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Press releases Saturday 10 July 2004
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(1) TOUGHER ACTION NEEDED TO COUNTER TOBACCO INDUSTRY INFLUENCE IN FORMULA ONE
(2) STAR RATINGS
ASSESSMENT IS FLAWED, ARGUE RESEARCHERS
(3) HOSPITAL INSPECTIONS MAY BE BETTER
GUIDE TO PERFORMANCE THAN STAR RATINGS
(4) MEDICAL
TRAINING REFORMS MAY HAVE DIRE CONSEQUENCES
(5) "YOU MAY HAVE OVERSTEPPED THE MARK" CANCER EXPERT WARNS PRINCE OF WALES
(1) TOUGHER ACTION NEEDED TO COUNTER TOBACCO INDUSTRY INFLUENCE IN FORMULA ONE
(British American Tobacco
and Formula One motor racing)
http://bmj.com/cgi/content/full/329/7457/104
As the British Grand Prix approaches, researchers in this week's BMJ call for tougher worldwide action to counter the tobacco industry's influence in Formula One.
Tobacco companies are increasingly reliant on sports sponsorship to advertise their products as more direct forms of tobacco advertising are curtailed by regulation.
In 1999, British American Tobacco (BAT) established its own Formula One racing team, British American Racing, giving the company more visibility than sponsorship.
The British American Racing car was a strategic decision to accomplish several business goals, write the authors. Internal company documents show that it has played a key part in promoting brand awareness, targeting children and young people through extensive television coverage, and reaching emerging Asian markets through planned race sponsorship.
During its first four years and a $500m investment by BAT, the team has never achieved higher than fifth place, but the partnership has been rather more successful in the business of selling cigarettes, they say.
Furthermore, Formula One seems comparatively content to be reliant on funding by tobacco companies and to be used to advance their global interests, they add. For instance, it has abandoned its commitment to be free of tobacco sponsorship by 2006 and is establishing races in countries with fewer advertising regulations.
Both the BAT documents and these recent events highlight how Formula One has become a core feature in the ongoing globalisation of the tobacco pandemic, say the authors. They urge all countries to ratify the WHO's Framework Convention on Tobacco Control to stop the continued use of Formula One racing to promote tobacco products.
Contacts:
Richard Hurt, Director, Nicotine
Dependence Center, Mayo Clinic, Rochester, MN, USA
Email: rhurt@mayo.edu
Jeff Collin, Lecturer, Centre on
Global Change and Health, London School of Hygiene and Tropical Medicine,
London, UK
(2) STAR RATINGS ASSESSMENT IS FLAWED, ARGUE RESEARCHERS
(Star wars, NHS style)
http://bmj.com/cgi/content/full/329/7457/107
The methods used to assess performance of NHS trusts are flawed, according to a study in this week's BMJ.
The performance of NHS trusts is monitored through the star ratings system, which the Department of Health introduced in September 2001. The Commission for Health Improvement was given responsibility for assessment in 2002-3.
Researchers from Newcastle upon Tyne analysed the rating system after their trust was downgraded from three stars (the highest rating) in 2001-2 to two stars in 2002-3.
The assessment showed that Newcastle had significantly underachieved on one key target (outpatient waiting times). The purpose of this target was to measure a trust's performance throughout the year, but only four quarter end days were used. With this method, a trust could have a considerable number of breaches during a quarter yet show none on the final day.
To achieve the target, trusts had to have had no more than five breaches during the year. Newcastle undoubtedly breached the target but other trusts with more breaches were judged to have met the target because their figures on the four quarter end days fell within requirements. This method is flawed, argue the authors.
The target also measured the number of breaches irrespective of the size and activity of the trust. Clearly it is easier for a small trust to meet the threshold of five or fewer breaches a year than it is for trusts with a large referral base, they add.
A three star rating brings appreciable benefits to a trust. With such high stakes, the performance assessments should be beyond reproach, yet this was clearly not the case in 2002-3, say the authors. These concerns have also been reinforced by a recent Royal Statistical Society report on performance monitoring in the public sector.
More statistical rigour is needed to ensure trusts' confidence in the ratings system, they conclude.
Everyone has always agreed that star ratings are not perfect but also that performance assessment can be beneficial, writes Anna Walker of the Healthcare Commission, in an accompanying commentary.
She points out that the statistical approach adopted was well established and known to the NHS including Newcastle. However the new healthcare inspectorate is not opposed to improvement of the performance ratings system.
She explains that the Commission wants a system of performance assessment that is more accessible to the public, that drives improvement in the NHS, that is seen as relevant and fair by the service and clinicians, and that is more comprehensive in how it measures organisations.
