On Friday March 31st, British airwaves were full of news about a significant change in Britain’s National Health Service.
Bleeding Obvious?
After its 8 AM news headlines, Radio 4’s flagship news program, Today, featured the boss of the National Health Service, Simon Stevens, explaining how the new system would be better even though long-established targets for waiting list times (18 weeks) would likely be missed.
Before the 8 AM headlines in a warm up feature Zoe Duncan entered the Nottingham home of Maureen Snelling who was getting an Intravenous infusion of an osteoporosis drug from community nurse Donna Roe. This was probably the bisphosphonate related Zolendronic Acid. (Check it and other biphosphonates out on RxISK).
Maureen explained how uncomfortable it was living with osteoporosis – feeling all your internal organs press up against you when you stooped down. Now, she would no longer have to take two buses across town to the hospital to get the injection there. While she could manage this, others, she explained, couldn’t. But even for her it was just luxury to be able to get the treatment at home.
Duncan put it to Roe that getting treatment like this organized at home was bleeding obvious. Sounding slightly taken aback at the choice of phrase, Roe agreed.
Duncan chased the Family Doctor, Annemarie Stewart, who explained it took 4 years to get the osteoporosis drug reclassified from a “Red Drug” to one that could be given at home.
Duncan then talked to the hospital who explained they were losing money in the process but were sucking up the loss as the new approach was clearly in the interests of the patient. Besides they might save on reduced use of Emergency Department resources owing to the reduced number of fractures everyone expected from getting anti-osteoporosis drugs delivered efficiently to older women.
Cut to 84 year old May Cumberbatch whose back had crumbled after she came off a stepladder. May would now get her treatment at home. Prompted by Duncan, between this and staying away from stepladders May figured she’d now be okay.
Seen from Space
Next up was Niall Dickson, CEO of something called the NHS Confederation, ex-CEO of the GMC. Dickson explained that these changes were a twenty-first century change to healthcare. Duncan and the listeners needed to realise, this was very different to the twentieth century privatization of the health system typically termed the Lansley reforms that in 2012 had been portrayed as so big they could be seen from space.
Natch, Dixon said. The Lansley reforms just involved a reorganization of the administrative deck-chairs. Once he said deck-chairs, no one had to mention the Titanic. Every listener will have known there is a desperation to keep the NHS afloat.
These changes Dixon said would deliver real and meaningful improvement in care.
Weren’t they really just about saving money, Duncan challenged. No Dixon said. They might not save any money but they were clearly the right thing to be doing as the Nottingham example made very clear. This was about repairing the breakages in our system – restoring links between general practice and hospitals and patients.
This Nottingham example has been trailed widely in all sorts of academic and lay media for over a year as an instance of the kind of innovative thinking that will transform current services and save the NHS. It is close to the only example being offered.
Psychosis Central
This is staggeringly beyond belief, a psychosis in spades, a triumph of the Sheriff of Nottingham over the good guys.
Making sure that more older women get osteoporosis drugs by delivering care at home is a recipe for more fractures not less, for a significant impairment in the quality of these women’s lives and for vast increases in expenditure beyond anything that healthcare functionaries or politicians appear capable of comprehending.
Here’s how it happens.
Twenty months ago, on a Friday I fell and broke my shoulder. The Xray above, taken an hour later, makes radiologists wince. The orthopedic team on call said it needed a plate. The operation was done that afternoon. I was in work on Monday.
This is the kind of health care that can be delivered free. It gets people out of sick beds, or saves their lives or otherwise leaves British citizens in the best shape possible to compete with the Americans and Germans and Chinese.
A few weeks later I opened my post and my jaw dropped. It was a letter from the local Health Board inviting me to a bone screening session. This was a pro-forma letter. Everyone – male and female to avoid gender bias – over a certain age – probably 50 maybe less – gets one.
Had I gone along, there is every chance the scan would have shown some bone thinning and I might have had an osteoporosis drug recommended. I could now be having infusions once every 3 months in my office here in the hospital.
This is lunacy. These drugs increase the risk of clinically significant fractures. Before we began using them widely in the 1990s, it was very rate to see spiral fractures of the femur – where the bone might shatter into twelve different bits. Before 1990, dentists never knew what it was like to try and drill into marble and rarely had to warn patients about osteonecrosis of the jaw.
