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Health Care

Polly on the NHS

Take the productive ward scheme. The ward manager, a nurse, has reorganised everything so that colleagues spend 40% more time nursing – no longer interrupted on average 115 times a shift, with less form-filling and no more hunting for supplies.

Having a matron who is in charge of the ward. What an amazing innovation, eh? I wonder who thought of it?

The rest of it is simply how much better the NHS is than it was. Which is of course true. But nowhere does she get the point that the NHS is not as good as it could be: as evidenced by the fact that every other European nation of similar wealth has a better system because none of them use the insane centralisation of the NHS.

So, Err, Rudy Giuliani Was Right?

You\’ll recall how Rudy Giuliani was mocked for his insistence that early treatment of prostate cancer enabled him to survive? The way in which everyone leapt up and down and insisted that the difference between the US and European numbers on years of survival was simply earlier diagnosis, not actually better outcomes?

Taking hormonal therapy early can help to slow the spread of prostate cancer by up to eight years, a study has shown.

Four months of hormone therapy delayed the spread of prostate cancer by eight years, American researchers report online in the Journal of Clinical Oncology. The effect of the treatment is to lower levels of the male sex hormone testosterone in the blood. It is an established treatment, but is generally given later in the course of the disease and for longer periods, when it can have damaging side-effects. “By taking a little bit of hormonal therapy early, patients may avoid having to take a lot of it later,” said Mack Roach, of the University of California in San Francisco, who led the team.

My word, seems he\’s right (even if for the wrong reasons).

w00t, w00t!

A drug that reverses severe liver damage could be used to treat disease in heavy drinkers who find it impossible to give up alcohol. Scientists developed the drug after discovering a way to prevent the formation of excessive scar tissue caused by cirrhosis, hepatitis and other medical conditions.

To their surprise the drug not only slowed progression of the disease but also reversed damage to the organ.

Decent present for the New Year, ain\’t it?

For Your Own Good, Of Course!

So the NHS is going to use regulation to put private competition out of business:

The \’worried well\’ are putting their health at risk by going for expensive body scans which use dangerous blasts of radiation, according to Government experts.

Now yes, such scans do indeed expose one to radiation, but:

Private clinics should stop offering whole body computed tomography (CT) scans and regulation of the industry should be tightened, Government advisers will say in a new report.

The scans could even be banned.

The risks of massive doses of radiation used to carry out the scans do not outweigh the risks for people who are not displaying symptoms, the report from Committee on the Medical Aspects of Radiation will say.

Some private healthcare clinics offer scans, ranging in price from £500 to £2,000, claiming to pick up early signs of cancer and heart disease.

You do not have to be a complete cynic to note that the State funded monopoly is suggestin that its private sector competitors, those offering a service which it does not and thus showing it up, are at risk of being banned.

Why shouldn\’t people spend their money as they wish?

Ooops, sorry, I forgot, that\’s the point, isn\’t it?

Die, You Rich Bitch You!

The ethos of the NHS laid out for you:

A WOMAN will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug.

Colette Mills, a former nurse, has been told that if she attempts to top up her treatment privately, she will have to foot the entire £10,000 bill for her drugs and care. The bizarre threat stems from the refusal by the government to let patients pay for additional drugs that are not prescribed on the NHS.

Ministers say it is unfair on patients who cannot afford such top-up drugs and that it will create a two-tier NHS. It is thought thousands of patients suffer as a result of the policy.

Better that she die rather than use her own money to live: equality is all.

The Rationing Service

Nice to see NICE being called what it actually is:

A life-saving treatment will be denied to tens of thousands of victims of Britain\’s most common male cancer after a U-turn by the NHS rationing body.

Prostate cancer treatment, by comparison with any of the female cancers (ovarian, breast etc) is already vastly underfunded.

The groundbreaking ultrasound therapy has been shown to kill nine out of 10 prostate tumours, and five years after treatment, 80 per cent of patients show no sign of the cancer recurring.

Compared with surgery or conventional radiotherapy treatment, it is not invasive and is far less likely to lead to devastating side effects such as impotence or incontinence.

But it costs £13,000 per treatment, not £4k or £5k.

