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30 June, 2006

Fat-buster not for NHS patients

A fat-busting drug that not only reduces bodyweight by up to 10 per cent but also helps to tackle other health problems such as diabetes and even smoking has been introduced in Britain. Rimonabant, also known as Acomplia, is the first drug to target a natural body system that governs a host of factors controlling appetite, weight, metabolism and energy use. Research suggests that it has the capacity to combat a smoker’s craving for nicotine.

Britain is the first country to receive Rimonabant, after the decision by drug regulators last week to grant it a licence throughout the European Union. Experts say that 20 per cent of Britain’s population could be eligible for treatment. However, the drug is unlikely to be widely available until it is approved by the National Institute for Health and Clinical Excellence. The institute, which advises on NHS best practice, is not expected to issue guidance on Rimonabant for two years. At a cost of 55.20 pounds per patient per month, or 1.97 per tablet, even treating a fraction of the group eligible could cost the NHS billions.

The drug’s manufacturers, Sanofi Aventis, argues that the drug represents good value for money when set against the 7 billion-per-year cost of tackling the problems connected with obesity and being overweight. Anthony Barnett, a diabetes specialist from the University of Birmingham who took part in yesterday’s launch at the Science Museum in West London, said that it would be a “great shame” if use of the drug was limited by funding issues. “The real question is, can we afford not to treat?” he said.

In a series of trials involving more than 6,000 patients in America and Europe, about a quarter of those taking Rimonabant lost more than 10 per cent of their initial body weight after a year. About a half lost more than 5 per cent of body weight. Waist circumference, seen by many experts as a more important measurement, was reduced by between six and seven centimetres. Significant improvements in measures of glucose control, cholesterol and triglyceride blood fats were also seen. These went far beyond what might be expected simply by losing weight. For example, levels of high-density lipoprotein “good” cholesterol, which reduce heart disease risk, showed an 8 to 9 per cent increase, but only half of this was because of weight loss. There is also trial data suggesting that the drug can help people to give up smoking by overcoming their cravings. However, it is being marketed only to tackle obesity.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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29 June, 2006

U.K.: Call for doctor training rethink

Thousands of doctors could face a "career black hole" under a shake-up of NHS training posts, medics say. About 21,000 junior doctors will be competing for 9,500 training posts in England next year. The British Medical Association's annual conference passed an emergency motion calling on the government to delay implementation of their plans. Doctors said junior medics will either be forced abroad or work in posts with no chance of career progression.

The government is revamping the training process for doctors by scrapping senior house officer posts. Doctors have traditionally gone through three stages of training - pre-registration house officer, senior house officer and finally specialist registrar. Under the government's plans there are just two training phases - a two-year foundation programme followed by a specialist training programme. The government said the aim was to speed up the training of doctors, but doctors said it may be part of an agenda to restructure the workforce.

Doctors who do not get training positions tend to end up in service posts such as staff and associated specialists (SAS) and are used to fill in gaps across departments. The posts offer no opportunity of progressing to become consultants. And as they are paid less than two thirds of what a consultant receives, the move could save the NHS money.

Dr Jo Hilborne, chairman of the BMA's junior doctors committee and a specialist registrar in Cardiff, said thousands of junior doctors were facing a "career black hole". "We are incensed at the cavalier way this announcement was made, with no discussion with ourselves. "This will dispose of the careers and aspirations of 11,500 junior doctors. "There is a concern that there is an agenda in the short-term to push lots of these doctors into service posts."

BMA chairman James Johnson said if the NHS was to lose doctors it had spent time and money training it would be a "terrible waste". "It is a huge crisis looming and it is completely unacceptable."

Health Minister Lord Warner accused doctors of seeking "cheap headlines". "It's absolute rubbish to say there will be thousands of junior doctors without jobs. "Some doctors may have to be flexible, but at the end of the day our changes mean that more doctors will go into specialties where there are shortages and more patients will be treated by trained doctors, meaning that patients benefit."

Shadow Health Secretary Andrew Lansley said medical students had been let down by the government. "I repeatedly questioned Labour over their planning failures for the provision of specialist training posts, but they appear to have proceeded without working them out."

Source



Another group of Australian public hospitals under fire

This time in the State of New South Wales

Too many patients are waiting too long to receive treatment in New South Wales public hospital emergency departments, the State Opposition said today. Opposition health spokeswoman Jillian Skinner today said Health Department statistics for April showed 1943, or 18 per cent, of patients with an imminent life-threatening medical condition were not seen within the recommended 10 minutes. An imminent life-threatening condition - such as a heart attack - requires treatment to commence within 10 minutes of the incident occurring.

Ms Skinner said 35 per cent, or 15,701, of patients with a potentially life-threatening condition were not seen within half an hour. These conditions include heavy bleeding, a major fracture, dehydration, and severe illness. Patients must receive treatment within 30 minutes of their accident or illness being diagnosed. Ms Skinner said 31 per cent, or 17,986 patients were not seen within the recommended hour.

Ms Skinner said the Government needed to recruit more nurses so extra hospital beds could be opened. "No matter how creative the spin doctors, the plight of very sick and badly injured patients is at stake, and Premier (Morris) Iemma and his health minister (John Hatzistergos) stand condemned for denying the problem," she said in a statement.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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28 June, 2006

NHS DOCTORS FED UP WITH CONSTANT GOVERNMENT BUNGLING

The Government’s reform agenda for the National Health Service came under sustained attack yesterday at the annual conference of the British Medical Association. Delegates made plain their opposition to a whole range of reforms in a series of debates that discomfited the BMA’s leadership — including what amounted to a vote of no confidence. A government that was welcomed by doctors when it came to office in 1997, and has spent unprecedented amounts on the NHS, thus finds itself lacking medical support. Speaker after speaker charged Tony Blair’s Government with incompetence, muddle, rushed and ill-considered reforms, and a secret desire to break up and privatise the NHS. The conference agreed to back the campaign group Keep Our NHS Public and only narrowly declined formal affiliation. The group anathematises private involvement in the NHS, seeing healthcare as a public service that can only be delivered by public servants.

The conference, which is the BMA’s policymaking body, also passed by a clear majority a resolution that declared the BMA leadership had failed “patients, the profession and the country by their failure to actively oppose the current wave of organisational and financial reforms which are destabilising the NHS”. The leadership defended its engagement with the Government, saying that to influence policy it needed to be in regular contact, but delegates passed the motion by a 58 to 42 per cent vote — a sharp and unexpected reverse. Moving the no-confidence motion, Natasha Arnold, from Islington, North London, said there was “a real and imminent danger to the future of the NHS”.

Earlier, one of the leaders of Keep Our NHS Public, Jacky Davis, said that the Government increasingly saw the NHS as no more than a “kitemarking”, or rubber-stamping, organisation that would certify treatments delivered by others.

Sir Alexander Macara, a former BMA chairman, said of the Government: “As well as providing new resources, it has introduced cavalier and ill-founded reforms based on an arrogant belief in the rectitude of its own theories. We must say to the Government, ‘Get on the right planet and listen to doctors’. We must ask the Government to have the courage and humility to say, halt.” This seems very unlikely, at least while Mr Blair remains at No 10. For him, reform is not fast enough. He believes that to improve efficiency and productivity the service has to endure some pain, and is likely to see yesterday’s debates as evidence that this is happening.

Earlier, James Johnson, chairman of the BMA Council, had criticised the “breakneck pace and incoherent planning” of the NHS reforms, which include patient choice, payment by results, and practice-based commissioning. Payment by results aims to pay hospitals per item of service, a policy likely to encourage them to do more and suck in huge amounts of NHS money. To counteract this, practice-based commissioning aims to put the power over money in the hands of GPs, who will want to retain as much of it as they can in primary care.

In theory, the two policies should create a pseudo-market that drives efficiency and shifts care out of expensive hospitals and into affordable primary care. But the policy has the air of having been assembled hurriedly. “The NHS is in danger and doctors have been marginalised,” Mr Johnson said. “Everyone is telling the Government: you must get the professions on board; you must involve clinical staff; you can’t make this work without doctors. “The Government’s favoured method of raising quality and keeping prices down is to do what they do in supermarkets and offer choice and competition,” he said. “But will it work in a health service? More ‘customers’ — we doctors are old-fashioned enough to call them patients — does not mean profit, it means more costs.”

Mr Johnson’s call for a line to be drawn in the sand was well received, but delegates had come to the meeting determined to give him and the rest of the BMA leadership a bloody nose, which they duly did two hours later. The Government can expect a more combative BMA, but may not mind. To it, how doctors behave is part of the problem, not part of the solution. The question is whether any health service can be delivered efficiently by a disaffected and truculent workforce.

Source



Bizarre medical appointment in an Australian public health system

The new chief of the Health Quality and Complaints Commission was a senior Queensland Health boss whose failure to resolve formal complaints over unsafe hours at Bundaberg Hospital led to surgeons quitting and Jayant Patel being hired. Dr John Youngman, a deputy director-general of Queensland Health during the discredited leadership of former Health Minister Wendy Edmond, will lead the new commission and oversee complaints from consumers, hospital staff and whistleblowers. He will work two days a week for $100,000 a year to head a board of five assistant commissioners including a former Beattie Government director-general Marg O'Donnell, whose husband Justice Martin Moynihan shut down the health inquiry for "ostensible bias".

Senior clinicians told The Courier-Mail yesterday the elevation of Dr Youngman was extraordinary given his previous No. 2 role in Queensland Health, which was found to have had a "culture of concealment" in inquiries by Tony Morris, QC, and Geoff Davies, QC. The head of the Patients' Support Group, Beryl Crosby, also slammed the appointment and said the Bundaberg Hospital disaster would not have happened if Dr Youngman had been more responsive to the pleas from surgeons for help. "It is bizarre that they would put someone in as head of the complaints unit who did not listen to complaints in the first place. This will not inspire confidence," Ms Crosby said.

In unchallenged evidence at the inquiry it was revealed that pleas by Bundaberg Hospital's then director of surgery, Dr Charles Nankivell, for urgent help were not dealt with by Dr Youngman in his role at the time as general manager (health services). Dr Nankivell had been pleading in writing for top-level intervention because he had been working dangerously long hours and feared his chronic fatigue would harm patients and himself. He had written to the heads of the hospital and the heads of Queensland Health to raise the concerns before patients were unnecessarily maimed or killed.

Dr Youngman's written response, described in the Commission of Inquiry report as "trite", did not address the safety concerns. Dr Nankivell, who quit in disgust, told the inquiry that Dr Youngman's response was the straw "that broke the camel's back". Dr Nankivell was replaced by Dr Sam Baker, who also quit in disgust, resulting in the hiring of the incompetent Jayant Patel who had been banned from performing surgery in the US. .

Dr Youngman told The Courier-Mail yesterday he had no recollection of the complaints by Dr Nankivell and Dr Baker, nor was he aware of their unfavourable evidence. He said the Davies inquiry had made no findings adverse to him and that his track record in safety and quality underlined his commitment to better health care. Dr Youngman said he had worked hard with limited resources and that as a top administrator he had not personally been part of a "culture of concealment". "From my point of view I undertook a very transparent role. I'm sure there are many people who support me and some who would not support me," he said. Dr Youngman has been working since last year as a consultant to Health Minister Stephen Robertson.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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27 June, 2006

U.K.: Choice between tweedledum and tweedledee fails to please

The Government’s choice agenda in the National Health Service is failing to satisfy patients, according to a survey. Released by the British Medical Association in Belfast as it assembles for its annual meeting, the survey suggests that NHS patients want to have choice, but would prefer choices other than those being offered by the Government. As a result, 55 per cent said that the NHS did not offer choice — even though the Government has extended its policy of providing a choice of hospitals. Patients can choose from five places to have operations, usually including at least one private-sector centre.

When participants were asked what choices they wanted to be able to make, 69 per cent said it was very important “to have a say in things generally”. Almost as many chose “timing of treatment”, then a choice of GP, type of treatment and specialist, in that order of preference. Just over half of the 1,077 adults interviewed by Andrew Irving Associates for the survey said they thought that choice of hospital was very important. Nearly a quarter said that hospital choice was the first thing that occurred to them when considering choice in the NHS. Only 7 per cent said that a say in things generally was on offer, even though that was what the majority of participants said that they wanted.

James Johnson, chairman of the BMA Council, said: “Patient choice is on the lips of every politician and drives the NHS reform agenda. “We wanted to find out what it means for ordinary people and how important it is to them. We found some suprising results which don’t seem to match government thinking. Most strikingly, the majority of people said that the NHS did not offer choice. “The concept of choice is very popular, but people’s priorities aren’t in line with the Government’s. The majority who thought there was no choice have either not been listening to the propaganda, or have been listening and haven’t been impressed.”

NHS reforms are set to have a high priority at this week’s conference, with a lengthy debate tomorrow on the reform of the NHS in England, followed by votes on detailed resolutions on the subject on Wednesday. “It’s a central issue for us and this is a very timely moment,” said Dr Michael Wilks, who will chair the conference. Other contentious issues to be discussed include the advertising of food and drink, putting GPs’ surgeries in supermarkets, the NHS IT system, education and training of doctors, and euthanasia.

Doctors are expected to express strong views on NHS deficits at a time when NHS spending has doubled. Some troubled hospitals have sought cuts in staff levels that could affect doctors. Mr Johnson reacted to reports that the Oxford Radcliffe Hospital had made two consultants redundant by saying that any redundancies among doctors would be “absurd and ridiculous”. Britain still had too few doctors, he said. “The whole emphasis of the Government’s policy has been on increasing doctors and medical students. It is a huge waste if it is going to pay to train doctors and them make them redundant. “We’re not prepared to see valuable assets wasted,” he said. “We will do everything in our power to help any doctors threatened with redundancy.”

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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26 June, 2006

NO CASH SO DOCTORS DISMISSED IN UK

Two doctors at a leading NHS hospital have become the first consultant surgeons to be made redundant as a result of the financial crisis in the health service. Oxford Radcliffe Hospitals NHS Trust, which has a 33 million pound deficit, has given two consultant gastrointestinal surgeons, one full-time and one part-time, three months’ notice. One of the surgeons, Simon Cole, is a former president of the Association of Surgeons in Training, while the name of the other has not been disclosed.

Jonathan Fielden, deputy chairman of the British Medical Association’s (BMA) consultants’ committee, said: “This is a deplorable step that shows the state of the financial crisis that many trusts are in. This will have a significant impact on patient care.” A trust spokeswoman confirmed the trust had to save 33 million pounds this year, adding: “A review indicates, among other things, a reduced number of gastrointestinal procedures. We are, therefore, matching our capacity to the reduced use of this service.”

The move comes as Debbie Abrahams, chairwoman of Rochdale NHS Trust, disclosed this weekend that she was resigning her post because of her anger at the use of private health companies in the NHS. At this week’s BMA annual conference its chairman James Johnson is expected to say the government’s NHS reforms have delivered poor value for money. He said that despite massive funding increases there has not been a dramatic improvement in patient care. “The NHS has got better, but not commensurately better, for the very large amounts of money spent,” he said.

Two official reports this week — one from the Organisation for Economic Co-operation and Development (OECD) and one from the government’s NHS inspectorate — are expected to show patients are still receiving substandard care. The OECD report will show that, in some areas, the NHS is lagging behind health services in 30 other European countries. It is expected to disclose: * Death rates from breast cancer in Britain are higher than in most other European countries. * Britain has fewer radiotherapy machines for treating cancer than most other European states and only a fraction of the numbers in France, Switzerland and Denmark. * The NHS has fewer doctors than European neighbours and almost half the ratio of doctors to patients as Greece and Italy.

The NHS inspectorate’s report is expected to say that services for chronic lung disease, which affects 3m patients in Britain, have been badly neglected. The Healthcare Commission will say that NHS treatment for conditions such as emphysema and bronchitis needs to be improved urgently. Chronic lung disease kills more than 30,000 every year, almost double the European average. The commission will add that patients suffering from respiratory disease have been given the wrong diagnosis or have not been diagnosed at all, leading to them being denied care. It will say the equipment available in the NHS to diagnose chronic lung disease is ineffective and that doctors and nurses do not know enough to operate the machines and interpret the results. Patients who are diagnosed with lung disease do not receive adequate health checks resulting in them losing out on necessary treatment.

