Three scientists who drew up the key World Health Organisation guidelines advising governments to stockpile drugs in the event of a flu pandemic had previously been paid by drug companies which stood to profit.
An investigation by the British Medical Journal and the Bureau of Investigative Journalism, the not-for-profit reporting unit, shows that WHO guidance issued in 2004 was authored by three scientists who had previously received payment for other work from Roche, which makes Tamiflu, and GlaxoSmithKline (GSK), manufacturer of Relenza.

City analysts say that pharmaceutical companies banked more than $7bn (£4.8bn) as governments stockpiled drugs. The issue of transparency has risen to the forefront of public health debate after dramatic predictions last year about a swine flu pandemic did not come true.

The UK, which warned that 65,000 could die as a result of the virus, spent an estimated £1bn stockpiling drugs and vaccines; officials are now attempting to unpick expensive drug contracts.

The cabinet office has launched an inquiry into the cost to the taxpayer of the panic-buying of drugs.

Although the experts consulted made no secret of industry ties in other settings, declaring them in research papers and at universities, the WHO itself did not publicly disclose any of these in its seminal 2004 guidance. In its note, the WHO advised: “Countries that are considering the use of antivirals as part of their pandemic response will need to stockpile in advance.”

Many nations would adopt this guidance, including Britain. In 2005, the government said it had begun bulk-buying the drug Tamiflu, initially ordering 14.6m doses after bird flu killed 40 in Asia.

The specific guidance on antivirals was written by Professor Fred Hayden. He has confirmed in an email that he was being paid by Roche for lectures and consultancy work at the time the guidance was produced and published. He received payments from GSK for consultancy and lecturing until 2002. He said “[declaration of interest] forms were filled out for the 2002 consultation”.

The previous year Hayden was also one of the main authors of a Roche-sponsored study that asserted what was to become a main Tamiflu selling point – its claim of a 60% reduction in flu hospitalisations.

Dr Arnold Monto was the author of the WHO annex dealing with vaccine usage in pandemics. Between 2000 and 2004, and at the time of writing the annex, Monto had openly declared consultancy fees and research support from Roche and GSK. No conflict of interest statement was included in the annex published by the WHO.

When asked if he had signed a declaration of interest form for WHO, Dr Monto said “conflict of interest forms are requested before participation in any WHO meeting”.

The third scientist, Professor Karl Nicholson, is credited with the WHO’s influential work Pandemic Influenza. According to declarations he made in the BMJ and Lancet in 2003, he had received sponsorship from GSK and Roche.

Even though the previous year these declarations had been openly made, no conflict of interest statement was included in the annex. Nicholson said he last had “financial relations” with Roche in 2001.

When asked if he had signed a declaration of interest form for WHO, he replied: “The WHO does require attendees of meetings, such as those held in 2002 and 2004, to complete declarations of interest.”

A WHO official told the BMJ it had to balance an individual’s privacy with the robustness of guidelines, which were subject to a wide external review process.

From: http://www.guardian.co.uk/business/2010/jun/04/swine-flu-experts-big-pharmaceutical

Millions of British women have potentially dangerous diets ranging from teenage girls missing out on healthy food to pensioners not getting their vitamins it is claimed.
Health experts pulled together the results of 110 separate scientific and medical research studies to paint a worrying picture of what the UK’s female population eats.

Not only are women in the prime of their lives not getting the right amount of nutrition, which in turn can affect the weight of newborn babies too, but the poor diet extends across all age groups.

The review, commissioned by the independent body Health Supplements Information Service (HSIS) discovered a lack of balanced meals in a nation hooked on junk food or obsessed with eating fads. Dietitian Dr Carrie Ruxton and researcher Dr Emma Derbyshire of Manchester Metropolitan University reviewed 110 published papers covering women’s health for the journal Nutritian Bulletin.

They discovered that even at school age, more than half of girls aged 11-18 to not get the recommended intake of such minerals as magnesium, found in fruit and veg to increase energy.

One in four were not getting enough zinc, 30 per cent were lacking potassium, 16 per cent were deficient in iodine and almost half failed to reach recommended levels of iron in their diet.

Between the ages of 19 to 50, 20 per cent of women were still not getting enough iron, vital for the production of healthy red blood cells, and 11 per cent had a deficiency in the vitamin B2.

