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(2)
SHOULD COMPULSORY SCREENING OF
IMMIGRANTS
BE PART OF UK PUBLIC HEALTH
POLICY?
(3)
RETENTION SCHEME COULD OFFSET GP
RECRUITMENT
CRISIS
(4)
SOME SCREENING TESTS SHOULD NOT BE
ADVOCATED
(5)
COMPANIES FLOUT LAW ON TOBACCO IN
TOOTH
CARE PRODUCTS
(1) NHS SET FOR
"AIRLINE STYLE"
TRANSFORMATION
(New providers in UK health care)
http://bmj.com/cgi/content/full/328/7435/340
UK health care may soon be transformed
by the
introduction of new providers, just as
low-cost airlines
Ryanair and Easyjet have radically changed
European air
travel in recent years, suggests an article
in this week's
BMJ.
Several new private providers have recently
been
awarded contracts to provide healthcare
services for the
NHS. Most of the work will be in general
surgery and in
areas with the longest waiting lists,
such as orthopaedics
and ophthalmology. As a result, NHS organisations
will
compete with private providers to attract
patients, writes
Penelope Dash, an independent advisor
in health care.
These new providers are introducing new
ways of
working, resulting in faster throughput
and lower costs.
As such, the NHS and existing private
providers are
having to re-examine how they provide
care.
If successful, this initiative may even
expand to include
diagnostics, primary care, and chronic
diseases, such as
asthma, diabetes, or heart disease.
The Government's recent attempts to open
up the UK
healthcare market to new providers look
set to continue,
says the author.
Will it work? Only time will tell. But
if the airline business
is anything to go by, things will certainly
be different, and
the cosy duopoly of the NHS and mainstream
private
providers will be a thing of the past,
she concludes.
Contact:
Penelope Dash, Independent Advisor in Health
Care, St
Albans, UK
Email: pennydash@aol.com
(2) SHOULD COMPULSORY
SCREENING OF
IMMIGRANTS BE PART OF UK PUBLIC HEALTH
POLICY?
(Compulsory screening of immigrants
for tuberculosis
and HIV)
http://bmj.com/cgi/content/full/328/7435/298
The UK government may be considering compulsory
screening of immigrants for tuberculosis
and HIV, yet
compulsory screening is not based on adequate
evidence
and has practical and ethical problems,
argues a senior
doctor in this week's BMJ.
Little evidence exists to show that early
detection of
tuberculosis in foreign born individuals
conveys
appreciable public health benefit to those
born in the host
country, writes Richard Coker of the London
School of
Hygiene and Tropical Medicine.
Indeed, what little evidence exists suggests
that the
introduction of compulsory measures may
mean that
some patients may delay seeking care and
pose a greater
public health threat.
HIV raises several important practical
and ethical
questions, he adds. For instance, would
such a policy
focus on all migrants, immigrants from
high prevalence
countries, asylum seekers, or some as
yet unspecified
population? And what about people from
within the
European Union who are able to move freely?
Furthermore, if a positive HIV status excludes
an
individual from entry (as has been proposed)
then might
such a screening policy create incentives
to avoid legal
routes of entry?
The United Kingdom has an enviable reputation
in
international public health, says the
author. It would be a
shame if this reputation was tarnished
through an ill
considered conflation of immigration control
and
communicable disease control.
Contact:
Richard Coker, Senior Lecturer, Department
of Public
Health and Policy, London School of Hygiene
and
Tropical Medicine, London, UK
Email: richard.coker@lshtm.ac.uk
(3) RETENTION
SCHEME COULD OFFSET GP
RECRUITMENT CRISIS
(Scottish general practitioners'
willingness to take part in
a post-retirement retention scheme:
questionnaire survey)
http://bmj.com/cgi/content/full/328/7435/329
Almost three quarters of general practitioners
in Scotland
plan to retire at or before the age of
60, but many would
be interested in a post-retirement retention
scheme that
could help to offset the current recruitment
crisis in UK
general practice, finds a study in this
week's BMJ .
Researchers surveyed 348 practising general
practitioners aged 55 and older about
their retirement
plans, their reasons if retirement was
planned before the
age of 60, and their interest in a retention
scheme.