You get what you\’re given in a Stalinist system, not what you might want nor what might actually be good for you.

Sir Liam Donaldson

He doesn\’t quite get it, does he?

Hospitals should be fined if patients get bad care that extends their stay or if they catch an infection, the Government chief medical officer has said.

You can see the thought process at work here. For profit companies would indeed be incentivised by such actions.

Sir Liam said the system of fines worked well in America, where private health care companies operate,

Indeed. The problem is, as some have noted, that we don\’t have such for profit healtth care here:

but critics said introducing it in the UK was \’absurd\’ as the taxpayer would end up paying the fine anyway.

In fact, one young shaver made the point very well:

Matthew Sinclair, Policy Analyst at the TaxPayers\’ Alliance, said: "Whether the Primary Care Trust or the hospital pays the cost of treating someone who has fallen victim to poor medical standards the taxpayer will still foot the final bill.

"This proposal might make sense in an insurance-based healthcare system which leaves provision to private companies, as seen in the most successful Continental countries, but not in the NHS as it currently stands.

"Without that separation between funding and provision we will never get proper incentives for reliable, safe and effective medical care. We would be in the absurd position of robbing Peter to pay Peter."

Is it possible to buy shares in the future of certain youngsters, to partake in the benefits of their obvious future success*?


* To be, at 22, and not yet a year out of university, the go to guy for a national newspaper on bureaucratic stupidity rather marks one out as one to watch.

Organ Transplants

There\’s good and bad in everything:

Hundreds of below standard hearts, lungs and kidneys have been taken from drug addicts and transplanted into critically-ill patients, The Daily Telegraph has been told.

That\’s the bad.

"We are getting desperate," he said. "We were much more careful 10 or 15 years ago because there were more donors. The age of donors is going up.

That\’s the good. Fewer people are dying of accidents at a young age (the most likely source for transplant organs).

Silver Pyjamas

Two questions about this:

Pyjamas that have been designed to protect hospital patients from the MRSA superbug have gone on sale in Marks & Spencer.
The £45 garment has silver thread woven into it, which tests show can reduce the spread of infections.
…Silver-laced nightwear has been tested in a handful of hospitals, but M&S has become the first retailer in Britain to stock the pyjamas.

1) Do they actually work?

2) If so, why is hospital issued nightwear not already using the technology?

Iatrogenic Deaths

Can\’t say that I\’m surprised at these numbers:

There were 9.1 million hospital stays in England in 2005/6 if day case, maternity and mental health patients are not included and Prof Sheldon\’s figures mean 910,303 of these patients suffered harm as a result of a blunder. In 91,030 cases it contributed to their death.

It\’s long been known that such mistakes are the third or fourth (thereabouts) leading cause of death. The only interesting thing is what is anyone going to do about it?

I\’ve got dim memories that someone has suggested a system rather like the one pilots use (which again, I\’m only dimly aware of). They\’re encouraged to report on their mistakes (anonymously, of course) and this then creates a database of things that are known not to be sensible to do. Again, I\’m dimly aware that there\’s been some pressure from within the medical system to not have to do this.

Worth noting that these numbers, while they might be better or worse for the NHS than other medical systems (I\’ve no idea which)  are certainly not unique to it.  There\’ve been reports of similar numbers (relative to population) from the US as well.

Just as an example, one number that went round the econ blogs a few weeks ago was that bariatric surgery ("stomach stapling") has a 1% mortality rate. Yet no drug would ever be approved which killed one in one hundred of those who took it. Either surgery is too little regulated for safety or drugs are too much, one or the other.


Rowan, you been talking to too many management consultants or something?

There is one key fact that every maternity expert appears to agree upon: one-to-one, dedicated care from a childbirth professional is absolutely key to facilitating a positive birth experience.

George Monbiot on Housing

George really does rather miss one point in this (actually, for him, rather good piece):

Shelter took me to meet Jacqueline Pennant, who lives with her children in a tiny maisonette in south Wandsworth. Jacqueline has osteoarthritis and a hairline fracture in the spine, a prolapsed disc and sciatica in both legs. She should be confined to a wheelchair, but it won\’t fit in the house. She dragged herself from one piece of furniture to the next, then up the narrow stairs, clutching at the bannisters, her face gnarled up in pain. I saw this in Britain, in November 2007.

