Has the Daily Mail Jumped the Shark?

The TV show Happy Days in many people’s view went in to a terminal decline when The Fonze jumped over a shark whilst water-skiing. Watching the show always involved suspending disbelief to quite a large extent as the Fonze is clearly a ridiculous character but the point when he jumped over a shark was the point at which the writers went too far. Was it hubris or over-confidence or simply desperation that led the writers to take their audience for granted? Either way it was a watershed moment. I wonder whether the Mail has similarly over-reached itself – not with its attack on Ed Miliband via his father so much, but by their attempted defence.

fonzie_jumps_the_shark

In many ways the attack on Ralph Miliband was typical of the Daily Mail – it is typical of their Modus Operandi: prejudicial, ill-conceived and misrepresentive of the subject. This response by Miliband Senior’s biographer is very telling.

The sole basis for this assertion was a diary entry at the age of 16 in autumn 1940, where Ralph Miliband wrote that “the Englishman is a rabid nationalist” and, “when you hear the English talk of this war you sometimes almost want them to lose it to show how things are.” Such sentiments might sound shocking, but they need to be put into their real context.

A few months earlier Miliband had arrived in Britain with his father, having walked from Brussels to Ostend, where they took the last boat leaving for Britain. While working hard to improve his English, he was also spending much of his time wandering through the streets of London trying to make sense of his new environment. He was in a constant state of anxiety about the fate of his sister and mother, who had remained in Nazi occupied Belgium as stateless Jews.

Because he believed that the earlier appeasement of Hitler was largely responsible for the situation, he was occasionally exasperated by the atmosphere of complacency and superiority amongst the British upper classes, and this no doubt provoked his intemperate diary outburst.

There is nothing new in any of this: The Mail has done this to many others. What is unusual is that Daily Mail could not deny Ed Miliband a response.

 

The petulance that accompanied the printing of Ed Miliband very measured article was impressive to behold.

Ed Miliband:

Britain has always benefited from a free Press. Those freedoms should be treasured. They are vital for our democracy. Journalists need to hold politicians like me to account — none of us should be given an easy ride — and I look forward to a robust 19 months between now and the General Election.

<snip>

The Daily Mail sometimes claims it stands for the best of British values of decency. But something has really gone wrong when it attacks the family of a politician — any politician — in this way. It would be true of an attack on the father of David Cameron, Nick Clegg, or mine.

There was a time when politicians stayed silent if this kind of thing happened, in the hope that it wouldn’t happen again. And fear that if they spoke out, it would make things worse.

I will not do that. The stakes are too high for our country for politics to be conducted in this way. We owe it to Britain to have a debate which reflects the values of how we want the country run.

The Daily Mail Comment

Red Ed’s in a strop with the Mail. Doubtless, he’s miffed that his conference was overshadowed by the revelations of his former friend, the spin doctor Damian McBride, serialised in this paper, which exposed the poisonous heart of the Labour Party.

Nor did he see the funny side when we ridiculed the yucky, lovey-dovey photographs of him and his wife, behaving like a pair of hormonal teenagers in need of a private room.

But what has made him vent his spleen — indeed, he has stamped his feet and demanded a right of reply — is a Mail article by Geoffrey Levy on Saturday about the Labour leader’s late father, Ralph, under the arresting headline ‘The Man Who Hated Britain’.

They seem to want us to believe it was an act of great magnanimity for them to publish the response rather the act of cowardice and calculation it really was. They know how much worse it would be if it was published elsewhere under the headline What the Mail refused to print. The choice of the grave photo shows the standard dehumanising attitude of the DM to those they oppose – although to be fair to them they have at-least acknowledged that this was in poor taste. Note the choice of language – responding to a deeply personal attack on his father, Ed is characterised as behaving childishly, whilst the Mail repeat the words ‘evil’ in reference to Ralph Miliband’s views.

