Saturday, June 16, 2007

NHS: Go blind, you peasants! We've got clerks to pay!

It's much more important to pay the vast army of NHS bureaucrats than give the sick the drugs they need. The NHS has 1.3 million employees, of whom less than 70,000 are doctors. Bureaucrats don't stop people going blind but the latest medications might. So what is the NHS for, exactly?

Thousands of people face severe loss of sight after a decision by the health watchdog to deny two leading treatments to NHS patients. The drugs Lucentis and Macugen have been shown to be the most effective means of halting the onset of wet age-related macular degeneration (AMD), the only treatable form of the most common cause of blindness in Britain. The condition affects about 250,000 people and claims 26,000 new sufferers each year. It damages the central part of the retina called the macula and leaves one in ten sufferers blind.

The National Institute for Health and Clinical Excellence has been under intense pressure to approve the drugs. Its draft guidance recommends that Macugen should not be used at all on the NHS in England and Wales, while Lucentis is recommended only for a small group of patients who have already gone blind in one eye and whose disease is progressing in their second. The guidance is open to consultation but is based on NICE’s appraisal of cost-effectiveness, which is rarely overturned.

Campaigners said that the decision was “cruel” and “appalling” and added that they hoped the watchdog would reconsider its position for a final ruling, which is expected in September. Patients in Scotland can already get both drugs after rulings by the Scottish Medicines Consortium, although there is concern that this will be overturned in light of NICE’s decision.

Thousands of patients who need urgent treatment to save their sight say that they have already been let down by local health authorities refusing to fund the drugs, known as antiVEGF treatments, on the ground of cost. Lucentis, the most effective, can cost up to 28,000 pounds for a course of 14 monthly injections, while Macugen costs 4,000 a year.

A study, published in the New England Journal of Medicine and reported by The Times in October, found that Lucentis can prevent vision loss and even improve sight in nine out of ten patients. The total cost to the NHS of treating all newly diagnosed patients with the drug would be about 400 million, experts say.

Andrew Dillon, chief executive of NICE, said: “When treatments are very expensive we have to use them where they give most benefit to patients. “Most people with AMD only seek help once the disease is beginning to affect their second eye. “Because of this, and based on the evidence they have seen, our independent advisory committee believes the right thing to do is to treat and try to save as much sight as possible in the better-seeing eye.”

The Royal National Institute of Blind People (RNIB) said that it was “outraged” by the guidance, which meant that patients would be treated only once they had irrevocable loss of vision. Steve Winyard, head of campaigns, said: “This preliminary guidance is worse than we ever imagined it could be. It is simply unacceptable that NICE is recommending that only a small minority of patients within England and Wales will benefit from these ground-breaking treatments.” The Macular Disease Society, along with the RNIB, will be submitting a response to NICE “to encourage a reanalysis”.


Some realism comes to British High Schools

Coursework [take-home assignments] is to be scrapped from most GCSE examinations in response to fears that it has allowed students to copy from the internet or to get their teachers, siblings or parents to complete projects for them. It will be replaced by work supervised in strict conditions at school, to be known as "controlled assessments".

Pupils will still be able to consult the internet and other source material, but teachers will be on hand to ensure that all work is suitably referenced and not simply "cut and pasted" by students claiming it as their own, the Qualifications and Curriculum Authority said yesterday.

The QCA said that traditional coursework completed by pupils at home will be scrapped in English literature, foreign languages, history, geography, classical subjects, religious studies, social sciences, business studies and economics for courses starting in 2009.

No final decision about English language and information technology has yet been made. Only practical subjects such as art, music, design and technology and home economics will retain a nonsupervised coursework element, which can be worth 20 to 60 per cent of the marks in certain subjects. Under the new regime controlled assessments will account for 25 per cent of marks in most subjects. [Only 25%? Why not 75%?]


Hay fever makes you dumb?