In particular there was a worrying lack of vitamin D among this child-bearing age group as this is the vitamin pregnant women need to strengthen a baby’s bones and reduce the risk of an underweight birth.

Up to 80 per cent of adult women get less than the amount recommended by EU health organisatons.

Even as they get older and are not constrained by the time pressures of work or bringing up children the diets of women do not become much better.

People aged over 65 need more vitamin D in their diet to prevent brittle bones but only a third of women in this age group meet their recommended daily levels, said the HSIS collective research.

Women need to make better dietary choices to ensure that they consume enough vitamins and minerals and, thus, safeguard their health. As a result, those women missing out on vital daily vitamins and minerals, should supplement their diet with a daily multivitamin. In addition, those not consuming 2 portions of fish a week, one of which should be an oily fish, should take a fish oil and Omega 3 supplement. ”

The report blamed a variety of factors from busy lives to a lack of cooking skills for the lack of key ingredients in a daily diet and called for more awareness of fortified foods and vitamin and mineral supplements to make up for this loss.

From: http://www.telegraph.co.uk/health/Millions-of-British-women-on-danger-diets

About one percent of IVF pregnancies are aborted every year, figures collected by the fertility watchdog show.The exact reasons for the terminations – which amount to an average of about 80 a year – are unclear, but will include medical problems with the foetus as well as social grounds, such as a relationship breakdown.

“Selective reduction” abortions, when one foetus is removed to improve the survival chances of another in a multiple pregnancy, are also included.

The figures from the Human Fertilisation and Embryology Authority, which regulates IVF clinics in the UK, were obtained as part of a Freedom of Information request.

They show that the proportion of foetuses aborted remained stable between 1991 and 2008, the last year for which data was available. In that year there were 65 terminations in 6,723 pregnancies.

The 18-34 age group saw the highest number of abortions, with 23 terminations, but they also had significantly more pregnancies than older IVF patients.

There was no information on the number of abortions of IVF pregnancies which had originally been funded by the NHS. Public provision of IVF is patchy, and many couples pay thousands of pounds to undergo fertility procedures privately.

Professor Bill Ledger, a member of the HFEA said: “I had no idea that there were so many post-IVF abortions and each one is a tragedy”, while former conservative MP Ann Widdecombe said some were treating babies like “designer goods”.

But Susan Seenan of the Infertility Network UK advised caution.

“Anyone who has undergone IVF knows what a long and difficult experience it can be. To make the decision to then terminate that pregnancy cannot be one that anyone takes lightly. I would imagine there are some pretty good reasons.”

Laura Riley, a spokesperson for the British Pregnancy Advisory Service, said: “Women and couples who have had donor insemination or IVF to become pregnant are unfortunately no more immune from the harsh vagaries of life than others who are lucky enough to be able to conceive naturally.

“Any woman can experience overwhelming life difficulties, such as intense relationship pressures or the diagnosis of a serious or lethal fetal medical problem. These may mean that she feels unable to continue with the pregnancy.”

From: http://news.bbc.co.uk/1/hi/health/10254133.stm

There will be a full public inquiry into the scandal hit Stafford Hospital in Mid Staffordshire NHS Trust, the government has announced.The Tories had promised the probe in opposition after reviews had criticised “appalling” standards which were said to have caused needless deaths.

Campaigners consistently said it was the only way to uncover the failings, but previous labour ministers had resisted.

As they emerged into the rain from the House of Commons to pose for photographers, Stafford Hospital campaigners hugged each other and laughed. “It’s the first time we’ve smiled since this whole thing began,” Julie Bailey told me. She’s the woman who founded Cure the NHS after her mother died at the hospital having experienced what Julie says was eight weeks of dreadful care.

The group has been pressing for a Public Inquiry since the Healthcare Commission first uncovered the extent of the problems at Stafford Hospital last year. They argued that anything less wouldn’t have the powers to answer all their questions. Julie Bailey looked tearful as I asked her about her mother’s experience.

“I’ve done this for her,” she said. “She’d have done all this and more if she’d had the chance.” She believes the public inquiry will mean people who’ve been able to duck questions until now will be forced to account for themselves. “It’s not about revenge,” she said, “it’s about accountability and openness. Tomorrow we’ve got to start a new beginning for the NHS because we don’t need any more unnecessary deaths.”

