Doctors' basic errors are killing 1,000 patients a month

The Independent 13 July 2012

Almost 12,000 patients are dying needlessly in NHS hospitals every year because of basic errors by medical staff, according to the largest and most detailed study into hospital deaths ever performed in the UK.

The researchers from the London School of Hygiene and Tropical Medicine and colleagues found something went wrong with the care of 13 per cent of the patients who died in hospitals. An error only caused death in 5.2 per cent of these – equivalent to 11,859 preventable deaths in hospitals in England.

Helen Hogan, who led the study, said: "We found medical staff were not doing the basics well enough – monitoring blood pressure and kidney function, for example. They were also not assessing patients holistically early enough in their admission so they didn't miss any underlying condition. And they were not checking side-effects... before prescribing drugs."

In one case a middle-aged man who had a cyst on his neck removed developed an infection. He was treated with antibiotics but medical staff did not realise he was not responding until it was too late and he died.

In another case, a 40-year-old obese woman was in hospital for three weeks while doctors investigated symptoms including vomiting and weight loss before discovering she had ovarian cancer. She was never given preventive treatment for blood clots – a risk of prolonged bed rest – and died of a clot on the lung.

The study was based on analysis of 1,000 deaths at 10 NHS trusts during 2009. Previous estimates have suggested up to 40,000 deaths a year are caused by errors in care but these have been based on international studies and have not directly linked the errors with the cause of death.

Dr Hogan added: "Hospitals must learn from careful analysis of preventable deaths and make every effort to avoid [them]."

Most of the patients who died were elderly and frail and suffering from multiple conditions. But some were in their 40s and 30s. More supervision by senior consultants was required to ensure junior doctors carried out proper assessment on admission and liaised with GPs and social services.

International evidence suggests one in 10 hospital patients suffers harm as a result of errors in their care, ranging from short-term effects from a wrong prescription to severe harm resulting from an operation on the wrong limb.

But the new study, published online in BMJ Quality and Safety, found errors of omission were more frequent than active mistakes.

Dr Hogan said: "The NHS in the future is going to have to look after very frail elderly patients as their numbers increase. Our systems are not robust enough to ensure we avoid harming them."

The authors say the quality of hospital care should be assessed on the basis of harm caused by errors, rather than on deaths. "If 95 per cent of deaths in hospital are not due to preventable poor care, the scope for hospitals to demonstrate reduction in their mortality rate is limited," they say.

A Department of Health spokesperson said it was an important study which revealed a picture of preventable deaths.

"Patients have a right to expect the very best care from the NHS. Any preventable death in hospital is unacceptable and we expect the NHS to ensure patients receive high-quality, safe and effective care. We know that data like this can help hospitals to improve services," said the spokesperson.

Man who died of dehydration was killed by hospital neglect

Neglect by medical staff led to a man dying of dehydration in a hospital bed, a coroner has ruled. Medical staff at St George's Hospital in Tooting, south London, did not give Kane Gorny vital medication to help him retain fluids. The 22-year-old, who was a keen sportsman, even phoned police from his hospital bed as he was so desperate for a glass of water, the inquest heard. Deputy Coroner Dr Shirley Radcliffe told the hearing: "A cascade of individual failures has led to an incredibly tragic outcome."

She recorded a narrative verdict at Westminster Coroner's Court and said Mr Gorny had died from dehydration contributed to by neglect. Dr Radcliffe said: "Kane was undoubtedly let down by incompetence of staff, poor communication [and] lack of leadership, both medical and nursing."

James Stevenson, the solicitor for Mr Gorny's family, said they were "devastated by the number of missed opportunities" to prevent his death.

What is Quantitative Easing and does it work?