I think it is obvious that sneezing and sore eyes (which I myself suffer badly from) would be distracting and tiring during an exam but I doubt that there is anything more than that going on. I hate to state the boringly obvious again but the fact that those on medication did worse probably means that it was they whose symptoms were worse. The absurd original heading on this article was: "Hay fever drugs ‘cost students an exam grade’". Hostility to drug companies obviously matters a lot more than the facts

Nearly three quarters of students taking hay fever medication can expect to drop a grade in their exams this year as ingredients in the most popular remedies interfere with their ability to concentrate, research suggests. Even hay fever sufferers not taking any medication face a 40 per cent risk of achieving lower grades than expected as a result of their condition, the study by the Education for Health charity has found. The study was funded by the drug firm Shering-Plough, which makes several hay fever remedies.

Samantha Walker, the charity's director of research and the lead author of the study, said that for too long hay fever had been regarded as a trivial condition. "Hay fever peaks between the ages of 14 and 24. This is precisely the time when many people are doing life-changing exams and we need to take it seriously," she said. She hoped that the study, based on the exam performance of 1,834 15 to 17-year-olds, would open a discussion on how to "remove the bias operating against those with hay fever" by shifting the examination season to a time that does not coincide with the peak pollen count. Dr Walker said she also hoped that the study, the first to analyse the impact of the condition on exam performance, would help students to manage their hay fever symptoms better by directing them towards the most appropriate, nonsedating medication.

The study compared the exam performance of participants in mock and final GCSE exams for maths, English or science. The normal expectation is that most children will achieve the same grade achieved in their mocks, or with increased effort, improve on them when sitting the exam. Any drop in grade is therefore unexpected. But the study found that those who had hay fever symptoms on an exam day were 40 per cent more likely to drop a grade between their mock and their final exam. This increased to 70 per cent if they were on a sedating allergy medication at the time of their exam.

Teenagers with severe hay fever, and a history of symptoms in previous years, were twice as likely to drop a grade. Michelle Cox, 18, sneezed her way through her English literature A Level paper on Monday and fears that it may well have cost her a grade. Ms Cox, from Bexleyheath, South London, had a similar experience when she sat her GCSE maths paper. "I was sneezing and my nose really hurt and I was so tired. I got a grade D, but had been expected to get a C," she said. She takes hay fever medication every day, but was not aware that it might be making her drowsy. She is hoping that things will improve for her remaining three A level papers.

Some 28 per cent of students on hay fever medication were on a sedating antihistamine. This is despite the wide availability of effective nonsedating treatments and guidelines recommending their use. Dr Walker said that the sedating treatments, containing the drug chlorpheniramine and most usually sold under the name Piriton, adversely affected exam performance. Students who fear that hay fever has interfered with their results can apply to the Joint Council for Qualifications, for their condition to be taken into account.


Obesity treated as child neglect in Britain

In a world where science trumped politics, it would be treated as a genetic abnormality

Obesity has played a part in at least 20 child-protection cases across Britain in the past year, a study has found. Fifty paediatricians were asked by the BBC if they thought that childhood obesity could be a child-protection issue.

One doctor spoke of a 10-year-old girl who could walk only a few yards with a stick. He believed that her parents were "killing her slowly" with a diet of chips and high-fat food. Some doctors now believe that extreme cases of overfeeding a young child should be seen as a form of abuse or neglect, according to the report.

Tabitha Randell, a consultant from Nottingham, said that in one case she saw a child aged 2«, who weighed more than 4st (25.4 kg). She said: "They said she was big-boned and they were, too. Parents' perception is a very real problem."


Will the UK boycott Palestinians? "War crimes, eh? Throwing civilians off the top of buildings? Attacking the wounded in hospitals? Using press insignia as camouflage for attacks, thus putting all journalists at risk? Dozens and dozens of civilians murdered, including children? So where's the call for a boycott of the Palestinians? To those for whom Israel is the cosmic villain of our times - even though it has never behaved in such a barbaric fashion - the implications of these terrible events in Gaza are simply unprocessable. Their extreme discomfiture is evident in their silence. If Israel kills Palestinians in its attempt to defend its civilians from being blown up in pizza parlours or pulverised by rocket attack, the media descends into an instant frenzy of (unjust and distorted) condemnation. But presented with this orgy of Palestinian violence in Gaza, there is little more than an embarrassed shuffling of feet."

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