If the professional ethos of journalism is to speak the truth to power then the Mail is undoubtably the very antithesis of a journalistic organisation. The reaction to this particular example though is interesting. The hardcore Mailites remain loyal but their wider credibility as a newspaper has been compromised. I – and many others – have long seen through them but the Mail has always maintained this pretence of seriousness. It is interesting, and not a little ironic, to see this pretence stripped away by their own bloody-mindedness. While Stephen Glover whines about the leftist conspiracy and alleged hypocrisy, the country at-large seems to take a different view. I find myself wondering if they have perhaps over-reached themselves this time?

I for one, truly hope so.

 

AFZ

A sad day for palliative care

Three weeks ago I wrote about my dismay at the Daily Mail’s attack on the Liverpool Care Pathway. This week Baroness Neuberger’s team has published its report: “More Care, Less Pathway.” Amongst its recommendations is this:

The name ‘Liverpool Care Pathway’ should be abandoned, and within the area of end of life care, the term
‘pathway’ should be avoided. An ‘end of life care plan’ should be sufficient for both professionals and lay
people.
Unsurprisingly the Mail is gloating over its victory:
  • Ministers order Liverpool Care Pathway to be ditched within a year,
  • Review by Baroness Neuberger reveals how end-of-life treatment was used as an excuse for appalling levels of care
  • Families were not told their loved ones were on the ‘pathway’ to death

The Mail has been leading a campaign against it…

I stand by every word I wrote three weeks ago. I am quite disappointed by how much the report has pandered to the Mail. If you read the comments sections of my last post, you will see many of the commentators are strongly opposed to the LCP. Whilst I think many of the comments are misguided, and just plain wrong I have not moderated any of them. (Unlike the Mail website which always blocks all of my comments posted as ‘alienfromzog’). I want to take this opportunity to respond to the comments, to the report and to the Mail. My main frustration is that when you read what people think caring for the dying should involve, it’s often words like “Caring,” “TLC” or “Individual” are used. Similarly many relatives say they want good communication. What is so frustrating is that this is precisely what the LCP is. What it’s for. If you don’t believe me , read this: Marie Curie Example LCP documentation.
It took years to recover from the damage done to the vaccine program by the Mail’s irresponsible reporting – and we’re still not there yet. This is why the Mail is so malevolent. And yes, I do blame the Mail in part for the children who have died of measles. Years of hardwork, research, evidence and education – all undone by Melanie Phillips and her malicious publication. And who suffers? The most vulnerable in society. There have been various articles and blogs written to defend the LCP. In all of them that I’ve read, they begin with an acknowledgement that the LCP used inappropriately has led to many of the problems reported in the press. I have not done that and this is deliberate. I am not pretending that bad practice does not occur. It does – in all areas of healthcare and all healthcare systems. I will always condemn bad practice but the idea that not using the LCP pathway properly means there’s a problem with the LCP is ridiculous. Moreover, by beginning with such acknowledgements I believe that all these articles and also the Neurberger report has conceded too much ground – allowing the LCP critics to claim victory.
Perfectly preventable problems of communication between clinicians, relatives and carers
appear to account for a substantial part of the recent controversy and unhappiness
surrounding the LCP.
I care about quality of care. Abolishing the LCP will make the Daily Mail happy. It will make the government look like they’re doing something and will almost certainly lead to less-good care. Almost without exception, the critics have said “Care of the dying should be….” and what follows that, as I said above, is in the LCP. So, in order to improve care we plan to abolish a tool that works when used properly rather than addressing the issues that lead to it not being used properly. This is insane. But then, that’s what government by tabloid press always is. My great fear is that scrapping the LCP will mean a return to ad-hoc, ‘hit and miss’ palliative care. This is a major backward step.
I do want to address a couple of specific points as well; firstly the LCP is not euthanasia by the back door. Secondly the payments for use of the LCP to hospitals have been presented as money for killing off patients and this is a gross misrepresentation.
I am against euthanasia. I think giving doctors the power the kill is a grave error – even when people are suffering horribly. Good palliative care is the very opposite of euthanasia. My professional experience – and this is especially true in children – is that we over-treat to the nth degree. We are not good in the profession in acknowledging that we cannot cure and fix everything. Most of us in medicine are ‘fixers’ by nature. A lot of what we do in medicine is nasty and invasive. I have no problem with doing nasty and invasive things to people who will benefit from them. I have major issues with doing nasty and invasive things to people when it will not help. This is about not having another round of chemotherapy when we know it won’t help. This is about not force-feeding people with artificial nutrition as their body shuts down. This is about not doing endless – and increasingly difficult  – blood tests just so we can chart the dying process. Integrating care pathways for dying patients mean we provide comfort and care for people in their last hours and days. This is vital.
The way the NHS funding works is quite complicated. Since the early 1990’s there has been a so-called purchaser-provider split and hospitals then get paid for providing specific treatments. One of the parts of this is so-called ‘quality-care indicators’  (or whatever they’re called this week). Essentially a portion of the money paid by primary care trusts / GP consortia is dependent on meeting the quality indicators. One such indicator was the use of the LCP in dying patients – x% was the threshold for payment. This actually makes a lot of sense; Let us assume that the LCP provides an excellent framework for caring for dying patients. Secondly, all patients who die in hospital are categorised as ‘expected’ or ‘unexpected.’ Death is often not a surprise – i.e. medical staff know that a patient is in the last phase of illness. The internal audit process simply reviewed what percentage of the ‘expected’ deaths were on the LCP when they died – i.e. had the medical team stopped doing invasive procedures on someone or were they still trying to cure? Nothing is absolute and some patients will die unexpectedly. Some people will have a theoretically reversible condition and it is right to keep on treating and yet we still fail – but the evidence is clear, in the majority of cases, we know someone is dying and the focus of care should change. A simple audit of whether the LCP is used of not is a good marker of this. The use of money to drive things is an inevitable consequence of how the modern NHS is structured – a perhaps cynical view that NHS trusts will only do things for financial incentives. On a more practical level, the trusts used this money to pay for specialist palliative care teams to support the use of the LCP and help the other clinical teams use it effectively. The abolition of such payments is a sensible political move but will probably also result in trusts not focusing on palliative care.
Speaking as the son of someone who died in an excellent hospice; speaking as a doctor who has worked on the wards where integrated care plans for dying patients have been used – and as someone familiar with LCP specifically I say this:

