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Press releases Saturday 23 February 2008

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(1) No good evidence that private treatment centres are value for money
(2) Antioxidants do not help children with Down's syndrome develop
(3) Investigation reveals "invisible influence" of sponsors in medical education

(1) No good evidence that private treatment centres are value for money
(Independent sector treatment centres: the evidence so far)
http://www.bmj.com/cgi/content/short/336/7641/421

There is no good evidence that independent sector treatment centres have provided additional capacity, value for money, or high quality care, argue researchers in this week's BMJ.

Despite this, the government is continuing with the programme. But Professor Allyson Pollock and Sylvia Godden from the University of Edinburgh warn that this will contribute to NHS deficits, NHS service closure and staff redundancies.

The policy of the Department of Health in England is to use NHS funds to contract with for-profit multinational healthcare corporations to deliver clinical services, they explain.

Part of this policy is the £5bn independent sector treatment centre programme, which over the course of two phases (waves) aims to provide extra capacity to the NHS and reduce waiting times for elective surgery.

Yet, four years into the programme, the Department of Health has not gathered adequate data to justify the policy, say the authors.

They reviewed the available data and evidence in terms of the programme's objectives and found a worrying failure to collect and publish data on performance.

For example, data on the number of available and occupied beds are collected annually from NHS Trusts, but no such data are collected from independent sector treatment centres. Without these data, it is impossible to assess the contribution that these centres make to capacity, productivity, or efficiency.

A recent report by the Healthcare Commission found that incomplete and poor quality admissions and outpatient data from independent sector treatment centres limited their ability to assess quality of care.

Furthermore, the first research on the quality of work undertaken by private centres, published in October 2005, stated that data were so variable in quality and so incomplete as to render "any attempt at commenting on trends and comparisons between schemes and with any external benchmarks, futile."

The Royal College of Surgeons of England also reported "increasing evidence" that these centres were unable to manage complications and patients were being readmitted to the NHS.

The failure on the part of the DoH to collect meaningful systematic data about quality of care heightens concerns about standards of care, write the authors. Data on workforce, contract performance and finances are also lacking.

The government's assurance that staff employed by the private sector in treatment centres would be 'additional' rather than parasitic upon the NHS has not been honoured. It has reneged upon its original guarantees, so that more than a quarter of the staff employed by the private sector are NHS staff.

Furthermore there is growing evidence that NHS funds are being diverted to the private sector for services they have failed to provide under the contract, they warn.

The government's failure to collect and publish meaningful relevant data on the productivity, performance, staffing and quality of private independent treatment centres, and its refusal to provide any data on their value for money is worrying, they say.

Professor Pollock cautions: "The policy of diverting scarce NHS funds into independent sector treatment centres is leading to fragmentation and financial instability and NHS beds and services are being closed to make way for the for-profit private sector. Despite assurances by the secretary of state for health, Alan Johnson, the available evidence suggests that the private sector is profiting at the expense of patients, the public, and the NHS."

Contact:
Allyson Pollock, Centre for International Public Health Policy, University of Edinburgh, Scotland, UK
Email: allyson.pollock@ ed.ac.uk

(2) Antioxidants do not help children with Down's syndrome develop
(Supplementation with antioxidants and folinic acid for children with Down's syndrome: randomised controlled trial)
http://www.bmj.com/cgi/content/short/bmj.39465.544028.AEv1
(Editorial: Giving antioxidants to infants with Down's syndrome)
http://www.bmj.com/cgi/content/short/bmj.39475.655058.80v1

Giving children with Down's syndrome antioxidants and nutrients does not help their condition improve at all, according to a study published today on bmj.com.

UK researchers studied the effect of giving such supplements to 156 babies under 7 months old with Down's syndrome over an 18-month period.

Down's syndrome is the most common genetic cause of learning disability in the UK affecting around 1 in 1,000 new born babies.

Previous studies have investigated the possibility that giving folate, antioxidants, or both might improve the effects of Down's syndrome, particularly language and psychomotor development.

