In the News
Private versus Public provision, the
The Times Wednesday, 11 May 2011
Dr Adrian Davis, GP in Lightwater, Surrey, writes “It may well be correct that hospitals may need to close if some NHS services are provided by private organisations. What is not (made) clear is that some private providers can treat patients better and at less cost. My local foundation hospital charges the NHS £169 for a physiotherapy appointment. I can get a similar physiotherapy appointment at a private practice for £45. The NHS could treat a great many more patients privately if GPs were able to access these services.”
Gerry Gajadharsingh writes: It seems clear that the common held belief, “I’ll use the NHS because it’s free” is coming under increasing scrutiny. Whilst of course it is “free at the point of access”, the above example questions whether, we as taxpayers, are getting value for money, if it really costs over 300% more to treat a patient in NHS hospitals compared to a private provider, there seems to be something seriously wrong with our health care funding. It’s interesting to note that the cost of my standard half our consultation, backed up by 24 years of clinical practice, is only 65% of the cost of an NHS appointment, probably with a clinician without the background that I have developed, also there is currently very little NHS provision of Osteopathy in the UK. When I look at my diagnostic role I’d love to see the cost comparisons to what we provide at The Health Equation with the level of service we provide and what similar provision costs within the NHS. Watch this space.”
“Sunshine vitamin” pills may extend the lives of cancer patients
The Independent Thursday 12th May 2011
Prof Angus Dalgeish, consultant medical oncologist at St George’s hospital, London, will tell a conference next week that he tests all his cancer patients for levels of vitamin D and prescribes supplements where they are low. At St George’s, where he runs a clinic for patients with melanoma, the deadliest form of skin cancer, tests showed that the majority had low vitamin D. He says “I spent a decade studying interferon for which the NHS paid £10,000 annually per patient years with very little benefit. Vitamin D is much more likely to give a benefit in my view”.
John Lappe, Professor of medicine at Creighton University in Nebraska USA, will describe a trial showing how vitamin D and calcium supplements given to cancer patients dramatically improved survival. The trial was originally designed to assess the effects of the supplements of osteoporosis and only later switched to examine their effects on cancer.
Vitamin D is the only vitamin that man makes themselves from the action of the Sun on the skin. Interestingly in the UK the UV from sunlight can only activate vitamin D in our skins between the months of March and September. Very few foods in nature contain vitamin D. The flesh of fatty fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks. Vitamin D in these foods is primarily in the form of vitamin D3 and its metabolite 25(OH)D3..This is what we test for when requesting blood tests. Some mushrooms provide vitamin D2 in variable amounts. Mushrooms with enhanced levels of vitamin D2 from being exposed to ultraviolet light under controlled conditions are also available.
Vitamin D promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal mineralization of bone and to prevent muscle spasm. It is also needed for bone growth and bone remodelling by osteoblasts and osteoclasts. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium and magnesium, vitamin D also helps protect older adults from osteoporosis.
Vitamin D has other roles in the body, including modulation of cell growth, neuromuscular and immune function, and reduction of inflammation and can be part of the cause of
some of the musculoskeletal presentations that we see.
NHS told to end culture of overprescribing
The Independent, Tuesday 4th January 2011
NHS patients are being prescribed too many drugs with detrimental effects on their health and the loss of millions of pounds in the health budget, the head of Britain’s drug safety regulator has said. Prof Sir Alasdair Breckinridge, chairman of the Medicines and Healthcare products Regulatory Agency (MHRA), said “an investigation has been launched into concerns about the lack of training of doctors in pharmacology. The study of GP’s in a healthcare centre, who hired a pharmacist to sit in on their consultations and check the prescriptions they wrote, reveal the scale of overprescribing. In most instances the pharmacist was able to remrove 30 to 40% of the drugs from prescription saving the NHS money and improving patient’s health. Some drugs are continued for long periods, often beyond the point when they are needed. They were justified in the short term but not in the long-term. We have more powerful drugs with more possible adverse effects than in the past”. He cited his own study in Liverpool in 2004, published in the BMJ, which showed that 6.5% of hospital admissions were due to adverse reactions to drugs.
Gerry Gajadharsingh says “increasing numbers of my patients are presenting with issues concerning polypharmany (multiple drug intake). The permutations of possible drug interactions increase enormously with the addition of each additional drug. As patients get older it is not unusual for them to be taking cocktails of drugs, an average 80 year old may be taking 7 or 8 different drugs, with some of them not needed and indeed some of them precipitating if not causing some of the patients symptoms. Writing to GP’s and specialists to try and persuade them to reduce and/or eliminate patient medications is increasingly common. There can also be interaction effects with over the counter (OTC) medication, alcohol, recreational drugs and supplementation. It is very important that clinicians understand the possibility of polypharmacy and appropriate steps are taken to ensure that patients only take the drugs they really have to.
Lack of sleep is a ticking time bomb
The Independent, Tuesday 8th February 2011
Prof Cappuccino, of Warwick Medical School, who led a study based on 470,000 people in eight countries including the UK, USA, Sweden and Japan tracked between 7 and 25 years, published in the European Heart Journal said “the trend for late nights and early mornings is a ticking time bomb for our health . The work/life balance struggle is causing too many of us to trade in precious sleeping time, we looked at the duration and quality of sleep. If you had difficulty falling asleep or you wake up in the night, that will affect the quality of your sleep”. People who regularly sleep less than six hours a night or whose sleep is disturbed have a 48% greater chance of developing or dying from heart disease and a 15% higher chance of a stroke. It is probable that sleep disturbance will also have profound effects on many other health issues.