Health Care

That WHO report

You know, there might just be a political motive here….you never know, eh? For it is indeed the WHO which compiles the statistics on the different health systems around the world. The statistics which place far greater weight upon equity of access and financing than upon anything so crude as the efficiency of said services actually curing disease.

Nordic countries, for example, have followed policies that encouraged equality of benefits and services, full employment, gender equity and low levels of social exclusion. This, said the Commission, is an outstanding example of what needs to be done everywhere.

You don\’t think that they might all be social democrats, do you?

I might even gird the loins and try reading the whole report.

Health inequality

Yes, health inequality is high. However, however….

This government can argue that is tackling all of the above. It can be proud of the progress made in improving overall health to the extent that life expectancy for the poorest has reached the average of just eight years ago.

Absolute health is improving. If we believe the Guardian editorial, it\’s improving fast too.

So, what should we concentrate on? Relative health or absolute?

Is it better that more people live for longer, or that people live for more equal periods of time?

I\’ve long said that I\’m not all that worried by inequality, as long as absolute levels (health, incomes, whatever) are improving.

Is there any reason why I should change my mind?

Curate\’s egg

This article is. Some very confused ideas about the costs of drugs:

Kidney cancer drugs could be produced for about a tenth of their current cost, Rawlins said. While developing such medicines from scratch added to these costs, as did some \’unnecessary\’ bureaucracy around clinical trials which should be scrapped, he said that was not the whole story.

Well, actually, at £550 million in development costs that is indeed a very large part indeed of the story. But this is excellent:

Rawlins, who is also the outgoing chair of the Advisory Council on Misuse of Drugs, also backed up suggestions last week by a senior government drugs adviser that drug crackdowns were misdirected. \’Parliamentarians think there\’s a legislative way out of it and there isn\’t,\’ he said, adding that it was \’absurd\’ to suggest teenagers could be locked up for possessing a few cannabis joints. \’There are criminal justice elements to the solution, but it\’s primarily a public health problem,\’ he added.

They are indeed primarily a public health problem.


Well, fancy that!

They also found that doctors paid particular attention to assessments that earned them extra money, including heart disease, diabetes and high blood pressure.

Gosh, to find out that incentives matter,such a shock, isn\’t it?

Curing the common cold, eh?

This looks interesting.

The drug – known as BTA798 – works by latching onto the cold-causing rhinovirus to prevent it breaking into the body\’s cells.

Peter Cook, Chief Executive of Victoria based drug development company Biota said: "This could be the world\’s first anti-viral treatment for the human rhinovirus. A safe and effective treatment for the virus will be a major breakthrough."

Not so muh because it cures a cold, but because we\’ve not managed to work out how to cure anyone of any viral disease as yet. We\’ve worked out how to stop someone being infected sometimes (vaccines) we can treat some of the symptoms, we can cut the viral load (all those HIV drugs), most people who get viral diseases simply recover or don\’t, but we\’ve never actually worked out how to "cure" any viral disease at all.

Be pretty cool if we had, eh?

The Costs of Stabbings

To the NHS: some £3 million a year apparently. Given the £100 billion or so spent on the NHS, this isn\’t even a rounding error, it\’s a rounding error on a rounding error.

This rather disgusts me:

Dr Lecky added: "It should be borne in mind that most of the cost of trauma, especially stabbing, is not to the health service but in billions per annum to the taxpayer through legal costs, loss of productive tax-paying years in those that die or are severely disabled and in long-term care.

I\’m familiar with the idea that you measure damages (in part) by calculating the wages lost . You (or your insurer) will pay much more for the lost wages of the person you\’ve just run over if they were making £1 million a year than if they were on the dole. That\’s compensation. I\’m also familiar with the way in which you (can) measure the loss to an economy by the future lost wages and or production, although that\’s a bit more of a stretch.

But to value someone by how much tax they would pay in future years? That\’s getting perilously close to arguing that we exist in order to feed the Treasury, isn\’t it?

Battling Obesity

Most serious, most serious indeed.

Alan Johnson, Britain\’s health secretary, got it right when he called for a national movement to tackle obesity in his Fabian Society speech. He\’s taken on board the sound advice offered to governments over many years now that to have any hope of stemming the tide of overweight and obesity, you need a societal approach that involves everyone in becoming part of the solution.

Hmm, OK.

There is ample evidence of what a complicated business it can be trying to deliver health messages. We know that what works usually has a sting in the tail – such as a penalty for not using a seat belt, or smoking in the wrong place – but we also know what doesn\’t really work.

Well, yes, if we\’re going to have to get all of society involved, we should indeed think about what all of society can actually do about this.

