Flu vaccines are not helping elderly patients

The Flu jab

 

Flu vaccines are not helping elderly patients and, despite vaccination programmes, the number of hospital admissions due to flu is not being reduced, reported The Times and other newspapers. The study by the Health Protection Agency "will fuel doubts over the effectiveness of the vaccine in older people" the newspaper said, and although the researchers are not recommending an end to the vaccination programme, they suggest other measures should be considered which might reduce hospital admissions such as treating chest infections, improving housing and promoting giving up smoking.

 

This story is based on a study that suggests the influenza vaccination programme in the elderly should be an area for further research. However, this study looked only at people who were already ill, and at the current time there is insufficient evidence from this study alone to conclude that influenza vaccinations are unnecessary for a vulnerable group of the population during the winter period.

 

Where did the story come from? The research was carried out by Dr Rachel Jordan of the Health Protection Research and Development Unit of the Health Protection Agency (based at the University of Birmingham) and other colleagues from the HPA and at Universities and hospitals in Birmingham, Nottingham Derby, and Aberdeen. The main sponsor of the study was the British Lung Foundation. It was published in the peer-reviewed medical journal Vaccine.

 

What kind of scientific study was this? This was a case-control study of sick, elderly people, which aimed to compare those who were admitted to hospital with an acute respiratory illness (cases) with those that presented to the GP with an acute respiratory illness but did not require hospital admission (controls). The participants were part of a larger study that was examining the risk factors for winter hospital admissions due to respiratory illness.

 

The researchers used a group of elderly people aged between 65 and 89 years old who went to the GP with an acute respiratory illness (or acute worsening of a pre-existing condition) between October 2003 and March 2004. The researchers selected six controls for each hospitalised case and these were matched as closely as possible in terms of sex, age and date of GP consultation. They examined GP records to obtain information about medical diagnoses, pneumococcal vaccinations, and whether the patient had received the recommended influenza vaccination for that winter in the three weeks prior to the start of the study.

These results do not "negate the need for influenza vaccine". Rachel Jordan, lead author

All patients included in the study were invited for interview with a nurse to look at social, medical and lifestyle factors. The study excluded patients with dementia and those who were unable to take part in the interview. Of the potential 3,970 people included in the original group, 157 cases and 639 controls were interviewed and included in the study analysis.

 

What were the results of the study? The researchers found there to be no difference in the rates of vaccination between those who were hospitalised for their illnesses and those who weren't; 74.5% of the hospitalised patients had been vaccinated compared with a vaccination rate of 74.2% in patients who weren't hospitalised. The difference remained non-significant even when adjusting for potential contributing factors such as chronic obstructive pulmonary disease (COPD), other medical illnesses, smoking and age.

 

What interpretations did the researchers draw from these results? The researchers conclude that in ill people, influenza vaccine did not reduce the number of hospital admissions due to respiratory illness during a typical winter.

 

What does the NHS Knowledge Service make of this study?

Although this study can provide some data on the effect of flu vaccination on the numbers of hospital admissions due to a respiratory illness over a winter period, several points must be kept in mind when interpreting the study. Newspaper headlines such as "flu jabs fail to cut illnesses" may lead you to believe that this study was looking at whether the vaccination could prevent infection with the influenza virus, which is not the case.

• The study only enrolled people who had presented to their GPs with "an acute episode of respiratory infection or acute exacerbation of pre-existing disease", i.e. people who were already sick. As such, it was designed to answer a very specific question about whether the influenza vaccination reduces "respiratory admissions" (which could include flu or not) to hospitals in those who are ill. The study could not and did not intend to determine whether the influenza vaccination can prevent infection.

 

• Grouping people under a broad definition of presentation – "acute respiratory illness or acute exacerbation of a pre-existing respiratory disease" – means that those with a wide variety of both viral and bacterial infections such as upper respiratory tract infections (coughs, colds, sore throats), influenza, acute bronchitis, infective exacerbations of COPD, and pneumonia would have been included. Through this method, it isn't possible to separate those patients who were admitted specifically for influenza. As the researchers conclude, their study shows that "influenza is not the sole driver of winter respiratory admissions".

 

• There are different types of influenza infection. Influenza is a virus, and different strains circulate during different seasons. Vaccinations are prepared before the flu season starts and are designed to protect against the strains that are predicted to be predominant. It is not always possible to get this 100% correct and the vaccination is always more effective in seasons where it matches well with the strains of virus that are causing infection. The researchers themselves note that "in the 2003–2004 season, the circulating virus showed antigenic drift compared with the vaccine strain". This means that the vaccine would not offer full protection against flu that season. This study cannot be generalised to predict what happens in seasons where the vaccine is fully matched to the viruses that are causing infection in the population.

 

• Controls were matched for age, sex and date of consultation but there are many other factors that could impact upon whether hospitalisation could be required for a respiratory illness, such as presence of asthma, COPD, or having a series of repeated infections.

This study suggests that influenza is not the "sole driver" of admissions to hospital for respiratory infections and that relying on a vaccine to prevent flu in order to reduce the winter bed pressures in hospitals is not sufficient.

 

This study was not set up to determine whether the vaccination works to prevent influenza infection in the elderly. The researchers themselves say that their results do not "negate the need for influenza vaccine, as other studies show small but demonstrable benefits in reducing both infection (an outcome this study did not look at) and subsequent morbidity and mortality in the elderly, particularly in a season where the vaccine is well-matched and there is high viral circulation". The efficacy of the vaccination in preventing infection is a separate issue and we support the call for further well-designed research to answer this question once and for all. The elderly should continue to be vaccinated against flu while this research is being conducted.

 

Sir Muir Gray adds... Hospital admission is determined by many factors, of which the incidence and severity of disease are but two. This does not mean that immunisation should be stopped; if you are offered an immunisation this study should not influence your decision, immunisation does much more good than harm and is still to be recommended.