This is a very sad day for the healthcare in the UK. There is not a problem with the LCP – there is only a problem with poor practice – rarely. The number of patients who have received excellent care far outweighs the few who haven’t. Not that those don’t matter, they really do but I am sure that the bad practice was worse before we had integrated care for dying patients and will probably be worse again. What’s most annoying is when you read the comments sections or listen to radio phone-ins people talk about what they want end-of-life care to look like and it is precisely what is in the LCP. It is worrying to me that the Daily Mail wrote a couple of sensational and misleading articles and forced this change of policy. Deeply worrying. I know that a small group of people in the late 90s worked very hard to put together the research and develop the LCP. I suspect they are very demoralised. I know a lot of people work in palliative medicine and I expect they are depressed and despondent. All because a lying, evil rag – not even fit to be fish ‘n’ chip wrapping – calls itself a newspaper and constant prints streams of lies and sensation. A sad day.

Dr alienfromzog BSc(Hons) MBChB MRCS(Ed) DCH

Liverpool Care Pathway – The Daily Mail vs Care for the Dying

An inevitable philosophical question:

I’ve been occasionally contributing to Angrymob for a few years now. Kevin (aka Uponnothing) very kindly gave me a login. I write because I care about the truth. I write because I believe that the lies and agenda of the Mail are pervasive and damaging. I write because I hope to share my thoughts with enough people to help change the story – to help people realise what the media in general and the Mail in particular are doing. To provide the facts – as best I can – so that people who know the Mail is lying have the ammunition to respond.