There must be a movement by companies, to make healthier choices over the products they make available. There needs to be a movement to tailor environments to favour people and public transport. Most of all there needs to be a movement to protect younger consumers, and that must not mean fudging the issue of health. We are all involved in becoming part of the solution, especially in grappling with the challenge of reducing childhood obesity. It takes a village, or nowadays the global village, to raise our children.

I\’m not sure Our Neville has actually thought this through properly. For we do know of a very powerful force which society as a whole can use: public shame.

If we simply insist that people should mock and jeer fatties whenever and wherever they encounter them then their noting the public contempt for them will get them dieting soon enough. This does hit all the correct contemprary buttons, doesn\’t it? Inclusive, check, societally based, check, communal action, check, both carrot and stick, check.

Heck, why not utilise one of the most powerful of human emotions, hatred of the out group?

So, who knows the words to "Who Ate All The Pies?"

Swimming With Dolphins

But swimming with dolphins, or dolphin-assisted therapy (DAT) as it is scientifically known, may not actually have any mental or physical health benefits to human beings at all, according to new research.

Now there\’s a surprise, eh? Swimming with dolphins is definitely fun, but health benefits other than swimming or having fun? Who thought that one up?

In 2005, a University of Leicester team tested the effect of regular swimming sessions with dolphins on 15 depressed people in a study carried out in Honduras and published in the British Medical Journal.

The team found that symptoms improved more among this group than among another 15 who swam in the same area but did not interact with dolphins.

But did they test it against other forms of exercise and other forms of having fun?

Treating Lifestyles

OK, so the NHS won\’t discriminate against you because of your lifestyle choices.

A personal lifestyle choice must not be used as a reason to deny someone treatment on the NHS, Andrew Dillon chief executive of the National Institute for health and Clinical Excellence said in an interview with The Daily Telegraph.

Only if that lifestyle choice means that the treatment won\’t work can they do so. Which, given that smoking now causes everything, won\’t make much difference.

However, here, they\’re lying.

Mr Dillon said the Citizens Council had also rejected any notion of Nice weighting their decisions in favour of the young over the old or those in work over those not.

He added: "Their response was that a year of life at age three was worth just as much as a year of life aged 83." When a group of schoolchildren were asked their response was the same, he said.

The proposed NHS Constitution says that patients have the right to drugs and treatments that have been recommended by Nice and if your doctor believes they are appropriate for you.

NICE of course approves drugs and treatments on the basis of quality adjusted life years. There is thus built into the system a bias in favour of drugs to treat childhood diseases and not those of old age.

Plus, of course, there is discrimination in such things as transplants: the 83 year old ain\’t gonna get the new heart when the 23 year old also matches the tissue.

While I also think that this bias is correct and sensible, it does mean that the man speaks with forked tongue.

I Wonder Who is Right Here?

So, lots of newly qualified GPs don\’t and won\’t have jobs as GPs.

One fully qualified GP is driving a taxi because he cannot find enough work as a doctor despite Government pledges to increase access to primary care and extend surgery opening hours.

Next week 2,500 doctors will qualify as GPs and the vast majority have not found full time jobs and will have to live \’hand to mouth\’, the British Medical Association has warned.

It costs the taxpayer around £250,000 to train each graduate to junior doctor level and many are considering travelling abroad or working in another speciality even though there is predicted to be shortage of GPs.

Dr Alex Smallwood, chairman of the GP trainees sub-committee at the British Medical Association said the problem was rife and was a \’huge betrayal\’ of junior doctors who had been encouraged into general practice.

He said: "Doctors will be stacking shelves, cleaning and driving taxis to make ends meet. If they can\’t get work as a doctor they have got to do something."

There are two explanations offered and one I\’m adding.

Mine is that markets, while pretty damn good, aren\’t in fact perfect. There\’s always a lag between people being qualified and their getting a job suitable for that qualification.

One of the other two is that extant GPs are greedy bastards and don\’t want to share the profits of their partnerships.

The second is that:

Prof Steve Field, chairman of the Royal College of GPs said practice partners were tightening their belts as income has dropped for the last three years and fears over the destablising effect of the Darzi polyclinics makes them reluctant to take on anyone long-term.

Now which you believe will probably depend upon your priors, but the idea that the market is just about to be comprehensively shaken up might make people hesitant to take on new partners seems likely enough to me.

Would you agree to expand production and share your income for the next 20 years with someone at a time when you\’re unsure what effect upon the business the building of a new large competing unit is going to have on that business?

Do we see fruit and veg shops expanding when Tesco builds next door?

This Doesn\’t Make Sense

Even by NICE\’s own rules.

