The Royal College of Physicians eagerly awaited report on the relationship between doctors and drug companies was released on Wednesday. It’s been covered heavily in the BMJ this week.

The report says:

it is our profession that has colluded in all of this and prepared to go along with it – we are the people to blame because we need not have stood for it

What is ‘it’, i hear you cry? The pens, tissues, M&S sandwiches, dinners, and so on i presume.

The BMJ editorial says the report is a missed opportunity due to a number of flaws in the design and execution of the report. It also suspects that the aim of the report was to patch up relations between the two sides – by blaming the doctors by the looks of things!

Up to 1700 bloggers signed away the intellectual propert rights to their blogs to Wellsphere. They were slipped up by the following clause in the Ts and Cs:

…All Website Materials, including any intellectual property rights in such Website Materials, are the property of Wellsphere, its affiliates, licensors, or the designated owners, and are protected by applicable intellectual property laws. You should assume that everything you see on this Website is copyrighted unless otherwise noted, and may not be used without our written permission except as provided in these Terms…

A great blog on the subject is on betterhealth, which includes some of the letters that Geoff Rutledge, a physician working for wellsphere, sent to bloggers.

1700 bloggers!! Geoff was a busy man.

Remedy UK have collected over 1400 signatures from doctors who think that Sir Liam Donaldson, the CMO, should be investigated by the GMC over the MMC ‘fiasco’.

The People were the only newspaper that I could find who covered the story this weekend, no doubt impressed by these angry words:

Remedy ’s Dr Richard Marks said: “We can’t have doctors making a mess of things and just walking away.

If I did that in the operating theatre I would be struck off.

Liam Donaldson and those around him should answer for what they did.”

Can we consider 1400 signatures a success? Would remedy have hoped for a little more media coverage for such a controversial topic? Do any doctors outside the walls of the DNUK forums care about this issue?

The BMJ published a study of over 8000 patients over 50, which apparently shows that patients with conditions such as osteoarthritis, cataracts and incontinence are not given as good treatment as those with conditions such as heart disease.

A variety of accusations are made from these findings:

1. That doctors are ageist.
2. That GPs are more likely to treat conditions for which they get bonus payments (on the QoF).
3. That 60,000 lives could be saved by putting people on beta blockers.

The accusation of ageism seems strange when the cut off age is 50 years (not a very old age at all). Furthermore, the study doesn’t compare those over 50 with those under 50 so how can we tell that age is the reason for poorer care.

Quality care indicators for each chronic condition are, of course, different. Examples include measuring HbA1c annually in diabetics, performing a dipstick in established urinary incontinence, and offering paracetamol in those with osteoarthritis. Given that they are all different and require varying degrees of time, is it surprising that results vary? Secondly, the evidence base for conditions such as diabetes, and hypertension is far stronger than in so called geriatric conditions. GPs might understandably focus on these conditions more.

The newspapers couldn’t agree on what the main point of the research was and came up with a variety of depressing headlines:

Over 50s being neglected in hospital – The Telegraph

Better care for elderly ‘could save 60,000 lives’ – The Indy

A third of elderly not receiving basic NHS care as campaigners call for laws against ‘ageism’ – The Mail

Over 50s could be losing out as hospitals discriminate on diseases and funding – The Times

This excellent article in The Guardian explains much of the media’s attitude towards doctors and the NHS:

Nearly all journalists aspire to emulate two stories: the Watergate scandal, which brought down a US president; and the thalidomide scandal, which, after years of campaigning and legal battles, forced a multinational giant to eat humble pie, and made Harold Evans and his Sunday Times Insight team world famous.

Thalidomide explains why, on the flimsiest of evidence, they accuse doctors of inflicting dangerous diseases or disabilities on children.

Due to this willingness to believe any story that is fed to them by an overzealous or even dishonest scientist or doctor, fiascos like the MMR scare happen and lives end up being put at risk. Do journalists get any training in critical thinking as doctors and scientists do?

Why do articles such as this one in The Observer about experimental cancer medicines make me so angry? I’m not against reporting on new trials and developments – the public ought to be kept informed of such things. But there’s something about this piece and much health reporting in the mainstream media that makes me squirm. For instance:

But among the many sufferers with terminal cancer, 782 men and women have that most precious commodity – hope. Conventional NHS cancer treatments such as chemotherapy and radiotherapy have failed them. They have nothing left to try. So they have volunteered to take part in clinical trials of unlicensed, experimental cancer drugs. With luck, these novel treatments may extend their lives.

