The drugs don’t work

The BMJ have a series of articles about neuraminidase inhibitors or Tamiflu and Relenza or panic-purchased anti-virals. For in at risk groups they reduce the duration of symptoms by between 0.5 and 2 days as opposed to between 0.5 and 1.5 days for healthy adults (not that much difference in my opinion). And yet this HTA assessment does distinguish between groups and says they are cost effective. NICE guidance recommended these drugs as options and ’said that its recommendations about oseltamivir and zanamivir should not reduce efforts to give vaccination (also called the flu jab) to people for whom it is recommended in national guidelines’ so the government hand that feeds is not bitten.

Antidepressents have also come under fire although here it is less about political action before evidence and more the increasing effectiveness of the placebo. Recently the UK Government’s Science and Technology committee evidence check on homeopathy discussed the placebo effect and the ethics of giving placebo as a medicine…

Boots teams up to Web MD to provide patient info

This new website from Boots and U.S.-based Web MD uses information from “NHS Choices, BMJ Best Treatments, WebMD and Boots” (NeLM news). Interesting features include a symptom checker and questions to ask your doctor. It has a comprehensive editorial policy covering conflicts of interest and a section explaining how to spot sponsored content (the tension between the two still remaining however, why not just go to NHS Choices?…choice of course…). The health areas it covers are comprehensive, not just minor ailments, primary care issues that you would expect. Perhaps as well as my future were-that-I-had-time-to-do study looking at Pubmed v NHS Evidence v Trip in terms of utility for scoping/systematic searching I’ll widen it to look at the best evidence based consumer health sites, unless this has already been done? This seems to be an expanding market.

Why we must ration health care

Peter Singer, the controversial ethicist based at Princeton University, writing in the New York Times argues for a rational debate about rationing in the face of decisions such as those around cancer drugs such as sutent:

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

 
If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

This debate will run and run…

Clinical Reader: Malicious or just stupid?

I’d never heard of Hanlon’s razor before. Apparently it is an adage that reads “Never attribute to malice that which can be adequately explained by stupidity”. I rather like that; I’ll have to remember it. It is a nice way to look at the world, as we can all be stupid sometimes. Take for example the new company Clinical Reader. The company has an online product that basically seems to be an RSS reader but that they decide which RSS feeds they’re going to track, not you. I came across it a few days ago as some clinicians were discussing what a good service it was on some mailing list. Well, I thought, that’s clinicians for you. The product didn’t seem bad enough to comment on, but likewise certainly didn’t seem interesting enough to comment on either – at least not from my point of view. So I thought to myself “well, our handsome and fragrant readership will probably come across it soon enough, and they can make their own perfectly balanced minds up about it…”, and left it there.

But today I see another twist on the Clinical Reader story, and what happens when you get involved in social networking tools without really knowing what you’re doing. The thing was that Nicole Dettmar (evidently a fan of The Prisoner) had pointed out in her blog that Clinical Reader were implying that they had been awarded ‘five stars’ by institutions such as the British Library, the NLM, Imperial College, The Lancet etc. She pointed out to them on Twitter than the NLM does not endorse anything, and that they ought to do something about it, and promptly received a reply threatening legal action (I love the use of ‘kindly’):

I mean to say, what a stupid (or malicious) thing to do. Of course everyone picked up on it and they received a barrage of tweets and blog commentary. As of writing they have since backed down, which they should do because they are plainly in the wrong, saying “We are keen to engage the twitter community the tweet made by a junior member of the team was poor judgment”. However the “five stars according to…” graphic remains throughout their site once you get past the first page.

Malicious or stupid? You decide. Either way it doesn’t reflect well on Clinical Reader.

Human slaves…in a robot world

I was reading a very interesting article in the New Scientist about, er, robots, that can detect our emotions. Or ‘machines’, if you prefer (I noticed that the title had been changed to ‘robots’ from ‘machines’, perhaps in a bid to raise eyebrows).

Yes, robots are fun and so are machines, but where is the health connection, you ask. Machines can distinguish between the 6 ‘basic emotions’, fear, disgust, surprise, anger, happiness and sadness, but only if an exaggerated expression is presented to them. (Digression: reading about basic emotions or universal expressions always makes me a little skeptical as different people have different ways of expressing themselves-you’ll find lots of exaggerated smiles in North America, but comparatively few in the UK).

My favourite part: machines have gotten quite skilled at differentiating between real and fake pain in humans.  One study by Littlewort et al saw computers correctly classify pain 88% of the time. Human volunteers got it right 50% of the time-perhaps they were guessing. Will this technology have ramifications for reducing numbers of benefits fraudsters and pill-poppers as well as people trying to separate pain into organic or psychosomatic causes? Oh, and teaching autistic children to correctly identify facial expressions?

I hope so. Although it is easy to see the scarier side of technology like this. Who knows, maybe we’ll all be forced to adopt poker faces in the future to avoid ‘mood profiling’ and targeted advertising.

