Margaret McCartney's Blog, page 3

Inside Health references 5/3/12

http://www.hpa.org.uk/webc/HPAwebFile...

This is the excellent Health Protection Agency chart that tells you when to send your kids to school (or not).

Temperature references:

 

NICE guidance

http://publications.nice.org.uk/fever...

“Detection of fever

In children aged 4 weeks to 5 years, healthcare professionals should measure body temperature

by one of the following methods:

• electronic thermometer in the axilla

• chemical dot thermometer in the axilla

• infrared tympanic thermometer (3.2.2)

Reported parental perception of a fever should be considered valid and taken seriously by health­ care professionals. (3.3)

oral and rectal routes should not routinely be used to measure the body temperature of children aged 0-5 years
in infants under the age of 4 weeks, body temperature should be measured with an electronic thermometer in the axilla
in children aged 4 weeks to 5 years, healthcare professionals should measure body temperature by one of the following methods:

electronic thermometer in the axilla
chemical dot thermometer in the axilla

NICE note that healthcare professionals who routinely use disposable chemical dot thermometers should consider using an alternative type of thermometer when multiple temperature measurements are required

infra-red tympanic thermometer

forehead chemical thermometers are unreliable and should not be used by healthcare professionals
reported parental perception of a fever should be considered valid and taken seriously by healthcare professionals”

 

http://onlinelibrary.wiley.com/doi/10...

“Chemical dot thermometers are used widely, but their clinical accuracy is not well documented. Temperature measurements with chemical dot and electronic thermometers were compared at the oral site in 27 adults and the axillary site in 44 adults and 34 young children in critical care units. In adults, mean readings with chemical dot thermometers were lower by -0.4°C orally, but higher by 0.4°C in the axilla. Axillary readings in children did not differ significantly with the two methods, although individual differences of ±0.4°C or more were common. Chemical dot thermometers provided rough temperature estimates, performing differently at the oral and axillary sites and in the two age groups.”

Here’s the great BMJ letter that made me interested in this

The inaccuracy of forehead thermometers

 

25 February 2013

http://www.bmj.com/content/342/bmj.d3...

 

 

 

Evidence in the Daily Mail

feature article

A poor show for evidence on Health Questions in Parliament today 26/2/13

The lack of evidence based discussion in Parliament is rather disconcerting.

First, there was praise for Silverstar charity , who offer diabetes screening – which is not recommended in the NHS. Anna Soubry was also praising Boots for offering ‘diabetes checks’ – which is not recommended on the NHS, is likely to use NHS resources in dealing with unwarranted tests, and inveigles the private sector into seeming  ’essential’ – when it’s doing tests that are not recommended by the evidence base we should follow. The lack of knowledge displayed by Anna Soubry is disconcerting for someone seemingly in charge of this policy.

Then there was a question for her on the subject of HPV vaccination, which she followed by raising “the lack of screening for young women under the ages of 25…which concerns me”. Has she not read the evidence, or considered the harms?

As for Jeremy Hunt. He started by suggesting

“There is far too much bureaucracy in the NHS….we need to free up the time of the people on the front line to care”. I’d consider this to be the dementia screening which he is insisting that hospitals do, or be fined, on every patient admitted over the age of 75.

Madeline Moon thought that GPs didn’t understand or weren’t ‘aware’ of rarer types of early onset dementia, which Jeremy agreed with.

He then said that there was a “widespread lack of understanding” about dementia in general, “we are also looking at a major programme to engage GPs because there are still sadly some GPs who think that it’s not worth diagnosing someone with dementia at all, and there is a lack of understanding and we absolutely have to put it right.”

I think he’s talking about me. I wish he would name the dissenters and then properly debate the issues. For the facts are

- screening for dementia is not evidence based

- because all screening does harm, it may do more harm than good, and will certainly do some harm

-It has not been approved by the National Screening Committee 

 

 

 

-there has been no recognition of the fact that people should have a right to decide whether or not they wish the dementia screening question and the risk of overdiagnosis or non-timely diagnosis

- the slur that people who think that screening for dementia is so problematic and so non evidence based are therefore suffering from a ‘lack of understanding’ and somehow that they may feel that patients are ‘not worth’ the effort is offensive. It’s because I care about good medical practice that I object to this political, not clinical, management tool. And here we have the crux:

Jason McCartney MP said there wasn’t enough being spent on dementia research. Jeremy said that he was going to “catalyse the private sector companies, because they know the size of the potential market for dementia is huge, and they have been frustrated in their attempts to get a breakthrough which is what we urgently need, we have to use that interest to excite their interest and keep them focussed on this really, really tragic disease. ..There are unacceptable variations in the rate of diagnosis of dementia across the country and we are committed to driving significant improvements….”

It gets worse.

