Wednesday, April 11, 2007

Busting modern medical myths

In the early days of medicine, physicians might diagnose patients using bumps on their head, or dispense a couple of leeches to draw off "ill humours". Yet a medieval doctor might give a more confident response than his modern equivalent if a patient asked for the evidence to support their treatment. These days, it seems many of our "tried and tested" approaches to disease are nothing of the kind.

Researchers writing recently in the British Journal of Surgery concluded the practice of daubing patients with a disinfectant skin gel prior to operations made little or no difference to the rate of infections they suffered afterwards. Simple soap and water was just as effective. However, despite this, it's more than likely that, in future, waking up after your operation in many British hospitals, you'll have that tell-tale orange stain around your wound. You'll have been given a treatment that doesn't work.

This isn't a single example. Many techniques in common use today don't have cast-iron evidence that they do any good. In some cases, firm evidence suggests the opposite is true. Andrew Booth, from the School of Health and Related Research (ScHARR) in Sheffield, is assessing the proportion of modern treatments that are "evidence-based" - supported by "randomised controlled trials", which, if run correctly, give the best view on the value of a drug or device.

In the UK, researchers have assessed this in a variety of different parts of the health service, from busy GP surgeries to specialist hospital haematology units. In many units, between 15% and 20% of the treatments offered did not have a shred of worthwhile evidence to support their use. Andrew Booth said the medical establishment was well aware of this. "The public might be surprised at the low number of treatments which have evidence that they work - but doctors might be surprised that it is so high," he said. He added that frequently, even when new research suggested clearly that doctors should stop using a particular treatment, nothing changed.

Michael Summers, chairman of The Patients Association, said patients would be "really surprised" to learn how little of what doctors did had been proven to work. "We need to improve medical training, to make sure that doctors do know more about the effectiveness of the drugs they are prescribing," he said.

One of those doing this is Professor Paul Glasziou, director of the Centre for Evidence Based Medicine at Oxford University. "I try to change the way individual doctors work," he says, "but really, the main thing we can hope to do is change the next generation of medical practitioners." He can list dozens of examples where treatments are still widely used despite it being clear that all they give patients is side-effects. "An example is PSA [prostate specific antigen] screening for prostate cancer. What the best studies tell us is that patients who have the test are equally likely to die from prostate cancer compared with those who don't," he says. "This actually does harm, because patients who test positive may undergo unnecessary prostate surgery. But the test is still being carried out."

Even a simple antibiotic eye-drop prescription for a child's minor infection is likely to make no difference, and may help make the bacteria involved more resistant to treatment, he says.

Part of the problem for doctors is the sheer quantity of research emerging from hospitals, universities and laboratories across the globe. "There are 90 new randomised controlled trials published every single day - this flood of information makes it very difficult for any doctor to stay up to date." And when the evidence is disregarded, Prof Glasziou says, patients can be harmed. When doctors measure blood pressure for the first time in a patient they should check both arms, as the readings may differ significantly. But Prof Glasziou says this guideline isn't followed everywhere. "I know of one case where a patient was being taken on and off his medication every couple of months simply because every time he visited the doctor, the reading was taken from a different arm. "There are a lot of good things out there, but an awful lot of myths as well."


The unfortunate British migration experience

The UK is in the grip of a serious 'brain drain', a leading academic has warned. Well-educated professionals and managers are leaving the country in droves, according to John Salt, an expert on migration from University College London. In their place, low-skilled workers from Eastern Europe are flooding in - leading to a 'de-skilling' of the workforce.

Professor Salt's findings will fuel concerns over Labour's opendoor immigration policies. According to official figures, between 2000 and 2005 a net total of 272,000 Britons emigrated, while a net total of 639,000 non-Britons moved here. But experts warn that in the past two years, up to 700,000 workers have actually arrived from the former Eastern Bloc. The majority are taking low-skilled jobs.

Professor Salt said that in 2005, 29 per of those arriving were in low-grade jobs and 37 per cent were not in work. Only a third were professionals. Of those leaving the UK, almost half - 42 per cent - were professionals or managers. They are heading mainly for New Zealand, Australia, the U.S., and Canada. In his report for the Organisation for Economic Co-operation and Development, Professor Salt said: "Migration flows are tending towards a de-skilling of the UK labour market."

