Sunday 23 December 2012

The Christmas spirit

After weeks of endless reinforcement of gender stereotypes in the form of 'his and hers' Christmas presents and a thousand other holiday-related nonsense articles that made me want to eat my eyeballs, on my final night at work before 2013, I finally came across a couple of articles that made me smile. So in the spirit of Christmas, or something, a not-so-angry post today!

The first one was an interview with Jim al-Khalili in the Independent, in which he talks about religion, Christmas and his appointment as the new head of the British Humanist Association. I'm a fan of his anyway, so in that respect I'm probably biased here, but it was great to read an interview with someone who is happy to say that while he is an atheist, he respects other people's rights to believe in god(s). While I absolutely adore Richard Dawkins, his constant Christian-baiting isn't productive, and - dare I say it - it gets a bit annoying at times. Although I can only assume his comments this week that raising a kid as a Catholic is worse than child abuse were made with the express intention of outraging 'Mad Mel' Phillips, which succeeded and of which I can only approve.

But I digress. Although Mr Al-Khalili defends the right of religious people to believe whatever they want, he is quite vocal about the need to keep those beliefs private - he advocates the exclusion of bishops from the House of Lords and argues against the teaching of creationism in science classes, as well as speaking out against the rise of pseudo-science in recent years. I for one look forward to having him as the president of the BHA because I think his 'niceness' can do much for humanism in the UK.

The second article that made me happy this morning was in the Guardian, which reported that Andrew Wakefield, the doctor struck off for causing the MMR vaccine scare, has won the inaugural Golden Duck award. Mr Wakefield beat Tory MP David Tredinnick and Prince Charles to the prize - I'm sure he'll be delighted with his win. Anyway, aside from making me laugh, it's also good to see that things are being done to raise awareness of pseudoscience and unsubstantiated claims. Hopefully, over time those who continue to believe in all kinds of alternative remedies will begin to appreciate the science that has shown time and again that these treatments are, in the best cases, no better than placebo, and in the worst they're outright dangerous.

Anyway, that's it from me for today. Merry Christmas everyone!

Tuesday 18 December 2012

Hysteria, media and ministers

Today is certainly not a great day for health reporting - I lost count of the number of objectionable articles I came across at some point during the night, but I'll focus on a few I do remember. There was the government decision to rate surgeons based on death rates in future - admittedly not so much an issue of poor reporting as one of poor policy - as well as Nice's rejection of a cancer drug and yet another 'wonder drug' that's made it onto the front page of the Express.
 
 
Let's start with the surgeons' league tables proposed by the new NHS Commissioning Board - reported in pretty much every paper. I don't think there was anything wrong with the coverage, but I do disagree with the proposal: Sir David Nicholson wants to create publicly accessible league tables of NHS surgeons around the country, based on how many people die on their operating tables. On the surface, I suppose that's reasonable enough - who would want to be opened up by someone with a track record of seeing people die while they're under the knife, right? But on the other hand, I'm not sure I'm convinced this won't deter surgeons from taking on particularly risky operations because chances are it would make them look worse. If someone has had massive haemorrhaging in the brain due to a ruptured aneurysm, there's basically a 100pc chance they're going to die if they don't undergo surgery. However, the risk of death during or shortly after the surgery may still be 50/50 or worse - I can't help but wonder if risky operations such as those won't be turned down and declared inoperable in favour of more straightforward surgeries... Anyway, enough about that.
 
 
The Daily Telegraph today reports that the National Institute for Health and Clinical Excellence has decided to reject bevacizumab, marketed by Roche under the trade name Avastin, for the treatment of advanced ovarian cancer (sorry, I'd link to it but it seems to only be present in the hardcopy). There's a general tone of outrage at what is implied to be a grossly unfair decision by Nice, the agency everyone loves to hate. At no point does it go into any detail about the reasons Nice came to this decision, although it does mention that it is the first drug in 20 years to have slightly extended the average life expectancy of women with late stage ovarian cancer.
 
Compare the Telegraph's stance with this explanation, right near the top of an article on the same topic on the Bloomberg website ("Roche's Avastin fails to win Nice ovarian cancer backing"):
 
"Although Avastin used together with paclitaxel and carboplatin chemotherapy did seem to help delay the cancer’s spread, “it was unclear whether this translated into an overall survival benefit,” Andrew Dillon, NICE’s chief executive, said in the statement. “There was no evidence to show that the clinical benefit of the treatment justifies its cost, when compared to existing treatments.”"
 
Surprisingly, it seems Nice does in fact have logical reasons for rejecting the drug and doesn't simply deny use of this treatment out of spite against ovarian cancer sufferers!
 
 
Finally just a few quick words on today's Express front page, which claims a cure for high blood pressure has been found. I'm neither a doctor nor an academic or statistician so don't have the expertise to go into the treatment and trial in question in much detail, but there were a few things I wondered about - aside from a natural scepticism about any 'wonder treatments' that appear on the front page of the Daily Express, anyway.
 