Although none have reported any significant effect, use of vitamin and mineral supplements is widespread in children with Down's syndrome in Europe and the USA due to marketing of commercial preparations claiming substantial benefits.

In this study, the babies, from several sites in England, were split into four groups. One group was given a daily dose of antioxidants, one folinic acid, one a combination of antioxidants and folinic acid, and one a placebo. All the supplements were given in a powder that could be mixed with food or drink.

After 18 months, the children remaining in the study were assessed for their mental and cognitive development.

The researchers found that giving the supplements made no difference to the biochemical outcomes in the children and did not improve their language or psychomotor development.

This study provides no evidence to support the use of antioxidant or folinic acid supplements in children with Down's syndrome, conclude the authors. Parents who choose to give supplements to their children need to weigh their hope of unproved benefits against potential adverse effects from high dose, prolonged supplementation.

These findings are supported in an accompanying editorial, which states that until evidence of any benefit of expensive vitamin supplements is available, they cannot be recommended.

Contacts:
Stuart Logan, Professor of Paediatric Epidemiology, Peninsula Medical School, Exeter, UK
Email: stella.taylor@pms.ac.uk

(3) Investigation reveals "invisible influence" of sponsors in medical education
(The invisible influence)
http://www.bmj.com/cgi/content/short/336/7641/416

Amid global calls to end drug companies' direct sponsorship of doctors' education, this week's BMJ reports on an investigation in Australia which reveals sponsor involvement in the education of thousands of general practitioners.

This weekend, a programme by the Australian Broadcasting Corporation will show that it is not uncommon for drug company sponsors to suggest speakers at sessions that are assumed by the thousands of general practitioners who attend them to be totally independent.

Drug industry representatives have confirmed that similar practices take place in the United Kingdom, where roughly half of all education for doctors is sponsored by drug companies, writes Ray Moynihan, honorary lecturer at the University of Newcastle in Australia.

He describes how leaked documents and emails from a range of sources show drug company sponsors having input into the selection of some speakers at seminars held in recent years, despite the fact that these have been aggressively sold to general practitioners in brochures claiming that "all content is independent of industry influence."

The drug industry's representative body Medicines Australia has confirmed that the practice of inviting input from sponsors into the selection of speakers is by no means uncommon, while the view from the drug industry is that allowing sponsors to suggest speakers does not compromise the independence of medical education, as the educational providers have ultimate control over who speaks.

However, research for the investigation in Australia reveals several examples where sponsors' suggestions were embraced by the company providing supposedly independent education, writes Moynihan.

Industry representatives in Australia and the UK strongly argue that, in the interests of transparency, doctors attending educational sessions should be fully and explicitly informed if sponsors have suggested speakers for these sessions.

Such a degree of disclosure could radically change perceptions of the content of accredited education, says Moynihan, which many doctors believe to be independent of sponsor influence.

The evidence, such as it is, tentatively indicates that the prescribing habits of doctors may be affected by attending sponsored educational events, albeit only in the short term.

A recent paper by Harvard Professor David Blumenthal, an internationally recognised authority on relationships between doctors and drug companies, and colleagues called on US academic medical centres to end the direct drug company sponsorship of continuing medical education events. They suggested the creation of a blind trust to fund education at an institution level. Others have called for medical education to be funded by the taxpayer through competitive grants.

Oversight of these educational events is currently a self-regulatory affair, and institutions seem uninterested in guaranteeing independence, argues Moynihan.

Perhaps the recent revelations from Australia, and confirmation from the industry itself that it is "not unusual" for sponsors to suggest speakers, will sharpen the lines of debate about how to achieve more independent education or at least greater transparency, he concludes.

Contact:
Ray Moynihan, Conjoint Lecturer, Faculty of Health, University of Newcastle, Callaghan, Australia, and Visiting Editor, BMJ
Email: ray.moynihan@newcastle.edu.au

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