How the NHS failed me and mine.
What it did, to the most important person
in my life and how it could happen to you unless
we do something about it!

Tuesday, 29 June 2010

Football, Finance and the NHS

It was all pretty abysmal. A group of highly paid professionals, headed by a £6million a year manager attempting to achieve what has not been done since, well, who can remember ?

As everything else in the this benighted land, we keep doing the same thing, over and over again with the same blind faith, that it might be different, this time. But it never is ! The finances of football, finance itself, and most of our state institutions, which now includes the bulk of our Banks, stumble on, now under the tutelage of the Lib-Con's (an apt naming, I think). As we are now "all in this together", it is expected that our input to Cameron's dream of a responsible society, will render us complicit in the in the vast swage of cuts and austerity that will now be my retirement birthright.

Like the FA, and all the Premiershits (to steal an acronym from 'Private Eye'), the country has been in the grip of politicians who have wedded themselves to various organisations, hell bent on feathering their own nest at the expense of us, the taxpayer, the football fan, the service user. We have been used as the money pit for the New Labour experiment, Thatcherism, Blair and Majors, personal agenda of sacrificing British lives in far flung places at the behest of Presidents called Bush, and the wonder of PFI and Independent Sector Treatment Centres. And that's the short list !

Under the sainted Margaret, we endured the 'privatisation' of services such as parts of the NHS, all of the Railways, Buses and some of the Prisons. Blair then assumed the mantle with a relish unexpected of a 'social democrat', and went even further with ID cards, parts of the Immigration Service, the fiasco of the NHS IT system, then the UK Border Agency. The only profit seen from this has been the vast sums paid to the large Accountants, Management Consultants and the now privatised Service Providers to the infrastructure of the UK. The Consultants, the Facilities Managers and unbelievably, the bodyguards for civil servants, senior soldiers and politicians in War zones reaped vast rewards. Despite the fact, that we have more than enough men with guns, in the pay of the state (and I should know), we have to pay a whole lot more 'mercenaries' (sic), to protect people and even convoys in foreign climes. We in fact, as a populace, seem to pay at least twice or more times for almost everything that politicians commit us to finance. Or we pay considerably more, than that which should be the 'going rate', for so much, such as ships, tanks, aircraft, firearms, IT services, computer software and so on, and on, and........

As for Medicine and Health care; we allow the private sector to cherry pick the easy bits, that is if anything can be called such,if you are a patient. ISTC's have had contracts to perform routine procedures and treatments at inflated prices which, then they did not undertake even though the bill had been paid. Partly due to administrative incompetence of the PCT's and others who commissioned the work in the first place and because these centres then failed in the delivery of those tasks or worse, they bodged the job and the NHS then had to put it right. Worse still, these' medicine factories' actually killed people sent to them and the NHS paid the damages to the bereft relatives.

Doctors who operate in the NHS as small businessmen (and women), have fared pretty well from the taxpayer as well. We have paid them handsomely to undertake 'so called' preventative measures, by monitoring patients for diabetes, heart attacks and strokes, hypertension, and then invoking protocols usually requiring drug interventions to modify the findings of any tests. Payments are made, usually based on the results achieved. But, these results have been shown not to be sufficiently productive as to keep said patients out of A&E when their symptoms exacerbate. Not really value for money then ? Treating symptoms is not the way to cut health costs as we all probably know but that is what we get. So the system eats money, and patients get sicker. Non insulin dependent diabetes sufferers become insulin dependent, non insulin diabetics ! What a misnomer and what a travesty ! Lets keep telling them to do the wrong things such as eating a balanced diet of one third carbohydrates which acerbates their condition by raising their blood glucose and pressurises the pancreas to secrete more insulin, which then further exhausts it, makes them fat which in turn increases insulin resistance. So lets just keep doing the same, and by some miracle it will all work out !

