The Insider's Guide To Cancer Prevention

The Guardian online have interviewed some of the leading Cancer specialist to report on how they are preventing cancer through the minefield of misinformation and scientific theories surfacing almost every week. This extract is taken from their website:

These experts spend their lives fighting cancer. They have heard every tip, sensible or not, for how to avoid it. They tell Oliver Laughland how their lifestyles have changed as a result.

The breast specialist

Tena Walters, 51, consultant, London Breast Clinic
Just this week the papers splashed on another piece of research criticising breast cancer screening, saying that for every woman saved by the procedure, up to 10 have been treated unnecessarily. This sort of coverage is a constant annoyance. The evidence just doesn't stack up. I've worked as a breast surgeon for 16 years, and have been having mammograms myself since I was 44, six years younger than the NHS breast cancer screening programme stipulates. To my mind, it is still the strongest preventative measure one can take, and dealing with the disease on a daily basis means I'm lucid with the statistical risks: one in 250 for 40-year-olds, one in 50 for 47-year-olds and, roughly, a one-in-10 lifetime risk.
I nip down to the radiographer once every year, in a spare five minutes, to get it done. It's always on my birthday, so I don't forget. I don't particularly enjoy it, as it can be awkward exposing yourself, especially to people you work with, but you get over it.
Despite coming into contact with the disease on a daily basis, much of my job is about reassuring women they can be successfully treated – I'm often with them through most of their treatment, from diagnosis to chemotherapy and carrying out surgery. Many clinicians working in the field will tell you to do all things in moderation; I abide by this, but also think moderation itself should be done moderately, too. While I lead a generally healthy lifestyle, I drink a glass of wine three nights a week, even though I know it enhances the risk of contracting the disease. I don't live my life in a constant state of paranoia.
One of the most vivid memories I have of my training is caring for an 18-year-old boy dying of leukaemia. There was nothing he should or could have done to stop it. It was then that I was struck by how much of life is a lottery.

The tumour specialist

Kairbaan Hodivala-Dilke, 45, professor of angiogenesis, Queen Mary University, London
It's factor 50 and no less for anyone in my family, and I am obsessive about it. When I see other people's children charging about in the sun without sunblock on, I think they're mad. Even if my two are out for less than an hour, I make sure they're caked in the stuff. My husband is a bluey-skinned, caucasian type – poor him – and absolutely hates wearing it, but when we're visiting family abroad, I can't deal with him unless he's got it slapped on.
At Queen Mary I study how blood vessels grow into cancers. I see the different ways cancer forms and is fed on a daily basis. Of course, I'm viewing it at work, inside a petri dish and through a microscope, but watching it every day makes me acutely aware of any lumps or bumps I see on anyone.
I have known since the age of 14 that I wanted to work in cancer research. My neighbour died of a brain tumour, and seeing the three small children she left behind inspired me to make a change. We're at the stage now, with certain experiments in my lab, where, at a very basic level, we can control cancer growth. There's not really a way to describe how exciting the work can be.
A family friend was recently diagnosed with breast cancer, and is convinced asparagus juice is going to save her. I am unpersuaded. Working as I do in controlled, rigorous research, the constant flow of reports I see presenting new prevention methods, is something I take with a pinch of salt.
The advice I constantly give to friends and family is that if you notice anything untoward, seek expert opinions as quickly as possible.

