NICE conflicts of interest call doctors claim

Doctors are calling on MPs to investigate potential conflicts of interest at the health spending watchdog NICE.

NICE conflicts of interest call doctors claimIn a letter to the Health Select Committee, they have expressed concern about financial ties to drug companies among experts working for NICE- the National Institute for Curbing Expenditure.

The concerns follow controversy over the recent NICE guideline on statin drugs.

The letter reflects continuing disquiet among some doctors and researchers over the recent decision by NICE to extend the availability of cholesterol-lowering drugs to millions of people at low risk of developing heart disease.

A majority on the NICE panel that recommended this had ties to pharmaceutical companies. Their interests were declared but the letter argues that is not enough to ensure impartiality.

“Transparency is important but accuracy and objectivity should be the gold standard expected of an independent panel,” it says.

The letter argues disclosure of a conflict of interest may even make matters worse because experts may feel “licensed” to emphasise their advice still further.

NICE rules stipulate that members of advisory committees should not have had a personal financial interest in a related company in the last 12 months.

One of the letter signatories, the former Conservative shadow health minister Lord Ian McColl, said this was dubious.

“They could have had millions paid before the 12 months. It really needs to be tightened up.”

Another signatory, a London cardiologist Dr Aseem Malhotra, urged NICE to act.

“I have always had tremendous respect for NICE but their conflicts-of-interest policy clearly needs to be strengthened so that the medical profession and patients can feel fully confident that decisions are made completely independent of personal or industry interests.”

The letter is clear that there is no suggestion of any impropriety, but it says the governance arrangements for conflicts of interest at NICE are “not fit for purpose”.

It proposes the establishment of “more independent panels” to minimise the possibility of conflicts of interest, and calls on the Health Select Committee to consider looking into the issue “as a matter of urgency”. They will discuss the matter later today.

In June, a letter supported by many of the same signatories argued that plans to extend the use of statins should be scrapped. It said NICE had used data which “grossly underestimated” the side-effects.

NICE wants to limit TV watching

Adults and children should consider having TV free days or limiting viewing to no more than two hours a day under new proposals to tackle obesity.

NICE wants to limit TV watchingThe National Institute for Curbing Expenditure (NICE) recommendations also include avoiding drinks with added sugar and limiting takeaways.

The draft guidance- the first on the subject since 2006, is aimed at helping people maintain a healthy weight.

Obesity rates have nearly doubled over the past 10 years in England.

Prof Mike Kelly, director of the Centre for Public Health at NICE, said a healthier diet and being more physically active was important for everyone not just those who were already overweight or obese.

“The general rule for maintaining a healthy weight is that energy intake through food and drink should not exceed energy output from daily activity,” he said.

“We all know we should probably take the stairs rather than the lift, cut down on TV time, eat more healthily and drink less alcohol. But it can be difficult to know the most useful changes that we can make in terms of our weight.”

The guidelines make a number of recommendations that aim to ensure the advice given about maintaining a healthy weight is more specific and based on real evidence.

There are also new recommendations encouraging people to monitor their weight and activity levels, using apps or regular weigh-in sessions.

The draft suggestions include:

  • Walking or cycling to school or work
  • Reducing TV viewing with strategies such as TV-free days or setting a limit of no more than two hours a day in front of the TV screen
  • Cutting down on calorific foods, such as fried food, biscuits, sweets and full-fat cheese
  • Adopting a Mediterranean diet high in vegetables, fruit, beans and pulses, whole grains, fish and olive oil
  • Avoiding drinks sweetened with sugar, including fizzy drinks, sports drinks and squash
  • Limiting the amount of fast food and takeaways
  • Limiting the amount of alcohol consumed, as alcoholic drinks are a source of extra calories

Last month, health leaders called for an emergency taskforce to be set up to tackle childhood obesity in England.

In an open letter to the chief medical officer for England, Prof Dame Sally Davies, they said “an entire generation is being destroyed by a diet of junk food and sugary drinks”.

