Wednesday, November 05, 2008

A little surgery on bureaucracy is needed

One British medical professor is thinking:

The past 50 years have produced an amazing blossoming of the biological sciences. But there is a little problem. How is a country with a healthcare system principled to provide care for all, able to afford the drugs that will cure all?

One solution is “top-up” fees. Where NHS funding is not available it has been suggested that patients be allowed to buy the drugs that they need. Mike Richards, the National Cancer Director, will report today and by exempting certain classes of patient (ie, those with conditions associated with the most pathos) recommend the principle to the country.

How do we doctors feel about this? Very uncomfortable. Just imagine the conversation: “You will be pleased to know that we can cure you. We have a marvellous new treatment.” “Great, doc.” “Oh by the way, have you got 50,000 pounds?” “Ehmm, OK . . . I’ll mortgage my house.” What about those patients who don’t have a house to mortgage? Are we saying that health is available only to the rich?

There is, however, fat in the system and it could be trimmed. The National Institute for Health and Clinical Excellence (NICE) is already too costly and unnecessary, with a role largely filled by the European Medicines Agency, which licenses treatments in the first place. We have 150 primary care trusts making 150 decisions on the same healthcare issues – including whether patients should receive high-cost drugs – at a cost of 5 billion.

Our country can have all the treatments that it needs for all the people that we treat by cutting bureaucracy. Surely it is better to slam a few fingers in desks and provide the band aids than forget the poor?


Unruly school pupils will be punished with... a foot massage

Pupils who create mayhem in the classroom are to face a punishment that will make them quake in their shoes. They will be asked to slip off their socks before being given a foot massage designed to control their unruly behaviour. Medical experts say there is little evidence that such treatment can improve the behaviour of young tearaways.

Yet Labour-run Lambeth Council in South London is to spend 90,000 pounds next year sending reflexologists into its schools to practise their soothing art. The team, from a company known as Bud-Umbrella, will work in 60 primary and 14 secondary schools, with children under 13 deemed to be badly behaved. The firm is run out of a flat [apartment] in Brixton and its website claims reflexology 'releases energy blockages', 'can calm aggressive feelings, improve listening skills, concentration and focus' and 'relieves headaches and sinus problems'.

Tory MP John Penrose is unimpressed. 'The idea that a foot massage is going to keep a hoodie happy is laughable,' said the member for Weston-super-Mare. 'Experienced teachers have a range of ways of dealing with badly-behaved pupils and stroking their feet is not one of them. 'Dealing with bad behaviour should not look like a reward to those who misbehave. Discipline should be brought back into schools.'

Mark Wallace, spokesman for the TaxPayers' Alliance campaign group, said: 'How on earth is the education system going to succeed if there are luxuries given out for naughty children and nothing at all given to those who work hard and do well? 'With everyone struggling in the financial crisis, this is crazy money being paid out on a crazy scheme.'

Despite Lambeth's enthusiasm for foot massage in schools, reflexology sessions are not provided for the wider public by the local primary care trust. The traditional healing art dates from the ancient Egyptians and Chinese. It involves manipulation of pressure points in the hands and feet and is often used to ease period pain, headaches, sinus and back problems as well as the effects of chemotherapy. By massaging different points on the feet, therapists claim they can unblock energy pathways and help the body regain its natural balance and heal itself. Reflexology is not a regulated therapy and medical authorities have raised concerns that qualifications are not needed to perform the massages.

However Lambeth Labour councillor Paul McGlone said the council was right to provide the alternative treatment. 'It's incredibly important that we address young people's behavioural problems and we make no apologies for using different and innovative methods but this obviously won't replace more traditional ways of dealing with anti-social behaviour. 'We need to deal with the root causes of young people's behavioural problems and nip them in the bud - prevention is better than cure.'


