Saturday, May 02, 2009

Screening

According to the BBC, there are some concerns over private health screening companies.
Health charities and government advisers say they have concerns about private medical screening to detect early signs of several diseases.

About 75,000 people in the UK have paid a US firm up to £150 for tests for conditions such as heart disease and strokes—often after getting letters.

Oh my goodness! They got letters? Quick, kill them all! Or something.
GPs say the letters are scaremongering and the tests are often unnecessary.

Hmmm. I might point out that it is surely up to individuals to decide whether or not they deem the tests necessary, no? It is up to the individual to decide whether they want to pay £150 for such a test, is it not?
Life Line Screening says it identifies risks and that NHS tests are only provided if patients display symptoms.

Well, this is entirely true. And I think that many people would like to know whether they are at risk of a stroke before they actually... you know... have a stroke.

Now, your humble Devil is no medico, but he does tend to think that people should make their own fucking decisions, rather than state-funded medicos doing it for them. In fact, as Ex-Pat Yank points out...
All told, the BBC report pulls together a remarkable alliance. Or, in other words, it rather boils down to this. According to that publicly funded TV channel, the “UK National Screening Committee” which is a government “advisory committee” housed within the government run health service, and charities that support that government “advisory committee’s” view, and GPs employed by that government run health service, all have serious reservations about private health screenings.

Is that a surprise?

Not really, no. Still the BBC does have the good grace to point out that those purchasing the services of Life Line Screening seem to be satisfied.
Customers spoken to by the BBC at a screenings said they were happy with the service, citing concerns over the length of time scans or tests can take on the NHS and the difficulty in obtaining appointments.

Naturally, the very next paragraph is...
But according to the body which advises the government on screening, the procedures offered by private companies such as Life Line Screening can be expensive, unnecessary and misleading.

The UK National Screening Committee says the NHS offers tests for osteoporosis, strokes and heart disease for free.

Fucking hell: how often must we say this—they are not "free". You have already paid for them and, as is entirely routine with the NHS, they will try their hardest to ensure that you either cannot get the scans, or that you do not get them until it is too fucking late.

Here's the beef: if these private screening companies are making false claims or anything similar, then they can be prosecuted under various Trading Acts: if they are not doing so, then might I suggest that the state and its employees—whose record on maintaining health is, to be frank, pretty fucking awful—shut the fuck up?

When you cunts have removed things such as C. difficile and MRSA (to pick just two examples) from our hospitals, then you might be able to pontificate. As Rod Liddle pointed out in the Guardian in 2003 and in The Spectator earlier this year, doctors have a pretty fucking special record.
Iatrogenesis accounts for the deaths of an estimated 72,000 British people every year — or slightly more than the combined numbers of those feckless people dying from smoking, drinking and being very fat. I suppose you could call it the silent killer; there are no government campaigns to educate the public about its lethality. When lists are published showing the top killer diseases it is never present, although it is the third most common cause of death.

The Chief Medical Officer, Sir Liam Donaldson, is not forever haranguing us about how we should avoid causes of iatrogenesis. I know of no medical pressure groups staffed by starch-shirted harridans screeching at us about the problem, nor taxes designed to prevent us from contracting it. And yet it is very easy to avoid iatrogenesis; all you need to do is never visit a hospital or a doctor, and indeed, if a doctor should approach you in a public place, then roll up your newspaper and swat him away, much as if he were a malarial mosquito, while holding your other hand tightly over your nose.

Iatrogenesis is the proper name for death by doctors. The latest figures I’ve seen, through the conduit of the Royal College of Physicians, is the one quoted above — a quite remarkable 72,000 deaths per year. Not all of them are the result of premeditated murder, of course; the overwhelming majority of victims are dispatched through pure incompetence or negligence. I am not sure if the figure includes those who die from infections generated in hospitals — my suspicion is, it does not. In which case you can add another 8,000 to the total, making a nice round figure of 80,000. Astonishing really, isn’t it?

And the vast, vast majority of that is "free" on the NHS. Aren't we lucky little serfs?

