NICE’s system used to decide whether drugs are cost effective is flawed

NICE’s formula which they use to decide whether NHS patients can have access to costly drug treatments is flawed and should be scrapped, according to a European Commission funded study.NICE's system used to decide whether drugs are cost effective is flawedThe National Institute for Curbing Expenditure (NICE) aka the Killer Quango uses a mathematical formula to work out whether it is worth the NHS buying medicines when their cost is judged against their potential benefits.

NICE’s decisions can be controversial because they decide whether patients suffering from potentially fatal illnesses such as cancer receive life saving treatments.

Nice uses a method called quality-adjusted life years (QALY) for assessing the value of new drug treatments in England and Wales.  The formula looks at the cost of using a drug for a year and weighs it against how much a patient’s life can be extended and improved.

If a treatment costs more than £30,000 per QALY – a theoretical unit representing one year in perfect health – it is generally not recommended as cost-effective by Nice.

But researchers from the European Consortium in Healthcare Outcomes concluded that the system failed to reflect variations in views on illness and disability.

The European research surveyed 1,300 respondents in Belgium, France, Italy and the UK, including 301 in the UK.

It concluded that the way people rate medical outcomes varied widely and could not be summed up in a neat medical formula, and suggested that the QALY indicator was an invalid way to make medical decisions, that should be scrapped.

For example, it found 71% of respondents would prefer to live 15 years in a wheelchair than die after ten or five years in a wheelchair. But the remaining 29% said they would prefer to die earlier than spend 15 years in a wheelchair.

Ariel Beresniak, the French doctor and economist leading the study: “Important decisions are being made on the basis of QALY, but it produces the wrong results. This isn’t a scientific way to classify and prioritise the drugs – mathematically, it’s flawed.

“We think it is time to open this debate, particularly as some of the newer European countries are trying to organise their health assessment systems and might be considering QALY.

“Nice has made negative recommendations about many major innovative drugs, based only on arbitrary incremental cost per QALY. Agencies such as Nice should abandon QALY in favour of other approaches.”

The full release with details of results, methodology and background on QALYs is available here:

Patients admitted to hospitals on bank holidays almost 50 per cent more likely to die

Patients are much more likely to die if they are admitted to hospital on a bank holiday because there are fewer doctors on duty according to new research.Patients admitted to hospitals on bank holidays almost 50 per cent more likely to diePublic holidays are usually tagged on to a weekend, providing a three or four day holiday, resulting in what the authors refer to as a “cumulative effect”.

The authors of the study Emergency medical admissions, deaths at weekends and the public holiday effect, published in Emergency Medicine Journal, wrote: “If we assume that patients with severe illnesses are no more likely to be admitted on any one day of the week than any other, then it becomes difficult to escape the view that a cumulative effect of lack of services and/or lack of doctors on public holidays must have a part to play in the higher public holiday mortality demonstrated in this study.”

According to the study, carried out at Dumfries Infirmary in south-west Scotland, patients admitted at weekends were slightly older, less likely to have cancer and more likely to have a respiratory problem. Those admitted on public holidays were also more likely to have a respiratory problem. But otherwise there were no distinctive differences in the caseload.

In all, 3.8 per cent died within seven days of admission, while 8.9 per cent died within 30 days. After taking account of factors likely to influence the results, death rates were only slightly higher at weekends.

But they were significantly higher for public holiday admissions – on weekdays and weekends – than for other days.

Some 5.8 per cent of patients died within seven days compared with 3.7 per cent of those admitted on other days of the week, while 11.3 per cent died within 30 days compared with 8.7 per cent of those admitted at other times.

This means that patients admitted as medical emergencies on public holidays were 48 per cent more likely to die within seven days and 27 per cent more likely to do so within 30 days.

There were no differences in senior doctor staffing between normal weekends and weekdays at the hospital – a factor frequently cited to explain the differences in death rates between weekends and weekdays.

Dr Sian Finlay, one of the researchers at Dumfries Infirmary: “Consultant physicians in Dumfries spend as much time on the acute medical unit during public holidays as they do on normal days and weekends.

“But it is also true that fewer consultants and junior doctors cover the other medical wards in holiday periods. It’s difficult to escape the view that higher mortality rates among patients admitted on public holidays reflects a cumulative lack of services and/or doctors during these three and four-day periods.”


Man flu does exist as men suffer more from high temperatures when ill

Man flu is not a myth as men suffer more from a high temperatures than women when they are ill a neuroscientist has found.Man flu does exist as men suffer more from high temperatures when illDr Amanda Ellison, a neuroscientist as Durham University, said that men really do suffer more with coughs and colds despite being accused of exaggerating symptoms to gain sympathy.

