In the spring issue of the Fabian Review, much space is dedicated to the topic of healthcare. The leading article claims its YouGov poll demonstrates that “people love the NHS for all its flaws" and that “there is still considerable support for further spending". It shows nothing of the sort. What it actually shows is that people are despondent and disappointed with the NHS.
The “considerable support" that the Fabians assert is not evident. Asked to choose between the statements: “The government should continue to increase the levels of funding, and increase taxes if necessary to pay for it" and “The NHS receives enough money and should use it better," only 38% of respondents agreed with the former statement, whereas 50% of respondents agreed with latter. Hardly a ringing endorsement.
These statistics are also slanted towards the left of the political spectrum. The respondents chosen came in equal quantity from Labour, Liberal Democrat and Conservative supporters. The local elections and the Crewe and Nantwich by-election make clear that there are far more Conservative than Labour supporters out there at the moment.
From the poll it is clear that people are still ideologically attached to the idea of healthcare free at the point of need. As such, this may be the only politically viable option for any party. However, it is still possible to unleash the power of enterprise and innovation in healthcare, and as luck would have it, we have produced a number of publications explaining just how this can be done.
The past two days have certainly been heated ones in Parliament. MP’s have been voting on amendments proposed to the Human Fertilisation and Embryology Bill. On Monday, I attended an event held by the Progress Education Trust entitled Half-truths? The Science, Politics and Morality of Hybrid Embryos.
Three panellists debated the topic: John Burn, Clinical Geneticist at Newcastle Hospitals NHS Foundation Trust and Professor at Newcastle University, (in support of the embryos); Josephine Quintavalle, Co-founder of Comment on Reproductive Ethics, (against); and Brenda Almond, Emiritus Professor of Moral and Social Philosophy at the University of Hull, (explaining the ethics of the bill).
Several examples why “closing some roads" would harm science in the future were provided from the audience:
IVF was highly debated in the past and is now a common technique for many people.
Organ transplantation initially provoked much public scrutiny, but today many people benefit from this practice.
Not enough adult stem cells could be obtained to replace the amount of tissue harmed by a heart attack affecting 25% of the left ventricle.
Far more animal DNA would exist in a human with a heart valve replacement supplied from a cow or pig than these cells would have if grown into a heart valve.
Only the mitochondria (energy providers for the cells) in the cell contain any animal DNA.
This issue was about a small clump of cells in a dish that will be prevented from becoming a full organism at day 14.
Ms. Almond described old definitions and proposed these ‘embryos’ be called “pseudo embryos", as they are not true embryos. Ultimately, this debate was less about the embryos and more about the government telling scientists what they may or may not do. Luckily MP’s recognised the need not to close the book on this topic. My favourite quote from the evening was from Prof. Burn comparing stem cells with replacing tires on his car: “ I don’t want retreads (adult stem cells), I want new ones (embryonic stem cells)!"
For a very long time doctors who worked with drug addicts have stated that addiction to illicit drugs like heroin is not stronger than that to legal drugs like cigarettes. But this message has not reached the public and has therefore not prevented the emergence of a huge therapeutic bureaucracy, which ironically – at least according to my experience in Germany – has provided jobs for ex-junkies.
Theodore Dalrymple analyses this therapeutic community in his new book Junk Medicine: Doctors, Lies and the Addiction Bureaucracy, which is dedicated to the war against withdrawal symptoms. He thoroughly debunks the disease model of addiction claiming that we should be really talking about a moral and spiritual problem requiring changes in behaviour. Based on U.S. government survey data among others the book provides plenty of examples contradicting the prevailing wisdom about addiction:
Just as with smokers the vast majority of people who try heroin either never use it again, use it just a few times, or only use it intermittently.
Even among heroin users, the heroin addict is the exception.
Experiments have shown that withdrawal symptoms were eliminated with placebo injections of saline solution.
Histrionic addicts…who complain of horrible discomfort in the presence of doctors…to obtain narcotics but act normally both before the visit and after.
Patients who repeatedly receive large doses of narcotics for pain... rarely become addicted.
