Wednesday, July 29, 2009

Too much Tamiflu on the shelf?

We have Tamiflu coming out of our ears. In January health minister Dawn Primarolo told the House of Commons that the nation had 11,000,000,000 milligrams of Oseltamivir (Tamiflu). The adult dose is 750mg per treatment course. She also said that 'the bulk of the current stockpile of Tamiflu is due to reach the end of its shelf life in financial year 2010-11, the remainder is due to expire in financial years 2011-12 and 2012-13'.

Stockpiled for the bird flu epidemic that never really was, this mountain of medication has led conspiracy theorists to suggest that the whole swine flu business is just about getting the stuff down our throats before the use-by date. I don't know about that but I am concerned that by trying to use it all up in time we may not be doing ourselves any favours further down the line.

While welcoming the telephone diagnosis of swine flu, Dr Holden, the British Medical Association's lead GP on pandemic flu, has said in Pulse magazine that he is worried that the threshold for issuing Tamiflu has been set too low, a policy that could come back to haunt the Department of Health if the virus becomes resistant to Tamiflu.

All Tamiflu does is limit by an extra day or two, symptoms that will, anyway, be self-limiting in most of us. That being so, how many of us really need it? Surely it's best to keep it for those whose age or circumstances mean their lives are at risk from the virus while sparing the rest of us both the side-effects of Tamiflu today (nausea, vomiting, diarrhoea and headache) and the possible danger of having nothing to take tomorrow.

Monday, July 20, 2009

Dept of Health have forgotten men's health

The Men's Health Forum, who run the malehealth site, have today hit out at the Marmot Review, the Department of Health's strategic review of health inequalities, because it fails to mention men's health at all.

MHF CEO Peter Baker says: 'Our main concern is that gender health inequalities are barely mentioned in the papers published recently as part of the consultation process. Where gender is mentioned, it appears solely as an issue for women. Men's health appears to be consistently overlooked.'

The Forum is calling on its supporters to back their campaign to get gender back on the agenda. Let us know what you think.

One John Hartson

When a young man like John Hartson is diagnosed so suddenly with such an advanced cancer we all feel a wild variety of emotions, me included. At 34, he is about the same age as I was when I was diagnosed with a different form of cancer. I'm still here and I feel lucky, I feel guilty and I feel glad that I was a bit of a hypochondriac which meant that I kept going back to the GPs when I thought something was wrong.

A friend of John Hartson's has apparently said that he thinks the former footballer was aware of the lump in his testicles for a while before he went to the doctor's. I don't know if he's right but this should be the lesson that we learn: seek treatment promptly if you find a lump. Testicular cancer is not any more common than it was before and it is not any more dangerous than it was before. (Testicular cancer can be cured in 99% of cases provided it is treated in time.) You don't need to examine your testicles every five minutes - I very much doubt John Hartson did - but you do need to be do is to be testicle-aware. If you have a lump, get it checked out.

AFC Wimbledon fans still get a little misty-eyed over a goal of John Hartson's at Selhurst Park that almost kept the Dons in the Premier League. Now the Welsh hardman, also a hero to fans of Arsenal, Celtic, West Brom, Luton and West Ham, has everyone wishing him well - even Eyal Berkovic. Get well soon, John.

Wednesday, July 15, 2009

McKinnon's crime is the worst: 'embarrassing a government'

The news that under our totally imbalanced extradition agreement with the USA, this government is prepared to expose a UFO fanatic to a potentially long prison sentence for the crime of hacking into US military computers looking for information about his favourite subject is worrying enough.

The Crown Prosecution Service say there's not enough evidence to charge him with any offence here even though he has admitted to hacking so clearly this is not the crime of the century. (Apparently, he found his way in to the Pentagon's network by guessing that the passwords would still be set to their default of 'password'.)

When you learn that the man in question, Paul McKinnon, has a form of autism, Asperger's Syndrome, it becomes doubly worrying. McKinnon's lawyers told the high court yesterday that former home secretary, Jacqui Smith's decision to extradite him was 'flawed' because it didn't take this into account. They're hoping to get the decision reversed.

If, as we're often told, we're all equal before the law, they should succeed. When Spain tried to extradite former Chilean dictator General Pinochet to answer war crimes charges, then home secretary Jack Straw turned the appeal down and let Pinochet fly home because, after looking at the medical evidence, he considered him medically-unfit to face trial. What's more McKinnon's case is far more clear cut than the General's. There was some doubt about Pinochet's medical capacity at the time and indeed, four years later Chilean judges ruled that he was perfectly capable of facing charges. But Asperger's Syndrome is not something that comes and goes.