She said men have more temperature receptors in the brain which causes them to experience the symptoms more acutely than women.

The difference is in the area of the brain which balances a variety of bodily mechanisms, including temperature.

The area is the same size in children, but when boys hit puberty testosterone starts to act on the area, known as the preoptic nucleus, making it larger.

Dr Ellison, 38, a senior lecturer at Durham, said: “When you have a cold one of the things that happens is you get an increase in temperature to fight off the bugs.”

“The bugs can’t survive at higher temperatures. When your immune system is under attack the preoptic nucleus increases temperature to kill off the bugs.”

“But men have more temperature receptors because that area of the brain is bigger in men than women. So men feel rougher when they have a temperature – and if they complain they feel rough then maybe they’re right.”

Dr Ellison, sets out her argument in her book, Getting Your Head Around the Brain, focusing on the difference between the minds of men and women.

The original research methods involved the study of brains in post mortem as well as images obtained from scans.

“My research is on how different parts of the brain communicate with each other,” she continued.

“My role is to put two and two together. There is no hard evidence that the feelings are worse in males than in females. This is a possible cause – but the argument will rage on.

“It is part of the whole argument about the differences between men and women and how their behaviour can be influenced by differences in their brains.”


Monday mornings are the A&E rush hour

Beware going to your hospital this morning- Doctors and nurses say that Monday mornings are the busiest time of the week.Monday mornings are the A&E rush hourThe busiest time in accident and emergency departments in England is Monday morning, hospital data shows.

There are 4,000 cases every hour between 10am and noon on Monday – twice the average.

Late morning was the busiest time of day throughout the week but Monday came out on top, figures from the Health and Social Care Information Centre show.

There were 17.6 million A&E visits in 2011-12, up from 16.2 million in the previous year.

The chief executive of the Health and Social Care Information Centre, Tim Straughan, said: “It is well-known of course that accident and emergency departments are very busy places.

“The fact that A&E services in England on average see twice the average number of new cases coming through the door collectively on a typical Monday morning indicates just how much society relies on these front line services.”

Dr Clifford Mann from the College of Emergency Medicine said: “As it is implausible that there is an acute deterioration in population health on each and every Monday morning the message inherent in these figures is a lack of primary care capacity.

“This in turn reflects the fact that there is a significant spill over effect from the weekend – again because of a lack of primary care provision.”

Number of mothers aged over 45 treble in a decade

The number of women having babies over the age of 45 has more than trebled in just over a decade as couples delay having children for career and financial reasons, according to official figures.The number of mothers aged over 45 treble in a decadeWhile the prevalence of teenage mothers has dropped dramatically since the 1990s, older mothers have reached the highest level seen in recent times.

A new analysis of birth records for 2011 published by the Office for National Statistics (ONS) confirms a major shift towards women having babies later in life, with even mothers in their early 20s becoming increasingly rare.

They show that less a quarter of births England and Wales in 2011 involved mothers under the age of 25 – half the proportion seen in 1970 and the lowest level since records began in 1938.

At the same time women over the age of 35 accounted for a fifth of the total in maternity wards, almost four times as many as in 1977, while those having babies over the age of 45 dramatically higher than a generation ago.

The ONS said the shift reflected a greater emphasis by women on building a career before having children couples with the impact of fertility treatment as well greater instability in relationships.

The figures also show the number of children born outside of marriage reaching a record high of 47.2 per cent.

Four out of 10 mothers over the age of 45 were also unmarried. Only 25 years earlier, almost eight out of 10 children were born to parents who had tied the knot.

But, significantly, the figures also hinted at major changes in the attitudes of fathers.

Birth registration records show that over the same period the number of men signalling a desire to play a part in the lives of children when they are not in a relationship with the mother has more than doubled.

Overall there were 723,913 live births in England and Wales in 2011, the most recent year for which figures are available.

A total of 1,832 babies were born to mothers over the age of 45 in 2011, almost three times the number as recently as the year 2000.

The figures bear witness to the impact of IVF, indicated by a marked rise in the number of women in their late 40s having twins or triplets.

In 1989, just three women in England and Wales had a multiple birth, a figure which was to increase more than thirty-fold in 20 years.

An analysis of birth registrations showed that almost a third of births were registered to couples living together but not married, up from only 10 per cent in 1986.

But more than one in 10 births were registered to parents who lived at separate addresses but were prepared to share responsibility.

That is three and a half time the level seen in the mid 1980s.