The Bankers (or should that be a W?) have the politicians in their pocket, because they ultimately control the system that provides the finance for everything, despite the vast sums we gave them. Politicians always want the blessing of International Finance so they will give them the austerity package they want. Once they have reached a certain level of remuneration it will not substantially effect any of their lifestyles and there will be little in the way of retribution for the Sir Humphrey's of this world, for forgoing a few notional perks to give the people the impression they 'are in this with us all'. All the International Accountants that are relied upon by politicians will now make money out of studies they will undertake to see where savings in the cost of the state can be made, despite the fact that they were complicit in the lack of any due diligence in the Banking fiasco, we are all now paying for.

The FA will no doubt find themselves a new England manager, probably at even more money, to preside over the bunch of over paid, uninspired Premier League players we have in any team, and we will wave the flag for them at the next International tournament with hope in our hearts but despair in our souls. The words 'we was robbed' springs to our lips but has a greater connotation than would normally be the case. Successive Governments have used us for their own ends, and those of their friends for most of my life time. We have been pawns in various social experiments for decades of succeeding Governments, footing the bill in the belief that this time it will be different. That the LibCon's will be the catalyst for a change from this is a pretty forlorn hope. That we will pay for it is a certainty.

Wednesday, 23 June 2010

Kinky Fats

NICE (National Institute for Health and Clinical Excellence -don't ask where the H went) today published it's report on fat. Jane Draper BBC Health Correspondent  has written it about at some length, but both she and NICE, seemed to have missed some of the point and dressed up the issue of Cardiovascular disease prevention as a bit of a 'trojan horse'; the policy of hiding the bad stuff in the good.

In the haste to condemn these products (trans isomer fatty acids) they have lumped them together with saturated fats to the detriment of the report and to health care in general. Science has once more been used as a political ploy to demonise fat as being very bad for all and flies in the face of all the evidence accrued over many years. And, once more, promote a diet high in carbohydrates on the 'eat well' plate of the sister Government propaganda machine, The Food Standards Agency. I have provided a picture of the two unsaturated fat types available. The one with the trans bond is the 'evil' one. The cis bond is the 'good' one, well, up to a point.  And yes we're treated like children again; good and bad used as some sort of scientific term when it isn't.

All of these fats do occur naturally, however trans bonds are generally man made. To enable oils to be used as fats they are partially hydrogenated; that is hydrogen is fired at the molecule to create a structure with a hydrogen atom either side of a double carbon bond (see above). There are none of these naturally occurring, although some forms of trans fats do, they are very small in number or volume, in the food chain of man. These man made fats are there to enable oils to be solid to some degree or other, to prevent them becoming 'rancid', to aid in cooking and to enable storage without refrigeration. They are of course cheaper than butter, which figures quite highly so far as the food industry is concerned and of course they can be said not to be 'saturated', which these days is a big selling point although wrong.

Trans fats are now universally believed, even by me, to be harmful to humans. The very fact that they are generally not natural, should ring alarm bell's in mans diet. But more, they have been associated with most of the diseases that we have been afflicted with, in the last 50 years, such as cardiovascular disease, kidney and liver disease and the inevitable diabetes. What has not been established however, although universally accepted, erroneously I would add, is that saturated fats have any link to any of these ailments. So by linking trans fats to these 'good' fats (bugger, I'm doing it now) terrible dangers lurk.

Saturated fats are naturally occurring. They are the fat on most meats although quite a large number of the monounsaturated and polyunsaturated fats also occur in these (Omega 3's for one). They are lard, dripping or tallow, which was the cooking medium in use until science enabled man to 'tinker' with nature and invent foods that fulfill the almost universal goal of the food industry to make something that looks good, tastes alright but is most of all cheap. And of course there is  butter and its derivatives such as ghee. Until we started to modify or redesign the molecular structure of oils, we were on the whole, quite healthy. Heart disease and Diabetes did not figure highly on the list of  ills that befell humankind. Humans lived for a surprisingly long time, so long as we did not fall to the bacterial and viral diseases such as diphtheria or polio or the plague. Look around a Victorian graveyard and you will see that many lived into their ninety's, or sadly died before the age of five.That we are living longer today is really a bit of an urban myth. Most who actually survived early childhood lived on average as long if not longer than us. So we have increased in number, to push up the averages not increased our longevity
The image shows the difference between the two types and you will see the reason for the title. Unsaturated has a 'kink' where the double bond occurs. The bottom one is that wonder of science, incidentally, Omega 3. It has a cis not a trans bond.  If you boost your intake of this particular one you could live for ever, or so the health lobby tells us. I tend to agree, but not without some reservation.  But, I also would say that grass fed organic meat, is almost as high in PUFA's as is salmon or other oily fish, except of course if it's farmed when it's less. But NICE do not suggest banning that source, any more than they advocate, in this latest misinformed missive, the banning of high fructose corn syrup (which they should), another man made product as dangerous as trans fats but more universally utilised, in the soft drinks industry,  when sucrose was previously (common sugar).

