the Scottish National Party 2 per cent, Plaid Cymru 1 per cent and other smaller parties or independents 9 per cent.

David Cameron said the polls showed anger over the expenses scandal had not subsided and had, if anything, 'got worse'. Trust had to be rebuilt 'brick by brick' with an early General Election, he repeated. 'What I have tried to do with my party is atone for the mistakes of the past by getting people to pay back money, by forcing some to retire, by threatening to withdraw the whip if they don't retire, but I recognise that is not enough,' he said.

'In the end what the British public want is all of that, plus a General Election - they want to be able to pass judgment on all their Members of Parliament.' 2.6.09

Thousands of patients could undergo unnecessary spinal operations because of new NHS guidelines on treatments for lower back pain, warn experts. Dozens of hospital consultants say the ‘cost- cutting' restrictions mean more patients will end up having major surgery.

They claim less risky procedures using spinal injections have been wrongly dismissed as ineffective, even though they help hundreds of thousands of patients with chronic back pain each year. Guidelines issued earlier this week by the National Institute for Health and Clinical Excellence ( NICE ) set out permitted treatments for patients whose back pain has lasted for at least six weeks but less than a year.

They endorsed widespread use of ‘alternative' therapy, letting patients opt for a three-month course of acupuncture, manual therapy such as physiotherapy, or exercise. Described as a ‘sea-change' for back pain sufferers, the guidelines also told doctors not to recommend therapies with ‘little evidence' to support them, controversially including injections of small amounts of steroids into the back, MRI scans, X-rays and ultrasound.

Now, many patients who fail to respond to initial treatment could miss out this intermediate stage and proceed straight to risky spinal fusion operations. NICE estimates the NHS will make annual savings of £33million on back injections and £11million on MRI scans. However, it will spend £24million extra on acupuncture and £16million extra on manual therapy, making the cost-cutting aspect negligible.

Around 50 specialists belonging to the Interventional Pain Medicine Group of the British Pain Society are writing to NICE , claiming it has dismissed good evidence about spinal injections, which do not cure pack pain but give a period of relief from chronic pain.

Dr Ron Cooper, past chairman of the group and a consultant pain specialist in Northern Ireland, said: ‘I have never known so many pain medicine specialists to be so furious. More patients will end up having more expensive surgery, which is unnecessary, risky and has worse results. '‘NICE made it difficult for us to submit evidence to a committee on which there was not one experienced pain physician.

‘The guidelines will make us the laughing stock of Europe, Australia and the U.S. where pain specialists will continue to have full access to a wide range of treatments.' Dr Raj Munglani, a consultant in pain medicine at West Suffolk Hospital, Bury St Edmunds, said: ‘There could be as many as 400,000 patients (a year) who will be eligible for spinal fusion – when it should be a last resort.

‘There is a lot of concern that this is actually a way of banishing waiting lists for some procedures, because they will no longer be available.'

Dr Serge Nikolic, a chronic pain specialist at Bart's hospital in London, said any savings made from the guidelines would be a false economy if they led to more spinal surgery. A NICE spokesman said: ‘The guideline sets out... those approaches which either don't work as well as alternatives, or for which there is little evidence of benefit. ‘The guideline recommends that new research is needed to decide if injections into the back are, or are not, effective.' 29.5.09

Plans to give patients cash payments to purchase NHS services will go ahead next year, in the face of fierce opposition from GP leaders. The controversial direct payments will start as a pilot of 5,000 patients in up 75 PCTs with the aim of leading to a much wider rollout. The schemes will include end-of-life care, long-term conditions, stroke, substance misuse and mental health.

The final make-up of schemes has yet to be decided, but the DH wants to try using both notional healthcare budgets and direct payments – as currently used in social care – during the pilots scheme. Direct payments of NHS funds are currently illegal, but the Department of Health is pushing ahead with legislation in the Health Bill to enable the NHS to make cash payments to patients from 2010. GPs are likely to be expected to take central role in the pilots, advising patients how to spend their on healthcare or other services.

Speaking at the Integrated Health Conference in London, Angela Hawley, self care lead for the Department of Health, admitted the pilots were ‘terribly contentious' but were part of a move to place the patients at the centre of their care. ‘These will put people in driving seat on health and well-being,' she said.

Professor Jon Glasby, co-director at the Health Services Management Centre at the University of Birmingham, welcomed the move as direct payments had been successful in social care. ‘They are very popular with patients and have been shown to have better outcomes for the same amount of money,' he said.

But GPC chair Dr Laurence Buckman slammed the pilots, saying they were against the founding principles of the NHS. ‘What happens when it runs out? If you give people a wad of money then what happens if they use it on their income tax, or petrol, or whatever?

‘This is the absolute antithesis of the NHS, providing the greatest good for the greatest number of people and to manage risk as high up the chain, so that individual bits of the health economy do not run out of money to treat the condition. ‘I am astounded the Government has decided to go down a route that is so irrational,' he said.

How pilots will work
Three models of personal healthcare budgets will be tested in the three year pilot programme.

If your back has been needling you for a while, it could be time for a trip to the acupuncturist, for experts have found that the ancient Chinese therapy can relieve a bad back better than anything else. As many as 85 per cent of us are said to feel a twinge or two at some point in our lives. Back pain costs the NHS £500million a year.

A study found that acupuncture, based on the theory that needles can release the body's vital energy, had a better success rate in relieving pain than conventional treatment. For the research, hundreds of adults who suffered from chronic lower back pain were split into four groups.

One received an individual programme of acupuncture; one group standard therapy; a third group had a simulation of acupuncture using toothpicks; and the fourth group had the usual care. After eight weeks, 60 per cent of those having some kind of acupuncture were much improved. For those having conventional care, it was only 39 per cent. After a year, between 59 and 69 per cent of those treated with acupuncture reported improvements, compared to 50 per cent of those having usual care.

Researcher Dr Daniel Cherkin said all the varieties of acupuncture 'had beneficial and persisting effects on chronic back pain', when compared to usual treatment. This makes acupuncture appear a promising option for chronic back pain, he explained.

'For clinicians and patients seeking a relatively safe and effective treatment for a condition for which conventional treatments are often ineffective, various methods of acupuncture point stimulation appear to be reasonable options. 'Furthermore, the reduction in long-term exposure to the potential adverse effects of medications is an important benefit.'

However, the findings do not establish whether the treatment actually helps heal or simply makes us think we feel better, said Dr Cherkin, of the Group Health Centre for Health Studies, in Seattle. Recent studies have suggested that simulated acupuncture, or shallow needling, appears as effective as needles penetrating the skin.

There are several possible explanations, according to the study, published in Archives of Internal Medicine. Superficial stimulation of acupuncture points may directly stimulate physiological processes that result in reduced pain and improved function. Or the improvement may simply be down to the patients' belief that acupuncture will make them well. 12.5.09

Have you ever been to a doctor who expressed negative views about alternative medicine? It's understandable that they would tell a patient they don't recommend something because they haven't thoroughly researched it - which is the truth - but to attempt to prevent their patient from getting treatment that has helped millions of people and is actually the preferred treatment method in healthier countries than ours is simple arrogance. And it may well be one of the major causes of prescription drug addiction. It's no coincidence that in the 12 European counties which have better health care than the UK, alternative medicine is used along side pharmaceutical medication to provide the best treatment for the patient, so the UK have clearly got healthcare wrong.

There are many doctors enlightened and responsible enough to admit this. Some even take the time to study alternative medicine so they can give real help to their patients instead of prescribing drugs that will numb the symptoms while, in fact, their condition is not improving and is probably getting worse.

But it seems that the vast majority of doctors dismiss alternative therapies out of hand. What they've learned in medical school is the only way, despite volumes of evidence to the contrary.

Their patients who suffer from chronic pain, for example, have usually never seen a chiropractor or an acupuncturist, nor have they tried other drug-free solutions. The patients often say they 'don't believe' in these things - even though they know virtually nothing about them - and their doctors, who know little if any more than their patients, often back them up. What the patients don't know is the vast majority of drugs - more than 90 per cent - only work in 30 or 50 per cent of the people who take them.

Sometimes a patient even hears about other treatments, asks their doctor about them, and is told by his doctor not to do it. Instead, the patient is given painkillers that do nothing to address the cause of the pain or improve the underlying condition.

- The patient can easily become dependent and on them and even become addicted,
- higher and higher dosages are sometimes required as the body builds up a tolerance to the drugs,
- the drugs have many side effects that, among other things, can inhibit the healing process,
- they mask the real condition, which may be getting worse, and,
- according to recent research, painkillers, when taken for an extended time, can actually cause pain.

Many doctors agree that doctors themselves are fuelling the prescription drug addiction epidemic by too frequently and too easily prescribing drugs. In truth, medical doctors don't know what else to do. And they know it. Despite this, they ignore and even attempt to nullify non-drug therapies that have proven successful all over the world and to which millions subscribe.

Medicine is constantly evolving and improving - which is why doctors are required to take continuing education classes to keep their license.

If more doctors would avail themselves of education on alternative therapies rather than attending big pharma-sponsored events designed to promote more drugs, many people would be healthier and we could see a vast decrease in prescription drug addiction however this isn't what the big pharmaceutical companies want, hence why doctors don't do it.

Medical doctors are invaluable when it comes to certain situations. But there are many conditions which they don't know how to treat and can be successfully treated without drugs.

When choosing a doctor, make sure you get one who has studied alternative therapies and is open to them. A doctor like that can not only save your life in a dangerous medical situation, he can also help improve the quality of your life with minimal use of addictive drugs.

More and more people are showing up at addiction treatment centers for help with prescription drug addiction. And many of those addictions started with a prescription from the doctor. Your choice of doctor may dictate whether or not you're headed in that direction. 2.5.09

Alcoholics and drug addicts told to sober up and get clean or lose their benefits

Alcoholics could have their benefits cut unless they agree to undergo treatment for their addiction, the Government hinted yesterday. Proposed laws to force heroin and crack addicts to go into detox could be extended, Work and Pensions Secretary James Purnell said.

The number of drink and drug addicts living on benefits has doubled in a decade to more than 100,000, about half of which are alcoholics. But the plan drew scepticism and anger from opposition politicians. Tory work and pensions spokes-man Theresa May said: 'Mr Purnell has failed to say when this will happen, how much it will cost and who exactly it will help.

This is a desperate move by a tired Government trying to seize the agenda after the fallout from Smeargate.' Liberal Democrat Steve Webb described the plan as 'fundamentally inhumane'. He added: 'There are far too few support services for alcoholics, and there is no evidence that people who are threatened in this way are more likely to seek help.'

The laws on heroin and crack are included in the Welfare Reform Bill, which is currently before Parliament. Mr Purnell said extending the scheme would 'help families suffering from the blight of alcoholism'. He added: 'We need to look through the eyes of the person defeated by an addiction that keeps them out of work and on the outside of the community and give them the help they need.

'We have introduced a new policy that will mean heroin and crack addicts get treatmentin return for benefits. We will actually help them rather than simply handing them money which ends up in pockets of drug dealers. 'But we can't abandon anyone to long periods on benefits without help to overcome problems. 'We are going to look at the arrangements for alcoholics on benefits, just as we did for problem drug users, so that people get the help they need to get sober, to get their life back and get back to work.'

Officials said the Work and Pensions Department and the Department of Health would commission research and then carry out a review to 'explore how we can make the benefits system work effectively for alcoholics.'

However, no timescale was given for the review. Most drinkers who live on benefits are among the 2.6million people on Incapacity
Benefit, which ministers have long acknowledged is collected by large numbers of people who are actually fit to work. In 1997 there were fewer than 49,000 claimants who were paid the handout because they were drink or drug addicts, but by 2007 numbers were in excess of 100,000, roughly equally divided between alcoholics and drug addicts.

Many addicts also claim linked benefits. Nearly 20,000 drink or drug addicts receive Disability Living Allowance, intended for people who need help with personal care or have difficulty walking. Mrs May added: 'This is just another smokescreen announced by Labour to deflect from their failure to grips with our welfare system.

'Under James Purnell the system is going to meltdown with more than 100,000 people claiming benefits because they are drug addicts or alcoholics.' 16.4.09

The capsule costs pennies, contains a simple cocktail of medicines, and halves the number of strokes and heart attacks. Doctors want to hand it out in the first mass medication for the middle-aged in Britain. So why are the big drug companies so uninterested?

A pill which could prevent hundreds of thousands of deaths from heart disease, the biggest killer across the Western world, has been shown to be safe and effective in its first trials on humans. The magic bullet, containing five medicines in a single capsule, sharply reduced cholesterol and blood pressure levels and has the potential to "halve cardiovascular events in average middle-aged individuals", the researchers say.

The finding is a major boost for a medication with huge potential against the worldwide epidemic of heart disease and stroke. Doctors say that, if further trials prove successful, all men aged over 50 and women aged over 60 should be offered the pill in what would be the first example of mass medication for the middle-aged in Britain.

Yet no Western pharmaceutical company has shown interest in developing the so-called polypill because it does not promise big profits. It would sell for pennies because its five constituent medicines are cheap, have been around for decades and their patents have expired.

In the UK, one in three men and one in four women die prematurely from heart disease and stroke. In 2005, cardiovascular disease caused more than 208,000 deaths, about four in 10 of all deaths. The idea of combating the heart disease epidemic by combining existing medicines into a drug cocktail called a "polypill" was first proposed six years ago. The pill contains aspirin to prevent blood clots, a statin to lower cholesterol and three blood pressure-lowering agents – a diuretic to remove water from the tissues, a beta-blocker to regulate the heart beat and an ACE inhibitor to relax the arterial muscles.

The current UK strategy of identifying and treating people at high risk of heart disease is failing because one-third of those who have a heart attack have no risk factors and one-third of those die. By giving the pill to everyone, the problem of identifying those at high risk is removed.

When the idea was published in the British Medical Journal in 2003, it was described as a "step of genius" and "possibly the most important paper the journal has published in 50 years". But progress in developing the idea has been slow, and the UK has been left behind.

Now, in the first trial to be published in a mainstream medical journal, researchers from McMaster University, Canada and St John's Medical College, Bangalore, have tested a version of the polypill in 2,000 people in 50 centres in India. The results, published in The Lancet, show that over 12 weeks the polypill reduced blood pressure and cholesterol in a similar way to its individual constituent drugs without increasing side effects. As patients are poor at taking multiple drugs, the single pill combination could "substantially improve adherence and therefore the benefits", they say.

Yesterday, Professor Malcolm Law of the Wolfson Institute of Preventive Medicine in London, one of the originators of the polypill concept, said he was encouraged by the results. "It shows you can make it, it works and it doesn't cause side effects," he said.

He and Professor Nicholas Wald, joint authors of the 2003 BMJ paper, have had talks with the Government's Heart Czar, Roger Boyle, and the Medicines and Healthcare products Regulatory Agency (MHRA) about obtaining a licence. Progress has been held up by a lack of funding and charitable foundations are being approached for support. "We have a patent and work is underway to do the necessary studies to gain a product licence through the MHRA," said Professor Law.

Professor Boyle suggested in 2007 that all middle-aged men and women should take a daily statin, one of the constituents of the polypill. The National Institute for Health and Clinical Excellence (Nice) said last year that more than one million adults at high risk of heart disease were missing out on statins that could save their lives. Nice said GPs failed to identify those at risk because patients were not routinely assessed.

Peter Weissberg, medical director of the British Heart Foundation, said the trial was "good news" because it showed the polypill worked. But it was the first of a series of "very important steps" that had to be taken before it would be clear whether its benefits outweighed its drawbacks. "I am sure there will be a public health benefit in terms of heart attacks saved," he said. "But will there be some people who are inadequately treated? There is scepticism that at the end of the day, one size fits all is going to work. If we are going to medicate the population we have got to show it does reduce heart attacks and strokes. We have got to have a drug that is safe, effective and that people are prepared to take."

The Stroke Association said: "High blood pressure and cholesterol are major causes of stroke and it is important that people take medication to combat these risk factors. By combining these medications in one pill, it will make it easier for people to take their medication. However, it is important that more research and investigation is done into this pill to ensure its safety." 31.3.09

Billions of pounds spent on fight against cancer have failed to significantly improve survival rates, study shows

The £2 billion ministers have spent on the fight against cancer have failed to significantly increase survival rates, according to a major new study. As a result the Government's target of achieving cancer survival rates as high as other European countries by 2010 may not be met, claims a leading medical journal.

With just one year to go, closing the survival gap appears 'optimistic' because progress in the UK is too slow, according to The Lancet Oncology journal. It is estimated at least £2 billion was spent in the early years of the Government's Cancer Plan. It led to NHS patients living longer but it's only a modest improvement in a system 'riddled with bureaucracy', says leading cancer specialist Professor Karol Sikora.

The Cancer Plan for England was introduced in 2000 and a study in the journal compared survival rates with Wales, which did not adopt one until late 2006. Latest data shows five-year survival rates for most common cancers improved in England between 2001 and 2007 compared with 2000 to 2005.

In men, the highest five-year survival was for testicular cancer, with 96 per cent surviving five years or more. For women, the highest five-year survival rate was for malignant melanoma - with 89.6 per cent surviving, says the Office for National Statistics.

Pancreatic cancer had the lowest five-year survival for both men (2.8 per cent) and women (3.1 per cent). Small improvements were recorded in survival rates for prostate cancer at 1.2 per cent, while breast cancer rates went up 0.9 per cent. Colon cancer rates improved 0.6 per cent in men and one per cent in women compared with those diagnosed between 2000 and 2004.

Professor Sikora, medical director of Cancer Partners UK, a private provider of cancer services which works with the NHS, said the study showed there had been no dramatic improvement in England despite the huge amount of cash spent by the Government. 'The bottom line is that there is no striking improvement, despite the huge resources involved and the very diplomatic language of the authors' he said in an accompanying editorial.

He said the 'well-conceived' plan had been hamstrung by a 'bureaucratic system of targets'. He said 'Cancer patients' notes have become riddled with shabby stamps warning of targets about to be breached. "The multi-disciplinary team at which every patient is discussed is now enshrined in the NHS culture but it is very time-consuming. 'Armies of administrators were recruited to operate the system, adding massively to the cost of care.

'The ridiculously poor performance of information technology in British hospitals dramatically increased the cost of trying to improve cancer care.'

Prof Sikora also argued that access to new cancer drugs is poor in the NHS, with the use of six cancer drugs approved in the past three years five-fold less in the UK than the EU average. 'The so-called postcode lottery abounds, with those that shout loudest getting better services' he added. His analysis is echoed in an editorial in the journal, which warns: 'Perhaps the time has come to consider rather more fundamental change in the NHS than the Cancer Plan offers.'

The new study, which looked at survival rates for 21 common cancers, found wide regional variations with people in the South having far better chances than those in deprived areas of the North. Researchers from Cancer Research UK's cancer survival group at the London School of Hygiene and Tropical Medicine, looked at survival for patients diagnosed before the cancer plan (1996-2000), during initialisation (2001-03) and after implementation (2004-06).

They examined one-year - which reflect early diagnosis - and three-year survival rates. They said 'The findings indicate slightly faster improvement in one-year survival in England than in Wales during 2004-06, whereas the opposite was true during 2001-03.' However, the Government's cancer tsar, Professor Mike Richards, said measuring survival alone was not a good indicator of whether the Cancer Plan was working. He said 'Cancer survival rates for most cases in England have been improving over the past decade. 'However we are not complacent, and we recognise that further improvements can be made.' He said the Cancer Reform Strategy, published in December 2007, aimed to tackle late diagnosis which was 'largely responsible' for the survival gap.

Shadow health secretary Andrew Lansley said 'While the Government has provided additional resources for cancer, the focus on a limited number of targets rather than overall cancer outcomes has distorted treatment. 'As a result, we have seen cancer patients in the UK getting later diagnosis and access to medicines, as well as lengthy delays for radiotherapy.'

But critics argue the time and the £2bn would have been far better spent on providing intravenous vitamin C treatment which is known to fight most cancers successfully and has excellent remission and recovery rates. 20.3.09 Click here further details.

Lower intelligence, memory problems, nightmares, depression, suicide... Statins are the new NHS wonder drug for cutting cholesterol. But do they have sinister side-effects? Could statins, the cholesterol-lowering drugs taken by more than three million Britons, be doing more harm than good to many thousands of patients? This is the rather alarming suggestion to emerge from two new studies.

The research challenges the medical convention that lowering your cholesterol is always a good thing - indeed, they suggest statins may affect intelligence, cause depression and even raise the risk of suicide. The studies add to a growing body of evidence that having low cholesterol levels may prove as dangerous as having high readings.

This has huge implications for British proposals to offer statins to all men over 50 and women over 60, even if they don't have a high cholesterol count. The NHS spends more than £500 million a year on statins. The drugs are commonly prescribed to cut the level of so-called 'bad' LDL cholesterol that our livers create.

In patients vulnerable to heart attacks and strokes, the drugs reduce the risk of fatty deposits gathering in their bloodstream and causing life-threatening blood clots. But cholesterol is also produced by the brain, where it is used to release vital chemicals called neurotransmitters that carry messages between brain cells. Now a study by Iowa State University suggests that statins inhibit this vital process.

When brain cells are deprived of cholesterol, they are five times less effective at releasing chemical messengers, says the research, published in the highly respected journal Proceedings Of The National Academy Of Sciences.

'If you deprive cholesterol from the brain, then you directly affect how smart you are and how well you remember things,' says Yeon-Kyun Shin, the biophysics professor behind the study. 'This may lead to depression and irrational acts.' He believes this is directly caused by disruption in the neurotransmitter release in the brain.

Indeed, statins were implicated in the suicide in April 2007 of London teacher Allan Woolley. After being prescribed the drug simvastatin, the housemaster at University College School in Hampstead complained of blackouts, insomnia and nightmares before he then killed himself by standing in front of a train. His family and friends said his death was completely out of character. The coroner ruled that the drug 'was involved' in his suicide.

Shin's findings reinforce another new study, which found that men with a combination of low cholesterol and depression are seven times more likely to die prematurely from suicide, accidents and other unnatural causes than men with only depression. Scientists who followed nearly 4,500 Vietnam veterans over a 15-year period say the disturbing findings may be due to low blood cholesterol reducing levels of the brain's feel-good chemical messenger, serotonin. Low serotonin is linked to depression, anger, sleep loss and other problems, says Dr Joseph Boscarino, of the American Geisinger research institute, who did the research.

'While it's generally understood that having low cholesterol is a good health sign, combined with other factors, it could actually put a person at risk,' says the report. In fact, there is a significant body of evidence to show that low cholesterol may be as dangerous as high cholesterol.

These reputable studies show how people with markedly low levels of cholesterol are more likely to die from a variety of causes, including strokes, certain cancers, liver disease, lung disease and suicide. The deaths from these other causes mount so quickly that the mortality rate for those with low cholesterol equals the rate for people with very high cholesterol, who are likely to die from heart disease.

The findings do not question the standard medical advice that people with high blood cholesterol should diet or take statins. Current guidelines from the Department of Health say that the maximum healthy total cholesterol level should be less than 5.0 millimoles per litre of blood (mmol/l).