The annual Leftist attack on Christmas has begun

British city dumps Christmas in favour of "WinterLight festival"

There will be something missing from Oxford's Christmas lights display this year - any mention of Christmas. Traditional themes are also being dumped in favour of a 25-metre high mobile of lanterns in the shape of the solar system. Organisers say the new two-month WinterLight festival will include events marking the Hindu Diwali and Jewish Hannukah festivals as well as Christmas. It also coincides with the start of International Year of Astronomy 2009.

But religious leaders in the city condemned the change. Sabir Hussain Mirza, chairman of the Muslim Council of Oxford, said: 'I'm really upset. Christians, Muslims and other religions all look forward to Christmas.'

Rabbi Eli Bracknell of the Jewish Educational Centre said: ' Anything that waters down traditional culture and Christianity is not positive for the British identity. WinterLight includes all festivals but it also conceals them.'

Reverend James Grote, of the John Bunyan Baptist Church, said: 'People are not offended by hearing each other's faiths.' But Ed Turner, deputy leader of Oxford council, said: 'We are not Christmas killers. There's no desire to downgrade its importance or prominence - there's still going to be a Christmas tree.'


Muslim chef sues London police after being asked to cook sausages and bacon for breakfasts

Sounds like he needs a job in a curry restaurant

A Muslim chef employed by the Metropolitan Police is suing for religious discrimination after he was asked to cook sausages and bacon for '999 breakfasts'. Hasanali Khoja accuses Scotland Yard of refusing to guarantee that he would not have to handle pork, which is forbidden in Islam. He said it was suggested he wear gloves when cooking pork products.

The 60-year-old claims the problem began when he was asked to move from his position as senior catering manager at Hendon Police College in North London, where he had been excused from touching pork. In his new role at the Empress State Building in West London, which is occupied by Metropolitan Police staff, he was expected to make '999 breakfasts' consisting of sausage, bacon and black pudding. The meal got its nickname because it is traditional for officers to insist on hearty fry-ups before starting their shift.

Mr Khoja, who joined the Met in 2005, said he was placed on special unpaid leave for a year after refusing to work without the guarantee he would not have to handle pork. He is now back at work at another Met building where he does not have to handle pork but has been downgraded to higher catering manager.

Mr Khoja, from Edgware, North London, said yesterday: 'I felt very unhappy about it. I was very upset and angry because it is not permissible in my religion. I was threatened that management would sack me if I did not follow instructions. But I never enrolled to cook pork. I refused to do it. I never did it and I never would.

'I had a letter from the human resources department saying that I would not be required to cook any pork. But this was not exactly what I wanted as a guarantee. The Met has shown no sensitivity towards my religion. Their response has been illthought and discriminatory.'

He added: 'My original contract did not include any kind of cooking. I was hired as a senior catering manager. 'I protested at the move and at having to cook pork. I was placed on paid special leave for a year. No Muslim in my position should have to face such harassment.'

Mr Khoja, who also sits on a Foods Standards Agency advisory committee on Muslim issues, is taking the Met to an employment tribunal which is expected to be heard next May. An informal agreement was reached in June excusing him from handling pork but Mr Khoja, who began his claim last year, wants it to be formalised.

His case is the latest in a string of race discrimination rows to engulf the Met in recent months, which contributed to the resignation of Sir Ian Blair. Britain's most senior Muslim officer, Assistant Commissioner Tarique Ghaffur, has accused the force of racial discrimination and the National Black Police Association has urged people from ethnic minorities not to join.

Mr Khoja was originally represented by Dr Shahrokh Mireskandari, the controversial lawyer at the centre of the race war, but changed solicitors in August. His current lawyer Khalid Sofi said there was an 'important issue of principle at stake in Mr Khoja's case'. 'He has genuine and strong religious beliefs and expects that they will be accommodated,' he added. 'The Met is a very large organisation and could easily have met his demands. 'Mr Khoja's case raises the general question of the Met accommodating the needs of the Muslim community at a time when there is a lack of confidence in the police among Muslims.'

