NHS Scandal

[Brian Ellis]

http://news.bbc.co.uk/2/hi/health/5172346.stm

I am aware of this because of the treatment or lack thereof received by friends.

1. a 70-y.o. patient with massive coronary infarction. Taken into ER and discharged the same day, after being seen by a cardiologist, with a bottle of aspirins and the urgent need for bypass surgery. He was admitted for a quadruple bypass 6 months later.

2. a 61 y.o. complained of lower abdomen pains, nausea etc. GP referred him and was told he had IBS and given some mebeverin hydrochloride pills. No improvement. Tests done after 3 months. 5 month wait for results. Dx: cancer of the caecum. Laparotomy of the caecum 4 weeks later, thankfully successful and he is currently "in remission" after 1 year. Time from 1st visit to doc to operation ~13 months. He is lucky there was no apparent metastasis in that time.

3. elderly woman (distant relative of my wife) with emphysema probably provoked by heavy tobacco use. Routine X-ray. Results 3-months later showing cancer of a pulmonary lobe. Inoperable because her emphysema had caused cardiac problems and she died the following year. Her death certificate stated heart failure aggravated by emphysema and cancer. I don't suppose that a quicker Dx of the cancer would have made any difference, but that is not the point.

Compare that with my own experience in Switzerland. Urologist suspected prostate cancer. Battery of tests done the same week. Results same week. probable confirmation. Following Tuesday transurethral biopsy done. Thursday, the results of the biopsy were confirmed. Following week: discussions with various docs as to course of treatment. Radiation decided, but had to wait 3 weeks for the biopsy lesions to heal. In the meantime, I was measured, tattooed and the jig/screen made. Time from suspicion to start of treatment: 5 weeks (would have been 3 weeks if I had opted for surgery).

[ND66]

The BS goes around everywhere:

Cost Of Cancer Drugs Skyrocketing

NEW YORK, July 12, 2006
--------------------------------------------------------------------------------
(CBS) For cancer patients, there's good news and bad news: many more drugs to call on as tools to fight the disease, but, at prices that rose 15 percent last year – five times faster than prices for other prescription drugs.

"I'm worried that the cost of cancer care is spiraling out of control," says Dr. Leonard Saltz, one of the nation's top cancer specialists, who sees a crisis looming for patients who may find themselves unable to handle the added cost.

At the same time, some drug companies are chalking up noticeably larger profits.

Genentech, the maker of the cancer drug Avastin, reported record earnings growth Tuesday, checking in with an increase of a stunning 79 percent.

Wall Street Analyst Geoffrey Porges says the key driver for the improved earnings "is the cancer drugs. And what's keeping those cancer drugs going so well – well, part of it is the pricing."

CBS correspondent Trish Regan reports Avastin, for example, costs $4,400 for a one month prescription; Erbitux, from Bristol-Myers Squibb, costs about $10,000 a month.

The pharmaceutical giants say the cost of developing and marketing the drugs, and not their ingredients, are the cause of their painful price tags.

Some of the most expensive prescriptions extend a patient's life by a few months or a year.

"That's really the crux of the problem," says Dr. Leonard Saltz, of Memorial Sloan-Kettering Cancer Center in New York. "For a modest improvement, there's a huge increase in cost."

The industry defends its prices, arguing that while new medicines come at a cost, they remain a very small part of total health spending and a very big part of improving cancer patient's survival chances.

"You can argue that they were the ones that took the risks, committed all the resources," says industry analyst Geoffrey Porges of Sanford C. Bernstein & Co. "But I think there's just a little bit of to and fro about what's reasonable... We're definitely on a collision course."

[Umfriend]

Let those who criticise the NHS, look at their own health organisations. If they find no negligence, waste, incompetence, mismanagement or other issues, then, yes, they can start criticising the NHS. Otherwise, shut up!

[GNEP]

All anecdotal evidence, Brian, so unfortunately doesn't count for much

However, given where I am currently playing with spreadsheets, I can say with some degree of confidence that you should not believe ANY stats or key performance indicators published by the NHS/DOH. Things will be (duh!) completely different in reality from the picture painted by the officials. Political spin goes too deep and the willingness to think of the message first and come up with some essentially random numbers to fit later is to be honest disgusting.

I have had to put my foot down on more than one occassion (the tacit threat being to leak to the press), and have been pushed to losing my temper with a fairly senior civil "servant" not too long ago. Luckily I had a pet professor on my side so I got my way. Doesn't always happen though, and I seem to be in the utter minority when it comes to sticking up for an "honest" approach to information that goes into the public domain. Perhaps because I am in the very fortunate position of them needing me more than I need them (i.e. I couldn't give a fig if they terminate my contract ) For those that actually value their job however I can see how this behaviour occurs all too easily.

Makes it all the more worrying that such a large proportion of the electorate is now either directly or indirectly in the employ of the gov.

Sorry - got a bit off-topic there. But I'm bored and fancied a rant

[ND66]

Let those who criticise the NHS, look at their own health organisations. If they find no negligence, waste, incompetence, mismanagement or other issues, then, yes, they can start criticising the NHS. Otherwise, shut up!

As I said, The BS goes around everywhere.