First off, having had a look at the actual research report, this was a multi-centre trial, involving 24 centres in several countries. The combined number of participants, in the control group and the renal denervation group, was 106. Now, hypertension is VERY common. In fact, the report points out that in 2000, almost a billion people worldwide suffered from it. So could they really not find more than 4 eligible patients per centre? It sounds like a very low number in an unnecessarily high number of clinics - but then, as I pointed out, maybe that's just me being ignorant.
 
Secondly, the trial was funded by Medtronic, the company responsible for the Symplicity method used, and the lead author of the study was a medical adviser to, you guessed it, Medtronic, as well as being the Chief Medical Officer of its partner company Ardian. Obviously that doesn't mean he's not an excellent and honest researcher, but it does make me wonder if a little caution is needed in accepting the study's findings.
 
And lastly, as the report itself points out: the trial wasn't double-blind, and there was no 24-hour monitoring of blood pressure, so there is some room for error - which is being addressed by a follow-up trial. All in all, I think maybe the Express would've been wiser to wait until some results from that trial have come out before proclaiming that it "could be available on the NHS by early next year." Putting in some words of caution slightly earlier than the very last paragraph, where Professor Jeremy Pearson of the British Heart Foundation warns that "this new treatment will not be right for everyone, and we don’t know whether the benefit and safety will be long-lasting," would also have been nice.
 
 
Right, I actually came across more slightly shocking articles, but I think I've gone on enough for one day. If at this point you're still reading... well, thanks, I appreciate it. Oh, and if anyone can enlighten me on whether my criticism of the renal denervation study is way off the mark, that'd be fab. It's always good to learn on the way!
 

Friday 7 December 2012

'Natural' cancer treatment?

There has been much publicity surrounding the disappearance of a woman with her seven-year-old son, who was recently operated on a brain tumour, this week. She had supposedly taken off because doctors had recommended the surgery be followed by radiotherapy (the standard recommended treatment for his particular form of cancer, and one supported by the boy's father) while she wanted him to only take 'natural' treatments in the wake of the surgery.

Happily, both mother and son were located yesterday; the woman reportedly claimed she didn't run, but had simply taken her son to London for treatment in a hyperbaric oxygen chamber. The logic behind treating possible remnants of cancer with oxygen escapes me, but there you go...

Anyway, the Daily Express today thought it necessary to publish a two-page spread questioning whether alternative treatment for cancer could work - and I use the word 'questioning' in a very loose sense here... After a brief introduction of the case, the first treatment-related comment in the article is 'There are dangers associated with radiotherapy in such a young child' - I would argue that this obviously starts the article of with bias, but I suppose there was probably going to be little hope of a fair and balanced article after the headline 'Do cancer alternatives really work?' anyway.

Then, it turns out, follows an entire article, explaining various alternative treatments, based on the opinions of one Dr Alyssa Burns-Hill PhD. After the first introduction, she is simply referenced as either 'Dr Burns-Hill' or 'our expert'. Her suggestions include an improved diet ('if we eat a lot of sugary treats we are in essence feeding any cancer cells'), complementary therapies, the Gerson treatment and homeopathy ('this is often disregarded because it works in a different way to conventional medicine'). To her credit, she does say patients should always speak to their doctors first if they have concerns about their prescribed treatments, but she goes on to recommend supplements of vitamin D3 and resveratrol, neither of which have to the best of my knowledge been convincingly linked to a reduced cancer risk (Incidentally, a resveratrol study was reported on earlier in the week, but - although I haven't had a chance yet to see the original report - it sounded like another media overreaction). While some of the suggestions are obviously harmless - of course advising people to eat lots of fruit and vegetables is a sensible suggestion - others simply cause people to become distrustful of the only cancer treatments that have actually been found to work: surgery, chemotherapy and radiotherapy!

Anyway, back to Dr Burns-Hill. Although they add the 'PhD' to her name on first introduction, it is not made very clear anywhere in the article she is NOT a medical doctor. For that matter, while she's apparently a member of a whole shopping list of professional organisations, has worked for major corporations and claims to be an accomplished public speaker, nowhere on her website does she reveal which institutions awarded her the MSc and PhD she puts behind her name. I've emailed her asking, hopefully she'll reply. They may have come from perfectly legitimate institutions of course, but generally, if that's the case, people seem to mention them on their websites... So I keenly await her response.

It's constant stories like this one in the tabloids, especially the Daily Express and the Mail, that feed people's suspicions about perfectly legitimate treatments and keep quacks selling sugar pills in business. A look at the comment section under the above story on the Daily Mail website makes it clear how many of that paper's readers seem to believe chemotherapy is just a big conspiracy by the pharmaceutical industry to make us even sicker... Now I'm fully behind the idea that the pharmaceutical industry is evil, but people, that doesn't mean they don't make loads of treatments that work!