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Press releases Saturday 29 July 2006
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(1) IS IT TIME
TO GIVE THE NHS MORE INDEPENDENCE?
(2) FOOD LABELS SHOULD LIST ALL FATS TO HELP CUT HEART DISEASE, SAY EXPERTS
(3) SURGICAL INSTRUMENTS MAY NOT BE FAIR TRADE
(4) PLAY IN EARLY CHILDHOOD HELPS STUNTED CHILDREN
(1) IS IT TIME TO GIVE THE NHS MORE INDEPENDENCE?
(An independent NHS?)
http://bmj.com/cgi/content/full/333/7561/251
In April this year, BMJ Editor Fiona Godlee called for an independent NHS run by a board of governors responsible for managing health care within a set budget and a broad political framework.
In this week’s BMJ, four opinion leaders give their views on whether it is time to give the NHS greater independence from government.
“Democratic control is essential,” argues Stephen Thornton, Chief Executive of The Health Foundation. “Democratic checks and balances are the best way to ensure we continue to move the NHS in the right direction, not the creation of a barely accountable technocracy that would place all power in the hands of professionals and bureaucrats."
The key issue is how to do this more effectively than at present. He believes the trick is to deal with the democratic deficit in policy making and commissioning while giving much more operational freedom to healthcare providers.
A second article, by Gwyn Bevan, Professor of Management Science at the London School of Economics, argues that the destabilisation of the NHS in England through successive reorganisations has meant that the only options for governance have been either a competitive provider market or a regime of targets.
Each has serious limitations, he says, and the movement from one to the other has contributed to the squandering of unprecedented increases in NHS funding. His call for 'independence' for the NHS is to design systems of local accountability that would offer an effective alternative to provider competition or a centrally-driven regime of targets.
General gractitioner Stephen Gillam warns that "an independent NHS will become a glorified commissioning agency as what used to be a national health service becomes an amalgam of free floating foundation hospitals, NHS trusts, private companies, and traditional primary care providers."
“We may now, indeed be ruled by fundamentalists whose faith in markets, competition, and the profit motive as the sole path to effective public service is unshakeable,” he writes. “Paradoxically, an NHS agency could spearhead the crusade.”
In the final article, two US health experts believe that the NHS has the inherent capability to become the greatest healthcare system of any nation.
They applaud Labour’s original plan for “modernisation” and advise not to remove NHS leadership too far from government power. But they wonder whether something big should change to steady the NHS on its worthy, inspiring journey.
“The NHS is not just a national treasure; it is a global treasure,” they write. “As unabashed fans, we urge a dialogue on possible forms of stabilisation to better provide the NHS with the time, space, and constancy of purpose to realise its enormous promise.”
Contacts:
Stephen Thornton, Chief Executive,
The Health Foundation, London, UK
Email: pressoffice@health.org.uk
Gwyn Bevan, Professor of Management
Science, London School of Economic and Political Science, London, UK
Email: r.g.bevan@lse.ac.uk
Stephen Gillam, General Practitioner,
Lea Vale Medical Group, Luton, UK
Email: sjg67@medschl.cam.ac.uk
Sheila Leatherman, Research Professor,
School of Public Health, University of North Carolina, USA
Email: sheilaleatherman@aol.com
(2) FOOD LABELS SHOULD LIST ALL FATS TO HELP CUT HEART DISEASE, SAY EXPERTS
(Editorial: Trans fatty acids
and coronary heart disease)
http://bmj.com/cgi/content/full/333/7561/214
Food labels should list trans fats as well as cholesterol and saturated fat to help reduce coronary heart disease, say researchers from the University of Oxford in this week’s BMJ.
Trans fats (also known as trans fatty acids) are solid fats found in margarines, biscuits, cakes, and fast food. Scientists think that our bodies deal with these fats in the same way as saturated fats.
Both saturated fats and trans fats increase the amount of low density lipoprotein (LDL) or ‘bad cholesterol’ in the blood and reduce the amount of high density lipoprotein (HDL) or ‘good cholesterol.’ People with high levels of LDL cholesterol tend to have a higher risk of getting heart disease, while people with high levels of HDL cholesterol tend to have a lower risk.
A recent analysis of all the evidence recommended that people should reduce or stop their dietary intake of trans fatty acids to minimise the related risk of coronary heart disease.
This analysis found a 2% increase in the energy intake from trans fatty acids was associated with a 23% increase in the occurrence of coronary heart disease. In fact, the authors noted that the harmful effects of trans fatty acids were seen even when intake was really low, only 3% of total daily energy intake (20-60 calories), about 2-7 g for a person consuming 2000 calories per day.