Dalrymple has plenty of experience in this field since he had been working as a prison doctor in northern England. Dalrymple’s book offers some hope and a good opportunity to rethink our hugely expensive, mostly unsuccessful therapeutic addiction regimes.
If you buy Junk Medicine here from our online bookshop, you can get it for just £11 – £4 off the retail price.
Healthcare is going to feature prominently in upcoming debates in the exhaustive race for the US Presidency. Despite their war of words, Senator Obama and Senator Clinton differ only in rhetoric in their disastrous plans to provide government-run healthcare. However, between Democrat and Republican the difference between the two candidate's healthcare plans will be stark. Either Democrat would likely create an inefficient and improvident behemoth, while McCain suggests innovative market based solutions, putting individual choice at the centre of healthcare.
In Fortune, Shawn Tully extrapolates the essence of what it is that makes the McCain’s healthcare plan so good. McCain's system will ultimately separate employment and healthcare by taxing the previously exempt corporate benefits. This extra tax will be covered by a federal tax rebate of $2,500 for individuals and $5,000 per family. With employers no longer paying for healthcare, the benefits will be passed on to the employees in higher wages. Individuals would then be free to invest in Health Savings Accounts (HSAs), allowing bespoke insurance plans that suit their stage in life. As Tully remarks: "In essence, McCain wants to create a kind of national insurance market that shoves more decision-making power into the hands of consumers."
Reading McCain's speech inspires confidence in the Arizona Senator. He rightly believes that the "key to real reform is to restore control over our health-care system to the patients themselves." The whole plan is modelled upon opening up competition: Millions of Americans would be making their own health-care choices. Politicians in the UK are also talking of patient choice, freedom and competition. However, such talk is disingenuous given the near unanimous defence of the NHS. Is it too much to ask for a bit of joined up thinking over here too?
In our Omega Project report back in 1984, we argued that GPs - Britain's family doctors - shpuld expand their practices to include diagnostics (like x-rays), outpatient services, even small operations. Well, at last the politicians have got the idea. Suddenly, up are springing 'polyclinics'.
The belief is that groupings of maybe 20-30 GPs mean patients can enjoy longer opening hours, a wider range of expertise, and a more comprehensive service. Buildings and equipment can be worked more efficiently, and back-office costs spread more thinly across the larger number of doctors.
Many advanced countries have had similar arrangements for decades. It hasn't happened in the UK because our health system is so politicized and ruled by vested interests. Nobody can ever agree on change, so it doesn't happen.
It's happening now - though some of the new polyclinics are simply replicating the facilities of nearby hospitals, rather than replacing or rationalizing things. With any luck, though, the extension of private-sector money and management, creeping up the system from primary care into activities that have traditionally been done in state hospitals, will revolutionize things. At a Cambridge Health Network meeting on this the other day, it was amazing how many NHS stalwats used the word 'market' - and as something they should be following, not resisting. I'm not sure thay quite understand what the 'market' is yet, or how quickly the chill wind of competition can sweep away an existing order. But, just maybe, the wind is getting up.
If you picked up the Daily Mail this week and came across this article you may have been quite cynical. Glass, in bones, that heals? They must be joking! Well, no, it is true. Scientists at three English universities (Imperial College London, University of Kent, and Warwick) are working together to develop just that – a glass to heal bones.
Now, before you go thinking they’re crushing up windows and putting them in people, glass can be (simply) defined as: a brittle, transparent solid made from silica without a crystalline molecular structure. Back in the 1969, Larry Hench developed BioGlass (pictured left), after being challenged by a US colonel to help Vietnam War vets with devastating injuries. BioGlass was the first man-made material to bond with living tissues, and has many uses today, including dental, middle ear implants, and orthopaedic applications.
In patients where grafts are necessary, often there is little spare bone to graft from one place to another. Animal grafts or bone from donor banks introduce immune responses, and require lots of medication to prevent rejection. This research aims to eliminate that need altogether.
Today, scientists are working on improving this glass, making it more bioactive and like the shape of trabecular bone. Researchers at Imperial College were the first to take BioGlass and make it into a 3-D porous structure. The improved shape allows cells to grow and form tissue, while providing strength and support like native bone.