The problems at Stafford – run by the Mid Staffordshire NHS Trust – were laid bare by the NHS regulator in March 2009.

The Healthcare Commission reported there had been at least 400 more deaths than expected between 2005 and 2008.

It cited a catalogue of poor standards, including cases where receptionists had been used to assess emergency patients.

But this was just one of a long-line of reviews.

These included an independent inquiry launched by the government. It was held in private and reported in February, saying the trust had become driven by targets and cost-cutting.

Campaigners believe the failings of Stafford go much further than one badly-run trust however. The trust had been climbing the NHS ratings ladder during the period in question and was even given elite foundation trust status.

So earlier this year the Labour government set up a further inquiry looking at the role of the wider regulatory agencies, but this was not enough for campaigners.

They demanded a more wide-ranging probe which had tougher powers. A public inquiry is held in open and is able to compel witnesses attend hearings and cross examine them.

Mr Lansley said: “We know only too well what happened at Mid-Staffordshire, in all its harrowing detail, and the failings of the trust itself.  “But we are still little closer to understanding how it was allowed to happen by the wider system.  The families of those patients who suffered so dreadfully deserve to know. And so too does every NHS patient in this country.

“This was a failure of the trust first and foremost, but it was also a national failure of the regulatory and supervisory system who should have secured the quality and safety of patient care.”

The inquiry will be chaired by Robert Francis QC who had led the government inquiry and was asked to do the same for the follow up one.

Mr Lansley said he did not want Mr Francis to go over the ground already covered, but focus instead on how the culture in the NHS allowed this to happen.

The final report is expected in March 2011.

The health secretary also said he wanted to strengthen the ability of staff to whistleblow.

He said he would be issuing guidance to trusts on their procedures as well as looking to introduce a contractual right for staff to raise concerns that are in the public interest.

Julie Bailey, founder of Cure the NHS, the campaign group set up by the families of victims, said: “A year ago David Cameron promised a public inquiry and he’s kept that promise.  The terms of reference and scope are just what we wanted.”

“Former health ministers, Department of Health executives in Whitehall and in Stafordshire will now have to exlain why they did not stop this disaster.”

From: http://news.bbc.co.uk/1/hi/health/10274537.stm

The first NHS nanny state scheme to offer cash rewards for losing weight has helped more than 100 obese people shed nearly two stone each in a year.

Cash payments of up to £425 were offered by an NHS primary care trust in Kent to 402 volunteers who signed up for the year-long “Pounds for pounds” trial in January 2009.

Among the 100 who completed the course, the average weight loss over the year was 25lb. However, they represented only a quarter of the total. In all, two-thirds of the volunteers failed to reach their weight loss target.

The mixed results are a disappointment to advocates of the use of financial incentives to change unhealthy behaviour. A growing body of experts say cash rewards may offer the best hope of persuading people to alter their lifestyles and head off the epidemic of chronic disease associated with smoking, drinking and overeating which threatens Western nations.

Last month, the National Institute for Clinical Excellence (NICE) held a two-day hearing to discuss the use of cash incentives in health. In addition to helping people lose weight and give up smoking, other schemes have offered rewards to addicts to stay off drugs and £10 record vouchers to young people who agree to have a test for chlamydia.

An independent evaluation of the Kent weight loss scheme by the University of Sheffield concluded that financial incentives worked for some people, but the high drop-out rate meant the true impact was unclear.

Claire Martin, acting assistant director of public health for NHS Eastern and Coastal Kent PCT, said: “Very often people lose weight, but when they stop their diet the weight returns. We need to invest in programmes that return a sustained weight loss and produce long-term health benefits.

“There were high drop-out rates and so it is very difficult to interpret the results to show how successful this would be across our population.”

The cost of the Kent scheme, run by a private company, Weight Wins, is around £180 per head. A spokeswoman for the Department of Health said the cost to the NHS of treating obesity-related conditions was £4.2bn.

Winton Rossiter, chief executive of Weight Wins, said 745 people had joined the scheme, more than half through the NHS Kent scheme and the remainder as private customers, paying a monthly fee. The average weight loss after one year was 15.8lb.

