Updated gold guide published

The Gold Guide, aka ‘A Reference Guide for Postgraduate Specialty Training in the UK’ was re-published this week. The guide clarifies amendments to speciality training made this year and includes a list of the specialties that have been uncoupled (all of them as far as i can tell) and confirms that FTSTA’s will be phased out, only remaining in areas where a two year training post cannot be arranged.

Download the document here or read more about it in this BMJ article.

Proof that GP appraisals work

A GP from Scotland was suspended for six months for giving a suicidal patient sleeping pills to enable the patient to kill herself.

According to The Independent, health authorities became suspicious after he listed helping patients at the end of their lives as one of his achievements during his GP appraisal.

Surely there is nothing wrong with ‘helping patients at the end of their lives’, but perhaps there was more to it than the article suggests.

Dr Kerr also told psychiatrist Dr Alexander Cooper, to whom he referred Patient A three months before her death: “Some years ago she discussed suicide with me and I’ve been in the habit of supplying her with barbiturate tablets which would assist her in her endeavour.”

A treatment for depression you wont find in the textbooks! (or even on google)

iwantgreatcare.org – the worst site on the web?

The concept is flawed (at best), the legal basis for the site is shaky, but surely the site’s appearance and usability are its greatest flaw.

Channel 4 Dispatches – confusing messages

Having watched Dispatches today, about the new HPV/cervical cancer immunisation, I was left a little confused: it seemed to argue that drug companies (GSK & Merck) used unscrupulous methods to get their vaccines licenced and approved for use by the NHS; then at the end of the programme it is clearly supporting the use of the vaccine. It is, of course, possible to have a useful drug that is unethically promoted, but I got the feeling that the programme was trying to make people doubt the efficacy of the vaccine based on the marketing strategy of the pharmaceutical giants. Anyone agree?

On a separate note, the programme contained a good example of the double standards of journalists: it criticised Merck for sponsoring a questionnaire asking parents whether or not they would like their daughters to be protected from cervical cancer by a vaccine (yes, obviously). Moments later Jane (our presenter) asks the parents of a woman with advanced cervical cancer whether they wish they could have vaccinated her against it!

If you missed it you can watch it online until next week here.

Or read about it on the C4 website.

Britain’s stroke shame

The Independent on Sunday, which i bought at Euston station today to get a free bottle of water (it wasn’t worth it – I feel cheated), featured this report about stoke management.

According to the Royal College of Physicians, stroke thrombolysis is occurring in under 1% of strokes, while less than 50% are having head CTs within 24 hours. The article goes on to describe forthcoming NICE guidelines:

According to Nice, all patients should be scanned, diagnosed and, if needed, treated with a clot-busting drug within an hour of the stroke. Currently only 0.8 per cent of stroke patients are treated this rapidly.

In an ideal world, but how many strokes present within an hour of onset? Many present on waking up or when a patient is found by a carer or relative – but its easier to blame “ignorance among NHS staff”.

Nice say patients with mini-strokes should be investigated and treated within 24 hours to minimise the risk of a major stroke and it says all stroke patients should be cared for in specialist units by highly skilled teams with access to the best equipment and technology.

Jail for cancer cure fraudsters despite no drug trial data

Three people who sold a cure for cancer to over 150 patients for £6800 per treatment were each sentenced to jail in Germany, according to The BMJ.

The remedy, Galavit, said to be discovered by Russian space scientists, has never been subject to clinical trials, but rose to fame after German actor, Ivan Desny, claimed to have been cured of prostate cancer using the drug – only for it to be revealed later that he had never had cancer.

The case raises an interesting question regarding alternative medicine and evidence based medicine: these quack’s surely aren’t the only ones to go around claiming that they can sell you the cure for terminal illnesses?

At the end of a 16 month trial the court concluded that it was sure that Galavit did not cure cancer, even if the drug’s lack of efficacy could be scientifically proved only by clinical trials. As such trials might cost several hundred million euros, it would be impossible to say for certain.

Promising results for dimebon in Alzheimer’s trial

An old Russian antihistamine, no longer in clinical use, may be effective at treating mild-moderate Alzheimer’s disease. The randomised, double blind, placebo controlled trial, published in The Lancet today, shows a significant improvement in cognitive function after 6 months in patients treated with dimebon versus those treated with placebo.

With the drug being an old drug, not requiring any further development, it is hoped that if further studies confirm its efficacy, it may be a cheap and effective treatment for dementia – see BBC News story.

Breast feeding releases ‘love’ hormone

A model to explain how bursts of oxytocin release come about during infant suckling was published today in Public Library of Science Computational Biology (click here for the paper).

Somehow, The Mail has concluded from this study that:

Breast-feeding DOES help mothers bond with babies – because it releases the ‘love’ hormone

Thanks, but we’ve known for decades that breast feeding releases oxytocin, or the love/cuddle/trust hormone at Daily Mail HQ. The article goes on to say that “[the study] has discovered that the action of a baby suckling actually changes how the mother’s brain behaves.” We already knew this – the study tries to explain how this happens using a computational model, but never mind.

From The Mail’s oxytocin factfile:

“Voles given the hormone are more likely to pair up.”

“Scientists have proposed spraying a fine mist of the chemical over violent mobs to calm them.” They may also cuddle and pair up, I suppose.

For a more useful guide to the benefits of breastfeeding try this BMJ review.

Clostridium difficile rates go up

Quaterly figures show that although MRSA rates are down, the incidence of C diff has risen by 6% in January-March according to The Mail. Thats 10,586 cases, 32% fewer than in the same quarter last year.

The article is quite balance for The Mail, but the following lines are a little odd:

Critics say the real incidence of MRSA could be much higher, as figures only record cases in the bloodstream.

This covers only 15 to 20 per cent of all hospital cases. The superbug affects other organs and even bloodstream cases may be under reported.

They must be referring to skin colonisation, which is an entirely diferrent issue.

In support of iwantgreatcare.org

Christina Patterson, of The Independent, thinks that the new rate your doctor website launched this week (see below) is a great idea – see article.

Getting quite irate about the medical profession she writes:

Honestly, you’d almost think that this was a profession that regarded itself as in some way separate from society and its petty demands, a profession which thought that “flexibility” was a concept that applied to patients’ time, but not, obviously, to its own, a profession which saw the word “modernising” as a synonym (and rightly, on the evidence of the past few years) for a whacking great pay-rise. A profession, in fact, which regarded its “customers” (who pay their salaries) with contempt.

Depressing reading for hard working doctors, many of whom already feel undervalued and disillusioned with the NHS.

Meanwhile, the bloggers continue with their assault on Dr Bacon, the sites founder, with legal advice for doctors who find defamatory remarks about themselves on iwantgreatcare.org