Monday, July 28, 2008

British hip and knee patients face delays due to emphasis on cheap cataract surgery

Thousands of patients could be facing unnecessary delays for hip and knee operations because the NHS is concentrating too much on cataract surgery, an expert has warned. More fiddling in response to targets. Cost instead of clinical need becomes the criterion for doing a procedure

The eye surgery has made up almost one fifth of all "extra" operations carried out using the additional cash ministers have pumped into the health service in recent years, figures show. As a result there has been a significant fall in waiting times for the procedure. But recent evidence suggests that surgeons could be carrying out cataract operations unnecessarily early on some patients, according to The King's Fund, the independent health think tank which collated the statistics.

Waiting times for other operations, in particular hip and knee replacements, have not fallen so fast, said John Appleby, the organisation's chief economist. "In reducing these waiting times we have done the easier operations and left the more difficult ones to last," he said.

The King's Fund calculates that of an estimated 605,000 "extra" operations carried out between 1998 and 2005, 115,000 were for cataracts. "I think that if you looked back from 1998 to now that many people would be surprised just how many of these extra procedures have been one operation, cataracts," Mr Appleby said. "Although the number of other operations being performed have increased as well, the figures show they have not risen nearly as much as cataract operations." He added: "There is also evidence that now some people are being admitted with rather good vision who would normally not be admitted for the operation so soon."

The think tank estimates that while a cataract operation costs the NHS around $1200 to $1400, the cost of a hip or a knee replacement is around 10 times that, at between $12,000 and $14,000.

Although cataracts can ultimately cause blindness some patients do not require surgery for months or even years after their initial diagnosis. Ministers have set a target that no patient should wait more than 18 weeks for treatment by the end of this year. Government spending on the NHS has more than doubled to $180 billion since the turn of the century.

A spokesman for the Department of Health said: "In England, by the end of December 2008, no patient will have to wait more than 18 weeks from the time they are referred by their GP for any treatment unless they choose to do so, or it is clinically appropriate. "Latest figures show the majority of patients are already being seen within 18 weeks and that the NHS nationally has achieved its milestones for March 2008.

"The increase in supply of cataract services has enabled the NHS to massively reduce waits for cataract surgery. Average waiting times for cataract operations 10 years ago were as long as 2 years, now it is around 3 months. The number of cataract operations have also nearly doubled in the last ten years. Ultimately, commissioning decisions are a matter for local primary care trusts."


Third of Britain's Muslim students back killings

Radicalism and support for sharia is strong in British universities

ALMOST a third of British Muslim students believe killing in the name of Islam can be justified, according to a poll. The study also found that two in five Muslims at university support the incorporation of Islamic sharia codes into British law.

The YouGov poll for the Centre for Social Cohesion (CSC) will raise concerns about the extent of campus radicalism. "Significant numbers appear to hold beliefs which contravene democratic values," said Han-nah Stuart, one of the report's authors. "These results are deeply embarrassing for those who have said there is no extremism in British universities."

The report was criticised by the country's largest Muslim student body, Fosis, but Anthony Glees, professor of security and intelligence studies at Buckingham University, said: "The finding that a large number of students think it is okay to kill in the name of religion is alarming. "There is a wide cultural divide between Muslim and nonMuslim students. The solution is to stop talking about celebrating diversity and focus on integration and assimilation."

The researchers found that 55% of nonMuslim students thought Islam was incompatible with democracy. Nearly one in 10 had "little respect" for Muslims.

In addition to its poll of 1,400 Muslim and nonMuslim students, the centre visited more than 20 universities to interview students and listen to guest speakers. It found that extremist preachers regularly gave speeches that were inflammatory, homophobic or bordering on antisemitic. The researchers highlighted Queen Mary college, part of London University, as a campus where radical views were widely held. Last December, a speaker named Abu Mujahid encouraged Muslim students to condemn gays because "Allah hates" homosexuality. In November, Azzam Tamimi, a British-based supporter of Hamas, described Israel as the most "inhumane project in the modern history of humanity". James Brandon, deputy director at CSC , said: "Our researchers found a ghettoised mentality among Muslim students at Queen Mary. Also, we found the segregation between Muslim men and women at events more visible at Queen Mary."