And last week, the head of NHS England, Simon Stevens, said obesity was “the new smoking” in terms of the impact on health and the cost to the NHS- which Health Direct posted at: Obesity is new smoking says NHS boss

Dementia care patchy- quango finds

The standard of care provided for people with dementia is “patchy”, the National Institute for Curbing Expenditure (NICE) has said. Dementia care patchy- quango findsSome people with the condition were not getting even basic levels of care, it added.

The warning came as NICE unveiled new standards for dementia care in England, covering issues such as housing and access to leisure services.

Care services were playing “catch-up” on dementia, it said.

The guidance is the first to be produced by NICE under its new extended remit.

To date, the organisation has focused on issuing recommendations about NHS treatments and encouraging healthy lifestyles.

But under the shake-up of the NHS, it now has responsibility for providing guidance on care and support provided by the likes of councils and care homes.

NICE’s dementia guidance includes 10 standards it wants the care sector to follow.

One calls for people with dementia to live in housing that meets their needs, while another says they should be given the support they need to access leisure activities.

Others focus on keeping patients involved in community life and ensuring they get access to services such as dentists and opticians.

NICE deputy chief executive Prof Gillian Leng said: “The general picture is that care is patchy.  We know that it is really good in places but it’s not consistent.  My personal view is that we are all playing catch-up because the number of people with dementia has been increasing so dramatically.”

Currently about 670,000 people in England are living with dementia but one in three over the age of 65 are expected to develop the condition.

George McNamara, of the Alzheimer’s Society, said people with the condition were being denied the quality of life they deserved.

“These standards will be a useful tool for the care sector and show what people with dementia and carers should be able to expect,” he said.  “But, as they are not mandatory, it’s a case of ‘wait and see’ as to whether this guidance will drive real change or just sit on the shelf.”

Low vitamin D levels need preventative action

There is growing awareness about the importance of the “sunshine vitamin” – vitamin D – for you health.Low vitamin D levels need preventative actionLow vitamin D levels need preventative action, but Professor Mitch Blair, from the Royal College of Paediatrics and Child Health, says more action is needed – potentially including fortifying more foods and even cutting the cost of the vitamin to make it more easily available,

Vitamin D is an essential nutrient that contributes to healthy, strong bones and helps to control the amount of calcium in the blood.

Unlike many other vitamins, getting your recommended daily amount of vitamin D is not that easy.

The main source is sunlight; but with short days, long nights and limited sunlight even during the summer, it’s not easy to get your fix that way.

Vitamin D can be found in some foods such as oily fish, eggs and mushrooms – but only 10% of a person’s recommended daily amount is found naturally in food.

Put bluntly, eating more fish and getting out in the sun a bit more won’t make much of a difference to your vitamin D levels.

Unfortunately, there is limited national research on the true extent of vitamin D deficiency in the UK population.

But we do know that there has been a four-fold increase in admissions to hospital with rickets in the last 15 years and that some groups are more ‘at risk’ than others – namely children, pregnant women and certain ethnic minority groups.

Pilot studies and regional monitoring suggests that vitamin D deficiency is likely to affect at least half the UK’s white population, up to 90% of the multi-ethnic population and a quarter of all children living in Britain.

A recent study in Australia revealed that a third of under-25% are vitamin D deficient – perhaps surprising in a country blessed with plenty of sunshine.

Vitamin D deficiency has been linked to a range of debilitating diseases in children and adults – including diabetes, tuberculosis, multiple sclerosis and rickets, a bone disease associated with poor children in Victorian England.

Lack of vitamin D is often cited as a contributory factor in broken bones and fractures, with obvious implications for some child protection cases.

Even the National Institute of Clinical Excellence (NICE) recommends supplements for pregnant or breastfeeding women and their children from six months to four years.

The Chief Medical Officer recommends supplements for children up to the age of five and the government’s Healthy Start programme provides vitamins free for people on income support.

Currently, many brands of cereal and orange juice contain added vitamin D which helps boost daily intake.