Patient care could be further damaged by the government’s radical reforms, Johnson will tell the BMA conference. He says the government’s policy of allowing patients to choose to be treated at private hospitals could undermine the NHS. He will warn that district general hospitals running casualty departments, intensive care units and maternity wards could close as treatment is siphoned off to privately run treatment centres. The Department of Health said patient care had improved dramatically, with record funding resulting in more doctors and nurses, wider access to medicines and the shortest-ever waiting times

Source



Rage at dental wait in Australian public medicine

More than 50,000 Queenslanders have given up trying to see a public dentist because of waiting times of up to five years, new figures reveal. Opposition health spokesman Bruce Flegg said the dental service was on the verge of collapse despite State Government claims of record funding. Dr Flegg said the waiting periods had resulted in general dental clinic treatments falling almost 20 per cent from 296,000 patients in 2004-05 to 240,000 in 2005-06. School dental clinic treatments had also fallen, from 670,000 to 630,000, over the same period. "Queenslanders are not getting value for the huge injection of taxpayer funds," Dr Flegg said.

The Australian Dental Association said in December that waiting times for Queensland public dental services were up to five years for a basic check-up. The Government's inability to attract staff meant the situation was unlikely to get better, it said.

The Opposition said it was not surprising that with fewer patients accessing treatment, dental emergencies at public hospitals had jumped 10 per cent. "These figures just blew me away . . . it reveals the extent of government mismanagement," Dr Flegg said.

Gold Coast pensioner Wayne Webb said he gave up waiting after three years - using his life savings of $5000 to get new teeth. Mr Webb, 52, told The Sunday Mail he first went for treatment at a clinic attached to the Gold Coast Hospital in 2003 and was told he was on an emergency waiting list. "They said to just wait. But I was in so much pain, I could not eat, I had to do something," Mr Webb said. "Stuff Mr Beattie. He promises all this money in the Budget to fix health, but what has he done for me? Nothing."

Health Minister Stephen Robertson said the Government would spend $137 million in 2006-07 to provide free public dental services - up $5.3 million on 2005-06. His office provided figures for the number of dental treatments in 2005-06 but no comparisons with the previous year. He said Queenslanders enjoyed Australia's "most comprehensive" public dental service and the Government would continue to push for the federal scheme to be reinstated.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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25 June, 2006

U.K.: ELITE DOCTORS LEFT JOBLESS BY "CUTS"

A group of junior doctors selected for a specialist course designed to train the next generation of GPs has been left jobless after offers were withdrawn because of NHS funding cuts. The 29 doctors, who have studied medicine for at least six years, learnt this month that they would not be able to join their three-year course in August. The Innovative Training Posts, the final stage of formal education, were introduced to single out and nurture the best primary-care talent. The course involves two years concentrating on various specialities in hospital medicine and one year as a GP registrar.

The junior doctors, many of whom are burdened with student debts, have been told that they must defer starting the training until February. It remains unclear how the funding shortfall will be remedied by then, when budgets are normally more stretched in the run-up to the end of the financial year. Doctors’ leaders gave warning yesterday that such drastic actions were destroying workforce morale and creating a uncertainty and disaffection with the NHS. They added that the future of healthcare was being severely compromised by the growing financial problems of the health service.

Many of the junior doctors, who qualified for the course after sitting a series of interviews and examinations, have been unable to get interim hospital jobs as all senior house officer positions have been filled. The crisis, caused by budget cuts by the London Deanery and ordered by the Department of Health, is the latest to hit the NHS as it struggles with an annual deficit of more than 500 million pounds.

Richard Savage, course organiser of the Guy’s and St Thomas’ Hospital vocational training scheme, who was involved in the training of three of the doctors, described the action as outrageous. “The bureaucracy in the NHS is now so disjointed that there is no forward planning,” he said. “It is simply worked from one financial year to the next.” The British Medical Association (BMA) said that it was seeking the urgent intervention of Lord Warner, the Health Minister, to resurrect the training of would-be GPs, who were from around the country and to be based in London.

Hamish Meldrum, the chairman of the GPs’ committee of the BMA, said that even if they managed to restart the course next year, the precedent was very dangerous and left them few employment prospects in the meantime. “Underlying this story is the problem that doctors’ training is under growing financial pressure,” Dr Meldrum said. “The country is crying out for fully trained GPs. It would be a tragedy not just for these doctors but also for patients and the wider NHS if medical training is cut as a result of NHS deficits.”

The London Deanery and the Department of Health denied that the course was being cut and said that they expected the students to begin their training in the new year. “We are reassured that the deanery is working with the BMA and doctors affected to offer them careers advice and support so that this has as little impact on their professional and personal circumstances as possible,” a department spokeswoman said

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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24 June, 2006

U.K. TO REVERSE COURSE ON IVF?

The present policy discourages it on pennypinching grounds -- but now they are beginning to realize that they need all the babies they can get!

Making fertility treatment freely available to all would boost Britain's population and help stave off the looming pensions crisis, scientists said yesterday. Using the latest figures on the costs of fertility treatment, researchers calculated the total value of an IVF baby to the British economy and compared it with a baby conceived naturally. They found that if the government invested in IVF and offered three cycles of fertility treatment on the NHS, the country would increase its population by 10,000 within two to three years. Currently only a quarter of IVF treatment is conducted by the NHS. Their calculations showed that once the extra cost is taken into account, every person born through IVF would on average contribute 147,138 pounds to the economy, compared with 160,069 pounds generated over the lifetime of a person conceived naturally.

"If a government invests in IVF treatment, essentially by paying for that treatment, and a baby results, the government starts earning money back two years later than if the baby was conceived naturally," said Professor Bill Ledger, head of reproductive medicine at Sheffield University.

The calculations are the first attempt to assess the value of children born through IVF to the British economy. The researchers worked on the basis of the child living to the average male age of 78, and the cost of IVF being 12,931 pounds per conceived live birth. In 2004, the National Institute for Health and Clinical Excellence, which governs what medical treatments are available on the NHS, recommended that couples should be offered three cycles of IVF on the NHS, but many primary healthcare trusts are unable to afford the cost.

Prof Ledger said he wanted to see universal NHS funding of three IVF cycles, instead of the current "postcode lottery" system which resulted in an average of less than one cycle being state-supported. Speaking at the European Society of Human Reproduction and Embryology yesterday, Prof Ledger said that providing three cycles of IVF to all couples would cost the government an extra 50-80 milion pounds, but the cost would quickly be recovered by taxes made from the boosted population.

In a separate study, Jonathan Grant, director of the Cambridge-based thinktank, found that more government funding of IVF would help improve Britain's low birth rate, which although at a 13-year high of 1.8 births per woman, is still below the 2.1 figure needed to maintain the population size. Without new policies to increase fertility rates, Britain and other countries in Europe will face ageing societies that cannot be supported because the workforce is too small. Predictions suggest that by 2050, a third of Europeans will be older than 65. "If three cycles of IVF were available on the NHS, we think we could put another 10,000 births into society from couples who are otherwise not going to have children," said Prof Ledger. "All we would like to see is three full cycles of IVF for all women who are eligible."

Other countries have already moved to bolster their populations by funding more IVF. In Denmark, 3% of children are born through IVF, compared with just 1% in Britain. In South Korea, where the fertility rate is 1.08, one of the lowest in the world, the government has pledged $38bn over five years to encourage couples to have babies. "If Gordon Brown is concerned about where his pension fund is going to be coming from, then it's clear that IVF can contribute to the economy significantly. It's really a win-win situation," said Dr Mark Hamilton, chairman of the British Fertility Society. "This isn't fertility clinics trying to drum up business. There are those who want babies through IVF but they can't afford it."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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23 June, 2006

NHS PENNYPINCHING (1)

Short term thinking

New guidelines for saving NHS money by prescribing older, cheaper heart drugs will mean less effective care for some patients, specialists claim. Primary care trusts have been told that at least 60 per cent of prescriptions for life-saving statin drugs should be for simvastatin and pravastatin, which are out of patent and much cheaper than newer, more potent statins. The policy emerged quietly last week as part of a report from the NHS Institute for Innovation and Improvement that claimed productivity and efficiency savings could be worth 700 million pounds a year. While the report makes no mention of any new target, an accompanying document says that generic statins should represent a minimum of 60 per cent of all prescriptions. “Greater savings will be achieved for larger shifts,” it says. While primary care trusts cannot force GPs to prescribe particular drugs, they can exert considerable pressure.

Pfizer, the drug company that makes Lipitor, the statin likely to lose market share as a result of any enforced change, says that the policy risks reversing recent advances in the management of heart disease. Olivier Brandicourt, Pfizer’s managing director, said: “Not only does this represent bad medicine and a further assault on clinicians’ freedom to prescribe the most appropriate medicine for their patients, but it could also slow progress towards the Government’s own goal of significantly reducing deaths caused by coronary disease by 2010.” He is backed by heart specialists.

John Betteridge, Professor of Endocrinology and Metabolism at University College London, said: “It is crucial that the quest for savings on prescribing costs for statins should not lead to less effective care for individual patients at high risk of cardiovascular events. I fear that this may be the case.” Professor Paul Durrington, of the Cardiovascular Research Group at the University of Manchester, said: “This is essentially robbing Peter to pay Paul. “Substantial numbers of patients with above-average cholesterol levels will fail to hit the Department of Health’s own targets with generic statins and these are also the targets GPs are contracted to achieve. “Failing to achieve these targets will translate into more expensive hospitalisation and surgical intervention.”

A recent paper in the British Medical Journal suggested that, at the right dose, all statins were of more or less equal potency, and that 2 billion could be saved over five years if the NHS prescribed only simvastatin. But Pfizer cites trials in which Lipitor produced greater reductions in cholesterol levels than simvastatin. Dr Berkely Phillips, medical adviser to the company, said: “The most important thing is that we are moving to new, lower targets for cholesterol. “The current target is 5 mmol/litre of total cholesterol but the Joint British Societies — the British Cardiac Society, the British Hypertension Society, Diabetes UK, Heart UK, the Primary Care Cardiovascular Society and the Stroke Association — have recommended that the target should be 4 mmol/litre. “On 40 mg of simvastatin, a normal dose, only 33 per cent of people would reach this target. Lipitor [atorvastatin] is more potent.”

The Department of Health denied that there was any new target. A spokesman said: “This is guidance for trusts showing the potential savings that could be achieved if their GPs prescribe lower cost statins.” He added: “There is no government ‘cholesterol target’. However, under the new GP contract, doctors are rewarded for controlling the cholesterol level of patients with coronary heart disease. We are not aware of any evidence that shows the prescription of low-cost statins — in line with guidance from the National Institute for Health and Clinical Excellence — will reduce the effectiveness of this measure.”

Source



NHS PENNYPINCHING (2)

Is infertility not a medical problem?

British couples who have difficulty starting a family are among the least likely in Europe to receive the IVF treatment that they need. According to a new league table published yesterday, Britain came 12th out of 15 countries that provided data for 2003, with only Macedonia, Croatia and Austria performing fewer cycles of fertility treatment per head of population. Clinics in Denmark, the top-rated country, where most IVF is provided free by the State, conducted 2,031 cycles per million inhabitants, compared with 633 in Britain. France, the country most comparable in size, comes ninth, with 1,009.

In global terms, Britain finished 16th out of 34 countries. Most of the lower-ranked nations, with the exception of America, which has no reimbursed provision of IVF, are from the former Soviet bloc, the Middle East or Latin America. Israel headed the world table by a distance, with 3,263 cycles per million; IVF is available free, and without limits.

Anders Nyboe Andersen, of Copenhagen University Hospital in Denmark, who led the team that compiled the European data, said that Britain’s position came as no surprise given the low priority that funding IVF receives from the NHS. While the National Institute for Health and Clinical Excellence (NICE) has recommended that three cycles be provided free to most couples in which the woman is under 40, the Government has asked primary care trusts to pay for only one and many do not offer even this limited service.

North Lincolnshire PCT is the latest to scrap free IVF treatment because of financial deficits. Dame Suzi Leather, chairman of the Human Fertilisation and Embryology Authority, recently described access to IVF as “the No 1 problem faced by patients” and called on the Government to implement the NICE guidelines. Dr Andersen told the European Society of Human Reproduction and Embryology conference in Prague: “The main reason for Britain’s position is that (IVF) is not available from the State.”

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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22 June, 2006

Young 'failed' on mental health

Mental health problems in children and adolescents are on the rise, the British Medical Association has warned, and services are ill-equipped to cope. One in ten children, aged one to 15, have a mental health problem, says a report from the BMA's board of science. But mental health services are failing the most vulnerable, such as children in care and those from black and ethnic minorities, they conclude. The board has urged the government to address problems with funding.

Around 1.1 million children under the age of 18 would benefit from support from specialist mental health services, the BMA has estimated. Children from poorer backgrounds, children in care, asylum-seeker children and those who have witnessed domestic violence, are all at particular risk of developing mental health problems, the report says. But vulnerable children may become stigmatised and struggle to access overstretched services.

The mental health problems covered by the report included depression, anxiety, self-harm, attention-deficit hyperactivity disorder, eating disorders and obsessive disorders. It is estimated that 1% of children and 3% of adolescents suffer depression in any one year. Self-harm is also on the increase with 11.2% of girls and 3.2% of boys committing an act of self-harm.

The figures suggest boys and girls tend to suffer from different mental health problems. Girls tend to have more emotional disorders such as anorexia, with a higher prevalence of conduct disorders such as frequent and severe temper tantrums among boys.

The board said that government policies designed to tackle the problem, including moves to reduce child poverty, must be properly implemented. They called for adequate funding and staffing of child and adolescent mental health teams, improved services for children in care and said racism within mental health services must be eliminated. And teenagers aged 16 to 18 years must receive appropriate care for their age and not just be passed on to adult services, they concluded.

Dr Vivienne Nathanson, Head of BMA Ethics and Science, said: "Children from deprived backgrounds have a poorer start in life on many levels, but without good mental health they may not have a chance to develop emotionally and reach their full potential in life. "There are a number of government policies currently being rolled out that are aimed at tackling these problems. It is essential that they deliver what they promise."

Dr Marcus Roberts, head of policy at mental health charity Mind, said: "This important report reminds us that environmental and social factors have a big effect on mental wellbeing, and also that services for young people's mental health are frequently lacking. "It's crucial that the right kind of services are there to break what can become a cycle, wherein poverty contributes to mental distress, which in turn leads to unemployment, stigma and further poverty."

Avis Johns, YoungMinds Development Director agreed: "With the majority of adults with mental illness able to trace their symptoms back to childhood it is essential we act now to prevent a generation of children being blighted by mental ill health."

Shadow Children's Minister Tim Loughton condemned long waiting lists for child mental health services, and the fact that some young patients were being forced to spend time on adult mental health wards because specialist services were not available. He said: "The government must take urgent action to make children's mental health services a priority.

A spokeswoman from the Department of Health said between 2002 and 2005 the number of staff working working in child and adolescent mental health services increased by more than 40%, and the number of cases seen has also increased by more than 40%. She said 300 million pounds had been invested in the service in the last three years, and experts were advising on how best to improve services. "The Department expects local specialist commissioning groups to use this cash to finance in-patient psychiatric units which allow for effective service planning for the local population."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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21 June, 2006

HUGE NHS DELAYS HURT WOMEN

Women with a family history of breast cancer are being forced to wait so long for test results that some choose to have their breasts removed before they know whether they have the faulty gene, say health campaigners. A report by the charity Breakthrough Breast Cancer says that women are suffering "agonising delays" of two years or more for genetic test results. Many women had undergone private tests in the meantime, but others had resorted to mastectomies rather than risk developing the disease.

The charity said that in some parts of the country tests could take just a few weeks, but it emphasised that there were wide variations between laboratories and that the process was causing unnecessary anguish. It said that some women tested in 2002 were still waiting. In 2003 the Government promised that by 2006 anyone taking a genetic test should get their results within ten weeks.

The Government said yesterday that laboratories were "making excellent progress" towards meeting the goal. About 5 per cent of the 41,000 cases of breast cancer diagnosed in Britain each year are due to inherited faults in genes associated with strong family histories of the disease. A further 10 to 15 per centoccur in women with moderate family histories.

Most genetic tests look for changes or faults in the genes BRCA1 and BRCA2. A woman with a fault in one of these is up to 85 per cent likely to develop breast cancer, and up to 40 per cent likely to develop ovarian cancer.

Genetic testing involves a two-step process. First, in the diagnostic part, a living relative with breast cancer is tested. Next, the healthy person is tested to see if she has inherited the fault. This is called predictive testing.

