Saturday, August 02, 2008

'Women must have brittle bone drug', campaigners beg NHS

The Health Secretary must overturn 'farcical' rules that deny thousands of women medicine for thinning bones, campaigners say. In an unprecedented move, the National Osteoporosis Society, of which the Duchess of Cornwall is president, is writing to Alan Johnson asking him to intervene over the 'unfair and clinically unworkable' guidance.

Guidelines set by the Government's drug regulator mean doctors are only able to give women with osteoporosis the cheapest drug available - even though a quarter cannot take it. Those who cannot tolerate alendronate will have to prove that their condition has worsened by up to 60 per cent before they are allowed to have alternative treatment. It is unethical as some women will have to get 'significantly worse' than other patients before receiving a treatment they need, the charity said.

It is likely to affect thousands who experience crippling stomach pains as a side-effect or do not respond to alendronate, which costs $100 a year. Other drugs cost $34 a month. A woman in her early seventies who cannot tolerate alendronate would have to get 20 per cent worse - using a clinical scoring system - to qualify for medication such as risedronate or etidronate. The same woman would have to deteriorate 60 per cent to be eligible for strontium ranelate.

Doctors fear that the restrictions proposed for England by the rationing body, the National Institute for Health and Clinical Excellence, could lead to an epidemic of broken bones among older women. Osteoporosis can affect anyone because of natural bone loss caused by ageing. But women are at greater risk. Up to 14,000 a year die as a result of an osteoporotic hip fracture. Many others experience debilitating pain and disability from fractures.

Last year, the charity won an appeal against even more draconian restrictions put forward by NICE. But it says this has made little difference in practice. It has decided not to appeal again - which would result in the same NICE team reviewing drug treatments for a third time - but it wants a fresh appraisal. In a letter to Mr Johnson, chief executive Claire Severgnini said: 'The recommendations remain unnecessarily restrictive, denying many patients treatment at a point where treatment might make most difference to longterm quality of life. 'Their condition must be allowed to get progressively worse before each alternative treatment will be prescribed. 'Using barriers to limit treatment without regard to clinical or cost effectiveness is not how NICE is meant to appraise treatment options.'

Nick Rijke, of the charity, said the whole process is a 'farce', based on a computer model of pricing options in which the cost of treating hip fractures was grossly under-estimated. NICE had failed to give the charity access to the model despite a legal judgment this year which ruled against similar secrecy used in a drugs ban imposed on thou-with Alzheimer's disease. Mr Rijke said: 'We have been left with no option other than to plead with the Department of Health to secure a fresh, open-minded and fair appraisal.

A Department of Health spokesman said NICE is appraising 'a number of treatments for primary and secondary prevention of osteoporotic fractures. 'Stakeholders have recently had the opportunity to lodge appeals against NICE's revised draft guidance and I understand that NICE has now received an appeal which will be heard in public. NICE will not issue final guidance to the NHS until the appeal has been heard and considered. 'It would be inappropriate for ministers to intervene in the conduct of an ongoing NICE appraisal.'


The state-sanctioned bullying of fat kids

Why is Britain opening so many `fat camps'? The evidence suggests they don't work, and only make overweight children feel isolated and ashamed

Last year's erroneously titled Foresight report on obesity, published by the UK government, recommended `fat camps' for overweight British teenagers, because apparently radical strategies are necessary to avert a public health catastrophe. This draconian policy found its way into the government's evidence-free obesity strategy, Healthy Weight, Healthy Lives, which prescribes anti-obesity interventions at the local level.

Consequently, Rotherham Primary Care Trust, as part of the new Rotherham Obesity Strategy, has unveiled a three-year plan targeting families with overweight children. The Trust identified Rotherham's fattest children and this summer banished 38 of them to a fat camp, the Carnegie Residential Weight Loss Camp, in Leeds.

This is not the first time that fat British children have been sent away because they are aesthetically unpleasing to their parents, peers and the public health establishment. The summer of 1999 saw Britain's first residential fat camp (based on the American model) open its doors to 40 overweight children. The Too Fat to Toddle camp, the first British fat camp for under-fives, opened for business late last year.

