Nhs Faces More Cuts To Avoid £10Bn Shortfall, Report Warns

[Kurt Barlow]

They're not neurologists. They're interventional radiologists (they're the doctors who actually do non-surgical procedures on arteries and veins).

And they do treat stenosed head and neck veins on a sporadic basis - but due to the risks of the procedure (estimated at approximately 5% having a potentially serious complication) they need strong evidence of a stenosis - i.e. MRI evidence of a stenosis, symptoms of a stenosis (severe headache, loss of vision, pain behind the eyes) and elevated pressure measurement at lumbar puncture.

When it comes to CCSVI, their view is that the scientific trials to date have shown that CCSVI is present in anywhere between 0-100% (*) of people with MS, and anywhere between 0-100% of normal healthy controls. The general interpretation of such test results is that such wide variability indicates that the test is unhelpful and is unlikely to be detecting a feature relevant to the disease.

(*) - this is the range of results from different trials. E.g. some trials have shown 0% of MS patients have CCSVI, and that some have shown that 100% have CCSVI.

I don't know about naltrexone or BCG, as I'm not a neurologist, and haven't asked a neurologist directly about these. With CCSVI, the neurologists are somewhat less dismissive, and have been pressuring the radiologists to consider performing the procedure (it was pressure from the neurologists that encouraged one of the radiologists to go and get trained in Italy by the guy that invented the procedure).

Maybe one day, after about 10 years of £200 a night hotel conferences Docs and NICE (big Pharma Mafia enforcers) might agree to prescribe these low cost zero risk drugs to MS patients at their request.

Alternatively the Govt could just cut the strangle hold Big Pharma and their tax funded sales people have (Docs) and allow the public to purchase (non controlled) drugs from pharmacies without a script. I can do that here in Saudi.

[aussieboy]

They're not neurologists. They're interventional radiologists (they're the doctors who actually do non-surgical procedures on arteries and veins).

And they do treat stenosed head and neck veins on a sporadic basis - but due to the risks of the procedure (estimated at approximately 5% having a potentially serious complication) they need strong evidence of a stenosis - i.e. MRI evidence of a stenosis, symptoms of a stenosis (severe headache, loss of vision, pain behind the eyes) and elevated pressure measurement at lumbar puncture.

When it comes to CCSVI, their view is that the scientific trials to date have shown that CCSVI is present in anywhere between 0-100% (*) of people with MS, and anywhere between 0-100% of normal healthy controls. The general interpretation of such test results is that such wide variability indicates that the test is unhelpful and is unlikely to be detecting a feature relevant to the disease.

(*) - this is the range of results from different trials. E.g. some trials have shown 0% of MS patients have CCSVI, and that some have shown that 100% have CCSVI.

I don't know about naltrexone or BCG, as I'm not a neurologist, and haven't asked a neurologist directly about these. With CCSVI, the neurologists are somewhat less dismissive, and have been pressuring the radiologists to consider performing the procedure (it was pressure from the neurologists that encouraged one of the radiologists to go and get trained in Italy by the guy that invented the procedure).

You are wasting your time attempting rational debate with a serial anecdotalist and a guy who has a number of issues betrayed by the occasional Muslim comment he can't help but let slip out. I had a botched operation on the NHS but I'd hope to be a bit more rational than to assume that all ops are botched on the NHS.

The vitamin D thread is indeed a good place to get an insight into the level of debate of any HPC science based discussion, but not for the reasons the previous recommender thinks.

Also, never forget the Fifth rule of HPC which states that any NHS discussion will assume that all medics earn $100k and are less intelligent and have less responsibility than anyone working in IT and should be paid buttons for operating on your nuts.

[Xurbia]

You are wasting your time attempting rational debate with a serial anecdotalist and a guy who has a number of issues betrayed by the occasional Muslim comment he can't help but let slip out. I had a botched operation on the NHS but I'd hope to be a bit more rational than to assume that all ops are botched on the NHS.

Priceless, was it brain surgery?

[aa3]

Indeed. The problem is that anytime anyone tries to make any kind of cut, all the pressure groups come out and shout 'discrimination'. The NHS has been very heavily criticised in the past as being ageist, in that it has been reluctant to offer treatments to the elderly even if they would be of benefit.

That was one of the powers of the national health system. In some countries something like 40% of the lifetime health spending is spent in the last few weeks of the person's life. A national health system can provide utilitarian trade-offs. Of course I'm not a communist, I believe there also should be a large private system, and in the private arena people can buy whatever they want.