Links to the headlines

Flu jab 'failing to save the elderly'. The Times, October 24 2007

Flu jabs 'fail to cut illnesses'. The Daily Telegraph, October 24 2007

Winter flu jabs for pensioners 'don't reduce hospital admissions'. Daily Mail, October 24 2007

No point giving flu jabs to over-65s, say doctors. Daily Express, October 24 2007

Flu jab is 'no use' for the old. The Sun, October 24 2007

Links to the science

Original study Jordan RE, Hawkerb JI, Ayres JG, et al. A case–control study of elderly patients with acute respiratory illness: Effect of influenza vaccination on admission to hospital in winter 2003–2004. Vaccine 2007; Sep 21 [Epub ahead of print]

Further reading Rivetti D, Jefferson T, Thomas R, et al. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev 2006, Issue 3

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The epidemiology of depressive disorders

Recently, the issue of whether depression is overdiagnosed has been discussed, by two leading Australian authorities, in the British Medical Journal ^1,2,. This timely debate has reignited the controversy about how depressive disorders are diagnosed, and whether the diagnostic criteria are sufficiently accurate, robust and reliable. Few reading this article have not suffered unhappiness at some time. Often such emotional discomfort can be a normal "physiological response" to major stresses and life events. The invisible line, beyond which such sadness becomes pathological, is notoriously difficult to identify. This article considers the arguments for and against the proposition that depression is over diagnosed.

Diagnostic precision may be possible in other branches of medicine; however defining mental ill health continues to pose challenges. Sophisticated investigations, relying on imaging or assays, do not have a role in diagnosing depressive illnesses. The diagnostic and statistical manual (DSM-III)^, published by the American Psychiatric Association, provides the basis for diagnosis in modern clinical psychiatry. DSM-III lists inclusion and exclusion criteria for the diagnosis of mental health disorders. Such a checklist approach, familiar to readers of "pop medical" questionnaires, may be based upon assumptions, and the reliability of DSM-III has been challenged ^{3, 4।}

Over diagnosis risks exposing those who are unhappy to potentially harmful effects of antidepressants, psychotherapy and electroconvulsive therapy¹.

Hickie argues that depression is not over diagnosed and that evidence suggests that prompt intervention can reduce the incidence of suicide ⁵, whilst proving cost-effective^{6, 7}. Therapeutic intervention relies on diagnostic tools with high degrees of specificity and sensitivity. "Tightening" diagnostic criteria, may appeal to epidemiologists and clinical scientists, however it risks denying treatment to the marginalised, who's suffering does not fulfil rigid tick box diagnostic criteria. Hickie cites evidence that increased diagnosis has improved treatment outcomes, leading to improved physical health, social functioning and employability with reduced levels of substance misuse). More widespread recognition of depressive illness may improve understanding about depression, helping to destigmatising mental illness⁸.

Summary

There can be no doubt that depression can be incorrectly diagnosed; conversely, there are many in whom depressive disorders continue to elude health professionals. The pharmaceutical industry will seek to promote new therapeutic agents in their quest to maximise profits. Meanwhile, governments struggle to contain the rising costs of healthcare, and rationing decisions are becoming more explicit. In many nations, as few as 10% of those suffering from depression ever receive treatment⁹. It is critical that we remember that this debate is about real people who are suffering. The government have identified mental health a key priority; mental health has been a Cinderella service for too long. It is essential that the NHS continues to fund treatment for those who may benefit from treatment.

Web resources

www.mind.org.uk

www.rcpsych.ac.uk

References

1. Parker G. Is depression overdiagnosed? Yes. BMJ 2007;335:328



2. Hickie I. Is depression overdiagnosed? No. BMJ 2007;335:329



3. Kirk SA, Kutchins H. The selling of DSM. The rhetoric of science in psychiatry. New York: Aldine De Gruyter, 1992.



4. Parker G. Beyond major depression. Psychol Med 2005;35:467-74



5. Ludwig J, Marcotte D. Anti-depressants, suicide, and drug regulation. J Policy Analysis Manage 2005;24:249-72



6. Simon G, Revicki D, Heiligenstein M, Grothaus L, Von Korff M, Katon, et al. Recovery from depression, work productivity and health care costs among primary care patients. Gen Hosp Psychiatry 2000;22:153-62



7. Sanderson K, Andrews G, Corry J, Lapsley H. Reducing the burden of affective disorders: is evidence-based health care affordable? J Affect Disord 2003;77:109-25



8. Pirkis J, Hickie I, Young L, Burns J, Highet N, Davenport T. An evaluation of beyondblue Int J Mental Health Promotion, Australia's national depression initiative



9. Lee S, Fung SC, Tsang A, Zhang MY, Huang YQ, He YL, et al. Delay in initial treatment contact after first onset of mental disorders in metropolitan China. Acta Psychiatr Scand 2007;116:10-6

Australian has 'world-first' conscious brain surgery

Mon Sep 24, 5:20 AM ET

 

An Australian man was conscious and spoke to his medical team during life-saving brain surgery in what doctors are claiming as a world-first procedure with cutting-edge technology.

 

John James said it was a strange experience to hear the doctors and nurses talking to each other as he lay on the operating table with a 1.5-centimetre (half-an-inch) hole in his head.

But he said he was confident throughout the April surgery to remove an aneurysm from his brain, which threatened to burst and kill him.

 

"The nurses looking after me, they were talking to me," the retired bus driver told a press conference in Canberra. "I could only see bits because I couldn't move my head at all."

"I wasn't worried whatsoever.... I was quite confident all the way through."

 

Doctors asked James to read the words and numbers on flashcards shown to him during the surgery so they knew they were not affecting his vision.

 

The team believes the combination of the technology and the small size of the hole in James's head, as well as the fact he was conscious throughout the operation, makes it a world first.

 

"As far as I'm aware reading the literature, this kind of thing done as a package has never been done before," Canberra Hospital neurosurgeon Vini Khurana said.

"So we were pleased. The result was obviously very good."

 

Virtual reality software, which created a three-dimensional image of James's brain, was used to allow the team to rehearse the operation to drain the blood from the aneurysm.

 

During the surgery, Khurana had a 3-D image of the brain projected onto one side of his eyepiece. On the other side he could see a close-up view of the brain through a microscope.

 

An ultrasound probe was also used to ensure that no more blood was flowing through the aneurysm after the drainage was completed.

 

"The technology we used was quite extraordinary," Khurana said.

 

"It's like GPS navigation that you use in the car being injected into your sunglasses as you drive."

 

James, who has since turned 78, initially went to the doctor because of problems with his vision and dizzy spells and scans revealed the potentially deadly aneurysm.