Mr Khoja is being supported by the Association of Muslim Police. The Met denies Mr Khoja's claim of religious discrimination. [Sounds like he WANTS them to discriminate -- in his favour]


British local council bans common expressions of Latin origin because they are 'elitist and discriminatory' and confuse immigrants

Bournemouth Council, which has the motto Pulchritudo et Salubritas - meaning beauty and health - has banned staff from using 19 Latin words Classics scholars have accused councils of 'ethnic cleansing' after they banned staff from using Latin words. The local authorities claim the terms are elitist and discriminatory, and have ordered employees to use often-wordier alternatives in documents or when speaking to the public.

Bournemouth Council, which has the Latin motto Pulchritudo et Salubritas - beauty and health - has listed 19 terms it no longer considers acceptable for use. They include ad hoc, bona fide, status quo, vice versa and even via. Its list of alternatives includes 'for this special purpose', in place of ad hoc and 'existing condition' or 'state of things', instead of status quo.

Mary Beard, a Cambridge professor of classics, said: 'This is absolutely bonkers and the linguistic equivalent of ethnic cleansing. 'English is and always has been a language full of foreign words. It has never been an ethnically pure language.'

Dr Peter Jones, co-founder of the charity Friends of Classics, said: 'This sort of thing sends out the message that language is about nothing more than the communication of very basic information in the manner of a railway timetable. 'But it is about much more than that. The great strength of English is that it has a massive infusion of Latin. 'We have a very rich lexicon with almost two sets of words for everything. To try to wipe out the richness does a great disservice to the language. It demeans it. 'I am all for immigrants raising their sights not lowering them. Plain English and Latin phrasing are not diametrically opposed concepts.'

Harry Mount, author of the best-selling book Amo, Amos, Amat and All That, a light-hearted guide to the language, said: 'Latin words and phrases can often sum up thoughts and ideas more often than the alternatives which are put forward. 'They are tremendously useful, quicker and nicer sounding. They are also English words. You will find etc or et cetera in an English dictionary.'

However, the Plain English Campaign congratulated the councils for introducing the bans. Marie Clair, its spokesman, said: 'If you look at the diversity of all our communities you have got people for whom English is a second language. 'They might mistake eg for egg and little things like that can confuse people. 'At the same time it is important to remember that the national literacy level is about 12 years old and the vast majority of people hardly ever use these terms. It is far better to use words people understand.'

Of other local authorities to prohibit the use of Latin, Salisbury has asked staff to avoid the phrases ad hoc, ergo and QED (quod erat demonstrandum), while Fife has banned ad hoc as well as ex officio.



A new paper by Kevin Anderson and Alice Bows has been published in the Philosophical Transactions of the Royal Society under the title: 'Reframing the climate change challenge in light of post-2000 emission trends'. It points out that the various "goals" for CO2 reduction touted by politicians are unscientific and unattainable. The Abstract states:
The 2007 Bali conference heard repeated calls for reductions in global greenhouse gas emissions of 50 per cent by 2050 to avoid exceeding the 2C threshold. While such endpoint targets dominate the policy agenda, they do not, in isolation, have a scientific basis and are likely to lead to dangerously misguided policies. To be scientifically credible, policy must be informed by an understanding of cumulative emissions and associated emission pathways. This analysis considers the implications of the 2C threshold and a range of post-peak emission reduction rates for global emission pathways and cumulative emission budgets. The paper examines whether empirical estimates of greenhouse gas emissions between 2000 and 2008, a period typically modelled within scenario studies, combined with short-term extrapolations of current emissions trends, significantly constrains the 2000-2100 emission pathways. The paper concludes that it is increasingly unlikely any global agreement will deliver the radical reversal in emission trends required for stabilization at 450 ppmv carbon dioxide equivalent (CO2e). Similarly, the current framing of climate change cannot be reconciled with the rates of mitigation necessary to stabilize at 550 ppmv CO2e and even an optimistic interpretation suggests stabilization much below 650 ppmv CO2e is improbable.

Why heart pumps could kill off the transplant

There are no rejection problems, and they cost a lot less than transplants. The new, smaller heart pumps could save thousands of lives. So why are they still treated as the poor relation?