But researchers worried about the harmful effects of low cholesterol estimate that the danger threshold may be just below 4.0mmol/l. One report claims that women on low-cholesterol diets may face infertility problems. This small study of 300 patients by the Toronto Infertility Clinic says that cholesterol is essential for creating the sex hormones oestrogen and testosterone.

Other U.S. research found that women with low cholesterol could be twice as likely to suffer from depression or anxiety problems.

Even more worrying, studies of older people have found that those on low- cholesterol diets have a much higher rate of stroke, possibly because cholesterol has a protective effect in mature brain linings. But the link between low cholesterol, decreased serotonin and dangerous behaviour is particularly strong and disturbing. A study of 80,000 Swedes, for example, shows that men who murder in a fit of rage tend to have below-average cholesterol.

Irish doctors report that cholesterol levels are significantly lower in people who have been admitted to hospital after harming themselves. Research in the animal kingdom supports the existence of this problem: studies of captive monkeys reveal that they become abnormally aggressive when put on low-fat diets. And studies on mice indicate that cholesterol may help the brain to suppress reckless impulses.

Meanwhile, the NHS continues to prescribe ever more statins. There is no doubt that statins are life- saving drugs for people who have already had a heart attack. But the guidelines are constantly being revised. Until 2006, statins were prescribed only to men and women under 75 who had a 20 per cent risk of developing coronary heart disease within ten years.

Now, the NHS recommends they are given to any adult with a total cholesterol of more than 5.0mmol/l who is thought at risk. Moving forward, the Government argues that giving all men over 50 and women over 60 a daily dose of statins would save lives, NHS funds and doctors' time.

However, Dr Alastair Dobbin, a GP based in Edinburgh, is highly critical of the policy. He has written in the British Medical Journal severely criticising the 'statins for all' approach. He believes it's an expensive waste of time that leaves millions of people falsely reassured and which may have damaging side-effects. 'The new Iowa study shows that we should be really cautious about handing out statins the way we do,' he says.

'We should be very careful about giving a drug to healthy people where there is any risk of any side-effects.' He adds: 'Research shows that in people over 69 who've had no symptoms of diabetes, angina, stroke or heart attack, statins don't reduce mortality. 'They're invaluable for patients who have had these symptoms, but there's no scientific case for giving them to anyone else.

'It's a sheer waste of money, but the Government is ignoring the research. 'On the other hand, studies have found that patients have suffered memory loss with statins - some people have been unable to even recognise their spouse - yet the problem has disappeared after they stopped taking the drug.' Yet rather than investigating the disturbing links with statins further, the medical establishment has largely hushed, ignored or discredited them, for fear of confusing the 'high cholesterol is bad' message.

One campaign group, The International Network of Cholesterol Skeptics, includes on its website a list of academic research articles and letters it feels have been unfairly rejected by medical journals. For the sake of everyone's health, and to save the NHS millions it hasn't got, perhaps the answer is to rewrite the public health message to read: moderation in all things - including cholesterol control.

But critics argue its simply another example of drug companies influencing the medical profession and government policy to engage in widespread drug use or vaccinations to boost profits. 10.3.06

Concerns over safety of cervical cancer vaccine after 1,300 girls experience adverse side-effects

More than 1,300 schoolgirls have experienced adverse reactions to the controversial cervical cancer jab. Doctors have reported that girls aged just 12 and 13 have suffered paralysis, convulsions and sight problems after being given the vaccine. Dozens were described as having pain 'in extremity' while others suffered from nausea, muscle weakness, fever, dizziness and numbness.

The vaccine is being given to girls under a Government programme to prevent women from developing cervical cancer. Ministers say it will ultimately save 700 lives a year. Some have dubbed it the 'promiscuity jab' because it is given to girls to protect against the sexually-transmitted HPV virus which causes 70 per cent of cervical tumours. Last night campaigners called for the vaccination campaign to be suspended in the light of the published side-effects.

But Government health experts insisted the Cervarix vaccine was safe and that the total of 1,340 reports was to be expected, given that more than 700,000 girls were vaccinated last year. They also said many of the reactions resulted from the act of injection rather than the vaccine, and said there was no evidence that the jab caused any of the serious conditions such as paralysis. Cancer charities urged parents to continue allowing their daughters to have the jabs, saying any risks were so minor and unproven that they could not outweigh the benefit of possibly saving lives.

The vaccination programme of young secondary school girls began in September last year following clinical trials on more than 18,000 women under the age of 26. Critics have claimed that not enough pre-pubescent girls were involved. The vaccine, which is administered in three doses, is also being given to girls aged 17 and 18. This will ensure that by 2011, all those under the age of 18 will have been vaccinated.

Reports of adverse reactions to drugs and vaccines are collated by the drug safety watchdog, the Medicines and Healthcare products Regulatory Agency (MHRA), from reports by doctors. Their latest analysis found there had been 1,340 reports in total, with 2,891 different adverse effects noted. Most were minor complaints such as rashes, swelling on the injection site, pain or allergic reactions. But there was a range of more worrying problems. Four girls had convulsions, one had a seizure and one had an epileptic fit.

There were several cases of paralysis. One had Bell's palsy, which paralyses the face; one had hemiparesis, which paralyses or severely weakens half the body; two experienced hypoaesthesia, in which the sufferer loses much of her sense of touch, and one had Guillain-Barré syndrome, which paralyses the legs. There were almost 20 cases of blurred vision and one girl was reported as developing anorexia.

Last night Jackie Fletcher of the vaccine support group Jabs said: 'When they introduced this new vaccine, we had major concerns about its safety. The current statistics detailing adverse reactions - including cases of epilepsy and convulsions - bears out that we were right to be concerned. 'The Government needs to look at the future of this programme given the number of side-effects coming through.'

The MHRA says the number of reported reactions does not necessarily mean they are side effects of the vaccine.

In its report on the most recent figures, released on Thursday, the MHRA said: 'The vast majority of suspected adverse reactions reported to MHRA in association with Cervarix vaccine have related to either the signs and symptoms of recognised side-effects listed in the product information or were due to the injection process and not the vaccine itself.

'For the isolated cases of other conditions reported, the available evidence does not suggest that the vaccine caused the condition and these may have been coincidental events. The balance of risks and benefits of Cervarix remains positive.' Robert Music, director of cervical cancer charity Jo's Trust, said: 'I urge every mother to ensure their girls have the vaccine, because we believe the obvious benefits outweigh the risks. Quite simply, the jab could save their daughters' lives.' 6.3.09

Millions of patients prescribed unnecessary pills because of 'tick-box culture', says expert

Millions of healthy older people are being prescribed pills that they don't need, claims a top doctor. The treatments for high blood pressure, high cholesterol or diabetes could in fact be harmful, warns Professor Michael Oliver. He blames the 'tick-box culture' - by which GPs are paid - and Health Service guidelines for encouraging the use of such drugs.

Professor Oliver, a former leading heart specialist, said: 'These bureaucratic demands can lead to over-diagnosis, overtreatment and unnecessary anxiety. 'A fit and healthy older person summoned by his GP for an annual health check can return home as a patient, scared and no longer comfortably ageing.'

Professor Oliver, professor emeritus of cardiology at the University of Edinburgh, launched his broadside against modern medicine in the British Medical Journal online. He argues that 'many Western governments regard all people aged over 75 as patients'.

Other critics claim that even younger people, such as those in their 60s, are being treated in the same way because of the pressures for preventive prescribing or a cynical way for drug companies to increase their profits. Around ten million Britons are aged 65 or over. Professor Oliver said that even if older people feel reasonably well, the 'NHS does not always permit such euphoria'.

'They may be told they have hypertension or diabetes or high cholesterol, that they are obese, they take too little exercise, eat unhealthily and drink too much. Many of these patients are told to have more investigations. Eventually most will be started on pills. Few seem to be considered not at risk for something,' he said.

Yet preventive action may be irrelevant and even harmful in the elderly, he claims. He highlighted three areas of concern - antihypertensive drugs, diabetes drugs and cholesterol-lowering drugs. Antihypertensive drugs are used to reduce blood pressure and are usually prescribed for life. But as many as one in five patients experience side effects, from tiredness and fatigue to impotence and heart rhythm disturbances.

Diabetes drugs can cause diarrhoea, nausea and vomiting, and dangerously low blood sugar levels. And cholesterol-lowering drugs, known as statins, interact with some other drugs and have side effects including abdominal pain, diarrhoea and nausea. The most serious adverse reaction is muscle weakness in about one in 1,000 users, with rare complications that can lead to kidney failure and death.

Professor Oliver said that too little attention was paid to potential side effects from medicating elderly people. Busy family doctors appear to assume that because a pill cuts the relative risk of a disease by 25 per cent compared with other or no treatments, it must be prescribed. Yet the reduction in absolute risk to the individual - the chances of a medical emergency or death - may be only one or two per cent.

'What kind of medicine is this?' he asks. 'It is politics taking preference over professionalism, obsession with government targets superceding common sense, paternalism replacing personal advice. 'This trend has many causes. 'These include over-enthusiastic and uncritical interpretation of various guidelines, the payment of GPs by NHS trusts for ticking boxes, the demands of government health economics and of insurance companies, and the relentless pressure from the drug industry,' he concludes.

The professor said guidelines were not 'commandments' and rigid adherence can result in a superficial diagnosis that leaves someone stuck with the label of a disease for the rest of their life. Professor Oliver, who describes himself as a healthy, fit, 83-year- old, said he was not arguing against treatment of disease or illness in over-75s, such as heart surgery, which clearly helped the individual.

But treating 'risk factors' must be approached with caution, he claims. 'The benefits and risks of treatment, and of remaining untreated, need to be explained fully to individuals, as it is they who should make the final choice.' It has been claimed by health experts that mass medication might be the only answer to cut such problems as heart disease. Statins could cut heart attacks by 30 per cent, some doctors have calculated.

Gordon Lishman, Director General of Age Concern, said 'Doctors have a tightrope to walk. Inappropriate and excessive drug prescribing is a real issue, especially as many older people have lots of different, overlapping health complaints. 'The answer is to treat each person as an individual, by fully investigating all their health problems and offering them personally tailored treatment with the aim of maximising their overall health rather than treating each illness in isolation.'

Dr Scurr's view: The tickbox culture that drives GPs
Doctors today are increasingly being forced to work in a ' tickbox' culture - the treatment we give is determined less by clinical benefit than by diktat, largely as a result of Government imposed guidelines and growing supervision of our work. This has led GPs to prescribe drugs when in many cases weight loss, exercise, and dietary change can be just as valuable.

The problem is that those changes are difficult and time-consuming - and, frankly, there's little political gain from these softer options, which is why there is no official pressure to introduce them. There has also always been a trend for doctors to add new drugs to a patient's regimen: 'Let's see if this will help.' Most are then reluctant to reduce them, even if they have produced no obvious benefits, just in case something goes wrong.

All of this means that some patients end up on a rather impressive number of pills they might not need, as Professor Michael Oliver says. In some cases the pills might actually put them at risk, such as blood pressure pills which could lead to too-low blood pressure if not needed. In medicine, as in many walks of life, it is easier to be seen to act, rather than just to support and contemplate.

One of my patients is 88 and yet had needed to see a doctor only twice in her life when she first came under my care two years ago: in 1926 for tonsillitis, and in 2002 when she fractured her hip. Yesterday, when I went to see her for our regular chat, we marvelled together at her good fortune; taking no tablets at such an age.

She told me that quite a few of her friends had been critical when they have heard that she takes no treatment to lower her cholesterol, and I suddenly felt a bit guilty. But her memory and intellectual functions are impressive, and she had already worked out that there was little to gain from such a regime at her age. Masterly inactivity is what GPs have always done, and must continue to do, despite the pressure to prescribe. Listening, and understanding, is a drug which doctors have always used and perhaps these days a drug which is falling from fashion. 4.3.09

"Striking and depressing" local management is putting future improvements in the NHS at risk, a report by MPs has said. The House of Commons' health committee said poor analytical and planning skills meant the aims set out in last summer's review risked being missed.

But the MPs also criticised key parts of Lord Darzi's plans for England , including the creation of polyclinics. NHS managers said the MPs had been unfair and progress was being made. The Darzi review was published to coincide with the 60th anniversary of the NHS. Ministers hailed it as a fitting vision for a modern health service.

At its heart was a demand to improve the quality of care by giving patients more choice and greater power in exercising their rights. This included creating personal budgets for those with long-term conditions so they could decide how NHS money was spent on them.

Doubts cast
It also called for the opening of polyclinics - super health centres housing a range of services including GP surgeries - across the country. And the review paved the way for the first-ever NHS constitution setting out what patients could expect from the service. Regional bosses also came up with their own priorities which ranged from tackling rising alcohol consumption to widening access to care.

But the cross-party group of MPs cast doubt on the ability of local health managers working for what are called primary care trusts (PCTs) to see through the vision. They went as far as to describe the quality of management as "striking and depressing", adding more emphasis needed to be placed on recruiting and developing better managers. Meanwhile, the report said the creation of polyclinics should have been piloted first with the final decision over whether they were needed left to local areas.

'Real change'
Health committee chairman Kevin Barron said the emphasis on quality and leadership in the Darzi review was welcome. But he added: "We remain very concerned that PCTs are not yet up to the task of putting these reforms into practice. "Lord Darzi's reforms must not just be the latest in a series of failures to make real change."

Both the British Medical Association and the Conservatives agreed with the criticisms of the polyclinics initiative. Shadow health secretary Andrew Lansley said: "It's worrying that such an expensive and lengthy review of the NHS has come up with virtually no new ideas and is more spin than substance." But David Stout, of the NHS Confederation, which represents managers, said: "I think it is a narrow and unfair view of management in the NHS. "There has been a lot of progress in recent years and we are aspiring to fulfil the vision." 13.01.09

A leaked memo reveals that there is 'a co-ordinated campaign' to derail alternative therapies on the NHS. The Queen's personal physician and Britain's leading homoeopath yesterday warned of a "co-ordinated campaign to derail complementary therapies in the NHS".

A leaked memo seen by The Independent on Sunday identifies several influential groups working together for the removal of homoeopathy from the NHS. According to Dr Peter Fisher, clinical director of the Royal London Homoeopathic Hospital, there has been a 20 per cent reduction in referrals to the hospital in the past year, as new patients are refused funding by a growing number of primary care trusts.

The hospital – an NHS centre of excellence – could be forced drastically to cut services if other PCTs introduce the same system and if funding for patients currently undergoing treatment is withdrawn. Dr Fisher, whose patients include the supermodel Claudia Schiffer, pointed to the fact that some six million people in the UK use complementary therapies each year. Advocates include David Beckham and Catherine Zeta-Jones.

Dr Fisher said: "There are some patients with conditions that prescription drugs alone do not help. There is a huge potential to help these patients and those who experience adverse side-effects from conventional medicines with complementary therapies."

"The campaign dates back two years starting with several eminent and mostly retired scientists and doctors who have a way of seeing the world and medicine which complementary therapies do not sit within," Dr Fisher said. "The pharmaceutical industry is worried for its future, as public opinion is shifting towards complementary therapies."

The memo, sent out by the president of the Association of the Directors of Public Health, Dr Tim Crayford, referred only to homoeopathy, but all complementary therapies are affected. Dr Crayford said: "The email... was certainly not about all complementary therapies. This paper was written to help PCTs focus on the delivery of essential services." 2.9.07

Deaths from hospital blunders soar 60% in two years as NHS staff 'abandon quality of care to chase targets'

The number of patients killed by hospital blunders has soared by 60 per cent in just two years, the Daily Mail can reveal. Official records show that 3,645 died as a result of outbreaks of infections, botched operations and other mistakes in 2007/08. That was up from 2,275 two years before. Critics say quality of NHS care has suffered as doctors and nurses come under pressure to meet Government waiting time targets.

The sharp rise is also down to the fact that more trusts have started to record medical errors - revealing a death toll which in previous years remained hidden under the carpet. But experts say the true toll is certain to be even higher, because many hospitals still do not record all of the 'patient safety incidents' - meaning that lessons which could have been learned are lost.

In October last year, the Patients Association warned that one in every 300 NHS patients were killed because of medical blunder. The latest figures, uncovered by the Liberal Democrats, show that 385 died last year due to botched operations and 156 because scans were read wrongly or patients incorrectly diagnosed. Some 309 died from infection control incidents related to hospital superbugs and 14 due to problems with documentation and records. Another 54 were killed by wrongly-administered drugs and 40 by faulty medical equipment. There were 171 cases of deaths following simple accidents, usually falls.

On top of this, 22 died as the result of abuse by hospital staff or visitors, and 135 died because they were not transferred properly between wards or hospitals. Another 487 killed themselves on hospital premises when their depression should have been spotted by doctors. A range of other blunders brought to total toll to 3,645.

The figures are certain to rise as hospitals get round to reporting mistakes which took place between April 2007 and March 2008 to the National Patient Safety Agency. 'These statistics are stark and the trend is shocking,' said LibDem health spokesman Norman Lamb. 'There needs to be a change of culture at the heart of the NHS. We have got far too many targets and there is a real risk that, although they are very effective at addressing a specific issue, they mean trusts do not see safety as a priority.'

Roger Goss of pressure group Patient Concern said: 'This news is shocking. Patients are already extremely nervous when they have to go to hospital, so they need this news like a hole in the head.' Peter Walsh of pressure group Action Against Medical Accidents, said many incidents are not reported in official 'patient safety' figures. He added: 'We need to make patient safety a much higher priority. Staff need training and there needs to be an overhaul of surgical practice, where many avoidable errors happen.

'Double- checking that you've got the right patient, that you're operating on the right side might seem obvious, but we know that it isn't routinely done at many hospitals. 'Resources and staffing are also an issue. It's no surprise to find that more things go wrong at weekends and at night.'

Concerns around the safety of many surgical operations carried out on the NHS are so serious that the all-party Commons health select committee is looking into the issue, and will report in April. Clare Bowen, whose five-year-old daughter Bethany died as a result of mistakes made during routine surgery in 2006, said: 'I have no doubt these figures will continue to rise unless hospital trusts, and surgeons in particular, are prepared to learn from their mistakes.' Miss Bowen, whose story is told in today's Good Health section, added: 'Nobody should be afraid to go into hospital. 'But equally, no one should be afraid of asking questions that will make the doctors in charge of their care think carefully about how they behave.'

The rise in avoidable deaths mirrors recent rises in NHS pay-outs for blunders. Around 6,000 cases go to court each year, and compensation to injured patients rose by 18 per cent last year, to £382million. A spokesman for the Department of Health said: 'The NHS sees a million people every 36 hours. Unfortunately, as in any health service, mistakes and unforeseen incidents will occasionally happen. 'Only a tiny number of errors put patients at serious risk and the quality and safety of healthcare is improving all the time.' 6.1.09

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

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

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

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

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. It's also no coincidence that in the 12 European counties which have better health care than the UK, alternative medicine is used along side pharmaceutical medication to provide the best treatment for the patient, so the UK have clearly got their healthcare policy wrong.

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

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

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

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

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

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

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

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

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.

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

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

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

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

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.

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.

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

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.

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.

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.

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.

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

'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

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

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

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

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

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

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

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

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.

Linus Pauling a double Noble prize winning scientist was right all along – Vitamin-C is toxic to cancer cells after all. There are lots of stories where people who were given only months to live, living 10+ years with regular infusion of Vitamin-C; their cancer having disappeared completely without dangerous surgery, chemotherapy and radiation.

The problem with surgery is that it causes ‘metastasis' which is another name for the spread of cancer in the body. Chemotherapy and radiation will kill some of the cancer cells but millions of more resilient cells still lurk around in the body causing the cancer to spread within years to other parts of the body. And the problem with chemotherapy is that it is toxic to both normal and cancer cells. However, because cancer cells grow at a very fast rate it kills more cancer cells then normal cells.

So it becomes a race of what kills you faster – the cancer or the effects of chemotherapy. During the second world war when they were ‘gassing' lots of people to death they noticed that the effect of the mustard gas was to reduce the number of white blood corpuscles so they thought we wonder if we can find a use for this and chemotherapy was born. According to a lot of people such as Dr Hamer this is a cruel and totally unnecessarily procedure.

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 therapy, given intravenously which forms hydrogen peroxide and attacks cancer cells combined with a radical change to Edith's diet. It was a bold approach, because study after study had disproved the theory, first mooted by Linus Pauling, that high doses of vitamin C could kill cancer cells. Pauling had gone to his grave, certain that the theory was right, and yet never having the recognition from his peers.

Within six months of treatment, Edith's breast had completely healed. Within a year all signs of cancer had gone. The family doctor saw her in the street a year on from his gloomy prognosis, and he was convinced he had seen a ghost. He asked her to have a scan, which revealed no trace of cancer whatsoever.

So why am I telling you this story? This week a news headline caught my eye. Researchers have finally confirmed that Pauling was right all along. When they gave three terminal cancer treatments high-dose vitamin C, their tumours shrunk. As they reported in the latest issue of the Canadian Association's Medical Journal, vitamin C is toxic to cancer cells. So why has it taken so long, 30 years in fact, to prove Pauling's theory? Because every study used vitamin C tablets, but it's only effective when given intravenously.

To me, this is a scandal. Too many people have died from cancer when we had the means at our disposal to have saved the lives of many, many cancer victims. It just required someone to have been open-minded enough to test properly. It just required someone to think beyond toxic pharmaceuticals. (Source: WDDTU - E-news broadcast. 242 - 23 March 2006) 5.8.08

The bug that can blast away cancer: Drug made from virus extends patients' lives

A common virus which causes stomach upsets is giving hope to cancer patients - by boosting their immune system and blasting away tumours.

Almost 80 patients with advanced forms of liver cancer, head and neck tumours and breast cancer are taking part in trials using a drug made from the reovirus. A number, who have struggled to benefit from chemotherapy, have seen astonishing results, with tumours shrinking and in one case disappearing altogether.

Experts say it is too soon to say if Reolysin is the 'magic bullet' that will kill off cancer, but they believe it may offer a way of extending the life of patients given a short time to live. Reolysin appears to kill off cancer cells by rupturing their walls, creating a chain reaction of 'explosions' which rip through tumours. As the tumours shrink they become less harmful and more easily treatable by chemotherapy.

At the same time, Reolysin seems to 'wake up' the immune system so it can recognise cancer cells as invaders, prompting the body to mount an attack on harmful cells. One liver cancer patient, Andrew McManus, 65, said last night: 'To put it bluntly, I could well be dead by now without this treatment.'

Reovirus infection occurs often in humans, but most cases are mild - causing a stomach upset. Its role in human disease is uncertain.

Canadian firm Oncolytics Biotech Inc, which created Reolysin, is working on trials with researchers from St James's Hospital in Leeds, the Royal Marsden Hospital in London and the Royal Surrey County Hospital. The drug is administered intravenously via a drip, with a patient receiving eight fiveday courses of treatment spread over six months. The only side-effects appear to be a flu-like ache and a raised temperature.