“These results suggest that long-term financial incentives could be the best single weapon in the war on obesity,” he said. Weight Wins is now offering a maximum payout of £3,000 to private customers who lose 150lb over 21 months and keep it off for three months. Customers pay £135 to join the scheme and £30 a month.

Healthy dividends

* In Essex, pregnant women who smoke have been offered up to £60 in food vouchers if they give up.
* In Hammersmith, west London, and in Bournemouth, the NHS has offered those under the age of 25 a £10 HMV voucher to have a chlamydia test.
* Weight Wins, a private company, charges a £10-£30 monthly fee and offers £150 to clients who lose 50lb and up to £3,000 for people who lose 150lb.
* In the US, employees of General Electric were paid up to $750 (£500) if they gave up smoking for at least 12 months.
* Several companies in the US offer a similar service, including Virgin Health Miles, StickK and HealthyWage.

From: http://www.independent.co.uk/pounds-for-pounds-scheme-helps-obese-people-shed-stones

NHS Hospitals will face financial penalties if patients are readmitted as an emergency within 30 days of being discharged, under new government plans.
The scheme was unveiled yesterday by Andrew Lansley, in his first major speech as the new health secretary.

Hospitals in England will be paid for initial treatment but not paid again if a patient is brought back in with a related problem, he said.

It has been argued that patients are being discharged early to free up beds.

The Conservatives have said cuts to the number of hospital beds under Labour put pressure on NHS staff to discharge people without support.

Between 1998-99 and 2007-08, the number of emergency readmissions in England rose from 359,719 to 546,354. But there was also a significant rise in the number of procedures performed over the same time period.

Readmissions as a percentage of all patient discharges went up marginally, from 8% in 1998-99 to 10.5% in 2007-08.

Speaking about his vision for the NHS, Mr Lansley called for patients to be given more control over their healthcare.

And he said hospitals would have the responsibility of looking after patients’ health and well-being for up to a month after they are discharged.

Currently primary care trusts and GPs look after patients once they are discharged from hospital.

Under the new plans hospitals would receive funding for the first hospital stay plus treatment for the patient’s first 30 days after discharge.

Mr Lansley promised to “empower patients as well as health professionals” and “disempower the hierarchy and the bureaucracy”.

He said: “We need a cultural shift in the NHS. From a culture responsive mainly to orders from the top-down, to one responsive to patients, in which patient safety is put first.

This change of direction will send a ripple through hospital managers with some enterprising chief executives will see it as a chance for hospitals to extend their services into the community.

If they are to provide extra follow up care, and bear the cost of unavoidable complications, hospitals will be hoping to see that reflected in the price they are paid for each operation.

England is unique in the UK in paying its hospitals for each treatment they carry out, a system called payment by results.

This will be the main lever which the Health Secretary can use to change the incentives in the system.

He said that targets focused on processes, data returns and more Department of Health circulars would not achieve these aims.

“Over the last ten years emergency readmissions have increased by 50 percent. Not, it seems, primarily because patients were more frail, but because hospitals have been incentivised to cut lengths of stay and send patients home sooner – process targets creating risks for patients.

“So in addition to getting rid of these targets – we’re going to ensure that hospitals are responsible for patients not just during their treatment but also for the 30 days after they’ve been discharged. It will be in the interests of the hospital for patients to be discharged only when they are ready and safe.”

And if a patient is readmitted within that time the hospital will not receive any additional payment for the additional treatment – they will be focused on successful initial treatment, he said.

Nigel Edwards, policy director of the NHS Confederation, which represents most NHS trusts, said the proposal to withhold money for readmissions was a good idea.

“The principle of offering this, as long as we don’t have hospitals getting in the way of GP care, is a perfectly sensible one and certainly one we see in other countries.”

Dr Anna Dixon of the King’s Fund said readmissions can occur because of a lack of proper care provision in the community. And she warned that abolishing targets might lead to a rise in hospital waiting times.

The British Medical Association’s Dr Hamish Meldrum agreed saying: “This could result in patients being kept in hospital longer than necessary, when it might be better for them to be at home.

“We should remember that there can be a range of reasons that a patient is readmitted, many of them beyond the control of the hospital.”

Katherine Murphy, director of the Patients Association, said: “We have always campaigned for patient safety to be at the forefront of services and withholding payment to fix poor outcomes and giving patients more information to help them make informed decisions about their care are significant steps towards this.