Our Glorious National Health Service, The Wonder Of The World, in action again.

The Extent of Autism

I\’m not all that sure about these numbers:

There are approximately 540,000 people with autism in the UK, of which 433,000 are adults who are largely unemployed.

That 540 k number: Just under one in 100 of the population or so. That looks to me like it\’s the number of people with both autism and autism spectrum conditions (like Asperger\’s Syndrome). That fits in with Simon Baron Cohen\’s (the leading researcher in the field) numbers.

Sort of important to note the difference though: Aspie\’s can be as little as being socially not very acute, while "classic" autism goes al the way to not interactinig with the outside world at all.

No, not the most massively important point ever, just an example of the way in which numbers can be expanded to make a case.

Most Odd

Dean Baker:

Of course the idea of Medicare beneficiaries flying around the world for healthcare is ridiculous. The rational solution is to fix the US healthcare system.

I\’m not sure I remember the last time I saw an economist arguing against trade.

Comparing Health Systems

Another report on the various different health care systems across Europe.


There\’s one set of complaints about the NHS which is easy enough to explain. Yes, we\’ve got the highest paid doctors and also the fewest. You can look at it one of two ways. The planners have decided to have fewer but better….or we\’ve had a little bit of producer capture there . The BMA is, after all, really a rather strong trade union. But the actual outcome, fewer doctors, isn\’t all that much of a surprise, given the expense.

The thing that is vastly more interesting, given the current debate in the US about how their system might change, is looking at those numbers for private health care insurance. Holland and France (the latter actually being, according to the WHO and the like, the best health system in the world) rely more upon private health insurance than does the US. At least, that is, in the percentage of the population covered by it.

As we\’re constantly told, there\’s 49 million in the US without health insurance. 16% or so of the population. Then we need to add to that those with only Medicad or Medicare to get to the number without private medical insurance. No, I don\’t know what those numbers are and can\’t be bothered to look them up. But say another 50 million or so (it\’s slightly complicated by the fact that many retirees will have both Medicare and private insurance)?

So the French and Dutch systems, both good ones, have private coverage rates of over 90% while the US is about, what, 70%? I think it\’s Arnold Kling who makes the point about all of this best.

There\’s two different things being talked about when we say "health insurance". One is the proper meaning of insurance: protection by pooling risks against catastrophic costs. Cancer say, being scraped up off the road after a car crash, a degenerative disease. In the French and Dutch systems these are insured by the State (via a variety of means, perhaps a tax on wages etc). Then there\’s what might be called health assurance. Paying for the regular doctors visits, injections, mild illnesses and so on. These are things that all of us will need at times. So paying for them through the tax system isn\’t really "insurance", because tax is simply taking a known amount of money to provide a known amount of care. We don\’t all, after all, even over the course of our lives, need that hugely expensive catastrophic care. Now the bulk of this care is provided by those systems via the same State financing methods: but with co-pays for it. 20% 30% in the case of the French system. That\’s what the private insurance is to cover.

Our Glorious NHS, by contrast, funds everything, the routine care and the catastrophic, solely via the tax system. Which could be why it doesn\’t work all that well.

The American system, by contrast (excluding the poor and the aged, who have Medicaid and Medicare respectively),  funds everything via the private insurance system. Which is also why it doesn\’t work very well: the incentive is of course for private insurers to dump those with one of those problems requiring catastrophic care.

A logical solution might therefore present itself. To get from the US system to the best in the world, why not adopt the financing methods of that best in the world? That is, for the insurance pooling via taxation to be only for catastrophic care? For routine care to be covered by private medical insurance? That is, take the amount the US Govt is already spending upon health care and redeploy it, and expanding, not contracting, the use of private insurance?

I think it\’s Glenn Whitman who explains why this won\’t actually happen though. The institutional pressures are such that those agitating for change want ever more of health costs to be carried by Govt, ever less by out of pocket or private insurance: even if the latter, more private payment, appears to lead to a better system.