Lead researcher Professor Alan Melcher said: 'We have had a few dramatic responses to Reolysin but we still have to be very cautious about getting up too much hope. We cannot say people have been cured. However, it is exciting and has got real potential.' One man, Henry Nelson, 74, of Halifax, with cancer of the head and neck saw a lump the size of a tennis ball in his neck almost disappear after chemotherapy plus Reolysin.

Professor Melcher said: 'It is a completely different approach to treating cancer. It is not just another drug. It is a virus and it seems to be very well tolerated in combination with chemotherapy. 'There is no magic bullet with cancer, but these combinations seem to be working.'
Experts say larger trials are needed before Reolysin can be widely available to patients. That could take up to five years.

In UK trials, 15 head and neck cancer patients have been treated so far. Of 12 for whom results were available, five have had a partial shrinkage of their tumours and in four the disease stabilised for between two to six months. Oncolytics also announced positive results from its other UK trials, for patients who have tumours which have failed to respond to standard therapy. Of 17, 15 experienced stable disease or better.

Liz Woolf, of Cancer Research UK, said 'If it proves successful in larger trials, the reovirus could one day become an effective new treatment to be used alongside chemotherapy, radiotherapy and surgery to benefit people with some types of cancer. However critics suggest that intravenous vitamin C does exactly the same and is a better treatment for cancer but there is no interest in it because it does not offer huge profits for the pharmaceutical industry. 8.6.09

A single injection of modified cells could halt the advance of rheumatoid arthritis, say UK scientists. The Newcastle University team is about to start small-scale safety trials of the jab, which will hopefully stop the immune system attacking the joints.

The Arthritis Research Campaign, which is funding the project, said if successful the treatment would be "revolutionary". It could be fully tested and available within five years. Rheumatoid arthritis is one of a family of "autoimmune" diseases, in which the body's defence systems launch attacks on its own tissues. In the case of rheumatoid arthritis, this means painful inflammation and progressive damage to the joints, eased only slightly by courses of painkillers and immune dampening drugs.

The precise trigger for these attacks is not known, but the latest technique, so far tested only on cells in the laboratory, aims to "reset" the immune system back to its pre-disease state. A sample of the body's white blood cells is taken and treated with a cocktail of steroids and vitamins which transforms a particular type of immune cell called a dendritic cell into a "tolerant" state. These cells are then injected back into the joint of the patient.

Professor John Isaacs, who is leading the research, said: "Based on previous laboratory research we would expect that this will specifically suppress or down regulate the auto-immune response."

Small trial
So far the team does not have any data about how well the treatment works in living creatures. The next step is an initial safety trial involving just eight patients, although this could lead to further trials with higher number of patients.

Professor Alan Silman, from the Arthritis Research Campaign, said that, if successful, the treatment could make a big difference to patients. He said: "The idea is to change these dendritic cells so that instead of being aggressive they return to their normal state. "The presumption is that they will stay this way, unless the same trigger which is thought to cause the problem in the first place is encountered again. "It could be a revolutionary development for rheumatoid arthritis patients."

He said that the technique would be labour-intensive, requiring specialist laboratory facilities, perhaps costing many thousands of pounds per injection, but this would still cost the NHS less than decades of prescription medicines to control the symptoms of rheumatoid arthritis. He also suggested that the same process might be applied to other auto-immune diseases such as type I diabetes, or even MS. 15.8.08

A cheap drug used to treat brittle bones helps halt breast cancer in its tracks, scientists report today. When used with a common chemotherapy drug, the tumours all but stopped growing - and the cancer remained at bay even after treatment had finished. The results were so dramatic that researchers believe the combination could be better at fighting the disease than any drug cocktail already in use.

And with the bone drug, zoledronic acid, costing under £1,000 per year of treatment - less than one-twentieth of the breast cancer 'wonder drug' Herceptin - price should not be a problem for the NHS. It is thought the chemotherapy drug doxorubicin 'primes' the tumour, making it sensitive to the bone-strengthening zoledronic acid. The treatment causes cancer cells to self-destruct and blocks the growth of the blood vessels needed to fuel tumours with oxygen and nutrients.

With both drugs relatively cheap and already in widespread use, the treatment could be approved for patients in as little as two years, providing doctors with a much-needed new weapon for a disease which kills more than 1,000 women a month in Britain alone. The drug combination is now being tested on 3,000 women with the results due in six months.

Sheffield University researcher Professor Robert Coleman said: 'It would be a very substantial breakthrough.' And he added: 'It is a completely new approach to treatment. It is relatively simple. It is not particularly unpleasant and it could also be applied to other cancers.' Working with Finnish colleagues, the British researchers examined the effect of using the doxorubicin, one of the most common breast cancer treatments, in combination with zoledronic acid, a member of the bisphosphonate family used to treat osteoporosis and ease bone pain in cancer patients.

Tests in mice showed that when doxorubicin was given first, followed 24 hours later by zoledronic acid, they stopped 99.99 per cent of tumour growth, the Journal of the National Cancer Institute reports. Effectively, the cancer was halted in its tracks. Professor Coleman said: 'The tumours didn't grow at all and the mice remained fit and healthy. When we stopped the treatment, they still didn't grow. This was a treatment that seemed to carry on working when it was stopped.' But when the order was reversed, or the drugs administered on their own, the treatment worked less well.

Dr Ingunn Holen, of Kuopio University in Finland, said: 'Our work, using a model system, has shown that treatment with the chemotherapy agent doxorubicin followed by zoledronic acid kills breast tumours.' Final results on the 3,000 women taking the drugs are not due until next year but the indications that the combination can stop breast cancer returning after surgery are promising.

'We are quite optimistic that the combination of treatment will work better than chemotherapy or other drugs that we tend to use at the moment to stop cancer from returning,' said Professor Coleman. 'Breast cancer treatment is improving every year and this could be yet another step forward.' He added that the combination could clear the regulatory hurdles between it and widespread use in as little as 18 months after the end of the trial.

Pamela Goldberg, of the Breast Cancer Campaign which funded the study, said: 'Despite the introduction-of new treatments, every year in the UK around 12,500 people will die from breast cancer. 'The results of this study are very encouraging and could change the way breast cancer patients are treated. 'The good news is the two treatments used in this study are relatively inexpensive and already used in the clinic. 'Therefore we should quickly see the benefits of giving women the best possible chance of beating breast cancer.'

James Mackay, a consultant at University College London, said: 'The concept that a drug we give for one purpose has got an antitumour effect is very exciting. 'Over the last decade, we have seen an improvement in the survival of patients with breast cancer but I think we all agree there is much room for improvement. 'Breakthroughs like this are very welcome.'

Dr Joanna Peak, of Cancer Research UK, said: 'The benefits of giving zoledronic acid after doxorubicin have only been shown here in mice and now need to be evaluated more fully in people with breast cancer.' 13.8.08

A breakthrough in cancer research could lead to a 'one-size-fits-all' drug that can tackle all forms of the disease. Scientists have unravelled the secrets of an enzyme called telomerase, which makes cancer cells immortal. This allows them to multiply uncontrollably and cause disease. The discovery paves the way for the creation of drugs that block the enzyme, stopping tumour growth.

Telomerase is at work in almost all human cancers. So a drug, or family of drugs such as this, could have a major impact in the treatment of the disease. Cancer affects almost 300,000 Britons a year and kills someone every four minutes. And the implications of the U.S. research do not end there, the scientists believe. New antiageing treatments and better drugs for agerelated diseases could also be on the cards as a result of the discoveries, the journal Nature reports. Liz Baker, of the charity Cancer Research UK, said: 'This is a crucial part of the puzzle in understanding how telomerase works.

'Fundamental research like this may help scientiststo design drugs that block telomerase and could potentially be used to treat a wide range of cancers. 'The researchers, from the Wistar Institute, in Philadelphia, have deciphered the structure of a key part of telomerase. In healthy cells, the enzyme is all but switched off, and the cells multiply a set number of times before dying, a fundamental part of the ageing process.

But in up to 90 per cent of cancers, the enzyme is activated, allowing runaway cell division and tumour growth. Solving the compound's structure will allow scientists to design drugs that deactivate the enzyme and halt the cancer. By targeting cancerous cells it is likely such medicines would be free of the side-effects such as pain, hair loss and nausea associated with conventional treatments. Previous attempts to make telomerase-blocking drugs have been thwarted by lack of knowledge about the enzyme.

Study leader Dr Emmanuel Skordalakes, described the breakthrough as 'extremely exciting'. He added: 'Telomerase is an ideal target for chemotherapy because it is active in almost all human tumours, but inactive in most normal cells. 'That means a drug that deactivates telomerase would likely work against all cancers, with few side effects.'

Decoding the mysteries of telomerase could also pave the way for therapies to combat ageing and age-related diseases. Switching on telomerase in a controlled, safe way, could, in theory, produce younger, healthier and longer living tissue. The researchers concluded: 'Because telomerase has a critical role in both cancer and ageing, these findings could potentially assist our efforts to identify and develop inhibitors and/or activators of this enzyme for the treatment of cancer and ageing, respectively.'

But the enzyme's structure is complex. Any drugs that are designed will have to go through years of laboratory, animal and human testing before they end up on pharmacy shelves. 1.9.08

Drinking fruit juice dramatically reduces the effectiveness of drugs used to treat cancer, heart conditions and high blood pressure, scientists say. Research has shown that orange, apple and grapefruit juice can also wipe out the benefits of some antibiotics and hay-fever pills. It is thought the drinks stop drugs from entering the bloodstream and getting to work in the body - possibly rendering them useless. The potential effects are so serious, researchers warned, that if in doubt, patients should swap fruit juices for water when on medication.

Researcher David Bailey said: 'This is just the tip of the iceberg. I'm sure we'll find more and more drugs that are affected this way.' Twenty years ago, Professor Bailey showed that grapefruit juice dangerously magnifies the effect of the blood pressure drug felodipine. His findings led to warnings that the drink should be avoided by those on some medicines.

The latest study shows that fruit juices can also reduce the power of medicines - potentially stopping them from doing any good. Professor Bailey, of the University of Western Ontario, in Canada, said: 'The concern is loss of benefit of medications essential for the treatment of serious medications.' Drugs shown to be weakened by grapefruit, orange and apple juices include the blood pressure-lowering beta blockers atenolol, celiprolol, and talinolol and the hay-fever treatment fexofenadine.

The multi-purpose antibiotic ciprofloxacin, used to combat germs behind food poisoning and bone and joint infections, is also affected. So is the cancer drug etoposide and a drug given to prevent the rejection of transplanted organs. Many other drugs are also likely to be affected, an American Chemical Society conference heard yesterday.

The study showed juices do not need to be taken at the same time as drugs to have a dangerous effect. Those drunk up to two hours before can reduce drug absorption. But patients need not stop drinking juice altogether. Professor Bailey said: 'Juice taken four hours prior to drug intake did not have an effect. Thus, it should be possible still to take grapefruit, orange and apple juices while on affected medications provided there is a sufficient time interval.

'I would recommend taking drugs with water on an empty stomach to get the most consistent effect.' The researcher, a professor of pharmacology, advised patients to speak to their doctor or pharmacist before taking fruit juice with medicines. Professor Bailey made the link after asking volunteers to take the hay fever drug fexofenadine at the same time as either a glass of water or grapefruit juice.

Taking it with juice cut its absorption into the bloodstream by half. Experiments showed naringin, the chemical which makes grapefruit taste bitter, blocked the drug from moving from the small intestine into the bloodstream. The researchers have pinpointed a naringin-like compound in orange juice and are looking for a similar one in apples. A different mechanism is at play with the drugs whose levels are boosted by grapefruit juice. There, juice deactivates a liver enzyme that breaks down drugs, making normal doses potential overdoses.

The study is not the first to highlight the dangers behind supposedly healthy juices. Last month, research from Harvard Medical School in the U.S., showed that one glass of orange juice a day can increase the risk of a form of diabetes linked to poor diet and obesity. But eating whole pieces of fruit cuts the likelihood of developing the disease. It is thought the lack of fibre in juices may cause spikes in blood sugar levels. 12.8.09

A senior executive with Britain's biggest drugs company has admitted that most prescription medicines do not work on most people who take them. Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline (GSK), said fewer than half of the patients prescribed some of the most expensive drugs actually derived any benefit from them.

"The vast majority of drugs - more than 90 per cent - only work in 30 or 50 per cent of the people," Dr Roses said. "I wouldn't say that most drugs don't work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there on the market work, but they don't work in everybody."

It is an open secret within the drugs industry that most of its products are ineffective in most patients but this is the first time that such a senior drugs boss has gone public. His comments come days after it emerged that the NHS drugs bill has soared by nearly 50 per cent in three years, rising by £2.3bn a year to an annual cost to the taxpayer of £7.2bn in 2003 (rising to £11bn in 2008). GSK announced that it had 20 or more new drugs under development that could each earn the company up to $1bn (£600m) a year.

Dr Roses, an academic geneticist from Duke University in North Carolina, spoke at a recent scientific meeting in London where he cited figures on how well different classes of drugs work in real patients.

Drugs for Alzheimer's disease work in fewer than one in three patients, whereas those for cancer are only effective in a quarter of patients. Drugs for migraines, for osteoporosis, and arthritis work in about half the patients, Dr Roses said. Most drugs work in fewer than one in two patients mainly because the recipients carry genes that interfere in some way with the medicine, he said.

Some industry analysts said Dr Roses's comments were reminiscent of the 1991 gaffe by Gerald Ratner, the jewellery boss, who famously said that his high street shops are successful because they sold "total crap". But others believe Dr Roses deserves credit for being honest about a little-publicised fact known to the drugs industry for many years.

"Roses is a smart guy and what he is saying will surprise the public but not his colleagues," said one industry scientist. "He is a pioneer of a new culture within the drugs business based on using genes to test for who can benefit from a particular drug."

Dr Roses has a formidable reputation in the field of "pharmacogenomics" - the application of human genetics to drug development - and his comments can be seen as an attempt to make the industry realise that its future rests on being able to target drugs to a smaller number of patients with specific genes.

The idea is to identify "responders" - people who benefit from the drug - with a simple and cheap genetic test that can be used to eliminate those non-responders who might benefit from another drug. This goes against a marketing culture within the industry that has relied on selling as many drugs as possible to the widest number of patients - a culture that has made GSK one of the most profitable pharmaceuticals companies, but which has also meant that most of its drugs are at best useless, and even possibly dangerous, for many patients.

Dr Roses said doctors treating patients routinely applied the trial-and-error approach which says that if one drug does not work there is always another one. "I think everybody has it in their experience that multiple drugs have been used for their headache or multiple drugs have been used for their backache or whatever. "It's in their experience, but they don't quite understand why. The reason why is because they have different susceptibilities to the effect of that drug and that's genetic," he said.

"Neither those who pay for medical care nor patients want drugs to be prescribed that do not benefit the recipient. Pharmacogenetics has the promise of removing much of the uncertainty." 8.12.03

Why do some people respond better to their medicine than others? It's a question that has long vexed doctors - and their frustrated patients.

With nearly all conditions there are many patients who show little or no response to medication. For instance, the two drugs most commonly given for an enlarged prostate are alpha-blockers and 5-alpha reductase inhibitors; yet only one-third of men prescribed them get what it described as a good response. In the rest, they can be ineffective.

Around a third of patients find that some cholesterol-lowering drugs make no difference to their health. Another third do not respond to beta-blockers (used for high blood pressure). Meanwhile, up to 50 per cent of people don't respond to tricyclic antidepressants. A small percentage of cases may have been misdiagnosed and so misprescribed, but non-response to medication is common. We are all different, so why should medication based on a ‘one-size-fits-all' approach help everyone?

Now researchers are finding that our genetic make-up is the key. While our genes determine our hair and eye colour and our susceptibility to disease, it appears they also play a role in how we respond to medicines. They can mean the difference between a drug working or not; and how well treatments work.

Pharmacogenomics - the study of the interaction between genes and drug response - looks like it will transform medicine. The understanding it is bringing opens up a world of personalised medicine, where drugs are tailor-made to each person's genetic make-up. For patients this is a revolution: a simple blood test or mouth swab could be used to get your gene variations identified, and your drug regimen tailored accordingly.

On trial
Now the first UK-based clinical trial into the effects of genes on drug effectiveness is to start at Liverpool University. The study, funded by the EU, will look at how people with different gene variations respond to the blood thinning drug warfarin.

The drug industry certainly sees this as the way forward. As Dr Mike Wyllie, chief scientific officer of UK drug development company Plethora Solutions and former director of drug firm Urology Pfizer, explains: ‘Personalised medicine will be used to identify the ideal drug combination, patients who are likely to respond and those likely to have unreasonable side-effects. A simple DNA sample can give all this information. ‘In the longer term, personalised medicine could play a greater role as we discover more about genetic variants that raise the risk of common diseases.'

Clinicians welcome the developments. Personalised medicines will impact on a huge range of diseases, including heart disease, diabetes, depression and asthma, according to Dr Michael Caldwell, founder of the Marshfield Clinic's pioneering, Personalised Medicine Research Program in the U.S.

Our response is in the genes
He has investigated the role of genetics in a number of drugs, including warfarin. ‘You can give the standard dose and some people are fine, while others have complications such as bleeding into the brain,' he says. ‘We showed that if you identify a patient's genetic make-up, you can get a better handle on the appropriate dose much earlier.' His team is using pharmacogenomics in a number of conditions, from heart disease to macular degeneration.

Meanwhile, work at the National Centre for Toxicology Research in America has shown that women with breast cancer who have a version of the gene SULT1A1 have lower survival rates with a standard dose of the drug tamoxifen after surgery, and may need different doses. And it's not just drugs that are affected by our genes, but also the way we respond to healthy foods.

A new study from the University of Madrid have found that when people with one type of gene take plant sterols - natural substances found in various plantderived foods - their cholesterol levels are lowered, but those without the gene see no benefit.

The idea of different responses to food is something doctors have known for a while. Professor Steve Field, chairman of the Royal College of General Practitioners, says: ‘For example, in some people eating cabbage helps protect against bowel cancer better than it does with other people.' Pharmacogenomics could help unravel these differences. Indeed, patients might also find themselves being prescribed a diet according to their genes.

Professor Field says: ‘It's terrific. In ten years' time, how we manage health will be very different. I think we will have more targeted medications, and gene testing early in life will predict what it going to happen to you later. You will live your life in a particular way; you may change your diet.' As Professor Field suggests, this is not a development for the distant future. Indeed, a number of tests can reliably predict responses or bad reactions to medicines, according to a report from the Mayo Clinic in the U.S.

Some doctors in the UK are already using such tests. ‘In a number of areas, personalised medicine is already here,' says Munir Pirmohamed, Britain's first professor of Pharmacogenetics at Liverpool University. For instance, tests are being used to see who is suitable for the breast cancer drug Herceptin. 30.12.08

Cholesterol pill warning: Scientists raise fears of cancer link to statin used by thousands

A drug used to treat high cholesterol could cause cancer, doctors warned last night. Heart experts called for caution over the use of Inegy, which is taken as a daily pill. At least one leading specialist said he would not take the drug, while others said the jury was still out.

The U.S. has ordered an investigation into Inegy, which combines the widely used statin drug simvastatin with a new medication called ezetimibe. While statins block cholesterol in the liver, ezetimibe blocks the absorption of cholesterol in the gut. In Britain, about 300,000 NHS prescriptions have been dispensed for Inegy in the last two years. Other patients use ezetimibe on its own.

NICE , the NHS 'rationing' body, last November approved wider use of ezetimibe for the treatment of hypercholesterolaemia, a condition leading to high concentrations of cholesterol in the blood. Results from a controversial study published yesterday in the New England Journal of Medicine show a higher than expected number of cancer cases reported among patients taking Inegy. It showed a total of 105 cancer cases among Inegy patients compared with 70 taking a placebo. That was an increase on the preliminary rates of 93 and 65 respectively reported in July.

The trial found no benefit of the drug in reducing aortic disease in patients with a partially blocked heart valve, and little effect on cardiovascular events such as heart attacks. The journal also noted that ezetimibe interfered with the gastrointestinal absorption not only of cholesterol but also other molecules that could conceivably affect the growth of cancer cells. Lead investigator Terje Pedersen, of Ulleval University Hospital in Oslo, said cross-checks with cancer rates in two much larger ongoing trials did not support the idea that Inegy was linked to cancer. There was no evidence for a cancer-causing mechanism, he told the European Society of Cardiology congress in Munich.

But Professor Heinz Drexel, of the University of Innsbruck in Austria and spokesman for the European Society of Cardiology, said: 'I am not sure that the efficacy is proven and I am not sure that the safety is proven. I wouldn't take the drug myself. 'In patients with an urgent need to reduce cholesterol I would give them the drug, but they are the exception and that is not consistent with how it is being used currently. 'It is being more widely used than I think it should be. We can use something else in patients whose cholesterol is not sky-high.'

An investigation by Oxford University researchers suggested that the higher rate of cancers could be a 'chance' finding, or a statistical fluke. But Professor Drexel said the size of the increase suggested it was not chance, although he accepted it did not prove the drug caused cancer. A longer follow-up will be needed to know for certain, he added.

Dr Mike Knapton, director of prevention and care at the British Heart Foundation, said: 'There is no suggestion that statins increase the risk of cancer. 'The combined evidence of all data on cancer and ezetimibe in combination with a statin shows no increased risk of developing cancer. 'The data from the big trials are encouraging but the evidence is not yet conclusive, because many of the patients studied have been followed up for a relatively short period of time so far. 'Because one study did show a cancer risk, it is crucial that others continue and are monitored closely to definitively confirm or refute any link. 'People should be reassured that drug regulators-will act quickly if robust evidence of risk to patient health appears.

'If you have been prescribed ezetimibe, you should continue to take it. If you have concerns about side-effects of this or other medication, you should talk to your doctor to weigh up the risks and benefits. 'A spokesman for Merck and Schering-Plough, makers of Inegy, said: 'We believe that the cancer findings in the study are likely to be an anomaly and that in light of all the available data, it does not support an association with Inegy.

'We are working with regulatory agencies to further evaluate the data. However, we do not believe that changes in the clinical use of Inegy are warranted.' While 300,000 NHS prescriptions have been dispensed for the drug in the last two years, experts say many of those are likely to be repeat prescriptions for patients who go back for more after a break or need their supply to be topped up. The actual numbers of those taking the drug in Britain is likely to be in the tens of thousands. 3.9.08

Having a flu jab does not cut the death rate among the elderly, claim researchers. They say vaccination has a virtually non-existent effect on the risk of dying prematurely and that previous studies have 'exaggerated' the apparent benefits. A study of 700 pensioners suffering pneumonia, a complication of flu, suggested those who had taken the jab were indeed less likely to die than those who were unvaccinated.

But closer analysis showed those who were vaccinated were healthier and more likely to look after themselves in the first place - which means they were less at risk of dying from flu-related complications. The study looked at data on 700 Canadians aged 65 and over. Half had taken the vaccine and half had not, but they were all admitted to hospital for pneumonia. Researchers from the University of Alberta found 12 per cent of patients died after a hospital stay of eight days on average.

