Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Take the case of macular degeneration
- Celine M Aranjo (22 April 2007)
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Right of information : A patient’s perspective
- Hemant Sharma, Vandana Girotra, Zergam Zia (25 April 2007)
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Ignorance is a public health issue
- Michael V. Williams (25 April 2007)
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Beneficial information?
- Erik Buskens (8 May 2007)
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Celine M Aranjo, Senior G.P. NSW, Australia 2208
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Someone (age unknown) is going blind because of macular degeneration (MD) The treatment is available but at his own expense not at the cost of the NHS. This is the story so far. How many more are there with similar stories? Is there anyone who is interested in the causes of macular degeneration, also occurring in the 'aged' other than 'age-related macular degeneration'(AMD)? In my limited experience, there are many 'aged' persons who have been prescribed and are taking regular doses of statins. Post-marketing surveys proclaim in no uncertain terms that statins can and do cause peripheral neuropathies, and is it not the fact that retinal neurons are the peripheral ends of the optic nerves? It is to be wondered epidemiologically, how many AMD cases are taking a statin drug. Furthermore, would it not be prudent to stop the offending drug and await regeneration of the neurons, if no irreversible damage has occurred? And what then if the new treatment is carried out at great expense, and the offending etiological factor has not been recognised and stopped? Competing interests: None declared |
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Hemant Sharma, Clinical Fellow Frenchay Hospital, Bristol, BS16 1LE, Vandana Girotra, Zergam Zia
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It is ridiculous, you want to hide,
You want to conceal the truth,
NHS cannot afford it, I can bear
The ethics of UK medicine is at low
Competing interests: None declared |
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Michael V. Williams, Dean, Faculty of Clinical Oncology Royal College of Radiologists, 38, Portland Place, London W1N 4JQ
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Dr Robert Marcus (1) indicates the importance of candour in outlining the choices available to individuals. However, there is also the effect on wider issues of public health and the availability of treatment options from which patients can chose. Unacceptable radiotherapy waiting times have been highlighted by the Royal College of Radiologists for over a decade (2). They have now started to improve but the last audit in September 2005 still showed that over half our patients wait longer than one month for curative treatment. What is probably not made clear to patients is the impact that this can have on their prognosis. A systemic review (3) has shown that for breast cancer a wait of longer than 8 weeks carries a 60% increase in the risk of local recurrence over 5 years. For post-operative radiotherapy of head and neck cancer, a delay of 6 weeks increases the risk of local recurrence 2.6 fold (3). Worse than this, delay may render patients untreatable. An audit of waiting times in lung cancer patients showed that 20% progressed so that they were unsuitable for radical radiotherapy whilst on a waiting list (4). An up-date in 2007 showed no change (5). These are significant risks to patients. Our failure to communicate them or to bring them into the public arena has contributed to the current lamentable state of our radiotherapy services. The report of the National Radiotherapy Advisory Group, which is presently with Ministers, proposes a plan to address these issues. References 1. Marcus R. Should you tell patients about beneficial treatments that they cannot have? Yes. BMJ 2007;334:826. 2. Dodwell D, Crellin A. Waiting for radiotherapy. BMJ 2006;332:107 -9 3. Huang J, Barbera L, Brouwers M, Browman G, Mackillop WJ. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 2003;21:555-63. 4. O’Rourke N, Edwards R. Lung cancer treatment waiting times and tumour growth. Clin Oncol 2000;12:141-4 5. Muirhead R, O’Rourke N. Waiting times for radical radiotherapy in NSCLC. Clin Oncol 2007;19: S41. Competing interests: I hold a joint lymphoma clinic with Dr.Robert Marcus. |
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Erik Buskens, Professor of MTA University Medical Center Groningen, Groningen, 9700RB
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Should we really tell patients about all the latest technological marvels? It would appear that too many treatments and technologies have been launched that afterward had to be removed from the market because of unexpected side-effects or technical failure. Early adopters may be keen on sharing their absolute and highly competitive drive to offer their patients the latest and obviously highest quality care. Apart from potential harm from offering largely experimental care one but has to look across the Atlantic to understand what the economic consequences might be. The USA is spending a multiple per 'adequately' insured citizen compared to Canada, and never has a real health benefit been established. This will be among the main topics of the upcoming election in the US. I really hope that every 6th US citizen currently denied access for lack of health insurance recognises this issue and will find allies among those better off. Around the world clinicians should take responsibility and sift evidence regarding clinical effectiveness while aware of societal priorities. This may entail limiting access to care that based on efficiency is not part of the local 'NHS' package. No one seems to be bothered by young families driving around rusty ramshackle cars lacking ABS, side air bags and what not, where Mercs and Volvos might save lives. Yet, being denied a PET scan for follow-up of disseminated cancer or MRI for a sprained knee seems unacceptable. Priority setting based on needs and affordability is compatible with most if not all Western European Health care systems. This should be cherished and not compromised by 'playing' the public. Primum non nocere also applies here because sooner or later accidents will occur, and harsh choices will have to be made anyway! Even from a Dutch perspective NICE appraisals seem like an elegant solution to several of the challenges, especially if fast tracks could be applied where indicated. Competing interests: None declared |
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