Cameron Declares War on Benefits Cheats…

All regular fans of Angry Mob will know that Uponnothing, regular writer, editor and host is away on honeymoon. Which is great news for him and Mrs Uponnothing. The really keen amongst you (yes both of you) will know that I occasionally write articles for Angry Mob which I hope are interesting and informative. With the move to the new site, I was granted my own log-in to the blog so I can post whenever and whatever I want… hehe!

The Prime Minister has made a key speech, picked up by all the papers and the wider media on plans to combat the great evil of benefit fraud: You can read the various angles here: Daily Mail The Express The Telegraph.

You may notice that the figure of £5bn keeps coming up. This is an interesting one as this is the figure for fraud and various errors that lead to over-payment. The actual figure for fraud is only £1.1bn.

But we all know that fraud is rampant – because the press keeps telling us about case after case of fraud; a quick search of the Daily Mail website reveals dozens of such stories.

Let us have a look at some of the facts (all of this data comes from the Department for Work and Pensions Official figures 2008-9, last complete set of data.):

Fraud: £1.1bn (0.8%), Customer error: £1.1bn (0.8%),  Official error: £0.8bn (0.6%)

The percentages are of the total benefits budget. So fraud is less than 1% of total benefits spending.

A couple of other interesting statistics worth noting:

  • under-payment due to errors: £1.2bn (i.e. more than fraud)
  • £10bn. The amount of unclaimed benefit that people are entitled to.
  • since 2001, fraud has been reduced from 2.1% of the benefit budget to 0.8% (halved in cash terms)
  • £15.2bn – the estimated loss to the treasury of Tax Evasion.

What’s my point in all this? I am not saying that benefit fraud is acceptable, it’s clearly not. What I am saying is that this is all part of an on-going narrative that paints anyone on benefits as a drain on society and probably a thief. It is cheap political points scoring at the expense of the vulnerable and that is sick. The print media (especially the Daily Mail) are particularly guilty of this.

AFZ

P.S. A couple of good articles on Liberal Conspiracy about this issue:

The Daily Mail Restoring my Belief in Human Nature – no really!

In general, the comments section of Mail articles is the best place to go for either a good laugh or general despair at how misinformed and prejudiced it is possible to be. However occasionally, the Mail publishes something so bad, that even the Mail readers can’t stand it.

This Repellent article by Janet Street-Porter is one such example.

Completely misinformed, misguided, offensive and dangerous. This article is also evil because it only serves to increase the dangerous stigma against mental illness that exists.

I don’t intend to respond completely to it, this article by Alastair Campbell in the Mirror does a pretty good job of that. I have only one observation to add – that the poorest in society are both more likely to suffer depression and less likely to seek help – despite what Janet seeks to assert.

However, this is one of those rare occasions when the best-rated comments underneath a Mail story are a source of hope and that is unusual.

Sick and Wrong

I think I should apply for a job as a Daily Mail writer. It seems so easy. In order to write a Daily Mail article one merely needs to follow this three step process:

1. Take a standard Daily Mail premise (i.e. “Asylum seekers are evil…)

2. Find a random statistic and throw it in.

3. Conclude that some part of the country in hideously broken.

This explains why the Daily Mail-o-matic is so astoundingly accurate.

So this story and editorial comment has a simple point to make: life-saving cancer drugs are being denied by NICE (National Institute for Health and Clinical Excellence), whilst at the same time the NHS wastes £21billion (yes billion) on ‘failed schemes to tackle inequality.’

The headlines are great aren’t they: Betrayal of 20,000 cancer patients… and NHS waste betrays our cancer patients.

I’m a huge fan of Warner Brother’s Looney Tunes Cartoons (Bugs Bunny, Daffy Duck, Road Runner etc.) and it’s a intriguing fact that they employed joke writers who got paid $50 for each gag that was then included in a cartoon. I’m beginning to wonder if the Mail employs headline writers on a similar basis; £1000 for ‘NHS Waste’ – £2000 for “cancer” etc. If so, they’re really earned their money. As usual, the article is almost entirely untrue. I think what depresses me most is the comments section of Mail articles. People actually believe this stuff. This is the main reason why I am very grateful to angrymob for allowing me to contribute articles. It’s extremely therapeutic to me to be able to respond – it is a shame that the angrymob readership is not as wide as the Wail, but it is a start. “You shall know the truth and the truth will set you free” as a wise man once said.

£21 Billion

I read this article because of the reporting on the workings of NICE but what really caught my eye was the £21billion claim. It’s classic Mail really; billions of pounds wasted on tackling inequality. Because we (Mail Readers) all know that tackling inequality is part of the evil-socialist-not-really-British-human-rights-nu-labor-agenda. It’s almost like subliminal messaging only with the subtlety of a bulldozer. The reason this line caught my eye so much is that there is no way it could possibly be true. And the writer must have know this – this can’t just be an error or a misunderstanding – it’s so off-the scale wrong that it’s obvious after about 2 seconds of thought.