Those who had been vaccinated were half as likely to die as unvaccinatedpatients - a finding consistent-with the benefits shown in previous studies. However, researchers then examined the patients' clinical records, and factors including age, sex, smoking, frailty and socioeconomic status. After these were taken into account, the relative risk of death was reduced by a 'statistically nonsignificant' amount, says the study published yesterday in the American Journal of Respiratory and Critical Care Medicine.

Dr Dean Eurich, of the university's school of public health, said it was 'implausible' that vaccination was halving the mortality rate among flu victims. Researchers suggested previous studies had not considered sufficiently that vaccinated patients who survived were probably healthier and better able to combat flulike complications than unvaccinated ones who died. But it is difficult to prove the so-called 'healthy-user' effect, they said.

Dr Sumit Majumdar, associate professor in the university's faculty of medicine and dentistry, said: 'It is seen in what doctors often refer to as their "good patients".' They are well-informed about their health and look after themselves, 'and quite religiously get vaccinated each year so as to stay healthy'. He advised those with respiratory or immune diseases to still get vaccinated, along with those taking care of the elderly.

A Department of Health spokesman said: 'Studies show flu vaccines give about 70 to 80 per cent protection against flu infection. That is why it is recommended to those aged over 65 and those in an at-risk group.' Dr Majumdar advised people with respiratory or immune diseases to still get vaccinated, along with those taking care of elderly people. 'But you also need to take care of yourself' he added 'because flu vaccine is not as effective as people have been thinking it is.'

The researchers claim that 'clearly inflated and erroneous' findings of the benefits of flu jabs from previous studies have done patients a disservice by stifling efforts at finding better vaccines, especially for the elderly. In November, the jab's co-inventor Australian biochemist Dr Graeme Laver told the Daily Mail the jab did not guarantee protection. He said 'I have never been very impressed with its efficacy. 'It is better than nothing and I wouldn't want to advise people not to take it, but you can't rely on it doing any good.'

A UK Health Protection Agency study also suggested that flu jabs did not reduce hospital admissions from respiratory infections. Plans to extend the flu jab programme to adults aged 50 to 65 and children under the age of two were given the thumbs down by three-quarters of GPs polled earlier this year. However, a Department of Health spokesman said: 'Studies show that flu vaccines give about 70 to 80 per cent protection against flu infection. That is why it is recommended to those aged over 65 and those in an at risk group.

'In the elderly, protection against infection may be less, but there is good evidence showing that immunisation reduces the incidence of bronchopneumonia, hospital admissions and mortality. 'Many countries support flu vaccination programmes. 'Uptake in older people in the UK is relatively high, being close to the 75 per cent target of the World Health Organization.' 30.8.08

'Greedy bosses make drugs too dear', claims NICE chief Professor Sir Michael Rawlins

The drugs industry is to blame for new treatments being judged too pricey for the NHS, the head of the Government drug-rationing body has said. Professor Sir Michael Rawlins, chairman of the National Institute for Health and Clinical Excellence, accused companies of driving up the price of vital new medicines to boost their profits and protect executive bonuses.

His comments came days after NICE was accused of giving kidney cancer patients an 'early death sentence' by refusing to approve four life-extending drugs for prescription on the NHS because they cost too much. NICE, which rates a drug's effectiveness against its cost, has previously come under fire for banning or restricting breakthrough medicines for a host of conditions, from breast cancer to Alzheimer's.

Professor Rawlins said: 'We are told we are being mean all the time, but what nobody mentions is why the drugs are so expensive.' He said overpricing kept share prices high - and ensured executives received healthy bonuses. Professor Rawlins added: ' Pharmaceutical companies have enjoyed double-digit growth year on year and they are out to sustain that, not least because senior management earnings are related to the share price.

'It's not in their interests to take less profit, personally as well as from the point of view of the business. All these perverse incentives drive the price up.' He told The Observer that companies were spending twice as much on marketing as development, and historically, many firms have taken the view that they should charge as much as they could get away with. On the decision to ban the kidney cancer drugs Sutent, Avastin, Nexavar and Torisel, Professor Rawlins said: 'We have a finite amount for health care, and if you spend money one way, you can't spend it in another.'

But Tory health spokesman Andrew Lansley said the Government must explain why new cancer drugs were more available in Europe and the U.S. The drugs industry insisted that prices have fallen more than 20 per cent in real terms in ten years. The Association of the British Pharmaceutical Industry said: 'Companies make a huge investment into public health when they develop a new medicine - it costs an average £550million and takes more than ten years. 'Naturally they will look to recoup such costs through the final price.'

Michael Summers, of the Patients' Association, urged NICE to listen to criticism. He said: 'We are talking about people dying of cancer and we really have to get it right.' 18.8.08

Gina Loxam was feeling a bit low, so she went to see her GP and was prescribed the anti-depressant, Seroxat. Ten years later, she is still on the drug because the severe mood swings, headaches, fatigue and weight gain she suffers when she tries to come off are unbearable. Gina, a 52-year-old finance and quality manager, is one of more than 600 people now suing the pharmaceutical company GlaxoSmithKline for damages on the grounds that they were not warned of the possible side-effects, such as personality changes, as well as addiction. The doctor told me it was not addictive and that's what it said on the information sheet,' says Gina, who lives near Morecambe in Lancashire.

Seroxat now carries the warning that some patients can have problems coming off it. However, the Seroxat patients are a tiny proportion of the growing number of people addicted to prescription drugs. It's thought that between three and seven million Britons are affected, with antidepressants, tranquillisers, sleeping pills and pain-killers the main culprits.

A recent report by the United Nations' International Narcotics Control Board predicted that the scale of the problem of addiction to legal drugs will soon overtake addiction to banned substances. Yet despite this, few patients receive any effective help - meanwhile, millions of pounds are spent helping those addicted to illegal drugs. In fact, the problem of prescription addiction has, for years, been ignored or denied by drug companies and successive governments.

The move to sue GlaxoSmithKline is just one sign of growing pressure for some sort of action. Earlier this year, a House of Commons inquiry into addiction to prescription drugs concluded that action was needed.

Inquiry confirms suspicions
The inquiry, by the All Party Parliamentary Group on Drug Misuse, heard evidence that, despite official warnings, tranquillisers in particular can be addictive, and that GPs were still handing them out on repeat prescriptions without seeing the patients to make sure they weren't having any problems. It was in 1988 that the drug watchdog first warned GPs not to give these tranquilliser drugs - known as benzodiazepines - for longer than a few weeks.

The instruction is still being ignored and benzodiazepines (the most widely used is Valium) are still prescribed in large numbers - more than nine million prescriptions in England in 2007 alone. And as Good Health has discovered, 12 per cent of those prescriptions were for more than 58 days, meaning they were intended for longterm use. Professor Heather Ashton of Newcastle University is one of the few academics trying to get a sense of the scale of the problem.

'I estimate that on average there are more than 180 patients in every general practice in the UK who have been taking benzodiazepines for six months or more,' she says. 'They are all at high risk of adverse effects caused by the drugs.'

Today, as many as one-and-a-half million people in the UK may be addicted to benzodiazepines. 'We also heard reports that an increasing number of people were having problems coming off other drugs, particularly sleeping pills, SSRI antidepressants and painkillers,' says Dr Brian Iddon, the Labour MP chair of the Drug Misuse parliamentary group.

Injustice
Patients who have become addicted to prescription drugs are filled with an all-too understandable sense of injustice. 19.8.08

Pill problem: GPs are accused of turning millions into drug addicts. Doctors have been accused of encouraging millions of people to become addicted to anti-depression drugs. Prescription drugs are destroying more lives than heroin and crack cocaine, according to Euro MP Chris Davies. He is demanding EU action to curb the use of "benzos" - benzodiazepines, commonly known as Valium, Librium, Ativan and Temazepam.

Widely prescribed by doctors as sedatives for anxiety, such drugs have created 1.2 million long-term addicts in the UK alone. One of them, 60-year-old Barry Haslam, from Oldham, was in Brussels today to press his campaign for EU action. Mr Haslam, founder of the Beat The Benzos campaign, said: "I lost 10 years of my life because of being prescribed these drugs. I still suffer the effects. I cannot even remember my children growing up and I'm determined that something is done." He went on: "If you're on heroin or crack cocaine there are places to go for help. But if you are a legal addict, there is nothing."

Last night Mr Haslam met EU Health Commissioner David Byrne urging Brussels to follow up European Parliament demands last year for new guidelines on the use of such drugs. He said he first became addicted when he went to a doctor for help after a breakdown triggered by stress. He soon became addicted but was still advised to increase the dosage of Ativan. "At one stage I was taking 24 pills a day, as prescribed by my doctor."

His wife Susan said: "He was suffering from withdrawal symptoms. He would sit on the bed at night and shake. And all the time he was told to take more and that there was no risk of an overdose. Now we know how dangerous these things are."

Advice for prescription drug addicts. Mr Haslam has been "clean" for 10 years and now spends all his time doing voluntary work to advise prescription drug addicts. "They come to me because there is nowhere else to go. There ought to be counselling and treatment centres but I was getting nowhere in the UK."

His MEP Mr Davies said: "This is a serious problem. Millions of people are being turned into lifelong addicts by doctors who continue to ignore prescribing guidelines. "But because these people don't have to steal to fund their habit their plight goes largely unnoticed by society. What we have are drug addicts created by the health service and the social cost of family breakdowns is immense." After the UK, Portugal is the second biggest user of "benzos" but all EU countries now report problems from the overuse of prescription drugs.

Physical dependence can start within four weeks of using such drugs with side effects including increased anxiety, aggression and insomnia.

Mr Haslam told the Commissioner that Brussels should be proposing strong health warnings on packaging, similar to warnings on cigarette packets, inspections of doctors' prescribing practices and the setting up of 24-hour helplines across the EU. 15.7.08

SOME common fertility treatments are no more effective than leaving things to Mother Nature, research suggested today. Scientists at Aberdeen and Oxford universities conducted a study into the drug clomifene citrate and artificial insemination involving couples throughout Scotland. The study found that couples using either method did not have significantly higher chances of falling pregnant than those conceiving naturally.

Some of the research was conducted using patients at the Simpson Centre for Reproductive Health at the Edinburgh Royal Infirmary, as well as hospitals in Dundee, Falkirk and Glasgow .

Experts writing in the British Medical Journal said current guidelines needed to be reviewed in light of the findings. One in seven couples in the UK experience infertility. Interventions to help these couples have been used for many years in line with fertility guidelines issued by the National Institute for Health and Clinical Excellence (Nice).

For the study, 580 women comparable in terms of age, body weight and the men's sperm quality were divided into groups.

One third were given sex advice and left to try to conceive naturally; one third were given clomifene citrate, which is inexpensive and is believed to correct subtle ovulatory dysfunction; while the remaining third were artificially inseminated without ovary stimulation. At the end of the study there were 101 live births.

There were 32 births among the 193 women trying to conceive naturally (17 per cent), compared with 26 among those on the drug (14 per cent) and 43 among those having insemination (23 per cent).

Although those receiving insemination had a higher rate of pregnancy, the experts said this was not significant enough to be solely down to the procedure.

The experts said: "Clomifene citrate or unstimulated intrauterine insemination seems to be no more effective than expectant management in couples with unexplained fertility."

The researchers concluded: "These interventions, which have been in use for many years, are unlikely to be more effective than no treatment. These results challenge current practice, as endorsed by a national guideline in the UK".

Siladitya Bhattacharya, professor of reproductive medicine at the University of Aberdeen , who led the study said that while the results appeared to show the drug was less effective than trying to conceive naturally, this was not statistically significant. He added: "The data does not show that there's any difference between the drug and no treatment, and IUI and no treatment". 8.8.08

With an annual NHS budget of about £5million, the Royal London Homoeopathic Hospital is one of four run by the NHS. It treats 30,000 patients a year for a variety of conditions including eczema, arthritis, allergies and stress. Such is the demand that it has just opened a 'herbal clinic'. But with budgets in crisis, critics claim spending on complementary medicine is frivolous - and last week it was revealed that GPs' homeopathic prescriptions have fallen by 40 per cent in two years.

Yet according to the journal Homeopathy, among those receiving these remedies, 60 per cent say their health improved after treatment. We spoke to a range of patients at the hospital who have turned to homeopathy.

Daphne Thornton , 66, from Hatfield, Hertfordshire. Problem: autoimmune disease.
Six years ago I began suffering stiffness in my neck, shoulders, back, groin and knees. I was diagnosed with the autoimmune disease polymyalgia rheumatica and my GP prescribed prednisolone, a steroid. I was reluctant to take it because of the side effects, such as weight gain, puffiness and muscle stiffness, but the results were remarkable. I was like a new person after one day. But a few months later I did begin to put on weight and my face appeared swollen, so I wanted to try complementary methods to try to control the side effects. I first came here in July 2005. Dr Saul Berkovitz, who leads the clinic, put me on homeopathic remedies at first - causticum, which is supposed to help stiffness, and cimicifuga, which alleviates aches. Neither helped. We then tried phosphorus - but that didn't work. It was only when I was put on a cocktail of herbal medicines including Rehmannia, Bupleurum (both Chinese herbal preparations), black cohosh, celery seed and liquorice root that I began to notice any effect. After a month or two of taking it I began to feel less stiff. We reduced the steroids by half a milligram at a time every few months until eventually I came off them completely. And I've been off them ever since.

Gertrude Gerstle, 63, now lives in Hawaii but was visiting her son in London . Problem: chest colds.
Every winter I would get chest colds and find it hard to breathe. My ex-husband suggested homeopathy so I came here a few years ago. The main remedy for two years was Pulsatilla. I didn't get chest colds after that. Then I became complacent. Two years later, I didn't take the tablets and I got a cold again. I never took conventional medicine for the chest colds and I was very surprised that homeopathic remedies worked. Today I'm visiting to say thank you to Dr Berkovitz.

Joshua Hall, three, from Laleham, Surrey, and his mother Angela, 33, a full-time mother. Problem: eczema.
Joshua had very severe eczema on the inside of his leg when he was a baby and the GPs wanted to give him steroid cream. I wasn't keen and as my father is a big believer in homeopathic remedies we came to see Dr Andrea Weissner when he was nine months old. She prescribed calcium sulphate drops, which he took daily, and Five Flower Cream for rubbing on the skin. Within two months it had significantly improved and within six it had cleared up. At first I was very sceptical and thought he may have grown out of it, so I stopped giving him the drops but the eczema came back. Now I'm a complete believer.

Roy Jose, 62, a retired history teacher from Tottenham, North London . Problem: myelofibrosis.
I have been coming here for three years. I have myelofibrosis, which means the larger bones that normally make red blood cells are not performing that function any more. Instead, the spleen and the liver are overcompensating. I am told I may need my spleen removed in a few years. The only thing that can help me is a bone-marrow transplant. I don't have many symptoms, apart from slightly low energy levels, but the only treatments I have are complementary - acupuncture and the homeopathic remedy ceanothus, which supports my digestive function. This seems to be keeping my condition in check. My blood counts seem stable and my spleen is not swollen.

Nike Jonah, 42, a project manager from East London . Problem: cluster headaches.
This is my first visit. I've been getting cluster headaches - excruciating pains in the back and side of my head - for the past 12 years. When I first got one, it was so painful I thought I had a tumour. I was living in America and the doctors didn't seem to know how to treat it. But since I came back to the UK I've been prescribed injections of the powerful anti-headache drug Imigran whenever I have an attack. But they are becoming less effective as the years go by. Also, I don't like injecting myself - as soon as the drug enters my body I tend to feel worse. I'm not a big fan of conventional medicine so I thought I'd try this out. I've been prescribed a homeopathic remedy called Natrum mur by Dr Berkovitz, so I'll just have to wait and see if it works.

Patricia Frith, 78, retired from the South Downs . Problem: lower backache.
I've been coming here since 1984 when I got pain in my lower spine and left hip. My doctor had tried everything and this was a last resort. I've been having acupuncture with Dr Adam Ward every three or four months since then and it's sorted me out. If I go for longer than four months without a visit, the symptoms come back. I also take arnica and copper oil to reduce the swelling when it's painful.

Jane Gilchrist, 95, volunteer from London . Problem: neck pain.
I'm here today to see if I can have acupuncture for terrible neck pains. I've been a huge fan of complementary medicine since I first came here when I was 70. I'm here all the time - I even volunteer for the coffee shop. I have three heart conditions but my cardiologist says my heart has hardly changed over the past 20 years. Every night I take 15 drops of Crataegus - the juice of the hawthorn berry - which is supposed to strengthen the muscles of the heart. And I also take Latrodectus mactans, a homeopathic remedy made from the venom of the black widow spider, which is supposed to be very good for the heart. In my handbag I carry arnica for my bruises because I'm always falling. I also take aconite for shock and Nux vomica for nausea.

Grahame Blakey, 41, a data manager from Horsham, West Sussex . Problem: psoriatic arthritis.
I've been coming here for about 18 months for psoriatic arthritis - a condition linked to psoriasis. I've had eczema since I was a child and more recently it's been the arthritis that has been bothering me. It started with my ankle swelling and becoming painful but then my knees and elbows became puffy, too. My GP prescribed methotrexate for the condition to suppress my immune system. I took it for more than five years. It kept the arthritis under control but as the disease progressed, the dosage increased and I was at risk of liver damage. I came to see Dr Peter Fisher who prescribed homeopathic tablets called Lycopodium. A few years ago when I'd had homeopathy for eczema, my condition got worse before it got better. But this time it took a couple of months to start working.

Bobbi Smith, nine, from Whitwell, Hertfordshire, came with her mother Maree, 31. Problem: asthma and allergies.
Both my daughter Bobbi and my youngest child Tommy, who is four, suffer from severe asthma and allergies. Bobbi is extremely allergic to nuts and Tommy has been rushed to hospital several times as a result of his asthma. We brought him here in February to see Dr Jennifer Lenhart who prescribed a homeopathic remedy and it's completely changed our lives. We've not had a single emergency trip to the hospital since. I wanted to see if homeopathy could help Bobbi. Today she's been prescribed mixed allergens to reduce the allergies and something called Apis for her runny eyes and nose.

Samuel Tilley, six, from Barnet, North London, came with his father Simon, 42, a teacher. Problem: eczema.
Samuel began suffering from severe eczema on his lower legs when he was three. Our GP had prescribed diprobase, an emollient and hydrocortisone cream but we felt uneasy about using steroid cream on him at such a young age as it thins the skin. We've been coming here for about a year to see Dr Lenhart who prescribed Five Flower Cream, a moisturiser containing Bach Flower Essences, to rub on in the morning, and calendula (marigold) beeswax ointment in the evening. Samuel takes a couple of sulphur pills daily for his general condition and twice a week he has anti-allergy pills. He takes flax seed oil and omega-3 oil pills which are also anti-inflammatory and his skin has been wonderful ever since. Now we come back every three to four months for a check-up. I teach science and I know people such as Professor Richard Dawkins claim that homeopathy doesn't work. I usually love his work - but from our own experience I have to disagree with him. 3.8.08

In 1854 an outbreak of cholera in London saw patients treated in 2 hospitals, the Middlesex hospital and the London Homeopathic Hospital. The death rate in the Middlesex hospital was 53.2% compared to only 16.4% in the homeopathic hospital. But the report of the Board of Health was presented to Parliament without the slightest reference to the London Homeopathic Hospital or to the brilliant results which its physicians had achieved.

In 2003 a senior executive with Britain 's biggest drugs company admitted that most prescription medicines do not work on most people who take them. Dr Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline (GSK), said fewer than half of the patients prescribed some of the most expensive drugs actually derived any benefit from them. "The vast majority of drugs - more than 90 per cent - only work in 30 or 50 per cent of the people," Dr Roses said. "I wouldn't say that most drugs don't work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there on the market work, but they don't work in everybody." Critics also point out pharmaceutical drugs are responsible for 18,000 deaths and 600,000 hospital admissions in the UK every year due to ADR's (adverse drug reactions).

With only 30% to at best 50% of the patients who take pharmaceutical drugs deriving any benefit from them, some people are beginning to ask the question ‘why aren't alternative forms of medicine used more often by the NHS'? It is well known there is a coordinated campaign to derail alternative medicine by the medical establishment, not because it doesn't work but because it is such a threat to them and the multi-billion dollar pharmaceutical drug companies which fund them.

It is clear those in the medical profession who are opposed to any alternative & complementary medicine may have a vested interest in trying to derail non-pharmaceutical medicine as they could be influenced by the drug companies who commission their unhelpful and often bias opinion. The drugs companies target newspapers with stories designed to create fear about a condition, and then company-sponsored advisory boards supply 'independent experts' for the stories, while consumer groups supply 'victims'. The drug companies argue that there are clear benefits to this system.

Dr Iona Heath, head of ethics at the Royal College of General Practitioners, warns that there could also be clear downsides: 'Alternative approaches - emphasising the self-limiting or relatively benign natural history of a problem or the importance of personal coping strategies - are played down or ignored. The disease-mongers gnaw away at our self-confidence. Inappropriate medicalisation carries the dangers of unnecessary labeling, poor treatment decisions, economic waste, as well as the costs that result when resources are diverted from treating or preventing more serious disease. At a deeper level, it may help to feed obsessions with health.'

In a recent survey published in the journal Homeopathy, 60% of patients said their condition had improved due to alternative medicine which is clearly alarming for those opposed to alternative medicine being made more available on the NHS, as it clearly out performs pharmaceutical medication where only 30 to 50% of patients derive any benefit from their drugs.

Critics of the medical profession argue the facts speak for themselves and those who are openly opposed to any form of alternative medicine being available on the NHS must be viewed with skepticism as their biased opinion is unhelpful and may be influenced by big business rather than by the best interests of the patient.

It is now been acknowledge by U.S. government scientists, whose work was published in the Proceedings of the National Academy of Sciences, who 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. However vitamin C injections have already been successfully used for some time in real patients and not mice by alternative medicine practitioners worldwide. The idea was first suggested by visionary Linus Pauling over 30 years ago. Pauling was among the first scientists to work in the fields of quantum chemistry, molecular biology and orthomolecular medicine. He is one of a small number of individuals to have been awarded more than one Nobel Prize, one of only two people to receive them in different fields and the only person in that group to have been awarded each of his prizes without having to share it with another recipient. But the cancer research market is worth billions of pounds per annum and so his discovery was brushed aside by the drug companies and medical community.

It is now clear the medical profession and their dogmatic reliance on toxic pharmaceutical medication is misplaced and at worst has been detrimental to the advancement of a combined ‘pharmaceutical & alternative' approach to the treatment.

It is clear the single pharmaceutical approach to medicine isn't working and those responsible for holding back the availability of alternative medicine on the NHS are to blame for many deaths and keeping patients sick, when they could have easily recovered with a combined approached to their treatment and care.

As the NHS moves forward to a new era of ‘patient choice' the patient should demand they are treated with their best interests at heart and not those of the medical profession or pharmaceutical drug companies, which has been the case for the last 150 years. 30.7.08

Each year thousands of hospital patients die as a result of human error. In a new Radio 4 programme GP Phil Hammond -who exposed the Bristol babies heart scandal in the 1990s - examines whether enough is being done to protect us. The late Dr Tom Chalmers, a distinguished medical researcher, once asked why doctors kill more people than airline pilots. The odds of dying in hospital as a result of human error are 33,000 times greater than the risk of dying in an air crash - an extraordinary figure, especially as most people are more scared of flying.