I have no idea really if I’m achieving anything.

But the question that I’ve pondered for sometime now – especially when I read stories like this one – is what is going on within the Mail? I wonder if they believe what they write? I wonder if they just want an agenda to push? And I wonder what level of research they do before holding a particular position?

Either way, what they publish is demonstrably false and often deeply poisonous. This is why I have written about vaccines so much. The recent events in Wales with measles have shown the real-world effects of the Mail’s agenda. And this is moreover true is so many areas – immigration, race relations, the Welfare State, the NHS, our attitudes to poverty…etc. etc.

So, whilst I continue to ponder that question, which I admit does intrigue me greatly, I will try to continue to respond when I have the time. For the most part I write about healthcare issues as this is what I know about.

On the subject of poverty I invite you to read this from my personal blog. (I make no apology for the theology).

 

The Liverpool Care Pathway

I think I should begin with a confession; I am not a big fan of the LCP. I will explain that comment in a moment but first I need to alter it slightly. My feelings have changed and I have become very keen to defend it because the attack by the Mail seeks to (well maybe not, see above, will- ) damage the way we care for the dying in this country. If you want to read about the pathway itself and to understand what it is and how it works, here is a good place to start.

Simply put, the LCP was designed to consolidate best practise in the care of dying patients. In the UK we have a hospice movement to be proud of. Most people, however don’t die in hospices – most people die in hospitals. Historically (by which I mean the last 30 years) and culturally, hospitals are not conditioned to best care in the process of dying. Hospitals are places for curing. Modern medicine particularly is built on the notion of curing everything. Trust me, doctors know this to be a lie. Most of us have had enough humbling experiences with meeting death to know that we can’t cure everything and that the old saw about medicine being the art of delaying the inevitable is not without its truth. However, and this is a vital and massive ‘however’ – we are in the business of healthcare. Providing curative treatment when possible and appropriate and dignity, compassion and comfort when not.

Recognising that a patient is dying is notoriously difficult but experienced nursing and medical staff will tell you that we often know that it’s time to stop. I graduated in a time when these kind of approaches were widely accepted and beginning to be more formalised. It is about the fact that most people die relatively slowly – by which I mean hours to days  and not the seconds to minutes we see in TV and movies. Given that putting everyone in a hospice is not practicable, I think most of us will agree that providing the best kind of end-of-life care in hospital is a priority.

The principals are this: When a patient is near to death; stop unnecessary and invasive interventions (like blood tests) and treat symptoms effectively. This usually means three things; analgesia, treating anxiety and treating secretions.

The Liverpool Care Pathway codifies these in a way designed to ensure that best possible care is provided. Feeding may be stopped as in the last few days as artificial feeding does more harm than good.

So why do I not like the LCP? Well, this is not really my area of medicine and as I’ve moved into my specialty of paediatric surgery, I haven’t done any adult work for over three years now. But I was a junior doctor on the wards – and anyone who has done that job will have dozens of stories of how the LCP is a really effective way of CARING for dying patients. My objection is the same as that of a professor of palliative care I know, the LCP is a little cumbersome and involves too much paperwork and it got a lot of national attention and funding  – potentially at the expense of other areas. But is does work. Really well.

The LCP is very very good at what it does. The LCP – or something like it – is exactly what I would want for me, for anyone I love – or for any human being near to death.

 

The Daily Mail’s latest Witchhunt.

Back in November, I picked up on Melanie Phillips evil comment piece on the LCP and its effects. I do not use the word ‘evil’ lightly but something so completely dishonest that increases distress and anxiety for people who are watching loved-ones die I think is evil. If someone wants to provide me a better word, please do. Again I don’t know if Phillips is being dishonest of just not bothering to research properly – but I suspect dishonesty as she has never effectively engaged with the debate or criticism – where it has been repeatedly demonstrated where she is wrong.