Last week it emerged that £21billion – a fifth of the entire annual budget – was spent on failed schemes to tackle inequality.

It took a little bit of research to work out what on earth this referred to and having found the answer, I have to admit I am impressed by their creativity. This figure is derived from a National Audit Commission report entitled “Healthy Balance” which looked at public health spending in England. As an aside, this is the short summary of the report:

The health of people in England has improved over the past ten years. Life expectancy has increased, infant mortality has fallen. Government targets to cut death from heart disease and stroke by 2010 have already been met. But if the big picture is positive, stark problems remain. Inequalities in the health of people from certain areas and social backgrounds has stubbornly resisted improvement, and has even increased in some cases.

So, public health programs from the government have been very successful but health inequalities remain a challenge. This is how they get to say that schemes to tackle inequality have ‘failed.’ So what of this £21 billion spent – from the article is seems this is a specific budget on schemes to tackle inequality – bureaucracy and PR are the sorts of things this statement conjures in my mind, certainly no actual healthcare. The reason I knew this was a lie, is the simple fact that this is impossible – there is no way the NHS could spend a fifth of its budget this way – it’s just untenable and hence the writers must have know it was false. So I found the figure of £21 billion buried in the article. What it comes down to is this; The government provides funding for the NHS in England by providing funds to PCT (Primary Care Trusts) who then control the money and ‘buy’ services from GPs and Hospitals (and other providers). The money is allocated on the basis of population size. However it is not distributed evenly as social deprivation has a strong correlation to healthcare needs and hence healthcare spending. How money is allocated is complicated – much of it is targeted or ring-fenced by the government and some of it is determined on a formula to allow for variations in need. Of the English NHS budget (around ~£70 billion) £21 billion is allocated according to this formula. What that means is this is not money spent on inequality measures but allocated on the basis of differing needs. And what’s it spent on? Well, everything the NHS does – hospital beds, operations, GP service, prescriptions etc.

As I said, it is impressively creative. A blatant lie, but a creative one.

NICE

The National Institute for Health and Clinical Excellence has a very difficult brief. They are charged with creating clinical guidelines based on the best available evidence in order to improve healthcare across the board and also to assess new therapies to see if they are both Clinically effective and Cost effective.

There are a lot of new cancer therapies that the drug companies keep bringing out. These drugs are often very clever and stem from a much better understanding of cancer biology at the molecular level. All of these drugs are very expensive.

In order to determine whether these drugs should be available on the NHS, NICE asks too questions; Does it work? (Clinical effectiveness) and Should we spend money on it? (Cost effectiveness). The second question is often the problem and as a clinician I have an instinctive distaste for the concept; my patient is ill, I want to make them better, this works and I don’t care how much it costs… However, whichever healthcare system you work in there are limited resources and hence the need to ask if therapies are cost effective. This is done using a methodology called QALYs (http://www.medicine.ox.ac.uk/bandolier/booth/glossary/QALY.html)

The concept is that a year of life lived at 100% health equals one QALY, whilst a year lived at 20% health equals 0.2 QALYs. The advantage of this approach is that is enables very unlike things to be compared such as therapies that treat disabling conditions against life-saving procedures. Ultimately it is impossible to put a value on human life. It is truly absurd. However in clinical practise where there is a limited pot of money – as there inevitably is, somehow we have to decide which treatments to use.

The interesting question is how much should the NHS spend per QALY gain?

To try and give some meaning to that here are a few examples (caution: the figures are made up by me to provide context)

Hip replacement
Patient aged 65
Life expectancy 15 years
QALY score without treatment; 0.4 x 15 years (i.e. an arthritic hip seriously decreases the individuals quality of life)
QALY score after hip replacement; 0.8 x 15 years
(Quality of life increased from 0.4 to 0.8)
QALY gain (0.8 x 15) – (0.4 x 15) = 6
Cost of Hip replacement £3000

Cost per QALY gain: £500

Neonatal care
Premature babies are extremely expensive…
28 week premature baby (born 3 months early)
Life expectancy without treatment: 0
Life expectancy with treatment: 70 years
QALY score with treatment: 0.8 (some prem babies achieve approximately full health, some never do, the range is massive)
A ’28-weeker’ would typically be in a NICU unit for 12 weeks at a cost of around £10,000 / week
QALY gain: 0.8 x 70 – 0 = 56
Total Cost: £120,000
Cost per QALY gain: £2150

Monoclonal antibody based chemotherapy for kidney cancer

Patient aged 38
Life expectancy without treatment: 3 months
QALY score 0.7
Life expectancy with treatment: 27 months
QALY score 0.5

QALY gain: (2.25 yrs x 0.5 QALY/yr) – (0.25 x 0.7 QALY.yr) = 1.125 – 0.175 = 0.95
Cost of treatment: £40,000 / year – total of £90,000

Cost per QALY gain: £95,000

[As I said, the figures are used purely to give context and I made them up myself. They are approximately accurate and there are studies out there that formally perform these calculations and then NICE makes a recommendation based on them.]