Mervyn King has turned our leaders into zombie puppets

Demand has not risen. Neither has production. Yet we have been duped into thinking that QE will kickstart the economy

• 
• • Simon Jenkins
  • guardian.co.uk, Thursday 12 July 2012 20.30 BST

‘This enormous sum does not exist and never has. It is not "printed" money or funny money. It is no money.' Photograph: Chris Radcliffe/AP

It must be the biggest confidence trick of all time. It is a cheat, a scam, a fiddle, a bankers' ramp, a revenge of big money against an ungrateful world. It is called quantitative easing, and nobody has a clue what it means. According to the Bank of England, the past four years have seen £325bn pumped into the British economy to kickstart growth, with another £50bn now on the way. This enormous sum does not exist and never has. It is not "printed" money or funny money. It is no money. The one silver bullet on which the coalition relies to pull Britain out of recession is a fiction.

I have spent the last year trying to find this money, if only because it seemed rather a lot – more than an entire annual take from income tax, VAT and corporation tax together. I have asked bankers, regulators, commentators, economists, and even trotted round to the Bank of England. Ask any of them after the £325bn and they stare at the ceiling or look at their shoes. Nobody knows. The money appears in no statistic of cash in circulation or on deposit. Bank balances have not altered. Demand has not risen. Production has not expanded.

Such professional and intellectual gullibility on a matter of national salvation is staggering. When Alistair Darling, as Labour chancellor, "pumped in" £75bn, he said it would stave off recession. George Osborne, then shadow chancellor, derided it as "the last resort of desperate governments", and Vince Cable said Britain was going down the road to Harare and hyperinflation. Yet when these two men came to power, they were overnight converts. They became zombie puppets of the Bank of England and its boss, Sir Mervyn King.

We know what QE is supposed to do. The Bank "buys back" the government bonds (or gilts) that were previously sold to banks. Since gilts are as good as cash, this merely replaces an interest-bearing bond with actual cash on the asset side of a bank's balance sheet. It is a paper transaction, moving sums from the bonds column to the cash column.

In theory, the banks have an interest in lending that cash at a profit to the public, or to companies. But that depends on buoyant demand and on finding businesses and individuals whose credit is secure. This is not the case when demand is stagnating. In addition, the banks are sitting on bad debts that need covering, and regulators are telling them to keep higher cash reserves. The banks duly sit on the cash or use it to buy more gilts. The money goes round in circles, collecting fees. It is like Irish truckers moving goods back and forth over the Northern Ireland border, picking up European Union bungs each time they pass customs.

The Bank of England quarterly bulletin is full of QE theology. Its report on a recent conference on the subject is pure angels on pinheads. There is talk of QE leaking from banks into equities and thus "growth", hence the brief surge in equity and commodity prices in the early days of the policy. But bank lending to businesses fell steadily throughout, and consumer demand stalled. As for the Bank of England's theory that "things would have been worse" without QE, where is the proof? The only thing worse would have been bankers' fees.

Osborne and Cable still utter strangled cries for banks to do "more lending to small and medium-sized businesses". They formulate endless schemes to "kickstart the economy". They know that none of these works, but we still have such flops as Project Merlin, theregional growth fund and the business growth fund. The British economy is in a classicKeynesian liquidity trap. It is starved of demand, but nothing is done to boost it.

Some unease over QE is detectable. Darling admitted in an interview as long ago as 2009 that "nobody really knows" whether QE made any difference. The Bank of England monetary policy committee, the Vatican of QE, saw one departing member, Kate Barker, admit in 2010 that QE "might not have a significant impact on the economy". Faisal Islam of Channel 4 published a survey of sceptics in Prospect magazine last winter, quoting the Southampton pundit, Richard Werner, as regarding British QE as "a sham".

The Bank of England loves QE because it is a policy under its control. It opposes genuine reflation as possibly leading to runaway inflation – hardly Britain's top economic problem just now. But the governor himself is in denial. He appears genuinely to believe that QE is "putting money directly into the wider economy" and that "the one word we need to hang on to … is patience". He has brainwashed the Commons Treasury select committee to this effect. It is like watching a patient haemorrhaging blood on the operating table and telling him to wait for a new hospital.