The charity surveyed 27 genetic counsellors and more than 50 women who had been genetically tested. More than half of the counsellors had patients who had opted to have their breasts removed while waiting for their results or the results for an affected relative. Jeremy Hughes, the chief executive of Breakthrough Breast Cancer, said that it was unacceptable that women were forced to put their lives on hold while waiting for vital test results. He said: "The decision to take such a test is extremely personal, complex and difficult enough. That some then feel compelled to make crucial healthcare decisions out of fear of developing breast cancer while waiting for their test results is appalling."

A spokeswoman for the Department of Health said that waiting times for results had been a problem. She said that an extra 18 million pounds in funding had been allocated to NHS genetic laboratories to speed up the process. "They are making excellent progress towards this important goal."

Source



Ambulance problems still not fixed

Despite Queensland government assurances



A boy who fell through an aquarium almost bled to death because an ambulance was diverted to treat a man whose throat became sore after eating a hamburger, paramedics claim. The boy, 12, from Mooloolaba, had to wait 30 minutes before another ambulance arrived to take him to Nambour Hospital.

The mix-up has been blamed on a faulty computer system and lack of experienced staff at a Queensland Ambulance Service communications centre on the Sunshine Coast. "The QAS management have assured the public that all the problems have been rectified, yet situations like this continue on a daily basis," a senior ambulance source said. "The computer system does not work and the operators don't have any clinical knowledge, so there is a huge risk that people could die unnecessarily."

But a QAS spokesman yesterday said the boy did not have life-threatening injuries and his case was given a Code Two (non-urgent) priority. The ambulance arrived after 27 minutes. "This matter was correctly coded and dispatched accordingly, the spokesman said. "From all the facts available, it was a straightforward case."

The source said an ambulance was dispatched to the boy after he crashed through the aquarium at his home a fortnight ago. But the paramedic was diverted to another "higher priority" case. "The second patient had been sick with a sore throat for a week and had aggravated it by eating a Big Mac," the source said. "Once the paramedic told the guy to gargle his medication, as prescribed by his doctor, she was again dispatched to the boy. "In her words they were `the most horrific injuries that I had seen that hadn't come out of a car accident - there was over half a litre of blood on the floor, the thigh bone was visible, as were tendons and a lot of tissue'."

The source said call centre workers were inadequately trained and crews frequently responded to "Code One" emergency calls that were little more than patient transfers to hospital. "Ring up with a runny nose or be involved in a minor nose-to-tail and you will get an ambulance Code One. But ring up after falling through an aquarium, or collapse with a stroke on the footpath, and your ambulance will probably take half an hour or more to get there," the source said.

The Sunday Mail reported in January how a Kilkivan man almost died when the ambulance service ignored his wife's initial call for help after a machine accident. Paramedics were dispatched only after she called a second time, an hour later. Ambulance Commissioner Jim Higgins blamed that delay on a fault with the dispatch system. A communications officer was counselled over the incident, but frontline staff complained that many Triple-0 calls went unanswered.

The article above appeared in the Brisbane "Sunday Mail" on June 18, 2006

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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20 June, 2006

There is no right to medical care

In the advertisement "A Renewed American Agenda" (USA Today, May 4, 2006)—placed by The Bedell World Citizenship Fund of Spirit Lake, Iowa, the organization urges us to "Recognize that All Americans Have A Right to Medical Care." I suppose they mean well but in fact they are perpetrating a gross misunderstanding about individual rights.

First, those who belong to this organization may mean no more than that we in these United States of America have a legal right to medical care, which is true enough but not crucial since governments can establish such rights—entitlements—whether justified or not. Those who have power have always been able to confer legal privileges on others especially if they can obtain these privileges from people by force of arms, by taxation or outright conscription.

Second, and which is the more vital point to make in response to this claim about a right to medical care, no one in fact has a natural right to medical care comparable to one's right to life, liberty, the pursuit of one’s happiness, private property, and so forth. These are what political theorists call negative rights because all they require is that people refrain from intruding on one another. But in fact no one can have a right to medical care because if one had such a right, others would lose their basic rights to liberty, and to property, which are unalienable and cannot be lost (only violated).

Medical care is a value doctors, nurses and other medical professionals would, if they were free men and women, provide to those they would choose as recipients, on terms they regard as acceptable. These provisions are not owed to anyone. Doctors, nurses, and other medical professionals may not be placed into involuntary servitude to those needing their services—the relationships must be voluntary, no matter how vital those services are to the recipients.

The belief that others may justly be placed into involuntary servitude so as to secure funds to pay medical professionals—who then will service those who need their work—is a gross error. In a free country—a just country—adult men and women treat each other as ends in themselves, not as unwilling tools, instruments, or means to each other’s ends. Just as I may not go over to my neighbor’s home and conscript some unwilling individual to come and mow my lawn or even drive me to the hospital (but must ask for this and await willingly given help), so any service such as medical care must be obtained without coercion.

There are those, of course, who believe that once it has been democratically determined that people must pay for medical services to all, there is nothing wrong with collecting the taxes for this purpose. This is wrong—no group or majority of a group may decide to take what belongs to people. It is no less unjust to do such a thing than it is to hang someone because the majority in some town decides it’s OK to do so, without first following due process, namely, demonstrating via the justice system that the hanging is deserved.

It needs to be reiterated again and again that taxation is a reactionary device that had been used by monarchs to collect “rent” from the folks who lived and worked on what the monarch (misguidedly) believed was his or her property. Taxation went hand in hand with serfdom and neither has a place in a free society where individual citizens are sovereign, not their government (which is merely an administrative agency to secure the rights of all the citizens, even non-citizens, of a country).

The myth of having a right to medical care—or all sorts of other services that need the work or resources of others—generates the mentality that people can proceed with their lives without having to be responsible for what living entails. These are all kinds of costs one must cover and be prepared to cover, alone or with the voluntary cooperation—trade, charity, generosity, or grant of loans—of others. Dumping these costs on unwilling others is like dumping pollution on unwilling others, a natural crime. The folks at the Bedell World Citizenship Fund ought not to be complicit in peddling the perverse political ideology that supports such practice.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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19 June, 2006

Campaign on Hospital Errors "Saves Lives"

A campaign to reduce lethal errors and unnecessary deaths in the nation's hospitals has saved an estimated 122,300 lives in the last 18 months, the campaign's leader said Wednesday. "I think this campaign signals no less than a new standard of health care in America," said Donald Berwick, a Harvard professor who organized the campaign.

About 3,100 hospitals participated in the project, sharing mortality data and carrying out study-tested procedures that prevent infections and mistakes. Experts say the cooperative effort was unusual for a competitive industry that does not like to focus publicly on patient deaths. "We in health care have never seen or experienced anything like this," said Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations.

Dr. Berwick of the Harvard School of Public Health announced the campaign's results Wednesday at a hospital conference in Atlanta. Dr. O'Leary was one of hundreds of industry dignitaries and representatives in attendance.

Medical mistakes were the focus of a 1999 report that said 44,000 to 98,000 Americans die each year as a result of errors and low-quality care. The changes Dr. Berwick sought included the deployment of rapid response teams for emergency care of patients whose vital signs suddenly deteriorated. Another change urged checks and rechecks of patient medications to protect against drug errors.

Source

A Skeptical note from a reader:

Perhaps my hospital did not participate in this study. I serve on the Quality Management committee, which investigates "medical" errors of any severity. I certainly would be aware of any deaths due to "medical errors". Based on The numbers reported (100, 000 deaths), our city should have several hundred such deaths. This is simply not true.

Dr Berwick must have taken a number from somewhere, but not from real world data. Some analysis has suggested that these alleged numbers consider those who have died where "medical errors" have been reported. This does not prove causation.

For example, it is easy to accumulate such numbers. If someone misses a dose of medication, or gets the wrong medication, this is counted as a "medical error". This type of error seldom leads to death. It is sloppy medicine, and is improved by constant attention. In truth, this procedure has long been on-going. Hospital committees keep track of these errors, and counsel people to do a better job of tracking this stuff. Many such people later go on to die, but counting a "medical error" by itself in no way indicates causation.

Dr. Berwick claims to have saved 122,300 lives out of 44,000 to 98,000 lives. Appears somwehat contrived to me - saving more lives than are allegedly lost.

Perhaps we were ahead of the rest of the country. "Rapid response teams" (code teams) have been around long before the 1999 report. And "checks and rechecks of patient medications" have been standard practice for a long time before 1999.

No doubt Dr Berwick and others have spent a lot of grant money studying this "problem". So self congratulation and declaring success is of course expected, and essential so they can have their grants renewed and continue their academic careers.

No doubt President Bush will hear of this. No doubt he will be convinced that more of "the poor" die due to "medical errors". To prove he is "sensitive" to "the poor", he will sign a bill requiring billions of dollars in computers and even more government auditors to protect medical workers from themselves, and to "save lives'. No doubt Dell and IBM and others are already counting their money.

One concern I and others have about this issue is the lowering of standards for nursing schools. The product is just not as good as it was. And more motivated nurses are going to school to get advanced degrees so they can push paper and not take care of patients. So what is left is the less competent and less experienced.

There are times when an inexperienced doctor in training orders the wrong dose of drug; an experienced nurse will usually pick up such an error in a heartbeat. Today, we are losing these experienced nurses. Some believe automated systems will bridge this gap. I am not convinced. With medicine ever more complicated, we need both better nurses and better machines. In fact, it takes a certain amount of smarts to run the machines. The fantasy from administrators of saving money by hiring lower paid, lower skilled workers is just that - a fantasy.



THE NEGLIGIBLE ETHICS OF THE AMA

Excerpt from Mystery Pollster

We have had some new developments over the last few days regarding the online Spring Break study conducted earlier this year by the American Medical Association (AMA). The story, as long time readers will recall, involved an AMA release that initially misrepresented the study, calling it a "random sample" complete with a margin of error and implying in some instances that results from a small subgroup of women that had actually gone on Spring Break trips represented the views of all the women in the survey. While my posts on the subject received a fair amount of attention in the blogosphere, the mainstream media -- including outlets that had reported the misleading survey -- largely ignored the controversy. This week that changed.

Here are details and links:

Although I had missed it, the New York Times did make a formal correction of a Week in Review story that cited results of the poll soon after American Association for Public Opinion Research (AAPOR) President Cliff Zukin wrote the Times to complain. Their correction now appears at the end of versions of the story available on the Web or through a Nexis search:

For the Record

A chart on March 19 about the history of spring break referred incompletely to an American Medical Association survey of female college students and graduates on vacation behavior. It was conducted online and involved respondents who volunteered to participate; they were not chosen at random.

Earlier this week, the Washington Post's Howard Kurtz devoted his Media Notes column to the story. Kurtz reviewed some of the most colorful headlines and quotations from the initial media coverage. "At the risk of spoiling the fun," he concluded, "it must be noted that this poll had zero scientific validity."

Kurtz also quotes Richard Yoast, the director of the AMA's Department of Alcohol, Tobacco and Other Drug Abuse as saying,

[H]is organization posted a correction on its Web site to note that this was not a nationwide random sample and should not have included a margin of error, as in standard polls. "In the future, we're going to be more careful," he says.

While they are at it, the AMA might want to be a bit more careful about the way they post corrections. As noted in my original post on this subject, the AMA did correct the methodology blurb in their online release, but the corrected version includes neither a trace of the original misrepresentation nor any statement that the current version corrects the original. Also, as Kurtz points out, the corrected AMA release continues to highlight statistics based on "only the 27 percent of the 644 respondents who said they had actually been on spring break," yet still "make[s] no distinction between those who have taken such trips and those who haven't" (see this post for details).

The appearance of the Kurtz item may have been the reason that the Associated Press issued this correction just yesterday:

Correction: Spring Break Risks story
Eds: Members who used BC-Spring Break Risks, sent March 7 under a Chicago dateline, are asked to use the following story.
05-31-2006 15:23
CHICAGO (AP) _ In a March 7 story about an American Medical Association survey on spring break drinking and debauchery among college women and graduates, The Associated Press, using information provided by the AMA, erroneously reported how the results were obtained. The AMA now says participants were members of an online panel, not a random sample

Finally, today's Numbers Guy column by the Wall Street Journal's Carl Bialik takes a close look at the story and the new communications initiative that AAPOR will undertake to try to react to stories like this more quickly:

Sixty years after its founding, a key association of professional pollsters is dismayed with all the bad survey numbers in the press. In an overdue response, the group is seeking new ways to curtail coverage of faulty research...

"Our ability to conduct good public opinion and survey research is under attack from many sides," the group's long-range planning committee wrote in a May report. As part of its response, Aapor, as the group is known, plans to hire a staffer to spot and quickly respond to faulty polls.

If Aapor does come down hard, and quickly, on bad research, it could drive pollsters to do better work and disclose their methods more fully, and perhaps even introduce higher standards to what is today an unruly industry. However, a solitary staffer will be hard-pressed to improve the treatment of polls by a numbers-hungry print and electronic press. [link added]

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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18 June, 2006

AMA: Buy insurance or face tax penalty

The Australian government already does exactly that

Hoping to prod an estimated five million uninsured Americans into buying health insurance, the American Medical Association Tuesday backed a tax penalty for individuals and families who make enough to buy medical coverage but choose not to. The AMA's policymaking House of Delegates vote in favor of what it called "individual responsibility" comes as state and federal lawmakers are weighing similar ideas in the form of legislation in Congress and statehouses across the country.

In the past, the .. AMA has shied away from government mandates as a way to provide health insurance coverage for more Americans. In this instance, the group acknowledged Tuesday at a press briefing that its support of tax penalties to encourage people to buy coverage would be a "significant shift" in the organization's thinking on matters of covering the uninsured. The vote at the group's meeting in Chicago this week means the AMA will put its lobbying clout behind state and federal initiatives that advocate a tax penalty for uninsured individuals making $49,000 or more a year and for families of four who make $100,000 or more if they do not buy medical coverage.

Under the AMA plan, individuals and families earning greater than 500 percent of the federal poverty level "would be required to obtain a minimum of catastrophic health care" coverage. The AMA would not specify the amount or specific kind of plan people should buy.

It's the latest of a growing number of legislative and political proposals that would require people to have coverage. In Massachusetts, Gov. Mitt Romney signed legislation two months ago that made his state the first to require state residents to have health insurance just as drivers must have auto insurance.

Although Romney's proposal is financed through hundreds of millions of dollars in assessments on insurers, penalties paid by employers and state Medicaid funds, the AMA's proposal is devoid of details. AMA officials did not offer a specific amount of tax penalties that would be levied against the uninsured. "This is our policy that would be used at the federal level to get uninsured people covered," said Dr. Ardis Hoven, a member of the AMA's board of trustees and an infectious disease specialist from Lexington, Ky. "I'd like to think of this as the carrot."

But the the plan's stick would most likely be wielded against those making a living wage--many of them younger individuals and families. Hoven and AMA officials said "young, relatively healthy individuals" account for most of the 11 percent, or about 5 million, of the nation's more than 45 million uninsured Americans. Passage of the measure by the AMA's House of Delegates was not without opposition among doctors and critics of such proposals in Washington. On a voice vote, AMA officials said it passed by a "large majority" of its 544-member House of Delegates. A specific vote count was not taken.

Critics of the AMA's move say the doctors are merely worried about their own bottom lines. "The AMA has a long history of sacrificing consumer freedom when physician incomes are threatened and they are doing that with this tax increase," said Michael Cannon, director of health policy studies for the libertarian Cato Institute in Washington. "They are trying to crack down on nurse practitioners because they don't like competition and I have not heard of any resolutions they have offered to make the health-care system more competitive, like opening your office longer or lowering your prices. These would be consumer friendly responses to competition."

Source



Socialized medicine is still a threat to freedom

We hear a lot from some legislators working hard to bring us peace in the world, jobs back to the U.S, higher wages for everyone, an end to terrorism and the health care we deserve. Of course, you know that health care is defined as somebody else paying for it and "free" health care is bound to cost more than anyone can afford.

When Hillary and her cronies failed to take over our health care system in 1993, they never gave up. They have been inching toward universality ever since. During that debate in 1993, we heard a lot about the Canadian Health Care system and how that should be our model. According to later articles in The New York Times and The Washington Times, the wonderful Canadian Health Care system developed serious problems.