In the USA most milk is supplemented with vitamin D, which has helped reduce deficiency, particularly in children. The Scientific Advisory Committee on Nutrition is currently looking into this.

We also need to make sure healthcare professionals – including GPs, paediatricians, doctors and nurses – know the signs and symptoms of vitamin D deficiency, but more importantly give appropriate advice to patients who are ‘at risk’ to prevent problems developing.

And it’s important that the public are aware of the implications of vitamin D deficiency, where they can get supplements and how they can boost their intake.


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:

Newborns facing unnecessary delays in treating infections

Some hospitals are causing unnecessary delays in treating newborn babies suffering from infections, the healthcare quango has said.Newborns facing unnecessary delays in treating infectionsThe National Institute for Curbing Expenditure (Nice) has published new guidance after finding variations in the treatment of babies with early onset neonatal infection.

It found delays at some hospitals in recognising and treating sick babies.

Early-onset neonatal infection – within 72 hours of birth – causes the death of one in four babies who are diagnosed, even when they are given antibiotics.

Nice’s recommendations urge medical staff to treat infected babies within an hour of diagnosis and use antibiotics appropriately to avoid the development of bacterial resistance to treatment.

Professor Mark Baker, director of Nice’s Centre for Clinical Practice at Nice , said: “Early-onset neonatal infection can be very serious and, at present, there is much variation in how it is managed, with sometimes unnecessary delays in recognising and treating sick babies.”

“Many babies are receiving antibiotics needlessly, and consequently there is concern that the effectiveness of antibiotics is being reduced because of the development of resistance to them.”

Early-onset neonatal infections, usually caused by organisms passed from mother to baby during birth, include group B Streptococcus (GBS), E.coli, Pseudomonas and Klebsiella.

Infections can develop suddenly and rapidly. Death rates are particularly high in premature babies and low birth weight babies, Nice said.

The infections may also cause babies to develop cortical lesions in the brain, and subsequently cause neuro-developmental delay.

Sue NHS if managers deny approved drugs says NICE

Patients should sue their local health authorities if they deny them drugs deemed cost effective for use on the NHS, the head of the National Institute for Curbing Expenditure (NICE) has said in a excellent example of the pot calling the kettle black.Sue NHS if managers deny approved drugs says NICESir Michael Rawlins, chairman of the killer quango watchdog, said “numerous trusts” were “acting unlawfully” in denying patients Nice approved treatments. Health trusts were wrongly using “delaying tactics” before allowing them, to save money, he said.

Sir Michael urged patients not to stand for such behaviour, saying courts would without doubt side with them.

He made clear his comments in an article for the Health Service Journal about problems many patients were having accessing a Nice-approved treatment, called dexamethasone intravitreal implants, for the common eye condition retinal vein occlusion. Installed every six months, the implants help prevent sight deterioration.

He said: “Quite clearly numerous trusts are acting unlawfully. They are denying patients an innovative and cost-effective treatment, recommended by Nice, that significantly improves their quality of life.

“The reason, of course, is that trusts do not wish to use their resources in this manner. Although they know that are required to make Nice-approved products available, they introduce delaying tactics.”

Disputes between primary care trusts (PCTs) and hospitals over payment meant “many months pass with the arguments going back and forth”, he added.

His advice was that organisations such as the Royal National Institute of Blind People (RNIB) should seek a judicial review in the High Court.

“The court would unquestionably uphold the claim,” he predicted.

However, he added such case would not reach court – the implication being that trusts would quickly back down if threatened with the prospect of costly legal action.

He noted that the NHS Constitution enshrined the patient’s right to Nice-approved drugs “if your doctor says they are clinically appropriate for you”.

The RNIB had found 37 of 125 hospital trusts were either not providing the dexamethasone implants or providing a restricted service.

Sir Michael also said NHS managers should show more allegiance to patients and less to their trusts.

“I want my clinical colleagues to start exercising leadership and ‘whistle-blow’ when their trusts fail to meet their legal obligations,” he said.

