HPV Vaccination; There's More.....

Moving on from my last post, I have looked at outcomes and costs of this protocol, and it seems to me that it is more of a ploy to give GP's 'something to do' (for which they will want paying-as always) and to make 'Pharma' richer, rather than anything of real worth.

The objective at the moment is to vaccinate young girls to 'prevent' in later life the incidence of cervical cancer and now throat cancer (and possibly genital warts). Well the cost is looking pretty staggering. If the NHS is to achieve it's goal of all teenage girls receiving Cervarix (GSK's version of the vaccine), it would cost, at £450 a 'pop', some £2.155 billion. If we add in the boys as well this goes up to £3.375 billion. And that's without factoring in the cost of administering 3 doses over six months which will be at least £5 and probably nearer £7.50 a 'go'. If some sort of 'target' payment is introduced to encourage take up, (likely-because GP's don't do anything for nothing) we're already looking at least an extra £22 million and more likely £40 million. That's an awful lot of taxpayers money, for a problem that isn't really, er... a problem. So what is?

Well, HPV Vaccines are not proven as being preventative, because the timescales involved can be as long as 40 years and generally at least 20 years, before Cervical Cancer develops. So, it will be along time before we know the real outcome of the vaccine protocol. In the majority of cases found, the lesions do not progress to cancer and those who end up with actual cancer have a quite low mortality. The incidence rate in the UK is in fact 8.5 per 100,000 (0.0085%) but the mortality rate is only 2.4 per 100,000, leading one to believe that treatments are very successful or (more likely) a lot of women are being counted who did not really have full stage 3 cancer. Both mortality and incidence have been falling (off a cliff) since the 1950's with the largest decreases in the quintile one would have expected to be most 'at risk', those sexually active in the 1960's (or 70's if not in London), the 55-64 year olds. This cohort have in fact had the most spectacular drop of all, in mortality of 79% (up to 2000). Mortality and obviously incidence increases with age unsurprisingly, but even in those over 65 the mortality is 11.8 per 100,000 or 0.0118%. These sort of percentages if seen in a clinical trial would be viewed as too small to count as significant.

There is now a view (a desperate one) that we should utilise HPV Vaccines for genital warts, (Gardasil is licensed for warts, but not Cervarix), and yes incidence has risen since the 1970's but is now slightly on the decrease. However at 148.7 per 100,000 could hardly be viewed as an 'epidemic' (1.49%). yet some clinicians advocate this for boys/girls and young men/women as a precaution against warts, which the last time I checked could hardly be viewed as 'terminal' and is eminently treatable. I feel all of this 'hype' of vaccination is counterproductive and dangerous. Good sex education and the discouragement of 'early' sexual encounters would be somewhat more in keeping with the needs of society. And, as I said in my last post the actual incidence of harm for vaccination is higher than the risk of cervical cancer.

Do we need to spend vast sums on vaccines of dubious benefit for 'so-called' cancers of extremely low incidence, such as throat, cervical and some sexually transmitted diseases generally without fatalities? Life itself is dangerous and to the best of my knowledge, no one has yet escaped alive. Whilst I would advocate cervical smear tests for women over 30 years (pap tests), I feel we are in danger of more 'disease mongering' if we continue down this road of trying to remove all risks from simply, well 'being' (alive that is). The sort of sums involved are colossal for rewards that are dubious, unsupported by any real scientific evidence, and that can cause harm, even death. The NHS has promoted mammography, DXA-scans, exclusively hospital births, hormone replacement therapy, even thalidomide in it's history (in the main for women) and some of these have turned out to be a tragedy of enormous proportion. In many ways it should take note of the old adage that 'if it ain't broke, don't fix it'.

No Shit Sherlock!

The Royal College of Surgeon's (RCS) recent report on the appalling death toll of patients admitted for out of hours and emergency surgery is to be commended. It has been a long time in coming and highlights the dangers associated with being admitted to Accident and Emergency in the evening, or worse, at the weekend. It sheds light on the dangerous and often fatal, lack of care imposed upon patients who present with, often simply diagnosed conditions, who then become even sicker than on admission due to lack of manpower, facilities and very basic care that all of us hope to avail ourselves of, should we be unfortunate enough to have an accident or become ill outwith the Primary Care pathway.

The NHS is quite good at the provision of elective surgery, especially cardiac surgery. It is however significantly lacking in safety when it comes to major general and emergency surgery, with both higher mortality and complication rates than are acceptable in the setting of modern hospital care. Of 170,000 patients treated for non-cardiac surgery we manage complication rates of more than half at 100,000! And of those, we actually manage to kill 25,000! Mortality rates for emergency surgery in England and Wales is over 25%, with early discharge and subsequent re-admission being a significant factor in these statistics. The other horrifying figure is that our chances of dying is 10% greater if it's a weekend!

Well I'm no stranger to this situation, when she, with whom I have have decided to end my days, became part of these same statistics. Delays, both in pain management, diagnosis and treatment at a very basic level were missing, possibly because it was early on a Friday evening. No Consultant on duty, just a few nurses or rather 'healthcare assistants'. Of Doctors, well none until some five hours into admission. Tests, well there were plenty of those, in fact it seemed to be a goal rather than any sort of pathway to treatment, as hindsight indicated that none of the results were followed up! An X-ray was eventually carried out, but nonetheless a a treatment protocol was then pursued that was contraindicated and injurious and resulted in an outcome she still lives with to this day and which will blight her life until it's end.

Weekend surgery did take place, 'squeezed' into the list between the 'elective' private patients who had the surgical suite given over to them for some Saturday 'bunce' for the Consultants. Postoperative care was poor to non-existent with severe hypotension ignored, as was the diabetic keto-acidosis, and very low oxygen saturation that kept triggering alarms ( to my alarm).

So, this report does not surprise me in the least. The apathy and stupidity demonstrated to me by my personal involvement in this event did at the time. Up to then (2008) I had not had any chance to witness first hand the terrible position in our hospitals especially in emergency care. Any contact I did have had faded, like most bad memories do; part of that 'defence' mechanism our minds have to retain sanity. Despite my many ailments, and a minor wound in my early history with firearms, none was dependant on a hospital stay and I hope that it remains so. So dear reader, I would suggest that you plan for any emergency you may have in health care for you and yours, on a weekday between 0900 and 1700hrs. Or of course join with me and others to press for a whole new paradigm in health care and medicine, that is patient centred and based on scientific treatments. I want to tear it all down, rip it to shreds, along with many of those that perpetuate it by virtue of vested interest or hubris or worst, apathy.