The thing is, it doesn't matter which population group you look at, you'll always see the same thing. Some people get more ill than others. It may be the more premature child, or the person with a specific type of cancer, or whatever.

That is where you need to empower terrifyingly intelligent bureaucrats who decide how to spend the money. And they decide where to put the bar, based on human judgement of quality of life, cost to society, opportunity cost of the money, etc.. Its deciding life and death, something we are quite uncomfortable with in this nation. For example one severely premature baby might be looking at a lifetime of surgeries and probable death before 5, they might decide not to proceed with surgeries soon after birth. Another baby this time not too premature, has some issues, but with a few surgeries has a realistic chance of a decent life.. they might proceed with surgery.

Unfortunately, everything in the NHS is highly politicised, and the group with the loudest voice tends to get what they want. One of the things that surprised me most, was when an radiologist expert in mammography told me, that it's not known whether the national breast cancer screening program has any effect on breast cancer survival rates. The evidence is contradictory and, as of yet, the question cannot be confidently answered. What was even more interesting was that when the scientific expert panel presented the scientific evidence to the (last) government, the government weren't interested, and simply stated that the project had the full and unequivocal support of the government, and that it should continue.

This is a perfect example of the problems faced in teh NHS. The study in Sweden raised the question of whether mammography is of a net benefit. It appears people are getting small cancerous masses, which come and go, which ordinarily they would never even notice. But when gettng screened once a year, those are found.. and then the system proceeds with the surgeries, possibly chemotherapy, and causes great morbidity to the patient. When it now looks likely on an individual level that the small mass would have gone away by itself.

In light of this new evidence, there is great resistance to stop spending more money in the system. A hell of a lot of people are now emloyed carrying out those proceedures for breast cancer. My personal opinion on this and all other issues, is unless there is a clear and defintitively positive benefit the default position should be to do nothing.

[Inca]

CCSVI & LDN do not have placebo controlled, double blinded studies that prove their effectiveness in MS. If they did have they would be available.

I am not sure what world you live in Kurt but Neurologists and doctors generally enter their professions to help people and would be overjoyed if there was a cure for MS. But they have to ration care as effectively and fairly as possible - wasting money on unproven anecdotal treatments is in no ones interest.

Maybe you should have a think about the mis-allocation of resources that your consumption of interferon encourages - an expensive drug that just does not work.

http://www.independent.co.uk/life-style/health-and-families/health-news/ms-drug-trial-a-fiasco-ndash-and-nhs-paid-for-it-1991104.html

If I was in your position I would be trying to get Campath off-label - that is something that can actually help.

[aussieboy]

Priceless, was it brain surgery?

You should be on the telly.

[aussieboy]

CCSVI & LDN do not have placebo controlled, double blinded studies that prove their effectiveness in MS. If they did have they would be available.

I am not sure what world you live in Kurt but Neurologists and doctors generally enter their professions to help people and would be overjoyed if there was a cure for MS. But they have to ration care as effectively and fairly as possible - wasting money on unproven anecdotal treatments is in no ones interest.

Maybe you should have a think about the mis-allocation of resources that your consumption of interferon encourages - an expensive drug that just does not work.

http://www.independent.co.uk/life-style/health-and-families/health-news/ms-drug-trial-a-fiasco-ndash-and-nhs-paid-for-it-1991104.html

If I was in your position I would be trying to get Campath off-label - that is something that can actually help.

The sweet sound of piss hitting a hurricane.

[Kurt Barlow]

You are wasting your time attempting rational debate with a serial anecdotalist and a guy who has a number of issues betrayed by the occasional Muslim comment he can't help but let slip out. I had a botched operation on the NHS but I'd hope to be a bit more rational than to assume that all ops are botched on the NHS.

The vitamin D thread is indeed a good place to get an insight into the level of debate of any HPC science based discussion, but not for the reasons the previous recommender thinks.

Also, never forget the Fifth rule of HPC which states that any NHS discussion will assume that all medics earn $100k and are less intelligent and have less responsibility than anyone working in IT and should be paid buttons for operating on your nuts.

WTF - does the fact I have a degree of respect for my hosts got to do with this debate????

Secondly wheres the problem in comparing anecdotes - I am not stopping anyone posting their 'good time experiences' with the NHS

[Kurt Barlow]

CCSVI & LDN do not have placebo controlled, double blinded studies that prove their effectiveness in MS. If they did have they would be available.

I am not sure what world you live in Kurt but Neurologists and doctors generally enter their professions to help people and would be overjoyed if there was a cure for MS. But they have to ration care as effectively and fairly as possible - wasting money on unproven anecdotal treatments is in no ones interest.