Julian Sturdy MP thought that more people should be diagnosed with dementia and thought these undiagnosed people were a “tragedy” because “drugs can stave off the condition for 1 in 3 to 1 in 4 people, can have a big impact, but also you can put in place support services for carers.”

Here we go. Jeremy’s statement is not ironic. If you are a pharmaceutical company, and you want to increase your market, you look for pre-disease – early stage disease. The problem is that early stage disease is often very unpredictable and will not always lead to the disease you think it will. So, for example, high cholesterol, or blood pressure, or breast changes on screening mammograms. The earlier you try and pick up ‘pre-disease’ on screening, the more difficult it is to know how these ‘early signs’ will behave. Pharmaceutical companies will benefit, as more people will be prescribed medication at an earlier stage – hence, for a longer time. But will the people being screened benefit? The test may pick up false positives (especially if someone is in pain or otherwise unwell and can’t answer the questions properly), or mild cognitive impairment, which goes on to produce dementia a minority of the time. The drugs on offer don’t prevent dementia for people with memory problems. As for people with dementia, Cochrane says they can produce an improvement of just over one point on the MMSE cognitive test scale (of 30 points) and a gain of 2.4 points on the PDS daily activities score (out of 100). I hardly think Jeremy’s faith in the drugs is well placed. Additionally, the idea that only a dementia diagnosis should prompt an older person to think about plans for future domestic arrangements is misleading – we all should do this as we get older, no matter what our current diagnoses are.

In short, the benefits of the drugs are being overhyped. This is not fair on patients or their families. Screening is being oversold without account for the evidence or it’s harms. People are not being allowed to make ‘no decision about me, without me.’ The debate today demonstrated ably that policy is being created by people who appear to not understand the science of screening. Worse, for all the debate about research, there was no word on how badly we treat and pay carers who do unbelievably difficult work with people with dementia every day – and who would be paid more, often, if they worked at a checkout. Why do we not value these carers more? We have this debate all the wrong way round.

It’s proof, at least, that Jeremy has not read the book my publisher sent him. So where has he got his information from – we were treated to a few tweets from his visit to Eli Lilly last month- who make the meds he wants us to prescibe more of. Surely it’s time for the NHS to be run outside party politics and given to an independent body to run, according to evidence, instead.

 

 

Inside health refs 12/2/13

References for tonights’ Inside Health

 

http://archinte.jamanetwork.com/article.aspx?articleid=1487292

 

http://scholar.harvard.edu/files/nkc/files/2013_pill_color_and_adherence_archives.pdf

 

http://usir.salford.ac.uk/7203/

 

http://www.npc.nhs.uk/merec/other_non_clinical/merec_bulletin_vol21_no3.php

 

http://www.genericsubstitution.com/

http://www.nao.org.uk/publications/0809/prescribing_savings_in_2008.aspx

http://www.ncbi.nlm.nih.gov/pubmed/1547760

 

http://www.ncbi.nlm.nih.gov/pubmed/96086

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/

http://apt.rcpsych.org/content/13/5/3...

Inside Health – yellow cards

Most recent Inside Health features the Yellow Card system, of which I am a big supporter.

Anyone can flag up a concern about a side effect of medication - right here. 

Women, cervical smears, and manipulation

These are two recent adverts for cervical screening. The first relies on fear, the second relies on promotion of screening as a lifestyle choice.

It’s striking that neither relies on fair information to invite women for screening. What is the risk of missing a single smear and dying of cervical cancer? I don’t know, but it is very low (see Raffle). Why do we not give fair information and instead rely on fear as a motivation for screening?

The results of a campaign like this include harms. Sadly, these often go ignored. Strikingly, many women have complained on websites about their exclusion from screening because they are aged under 25. Many of these women feel that they too could leave their child an orphan because they aren’t eligible for screening.  It’s clear that in this group of women, screening is unhelpful and harmful. But because screening is presented by the NHS as a simple choice rather than a complex process and balance of harm and help, we invite women under 25 to see themselves as at risk simply because of their age, and we offer them fear rather than information.

The continued use of fear to scare women, rather than fair information to give us knowledge and the ability to make informed choices is an ongoing scandal. It degrades women. It needs to stop.

 

 

 

references for Inside Health 22/1/13

 

 

 

 

 

http://pediatrics.aappublications.org/content/early/2013/01/15/peds.2012-2592.abstract

http://www.bmj.com/content/340/bmj.c2161

http://www.thecochranelibrary.com/use...

 

 

 

 

press releases for your entertainment (please note; a lack of evidence follows)

BEAT BLUE MONDAY

Monday 21st January 2013 – The Most Depressing day of the year!

