Interpol is seeking the arrest of the boss of the a French company PIP (Poly Implant Prothese) whose breast implants are at the centre of an international health scare.Jean-Claude Mas, 72, is wanted by Costa Rican authorities for crimes involving “life and health”, according to the international police agency’s website. Mr Mas was reportedly last seen in the Latin American country.

Interpol, which is based in France, issued a so-called red notice for Mr Mas, who ran Poly Implant Protheses (PIP), which is in liquidation.

France on Friday offered to pay for 30,000 women to have their PIP implants removed because of the risk the products could rupture and leak industrial-grade silicone.

But the Department of Health said it was not echoing the French advice as there was no evidence to support it. However they are reviewing the data and more information will be made this afternoon.

The Medicines and Healthcare products Regulatory Agency (MHRA) pointed out that there was no evidence of any disproportionate rupture rates other than in France.

A spokesman said: “We therefore do not believe that the associated risks of surgery from breast implant removal can be justified without further evidence.

“We will continue liaising with the French medicines and medical devices regulator and we are awaiting the evidence to support the decision made in France. This will be evaluated as a matter of priority by our clinical and toxicological experts and we will issue further advice if necessary.

Tens of thousands of women in France, Britain, Italy, Spain, Portugal and other countries in Europe and South America have had implants made by PIP, which has now closed.

The implants are filled with an unapproved non-medical grade silicone believed to be made for mattresses and there have been reports that the protective barriers are faulty.

The British Association of Aesthetic Plastic Surgeons (BAAPS) took a different stance from the Government and said it considered the French advice “not unreasonable”.

BAAPS president Fazel Fatah said: “If women are concerned or experience adverse symptoms they should see their surgeon, to discuss options such as having a scan to determine whether there is any weakening or rupture. If there is, we reiterate our previous recommendations – to have both implants removed.”

Figures from the MHRA suggest 84,300 PIP implants have been sold in the UK since 2001.

Based on the assumption that each woman has two implants, at least 42,000 women in the UK could be affected, according to the regulator.

But the figure could be higher because women undergoing breast reconstructive surgery following cancer may only have had one implant.

Health officials have issued a warning about the serious threat posed by the norovirus bug after an outbreak has seen cases jump by 20 per cent on this time last year.The winter diarrhoea and vomiting bug has affected 35 hospitals, with hundreds of beds unavailable after 27 wards were shut in the past two weeks to isolate infected patients and deep cleaned.

Overall confirmed individual cases across the country from July to mid-December are 19 per cent higher than during the same period last year.

Norovirus is extremely contagious and can be lethal to the elderly, very young or very sick patients.

People who have been ill are being asked not to visit friends and relatives in hospital until they are well.

Medical bosses at hospitals across the country are working to prevent the condition spreading and to reopen wards that were closed yesterday.

Nationally data from the Health Protection Agency released last week shows that norovirus rates remain below the level expected for this time of year, possibly reflecting the mild weather until now.

The HPA declares norovirus season has started when 4.8 per cent of calls to NHS Direct are about vomiting. Last week there were 4.2 per cent of calls about vomiting.

The first sign of Norovirus is usually a sudden sick feeling followed by forceful vomiting and watery diarrhoea. Other symptoms include a raised temperature, headaches, stomach cramps and aching limbs.

The data showed that last week the North East and South West were the worst affected.

Three hospitals reported that 124 beds are unavailable as a result of the ward closures. It is thought that the true number across all eight hospitals will be more than 200.

Wards were also closed to new patients at Montagu Hospital in South Yorkshire while 82 beds were closed on two wards at Northwick Park in Harrow, north London.

Croydon Health Services said it had one ward closed to new admissions.

Two wards were also closed at Warwick Hospital and the Richard Wells Ward was shut at Bedford hospital to contain a bout of gastroenteritis.

Director of nursing and patient services at Bedford hospital, Eiri Jones, warned visitors not to sit on hospital beds and not to visit at all if they had been ill in the preceding 72 hours.

Queens Hospital in Burton had one ward temporarily closed after a number of cases of diarrhoea and vomiting while the Countess of Chester Hospital had visiting restrictions in place at four wards to contain the outbreak.

A 14-bed ward at the University Hospital Southampton Trust was closed and County Durham and Darlington said it had seen isolated cases but had not had to close any wards.