“We welcome a much greater emphasis on the patient experience and a focus on patient needs and helping patients play a bigger role in shaping their health service.”

From : http://news.bbc.co.uk/1/hi/health/10262344.stm

The rate of men dying from the deadliest form of skin cancer has doubled over the past three decades.
Figures from Cancer Research UK show a steep increase in deaths from malignant melanoma, especially in elderly men.

In the late 1970s fewer than 400 (1.5 per 100,000) men died from melanoma but that figure has now risen to over 1,100 (3.1 per 100,000).

Yet the cancer is preventable if people avoid sunburn and deal with ‘worrying’ moles early, the charity said.

The death rates for women have also risen, from 1.5 to 2.2 per 100,000.

The figures also reveal that although more women are diagnosed in the first place, more men die from the disease.

In men aged over 65 deaths have risen from 4.5 per 100,000 to 15.2 per 100,000 over the past 30 years.

Caroline Cerny, from Cancer Research UK, said men needed to learn to look after their skin.

“Too often men leave it up to their partners or mothers to remind them to use sunscreen or cover up with a shirt and hat, and even to visit the doctor about a worrying mole,” she said.

The figures suggest men are either not aware of skin cancer symptoms or are ignoring them and putting off going to see their GP, she added.

“It’s crucial that people go to their doctor as soon as they notice any unusual changes to their skin or moles – the earlier the cancer is diagnosed the easier it will be to treat.”

Care services minister Paul Burstow said that the figures were worrying and everyone needed to be vigilant.

“Seeing many people with sunburn from the recent sunny weather is a reminder of how easy it is to damage your skin,” he said.

Dermatologist Dr Jonathan Bowling, from the Radcliffe Hospitals Trust and the private Cadogan clinic, said it was vital that anyone with any concerns about their moles seek help from a qualified dermatologist.

“If you are worried about a mole, go to a GP,” he said. “Either he can refer you, or if you are still worried you can ask to see a dermatologist.”

From: http://news.bbc.co.uk/1/hi/health/10172892.stm

The National Institute for Curbing Expenditure (NICE) wants to set a minimum price for a unit of alcohol in its latest wheeze to crack down on problem drinking.
The public health quango, which labour set up as the Government’s drugs rationing body, has spent two years looking at how to reduce alcohol-related health problems.

One in four people drink at levels that could be putting their physical and mental health at risk, according to official figures.

The move will reignite debate about how best to deal with the problem.

Deaths from alcohol abuse have more than doubled in the last 16 years, with almost 9,000 a year now succumbing to conditions such as alcohol poisoning and liver cirrhosis

More than 860,000 people a year are also admitted to hospital because of alcohol and the cost to the nation of excessive drinking is put at an estimated £27 billion a year.

Health experts and charities have all backed calls for a minimum price per unit to curb Britain’s binge drinking culture.

But many in the drinks and retail industries are strongly opposed to such a move and believe a minimum price would disproportionately hit responsible drinkers.

The move has already been backed by the British Medical Association (BMA) and the Royal College of Physicians.

Analysis by Sheffield University found that setting a minimum price of 50p a unit would save up to 3,400 lives a year without hitting moderate drinkers.

A draft of the Nice guidance, published in October last year, recommended the introduction of a minimum price per unit and said there was “sufficient evidence … to justify the introduction of a minimum price per unit.”

As well as overall consumption levels, a minimum price would also help to reduce binge and underage drinking, advocates believe.

Minimum pricing is expected to have a much harder impact on supermarkets and off licenses than pubs and restaurants, which sell alcohol at higher prices.

Supermarkets in particular have been criticised for selling alcohol at very low prices, including cans of beer for as little as 22p each.

The Wine and Spirit Trade Association said that minimum pricing “would punish millions of innocent consumers” without solving the problem of alcohol misuse.

From: http://www.telegraph.co.uk/Minimum-price-for-alcohol-to-be-backed-by-Nice

A shortage of junior doctors to start work in hospitals this August is forcing the NHS to try to recruit from India.Tighter immigration rules introduced in recent years meant many overseas medics left Britain and returned home.

But the exodus, added to new European regulations limiting the hours of doctors, caused unfilled vacancies.