Of 333 who answered the question of age
of intended
retirement, 20% (68) planned to retire
before 60, 51%
(170) at 60, and 29% (95) planned to continue
beyond
60. Eighty one per cent (55) of those
intending to retire
before 60 cited excessive workload as
the reason.
Some 243 (70%) GPs indicated an interest
in a retention
scheme. Around two thirds said they would
prefer to be
retained by their current practice, and
over half expected
to continue working in the scheme for
more than two
years.
Even if only half of those who expressed
an interest in
such a scheme applied it would provide
the equivalent of
40 full time posts in Scotland, which
could partly offset
the recruitment crisis, say the authors.
In addition, these
experienced general practitioners could
provide a
valuable education resource.
Contact:
Margaret Chambers, Associate Dean, NHS
Education
for Scotland, Lister Postgraduate Institute,
Edinburgh,
Scotland
Email: margaret.chambers@nes.scot.nhs.uk
(4) SOME SCREENING
TESTS SHOULD NOT BE
ADVOCATED
(Screening without evidence of efficacy)
http://bmj.com/cgi/content/full/328/7435/301
Certain screening tests for cancer are
of unproved value
and should not be advocated, argues a
senior doctor in
this week's BMJ.
The blood test for cancer of the prostate
(PSA) is an
example, writes Professor Malcolm Law
at the Wolfson
Institute of Preventive Medicine. Despite
there being no
published trials showing that early detection
reduces
mortality, and separate evidence that
it may not reduce
mortality, many healthy men have been
tested and have
received treatment that can cause incontinence,
impotence, and other complications.
While mammography and cervical smears have
been
shown to reduce cancer mortality and are
to be strongly
recommended, breast and testicular self
examination are
further examples of the failure to apply
scientific rigour to
screening, he says.
Self examination has been widely advocated
on the
assumption that it must be beneficial
and cannot do
harm. Yet in a recent large trial, breast
self examination
did not reduce mortality from breast cancer
but caused
more surgical biopsies and thereby more
anxiety. This
result should discourage prostate and
testicular
screening.
Giving information to people considering
these unproven
screening tests when the only honest information
is
complete uncertainty is useless, argues
Law, while
encouraging people to decide for themselves
is ducking
the issue.
For a new drug, a rigorous set of experimental
data must
be presented before it is licensed for
use. The same
rigour should apply to medical screening.
Contact:
Malcolm Law, Professor of Preventive Medicine,
Wolfson Institute of Preventive Medicine,
Barts and the
London School of Medicine, London, UK
Email: m.r.law@qmul.ac.uk
(5) COMPANIES
FLOUT LAW ON TOBACCO IN
TOOTH CARE PRODUCTS
(Use of tobacco products as dentifrice
among
adolescents in India: questionnaire
study)
http://bmj.com/cgi/content/full/328/7435/323
Up to 68% of adolescents in India use dental
products
containing tobacco, despite a law barring
manufacturers
from using tobacco as an ingredient in
any toothpaste or
toothpowder, reveals a study in this week's
BMJ.
The authors believe that many companies
are taking
advantage of a widespread misconception
in India that
tobacco is good for the teeth by packaging
and
positioning their products as dental care
products.
Researchers surveyed samples of school
students aged
13-15 in 14 Indian states. The use of
tobacco products
as dentifrice varied from 6% (Goa) to
68% (Bihar).
Of the specific products, tobacco toothpaste
and tooth
powder were common in all states. Other
dentifrice
products containing tobacco included mishri
(roasted
and powdered tobacco), gudakhu (paste
of tobacco and
molasses), and tobacco water used for
gargling.
The 1992 amendment to India's Drugs and
Cosmetics
Act 1940 barred manufacturers from using
tobacco as
an ingredient in any toothpaste or toothpowder,
say the
authors. But, ten years on, this study
shows clearly that
the regulations have not been implemented
adequately.
Contact:
Prakash Gupta, Senior Research Scientist,
Tata Institute
of Fundamental Research, Colaba, Mumbai,
India
Email: pcgupta@tifr.res.in
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