A spokesman for Queen Mary said the university was aware the preachers had visited but did not know the contents of their speeches. "Clearly, we in no way associate ourselves with these views. However, also integral to the spirit of university life is free speech and debate and on occasion speakers will make statements that are deemed offensive."

In the report, 40% of Muslim students said it was unacceptable for Muslim men and women to associate freely. Homophobia was rife, with 25% saying they had little or no respect for gays. The figure was higher (32%) for male Muslim students. Among nonMuslims, the figure was only 4%.

The research found that a third of Muslim students supported the creation of a world-wide caliphate or Islamic state.

A number of terrorists have been radicalised at British universities. Kafeel Ahmed, who drove a flaming jeep into a building at Glasgow airport last year and died of his burns, is believed to have been radicalised while studying at Anglia Ruskin university, Cambridge.

Wes Streeting, president of the National Union of Students, condemned the study. "This disgusting report is a reflection of the biases and prejudices of a right-wing think tank - not the views of Muslim students across Britain," he said. "Only 632 Muslim students were asked vague and misleading questions, and their answers were wilfully misinterpreted."

Some of the findings amplify previous research. A report by Policy Exchange last year found that 37% of all Muslims aged 16-24 would prefer to live under a sharia system. Baroness Warwick, chief executive of Universities UK, said: "Violence, or the incitement to violence, has no place on a university campus."


The return of Killer Chlorine

Numberwatch After many mind-sapping years of trawling through the morass of health scare stories, I formulated a number of laws, one of which was the Law of Beneficial Developments:
The intensity of the scaremongering attack on any new development is proportional to the level of benefit that it endows.

Unbelievably, the Chlorine Scare has returned. According to the science editor of the Daily Telegraph, Babies exposed to chlorinated water are at risk of heart problems.

The first chestnut here is the appearance of a Trojan Number, so called because it is the stratagem by which authors infiltrate their findings into the columns of the media. In this case it is an impressive 400,000, which is the number of babies said to be involved in the study. In fact, almost all of them have no part in the study at all, as they are normal, healthy births.

As I wrote in a book called Sorry, Wrong Number! in 2000, chlorine is essential to life on earth, not only in the form of its sodium salt, but as a constituent of more than more than 1500 vital compounds in plants and animals, including our digestive juices. The chlorination of drinking water has saved more human lives than any other hygienic measure.

However in 1991, Greenpeace activist Christine Houghton said: "Since its creation, chlorine has been a chemical catastrophe. It is either chlorine or us." Even by Greenpeace standards this was a pretty remarkable piece of ignorant, hysterical nonsense. When chlorination was stopped in Peru in 1991 as a result of pressure from the EPA and Greenpeace, an epidemic broke out that spread through Latin America. Some 800,000 people became ill with cholera and 6,000 people died. Millions of people are still dying all over the world because of dirty water.

The anti-chlorine movement was one of the many legacies of Rachel Carson. It was intensified by an EPA study in the mid 1980s that purported to show that one of the by-products of chlorination (trihalomethanes) was carcinogenic. This involved subjecting hapless rodents to very high concentrations. That was a classical piece of junk epidemiology, based on accidental correlation, of the sort that editors cannot resist. Take just one of the conditions mentioned:

Anencephalus is so rare that most people have never heard of it. Its frequency is less than two per ten thousand of live births, so the impressive number whittles down to something under 80 actual cases. These are then divided into at least two groups - those who are exposed to the putative cause (at an arbitrary threshold) and those who are not. So the whole claim is based on a group of less than 40 babies - unlikely to produce a significant result, even with the debased statistical standards used by modern epidemiology.

Then there is the measure of exposure itself. How much of the dreaded fluid did the pregnant women drink? How did the boffins distinguish between a thirsty mother in a low dosage area and a non-thirsty mother in a high dosage area? The other glaring defect is that this is clearly a Data Dredge, given away by the fact that three conditions are mentioned. How many others were looked at we are not told.

The abysmal standard of significance in modern epidemiology is a one in 20 chance of the result having occurred by accident. But if you look at ten different diseases, this standard means that the probability of at least one crossing a given threshold of risk level becomes 40 per cent, which should be adjusted for, but isn't. As for the threshold itself, for a variety of reasons such as confounding factors, most scientists would be looking for more than a doubling of risk before claiming significance.