Visitors to Northern Devon hospitals were warned only close relatives should visit patients and Mid Essex Hospital Trust said it had closed wards last weekend because of a similar outbreak.

The Royal College of GPs say the virus has not been a major problem so far this year – although outbreaks can occur very quickly, as the complaint is extremely infectious.

A statement from the Health Protection Agency said: “Norovirus is highly contagious and can be transmitted by contact with an infected person; by consuming contaminated food or water or by contact with contaminated surfaces or objects. The virus spreads rapidly in closed environments such as hospitals, schools, nursing and residential homes.

“Anyone who thinks they may have norovirus should not to go to their doctor’s surgery or A&E as this could spread the illness to vulnerable people and health care workers.”

Home healthacre checks ‘fell significantly’ under the Care Quality Commission (CQC) quango warns NAO.Work on checking standards in English care home fell “significantly” after a new watchdog was introduced, the National Audit Office (NAO) has warned in a new report.

It has accused the Care Quality Commission for failing to follow up a whistle blower’s warnings of alleged abuse of patients at the Winterbourne View care home near Bristol, of failing to “provide value for money”.

The CQC was established by Labour and cam into being in April 2009, bringing together three predecessor organisations – the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission.

But the NAO report said work on inspecting health and social care organisations “fell significantly” after April 2009, “due to the Commission’s decision to prioritise registration over compliance”.

Besides checking institutions, the CQC also has responsibility for registering them.

The report found the CQC “diverted resources in a bid to meet the statutory timetable for registration”.

As a result, it completed just 47 per cent of its target number of compliance reviews of standards of care between October 2010 and April 2011.

Government recruitment restrictions meant 14 per cent of staff positions were vacant last September, with serious shortages of registration assessors and compliance inspectors.

The CQC was established with a budget six per cent lower than the money given to the organisations it replaced, the NAO noted.

Amyas Morse, the Auditor General, said the CQC has had “an uphill struggle to carry out its work effectively and has experienced serious difficulties”.

Margaret Hodge, chairman of the House of Commons’ Public Accounts Committee, said of the CQC: “This report raises serious concerns about whether it is up to scratch.”

Cynthia Bower, the CQC’s chief executive, said it was now “firmly on the right track”.

From: http://www.telegraph.co.uk/Care-home-checks-fell-significantly-under-CQC-warns-NAO

Are women being over examined by an over cautious health nanny state?In an uncertain world, we want to believe in the certainty of medicine: that it is omniscient and operates in absolutes. In reality, this is far from the truth. The world of medicine reflects the world we live in; constantly in flux with multifarious contradictions.

Scientists relish this fact. However, for those on the outside, this can be bewildering. We are told one thing one minute, only for it to be ridiculed the next. With its definitions and protocols, medicine serves to give the illusion of stability when, in truth, doctors are all too often unsure.

The furore around breast screening perfectly illustrates this. It began when the Government’s cancer “tsar”, Prof Sir Mike Richards, announced that he is setting up an independent review of the NHS programme.

He has also ordered that patient leaflets, which explain the screening programme, be rewritten to take into account claims by some experts that the benefits have been exaggerated.

Understandably, this has prompted widespread confusion. The issue of breast cancer is always emotive. When I worked in breast surgery, I saw first hand the horrors of this disease on sufferers and their families, and it is vital that we do everything we can to treat and prevent it. But the debate over screening has been raging for some time within the medical community. I remember attending a lecture on this issue when I was at medical school more than 10 years ago.

The NHS screening programme was introduced by the Thatcher government following the 1987 Forrest Report, which recommended a national screening programme for breast cancer for women aged between 50 and 74. The report was based on the most up-to-date research.

But, since then, by comparing countries that have a screening programme with those that don’t, evidence has emerged suggesting that the steady fall in mortality in Western countries is not due to the screening programme, but to improved treatment and service provision.

If this is shown to be true – and it’s still a big if – then this would mean we are needlessly screening thousands of women. And there is an argument that many of the tumours detected by screening would not actually have developed into a life-threatening cancer.

For every screening test, whatever the disease, there is a margin of error. How good a test is can boil down to two things. The first is sensitivity, which measures how good the test is at giving a positive result in those who have the disease. The second is specificity, which refers to how many of those tested are disease-free and test negative.