Long waits are customary in Canada and sometimes death intervenes while awaiting the care one needs. In Toronto, overcrowding one day forced hospitals to turn away ambulances at 23 of the cities 25 hospitals. The New York Times said that a Toronto man distraught over his sick infant's condition, took a doctor hostage at gunpoint to avoid the long wait to see a physician. The police arrived and shot the man to death. No word on whether or not the infant received the care his father was seeking for him.

A 58-year-old woman who had been waiting for open-heart surgery for five years, spent the night prior to her surgery on a gurney in the hallway of the hospital. 66 other patients, spending the night in the same hallway joined her. In Vancouver, some reports are that delays are so serious that 20% of heart attack patients who need treatment in 15 minutes, are forced to wait one hour or longer. Many Canadian doctors are urging their patients to come to the United States for treatment. You don't suppose we Americans will be forced to pay for Canadians health care too, do you? Just asking.

In Canada, however, there are no problems or long waits for dental care or veterinary care. You guessed it. Both of these services have not been taken over by government and allow for private treatment. People who are required to wait for long periods of time to receive MRIs, are going to their local vet clinic in order to get them right away. In Canada, one can receive treatment for a toothache much faster than for cancer. The demand for free health care has outweighed the supply. Unable to reduce the demand, the suppliers have had to reduce the services. Results ---- long waits. It's not rocket science, folks. Lets call it The Law of Supply and Demand 101.

Remember when you hear someone say, "everyone deserves health care." Where do you draw the line? If you fall into that trap, then doesn't everyone deserve food, shelter, clothing, perhaps a new car? Our healthcare system is the best in the world. But it will eventually collapse under its own weight. It doesn't have to be this way. Most insurance covers everything from doctor visits to heart transplants and everything in between. Therein, lies the problem.

What I want is low premiums and coverage for catastrophic illness. I'll pay my own doctor visits and routine costs, thank you very much.

This started me thinking. My homeowners insurance and auto insurance is such a plan. When my plumbing goes out, I call the plumber and I pay him. I do the same with the HVAC. But if a fire or tornado comes through, I'm covered. It's the same with my car. I pay for oil changes, brakes, transmission repair, etc. I even replaced my engine a few years ago and never depended upon my insurance company. Imagine that. But, once again, if an accident happens, my insurance is there. I'm in "good hands."

Why can't health insurance be the same? Companies always pass through the cost of doing business. When you lower the cost to the consumer..voila.more is consumed. Low co pays for doctor visits equals more doctor visits and someone else paying for it (insurance companies). Then insurance companies recoup the costs in increased premiums. Around and around we go.

We haven't even mentioned the additional cost to the healthcare industry by lawsuits and skyrocketing malpractice insurance costs. Many communities across the country have no physicians because of this very real problem. We'll have to save that for another day. Just remember nothing is free. So when it's "free", we certainly can't afford it.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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17 June, 2006

Crisis Seen in Nation's ER Care: Capacity, Expertise Are Found Lacking

Emergency medical care in the United States is on the verge of collapse, with the nation's declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner. That's the grim conclusion of three reports released yesterday by the Institute of Medicine, the product of an extensive two-year look at emergency care. Long waits for treatment are epidemic, the reports said, with ambulances sometimes idling for hours to unload patients. Once in the ER, patients sometimes wait up to two days to be admitted to a hospital bed.

As a system, U.S. emergency care lacks stability and the capacity to respond to large disasters or epidemics, according to the 25 experts who conducted the study. It provides care of variable and often unknown quality and depends on the willingness of doctors and hospitals to lose large amounts of money. Fixing the problems is likely to cost billions of dollars and will require the leadership of a new federal agency, which Congress should create in the next two years, they wrote. "This is a crisis that could jeopardize everyone in this room, and all their loved ones," A. Brent Eastman, a surgeon and chief medical officer of the ScrippsHealth hospitals in San Diego, said at a daylong conference on the reports, which were prepared by the National Academy of Sciences' Institute of Medicine. "There is just such a gap between what the public knows, or thinks it knows, and the reality. And it is getting worse," said Robert B. Giffin, the Institute of Medicine staffer who headed the study.

The reports -- on hospital ERs, on pediatric emergency care and on pre-hospital care given by ambulance services -- were embraced by the 24,000-member American College of Emergency Physicians, and its president said that the endorsement was telling. "What other industry says, 'Hey, look at us, our whole system is broken'?" said the group's president, Frederick C. Blum, a physician in Morgantown, W.Va.

Two key steps for improving emergency care are regional planning and creating a standard way to measure outcomes, so that low-quality ERs and ambulance services can be identified and fixed, the committee wrote.

Emergency medical care is a legal right for all Americans. Under a law enacted in 1986, emergency rooms must evaluate and stabilize anyone who shows up. That requirement -- bolstered by physicians' ethical duty to treat the ill -- has made hospital emergency departments subject to unique pressures. From 1993 to 2003, the U.S. population grew by 12 percent but emergency room visits grew by 27 percent, from 90 million to 114 million. In that same period, however, 425 emergency departments closed, along with about 700 hospitals and nearly 200,000 beds.

ERs are notorious money losers. About 14 percent of ER patients are uninsured. About 16 percent are covered by Medicaid, the federal-state insurance program for the poor, and 21 percent by Medicare, the program for the elderly. More than half of hospitals report losing money on emergency care of both groups of government-insured patients. All of this has led to extreme bottlenecks in ERs, manifested by delays in every step of treatment, according to the reports.

In 2003, 501,000 ambulances were diverted from the hospital where they normally would have delivered a patient because the ER was full. In 2004, 70 percent of urban hospitals reported that their emergency departments had been "on diversion" at least once. Nationwide, about 14 percent of ER patients end up admitted to the hospital. A study by the Government Accountability Office in 2003 found that 20 percent of emergency departments had to "board" patients in hallways or other temporary space, for an average of eight hours, before a bed opened. The American College of Emergency Physicians several years ago surveyed 90 emergency departments on a single Monday evening. Seventy-three percent reported that they had two or more patients boarding.

A 2004 study found that ERs at university-based hospitals were classified as crowded 35 percent of the time, meaning all emergency beds were occupied, patients were in the hallways, the waiting room was full, and the waiting time for treatment was more than one hour. Another hazard largely unrecognized by Americans is that hospitals, especially in rural areas, often cannot find specialists such as orthopedic surgeons and neurosurgeons willing to cover the ER. In some cases, this is because doctors are unwilling to treat high-risk patients with complicated ailments, many of them uninsured, at inconvenient times. Sometimes it is simply a function of shortages. In 2002, there were fewer practicing neurosurgeons in the United States (about 3,000) than a decade earlier.

Largely unknown is the human cost of these problems. Many studies have shown that high-stress, chaotic environments contribute to errors. One from 1991 showed that though relatively few "adverse outcomes" occur in the ER, it was the site of 70 percent of those attributable to negligence. The number of deaths caused by a delay in treatment or lack of expertise is especially uncertain, though it may not be small. San Diego established a trauma system in 1984 after autopsies of accident victims who died after reaching the ER suggested that 22 percent of the deaths were preventable, said Eastman, one of the Institute of Medicine committee members.

Trauma care in many ways is the model on which the committee hopes the emergency care system will be rebuilt. Some states and urban areas have systems in which the level of trauma care every hospital is capable of providing is known and a centralized dispatching agency directs patients based on real-time information about each hospital's capacity and staffing. Although the vast majority of ER patients have not suffered trauma, about half need attention within an hour of arrival at the hospital, according to a study in 2003. Because not every hospital or even every city can provide all services, "the committee supports further regionalization of emergency care services," the authors wrote.

Even without systemwide reform, hospitals can do many things to make the flow of patients more efficient and to be ready for predictable spikes in demand, said Benjamin K. Chu, an ER physician and regional president of a Kaiser Health Plan in California who was also on the expert panel.

The report on ambulance service called for standardizing the training of paramedics and creating guidelines for pre-hospital care based on research. The report on pediatric care emphasized that 27 percent of ER patients are children and that many hospitals lack the expertise or the equipment to meet the needs of those who are critically ill.

The District's emergency and trauma services measure up well. A report this year gave the city an A-plus in "its support of an emergency care system." Though the assessment was somewhat skewed by the District's compact geography and urban makeup, population-adjusted numbers showed more emergency departments, board-certified emergency doctors, hospital-staffed beds and trauma centers than in any state, and probably more than in many local jurisdictions, although the report did not look so narrowly.

Still, the American College of Emergency Physicians noted, emergency services in the city "are regularly reaching their capacity, and patients are frequently and increasingly diverted to other facilities." In 2004, for example, Washington Hospital Center's ER was "on diversion" for nearly 2,100 hours. Howard University Hospital's ER turned away patients for the same reasons for almost 1,200 hours.

Source



THE INDIAN OPTION AGAIN

To help cut its health care costs, Blue Ridge Paper Products is considering a program that gives employees the option of traveling to India to receive medical care. “If the due diligence and feasibility checks out positively, then we plan to offer this as an option,” said Darrell Douglas, the company’s vice president of human resources. The possibility of significant savings has led Blue Ridge Paper to consider the plan, which includes company-paid travel and lodging for a family member and the patient to undergo approved procedures at an internationally accredited hospital in New Delhi or elsewhere in India.

The kicker for the patient is the opportunity to share in up to 25 percent of those savings, which could amount to thousands of dollars for a hip procedure that costs $50,000 in North Carolina, but only about $18,000 in India, including the related travel expenses for two people.

To look into the program, Blue Ridge Paper is working with IndUShealth, a Raleigh company that coordinates overseas health care in Indian hospitals for American patients. “We’re not exporting health care to India as much as importing competition in the United States,” said company President Tom Keesling, a former hospital CEO who helped launch IndUShealth last year.

The number of Americans traveling to countries such as India and Thailand for health care is rising, drawing increasing interest in what has been dubbed “medical tourism.” “It is a leading-edge type of service that’s just beginning to get some attention,” said senior health care consultant Steve Graybill of the Charlotte office of Mercer Health & Benefits, a New York-based consulting firm.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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16 June, 2006

Left-leaning doctors promote sweeping social meddling

The American Medical Association, meeting in Chicago this week, will consider a controversial proposal to fight obesity by taxing soda pop. A committee of the influential doctors' group is recommending the AMA lobby for a "small" federal tax on sugar-sweetened soft drinks, with proceeds going to anti-obesity efforts such as physical activity programs and healthier school meals. The committee did not specify how high the tax should be. But a consumer group, Center for Science in the Public Interest, estimates that a 1 cent a can tax would raise $1.5 billion a year. That's more than the advertising budget of McDonald's.

These are among the proposals the American Medical Association will consider this week during its annual meeting at the Hilton Chicago: Support a 50 percent reduction in salt in processed foods, fast foods and restaurant meals over the next decade. Urge health insurance plans to cover stomach-stapling surgery for weight loss. Oppose beer ads on college sports broadcasts. Prepare a report summarizing video game research, including emotional and behavioral effects and addictive potential. Push to ban smoking in all public places and workplaces. Urge school health classes to "discuss the importance of routine pap smears in the prevention of cervical cancer." Support mandatory school instruction on the dangers of Internet pornography.

During its five-day meeting, the AMA's governing House of Delegates can accept, reject, amend or table these and dozens of other proposals. A 12-ounce can of Pepsi contains 150 calories of sugar or high fructose corn syrup -- the equivalent of 10 teaspoons of sugar or a 3.2-ounce reduced-fat ice cream cone at McDonald's.

In the late 1970s, teens drank nearly twice as much milk as soft drinks; now they drink twice as much soft drinks as milk. Pop is "devoid of nutritional value" and contributes to increasing obesity rates, the AMA committee said. The committee cited one study that found the odds of a child becoming obese increases 60 percent for each additional can of pop consumed each day. However, the committee report noted that other studies have found no link between soft drinks and obesity. The AMA committee also endorsed soda pop taxes imposed by state and local governments. Diet pop, flavored milk and sugary fruit drinks should be exempt, the committee said.

More than a dozen states have passed soft-drink taxes, but in recent years several states have repealed such taxes. States typically use soft-drink taxes for general purposes, rather than for obesity programs. Taxing soft drinks is "misguided," said Kevin Keane of the American Beverage Association. "It will not move the needle one ounce in addressing health and wellness issues." Doctors should know better than to target a single food, Keane said. "People consume a lot of calories every day. Why pick on one particular product?"

Of course, soda pop is not the only cause of the obesity epidemic. But pop makes an easy target because it has no redeeming nutritional value, said Michael Jacobson of the Center for Science in the Public Interest. "It's a simply defined category of food that's pure junk." The AMA's House of Delegates can accept, reject, amend or table the committee's recommendation. An AMA endorsement of a soft drink tax could be "extremely useful" to legislators who push such measures, Jacobson said. However, he added that a federal soda pop tax is unlikely. "Tax increases are not popular with this administration or Congress," Jacobson said. "It would be dead on arrival."

Source



Bloated NHS to get the Tesco treatment

Health chiefs want to use 'lean thinking' management techniques to remedy an inefficient service

Hospitals and surgeries need to adopt the "lean" management techniques used by companies such as Tesco and Toyota to reduce the inefficiency and hold-ups experienced by patients in the NHS. Health service leaders want hospitals to improve their service by better understanding how patient demand varies and identifying and removing the valueless activities that create bottlenecks in the system.

These include getting patients from accident and emergency to the operating theatre more quickly by removing unnecessary paperwork and reducing the number of different staff involved. It also involves improving the layout of hospitals, so that waiting rooms and items such as diagnostic machines are where they are needed most, to save time and money and reduce patient and staff stress.

One hospital trying the "lean" approach, a production methodology first developed about 60 years ago by Toyota, found that processing a routine blood sample involved 309 separate steps, which it reduced to 57 with simple changes. They also found that under the current system more than 250 different interactions took place to discharge a patient with complex health problems. A report commissioned by the NHS Confederation, Lean Thinking for the NHS, concludes that the lean system, which is also used by the Royal Navy and Royal Air Force, could revolutionise health care and dramatically improve quality and efficiency.

The key is to remove activities that do not add value to the customer, or patient, by redesigning how services work. Early results of a study by Bolton Hospitals NHS Trust, with the assistance of the RAF, showed that the lean method helped to cut by a third death rates for patients having hip operations; reduced paperwork in the trauma unit by 42 per cent; and halved the amount of space needed by the pathology department.

Nigel Edwards, policy director of the NHS Confederation, which represents health service managers, said: "Many ideas about the organisation of work are deeply held and often wrong." Australian health chiefs at Flinders Medical Centre in Adelaide, who redesigned their care based on the lean model, found that it allowed them to do about 20 per cent more work and offer a safer service on the same budget and using the same infrastructure, staff and technology. Gill Morgan, the NHS Confederation's chief executive, said that more was needed to improve frontline services. "The NHS can learn from the latest thinking as adopted by the Royal Navy, RAF, Tesco and Toyota. NHS managers want to be at the vanguard of modern techniques to improve patient care." She said that the pioneering work done at Bolton and Wirral, which had also adopted the method, showed what could be done. David Fillingham, chief executive of Bolton Hospitals NHS Trust, added: "When we started out, some people were very sceptical. But I've never seen anything that energises staff in this way."

Results of a survey of 203 NHS chief executives, released by the confederation at its annual conference yesterday, showed that 95 per cent accepted that the NHS must increase productivity and cut waste before they could justify more government funding. Tony Blair has also called for trusts to improve efficiency. In an interview with Health Service Journal, published today, he says that the principles of quality healthcare provided equitably and free would remain abstract concepts without good NHS management. The Royal Navy adopted the lean method after it felt pressure to reduce its aircraft support costs by 20 per cent. It managed to reduce the number of aircraft repair bases and saved millions of pounds on its Sea King and Lynx helicopter operations.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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15 June, 2006

German government doctors to step up strike

Up to 20,000 doctors in Germany have said they are escalating industrial action by going on indefinite strike. The dispute is over pay and working conditions at state-run hospitals as well as at 40 university clinics. Some of the hospitals are in cities staging the World Cup, including Cologne, Munich and Leipzig. Thousands of doctors have already stopped work, delaying some operations. The doctors began their industrial action three months ago.

Their union says they work on average 60 to 80 hours a week - double the number in their contract. The doctors are also demanding a 30% pay rise. Many German doctors have moved abroad to work, the BBC's Tristana Moore reports from Berlin. In the UK, for example, they can earn about twice as much and work fewer hours.

The doctors' union held talks with the employers' association on Saturday. Union leaders are meeting in Frankfurt later on Monday to discuss a new offer that is on the table.

