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(2) GOVERNMENT
WILL FALL SHORT OF CANCER
TARGETS BY
2010
(3) WAITING
LISTS INITIATIVES HAVE NOT
DIMINISHED
THE DEMAND FOR PRIVATE
MEDICINE
(4) CHILDREN
WITH EGG ALLERGY CAN BE SAFELY
GIVEN MEASLES
MUMPS AND RUBELLA VACCINE
(Funding of long term care for older
people needs to be
publicly debated)
http://bmj.com/cgi/content/full/320/7239/936
The inequity of resources across the UK
for funding the
needs of the elderly is a "national disgrace"
conclude the
presidents of the Royal College of Physicians
of Edinburgh,
Glasgow, and London and the president
of the British
Geriatrics Society. In a letter in this
week's BMJ, they write
that a year on from the report of the
The Royal Commission
on Long Term Care, one of the principal
recommendations "a
partnership between public and private
funding, with state
help for the poorest" has not been acted
on.
Funding causes the most hardship and anxiety
for older
people, they write, and is the main source
of inequity in the
system. They cite a court case which judged
that free NHS
care could only be provided when health
was the
predominant need, with nursing care provided
by social
services. This is typical of the national
situation, they say.
They also cite a British Geriatric Society
survey conducted in
January this year which showed that most
of its members
would not be able to offer nursing care
on the NHS even for
a person who was partially paralysed,
doubly incontinent, and
found it difficult to eat or speak. The
authors call for the long
term care of older people to be included
in the public debate
on healthcare funding, and for the government
to act swiftly
on the Commission's recommendations.
Contacts:
Dr John Petrie, President of the Royal
College of Physicians
of Edinburgh
Dr Brian Williams, President of the British
Geriatrics Society,
London.
(2) GOVERNMENT
WILL FALL SHORT OF CANCER
TARGETS BY 2010
(How many deaths have been avoided
through improvements
in cancer survival?)
http://bmj.com/cgi/content/full/320/7239/895
(Cancer trends in England and Wales)
http://bmj.com/cgi/content/full/320/7239/884
The government will fall short of its target
of 100 000 fewer
cancer deaths among the under-75s by 2010
unless it tackles
socio-economic inequalities, shows research
in this week's
BMJ. The target was published in July
last year in the White
Paper Saving lives: our healthier nation
and included 60 000
fewer deaths through prevention and 40
000 as a result of
better screening and treatment.
Mark Coleman of the Department of Epidemiology
and
Population Health at the London School
of Hygiene and
Tropical Medicine, and colleagues compared
the survival
rates five years after diagnosis of 1.5
million cancer patients
between 1981-5 and between 1986-90 in
England and
Wales, to see how many deaths had been
avoided through
improvements in cancer survival. Avoided
deaths were
calculated as the difference between the
observed and
expected excess deaths from cancer.
Just over 17 000 deaths were avoided within
five years of
diagnosis among patients diagnosed with
cancer in 1986-90,
representing almost 3.5 per cent of all
excess deaths if
survival rates had remained at 1981-5
levels. Two thirds of
the avoided deaths arose from improvements
in survival for
just five cancers, including those of
the breast, colon, and
rectum. But survival had scarcely improved
at all for the
common cancers of the lung, prostate,
stomach, ovary and
brain, which account for a third of all
cancers.
Based on these survival trends, around
24 000 excess cancer
deaths within five years of diagnosis
among the target age
group would be avoided by 2010, and not
the hoped for 40
000, conclude the authors. Small improvements
in survival for
the common cancers would make a big impact
on the figures,
they say, and eliminating inequalities
would save almost
13000 lives every five years.
In an accompanying editorial, Heather Dickinson
from the
North of England Children's Cancer Unit
at the University of
Newcastle upon Tyne, points out that "Eliminating
the class
difference in survival would almost certainly
save more lives in
the next decade than innovative treatment."
She also
challenges the government to use reliable
evidence on which
to base its policy decisions and fund
the accrual of this
information. Data on incidence, mortality
and survival by
cancer type are inadequate, she says,
and it takes six years to
report the number of cancers occurring
in a specific year.
Contacts:
Dr Mark Coleman, Department of Epidemiology
and
Population Health, London School of Hygiene
and Tropical
Medicine.
