Phones, Breasts, and Vaccines.

The report on the dangers of using mobile phones has been published in the BMJ, and frankly it tells us very little. The cohort sample did not include those who use them for business, who would be the heaviest users, one would think. So not to include these users is a glaring error surely, as in most things, dose dependency would be a significant element of any dangers.  Considerable heterogeneity in the cohort sample also leads one to the belief that significant factors unrelated to mobile phone use, could be at play or simply that those with a subscription may not even use their phone or use it infrequently or with some device that moves it from their head. This study then proves little and reinforces the tenet in scientific study that 'correlation (and observation) does not prove causation', or in this case does not prove any absence of harm. My advice then, for what its worth, is to avoid prolonged conversations, use some form of earpiece to move the mobile away from your brain, and eliminate their use by young children.Oh and wait for some real evidence of any lack of harm, before you drop your guard.

Breast Cancer is again in the news with further evidence of the harms attendant on Mammography Screening. The cited study highlights the increased liklihood of 'false positives' in line with the frequency of mammograms. And the recent Swedish Study reports that screened women had a higher incidence of breast cancer than did those who were not screened and of course the study, published in the 'Lancet' has a pay wall, except for the abstract. Is it any wonder then, that women have little information of an unbiased nature available to them, when this important study is virtually hidden from view, with little or no publicity attached. So the impossibility of informed choice continues. Mette Kalager's  comment in the same journal is telling. Is it not time that the facts were presented to women so as to enable them to discern dogma from fact?

Vaccines rear their dubious benefit once more now the 'flu season is with us once more. Health Professionals (sic) are entreating all over 65, pregnant women and the vulnerable to get their 'jabs'. I have to confess that I don't do it  (there's a surprise then) because I feel it to be worthless. The vaccine offered is not comprehensive for many 'flu strains nor is it tested fully for safety, so I'll take my chances, keeping my Vitamin D3 levels high. Recent studies  have shown little effect for vaccines for the elderly or indeed for those less so.  To be frank, I would be loath to give these vaccines to anyone. They are symptomatic of the interfering nature of the state to govern our health by diktat or worse, 'nudging', without any foundation of the intervention as having value. Most are ( in my view) worthless or even dangerous.

I am capable of acting in my own best interests and I do not need the ambivalent support of the State to guide me toward the best outcome for me. So I told the GP, when he 'hounded' me, as to why I hadn't taken up their generous (and incentivised) offer of a 'flu vaccination, to read the science, and politely suggested that he was just trying to fill the quota and thus get the money. I was astounded when he actually agreed. I think that some Doctors are as much victims of the system that tries to turn citizens into a vulnerable client of the state bureaucracy of health as are we all. Not that I view that as an excuse. Just 'following orders' has never been a worthy defence, even for a Doctor (sic).

You Want To 'Save' The NHS. Why?

As Thursdays report from the Care Quality Commission reverberates around the media, and adds to the mountain of evidence of misery, that is perpetrated upon that most 'captive' of all audiences, the Hospital Patient, is it any wonder that I question the motives or naivete of those who campaign to save our NHS?

This follows on from the  Royal College of Surgeons Report of only last week highlighting the appalling care meted out to patients who submit to emergency surgery, who or are admitted to A & E Departments at nights and weekends. The NHS is patently sick and cannot provide even the most basic standards of care, despite the vast sums of money extracted from the public to pay for it. 

It seems that the usually 'piss poor' CQC has followed Lansley's diktat and undertaken a number of unannounced 'spot' checks on Hospitals to formulate the report and found many Hospitals sadly wanting in the care of the elderly. Well once more I say 'no shit sherlock'. I could have told you that! Well more power to them, but I have to ponder as to whether they are an adequate provider of vigilance when they continue to be the 'licenser' of Health care Providers as well as it's invigilating body. They are funded by the very organisations they presume to police, which is a clear and present danger of potential bias and lack of independence. They have hardly covered themselves with any 'glory' in the past and the body itself is peopled by many 'refugees' from the PCT's and Hospital Trusts. It is highly likely that without the Health Secretary's urging that this report would have even been compiled. So I have to thank Andrew for that, although little else.

The NHS costs the taxpayer just shy of 8% of GDP in 2009/2010 (just over £100 billion) up from its initial cost in 1949/50 of less than £500 million (£11 billion at today's prices). The greatest volume increase being some £46 billion in the 'Blair' years (1997-2008). Yet we have seen very little improvement (er.. none) in the standards of care or the safety of patients despite this vast increase in expenditure. Under staffing and 'dumbing down', yes we have seen much of that. Vast increases in the apparatchiks and their enforcers and huge increases in pay for GP's and Consultants. Intensive 'marketisation' including PFI and the ISTC's, which even though some patients have been happy with (in the main due to short stays and hotel style accommodation) , does not detract from the view that a properly organised and adequately funded public health service, should be able to do better than the 'private sector', because there is no profit margin to factor into the equation. Hip replacement in the NHS, say £6000. In the 'private sector' £6000 + profit of 25% = £7500. And of course no 'backstop' in event of an adverse incident except to rush the inconsiderate sick patient to the nearest A & E of the NHS.