This week, officialdom's war against fat children was stepped up a mark. The government revealed that, starting in the next school term, parents will be sent `fat reports' on their children. As part of the anti-obesity crusade, schools will weigh children at the age of four to five and again at 10 to 11 and send details about their Body Mass Index to parents, with advice on whether their child's weight is unhealthy. And Sunday's Observer reported that Britain's first live-in fat camp - a `boarding school exclusively for overweight and obese teenagers' - will open soon in the Lake District.

It is deeply frustrating that British policymakers did not heed the lessons of the American experience, where fat camps have existed for 45 years, before unleashing yet another futile childhood obesity intervention.

The first fat camp for children, New York State's Camp Napanoch, opened in 1963. Three years later, it was out of business. During the next 30 years, a large number of fat camps appeared across America. Eventually, the fat camp business turned sour and most camps went bust. By the mid-1990s, there were fewer than 20 fat camps in operation. Today, there are only a dozen left.

Why is business so bad in America, the world leader in fat children and obsessive parenting? Because the dirty little secret of fat camps is that they do not work. It is true that often a child will go to a fat camp and return home a stone or two lighter. At the UK's original fat camp in Leeds, obese teenagers typically lose 12lb over a one-month residential stay.

Chances are, however, that they will regain the weight in a few months. The Los Angeles Times reported that only one in 10 American campers actually keep the weight off. A New York Times investigation found that the majority of campers attending these programmes are repeat customers.

Individual camp's self-reporting success stories are littered with methodological problems, as most fat camps neither track nor report post-camp outcomes. Most do not remain in contact with their customers and camp `graduates' cannot be trusted to honestly respond to questionnaires that attempt to keep tabs on their weight history.

Most fat campers regain substantial amounts of weight within the first year. In a warning to parents, Dr Oded Bar-Or, director of McMaster University's Children's Exercise and Nutrition Center, said: `If you think the camp is going to solve the problem - the child will at long last lose weight and keep it that way - you can forget it.'

Therefore, it is unsurprising, yet deeply revealing, that the Rotherham Obesity Strategy provides information neither on the anticipated effectiveness of its own fat camps nor on the effectiveness of similar camps. To be fair, it cannot do so because there is no empirical evidence, as the Foresight report acknowledged, that government intervention in this area produces the desired outcome.

Most tellingly, perhaps, last autumn a qualitative study of the management of childhood obesity was published in the journal, BMC Family Practice. In this study, a representative group of primary care doctors in the 39 general practices that contract with Rotherham Primary Care Trust concluded that the evidence base for these programmes remains poor.

Earlier, the prestigious Cochrane systematic reviews of interventions for childhood obesity, which included 18 studies of various different treatments, found none of them to be effective....

Fat camps isolate children with a weight problem and add to the distress of an obese child. Professor Nick Finer of Luton and Dunstable Hospital's Obesity Research Centre, says: `You have to consider the psychological effects of sending your child away to such a place. Society already discriminates against fat people and I'm concerned that children might see being sent to these camps as a punishment for being fat.'

Fat children are expected to suffer, with stereotypical jolliness, the slings and arrows of a society dangerously obsessed with thinness. Probably, school playgrounds will always witness the bullying of fat children. But, as adults, we can and should eliminate fat-based bullying from government policy.


Turning the tables on the Inquisitors

Catholic barrister and legal author Neil Addison offers a personal view on the case of Christian registrar, Lillian Ladelle. Addison argues that Ladelle's victory provides welcome recognition for the right of religious people to refuse to carry out work which contradicts their beliefs. And the widespread condemnation of the court victory shows up the intolerance of today's liberal crusaders

In June, Christian registrar Lillian Ladelle won a case for religious discrimination against her employers, Islington Council in London, after she was `discriminated, bullied and harrassed' for refusing to conduct civil partnership ceremonies for gay couples. To judge from the howls of anguish following the judgement, one might think that the Inquisition was already setting up stakes outside St Paul's, with the Archbishop of Canterbury issuing fatwas from Number 10.

`Secularism in peril!', declared the National Secular Society (NSS) (1) after its president, Terry Sanderson, wrote in a Guardian comment piece that `This is a catastrophic judgment, not just for gay people but for the wider community'. It might seem easy just to dismiss this comment as just one, rather predictable, reaction by a particularly anti-religious organisation. But, significantly, the Commission for Equality and Human Rights (CEHR) decided that the NSS statement should be the only information about the Ladelle case to be put on the its website (it has now been removed).