Email: m.coleman@lshtm.ac.uk
Dr Heather O'Dickinson, Department of Child
Health, Royal
Victoria Infirmary, Newcastle upon Tyne.
Email: heather.dickinson@ncl.ac.uk
(3) WAITING LISTS
INITIATIVES HAVE NOT
DIMINISHED THE DEMAND FOR PRIVATE
MEDICINE
(Private funding of elective hospital
treatment in England and
Wales, 1997-8: national survey)
http://bmj.com/cgi/content/full/320/7239/904
The demand for privately funded surgery
has remained high
despite years of effort to reduce NHS
waiting lists, suggests
research from the University of Nottingham
in this week's
BMJ.
Williams and colleagues assessed the proportion
of scheduled
admissions to all NHS hospitals and to
215 of the 221
independent hospitals for non-psychiatric
and non-maternity
care for the financial year 1997-8 in
England and Wales
which were funded privately, and compared
the findings with
those of three similar surveys in the
previous 20 years.
The results showed that 14.5 per cent of
patients had been
privately funded, including 13.5 per cent
of surgical patients.
These figures have remained constant for
the past 20 years.
One in 10 private patients had been treated
in NHS hospitals,
compared with 1 per cent of NHS patients
in private
facilities, but it is unlikely that all
the surgery carried out
privately would have been done in the
NHS, say the authors.
The data show that a higher than average
proportion of
patients pay for surgery to relieve severe
disability and
discomfort, such as hip replacement and
cataract removal,
and to delay the risk of death, such as
coronary artery
surgery. But there were also a higher
than average proportion
of procedures for cosmetic surgery and
gender reassignment,
considered low priority in the NHS, and
of some procedures,
such as middle ear drainage with grommets
and varicose vein
stripping, whose effectiveness is, in
some cases, questioned,
say the authors.
Contact:
Professor Brian Williams, School of Community
Health
Sciences, University of Nottingham.
Email: b.t.williams@nottingham.ac.uk.
(4) CHILDREN WITH
EGG ALLERGY CAN BE SAFELY
GIVEN MEASLES MUMPS AND RUBELLA VACCINE
(Recommendations for using MMR vaccine
in children
allergic to eggs)
http://bmj.com/cgi/content/full/320/7239/929
Children with egg allergy can safely be
given the measles,
mumps and rubella (MMR) vaccine, shows
a review of the
available evidence in this week's BMJ.
The MMR vaccine is
grown in cultures from chick cells, and
there have been
concerns that the vaccine could trigger
a dangerous reaction
in children who are allergic to eggs.
Khakoo and Lack, from the Department of
Paediatric
Allergy and Immunology at St Mary's Hospital,
London,
show that most of the reported life threatening
allergic
reactions to the MMR vaccine have been
in children who
were not allergic to eggs. Egg allergy
is not always tested for
correctly, they say, and the data from
properly conducted
food allergy tests show that the amount
of egg needed to
provoke a reaction is at least 100 000
times more than is
found in any dose of the vaccine. Using
annual data on live
births and a 1 per cent rate of allergy
to eggs in early
childhood, the authors calculate that
almost 6000 MMR
vaccinations in England and Wales are
given to 1 to 2 year
old children with egg allergies with no
adverse effects.
The authors argue that the main culprits
in children who have
reacted to the MMR vaccine might be gelatin
and the
antibiotic neomycin, both of which are
found in much larger
quantities than egg cells, and which are
known to cause
allergic reactions. Only children with
a known egg allergy
who have had a life-threatening reaction
or who have egg
allergy and chronic severe asthma may
be at risk of adverse
effects from MMR vaccination. These children
should be
vaccinated in hospital, but they represent
a tiny minority of
children with egg allergy, say the authors.
"The MMR
vaccine is as safe as any other vaccine,
and children with an
allergy to eggs must not have their vaccinations
delayed,"
they conclude. Their recommendations have
been endorsed
by a specialist committee of the Royal
College of Paediatrics
and Child Health and the British Society
of Allergy and
Clinical Immunology.
Contact:
Dr Gideon Lack, Department of Paediatric
Allergy and
Immunology, St Mary's Hospital, London.
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