First They Came For Your Daughters.........

And now for your son's.

A recent headline story in the Independent caught my eye as an example of 'disease mongering'. My dislike of HPV vaccination will have been made clear from my last post, as I feel it is a somewhat large hammer for a very small nut. The vaccine Gardasil, from Merck is seen in this light by myself and and many others. Age standardised mortality rates of Cervical Cancer in the UK stood at 2.4 per 100,000 in 2008 and falling which is a risk of .0024% if my calculation is correct. Down it seems from 1971 of 7.1 per 100,000 and in most of those years the vaccine did not exist. It is also somewhat easy to cure and in many cases no harm results from infection with even the low percentage of CIN 3 lesions detected only progressing to actual cancer 1% of the time. So why we should vaccinate against such a problem bemuses me, when we ignore many other cancers of much higher rates of incidence.

Michael Douglas, a throat cancer sufferer.

A new 'epidemic' it seems, is now being sold as a reason to vaccinate young boys as well as girls. We are told, that Oropharyngeal Cancer (throat cancer) has increased alarmingly, by some 73%! And that HPV vaccines will guard against it's further spread. It is only when you read the actual figures that the figure is put into context. A rise from 1 per 100,000 to 2.3 per 100,000. So yes, it is a rise but that's the 'actual' (rather than relative) risk which remains almost too small to measure, in scientific terms. And one must remember that the 'actual risk' of harm from the vaccine itself. exceeds that figure by some 50% (playing them at their own game), it's about 3.5 per 100,000.

The increase is laid at the door of 'yoofs' predilection for oral sex as opposed to the 'missionary position' one assumes, which does lend to them, some inclination against unwanted pregnancies. It's a pity that such a risque form of sex should be viewed as 'risky' by the Professor (honourary) who broke the story; Hisham Mehanna. This practise increases the risk of HPV infection of the throat by this 'staggering amount' (sic), sufficient for him to advocate HPV vaccination. Yet quite a number of Scientists find themselves at odds with this because the protocol remains largely unproven and in most cases the recipients would have to wait some twenty to thirty years for any evidence that it was, to come to light. And of course, the vaccines do not protect from all HPV strains so their effect is at best 70% for 4 to 10 years.

At the moment the NHS continues to roll out the HPV vaccination of young girls but not boys. This story is a 'move' by someone who combines both Private and NHS careers to frighten young women, girls and now anxious parents, to press for this vaccine to be available for all. It seems a cynical ploy to me to once more 'generate' more things to do for an already declining resource fund; the NHS. I could point out that Mehanna receives funding for some of his studies from GlaxoSmithKline, the maker of one of the two major vaccines; Cervarix. But of course I wouldn't do that, would I?

Health Misogyny

Health care in general and the NHS in particular, places far too much reliance upon the notion of prevention and 'early' detection of disease, or rather the 'markers' of what is assumed to be a possible or maybe disease, or condition. This particular trait, and it is redolent of all health care models throughout civilisation, is directed more at women than men.

Perhaps the concept of women being fragile, vulnerable to all sorts of ailments diseases and conditions, that are either particular to, or more predominant in their sex than males, is where this founded. And, of course when this process of labelling all women as potential harbingers of their own doom came to pass, it was men who set about building the edifice of treatments, allocated specifically to the 'fairer' sex, to save them from their 'treacherous' hormone ravaged bodies. And what a crock of s**t, it has all turned out to be.

Mammograms, Cervical Smear Tests, Hormone Replacement Therapy, Vaccines targeted for Cervical Cancer, 'Medicalisation' of Pregnancy, Osteoporosis treatments (mainly for women) and the general consensus that women need 'protecting' from the ravages of their own predisposition to ailments arising from their femininity. Men and some women, are unable to resist the urge to prod, poke and peer into the extremities of women simply to reassure themselves, and vulnerable women, that all is as it 'should be'. A whole industry in Medicine and Health care has sprung from this, including the desire of men, often imposed upon women, to aspire to a stereotype image of the size 10 with big breasts and shapely bottoms. Culminating of course in the Breast Augmentation, Reduction and Botox protocols that has spectacularly 'gone wrong' in the case of the PIP debacle.