 

Surgery was required but because the aneurysm was behind his right eye the operation could have blinded him, which is why the doctors wanted him awake during the procedure.

 

The great-grandfather, who was sent home two days after the operation, said he felt fine after the surgery.

 

"I had to sit for an hour to make sure everything was alright," he said. "I just came back to normal after that."

PM in pledge to beat hospital bugs

 

Press Assoc. - Sunday, September 23 06:02 am

 

Gordon Brown has set the stage for his first Labour Party conference as leader with a pledge that every hospital in the country will undergo a ward-by-ward "deep clean" in a bid to drive out superbugs from the NHS.

A buoyant Prime Minister arrived in Bournemouth on Saturday amid a swirl of speculation that he will capitalise on his opinion poll lead to call a snap general election this autumn.

 

That speculation was intensified by an ICM poll for the Sunday Mirror which put Labour on 39%, six points ahead of the Tories on 33%, with the Liberal Democrats on 19%.

 

The findings suggest that Labour has emerged from the Northern Rock crisis with its reputation for economic competence intact.

 

Chancellor Alistair Darling will tell the conference that through its "strength of purpose" the Government has built "one of the strongest economies in the world".

 

The confidence coursing through the party was graphically illustrated by Foreign Secretary David Miliband, who suggested that it was now looking forward to a second decade in power.

 

"We didn't solve all the problems of the world in 10 years in government. Well, this is a party that is planning how it is going to use the next 10 years to go further towards solving them," he told The Observer.

 

The Prime Minister refused to be drawn on whether he intended to go to the country this autumn, telling The Sunday Times: "My focus is and will remain on the work that needs to be done".

 

He was, however, swift to launch his first policy initiative, promising that over the next 12 months all hospitals would be restored to a pristine state of cleanliness to rid them of MRSA and C-difficile.

 

Officials said that it would be up to individual NHS trusts to decide how the cleaning programme was implemented. However, it is thought wards could be closed for a week at a time while they are systematically cleansed.

MEDICAL MATRIX readers can you assist with TV documentary?

Tiger Aspect productions are one of the UK's leading independent television production companies, responsible for respected and varied factual output (the Monastery, Seaside Parish, Diet Doctors and more).

We are currently focusing on a feature dealing with people who suffer from excess sweating (hyperhidrosis). We are looking for case studies who would be willing to discuss with us the issues they have faced and the treatments they have used to combat the problem. We are looking for a variety of experiences. If you suffer from the problem or have a story relating to excess sweating we would love to hear from you.

Of course we understand that this is a delicate subject and we can confirm that any contact with ourselves is in strict confidence, there is no obligation to be part of the program and no information will be shared or broadcast without permission from the case study.

Please email - duncanthompson@tigeraspect.co.uk

Alternativly please call Duncan Tompson on: 0207 434 6909

Knife crime-an emerging public health issue

Report by Dr. Tom Fitzgerald - for Medical Matrix

 

According to a recent study, published by the Centre for Crime and Justice Studies, recorded muggings, involving the use of knives, have increased from 25,500 in 2004-5 to 64,000 in the year to April 2007. This reflects 175 victims every day, compared to just 69 in 2004-5.

 

Every day, between 1997 and 2005, 13 people required hospital admission for treatment following stab injuries ¹. Knife-related injuries are a major public health issue and treating victims of knife crime places a massive strain on our already overstretched NHS.

 

Injuries caused by knives can have a devastating effect on victims and their loved ones. According to Home Office figures, between 1995-200, 37.9% of homicide victims were the victims of stabbings-the commonest cause of death. A similar study in Scotland revealed an even more alarming picture, with the homicide rate for stabbing-related assaults increasing 164% between 1981 and 2003². An audit of forensic knife injuries at one East London hospital revealed 309 injuries over a 2 year period, of which 259 victims required admission, 184 required surgery and 8 died of their injuries ³. This audit suggested that the injuries were becoming more serious. In an editorial in the BMJ in 2005, a team of emergency physicians called for a ban on pointed-tip kitchen knives of the dagger variety, which anecdotally are thought tobe used in a significant proportion of forensic knife injuries ⁴.

 

There are no reliable statistics on the incidence of knife carrying. With the rise in gang culture, many young people carry knives because of peer pressure or for protection against assailants. This creates a vicious cycle and evidence suggests that young people carrying knives are themselves more likely to be victims of knife-inflicted injuries. Evidence from the British Crime Survey 2005-6 suggests that young men, those from minority ethnic communities and the poor are most likely to be victims of violent crime ⁵.

 

Tackling the rise in knife crime will require an integrated approach, involving a number of government departments and other agencies. This must include action to address the root causes of violent crime as well as robust measures to deter young people from carrying knives. Further research will be required to evaluate various interventions to reduce knife-inflicted injuries. Steps need to be taken to reduce poverty, unemployment and social deprivation-all factors known to predispose young people to commit violent acts. Young people need positive role models, together with training opportunities if they are to turn their backs on the sub-culture of violence and knife carrying. Educational strategies will be required to provide young people with information about the consequences of knife injuries. High profile knife amnesties, such as the 2006 amnesty which saw 90,000 knives surrendered, are only part of the solution. The Violent Crime Reduction Act 2006 gave teachers tough powers to search pupils, suspected of  carrying weapons. The Act also raises the age at which young people are allowed to purchase knives from 16 to 18. Currently, those prosecuted for carrying knives illegally may be imprisoned for up to 2 years, yet custodial sentences are rarely handed down. This is an ineffective deterrent and tougher penalties, together with robust enforcement have a vital role in preventing the increase in knife crime.