Steve Winyard, head of policy at the RNIB, who raised the matter with Sir Michael, commented: “If Nice has done all the detailed work on cost effectiveness then I think it’s inappropriate is for PCTs or hospitals at local level to make decisions that run counter to that.

“Nice doesn’t come to these decisions lightly and it would like to see patients across the county benefit.”

Last autumn it emerged that about a quarter of PCTs were blacklisting more expensive drugs, even if Nice-approved, in favour of cheaper ‘generic’ versions.

In January Andrew Lansley, the Health Secretary, promised to introduce an “effective compliance regime” to end “postcode prescribing” of Nice-approved treatments.

Health authorities often put pressure on doctors not to prescribe certain treatments if there are cheaper alternatives available.

However, health authorities themselves are under intense pressure to use ever more limited resources as efficiently as possible.


Thousands denied IVF because of British red tape restrictions

Thousands of couples in Britain are being denied the chance to become parents because the country has one of the most restrictive policies in Europe when it comes to publicly funding fertility treatment.Thousands denied IVF because of British red tape restrictionsThey were speaking after a study was presented at an IVF conference showing that only Russia and Ireland offer worse access.

At the moment about 13,000 babies are born every year in Britain thanks to IVF and another technique called ICSI, which is mainly used to counter male infertility.

However, the new study indicates that number could be up to three times higher, if our policies matched those of the most generous nations.

Among those with more generous IVF programmes include Slovakia, Montenegro, Czech Republic and Slovenia.

Dr Mark Connolly, an American health economist based at Groningen University in The Netherlands, compared public funding of Fertility treatments and how frequently they was used in 23 European countries in 2008. The UK came third from bottom in terms of reimbursement, and also had among the lowest number of “assisted reproduction technology” cycles per million people.

Europe-wide, he said there was a “highly significant relationship between high levels of public reimbursement and high levels of utilisation”.

For example in Belgium, one of the most generous countries, there were 2,479 cycles per million people. In the UK there were only 825.

Under guidelines issued by the National Institute Curbing Expenditure (Nice), primary care trusts (PCTs) should offer up to three full cycles of IVF – which includes giving hormones that stimulate release of eggs, egg retrieval, test-tube fertilisation, reimplantation of viable embryos and freezing of unused embryos for later use – to infertile women from 23 to 42.

In practice, only a quarter do so, found a group of MPs who looked at provision across England last year. Since then some have tightens restrictions, such as refusing treatment to smokers and the obese, to reduce costs.

Speaking at the annual conference of the European Society for Human Reproduction and Embryology (ESHRE) in Istanbul, Dr Connolly said most English PCTs were “feeble” in their ability to fund three cycles of IVF.

Clare Lewis-Jones, chairman of the National Infertility Awareness Campaign, said: “For thousands of couples here, the dream of having a child of their own remains elusive: many are denied IVF because their PCT or health board is reluctant to fund sufficient treatment.

“We will continue our fight for fair and equitable access to IVF and ICSI on the NHS, a situation that simply does not exist in the UK.  Despite the fact that IVF was pioneered in our country, we are near the bottom of the list in terms of the number of cycles performed.  Those suffering from the disease of infertility have the right to expect the chance to have a healthy baby of their own.”


Obesity a derogatory word claims nanny quango NICE

The word ‘obesity’ could be considered ‘derogatory’ and public health professionals should use it with care, according to the nanny quango NICE.Obesity a derogatory word claims nanny quango NICEA quarter of adults in Britain are now obese, a figure that is due to more than double by 2050. Those from poorer backgrounds are much more likely to be obese than the more affluent.

But a government quango is now advising public health experts drawing up anti-obesity plans around the country to avoid using the ‘obese’ word itself for fear of upsetting people.

Health campaigners have night attacked the softly softly approach, describing it as “extremely patronising”.

Under draft guidance issued by the National Institute for Curbing Expenditure (Nice), those who are obese should merely be encouraged to get down to a “healthier weight”.