When the South African surgeon Christiaan Barnard carried out the first heart transplant in December 1967, the world held its breath. His patient, 53-year-old Lewis Washkansky, lived for only another 18 days. The drugs he needed to stop his body rejecting the new organ compromised his immune system to such an extent he couldn't fight off other illnesses, and he died of pneumonia. But the precedent had been set: the most powerful and emotionally iconic of human organs could be taken from the body of a dead person to give the chance of an extended life to another. It was a transforming, era-defining moment that reinforced our faith in medical science and ensured Barnard's place in history. But how successful would heart transplantation be in the long term?

Just over 40 years later, the very same question is still being asked. The procedure, and the drugs needed to maintain a newly donated heart, may be much more sophisticated, and heart transplants may be regarded by the public as one of the most glamorous of surgical career paths, but surgeons themselves are carrying out significantly fewer of the operations. This is partly because a range of other treatments is available to patients, and partly because of the low number of suitable donor hearts.

When surgeons do operate, the outcome is often poor. Of the 100-plus people who receive a new heart each year, 10 are likely to die within 12 months as a result of donor-organ rejection and other complications; and of the remainder, a significant proportion will develop cancer within five years from the toxic anti-rejection drugs they must take for the rest of their lives. Specialists argue that the number of long-term survivors has increased, with some living for decades; but they admit that most transplant patients die within 10 years of receiving a new organ.

In the past year and a half, the deaths of 11 patients who had just received new hearts has raised more serious questions about our cardiac-transplant programme. In that time, both Papworth hospital in Cambridgeshire and Harefield, on the outskirts of London - the most prestigious centres in the UK for heart transplants - have had to suspend these operations because of a run of unexplained deaths: seven patients at Papworth from January to September 2007, and four at Harefield who died one after the other between July and October this year. None of the victims survived to leave hospital, each one dying within a month of their operation. An inquiry at Papworth, where the deaths represented more than one-third of the 20 transplants carried out there last year, was inconclusive. At Harefield, an inquiry is ongoing.

Meanwhile, the number of organ donations has plummeted to an all-time low: only 135 patients received new hearts in the year to April 2008; more than 500 hearts were offered for transplant, but many were not considered a suitable match or of sufficient quality for their intended recipients. At the procedure's peak, in 1989/90, there were over 400 heart transplants. Today there are simply fewer good hearts to choose from, because seat-belt legislation has dramatically cut the number of deaths in road accidents, and thus the number of hearts available for transplantation, and because families are often unwilling to offer up their newly deceased loved ones for organ harvesting. There are now so few heart-transplant surgeons in the country - 50 at most - that it's easy to imagine a time when they outnumber the available donors; not a state of affairs Barnard could have imagined all those years ago.

Against this background, some heart surgeons are arguing that we need to think again and turn our attention to electric heart pumps, an apparently riskier medical solution, but one that offers a cheaper, off-the-shelf opportunity to save a life without someone having to die first; and one that has been proved to have therapeutic potential for those who merely need to rest their heart, not replace it.

Paul Maidment, an army chef, is a case in point. At the time that the unlucky patients at Papworth and Harefield were preparing themselves for transplant surgery last year, Maidment was larking about with his mates in the catering corps in Iraq, fronting a band called the Basra City Rollers. By May this year he was fighting for his life, his heart stopping every few minutes even as doctors struggled to keep it going. It was not a stray bullet that had caused the lethal damage, but a rare adrenalin-secreting tumour that was pouring toxic quantities of the fight-or-flight hormone into his bloodstream, sending his blood pressure soaring and putting a fatal strain on his heart. At the age of 28, Maidment appeared to have metamorphosed from a muscle-bound model for army recruitment into a near-corpse, wracked by repeated heart attacks.