So what threshold would you put for deciding whether a treatment is cost-effective?

NICE typically works to a threshold of £20,000 – £30,000.

Ultimately we have to have a way of decided what to fund and what not to. Whilst the QALY method is undoubtedly crude, I don’t think there is a better one.

So let’s look at the NICE decisions, The Mail is complaining about – I looked up the NICE rulings on two of them:

Sorafenib

This is a drug for advanced HCC (a type of primary liver cancer). NICE concluded that the drug does improve life expectancy – the median survival advantage is 2 ½ months. So patients given this drug improve their prognosis from 14 months to 16 ½ months. At a cost of £51,900 per QALY gained.

Lepatinib

Lepatinib is used for advanced breast cancer. However it is only suitable for a minority of patients with this disease. The conclusion was that Lepatinib is clinically effective and improves mean survival from 17.6 weeks to 27.1 weeks. At a cost of £67,847 per QALY gained.

Why this article makes me so angry.

There is a vitally important debate underlying all of this. The question of what we as a nation and a society are prepared to spend on healthcare resources is vitally important. It is very difficult to decide whether end-of-life drugs are useful or not and there is no doubt that an extra few months spend with loved ones is extremely valuable.

However every £1 spent on one of these massively expensive drugs which have very limited benefits is money that cannot be spent on other healthcare spending. I think that part of the answer is that we should, as a nation, be prepared to spend more than we do but that’s my personal view. I also think that whilst drug companies are entirely legitimate in seeking to make a profit, some of the mark-up on medical products is simply immoral. What angers me is that this kind of article with all its inaccuracies has two effects; firstly it makes proper debate much more difficult and secondly it induces significant (and usually misplaced) anxiety in cancer patients and their families. And that to me, as a simple clinician is evil.

The Daily Mail Campaign to Kill Children

I was flicking through a copy of the Daily Mail on Tuesday that someone had left in the coffee room. A Colleague asked me if it was really a good idea to read that just before operating as it’s quite hard to perform surgery when shaking with anger.

It wasn’t actually a problem because the article that I want to talk about didn’t actually make me angry, simply because I can’t take the Mail seriously.

However, I think that might be a mistake. Sadly lots of people do take the Mail seriously – as is evident from the comments section of each article.

The story I want to bring to the Mob’s attention from Tuesday’s Wail is this one: ‘Agony of doctor’s receptionist paralysed by swine flu jab‘ about the Swine flu vaccine. Along with this one from a few months back: ‘MMR and the lessons doctors must learn‘ which I looked up on the website deliberately as I was very curious as to how they would report the Andrew Wakefield story.

The Daily Mail hates vaccines. I can’t quite work out why, but any anti-vaccine nonsense they can pick up anywhere gets an instant story. Which is intriguing as the Irish Daily Mail is campaigning for the Irish government to fund the HPV vaccine.

Swine Flu Vaccine (2/2/10)

A GP receptionist contracted Myasthenia Gravis six weeks after having the H1N1 vaccine and now is quite debilitated by it. So it must be the vaccine that’s the cause and isn’t it awful how she was advised to get it and is now really disabled. (I’m paraphrasing only very slightly).

Increasingly, I am discovering that the media cannot do nuance. Everything has to be black and white. Almost nothing in life is that straight forward and certainly nothing in medicine. The issue of a potential flu pandemic poses a problem for the media. The question the media has been wrestling with since H1N1 became pandemic is this: Is swine flu like any other flu or potentially the end of the world as we know it? The problem for the media is that the only honest answer to that is “both.”

There is nothing special about the H1N1 strain that’s going around the world at the moment. H1N1 isn’t particularly deadly but it is a strain of flu that hasn’t been seen much for around 40 years and that’s the key. Every 40 years or so there is an influenza pandemic across the world. There’s a very good reason for this. The ‘H’ and the ‘N’ names of influenza are the type or strain. There are multiple sub-types but in general, being immune to one subtype of H1N1 would make you immune to any of the other subtypes in that group. Whenever a strain spreads through the population, some people die, some get ill and then get better and some contract it without ever having any symptoms.