Attempts to recruit scores of Indian doctors foundered on a disagreement between government departments.

“We pulled the plug on overseas recruitment far too quickly,” said Professor Derek Gallen, who is postgraduate dean of medical training for Wales.

“We didn’t realise what the implications of that action would be two, three or four years down the line,” he added.

The Welsh Deanery is one of four medical training schools across the UK which has been recruiting in India over this year.

The other deaneries involved cover the Severn area, the West Midlands and Northern Ireland. In total, they plan to take more than 100 junior doctors over to the NHS.

The deaneries are looking to recruit in areas such as paediatrics, obstetrics, gynaecology, anaesthesia, as well as accident and emergency.

The need for junior doctors is most acute outside the big metropolitan areas.

The European Working Time Directive, which was fully introduced into the NHS last August, limits doctors to working no more than 48 hours per week and has left gaps on rotas.

Some district general hospitals have had trouble attracting enough staff to cope with the changes leading, in some cases, to services being cut.

In May, the Victoria Hospital in Kirkcaldy had to close its accident and emergency department overnight for a week due to a shortage of junior doctors.

At Erne hospital in Enniskillen, its obstetric and gynecology service had to be suspended for several weeks for the same reason.

The shortage of junior doctors means hospitals are struggling to fill vacancies, and having to devise their own initiatives to recruit doctors wherever they can find them.

From: http://news.bbc.co.uk/1/hi/health/10202803.stm

Chief Medical Officer Sir Liam Donaldson’s scheme for inspectors to be appointed by every health trust has been rejected by the BMA.
Ten years after the reputation of the medical profession was ripped apart by the Bristol children’s heart surgery disaster and the Harold Shipman murders, efforts to introduce regular checks on doctors’ competence, known as the medical MOT, have foundered again.

Leaders of the British Medical Association have detonated a bombshell under the latest negotiations, calling on the General Medical Council, the profession’s disciplinary body, to go “back to the drawing board” with its plans for five yearly checks to ensure doctors are up to date and have the necessary skills.

The repeated failure to agree on a system of checks during the decade-long stand-off between the two organisations has left patients without the fundamental protection of knowing that the doctor treating them is safe.

Under the current system, doctors join the medical register on passing their qualifying exams and may not undergo further checks on their competence for the next 40 years.

The GMC first proposed in June 2000 a system of regular checks for doctors. That provoked outrage and led to a vote of no confidence in the GMC at the BMA’s annual conference the same month, the first in its history.

Five years later the two sides were nearing agreement when Dame Janet Smith forensically demolished the plans in the Shipman inquiry, saying they had been so watered down that to compare them to an MOT for a car would be a travesty.

In 2006, Sir Liam Donaldson, the Chief Medical Officer, proposed a new scheme, including medical inspectors to be appointed in every trust to police the performance of doctors, which has formed the basis of negotiations since. Now the BMA has rejected these.

Its response caused disquiet among other medical organisations who suggested the association’s trade union instincts may have disrupted its professional good sense.

John Black, president of the Royal College of Surgeons, said: “The BMA are being totally unrealistic. An awful lot of time has been put into this. We [the Royal College] will not be going back to the drawing board.”

Mr Black added: “Parliament has decided that doctors should be revalidated and what patients tell us is that they are amazed we haven’t been doing it already. We fully accept that the process must be made as simple as possible, consistent with its having teeth. But the public expect us to get on with it.”

Hamish Meldrum, chairman of the BMA, said: “While the BMA agrees with the principle of revalidation … [we] will resist any proposals that … take doctors away from treating patients. It is essential that any system we have in place is fair for all doctors across the board.”

The BMA said the main concerns were that specialist standards set by the Royal Colleges were “far too complex,” having Royal College representatives sit on revalidation panels was “unacceptable”, and no costs were given for implementing the proposals.

Dr Meldrum said: “The proposed system will do very little to weed out underperforming doctors but will add yet another layer of bureaucracy to the doctor’s role. This does not make sense at a time when doctors are facing increasing pressure to spend more time with their patients. With the NHS facing cuts, this is not the time to spend invaluable resources on forcing doctors to dedicate time to box-ticking and form-filling exercises.

From: http://www.independent.co.uk/doctors-fail-to-agree-tests-on-competence