 

Web resources:

 

http://www.kcl.ac.uk/depsta/rel/ccjs/knife-crime-2006.pdf

 

http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhaff/433/433we03.htm

 

 

References:

1.      Maxwell, R., Trotter, C., Verne, J., Brown, P., Gunnell, D. (2007). Trends in admissions to hospital involving an assault using a knife or other sharp instrument, England, 1997-2005. J Public Health (Oxf) 29: 186-190

2.      Leyland, A. H. (2006). Homicides involving knives and other sharp objects in Scotland, 1981-2003. J Public Health (Oxf) 28: 145-147

3.      Konig, T., Knowles, C. H, West, A., Wilson, A., Cross, F. (2006). Stabbing: data support public perception. BMJ 333: 652-652

4.      Hern E, Glazebrook W, Beckett M. Reducing knife crime. BMJ 2005;330: 1221-2

5.      British Crime survey 2005/06 Home Office

anti-euthanasia talk

  SPUC  Kensington & Chelsea  Branch

 

Dear  Medical Matrix readers,

 

You  are all very  welcome  to  hear  Miss  Teresa  Lynch,  founding  Chair,  talk  about  the  aims & achievements  of  'Nurses  opposed  to  euthanasia'.  The  group  supports  nurses  and  other  medical  professionals  threatened  with  having  to  let  patients  die  in  hospitals  today ~ http://www.spuc.org.uk/about/noe/   I  enclose  the  aims  of  NoE

          7.30p.m,  Tues.  25th  Sept,

              24  Smith  Terrace,

           LONDON,  SW3  4DL

        (All welcome;  Admission  free  of  course)

The  nearest  tube  is  Sloane  Square & walk  down  the  King's  Road,  left  into  Smith  Street,  right  into  Smith  Terrace;  there  is  free  meter & single-yellow  line  car  parking  around  Smith  Terrace  after  6.30pm.

 

Here  are  some  relevant  links  http://www.spuc.org.uk/ethics/euthanasia/

 

SPUC's  free  Pro-Life  Times  ( http://www.spuc.org.uk/pro-life-times/  &  prolifetimes@blueyonder.co.uk )  constantly  opposes  euthanasia.  Might  you  be  interested  in  submitting  an  article  about  euthanasia-related  matters ?  I  trust  you  are  aware  of  our  division  'No less Human'  for  those  with  disabilities  http://www.spuc.org.uk/about/no-less-human/

 

See  also  http://www.spuc.org.uk/about/pfn/  (we  can  provide  100s  of  leaflets  about  'Patients First'  if  you  know  of  those  interested),  and  links  to  relevant  books  at  http://www.chninternational.com/no_water_no_life_bk_by_g_craig.html  and  http://www.argospress.com/Resources/medical/book-0253205174.htm

 

All  kind  regards.

In  defence  of  life,

 

William Jolliffe  (Branch  Secretary), 

 

24  Smith  Terrace,  LONDON,  SW3  4DL;  Tel. 020 - 7352 - 7212 / Mobile 07973 - 510 - 144
williamhmjolliffe@yahoo.co.uk
www.jolliffephotos.com

The Ethics of Cosmetic Surgery

 

 

Advances in plastic and reconstructive surgery have revolutionised the management of patients suffering from disfiguring congenital abnormalities, burns and skin cancers. Aesthetic (or cosmetic) surgery refers to plastic surgery performed to improve physical appearance in the absence of pathology. The demand for aesthetic surgery has increased in recent years as our culture has become more concerned with image and appearance.

 

Many regard aesthetic surgery as a panacea for their personal and relationship difficulties. This may reflect modern image-obsessed popular culture, but it can be due to deep-rooted insecurities. Body Dysmorphic Disorder (BDB) is a psychiatric syndrome, characterised by a pre-occupation with a non-existent or minimal cosmetic "defect" associated with persistent attempts to have the defect surgically corrected. BDB is increasingly recognised, and may be becoming more prevalent.

 

In the National Health Service (NHS), finite resources limit the availability of aesthetic surgery to those who suffer significant psychological distress due to their appearance. In the independent healthcare sector, aesthetic surgery has increased in popularity, reflecting increased consumer demand.

 

In 1979, Beauchamp and Childress published Principles of Biomedical Ethics, in which they presented four "principles" that have since been adopted as the ethical basis for contemporary UK medical practice. They argued that these principles "bridged" high-level moral theory and what they described as "low-level common morality". These principles included: respect for autonomy, beneficience, non-maleficience and justice. Whilst these principles were developed to guide physicians treating those suffering ill health, they provide the ethical framework which underpins modern surgical practice.

 

Respect for Patient autonomy

 

In general, competent adults have the right to decide whether they wish to undergo a surgical procedure. Providing they are given sufficient information, on which to make an informed decision, patients' wishes must be respected. Information must include the risks of surgery together with alternative options. These principles still apply to aesthetic surgery where patients are not suffering from an "illness".

 

Beneficience

 

This principle requires medical practitioners to act in patients "best interests". Undertaking surgery to improve a patients self-image and esteem is acceptable. However, defining patients best interests can be very difficult. Many people experience real pain, discomfort, social handicap and suffering because they are self-conscious about their appearance. This group benefit from aesthetic surgery.

 

Non-maleficience

 

This principle ensures that doctors never act against patients' best interests or in a way that may harm a patient. Consultant plastic surgeons may decline to operate on patients if they do not believe that surgery is in patients' interests. Surgeons are reluctant to operate on those with unrealistic expectations, as the risks of surgery may outweigh any benefits. Patients with serious health problems are at increased risk of suffering complications under general anaesthesia, and again the risks may outweigh the benefits. All such assessments need to be made on an individual basis. In the past, there has been a perception that surgeons have a potential conflict of interest in the independent sector. No surgeon would ever proceed with an operation merely for personal pecuniary gain. All surgeons take their duty of care to their patients very seriously.

 

Justice

 

This principle requires doctors to ensure that medical care to available to all. Equitable access to healthcare is regarded as a basic human right. However, resources are limited and it is not possible for the National Health Service to provide aesthetic surgery for all those who would like it. "Rationing" takes place on the basis of clinical need. Inevitably, this introduces subjective judgments about whose need is greater. In the private sector, those who can afford to pay can undergo surgery.

 

 

 

With appropriate patient selection, aesthetic surgery can offer excellent cosmetic results. Patients must undergo thorough pre-operative assessment and counseling before surgery. This may require expert psychological assessment. Surgeons must ensure that patients' expectations are realistic. Surgeons need to explain the likely benefits of surgery, alternative non-surgical options as well as the risks of surgery and anaesthesia. Patients need to make an informed choice regarding whether surgery is right for them. Consultant surgeons and consultant anaesthetists treating patients, undergoing cosmetic procedures, should be on the General Medical Councils' Specialist Register. Surgery should only be undertaken in premises that are fully-equipped, with resuscitation facilities and staff trained in advanced life support. Clinics and hospitals providing aesthetic surgery should be registered with the Healthcare Commission.