All of the people who survive then carry immunity to that strain. Eventually enough people in a population are immune that the epidemic dies out. Each individual who carries a virus will expose other people to it but only some of them will contract it and as the number in a population who are immune to that strain increases, the chances of making that jump from person to person falls and the epidemic slows and then ends. So why do we see these periodic pandemics of influenza? 40 years ago, lots of people were immune to H1N1 – having been exposed to it. As many of that generation die off, the number of immune individuals in the population drops and when it falls below a critical level a pandemic becomes possible.

So how bad can a flu pandemic be? We don’t really know the answer to that question. The Pandemic of 1918-21 was devastating, killing many more people than the First World War. The problem is that you cannot just transpose that onto 2009-2010 and use that as a basis to predict what a pandemic would look like. There are too many unknowns. In 1918 there was a massive refugee population, people were undernourished and unhealthy and there were no antibiotics. (Most influenza deaths are due to secondary bacterial infections). Conversely, the world is much more inter-dependent now with international air travel making it possible for diseases to spread very rapidly across continents.

So, when we saw a pandemic beginning in 2009 in Mexico. The government, very sensibly put orders in with 2 companies to produce vaccines as soon as possible. That vaccine is certainly one of the reasons why there have been so few deaths thus far – although it’s far too early to be complacent. The H1N1 vaccine was tested on over 50,000 volunteers across the world before being rolled out. Even if it hadn’t I would still have had it. There is nothing new in making influenza vaccines, we’ve being doing it for a while now – the technique is the same it just has to be tailored to each individual strain. Most people who get flu have a self-limiting illness. A small number become very ill.

This story is a classic example of the inaccuracy of headlines – even within the article it becomes clear that the headline may not be entirely true. A couple of points to draw your attention to: an unattributed specialist apparently told her the vaccine was responsible for her condition. Her Myasthenia Gravis started six weeks after she had the vaccine. There is no evidence at all in the medical literature linking MG to any influenza vaccine. This is a classic example of the Post hoc ergo propter hoc fallacy. We’ll come back to that.

Human Papilloma Virus

Most cancers are not caused by viruses. Some are. Wouldn’t it be wonderful if we could make a vaccine for the viruses that cause such cancers and hence totally prevent them – rather than just screening for them and then having to do invasive treatments.

Cervical cancer is a devastating disease affecting young women. The new HPV vaccines are a massive step forward and will literally save thousands of lives. The vaccines have been through rigorous safety checks and, as always are carefully monitored as the new vaccine program is rolled out.

A few months ago, the Daily Mail ran this story: ‘The worries over the cervical cancer jab and the questions that must be answered‘. The main argument being that the HPV vaccination is responsible for these devastating effects. Of course there’s no evidence beyond the fact that the symptoms began after the vaccination (post hoc ergo…) but that didn’t stop the Mail from making the link sound undeniable.

However what really angered me was the placing of the photo of Natalie Morton in the article, whose post mortem showed there was no way the vaccine could be responsible for her very sad and very untimely death. Not only is that hugely irresponsible – associating the sad death with the vaccine in such a way that will undoubtedly scare people – but moreover I can think of nothing more insensitive and insulting than to use the death of a child to further a particular cause – especially when the evidence is clear that her case does not in any way support their argument.

MMR and Dr Wakefield

After a very long enquiry, the General Medical Council has finally produced its verdict on Dr Wakefield. Andrew Wakefield was responsible for the massive MMR scare in Britain. Well, actually, Andrew Wakefield was in part responsible for the massive MMR scare in Britain. The Daily Mail is in part responsible. Other news organisations have a measure of culpability too, but no newspaper more than the Mail sought to further the view that MMR is linked to autism. As can be seen from the following articles: ‘Six months after the MMR jab… a bubbly little girl now struggles to speak, walk and feed herself‘. Baby died ten days after being given MMR jab ‘because of failure to warn of possible complications‘. Another study raises questions over MMR‘ and there are many others. Honesty compels me to tell you that not all of the articles were anti-MMR but in many ways that’s beside the point.

Once again the post hoc fallacy (after the event, therefore because of it) – because the autism becomes apparent after the vaccination it must be caused by it.

Let us clear one thing up, there is no link between MMR and autism. I am as certain of that as it is possible to be certain of anything in medicine. If there was indeed, even a small risk, then the rates of autism would have increased when MMR was rolled out. They didn’t. At all.

Much of Dr Wakefield’s ‘success’ was born out of the huge need for parents who see their child ‘becoming’ autistic to find an explanation, a reason, someone or something to blame. This is an entirely normal and healthy part of grief. It is however extremely sick to prey on this need. And that is what Wakefield and The Daily Mail and many others have (whether consciously or not) ceaselessly done. So now that the GMC has finally concluded in an official way how unprofessional Wakefield was, I was very interested to see The Mail reporting of this.

This is what they managed: ‘MMR and the lessons doctors must learn‘. It’s so refreshing to see a newspaper admit its mistakes. To see in print the contrite tone, the sorry we scared you for no good reason. It’s wonderful to see the we got it wrong.