I have written at length about Screening for Breast Cancer in the past and  more evidence has comes to light about it's futility for most, and the lie perpetrated that many are 'saved', when in fact the so called cancer found, is not really 'cancer' at all. And it would have likely responded to 'watch and wait protocols' rather than going in with the knife, radiation and chemotherapy. The 'treatment' of Ductal Carcinoma In Situ (DCIS) is redolent of this mindset. Studies conducted also continue to find that mammography seems to increase the incidence of breast cancer than reducing it. The main problem is however that women are treated as pawns, and deprived of the information needed to make an informed decision about whether or not, to submit to this 'testing' (sic) protocol.

Cervical Smear Tests are also 'sold' to women as essential to health and whilst there is little harm invoked by them, when an abnormality is detected the 'system' once more tends to 'overtreat' and frighten women into interventions that can be counter productive. Firstly the incidence of cervical cancers is quite low at 2.4 per 100,000 (European age standardised mortality)  and certainly screening young women (up to 30 years) has been shown to be of little worth. The trend also has been been downwards for the past thirty years (from 7.1). As the mortality rate for Prostrate Cancer is rising and  close to 10x  higher at 23.9 per 100,000 it seems strange that this is not targeted, when Cervical Cancer is. But of course 'overdiagnosis' is really the problem in oncology, especially for treatment protocols directed at women and it continues, without abatement.

We now have the HPV vaccine, targeted (again) at young women to prevent cervical cancer and genital warts yet the vaccine (Gardasil/Cervarix) is only admitted as being effective against two strains of the Virus (types 16 and 18) and there are allegedly thirty strains that are cancer promoting. As the target cohort is 11 to 13 years old females (although now men are now being targeted too!) prior to likely sexual activity and protection is only afforded for ten years at most, it seems perverse to leave them without protection in the years when activity is likely to be elevated, so is it worth it? Even of course if you even think that the vaccine is any good in the first place, which viewing the evidence it seems not, to me. I personally feel that the whole concept of an 'epidemic' of HPV infections is pure hype to sell an unproven vaccine, mainly to women, for their daughters, to swell the coffers of  'Pharma' at a time when the 'blockbuster' drugs are coming off patent. Do young girls need a pretty useless vaccine for a relatively easily treated disease of very low incidence? Make up your own mind, your informed mind. This JAMA editorial may help.

And what of HRT? It was proffered as the panacea for menopausal symptoms and the retention of 'youthful vigour' in women of a certain age and although for many it did precisely that, it exacted a price; breast cancer. Even with short term use, risks of both cardiovascular disease and thromboembolism were also increased tremendously and the ovarian cancer risk increased in the oestrogen only cohorts by some 60% (relative risk). Except for extreme cases, it is used rarely for menopausal symptoms today, but that did not stop 'Pharma' from reaping tremendous profits, from an ill conceived and dangerous drug that is now seen as being counterproductive despite its benefit for the prevention of osteoporosis (but not treatment).

Way back in history we had thalidomide, that was targeted at women to eliminate or ameliorate the problems of 'morning sickness' in pregnancy. As most will know, it wreaked terrible havoc with lasting and appalling effects, but now new information is coming to light about a virtually forgotten drug called Diethylstilboestrol (DES) which seems to cause a rare form of cancer of the vagina and cervix called 'clear cell adenocarcinoma' or CCAC, in the second generation .The Independent on Sunday of today, has highlighted this, but the story has been around for some time with $1.5bn paid out already to victims. Surprisingly, this drug is still used in the UK (but rarely) under the 'Apstil' brand for prostrate cancer and advanced breast cancer in post-menopausal women. (Another crock of s**t?). It was another drug invented for the 'medicalisation' of pregnancy.

It is quite rare in fact for any women to have a home birth. They are taught to fear this in case of complications and the need to ensure their offspring are 'safe'. The truth is in fact that home is a much safer place than hospital, as many of us will know, when we went to hospital for one problem and ended up with many more. The following are some interesting statistics.

	Births (  percent of total )		Perinatal Mortality ( per 1000 births )
	1958	1970	1958	1970
Hospital	49	66	50.1	27.8
GP Unit	12	19	20.3	6.1
Home	36	12	19.8	4.3

 ( Statistics resulting from 1958 and 1970 perinatal surveys in Britain. Sources: Sheila Kitzinger, Homebirth and Other Alternatives to Hospital, and Marjorie Tew, Journal of the Royal College of General Practitioners, August 1985.)

Prospective mothers will be told that they are putting their baby 'at risk' if they stay at home for their birth, and I would be the first to advocate that any at risk should be hospitalised, but for healthy women, especially in their second pregnancy, with no known risks, it is cheaper, safer and less traumatic for mother and baby. Yet a whole industry has grown up in the NHS to foster the idea that no other protocol should be countenanced.