 

 

For further information:

 

The British Association of Aesthetic Plastic Surgeons

www.baaps.org.uk

This email address is being protected from spam bots, you need Javascript enabled to view it

References

 

Beauchamp and Childress, Principles of Biomedical Ethics, Fourth Edition.

Oxford. 1979

Andrew Wakefield: Galileo or Shipman

There is a free circus in town, or rather in the Coliseum, for the next month. Get your tickets at the GMC, and hear good doctors made fools of trying to defend an open mind.

I spent the morning at the GMC, on Euston Rd, where they will decide whether Andrew Wakefield is a son of Satan or a misunderstood honest researcher doing his best to make sense of a complex topic. This morning's session was one of the supporting or warm-up acts, Richard Horton, Editor of the Lancet. Horton is one the few remaining voices for free medical thought, fewer since Richard Smith left the British Medical Journal.

The first few hours raised the following questions

The procedure - Can the GMC set the standard, prosecute offenders and judge the case? All in all, a bit like the Inquisition

The GMC Panel - ? fit for purpose - too early to say - none of them said very much.

The prosecution, 'Miss (married) Smith' more of an actress than a barrister - perfect pitch, excellent vocal modulation, and a full range of styles. She was able to encompass serious, pitiful, scathing, patronising and even attempt humour, using a wonderfully contrived Sloane-style diction, within one speech. RADA 1985?

The defence, I warmed to the defence Barrister, sensible, down to earth and very aware of the size of the storm in the GMC teacup. Everyone should have one.

The question to be decided Galileo or Shipman? - Not Shipman, as no patients have ever come to harm as a result of Dr Andrew Wakefields clinical activity. But you can't tell that from the size of the party.

Galileo? Yes and No! This is not a big controversy, these are not ideas that will shake the universe. MMR and autism are they associated? the paper about which there is all the fuss, actually concluded that there was no evidence that they were.

However, what did Galileo actually change? were his ideas earth shattering? not immediately but they opened the floodgates to allow scientific thought to think the unthinkable and unseat the Church from its position as the arbiter of knowledge.

Wakefield is guilty of looking for a cause for autism. Autism, like Alzheimers, like Polycystic ovaries, like heart disease did not exist in Galileo's time. They are all conditions of which we do not know the cause. They are spreading faster than the plague in the middle ages. The plague left a third of the population dead. By contrast, these diseases are big business. The healthcare industry provides reliable growth, year on year. The economy of health would bankrupt America and most of the Western world.

As doctors we are taught that we do not know the cause of these conditions. We tell you, our patients that we do not know the cause of these conditions but take these drugs, and it will all get better.

But we know the cause of everything else, we know how computers work, how to get rockets in space, we know what caused the World Trade Center to collapse, we even know how to predict a hurricane. But we don't know the cause of diseases that are unheard of in the developing world, that people only get when they move to the West, diseases that are rising in incidence year on year, that even in the West occur more often with an unhealthy lifestyle than with an unhealthy lifestyle ??? has anyone in the audience got any ideas??

Are they
1) - Visitations from outer space
2) - Down to processed food, the way we live and what we do to ourselves
3) - Caused by viruses at the neuromuscular junction *


Even twenty years ago these diseases were rare, dementia in the under eighties was rare, so rare that if a 'youngster' became demented, they warranted a brain biopsy. Now dementia is so common patients rarely even get a CT Scan. Polycystic ovaries were called SteinLeventhal syndrome and went to a specialist clinic. And type II diabetes - there was no type II diabetes.

Andrew Wakefield dared to ask what causes Autism. We live in a cause and effect universe, that is not an unreasonable question.

So if you can think what might be causing the current epidemic of disease, from glaucoma to dementia, from diabetes to cancer - answers on a postcard please

The first correct answer wins a cat and the editor's decision is final




* Recent answer from a Teaching Hospital consultant when asked what he thought caused irritable bowel syndrome.


Copyright (c) Dr. Liz Miller

http://www.drlizmiller.co.uk

Just as you thought it was safe to go into hospital

Finally, even the BBC has noticed that there will be no doctors on the hospital wards this week as doctors complete their biannual migration.

Yes don't be ill - this month, or next month, or anytime before Christmas. If you want your doctors trained, I would recommend you time your illness for early January 2008. Just after the Christmas break. By then, the doctors will have been in the job for five months, and should know what they are doing.

Research (I love that word, its covers more than Elizabeth Arden over 55s make-up) shows that in Industry it takes five to six months before a person has learnt their job well to be of value to their company. Which is almost exactly the time, when we get ready for the next round of medical chairs.

This year there is a severe shortage of chairs, leaving approximately 10,000 doctors without a job. Many of these are top class graduates, not great at filling out forms and describing themselves in 100 words or less, but prize winners, first class students, able and willing.

Political correctness has gone beserk. It is has been decreed that all doctors must compete on an equal footing. In order not to give bright hard working graduates an unfair advantage, they hvae not been allowed to mention their class of degree, their prizes or any other achievement gained during their student years. So the decision as to who to employ has been made largely on their ability to fill out a form. Bureaucracy begets bureaucracy!

The bureaucrats are in the process of making medicine in their own image. Form filling rules. It no longer matters what happens to a patient, or what you learn from your experience only that you fill in the correct accident form to make sure you are 'covered'. This system will only work if doctors are selected from an early age, on their ability to fill out a form properly. This suits 'Sensitive-Individuals' that is fear-driven, task not people-focused individuals who are not fit to be let out on their own in a mortuary.

It is amazing how much has been lost in the present sandstorm of confusion

1)Modernising medical careers - a way to shorten and cheapen the way we train doctors
2) An IT collapse and fiasco providing a diversion worthy of the French Resistance to make sure no one noticed exactly how many doctors would be unemployed.
3)10,000 unemployed doctors
4) Everyone swapping jobs August 1st - so just make sure you aren't ill.

And now, as everyone is going on holiday, lets take our illnesses abroad.

That comment is truer than I realised. I have had an interesting conversation with a Refugee liason worker, the days of medical tourism are over. Refugees now go to Italy and Germany for their medical care, rather than the UK. It may be easier to get treated here, but the quality is not what it was.