Dr Chalmers came up with a number of reasons for this apparent discrepancy - such as the requirement that pilots take time off for sleep, undergo random breath-testing and that their skills are tested every six months. But he saved his harshest comment until last: 'If doctors died with their patients, they'd take a great deal more care.'

Most doctors bristle at the suggestion that they don't take patient safety seriously enough. After all, medicine is more complicated than aviation and it's impossible always to get it right. Even the best doctors make mistakes. Errors happen either because we do the wrong thing (make the wrong diagnosis or give the wrong drug) or we do the right thing wrong. Often, we blame 'the system' for causing errors - the lack of manpower that leaves exhausted and inexperienced staff without supervision - but errors can happen in ideal circumstances.

Take the story of Elaine Bromiley. Elaine was 37 when she was booked in for routine sinus surgery under general anaesthetic. Her anaesthetist had been a consultant for 16 years, her ENT surgeon had 30 years under his belt. The theatre was well equipped and there were no emergencies elsewhere. As her husband Martin observed: 'This was a dream scenario for safety; a senior surgical team working undisturbed in state-of-the-art surroundings.' And yet Elaine's anaesthetic went tragically wrong and repeated attempts to ventilate or to intubate - pass a tube into her airway - failed.

'Can't intubate, can't ventilate' is a rare but recognised emergency, which requires an emergency tracheotomy, cutting a hole in the throat to pass the tube through. However, the consultants decided to keep attempting to intubate, finally abandoning the procedure hoping that Elaine would wake up. She never regained consciousness and died 13 days later.

Martin Bromiley was initially told that his wife's death was bad luck. But as a pilot, used to analysing critical incidents, he wanted to hear the results of the ensuing inquiry. Bromiley insisted on an independent review which concluded that, given the experience of the surgeons, it should have been possible to follow the emergency protocol and perform a tracheotomy. So why didn't it happen? Errors happen not just because of lack of skill or knowledge but for behavioural reasons. Put someone in an extremely stressful situation and even the most senior clinicians can lose the plot.

The role of these human factors in error is well recognised in aviation and Bromiley recently founded a charity to help health professionals make better decisions under pressure. What is needed is a team culture where even the most junior member of staff can raise concerns. Bromiley's inspirational approach -wanting us to learn from his wife's death - contrasts with my aggressive exposure of medical scandals.

In 1992, I published confidential audit figures from Bristol Royal Infirmary showing that its results for complex heart surgery on children were very poor. The Department of Health knew about the results in 1988 but didn't step in until 1995. I thought my articles would at least spark an investigation, but the surgeons carried on for another three years until the death toll was too high to ignore.

A subsequent public inquiry concluded that, between 1991 and 1995, as many as 35 children under the age of one died who would not have done if they'd been treated elsewhere. The surgeons were enraged at having their audit figures published. They didn't stop and reflect. They adopted a siege mentality and carried on regardless. Defensiveness was culturally ingrained. I trained during the days when junior doctors clocked up 120 hours some weeks. The NHS paid lip service to safety and junior surgeons were often left to perform complex operations for the first time alone.

Mistakes were buried - along with the patients - and you muddled along doing your best. There were huge variations in quality and thousands of avoidable errors across the whole of the NHS. It took the Bristol Inquiry to force politicians and the medical establishment to take safety seriously. This sparked a sea change in accountability, including the setting up of the National Patient Safety Agency to monitor and learn from errors.

But has all this made the NHS safer? In parts, yes. Bristol has become one of the safest places to have heart surgery. And the publication of outcomes for heart surgery across the NHS has coincided with a reduction in death rates. But doctors in other specialties have been slow to open themselves up to scrutiny. As a result, patients aren't as safe as they should be.

How can it be made safer? During the making of the Radio 4 documentary, all the NHS staff I spoke to were passionate about patient safety, but said a culture of blame and exposure was its enemy. Errors will inevitably occur, but what staff need to prevent these happening again is time and support to understand and learn from them.

Learn from near misses
This approach doesn't excuse negligence - but often disasters happen because of a chain of contributory factors, rather than the single action of one person. One of the pioneers of a more open approach is the surgeon (and Health Minister) Lord Darzi.

Ten years ago, Darzi decided to introduce a black box in his operating theatre at St Mary's Hospital, London. This recorded the patients' vital signs, the anaesthetic procedures and, contentiously, the surgical team, on video, as it went about its business. Initially, he too struggled against the defensive culture: within 24 hours, someone had put bin liners over his cameras. But the black box remains. His colleagues now realise that the recorded information allows them to learn from near misses so tragedies are avoided.

Darzi has also developed a simulated operating theatre that teaches his team to manage common distractions (e.g. constant interruptions during surgery) and rare, life-threatening emergencies. Pilots are legally obliged to spend 16 hours a year in a simulator, proving their competence, but for surgeons and anaesthetists, it is still optional. Darzi is also helping to pioneer a surgical checklist with the World Health Organisation to ensure patients are given the appropriate drugs and that everyone is prepared for what might go wrong.

This also encourages staff to speak up. However, for the NHS to embrace safety requires the political recognition that it's not about waiting lists and how quickly you get treated that matters, but how safely.

Safe staff report more errors
One in ten patients admitted to an NHS hospital is accidentally harmed - and for one in 300 patients, medical error results in death - yet still not everyone accepts change. Some doctors think checklists reduce them to factory workers, others have a tantrum if someone reminds them to wash their hands. Safe hospitals tend to be calm ones, where everyone accepts feedback and works in a team.

Safe staff also tend to report more errors. The hospital that admits to nothing generally has the most to hide. So can patients do anything? In America, the error rate is lower than in the UK. Doctors, ever wary of litigation, take safety seriously and patients join in. There, patients are encouraged to ask about a surgeon's training and success rates, query medication, insist on hand washing and ensure the nurse has read their ID bracelet.

In the UK, we lie back and take it. It's far easier to trust professionals. I've never met anyone who knocks on the cockpit and asks the pilot how often he's landed the plane - you assume he's competent, because he's still alive. If Darzi gets his way, one day we may be able to take safety in the NHS as a given. But not yet. So keep your eyes peeled and keep asking questions. 5.8.08

The drugs-rationing body for the NHS has been accused of bullying, ignoring and patronising patients. The unprecedented attack follows the highly-controversial decision to ban drugs that can extend the life of kidney cancer victims. Experts asked to advise the National Institute for Health and Clinical Excellence have lodged complaints, describing the consultation as a sham.

Two patients' representatives attacked the system as 'flawed and irrational' while the charity Kidney Cancer UK is also expected to make an official complaint about being ignored. Nice's decision to ban four drugs widely available in Europe and the U.S. was described as a 'death sentence' by doctors, patient groups and campaigners. Now the complaints have shed new light on the way such life-and-death decisions are made.

Bill Savage, a retired management consultant who has had a kidney removed, was asked to address the decision-making panel as an expert witness. He said last night: 'The process is a sham consultation which ignores patient views. 'The chairman was intimidating and oppressive towards us and we were patronised and bullied by a process that marginalised us. 'It is a cruel deception made worse by a decision-making process which did nothing to elicit information from patients about the devastating impact of the disease.'

Mr Savage, 61, from Amersham in Buckinghamshire, said the patient witnesses had to sit through 101 pages of a Powerpoint presentation focusing entirely on mathematical calculations and the cost-effectiveness of the drugs. He said: 'It was inevitable all the treatments would fail Nice evaluation because, by their nature, all new cancer drugs are expensive as they have a long development time. 'The system is a farce. I have yet to receive a reply to my complaint and that was lodged more than three weeks' ago.'

The process led to draft guidelines issued by Nice last Thursday on the drugs Sutent, Avastin, Nexavar and Torisel. Nice admits they work but says they cost too much. A year's use of Sutent is £24,000 but the drug can double life expectancy, to 28 months, compared with the treatment which will be used instead for around 1,700 patients a year with advanced kidney disease.

Critics say people are being sentenced to death because Nice places too great an emphasis on the cost of drugs and not enough on the benefits of extending patients' lives. Mr Savage's complaint has been backed by two of the other three 'patient experts' involved.

Campaigner Kate Spall, who had won treatment for 80 patients this year by challenging the policies of local primary care trusts, drew up a submission to Nice with the help of scores of sufferers. She was so disgusted by the process, however, that she demanded her name be removed as a 'consultee'. She said she was sidelined at the two-hour meeting in London with more than 30 members of the Nice technology appraisal committee. It was led by Professor Andrew Stevens, who also headed the committee responsible for controversial restrictions on Alzheimer's drugs.

Mrs Spall, who runs the Pamela Northcott Fund in memory of her mother - who was prescribed one of the drugs too late - was appalled by the experience. She said: 'We waited for our opportunity to contribute - and it never came. 'I don't think they used the word patient even once during the meeting and the process is designed to exclude expert patients they invited to take part.'

In her official letter of complaint she said: 'The system and procedure is flawed and irrational and fails to consider the patient views as represented by the experts. It is designed to alienate the patient expert by failing to provide an agenda in advance; failing to provide a full agenda at the meeting and subsequently leaving no time or space in the procedure to hear or question the patient expert.

'Due to this appalling experience and failure by the panel at Nice to listen to the views of expert patients, any decision the panel make will be unsound and open to challenge. 'In the interim I wish for my name to be taken off any documents noting me as a patient expert and consultee.

'I was not given the opportunity to do either and it would be inaccurate and misleading to the public to suggest otherwise.' Mrs Spall added: 'What is the point of asking patients to take part when their views are not taken into account?' She said the committee chairman had repeatedly described Nice as the 'buyer for the NHS'.

Mrs Spall said: 'This does not seem right to me. By concentrating on cost alone they are leaving patients with advanced disease with no treatment options.' Kidney Cancer UK is also understood to feel its views were ignored. Spokesman Pat Hanlon said: 'This draft recommendation will have a devastating impact on patients with advanced kidney cancer, as it could result in a life or death situation.' Phil Ranson, from Nice, said last night that letters replying to the complaints were about to be sent out, so he was unable comment. 11.8.08

Arrogant, illogical and totally out of touch, NICE must be scrapped ...it's killing too many people

Patronising. Bullying. Intimidating. That is how the body which makes life-and-death decisions on the rationing of NHS drugs and treatments was described in yesterday's Daily Mail - by two of the very experts who advise it. These same patients' representatives complained of a flawed and irrational decision-making process at the National Institute for Health and Clinical Excellence (NICE) which paid no heed to their views and ignored the needs of patients.

Their complaints cannot be ignored. They come just days after NICE's misguided and barbaric decision to ban four kidney cancer drugs that are widely available in Europe and the U.S. and can double life expectancy for those who suffer from the condition. Since treatment costs are largely paid by governments, we have to accept that it is sensible they are controlled. But the controls that operate in the UK are excessive and lead to desolation and death. To explain why the decisions made by NICE are so unfair and irrational, we have to examine how drugs are developed.

There is no getting round the fact that the costs incurred by the big pharmaceutical companies which make drugs to treat us are enormous. For every drug that comes on to the market, about 10,000 other drugs are investigated and then discarded. The development cost of each drug averages about £750 million. It is reasonable, of course, that drug companies should be allowed to make a profit because that profit allows them to invest in research, and ultimately leads to new drugs and an improvement in human health.

During their development, drugs are examined in the laboratory, tested on animals to assess their side effects, and then given to people to make sure they are effective and safe. The time taken from the original brainwave to final testing averages ten years. Once the drug company is happy that the drugs are effective and not toxic, they will apply to the European Medicines Agency (EMEA) to get a licence to sell their product, which will be issued (on the information presented to them) only if that product works and does not cause the patient to have a significant adverse reaction.

The process of scrutiny by EMEA of an application by a drug company is lengthy and obsessively detailed - and quite rightly so, as the Agency needs to know that new treatments will not harm patients. A similar process is undertaken in the United States by the Food and Drug Administration. At the time of licensing, there are negotiations by individual governments and health care providers with individual pharmaceutical companies about drugs costs. These negotiations do not significantly hold up treatment. Then, Europeans and Americans get the drug they need.

What happens in the UK? The situation is totally different. In the UK, bureaucracy rules and is unaccountable. This process holds up treatment. 'Sorry chaps, no treatment for you unless you can survive the next few years till we've made up our minds.' Here's some history. In 1999 the UK Government established NICE or, as we doctors call it, Not-NICE. The body was set up to examine the value for money of drugs. NICE is run by health economists, with a marginal input from patients and the medical profession.

The whistle starting the process by which NICE approves drugs is blown by the Government but, for each drug, government takes an extraordinarily long time to blow the whistle. An objective observer might even suggest that the Government has often lost the whistle. Either that or it's deliberately slowing the pace of approvals to act as a brake on the accelerator pedal of drug spending by the NHS.

Whatever the cause, the net effect is that, in many cases, the European licence is given three or four years before NICE decides when drugs should be released. In the UK, during this period, people are dying because of the unavailability of treatment. But even then, the NICE decision is not final. There is more bureaucracy to go through, more layers of approval, or should we say disapproval. Every NICE decision on a drug is open to consideration by each and every one of the 149 Primary Care Trusts which have control over NHS spending. They must give their approval, and they do not like to hurry their decision-making process.

As a cancer specialist, I have been asked to give evidence to NICE committees on the efficacy of drugs. The last time, my opinion was considered by a committee of 43 people, only one of whom appeared medically qualified. There is input from patient groups into the committees but, as we have seen, this seems largely irrelevant. NICE has produced 407 rulings on cancer drugs in the past seven years. It would be an understatement to say that almost all of them have been controversial.

In recent times, NICE seems to have shifted the ball park for the way it calculates the cost-effectiveness of drugs to the depths of the deepest ocean. The methods are illogical, often unintelligible, they are not accepted by clinicians and they produce cost estimates that are wildly inaccurate. That ruling on kidney cancer drugs appears, in terms of logic, to have come from distant parts of the galaxy, where calculator buttons have been pressed by alien thumbs. The decision to ban them was based on an incorrect formula for calculating the cost of the drugs - if the true costs had been used, NICE would have had to approve them under its own guidelines. Little wonder there have been such protests from doctors and patient groups.

The decisions made by NICE have in many cases been challenged in the courts and often reversed. The costs for NICE in legal fees in contesting individual appeals can easily reach six figures. This happened with the appeals against NICE's 2006 decision to ban the Alzheimer's drug Aricept, even though it had been widely demonstrated to be effective and would have cost only £2.50 a day.

It is completely unfair that so much money should be spent by NICE defending its controversial decisions. These legal fees could be used to save lives - they would comfortably cover the drug costs for thousands of patients. So, what are we to do about NICE? God forbid that the Government should ask clinicians or patients this question. If they did, they would find a unanimous response which would be to close down the organisation.

It is an organisation that has shown itself to be absurd and irrelevant at best, incompetent and deadly at worst. There is no exact equal in the rest of Europe or in the United States. The only hope for patients is that someone quietly locks NICE's battered front door, and then throws away the key. 12.8.08

The head of the NHS rationing watchdog has said he is 'genuinely sorry' for a delay in approving a new treatment for blindness. But campaigners said Andrew Dillon's comments would be of little consolation to the thousands of Britons who have lost their sight in the two years it took NICE to make its final decision. The watchdog has now approved Lucentis, which is used to treat wet age-related macular degeneration, a condition which affects 26,000 new sufferers every year.

NICE's original recommendation was that patients had to wait until they went blind in one eye before they would be given treatment to save the sight in the other. The proposal caused a huge public outcry from doctors and campaigners, prompting a U-turn in December last year before further consultation resulted in the final decision today. Mr Dillon, the chief executive of NICE, seemed to blame these protests for slowing the decision to make Lucentis more widely available. He claimed that because NICE's rulings were not made behind 'closed doors' and were open to being challenged, lengthy delays often occurred.

But campaigners said the procrastination, which potentially cost the sight of 50 patients a day, was not their fault. The Royal College of Ophthalmologists said the latest guidance was nearly identical to the suggestions it made two years ago and campaign groups pointed out that without their intervention, NICE might never have overturned its original decision. Winfried Amoaku, of the Royal College, said: 'It has taken over two years for NICE to formally consult stakeholders on each stage of its deliberations - after which they have implemented all but one of the recommendations made by the College in its original submission in August 2006. 'In that time, around 50,000 patients have been diagnosed - and many hundreds of patients have gone blind - some of them needlessly.'

Tom Bremridge, of the Macular Disease Society, said: 'Those responsible for NICE should be aware that during the cumbersome two-year review process, 152 PCTs have individually had the power to decide whether to let patients go blind or to save their sight. 'The resulting stress and suffering has been cruel and unnecessary.' Mr Dillon told the BBC Radio Four's Today programme that it was important that all parties had the opportunity to have their say. He said: 'Everybody involved needs to look back to see if there was anything they could have done to have speeded up the process. 'It would be very easy to make decisions behind closed doors. Nobody would find that acceptable.

'Once you start consulting, once you start giving people the opportunity to appeal, all these things add time. But Steve Winyard of the Royal Institute of Blind People (RNIB) said: 'These are warm words from NICE but we now need action. 'The process is far too slow and thousands of people have gone blind unnecessarily because of this long wait. It put people in the impossible position of paying for private treatment or going blind, and understandably many were very upset and frustrated. 'He added: 'We asked NICE why there were long periods when nothing was happening, but never got a clear answer.

'At times things moved at a snail's pace and we'd like to see real urgency in the process. Our evidence and responses to consultation were delivered on time and it's difficult to see what lessons we have to learn.' RAF war veteran Dennis Devier, who has very limited sight after being refused Lucentis when he started to go blind two years ago, also criticised the apology from Mr Dillon. The 85-year-old from Henley-on-Thames in Oxfordshire, who is a full-time carer for his wife Frances, paid £10,000 to have the injections privately after a fundraising campaign by his local newspaper.

He lost sight in his left eye in 1994 due to wet AMD and was diagnosed with the condition in his right eye in May 2006. He said yesterday: 'It's all very well to apologise now, but its too late for those of us who have now lost their sight. 'While I was appealing the PCT's decision not to give my the injections on the NHS, I lost a crucial three months. My sight now is very limited. 'The new guidance recommends that all patients in England be offered Lucentis, which is already available in Scotland.

However, NICE has dismissed an appeal by drug maker Pfizer to fund NHS treatment with an alternative treatment called Macugen, for patients sensitive or allergic to Lucentis. Mr Amoaku said: 'This unfairly penalises the 3 per cent of wet AMD patients who may be allergic to Lucentis, where a reaction to the drug can cause additional damage to the retina. 'The U-turn comes with an agreement between NICE and the drug's manufacturer Novartis which means the NHS funds only 14 injections of Lucentis, with the cost of further treatment topped up by the company.

This could increase pressure on the Government to remove restrictions on patients who pay privately for drugs on top of their NHS care. When my wife, Mary, was told in February that she had a condition that could blind her within months, we were horrified. But we were assured that there were drugs that could deal with the condition and we were confident that the NHS, of which we have always been proud, would swing into action and see us through. How wrong we were. What we have discovered is that Britain's brilliant doctors have their hands tied by bureaucracy, bureaucracy that costs some their sight, and others their lives.

There are 26,000 new cases of my wife's condition - wet age-related macular degeneration - every year. Thankfully, the blindness it causes can be averted with a highly-effective drug, Lucentis. The bad news is that this drug, so badly needed by my wife and thousands of others, was only made available to all yesterday. Not because of clinical trials or even waiting lists, but simply because it has taken the National Institute for Health and Clinical Excellence more than two years to decide to compel our primary care trusts to supply it.

Unfortunately, in the absence of meaningful guidance from NICE - as has been the case with Lucentis - a postcode lottery is created as PCTs make their own decisions on whether to prescribe. My wife was a loser in this lottery. While our neighbouring trust of Sandwell has been supplying Lucentis since January 2007, our local PCT, Birmingham East and North, has not. And my wife has suffered as a result. Her sight has deteriorated over the months we have been waiting, but not nearly as quickly as it might have done. Wet AMD can blind you in as little as three months.

Many will not have been as fortunate and it is quite clear that the blame for that lies at the door of NICE. Now Mary will finally get her sight-saving treatment. She can no longer see faces on the television, but with luck, she will not lose her sight completely. When my wife was diagnosed with macular degeneration, our consultant at the Good Hope Hospital in Sutton Coldfield immediately prescribed Lucentis.

But her expert medical judgment was thwarted by a committee of bureacrats at our PCT who wanted to save money and had been given the loophole to do so by NICE's indecision. But it's not just NICE's fault. The PCTs also play a part in this debacle and often seem more interested in saving money and allocating funds to their own pet projects than helping patients.

Indeed, our PCT, which apparently didn't have enough money to save my wife's sight, has recently launched a £250,000 programme to educate its obese staff about overeating. More than 200 of its employees will get pedometers and personal trainers. This is outrageous.

I am 78 now. I spent 38 years in the Royal Army Ordnance Corps. During that time my wife put her heart into voluntary work with Army wives and families and when I retired she continued to do voluntary work for Oxfam. We believe in putting time and effort into society. But what happens when my wife needs something back?

Nothing. Huge amounts of money are poured into a swelling health bureaucracy that devours money which should be spent on patient care and also decides who gets what treatment, on financial and not medical grounds. At the top of this bureaucratic heap sits NICE. It is reckoned that during the two years that NICE has contemplated whether or not we can afford Lucentis, 20,000 have lost their sight.

It's an inhuman price for a system that puts paper-pushing above care, and apparently puts money above the one thing the whole institution was set up to protect: the patient. NICE was also under fire from terminally ill patients yesterday - for blocking drugs to treat advanced kidney cancer. A 50-strong group of sufferers and their families, some in wheelchairs, staged a protest at central London headquarters of the National Institute of Clinical Excellence (NICE).

Four drugs which slow the progession of renal cancer will not be available on the NHS, Nice announced earlier this month. The demonstrators said they felt 'angry and abandoned' after meeting with chief executive Andrew Dillon as part of the consultation process. Protest organiser Clive Stone, from Witney, Oxfordshire, said: 'My personal message to him was that I'm dying and he's taking any hope away from me. I'm appalled.

'These drugs have been known to extend life for at least two years. Without that we're gonners. There's nothing else.' Nice ruled that the medicines - Sutent, Avastin, Nexvar and Torisel - only extend a patient's life by an average of five to six months. They therefore cost six times the NHS budgeting limit of £30,000 per patient per year, the committee said.

A group of 26 oncologists said in a letter to the Sunday Times that they were 'dismayed' by the ruling over the drugs, which are freely available in other countries. 28.8.08

Why have NICE approved a weight-loss drug banned in America over suicide fears?

A weight-loss drug banned in the U.S. over fears it can heighten the risk of suicide has been given the go-ahead in Britain. Acomplia will be available to overweight or obese patients who cannot take, or who have had no success with, the two other weight-loss drugs available on the Health Service. But a series of scientific studies have raised concerns that it can induce suicidal thoughts in those already suffering from depression.