The neurologist

Peter Rothwell, 47, professor of clinical neurology, University of Oxford and John Radcliffe hospital
I wake early, about 6am, come downstairs, tend to our three young children, then pop my daily low-dose aspirin, doing it on an empty stomach (which isn't recommended, of course), as I don't take breakfast. It has been a routine since my research into the effects of aspirin on cancer prevention really started getting interesting, around three years ago.
We had already shown, in 2007, that taking a high-dose aspirin on a daily basis for about five years reduced the long-term risk of contracting colon cancer by about 50%, but around 2009 we began to show that a low-dose pill had the same effect, as well as significantly reducing the chance of other cancers, including oesophageal.
Most of my research is clinical, but the aspirin work has been mainly paper-based, and over the years I've trawled the archives of many old trials from the 1980s onwards that looked at the effect of a daily aspirin on the risk of stroke and heart attack. We spent hundreds of hours looking through thousands of dusty case notes, extracting information on cancers. It's a lengthy process, and has also required us to trace what happened to participants after the trials finished, to see if they developed cancer subsequently.
Ironically, it has probably not helped my own health, as I conducted the work outside my day job, in spare evenings and weekends, without any funding, and completely stopped exercising because of it.
Having access to the information on people's struggles against cancer has been a great privilege. One of the trials we studied was Sir Richard Doll's British Doctors Trial, where all participants were clinicians themselves, and several were researchers I had admired and revered over the years. It's so important for researchers who advise the public to participate in research or to adopt a particular lifestyle to be willing to do the same themselves. If we don't practise what we preach, we lose a degree of our credibility.

The prostate specialist

Jonathan Waxman, 49, professor of oncology, Imperial College London and Hammersmith hospital
There are established studies that argue vegetarians are 50% less likely to contract certain common cancers than carnivores. Having flirted with vegetarianism at various stages of my life, I eventually gave up 15 years ago – nothing is better than a well-roasted chicken.
I am an oncologist specialising in prostate cancer, and in the early 1980s discovered a pioneering form of medical treatment for the disease, which until then was treated with surgical castration to cut hormone production. It is said a Mediterranean-style diet can be an important preventative tool against cancer of the prostate – eating lots of processed tomato products and olive oil. I do both, predominantly for their taste, and keep a keen eye on my weight.
It is my emotional lifestyle that has changed enormously as a result of working with cancer. Witnessing the effects of such a destructive disease over such a long period has meant locking your emotions away in a freezer, hardly being able to feel any more. I lost my father to cancer, and it was only years later that I came to terms with it. Letting my emotional guard down while discussing it with friends, it finally hit me. Before, I had simply glossed over the pain of my loss.
Cancer is at the forefront of my mind all the time, not simply because of work, but because I fear contracting it. In that respect, it influences my consumption of the things around me. I'm no profligate, so it means appreciating the day, sniffing the air, enjoying the sunshine, treasuring the moment. I love what is around me more as a result of this most deadly disease.

The colorectal specialist

Robert Steele, 60, professor of surgery, Ninewells hospital, University of Dundee
Over the decades spent working in oncology I've made a number of changes to my life. I gave up smoking as a junior doctor while working on a respiratory ward and seeing so many lung cancer patients, I started taking vitamin D tablets after reading research linking a deficiency (of which there is much in Scotland due to the lack of sunlight) to certain types of cancer, and have always watched my weight.
These have all been relatively painless. But in 2007, after attending the launch of the most compelling research I have read into lifestyle choices and cancer, I decided to temper my intake of red meat. As director of the Scottish colorectal cancer screening programme, I was aware of the links between excessive red and cured meat consumption with this and other forms of cancer, yet I still ate one meal a day that contained it.
I'm now down to about twice a week, and have almost completely cut out cured meat. Reneging on bacon rolls has been difficult, but I know that twice a year – new year's day and my birthday – my wife, herself a nutritionist, will cook me them as a treat. It's something to look forward to, at least.
Seeing and operating on colorectal cancers regularly is a powerful stimulus – they don't look pretty at all. But I'm not in the business of telling people certain things should be banned completely. Nor am I one to dismiss leftfield practices outright. As well as surgery and screening, I have research interests in prevention, and have seen projects on all manner of quirky methods. If people wish to use homeopathic medicine in an attempt to prevent cancer, despite there being no medical evidence for its success or any active component whatsoever, the placebo effect itself may be strong.