Since the CEHR has a statutory responsibility to oppose all forms of discrimination, one might have expected it to have applauded, rather than criticised, a victory for a victim of religious discrimination. But the reaction of the CEHR and other `liberal' commentators to the Ladelle case has shown up the nasty, intolerant underside of the modern diversity and equality establishment, and its double standards concerning the interrelationship of Christianity, law and society. In addition, the reactions demonstrate an increasing inability to understand the concept of conscientious moral objection.

If you take the trouble to read the tribunal judgement in the Ladelle case (2), it will become clear that Ladelle was not trying to avoid her work responsibilities, nor was she abusive or insulting to any gay colleagues or members of the public. She had moral, religious objections to performing civil partnership ceremonies because she saw that as an endorsement of homosexual conduct - something she disagreed with. So, when a civil partnership came up, she asked other staff members, who were happy to perform them, to step in. This did not cause any administrative problems for her employers, Islington Council. It did not delay or cause problems for a single civil partnership and no complaints about Lillian were received from any gay member of the public.

But two employees at Islington, who described themselves as `members of the gay community', complained about Ladelle. In consequence, Lillian was bullied by her manager and details of her personal situation and a `confidential' management letter about her was revealed to the local Lesbian, Gay, Bisexual, Transgender (LGBT) Forum. What her complainants ultimately objected to was not what Lillian did or how she acted, but what she thought and what she believed. She could not be allowed to continue her work in peace, she had to be challenged and her views had to be changed because, in the mind of the heresy hunters of the modern diversity industry, she was guilty of `thought crime'.

Ladelle's case was brought under the 2003 Employment Equality (Religion and Belief) regulations (3), which were brought in at the same time as the Employment Equality (Sexual Orientation) regulations (4). In paragraph 50 of its judgement, the employment tribunal notes that there is a complex interrelationship between these two sets of regulations and the two principles of non-discrimination they represent: `This is a case where there is a direct conflict between the legislative protection afforded to religion and belief and the legislative protection afforded to sexual orientation. One set of rights cannot overrule the other set of rights.'

In all areas of discrimination law, there is the question of `reasonable accommodation' so that, for example, Sikh employees are not required to take off their turbans in order to conform to the uniform worn by everyone else. However, during the tribunal hearing, Ladelle's manager said: `I don't believe we should be accommodating people's religious beliefs in the registry service.'

The tribunal had to reject that point of view just as they would have to reject the point of view of any manager who didn't believe it was necessary to accommodate someone's sexual orientation, disability, sex, race or age. If it had been impracticable for Islington to accommodate Lillian, or if it would have made the working of the registry service impossible or unreasonably difficult, then Ladelle would not have won her case. But the evidence was that Ladelle's unwillingness to conduct civil partnerships caused no such problems. Her manager was not prepared to accommodate her religious beliefs because the manager did not agree with them.

Rod Liddle criticised Ladelle in The Sunday Times and described Christians as a `vanishingly small section of the British population' (5). Even if assuming, for the sake of the argument, his remark is true, surely the whole purpose of discrimination law is to protect minorities? In any event, the number of civil partnerships in 2007 - 8,728 - is also `vanishingly small' compared to the number of marriages - 275,140 (7).

Part of the hysterical overreaction to the Ladelle case arises from a profound theological illiteracy in modern society and a refusal to recognise that there is a distinction between discriminating against someone because of their actions and being morally complicit in those actions. For example, Ben Summerskill, the national director of the gay rights campaign, Stonewall, suggested on BBC News that because of the Ladelle case, Christian firefighters might refuse to rescue gay people trapped in a burning building. In a recent BMA general meeting it was suggested that Muslim doctors might refuse to treat alcoholics. In neither of these hypothetical situations would a Christian or Muslim have any theological, or legal, basis for refusing their services because in neither case would they be morally complicit in the actions of the people they were assisting.