The drug, taken orally as a pill once a day, has not been authorised in the U.S. because of safety fears, although it is available in France and Germany. Acomplia, also known as rimonabant, went on sale in Britain in June 2006 but approval from the National Institute for Health and Clinical Excellence, or NICE, for use on the NHS was issued only yesterday.

Trials have shown that it could help two out of five patients (40% success) lose 10 per cent of their weight. So yet another drug with a higher failure rate than success rate has been given the go ahead by NICE. In July last year, the European Medicines Agency warned that rimonabant may be unsafe for patients suffering major depression or who were taking antidepressants.

Evidence suggested one in ten of those taking the drug may develop mental side-effects including low mood and depression, anxiety, irritability, nervousness and sleep disorders. The Nice guidance recommends rimonabant 'as an addition to diet and exercise for adults who are obese or overweight and who have had an inadequate response to, or are intolerant of' the other two main weight-loss drugs. These are Xenical, also known as orlistat, and Reductil, or sibutramine.

However, Xenical cannot be used by those with bowel problems, and Reductil cannot be used by those with high blood pressure. The go-ahead means doctors will have a choice of more drugs to help those wanting to lose weight. All the drugs cost about £2 a day. Nice's guidance said treatment with Acomplia should be continued beyond six months only if the person has lost at least 5 per cent of their initial body weight since starting on the drug. Patients should be taken off the drug if they return to their pre-treatment weight.

The guidance added: 'Treatment should not be continued for longer than two years without a formal clinical assessment and discussion of the individual risks and benefits with the person receiving treatment.' Andrew Dillon, chief executive of Nice, said: 'This is good news for patients for whom orlistat and sibutramine are not effective.

'Being overweight or obese can lead to a range of serious health problems, including heart disease, Type 2 diabetes, osteoarthritis and some cancers.' Government figures released in January showed that more than one million prescriptions for obesity drugs are now given out to patients.

There were 1.06million prescription items for obesity drugs in England in 2006 - more than eight times the 127,000 figure for 1999. Dr David Haslam, clinical director of the National Obesity Forum, said: 'The new guidance from Nice is of real benefit to doctors trying to manage this growing group of patients. 'They have got the balance correct, because it will only be used on those patients for whom it will be good. Patients will not be put at risk.'

A recent survey by the International Association for the Study of Obesity showed that Britons are becoming the fattest people in Europe. English and Scottish women lead the heavyweight league, with almost six in ten overweight or obese. Men fare little better, with at least two-thirds too heavy for their height. Fast food, lack of exercise and a growing reliance on time-saving technology are all blamed for making us the second-fattest nation in the developed world. Only the U.S. outranks us. 25.6.08

Banned: Slimming drug linked to suicide is taken off the shelves 4 months after gaining NICE approval

Safety chiefs have suspended the use of a weight loss drug over concerns that it may be linked to suicide and sudden death. Officials said the risk of side effects from the drug, Acomplia, outweighed its benefits. Almost 100,000 Britons have used the drug since its launch two years ago, when it was hailed as a £2 a day wonder pill.

However, seven deaths, including a suicide, have been associated with the anti-obesity treatment, which also doubles the risk of psychiatric disorders. Around 2,500 adverse reactions have been reported by British patients since it became available to private buyers two years ago. U.S. authorities refused to approve the drug amid mounting scientific evidence of the suicide dangers.

But just four months ago Acomplia was cleared to be used as a 'last-chance' solution on the NHS by the Government's rationing body, the National Institute for Health and Clinical Excellence. Warnings on packets about the higher risk of depression, anxiety and other 'serious' side effects were strengthened after the European Medicines Agency said Acomplia should not be taken by patients with major depression or on antidepressants. Now the EMA has decided to suspend the medicines licence for Acomplia because the 'benefits no longer outweigh its risks'.

It said: 'New data from post-marketing experience and ongoing clinical trials indicated that serious psychiatric disorders may be more common than in the clinical trials.' The EMA said the drug had also proved less effective in 'real life' than in clinical trials.

Patients taking Acomplia are advised to see their doctor or pharmacist but will not be harmed if they stop taking it immediately. Acomplia, also known as rimonabant, was licensed for obese people, as well as overweight patients who have type 2 diabetes or cholesterol problems. Trials showed it could help two out of five patients lose up to ten per cent of their body weight, and help smokers quit.

But evidence emerged that one in ten users may develop mental health side effects including low mood and depression, anxiety, irritability, nervousness and sleep disorders. A scientific review in The Lancet medical journal found a 40 per cent higher chance of being harmed by 'adverse events or serious adverse events'.

The review of trials involving more than 4,000 patients found they were three times more likely to stop treatment because of anxiety than patients given a dummy drug and two and a half times more likely to stop because of depression. Of the total number of reactions reported to Britain's drug regulator, the Medicines and Healthcare products Regulatory Agency, 1,146 involved psychiatric disorders such as depression and suicidal thoughts.

The pill, made by the French firm Sanofi-Aventis, works by interfering with a system in the body which controls energy levels, reducing the cravings for food and helping to prevent fat from being deposited. Weight loss drugs are regarded as important weapons in the war on fat, where changes to lifestyle and diet have failed.

Acomplia costs £44 a month in the UK, and is marketed in 18 European countries. Of patients taking the three licensed drugs, one in ten takes Acomplia - currently estimated to be around 20,000 patients. One in four patients uses sibutramine and two-thirds are using orlistat.

The European regulatory body gave approval in principle for a version of low-dose orlistat called Alli to be sold over the counter. It is already available in the U.S. A spokesman for Sanofi-aventis said 'The company will comply with the European Authorities request to temporarily suspend the marketing authorisation of Acomplia in obese and overweight patients and will make every effort to actively support patients and health care professionals in this process.' 24.10.08

Campaigners are hailing a landmark victory in the fight to overturn a ban on £2.50-a-day Alzheimer's drugs for thousands of NHS patients. The Government's rationing body has been refused the right to appeal against a court order forcing it to reveal how it came to restrict the drugs.

The order by the High Court followed a concerted campaign led by the Alzheimer's Society and partly funded by Daily Mail readers, who raised £230,000. Yesterday's decision by the House of Lords not to allow an appeal confirms the process used by the National Institute for Health and Clinical Excellence in restricting the drugs was unfair in its secrecy.

It means campaigners will be able to take a proper look at the costing calculations used by NICE when it chose not to allow the drugs for patients in the early stages of the disease. The three anti-cholinesterase drugs Aricept, Exelon and Reminyl can only be prescribed for those with moderate symptoms of Alzheimer's, not those in the early stages, who know they are losing their minds. Even though the drugs only cost £2.50 a day for each patient, NICE says they are not costeffective.

As a result, it is thought as many as 100,000 newly diagnosed patients are being denied the drugs each year. In May, three Appeal Court judges found against NICE , saying it must release a full version of the computer cost- effectiveness model used to restrict access to the drugs. By refusing to do so, NICE had put those taking part in consultation - including the Alzheimer's Society - at significant disadvantage in challenging its reliability.

The judges ruled NICE 's actions were 'procedurally unfair'. Experts also argue that NICE 's secretiveness undermines confidence in its rationing of other drugs. Neil Hunt, chief executive of Alzheimer's Society, described the Lords' move yesterday as a ' landmark decision'. 'Having access to NICE 's model will allow us to scrutinise NICE 's calculation and to try to make sense of this unfathomable decision,' he said. 'We strongly believe that NICE 's decision to deny people in the early stages of Alzheimer's disease access to drugs is fundamentally flawed. 'For the price of a cup of coffee, drug treatments can give people hope, dignity and time when it is the most precious.'

Dr David Wilkinson, a leading old age psychiatrist, said some patients and their families have been forced to pay privately for the drugs. 'Most other countries have long since accepted these drugs are effective and make a difference,' he added. The drug firms Eisai, licence holder of Aricept, and Pfizer, licence holder of Exelon and Reminyl, also welcomed the decision. A spokesman for the Association of the British Pharmaceutical Industry said: 'This is a victory for common sense.

'Many patients would be justified in wondering why NICE keeps its decision making process so secret - and why it fought so hard to keep it secret. 'For the first time, the outside world will be able to scrutinise the kinds of calculations and assumptions being used by NICE and enable people to point out where NICE is getting it wrong.'

Andrew Dillon, the chief executive of NICE , said he was 'disappointed' that the House of Lords will not hear its appeal and will make its computer models available on request. He added: 'It is important to recognise that we have not been asked to amend or withdraw our current guidance on the use of these drugs.' 30.10.08

Clinical trial databases are sprouting like weeds, but do they provide the information needed, as around 80% of drugs fail at this stage.

It has become relatively common in psychiatry to hear clinicians and clinical researchers discuss a 'failed trial' - a trial that has failed to confirm the expected superiority of a drug over a placebo condition.

This expectation of superiority may arise, in the United States, on the basis of Food and Drug Administration (FDA) approval of a drug for use, or may simply arise from overconfidence in the drug performance in an early trial.

In either case, the notion of a failed trial, rather than simply a 'negative trial', tends to rely on an overly positive, and perhaps myopic, view of study results, in which an agent with initial evidence of efficacy is assumed to be always efficacious. Subsequent, counterintuitive findings are then assumed to be the result of some failure of 'assay sensitivity' of the trial (e.g. a flaw in sample selection, outcome assessment, clinician adherence).

This reasoning, however, has the potential of distorting the scientific process, such that the adequacy of the trial is judged not by the design but, instead, by the results of the trial itself. Accordingly, we are concerned that the notions of 'failed studies' and 'assay sensitivity' as applied to psychiatric clinical trials are not only scientifically misleading, but also that they have the potential of impeding scientific inquiry and advances in clinical research.

Growing numbers of pharmaceutical companies are halting trials - as 80% of drugs fail stage III trials

Drug trials are over too soon, warn doctors. The benefits of new cancer drugs are being "exaggerated" because trials are stopped too soon, research claims. It says growing numbers of pharmaceutical companies are halting trials, (as around 80% of drugs fail at stage III trials) including those for the breast cancer drugs Herceptin and Lapatinib - shortly after receiving good interim results. And it warns that patients could be at risk if drugs are licensed and rushed into clinics before possible side-effects are identified.

PHASE I: Are not designed to see if the drug works, it is to establish how the body deals with it. Often the most dangerous part of the trial process as this is when a new drug comes into human contact for the first time. Only very small doses are give to volunteers. These first studies evaluate how a new drug or therapy should be given (by mouth, injection into the blood or injection into the muscle), how often, and what dose is safe. A phase I trial usually enrolls a small number of patients, sometimes as few as 6 to 10 people.

PHASE II: Are much larger and involve a group of a few hundred people suffering from the disease the drug is designed to treat. A phase II trial usually focuses on one type of illness, continuing to test the safety of treatment and beginning to evaluate how well it works. This is the essential intermediate step that will determine whether the drug will go into bigger and more costly phase III trials.

PHASE III: These studies test a new drug, a new combination of drugs or a new therapy in comparison to the current standard treatment. A participant will usually be assigned to the standard group or the new group at random (called randomization). Often it involves "double blind" trials, where neither the patient nor doctor knows who is being given the new drug. Phase III trials often enroll large numbers of people and may be conducted at many doctors' offices, clinics and centers nationwide.

It is here at stage III trials that 80% of drugs tested fail to establish their effectiveness and so it is becoming ever more popular for drug companies to halt stage III trials once they have 'some' favourable data to publish. They release a story to the press of usually just one person who has responded well to the medication to create public awareness and also demand for the partially tested and unproven drug, Herceptin was one such case.

But the real benefit of some drugs may be exaggerated because of a growing tendency for firms and investigators to call a premature halt to trials the moment a benefit appears, experts warn today. Without such evidence, unsafe and ineffective drugs are being marketed and prescribed, and patients' health could be jeopardised. Three-quarters of the trials were halted after independent monitoring committees said the drugs were so successful, it would be "unethical" to deprive patients of them.

Italian researchers writing in the cancer journal Annals of Oncology reveal a dramatic increase in the number of studies terminated early. They claim that in some cases drug companies are rushing with early, incomplete results to the licensing authorities. One reason, the researchers suggest, is a desire to get their drugs on the market ahead of their competitors. Among 14 of these early results published between 2005 and 2007, 11 were used to support a licence application.

"This suggests a commercial component in stopping trials prematurely. In fact, this strategy could guarantee quicker access to the market for companies," said one of the authors, Dr Giovanni Apolone from the Mario Negri Institute for Pharmacological Research in Milan.

Without the complete information gathered from a full-length trial, he says, it is not certain that a drug is both as effective as the investigators say, and safe in the long term. It can take years for the adverse effects of a drug to come out. The 25 prematurely halted trials in the study lasted, on average, for 30 months.

Professor Stuart Pocock, professor of medical statistics at the London School of Hygiene and Tropical Medicine, said there was "an underlying bias towards exaggeration in a trial that stops early". He cited as an example the trials of one of the earliest Aids drugs, AZT. In the United States trials of AZT were stopped early when it appeared that people with HIV were doing well. But the European arm of the trials "went on much longer and showed nothing like the same breakthrough", he said. "That's why they decided they needed multi-drug therapy."

Among the drug trials that have been stopped early are those of well-known drugs heralded as breakthroughs, such as Herceptin (trastuzumab) and Tyverb (lapatinib) for breast cancer and Avastin (bevacizumab) for bowel and renal cancer. The quality of drug trials had risen enormously in the past 20 years, said Professor David Kerr, editor in chief of the journal, but he added: "Interpreting trials that have been stopped prematurely must be done with caution."

He and the other experts said trials should not often be stopped early - the ethical duty to give all patients in the trial the drug that is working best should not override the duty to the public at large to obtain better long-term data on how well and how safely the drug works. "We, as scientists, put a great deal of work and effort into designing appropriate clinical trials, and in all but the rarest of cases we should not rush to abandon those designs in the face of early signs of benefit," he said.

The Italian group analysed 25 randomised controlled trials of cancer drugs that had been stopped early after showing some benefit to patients in the years between 1997 and 2007. More than half of them were stopped in the past three years. Five of them had enrolled less than 40% of the target number of patients. "It is obvious that the risk of overestimating treatment effects increases markedly when the sample is small," they write.

They recommend that an independent board of scientists should make the decision to stop a trial or continue. Professor Kerr called for transparency from the drug companies, saying they should publish the protocol for every trial. 15.3.08

As more people fill surgeries seeking a cure for ageing or alcoholism, doctors are rebelling. Perhaps we need less medicine, not more.

In the offices of the lobby group Action for ME, Brian Dow insists that what used to be dismissed as 'yuppie flu', then chronic fatigue syndrome, is also an illness, 'myalgic encephalomyelitis', even though there is no evidence, despite the name's suggestion, of brain infection. 'It is an illness,' said Dow. 'Calling it chronic fatigue syndrome is like calling Alzheimer's chronic forgetfulness - it just doesn't do justice to the condition.'

Children that used to be troublesome now suffer from ADHD - attention deficit-hyperactivity disorder. Men who fail to perform are now suffering from 'erectile dysfunction', curable with a little blue pill. Middle-aged men who used to be grumpy are now suffering from the 'male menopause', in need of hormone therapy.

But last week, the doctors hit back. In a special edition of the British Medical Journal , the clinical publication of the British Medical Association, physicians and academics tried to turn back the tide on the 'medicalisation' of everyday life. People, who would previously learn to deal with common problems themselves now turn to their doctors for help - and the doctors have had enough. It is not only the patients they are fed up with, but their lobby groups and an unquestioning media and drugs companies determined to turn everything into a 'disease' in need of treatment.

They fear this medicalisation has gone too far and is harming society, preventing us from accepting our humanity. It encourages us to see ourselves as victims in search of a cure, perpetually suffering from one ailment or another.

In 1976, the writer Ivan Illich warned in a book, Limits to Medicine, that 'the medical establishment has become a major threat to health'. At the time, he was dismissed as a maverick, but a quarter of a century later, even the medical establishment is prepared to admit that he may well be right.

In its leader comment last week, the BMJ argued that there was almost certainly too much medicine and doctors should encourage people to look after themselves. 'The cost of trying to defeat death, pain and sickness is unlimited and, beyond a certain point, every penny spent may make the problem worse, eroding still further the human capacity to cope with reality,' it thundered.

The BMJ undertook a poll among British doctors to decide the top 'non-diseases' that are defined as medical conditions but that doctors feel shouldn't be. In first place came 'ageing', followed by work, boredom and bags under the eyes. But the list of bugbears continued through baldness and freckles, ugliness, jet lag, gap teeth, smoking, shortness, nail-biting, bad breath, allergies, shyness, insomnia, hairiness and diabetes.

From doctors and patients to drug companies and the media, there are relentless pressures to classify any condition as a disease. Richard Smith, the BMJ 's editor, wrote: 'Doctors, particularly some specialists, may welcome the boost to status, influence and income that comes when new territory is defined as medical. Global pharmaceutical companies have a clear interest in medicalising life's problems. Likewise companies manufacturing mammography equipment. Many journalists and editors still delight in mindless medical formulas, where fear-mongering about the latest killer disease is accompanied by news of the latest wonder drug.'

Dow, at Action for ME, says that having it accepted as a medical condition has definite advantages: 'If you don't validate it by calling it a condition or illness, you are almost saying it doesn't exist. People care about it being recognised as serious, and about doctors taking it seriously.'

Even people with conditions that definitely exist - such as alcoholism - can benefit from having it classified as a disease. Eric Appleby, the director of Alcohol Concern, doesn't classify it as a disease, but he understands why AA does: 'Calling it a disease takes any moral judgment out of it. It's a clear, straightforward message that can help a lot of people. If alcoholism is a disease, then the alcoholic is absolved of blame.'

But drug companies have a vested interest in disease-mongering - because they profit by providing cures. Conditions are hyped as diseases, mild conditions as devastating, rare conditions as common. Whereas shy people used to just rely on a glass of wine, Roche developed the drug Manerix to treat 'social phobia'. It initially claimed that one million Australians suffered this 'soul-destroying' disorder, but then admitted it couldn't even find enough people for clinical trials.

The drugs companies target newspapers with stories designed to create fear about a condition, and then company-sponsored advisory boards supply 'independent experts' for the stories, while consumer groups supply 'victims'. The drug companies argue that there are clear benefits to this system. Their drugs are popular because they improve lives.

Dr Iona Heath, head of ethics at the Royal College of General Practitioners, warns that there could also be clear downsides: 'Alternative approaches - emphasising the self-limiting or relatively benign natural history of a problem, or the importance of personal coping strategies - are played down or ignored. The disease-mongers gnaw away at our self-confidence. Inappropriate medicalisation carries the dangers of unnecessary labelling, poor treatment decisions, economic waste, as well as the costs that result when resources are diverted from treating or preventing more serious disease. At a deeper level, it may help to feed obsessions with health.'

When it was launched, Viagra quickly became one of the bestselling drugs of all time, presumably because men found it helped. But Kaye Wellings, director of the Centre for Sexual Health Research in London, warned that relying on these treatments could mean that people fail to address relationship problems: 'Thinking that a little blue pill will fix it could leave the underlying problems there. Doctor's don't want their surgeries full of people seeking medical solutions to their relationship problems.'

At a philosophical level, Illich argued in his book that death, pain and sickness are part of being human, and that cultures have developed the means to help people cope with all three. Modern medicine has destroyed these practices.

But with all these treatments, are we feeling any better? Apparently not. Studies by Amartya Sen, a Nobel-prize winning economist, show that the more a society depends on healthcare, the more likely are its inhabitants to consider themselves sick. In a world where perception is reality, perhaps we are better off with less medicine, not more. 14.2.02

Big business is pushing politicians into peddling their pills, claims medic. DOCTORS give you medicine to make you better or improve your health, right? Not so, according to Kentish Town GP Dr Iona Heath. Writing in the British Medical Journal, the GP from the Caversham Group Practice in Leighton Road, has attacked government policy for promoting drugs that prevent illnesses. She claims they are creating a scare culture that is unnecessary, affects quality of life and has disastrous knock-on effects.

And behind the government's misguided aim of using medicines to prevent illness are drug companies pushing their wares on health policy makers, Dr Heath claims. To sell drugs they have created a prevention culture that makes people sick with worry, she says. Dr Heath also claims that treating the side effects of this drug use costs the NHS nearly £500m a year and uses up almost five per cent of hospital beds – drawing cash away from much-needed treatments.

Dr Heath said: “There is evidence that the more people are exposed to the rhetoric of preventative health care, the sicker they feel.”
She wants a tax placed on drugs like statin, which reduces the risk of heart attacks, and the cash spent on treatments in developing countries.
Dr Heath says: “There is excessive self-confidence of preventative medicine. The emphasis on preventative care damages patients by tipping them towards misery. “This process is built on a foundation of fear and is fanned by economic and political pressures.”

And she says that this is partly down to a chain of pressures in forming health policy. She said: “We need to move away from the bullying of patients by doctors, of doctors by politicians and of politicians by multinational corporations.”

The pharmaceutical industry lobbyists set the agenda for what doctors should be doing, Dr Heath claims. She writes: “It is in the interest of the pharmaceutical industry that the majority should be persuaded that they need to take action to remain healthy by being screened and taking preventative medicine. “How can this level of medicine taking be appropriate in a population which, by all objective measures, is healthier than ever before in history?”

And she asks the philosophical question: “As doctors, are we simply interested in postponing death? “Should we not also be interested in reducing rather than fanning the human burden of fear and in emphasising rather than undermining health? “It is contingency – chance, fate, uncertainty – that makes life beautiful. It is the enduring truth that we can never know what will happen tomorrow, whether or not we have taken our aspirin, that makes life thrilling.” 29.4.05

An education trial of just 3 pupils hailed a success by Government ministers

PARENTS will be able to drop their kids off for lessons at supermarkets, it emerged yesterday. Hour-long one-to-one tuition will be provided while mums and dads shop. The supermarket swots scheme is part of a drive to help children struggling at school with reading and writing.

The Government idea was trialled with three pupils at an Asda in Bexleyheath, SouthEast London – and proved a success. Bexley Council arranged for teachers to use a room at the store to work with kids. Teachers select the pupils who they think need extra help.

Ten councils are running the Making Good Progress scheme, which provides ten one-on-one after-school tuition sessions. Now ministers want to extend it to more weekend sessions at supermarkets. Schools minister Jim Knight told The Sun: “It's been a big success. It's helping children who are struggling at school but is convenient for parents too. “I'd like to see this sort of scheme extended across the country.” 30.6.08

Prince Harry's £1.1million charity has given just £84,000 to the Aids orphans it was set up to support, it was revealed yesterday. Sentebale - the charity the prince founded in honour of his late mother - has distributed less than a tenth of money it has raised and has almost £600,000 still sitting in a bank account.

Yet £250,000 has been spent on staffing costs, with one official paid more than £90,000, according to the first accounts filed to the Charity Commission. Aides admitted Harry was "bitterly disappointed" by the charity's performance and said he desperately wants the money to help orphans he met in the southern African country of Lesotho. But officials also stressed that any new charity needs to take time establishing its organisation and operation before handing out money.