"We have and will make improvements, she says. "We will be looking to engage with doctors, nurses, and others across the NHS about how this system might work."
Contacts:
Paper: Miles Irving or Richard Barker,
Newcastle upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon
Tyne, UK
Email: m.h.irving@ncl.ac.uk
Commentary: Graham Capper, Head
of External and Internal Relations, Healthcare Commission, London, UK
Email: Graham.Capper@healthcarecommission.org.uk
(3) HOSPITAL INSPECTIONS MAY BE BETTER GUIDE TO PERFORMANCE
THAN STAR RATINGS
(Dr Foster's case notes CHI
ratings and HSMRs: is there a relation?)
http://bmj.com/cgi/content/full/329/7457/73
Hospital inspection scores may be a better measure of performance than star ratings, according to an analysis by Dr Foster in this week's BMJ.
From 2001-3, the performance of NHS trusts has been monitored through a star rating system established by the Department of Health (DoH). The Commission for Health Improvement (CHI - now part of the Healthcare Commission) has conducted on-site inspections that give hospitals scores for a variety of issues related to quality of care.
Researchers analysed whether there was a relation between both CHI star ratings and CHI inspection scores and hospital death rates, known as hospital standardised mortality ratios (HSMRs).
They found no significant relation between HSMRs and DoH star ratings: an increase in one star was associated with a 0.4% fall in HMSR. However, they did find a significant relationship with CHI inspection scores: each point increase in the CHI inspection score was associated with a 1.35% decrease in HMSR.
These findings suggest that inspection scores may provide the public with a better guide to an important measure of hospital outcomes than star ratings, conclude the authors.
Contact:
Kelly Lewis, Head of Business Development,
Dr Foster Ltd, London, UK
Email: kelly.lewis@drfoster.co.uk
*Dr Foster is an independent organisation that analyses the availability and quality of health care in the United Kingdom and worldwide (www.drfoster.com)
(4) MEDICAL TRAINING REFORMS MAY HAVE DIRE CONSEQUENCES
(Reform of undergraduate medical
teaching in the United Kingdom: a triumph of evangelism over common sense)
http://bmj.com/cgi/content/full/329/7457/92
Current reforms of medical training may have dire consequences for the future of the medical profession and patients, warn researchers at Bristol University in this week's BMJ.
Traditional medical training produces doctors with a sound knowledge base that allows them to practise across a broad spectrum of medicine. However, reforms endorsed by the UK General Medical Council aim to replace traditional teaching methods with student led and problem based approaches.
About a third of UK medical schools have now embraced these principles, yet there is no evidence that the "new" strategies will produce better doctors, and a risk that students with inadequate knowledge will become poor clinicians, argue the authors.
Diversity in the approaches to medical training is to be welcomed, but only if the end result is doctors who are truly fit for purpose, they add. "The absence of any evidence that new ideologies will produce better doctors than do traditional curriculums forces us to conclude that these reforms are being propelled more by evangelical zeal than by rationale."
They call for a rigorous comparison of "traditional" versus "new" curriculums to determine the best strategy for training doctors. "The training of doctors is too important an activity for bold experiments to be conducted without discovering what really happens," they conclude.
Contact:
Dr Cherry Lewis, Research Publicity
Officer, Public Relations Office, University of Bristol, UK
Email: Cherry.Lewis@bristol.ac.uk
(5) "YOU MAY HAVE OVERSTEPPED THE MARK" CANCER EXPERT
WARNS PRINCE OF WALES
(An open letter to the Prince
of Wales: with respect, your highness, you've got it wrong)
http://bmj.com/cgi/content/full/329/7457/118
In this week's BMJ, a leading breast cancer expert warns the Prince of Wales that he may have overstepped the mark with his public support for alternative medicine.
"Over the past 20 years I have treated thousands of patients with cancer," writes Michael Baum, Professor emeritus of surgery at University College London. "The power of my authority comes with a knowledge built on 40 years of study and 25 years of active involvement in cancer research."
"Your power and authority rest on an accident of birth. I don't begrudge you that authority, but I do beg you to exercise your power with extreme caution when advising patients with life threatening diseases to embrace unproven therapies."
He adds: "It is in the nature of your world to be surrounded by sycophants who constantly reinforce what they assume are your prejudices. Sir, they patronise you! Allow me this chastisement."
"I have much time for complementary therapy that offers improvements in quality of life or spiritual solace, providing that it is truly integrated with modern medicine. But I have no time at all for "alternative" therapy that places itself above the laws of evidence and practices in a metaphysical domain that harks back to the dark days of Galen."
"With respect your Highness, you've got it wrong."
Contact:
Michael Baum, Professor emeritus of surgery and visiting professor of medical Humanities, University College London, UK
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