Follow the Money
But its not just the cost of the drugs that’s the problem. The price we pay for the drugs doesn’t improve anything. People are more likely to end up in beds or off work or if at work to be impaired so that Britain is less likely to be able to compete with the Koreans or Mexicans or the soon to be independent republic of Gibraltar.
Beyond their price, the drugs lead to the employment of staff to run the screening program and an increasing number of auditors and managers to monitor why we seem to be having more fractures rather than less. And all this will lead to a climate of bullying and harassment of nursing and medical staff who exercise any kind of discretion. The exercise of discretion is blamed for things going wrong.
What is mad about all this is it is happening against a background of no-one having access to the data from biphosphonate trials or the trials of other drugs creeping in for osteoporosis. The literature that underpins the guidelines recommending these drugs is ghost-written and no-one – not the regulator (FDA – MHRA – EMA) or the guideline writers or the notional authors of any papers has access to the data.
When access has been extracted, it turns out there has been a representation of the data that could be regarded as fraudulent.
And yet – as Fragile Doctors and Stevie’s Story shows – doctors will get incredibly nasty if you show a reluctance to take the medication. That’s partly because the system is gamed so they get paid more – or get paid at all if you take the meds. And its partly because most doctors still believe in the Evidence.
This crazy situation doesn’t just apply to bone medicine. It applies right across the medical board. Its part of what is leading to the opioid epidemic in North America – managers and patients want patients to be treated according to guidelines that are gamed.
In all these cases, pharma can plead innocence and point to the fact that they are getting comparatively little for the drugs. Enough to make them the most profitable companies on the planet, but still comparatively little compared to what is being spent on osteoporosis – which close to didn’t exist forty years ago.
Perplexed the managers and politicians go back to re-organizing the deck-chairs. Perhaps if people get their treatment at home everything will be just fine.
This has nothing to do with privatization. Its the same in public health and private health systems and is everywhere leading to a growing psychosis.
It would be great if anyone having problems on an osteoporosis drug or with the osteoporosis octopus could report to RxISK or send us your story.
mary says
Eye-opening and eye-watering all in one post! Your x-ray certainly causes an intake of breath – much as it did at your Hay appearance last year. Your point then, as now, was of course to do with the follow-up letter and its contents. Do you recall the attitude of one young trainee doctor who was not amused at your rejection of the follow-up appointment? From his attitude, I should say that, if he’s now fully qualified, he’ll certainly be feeding the latest brand of smarties to all of a certain age who meet him! I take it that letters, such as the one you received, go out to anyone who trips and causes themselves some damage? They are, as yet, kept as a special delivery for a certain group – the ones most likely to bend to the request as a result of their misfortune, I guess. How long before these letters go out to ALL of a certain age I wonder ? Will they become the next ‘just incase’ tablet? If we dare to refuse, in future, will our choice be discounted by a judge , just as the will of a parent regarding her children’s vaccinations was discounted as explained in today’s news?
From your swift recovery, maybe your bones are as strong as ever. Maybe it’s a good idea to take water with your drop of whiskey from now on though!
As for the ‘home treatment’ – it reminds me of ‘care in the community’ on its introduction. I guess ‘home treatment’ does away with the chance that people will compare notes at a clinic setting and come to a realisation that the miracle of modern treatments is not all it’s cracked out to be.
Carla says
How can medicines be so beneficial if they induce so many sinister diseases?
I scratch my head, in perpetual disbelief and feel so overwhelmed and so totally perplexed, by what these medicines can induce.
Being damaged by medicines, my mind is always looking for natural ways on how to treat.
For many poor people who are on a long list of medicines, they have to be very mindful of what they put in their mouths.
For example, warfarin is one of those medicines that quickly comes to my mind. Some foods cannot be eaten or moderately eaten, whilst you are on this medicine?
Withdrawing from certain medicines can be fraught with danger however, if a clinician supports and closely monitors the patient hopefully dangerous side effects can be prevented.
My brain goes into overdrive, continuously thinking of the long term side effects however, clinicians say the benefits outweigh the risks? How can this be so?
Yes, Mary, modern medicine is not all it’s cracked out to be.