Sentimental, trite, cliched. Is this what Observer readers want to read?

Never mind the style, what about the content? Take this paragraph:

The brave, unacknowledged efforts of these 782 patients have already helped scientists produce new drugs that work in cancers that were previously hard to treat, allowing people to extend their lives and spend a few more months or even years with their loved ones.

Great, but what are these drugs called? How effective are they? How harmful and expensive are they? The whole point of medical research is to be scientific, so why are the public subjected to such vagueness?

Finally, here’s my vote for ‘paragraph most in need of the editor’s pen’ of the week:

Tests in laboratories, usually involving mice or rats, yield only so much knowledge. Sooner or later real patients are needed to help translate research into, hopefully, new drugs – a process scientists call ‘from bench to bedside’. These trials in experimental drugs are vital in that. ‘We need human beings to take risks,’ said Newell. Experiments to ascertain the right dosage, for example, may involve suffering along the way. Ethically, only patients who have exhausted all other options are allowed to take part in these trials, although others exist for patients still being treated on the NHS.

The Guardian reports on new figures from Enfield including that 272 operations were cancelled in May for non-clinical reasons, which it assumes means computer errors. Surely there are lots of other reasons to cancel procedures?

My own experience is that while new computer systems can speed certain things up, such as requesting scans and making appointments, bugs and oversights in the programming of the software which can, at best be frustrating, and at worst lead to potentially dangerous delays and errors.

This story in The Times highlights something that has struck me during my recent weekend night shifts. Its so common to see thirty- or forty-somethings with chest pain that it raises little more than a wry smile amongst doctors. One man in his thirties was wheeled in by the ambulance after being found pulseless with cocaine next to him. The most striking thing about the arrest was that nobody seemed particularly surprised by it – just another person having a heart attack on cocaine. I reckon it wont be long before the rest of the press cottons on to this and we start to hear a lot more about cocaine’s side effects.

BBC News reports on rember, a new drug for dementia that shows promising results in a phase II trial. Another trial suggests that statins might prevent or delay the onset of dementia.

New therapies for dementia seem to be coming along thick and fast (eg dimebon) and the press love to write stories about them. But how many of them actually work? Take tarenflurbil for instance. As recently as June, BBC News reported on this exciting new drug:

Experimental drugs are being hailed as a potentially exciting step forward in the treatment of Alzheimer’s. The drugs, still in clinical trials, form a new class called gamma-secretase modulators (GSM). Doctors are in the third and final phase of trials on human volunteers to test the first GSM, a molecule called tarenflurbil, branded as Flurizan.

Unfortunately, trials on tarenflurbil have been abandoned since the trial “had failed to achieve statistical significance on either of its two primary endpoints”. This is according to the press release from the International Conference on Alzheimer’s Disease – the same conference where rember was presented. So why did the BBC not report on this as well?

BBC caption which says it all: "Jimmy Hardie used to mistakenly put sugar in the fridge"

This week’s Private Eye features a startling story from the Philippines. (The story has been around since April but this is the first time I’ve heard of it)

Jan-Jan, a florist from Cebu City told a press conference (as quoted in The Eye):

“I got very drunk on New Year’s Eve and paid a male prostitute 100 pesos for a night of sex. But an argument started when I criticised the size of his wang, and before I knew what was happening, he shoved an aerosol can of Black Suede body spray right up my bottom, where I could not reach…When I awoke next day, I knew something was very wrong. So I told my family what was happening and went to the Vicente Sotto Medical Centre, expecting professional courtesy and sympathy for a victim of sexual abuse. But instead, a dozen doctors and nurses stood around pointing and jeering at me while the can was being removed, and took a video of the entire operation which ended up for several weeks on YouTube.”

The Sun-Star newspaper goes on:

The unauthorized 2:54-minute video of a noisy operating room shows VSMMC doctors and nurses laughing, giggling and cheering. At one point, a hand appears with a cell phone camera taking a close-up picture of the surgery. As a doctor gingerly pulls out the six-inch long canister from the male patient’s rectum, someone shouts, “Baby out!” amid loud cheers. The doctor then removes the canister cap and sprays the contents toward the crowd of nurses and doctors viewing the procedure.

Readers with a strong stomach can watch it on YouTube.