Now, if you act on the results every time a test records a positive – in the case of breast cancer by doing invasive surgery or giving radiotherapy or chemotherapy – the sensitivity and specificity has to be very high (as near to 100 per cent as possible) to warrant a national screening programme. If it’s not sensitive enough, you’ll be giving women false reassurance when, in fact, tumours are being missed. Similarly, if it’s not specific enough, you’ll be needlessly treating people, with all the associated risks that treatment brings. It is this that is concerning some experts.

They argue that women are being over-diagnosed and over-treated because screening is not specific enough. It can pick up breast abnormalities that may look worrying when biopsied but are actually harmless. It’s a balancing act between saving lives and not causing harm by needless treatment. While doctors are used to adapting to changes in evidence, this is little consolation to women who worry about the disease.

It is perfectly sensible to have an independent review of the research, but I can’t help but think of the women who have had treatment,or are facing treatment, or those who are deciding if they should go for screening. The fact that the current debate waging in the medical establishment is part of the reflexive process that underpins science is of little comfort to them.

Let’s deal firmly with those who fail in patient care

Health Secretary Andrew Lansley should be congratulated – and it’s not often I say that – for his announcement last week that widespread spot checks on hospitals and care homes will be introduced in a drive to improve standards.

The checks will be undertaken by the Care Quality Commission (CQC). It comes after the Government reviewed the findings of the first wave of unannounced visits to care of the elderly wards in the summer. Over half the hospitals inspected had problems, particularly in relation to issues around patient dignity.

Spot checks are the way to tackle this and weed out bad practice and serious failings. But, they will only have any meaning if the CQC – often felt by those campaigning for improved standards as toothless – act on what they find. We don’t need endless reports and bureaucratic stalling. If it will work, the CQC will have to use its muscle. Those in charge of wards and hospitals found to be failing must be held accountable and dealt with firmly.

From: http://www.telegraph.co.uk/the-ifs-and-buts-of-breast-screening

The first new skin cancer treatment since the 1970s has been rejected by the NHS’s rationing body, in a decision branded a “death sentence” for patients.Clinical trials had shown that half of those who were given the drug were still alive a year later, twice as many as those given an alternative treatment.

The drug, called ipilimumab, works by teaching the immune system how to tackle melanomas and was widely seen as an important advance on “old-fashioned” chemotherapy.

But in draft guidance NICE- the National Institute for Curbing Expenditure has recommended that NHS trusts do not prescribe the treatment, because it costs about £80,000 per patient and because it had doubts over the research data.

It means that unless the manufacturer cuts the price, the only way that the growing number of advanced melanoma sufferers can access the drug is by applying to the Government’s Cancer Drugs Fund.

The decision comes after a provocative academic report claimed that some expensive cancer drugs are “futile” as they cost a lot and cause toxic side-effects yet only give dying patients a few more weeks to live.

In a joint statement, the support group Factor 50 and charity SKCIN said: “The breakthrough that patients and clinicians throughout the UK have been waiting for has arrived in the form of this drug.”

“Standard treatments that have been available since the 1970s are ineffective and to deny this drug to patients, many of whom are young and with very young families, has undoubtedly handed them down a death sentence.”

“To have come so close to a breakthrough and to be told no at this stage is truly devastating.”

Dr Pippa Corrie, Consultant Medical Oncologist at Cambridge University Hospitals NHS Foundation Trust, added: “Licensing of this drug for use in the UK marked a step change in melanoma patient care, and whilst the Nice decision is predictable, it is disappointing.

“It is essential that we all work to avoid any negative impact on facilitating patient access to this drug. Our patients have waited too long already.”

Rates of skin cancer are rising faster than any other type of the disease in Britain and it affects teenagers and young adults more than any other group.

Almost 12,000 people now develop the most serious kind, malignant melanoma, every year and about 2,000 will die after it spreads across the body.

For the past 30 years the only treatment has been a type of chemotherapy called dacarbazine which is not seen as particularly effective and leaves patients tired and at greater risk of infection.

The new treatment, marketed by Bristol-Myers Squibb as Yervoy, is taken in just four injections, one every three weeks and is said to have fewer side-effects.