'Marketisation' then is likely to do little more than bankrupt many Hospital Trusts in the 'brave new world' of the HSCB with the large cohort of  'privateers' extracting ever more from an already creaking budget. But more; the growth of 'disease mongering' in the Primary Care sector will grow at an even faster pace, driven to new heights by the involvement of  'Big Pharma' in the provision of service as well as drugs. There is an already unhealthy relationship between the drug industry and many Doctors and Clinicians as Fiona Godlee stated in her recent BMJ Editorial, citing this study from the US and Canada as evidence of  'less than honest' dealings. I would cite more but the BMJ will not dispense with the 'paywall' on many occasions, thus actually adding to the censorship of that which goes on in the world of medicine, without the knowledge of those who are ultimately paying for it!

I actually find the original NHS model of universal health care as being a fine and principled concept that I supported for many years. I do not do so now, not from any perverse hatred of that concept but that it no longer ticks any of the boxes of its founders. Since 1979 it has been guided by the politics of greed and stupidity, most largely imported from USA. It has received huge increases in funding that have been 'squandered' on flights of fancy that did nothing to improve or even alter patient outcomes. The NeoLiberals gave most of it away to private sector companies who frankly would have no more idea about 'competition' than flying to the moon! Most would not survive at all but for the largess of the taxpayer, they have no other clients! Like the Banks, they have grown fat and lazy on our money, often without having to tender for anything. Like the Banks they have given us little in return, except another bill for our offspring's to pay.

What I would like to see is a new NHS. One that fulfils its original criteria without all the bureaucracy, hypocrisy and reverence afforded to Doctors and Clinicians as if they are some sort of superhero's. There are plenty of good guys out there, they just seem to have lost the ability of shouting louder than the bad one's. Instead of talking 'ball's' they need to find some.

Counting the Harms (and the cost),

I hold the view that the NHS is responsible for considerable harms. The cost of those harms, both financial and in lives, are often overlooked by the populace, because they hold to their bosom's a number of myths about disease, and how it can be avoided by 'screening'. That protocol is more of a political imperative than one borne out by the science. Cancer is one of these. We all want to believe that the NHS can save us from a terrible termination of our lives by 'catching' this scourge of contempory existence, in it's early stages and thus saving, or at least prolonging our lives. We are deluded. And it is 'bosoms', probably most of all, where screening concentrates it's efforts.

Breasts, define the difference between the sexes, perhaps more than any other element of  appearance and they are an emotive indicator of feminism, much admired by men and cherished by women, whose fear of breast cancer and the loss of that essential feminism, seems to be a real and present danger. But, that is largely a myth. Incidence is in fact between 1 and 2 per 1000 per year, dependent upon whether you are pre, or post menopausal. In fact 80% of detected breast cancer occurs in women over the age of 50, so this cohort is the most at risk. However, if we compute that into a ten year risk analysis, then 994 women out of 1000 will not get breast cancer.

Fiona Godlee in the BMJ of March 2006 questioned the ethics of screening and came to the conclusion that it was overstated for efficacy and 'over diagnosis' was a considerable failing of the system. This is reflected in the views of Professor Michael Baum in this critique he wrote in 2008, shortly after he resigned from the programme which he had helped to set up. Principal amongst his thoughts, are that screening does not cure anything it just detects asymptomatic disease; breast cancer, well maybe. But 'catching it early' does not devolve any cure, merely a postponement of the inevitable fate of us all, for a somewhat flawed paradigm of periodic testing, that in itself has unpleasant and somewhat dangerous implications for the recipient, with no gaurantee of longer or better life than would have been the case without it.

Mammography is the current test protocol for the early detection of abnormalities, which involves quite high levels of ionising radation, being delivered in several doses, to ensure an 'allegedly' complete picture of the breast. In fact the dose is equal to 1000x that from a standard chest X-ray, so there is some considerable dangers attached to screening in this manner. This holds true when pre-menopausal women are screened, as is the current plan (coming soon to screening centre near you), because the cumulative dose will increase significantly due to the longer screening periods. A dose level of 1 rad in total is often the case, so over time this can add up to a significant risk for cancer in it's own right. In fact the estimated risk of cancer from mammography was calculated, based upon a life total of 24 screenings, of the digital type (which uses a much lower dose than film screening, usually employed in the UK) that 8.6 women per 10,000 would develope cancer as a result of screening, in itself. That, I would add is not far short of the overall risk of 1/1000 of getting cancer anyway.