A Home Office spokesman said it was introducing a points-based immigration scheme from 2009 which will make it harder for lowskilled migrants to gain work visas.

Organised gangs are offering to smuggle thousands of illegal immigrants into Britain for as little as 200 pounds from a new base near the closed Sangatte welfare centre, it has emerged. Up to 500 migrants at a time are sleeping in the French camps being run by Afghan gangs. The flow of arrivals is so constant that authorities in Calais are planning to open a new welfare centre, dubbed Sangatte Two.


British conservatives not allowed to criticize immigration

The future of a Conservative candidate was hanging in the balance last night after he became embroiled in a race row over his campaign literature, The Times can reveal. Luke Mackenzie, a Tory candidate in a British National Party (BNP) target ward in Basildon, was accused of peddling scare stories by suggesting that people who wanted to stop asylum-seekers being given council houses should vote Conservative. David Cameron faced calls to disown the candidate last night, but the Conservative Party avoided immediate action, saying that it would examine the election leaflet this week. This contrasted with the swift action last month to dismiss Patrick Mercer from the Tory front-bench after he referred to “black bastards” in the Army. A Tory spokesman said: “We encourage all councillors to confront the BNP and not to pander to them.”

Mr Mackenzie, who is standing against the local council’s only ethnic minority councillor, told The Times that he did not believe that his remarks would inflame racial tensions because “people were aware of this anyway”. The leaflet, headed “Conservatives: We’re on your side”, refers to being on the “front line” in a “battle”, talking about local people “getting organised” and “fighting back”. It says: “I support Conservative policy of giving council housing to Basildon residents and not [of it] being used to house asylum seekers. There is a shortage of homes, but at the same time the Labour Government is encouraging record levels of immigration.”

Opposition politicians said that the remarks were highly inflammatory and echoed the message used by the BNP in other parts of the country.

Mr Mackenzie, a 21-year-old politics student at Westminster University, is standing in the local elections against Labour’s Swatantra Nandanwar in a ward where the BNP took 22.7 per cent of the vote in 2004. The party’s record for the area is 25.3 per cent in the Fryerns ward last year. This year the BNP is contesting 11 of the 14 seats up for election in Basildon, part of a remarkable surge of activity across the country. It is to field 655 candidates, double the number who stood last time. It currently has 49 council seats.

Mr Mackenzie denied accusations he was stoking up racism. “At the end of the day it’s [the main parties] not saying things like this that is encouraging racism tension because the only place people can turn to is the British National Party.” He said that there was strong feeling among residents that people from outside the area were causing a housing shortage. “They blame the influx of immigration [as one reason for this], because there isn’t enough housing in the UK and you’ve got thousands of people coming from abroad.”

Asked what he thought Basildon residents felt about immigration, he said: “They think it’s entirely out of control.” He said that it was a view that he shared, adding: “The cause of this is that there is no real control over who is here.” It is already virtually impossible for asylum seekers to get housing in Basildon after the council changed the system to give preference to people who have been in the area a long time.

Jon Cruddas, a Labour MP and deputy leadership contender who campaigns against the BNP, said: “This dangerous exploitation of people’s fears is a gift to extremist organisations such as the BNP. Peddling myths about immigrants pouring into a town or about asylum seekers supposedly being given council housing ahead of other residents is incredibly unhelpful. If David Cameron is serious about fighting racism he should disown this candidate straight away.”


Britain's Leftist government shafts retirees and the poor: "To the great anger of the millions who have seen their retirements ruined as a result of his infamous tax raid on pension funds in his first Budget in 1997, official documents released under the Freedom of Information Act last Friday revealed that he had been well advised by Treasury officials of the disastrous consequence of his actions but chose to pursue them regardless. Now there is another great betrayal to expose: how Mr Brown’s policies have hindered, rather than helped, the poorest and most vulnerable in society, the very people he professes to champion. The Business has discovered the smoking gun and, as with the pensions scandal, the facts make for grim reading. Statistics from the Department of Work and Pensions (DWP) unearthed by The Business reveal that the income of the bottom 10% of the population fell from £91 a week in 2004-2005 to £89 a week in 2005-2006, a 2.2% drop. In stark contrast, the top 10% saw their income rise from £820 to £840 a week; those in the fifth (or middle) decile saw their income rise from £283 to £286.

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