In a trial on patients who had undergone prior therapy for skin cancer, 46 per cent who took the new drug were still alive after a year compared with 25 per cent who had not taken it.

In addition, 24 per cent were still alive at two years compared with 14 per cent of those who did not take the drug, and the median survival was 10.1 months compared with 6.4 months among those who did not take it.

But Nice, which assesses whether or not new treatments should be widely available on the NHS in England and Wales, has recommended against its use.

Sir Andrew Dillon, its chief executive, said: “We need to be sure that new treatments provide sufficient benefits to patients to justify the significant cost the NHS is being asked to pay.”

He said the evidence showed that ipilimumab was only effective for a “small percentage” of patients, it was not clear how long its effects last, and that it was linked to “a number of adverse reactions”.

“The Committee considered all these factors and concluded that, on the basis of the evidence provided so far, ipilimumab could not be considered a cost-effective use of NHS resources.”

But he added that the decision is open to public consultation while the manufacturer can offer to cut the cost.

Amadou Diarra, European Vice President and General Manager at Bristol-Myers Squibb UK, said: “We are fully committed to demonstrating that Yervoy represents real value for money to the NHS, and we will be submitting further evidence the hope that Nice will reconsider this decision so that all patients with metastatic melanoma can access this potentially life-extending treatment.”

From: http://www.telegraph.co.uk/Death-sentence-as-NHS-watchdog-rejects-skin-cancer-drug

Patients have been left at risk as the country’s main health watchdog quango carried out 70 per cent fewer inspections in order to focus on bureaucracy MPs find.The Care Quality Commission was guilty of a “significant distortion” in its priorities as it concentrated on red tape rather than checking that hospitals and care homes were safe, according to the Health Select Committee.

The situation was made worse by the fact that almost 300 posts were unfilled at the regulator and it failed to make Government understand the difficulties it was facing in adding dentists to the professions it monitors.

A damning report accuses the CQC of responding “woefully” to a whistleblower who uncovered abuse of people with learning disabilities at a private hospital, and of only offering “out of date and unhelpful” information to the public.

The MPs also call on the watchdog to focus on the broader culture at hospitals and care homes, rather than individual failings in treatment, to make sure that complaints are not being suppressed.

Stephen Dorrell, the Health Secretary under John Major who now chairs the select committee, said: “In its review of the CQC, the Committee concluded that the organisation’s priorities became distorted by a statutory deadline for the registration of dentists and that this distortion led directly to a drop of 70 per cent in inspection activity during the second half of 2010-11 compared with the same period in the previous year.

“The primary causes of this distortion, which resulted in increased risk to patients, were the unrealistic statutory obligations imposed on the CQC.”

Rosie Cooper, a Labour member of the committee, said: “I was really disappointed that the CQC allowed itself to get trapped in the regulatory profess and that restricted its ability to carry out inspections, which left vulnerable people at risk.”

The CQC, which has a budget of more than £160 million, was formed in 2009 in a merger of three separate watchdogs for healthcare, mental health and social care, and set about registering thousands of NHS hospitals and care homes.

But it missed its target of registering 8,000 dentists by April because of its complex process and the deadline for putting GP practices on its books has been postponed for a year so it can catch up.

As a result of this focus on administration, the select committee says that CQC inspections to see if patients are being looked after safely fell by 70 per cent, from 6,840 between October 2009 and March 2010 to 2,008 in the following six months.

Meanwhile its number of job vacancies rose from 148 in June 2010 to 297 a year later, “a further cause for concern”, almost half of whom were the inspectors and registration assessors it needed the most.

The MPs said the watchdog should have argued its case to Government more persuasively and far sooner.

Caseloads for the CQC’s inspectors have risen from 50 to 62 organisations over the past year, and so many assessments are mere “box-ticking” exercises carried out from its offices.

After a nurse contacted the CQC to complain about abuse at Winterbourne View, its response was “woefully inadequate”. Calls from whistleblowers elsewhere increased after the scandal was exposed by Panorama but this could be “only the tip of the iceberg”.

The CQC has a website where patients and relatives can read reports on hospitals and care homes but in many cases they are “several years old” and contain “limited” information.

The MPs say that inspectors should visit hospitals and nursing homes every year and speak to staff, patients and visitors to get a true picture of the quality of care being provided, rather than just relying on easily met targets.