And so we come to this week’s piece. The British Medical Association has been discussing the LCP and the public’s perceptions leading to this Daily Mail headline:

‘Don’t call it the Liverpool Care Pathway’: Doctors admit it sounds like a one-way ticket to the grave

  • Leading doctors have admitted that there are problems with the controversial end of life care regime
  • Involves withholding food and water from the dying patient and is meant to help them die with dignity
  • Doctors admitted some patients have been left on it for weeks without having their case reviewed
As always, the culpability lies with the medical profession and not with the Daily Mail for printing misleading articles… The implications that doctors are killing patients or that they don’t care or that somehow this is a NHS initiative to save money are ———– well, I don’t know, I’ve run out of adjectives… (insulting, misleading, offensive, damaging, dangerous, horrific, indefensible, typical for the Mail, wrong, cynical, plain dishonest) – take your pick!
Well, actually I think all of those and then some more:  The implications that doctors are killing patients or that they don’t care or that somehow this is a NHS initiative to save money are insultmisleadinglyoffensivelydamaginglydangeroushorrificlyindefensiblelytypical-for-the-Mail-wronglycynicallyplain-dishonestetc!
As always the comments section provides a worrying perspective, but this is my favourite:
comment
No my dear-UKIP Supporter the reason they don’t have this ‘uncomfortable controversy’ in the States, is I suspect, because they are blessed enough not to have the Daily Mail.
AFZ

Vile Product

I genuinely didn’t think it was possible for me to have more contempt for the Mail. It turns out I was completely and utterly wrong:

20130403_073440

I think that pretty much everyone who’s heard this story of the Philpot family will have been deeply saddened and upset. It is a very bizzare tale of a couple conspiring to set alight their own home and implicate someone else. Ultimately, six children lost their lives in this fire. The Philpots will be sentenced today for manslaughter.

Of course you can trust the Mail to provide a different angle.  There is much to be said about this story but according to those wise social commentators at DM it’s emblematic of the Welfare Culture of Britain. The implication is clear, anyone on benefits may be just like them.

This leaves me with a question, which is more revolting; implying that all benefit claimants are like them or using the death of six children to further an agenda?

I am really not sure, but I am astounded, once again by the vileness of the Daily Mail.

AFZ

Something Positive About The Daily Mail

Now, bear with me!

On Facebook there is an identity referred to as “The Medical Registrar” this is a small number of doctors who post pithy and interesting comments about medicine. Sharp humour is the usual modus operandi. Along with the occasional rant.

A couple of weeks ago they posted on the drivel that Melanie Phillips constructed to assault the Liverpool Care Pathway. If you’re not familiar with the Liverpool Care Pathway (LCP), it has been around for a few years now and is a consolidation of best practice in patients who are dying. This is important because whilst we have an unbelievably excellent hospice service in this country, most people who die in the UK, die in hospital. In part because there are not enough hospice beds. In part because it is not always possible to transfer people in a timely manner.

If you want to read Melanie Phillips’ nonsense you can find it here. Subtle as always.

However, this post by the Medical Registrar last week made me smile a lot:

I do think that ‘publicity seeking hack’ is spot on, as indeed is ‘fish and chip wrapper.’

Now, I really like fish and chips, so I have to admit that The Daily Mail makes very good wrapping and to be honest, I can think of no better use for it.

AFZ

Freedom for what? To kill young women?

As regular readers of this blog know, the Daily Mail believe that the vital importance of a free press is an excuse for anything they want to do. The confluence of reporting and commentary is so insidious and malevolent. Many newspapers are guilty but the Mail is the biggest culprit.

For me, one of the best examples of this is in the reporting of vaccine stories. I have written about this before. I wonder if I should apologise for covering old ground, but then as long as the Mail puts real lives are risk by cynically exploiting people’s fears in order to push an agenda and sell newspapers, I think I will feel compelled to respond.