The French Paradox


Yes, I\’m banking on the French Paradox, a phenomenon first noted by an Irish doctor in the early 19th century. It refers to the relatively low incidence of coronary heart disease among French adult males, even though their diet tends to be high in saturated fats.

It is suggested that the explanation lies in their regular consumption of red wine, one of the ingredients of which – resveratrol – is believed to help fight cancer, heart problems and degenerative nerve diseases.

Not entirely sure about that. I\’ve heard an alternative explanation. Spcifically about the Gascon diet. That people in that region have been eating a diet very high in animal fats for a couple of thousand years: those genetic markers for diseases caused by such a diet have been bred out of the population as those with them died before reproducing some 1500 or more years ago.

I\’d rather, of course, believe the red wine story (indulging as I do in a copa or three to wash down the churrasquera here) but I\’m not wholly convinced. Does anybody know whether studies have been done on immigrants to such high fat eating areas to tease out whether it is genetic or wine based?

Latest Diet Advice

Most amusing really. We\’re told all about things we must avoid in order to beat the "rising cancer rates".

No more than two units of alcohol a day for men, ie, one pint of weakish beer. One pound of red meat a week, tops. Wholegrains and beans at every meal. No bacon, ham, salami, ever.

Difficult to reconcile this with the fact that with alcohol, just as an example, you need to consume 63 units of alcohol a wek to get to the same health risks as teetotallers.

Further, it\’s very difficult to reconcile this with hte fact that we don\’t actually have "rising cancer rates". What we have is increasing life spans, meaning that we\’re not all dying of things other than cancer and are staying alive long enough to get it. Age adjusted cancer rates (which are the true measure) are falling.

Sorry, this study does not compute.

Rickets Returns

At least they\’re not trying to cover up (sorry) the cause here:

Rickets, a softening of bone tissue often characterised by bowed legs, is caused by a vitamin D deficiency and was associated with Victorian slums. But a study found that there were 56 suspected cases between 2003 and 2005 in the catchment area of two primary care trusts that cover Blackburn with Darwen and Burnley, Pendle and Rossendale, in Lancashire. A large proportion of the cases came from the Asian community of Blackburn with Darwen.

Public health officials say that the problem is genetic and cultural. The religious imperative to use a hijab to cover up in public means that some women are not exposed to enough sunlight. Dr Ellis Friedman, the director of public health for East Lancashire, said rickets “is caused by a combination of skin colouration, diet and dress, not poverty”.

There\’s a reason why us adapted to northern climes have pale skin: yes, it makes us more liable to skin cancer, but less so to rickets. Add in, as they say, the covering up and….well, the usual "cure" for rickets is to drink milk isn\’t it? Something not part of the traditional South Asian diet?


Bravo, Bravo Mr. Cohen. Sticking it to the homeopaths.

One tiny niggle: the placebo effect is real and when there\’s no other available treatment, why not use it?

But as to the use against malaria, or AIDS, thi is absolutely correct:

This is murder. It\’s really that simple.

Claire Verity

This is interesting about Claire Verity:

Channel 4 has launched an investigation into the qualifications of Claire Verity, the nanny who appears on its television series Bringing Up Baby, in which she advocates a 1950s-style approach to parenting.

A spokeswoman for Channel 4 yesterday confirmed that an inquiry into Ms Verity\’s qualifications was under way after indications from the awarding bodies where she is said to have received her accreditation that they had no records of her attendance. The spokeswoman stressed that a maternity nurse did not need any formal qualification to practise.

The techniques used by Ms Verity, 42, originally from Harrogate, North Yorkshire, have caused concern among parents and children\’s organisations; they include instructions to leave babies to cry, or outside "to air" and limiting cuddling time to 10 minutes a day. The NSPCC said her methods were "outdated and potentially harmful", while the Royal College of Paediatrics and Child Health said her recommendation that babies sleep alone in a separate room contradicted official guidance on reducing the risk of cot death.

The channel\’s spokeswoman added: "We are looking into them [the qualifications] … We got her background information from her agent and we realised some of those were erroneous soon after we released information about Ms Verity. As soon as we realised this, we withdrew the information … we would like to make it clear you do not need any formal qualification to practise as a maternity nurse."

Most interesting, don\’t you think?