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!