Read the latest HealthWatch newsletter:  Newsletter 115, Spring 2021

Published: January 2021

The first fully-online HealthWatch Newsletter is a combined Autumn-Winter issue packed with important features by some new contributors. Read the individual articles below, or access a printable pdf format here.

Our latest progress report on projects HealthWatch has been involved in, and other stories about evidence in health care.

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By Simon Peck

I should probably start by introducing myself as I have followed a most unusual career path. I started my medical career working in anaesthetics but for two decades have worked in the insurance industry, where I have developed a specialist expertise in countering healthcare fraud waste and abuse. Along the way I trained as an investigator, initially informally with NEFF (North East Fraud Forum), which is a public-private partnership set up by Northumbria Police, and later taking a formal qualification accredited by the Centre for Counter Fraud Studies at Portsmouth University.

In 2011, quite by chance, I went to see a group of doctors because their billing had escalated precipitously. During the conversation I made a casual remark about the state-of-the-art consulting room and brand new equipment, and the senior partner informed me that he now sent all his patients to a new hospital who had paid for everything – his staff had been taken onto the payroll, the equipment was free and the hospital were even funding an agency to do his billing. I asked him to explain a little more and he immediately started to be evasive.

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The HealthWatch Award 2020 was presented on 20th October to Professor Jennifer Rogers. Professor Rogers is Head of Statistical Research and Consultancy, PHASTAR and Vice President (External Affairs) at the Royal Statistical Society. It was a happy coincidence that her presentation was on World Statistics Day. A recording of her 50-minute presentation in full including the slide show and the questions and answers that followed can be seen online here. An adapted transcript of her talk follows.

News headlines are telling us what we should do, how we should live our lives, but headlines can be misleading and our own personal experiences can skew our understanding. Would it not be better to give people the tools they need to ask the right questions?

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The 2020 Chair's report was delivered by Susan Bewley at HealthWatch's first virtual AGM, on Tuesday 20th October 2020

Last year I started with a reminder of the history of the charity that was rooted in the Campaign against Health Fraud. We consciously moved from being 'against' things, to being 'for' fair testing, and 'for' science and integrity in healthcare. We have always been particularly concerned about people being deceived about illusions of cures from those posing as healers when people are at their most vulnerable - when ill or depressed.

Just as you thought bias, dishonesty, corruption and fraud couldn't get worse the pandemic (or syndemic) hit. This year's events with Covid-19 and its aftershocks undoubtedly play into all our deepest fears, uncertainties and hope in science, and yet also into the hands of those who are fools at best, and greedy liars at worst. It has shown, more than ever, how hungry people are for trustworthy, reliable, scientific information. Yet more than ever, misleading information flows around the internet faster, further and deeper than truth.

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By Caroline Struthers

“First Do No Harm”, the Independent Medicines and Medical Devices Safety Review focusing on three drug/devices aimed at women (aka the Cumberlege report) was published on 8 July 2020.(1) It should have welcome implications for much-needed change in the way patients are treated.

Two of the review’s proposals are that there be a new Patient Safety Commissioner and Redress Agency established. However, they would only look at harms from “medicines and medical devices”. The review did not consider potential harms to patients from psychosocial and behavioural interventions which are still widely recommended within the NHS for the ever-expanding range of patients who find themselves in the “medically unexplained symptoms” (MUS) swamp. Currently, patients with a range of unexplained conditions such as chronic fatigue syndrome (also known as myalgic encephalomyelitis) and irritable bowel syndrome would fall under the UK Government-funded IAPT (Improving Access to Psychological Therapies) remit.(2) The inclusion of MUS patients under IAPT signifies a massive expansion of its coverage, far beyond the patients with common mental health complaints where it originated. The benefit of this expansion to MUS patients is doubtful.(3)

There is currently no UK mechanism for recording or monitoring harms from these types of interventions, or for challenging the assumption that they are appropriate first-line treatment options for long-term conditions where either the cause or the perpetuating factors are unclear.

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One clear stand-out winner was approved by all four judges of this year’s HealthWatch Student Prize: Matthew Choy, final year student at the University of Cambridge School of Clinical Medicine, took the £500 first prize.

Matthew, who is from South London, popped up at our virtual AGM on 20th October to receive his prize and have a chat with Nick Ross, before excusing himself to revise for an exam the next day. Matthew says he came early to sceptical thinking: “It was reading 'Trick or Treatment'* back in high school that tipped the balance for me to choose medicine instead of law, as I realized I could combine both my interests in healthcare and debating that way.” He is a keen and competitive debater with a side interest in medico-legal matters, and hopes to pursue a career in academic surgery, ideally neurosciences.

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By David Bender

Most of the “easy” questions in nutrition research were answered in the last century: how many calories do we need to maintain body weight and carry out exercise and work?; how much of the vitamins and minerals do we need to prevent deficiency disease?; how much protein do we need? (although this is still controversial).

Over the last 50 years, the emphasis has been on achieving “optimum nutrition” to promote the best possible state of health, rather than preventing deficiency diseases. Optimum health is a more difficult goal. We cannot really define it; it is certainly more than just the absence of disease. If our aim is to devise diets to promote healthy longevity then we are probably looking at studies lasting 70 or more years to test whether they work or not.

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By Caroline Richmond

In 1909 and 1912 the British Medical Association published two books, Secret Remedies and What They Contain, and More Secret Remedies. They were a response to the thousands of ads for medicines, mostly worthless but some harmful, that assailed the public from billboards, newspapers, magazines, buses, trams and railway stations.

The remedies covered almost everything conceivable — cure-alls like Burgess’s ointment, nostrums for coughs and colds, consumption, headache, ‘blood purifiers’, kidney medicines, obesity, diabetes, skin disease, baldness, cancer, and epilepsy. There were remedies for teething in babies, ear disease, deafness, piles, rupture and inebriety. Most cost between 1s and 1s 1½d (s being shilling and d being pence) for the basic size. Some came in a range of sixes. The average weekly wage for a 55-hour week at the time was £1/10s for men and 12s for women, so they were not cheap. The books cost 1s each, cheaper than almost all the nostrums, and were crammed with information — each had 250 pages of small type. They clearly sold in huge quantities: my copy of the first volume was one of the seventy-second thousand. A tax, stamp duty, was chargeable on patent medicines, bringing the government of the day £50,000 in 1908. Advertisers had to print the stamp on the label and many used this to imply official endorsement.

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