There\’s three drugs for rheumatoid arthritis. No one knows which one a patient will respond to. So currently they try the three out and see what works. (I simplify of course). The new rules say:

The National Institute for Health and Clinical Excellence (Nice), today issues a final appraisal document – the last draft before definitive guidance is issued – stating that patients who do not respond to one powerful drug cannot try another of the same type.

Currently doctors are able to try patients on three variants of a drug type which work by blocking the action of a chemical.

If one does not work or its effectiveness wears out over time, sufferers can switch to another, prolonging the period they can remain fit and active.

But the drugs are very expensive, with even the cheapest costing around £100 a week per patient.

Now ra can be crippling, and even when it isn\’t, extremely painful. The NICE rules are that (roughly) the NHS will pay for treatments that cost less than £50,000 per quality adjusted year of life.

To deny drugs for ra costing £5k a year means that they are assuming that the disability of ra is 10% or less or the value o life itself…..which, given that people can be entirely incapable of work as a result, seems incredibly low.

There\’s something odd about this decision.

There\’s some 20,000 people who have so far switched such drugs, so that\’s the number this will affect. A savings of perhaps £100 million per year

To leave 20,000 people in severe and debilitating paid for perhaps decades?

One thousandth of the current health budget. a rounding error in government finances.

Doesn\’t sound quite right to me really.

The NHS and Health Tourism

OK, so there\’s an EU Directive going through the works to insist that you can travel abroad to get health treatment, the NHS picking up the bill.

Some worry that this will mean Johnny Foreigner comes to the NHS for treatment:

A spokesman also insisted that the NHS would not suffer from an invasion of “health tourists” because the EU proposal states that if a particular service is being overloaded, the Government can apply for it to be omitted from the equal access scheme.

I don\’t think that\’s the reason, do you? Why would you leave your home country to get worse treatment abroad?

Kings County Hospital

This is pretty sick. Very sick in fact

Surveillance video footage inside a New York hospital has shown staff ignoring a patient for an hour after she collapsed and lay dying on the floor.

They actually had left her waiting for psychiatric treatment for 24 hours before she collapsed and died.

In the video, Esmin Green, 49, is seen slumped in her seat just a few from an observation window and then falling to the floor of the psychiatric emergency room at Kings County Hospital in Brooklyn.

A member of hospital staff and a security can later be seen passing by without doing anything, the latter staring at her for about 20 seconds before walking away.

Another security guard later pushed his chair into view of the camera, looking at the prone woman before he too left.

This will undoubtedly be used as an example of the horrors of the US health care system, the way in which its profit making nature makes it so uncaring of the real needs of patients. You can just see people sharpening their keyboards, can\’t you?

Only one slight problem, sick indeed as the story of her non-treatment is. Kings County Hospital is not in the private sector. It\’s part of the Health and Hospitals Corporation:

The New York City Health and Hospitals Corporation (HHC), the largest municipal hospital and health care system in the country, is a $5.4 billion public benefit corporation that serves 1.3 million New Yorkers and nearly 400,000 who are uninsured.

This is already public sector health care.

Wonder who the first polemecist to get that wrong will be?

Polly Today

Oh, my, yes, the NHS is wonderful and getting better all the time:

Best of all, mortality amenable to healthcare figures – the avoidable death rates – now show a 21% improvement, far more than any other EU country. As those figures cover only 1998 to 2003 before the big spend, they are expected to have improved sharply.

Yes, you would expect a doubling of the cash spent to improve the results of a system. But let\’s take this measure, the very one that Polly thinks is he way we should measure the system, and see where that takes us, shall we?

Avoidable mortality is death from diseases such as tuberculosis, septicemia, hypertension, influenza, peptic ulcer, appendicitis, etc. Paris also has the lowest avoidable mortality rates while London has the highest and New York in between.

The NHS is in fact worse than the French system (with its horrible and pernicious top up private insurance), worse even than the US system (with its pernicious profit making from sick people). In fact, on this measure, the one Polly wants us to use, it\’s shit.

That must be why so many countries have copied our "Wonder of the World" then.


The government is to allow organs to be taken from people before they are officially brain dead in an effort to tackle the shortage of transplant donors.

Not dead yet, eh?

Celebrating the NHS

The Observer runs a long story about how the NHS saved the lives of a 34 year old pregnant woman in heart failure and her child.

Excellent stuff indeed.

However, I\’ve got only one question.

While it was indeed the NHS which saved these two lives, is it in fact true that only the NHS would have saved these two lives?

Would the outcome have been the same under the French, Swedish, Danish, American, Canadian, German systems?

In other words, is this a celebration of the NHS specifically, or is it a celebration of any reasonably modern health care system?

The way the piece is written definitely suggests the former….but I have my suspicions that it\’s really the latter.