Maybe you should have a think about the mis-allocation of resources that your consumption of interferon encourages - an expensive drug that just does not work.

http://www.independent.co.uk/life-style/health-and-families/health-news/ms-drug-trial-a-fiasco-ndash-and-nhs-paid-for-it-1991104.html

If I was in your position I would be trying to get Campath off-label - that is something that can actually help.

For one reason - neither are patentable therefore there is no commercial driver to carry out double blinded placebo controlled trials. So unless such trials are publically funded users are indeed reliant upon smaller clinical studies and anecdotal reports. LDN costs next to nothing so it is hardly a misallocation of resources against many examples of what NHS funds are spent on.

I don't dispute the issue of Interferon then again its better than nothing and the NHS ain't paying for mine

As for Neurologists (and Opthalmologists) doing their best - in my case they just looked blank and said come back in January (2011). Not even oral steroids offered let alone the clinical standard of IV steroids for Optic Neuritis.

[Inca]

For one reason - neither are patentable therefore there is no commercial driver to carry out double blinded placebo controlled trials. So unless such trials are publically funded users are indeed reliant upon smaller clinical studies and anecdotal reports. LDN costs next to nothing so it is hardly a misallocation of resources against many examples of what NHS funds are spent on

hmm - so the private sector cannot come up with any support for LDN or CCSVI? I thought the private sector was the answer to all healthcare problems?!

btw - there are a number of publically funded studies taking place into ccsvi - given that publically funded healthcare has much to benefit if it is a proved treatment

You want the nhs to fund totally unproven treatments and you also want it to fund the snake oil crap that you want to pump into yourself. At the same time you rail against other treatments (that at least have a scientific basis)

Hypocrite

[Inca]

As for Neurologists (and Opthalmologists) doing their best - in my case they just looked blank and said come back in January (2011). Not even oral steroids offered let alone the clinical standard of IV steroids for Optic Neuritis.

what?

In the majority of cases treatment for optic neuritis is not indicated.. Systemic steroids can be given which may limit the duration of the episode but have not been proven to affect the eventual level of vision which is achieved. Because of the potential side effects associated with this treatment the use of systemic steroids is usually limited to particular circumstances in optic neuritis where it is important to limit the duration of the episode. For instance, in an episode of optic neuritis affecting a patient with only one functioning eye.

http://www.privatehealth.co.uk/diseases/eyes/optic-neuritis/

Have you done any research at all?

[needsleep]

Private healthcare provides choice, nothing more. In some cases using it in preference to the NHS can be a very poor choice. I would never have any major surgery in a private facility. My missus is in the medical business and knows people who work in private hospitals - they have a standing joke that the emergency number in those places is 999.

[Kurt Barlow]

hmm - so the private sector cannot come up with any support for LDN or CCSVI? I thought the private sector was the answer to all healthcare problems?!

btw - there are a number of publically funded studies taking place into ccsvi - given that publically funded healthcare has much to benefit if it is a proved treatment

You want the nhs to fund totally unproven treatments and you also want it to fund the snake oil crap that you want to pump into yourself. At the same time you rail against other treatments (that at least have a scientific basis)

Hypocrite

Twunt

If you read my post you would have also seen that I suggested that patients be free to purchase non controlled drugs themselves and make an informed choice.

Why shouldnt I be allowed to purchase Naltrexone and make an informed choice. Why do I have to go cap in hand to a Doctor?

Another question for you - are you suggesting that only drugs with a double blind placebo controlled trial for the specific condition should be prescribed?

[Kurt Barlow]

what?

http://www.privatehealth.co.uk/diseases/eyes/optic-neuritis/

Have you done any research at all?

Yes I have and I know thats what happens in Britainistan - zero cost treatment or have an asprin. However in the states and most other countries around the world (according to my American GP, Jordanian, Egyptian, and Saudi Neuro's) this is not the approach and early intervention is seen as key to modifying the course of the disease. I had to recount my experience at Addenbrookes repeatedly to staff at Dhahran hospital who were universally appalled. It is partly based on their responses i have such a negative view of the treatment I recieved.

Not treating ON is simply the NHS method

Edited December 28, 2010 by Kurt Barlow

[Kurt Barlow]

what?

http://www.privatehealth.co.uk/diseases/eyes/optic-neuritis/

Have you done any research at all?

In my case i had quite severe head and eye pain and was really ill. When treated with IV steroids at least the pain went after the first / second infusion (edit - and was able to get on with life, my job etc). God knows where i would have been if I had had to wait until January 2011 :angry:

Edited December 28, 2010 by Kurt Barlow

[xux42]

[/b]

Twunt

If you read my post you would have also seen that I suggested that patients be free to purchase non controlled drugs themselves and make an informed choice.