Source



Lawyers could kill off computerized medical consultations

The number of doctors and hospitals making virtual house calls has exploded in recent years, which has lawyers cautioning the medical community about the legal dangers of treating and monitoring patients via the Internet. Attorneys warn that virtual medicine -- which has popped up in hospitals and clinics in more than a dozen states in the last two years -- could open the floodgates to malpractice claims, privacy disputes and licensure problems. "My concern is that this would open up lawsuits," said attorney Brett C. Powell of Hicks & Kneale in Miami, who handles malpractice appeals for doctors and plaintiffs. "I can foresee a claim down the road where the patients are claiming negligence for failing to recognize a situation. With these virtual house calls ... you could say not only did he not have an adequate examination, but he didn't even see me."

Lawyers' concerns stem not only from the increase in doctors participating in virtual medicine, but by the growing number of insurance carriers that have been willing to pay for online visits. For example, this July, some Cigna HealthCare members in California will be able to conduct online doctor's visits, a service that will also be available next year to members in New York, Florida and Arizona. And some insurers have already started remimbursing doctors for online visits. In Georgia and New York, children are being diagnosed for ear or throat infections by pediatricians via the Internet and high-tech video equipment. In Texas, Pennsylvania and Illinois, nurses are taking digital pictures of hospitalized patients and e-mailing them to doctors, who e-mail instructions on what to do if the person looks too pale or a sore looks infected. In Hawaii and Pennsylvania, homebound patients are holding videoconference calls with their doctors, and transmitting vital signs through devices hooked to computers.

Lawyers, meanwhile, are ambivalent about what they're seeing on the medical front. "I've seen a burst of activity in the last 18 months," said Sharon Klein, a partner at Philadelphia's Pepper Hamilton who specializes in health care law. The nation's legal system, however, has not kept pace with the technological advances regarding virtual house calls, cautioned Klein, who notes that remote caregiving raises concerns about malpractice claims, privacy, confidentiality and security-of-communication claims, as well as about the practice of medicine across state lines. In the last 18 months, Klein has counseled many hospitals in the practice of "virtual rounding," where doctors and specialists check on their patients from remote locations with the help of digital images displayed on computers. She said that it has become a particularly popular practice in children's hospitals.

In helping hospitals use virtual rounding, Klein has drafted hundreds of confidentiality agreements in recent years, in which everyone from doctors and nurses to technology installers and pay groups sign disclaimers promising to keep patient information confidential. Klein also has offered a number of tips on avoiding litigation to health care providers that use virtual medicine. They include making sure patient information is encrypted and being aware of medical-license barriers. In the event something goes wrong and a lawsuit is filed, jurisdictional issues may arise. If physicians prescribe telemedicine services in states in which they are not licensed, malpractice insurance claims could be denied.

Avoiding licensing problems is a top priority for attorney Jane Arnold, whose advice regarding virtual medicine has been sought out in recent years by a growing number of specialists. Arnold's clients include radiologists who read films in the middle of the night from their homes, obstetricians who use fetal monitors to check on pregnant women through secure Web sites on the Internet, and a Phoenix oncologist who does video conferencing with cancer patients in small towns. "Doctors who have been in practice for years and years and years are coming to embrace the convenience and the quality of data that is available," said Arnold of the St. Louis office of Bryan Cave.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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14 June, 2006

LOTS OF IRISH DOCTORS SOON

A senior Trinity College professor has condemned Bank of Ireland for providing interest-free loans to students in traditional professions who are likely to become high earners. The bank is targeting undergraduates in medicine, dentistry, pharmacology and veterinary, saying 0% interest loans to these students are a guaranteed investment. “There is an extremely competitive market out there,” said Mary Brennan, a bank spokeswoman. “Studies show that 80% of people are unlikely to change banks. Students who become veterinarians or pharmacologists are strong business customers for us.” Other students taking out Bank of Ireland loans are charged 9.2%.

Sean Barrett, economics professor at Trinity College, said preferential treatment by Bank of Ireland was subsidising traditional professions. “Because courses like medicine have until recently restricted the numbers allowed into their courses, they have enhanced their earnings. It is not defensible economic practice. The bank needs to encourage those doing commerce, business, art or history as they are the real engine of the Celtic tiger, not these old-style restrictive professions.”

Ulster Bank offers larger loans — up to 15,000 euros more than the standard maximum — exclusively to students in nine “professional” subjects such as trainee solicitors and student doctors. AIB said it occasionally engages in tactical pricing to recruit students but that “all students are equal in the eyes of the bank”. Aoife McArdle, welfare officer at National College of Ireland student union, said: “ Just because someone does medicine doesn’t mean they will be good at repaying their loans.”

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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13 June, 2006

U.K.: A BILLION POUNDS SPENT ON "ADVISERS" BUT NO MONEY FOR MORE DOCTORS, NURSES AND DENTISTS

The cost of hiring management consultants to advise on cutting NHS budgets was condemned yesterday by a leading union which said that some consultancy contracts were now reaching 150,000 pounds. Amicus, the country’s largest manufacturing union, said that consultants were being paid 1,200 pounds a day to give advice on how trusts could save money. The union said that contracts usually ended up with hundreds of health jobs being axed.

The so-called “turn-around teams” have been hired to alleviate the financial crises in a number of NHS trusts across the country which are blamed for most of the health service’s 512 million deficit last year.

Derek Simpson, the general secretary of Amicus, said that hiring private consultants was “political dogma gone mad”. He added: “We have to combat the philosophy that private is best. Not only is private provision detrimental to patients, it is costing taxpayers millions of pounds. As the so-called ‘turnaround’ experience demonstrates so vividly, privatisation does not provide value for money.”

Hospital doctors called last week for an end to NHS spending on management consultants, who cost an estimated 1 billon last year. They also accused the Government of “short-sighted” staff planning over fears for the future employment prospects for junior doctors. Paul Miller, the chairman of the British Medical Association consultants committee, said that ministers risked destroying the NHS if they continued to waste money.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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12 June, 2006

Huge Legal Win for Compounding Pharmacists

It is a welcome outcome when the judicial system issues a ruling that helps solve a medical problem rather than compounding or creating a new one. An Association of American Physicians and Surgeons' "News of the Day in Perspective" release on May 28, 2006 notes such an occurrence.

Tens of millions of Americans take customized preparations prescribed by physicians and mixed by compounding pharmacies instead of mass-produced, FDA-regulated drugs. These include hormones, topical creams for nausea, dermatologic and ophthalmologic preparations, and pain medication.

In a landmark ruling, U.S. District Judge Rob Junell in Midland, Texas, ruled that customized compounds created by compounding pharmacies are not new, unapproved drugs that must be sanctioned by the U.S. Food and Drug Administration. AAPS assisted by filing two amicus briefs in support of the compounding pharmacies in the case 'Medical Center Pharmacy v. DOJ, HHS, FDA.'

Austin lawyer Terry Scarborough, who filed the lawsuit against the FDA on behalf of 10 pharmacists, praised the decision: "We are pleased the court ruled from the bench on the most important issue - that compounds don't create 'new' drugs as the FDA suggested." Scarborough said that Judge Junell indicated he would issue an injunction barring FDA inspections that exceed its authority. Kristie Zamrazil, a spokeswoman for the Texas Pharmacy Association, said the decision preserves the roots of pharmacy. "Compounding has been part of pharmacy practice since its origins. Judge Junell's ruling is a win for patients and recognizes the important health-care service that pharmacists have provided through the ages." (Lavlan Copelin, Austin American-Statesman 5/27/06)

Ken McLain is a pharmacist for the Sav-On pharmacies in Orange County, Calif. While the drugstore he serves in Newport Beach no longer does much compounding, he notes that a ruling against compounding would have had significant detrimental effects upon patients and health care. "There are a number of pharmacies that specialize in compounding that provide needed medicines for many patients. Often patients have specialized needs such as requiring higher/lower doses of a medication or have allergies to filler materials or certain drugs. "Pharmaceutical companies are not able to provide or manufacture pills, tablets, lotions or creams for every known disease, illness or injury. Many patients are extremely dependent on the skills of the pharmacist."

A new drug is subject to the FDA's onerous new drug application process, stated AAPS General Counsel Andrew Schlafly, who filed an amicus brief for the pharmacists.

According to this ruling, "Compounded drugs are fully legal and not subject to the requirements and prohibitions imposed on new drugs by the 1938 Food, Drug and Cosmetic Act," Schlafly further notes. Adds AAPS Executive Director Jane Orient, M.D., who has a way of cutting through the camouflage: "Compounding pharmacies could not possibly meet the onerous, expensive and time-consuming FDA requirements. "They make prescriptions one at a time. The FDA requirements are designed for manufacturers who make pills by the billions. Ophthalmologists and dermatologists - and their patients - would be especially hard hit. The products their patients need are not available except from compounding pharmacies."

In an era of mass impersonal medical care controlled by insurance companies and government, and with professional relationships worsened by trolling trial lawyers, patients are crying out for some personal care. Ideally, specialized care should be the goal of the future. Why take the art out of the art and science of pharmacology? Pharmacists are well trained professionals who significantly add to health care in a one-on-one relationship.

An unwise judicial ruling would have relegated them to pouring pills from many large white bottles to smaller clear ones. It is indeed a rare day in June when a legal or judicial man makes a decision that contributes to better health care. So kudos to Texas Judge Rob Junell. A written order to make this wise ruling binding will be issued in late July.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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11 June, 2006

Massachusetts owes $86.6m to the US, audit says

And these bureaucratic bunglers think they are the light on the hill!

State Medicaid officials repeatedly violated federal laws and regulations and must return $86.6 million to the US government, a new federal audit has found. The audit, by the inspector general for the US Department of Health and Human Services, found that from 2001 to the first quarter of 2004, state Medicaid officials overcharged the federal government for services provided by the state Department of Social Services. The audit found that the violations did not involve willful misconduct, but resulted instead from lax oversight.

In all of the reported violations, state Medicaid officials billed the federal government for care that was not directly related to arranging medical services. The audit documented hundreds of thousands of instances of those improper claims over the period studied, times when the state overcharged Medicaid by amounts ranging from $209 to $295. State Medicaid officials labeled the audit ``seriously flawed and erroneous" and said they would contest the findings in a reply to the federal government that they plan to submit at the end of the month.

In one example cited by Inspector General Daniel R. Levinson, the state billed federal Medicaid officials for a social worker who called a child's school, asking that the child be allowed to return to class. In another reported violation, the state billed Medicaid for a social worker who accompanied a child to court. ``We attribute these unallowable costs to the state agency's lack of procedures for ensuring compliance with Medicaid requirements," Levinson wrote in his 13-page report, a copy of which was obtained by the Globe. ``The state must comply with all federal requirements."

Beth Waldman, the state Medicaid director, said the federal government had reached an agreement with the state in 1994 to allow Massachusetts to bill for such services. ``We believe that they are allowable under the regulations that [the federal government] worked with us to put in place and that they understood that at the time," Waldman said in an interview yesterday. ``So, if they want to change them, that's fine, but you can't do it retrospectively, and you can't do it through an audit."

Waldman sounded a skeptical note, saying she ``would not be surprised" if the federal government brushed aside the state's reply and demanded return of the $86.6 million. It would then be up to the Legislature to decide how to handle the hit to the state budget, she said. ``Eighty-six million dollars is a lot of money; there's no doubt about that, but there's not going to be an impact on the kids," because the services under review have already been provided, Waldman said. ``It would be a hit to the General Fund".

More here



THE NEW YORK MESS

It makes even the dubious Massachusetts initiative look good

For years this nation has sought a way to provide every American with affordable health-care coverage. Now the problem is coming to a head. Small businesses and the self-employed are multiplying by the day-yet they cannot access affordable health insurance. Today, the fastest-growing group of uninsured are small-business owners and independent contractors. They are shut out of buying insurance at group rates.

The choice is clear: We can set aside special-interest politics in order to expand coverage for all. Or we can continue utilizing the power of government to exclude some-namely small businesses and the self-employed-while rewarding others. Massachusetts has chosen the first path, while New York seems intent on catering to special interests. The Massachusetts legislature recently passed a bipartisan bill that seeks to insure every resident. It requires able-bodied people to obtain coverage at group-health rates. It gives the self-employed the same buying power and tax breaks enjoyed by large corporations when purchasing health care. Finally, it provides subsidies, scaled to income and family size, that allow people to buy insurance though groups formed by religious, civic, and community organizations. The Bay State health proposal uses a combination of market innovations, quality improvements, and government support to provide fair care for all.

The Massachusetts approach is not perfect. But it stands in stark contrast to the so-called "Fair Share Health Program" bill being pushed by New York Assemblyman Daniel O'Donnell. The New York bill is a typical example of the quick-fix solution that misguided legislators and labor organizations are proposing in states all around the country. Modeled after legislation that passed in Maryland, the bill would force companies-Wal-Mart in particular-to pay an arbitrary amount of their payroll toward health benefits. Specifically, it would require companies with over 10,000 employees in the state to contribute 8 percent of their payroll to health-care coverage.

Troublingly, it was introduced without any serious study of the long-term effect of these massive health obligations-whether they would result in the same unfunded liabilities that are now pushing our auto and steel companies toward bankruptcy. Nor was there any evaluation of whether such a bill would encourage companies to pare back benefits to minimize coverage. Or whether the bill would simply shift costs from state-subsidized programs to private businesses.

Because this type of legislation is driven by politics and not facts, it fails to address the real issue: More people have to find health insurance on their own. Indeed, the proposed New York legislation is a triumph of special-interest politics. It completely ignores the urgent needs of small businesses and the self-employed to access affordable care. According to the Kaiser Family Foundation, last year only 59 percent of firms with fewer than 200 employees offered health insurance, compared to 98 percent of firms with 200 or more employees. Additionally, the Employment Policies Institute reported that a full 45 percent of the uninsured work in firms with fewer than 25 employees.

New York's legislators should be able to work together with our business and community leaders to provide health care for all without resorting to political ploys like "Fair Share Health Care." The problems facing our health-care system are bigger than any one business or group of citizens, and we must continue to seek solutions that include everyone, instead of attacking one group or benefiting a privileged few.

As Massachusetts has shown, it is possible for a broad coalition to come up with a real solution that provides affordable and fair health care for all. It's a great model for the Empire State-perhaps even the starting point for a New York health-care revolution.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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10 June, 2006

Personal injury lawyers and unharmed plaintiffs abuse the system

Personal injury lawyers often recruit unharmed plaintiffs in an attempt to win big money. These unharmed plaintiffs take compensation away from those patients who have truly been harmed

* Personal injury lawyers have found attacking our healthcare system to be a gold mine. From 2003 to 2004, personal injury lawyers received more than $18 million from medical malpractice lawsuits alone. ("Trial Lawyer Investment Pays Dividends," PRNewswire, May 8, 2006)

* In a scandal that has rocked the U.S. legal system, Dr. Ray Harron made more than $5 million for his work as an "expert-for-hire" in diagnosing many fraudulent silicosis and asbestosis claims. Harron is one of several doctors who contributed diagnoses for more than 20,000 lawsuits. In one day alone, Harron diagnosed 515 people - meaning he had less than one minute a piece to read X-rays and make diagnoses if he worked an eight-hour day. Harron and others were paid significantly more by screening companies for making positive diagnoses. ("Beware the B-Readers," The Wall Street Journal, January 23, 2006)

* Millions of dollars in compensation that should be going to critically ill and dying victims of asbestos exposure is being paid to people who are not sick.

* A study by Academic Radiology had a board of independent doctors reviewchest X-rays that had been entered as evidence by trial lawyers in asbestos lawsuits. In the original trials, doctors paid by trial lawyers to serve as "expert" witnesses concluded that 96 percent of the X-rays showed asbestos-related abnormalities. Doctors conducting the study found that fewer than 5 percent of the X-rays showed such damage. ("The Great Asbestos Deception," San Diego Union-Tribune, August 13, 2004).