The essence is, that they suggest a reduction in trans fats and saturated fats, such as butter, cream, cheese etc,  by the imposition of tax on these products in the form of VAT (probably). Probably also, some sort of tax on 'fast food', to curb its consumption. The former would decimate the already faltering dairy farmers, especially the organic one's whose cows yield products high in butterfat and form the backbone of what I believe is a healthy diet, and the latter would hit the poorer members of society, who eat an unhealthy diet with large quantities of the rubbish peddled by the likes of companies with Scottish names or with a military ring. Far better to educate than regiment, has always been my view, but NICE and governments of all parties cannot cease to impose rather than cajole, so we tend to end up with the worst policies usually founded in bad or out of date science. They are still telling us to eat '5 a day', lower our saturated fat consumption and have a third of our nutrition from carbohydrates; all policies that have been shown to be worthless or even dangerous.

I quote from renowned Cardiologist, E H Ahrens Jnr, who did support low fat diets at one time but changed his mind; " If the publics diet is going to be decided by popularity polls and with diminishing regard for the scientific evidence, I fear that future generations will be left in ignorance of the real merits, as well as possible faults in any dietary regimen aimed at the prevention of coronary heart disease".

If we are to believe NICE, who allege to be an evidence based advisory and research body, then what is that evidence that links heart disease to saturated fat intake? Simply there is none really, there is largely however the absence of proof. In the presence an unproven hypothesis, rebuttal should sound it's death knell, but in the fat-diet-heart hypothesis, which has been denied any proof of it's existence in many huge and expensive studies since 1948, it suits its defenders to keep trotting out the same unproven drivel over and over again. I could list these endlessly but Mary Enig has succinctly achieved it better than I. One study does stand out though. That of Framingham; the longest in the history of the world. In more than 60 years no link has been found at all, between saturated fat consumption and CVD, despite many efforts to find one. I repeat none.

Even better, fat consumption actually helps to make you thin, as well as enabling the better absorption of fat soluble vitamins and minerals, essential for health. Reduction in our dietary intake,  in the last thirty years has done nothing to achieve the goal of it's propounders, in fact the converse is true. There is in fact, considerable evidence that omission from our diet of saturated fats has gone some way toward increasing levels of obesity, strokes and diabetes. You will notice that I do not include CHD or CVD because these have consistently fallen since the end of rationing in this country. So where they get the figure of 40,000 possible lives saved per year if we eliminate both (they do not attribute numbers to each class of fats), I know not.

Lastly we should look at the 'paradox's'. France is always the top of the list with Switzerland a close second. In these countries saturated fat consumption is the highest and yet despite many parallels with the UK such as blood pressure, exercise, serum cholesterol etc., France has the lowest incidence of CVD in Europe, even though as a percentage of calories they consume over 15% as saturated fats. Does this not tell you something? NICE needs to do the maths. An even better exposition is by Gary Taubes. It's worth a read.

Thursday, 10 June 2010

The Most Expensive Confidence Trick in Healthcare

Yes it is!  Statin's are precisely that; a confidence trick.  HMG- CoA reductase inhibitors, to give them their correct title, are probably the most prescribed drug in the history of the world, accounting for $25 billion last year, in the US alone. Making 'Big Pharma' the eye watering profit machine it had always wanted to be, creating a profit stream more lucrative than any other drug protocol in use in the Western World. And yet it is pointless, expensive and does almost nothing in terms of its goal, of achieving lower rates of CHD/CVD in mankind and absolutely nothing at all for womankind.