So the current Mail  campaign is against the HPV vaccine: Girl, 13, Left in ‘Waking Coma’ and Sleeps For 23 Hours a Day After Severe Reaction to Cervical Cancer Jabs. Now, you don’t have to be a doctor to begin to doubt the veracity of the headline, simply reading the article itself is a good start;

“But just weeks after she received the third dose of Cervarix in May this year she began to feel exhausted.”

Let’s just cover some facts:

  1. Cevical cancer is caused by a virus (Human Papilloma Virus).
  2. The current vaccine protects against 70% of the strains that cause cancer
  3. By preventing the virus infection, the vaccine prevents the cancer
  4. If you look at the data (also in the article) the vaccine is very safe.

The subject of this article has been diagnosed with chronic fatigue syndrome. This remains a controversial issue for lots of reasons, not least because despite a lot of research, a cause has not been clearly identified. Therefore to ascribe her symptoms to the vaccine that was given weeks before is a very speculative statement at best.

Lets have a look at the little information panel they’ve included:

Now I assume that they’ve got this data from the MRHA (The medicines and healthcare products regulations agency). On their website I couldn’t find the up to date figures because they don’t publish them routinely but they are available on request. However the initial figures from the first two years are here. The importance of this is how closely vaccine reactions are tracked and recorded. So lets look at the side-effects; 4445 out of over four million vaccines is around one in a thousand reported side-effects. Of those the vast majority were local reactions and rashes. Now I don’t want to underestimate the significance of a sore arm, but I think cancer can be quite nasty too. Allergic reactions are important, because a severe reaction can be very dangerous, but the figures for anaphylaxis are extremely low. The final comment about Guillan-Barre syndrome is also very disingenuous. GBS is a nasty condition but it occurs sporadically and rarely in the population all the time. The important point is that people notice when they occur after a vaccine. If the two really were linked then the rate in the vaccinated population would be higher than the background rate. It is not.

Please remember people, coincidence is not the same thing as causation. It seems that if something occurs around the time of the vaccination, then the vaccine must be to blame.

I firmly believe that the press has an important role to play in keeping the powerful accountable. However, making stuff up and stoking up fear is something very different. I wouldn’t mind but the HPV vaccine will save many young women from a horrible and early death. If the vaccine really is dangerous then we shouldn’t use it. But it’s not. The ever-increasing evidence is that the vaccine is very safe.

I wonder, if in 15 years time someone did a study which showed that cervical cancer was massively more common amongst the daughters of Daily Mail readers, would they publish an apology? No, I thought not.

Here’s a headline for you:

Reading the Daily Mail can cause cancer in your children!

 

AFZ

Reason for hope

So whilst Uponnothing is away, I’m taking advantage of my posting privileges.

On Wednesday the Mail front page headline was this: The shirking classes: Just 1 in 14 incapacity claimants is unfit to work

This is classic Mail in so many ways, see how many you can count. These are the ones, I found:

1. Abuse of the poor

2. Abuse of the vulnerable

3. The use of dodgy statistics

4. The headline contradicted by the story

5. A Tax-payers’ Alliance quote

Everyone on incapacity benefit is facing a ‘testing’ process to decide if they are fit for work. Because this began with a pilot system and is now being rolled out we get a drip-drip effect as each set of statistics are released. The way it works, is that the government pay ATOS (A French company) £100m to assess people as belonging in one of three groups; ‘unfit for work’ ‘activity group’ and ‘fit for work.’ This, in principal is a good idea; people who wish to claim Employment and Support Allowance (that is replacing incapacity benefit) by definition will fit into these three groups. And moreover there are a lot of people who cannot work, who want to work and who will be able to work with support. It is even the case that people put into the activity group do get support to help them back into the work place.

The problem lies with the testing process, which according to the Work and Pensions Select Committee is completely flawed. 40% of people who appeal against the ATOS decision get the decision reversed and over 80% are successful if they have expert representation. (The tribunals alone cost the tax-payer £30m). This is of course, buried in the article thus destroying the credibility of the headline…. Overall, so far 160,000 people have successfully appealed.