The lung specialist

Adam Dangoor, 42 medical oncologist, University Hospital Bristol
A while ago I was approached by a teenager outside our local grocery shop. She asked me to buy her some fags, and I had to tell her she'd asked the wrong person. I am a medical oncologist specialising in the treatment of lung cancer; seeing people smoking as young as that is a constant frustration.
Of the lung-cancer patients I deal with, around 90% of them are smokers. Fortunately, I have never taken it up. My mother was a nurse, and when you start your medical training, as a teenager in my case, meeting patients with serious illnesses, it makes you consider your own mortality and think twice about engaging in risky habits.
I recall sharing a flat with smokers a few years back, and was amused at the contradictions in their lifestyles: I'd see one go out and enjoy a heavy night of social smoking and then wake up the next morning and eat a bio-yogurt for the health benefits he thought it would provide. Going out with them could be uncomfortable; before the smoking ban, I'd sit in pubs and sometimes have to leave early as their smoke stung my eyes.
On occasion, I'll have to tell three or four people in a day they've got months to live. It's a difficult part of the job. I try not to take my work home with me or let it affect me too much, but to really empathise with your patients you have to try to see things through their eyes. If I treat someone close to my age with young children, like me, it's hard not to think about it later.
It's not uncommon to have patients approach me, clutching the latest Daily Express front cover, demanding treatment they've seen reported in the tabloids. It can be difficult to explain there's not yet sufficient evidence for offering it – and in some cases no evidence at all.
Ultimately, however, oncology is a hugely satisfying speciality. Whether it be about prolonging life, relieving pain or psychologically supporting a patient and their family through illness, I find what I do hugely rewarding.

Study Links Autism To Maternal Obesity

The following extract has been taken from the NHS Choices website and reports a study published associating the risks for pregnant women (suffering from either obesity or type 2 diabetes) having babies with autism.

“Obese women and those with type 2 diabetes could be increasing their chances of having a child with autism or another development disorder,” BBC News has reported.
The causes of autism and development disorders are not fully understood, and at present researchers are examining a range of environmental and genetic factors that might be involved. This news is based on research examining whether a child's chances of developing these conditions related to their pregnant mother having "metabolic conditions" - diabetes, high blood pressure and obesity. To explore potential links the researchers recruited children with autism spectrum disorder, developmental delay and typical development, and looked at whether their mothers were affected by any of the three metabolic conditions during pregnancy. They found a number of associations between mothers having them and their child's chances of developmental delays and autism, as well as lower scores on several markers of development, particularly expressive language.
Due to its design, the study can only show that metabolic conditions during pregnancy are associated with autism and developmental delays, and can’t prove there is a cause-and-effect relationship. However, the study’s results do warrant more research into the effects of maternal metabolic conditions, perhaps with long-term research that can prove that these conditions actively contribute to autism. Although it will be some time before there is any definite proof, staying a healthy weight during pregnancy remains a sensible measure.

Where did the story come from?

The study was carried out by researchers from the University of California and Vanderbilt University in the US. It was funded by the US National Institutes of Health, the US Environmental Protection Agency and the MIND Institute. The study was published in the peer-reviewed journal Pediatrics.
This story was covered accurately by the BBC and The Daily Telegraph.

What kind of research was this?

This was a case-control study that aimed to investigate associations between mothers’ “metabolic conditions” and the chance of their children having autism or developmental delays during early childhood. In the study the researchers classed diabetes, high blood pressure and obesity (body mass index [BMI] greater or equal to 30) as metabolic conditions, and recorded the prevalence of these conditions in mothers who went on to have children with autism spectrum disorder, developmental delay and typical development. They also aimed to determine whether these metabolic conditions were associated with specific developmental effects.
The researchers state that the prevalence of autism spectrum disorders is 1 in 110 children, making it relatively rare. Case-control studies are a good way to investigate rare events as they look at a group of people with a particular condition and examine their circumstances compared with those of a group of people without the condition. In this way they can look for differences between the two groups that may suggest links to the condition of interest.
Since case-control studies start with people known to have the condition of interest (in this instance, autism) it is possible to enrol a sufficient number of affected patients.Case-control studies also have limitations as they are retrospective, and their control subjects have to be selected carefully in order to minimise the risk of bias. However, it is not always possible to completely remove or minimise bias from the results. Crucially, as they do not follow people up over time they cannot prove cause-and-effect relationships, only find associations.

What did the research involve?