Sentebale - which means "forget me not" - has raised £1.15million since it was launched two years ago. It received £150,000 from last year's Concert for Diana and £752,000 from the British Red Cross's Lesotho fund. But only £84,000 has been paid out to support children in Lesotho , where 200,000 youngsters have lost at least one parent to the disease.

Accounts for the charity's first 17 months show the vast majority of its spending went on running costs, including £75,000 on vehicles and equipment and £86,000 on setting up a website. Another £47,000 was paid to the offices of Harry's father Prince Charles and his wife Camilla, to cover consultancy charges and salaries there, according to the accounts.

Repayments worth £21,715 were made to Traditional Arts, a company where Sentebale's chief executive Geoffrey Matthews is a director. Mr Matthews also received fees worth £38,989. A Clarence House spokesman said: "Prince Harry is not angered by Sentebale's performance.

"He understands the importance of establishing its office on the ground in Lesotho . "It has begun to fulfil his vision of supporting small, community-based projects and by the end of August it will have spent £225,000 directly on such projects. "The last thing he wanted was for Sentebale to distribute funds without checking they were going to the right projects."

Sentebale was set up in 2006 by Prince Harry and Lesotho 's Prince Seeiso to help children affected by the country's HIV/Aids pandemic. Lesotho has one of the worst infection rates in the world. More than one in six of its 2.2million population are estimated to be HIV positive.

Harry spent two months working with children affected by the disease in 2004, during a gap year before he started his Army training, and was deeply moved by their plight. He said he wanted his charity to honour his mother's work with Aids victims and orphaned children, adding: "I really feel that by doing this I can follow in my mother's footsteps and keep her legacy alive." 18.3.08

A drugs manufacturer has been criticised, but not prosecuted, over claims that it withheld information about the increased risk of suicide for children taking Seroxat, the bestselling antidepressant drug. Ministers have promised to tighten laws that require pharmaceutical companies to disclose data from clinical trials after a report suggested that GlaxoSmithKline (GSK) knew about safety risks but failed to report them to the medicines safety watchdog for five years.

GSK should have been much quicker to raise the alarm on the risk of suicidal behaviour associated with the drug in under18s, the Medicines and Healthcare products Regulatory Agency (MHRA) has found. But after a four-year investigation involving a million pages of evidence, the agency has said that it would take no legal action against the company because it has no realistic prospect of securing a conviction.

GSK submitted data from clinical trials to the MHRA in May 2003 showing that patients under 18 had a six or sevenfold increased risk of suicidal behaviour if they were treated with Seroxat than if they received a placebo. Data also showed that the drug was not effective for treating depression in children and adolescents. Leaked documents suggested that GSK had known about these results as early as 1998.

Seroxat is the most frequently prescribed antidepressant in Britain and among the selective serotonin reuptake inhibitors ( SSRI ) group of drugs that account for 16 million prescriptions a year. It was subsequently banned for use in under18s.

GSK rejected claims that it had improperly withheld trial information about the drug.

Kent Woods, chief executive of the MHRA, said yesterday that the agency was disappointed that the company had not given it the information earlier, adding that drug companies had an “ethical responsibility” to do so. 7.3.08

The NHS faces a spiral of decline compared with health services in other advanced countries because Gordon Brown is backing away from making reforms, a report has claimed. The study, by the Reform think tank, says ministers and the Department of Health, are "in denial" over what is going on in the health service.

The NHS faces a "perfect storm", caused by a combination of an ageing population, economic pressures, expensive new technologies and a population with constantly rising expectations, according to the report. The Prime Minister's claim to have all but completed Labour's ''change agenda" - involving more patient choice and expanding the role of the private sector in providing NHS care - is "profoundly misleading", it says.

The reality, it claims, is that the ambitious ''change agenda" has been at best halted and at worst placed in reverse since Mr Brown entered No10 last June. "Each of the reform programmes is either far behind schedule or in actual retreat," the report says.

It adds that a recent decision by Alan Johnson, the Health Secretary, to downgrade its programme for providing new independent sector treatment centres (private hospitals in which care is paid for by the NHS) was the "most obvious sign of this change".

Reform suggests that the private sector, which has geared up to take on an ever increasing amount of work within the NHS, can no longer expect "any substantial increase in opportunities from the NHS over the next three years". The Government is, it says, turning a blind eye to evidence from countries such as Spain, Australia, Denmark and Belgium, where waiting lists have been virtually eliminated and services improved by bolstering choice and encouraging competition.

The report, NHS reform: National Mantra, Not Local Reality, uses recent academic studies to show that the performance of the NHS in treating patients from birth to old age is lagging behind comparable equivalents abroad. Nick Bosanquet, a professor of health policy at Imperial College London and a consultant director of Reform, said: "The NHS does not need a 'charter' which amounts to a statement of good intentions.

Encouraging people with type 2 diabetes to monitor their own blood sugar levels may not improve care and is a waste of NHS resources, two studies suggest. One group of researchers found patients who self-test are more likely to end up depressed than in better health. Another found self-testing costs £90 extra per patient per year and may lead to worse quality of life, the British Medical Journal reported.

But the government said for some people self-monitoring could be very useful. Being able to monitor blood sugar levels is very helpful for patients who need to take insulin to control their diabetes. In recent years there has also been a big push to encourage self-testing in diabetic patients not treated with insulin.

There are 2.35m people with diabetes in the UK , the vast majority of whom have type 2 diabetes where the body does not produce enough insulin or the insulin that is produced does not work properly. A trial of 180 people newly diagnosed with type 2 diabetes in Northern Ireland found self-monitoring did not improve blood glucose control compared with normal care. And those who self-monitored had a 6% higher score for depression.

Study leader Dr Maurice O'Kane said: "What we can say is if people do not want to monitor there's no evidence their care will be inferior." NHS funding of test strips increased from £85m to £118m between 2001 and 2003. University of Oxford researchers looked at the cost-effectiveness of self-monitoring in type 2 diabetes on top of usual care, using results from a trial of 450 patients published last year. They found self-monitoring of blood glucose is significantly more expensive and associated with a lower quality of life, probably due to increased levels of anxiety and depression.

Study leader Dr Judit Simon said: "The current study shows routine self-monitoring is not cost-effective and there is a negative effect on quality of life for some people." Libby Dowling, care advisor at Diabetes UK , said decisions on self-monitoring must be made on an individual basis and patients must be educated on what to do with the results.

"Poorly controlled diabetes can increase the risk of complications such as heart disease, blindness and stroke, so short-term cost savings made by reducing the number of people self-monitoring could be dangerous for the individual and lead to higher costs for the NHS in the long term."

A spokesman for the Department of Health said: " NICE guidelines state that for some people self-monitoring can be useful in their overall approach to self-care. "However, self-monitoring cannot be looked at in isolation and in order to obtain maximum benefit people with diabetes need to access to the right education and support to understand what the results mean for them personally." 18.4.08

Around 70 per cent of GPs feel complementary medicine should be freely available

HOMEOPATHY is one of the most hotly debated areas of alternative medicine. Yet its supporters point out that the numbers of those turning to homeopathic remedies is growing by around 20 per cent a year and last year 22 per cent of people in the UK bought remedies for a wide range of ailments.

It's estimated that around 30 million people in Europe visit homeopaths and here the therapy has had many high-profile supporters including the Queen, Sir Paul McCartney, Jude Law and David Beckham. Homeopathic remedies differ from conventional drug-related treatments by using raw extracts from plants or animals, or powders of minerals and salts made into a `tincture' and mixed with alcohol.

They treat a variety of conditions from sore throats and chronic illnesses such as arthritis through to asthma, anxiety and chronic fatigue. Patients are given tiny diluted doses of something that causes symptoms similar to those they are already experiencing. So coffee, which uses sleep disturbance, can be used as a homeopathic treatment to prevent insomnia. The theory is that a minute quantity will stimulate the body's own healing powers without side-effects.

But among the medical profession and scientists there are those who believe this theory flies in the face of science which follows the principle that the stronger the medicine - or the more concentrated a dissolved substance - the more powerful it becomes.

Homeopathy's outspoken critics include Prof Michael Baum, Professor Emeritus of Surgery at University College, London. "There's a complete lack of clinical evidence to support alternative remedies," he says. "Medicine is based on evidence. If a drug or surgical treatment does not pass stringent surgical trials, it is abandoned.

"The results of clinical trials are published whether they are favourable or not. Yet when it comes to homeopathy, the standards of evidence are highly questionable." But Andy Kirk, chair of The Society of Homeopaths which is the largest body of professional homeopaths in Europe, points to its general acceptance within the National Health Service as it has been available since its inception in 1948.

He says: "Around 70 per cent of GPs feel complementary medicine should be freely available. "Also, substantial savings could be made by introducing homeopathy into general practice."

There are around 3,900 registered homeopaths practising in the UK and five NHS-funded homeopathic hospitals. Kirk adds: "It's been shown that adding therapies such as homeopathy, at a minute cost to conventional NHS care, results in improved outcomes for similar or reduced cost.

"By comparison, the NHS spends £466m a year treating adverse effects (ADR) from medicines." 22.11.07

Multinational drug companies are showering doctors in the developing world with gifts and inducements to persuade them to prescribe drugs of dubious value, an investigation has revealed. Intense marketing of medicines has resulted in up to half of drugs being wrongly prescribed, the campaign group Consumers International says in its report Drugs, Doctors and Dinners. It calls for a ban on gifts to all doctors.

A GP in Malaysia, Rafik Ibrahim, who practises near the capital, Kuala Lumpur, described how in a period of five weeks in August last year he spent 17 hours with drug-sales representatives who approached him on behalf of 25 drug companies. In Pakistan, doctors who wrote 200 prescriptions for one high-price drug were offered the down payment on a new car.

Multinational companies are turning to the developing world as profits stagnate in the West. But regulation in these countries is weak and drug sales representatives can influence prescribing by the inducements they offer. India was one of the fastest-growing markets last year, with sales increasing 17.5 per cent to $7.3bn. But the health commission, in 2005, labelled 10 out of the 25 top-selling medicines as being "irrational or non-essential or hazardous".

Richard Lloyd, of Consumers International, said: "The pharma industry sees the developing world as a trillion-dollar opportunity... but consumer health expenditure in these countries can ill afford to be squandered." He added: "The best way to ensure patients in the developing world get rational impartial treatment is... to ban gifts for all doctors." 31.10.07

They know next to nothing about the powerful drugs they prescribe for you, leading medical experts admit Doctors know so little about the drugs that they are prescribing that their
ignorance is harming – and sometimes killing – their patients, leading pharmacologists have said this week.

They are no longer being taught the basics about drugs and how they work – and so instead they have to be led by drug salesmen, who make great claims for their drugs while underplaying the dangers. It's an alarming situation that is worrying medical students, who have privately expressed their concerns about their lack of prescribing knowledge, says Prof David Webb, professor of therapeutics and pharmacology at the University of Edinburgh.

Patients are becoming ill and some are dying as a result of poor prescribing. There is no doubt about that. A substantial proportion of that is undoubtedly avoidable, he said, 'The level of doctors' drug knowledge is especially worrying at a time when drug company hype and influence has reached fever pitch, and when drugs have become more complex, and dangerous, too.

Even on conservative estimates, 1 out of every 16 hospital admissions is caused by an adverse reaction to a drug. Once there, up to 10 per cent of those will suffer another adverse drug reaction while in the care of a hospital doctor. It's a scandal – but it doesn't have to happen to you or your family. It's all the fault of the training hospitals, which are no longer teaching basic pharmacology and prescribing.

The competence of young doctors in prescribing is a very serious problem, says Prof Sir Michael Rawlins, chairman of the UK medical standards group, National Institute for Health and Clinical Excellence (NICE). Ultimately, the blame lies with the General Medical Council, he says, which has changed the emphasis of doctor training to 'problem solving' rather than learning the basics.

The GMC issued its new teaching edict around 16 years ago, around the time when drug companies were coming up with more complex medications. The problem has been exacerbated more recently by the UK government's obsession with performance targets. As a result, many clinical pharmacology departments had closed down, and there are just 68 specialists who practise clinical pharmacology and therapeutics in Britain, a fall of 24 per cent over the last 10 years.

Of those that are left, half will retire in the next 10 years, and are unlikely to be replaced. How you can make up for your doctor's ignorance. Even Prof Sir Michael Rawlins admits that you can no longer depend on the knowledge of your doctor. He just doesn't know. But you can know everything that's important to know about every major drug, every major medical procedure – so you can make sensible decisions based on scientific fact. Your health is far too important to leave in the hands of doctors who have never been taught the basic of pharmacology.

More than 80 percent of Britons with a serious long-term lung disease that is linked to smoking do not know they have the illness, health experts said on Thursday. Chronic Obstructive Pulmonary Disease (COPD), which includes bronchitis and emphysema, is a leading cause of death worldwide but it is often undiagnosed.

"It is crucial to identify smokers with COPD and take urgent action to support them in stopping smoking because the most effective way of halting the progression of the disease is to stop smoking," said Professor Robert West of the charity Cancer Research UK.

West and his team identified 1,093 people with COPD after conducting lung function and saliva tests on 8,215 people over 35 years old. More than 80 percent of them were not aware they had COPD. The research published online by the journal Thorax found that smokers who had the illness were more dependent on cigarettes and smoked more than people without it.

Deaths from COPD are increasing in most countries. The World Health Organisation (WHO) estimates it will become the third-biggest cause of death worldwide by 2020. The illness afflicts people over 40 who have been smoking for many years. It contributes to other disorders such as pneumonia, heart disease and stroke. There is no cure but treatment can relieve the symptoms and therapies to slow its progression are being tested.

The illness begins with a persistent cough and increased mucous. It eventually leads to fatigue, shortness of breath and difficulty breathing as the lungs are destroyed.

"But many smokers think these are normal symptoms of smoking and do not realise that they can be the beginnings of a disease which, in many cases, will leave them disabled or dead if they do not stop smoking," said West. 21.9.06

Nearly 200 criminals who were forced to tackle their heroin addiction in prison by going cold turkey have won a £750,000 payout.

The out of court settlement from the Prison Service has been rubber stamped by a High Court judge. It comes following a test case by six inmates, but with the Government keen to avoid additional costs, the 197 prisoners can now expect to receive over £3,750 each.

The prisoners say a lack of treatment during withdrawal amounted to assault, but Shadow Home Secretary David Davis said the case set a 'disastrous' precedent and accused Home Secretary John Reid of failing to protect the public.

A Home Office spokeswoman said: 'It was decided, however reluctantly, to settle these cases outside of court in order to minimise costs to the taxpayer.' Former Tory prisons minister Ann Widdecombe said: 'It's an insult to every victim and every law abiding person. As far as I'm concerned there is no human right to continue a drug habit when you go to prison.'

Alternative treatments do work - Science backs up claims for certain therapies

It's A controversial field of medicine dismissed by some as quackery - but now a new book claims to reveal which complementary therapies are backed by scientific evidence that they really do work. A review of more than 10,000 studies found that echinacea and melatonin are among those with proven benefits, but the jury is still out on claims for some popular remedies, such as green tea.

Professor Jayney Goddard, president of the Complementary Medical Association (CMA), who edited the book, said that she had been surprised by the evidence for some of the treatments. "A real old wives' tale, which is taking hawthorn for the heart, is actually borne out in trials," she said. "With complementary medicine a lot of detractors will say there is no evidence - in actual fact if they took the time to look, there is an incredible amount."

The newly published encyclopedia gathers evidence on complementary medicine based on double-blind, placebo-controlled studies, regarded as the best assessment of whether a treatment is effective. However, one problem is that this type of study is difficult to carry out on therapies prescribed on an individualised basis, such as acupuncture, or homeopathy.

Another reason for a lack of research in the field of complementary medicine, Goddard explained, was that there is little incentive to invest in researching remedies which cannot be exclusively manufactured by a drugs company. "You can't patent a herb, you can't patent massage and you can't patent homeopathic remedies or a vitamin," she said. "The people who actually do the large-scale medical trials are the pharmaceutical companies, but if they can't get a product out of it, why should they bother? "Some people hold a view of big, bad pharmaceutical companies', but actually they are just companies that have a legal duty to their shareholders to make a profit."

Recent research revealed that people in Britain now spend up to £191 million on complementary therapies annually, an increase of 32% in the past five years. The use of these remedies is still hotly debated. While supporters include Prince Charles, some of the UK's most eminent doctors last year called for a halt on NHS spending on treatments such as homeopathy. A spokeswoman for independent science body the Royal Society said it was vital that complementary and alternative medicines were properly tested and patients did not receive "misleading information" about their effectiveness.

"Furthermore, NHS provision for complementary and alternative medicines, as for conventional medicines, should be confined to treatments that are supported by adequate diagnosis together with evidence of both effectiveness and safety," she added. Dr Mairi Scott, chairwoman of the Royal College of General Practitioners in Scotland, said there were some complementary therapies patients put "great faith" in: "Homeopathy is available within the NHS, although it is a pretty scarce resource. I think there is not a lot of evidence for it, but there is a recognition that some patients feel the benefit from it sometimes.

"Other therapies such as reflexology are more about relaxation and coping strategies and are not what I would call therapies in the traditional sense." She added: "As long as the patients have the information from people who deliver these services and they operate within a safe environment, then we wouldn't have comment one way or the other." Sunday Herald Sept 07.

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Appliance of science proves complementary

For some people it is just a collection of old wives' tales. But for others it is the secret to a longer, healthier life. Complementary medicine has sharply divided opinion with question marks over the scientific truth behind claims. But now an encyclopedia has been published including much of the scientific research into this increasingly popular branch of medicine.

Professor Jayney Goddard, the President of the Complementary Medical Association, has edited Complementary and Alternative Health: The Scientific Verdict On What Really Works. It looks into 10,000 scientific trials. Most trials are double blind, which means neither doctors nor patients know who is taking the real substance and who is taking the placebo.

But Prof Goddard says it is still not enough. "The problem is that most research is carried out by pharmaceutical companies looking to patent a product," she said. "But you can't patent herbs or massage. So there needs to be much more research carried out. "However, a lot of research backs up many of the claims made about complementary treatments.

"For example, the latest research has shown that arnica helps in reducing swelling and bruising." She added: "I am not saying these are an alternative to modern chemical medicine, they are meant to be complementary.

"In France and Germany doctors deal with complementary medicine as much as they do with ordinary medicine. That is why St John's Wort is the most common anti-depressant prescribed in those countries. "We have a different attitude in the UK, although that is changing with a new generation of doctors."

The complementary market is growing with £191 million sales in the last year, 32% up on five years ago. The increasing popularity has been noted at the Union Street branch of Holland and Barrett. Store manager Stephanie Hundtofte said: "We find the most popular products are anti-arthritis ones, such as codliver oil and fish oils. "St John's Wort is very popular as an anti-depressant. It is not addictive, like other, conventional anti-depressants." Sept 07

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Co-ordinated campaign to derail alternative therapies on the NHS

In the year 1854 a terrible recrudescence of cholera, due, as was supposed, to the contamination of the water furnished by the notorious Broad Street pump, in the parish of St James's, Westminster, ravaged the Metropolis and particularly the immediate neighbourhood of the Hospital (Golden Square) and which to the present day constitute the treatment mainly relied upon by homœopathic practitioners.

The whole of the wards of the London Homœopathic Hospital were devoted to the treatment of the epidemic, and 64 cases of cholera and 331 of choleraic and simple diarrhœa were treated. Of the 61 cases of cholera treated, 10 died, a percentage of 16.4. The neighbouring Middlesex Hospital received 231 cases of cholera, of the cholera patients treated 123 died, a fatality rate of 53.2 per cent.

Returns were sent in from the London Homœopathic Hospital, giving the names and addresses of the patients treated, the symptoms, remedies, and result in each case, and a summary of those results. This was not a question of theory, or of any particular school; it was a question of facts and statistics affecting the public health.

But the report of the Board of Health was presented to Parliament without the slightest reference to the London Homœopathic Hospital or to the brilliant results which its physicians had achieved. Complaint was, of course, made to the Board of Health and duly reterred to its Medical Committee, with the result that the Board received from the committee a resolution, which, for ingenuity of disingenuousness and illiberality, can hardly ever have been equalled. "That by introducing the returns of homœopathic practitioners they (the Treatment Committee) would not only compromise the value and utility of their averages of Cure, as deduced from the operation of known remedies, but they would give an unjustifiable sanction to an empirical practice, alike opposed to the maintenance of truth and to the progress of science".

The House of Commons, which was more anxious for the "progress of science" and the "value and utility of averages" than for "the operation of known remedies," to say nothing of its great duty to the people it represented, forthwith ordered a special return of the ignored homœopathic statistics, which was in due course made by the Board of Health, and these returns were ordered by the House to be printed on May 21, 1855. They remain among Parliamentary Papers to this day, a standing monument alike of the success of the new policy and of the obscurantism of the old.

Against this backdrop, a leaked memo of September 2007, has reveals that there is 'a co-ordinated campaign' to derail alternative therapies on the NHS.

The Queen's personal physician and Britain's leading homoeopath yesterday warned of a "co-ordinated campaign to derail complementary therapies in the NHS". A leaked memo seen by The Independent on Sunday identifies several influential groups working together for the removal of homoeopathy from the NHS.

According to Dr Peter Fisher, clinical director of the Royal London Homoeopathic Hospital, there has been a 20 per cent reduction in referrals to the hospital in the past year, as new patients are refused funding by a growing number of primary care trusts. The hospital – an NHS centre of excellence – could be forced drastically to cut services if other PCTs introduce the same system and if funding for patients currently undergoing treatment is withdrawn.

Dr Fisher, whose patients include the supermodel Claudia Schiffer, pointed to the fact that some six million people in the UK use complementary therapies each year. Advocates include David Beckham and Catherine Zeta-Jones. Dr Fisher said: "There are some patients with conditions that prescription drugs alone do not help. There is a huge potential to help these patients and those who experience adverse side-effects from conventional medicines with complementary therapies."

The four NHS homoeopathic hospitals combine therapies to treat chronic conditions, such as depression, irritable bowel syndrome and osteoarthritis that conventional medicines alone can fail. But this relatively new integrated approach offends the beliefs and aims of certain groups. "The campaign dates back two years starting with several eminent and mostly retired scientists and doctors who have a way of seeing the world and medicine which complementary therapies do not sit within," Dr Fisher said. "The pharmaceutical industry is worried for its future, as public opinion is shifting towards complementary therapies."

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Talk therapy for the depressed 'could be wasting millions', say psychotherapists

Depression sufferers may not be receiving the most suitable treatment because of a Government obsession with one type of therapy, warn leading psychotherapists. The idea that Cognitive Behavioural Therapy is more effective than other methods is a 'myth', they claim. Last year Health Secretary Alan Johnson announced that by 2010, the Government would spend £173million a year on CBT.

Rather than using drugs to treat depression and other mental health disorders, CBT involves talking through issues. Instead of investigating the causes of mental health problems, it explores how a patient thinks about the world, with the aim of changing their thinking and actions to relieve distress and symptoms. For example, a patient having a bad day feels low and goes out to the shops, where they meet someone they know who apparently ignores them. CBT offers alternative ways of looking at the situation so the patient does not jump to the conclusion they are being ignored, which leads to a vicious circle of lower self-esteem. Instead the patient is encouraged to think about the other person's feelings, and what helpful actions could be used to make the situation better.