Nobody at the Royal Devon and Exeter hospital knew what to do. David Smith, the cardiologist treating Maidment, was aware of implantable electric heart pumps that could take the strain off exhausted hearts like his, giving the muscle vital time to recover. Smith had read a paper produced by a team in Oxford - one of a small number of groups lobbying for the use of such devices - which had achieved remarkable results with the handful of patients who had received charitable funding for the devices (each unit costs between 40,000 and 60,000 pounds).

The problem in this case wasn't funding but logistics: how to get Maidment to Oxford's John Radcliffe hospital, where a pump could be fitted while he was still attached to the roomful of equipment that might or might not keep him going for the journey. A Sea King helicopter was scrambled by the army for the 40-minute trip. His parents, Steve and Sandy, followed by car. "We'd been told he would probably die on the journey," says his mother. "He was cold and sweaty, and his skin was like candle wax, the most awful colour I have ever seen." By the time the couple reached the hospital, the pump was already in. Stephen Westaby, a cardiac surgeon turned professor of biomedical sciences, who has led the world in the use of the technology, assured them their son would live.

Four days later Maidment's heart was sufficiently rested from its trauma for the pump to be removed. Two weeks after that, he was off the drugs that had kept him unconscious while he recovered. Coincidentally, a letter announcing his promotion from corporal to sergeant had arrived at his home during his suspension from existence. Life, for him, goes on.

For many sufferers of heart problems, that is not the case. Britain has one of the highest heart-disease rates in the developed world: 700 people a day have a heart attack, which usually leaves the muscle damaged and weakened. Every year 100,000 people die of heart failure, either as a result of this damage or as a consequence of infection, high blood pressure or inherited heart weakness. At the moment only 105 of these patients have made it onto the heart-transplant waiting list because the number of available organs is so small. But could many more benefit from a pump?

The doctors crusading for their greater use are convinced that the life-saving possibilities of the new battery-operated devices have been under-researched to keep a lid on spiralling healthcare costs, and to ensure that talking up the pumps does not deal a potentially fatal blow to Britain's struggling heart-transplant industry. They are keen that patients should have a range of treatments available and want to widen the debate, not narrow it.

There are also uncomfortable ethical issues that the campaigners would rather not address. The advent of electric heart pumps raises the possibility of thousands of wealthy old people demanding access to a new lease of battery-powered life. In the United States, Westaby's innovation is proving popular with a growing number of over-75s. There are an estimated 1,000 battery-operated elderly Americans going about their business in the US. The record for the oldest patient to be fitted with one has just been set by an 87-year-old from San Diego. Because the research isn't available, nobody knows how long these patients may live.

Back in the more prosaic world of the British NHS, the deaths at Papworth and Harefield have raised inevitable questions. Is the stock of good hearts decreasing? Are surgeons doing enough operations to maintain their skill levels? "There was no common factor to explain the deaths which occurred here," said a Papworth spokesman.

While awaiting the full results of their inquiry, Harefield say they see no obvious pattern emerging: their four deaths involved hearts from three different unidentified retrieval centres, with three different surgeons operating. In addition to Harefield and Papworth, specialist units in Newcastle, Manchester and Birmingham also receive heart-transplant patients. A handful more are occasionally carried out in Glasgow (three in the year to April 2008) and at Great Ormond Street children's hospital in London, which did nine in the same year. Each centre employs up to five highly skilled transplant surgeons to give the requisite 24-hour cover. That means most of them are doing no more than four to six transplants a year - considerably fewer than, for example, liver- or kidney-transplant surgeons. The UK performs between 600 and 700 liver transplants a year and more than 1,300 kidney transplants.

Children currently have better survival rates than adults for heart transplants, and as yet there is no immediate possibility of a paediatric pump being made available to them. For around 30 youngsters a year, transplantation is their best chance of a span of extra life. Mike Burch, a senior cardiologist who is lead transplant consultant at Great Ormond Street, says he has used 16 heart pumps in children to keep them alive while they wait for a donor organ, but in none of these cases did the child's heart stage the miraculous recovery seen in adult hearts relieved of the burden of pumping. He thinks donor- organ transplants will for some time remain the only option for children.

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