* Of the money paid out to date from the largest asbestos trust fund, 60 percent of those payouts have gone to non-injured plaintiffs - each of whom have received an estimated $60,000 despite their lack of injury. ("Diagnosing for Dollars," Fortune, June 13, 2005)

* The legitimacy of evidence used in Fen-Phen class action lawsuits across the nation has been called into question in light of the arrests of former class action plaintiffs in Jefferson County, Mississippi. The former plaintiffs allegedly faked prescriptions of the diet drug in order to collect $250,000 from the $400 million settlement. ("Fen-Phen Arrest Revive Rap on County," Jackson Clarion Ledger, August 7, 2004)

* Since its widely used cholesterol-lowering drug Baycol was withdrawn from the market, Bayer is facing more than 8,000 lawsuits. The New York Times notes that at least 6,000 of those lawsuits, however, are being filed by people who did not suffer any side effects whatsoever. (Scott Gotlieb, M.D., The New York Times, February 26, 2003)

Outrageous personal injury lawyer advertising frightens doctors and patients

* Almost 80 percent of Americans believe advertising by personal injury lawyers encourages people to sue even if they have not been injured. (Sick of Lawsuits National Survey, Conducted by Public Opinion Strategies, August 16-18, 2005)

* Twenty-five percent of patients said they would immediately stop taking a prescribed drug if they saw an ad for a lawsuit involving that drug. (Pharmaceutical Liability Survey, Harris Interactive, July 15, 2003)

* Nine mental health patients in South Mississippi stopped taking their prescribed medications after seeing personal injury lawyer advertising regarding Zyprexa and Risperdal - drugs used to treat patients with schizophrenia and bipolar mania. "People see these ads and they think that they're bad for them, so they quit taking them," said Teri Breister, executive director of the National Alliance for the Mentally Ill in Mississippi. "But these patients' lives have come apart again. Every time they stop taking their medications, the episodes become worse." ("Tort Advertisements Worry Some Health Advocates," Biloxi Sun Herald, March 21, 2004)

Source



THE GERMAN MELTDOWN

In the past few months, hordes of white-coated doctors have made regular - and noisy - appearances on the streets of German big cities. More than 12,000 employees of university and state hospitals in nine German states have protested long hours and pay levels far below that of their colleagues in the rest of Europe. "The working conditions at the clinics are getting worse and worse," says Athanasios Drougias, of the Marburger Bund, Germany's biggest doctors' union with nearly 105,000 members. And the head of that union, Frank Ulrich Montgomery, recently told German radio that 1 in 3 doctors are now seeking work outside of Germany because of poor working conditions.

The high-profile strikes at about 40 hospitals over the past few months are drawing attention to the difficult working conditions faced by the nation's primary caregivers. But they're also revealing something else: the troubles facing Germany's over-extended social-welfare model, and the long road Angela Merkel's government faces in correcting it. Germany is suffering from rocketing public spending costs and an inflexible labor market that critics say has scared off investors and contributed to the fact that 4.5 million Germans are out of work.

Though still a world-beater in exports, Germany hasn't shown the fervor that economists say is needed to trim social services and battle unemployment. As a result, Europe's traditional economic engine has faltered as countries with more dynamic labor-market policies - such as Britain and Sweden - thrive. The jobless rates of the two economies, at 4.7 and 6.4 percent respectively, are well below that of Germany, which is hovering around 11 percent. More flexibility in their hiring and firing laws, and a willingness to pay top money for high- quality labor, has made Sweden and Britain serious competitors for German medical talent.

In the past three years, doctors have been "fleeing the country," says Mr. Drougias. According to one German doctors' association, 12,000 German doctors are working abroad. Most are on short assignment in the US, says Roland Ilzhoefer, the organization's spokesman. But at last count, 2,600 were registered in Great Britain. More than 1,000 others are in Scandinavian countries, he adds. "We know that doctors here are unhappy with working conditions and the large amount of bureaucracy," he says. "But ... it also has a lot to do with money. They can earn double or triple the amount abroad."

A 2004 comparative study of doctors' wages, conducted by the London-based National Economic Research Associates for the British Department of Health, confirms the claim. Considered by German experts to be the latest and most viable such study, the report acknowledges the difficulty of drawing exact comparisons because of the disparate ways in which countries and research institutes calculate and collect data. Nevertheless, a general trend is clear: Estimates of hospital doctors' average annual earnings in 2002 ranged from $35,000 to $56,000 in Germany; $127,285 in Britain; and $165,000 to $268,000 in the US. Swedish hospital doctor salaries were estimated at only $56,000 a year - similar to the German figures.

The departure of young doctors, coupled with a decreasing number of medical students, has already had an impact on Germany's hospitals, where 3,000 positions are unfilled at the moment, says Mr. Ilzhoefer. The German government seems well aware of this new reality. Chancellor Angela Merkel has called healthcare reform "more difficult than any other" that Germany is being forced to undertake.

The system, which provides patients comprehensive coverage for low monthly payments, currently costs the government 143 euros ($183) billion a year, says Jochen Pimpertz at the Institute for German Economy in Cologne. But employers also shoulder considerable economic burden for the plan. As it stands, they must pay an additional 6.5 percent of an employee's salary toward healthcare. Mr. Pimpertz says the number is already among the highest in Europe, and says that it will only rise in the coming years. As it rises, hiring new workers will become more expensive - and thus less likely to happen, making Germany's labor market less competitive, he says. "Increasing healthcare payments lead to increasing labor costs for companies," says Pimpertz. "That is surely one of the biggest disadvantages to investing in Germany, and it's a major problem for our labor market." The more an employer has to pay for his employee's coverage, the more he is likely to pull up stakes and move on.

"Climbing healthcare costs mean climbing labor costs," says Max Hoefer, director of the German Institute for Health Economics. "This makes products more expensive and leads to automation and, eventually, job cuts." Government proposals for healthcare reform have been stalled by political bickering. The migration abroad, meanwhile, shows no signs of stopping, says Ilzhoefer. In addition, those who do stay are increasingly eyeing other options. "They're no longer going into patient care," he says. "They're becoming medical journalists or working for pharmaceutical companies and consultancy groups."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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9 June, 2006

ANOTHER TRIUMPH OF SOCIALIZED MEDICINE

A Queensland farmhand was forced to deliver his dead baby in a car beside the road after his wife - having her first child - was turned away from their local hospital and told to drive to another facility three hours away. An investigation has been ordered into why 34-week pregnant Sharon Walker, 35, was not provided with an ambulance for the 270km journey from Emerald to Rockhampton, in central Queensland, and why she was turned away when the hospital knew she was in labour. The examining doctor had warned her that it would probably be a breech birth because the baby had turned in the womb.

Two hours into the trip, the mother's waters broke and the baby's father, Steven Walker, had no option but to deliver the baby son he knew was dead. "Sharon was in pain and was pushing, and I was just there gripping this little baby tight and the thought came over me that this was my son I was pulling out," Mr Walker said yesterday. My panic was starting to rise. When I looked down and I was holding his foot, and he just looked like a really good little baby - it just gutted me. "But most of all I knew that I should not be there, that Sharon should not be going through this."

Mrs Walker said she was feeling pains on the morning of May 16 and rang the nearby Emerald hospital. The midwife told her to come in straight away. She was examined and told there was no heartbeat. The hospital rang her husband and informed him, and said Mrs Walker had to be driven the three hours to Rockhampton because she was "high risk". The doctor gave her a letter for the Rockhampton medical staff in which he said Mrs Walker had dilated 2cm and that it would probably be a breech birth.

State Opposition frontbencher Vaughan Johnson raised the issue yesterday in Parliament, asking Health Minister Stephen Robinson if this was the sort of treatment women could expect under his Government. Mr Robinson said an investigation had been ordered, but later issued a press release in which he said a decision was made by clinical staff at Emerald for the patient to travel to Rockhampton, and that labour commenced in transit. Mrs Walker denied that yesterday, saying she was having pains seven minutes apart at Emerald, and the doctor had said in his referral letter that she was already dilating. "What I don't understand is why an ambulance was not ordered when they knew I was giving birth," she said. "I knew we couldn't make it and I yelled at Steven to pull over because I could feel the baby coming. "He stopped at a little store, raced in and screamed to call an ambulance, came out, tore my clothes off and he could see the feet already."

Mr Walker said he was "operating on adrenalin but was unable to pull the baby's head out. "I was afraid I would lose Sharon. We knew the baby was dead, but I didn't want to lose them both," he said. The ambulance arrived and officers helped deliver the baby. "We were put in the ambulance and the baby was wrapped in a blanket and put in with us," Mrs Walker said. "He was a beautiful, fully formed little boy. We named him Marshall Henry Walker, and held a funeral service for him in Rockhampton two days later. "I never want this to happen to anybody else."

Source



HUGE INCREASE IN SPENDING ON NHS STILL NOT ENOUGH

Bureaucracy is a bottomless pit

The NHS deficit more than doubled last year to 512 million pounds, the Government announced yesterday. This is more than twice the target of 200 million set at the start of the year and makes it the second successive year in which the NHS has failed in its statutory duty to break even. At least 15,000 jobs are to go in the attempt to cut costs.

However, such was the expectation of an even bigger deficit that Patricia Hewitt, the Health Secretary, was able to announce the figure with a sense of relief. It is less than the 620 million predicted at the half-year and hundreds of millions less than some expected. Ms Hewitt said that the deficit was concentrated in a relatively small number of organisations, was not the fault of reforms and that she would be “held accountable” if the NHS did not return to overall financial balance by next April.

Sir Ian Carruthers, acting chief executive of the NHS, said that patient care was improving, in some cases dramatically, but admitted the deficits were a “blot on the landscape”. Andrew Lansley, the Shadow Health Secretary, said that the figures would deepen “the crisis of confidence in the Government’s stewardship of the NHS”. He added: “The gross deficit — the figure for NHS trusts and primary care trusts — is 1.27 billion pounds. It is this vast sum that directly gives rise to the serious consequences in cuts in services and frontline posts. “The Health Secretary is living in a parallel universe, in which everything gets better and nothing is wrong. Hard-working NHS staff are in the real world, where they deliver in spite of the Government’s policy failures.”

A breakdown of figures shows that in 2005-06, primary care trusts (303 organisations) were in deficit by 476 million pounds, compared with 272 million in 2004-05. Acute trusts had a deficit of 545 million (246 million), while teaching trusts’ deficit was 62 million (78 million). The overall figures would have been much worse if strategic health authorities (SHAs) had not managed to save money, underspending by 524 million. That surplus, set against the overall NHS deficit, halved the total overspend. Overall, 31 per cent of the 566 NHS organisations failed to break even in the year 2005-06, compared with 28 per cent the year before.

Niall Dickson, chief executive of the King’s Fund think-tank, said that the figures masked the true scale of the financial problems. “The gross deficit has increased throughout the NHS to 1.27 billion and has been reduced to a net of 512 million only by using increased surpluses from other parts of the service” he said. “In fact, more NHS organisations are in deficit than predicted, while the net deficits for primary care trusts and hospitals are worse than last year.” Sir Ian also released his annual report on the NHS yesterday, which highlighted how waiting times have fallen to the lowest level recorded. The NHS was on target for a 20 per cent drop in cancer deaths in under-75s by 2010, and a 40 per cent reduction in heart and stroke deaths.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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8 June, 2006

BRITISH DOCTORS NOW TO BE REWARDED FOR BEING GOOD BULL-ARTISTS

Every doctors' surgery is to be inspected and awarded Michelin-style stars so that patients can tell the quality of care offered by their GP at a glance, The Times has learnt. Expert panels will give family doctors one of three gradings in a move backed by ministers desperate to show that patients are getting value for money from huge GP pay rises. The scheme, being drawn up by the Royal College of General Practitioners, will run alongside government plans to publish detailed patient surveys of each surgery's performance.

Ministers want to increase the pressure on GPs to perform after salary rises last year took average annual pay to 94,000 pounds. Critics believe that the GP contract was bungled and won too little in return for the NHS. The new GP ratings will be reviewed - with the possibility of upgrade or demotion - every three years after a two-day assessment by a panel including a doctor, nurse, surgery manager and patient representative, The Times understands. Britain's 10,500 GPs will be encouraged to display their rating on a plaque outside their surgery and also on letterheads. Practices that repeatedly fail to achieve the basic level can expect to be replaced.

The scheme should be in place by next April. Around 2,000 surgeries have so far signed up to a forerunner scheme called practice accreditation. Mayur Lakhani, chairman of the college, said that the rating system would improve standards and make the system more "customer-focused".

Dr Lakhani, who is also visiting professor in the Department of Health Sciences at the University of Leicester, said that it would provide patients with a clear indication of qua-lity, not dissimilar to the Corgi rating given to plumbers. It will apply to all providers and help patients to choose between the growing number of private health firms looking to move into the family doctor sector. "This would be the most important advance in general practice in a generation," Dr Lakhani said. "At the moment we don't really know what the accreditation is, what it represents. As a result you get a small number of practices that aren't up to scratch and we have no mechanism, no handle, on how to get things to improve."

The minimum standard - a Level 1 rating - will require GPs to pass a wide range of assessments. These include opening hours, prompt telephone answering and flexible booking to fit in with patients' busy lives as well as the standard of facilities and quality of care from doctors and nurses. Levels 2 and 3 will be judged on similar but higher standards, with the top grade requiring extra measures such as research into patient needs and greater responsiveness to community needs.

The Times can also reveal that six million patients will be asked to assess their GPs over the next year after complaints about problems in booking appointments embarrassed Tony Blair on live television during the general election. Anonymous results will appear on primary care trusts' websites so that the public can compare surgeries. Sources at the Department of Health confirmed that Patricia Hewitt, the Health Secretary, strongly supported the ratings as a way to regulate general practice and inform patients better.

The drive for more information was given extra impetus when Mr Blair admitted during the election that he was "astonished" after an audience member said that she could not book a GP appointment. Surgeries were refusing to book ahead so that they met government targets to see everyone within 48 hours of an appointment being made.

Dr Lakhani added that failure to reach Level 1 would put the surgery at risk of being dropped by the local primary care trust. He said that GPs would require considerable support to assist with regulation and reform, which the college would help to provide. He will outline the broader changes to the profession in a conference speech this week.

Source



Public hospital negligence in Victoria, Australia

A top Victorian surgeon has blamed communication and system failures at the Royal Children's Hospital for a medical disaster that left a baby brain-damaged. Prof Paddy Dewan told a medical inquiry yesterday he was astounded not only that a toxic glucose dose was put in the boy's drip, but also that the treatment continued unchecked. The pediatric surgeon labelled the child's case an "unbelievable scenario" compounded by an overlap of medical and surgical unit care.

The Medical Practitioners' Board of Victoria is investigating unprofessional conduct claims against three doctors in the wake of the tragedy. Dr Lea Lee Foo, Dr Shobha Iyer and Dr David Tickell face potential penalties ranging from counselling to deregistration if found guilty. Dr Foo is accused of ordering the wrong intravenous drip fluid solution. The two others are accused of failing to properly examine the child and check his fluid treatment. The doctors deny being unprofessional.

The disciplinary hearing has been told the baby, who cannot be identified, suffered permanent brain damage after he was given a glucose solution 10 times stronger than advised. The boy was admitted suffering vomiting and was diagnosed with an abdominal problem that needed routine surgery. The drip was inserted in the early hours of September 19, 2001.

Prof Dewan said he had discussed the baby's condition and treatment with the boy's father, Dr Foo, registrar Dr Gehan Roberts and at least one nurse for up to an hour. It was agreed 50 per cent glucose would be added to an intravenous drip mix to make up a 5 per cent solution. Instead, the baby was given a 50 per cent glucose concentration. "To give an infusion of 50 per cent dextrose is a toxic solution and that was not the order that I gave," Prof Dewan said. He believed the registrar clearly understood the instruction, but conceded the junior doctor may have been confused.

Asked about a program the hospital had brought in to encourage staff to speak up about concerns, Prof Dewan replied: "Junior staff and nurses are not going to speak up if they see a professor getting fired for doing so." The hospital sacked Prof Dewan three years ago after the board decided his relationship with surgeons had deteriorated beyond repair. Before his sacking, he aired allegations about patient safety risks.

Nurse Jayne Morrison told yesterday's inquiry she held up a piece of paper to Dr Foo to confirm it was the right order, but did not discuss it.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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7 June, 2006

THE NHS GOOFS AGAIN

They tried their best to condemn a large group of people to death

A cancer drug that the Government value-for-money watchdog wanted to deny to NHS patients has celebrated five years of use with stunning results. Glivec, the biggest breakthrough in cancer therapy for a generation, has kept alive 90 per cent of the patients with chronic myeloid leukaemia (CML) who have been taking it in those five years.

Yet, if the National Institute for Health and Clinical Excellence had had its way, many would never have received the drug. Its initial advice, in May 2002, staggered patients and specialists involved in the trials as well as the maker, Novartis. But after an outcry it reconsidered its advice, making the drug available to more patients.