From: http://www.telegraph.co.uk/Patients-left-at-risk-by-watchdogs-focus-on-red-tape

The Government’s drugs spending watchdog has decided that the first pill to treat multiple sclerosis (MS) is too costly to be prescribed on the NHS.The draft decision dashes the hopes of thousands of sufferers with the auto-immune disease who receive little benefit from current drugs.

There was enormous excitement among Britain’s 100,000 MS sufferers in January when EU drugs regulators gave fingolimod preliminary marketing approval.

Novartis, which markets fingolimod under the brand name Gilenya, subsequently applied for it to be prescribed on the NHS in situations where existing drugs do not work.

To receive these drugs, called interferon therapy, patients either have to self-inject every few days or go to hospital for supervised infusions.

A trial, published last year in the New England Journal of Medicine, showed that fingolimod halved the number of disabling relapses compared with interferon beta.

However, the National Institute of Curbing Expenditure (Nice) has decided that – at £20,000 a year – fingolimod “would not be a cost effective use of NHS resources”.

Prof Carole Longson from Nice said: “Unfortunately our independent committee wasn’t given sufficient evidence to show that fingolimod could reduce relapses considerably better than the other treatments currently being used.”

MS charities last night said the decision was “disappointing”.

Simon Gillespie, chief executive of the MS Society, warned: “It will leave some people with no effective treatment option.”

He added: “Access to MS treatments in the UK is very poor – in fact people with MS would be better off living almost anywhere else in Europe, and this decision will only deepen that inequality.”

The German health service is already paying for 2,000 people to receive fingolimod for highly active relapsing-remitting MS (RRMS).

Fingolimod is an immumosuppressant and, while it is well tolerated by most patients, it does have side effects in some.

From: http://www.telegraph.co.uk/MS-pill-rejected-as-too-costly-by-Nice.html

The National Health Service could face a “diabetes time bomb” according to an audit of patients in England and Wales.
The report says 800,000 Type 1 and Type 2 patients have elevated blood sugar levels which could lead to kidney failure, limb amputation and stroke.

It warned that many of the patients were young or middle aged and could require “substantial hospital care in a matter of years”.

Diabetes UK said the findings highlighted the need for urgent action.

All forms of diabetes result in raised blood sugar levels. If this is not controlled then it can cause serious damage.

The NHS Information Centre report confirmed that the number of cases of diabetes, especially Type 2, is increasing – particularly in deprived communities.

When it came to controlling blood sugar levels, around a third of more than 2 million patients had raised levels that placed them at risk of developing complications.

This was a greater problem for the under 55s.

Nearly 300,000 people were at “high risk” and 144,000 were at “dangerously high risk” in that age category.

The report also found nearly half of patients were not getting the appropriate checks.

The National Institute for Health and Clinical Excellence recommends patients with diabetes receive nine checks annually including: blood sugar levels, whether they are smoking, and an assessment of damage to the eyes or feet due to diabetes.

The study showed that only 53% of patients with Type 2 diabetes and 32% with Type 1 received all nine tests.

Dr Rowan Hillson, National Clinical Director for Diabetes, said: “I am very concerned that the National Diabetes Audit shows that we still have a long way to go in delivering basic standards of diabetes care for everyone.

“In particular, young and middle-aged people with diabetes are not getting the regular checks they need to manage their condition and improve outcomes.

“These checks are vital to reduce serious but avoidable complications. All health care professionals should follow NICE’s clear recommendations. There is no excuse for not doing the basics well.”

Barbara Young, Chief Executive at Diabetes UK, said: “This highlights the need for urgent action to ensure that people with diabetes start to receive all the basic care processes otherwise there will be more amputations, more people going blind, and more cases of kidney failure, heart disease and stroke.”

From: http://www.bbc.co.uk/news/health-13928359

The number of cases of measles in the first five months of this year have surpassed the total for the whole of 2010, according to new data.
The Health Protection Agency (HPA) reported 496 cases of measles in England and Wales up to the end of May this year, compared with 374 for the whole of 2010.

Most cases were in London and the South East, and children and teenagers were most commonly affected.

Small outbreaks have occurred in universities, schools and families, and there have been links with travel abroad after a surge in cases across Europe.

HPA data also show a rise in the proportion of children having the combined measles, mumps and rubella (MMR) vaccine.