Why shouldnt I be allowed to purchase Naltrexone and make an informed choice. Why do I have to go cap in hand to a Doctor?

Another question for you - are you suggesting that only drugs with a double blind placebo controlled trial for the specific condition should be prescribed?

Jeepers, thought I droned on about stuff but blimy medics and the ill don't half go on about medical practice.

You'd think health was more important than money and house prices the way they go on...

[Kurt Barlow]

CCSVI & LDN do not have placebo controlled, double blinded studies that prove their effectiveness in MS. If they did have they would be available.

I am not sure what world you live in Kurt but Neurologists and doctors generally enter their professions to help people and would be overjoyed if there was a cure for MS. But they have to ration care as effectively and fairly as possible - wasting money on unproven anecdotal treatments is in no ones interest.

Maybe you should have a think about the mis-allocation of resources that your consumption of interferon encourages - an expensive drug that just does not work.

http://www.independent.co.uk/life-style/health-and-families/health-news/ms-drug-trial-a-fiasco-ndash-and-nhs-paid-for-it-1991104.html

If I was in your position I would be trying to get Campath off-label - that is something that can actually help.

Thanks - how many deaths did that stuff cause in the clinical trials?

[Inca]

If you read my post you would have also seen that I suggested that patients be free to purchase non controlled drugs themselves and make an informed choice.

Why shouldnt I be allowed to purchase Naltrexone and make an informed choice. Why do I have to go cap in hand to a Doctor?

You are free to purchae non-controlled drugs in the UK. LDN is a controlled drug.

Another question for you - are you suggesting that only drugs with a double blind placebo controlled trial for the specific condition should be prescribed?

No

In my case i had quite severe head and eye pain and was really ill. When treated with IV steroids at least the pain went after the first / second infusion (edit - and was able to get on with life, my job etc). God knows where i would have been if I had had to wait until January 2011

Nevertheless there is no standard approach - as you earlier suggested. Just like your horseshit 70% of people treated with ccsvi stat earlier. Sloppy thinking.

Thanks - how many deaths did that stuff cause in the clinical trials?

Would hope you have done the research yourself. There has been one death - due to ITP which is easily monitored and treated.

90% of disease activity in MS is sub-clinical. It slowly eats up your brain and you move from CIS to RRMS to SPMS.

If you want to make a difference to the outcome you treat it as aggressively as possible as early as possible.

If you think your doctors are so great why have they not given you treatment that will help you in the long term? Betaferon / Rebif are not going to make any difference to you.

[aussieboy]

WTF - does the fact I have a degree of respect for my hosts got to do with this debate????

Now, this bit makes no sense.

Secondly wheres the problem in comparing anecdotes - I am not stopping anyone posting their 'good time experiences' with the NHS

And this bit ignores the whole basis of evidence based medicine, which leads us in turn to a world where Mary McKillop becomes a saint for curing three cancers.

[giantbat]

My Primary Physician here is a yank. Inside 2 minutes diagnosed my predicament and got me into Dhahran hospital as an emergency admission. In contrast I had previously been to see my british GP, and 4 ******wit Opthalmologists (at Addenbrookes) all who misdiagnosed me and failed to treat. You are better off visiting an African Witch Doctor than a British Quack.

In Dhahran my Jordanian Neuro, Saudi female neuro, and Eygptian Neuro were brilliant. Lansley should cut Doctors salaries in the UK by 70% - hopefully they will leave and can be replaced by cheaper, better trained foreign docs.

The latest pay proposal to doctors from NHS employers is an 'incremental pay freeze'. Rather than the cost of living pay freeze applied to the rest of the public sector this is actually equivalent to a ten percent pay cut for 2011 and 2012 for most junior doctors. This is after several years of below inflation pay 'rises' and falling banding supplements. Junior doctors are probably entitled to feel somewhat aggrieved - we are now far behind dentists and lawyers and other commensurate professionals. Difficult to know what fair pay should be as a doctor but we continue to be the poor man of the remaining professions.

You condemn all british doctors and the NHS off the back of a single apparent misdiagnosis.Generally if it takes 12 doctors to finally reach a diagnosis you have either been seeing the wrong kind or the disease is bloody hard to diagnose. It is interesting you praise the middle eastern neurologists since the majority will have trained in either the UK or continental US themselves! The NHS has and always will be supported by a large minority of foreign graduates. They are however a mixed bunch and in my experience usually no better trained than home grown graduates with poorer communication skills.