 

‘Blue Monday’ is believed to be the most depressing day of the year according to calculations by psychologist Dr. Cliff Arnall in 2005. Blue Monday falls on the Monday of the last full week of January and this year is on Monday 21st January 2013. Feeling Depressed yet? Well read on… Dr. Arnall calculated many factors, such as weather conditions, debt level, time since Christmas, time since failing New Year Resolutions and low motivational levels using the following equation:

 

[W + (D-d)] x TQ

        M x NA

The equation is broken down into seven variables: (W) weather, (D) debt, (d) monthly salary, (T) time since Christmas, (Q) time since failed quit attempt, (M) low motivational levels and (NA) the need to take action. However, John Bell & Croyden have selected their top 5 products to perk you up and beat the blues!

Aduna Boabob Fruit Powder (£18 for 170g)

100% natural, nutrient-dense raw whole food and an excellent source of Vitamin C, Calcium,  Potassium and thiamin, a source of vitamin B6. These nutrients combine to support energy levels, the immune system and the reduction of tiredness and fatigue. http://www.johnbellcroyden.co.uk/webapp/wcs/stores/servlet/product_10251_22_21089_-1__baobab-fruit-pulp-powder-170g

 

Karma St Johns Wort Extract (£9.50 for 425g)

A Traditional herbal medicinal product used to relieve the symptoms of low moods. St Johns Wort  is especially effective to treat mild forms of depression.   http://www.johnbellcroyden.co.uk/webapp/wcs/stores/servlet/product_10251_22_18887_-1_25354_karma-st-johns-wort-extract-425mg-30-tablets

 

BetterYou D Oral Vitamin D3 Spray by Jan de Vries (£7 for 15ml)

Contains 100 sprays enough for a 3 month supply. Vitamin D3 is manufactured by our bodies  when our skin is exposed to UVB rays from the sun and aids calcium absorption which is fundamental for maintaining healthy teeth and bones. Research shows that in the winter months we lack Vitamin D. http://www.johnbellcroyden.co.uk/webapp/wcs/stores/servlet/product_10251_22_60651_-1_25813_betteryou-d-lux-1000-oral-vitamin-d3-spray-15-ml-by-jan-de-vries

 

DoMatcha Tea (£25.50 for 30g) – EXCLUSIVE to JB&C

DoMatcha tea contains the finest Japan’s tea leaves that guarantee the highest nutritional value as well as a sweet and pleasant flavor. The leaves are hand picked in the spring when they are young and fresh and most vibrant. The tea raises energy levels for up to 4 hours, creates a state of relaxed yet calm mental alertness and contains 137 times more antioxidants that steeped green tea.

http://www.johnbellcroyden.co.uk/webapp/wcs/stores/servlet/product_10251_22_61551_-1__domatcha-ceremonial-japanese-green-tea-30g

 

SAD Solutions Blue Light LED Poratble Light Therapy (£150)

Up to a third of the population in Britain suffers from seasonal affective disorder (SAD) also known as winter depression, according to MIND, a leading mental health charity in England and Wales. This is a Easy-to-use and portable BLUE Light uses blue light technology to give a quick, safe and 100% Medical CE certified effective light treatment for those suffering with SAD disorder which can improve mood. http://www.johnbellcroyden.co.uk/webapp/wcs/stores/servlet/product_10251_22_60519_-1__sad-solutions-blue-light-led-portable-light-therapy-1-unit

 

- Ends -

All products mentioned are available from John Bell & Croyden in store at 50-54 Wigmore Street, London, W1A 2AU and online at http://www.johnbellcroyden.co.uk For samples and imagery please contact

 

Inside Health – 15/1/12

On Amitriptyline  – here is the very good information website we talked about http://www.painconcern.org.uk/2011/04...

Asthma, eczema and ‘junk food’ study

http://thorax.bmj.com/content/early/2...

How to profit from celebrity illness

I find this wish to profit from the illness of another pretty appalling. Press release recieved this am.

 

Email follows:

“Good morning,

Following the news that self-proclaimed ‘fitness fanatic’ Andrew Marr has suffered a stroke, I wanted to get in touch to offer expert comment from Preventicum and Medical Director Dr Garry Savin.

Preventicum offers the most comprehensive and technologically advanced health screening on the market, which allows for the early detection of conditions, often symptom-free in the early stages, that might lead to strokes (e.g. aneurysms) with clients able to take preventative steps to mitigate against more serious conditions that can arise if left undiagnosed.

There are often a number of underlying conditions that can precipitate strokes and Dr Savin would be delighted to discuss potential triggers (highlighting how they can be detected and treated) as well as the consequences of suffering a stroke and how the rehabilitation process might work. Do please let me know if this might be of interest.

 

Please don’t hesitate to contact me with any questions. I can be reached on . Further details about Preventicum can be found at www.preventicum.co.uk ”

Very best wishes

Francesca”

If you want to know why I think these non evidence based screening tests should be avoided, see   http://privatehealthscreen.org/