The researchers recruited 1,004 children aged between two and five years: 517 with autism spectrum disorder, 172 with developmental delay and 315 children with typical development. The children with typical development were matched to the children with autism spectrum disorder based on age, gender and the region where they lived.
These typically developing children were identified from state birth records. The diagnoses of autism and developmental delay were confirmed clinically and the children’s development was assessed using two recognised assessments of learning and behaviour: the Mullen Scales of Early Learning (MSEL) and the Vineland Adaptive Behaviour Scale (VABS).
Data on the mothers’ health during the pregnancy was obtained from medical records, birth files and from a structured interview with each mother (the Environmental Exposure Questionnaire). The researchers also collected demographic information on the participants.
The researchers analysed the prevalence of the metabolic conditions in the mothers of children with autism spectrum disorder, developmental delay or children with typical development. They then compared mothers with metabolic conditions with mothers with no metabolic conditions and a BMI of less than 25 (a healthy BMI is between 18 and 25). When the researchers were carrying out the comparisons, they adjusted for a variety of demographic factors including the child’s age and gender, mother’s age at delivery, race/ethnicity, educational level and whether the delivery was paid for by the government or by private medical insurance.

What were the basic results?

The prevalence of type 2 diabetes and gestational diabetes was higher in mothers who went on to have children with autism spectrum disorder or developmental delay. The prevalence was:
  • 9.3% in the autism spectrum disorder group
  • 11.6% in the developmental delay group
  • 6.4% in the control group (typical development)
Having a mother with type 2 diabetes was significantly more common in the children who had developmental delay than in those with typical development (OR 2.33, 95% CI 1.08 to 5.05). For children who had autism spectrum disorder, the rate of maternal diabetes was not significantly different (in other words, it was not meaningful in statistical terms) compared with mothers of children with typical development.
The prevalence of hypertension was low in all groups, but again more common in mothers of children with autism spectrum disorder or developmental delay:
  • 3.7% in the autism spectrum disorder group
  • 3.5% in the developmental delay group
  • 1.3% in the control group
Hypertension was not significantly more common in the developmental delay or autism spectrum disorder groups compared with the control group.
The prevalence of obesity (a BMI of 30 or more) was also more common in mothers of children with autism spectrum disorder or developmental delay:
  • 21.5% in the autism spectrum disorder group
  • 23.8% in the developmental delay group
  • 14.3% in the control group
Compared with the control group, obesity was significantly more common in the developmental delay and autism spectrum disorder groups (OR 2.08 95% CI 1.20 to 3.61 for developmental delay and OR 1.67 95% 1.10 to 2.56 for autism spectrum disorder).
The researchers then considered all three conditions together, which they called “metabolic conditions”. They found that metabolic conditions were more prevalent in mothers of children with autism spectrum disorder and developmental delay compared with mothers of children developing typically. The prevalence of maternal metabolic conditions was:
  • 28.6% in the autism spectrum disorder group
  • 34.9% in the developmental delay group
  • 19.4% in the control group
When compared with the control group these differences were statistically significant for both the mothers of children with autism spectrum disorder (OR 1.61 95% CI 1.10 to 2.37) and developmental delay (OR 2.35 95% CI 1.43 to 3.88).
The researchers then looked at the children’s development, by assessing factors such as their use of language and their motor skills. Maternal diabetes or any metabolic condition was associated with poorer development in the child, particularly expressive language.

How did the researchers interpret the results?

The researchers concluded that maternal metabolic conditions “may be broadly associated with neurodevelopmental problems in children” and that “with obesity rising steadily, these results appear to raise serious public health concerns”.


This case-control study has found an association between maternal metabolic conditions (diabetes, hypertension and obesity) during pregnancy and the chances of children having autism and developmental delays. These conditions were also associated with lower scores on several markers of development, particularly expressive language.
Due to the study design, this study can only show that metabolic conditions are associated with these outcomes. Case-control studies are useful for investigating rare conditions, such as autism spectrum disorder, as case-control studies start with people known to have the outcome, and therefore allow researchers to have sufficient number of patients to study in a meaningful way. However, case-control studies also have limitations. For example:
  • The controls were selected carefully, to minimise the risk of bias, but it is still possible mothers could have been generally healthier for a number of reasons, including  socioeconomic status. This could partially explain the explain the associations seen in the study.
  • Also, the study relied in-part on the mother’s report of her health during pregnancy. This leaves the possibility that there may have been inaccuracy in recording this information, although the researchers did compare a proportion of the results to medical records, and found good agreement.
The exact causes of autism are still not known, but the latest research is looking at the potential genetic and environmental causes of the condition. While this research has provided results suggesting a potential link to maternal metabolic conditions (defined as obesity, diabetes and blood pressure), it should be remembered that the study only found associations rather than a cause-and-effect relationship.
The authors have raised serious public health concerns about rising levels of obesity and the possibility of a link with autism. However, further studies, perhaps of a prospective nature, are needed to continue assessing this potential link. While waiting for definitive proof, staying a healthy weight during pregnancy remains a good idea.