When implanted, these bioactive glasses gradually release necessary ions, such as calcium and phosphorus, stimulating the bone to mend itself. They are also biodegradable, and slowly break down as the bone re-grows, preventing a loss of strength while repairing. These glasses are now being combined with other materials on the nanoscale, widening their potential applications in the body. These implants have the potential to greatly improve patients’ quality of life and change the future of medicine.
96. "Private sector health and education cream off the very best in resources and personnel from the state sector."
When people pay for private health and education, they save the state money because it no longer has to provide facilities for them. Furthermore, the money they spend for themselves means that the total expenditure on health and education is increased. And because the private sector has to be responsive to what consumers seek, it gives the public sector some idea of what it is that people want. It is not true that it drains away state service personnel; only a tiny fraction of those going to work in private healthcare come from the state sector.
Private health and education do not take resources away from the public sector; they give it more to spend per head. They may, by providing more flexible conditions, attract some of the most talented personnel. But they also improve conditions in the state sector by taking away some of its workload; and there may always be those who prefer to work in the state sector. Machines bought for use in private medicine increase the total supply of health equipment and the supply of equipment per head for the population. Their use enables waiting times for NHS equipment to be cut.
The private sector often acts as pacemaker for the public sector, making advances in services and techniques which the public sector can follow. Some of the innovative treatments are available first in the private sector, and spread over into the state sector once their value and efficacy have been established. In both health and education it is not so much the financial rewards which draw people to the private sector; it is the attitudes and conditions they find there. The weight of bureaucratic compliance and the endless form-filling are absent, and personnel have more time to interact with those they are serving. The parallel private services do not undermine the state services; they bring about their improvement.
I'm suffering from an overdose of headlines again.
This time, the scare is vitamin tablets. A Copenhagen University among 230,000 people, we're told, says that taking vitamin pills might not do you any good and might actually do you positive harm. Really?
Well, I'm no biochemist, and not even in the pay of any pill producers. But the headline sounded pretty daft to me. And I've never really trusted Danish science after the way they beat up Bjorn Lomborg so mercilessly instead of getting to grips with his arguments. Yet the story was so well-spun by its promoters that I had to read quite a long way down the coverage before I could get a balanced picture.
It took a lot of reading to discover that even the spinners of this story aren't saying that a daily multivitamin pill will do you any harm. They're talking about people taking really big doses of a single supplement - Vitamin A, E, C, Beta-Carotene and Selenium. I discovered that the researchers had started by reviewing 815 (some reports say just 467) clinical trials. But a lot of these were studies on very sick people, whose experience is probably not very relevant to the rest of us. Then, it seems, the reviewers eliminated all but 68 because they showed no deaths. Yes, well that would skew things a bit, wouldn't it? By the time they had eliminated the Selenium studies (which showed a reduction in deaths), they were down to less than half a dozen studies, on which the scary headlines are based.
Well, scary headlines sell newspapers and a balanced appraisal of complicated science doesn't. Ask Bjorn Lomborg.
Here's an idea. Give patients in Britain's state-run National Health Service (NHS) their own healthcare budgets. Then they would be able to buy in the treatment they want, from whatever source they choose, rather than having to put up with the decisions of some distant central bureaucracy. Most patients, especially those with long-term conditions, know what kinds of treatment work best for them, so aren't they best placed to decide their own treatment regime anyway?
You might think this idea is just another rant from the swivel-eyed market zealots of the Adam Smith Institute. But no, it comes straight from Britain's government – a Labour government. Health adviser and clinician Lord Darzi (pictured) wants tens of thousands of patients with diabetes, multiple sclerosis and motor neurone disease to get their own budgets.
I welcome this move. We've long believed that patients, or at least their family doctors, should be in charge of the money that is spent on patients – and that politicians, the Department of Health, and local officials should not be. Then perhaps care might be delivered to serve the needs of patients, rather than for the convenience of bureaucrats. That was where the NHS was heading before it went up a lengthy statist siding under Health Secretary Frank Dobson MP in 1997. So awful was that experience that Labour reformers have been trying to get it back on track ever since. But of course, nobody can admit that Mrs Thatcher's GP-budgets policy was in fact on the right lines.
