The National Institute for Health and Clinical Excellence is no stranger to controversy, especially in relation to the drugs which it has denied to patients in recent years, most notably Herceptin. It is now back in the headlines for not making available a drug for treating rare blood cancers. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
 
It is not recommending azacitidine or Vidaza for treating myelodysplastic syndromes (MDS), a debilitating bone marrow disease on the grounds that it is too expensive. The move has angered cancer charities. Celgene UK, which manufactures the drug has said that it plans to appeal the ruling and David Hall, Chairman of the MDS UK Patient Support Group said that the decision is a huge blow to MDS patients.
 
He said: “A total of only 700 patients a year in England and Wales would require treatment with azacitidine so we do not believe that providing this life-extending treatment would make a huge impact on the NHS budget.” The cost of azacitidine is estimated to be £45,000 per patient.
 
http://news.bbc.co.uk/1/hi/health/8548114.stm

The post this week follows on from the comments made by the House of Commons Science and Technology Committee in which it said that the NHS should stop funding homeopathy.

In a move widely criticised by manufacturers and supporters of homeopathy, the committee said that the practice only worked because of the placebo effect, it amounted basically to sugar pills and was not enough to justify the estimated £4m that is spent on homeopathy by the NHS each year.

The committee also said that the Medicines and Healthcare Products Regulatory Agency should not allow labels on homeopathic medicines to carry medical claims. The committee is backed in this war of words by the British Medical Association which has also expressed concern about the funding going into homeopathy and has called for an official review into its effectiveness.

Supporters of homeopathy are passionate in their beliefs so it will be interesting to see how the debate proceeds. Will there be greater analysis into the benefits or otherwise of homeopathy. We are likely to see impassioned arguments on both sides. It will be fascinating to see this develop over the coming days and weeks.

http://news.bbc.co.uk/1/hi/health/8524926.stm

The BBC is running a story on the fact that the fastest growing part of the cosmetic surgery industry is male breast reductions. The figures, from the British Association of Aesthetic Plastic Surgeons, show that these procedures rose 80% from the figures in 2008 with pressure generated by men’s magazines being at least partly responsible.

Although 9 out of 10 cosmetic procedures were still carried out on women, according to the figures, there was a big rise in breast reductions for men. The top two procedures on men are still nose jobs and work on the skin around the eyes.

Consultant plastic surgeon Rajiv Grover agreed that increased coverage in the media could at least partly account for the demand in surgery amongst men. He said: "Many men are feeling the pressure from men's magazines that weren't even being published five or six years ago. In addition, they are just realising that they can get something done about it."

This week’s blog post concerns new research from Oxford University which has developed a new way of looking at cancer cells and which is being seen as a really significant finding in the fight against the disease.

The research [Stem cell research could weed out cancer] involves isolating cancer stem cells, keeping them in a laboratory and using them to test against possible new drug treatments. This is a far quicker way of using them effectively; the previous way of using cancer biopsies from human patients, enriching their number in samples and waiting to see if they produced tumours in mice was laborious by comparison.

Dr Trevor Yeung, from the Weatherall Institute of Molecular Medicine at the university was even for claiming that this new development could lead to a cure. He said: “Cancer stem cells drive the growth of a tumour. If we could target treatments against these cells specifically, we should be able to eradicate cancer completely."

He said that people previously assumed that cancer stem cells made up a small proportion of the cells in a tumour but this wasn’t correct and the most aggressive tumours are composed mainly of cancer stem cells.

Important new research which could in time, prove crucial to our understanding of how tumours develop and spread, and which could even lead to a breakthrough in our knowledge of how to beat cancer? Or are these claims from the university premature and intended mainly to grab headlines?

Your views matter too! Let me know what they are.

Noticed this on the BBC website, a story from the Netherlands claiming that MRSA is mainly spread by patients moving between hospitals.

The study looked at different strains of the disease across 26 European countries and found that they were geographically concentrated. Hajo Grundmann from the University Medical Centre in Groningen in the Netherlands, said that:

“MRSA appears to be spread by patients who ping-pong around between hospitals. These are often frail or elderly people with on-going health problems."

“The exciting thing is that if we know that MRSA is spread by this core group who are going back and forth between hospitals, we can do something about it and we may ultimately be able to eradicate MRSA."

“The message of this report is that doctors should try to identify people who often move between hospitals or other health care institutions such as nursing homes and they should be screened for MRSA.”

Has there been any research already done specifically on MRSA and its spread?

It’s an interesting new development which does appear to add towards our understanding of the disease although the report contains comments from Dr Richard James from the University of Nottingham in which he says that the study found few community-acquired strains of MRSA because it concentrated on invasive infections.

He says: “Community-acquired MRSA strains cause infections in younger people in the community who have had little contact with healthcare systems. These are unfortunately much less likely to be controlled by interventions that reduce transmission of hospital-acquired MRSA strains.”

So, a partial breakthrough in understanding MRSA?

Let me know what you think.

Welcome to the Medical Claims UK blog!

By way of quick introduction, my name is David Goodman and I am a legal journalist working at Winston Solicitors LLP who specialise in medical negligence claims.

For my opening post I thought I would publish details of an interesting piece I came across on the BBC News website from a renowned surgeon. It touches on issues that we encounter regularly from a legal perspective when dealing with clinical negligence claims.

In his article for the BBC dated 5th January 2010, Dr Peter McCulloch said that the Nuffield Department of Surgery, where he works, is looking at ways of using techniques from other industries to help patient safety. He uses an example where there had been a routine, if difficult, operation, leading to the patient’s health declining through a breakdown of communication between hospital staff.

The case study is one that we are all too familiar with and is worth repeating here: 

“The story of the patient in the intensive treatment unit (ITU) was one all the consultants at the Morbidity and Mortality meeting had heard before: most of them had had a similar case themselves. The original operation had been long and difficult, the patient frail and unfit.
 
The surgeon had been worried, but initially all seemed to go well. The surgeon ordered intensive observation and gave detailed instructions for post-operative care. But when the patient became ill on the third night, these had not been transferred, the appropriate care had not been given, and the vital recording in the notes had been lost. The nurses knew what to do, but the registrar, who had reluctantly filled the vacant rota posting at the last minute and was inexperienced in the speciality, did not. Insecure and not wishing to appear incompetent, he attempted to manage the situation for several hours without senior help. Help from other departments had been hindered by evident tensions between the registrar and the nursing staff, leading to confused communications. By the time senior help was called and theatre prepared, the patient's situation was grave”

Dr McCulloch suggests that three things are needed to improve reliability in healthcare:

1. The system needs to be reanalysed to eliminate the obvious pitfalls.
   
2. The training of staff to improve communications.
   
3. The use of technology to be assessed.

Effective communication is essential if healthcare is to work properly and there has to be a move away from a fear of confronting problems.

Dr McCulloch mentions aircraft training in briefing, debriefing and keeping a "flat" hierarchy which can improve both teamwork and technical error rates in operating theatres. He also mentions the car production “Toyota”-style re-design of ward care processes, saying that using the input of the "coal face" workers, can dramatically improve them.

I like this piece and the thinking of trying systems from other industries. It’s innovative and new working practices have to be looked at without prejudice. However, the question has to be, does the healthcare system as a whole want change? Does it embrace change in the way Dr McCulloch would like?

Do you work in healthcare?

If so, what do you think and can you think of any other examples of how working practices in other industries can improve healthcare? Let me know.