That story reminds me of the time I had a suitcase stolen and lost half its contents. The other half were left with the case, round the corner. I couldn't bear to wear anything that had been left with the case - after all if it wasn't good enough to be stolen, it definitely wasn't good enough for me.

So if our health care isn't good enough for an asylum seeker, why is it good enough for us?

(c) Dr. Liz Miller

http://www.drlizmiller.co.uk

MEDICAL MATRIX is part of RED CUBE MEDIA LIMITED © 2007, All Rights Reserved. Company No.: 6309631 VAT No.: GB 863 7338 95.

Shopaholics need therapy

By Emily Nash.

 

Popping out for some retail therapy in the lunch-hour is a source of comfort for many stressed and depressed workers.

 

But those who take it too far and become real shopaholics have a serious psychiatric disorder, experts said yesterday.

 

Easy credit, advertising and the glamorous designer clothes featured on TV contribute to lavish spending, they claimed.

 

Now compulsive shopping has finally been recognised as a unique condition and listed alongside addictions to gambling and alcohol in the official reference book for US psychiatrists, The Diagnostic and Statistical Manual of Mental Disorders.

 

The inclusion is likely to be mirrored in its European equivalent.

Researchers believe the disorder affects about one in ten people, with women nine times as likely as men to be hooked.

 

The addiction is high profile — society girl Tara Palmer-Tompkinson famously sought help after spending £20,000 in a designer clothes spree.

 

'You can't open your eyes, you can't eat your cereal without being persuaded to buy something,' said Dr Adrienne Baker, senior psychotherapy lecturer at Regent's College in London.

 

'It is usually written off as affecting only bored, affluent, middle-aged women but it affects people from any background.'

 

Robert Lefever, director of the Promis recovery centre in Kent, has treated the condition with group therapy for 17 years.

 

One former patient was dubbed Anne of the 1,000 T-shirts. 'She didn't even unwrap the T-shirts, just piled them up to the point where she could not even get into her bedroom,' he added. 'But she's doing fine now.'

Smoking marijuana increases the risk of schizophrenia

A study from the Lancet has suggested that cannabis users have a 41 per cent increased risk of developing a psychotic illness such as schizophrenia.

 

A team of researchers led by Dr Stanley Zammit from Bristol and Cardiff Universities undertook a meta-analysis of 35 studies. The researchers concluded that there is 'a consistent association between cannabis use and psychotic symptoms, including disabling psychotic disorders'.

 

An accompanying editorial from two Danish researchers suggests that up to 800 schizophrenia cases each year in the UK can be linked to cannabis use.

 

Although this study is one of the most comprehensive of its kind, the researchers emphasise that a randomised controlled trial with a long-term follow-up is required to investigate whether there is a direct link.

 

Comment below and tell us what you think

The real reason why Blair wouldn't leave

At last we know the real reason why Blair wouldn't resign.

What would you do if you knew your successor was going to be better than you, at everything?

You would do what you could to stop him - at least you would if your name was Tony Blair.

Since Brown came to office about a month ago, we have had two terrorist attacks, the worst floods in living memory and the usual summer wingeing. Gordon Brown, bless him, has not missed a beat.

Just imagine what would have happened if Blair had been running the country, his little face would have been everywhere! and we would have half a dozen new laws on the statute book allowing the police to detain anyone anywhere, anytime because they felt like it. To his credit, Brown has only made one change, keep suspects detained for longer. Fair enough.

Well done Gordon! we have hardly seen you and you haven't missed a beat. You have just done it. Blair was right (from his perspective) to stop you taking over, he could see how good you might be - its early days but what a star you have turned out to be! It must be galling indeed for Tony Blair to see how you have handled your first month in office. No fuss, no spin, you have just got on with the job. For the first time in many years, the country can breathe again. At last someone with real leadership qualities, not just a good sales pitch !!

By the way, we now know why Tony Blair supported George Bush in the American invasion of Iraq. Being the US appointed International Envoy to the Middle East should secure Tony's pension fund even it won't resurrect a Blair legacy from the shambles that is now Iraq

- not the man Gordon would have chosen by all accounts

http://www.gulf-daily-news.com/Story.asp?Article=189096&Sn=WORL&IssueID=30131


Copyright (c) Dr. Liz Miller

http://www.drlizmiller.co.uk

Junior doctor shambles threatens the NHS

From letter to The Times

Sir, Last week a ministerial statement confirmed that almost half this year's applicants under the junior doctors' career and appointments system have had their careers in UK medicine abruptly cut short.

 

This stark fact was transmuted by the subsequent press release into "good news", because 85 per cent of available jobs will be filled by August 1. Even if this obfuscation of job-fill with appointment rates were true – and we believe it is a gross overestimate – it fails to acknowledge that a 15 per cent vacancy rate is ten times that of previous years in most specialties.

 

Alarmed at so many posts being vacant on August 1, the Department of Health gives trusts two weeks to manage what the hugely expensive national competition failed to achieve in six months. Before August, trusts are ordered to find somewhere to shuffle 10,000 doctors for three months until the current crisis is past, and these doctors can then be quietly lost from the NHS for ever.

 

Our poll shows that one third of the 4,000 who have not found jobs as doctors are among our very best graduates, with either a first-class degree or distinction. This cull of the best happened because the best graduates naturally apply for the most competitive posts and the new system randomly limited half of the applicants to just one interview.

 

This new career structure is a top-down straitjacket forcing doctors to choose immutably their area of training merely two years after qualification. Hundreds of doctors now face transportation for seven years to posts geographically remote from their families. Although the professionalism of doctors will save the NHS from chaos in August, the NHS cannot be saved in the long term from the consequences of culling 30 per cent of our best doctors.

 

Some flexibility and free market in posts must be reintroduced into training and appointments. Those discarded this year should be guaranteed the right to compete again on a level playing field for the next rung up on the career ladder.