So, direction-changing as it is, the new initiative is as typically cautious and – well, bureaucratic – as you would expect from a highly centralist administration. It's limited to folk with these very long-term conditions. And they won't get cash to spend, nor anything like it – a new voucher scheme is imagined. (And I can well imagine all the bureaucracy that will go along with that.) I really do wish that our leaders could simply admit that their former Health Secretary made a mistake, apologize for the billions of wasted taxpayers' money that has been thrown at trying to correct it, and agree that patient- or GP-centred budgeting is indeed the best direction of travel for UK healthcare. Don't you?
A New York Times article by Robert Pear reports on a US government research finding that the there is an widening socio-economic disparity in life expectancy, as well as in income levels. Not only has the income gap been widening, but the number of years that affluent people can expect to live is moving further ahead than those expected by poorer people. Tim Worstall discusses the findings on his own site.
The trend has happened despite federal attempts to narrow the gap. It has widened between income groups, social classes and ethnic divisions. In two decades the gap between top and bottom had widened from 2.8 years to 4.5 years.
The gaps have been increasing despite efforts by the federal government to reduce them. One of the top goals of "Healthy People 2010," an official statement of national health objectives issued in 2000, is to “eliminate health disparities among different segments of the population," including higher- and lower-income groups and people of different racial and ethnic background.
Several possible reasons are advanced as possible explanations for the widening gap. Richer, better educated people are more likely to know about and take advantage of the latest discoveries in the treatment of cancer and heart disease. They are less likely to smoke, and more likely to have regular check-ups and screenings. More of them are covered by health insurance, and they are more likely to be well-informed about the importance of diet, exercise and healthy lifestyles.
Tim asks whether anyone thinks gains in life expectancy by the affluent are a bad thing because they increase inequality. Some people express the view that general gains in affluence are bad if their corollary is greater inequality of income. Do they take a similar view on life expectancy? There's a different view, though. In many areas, including education, some experts claim that the easiest way to improve the average is to pull the tail up; that is, to concentrate on improving the standard of those at the bottom. It is at least plausible that the same might be true of life expectancy, and that if the poor can be encouraged and enabled to take the positive actions which the affluent have been doing, the general average will be raised more readily. A general increase in healthy life expectancy seems a worthier goal than greater equality in this area.
In the spring issue of the Fabian Review, much space is dedicated to the topic of healthcare. The leading article claims its YouGov poll demonstrates that “people love the NHS for all its flaws" and that “there is still considerable support for further spending". It shows nothing of the sort. What it actually shows is that people are despondent and disappointed with the NHS.
The past two days have certainly been heated ones in Parliament. MP’s have been voting on amendments proposed to the Human Fertilisation and Embryology Bill. On Monday, I attended an event held by the 
For a very long time doctors who worked with drug addicts have stated that addiction to illicit drugs like heroin is not stronger than that to legal drugs like cigarettes. But this message has not reached the public and has therefore not prevented the emergence of a huge therapeutic bureaucracy, which ironically – at least according to my experience in Germany – has provided jobs for ex-junkies. 
Healthcare is going to feature prominently in upcoming debates in the exhaustive race for the US Presidency. Despite their war of words, Senator Obama and Senator Clinton differ only in rhetoric in their disastrous plans to provide government-run healthcare. However, between Democrat and Republican the difference between the two candidate's healthcare plans will be stark. Either Democrat would likely create an inefficient and improvident behemoth, while McCain suggests innovative market based solutions, putting individual choice at the centre of healthcare.
In our Omega Project report back in 1984, we argued that GPs - Britain's family doctors - shpuld expand their practices to include diagnostics (like x-rays), outpatient services, even small operations. Well, at last the politicians have got the idea. Suddenly, up are springing 'polyclinics'.
If you picked up the Daily Mail this week and came across 
I'm suffering from an overdose of headlines again.
Here's an idea. Give patients in Britain's state-run National Health Service (NHS) their own healthcare budgets. Then they would be able to buy in the treatment they want, from whatever source they choose, rather than having to put up with the decisions of some distant central bureaucracy. Most patients, especially those with long-term conditions, know what kinds of treatment work best for them, so aren't they best placed to decide their own treatment regime anyway?