Using Twitter to track disease outbreaks

A few months ago I wrote a short post on Phil Baumann’s 140 healthcare uses for Twitter. Well, Chris Thorman over on Software Advice has written a longer piece on the potential of Twitter for identifying and tracking disease outbreaks in real-time. To get some vaguely reliable data from Twitter, rather than the mess of misinformation with the occasional piece of truth thrown in which is Twitter as of today (oh, cynic that I am), it would  be necessary to have a uniform set of diagnostic codes, “hash tags” and a proper authentication system, e.g. as Chris writes:

“…This adoption by doctors would need include a verification system that only allows trusted or authenticated users to tweet about information contained in the EMRs. What we’re trying to avoid is aggregating a whole mess of data related to a particular disease. Authenticating users to make sure they are who they say they are avoids this problem. With a uniform set of diagnosis codes and a proper authentication system, suddenly the trending data sent out by these verified doctors’ tweets goes from speculative to extremely reliable.”

I do actually think that Twitter or a similar technology could be very useful in tracking the early signs of a condition, or any other “rare event” pattern. In fact I’d be amazed if we weren’t using it this way very soon. What is required however, as always, in some kind of central, trustworthy institution to organise, analyse, study and disseminate the data that comes in, as well as ensuring the diagnoses are correct and not just false positives. That’s the hard part, not some Dr in a clinic in Great Yarmouth tweeting that one of their patients has a sniffle. Anyway, take a look and see what you think. Twitter fans will like it at least. Another step towards world domination.

NHS health records to private sector?

Personally, I’d be delighted if the Tories got Google or Microsoft or someone to build the NHS records system. Might actually work. Read the news story on the HSJ here. That nice (?) Mr Cameron also says he will review all quangos should they come into government, including the bloated (did I say bloated?) NICE and Care Quality Commission. Keep the public sector on their toes eh David? Mind you, the opposition always says they’ll get rid of quangos, until they get into office then they just create a whole lot more. Jobs for the boys (and girls).

What will US healthcare reform look like?

Fascinating article  in Economist about the United States healthcare system that proves that throwing money at a system doesn’t necessarily relate to either efficiency or quality. They may end adopting compulsory insurance and some form of the QOF to remedy this. Will they set up a US version of NICE? It’s too early to tell although if they do I’d be happy to help…

Complementary therapy and disenfranchisement

Stephen Ginn, a psychiatrist with the wonderfully named Frontier Psychiatrist blog (Avalanches ooh!), went to a meeting at Kings College debating the thesis that complementary (and/or complimentary even I suppose) medicine causes more harm than good. Simon Singh was apparently heckled several times and things got a bit heated. Why do alt peeps feel so threatened. Is is cult mentality? Or merely the suggestion of denying their feelings? The comment that if conventional medicine can’t offer time, personalised approaches, an appreciation of social context or uncertainty then perhaps that explains why alternatives look so attractive and perhaps anger results in being made to feel trapped between a rock and a hard place. I hate going to see my GP (feel patronised and hate being messed around with like an object, open your mouth, sit down, say whatever you like I’m going to say what’s wrong with you anyway ahem) but still I don’t want a smiley witchdoctor instead. I agree that with growing choice and the feeling that health is a consumer issue like everything else conventional medicine has to buck up. For example my GP’s practice has a late night they didn’t tell me about, you can’t book online, they assume you don’t work, I don’t in fact care about continuity of care I just want a competent practitioner every time etc…I think it would help if people were taught about health in terms of the other threat to medical care which is self medication. It might just open up a debate about priorities. I fear that most people think that it’s enough to feel better instead of knowing whether they are better, the hopeful and fighting cancer patient is the popular example. Or else living with uncertainty is worse than knowing within themselves, an intuitive, gut feeling, feelings being the moment, the mental calm that is the opposite of life’s uncertainties, chance, spontaneously arising and resolving illness, random events and unpredictability.

Seeing the light for the pollen trees

Just saw Lloyd’s Pharmacy advert for the hayfever device so I’m like eh what is it? I have hayfever and would like to know about anything I can add to my regimen of generic antihistamines, nasal spray and eye drops although I am going to be more sceptical than most especially as it now involves a therapy, something I associate with something a sticking plaster, a comforter as opposed to a treatment…but anyway it’s two pronged battery operated device which uses light therapy and you insert into your nose a few times a day to give general relief to nasocongestive symptoms.

So how does it work? Off to the blogs and first the usual people saying well it works for me so why do I need evidence (oh dear) but then more interestingly the argument that the trial supporting the sale of these devices (Lloyds is not alone in marketing them) employs a sham sham comparison (it is based on red light therapy and the sham light was internally disconnected thus making the one with the light a rudolf the reindeer giveaway). Go to pubmed and the newest study I found with a very simple search was a phase II study that did find benefit but with caveats that mechanism of action was unclear, that compliance was not followed and reading the abstract alone it is clear that the outcomes are fuzzy: severity rating scales and other subjective measures. I am not totally confident that I could rate my symptoms and that the advice that seems to counter reality works best: staying away from pollen really is the best way to avoid symptoms. If you want something to make yourself feel better, and much of the effect of this deivce seems to be part of the powerful placebo effect especially favoured by erm acupuncturists ahem for example, then buy some massive wrap around sunglasses. Less pollen will get into your eyes and at least if your eyes are red and sore then no one need know!