The Nordic Cochrane Centre has conducted extensive research on the subject and came to the following conclusions;-

 Absolute risk reduction for screening is 0.05%
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Screening led to an absolute risk increase of 0.05% due to a 30% overdiagnosis and overtreatment.


So, for 2000 women screened for 10 years, 1 (that's one) will have her life prolonged and 10 (that's ten) healthy women, will undergo unnecessary treatment including breast removal, chemotherapy and radiotherapy, for no useful purpose. The Centre has produced a leaflet which gives an unbiased and scientific evaluation of screening to enable women to make an informed choice, as opposed to the over emotional and biased view portrayed by the NHS and indeed most Physicians.

There have been many studies undertaken to prove or disprove the efficacy of mammography, and the results have been ambiguous a lot of the time, but the the Canadian Trials are viewed as being amongst the best and it is clearly stated that screening had no impact on mortality (post menopausal women 50-59). Here is the view from the Cancer Prevention Coalition in the US who have considerable reservations about it's outcomes and the forces at work that advocate it's use. And this riposte published in the The Lancet from February of 2002 looked at the attempts to 'rubbish' the Canadian and Malmo trials which, when evaluated showed no difference in mortality between screened and unscreened women (see here for more comment). Even the quite militant screening advocates, the US National Breast Cancer Coalition, indicate that screening only reduces the absolute risk by 0.07% ( in women between 50 and 65).


So at best we can hope for a very small, numerically insignificant reduction or no reduction, in breast cancer in post menopausal women, by mammography screening, for some extremely unpleasant side effects and a 10x higher risk of over diagnosis and treatment. Many cancers detected are in fact benign or self limiting and will regress if left or simply stay the same. We do much harm and very little good by screening and for women with breast cancer, a majority will have found it themselves and screening will have played no part, or worst the lump will have appeared between screenings. In other words screening finds very little vigorous tumours but is good at finding and treating cancers that are not usually life threatening. This skews the picture even more.

And what of cost to the NHS? Well around 2 million tests are undertaken each year and rising. The cost of the tests was £166 million (in 2008) but obviously more now. If we add in the re-tests, biopsy and operation and therapy costs so that we save one women in 2000 (in 10 years) but at the same time treat 10x that number who do not even have cancer, we are talking about £500 million or more. How can the NHS justify this enormous cost without having better outcomes? And why do women tolerate this appalling invasion of their bodies with all the attendant risks, amongst which is the fact that if they have already got cancer at testing, the 'squeezing' effect of the plates is likely to cause it spread much more quickly because of the force employed which is about 200 newtons (45 lbs).

Screening is not prevention, merely the detection of a marker for a given disease, or an actual tumour in the case of cancer. We 'sell' to women the view that we are preventing their untimely demise from cancer by screening, which is of course a complete lie.  It is in the interests of all involved in this 'industry' of testing that it continues and proliferates as it has done since 2008, when the 'saintly' Gordon (Brown) decided, without any scientific input, that he would fund a whole new paradigm of test protocols to enable the 'plebs' extend their life spans. As is usual Physicians and the NHS leapt at this opportunity for even more incentive payments to increase their wealth (and power).It reinforced the  utilitarian principles that have driven the Neo-Liberal doctrine since Tony Blair's ascendency and for all his heirs and sucessors including the tossers 'toff's' who now rule.

There are other alternatives for those who are particularly 'at risk' like the genetically disposed cohort, such as MRI and/or thermographic imaging, both of which are significantly more benign, or even entirely so. There is also considerable hope for a simple saliva test that will provide a non invasive test. There is also considerable evidence that maintaining sufficient levels of Vitamin D3 by exposure to sunlight (without sunscreen) can confer protection against breast cancer.

Well ladies, I have strayed into territory that many men would fear to tread, but I feel that you are all being manipulated by the emotional baggage surrounding this issue. Mammography is oversold and is wanting of evidence to justify both it's expense and it's outcomes. It appeals to the emotional attachment you have to a part of your body that feeds your offsprings, tantalises and fascinates most of mankind, and in many ways defines your femininity. It plays to the fears we all have of the 'big C' as John Wayne called it, and gives false hope for a dubious protocol that feeds an industry without morals, and an NHS that kills 25,000 people a year due to preventable adverse events ( Ian Kennedy's report of the  Bristol Heart Inquiry). Let us 'clean the stables'of that mess instead of  venturing into prevention strategies of little worth.






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