Yesterday, at a meeting in London, survivors gathered to hear the latest data. Sandy Craine said: "When Glivec became available five years ago, I would never have believed I would be standing here today. "I was diagnosed in 1999 in the accelerated phase of CML and was told that, without invasive chemotherapy, followed by a stem cell transplant, I had about 12 months to live." Ms Craine travelled to the United States to get on to a trial of the drug. "Glivec saved my life," she said.

There are between 600 and 800 cases of CML diagnosed in the UK each year. It is a cancer of the bone marrow, caused by an unusual rearrangement of chromosomes 9 and 22, generating a new chromosome that in turn produces a protein that drives the disease. Professor Charles Craddock, of the University of Birmingham, said that before Glivec the outlook for such patients was "pretty gloomy". A bone marrow transplant could cure a minority. Some found the drug interferon alpha effective, but at the cost of permanently feeling that they had flu.

Glivec was fast-tracked by the US Food and Drug Administration and licensed in record time, on June 5, 2001. Since then, more than 1,000 patients have been followed. In 90 per cent of those on Glivec, the aberrant chromosome was eliminated. "There was major scepticism that a single drug would give a prolonged response, but it has," Professor Craddock said. "In 10, 15 or 20 years' time, we could have treatments based on the Glivec experience that knock out the cells that cause the problems."

The side-effects of Glivec are not negligible, but they are less than those of interferon alpha. The drug also works well for a rarer cancer: gastro-intestinal stromal tumours (GIST), which form in the digestive system. Before Glivec, there was no treatment for GIST except surgery, and the tumours often returned. The drug has greatly extended the survival of GIST patients and in many the tumours have disappeared.

The drug costs 14,000 pounds per patient per year, and for some patients with CML a bone marrow transplant may still be preferred, but for GIST patients there is no alternative. Thalidomide, notorious for causing birth defects in thousands of children in the 1960s, significantly increases survival in patients with multiple myeloma, a study shows. The results were reported to the American Society of Clinical Oncology yesterday.

Source



A NHS DEATH SENTENCE AVOIDED VIA PRIVATE MEDICINE

A delivery driver's life was saved when his colleagues paid for a brain scan that revealed a life-threatening tumour. Gary Harris, 38, had been put on a three-month waiting list for an NHS scan but was later told by doctors that he would have died within two weeks had he not had an emergency operation to remove the tumour.

All 60 employees at Park Furnishers, Bristol, paid 12 pounds each - a total of 720 pounds - to cover the cost of having the scan done privately because Mr Harris was convinced that there was something seriously wrong. Mr Harris, a keen cyclist, said: "My workmates made sure I could live. How can I ever repay or thank them for such unimaginable kindness?" He had experienced dizziness and vomiting over five months, and went to his GP several times. He said: "I could count on one hand the number of times I had visited the doctor before all this. So in November last year, when I started experiencing dizziness and vomiting, I knew something was seriously wrong."

During the next four months GPs from The Crest Family Practice in Bedminster, Bristol, diagnosed winter vomiting sickness, vertigo, stress and possible eye strain. After one attack of vomiting and numbness he visited an accident and emergency department, where he says that he was told to take ibuprofen and paracetemol. He said: "Eventually they agreed for me to see a neurologist at the beginning of April. He thought it was neck arthritis from the cycling but said he would put me on the list for a CT scan as a precaution. That wasn't going to be until July. "He could have sent me straight away for an emergency scan, but decided not to. "Then my warehouse manager came and told me to get a private scan and not to worry about the cost. It took my breath away."

The scan took place on April 27, and revealed a large tumour that had started attaching itself to his brain stem. The next day he was admitted to Frenchay Hospital, where he underwent more tests and had a drain inserted to remove fluid on his brain before undergoing 13 hours of surgery a week later. Mr Harris said: "The neurosurgeon at Frenchay, Mr Porter, told me without an operation I would have two weeks to live. It would have been a painful and unpleasant death. "He told me my brain would have been crushed as the tumour was so big. If I had relied on the NHS I would have died seven weeks before the scan they offered me."

Mr Harris was discharged from hospital on May 17. The surgeon told him that his recovery was remarkable. Mr Harris's wife, Kim, 28, with whom he has a daughter, Gracie, 4, has given up her job to look after him. She said: "For months our lives were on hold. We couldn't do anything and we just didn't know what was wrong. When the scan showed up the problem it was almost relief that it had a name. "Then reality set in that we could be about to lose him. We can't describe how grateful we are."

Last week staff at Park Furnishers were handed a note with their payslips from Deryn Coller, the company director. At the top was written: "Last month you saved someone's life." He also added 20 pounds to everyone's pay to thank them. Alfie Dibble, Mr Harris's manager, said: "Gary is a great bloke and it was never an option not to help him. Everyone feels very emotional about what he's been through and proud to have been able to help." Mr Harris intends to pursue complaints against the doctors he consulted. The GP surgery declined to comment.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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6 June, 2006

Analysis: Massachusetts Health Care Plan Intrusive, Expensive

The new Massachusetts health plan has dominated the policy conversation recently, causing more division among conservatives than liberals. The law, designed to make the state the first in the nation to achieve universal health coverage, was signed April 12 by Gov. Mitt Romney (R). He was flanked at the by-invitation-only signing ceremony by the Democratic leaders of the Massachusetts legislature and by U.S. Sen. Ted Kennedy (D-MA), a longtime advocate of universal health coverage. The biggest concern among conservatives is the requirement that every individual in the state must purchase health insurance or face financial penalties. Such mandates are almost impossible to enforce, even with the fines and other enforcement provisions in the law. Further, the state must specify what kind of insurance people are required to buy and how much they should pay, taking away the ability of markets to compete freely and for people to purchase the coverage of their choice.

Market-oriented analysts are also concerned about the back-door employer mandate. The Massachusetts legislature wanted to force employers with 11 or more employees to pay a $295 annual fine for each employee without health insurance. The governor vetoed the provision, but leaders of the heavily Democratic House and Senate have said they will override.

House Speaker Salvatore DiMasi (D-Suffolk) called the veto disingenuous, saying the law was crafted with concessions and compromise. "To change anything will disturb the delicate balance that made this law possible," DiMasi said. Note to employers: $295 is only the beginning.

While many free-market groups--such as the Pacific Research Institute, Cato Institute, and Council for Affordable Health Insurance--have been highly critical of the Massachusetts plan, the conservative bellwether Heritage Foundation was very involved in helping the governor craft the legislation. The governor credits Heritage with creating the new Federal Employees Health Benefits Program-like insurance connector to offer insurance options and collect and distribute premiums. Bob Moffit of Heritage stood behind the governor at the signing ceremony.

An integral provision in the new plan is the requirement that every employer with more than 10 employees, such as your local automotive garage, must offer a Section 125 cafeteria plan so employees can use pre-tax money for their insurance premium contributions. And that's only the beginning of the reporting requirement, mandates, penalties, and other enforcement provisions in the new law. For example:

* The law requires every employer and employee in the state to sign "under oath" a Health Insurance Responsibility Disclosure form, testifying to whether the employer has offered insurance and whether the employee has accepted or declined.

* It creates at least 10 new boards and commissions to create and run the new health system, such as the Health Care Quality and Cost Council, Payment Policy Advisory Board, and Health Access Bureau.

* New and existing state agencies will be checking on individuals' insurance status, monitoring their income to see whether they qualify for subsidies, and tracking individual health habits (such as smoking and wellness activities) to determine their insurance rating category.

The plan also includes a major expansion of Medicaid and the State Children's Health Insurance Program to cover children in families with incomes up to 300 percent of the poverty level. The state has made it clear it is doing all it can to maximize collection of federal matching funds to help finance the new plan.

My biggest concern is over the financing. The state says it is just moving money around--redirecting about $1 billion in uncompensated care money to subsidize health insurance for those under 300 percent of the poverty level (about $50,000 a year for a family of four). But there is nothing in the law to keep health insurance costs from soaring. Policies offered through the new health insurance connector must have first-dollar coverage and include all of the 40 coverage mandates on the books, with none of the provisions that are working in the private sector to engage consumers as partners in managing health costs. Estimated premiums are unrealistically low and will quickly lead to higher taxes and "assessments" on individuals and employers.

Nonetheless, newspapers around the country are falling over each other in their effusive praise of a Blue state, led by a Republican governor, building a bridge across the political chasm to go where no state has gone before. Romney's term ends this year, and he is likely to be spending a lot more time in Iowa and New Hampshire than in Massachusetts as this plan gets up and running. The worry is that he has laid the foundation for what can become a very intrusive, onerous, and expensive health plan for Massachusetts. Other states, which are firing up their photocopiers now, should wait to see how this works out before rushing to follow the Bay State's lead.

Source



More stupid and self-defeating government penny-pinching

Queensland taxpayers are paying millions extra for costly open-heart surgery because of restrictions on more cost-effective preventative heart operations. In its latest Australian hospital statistics 2004-05 report released last week, the Australian Institute for Health and Welfare said Queensland hospitals were performing 20 per cent fewer operations to prevent heart attacks and 17 per cent more operations to treat heart attacks compared with other states.

Historical under-funding and quotas placed on hospitals and doctors from performing less-expensive coronary angioplasty operations have been blamed by medical groups for what they say is a "backward" situation. They say patients prevented from having an angioplasty often end up needing more expensive coronary bypass operations which also have greater risks. Cardiac Society of Australia Queensland president Con Aroney said his group had been warning about the imbalance for years. He said there were significant differences between the two operations.

Dr Aroney said coronary angioplasty was a less expensive and less invasive form of surgery done through keyhole-type incisions in the groin rather than opening the chest. "It involves unblocking arteries using a catheter procedure rather than using open-heart surgery to do a bypass," he said. "The costs are very different - from several thousand dollars for an angioplasty compared with tens of thousands for open heart."

"Angioplasties are recognised around the world as the most contemporary and effective form of treatment for heart disease," Queensland Health chief health officer Dr Jeannette Young said. Australian Medical Association Queensland president Zelle Hodge said it was fair to say that patients that "need an angioplasty and don't have it, will be more likely to need a bypass". "It is very important that people who could be treated by angioplasty are done so," Dr Hodge said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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5 June, 2006

NHS refuses to fund new prostate therapy for men

Hundreds of men are being denied an alternative to radical surgery for prostate cancer because the National Health Service is refusing to pay for it. Hard-up primary care trusts across England have stopped funding brachytherapy, a new form of radiotherapy, although it has been approved by the National Institute for Health and Clinical Excellence (Nice).

Doctors and patient groups have accused the NHS of discriminating against men. John Neate, chief executive of the Prostate Cancer Charity, said: "Nobody should have to battle bureaucracy when they need all their energy to come to terms with a diagnosis."

Brachytherapy has fewer side effects than removing the prostate or giving radiotherapy for five days a week over seven weeks. Only 10%- 15% of men are left impotent after brachytherapy, compared with about 50% of men who undergo surgery.

The 9,000 pound treatment takes just one day. The patient has radioactive pellets implanted into the prostate gland. These target and kill the cancer.

Brachytherapy is not suitable for all prostate cancer sufferers but doctors believe that it is the best treatment for patients who have small tumours which have been caught at an early stage. Stephen Langley, a consultant at the Royal Surrey County hospital in Guildford, one of about 10 in England offering brachytherapy, said: "A similar number of men die from prostate cancer every year as women who die from breast cancer, but there is a fraction of the money going into prostate cancer."

The issue will be raised this week at the British Medical Association's staff and associate specialists conference. The Department of Health said: "With devolved decision-making, trusts can make different choices. The principle of local autonomy is important."

Source



VAST NHS COMPUTER BUNGLE

Evidence that the government's troubled 20 billion pound National Health Service computer system has lengthened waiting times for patients has emerged for the first time. It was hoped that a pilot scheme for the technology at the Nuffield Orthopaedic Centre NHS Trust in Oxford would show the benefits of the delayed system. Instead, when it went "live", the computers crashed, data could not be found and some patients found that they were facing among the longest waits for operations in the country.

In December 2005, just 12 people were waiting more than six months for an operation in England. But in the same month the Connecting for Health computer systems were launched at the Nuffield and the number of people waiting longer than six months started to rise. Within a few weeks more than 100 people in England were waiting longer than six months, most of them at the Nuffield, which insists that the problem is now resolved.

Staff who were instructed to sort out the problem could not even establish from the malfunctioning computers which patients had been waiting the longest and the numbers kept climbing. Details of the waiting list problems at the Nuffield, released under the Freedom of Information Act, will increase pressure on the government for an independent review of the scheme.

Lord Warner, the health minister, confirmed last week that the system was already delayed and would cost up to 20 billion pounds. The figure originally given by the government for the project was 6.2 billion.

The problems at the Nuffield were so severe that hospital managers could not even compile accurate data for the Department of Health on patients waiting to be treated. Figures now released by the hospital show that it repeatedly breached the government's key target of keeping no patient waiting longer than six months for an operation. On March 31 the number of patients waiting longer than six months for an operation was 123, out of a national total of 199 patients. This meant that the hospital, in most areas one of the best performers, had temporarily fallen to the bottom of the national league table for patients waiting longer than six months.

Leon Price, 31, who had to wait longer than six months for a back operation, said: "You have to wait long enough to be seen without problems like this. It's ridiculous that people were waiting even longer because of a faulty computer system."

The hospital is now confident that it has addressed the problems and that no patients are breaching the government's key six-month waiting target. Computer experts say the problems at the Nuffield highlight the need for a national review of the programme.

Ross Anderson, a professor in security engineering at the University of Cambridge, warned that the new system was likely to cause "chaos and disaster" in the NHS. "They're ripping out the old systems but they're not replacing them with anything better," he said.

The Connecting for Health scheme is intended to create centralised medical record systems for 50m patients and link more than 30,000 GPs in England to 300 hospitals by 2012. Many doctors and IT experts are concerned that a centralised system will make the NHS even more vulnerable to damage from computer failures. Connecting for Health said that the old computer systems at the Nuffield were in a state of near collapse and the new ones would improve patient care, although there had been initial problems. "It did cause disruptions to some patients, for which we are sorry," said a spokesman.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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4 June, 2006

MORE NHS PENNY-PINCHING

But there's plenty of money to pay hundreds of thousands of bureaucrats

Cancer charities reacted with anger and disappointment yesterday to new recommendations from the health watchdog not to make two new treatments for bowel cancer available on the NHS. In draft guidance, the National Institute for Health and Clinical Excellence (NICE), said it did not believe that the treatments bevacizumab (Avastin) and cetuximab (Erbitux) were cost effective. The guidance, which is not final and is open to consultation, said that Avastin should not be recommended for use as the primary treatment for somebody with advanced bowel cancer. Erbitux is not recommended for any second line treatment, after other treatments have failed, of advanced bowel cancer.

Ian Beaumont, of Bowel Cancer UK, said the charity was very disappointed at the decision, given the proven efficacy of the drugs and that the UK had been in the forefront of their development. “It looks as if we will, once again, be at the very back of the queue when it comes to being able to make them available to patients. “It is also very hard not to be angry and cynical when NICE appears to be making its decisions on the basis of financial expediency rather than clinical efficacy,” he said.

Joanne Rule, chief executive of the charity Cancerbackup said that the new treatments were already widely available in the private health care sector. The charity Beating Bowel Cancer said that all bowel cancer patients should be entitled to the best course of treatments available to each of them, regardless of their ability to pay.

Andrea Sutcliffe, deputy chief executive of NICE, conceded that Avastin does show some increased benefit over the standard treatment for bowel cancer, but said it did not justify the cost. NICE had been unable to say whether Erbitux was better than any other existing treatments. “Neither of these drugs represents a good use of scarce NHS resources,” she said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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3 June, 2006

Is the U.S. stealing health care workers from abroad?

It's become a stock image in the immigration debates: the flooded emergency room, halls packed with sick illegals seeking subsidized care. But now that image's negative is at the heart of a far smaller battle-not over the immigrants awaiting care in the E.R., but the immigrants providing it.