Or sadly not. It’s okay, it’s all the fault of doctors.

Vaccines and informing the public.

Why does this all matter, why have I taken over 1500 words to go through these three inter-related topics? The answer to that is simple; vaccines save lives. Lots of them. In modern medicine, heart transplants and intensive care units grab the headlines. The latest cancer therapy or cardiac medicine is hailed as a massive breakthrough. However none of these come close to vaccines. No single intervention has been more effective, has been responsible for more lives saved than vaccines.

None.

We don’t fear most of these diseases anymore – we’ve forgotten how bad they can be. Talk to people who were parents before the polio vaccine became available – they were terrified when there was a big outbreak because their children could go to bed healthy and wake up paralysed or not even wake up at all. That simply does not happen in Britain anymore because we have eradicated polio in the western world.

Vaccine safety is not a simple issue. No vaccine is 100% safe. Nothing in medicine is. Nothing in life is for that matter. Intriguingly the oral polio vaccine has never been a cause of controversy whilst that was the least safe of mass vaccinations. Not widely known, because it’s not widely reported, all of the cases of polio in the UK in the past 30 years (that weren’t contracted abroad) were caused by the vaccine. This is the main reason for the switch to the injected polio vaccine.

There is this very dangerous perception that not vaccinating yourself or your child is a risk-neutral and a morally neutral choice. It’s not. “I wouldn’t take the risk of having my child vaccinated….” is the phrase you hear. The answer to that is two fold. First and foremost, not vaccinating is not a risk-free choice. In fact, not vaccinating carries more risk than vaccinating – this is the reason why we have vaccine programs.

Vaccination has been a true victim of its own success. Because these diseases are now rare (because of vaccinations) they are not feared anymore. The perception of risk is misguided. People think that these diseases don’t exist anymore. Secondly, the highest cause of death for children over the age of two is road traffic accidents. There hasn’t been a vaccine-related death for at least ten years and yet how many parents stop and think before putting their child in the back of the car. Nor should they, necessarily – you can’t live your life like that. The problem is the perception of risk is massively misplaced.

I am not arguing that parents shouldn’t be able to make informed choices about vaccination. In fact, I’m arguing the exact opposite; it should be informed choice. And I am not for one moment suggesting that the medical profession has not been guilty of not communicating effectively. We have not done enough to get the message across. The introduction of Meningococcal C vaccine has saved lives; from 100 deaths per year of meningitis from the group C bacteria to none. HiB (haemophilus influenza B) saves lives, as does tetanus and diphtheria vaccines.

Some people are not able to have vaccines – children with HIV for example cannot have live vaccines. They can still be protected by being in a population that is vaccinated. So choosing not to have a vaccine, also has an impact on other people.

Sadly, there is a very real consequence to the media coverage of these stories. Thanks to the drop in MMR uptake we have are seeing more and more measles cases. It is entirely true that measles is a mild disease. Most of the time. But children are sometimes left severely disabled by it. And two children have died.

One can never be entirely sure, but it is not remotely unreasonable to assert that those two deaths were due to fear of the vaccine. How about this for a headline: Andrew Wakefield and the Daily Mail linked to the death of two children.

Of course, you couldn’t run that, it‘s true.

More Lies about the NHS

There must be something wrong with me. I read Richard Littlejohn’s column from 30th November (Thank heavens my sick mum wasn’t at the mercy of the NHS) and I didn’t get angry.

Was this because I agreed with what RLJ had to say?

No.

Was this because RLJ extensive research had led to a well thought-out argument that I found interesting?

No.

Was it because his column contained some facts for a change?

No.

So why wasn’t I angry?

Simply because it was RLJ being RLJ and I’m told you shouldn’t shoot a duck for quaking.

Normally this kind of thing makes me really very very angry. I have a small confession to make at this point. I am an unrepentant apologist for the NHS. I work in it, I am aware of its limitations and issues and I could write long articles on what’s wrong with it. I don’t for three reasons. Firstly, the NHS is much – and unfairly – maligned. Two, the problems of it are almost always different to the issues raised in the press. And thirdly, and much more importantly, the NHS is an amazing thing and whilst it does have issues they are, in the real world, a price well worth paying for comprehensive healthcare. I am proud of the healthcare the vast majority of patients receive and the work we do in the NHS. It is hugely frustrating to see this constant abuse in the press. And it’s not just about the shear insult of this but every week I have to deal with the anxiety created in patients before they even make it to the hospital door. Of course, it is not surprising that anyone who reads our papers is scared of being admitted to hospital.

So, let’s summarise RLJ argument;

1.His mother was involved in a traffic accident and was well looked after in a hospital in the states.