Let’s have a look at the figures (from the article)

33% drop out before completing the process

39% declared fit for work

17% able to work with support

7% unable to work

Yes I know that the figures don’t add up. So let us look at this for a moment, the headline is claiming that 13 out of 14 people who claim Employment and Support Allowance are ‘Shirkers’ or whichever term of abuse you want to use – that’s 93%. Which isn’t even true on the basis of these figures. 24% are not able to work at present (The 17% in the support group are not able to work, but may be able to do so…). In addition they are assuming and/or implying that the third who don’t complete the process were by definition trying to cheat the system. An assertion for which there is no evidence whatsoever. Not to mention the fact that over 160,000 people have successfully appealed (which is 14% of the total). Never mind the fact that being turned down even if it is the right decision does not mean that someone was trying to defraud the system – many would have been honestly applying for a benefit they were told they might be entitled to. That’s what they are supposed to do.

These articles make me extremely angry. I don’t have the time, nor do I wish to make and already over-long post even longer, to explain fully the truth behind these stats and how I have no confidence at all in ATOS’s assessments. The point of the article, though, is not to inform and educate but to slur and demonise anyone who is unfortunate enough to be disabled. And that is plain wrong.

But as, you may have noticed, the headline for this post was ‘Reason for hope’ and I promise you my headline will not be contradicted by the body of my article. In general, reading the comments section of Mail articles is darkly amusing and more than a little depressing. Usually the most highly rating comments are those that have swallowed the Mail lies completely and want to be angry at, and abuse whoever is the Mail’s target this time.

But, but! When I looked today, this was the most highly rated comment:

Best rated

Can it be true? Are Mail READERS finally realising that they cannot trust anything they read?

Maybe, just maybe.

AFZ

Bad Journalism

As has been highlighted before on this blog the Daily Mail is particularly adept at exploiting the PCC’s ruling that ‘headlines are not actually part of a story’ and hence do not have to be accurate.

I was browsing through the brilliant Ben Goldacre’s Bad Science blog this morning and found an excellent article highlighting another way that the Mail seeks to mislead and yet stay within the ‘constraints’ of the PCC codes.

In essense, Dr Goldacre explains how the Daily Mail – continuing it’s bizzare oncological-ontology project* – ran a story claiming that a certain diet could reduce breast cancer risk by 40%. As Ben explains, there is no basis at all for this claim within the research. This study doesn’t assess cancer risk at all. It simply shows that certain dietary pattern can have effects on hormone levels. It is speculative in the extreme to make the link from the diet to breast cancer risk.

The Daily Mail know this. I know that they know this because they admit as much – all the way down in paragraph 19.  Ben explains very well in his blog the research that shows how people read newspapers and how this caveat is very likely to be missed by many (if not most) readers. However the Daily Mail can still claim accuracy for their article because it’s in there somewhere.

I do not think this is accidental. I think they know exactly what they are doing – they are using this technique to deliberately misinform.

That is journalism of the worst kind.

AFZ

*Daily Mail’s on-going oncological-ontology project: to categorise all objects in the world as either ‘those that cause cancer’ or ‘those that cure cancer. Recent entries include Facebook as both a cause and a cure.

Daily Mail vs NICE

(National Institute for Health and Clinical Excellence)

It is becoming clear that the Daily Mail hates NICE. Now for many people that is recommendation enough for the much-maligned body, however I think we do need to look at this in a little more detail. I am not sure why the Mail hates NICE so much except perhaps that NICE gets to decide a lot of national policy in terms of where healthcare funding priorities are. In this article I spent some time explaining how NICE do this but in short they decide what PCTs should fund on the basis of what works and is cost effective. I think this is the reason the  Mail do not like it because they seem to think it is their right to decide where NHS money is spent. Please pause for a moment and reflect on what a horrific prospect that is.