If a gay couple is trapped in a fire, then a firefighter who saves them is passing no moral judgement on them or their sexual activities nor is he morally complicit in them. However, a registrar who `marries' them is morally complicit. Similarly, a Muslim doctor who treats an alcoholic is not morally complicit in their alcohol drinking, but a Muslim shop assistant who sells alcohol is. This failure to recognise the concept of moral complicity lies at the heart of the problem that the Roman Catholic adoption agencies face since being required to abide by the Sexual Orientation Regulations. If an adoption agency places a child for adoption with a gay couple then it is, in effect, giving moral approval to that relationship and is thereby morally complicit in it. There is no explicit scope for conscientious objection and the giving of a child for adoption is treated on the same legal basis as the selling of a beef burger.

Several commentators on the Ladelle case have suggested that, because Lillian was engaged in a secular employment, her religious views should have no relevance. I have some sympathy with that view. However, if we are to have a division between secular and sacred then that division cannot just be one way. If religious belief should stay out of secular employment and services, then surely discrimination law should similarly stay out of religion services and employment, but that is not the way the law works. In 2007, the Bishop of Hereford was taken to an employment tribunal over his decision that the diocese should not employ a gay youth worker (8). The Christian views on sexual morality were not regarded as relevant by the tribunal.

By extending anti-discrimination laws to cover sexual orientation and religious belief, the law has, in effect, entered the area of personal conscience to an extent not seen in this country since the repeal of the Anti-Catholic Test Acts in 1829. Today, the descendents of Torquemada and the Inquisition no longer work for the Church - they have instead become diversity officers mercilessly enforcing the new orthodoxy and relentlessly hounding those, like Lillian Ladelle, who are the heretics of the new age.


"Blame everybody but the guilty party" loses for once in Britain

A couple ordered to $2 million damages to a boy who suffered brain damage on a bouncy castle have won their appeal in a 'victory for common sense'. Timothy and Catherine Perry were held responsible for the accident in which 13-year-old Sam Harris was kicked in the head by an older teenager. But yesterday the country's top judge overturned a High Court ruling in May that the couple had not paid close enough attention to the children's party.

Lord Chief Justice Lord Phillips, sitting with Lord Justice May and Lord Justice Wilson at the Court of Appeal, overruled Mr Justice Steel's decision by declaring that it was a 'freak and tragic accident'.

Legal experts hailed the decision a victory for those supervising bouncy castles who had been left open to compensation claims by parents over even minor accidents.

The accident happened at a tenth birthday party the Perrys were holding for their triplets in a playing field in Strood, near Rochester, Kent, in September 2005. Sam Harris, then aged 11, asked Mrs Perry if he and another boy, Sammy Pring, 15, could have a go. The Perrys had also hired a bungee run and while Mrs Perry had her back turned, Sammy accidentally kicked Sam in the head when performing a somersault. Sam suffered a 'very serious and traumatic brain injury', and now needs round-the-clock care. His parents, Janet and David Harris, who are separated, sued the Perrys.

The High Court ruled that Mr and Mrs Perry should pay an immediate $200,000 to the Harris family and were liable to pay up to as much as $2 million more in damages. But yesterday the High Court ruling was overturned. Sam will not receive any compensation and his parents are expected to take their case to the House of Lords.

Neil Addison, a barrister specialising in civil law, said: 'This appeal simply marks common sense. 'It is a tragic accident and one obviously feels sorry for the boy and his parents but I am not at all surprised at the outcome.'

During the appeal hearing, Lord Phillips said Mrs Perry was under no obligation to keep the bouncy castle under continuous observation, and it was not 'foreseeable' that it posed a 'significant risk of harm'. He added that Mrs Perry had acted 'reasonably' in believing she could supervise the castle and the bungee run at the same time.


Brownout: "A year ago, British Prime Minister Gordon Brown was enjoying a honeymoon as a new prime minister, building on a decade of Labour Party dominance under Tony Blair. How things have changed. A poll yesterday for the Independent newspaper found nearly a quarter of Labour voters believe Conservative Party leader David Cameron would make a better prime minister than their own Mr. Brown. Among all voters, Mr. Cameron held an 18-point lead on that question. That's why the Scotsman, the leading newspaper in Mr. Brown's native Scotland, is rattling political china with its report that Labour ministers are considering a "suicide election" to give the party a fresh start under a new leader. Under this scenario, Mr. Brown would be dumped either this fall or next spring, and the party would call an immediate election in which defeat would be the most likely outcome".

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