Women are continually treated as if to be female is an illness in itself and that your whole life has to be conducted under the microscope of the Health care Profession. Many of the ailments that women are heir to have their risk inflated out of all proportion to reality. many, as I have pointed out are very low; much lower than many that are completely ignored by medicine. We continue along the road of epidemiology and genetics as twin pillars of research but it is a blind alley, especially for women, who have suffered more than men in this construct of blaming their ills upon hedonistic lifestyles, stupidity, and poverty. Most if not all of the breakthroughs in medicine have been due to luck more than insight. Failed aspirations are in fact the predominant factor in Health care, and the 'expert committee' the death knell of common sense.

To treat women as the 'milch cow' of medicine is patronising, condescending and it is without doubt misogyny. Doctors and Clinicians should cease this continual search for things they can 'invent' to fill in their time before their wealth laden retirement. Perhaps they have; children. But that must wait for another day.

By writing this post I could perhaps be accused of the sin I am trying the exemplify. I really hope not.

2011; End of Term Report.

2011 seemed a little like living in some sort of  'time warp'. Paranoia reigned, mainly about 'benefit scroungers' and immigrants and the need to ensure those that are financially supported by the state 'get a job'. A bit bloody difficult that if there aren't any! But of course such policies appeal to the baser instincts of the people who are (generally) misled into the view that all on the 'dole are shiftless, workshy leeches. They may of course change their mind about that, when the redundancy notice drops on the mat.  And of course we had that elaborate fireworks 'jamboree' at the Thames Embankment, at the turn of the year. 'Circus' (without the bread)  would be my summation of that. They'll be plenty of the circus element to take out our minds off the the 'crisis' in 2012 with the Olympics (which has just had an extra £270m added to the bill for security to pay for an additional 13,700 personnel from G4S. That works out at £20,000 for six weeks work yet the 'going rate' is about £10 an hour. Could it be that we are being 'screwed', by the Governments favourite 'Security' Co? ) and the Jubilee celebrations being the most prominent, but still, we get a day off work to pay homage to the Royals, so that's alright then!

Delving into the 'nitty gritty', this was the first full year of the Toffs Academy's rule and Edd and, err Edd's reign on the opposition benches. What a triumph it all was, with the competition for the middle ground of mediocrity almost reaching fever pitch. The cut and thrust was painful to watch, with minutiae of each of the party's doctrine being dissected and found to be - the same! The Headmaster shone through it all with aplomb, and that was just his face. But seriously, where is the difference, the defining policy, the moment of inertia that could lift us from this politically imposed state of misery in which we are living; I'm still waiting.

'Hacking' came to prominence, with News International holding up it's hands to the offence of listening to peoples voice mail messages. Well sorry, I simply cannot get worked up about a a bunch of idiots who are so stupid as to actually leave any significant personal information on a mobile phone voice mail system, which is designed to ensure that you know someone called when you were on the 'phone or off the air! Nor am I impressed by the state expending my money on an enquiry that is designed to 'up the ante' on the damages that will be paid to a bunch of self serving, publicity seeking third rate celebrities like Prezzer and 'Huge' Grant. If NI had actually listened in, to a 'phone conversation, that would be different, but they didn't. That privilege is reserved for the security services and the US Government. So get over it, go home and stop filling the media with your contrived and silly outrage; it's your own fault!

Meanwhile, back on Earth or the planet Zog, as it seems to me (or maybe 'Life on Mars' as Francis Wheen says) much more important things were happening.

The NHS was transformed from being a dangerous organisation, entrenched in mediocrity, mendacity and self interest, to a 'shining light' of health care for the people. Privatisation and Marketisation was the route being taken by the Government, but that was a step too far for the pressure groups that sprang from the woodwork. Many of these comprised of Doctors and other Health care providers complicit, even actively involved in the reforms of  Tony Blair. Well wake up and smell the coffee, it's already happened! What do you think ISTC's, Foundation Trust's and Primary Care by GP's is! The last 'lot' (Labour) were already well on the way to that goal before Cameron et al came on the scene. GP's have always been private contractors to the NHS, either as partnerships, individuals or limited companies. If you want to criticise a system that allows this, then start with them. They've always stood on the outside, looking in, and however you want to cut it, GP's are not state employee's, which only makes me wonder why we are contributing to their pension's, but that's another story. And, all of the hand wringing of the 'Guardian' readers seemed to be out of step with the fact the Nu Labour had been the architects of most of the changes in the NHS, and Lansley is only continuing a process commenced by Tony Blair and Gordon Brown. So everything is different, but stays the same.