Importance of dental hygiene

Brushing one’s teeth has long been considered an important part of dental care and good personal health.

As long ago as 3000 BC ancient Egyptians constructed crude toothbrushes from twigs and leaves to clean their teeth.

Similarly, other cultures such as the Greeks, Romans, and Indians cleaned their teeth with twigs.

Some would fray one end of the twig so that it could penetrate between the teeth more effectively.

Thankfully, modern mouth cleaning equipment have evolved markedly.

Modern medical research has shown that brushing teeth properly can prevent cavities, and periodontal, or gum disease, which causes at least one-third of adult tooth loss.

If teeth are not brushed correctly and frequently, it could lead to the calcification of saliva minerals, forming tartar.

Repeated medical research has shown that poor dental health has been associated with heart disease and shortened life expectancy.

Modern day toothbrushing as a regular habit became prevalent in Europe from the end of the 17th century.

The first mass produced toothbrush was developed in England in 1780 (but was never actually used).

In the United States, although toothbrushes were available at the end of the 19th century, the practice did not become widespread until after the Second World War, when US soldiers continued the toothbrushing that had been required during their military service.

Dental bacteria thrive in hard to reach areas – such as between your teeth. So it is important to clean between your teeth to prevent gum disease.

Even if you floss only ever so often, it is better than never and can make a difference to the health of your mouth. Your dentist or hygienist will advise you on how best to use both floss and inter-dental brushes.

Children as young as 12 given nicotine patches on the NHS- which parental knowldege

Children as young as 12 are being given nicotine patches by NHS nurses at school- without the knowledge or permission from their parents.Children as young as 12 given nicotine patches on the NHSThe patches are being distributed by nurses employed by NHS South West Essex who visit schools every fortnight and speak to the children confidentially.

NHS guidelines say children as young as 12 can access nicotine patches from chemists and GPs throughout the country, but it’s up to each primary care trust what services they offer.

Parents at one school in Basildon, Essex voiced concerns that parents weren’t being told about the service.

Danielle Northcott, 39, whose 13-year-old daughter Amaris is a pupil at Basildon with Woodlands School in Takely End, Essex, where patches are distributed, said: “Woodlands is a good school and even though I didn’t know the nicotine patches were available I would rather her have that than a cigarette in her mouth.

“As parents I do think we should have been consulted on it and the school should have been clear about it.

“Some parents will not agree with the meetings between the child and the nurse being confidential and it will divide opinion. The only thing that worries me is that the patches will become a status symbol and children could want them just to look cool in front of their friends.”

NHS South West Essex employs health group Vitality to run the service.

Vitality also offers children advice on weight loss and well-being and also issues the patches to children at drop in sessions across Basildon at the Laindon Health Centre, Pitsea Health Clinic, and the Basildon Centre.

New research shows that over 30 per cent of UK smokers keep their habit under wraps and more than 50 per cent say the person they most want to hide their habit from is their mother.

A spokesman for North East London NHS Foundation Trust, which runs the Vitality service, said: “Encouraging young people to quit smoking may prevent them from taking up the habit longer term, and so it is important they have somewhere to find confidential support for this.

“NHS stop smoking support is provided locally by GPs, community pharmacies and specialist stop smoking services, who are able to offer a range of advice and support on stopping smoking to people aged 12 and over, in line with NHS and NICE (National Institute of Curbing Expenditure) guidelines.

“This support is provided by healthcare professionals such as school nurses or health improvement practitioners, and may include nicotine replacement therapy (NRT) provided the young person is assessed as competent to consent to using this product.

“The use of NRT is fully explained to the young person.  We always encourage young people to inform their parents or carers if they are having support with quitting smoking or having NRT, but they are not obliged to do so.”


New Meningitis B vaccine for killer strain of meningitis is licensed

A meningitis B vaccine that could save thousands of lives has been licensed for the first time, in a move hailed as the most important breakthrough in 30 years.New Meningitis B vaccine for killer strain of meningitis is licensedThe vaccine could soon be available privately and Government advisers are deciding if it should be introduced into the free NHS childhood vaccination programme.

The jab, called Bexsero, has been licensed for use in babies from the age of two months and offers protection against the majority of meningitis B strains that occur in the UK.

Up to 2,000 people are infected with meningitis B each year in the UK and one in ten will die despite receiving prompt medical treatment.

A further one in four will suffer lifelong disability as a result of the brain disease.

Meningitis is commonly cited as the most feared disease by parents because it strikes otherwise healthy children who can deteriorate and die within hours.