If all these medicines made every one of us healthy, many professionals would be out of business.
What an incredibly deceptive world we live in!
Many patients who are on meds are also complaining of their teeth becoming brittle.
Some medications cause dry mouth, which reduce saliva flow and increases the chances of cavities.
Clinical experience tells me which medicines are inducing problems with teeth and osteonecrosis.
I think many already know which medicines are likely to cause problems to teeth!
I can just imagine what some medicines do to the rest of the body.
I am still grappling with these facts and my head still can’t get around what they are capable of inducing?
You go to fix up one problem??? and another handful are created in the process.
This does not sound like healing to me?
The sad reality is:Too many believe without questioning what is really going on?
mary says
I reckon that it’s because these problems are not true for ALL patients ALL of the time that they are dismissed so readily. Our son has lost every single tooth due to antipsychotic medications. Three dentists, at different points in his treatment, have told him that his decaying teeth are as a result of the medications he’s on. If dentists realise this – why don’t doctors? Also, since dentists DO realise this, shouldn’t they be speaking out about such cases? We must ALL be working together on these issues if we’re to have any chance of getting to the real truths of the matters. Warfarin is also likely to attack teeth as a friend of mine knows to her cost. In her case, the teeth did not rot, they just dropped out – looking perfect on inspection ( her words not mine!).
Carla says
Unfortunately, some clinicians believe that ‘Mims’ is the holy grail to all their questions.
Intellectual property should be shared with patients and if clinicians know that some meds are causing harm, they should speak up.
Why do people who work in the medical establishment have to be privy to this information? As far as I am concerned, It should be shared.
If it is not documented and clinicians see patterns forming, it does not mean that if clinicians complain, it will be documented for all to see.
If a mass of patients complain, it becomes a class action and something can be done to eradicate that particular class of drug, off the market.
I can’t understand why the same can not be done with other class of drugs that are notorious for causing so much harm.
If a drug impacts the heart, breasts, lungs or other organs, somehow a class action, assists.
However, when the delicate brain is impacted, it becomes too damn hard!
Sadly, many know that something is not right but the processes continues to rinse and repeat the same ongoing cycle.
annie says
Deeply betrayed
“Patients who need to safely withdraw, are withdrawing – or indeed have withdrawn and are still suffering after complete withdrawal – from these prescribed benzodiazepines and antidepressants all need appropriate help (including appropriate professional medical help) where the issues of the drug effects are honestly recognised and taken into full consideration. Currently the harmful effects of these prescribed drugs are being routinely evaded, and affected patients can be left feeling deeply betrayed. The principle of duty of candour is directly relevant here.
http://www.parliament.scot/gettinginvolved/petitions/PE01600-PE01699/PE01651_BackgroundInfo.aspx
“Patients are repeatedly told to go back to their GPs and local health boards if they experience problems and are dissatisfied. Individual personal experiences show how far this has got them: if patients cannot get any acknowledgement from their GP that (for example) prescribed benzodiazepine and/or antidepressant dependence or withdrawal is the cause of their wide-ranging, debilitating and confusing symptoms, how can affected individuals hope to get any appropriate advice, care, tests or necessary treatment? It has become abundantly clear that currently patients are consequently suffering very serious harm, disability or even death/suicide.
Wherever you are in the World, please sign this petition and join all the others from all parts of the world
http://www.parliament.scot/GettingInvolved/Petitions/PE01651?UserAdvice=true
annie says
@Wessely @Pariante @GSK – still foraging to understand their chosen subject as ‘Health Spectators’ ..
Simon Wessely Retweeted
Carmine M. Pariante @ParianteSPILab Apr 19
Depression, a disease of the mind? Actually our immune system could be the culprit
https://health.spectator.co.uk/depression-a-disease-of-the-mind-actually-our-immune-system-could-be-the-culprit/
The consortium is being led by Professor Ed Bullmore, head of the Department of Psychiatry at Cambridge University, who also works for GlaxoSmithKline.
‘In the treatment of depression, we haven’t been making as much progress as we’d like to see over the last 20 years or so,’ he says.
Understatement of the Century .. ?
Antidepressants, Benzodiazepines,, overkill, need we say more .. ?