So, if people want to shell out £150 for private screenings (whatever their efficacy), I really think that the state health agencies should take a good look at themselves and...

... SHUT THE FUCK UP.

23 comments:

Hugo said...

Whenever doctors go on strike, the death rate declines slightly but significantly.

"Doctors' strike in Israel may be good for health"
http://www.bmj.com/cgi/content/full/320/7249/1561
BMJ 2000;320:1561 ( 10 June )

Martin said...

"Government accuse company of scare mongering".

Pot, kettle, noir.

Mark Wadsworth said...

More to the point, what on earth is a "health charity"?????

Anonymous said...

John Crippen will have something to say about this...

Mr Eugenides said...

Crippen's too busy bumping off his patients to comment right now...

Log on, Doc, we're mocking you!

Dr John Crippen said...

Just caught up with this.

Gawd, DK, that's really depressing. If people of your intellect can be taken in by these fruadsters, what hope is the for the elderly worried well whom they target?

Whatever the flaws in the NHS (too numerous to mention) their existence does not validate these American fruadsters' nefarious activities.

Take a look at "Penman & Sommerlad Investigate" in the Mirror and the impeccable source upon which they base their investigation.

http://blogs.mirror.co.uk/investigations/2009/02/life-line-screening-a-medical.html

I know you are approaching this from your perceived "libertarian" position but all your arguments could be used to validate those central heating engineers who charge old ladies silly money to "check" their boiler for the winter.

Shame.



John

the a&e charge nurse said...

Devil, can you name ANY test the public is missing out on that is even remotely as important simple advice like eating healthily and taking exercising?

It goes without saying that you (and other libertarians) become rather angry when diseases directly related to smoking and boozing are highlighted.

Then there is the issue of 'incidentalomas': abnormalities detected by a test that are almost certainly benign but invariably lead to further investigations (just to be certain).

Do you have one shred of EVIDENCE that more and more tests actually make any difference?

Anonymous said...

Doc Crippen,

Exactly why are these test suspect?. Are the tests bogus or are they not able to show potential problems or are they valid tests that might show up future problems?.

Devil's Kitchen said...

A&E,

"Devil, can you name ANY test the public is missing out on that is even remotely as important simple advice like eating healthily and taking exercising?"You're the nurse: you tell me. But eating healthily and exercising are indeed valuable things. So what?

"It goes without saying that you (and other libertarians) become rather angry when diseases directly related to smoking and boozing are highlighted."Boring, pointless, false ad hominem...

"Then there is the issue of 'incidentalomas': abnormalities detected by a test that are almost certainly benign but invariably lead to further investigations (just to be certain)."You are the medico: you are the one who carries on about the value of the NHS, and the value of life. Is "almost certainly benign" good enough, A&E? What about to the person concerned?

A friend of mine has been very worried about some lady things: as such, she decided to go and have an unscheduled smear test (on the NHS). Five fucking weeks later she is still waiting for the results.

You and Crippen are the technical people, so you tell me: by how much might an aggressive carcinoma, for instance, advance in five weeks?

"Do you have one shred of EVIDENCE that more and more tests actually make any difference?"Of what relevence is that? Absolutely less than none.

If people want to pay for the tests, then they can do so; the tests and any results will be subject to precisely the same laws regarding fitness for purpose, fraudulent selling, etc. etc. as any other product.

Why you state-directed medicos should think it right that you have a monopoly on health provision I've never quite understood: perhaps you would like to tell me?

Ultimately, if people want to pay for this product, then they can. If they want to pay for these tests, and any follow-ups, then they can do so. Any claims of the testers are governed by trading standards laws.

DK

Frank Davis said...

I guess that if anyone wants to waste money paying for health checks, it's up to them.

Personally, I'm just sick to death of people trying to make me worry about my health.

I figure that I'm going to die anyway of something or other some day, so why fret about it?