The immigration bill passed by the Senate last week includes a provision that would allow unlimited entry to foreign-trained nurses until 2014, and as a committee attempts to reconcile that bill with the less permissive House version, an open door policy for foreign nurses has a shot at becoming law. A free flow of RNs may seem like sound policy for a country in the midst of a severe nursing shortage, but opponents claim it's parasitic, emblematic of a ruinous American practice of stealing skilled labor from poor countries that can ill afford to export their most educated workers. The Philippines, in particular, seems to be hemorrhaging nurses, while the U.S. soaks up thousands of Filipino-trained RNs annually. Last week, a New York Times article, headlined "U.S. Plan to Lure Nurses May Hurt Poor Nations," implied that the Philippines' health system risks collapse if the U.S. keeps it up. Talking Points Memo Blogger Nathan Newman excoriated supporters of the Senate provision, complaining that " The U.S. refuses to invest in training and education of our own population, then instead leeches off the tiny investments in education done by developing countries."

The vision of American hospital administrators prowling the streets of Manila poaching nurses from Filipino hospitals presupposes that the number of Filipino RNs is fixed, completely independent of U.S. demand. But that hasn't been true for at least half a century. According to Catherine Ceniza Choy's 2003 book Empire of Care, Americans began training Filipino nurses in 1907, and the first wave of Filipino-trained nurses arrived in the United States between 1956 and 1969 as part of an Exchange Visitor Program. The Philippines has since become the world's largest exporter of trained nurses according to the World Health Organization. Filipino nurses trained in Americanized schools in English have been showing up in the U.S. for decades and in droves, and a nursing education has long been seen as a ticket out.

The government of the Philippines clearly thinks it gains something when America "leeches" off its investment. The government has consistently lobbied for more, not fewer, nursing visas in the United States and United Kingdom, with an eye on the massive remittances nurses send back to families still at home. The Philippines is heavily dependent on money sent from abroad; the government is famous for encouraging its citizens to leave, and eight percent of its population resides abroad as domestic workers in Malaysia, English teachers in China, and nurses all over the developed world. According to the Philippines Central Bank, large scale labor migration brought home remittances totaling $9.7 billion last year, and nurses have historically been among the most stable earners.

If the United States agreed to take in fewer nurses, would Filipino hospitals suddenly be flush with staff? Not likely. According to a 2005 report by the International Council of Nurses, new Filipino graduates "report that they can't find jobs in nursing." It's true that the Philippines suffers from a nursing shortage, but it doesn't suffer from a lack of trained nurses. Its hospitals are simply too poor to employ adequate numbers of them. That's a tragedy, but it won't be solved by slamming the gates at the U.S. border. Underfunded health care programs are a symptom of poverty, not of poaching. If the United States were to turn away nurses seeking placement, they would simply fill vacancies in every other developed country-the current nurse dearth is a global phenomenon affecting every region on Earth. U.S. demand has created supply in the Philippines: The medical professionals leaving now-at least some of whom will eventually return-would have been far less likely to invest years in study and training without the prospect of high pay abroad.

The Philippines won't suffer for the opportunities America offers its citizens. But it's not for well-meaning Westerners to decide where a health care worker would be "better off" anyway. Workers are not the property of countries that train them, and any policy that seeks to limit their options will prove cruelly restrictive. After all, stemming the flow of skilled labor doesn't just mean locking workers out of wealthy nations. It means locking them into poor ones.

Source



Australian Medical School biases to be investigated

There are four generations of doctors in Lucy Verco's family and yet, despite recieving 99.9 in her academic results, she was rejected by the University of Adelaide's school of medicine. Ms Verco said she felt "insulted" after being told she had not made the grade following an interview. The 20-year-old is now studying medicine at the University of Melbourne.

Federal Education Minister Julie Bishop has ordered medical experts to investigate methods for selecting medical undergraduates, after The Australian reported concerns that students applying for medical school places were being subjected to "personality assessments".

Ms Verco received the near-perfect results in her Tertiary Admissions when she finished Year 12 in 2003. "I thought the point of the interview was to show that students didn't have any psychological issues or anything like that," Ms Verco told The Australian. "If I'd been tripped up on my marks I could have thought I could have worked harder but it wasn't my fault. "It was quite personally insulting to find that a 30-minute interview could determine that I was a bad person or that I wouldn't go through."

The concerns about "personality assessments" include claims that medical schools were asking students their views on the Iraq war and gay marriage. Adelaide University's former deputy chancellor Harry Medlin has also criticised the institution's medical school for an unwritten discrimination policy against private-school students and the children of doctors. The Australian understands at least six children from prominent medical families have been rejected during the Adelaide University interview process in the past three years.

But the interview process has been defended by eminent educators including professors Peter Smith and Richard Henry of NSW University's faculty of medicine. It is argued the structured interview leads to a selection of a "better cohort of medical students who make better doctors". They argue knowledge and skills form only part of what makes a good doctor.

Ms Verco was educated at Adelaide's exclusive girls' school Wilderness and is the daughter of highly regarded Adelaide obstetrician Christopher Verco. Her grandfathers and great-grandfather were specialist doctors. Her great-great-uncle was dean of the university's faculty of medicine. Ms Verco's mother is Judith Sloan, an economist whose credentials include being a commissioner with the Fair Pay and Productivity commissions and a director of Santos.

Ms Verco said the interview process was fraught with problems as students were asked different questions in each interview. Apart from the usual questions about teamwork, difficult situations she had faced and her strengths and weaknesses, Ms Verco was asked how she would deal with the family of a deceased cancer patient who had found a cure overseas via the internet. "I think it's a difficult question to ask a 17-year-old. Even if you're a 45-year-old oncologist it would still be very hard," she said. She was not specifically asked about her family history.

Professor Sloan has pursued the university since her daughter's rejection in early 2004 in the hope of effecting change for future students. "(The interview process) is supposed to be the great leveller but people spend a lot of money on preparations for the (exams) and people lie (in the interview)," Professor Sloan said. The university's Health Sciences faculty executive dean, Justin Beilby, said the process had been validated and that there were set questions.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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2 June, 2006

BRITISH COMPUTER BLOWOUT

Doctors are cautioning that a failure to consult staff and patients over the new multibillion-pound NHS computer system will add to a 2½-year delay announced by ministers. The British Medical Association (BMA) said that patients should be asked for consent before their details were put on the national electronic database. But the Government, which is planning to presume patient consent, said that this would take up extra time for doctors on a system already suffering serious delays.

The price of an electronic system to keep records is set to rise from 6.2 billion pounds to about £20 billion, Lord Warner, the Health Minister, said yesterday. The system, which will computerise records for 50 million patients, will not be ready until 2008, and is likely to be criticised in a National Audit Office report next month.

Hamish Meldrum, chairman of the BMA’s GPs Committee, said: “Family doctors are concerned that this scheme . . . is trying to do too much too quickly and could threaten patient confidentiality.” The program, Connecting for Health, has four main projects: online booking; centralised, electronic medical records; e-prescriptions; and fast network links between NHS organisations. A spokesman for the Department of Health said: “The NHS IT program is one of the largest IT projects in the world and will revolutionise patient care. As with any large, complex program there will be difficulties.”

Source



U.K.: Patient surgery choice extended

Surprise! A choice between a dirty State-run tweedledum and a dirty State-run tweedledee is not attractive to patients

Patients are to be given a choice of hospitals across England for operations as a key NHS reform is expanded. Ministers will announce later that the 32 foundation trusts will be added to the list of local hospitals patients currently choose from. From the start of this year, people have been able to choose from at least four hospitals for elective surgery. But patient groups said people tended to want to stay local so the extra choice would not mean a great deal. Patient choice has been one of the government's key reforms to make the NHS more patient-friendly.

Since January, patients have had a choice of at least four hospitals for treatment, one of which can be a private centre. Many primary care trusts included more than the minimum of four on their lists, to which they will now add the 32 foundation trusts, top performing hospitals which have been given more autonomy than other hospitals. By 2008 patients will be able to choose any hospital in the country.

But despite the government's enthusiasm for the reforms, opinion polls have consistently rated it as a low priority for patients. The Department of Health's own research published at the launch of patient choice in January found that eight out of 10 knew little about it. And only 14% would be prepared to travel outside their area for treatment.

The roll-out has also been hampered by delays to the 6.2 billion pound IT upgrade. As part of the project, a system called choose and book was meant to set up to allow appointments to be made online. But only a quarter of GP surgeries had the system in place at the beginning of the year and a fifth still do not have it, the latest figures suggest.

Patients Association chairman Michael Summers said: "We were very much in favour of patient choice when it started. Patients have told us that they appreciate having choice of local hospitals. "However, it also seems they are not all that interested in being able to go to hospitals anywhere in the country. "People don't want to travels miles and miles. There are exceptions where this will not be the case, but on the whole extending the choice does not mean a great deal to many."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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1 June, 2006

Why Is the Best Sunscreen Blocked by FDA?

We think of July and August as the peak of summer, but when it comes to sunburn, now is the peak. Next Tuesday, June 21st, is the longest day of the year, when the sun is highest in the sky, so it's now that the sun does the most damage. Like most people, you probably think you know what to do about it. You slather on the sunscreen when you're out in the sun.

Our suntan lotions are good at screening out the sun's UVB rays - the ones that cause sunburn and skin cancers - but most people don't realize their sunscreens don't offer much protection against UVA rays, the ones that put wrinkles in your skin. "Ultraviolet A light ages your skin. And the reason it does that, it's a longer wavelength, so it can penetrate deeper into the skin, and instead of attacking the upper layers of the skin where skin cancer often forms, it attacks the layers that give your skin its tone, its elasticity, as we call it. . You get the lines, the wrinkles, all the things associated from aging," said Dr. Darrell Rigel, clinical professor of dermatology at New York University

But there's good news. Lotions that contain the ingredients Oxybenzone, Titanium Dioxide or Parsol 1789 block out some UVA rays. Doctors say a chemical called Mexoryl offers even better protection. "It produces a product which gives us almost perfect protection against sunshine," said Dr. Vincent DeLeo, chairman of dermatology at Columbia University. People are happily protecting themselves with Mexoryl on the beaches of Rio de Janeiro, the streets of Paris, in Canada, Mexico and Australia. Mexoryl "is the No. 1 individual ingredient in terms of protection from Ultraviolet A radiation," Rigel said.

But even though dermatologists say Mexoryl is the best, you cannot legally buy it in the United States. It's illegal, because the Food and Drug Administration won't approve it. They won't even say why. The FDA is charged with making sure no drug is sold unless the government is convinced it's safe and effective. Dermatologists think it's just stuck in the bureaucracy. It routinely takes 12 to 15 years for a drug to get approval. After an approved drug - Vioxx, for example - gets bad publicity as a health risk, the FDA gets particularly cautious.

But is there no common sense here? All drugs have risks as well as benefits. Mexoryl has been in use in other countries for 13 years. It's passed many safety tests. Why won't our FDA even talk about it? Although buying or selling sunscreens with Mexoryl is illegal in the United States, that doesn't mean sunscreens with Mexoryl aren't bought and sold here. We found it at some pharmacies. It was expensive - $30 to $50. "People really want this stuff. People go to pharmacies and they keep it under the counter, like it's a secret ingredient, like prohibition or something and people will still buy it," Rigel said. I don't fault the pharmacies, they're serving their customers.

Everyone is always telling us, protect yourself from the sun, but then the government won't give us permission to have the best sunscreen?

Source



Theory, Evidence and Examples of FDA Harm

To obtain permission to market a drug, the manufacturer must satisfy the FDA that the drug is both safe and effective. Additional testing often enhances safety and effectiveness, but requiring a lot of testing has at least two negative effects. First, it delays the arrival of superior drugs. During the delay, some people who would have lived end up dying. Second, additional testing requirements raise the costs of bringing a new drug to market; hence, many drugs that would have been developed are not, and all the people who would have been helped, even saved, are not.

In addition, because FDA approval is mandatory, industry and medicine must heed FDA standards regardless of their relevance, efficiency, and appropriateness. Not all testing is equally beneficial. The FDA apparatus mandates testing that, in some cases, is not useful or not appropriately designed. The case against the FDA is not that premarket testing is unnecessary but that the costs and benefits of premarket testing would be better evaluated and the trade-offs better navigated in a voluntary, competitive system of drug development.

Three bodies of evidence indicate that the costs of FDA requirements exceed the benefits. In other words, three bodies of evidence suggest that the FDA kills and harms, on net. First, we compare pre-1962 drug approval times and rates of drug introduction with post-1962 approval times and rates of introduction. Second, we compare drug availability and safety in the United States with the same in other countries. Third, we compare the relatively unregulated market of off-label drug uses in the United States with the on-label market. In the final section, before turning to reform options, we also discuss the evidence showing that the costs of FDA advertising restrictions exceed the benefits.

Comparison of Pre- and Post-1962

Sam Peltzman (1973) wrote the first serious cost-benefit study of the FDA. He focused his attention on the 1962 Kefauver-Harris Amendments to the Food, Drug, and Cosmetics Act of 1938, which significantly enhanced FDA powers. The amendments added a proof-of-efficacy requirement to the existing proof-of-safety requirement, removed time constraints on the FDA disposition of NDAs, and gave the FDA extensive powers over the clinical testing procedures drug companies used to support their applications.

Using data from 1948 to 1962, Peltzman created a statistical model to predict the yearly number of new drug introductions. The model is based on three variables, the most important of which is the size of the prescription drug market, lagged two years. The idea is that if the prescription drug market were large two years ago, manufacturers would invest more money in research and development, which would pay off two years later in a new drug. (Prior to 1962, it took approximately two years to develop a new drug.) Despite the model's simplicity, it tracks the actual number of new drug introductions quite well....

Because Peltzman's model tracks the pre-1962 drug market quite well, we have some confidence that if all else had remained equal, the model also should have roughly tracked the post-1962 drug market. Peltzman's model, in other words, estimates the number of new drugs that would have been produced if the FDA's powers had not been increased in 1962. Thus, by comparing the model results with the actual number of new drugs, we can draw an estimate of the effect of the 1962 amendments. The model predicts a probable post-1962 average of forty-one new chemical entities (NCEs, or new drugs) approved per year.

The average number of new drugs introduced pre-1962 (forty) was also much larger than the post-1962 average (sixteen). Thus, whether one compares pre- and post-1962 averages or compares the results from a forecast with the actual results, the conclusions are the same: the 1962 Amendments caused a significant drop in the introduction of new drugs. Using data of longer span, Wiggins (1981) also found that increased FDA regulations raised costs and reduced the number of new drugs.

Even if FDA regulations have not improved safety, they might be redeemed if they have reduced the proportion of inefficacious drugs on the market. Using a variety of tests, however, Peltzman (1973) found little evidence to suggest a decline in the proportion of inefficacious drugs reaching the market since 1962. Thus, he concluded, "(the) penalties imposed by the marketplace on sellers of ineffective drugs prior to 1962 seem to have been enough of a deterrent to have left little room for improvement by a regulatory agency." (1086) Similarly, in their survey of the literature, Grabowski and Vernon (1983) conclude, "In sum, the hypothesis that the observed decline in new product introductions has largely been concentrated in marginal or ineffective drugs is not generally supported by empirical analyses" (34).

The costs of FDA regulations do not vary with the number of potential users of the drug, so the decline in drug development has been especially important in the treatment of rare diseases. By definition, each rare disease afflicts only a small number of people, but there are thousands of rare diseases. In aggregate, rare diseases afflict millions of Americans: according to an AMA estimate (AMA 1995), as many as 10 percent of the population. Thus, millions of Americans have few or no therapies available to treat their diseases because of increased costs of drug development brought about by stringent FDA "safety and efficacy" requirements. In response to this problem, in 1983 the Orphan Drug Act was passed to provide tax relief and exclusive privileges to firms developing drugs for diseases affecting two hundred thousand or fewer Americans (AMA 1995). It would be better to reduce or eliminate FDA regulations for all drugs and patient populations.

The Grisly Comparison

The delay and large reduction in the total number of new drugs has had terrible consequences. It is difficult to estimate how many lives the post-1962 FDA controls have cost, but the number is likely to be substantial; Gieringer (1985) estimates the loss of life from delay alone to be in the hundreds of thousands (not to mention millions of patients who endured unnecessary morbidity). When we look back to the pre-1962 period, do we find anything like this tragedy? The historical record-decades of a relatively free market up to 1962-shows that voluntary institutions, the tort system, and the pre-1962 FDA succeeded in keeping unsafe drugs to a low level. The Elixir Sulfanilamide tragedy, in which 107 people died, was the worst of those decades. Every life lost is important, but the grisly comparison is necessary. The number of victims of Elixir Sulfanilamide tragedy and of all other drug tragedies prior to 1962 is very small compared to the death toll of the post-1962 FDA.

Much more here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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