“that could open the door to new medicines”
And a whole tranche of what comes after SSRIs sounds reasonably accepting .. ?
annie says
Sign yourself up for Rxisk.org
Newsletter
April 2017
I wanted to share with you some recent improvements to the RxISK website:
Consolidated drug information – Added patient experiences from RxISK reports (where they have consented to share these), relevant RxISK guides, as well as blog posts, to consolidate this unique information about a drug all in one place.
Drug search – Added ability to search not only by drug but also by route of administration. Simplified presentation of available generic and brand names, routes of administration, dosages, and prescribable names.
Reported side effects – Now using latest openFDA data for reported side effects and displaying “top 100” side effects.
Product data sheets – Added links to 50,000 FDA-approved labeling by packager and brand.
We will continue to improve the material available for each drug over the coming months and add additional filters, such as sex, age, and PRR.
Check out the Paroxetine page to see some of these improvements.
Thank you for your support.
Your feedback, as always, is greatly appreciated.
David Healy, MD
PS. You can find me on Twitter @DrDavidHealy. And you can also follow RxISK on Facebook and Twitter.
Brian Steere says
Part of my ‘re-education’ includes Dr David Healy’s example. But is open in many fields and levels of human endeavour and culture. But for all the RxISK involved I note that Pharma seems to define the scope of responses here – as if the captured regulated ‘medicine’ is the only ‘real’ approach to health.
Vitamin K2 – as I have recently found out is very significant for the directing and placing of calcium where it belongs. IE: in the bones and not in soft tissues, arteries and etc.
I encountered this information when looking at information related to taking significantly larger doses of D3 (calciferol) than the minimum ‘official’ recommended ‘international unit’ levels – (all of such I take with a pinch of sea-salted un-demonized butter – that is to say I believe ‘official’ nutritional information itself is ‘doctored’, in favour of promoting pharma defined and regulated sickness – and some of that is simply the bias of a pharmaceutical training).
If you want look up information on K2 and calcium it may be helpful for you and others:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566462/
looks like one pubmed example (from searching “K2 and calcium”).
The synergy of healthy function is much more complex than the mechanistic model that suits (and is retarded to protect) the pharmaceutical approach of external leverage and interventions that of course sets up all kinds of negative synergies that become very complex to break out of – even if waking to the desire to do so.
The pattern of any negative loop is of a negatively defined sense of life and self – such that our minds are predicated on what we don’t want rather than what we do. This may not seem obvious – but is mirrored in the promotion of fear and guilt that then sells or demand powers to ‘protect’ from. I see this pattern as extremely deep seated and pervasive – and re-enacting itself as fear fulfilling prophecies – that manipulative opportunism exploits.
Eugenics focuses on the ‘weak and sick’ with intent to eradicate them. This is the primary error of focusing (giving energy) to what you don’t want or hate in self and see in Other – and seeking to pushit down or eradicate it. Likewise the public hatred for eugenics pushed it down as if it had been eradicated – but the more aware I become of the actual human costs of pharmaceuticals and biologics – along with Big Ag/Food – and a cartel of corporate lobbies, the less I am able to dismiss what once would have seemed an absurd or insane agenda. In any case a very destructive network of interests work together to make sanity seem the madman. As without – so within perhaps. For what is culture but the embodiment of ideas held true and valued?
Lack of foundation is not an externalised sin of random or genetic misfortune – but a Call to recognize and release the false in embrace of the true. Of what resonates true to the best of our current integrity of being – and not just a priesthood of initiate insiders. I expect I wrote overlong – but context is part of content – or it can be mistaken or misused.
Sally Macgregor says
For what it’s worth – I reckon abolishing Public Health England (one, seriously money draining arm of our NHS) would help the coffers a great deal. Not sure in Wales, but here all these Public Health screening programmes, invitations to attend clinics etc – and presumably the Home Care initiatives – are the deluded offspring of PHE. (Or NHS England – no one knows which body is which here). I’d have loved to hear your story of trying to explain why you wouldn’t attend the bone clinic David – my attempts to disengage from the diabetic clinic were farcical. I have a twinge of sympathy for the nurse’s demented attempt to force me to take statins now – presumably she was fearful of the consequences if she couldn’t tick all the required boxes. And the surgery was frightened of the repercussions if it didn’t meet the targets imposed by PHE. It is all truly mad. But it’s also scary, going it alone and refusing to engage.