What bothers me are the increasing numbers of letters I seem to be getting from my GP (never mind American con artists) to have some test or other done. They seem to think it's their job to tell me when I'm not well, when actually it's my job. So I don't do any of the tests. In fact, I haven't been to my GP for over 2 years. And I intend to stay away as long as I possibly can.

assegai mike said...

I think some of you commenters are throwing away the baby with the bath water. Because doctors and nurses are employed by the NHS, doesn't make them Bad People, or incompetent.

In my late 30's, while having some stitches removed, duty nurse observed that I had never had a full check-up and suggested I do so. I was immediately diagnosed as being Type2 diabetic. My subsequent and ongoing treatment as a result of this intervention will undoubtedly lengthen my life, accidents and non-diabetic illness notwithstanding. Big tick from me.

Well-known(I believe) problems with the NHS: 1) it's tax-funded 2) it has too many managers, too few trained medicos 3) like teaching, the police, the civil service, it has become politicised under the current administration, resulting in even well-meaning doctors becoming finger-waggers first and healers second 4) much of the public believes the propaganda that it is "the envy of the world" etc. Something can relatively-easily be done about 2), 3) and possibly 4) but we have to accept 1) with many but not all of its faults if we wish to continue with a tax-funded health service.

Anecdotally, I constantly hear from friends and relatives over there amazing stories about the excellence of the French system, also publicly-funded. For the money we pay, we should expect at least the same.

the a&e charge nurse said...

Devil - I cannot comment on your friends case, although I hope she is well.

Generally 'no news is good news' although cock ups occur in all systems.
I don't know if the delay is because of the 'Goody effect' but the uptake of smears has risen quite markedly in recent months.

The substance of your argument is that anybody should be free to obtain whatever tests they want, whenever they want them irrespective of the evidence base and the possibility that health fears are being manipulated.

I don't actually disagree with this after all it's their time and money.
But let's say an abnormality IS picked up - do you think they should go running to the GP screaming, oh my god, they've found this or they've found that, because presumably great pressure to initiate further tests like ultra-sound guided biopsies and so on ?

That sort of stuff costs money - so, we either divert finite NHS resources to the worried well (to enable yet more testing) OR we can rely on GPs as well as the other pathways to care such as A&E, etc.

Dr Crippen is right - generally this racket that will primarily benefit the providers although I reluctantly accept there is always a chance that significant pathology may be detected.

North Northwester said...

Now here's a coincidence. DK and me posting on the same subject on the same day. Spooky.

On the NHS generally:

All systems allow problems to occur as resources are finite and people are imperfect, but think of this.

Say the government suggested that from now on all food would be produced on State-owned farms run by accountants and tilled by trade unionists whose unions had a history of extreme militancy - and whose crops would be cleaned and cooked and allocated free of charge at restaurants and shops set up and financed and mostly owned by the government according to political decisions taken in Whitehall and amendable only by committees. Imagine also that the government actively discouraged private sector farming or voluntary farming collectives, and actually banned certain types of food preparation and retailing, and insisted on licensing [under state training programmes] all the farmers and chefs and warehousemen and delivery van drivers at the public cost.

Would you actually expect to eat well in such a country? Would you vote for such a programme to be introduced compared with what we have today?

And why don't we starve under our present arrangements, or have one agriculture industry producing safe, clean, nutritious luxury food for the rich and another, second-class food industry that produces imperfect, nasty, dangerous, and under-supplied food for the poor?

Anonymous said...

The quotes made about iatrogenesis are exactly the point the critics are trying to make. Screening has a downside.

You can't have it both ways DK. If you think medical interventions are so damaging why support screening of dubious value?

Anonymous said...

"But let's say an abnormality IS picked up - do you think they should go running to the GP screaming, oh my god, they've found this or they've found that, because presumably great pressure to initiate further tests like ultra-sound guided biopsies and so on ?"

So you think that someone who's been paying thousands of pounds a year in tax to fund the NHS should be denied treatment solely because some NHS doctor didn't authorise the tests that showed an abnormality?

Anonymous said...

"You can't have it both ways DK. If you think medical interventions are so damaging why support screening of dubious value?"