2. The NHS might have killed her because all British hospitals are dirty and you will pick up a deadly disease in you are unfortunate enough to be admitted one.

3. American Healthcare is great and insurance works while the billions we spend on the NHS are a waste as there’s no good outcomes or accountability.

If I only I knew where to begin with this. I must warn any brave readers that in order to write this I have done some actual research and have provided references at the bottom so that all the facts can be checked. That’s right – this article ought to come with a health warning to anyone who reads RLJ regularly; WARNING, the following contains actual facts and not RLJ delusions.

MRSA

I think I want to begin by talking about MRSA. To be fair to Littlejohn, almost no one in the press gets this right. My own personal rant is that MRSA is NOT a superbug. (E.coli 0157 now that’s another matter…. sorry, getting of the point). MRSA stands for Methicillin resistant Staphlococcus aureus. Staph. auerus is an extremely common bacteria, it is on the skin of at least a third of the people who read this article. It can be treated with various antibiotics including penicillins. Methicillin is not used in the UK – it is most closely related to Flucloxicillin (a type of penicillin). MRSA is Staph aureus that is resistant to flucloxcillin. This is not a major problem, as the vast majority of strains of MRSA are fairly weedy and are sensitive to multiple antibiotics and are fairly easy to treat. It is quite misleading to say that someone died of MRSA – they died of Staph. aureus infection and the MR bit or otherwise is usually irrelevant. Hospital-acquired infections are common and in general have nothing to do with hospital cleanliness. I know, what a ridiculous thing to say! Well, firstly the majority of infections that patients get come from their own skin. The main reason why people get infections in hospital is not because they’re in hospital but because they’re ill. By definition the people in hospitals are those that will be most vulnerable to picking up infections. This is why hospital cleanliness matters because it is about minimising the risk to vulnerable people. However, and this is the key, even if the hospital walls, floors, ceilings and beds were entirely sterile it would not stop people getting infections.

So what’s all this fuss about MRSA? The answer to that is multifactorial. I think there are two important reasons. Staphlococcus aureus is a very clever bug and can infect multiple sites in the body; it can cause skin infections, urinary infections, pneumonia, septicaemia (blood infection) to name but a few. The other reason is that the methicillin-resistant strains of Staph aureus are only found in hospitals or other institutions. Places where antibiotics have been used. And hence there is an assumption that MRSA has been acquired in hospital. MRSA infection can certainly be reduced by increasing cleanliness but to some extent that’s irrelevant, remember that most infections come from skin (and it’s impossible to ever fully sterilize a patient’s own skin). Do you really care whether you have a MRSA or an MSSA (common-or-garden Staph. auerus) infection, if I can treat it for you either way? There is no evidence that MRSA strains are more deadly that non-resistant strains.

Here’s some facts you’ll never hear in the press:

1.      MRSA is a worldwide problem. (Probably the greatest problem is in Japan for various historic reasons).

2.      MRSA became endemic in UK hospitals in the early 1990s.

3.      MRSA-related deaths are falling.1

4.      MRSA is a major problem in the USA. This is a quote from a CDC report. (The CDC is the Centre for Disease Control and Prevention – one of the world’s leading authorities on infectious diseases).2

“Hospital-acquired infections from all causes are estimated to cause >90,000 deaths per year in the United States and are the sixth leading cause of death nationally. Nosocomial infections increase patient illness and the length of hospital stays. The direct cost has been estimated to be >$6 billion (inflation adjusted)  costs of longer inpatient visits are shared by hospitals.”

So, please, can we move on from the myth that NHS hospitals are uniquely dangerous because only we have MRSA and it’s a superbug?

The US Healthcare system and its costs

So let us look at the US healthcare system. The top hospitals in the USA are amazing and provide amazing healthcare, many of them are world centres. However there are a few minor points worth noting. Healthcare in the US is astoundingly expensive.

Here are some interesting statistics;

46.3 million3 – that’s the number of Americans with NO healthcare coverage. (15% of the population). In the event of an emergency they do indeed get treatment – but it is strictly emergency only. So cancer surgery is not covered, on-going asthma care is not covered. People with bad asthma need on-going treatment to control their disease. Without this hospital admissions are common. Emergency cover will patch them up (usually) and chuck them out to come straight back in again the next time. The frequency and severity (i.e. whether it is life-threatening or not) of attacks can be reduced with good on-going treatment. Not available to 46.3 million Americans unless of course they pay for it themselves.

The leading cause of bankruptcy is the US is healthcare costs4 – even people with healthcare insurance struggle – limitations on cover, the deductible (i.e. how much you have to pay yourself). Imagine recovering from a serious illness to then lose your home.