Lipid lowering as it is termed often, is the manipulation of the liver's output of lipoproteins to fulfil the dubious hypothesis that reducing cholesterol in the body will safeguard you from a heart attack. It has been 'trashed' many times since its inception in the 1980's by significant scientific evidence, but the myth still prevails despite all of this. Many renowned scientists and doctors, some represented by the  Cholesterol Skeptics argue that it's bunk. It is, without a shadow of doubt.

Across the many studies undertaken over quite some years, since the synthesis by Merck of red yeast rice to lovastatin, it is likely that most people taking a statin, who are in the 'high risk category' for heart disease will, live on average two months longer, in thirty years, than if they didn't (take a statin that is). If you were not at 'risk' ie: did not have a pre-existing heart problem, statistically you would not live a day longer. If you are a woman, even with a heart condition, you would benefit by living not one day longer.  But your risks of death from other causes would be increased. Why one might ask?

They can cause rhabdomyolysis which can be fatal.(Quite rare)

They cause polyneuropathy, memory loss, depression, confusion, impotence, and major birth defects.

They cause muscle weakness, and pain in 20% of people taking them.

Although not proven (yet) it is alleged they cause heart failure and may increase the risk of cancer.

Chris Cresser who is the Healthy Skeptic has recorded this for your information and advice. He's not going to take any statin's that's for sure.

In this country as in most of the West, we seem to have been taken in by the weight of 'Big Pharma's' publicity machine. Worse, doctors and scientists, who really should know better, have as well. They should read the full studies when looking for evidence, not just the abstract, because said 'Big Pharma' is often guilty of tacit concealment of adverse results by burying them in a vast database of facts.

One thing is fairly certain; statin's deplete the bodies stores of CoQ10, which is an essential for healthy cells. So important in fact that there was plan by Merck to incorporate it into a statin pill in 1990, to offset this depletion. In the end they did not, as combination pills are difficult to get by even the usually 'revolving door' of the FDA (well that's my assumption). However, the very fact they bothered to design such a drug, goes some way towards giving legs to this view. That the highest levels of CoQ10 are found in muscle and other cells with high energy demands, like the heart, does beg the question that lowering the level of this ubiquitous substance (it's name is Ubiquinone because of its presence in all cells) will stop ATP production, conversion of which to ADP, is the basis of energy release at cellular level. As it is derived from the same initial steps as cholesterol,  Acetyl CoA, in the bio synthesis of cholesterol, it is not rocket science to take the view that it will be lost in the reduction of the liver's capabilities of cholesterol production, by the use of statins.

I realise that the forgoing is of itself a bit technical, but I have tried to make this accessible by gist of simple language. The 'mystification' of science and medicine in particular, is not something to which I subscribe. We all have to take control of our destiny, in this life. Nothing, sadly is as it seems, especially in Health care and the NHS. We all have to make up our own minds. Hypertension is rife in our society, for men, especially over 50. And yet, it is readily cured by lifestyle changes. But, like statin therapy, the doctors could not turn a dollar (pound) if we adopted this as the strategy, to cure the problem. So, drugs were invented to ameliorate its symptoms but not to cure it. There's no money in curing, for 'Big Pharma', or for doctors, with QOF's (quality outcome frameworks) to fulfill.

There is, sadly, money in everything in the NHS and Medicine. The patient is just the pawn in an elaborate game of chess, with taxpayer gold as the prize. Politicians buy into it, because it's expedient. The public accept it, because their minds are full of short term 'proxy' fulfillment of fantasies about Football and Celebrity. It's not until something adverse impinges upon their lives, that they realise the huge sums we are spending on keeping the NHS afloat are being used for the profligate lifestyles of Consultants and Managers who profit from our ignorance.

I will explain soon how the treatment of Diabetics is one of despair, that again profits Medicine and 'Big Pharma' at the expense of patient outcomes.

Wednesday, 2 June 2010

FDA approves drug for the annoyingly cheerful

 Before I launch myself into the exposition of the unmitigated confidence trick of Cholesterol and Statins I thought I'd share this with you from Chris.

It's priceless and for the Americans amongst us, it's not true just ironically funny.

FDA approves drug for the annoyingly cheerful