Happy Easter!!!

Wishing everyone a Happy Easter from all of us at Care Recruitment!!!!!

Rise in Womb Cancer Rates

According to the charity Cancer Research UK over the past decade there has been an 18% increase of patients dying from uterine cancer.
Many researchers are blaming obesity as the primary cause in this rise.
Cancer of the womb is the fourth most common cancer in women and tends to occur after the menopause.
The incidence of womb cancer now stands at 19.6 per 100,000. Survival rates have improved with 77% of women now living at least five years after treatment. However the death rate has increased with 1,937 women dying in 2010. 
Prof Jonathan Ledermann, a gynaecological cancer expert at the charity, said: "It's hugely troubling that more women are dying from womb cancer, but we shouldn't let this cloud the fact that the chances of surviving the disease are still better than ever.
"This is due to better organisation of care for women's cancers and more widespread use of one-stop clinics for post-menopausal bleeding, as well as advances in the use of surgery, chemotherapy and radiotherapy through clinical trials."
Rachael Gormley, from the World Cancer Research Fund, said: "Womb cancer is one of several types of cancer where there is strong evidence that obesity increases risk. Others include breast, bowel, oesophageal, pancreatic and kidney.
"As levels of obesity rise, we can expect the number of cancer cases to also increase.
"Taking steps to avoid becoming obese, such as eating a healthy diet and being active each day, is one of the most important things we can do to reduce our risk of cancer."

Fast Food Associated with Depression

Spanish researchers from the University of Las Palmas in Gran Canaria and the University of Navarra  have published a study showing an association between consuming high levels of fast food and baked goods and the risk of developing depression. 

The following results and extract has been taken from the NHS Choice website:
In total, 8,964 participants were included in the study. Participants with the highest consumption (quintile 5) of fast food and baked goods were more likely to be single, younger, less active and have worse dietary habits than participants with the lowest consumption (quintile 1).
After a median follow-up of 6.2 years, 493 cases of clinical depression were reported.
When assessing the relationship between fast food consumption and the development of depression, the researchers found:
  • There were 97 cases of depression in the group with the lowest consumption (quintile 1) compared with 118 cases in the group with the highest consumption (quintile 5). When the sizes of the quintiles were taken into account, this equated to people with the highest levels of consumption having a 37% greater risk of developing depression than those with the lowest levels of consumption (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.01 to 1.85).
  • Intermediate levels of consumption (quintiles 2, 3 or 4) were not associated with significantly increased risk of developing depression compared to the lowest consumption level.
When assessing the relationship between commercial pastry consumption and the development of depression, the researchers found:
  • People with the highest level of consumption (quintile 5) had a 37% increased risk of developing depression compared to the lowest consumption group (quintile 1) (HR 1.37, 95% CI 1.01 to 1.85).

Obesity Linked To Kidney Cancer

Cancer Research Uk has released figures showing that cases have risen to more than 9,000, up from 3,000 in 1975.This makes kidney cancer the eighth most common cancer in the UK.
The charity says that some of this increase could be due to the greater use of imaging techniques helping to diagnose more kidney tumours.
This taken into account, rising obesity levels are also a factor. After smoking, obesity is one of the main risk factors for kidney cancer, with research suggesting it increases the risk by 70%. 

Figures show that in 2009 there were 9,286 new cases of kidney cancer in the UK. 5,706  in men and 3,580 in women. This represents about 19 new kidney cancer cases for every 100,000 men in the UK and more than 11 new cases for every 100,000 women.