The 'bandwagon' of Pharma continued, although in somewhat abated form now that the so called 'blockbuster' drugs have gone off patent, and some of the seedier advances elicited huge payouts for the harms they had caused ($3 billion from GSK for fraud and mis-selling), but that didn't stop Andrew Witty getting a knighthood. Who says crime doesn't pay! Cameron decided that they (Pharma) were so poverty stricken that we needed to give them some of our money and a lot of our patient information, to get them to cause some more carnage by helping them develop some new drugs. We need some more 'lifestyle' drugs like a hole in the head, and the hand full of very expensive drugs thus far developed to treat relatively rare conditions have only had modest or even no benefit to society, except of course to Pharma's coffers.

The NHS remains 'broken' and all the rhetoric about 'saving it' is counterproductive. More 'marketisation' will not make one iota of difference to current appalling status of the patient in all of this. 2011 saw the exposure of terrible standards of care that have prevailed, and been tolerated for years. Winterbourne View, failure to provide adequate nursing, dignity and nutrition to the elderly and those with mental health issues and learning problems. The 'Stafford Hospital' enquiry, the appalling problems in A&E at weekends and nights, and substandard care in Trauma and Surgery; the list is almost endless. A new paradigm needs forging to bring the NHS up to a standard that is in accord with the vast sums expended, most of which has been allocated to the payment of the management, consultants and temporary staff at exorbitant rates. And of course PFI, PPP and ISTC's. Despite the fact that the ConDems criticised the finance model, they have still seen fit to go ahead with the £450m Liverpool Hospital PFI contract with a consortia of Laing, Interserve and FCC. There is also some evidence that Trusts are retaining patients on wards, to enable payment of treatment tariffs simply to 'grab the cash', when many could be discharged to home (much safer than hospital) and treated by their GP's.

All of the privatisation and commercialisation models will do nothing to advance patient care. To proffer the view that excellence will be intrinsic to allowing further private companys' to undertake treatment at Primary or Secondary level is littered with pitfalls. Thus far it certainly has not been proven, in fact costs have escalated out of proportion to the outcome. Time and time again it has been demonstrated that the private sector is only interested in 'cherry picking' those areas of treatment that are simple and straightforward and with little to no need for the 'back up' of an emergency department, and when things have 'gone wrong', which they have, patients have been rapidly handed over to NHS Hospitals to try and salvage something from the situation. 

Competition has long been viewed as being the spur to excellence within capitalism by successive governments since the Thatcher days, but the proof has been sadly lacking, with greed and mendacity demonstrated just as readily as in the public sector, in fact the paradigm has been so corrosive as to be valueless. Numerous companies have been earmarked by Government as 'preffered providers' in many sectors and proven to be incompetent, target driven, purveyors of substandard products and services. The simple model of capitalism is 'buy cheap and sell dear'. There are better ways of producing a better outcome for patients than that. We only have look to Winterbourne View and to the NHS IT programme to see the failings of the unbridled pursuit of money.

The organisations too, that oversee the NHS and Social Care also continue to give concern, with the CQC failing miserably in its raison detre to protect the vulnerable and curb dangerous practise because it spent too much time on the registration of the myriad components of Health care (which yields its funding) than on the protection of patients from harm. It does seem to have raised it's game a little now but like most things in Health care it's too little and too late.

And what of the Medicines and Health care products Regulatory Agency (MHRA)? Well, they seem to have gone to sleep on job, because they were warned back in 2006 about PIP's toxic breast implants after approving them without demur years previously. Could it be anything to do with alleged opinion of many that they are a bit 'cosy' with 'Pharma'. As is usual, I could not possibly comment on such a salacious view! Perhaps if anyone had checked the content the penny might have dropped because most comprised the sort of silicone used for sealing around baths and showers (Rhodorsil) or for oils seals and 'O' rings in automotive products (Silopren). As even the (fairly lax) FDA in the US banned this device in 2000,  what happened to the continuous assessment process that should have been in place?

Too often the bodies we pay with our hard earned taxes to safeguard us from harm are found wanting. and the NHS which is now consuming approaching 10% of GDP is found to be toxic for patients. When will lessons be learned?  Approximately when Doctors accept a 'duty of candour', or hell freezes over (not necessarily in that order).