And to some extent it has already happening with the government’s ludicrous idea of setting up a special fund for cancer drugs. A couple of points before I explain my objection to this fund:

1.      I am a doctor – a surgeon in fact and am used to dealing with patients with cancer. I want my patients to have to best possible care.

2.      When I was seventeen my mum died from breast cancer. I know what it is like to watch someone slowly die from cancer.

These two statements are important because I do not think it right to set up this special fund. The reason NICE did not recommend these drugs is because they do not work very well and they are extremely expensive.  If we had an infinite amount of money then I would have no objection but one thing needs to be clear; by funding cancer drugs we are not funding something else – something that works a whole lot better. The technical term for this is opportunity cost. This is the problem, by doing one thing, we cannot do another, so it’s vital that we do things that work.

So today’s story really caught my eye: Azheimer’s victory for the Mail and comment here

I’m not sure if it’s the gloating or the glaring inaccuracies that annoyed me most.

So let’s summarise the story:

1.      The EVIL NICE wouldn’t allow doctors to prescribe three drugs for Alzheimer’s disease unless people were really ill.

2.      The Daily Mail raised lots of money for a judicial review forcing NICE to make a U-turn.

3.      Fewer than one-in-ten Alzheimer’s patient’s currently receive the drug whilst trials clearly show a benefit if started early

Dementia of whichever form is a very cruel condition, it slowly robs someone’s personality, often leaving relatives grieving for the loss of their loved one long before they’ve died.

I have read the NICE summary report and – even though it’s not my area, I know how to read clinical evidence, it’s part of my job. The main problem with these drugs is that whilst they are relatively cheap they do not work very well. In a small number of people they have significant benefits for a short space of time whilst in many they have no effect whatsoever.

I just want to answer those three points from above.

1.      One of NICE’s roles is to advise on new therapies and treatment’s effectiveness. When NICE recommends a drug/therapy PCTs (Primary Care Trusts, who currently control the NHS money) HAVE to fund it – by law. When NICE state that a therapy is not cost effective then the PCTs have it within their discretion to fund it if they want to. But to do so means not funding something else.

2.      The Judicial review is interesting, here’s what it said;

On 10 August 2007 the judge ruled in favor of NICE on five out of the six grounds bought in court. The judge found that NICE:

  • did appropriately take into account the benefits these drugs bring to carers
  • appropriately reflected the costs of long term care in its calculations
  • did not breach principles of procedural fairness by providing a ‘read only’ version of the economic model
  • was not irrational in concluding that there is no cumulative benefit to patients after 6 months’ treatment with these drugs
  • that NICE’s assessment and consideration of the AD 2000 study was not irrational.

The judge ruled against NICE on one of the six grounds bought in court. She found that NICE did breach its duties under the Disability Discrimination Act and the Race Relations Act by not offering specific advice regarding people with learning disabilities and people for whom English is not their first language in its technology appraisal guidance

3.      The trials clearly show that the benefits of these drugs is quite limited and are seen in a minority of patients.

I am very pleased that NICE has now recommended that these drugs be made available. I hope they bring help to many people. However my confidence in these medicines is not because the Daily Mail said so but because of what the evidence showed. Analysing the evidence is very complex. I am an expert and in the hour or two I had to spare today I was only able to scratch the surface. It takes a lot of time and skill to do this properly.

Reading through the NICE website today, particular the submission from the Royal College of Psychiatry it is possible to conclude that when NICE ruled not to approve these medicines five years ago for mild dementia they got it wrong. I’m not sure, but if they did, that’s not surprising, this is a particularly difficult decision in a field where none of the decisions are easy.

However, that does not mean that the process is wrong, that does not mean that NICE does not do a very difficult job well.

It is becoming clear that the Daily Mail believes it has the right to decide on Healthcare spending priorities and I want everyone to realise how terrifying that prospect is.

AFZ

P.S. Well done to anyone who’s managed to read all this!