Kidney cancer is now the sixth most common cancer in men and the ninth most common cancer in women.

Health regulator 'still failing' in duty to protect patients

This article has been sourced from the Telegraph and highlights the serious nature of the lagging care system in which we live:

A senior board member at the health and social care watchdog has warned that despite a series of damning reports the regulator is still failing to protect patients from poor treatment in hospitals and care homes.

Kay Sheldon, a psychiatrist and a non-executive director and at the Care Quality Commission spoke to the Daily Telegraph warning that the regulator is still failing to protect patients in care homes and hospitals.
She said: "There are risks to patients because the CQC is not doing its job. There are things happening in care homes and hospitals that are not being picked up.
"The CQC is saying that things have improved but I am not convinced that is real."
She said changes in the pipelines to the inspection system will not improve matters or safeguard patients.
"It will unravel and we need to say stop now, and get some proper leadership in.

"The culture is oppressive and there have been allegations of bullying that have not been investigated. The organisation is in crisis mode and is still concerned with its own reputation."
She said inspectors had failed to detect risks to patients at Furness General Hospital, in Barrow, where seven babies died and only took the issues seriously after the coroner intervened.
Joshua Titcombe died in October 2008, nine days after he was born when midwives failed to diagnose and treat a serious infection.
Five other babies died in 2008, one on Christmas Day in 2010 and one in April 2011. However the CQC had found the unit was compliant with standards in July 2010.
The CQC launched an investigation after the inquest into Joshua's death but only found six areas of concern, none of which were followed up, Ms Sheldon said.
In December last year the foundation trust regulator, Monitor, found 119 problems at the trust, 66 of them marked as 'red' being the most serious.
Ms Sheldon said she raised concerns about the quality of the CQC inspections and the lack of action taken with the CQC board but was told it had been a 'robust' piece of work.
Even when she told the Department of Health of the lack of action at the CQC she was told it had to be dealt with internally by the CQC.
Ms Sheldon, who was awarded an OBE last year for her services to healthcare, She said: "I am concerned that many of the problems persist.
"I am concerned that we are not an effective regulator of health and social care.
"For example, I have serious concerns about how effective the CQC was in identifying and acting on concerns at Morecombe Bay hospital trust in the maternity services and in A&E at Lancaster.
"The inspectors are not specialists in their areas and have heavy workloads so even when they did identify risks to patients those were not followed up on by the CQC.
"It is only when Monitor and the coroner identified the same and more serious problems that the CQC began to take the issue seriously.
"I raised my concerns with the chief executive and the director of operations at the CQC but they did not reply.
"As requested, I then emailed the Department of Health with my concerns and they said the issue should be dealt with within the CQC."

Minimum Alcohol Unit Price

Due to the devastating nature of English binge drinking with causes health problems as well as crime associated issues, the government has unveiled plans for minimum alcohol pricing  of 40 pence per unit in England. 
It is estimated that each year alcohol causes over 1 million NHS hospitalisations and 1 million violent crimes in England, primarily through binge drinking. Earlier this week NHS figures revealed that deaths from liver disease had risen by 25% in less than a decade, mainly driven by alcohol.

The strategy has also called for consultation on multi-buy deals offering cheap alcohol in bulk, as well as a "zero tolerance" approach to dealing with drunken behaviour in A&E departments and new legislation over the licensing of pubs and clubs. The strategy is still at a proposal stage but the government hopes to implement it by 2015.

3,500 fewer nurses working in the NHS

As the NHS struggles with quality of care standards, budget cuts and a reformation that threatens to damage it even further we learn of shocking figures regrading the cutting of nursing posts.

An NHS workforce census has shown that there are 3,500 fewer nurses working in the NHS than in 2010 and the number of managers has also dropped significantly. It is the biggest fall in staff figures for a decade and comes as the NHS is making £20 billion in efficiency savings by 2014/15.