Legislation introduced in Denmark in 2004 mandated that all oils and fats used in locally made or imported foods must contain less than 2% industrially produced trans fatty acids. This virtually eliminated trans fatty acids and had no effect on quality, cost, or availability of foods.
And in January 2006 the US Food and Drug Administration mandated that all food manufacturers provide the content of trans fatty acids and cholesterol in addition to saturated fat on nutrition labels for all manufactured foods, write the authors.
The UK Food Standards Agency is currently pressing for revision of the European directive that governs the content and format of nutrition labels on foods marketed in the United Kingdom and other European countries, so that these fats are labelled.
They believe that mandatory addition of the content of saturated fat and trans fatty acids to nutrition labels would enable consumers to make healthier food choices that could lower LDL concentrations and reduce the risk of coronary heart disease and other vascular events.
Contact:
Robert Clarke, Honorary Consultant
in Public Health Medicine, Clinical Trial Service Unit and Epidemiological
Studies Unit, University of Oxford, UK
Email: Robert.clarke@ctsu.ox.ac.uk
(3) SURGICAL INSTRUMENTS MAY NOT BE FAIR TRADE
Online First
(Fair trade for surgical instruments)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38901.619074.55
The NHS may be buying medical equipment unethically and exploiting developing countries, it has been claimed in an article published on bmj.com today.
Unlike the campaigns for fair trade of goods like bananas and coffee, there have been no such campaigns for medical commodities, says Dr Mahmood Bhutta, a specialist registrar in otolaryngology (head and neck surgery) at Guy’s and St Thomas’ Hospital in London.
Dr Bhutta says that while NHS suppliers are encouraged to act in an ethical business manner, they do not and there are currently no checks or assessments made into the origins of surgical instruments used by the NHS.
“The trade in surgical instruments is open to unethical sourcing because many such instruments are manufactured in the developing world,” writes Dr Bhutta.
The global trade in hand held stainless steel surgical instruments is worth around £352million ($650m, €507m) a year and many of these instruments are made by firms in towns in Europe and Asia. The two largest producers are Tuttlingen in Germany and Sialkot in Pakistan.
Companies in Sialkot use more traditional production methods with most instruments manufactured and finished by hand, so production is more labour intensive, employing 50,000 people (7,700 of whom are children aged from 7 and older) to supply a fifth of the world’s surgical instruments.
Many firms in Sialkot sub-contact the initial production of these instruments to workers in small workshops or their own homes in an attempt to reduce overheads and minimise costs. These workers earn around £1 a day ($2, €1.50).
The firms sell to suppliers and retailers in the developed world who then sell on to companies in Germany which sell to the NHS and elsewhere in the world at a marked up price, says Dr Bhutta.
“The solution lies in purchasers insisting on fair and ethical trade when sourcing instruments,” he adds.
Contact:
Mahmood Bhutta, Specialist Registrar
Otolaryngology, Addenbrooke’s Hospital, Cambridge, UK
Email: m.bhutta@doctors.org.uk
(4) PLAY IN EARLY CHILDHOOD HELPS STUNTED CHILDREN
Online First
(Effects of psychosocial stimulation and dietary supplementation in
early childhood on psychosocial functioning in late adolescence: follow-up
of randomised controlled trial)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38897.555208.2F
Psychosocial stimulation in early childhood has long term benefits for stunted children’s emotional outcomes and attention, finds a sixteen-year study published on bmj.com today.
Growth retardation or stunting affects 30% of children under 5 years globally and is associated with poor development and behavioural problems in late adolescence. Some studies suggest that psychosocial stimulation in early childhood reduces antisocial behaviour and delinquency in adolescence, but evidence is limited.
So researchers set out to determine whether dietary supplementation or psychosocial stimulation given to stunted children early in life had any long term benefits for their psychosocial functioning in late adolescence.
In 1986-7, they identified 129 stunted children (age 9-24 months) living in poor neighbourhoods of Kingston, Jamaica. Children were assigned to one of four groups: control (no intervention), supplementation with 1 kg milk based formula each week, stimulation (weekly play sessions with mother and child), or both, for two years.
In 2002-3, 103 adolescents aged 17-18 years were re-examined to assess their psychosocial functioning (self esteem, anxiety, depression, and antisocial behaviour).
Those who had received stimulation reported less anxiety, less depression, and higher self esteem, and parents reported fewer attention problems. Supplementation had no significant effect.
Psychosocial stimulation in early childhood had sustained benefits for the psychosocial functioning of stunted children, say the authors. The next challenge is to develop interventions that can meet the needs of the enormous number of stunted children, they conclude.
Contact:
Professor Susan Walker, Epidemiology
Research Unit, University of the West Indies, Kingston, Jamaica
Email: susan.walker@uwimona.edu.jm
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