Um, he's a libertarian: only authoritarians believe you can't disagree with something yet support the right of people do to the thing you disagree with.

Alcohol and tobacco are damaging, but only health Nazis try to force people not to drink or smoke if they choose to do so. Unsurprisingly, the NHS is full of people who believe they have every right to force others to avoid behaviour they don't like; after all, libertarians are hardly likely to choose to work for a tax-funded, government-run organisation which does everything it can to eliminate private competition.

Occam said...

An asymptomatic incidental finding is highly likely to be benign. The nhs can't, and shouldn't, investigate all of these. People get sick and die; all the tests in the world won't stop this. The difficulty is balancing the cost of a test against it's sensitivity, specificity, and potential to act on any abnormal finding. Encouraging private screening, with inevitable nhs funded further tests, directs an even more disproportionate share of the nhs cake to the worried well. If you were to argue paying for the further tests and the 'iatrogenic' risks associated was the responsibilty of the person paying for the initial test then your argument would at least be coherent, all be it simplistic and wrong.

Chalcedon said...

It does NOT include nosocomial infections. there are two numbers, those catching a disease in hospital and those that are killed by it.

100,000 fucking cases per year and around 5000 deaths per year. NHS trusts do not have to report these numbers by the way. It is an utter disgrace. Dirty hospitals not cleaned adequately by undertained, poorly paid staff. I'm going to cool off as this is .........aaaarrrrgggghhhh something that can be dealt with if there was the will and the money to do it.

Anonymous said...

People have a right to waste their own money but companies offering such services should not do so under false pretences. Screening has risks as well as benefits. It is very difficult for a misinformed public to grasp this.

Suppose there is a scan that can pick up, say, lumps in the lung. There could be downsides to having such a scan. It would cost money and there might be a substantial radiation dose. If it involved contrast there might even be a risk that the scan could kill you as a result of an adverse reaction. If a lump was found that would cause anxiety. It might require further tests. It might need a needle stuck into it to obtain samples. That would carry a risk. It is not impossible that the overall risks of the screening process might outweigh the benefits. It might even be that nasty abnormalities discovered might still not be curable. Furthermore cancers found on screening tend to be indolent or very slowly progressive so may not need to be discovered.

Unfortunately these issues can easily be glossed over by companies just out to make money from vulnerable people.

john in cheshire said...

The sooner the NHS is privatised the better. I dread becoming ill and actually having to go into hospital. That's more frightening than swine flu.

UK Voter said...

The reality is, if people can afford to pay for a private screening they will. Far better than having to go through the macinations of trying to get a similar screening on the NHS, where even though it is a public service, you still get the impression you are taking up their time and that you must appreciate that it is a free service. Is it hell, we are all (well those of us that work) paying through the nose for this "free service". Do we get value? I don't think so.

Anonymous said...

"Encouraging private screening, with inevitable nhs funded further tests, directs an even more disproportionate share of the nhs cake to the worried well."

'Worried well'... in other words, the people who pay the taxes who keep the NHS operating.

This cuts to the very core of the problems with the NHS: in theory it claims to provide free healthcare to everyone, but in reality it's theft-funded, rationed care with priorities set by unaccountable bureaucrats who are more than happy to see a possible problem left to turn into a mortal condition so long as it saves a few quid.

"People get sick and die"

That's the NHS red in tooth and claw, and a clear demonstration of why we would rather be allowed to pay for our own healthcare than be bossed around by petty bureaucrats.

(P.S. I was kind of amused to see that the 'word verification' for this post is 'diess'... killing people seems to be one of the things the NHS does best)

the a&e charge nurse said...

Err, I hate to tell you this, anonymous (08:00) but ALL health care is rationed.

Or maybe you know of a system where patients can have any test they want (5 minutes ago) with a panoply of specialists on standby to interpret the multitude of investigation that their increasingly neurotic 'customers' demand?

Here is just one example of why some people believe that gullible punters might need to be saved from themselves
http://drgrumble.blogspot.com/2009/05/atrial-fibrillation.html