Part of the scariness is lack of proper information. Not just the drug data – but sensible, straightforward info about diseases. You can’t trust any of the big charity websites like Cancer Research UK, or Diabetes UK because they are all – probably without exception – funded by Big P, albeit at arm’s length. They are in the business of fear-mongering because frightened people take drugs. Thus it becomes impossible for people/patients to make any kind of informed choice about risks and treatments. Rob (husband) asked repeatedly for evidence about the standard post-coronary-bypass cocktail: statin, ACE inhibitor and beta blocker. He wanted to know why he had to take drugs that lowered cholesterol and heart rate and blood pressure when all those measures were normal, despite his blocked tubes. And all of which come with significant unpleasant debilitating side effects. No cardiologist could say anything except – ‘I don’t know’ – because they had never actually seen the detailed data. They had no evidence. Nowhere, but nowhere can anyone get at the heart of the matter: should I take this drug or not? Rxisk is the best source of information ever – but even then it’s still frightening to take a big jump in the dark, in the teeth of medical advice and refuse medication.
mary says
In the main, Sally, such clinic visits, here in Wales, begin with a letter inviting you to telephone for an appointment – therefore, if you don’t phone you won’t have an appointment! End of story – or is it?
Heather says
Taking Sally’s and Mary’s point – I’ve just been conferring with other parents who have list together young by prescripticide to RoAccutane-isotretinoin and the inevitable prescribed follow-on of SSRIs and other anti-psychotics. We all feel amazed that, in the light of so much well publicised evidence, dermatologists go on prescribing RoAccutane and GPs keep giving all this the nod, almost denying that terrible damage is occurring, from the anecdotal personal parental reports they are hearing about their patients. I now wonder whether it’s like the statins etc, they HAVE to offer them because it’s being enforced as a recognised ‘effective’ method of treatment, by PHE. It’s a quick fix of course, if a dermatologist has a list of 20 patients to see in a day, if he hands out prescriptions of RoAccutane to them all, mostly their acne will soon improve. And when they drift into psychosis later, and get arthritis so they can hardly work, or lose their colons, or lips, have such boils in their mouths that they cannot eat, or worst of all particularly most obvious in young men, get erectile dysfunction so lose relationships, —– well, hey-ho, it’s not the dermatologists problem, it belongs to other specialities now, if indeed there IS a problem, because if there are mental side effects (which there pretty well always are with this drug, in varying degrees of severity) then all you have to do is make light of them, pat the patient on the head and send them off with either ‘it’s to be expected and it will get better’ or ‘what a lot of fuss about nothing, your acne is better isn’t it, well then…’ Or worst of all, ‘what you are reporting is all in your mind.’ GPs MUST SURELY KNOW what’s going on, so why do they seem to close their ears and avert their eyes from it? Please, can we have an answer here from a GP so we understand. And don’t give us the one about ‘it’s the only effective acne treatment we’ve got’ because we’re heartily sick of hearing this, and there ARE other effective treatments out there, Blue Light for one, special diets for another, geared to each individual and their type of acne, but they take a bit more time. And they don’t kill you.
Over the last two days, I have heard such ghastly, heartbreaking accounts of suffering, and such ineptitude by medics in the treatment of them, that I frankly feel lost for words and wonder if a really HUGE gesture is needed now. We’ve done all the MHRA reporting and followed the normal reasonable channels for 34 years and yet people are still dying, almost one a month according to MHRA reported figures (which we feel are very conservative). We’ve tried everything we can think of. Is it maybe time for something else? PLEASE, PLEASE, PLEASE Dr David Healy, tell us what more we can do now because we can’t stand by and watch this going on, and if this is being pushed on us thanks to PHE initiatives, how can we change them? WE PARENTS ARE ABSOLUTELY DESPERATE.
Heather says
Correction, ‘parents have lost’ not ‘list’. Sorry.
Heather says
And please note, we don’t have only ‘Dermatology Clinics’ now, if you have acne you are probably sent to the ‘RoAccutane Clinic’ !! Just like going to the Statin Clinic or the Bone Clinic or the Diabetic Clinic. And you are told how lucky you are…..