The guidance states that public health professionals should know “the appropriate language to use”, advising them: “Referring to ‘achieving a healthy weight’ may be more acceptable for some people.”

The document continues: “Directors of public health and local government communications leads should carefully consider the type of language and media to use to communicate about obesity.

“For example, it might be better to refer to a ‘healthier weight’ rather than ‘obesity’ – and to talk more generally about health and wellbeing or specific community issues.”

Ironically, the advice is contained in a paper that makes no bones about its subject matter: it is called Obesity: Working with Local Communities.

But Nice officials concluded that while the term was fine for health professionals to use among themselves, they should handle it with care in public.

They warned: “The term ‘obesity’ may be unhelpful – while some people may like to ‘hear it like it is’, others may consider it derogatory.”

However, Tam Fry, of the National Obesity Forum, said: “This is extremely patronising. They should be talking to people in an adult fashion.

“There should be no problem with using the proper terminology. If you beat around the bush then you muddy the water.”

Obesity is a medical term, defined as having a body mass index (BMI) of 30 or more. BMI is calculated by dividing one’s weight in kilograms by the square of one’s height in metres.

Mr Fry went on: “Obesity is a well defined, World Health Organisation standard that everybody can understand.”

“It is the point where the individual is so overweight that they are at risk of other health problems.”

Squeamishness over use of the word is not new. When the National Child Measurement Programme was launched in 2008, Department of Health officials decided against using the words “fat” or “obese” in letters to parents. They were simply told their son or daughter was overweight.

Such fears of upsetting people are not shared by Anne Milton, the Public Health Minister. Two years ago she said that people should be told they were “fat” rather than “obese” because she felt the word was more hard-hitting.

She said: “If I look in the mirror and think I am obese I think I am less worried [than] if I think I am fat.”


New IVF postcode lottery meaningless ruling by NICE quango

Gay couples and women over 40 will be entitled to the same free IVF treatment as heterosexual couples on the NHS for the first time under new guidelines published today.New IVF postcode lottery meaningless ruling by NICE quangoSame sex couples will be given the same rights as heterosexual couples under guidance issued by the killer quango National Institute for Curbing Expenditure (NICE).

The NHS will also extend the upper age limit for IVF by three years to 42, following advice that suggests many women in their late 30s and early 40s could conceive after treatment.

Fertility experts questioned whether health authorities could afford to widen eligibility criteria, when only a quarter currently fund three cycles of IVF for infertile couples, as recommended by Nice.

Gedis Grudzinskas, emeritus professor of obstetrics and gynaecology at Barts and the Royal London Hospital, said that while the new guidance reflects “social changes” there were questions over whether NHS trusts could afford it.

“How do we reconcile the changes in society and equality of access to healthcare, with the economic predicament?” he said.

The new guidelines call on health authorities in England and Wales to fund fertility treatment known as intra-uterine insemination (IUI), using donor sperm, for people in same-sex relationships.

The move follows a relaxation in the law, made under Labour in 2008, to put same sex parenting on an equal legal footing.

The recommendation follows implementation of the Human Fertilisation and Embryology Act 2008. It abolished requirement for fertility clinics to take into account a child’s need for a father or a male role model before agreeing to treatment. Gay couples or single women now need only show they can provide “supportive parenting”.

Demand from gay couples paying privately for fertility services has subsequently boomed, say clinics. Official figures show the number of lesbian couples undergoing IVF rose from 178 in 2007 to 417 in 2010.

One cycle of IVF can cost up to £8,000 privately. Because success rates are low – typically 20 per cent for a 38-year-old – couples can spend tens of thousands on treatment.

Meanwhile Josephine Quintavalle, founder of Comment on Reproductive Ethics, described the same-sex move as “absurd”.

She said: “We are not prepared to accept what constitutes fertility from a biological perspective. Fertility treatment is very important but in this case what we are trying to do is rewrite biology.”

Under the Nice guidelines, women aged 40 to 42 deemed to have no chance of conceiving naturally should be offered one full IVF cycle. In this age group one in eight will give birth after one cycle.