Who now believes that drinking tap water causes cancer? Yet 6,000 Peruvians died because of that claim, which was subsequently withdrawn. Fortunately, such scares (and miracle breakthroughs) are now so frequent that ordinary people have become blase about them - they yawn and turn to the sports pages. But there is no accounting for what politicians will do.

Like footballers, epidemiologists talk in cliches. After a while you can predict what they are going to say:
"The biological mechanism for how these disinfection by-products may cause defects are still unknown"

"...more research needs to be carried out to determine these side-effects."

The establishment media go through the ritual of publishing this nonsense. Hardly a day goes by without at least one scare or breakthrough. They are just page fillers, but there is always the danger that someone will take them seriously. As for the epidemiologists, irresponsible is an inadequate word. Reel off a few acronyms (DDT, HRT, MMR for example) and you uncover stories of millions of unnecessary deaths and lives turned to misery, all caused by the rejection of the boons of scientific research because of mindless attacks.



Labour faces being kicked out of office by angry motorists if it continues to 'unfairly demonise' the car, a top Government adviser warned today. Families are 'rebelling' against unfair car taxes, restrictions on their freedoms, and attacks on 4X4s and luxury cars by politicians and campaigners driven by 'ideological dogma' rather than hard-facts, Richard Parry-Jones claimed.

Mr Parry-Jones was appointed by the government to look at how technology can be used to cut pollution. But the former Ford Motor Company executive turned on his new employers yesterday urging them to stop the war on the motorist. Unfair motoring taxes and attacks of family runarounds were the result of 'muddled thinking' based on prejudice and dogma rather than hard scientific facts, he said. 'If you price consumers out of their cars, they will probably throw you out at the next election,' he said.

He added that Prime Minister Gordon Brown and his ministers must 're-assess the political bias against cars'. He accepted that cars did have some impact on climate change - but pointed out that they represented only 8per cent of the problem while appearing to get 100 per cent of the blame. Tax raised from motorists and motoring was 'disproportionately high', he said.

Mr Parry-Jones is a world-renowned motor industry expert who has just been appointed as a ministerial adviser to John Hutton's Department for Business. He is chairing Mr Hutton's Automotive Industry Growth Team, looking at how to create 'greener' cars and cut costs. His speech follows a visit this week by Mr Brown, Mr Hutton, and Transport Secretary Ruth Kelly to the British International Motor Show in London's Docklands where the PM met motor industry bosses to discuss 'green' cars. Mr Parry-Jones recently retired as chief technical officer and head of research at Ford.

He said politicians must carry the confidence of Britain's 30 million voting motorists if they want achieve or maintain office:''If politicians go too fast, ultimately they get detached from the electorate and get thrown out.' He noted: 'What on Earth are we doing allowing our elected representatives to decide for us what we should be allowed or encouraged to drive, or what should be banned or penalised in the name of climate change.'


UK: Painter fined for smoking in own van: "A painter and decorator from Ceredigion says he is 'dumbfounded' after being slapped with a $60 fine for smoking a cigarette in his own van. Gordon Williams says he had popped to the shops earlier this month, when he was pulled over by council officials. 'I was told that because my van is my place of work I had broken the smoking laws,' he said. ... The grandfather decried the on-the-spot penalty as the 'Big Brother state going too far.' He added: 'I respect anyone who chooses not to smoke, but I would also ask for the same respect to have the freedom to smoke in my own private vehicle.'"

Bungling British bureaucrats again: "Confidential tapes and internal documents have exposed bullying and bungling in Gordon Brown's flagship tax-credit scheme that will cost the taxpayer up to $5.6 billion. More than 1.5m people have been told that they were overpaid tax credits and should now give back the money. Tax officials told them it was their own fault and informed some victims they had no right of appeal. However, many victims have turned the tables on the tax-man, using evidence from their own case files, obtained under data protection laws, to prove officials' errors were to blame. This has revealed government offices in disarray, random errors inserted by computer into claimants' files, and officials misleading claimants about the right of appeal. HM Revenue & Customs (HMRC) is now preparing to write off $5.6 billion"

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