 

Yrs faithfully,

 

MORRIS BROWN, Professor of Clinical Pharmacology, Cambridge

PETER BARNES, FRS, Professor of Respiratory Medicine, Imperial College

NICHOLAS BOON, President Cardiovascular Society

NICHOLAS BROOKS, Past-President Cardiovascular Society

JOHN CAMM, Professor of Clinical Cardiology, St George's Hospital

MARK CAULFIELD, Professor of Clinical Pharmacology, Queen Mary London

ANGUS DALGLEISH, Professor of Oncology, St George's Hospital

JON FRIEDLAND, Professor of Infectious Diseases and Immunity, Imperial College

JOHN GIBSON, Professor of Respiratory Medicine, Newcastle

ASHLEY GROSSMAN, Professor of Endocrinology, Queen Mary London

TONY HEAGERTY, Professor of Medicine, Manchester

HUMPHREY HODGSON, Vice-Dean, RFUCMS

JUAN CARLOS KASKI, Professor of Cardiovascular Science, St George's Hospital

CHRISTOPHER KENNARD, Vice Principal, Charing Cross Hospital

KAY-TEE KHAW, CBE, Professor of Clinical Gerontology, Cambridge

JOHN LAZARUS, Professor of Clinical Endocrinology, Cardiff

STAFFORD LIGHTMAN, Professor of Medicine, Bristol

JIM McKILLOP, Professor of Medicine, Glasgow

PETER McCOLLUM, Professor of Vascular Surgery, University of Hull

JOHN MONSON, Professor of Surgery, Hull

STEPHEN O'RAHILLY FRS, Professor of Medicine and Biochemistry, Cambridge

MARK PEPYS FRS, Professor of Medicine, RFUCMS

RODNEY PHILLIPS, Professor of Clinical Medicine, Oxford

PHILIP POOLE-WILSON, Professor of Cardiology, Imperial College

JON RHODES, Professor of Medicine, Liverpool

JIM RITTER, Professor of Clinical Pharmacology, Kings College London

BRIAN ROWLANDS, President of the Association of Surgeons

NEIL SCOLDING, Professor of Neurology, Bristol

JAMES SCOTT, FRS, Professor of Medicine, Imperial College

RAJ THAKKER, Professor of Academic Endocrinology, Oxford

DOUGLAS TURNBULL, Professor of Neurology, Newcastle

ROBERT WILCOX, Professor of Cardiology, Nottingham

MARK WILES, Professor of Neurology, Cardiff

LORD WINSTON, Emeritus Professor of Fertility Studies, Imperial College London

Salman Rushdie - Unreadable and unread

Before we get too excited about defending Salman Rushdie rather than handing him to Iran, has anyone actually read his novels? does anyone know anyone who has read his novels? I have bought more than my fair share, and have not managed to get beyond the first hundred pages. I lie I got a dutifully ploughed a third of the way through Midnight's Children and had a fair stab at Satanic Verses. They are unreadable and consequently unread. He doesn't sell, and even the people who have his books on their bookshelves, haven't actually read them.

Why waste an honour on him? his book sales belie the real picture. The man has less appeal than a Turner prize and at least people go and look at the Turner prize. The reason that Salman Rushdie was given a knighthood was political. Lets provoke the muslims extremists, show how awful they are, and then we can remove further civil liberties.

Giving Salmon Rushdie a knighthood can only be seen as an act of deliberate provocation. Well personally I don't want to see London bombed for the sake of a second rate novelist. Bad books, in bad taste, that no one reads. Let him return to literary obscurity, and falling sales without undeserved publicity for his overrated books.

Hand back the knighthood Salman, you didn't deserve it anyway and enough people have died defending your self promoting agenda. Return to oblivion, from where you should never have been raised. I loved Suitable Boy and God of Small Things, but Satanic Verses, Midnights Children, not in the same league, Unreadable and unread!


Copyright (c) Dr. Liz Miller.

Terror checks pledge on NHS staff

A Jeep Cherokee was driven into the main doors of Glasgow Airport An immediate review of NHS recruitment will be carried out following the attempted bomb attacks in London and Glasgow, Gordon Brown says.   The review comes after eight suspects with links to the health service were arrested. Two are brothers.   Background checks on skilled migrant workers will be expanded, said the prime minister.   Meanwhile, security experts are considering relaxing the terror threat to the UK from "critical" to "severe". It sends rather a chill down the spine to think that people's values can be so perverted Dame Pauline Neville-Jones, former head of the Joint Intelligence Committee How doctors are vetted Mr Brown told his first question time as prime minister it was "vitally important that the message is sent out to the rest of the world that we will stand strong, steadfast and united in the face of terror". The new terrorism minister Sir Alan West will carry out the NHS review.   Mr Brown said sponsors of skilled workers would be asked to provide background checks on them. The Home Office was unable to provide more details about how the new checks would work.   NHS Employers, which represents health trusts, said on Tuesday that the NHS checked applicants' clinical and linguistic ability rather than their political or extremist affiliations and did not think that this should be changed.   Among other measures, Mr Brown also said a watch list of potential suspects would be expanded to warn authorities across the world, and the admissibility of intercept evidence in court would be reviewed. New agreements will be signed with countries around the world to ensure a co-ordinated response to the terror threat.   Threat level A burning green Jeep Cherokee loaded with gas cylinders crashed into the doors of Glasgow Airport's on Saturday afternoon. The previous day two Mercedes containing petrol, gas cylinders and nails were found in central London.   ARRESTS TIMELINE 30 June Dr Kafeel Ahmed and Dr Bilal Abdulla arrested at Glasgow airport after burning car driven into doors of main terminal 30 June Dr Mohammed Asha, 26, and his wife Dana Asha, 27, arrested on the M6 near Sandbach, Cheshire 30 June/1 July Dr Sabeel Ahmed, 26, arrested near Liverpool's Lime Street station 1 July A 28-year-old man and a 25-year-old man, thought to be medical students or doctors from Saudi Arabia, arrested in Paisley 2 July Dr Mohammed Haneef, 27, detained in Australia, and a second doctor is questioned 3 July Second doctor questioned in Australia is released without charge Timeline: Failed bomb attacks Send us your comments Brown and Cameron clash Seven of those arrested are believed to be doctors or medical students and one used to work as a laboratory technician. Six are being questioned at London's Paddington Green police station.   A seventh, Dr Kafeel Ahmed remains in hospital after the Glasgow attack, and an eighth, Dr Mohammed Haneef, is still being questioned in Australia after his arrest at Brisbane Airport.   Dr Kafeel Ahmed is the brother of Dr Sabeel Ahmed, who was arrested in Liverpool on Saturday.   The first phase of the investigation - rounding up suspects to prevent further attacks - is drawing to a close.   Investigators are instead focusing on analysing evidence and interviewing suspects.   If the Joint Terrorism Analysis Centre concludes another attack is no longer imminent, the threat level will return to severe.   That would mean a slight reduction in security procedures and controls.   MI5 database Dame Pauline Neville-Jones, former head of the Joint Intelligence Committee, and new shadow security minister, said she was shocked by the NHS link.   "It sends rather a chill down the spine to think that people's values can be so perverted.   "It means obviously that you can't make any assumptions, or have any preconceptions about the kind of people who might become terrorists. It does mean that you widen the net, obviously." Controlled explosions were carried out on a car in Glasgow on Tuesday Who are bomb suspects? Vetting foreign doctors Security sources have told the BBC none of the suspects had been under surveillance or the subject of an anti-terrorism operation before.   But details of some of them were on an MI5 intelligence database because of their alleged links with other individuals or inquiries. Canon Andrew White, a British cleric working in Baghdad, claimed an alleged al-Qaida leader in Iraq warned of the attacks.   Mr White said the man warned his group was planning an attack and said "those who cure you will kill you", an apparent reference to the NHS link. Meanwhile, passengers at Heathrow Airport suffered further disruption on Wednesday as thousands of travellers tried to re-book flights cancelled following a security alert.   Queues formed early outside Terminal 4 as passengers who were turned away on Tuesday after a suspicious package was discovered tried to continue their journey.   More than 100 flights were cancelled on Tuesday.   Police have urged anyone with information to phone the confidential Anti-Terrorism hotline number on 0800789321.