[Brian Ellis]

All anecdotal evidence, Brian, so unfortunately doesn't count for much

I agree the 3 cases I describe are anecdotal, but they confirm what the BBC (who presumably researched, at least to some extent, what they published) say. If just one avoidable death is caused by delays in the procedures, that is one death too many.

Umf: don't start me on the local NHS, which is about as incompetent as can be (worse than the UK), but I've not heard of unnecessary delays in test results or treatment. However, I did describe my experience in Switzerland, where I was living at the time I was Dxed with cancer. It is not perfect there, either, but substantial delays are almost unknown.

Anecdote of Cyprus NHS: when I broke my leg, I was taken to ER, X-rayed within 15 minutes, Dxed in a further 5 minutes. Orthopaedist called. He arrived an hour later, looked at the Xrays and started to plaster my leg (which was swollen the size of a football). He told me to come back in 4 weeks. This was on a Friday. Over the weekend, the swelling went down somewhat and my leg felt like a clapper in a bell with almost no support from the plaster. I phoned my GP who told me to go privately to a named orthopaedist, which I did. He changed the plaster, tut-tutting all the time and said that there would be further reduction in the swelling and he would put on a walking cast the following week, when it should have subsided. If I had followed the first NHS guy's instructions, I would probably still be limping with an improperly set bone. Total cost of the private orthopaedist, incl 3 casts: £45 = $90.

So, no, the NHS here is a mockery (mega complaints in paper etc.

[schmosef]

Um, Brian... don't you find this thread, Umf's post, and your response, well... just a 'little bit' ironic?

[Dr Mordrid]

Pure socialized medicine is usually implemented for universal access. Universality is a nice goal, but the cost controlls necessary are often draconian as in Brian's examples. For some patients, such as those over 50-55, they delay treatment hoping the patient will die first.

Harsh judgement? For many of the cases I've seen it's the only reason that would pass Occam's Razor.

This is why so many Canadians flee their oh-so-wonderful system for treatment in the US. Detroit, Cleveland, Minneapolis etc. hospitals are full of 'em and have been for many years.

[schmosef]

I don't know a single Canadian who thinks our health care system is "oh-so-wonderful".

We do all agree that universal coverage is important and that our current system is broken.

Every politician says they have a plan for fixing it but when they get elected they don't implement it.

[Technoid]

Every politician says they have a plan for fixing it but when they get elected they don't implement it.

As one of our braindead swedish politicians once said:
"I cant understand the voters, they seems to think that election promises are meant to be kept"

[Whirl-Secret]

NHS is generally essential, but we all have our stories of woe! I had a football (soccer) injury that left me unable to walk properly and with a 'locked' knee. The Doc at A&E took an x-ray and said there was probably cartilage damage and sent me to physio, 2 months of very painful physio and they said they couldn't help (no improvement at all) and sent me back to the doc. The doc said "no, the physio is working" and sent me back again even though the physio ppl had written to him saying they couldn't help.

I went to my GP and luckily her boyfriend had just gone to a subsided but private sports injury clinic, and those ppl immediately reccomended a private MRI scan. The GP said that all she could do was write to an orthopoedic doctor - which would give 3 months wait for an appointment and then (if he agreed) another 9 months wait for the MRI scan.

So after paying for the MRI scan I was told I urgently needed an operation for torn ligaments, and would end up needing a knee replacement operation and eventually an opposite-site hip replacement operation if I did not do it soon. Asked my parents for some (lots of) money and had the operation, which showed the ligament was torn and stuck up in the joint of my knee - so the physio exercises had been prising my knee apart (I told you it was painful!). The surgeon that operated was horrified that I did not get a scan refferal previously.

Soon after, I had the operation and physio privately and another 2 years later I was able to play football again without pain.

My personal moral of the story? NHS is probably very good for many kinds of treatment, but sports injuries (apart from obvious fractures etc) I really should have insurance for!

[Umfriend]

As one of our braindead swedish politicians once said:
"I cant understand the voters, they seems to think that election promises are meant to be kept"

And it's the politician who is braindead???

[Umfriend]

Umf: don't start me on the local NHS, which is about as incompetent as can be (worse than the UK)

Exactly and therfore I suggest you fix your local NHS first before uttering any criticism of the UK NHS.

I am not quite sure you get what I am on about but it'd help me personally if you'd reflect on this suggestion and its merits.

[Victorian]

Pure socialized medicine is usually implemented for universal access. Universality is a nice goal, but the cost controlls necessary are often draconian as in Brian's examples. For some patients, such as those over 50-55, they delay treatment hoping the patient will die first.

Harsh judgement? For many of the cases I've seen it's the only reason that would pass Occam's Razor.

This is why so many Canadians flee their oh-so-wonderful system for treatment in the US. Detroit, Cleveland, Minneapolis etc. hospitals are full of 'em and have been for many years.

I call bullshit. There is no 'delay of treatment hoping that the patient dies first.' in Canada. Hell, I know people that are in their late 80's getting cancer treatments/operations, hip replacements and so on.

annecdotal? yes, but I guarantee that if any such 'policy' was in place there would be rioting in the streets of every Canadian city/town.

[Dr Mordrid]

Canadians are too nice to riot. They just mortgage the house and come to Detroit etc. to get their MRI's, heart caths, bypasses etc. Worked on them myself on a daily basis, and my still-working compatriots tell me nothing has changed.

Dr. Mordrid