Sunday, 10 October 2010

Diana Watch

2 tweets from my brother from Thursday morning.

“It's at this point of the morning I wish I'd been lazy and driven in to work rather than cycle”, followed 57 minutes later by, “In ambulance on way to hospital having been knocked off my bike. Suspected broken leg.”

He had indeed broken his leg, in several places, but the rest of him was fine. Friday afternoon for him consisted of a rather long surgical procedure to put all the broken bits of bone back into some sort of order using chisels, drills and various bits of Meccano (orthopaedic surgery is not the most delicate of affairs). And now begins, what might be but then again may not be, the long road to recovery.
I just want to say thank you to everyone who helped him. All the people that helped at the scene and to the ambulance crew. To the A and E staff, the ward staff and even the surgeons who I have been known to mock from time to time. Thank you all so much.
I know it's pointless because none of them read this but I think everyone should know that most people aren't twats and are actually quite nice and the NHS is fucking brilliant and I love it, warts and all. OK, maybe not the warts.

Did one of our papers some how manage to get a picture of Princess Diana on the front page? Of course they did but can you guess which one? Of course you can because it was the Express,


My question to you on this lovely Sunday morning (well it's lovely here) is, who would work for NICE? Really, why would you? You just can't win and you have to interviewed by the enormo-twat that is John Humphrys (He was born in a Welsh town called Splot apparently, I think we have discovered the seat of the Humphrys anger, his home town has a stupid name.)
Their latest kicking from the press came after they did what all proper scientists, skeptics and, to be honest, right thinking people should do, they changed their minds, and therefore advice, in the face of new evidence.
In 2007 the organisation decided, with the help of advanced computer modelling and complex algorhythms rather than the more powerful personal anecdote, that the evidence for the prescribing 3 drugs, Aricept, Exelon and Reminyl, for early to moderate Alzheimer’s disease was not strong enough for them to recommend them and so they didn't. This caused a bit of a fuss at the time because the drugs had been available before and they are not that expensive, the figure being bandied around is £2.80 per day. Some even went as far as to call NICE cruel, which was a little harsh. The evidence was weak so they were withdrawn from NHS prescribing, as it should be (they were still available privately though). We practice evidence based medicine, that is the way it works.
This week, following the consideration of 17 new studies (well according to NICE anyway so dispute this), it seems that the evidence base has shifted in favour of these drugs and so the decision was changed. Now that we know that they work and that they are safe and cost effective then now they can be prescribed. Personally I don't see what is wrong with that but, as I have complained about before, our press does not cope well when faced with a nuanced argument and they see changing your mind in the face of new evidence as a sign of weakness. It is reported that you were wrong rather than the situation has changed.
In British politics it seems that the worst thing that you can be accused of is a U-turn and the press, most of whom haven't shifted any of their ideologically views since some time during the reign of Queen Victoria, usually attach the word “humiliating” to the phrase U-turn just to reinforce their point. And so it was for NICE. The Telegraph had “Alzheimer's u-turn by Nice to allow drugs for mild cases” and the Mail went with “Alzheimer's victory for the Mail: Now just £2.50 can buy a life after U-turn on drugs banned by NICE”, in fact every paper I have looked at on-line (so not The Times then) called it a U-turn.
One of the interesting things is the wide range in the numbers that various papers said were effected by this decision. The Telegraph said “around 80,000”, the Guardian had “Tens of thousands”. The Mirror used the figure of “465,000” people, whilst the Mail claimed a rather vague “Hundreds of thousands”. The Star had something about boobs.
According to the Financial Times this change will cost the NHS £13 million per year so I ask the question that many have asked critics of NICE (including on the Pod Delusion podcast a few weeks ago, Episode 53 I think) what would you do? Rather than just carping on all the time put yourself in their shoes. It is a limited drugs budget and to spend £13 million on these drugs you would have to stop spending it on some other drugs, so which patients, who can all bring a miserable story and sad faced picture guaranteed to get them into the next round of the X-factor, would you tell they couldn't have their drugs? Come on journalists who do nothing but criticise others, what would you do? The likelihood is you will choose something that is close to you because a member of your family has suffered from it and excluded other things because, perhaps, you think that they are self inflicted and shouldn't be treated on the NHS. This is why something like NICE has to exist, to remove to emotion from decisions such as this and consider them in a purely rational, scientific way.

As usual I've rambled on, let do some awards,

The Award for Turning Out Not To Be An Arse (Possibly. Although it may have been for publicity but does that matter in the end, isn't the outcome the important thing whatever the motivation)

If you write a letter to your favourite film star you probably don't expect him to reply, after all Jim'll fix it hasn't been on television for years. You also probably don't expect that film star to turn up at your school either although that is exactly what happened to Bea Delap.
She wrote to Capt. Jack Sparrow from the Pirates of the Caribbean films asking for help with a mutiny and he, err, turned up to Meridian Primary School in Greenwich, London. Whilst he didn't help the children with their mutiny, Capt. Jack (played by Johnny Depp) did offer the children some excellent advice, always remember to brush your teeth.

The Award for Best Line of the Week,

One of the rescue teams has managed to break through into the underground chamber where the Chilean miners have been trapped for the last 66 days. A Journalist excitedly asks Chilean mining minister Golborne "how are the miners?", who replied "a lot calmer than the journalists." Nice.

That will do I think. The usual degree of rambling has been achieved and now I must stop, there are sick people to visit. Off to Devon now to visit our god daughter who's not been well either but the NHS made her better also, damn they are great and not just because they employ me.
Have a super fun week.

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