Tough times coming for the public sector in general. It should be cut down to size certainly but I believe (probably selfishly) in a targetted fashion. The current nonsense about cutting everyones pay and conditions whilst leaving a hugely bloated public sector workforce intact is counter productive. Ultimately such a large state is unsustainable. I know one thing 'Kurt' - if you cut my pay by 70% I will certainly leave for warmer climes - my blood is boiling already.

GB

[Bloo Loo]

The latest pay proposal to doctors from NHS employers is an 'incremental pay freeze'. Rather than the cost of living pay freeze applied to the rest of the public sector this is actually equivalent to a ten percent pay cut for 2011 and 2012 for most junior doctors. This is after several years of below inflation pay 'rises' and falling banding supplements. Junior doctors are probably entitled to feel somewhat aggrieved - we are now far behind dentists and lawyers and other commensurate professionals. Difficult to know what fair pay should be as a doctor but we continue to be the poor man of the remaining professions.

You condemn all british doctors and the NHS off the back of a single apparent misdiagnosis.Generally if it takes 12 doctors to finally reach a diagnosis you have either been seeing the wrong kind or the disease is bloody hard to diagnose. It is interesting you praise the middle eastern neurologists since the majority will have trained in either the UK or continental US themselves! The NHS has and always will be supported by a large minority of foreign graduates. They are however a mixed bunch and in my experience usually no better trained than home grown graduates with poorer communication skills.

Tough times coming for the public sector in general. It should be cut down to size certainly but I believe (probably selfishly) in a targetted fashion. The current nonsense about cutting everyones pay and conditions whilst leaving a hugely bloated public sector workforce intact is counter productive. Ultimately such a large state is unsustainable. I know one thing 'Kurt' - if you cut my pay by 70% I will certainly leave for warmer climes - my blood is boiling already.

GB

yep ALL public sector pay should be cut by 50% above 25K..

that includes doctors, lawyers, admins, MPs, PMS, LORDS, LADIES, contractors, CEOs, middle managers, car park profiteers, and PFI contracts suitably adjusted if wages withing THAT organisation are not trimmed in line with their Public Sector Paymasters.

[bogbrush]

hmm - so the private sector cannot come up with any support for LDN or CCSVI? I thought the private sector was the answer to all healthcare problems?!

btw - there are a number of publically funded studies taking place into ccsvi - given that publically funded healthcare has much to benefit if it is a proved treatment

You want the nhs to fund totally unproven treatments and you also want it to fund the snake oil crap that you want to pump into yourself. At the same time you rail against other treatments (that at least have a scientific basis)

Hypocrite

Private activity in healthcare is distorted by both patent law and the frigged health market.

If neither existed your cheap medicines would be long tested by now, done by people who just want to make people better.

Edited December 28, 2010 by bogbrush

[SarahBell]

I have to thank america for it's lack of free health care.

Whilst trawling many internet forums I've discovered pages and pages of people who've lived with horrendous symptoms for months and years because they don't have access to a doctor and basic treatment for free.

Without these long winded posts detailing symptoms I'd have a lot less information to be reading through!

[Inca]

Private activity in healthcare is distorted by both patent law and the frigged health market.

If neither existed your cheap medicines would be long tested by now, done by people who just want to make people better.

????

Do you have even the slightest clue what you are talking about?

Patent law is the mechanism that supports investment by private companies in healthcare

You have no idea what CCSVI is or what LDN is or how they may help MS so it is best that you just keep your mouth shut

[giantbat]

yep ALL public sector pay should be cut by 50% above 25K..

So you keep repeating ad infinitum..evidence?

that includes doctors, lawyers, admins, MPs, PMS, LORDS, LADIES, contractors, CEOs, middle managers, car park profiteers, and PFI contracts suitably adjusted if wages withing THAT organisation are not trimmed in line with their Public Sector Paymasters.

To butcher a phrase 'we are all equal but some are more equal than others'. I think lumping car park profiteers and doctors/nurses etc together is unhelpful. You might not like that highly trained NHS professionals are paid a salary above the median national wage but sadly for you we command a higher wage because the work is specialised and requires years of training. A random internet forum poster is unlikely to be able to do my job. In a similar fashion an engineer or computer programmer does something i cannot.

Perhaps more focussed trimming to remove the chaff from the public sector rather than cutting the front line staff might be a more sensible approach? We all know that labour massively expanded the public sector without increasing productivity! I would suggest cutting the 'non jobs' first and reducing senior managers pay and tackling the pension looming pensions crisis to convert public sector pensions to a similar package held by the private sector.

Right off to bed.