McKinnon, whose Asperger's was diagnosed by the UK's leading authority Cambridge Professor Simon Baron-Cohen is backed by the National Autistic Society.

Mark Lever, chief executive of the National Autistic Society, said yesterday: 'We strongly believe that Gary should be allowed to stand trial in the UK where he has a familiar support network in place and his needs in relation to his Asperger syndrome can be better met. People with Asperger syndrome are often much more vulnerable than first appearances would suggest and are particularly susceptible to mental health difficulties; extradition would be highly inappropriate and potentially very damaging.'

McKinnon's only crime appears to be embarrassing the US government and no reasonable human being would want to see a man with a developmental disability clapped in jail for that. Trouble is, as we learned last week through the case of Ronnie Biggs: embarrassing a government is pretty much the worse crime you can commit.

Monday, July 13, 2009

What celebrities can teach us about health

Celebrities are great for helping to get media coverage for a difficult health story. But you need to be careful.

We've got a really interesting interview on malehealth with Steve Redgrave - a man with nearly as many long-term health conditions (3) as he's got Olympic Golds (5). But listening to all that people like Steve or former Spurs captain Gary Mabbutt have achieved despite having a condition like diabetes might lead you to conclude that diabetes is not a serious condition. It is. It can kill.

Today's news that men over 35 are twice as likely to develop diabetes as women of the same age ought to kick any complacency into touch. Yes, diabetes can be managed but only if you're getting treatment and you can only get that if you see a doc. If Mabbutt's diabetes hadn't been diagnosed he wouldn't have even been playing park football let alone turning out alongside Glen Hoddle and Ossie Ardiles at one of the world's finest clubs. So what is the conclusion you should draw from celebrity interviews like Redgrave's? It's this: managed conditions are not the the end of the world but unmanaged ones can kill.

Talking of celebrity tie-ups, drug company Lilly who make the erectile dysfunction drug Cialis have teamed up with former England spin king Phil Tufnell to raise awareness of the problem. Picking up on the Ashes theme, the site's called Bowl Your Maiden Over.

There are cricket puns all over the shop - a bit like Phil's bowling on a bad day - and a rather stilted conversation between the great man and Dr Rob Hicks about England's Ashes chances. It's easy to be cynical about this sort of puff but if it encourages men to discuss a subject that affects, frankly, all of us at some time in our lives it's got to be a good thing. And Tuffers deserves credit for having the balls - sorry, couldn't resist - to get involved.

Of course, England's jammy Ashes escape yesterday must have put a spring in every Englishman's stride but if things don't go so well at Lords - where England haven't beaten the Aussies since 1934 - the site should get more hits than even Ricky Ponting's bat.

Friday, July 10, 2009

Breast cancer screening: everybody hurts

'The question is no longer whether breast cancer overdiagnosis occurs, but how often it occurs' says an editorial yesterday's British Medical Journal.

Many women it appears are having unnecessary chemotherapy, surgery and other treatments for breast cancer. This is unpleasant and dangerous for them, a waste of money for the NHS and misleads the rest of us about what modern medicine can really do. The apparent rise in breast cancer is, it appears, linked not to a real rise in breast cancer but to a rise in breast cancer screening.

The problem is that breast cancer screening - the mammogram - is not sophisticated enough. It cannot tell - and nor can the docs - whether the tumours it detects are life-threatening or not. You might argue that it's good to err on the safe side. The problem is there isn't a safe side.

Patients tend to be pro-screening. Ask a cancer patient and they'll demand screening on the grounds that it might well have picked up their cancer sooner. Ask the family of a dead cancer patient and they'll be even more vehement.

It's understandable but it makes no sense if screening is not possible. The MHF does not call for prostate cancer screening because there are no screens currently available that don't carry the risk of overdiagnosis. The same appears to be the case with breast cancer - and to quite a shocking degree. The research into overdiagnosis in several countries including the UK concludes that one in three breast cancers detected in a population offered organised screening is overdiagnosed.

Of course, every case is different and nobody is calling for the end of the mammogram. Overdiagnosis particularly affects older women because they have slower growing tumours and fewer years of life ahead - a point that isn't particularly well-covered in the press today and may lead to younger women making poor treatment decisions. But at medical school all students are taught on day one: first do no harm. That's why the NHS recently scrapped its leaflet inviting women to have a mammogram.