£92.5bn – the cost of the entire NHS for the financial year 2008-95

$596.6bn – the combined cost of the US Medicare and Medicaid programs6. That’s £360bn. Medicare provides healthcare coverage for the elderly and Medicaid for the poorest. The majority of uninsured people are too well off for Medicaid but can’t afford insurance or their employer doesn’t provide it. Both of these programs still involve premiums and co-payments in addition to the government £360bn. Medicare has about 45 million people enrolled and Medicaid 50 million. So, in summary; the inefficient, expensive NHS covers 60 million people entirely for £92.5bn, whilst Medicare/Medicaid provides basic coverage (but not without co-payments) for 95 million people for £360bn. In fact, the US spends more per population on a basic healthcare system that only covers the oldest and poorest than the UK government spends on a healthcare system that looks after everyone. In UK terms that would equate to the government spending around £120bn for basic (so-called safety-net) coverage of less than 20 million of the UK population.

And here’s the real shock; for all the money they spend, the US life-expectancy is less than that of the UK.7

I am seriously impressed by anyone who’s still reading at this point. And this is part of the problem, the sort of trash that the Daily Mail puts out is much easier to read than the complex facts that actually reflect the truth of healthcare. There is so much more I can write – about unnecessary and invasive tests, about the benefits of preventative medicine but I think I should stop now.

The NHS is far from perfect but it is very very good. It is also unbelievably cheap for what we get for our money – worryingly to those who work in it, it is the most efficient healthcare system in the world. The problem is that for ideological reasons (i.e. Government=bad) The Daily Mail and those like it want to force us to take on a US-like model of healthcare. They’ll get their 5* hotel room hospital beds and everyone else will suffer. We will see the poor and the elderly left to die quietly or to live with their debilitating disease as the insurance companies make a fortune. And if the American example is anything to go by, ultimately we all end up paying more for sub-standard healthcare coverage for the most vulnerable.

I want to apologise for the length of this article but someone has to stand up to the constant lies of the Daily Mail. The NHS is an amazing thing and whilst it does have issues they are, in the real world, a price well worth paying for comprehensive healthcare. I am proud of the healthcare the vast majority of patients receive.

Dr alienfromzog BSc(Hons) MBChB MRCS(Ed)


References:

1.      Department of Health: http://tinyurl.com/6kjbue

2.      Centre for Disease Control and Prevention paper: http://tinyurl.com/ybvp2p3

3.      US Census: http://tinyurl.com/ln5a2q

4.      Baltimore newspaper article: http://tinyurl.com/ylg2fet

5.      HM Treasury corrected figures: http://tinyurl.com/yzme4ng

6.      Official financial report of Medicare and Medicaid; http://tinyurl.com/yguq2wn

7.      World Health Organisation figures: http://tinyurl.com/yguq2wn

Lies, Damn Lies and Statistics

I really shouldn’t be surprised anymore should I? However yesterday’s headline piece in the Daily Wail: ‘Random attack by thugs every 30 seconds as ‘stranger assaults’ soar in binge Britain‘; was an impressive piece of extreme dishonesty. The old saying about lies, damn lies and statistics really belongs in the Daily Mail because everybody knows that statistics can prove anything. Now I’m no expert… well, actually, I am an expert… statistics are really powerful and are a vitally important way of ascertaining the truth of complex problems such as crime rates. It is obviously true that statistics can and often are twisted to make whichever point the user of statistics wants to make (as this article brilliantly demonstrates). The fault lies with the argument and not the statistics. The great irony is that the Mail often abuses statistics and uses them to make any point they wish, whilst at the same time fuelling the belief that statistics cannot be trusted and thus appealing to the preconceived ideas of the reader. Crime rates are probably the best example of this.

This article is based on the British Crime Survey data released last week. The report can be found here on the Home Office website [PDF file]. The BCS is a very interesting, powerful and important piece of research. For obvious reasons, the public have very legitimate concerns about crime, and hence the government needs to know what is happening with crime – both in order to shape policy and to demonstrate to the electorate the effectiveness or otherwise of various policies. One set of data that is used is the recorded crime rates – crimes reported to police. There is no doubt that these figures, whilst important are flawed. Not all crime is reported – for a lot of reasons; and thus the reported crime rate may not reflect what is actually happening. Is a rise in the reported crime rate a good or a bad thing? Well, a rise in crime is clearly a bad thing – but if crime rates are steady and the rise is a reflection of increased confidence in the police then clearly it is a good thing. Hence the British Crime Survey which seeks to ascertain by means of extensive research people’s actual experience of crime and thus what the actual crime rates are.

You get a very good idea of the intent of the article from this one line:

“The true picture of street violence could be even worse. Some experts believe that fewer than a half of such crimes are reported to police.”