Campaigners urged the Government to introduce the vaccine routinely as soon as possible after previous jabs against the disease took five years from licensing to reach the general population.

Steve Dayman, founder of the charity Meningitis UK, who lost his 14 month old son Spencer to meningitis and septicaemia, said: “This ground-breaking vaccine is the most important development since I lost my son to meningitis 30 years ago.

“The news is the most significant step forward in the fight I have ever heard.

“The Government must introduce the Meningitis B vaccine into the immunisation schedule as soon as possible – it will save thousands of lives and spare families so much suffering.

“Any delay means lives will be lost.  The last major meningitis vaccine took five years to be introduced – we cannot wait that long again.  Cost shouldn’t be a barrier for this vaccine either – you cannot put a price on life.”

“Please support our Beat it Now campaign. Together we can end the heartache caused by Meningitis B.”

There are already vaccines against the other major causes of meningitis, Hib and meningitis C, which saw substantial reductions in deaths and disability from the disease.

The Health Protection Agency estimates that since 2000, the MenC vaccination programme has prevented over 9000 cases of serious disease and more than 1000 deaths. Uptake rates of the vaccines, given to babies, has remained consistently high.

Doctor and nurse shortages on wards cause thousands of NHS deaths a year

Shortages of doctors and nurses on hospital wards are likely to cause thousands of deaths a year, a new study has suggested.Doctor and nurse shortages on wards cause thousands of NHS deaths a yearResearchers found that patients were almost 10% more likely to die when there were fewer medically-trained staff available.

It is thought that those being treated in overstretched hospitals are more prone to developing fatal complications and infections because they are not properly monitored.

The study from the University of Southampton and Imperial College London looked at almost 70 million records of patients who had surgery between 1997 and 2009.

Researchers calculated how many had later died of complications including pneumonia, bladder infections or blood clots – conditions which could normally be treated if detected early but if not properly monitored could be fatal.

They found that across the NHS every year around 28,000 patients died as a result of complications which might potentially have been cured.

The study, published in the International Journal of Nursing Research, also considered data on the numbers of doctors and nurses on all wards.

It found that patients were 9% more likely to die if there were fewer doctors than average, and 8% more likely to die if there were fewer nurses.

It also showed that patients on wards where there were more untrained workers such as healthcare assistants were 10% more likely to die.

Professor Peter Griffiths, who led the research, said that while some very frail patients would have died regardless of the standard of treatment, a high proportion were probably due to poor care.

He said: “The suspicion is that poor care is a very plausible explanation in a lot of these cases. If a hospital responds with the best possible care, the consequences of that complication should be less. If you do not have enough staff, they cannot provide good care.”

The results will cause concern because many debt laden hospital trusts have been axing nursing posts or imposing recruitment freezes, with thousands cut in the last two years.

Number of children with asthma admitted to hosptal falls since smoking ban

The number of children with symptoms of asthma who have been admitted to hospital  has fallen since the ban on smoking in public places came into effect.Number of children with asthma admitted to hosptal falls since smoking banResearch shows there was a 12.3% fall in admissions in the first year after the law came into place in July 2007, and these have continued to drop in subsequent years, suggesting that the benefits of the legislation were sustained over time.

NHS statistics analysed by researchers at Imperial College London showed the fall was equivalent to 6,802 fewer hospital admissions in the first three years of the law coming into effect.

The findings Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England have been published in the journal Pediatrics.

Asthma affects one in every 11 children in the UK.

Before the ban was implemented, hospital admissions for children suffering a severe asthma attack were increasing by 2.2% per year, peaking at 26,969 admissions in 2006/07.

The findings show the trend reversed immediately after the law came into effect, with lower admission rates among boys and girls of all ages, in both wealthy and poor neighbourhoods and in cities and rural areas.

Previous studies have shown that hospital admissions for childhood asthma fell after smoke-free legislation was introduced in Scotland and North America.

The smoking ban in England has also been found to have reduced the rate of heart attacks.

Dr Christopher Millett, from Imperial College London’s School of Public Health, led the study.

He said: “There is already evidence that eliminating smoking from public places has resulted in substantial population health benefits in England, and this study shows that those benefits extend to reducing hospital admissions for childhood asthma.

“Previous studies have also suggested that the smoke-free law changed people’s attitudes about exposing others to second-hand smoke and led more people to abstain from smoking voluntarily at home and in cars.

“We think that exposing children to less second-hand smoke in these settings probably played an important role in reducing asthma attacks.

“The findings are good news for England, and they should encourage countries where public smoking is permitted to consider introducing similar legislation.”