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Monday, January 9, 2012

Health boss says patients should sue health trust for best drugs

Professor Rawlins, the chairman of the National Institute of Health and Clinical Excellence, said the economic pressure on trusts meant that “completely illegal” decisions were being made to limit the use of expensive drugs.
He told the Financial Times: “I just wish a patient organisation would take a Trust to court for failing to comply.”
Nice has been criticised for ruling against the prescription of expensive new drugs on the grounds that they are not cost-effective.
But Sir Michael told the paper that most of Nice’s recommendations were in favour of prescription and that it was other bodies that blocked the drugs’ use.
Sir Michael criticised the local lists of approved medicines drawn up across the NHS which “second-guess” and sometimes ignore Nice recommendations.

Leading cosmetic surgery group refusing to fund new breast implants

Ministers have agreed to pay for the removal of the French-made silicone products for women who had them on the NHS, and have called on private clinics to acknowledge their “moral duty” to offer the same service.
Although the Department of Health said it would “pursue private clinics with all means at its disposal to avoid the taxpayer picking up the bill”, it confirmed on Friday night that it would help women if their clinic was no longer in operation or refused to care for them.
Officials say the implants – thought to have been fitted in some 52,000 women who wanted larger breasts for cosmetic reasons or after cancer surgery – only need to be replaced if they have ruptured but will also carry out the procedure if the patients are worried about them.
Most independent providers have agreed to provide free surgery for their patients who received implants made by the now-defunct Poly Implant Prothèse – which were filled with non-medical grade silicone intended for use in mattresses – at least one is holding out while another has so far refused to reveal its policy.
Transform Cosmetic Surgery said the Government needed to “accept its responsibility” for the problem as the implants had been approved for use by a watchdog, the Medicines and Healthcare products Regulatory Agency.

More than half of hospital beds cut were for elderly patients

Experts have warned that elderly patients are being discharged too early, putting their health at risk and increasing the likelihood of them being readmitted to hospital.
The full scale of the cuts emerged after a year in which the NHS faced sustained criticism for its treatment of the elderly.
The Daily Telegraph surveyed 172 NHS trusts about how many beds they had closed.
Of the 39 trusts which responded, it emerged a total of 469 hospital beds have been cut since April 2010. Of these, 259 were specifically elderly beds.
According to the latest Department of Health figures, 17% of the 121,000 beds in NHS hospitals are for the elderly, suggesting that managers have deliberately targeted elderly beds for cuts.

Radioactive cream used to treat skin cancer

The therapy for basal cell carcinoma, the most common form of skin cancer, uses a radioactive isotope to kill tumour cells in just half an hour while leaving the skin around it unharmed.

Although it has not yet been approved for use, a study of 1,000 patients in Rome found it completely removed tumours in 95 per cent of patients with just one treatment.

Larger trials have been set up in Germany with the intention of bringing the therapy to the market.

Basal cell carcinoma is caused by exposure to harmful UV rays from natural light or sunbeds and accounts for about 80 per cent of all skin cancer cases, or 90,000 cases a year in Britain.

It not normally metastatic, meaning it does not spread through the body or pose a threat to life, but the routine treatment is surgery which although effective can leave unsightly scars.


In some cases, for example where the tumour is on the face, there are alternative ointments and light-based therapies but most are only suitable for lumps which do not penetrate too deeply into the skin.

Now researchers say they have developed a new cream using rhenium-188, a radioactive isotope, which can kill even deep tumours without side-effects in the vast majority of cases.

A base layer applied directly onto the skin protects healthy cells from the radioactive element, which sits on top of the base where it can irradiate the skin below and shrink the tumour.

It could dramatically improve the quality of life of patients who could otherwise require skin grafts and face serious scarring as a result of surgery, researchers said.

Dr Ulli Köster, a researcher at the Institut Laue-Langevin (ILL) in Grenoble, France, where the radioactive material is produced, said: "Typically this disease is treated by surgery, and since it doesn't metastase this is usually OK.

"But the problem is if the tumour is on the face, on the nose, ear or somewhere, it is strongly disfiguring – someone can have a big scar or lose half of his face.

"This is a localised radiation therapy which in more than 95 per cent of cases a single treatment is sufficient to make the cancer go away."

Dr Maria Gonzalez, a dermatologist based at Cardiff University, said: "It is very specific types of patients who would choose this treatment.

"It would be very useful to have as an alternative to surgery. Sometimes if the tumour is very large, especially on the face, or the patient is elderly then it is not a reasonable approach to excise it (cut it out)".

Martin Ledwick, of Cancer Research UK, added: "I would imagine we are not talking about a major breakthrough but another option. It is nice to have a menu of different options for people, particularly with things that can have a cosmetic impact."


Sleep apnoea and trying to overcome the snoring it causes

I’m always keen to learn of people’s subjective experience of a treatment or procedure that raises doubts about its usefulness. Many will have heard of the disorder known as obstructive sleep apnoea, whereby breathing is interrupted during the night. Its two main knock-on effects – stentorian snoring and chronic exhaustion – can be eased by surgery to the back of the throat.

But some sufferers are understandably not very enthusiastic at the prospect, so opt instead for a CPAP (continuous positive airways pressure) device, which involves wearing a face mask at night through which air is pumped to keep the airways open.

Last year, Danish medical researcher Peter Gotzsche – who likened his snoring to “the roar of a ferocious animal” before a kill – was keen to give it a try. “When it started, it blew me up like a balloon,” he writes in the British Medical Journal. “It was very unpleasant, and after a while my throat dried out.” He consulted the 100-page manual that came with the device, but was unable to locate the relevant passage that would allow him to turn the pressure down.

The following night was no better, at which point he decided to read the manual thoroughly. To his dismay, he found buried in the text a warning that there was no guarantee that the CPAP device might not be lethal.

“I decided any inconvenience of my condition did not justify the risk of dying of the treatment,” he said.

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