Managers saw their numbers falling by 8.9 per cent to 38,214 in the year to September last year, NHS support staff fell to 219,624, a fall of 5.9 per cent since 2010, while the number of hospital and community health service nurses fell by 3,411, or one per cent.
Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing (RCN), said the loss of qualified nurses was "incredibly worrying. These figures are yet further evidence of the rising scale of cuts to NHS jobs and services and tally up with the RCN's findings which in November revealed at least 56,000 NHS posts are to go across the UK. Yesterday's NHS staff survey shows clearly the impact of these cuts, with two thirds of respondents saying that there are not enough staff to allow them to do their jobs properly. Despite the rhetoric, we know that frontline jobs are not being protected and NHS trusts must stop making cuts in a quick fix attempt to save money. Put bluntly, the idea that cutting hundreds of jobs from a hospital will not affect the care of patients is ludicrous. There is no doubt that the impact of these cuts, combined with the upheaval created by the Health and Social Care Bill, means that the NHS is becoming seriously destabilised. We know that savings need to be made, but cutting frontline staff and services that vulnerable patients rely on is just not the way to do it."

6 Million Deaths From Tobacco

Global death figures from smoking top 6 million (80% were from low- and middle-income countries, according to new research from health lobby campaigners) as Revenues from global tobacco sales are estimated to be close to £316bn.

British American Tobacco and Imperial are two of the biggest companies. Whilst BAT sells very few cigarettes in the UK, it is a big player in many emerging economies. In Turkey it sells Viceroy and Pall Mall brands; its Kent cigarettes are big sellers in Russia, while Gold Flake and John Player Gold Leaf are popular in Pakistan. Rothmans in Nigeria and Kent and Montana in Iran are also important for BAT. India, Vietnam, Bangladesh, Iraq, Egypt and Yemen are also promising markets for the company. 

A British American Tobacco spokesperson said: "There is constant speculation that we're breaking into emerging markets to avoid regulation. But this is not true. We didn't invent smoking, nor 'export' it anywhere, and we have been in many of these developing markets for hundreds of years – in the case of Africa, India and Brazil, since the early 1900s.
"As disposable income grows around the world, particularly in developing countries, more smokers are upgrading to premium brands rather than low quality local alternatives – and this doesn't just apply to cigarettes."
Health lobby campaigners produced a study regarding tobacco which identified it as the No 1 killer in China, where smoking is said to cause 1.2 million deaths annually. It is also blamed for more than a third of male deaths in Kazakhstan and in Turkey – other major smoking nations.

Antibiotic Crisis

A report by the World Health Organization (WHO) setting out ways to fight the growing problem of antimicrobial resistance (AMR) has brought to light the possibility that we are facing an antibiotic crisis that could make routine operations impossible and a scratched knee potentially fatal. AMR occurs when bacteria and viruses adapt to treatments and become resistant to them. 
The report also stated that increasing use of antibiotics can lead to the formation of “superbugs” that resist many of the antibiotic types we currently have. It outlined a variety of measures that are vital for ensuring we can still fight infections in the future and described how other major infectious diseases, such as tuberculosis, HIV, malaria and influenza, could one day become resistant to today’s treatment options.

However gloomy this news is, Dr Margaret Chan, director general of WHO, said: “much can be done. This includes prescribing antibiotics appropriately and only when needed, following treatment correctly, restricting the use of antibiotics in food production to therapeutic purposes and tackling the problem of substandard and counterfeit medicines.” 

'Bad science' should not be used to justify NHS reforms

Following months of arguments and negative press and sheer panic around the future of the NHS comes this article from the Guardian questioning the accuracy of the reports published by several academics who are supporting the reforms:

The drip-feed of pro-competition arguments from economists Julian Le Grand and Zack Cooper at the London School of Economics raises serious questions about the independence and academic rigour of research by academics seeking to reassure government of the benefits of market competition in healthcare.
Last July, Cooper and several colleagues released an unpublished paper to coincide with the prime minister's announcement that he was setting up a forum in response to concerns about his health bill. The authors were sufficiently persuasive for David Cameron to declare "Put simply: competition is one way we can make things work better for patients. This isn't ideological theory. A study published by the London School of Economics found hospitals in areas with more choice had lower death rates."
The study in question claimed that competition in the NHS saved lives. The authors claimed that if heart attack mortality rates were used as an indicator of quality, mortality rates fell more quickly and therefore quality improved for patients after competition between hospitals was introduced to the NHS in their area. But if you examine the evidence it is clear thatcompetition had nothing to do with it. The intervention that the authors claimed reduced deaths from heart attacks was patient choice – a proxy for competition. In 2006, patients were given choices of hospitals, including private providers, for some selected treatments, mainly non-emergency surgery. Yet there is no biological mechanism to explain why having a choice of providers for cataract, hip and knee operations could affect the overall survival rate from heart attacks. These are emergencies where patients do not exercise choice over where they are treated and are usually treated in the NHS.
As the government's own cardiac tsar Roger Boyle explains. "Patients can't chose where to have their heart attack or where to be treated. It is bizarre to choose a condition where choice by consumer can have virtually no effect. Patients suffering severe pain in emergencies clouded by strong analgesia don't make choices. It's the ambulance driver who follows the protocol and drives to the nearest heart attack centre." 
So among the numerous problems with this study the authors have made the cardinal error of confusing minor statistical associations with causation. Deaths from acute heart attacks are not a measure of the quality of hospital care as a whole, as they claim, but rather a measure of access to and quality of cardiology care. Gwyn Bevan, professor of management science at the London School of Economics, who carried out a review of patient choice and competition in the BMJ commented on the paper's shortcomings. He subsequently went on to say that he was "perplexed" by Andrew Lansley's emphasis on the role of choice and competition because "the evidence is very weak and contested".
"In fact, I would argue that we don't have any strong evidence of that effect. To my mind, the jury is at best still out on whether choice and competition will improve quality of care in the NHS." 
Cooper and colleagues were at it again in February, press releasinganother as yet unpublished paper, once again coinciding with an important NHS event – Cameron's summit on the NHS bill. This time the authors claimed that length of stay fell more rapidly in NHS hospitals experiencing greater competition, but appeared to be unaware that lengths of stay differ between the four conditions they chose to examine. These were elective hip replacements, knee replacements, hernia repairs and arthroscopies (keyhole examination and sometimes surgery to repair joint damage), for which lengths of hospital stay vary widely. Arthroscopy may be done as an outpatient or day case procedure and therefore may not be recorded in statistics derived from admissions to hospital. Hernia repair usually involves admission as a day case although this varies according to the type of procedure and median lengths of stay range between one or two days. In contrast, for hip and knee replacements the median lengths of postoperative stay are four or five days depending on the procedure. 
So, if providers switched to doing more arthroscopies and hernia repairs and fewer hip and knee replacements they will appear to have shortened their pre-operative and post-operative length of stay to less than a day. Length of stay should also take account of other factors such as whether patients are fit for discharge, especially if they live alone, and the need to avoid readmissions due to complications or premature discharge. So if hospitals switch to operating on patients who are well and healthy or to easier procedures they will also appear to have shortened their length of stay.
Equally, the authors did not look at how clinical coding changed following the introduction of the "payment by results" tariff in 2006, which was modelled on the payment system used in the US. Gaming, upcoding and diagnostic drift are widely recognised in research in the US where providers seek to improve and increase their payments through fraudulent billing and accounting by claiming for work that hasn't been done, or for making out that patients were sicker and more complicated and expensive than they are.
Even without fraud, in the NHS arthroscopy which may previously have been coded as an outpatient activity or not at all (ie it would not have been counted as an admission) may now be recorded separately as a daycase inpatient procedure. Similarly, patients undergoing simple surgical hip replacements might be billed as more complex.
These changes in coding distort measures of productivity so that providers appear to be more efficient as they appear to do both more cases and more complex operations and procedures in the time period.
Le Grand and Cooper call themselves "empiricists" and all those that disagree with them "intuitivists". Yet unlike scientists, they do not appear to have carried out real life observational work in general practice or on the wards, nor have they thought through how financial incentives can change the data. Neither do they appear to have tested their theories with experiments, or adapted their models to see if they are also compatible with different explanations from the many that could be derived from historical data. While their data dredging has generated weak statistical associations, they have made the cardinal error of assuming these associations were causal. Bad science makes bad policy, bad policy leads to careless talk and careless talk costs lives.

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