But leading psychotherapy experts at an international conference at the University of East Anglia will today demand a wider range of therapies on the NHS. While acknowledging CBT's value, they believe it is receiving the lion's share of funding to the exclusion of other treatments, which they claim are equally effective and, for some patients, better. Professor Mick Cooper of the University of Strathclyde said: 'The Government's decision to spend £173million on CBT can only be applauded, but not all clients will benefit from that approach. 'There is clear evidence that some clients will do better with other forms of therapy. It all depends on who the client is, and what kind of treatment they can most make use of.'

Professor Cooper added: 'More important is the client's level of motivation. After that, the key ingredient seems to be the quality of the therapeutic relationship, with warm, understanding, trustworthy therapists having the best results.' Critics say CBT, which is provided on an individual basis or as group therapy, is just a 'sticking plaster' approach to problems. The Government's increased funding, which will allow 900,000 patients to receive treatment, was announced as part of its Improving Access to Psychological Therapies programme. But at today's conference of the World Association for Person-Centered and Experiential Psychotherapy and Counselling, British and U. S . researchers will present data that they say debunks the widespread belief in CBT's superior effectiveness.

In a joint statement headed by Professor Cooper, they said that the assumption was merely a result of its increased funding meaning that more studies had been published on it. Professor Cooper said: 'The result is a widespread belief that no one takes responsibility for. In other words, a myth. This situation has direct negative consequences for other welldeveloped psychotherapies. 'People who get therapy show substantially more change than people who don't get therapy, regardless of the type of therapy they get.'

A review of more than 80 studies found these other forms of psychotherapy were as effective as CBT. Professor Cooper said: 'In view of these and other data, it is scientifically irresponsible to continue to imply and act as though CBTs are more effective. Such claims harm the public by restricting patient choice and discourage some psychologically distressed people from seeking treatment. 'We urge our CBT colleagues and Government officials to refrain from acting on this harmful myth and to broaden the scope of access to include other effective forms of psychotherapy and counselling.' 7.7.08

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Are we being hoodwinked by alternative medicine? Two leading scientists examine the evidence

Just how effective is complementary medicine? In a new book, Edzard Ernst, the UK's first professor of complementary medicine, and Simon Singh, a leading scientist and documentary maker, set out to answer that question. They have produced a definitive - if controversial - guide to what works, and what doesn't. It makes indispensable, if sometimes alarming, reading...

Which therapies work and which ones are useless? Which therapies are safe and which ones are dangerous? These are questions that doctors have asked themselves for millennia in relation to all forms of medicine. And yet it is only comparatively recently that they have developed an approach that allows them to separate the effective from the ineffective, and the safe from the dangerous.

This approach, known as evidence-based medicine, has revolutionised medical practice, transforming it from an industry of charlatans and incompetents into a system of healthcare that can deliver such miracles as transplanting kidneys, removing cataracts, combating childhood diseases, eradicating smallpox and saving millions of lives each year.

Evidence-based medicine is about using the current best evidence - gathered through clinical trials and other scientific investigations - to make medical decisions. Alternative medicine claims to be able to treat the same illnesses and diseases that conventional medicine tries to tackle.

We set out to establish the truth of these claims by using the principles of evidence-based medicine. Some people will be suspicious of this, perceiving evidence-based medicine as a strategy for allowing the medical establishment to defend its own members and treatment, while excluding outsiders who offer alternative treatments. In fact, the opposite is often true - evidence-based medicine actually allows outsiders to be heard; it endorses any treatment that turns out to be effective, however strange it may seem.

In the 18th century, for instance, lemon juice as a treatment for scurvy was regarded as implausible but the establishment had to accept it because it was backed up by evidence from trials. We had no axe to grind - indeed Professor Ernst even practised as a homeopath for many years (as well as receiving treatment as a patient) - and we came to our conclusions based on a fair, thorough and scientific assessment of the evidence.

So what did we find? While some therapies do provide some health benefits (e.g. osteopathy), most have nothing to offer. Many popular therapies are "effective" only because they are good at eliciting a placebo response; making the patient feel better simply because they believe the treatment will help.

You might feel that as placebos help patients, this alone justifies the use of the therapy. But any treatment that relies on the placebo effect is essentially a bogus treatment. And it's far from cheap.

(However, anti-depressant tablets taken by millions of Britons may be a waste of time and money, research shows. An analysis of dozens of studies involving thousands of patients revealed that some of the most widely-prescribed anti-depressants work little better than dummy pills. The drugs studied - including Prozac, Seroxat and Efexor - were little more effective than placebos in improving the mental health in the majority of cases, the University of Hull research showed).

Alexander Technique, for example, can require between 30 and 100 sessions with a therapist. If alternative practitioners are making unproven, disproven or vastly exaggerated claims, and if their treatments carry risks, then we are being swindled at the expense of our own good health.

And what about the cost to the NHS? The £500million it spends annually on unproven or disproven therapies could instead, for example, pay for 20,000 more nurses.

Too many alternative therapists remain uninterested in determining the safety and efficacy of their interventions. These practitioners also fail to see the importance of rigorous clinical trials in establishing proper evidence for or against their treatments - where evidence already exists that treatments are ineffective or unsafe, alternative therapists carry on regardless.

Despite this disturbing situation, the market for alternative treatments is booming, and the public is being misled over and over again, often by misguided therapists; sometimes by exploitative charlatans. It is time for the tricks to stop, and for the real treatments to take priority. The same scientific standards, evaluation and regulation should be applied to all types of medicine.

If this doesn't happen, then homeopaths, acupuncturists, chiropractors, herbalists and many other alternative therapists will continue to prey on the most vulnerable - raiding their wallets, offering false hope and even endangering their health.

• ALEXANDER TECHNIQUE

WHAT IS IT? A technique for relearning correct posture and body movements. Alexander teachers guide their clients through exercise sessions using a gentle, hands-on approach. As plenty of repetition is needed, 30 to 100 such sessions are usually required to master the technique, demanding a considerable level of commitment from the client, in terms of both time and money.

DOES IT WORK? Very little research so far has been conducted on the technique. Some promising findings have emerged in terms of improvement of respiratory function, reduction of anxiety, reduction of disability in Parkinson's disease and improvement of chronic back pain. However, for none of these conditions is the evidence sufficient to claim that the Alexander technique is effective.

• AROMATHERAPY

WHAT IS IT? Plant essences (known as "essential oils") are used to treat or prevent illnesses or enhance wellbeing. There are several ways of doing this. Most commonly, the diluted oil is applied to the skin via a gentle massage, but it can also be added to a bath or diffused in the air.

Aromatherapists believe that different essential oils have different specific effects. Aromatherapy is advocated for chronic conditions such as anxiety, tension headache and musculoskeletal pain.

DOES IT WORK? Some clinical trials confirm the relaxing effects of aromatherapy massage. However, this is usually short-lived and therefore of debatable therapeutic value. Some essential oils do seem to have specific effects. For instance, tea tree has anti-microbial properties. However, these efects are far less reliable those of conventional antibiotics. There is no evidence that aromatherapy can treat specific diseases.

• BACH FLOWER REMEDIES

WHAT IS IT? Highly diluted flower remedies intended to cure emotional imbalances said to be the cause of all human illness. According to advocates of flower remedies, wild rose is helpful for apathy, heather for self-centredness. The remedies (Bach Flower Remedies is a brand name) are produced by placing the fresh flowers into spring water. Subsequently, brandy is added to make up the actual remedies, which are so dilute that no pharmacological effect is conceivable.

DOES IT WORK? Flower remedies are based on concepts which contradict current medical knowledge. Several rigorous trials of flower remedies have been conducted. None shows that this approach is effective beyond placebo in curing disease or alleviating symptoms. Flower remedies are a waste of money.

• CHIROPRACTIC THERAPY

WHAT IS IT? Chiropractors use spinal manipulation to realign the spine to restore mobility. Initial examination often includes X-ray images or MRI scans.

Spinal manipulation can be a fairly aggressive technique, which pushes the spinal joint slightly beyond what it is ordinarily capable of achieving, using a technique called high-velocity, low-amplitude thrust - exerting a relatively strong force in order to move the joint at speed, but the extent of the motion needs to be limited to prevent damage to the joint and its surrounding structures.

Although spinal manipulation is often associated with a cracking sound, this is not a result of the bones crunching or a sign that bones are being put back; the noise is caused by the release and popping of gas bubbles, generated when the fluid in the joint space is put under severe stress.

Some chiropractors claim to treat everything from digestive disorders to ear infections, others will treat only back problems.

DOES IT WORK? There is no evidence to suggest that spinal manipulation is effective for anything but back pain and even then conventional approaches (such as regular exercise and ibuprofen) are just as likely to be effective and are cheaper.

Neck manipulation has been linked to neurological complications such as strokes - in 1998, a 20-year-old Canadian woman died after neck manipulation caused a blood clot which led to stroke. We would strongly recommend physiotherapy exercises and osteopathy ahead of chiropractic therapy because they are at least effective and much safer.

If you do decide to visit a chiropractor despite our concerns and warnings, we very strongly recommend you confirm your chiropractor won't manipulate your neck. The dangers of chiropractic therapy to children are particularly worrying because a chiropractor would be manipulating an immature spine.

• HYPNOTHERAPY

WHAT IS IT? The use of hypnosis, a trance-like state, for therapeutic purposes. In recent years, hypnotherapy has become recognised in several areas of healthcare - it is practised by several healthcare professionals, including psychologists, counsellors and doctors.

Hypnotherapists treat a range of chronic conditions, including pain, anxiety, addictions and phobias.

DOES IT WORK? Dozens of clinical trials show that hypnotherapy is effective in reducing pain, anxiety and the symptoms of irritable bowel syndrome. However, the evidence is that it's not effective to help you stop smoking, even though it is frequently promoted in this context.

• MAGNET THERAPY

WHAT IS IT? The use of magnetic fields from static magnets, which are usually worn on the body, to treat various conditions, most frequently pain.

These days rapidly fluctuating magnetic fields are used in conventional medicine in high-tech imaging machines (such as MRI scanners) and for promoting the healing of bone fractures. However, alternative medicine tends to use static magnets, which create a permanent magnetic field, to treat many conditions, mostly to alleviate chronic pain.

Static magnets are worn as wrist bands, belts, leg wraps, shoe inlays, patches, etc and can be purchased through numerous outlets; more often than not, the consumer/patient would not have had any contact with a healthcare practitioner.

DOES IT WORK? There is no evidence that static magnets offer any medical benefit for pain relief. As they are usually self-administered, there is a danger of missing serious diagnoses and losing valuable time for early treatment of serious diseases.

• OSTEOPATHY

WHAT IS IT? A manual therapy which focuses on the musculoskeletal system to treat disease. Osteopaths use a range of techniques to mobilise soft tissues, bones and joints. Osteopathy and chiropractic therapy have much in common, but there are also important differences.

Osteopaths tend to use gentler techniques and often employ massage-like treatments. They also place less emphasis on the spine than chiropractors, and they rarely move the vertebral joints beyond their physical range of motion, unlike chiropractors. Therefore osteopathic interventions are less likely to injure.

In general they treat mainly musculoskeletal problems, but many also claim to treat other conditions such as asthma, ear infection and colic.

DOES IT WORK? There is reasonably good evidence that the osteopathic approach is as effective as conventional treatments for back pain (if, however, you receive no significant benefit then be prepared to switch to physiotherapeutic exercises, which is backed by similar evidence and which is more cost- effective as it is often done in groups). There is no good evidence to support the use of osteopathy in nonmusculoskeletal conditions.

People with severe osteoporosis, bone cancer, infections of the bone or bleeding problems should confirm with the osteopath that they will not receive forceful manual treatments.

LOOK BEFORE YOU LEAP

Advice for anyone considering alternative medicine:
• Consult and inform your GP - the treatment might interfere with any ongoing conventional therapies.
• Do not stop your conventional treatment unless your doctor advises that this is sensible.
• Alternative therapies can be expensive, so make sure there is evidence to support the efficacy of a therapy before spending huge sums of money.
• Every treatment carries risks, so make sure the risks are outweighed by the benefits. 8.04.08

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Drug trials are over too soon, warn doctors

Drug trials are over too soon, warn doctors. The benefits of new cancer drugs are being "exaggerated" because trials are stopped too soon, research claims. It says growing numbers of pharmaceutical companies are halting trials - including those for the breast cancer drugs Herceptin and Lapatinib - shortly after receiving good interim results. And it warns that patients could be at risk if drugs are licensed and rushed into clinics before possible side-effects are identified.

The study by Dr Giovanni Apolone, whose findings are published in the journal Annals of Oncology, analysed 25 controlled trials. Picked at random, each lasted around 30 months and was stopped early because it showed a benefit to patients.

Dr Apolone, of the Mario Negri Institute for Pharmacological Research in Milan, said: "When we analysed 25 trials over a ten-year period between 1997 and 2007, we found more than 50 per cent were stopped within the past three years.

"While this could guarantee quicker access to the market for companies, it could also lead to an 'immature' evaluation of the benefit and risk balance of new drugs. "We believe that only untruncated trials can provide the full level of evidence required to safely translate treatments into clinical practice.

"Without such evidence, unsafe and ineffective drugs could be marketed and prescribed, and patients' health could be jeopardised." Three-quarters of the trials were halted after independent monitoring committees said the drugs were so successful, it would be "unethical" to deprive patients of them. Dr Apolone stressed there there was no evidence anything was wrong with the trial results and that he was not questioning the integrity of those monitoring them. Professor David Kerr, editorin-chief of Annals of Oncology, said: "We, as scientists, put a great deal of work and effort into designing appropriate clinical trials, and in all but the rarest of cases we should not rush to abandon those designs in the face of early signs of benefit."

A spokesman for the Association of the British Pharmaceutical Industry said it strongly rejected any suggestion that commercial interests led to trials being halted early. "The interest of patients is the overriding concern," he added. 9.04.08

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GPs have given an overwhelming vote of no confidence in the Government's handling of the NHS.

The Government was accused of displaying "all the hallmarks of the very worst dictatorships" and of introducing reforms with little evidence that they would work. Doctors attending the Local Medical Committees conference, held by the British Medical Association in central London, voted overwhelmingly in favour of a motion saying members had no confidence in Health Secretary Patricia Hewitt or the Government's handling of the NHS.

Eric Rose, chair of the BMA's practice finance sub-committee and former chairman of the conference, said he had initially had great hopes when Labour came to power. After all, he said, this was the party that had created the NHS and who had an election slogan saying there were 24 hours to save the NHS. "Ten years later, the reality is that a golden opportunity is being wasted and the dangers to the fabric of the NHS appear greater than ever. "This Government appears to pay too much attention to Downing Street policy advisers who have never worked in the service."

He said the Government had done "untold damage" to the careers of a generation of young doctors and was blaming GPs over out-of-hours services despite the fact that they "fairly negotiated" a contract allowing them to opt out. He said the Government displayed "all the hallmarks of the very worst dictatorships" and said doctors were being made "scapegoats" for its failings. He said: "Nobody is more responsible for this than the Secretary of State, 'Call me Patricia'. "I don't want to be on first name terms with someone I can't trust. I don't want to hear or listen to your sugary words any more. "I hope you yourself will soon be hearing some sugary words: 'You're fired."' He said the Government was damaging the fabric of the NHS and had "squandered millions of pounds of taxpayers' money" and squandered the goodwill of a dedicated profession.

Earlier, Dr Hamish Meldrum, chairman of the BMA's General Practitioners' Committee, told the conference there should be "no apologies" for the fact that UK GPs are among the best paid in Europe. Official figures show that GPs now earn, on average, more than £100,000 a year.

Chancellor Gordon Brown, who becomes Prime Minister at the end of this month, has said there needs to be more flexible access for patients seeking care outside office hours. But Dr Meldrum warned today there would be no renegotiation of the main principles of a controversial GP contract which came into force in 2004. Under that contract GPs were able to opt out of providing out-of-hours care and also saw a big rise in their salary, which has attracted widespread criticism.

Dr Meldrum told the conference: "I make no apologies for the pay increases that we successfully negotiated for GPs under the new contract, and no apologies that we are amongst the best paid in Europe - no apologies because you deserve it, as we provide the best care. "As I emphasised last year, there is no going back on the agreement on MPIG (minimum practice income guarantee) or on any change to contractual hours."

Dr Meldrum also warned Mr Brown that a key Government target - that all patients receive treatment within 18 weeks of referral by their GP by the end of 2008 - could fail if obstacles were not removed. 15.7.07

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Call for Clinical Trials Registry Gaining Momentum

For years, most clinical investigators working with experimental drugs have had some discretion about publishing their research findings regardless of the outcome. But after a lawsuit involving depressed minors reached a New York court and the front pages of major newspapers, the public started questioning the ethics of selective publication of research results.

The New York State Attorney General Eliot Spitzer filed a suit charging the pharmaceutical company GlaxoSmithKline (GSK) with "repeated persistent fraud" by not publicising unfavorable studies of one of its drugs, Paxil, that was tested on depressed children and adolescents.

The British firm had tested the efficacy of Paxil in at least five different studies, four of which yielded findings linking the use of Paxil to suicidal thoughts children experienced. GSK only published the study containing positive results. Partly as a result of the ensuing controversy, the American Medical Association (AMA) announced this summer that it would call on the Department of Health and Human Services to create a comprehensive, centralized clinical trials registry.

"Several members of Congress have indicated interest in pursuing legislation to create the registry," the AMA said in a statement. "Merck & Co. has said it supports expanding an existing government clinical trial registry to include all drugs. GlaxoSmithKline announced it will post the results of all its drug trials on the Internet."

The AAMC also supports the creation of a public registry. "The association believes a mandatory public clinical trials registry would be a significant step toward strengthening the reliability and credibility of clinical research, which is so vital to advancing medicine and improving health," said AAMC President Jordan J. Cohen, M.D. "A registry will ensure that all scientifically valid results reach the public arena and that members of the medical profession and patients, as well as federal decision makers, will have access to more than just the select findings published in medical journals or the press."

In the UK the House of Commons Health Committee Report has recommend that a clinical trials register be set up and maintained by an independent body and the results of all clinical trials data, containing full trials information, be put on the register at launch as a condition of the marketing licence as clinical trails are fraught with problems and manipulation. Click here for further details.

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Coma victim able to speak again after pioneering magnetic field therapy

A man who suffered brain damage in a car crash can speak again after doctors waved a magnet against his head while he was in a coma. Doctors believe the electromagnetic field encouraged nerve cells to send a 'wake-up' signal to the brain. Although magnetic therapy has been used to treat depression, Parkinson's disease and migraines, it is the first time it has been tried out on coma victims.

Josh Villa was 26 when his car mounted the kerb and flipped over, leaving him unconscious. After a year there was no sign of improvement. But Dr Theresa Pape signed him up for experimental treatment using magnets, New Scientist reports today. The technique - called transcranial magnetic stimulation or TMS - involves placing a coil of wire covered in plastic next to a patient's head.

When a rapidly changing current flows through the coil it creates a strong magnetic field - similar to the field created by a hospital MRI scanner. After 15 sessions there were signs of improvement. Dr Pape said: 'They [the words] were very slurred but they were there. He'd say erm, help, help me.' Mr Villa's mother, Laurie McAndrews of Rockford, Illinois, said: 'You started talking to him and he would turn his head and look at you. That was huge.' He began to obey simple instructions - such as following the movement of a thumb around the room and speaking single words.

Dr Theresa Pape, of the U.S. Department of Veterans Affairs in Chicago who helped treat Mr Villa said: 'They were very slurred but they were there. He'd say "erm", "help", "help me".' When the doctors ended the TMS treatment after 30 sessions, Mr Villa's condition worsened slightly and he became tired more easily. However, he was still better than before. Another 10 sessions failed to make any improvement and he was sent home.

His mother believes that the treatment made a difference - and that he is easier to care for than before. 'When you talk to him he will move his mouth to show he is listening,' she said. 'If I ask him "Do you love me?" he'll do two slow eye blinks, yes. 'Some people would say it's not much , but he's improving and that's the main thing.' She added: 'Before I felt like he was not responsive, that he was depressed almost. 'Now you move him around and he complains - he can show emotions on that level.'

TMS can be carried out without sedation of anaesthetic. Some patients liken the sensation to being hit on the head with a rubber - and complain that it leaves them with a sore scalp for a few days. Neuroscientists describe the case is intriguing - but say it is too soon to say whether magnets make any difference.

Dr John Whyte of the Moss Rehabilitation Research Institute in Philadelphia said: 'Even after eight months it is not uncommon for patients to transition from the vegetative to the minimally conscious state without any particular intervention.' However, he says TMS should be investigated as a way of rousing patients from deep comas. Dr Papae is convinced that the treatment helped. His condition had not improved since four months after the car crash. And after the 15th session, he improved with each dose of treatment. She plans to treat a second coma patient later this year. 16.10.08

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The revolutionary window that could wipe out nuisance noise

Be it by noisy neighbours, faulty car alarms or roaring jets, a good night's sleep is spoilt all too often. But relief is on the way, with the invention of a soundproof window. Billed as better than double, or even triple, glazing, it uses postage-stamp-sized patches of ceramic to sense incoming sound - and block it out.

Tests show the design is particularly effective at drowning out the dull, droning din made by planes, heavy traffic, road drills and lawn mowers. The brainchild of German mechanical engineers, it could be on the market in four years, with mass production reducing the price of an average-sized pane to less than £70. Tests have shown it works best at blocking out sounds of 90 to 100 decibels - the equivalent of a passing train or nearby lawn mower.

Double and triple glazing is not very effective at stopping such droning sounds. But in tests in the lab, the special glass cut the noise by up to half and in theory could prevent it completely.On hitting a window, noise usually passes into a building by causing the window to rattle. The new glass creates a second set of vibrations which cancel out the first.

The ceramic patches sense incoming soundwaves and, using a series of wires, transmit the information to a tiny computer. It calculates the vibration and sends back a signal which makes the patches vibrate at exactly the right frequency (inverted) to make the window rattle in the opposite direction.

If the calculations are just right, the two sets of vibrations should cancel each other out (phase cancellation). Researcher Dr Thilo Bein said: "A window acts like a loudspeaker and a membrane. If you control the vibration of the window, you can control the transmitted noise in such a way that it is not acting like a membrane or a loudspeaker."

The noise-sensing patches currently in use are not transparent and so have been embedded in the window frame. However, the researchers, from the Fraunhofer Institute for Structural Durability and System Reliability in South-West Germany, are confident of developing see-through patches which are just as effective.

In time, the technology could be applied to car windows and windscreens- allowing occupants to talk without raising their voices, even at high speeds. Critics caution, however, that faults could be difficult and expensive to repair. They also question how quickly the technology would be able to respond to rapidly changing levels of noise, such as that found near airports. 10.5.07

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New 'sleep machine' could signal the end of insomnia