The first MMR vaccination is given when youngsters are around 13 months of age, with a booster jab before they start school (usually between the ages of three and five).

Among youngsters aged two, quarterly figures for January to March show 90% had received their first jab – the highest level for 13 years and a 0.6% rise on the previous quarter.

The figures showed that by the age of five, 92.8% of children had received their first dose.

However, not all parents take their child back for the second dose. Among children aged five at the start of the year, only 85.1% had received both doses.

Dr Mary Ramsay, head of the immunisation department at the HPA, said: “We’re very encouraged to see that UK MMR uptake has reached 90% in children aged two, indicating increasing levels of trust by parents in the immunisation programme.

“We’re on the way to reaching our goal of 95% uptake. But anyone who missed out on MMR as a child will continue to be at risk of measles, which explains why we are seeing these new cases in a broad age range.

“It’s that time of year when children are travelling on school trips and family holidays and we are reminding parents and young adults of the importance of immunisation before they travel.

“We cannot stress enough that measles is serious and in some cases it can be fatal.”

From: http://www.independent.co.uk/measles-cases-pass-total-for-2010

Only 56% of the government’s £50 million interim Cancer Drugs Fund – or just under £27.5 million – was spent by Strategic Health Authorities (SHAs) in England during the time the Fund was available from October 2010 to March 31, 2011, new figures show.
This spending rises to just over £32.5 million (65%) if anticipated future costs are included for patients whose treatment was initiated before March 31, says leading charity the Rarer Cancers Foundation (RCF), in a new report evaluating the impact of policies to improve access to cancer treatments.

The study shows that 2,880 applications were made to the interim Cancer Drugs Fund during October 2010-March 31, 2011 (773 applications in March alone) and that, overall, 2,506 cancer patients gained access to treatment as a result of the Fund, although applications for 187 patients were denied.

It also reveals a dramatic postcode lottery with a northsouth divide in approvals, as SHAs in the south of England approved a lower number of applications than those in the north.

For example, NHS South Central approved around 75% of applications during the period whereas NHS North East approved every application it received, and while NHS South West used less than a quarter of its allocated funds, NHS Yorkshire and the Humber spent slightly more than its allocated budget.

Most SHAs have taken steps to expedite the application process for the Fund, with one – NHS East of England – removing the requirement for clinicians to submit exceptional-case applications before they can access the Fund.

Also, six out of 10 SHA operate lists of drugs which will be routinely reimbursed through the Fund. “This approach reduces bureaucracy, enables rapid decision-making and provides greater certainty to clinicians and patients,” says the RCF.

However, NHS North West’s operation of a negative list of drugs which will only be funded in exceptional circumstances breaches the spirit of the Cancer Drugs Fund policy, says the RCF, adding that, despite guidance instructing SHAs to cease using negative lists, NHS North West’s list was still operational on June 3, 2011.

The Fund could potentially benefit more than 30,000 patients, enabling them to access 34 treatments which would not have been routinely available on the NHS, and patients with bowel, kidney and blood cancers have been among the greatest beneficiaries, the report finds.

The most-requested drug – by far – has been Roche’s Avastin (bevacizumab), followed by Merck & Co’s Erbitux (cetuximab), Novartis’ Afinitor (everolimus), GlaxoSmithKline’s Tyverb (lapatinib) and Roche’s MabThera (rituximab).

Commenting on these findings, RCF chief executive Andrew Wilson said that while it was “great news” that thousands of patients have benefited from the Fund, it was concerning that 187 patients had been denied life-extending treatment “despite money going unspent and the emergence of significant regional variations in approval rates.”

The report also looks at progress with Primary Care Trust (PCT) exceptional-case processes. It estimates that 7,743 applications were submitted between April 2007 and December 2010, and suggests that the substantial increase in application rates during October-December last year reflects the fact that many SHAs required clinicians to submit exceptional-case applications to PCTs before a treatment could be considered for reimbursement from the Cancer Drugs Fund.

October-December 2010 (the period in which the interim Fund was introduced) also saw a dramatic drop in the exceptional-case approval rate.

This is likely due to more clinicians being encouraged to apply for treatments which would have stood little chance of being approved before the Fund was introduced, the Foundation suggests, although it adds that this requires further investigation.