To be fair, this statement is not necessarily false. There probably are some ‘experts’ who believe rates are much higher, though it would be nice to know who they are – no wait, I know who it is, it’s the Daily Mail editorial board… Of course it could be true but it’s the second part of the sentence that’s worrying to me. We know the statistics come from the British Crime Survey and are hence related to actual crime rates and having nothing to do with reported crime rates so it is totally irrelevant that fewer than half might be reported – that does not affect these figures at all. Not so much Lies and statistics as statistics, reporters and lies (rearrange these words to make a sentence). There’s even a complaint that we’re convicting too many women:

“Last month, the Daily Mail revealed that the Government’s own figures show the number of women being convicted for murders, vicious assaults and other attacks has rocketed by 81 per cent since 1998.”

So our failed justice system is now convicting too many criminals? I’m confused.

The main thrust of the article is aimed at showing how out of control violent crime is and quotes this stat that violent attacks by strangers has risen from 32% of all violent crime to 50% of all violent crime.

The most important fact that I want to communicate here is the one they don’t tell you: Violent crime is down. Way down. It’s less that half its peak level which, for the record was in 1995. We are now back down to 1981 levels (oh, sorry, didn’t you know that crime (and violent crime) rose steadily though out the 80’s until the mid-nineties and has been falling since?)

Please do not misunderstand me, one crime – especially one violent crime – is one too many and there is a lot of violence out there. However because that is true, we should celebrate the massive reduction in violent crime that has taken place. Furthermore the use of crime as a political weapon by stoking up the fear of crime is particularly sick.

So, finally what about this claim that stranger attacks have soared from 32% to 50%. There were approximately 4 million violent crimes in 1996. 32% of 4 million is 1.3 million and 50% of 2 million is 1 million. How’s this for a headline? Violent attacks by strangers SOAR from 1.3 million to 1 million.

Lies, Damn lies and Daily Mail Reporting.


P.S. I notice that the byline is given to one James Slack – maybe that’s a description of the journalist rather than his name?

Littlejohn Strikes Again!

At the end of his column of bile 22nd September Richard Littlejohn included the following few lines:

Who you gonna call…?

While all the main parties now accept belatedly that there must be cuts in public spending, the message doesn’t seem to have permeated downwards.

Town Halls are still advertising an exciting array of lucrative, pointless non-jobs. Lancashire County Council, for instance, is desperately seeking a Myth Busting Project Manager on £30,000 a year, plus usual perks.

The successful applicant will be responsible for ‘researching Lancashire communities’ attitudes and responses to migrants and formulate and deliver a positive campaign to dispel negative myths and perceptions…’

After that, I lost the will to live. However did they manage without one?

When the money’s running out and it don’t look good, who you gonna call…? Mythbusters!

Now I have to admit that Lancashire County Council could probably have chosen slightly better phraseology for this job advert from a public relations point of view but then presumably, at the request of the Daily Mail, all the PR experts have been fired. Perhaps more to the point, I am suffering under the illusion that the job of newspapers is to inform their readers about what’s happening in the world and thus when faced with something like this, it is important for them to look beneath the surface and find out the truth.

Typically the Guardian has looked behind the headline and got somewhere nearer the truth of the matter. Firstly, it is a Conservative-led council that’s responsible for this and it’s a multi-agency post (including the Police and Fire Service), paid for from visa fees. In a community where leaflets have been circulated claiming that the Muslims are responsible for the drug problem, if I was a LCC tax payer, I’d want to know what my local government/police was doing about this! A mythbuster is clearly needed!

As a final irony, the Tax Payers Alliance, anxious to boost their profile, link to any media story in which they are mentioned on their website. So the Guardian story arguing that this is good use of tax payers’ money can be found on the Tax Payers Alliance website!

To return to RLJ, I wonder when we’re going to get a Littlejohn-Mythbuster. I don’t think there’s any doubt that it would be a full-time post. Speaking as a tax payer (and a higher-rate one at that…) I wonder why my government hasn’t started advertising for one yet?

AFZ


It is always interesting when Richard Littlejohn – Salary over £800,000 a year for repeated the same made-up drivel twice a week – criticises the salary of others – in this case a significantly less £30,000 per year. As AFZ points out, ‘mythbusters’ only exist to counter the lies, distortions and hateful bile spouted by newspapers and we could easily employ a full time mythbuster to wade through the lies that Littlejohn swamps his readers with twice-weekly. Littlejohn this week had to apologise ‘unreservadly’ for his statement that most of the crime in the UK is conducted by ‘Eastern European gangs’, for a complete run down of how long the apology took to come forth and what a laborious process it is to get any response from the PCC or the Daily Mail read this blog post by Tabloid Watch.

With regards to The Taxpayers Alliance, wonderfully I heard on Twitter last night via Jamie Sport that one of the Directors of The Taxpayers Alliance lives in France, only spends two weeks in the UK each year and doesn’t pay tax. Now that, you really couldn’t make up.

Uponnothing.