Needle sticks endanger surgeons-in-training

 

 

By Gene Emery

 

- Surgeons in training are accidentally stuck with a potentially contaminated needle once every seven months, increasing the risk that they will develop AIDS or hepatitis, U.S. researchers reported on Wednesday.

 

Many do not bother to report it, the researchers said in the New England Journal of Medicine.

 

If reported immediately and treated within 24 hours, the chance of getting the AIDS virus following a needlestick from an infected patient is almost zero, said Martin Makary of the Johns Hopkins University School of Medicine in Baltimore.

 

Half of the surgical residents failed to report such injuries to their employee health center, usually saying they were too busy. Two-thirds of the injuries were self-inflicted, often while putting in stitches.

 

Even when doctors were treating high-risk patients, they failed to report the needlestick in 16 percent of the cases.

 

Male doctors, those who had been stuck frequently before, and surgeons who knew that nobody else had seen them get stuck were the least likely to report the incident, the researchers found.

 

Doctors "don't talk about it," said Makary. "There's no public reporting system they're part of, no focus groups, no chat rooms. This is something people keep to themselves and, understandably, they don't want the stigma. There's some degree of humiliation involved" when you have to acknowledge that you made a mistake.

 

And the treatment itself "takes a huge toll on someone, especially when you're working 30- and 36-hour shifts routinely each week. It's a stressful job, long hours, high responsibility," and the medicine you have to take for a month to prevent illness produces nausea, said Makary. "That's a bad combination."

 

He said the system puts surgeons in training at risk because "we tend to put our most vulnerable and least-trained surgeons on the front lines of battle" doing simple surgical procedures on the patients that are the most likely to be infected with hepatitis B, hepatitis C and the AIDS virus.

 

The National Institute for Occupational Safety and Health has tracked thousands of needlestick injuries that are reported, and infection rates vary. An estimated 0.3 percent of healthcare workers get HIV from a needle stick and up to 30 percent are infected with hepatitis B after such a stick.

Helping yourself first, the disgrace of general practice

The target of my ire are GP Partners. Privately, and in a whisper, GP partners admit they have never had it so good. Less work and more money certainly doesn't make Jack a dull boy. Although the work that is left is dull. You can't expect to take home £250,000 plus a year without having to fill in a few forms, or rather fill in the blanks and adjust the data on a computer screen. Worse still, you can't expect a locum to stay late to maximise your practice income. You have to do that bit yourself.

The outcome of primary health care is to score the maximum number of QOF points. The highest scoring GPs in the Super Mario Nintendo game of Primary Health Care get the most points. Points mean prizes and prizes mean higher salaries, better premises, longer holidays, less work and most popular of all straightforward cash.

Too late, the government spotted its mistake. So no more pay rises for the newly made millionaires. Unfortunately, GPs practice expenses have increased slightly, so a gap in the exponential growth of GP income looms. Self interest is a wonderful thing. No sooner does someone try to limit self interest in one direction than self interest rears its ugly little head in another direction.

GP Partners response to the Government's 'we think we overpaid you last year' beggars belief. Under the guise of 'Safeguarding patient services, maintaining cost effectiveness' the British Medical Association (the doctors trade union) offers the following advice

1) Do not do anything you do not have to (hereinafter known as 'non-obligatory' work)
2) Do not do anything for which you will not be paid (hereinafter known as 'unfunded' work)
3) Do not do anything where you don't think you are being paid enough (hereinafter known as 'underfunded' work)
4) Do not do anything which you might reduce your money from other sources (hereinafter known as 'the correct resource stream')
5) Do not do anything that is 'Not beneficial for patients'. ie do nothing that has not been approved by 'NICE' or has a protocol attached. That cuts out lots of things from syringing ears to home visits. So if hasn't got a 'NICE' guideline or protocol , don't waste your precious money earning time on it.
6) Think carefully before taking on new patients. They may cost the practice more than the income they bring with them. Grannies and asylum seekers be warned, you are not cost effective.
7) Charge more for non NHS work, like signing a passport photo and medical reports. In short do whatever you can get away on this side of the law. And if you do break the law, don't get caught and don't mention where you got your ideas.

Well done BMA ! your suggestions reduce work sufficiently to give GP partners a relative pay rise thus allowing the exponential income growth curve to be supplemented with other more lucrative activities.

The organised self interest of the medical profession beggars belief. Please if the nice Sun journalist is reading get a copy of 'Safeguarding patient services, maintaining cost-effectiveness' I'll even send you a copy. Then expose the medical leadership for who and what it is. These are the same kind of doctors who are responsible for MTAS, the GMC fiasco and Modernising Medical careers, as well as selling off the NHS to the highest bidder. For the sake of the few jobbing doctors left who do the job not for the money but for the love of it.




Copyright (c) Dr. Liz Miller

http://www.drlizmiller.co.uk