Andy Hall wrote: .
It certainly isn't a non issue. Prescribing something of doubtful value & justifying it because they are 'cheap' is a terrible waste of limited resource. If they are cheap & prescribed by the million its still lots of money.
I rather think it is. If statins were the wonder drug they are claimed to be my daughter would be picking up people who didn't take them.
Exactly the point Bob. Apart from the waste of resource & the side effects there is no clear evidence that high/bad cholesterol levels cause CV attacks. So why blanket precribe them.
Which makes a complete mockery of the NHS. You shouldn't have to do 'deals' with your GP. You get better healthcare if he gets better 'target meeting' help from you?
No, but one has to start somewhere.
In comparison to the potential cost of long term care of those disabled by cardiovascular events, it's very cheap.
No. You're not looking at the overall picture which would need to include a study of a large population over a long time. It can't be done based on one tiny set of data from an ambulance log book.
They aren't blanket prescribed any more than anything else.
Side effects are comparatively rare, taken across the population of users and specific tests should be done. If the GP isn't doing that, then it's a different matter. Equally if the patient is popping white pills because the doctor says so without researching them for himself as well, then that's foolhardy on the part of the patient.
The NHS is a mockery and always has been. The thought that healthcare can be provided for free and forever to all at the point of use and be uniform regardless of geography, is a socialist wet dream belonging to the 1940s.
None of those things are achievable or even desirable - certainly not national uniformity.
The way to get better healthcare is to take responsibility for it oneself. The doctor should be a professional advisor and not the determinant of all that happens to the patient. That is the patient's responsibility.
On the specific subject of blood glucose measurement there is a long running saga where NICE have said that patients should be prescribed test strips if it will help them with their diabetic management. However, they are expensive. Retail price is around 50p a strip, NHS price probably around 30p. To use them in order to manage BG effectively on an ongoing basis, one might need to test 8-10 times a day initially and perhaps 2-3 times a day once one knows the effect of eating particular things, amounts and combinations.
Many PCTs prefer an alternative, which is a quarterly or twice yearly blood test known as HbA1C. This "measures" the result of how effective BG control has been or the previous 6 weeks or so. It's of some use to the medical professionals in that they can know if it's been good or not. It doesn't help the patient to manage their diet and exercise on a daily basis. Needless to say, the test is cheap - something like £7, so obviously appealing to PCTs.
The figure obtained from the test is a percentage and for non-diabetics generally less than 5-6%. NICE have given a guideline of 7.4% as a target for GPs to use, and it is one of the contributory factors to their getting bunce for diabetic management. They have even gone as far as to say that getting under this figure represents "good control" for diabetics. One is immediately suspicious of such numbers. Why not 7.3% or 7.5%? The answer is simply taken from across a broad group of diabetic patients (not the population as a whole) and represents a relatively easily achieved target that can be achieved for most patients. It has little to do with outcome.
I had a "discussion" with the PCT about this, after they attempted to remove strip prescriptions and they relented. I suspect that man people won't have bothered, but then they may not test anyway, preferring to pop a white pill and have the doctor take care of the quarterly HbA1c measurement. Unfortunately, it's not a very good measure of outcome and is useless as a management tool to the patient.
The agreement was to include extra HbA1c tests if strips were prescribed. It's somewhat irrelevant because my HbA1c figure is always in non-diabetic range of < 6% anyway. However, these tests are one of the check boxes for GP diabetic care. The question is not so much one of doing a deal, but rather that the NHS measuring and treatment regime is based on cost and not outcome. Put a different way, HbA1c tests plus white pills are substantially less expensive than test strips. I want to have the regime that works for me, based on my taking prime responsibility rather than subcontracting to the quack. He doesn't disagree with that notion, and also believes that the targeting system is ridiculous.
The message from "The Medway Handyman" contains these words:
France was outraged when Greenwich was adopted by International agreement. In French eyes Paris was the centre of the world and French the one true international language, but they had not done the hard work, and most of the charts in use round the world already used Greenwich so it was the obvious choice, even to the Merkins, who would no doubt have preferred international agreement that the conference should pick its location as a key point on the Prime Meridian.
Which have now changed and in due course the Prime Meridian will escape from Greenwich. No doubt the French were an enthusiastic part of that conspiracy.
This wasn't a change of goalposts.
BTW, the same thing has happened with BMI in recent years.
Err, no there aren't. Diet, exercise and stanols can only reduce cholesterol by about 10%.
Indeed, it demonstrates the reason that I do not customarily take medical advice from handymen, no matter how good an installer of decks they are.
Who knows? Be glad they aren't measuring it in barrels per acre, or somesuch.
We were somewhere around Barstow, on the edge of the desert, when the drugs began to take hold. I remember Rod saying something like:
It's a tiny risk - you're more likely to develop rhabdo from injury, from what I can see.
All depends on definition of 'tiny'. I just typed rhabdomyolysis as one example, SIM (statin induced myopathy) is rather more common but, I think, less likely to be fatal in the short term.
"Lipid-lowering drugs produce myopathic side effects in up to 7% of treated patients, with severe rhabdomyolysis occurring in as many as 0.5%"
(Of course, there are loads of possible sources all with their own measures of side effects.)
When you get doctors suggesting (as I heard on the radio some time ago) that they are safe enough to give to everyone, I think that they need to be much less likely to cause rhabdomyolysis than even 0.5% of treated patients.
[I also enjoy watching House M.D. which might be why...]
It depends on the indvidual, the causes and the circumstances.
But I think it could be done if we got rid of all the hospital managers and administrators. Bring back Matron to look after the wards and appoint ONE administrator to look after the drugs costs that are administered over all the wards. Computers are wonderful things these days.
Just round the back of me is a building with about 50 to 100 staff (possibly more, looking at the size of it) that are connected to the NHS by the badge that is on the front of this building. What on earth are they doing??
We don't have that, even in these early days. The Scots get that and this free and who pays for it? the rich South. The Welsh are the same, they get free this and that and once again, who pays for it? Once again the rich South.
Gordon Brown, a well know Scot, sells us down the river without a referendum. Why do we need all those MPs now and the house of Lords? we could save a fortune by sacking them all.
It is all right saying that, but the level of poverty was recently put at about £16.250.00. There are a lot of people below that line. I am a pensioner and I am above it. For how long? I don't know with the way gas, electricity, food, water, council tax etc. is going up. Not to mention the cost of running a car.
On this, we agree. Roll on the time we can see a GP in the local supermarket free of charge.
Andy, stopping you here, just what is your full time job?
I have an aversion to NICE, in the fact that they are not nice to English patients.
Dave
France you twit. Pint for the fella... Glass of white wine/ fruit-based drink for the lady!
Not if it doesn't work it isn't.
Can you imagine the Merkins altering all their GPS satellites? I can't.
Dave
If you mean Body Mass Index its a totally discredited system. I have the same BMI as did Arnold Schwarzenegger when he won the Mr Olympia for the 7th time.
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