If the government really wanted to inject cash into the economy, it would address the liquidity trap head-on. It would order the Bank of England to add, say, £1,000 to the current account of every adult citizen as a "people's bonus". Such an injection would not depend on Bank discretion. It would not await a government infrastructure project or a business wanting to invest. It would instantly transfuse between £30bn and £40bn of cash into the demand side of the economy.

This need have no impact on Osborne's borrowing targets or deficit, since it would be new money. The chancellor would declare the bonus "off-limits", an emergency stimulus to growth. It might push up some prices and suck in some imports. It might seem to reward the feckless as well as the thrifty. But it would do what the government claims it wants to do – that is, "inject money into the economy".

Opposition to doing this seems to be not practical but moral. It is basically about class. To bankers and politicians, giving cash to ordinary people is vulgar and indulgent. So they pretend. They pretend to pump money into the economy through lending, but do not even do that. They pretend to give money to banks, but in fact nothing is injected anywhere.

When Britain devalued its way out of the last great economic recession in 1931, a bewildered Labour chancellor, Philip Snowden, wailed that: "Nobody told us we could do that." Nobody seems to have told David Cameron and George Osborne that you cannot kickstart growth by using QE, only by really pumping real money into the real economy. They have been duped by the greatest bankers' swindle on earth.

It takes more than a stroke of genius to become a true champion

Dominic Lawson in The Independent

When does talent become genius? We all have a view; but when asked to be precise, it's hard not to sink into the hopelessly circular argument that we know what genius is when we see it. Yet anyone who watched Roger Federer's forensic dismantling of Andy Murray in the men's final at Wimbledon would have no problem in identifying the Swiss as a genius, and that simple fact as Murray's nemesis.

Thus a familiar-sounding headline on one report of the match was: "Only one winner when talent meets genius." Familiar sounding, because it repeats what was written the last time the two met in a grand slam final, the 2010 Australian Open: "Federer's genius alone beats Andrew Murray". Murray cried after that one, too. Well, it must be frustrating when you push yourself to the limits and beyond, and the opponent wins with apparently effortless ease.

Except it isn't like that at all. Although we tend to think of genius as something akin to magic, a kind of short-cut to mastery of the elements, it is nothing of the sort. A proper investigation of the careers of the supreme achievers, whether in sport or other fields, reveals that they are based above all on monomaniacal diligence and concentration. Constant struggle, in other words. Seen in this light, we might define genius as talent multiplied by effort. In cricket, this would be true of Sachin Tendulkar; in chess, Bobby Fischer.

I was at a dinner with that supreme raconteur among philosophers, Isaiah Berlin, when he was asked how he would sum up genius. He immediately recalled the ballet dancer Vaslav Nijinsky, who was questioned about how he managed to leap in the way he did. The Russian replied that most people, when they leapt in the air, would come down at once, but: "Why should you come down immediately? Stay in the air a little before you return, why not?" That effortless ease defined genius, said Berlin. To watch Federer at his greatest is to see something similar to Nijinsky's description: the movement of his body appears to defy the laws of gravity, as if hovering above the surface of the planet, free of all weight or friction. Yet in logic we know that this cannot be. He is constructed of the same matter as the rest of humanity, with nothing remotely abnormal or other-worldly in his skeleton or musculature.

In a wonderful 2006 essay entitled "Federer as Religious Experience", David Foster Wallace wrote that "Roger Federer appears to be exempt from certain physical laws... a type that one could call genius or mutant or avatar, a creature whose body is both flesh and, somehow, light." Yet this is nothing more than an illusion – one which the performer will be keen to encourage, both to thrill the public and to intimidate his opponents. Nijinsky, for example, must have known very well that his astounding entrechats and grands jetes were the product of thousands upon thousands of hours of excruciating practice, without which his talent could never have evolved beyond dilettantism.

By the same token, the greatest talents of our age appreciate that in a brutally competitive world, to skip a day of such rigorous training is to risk decline and even mediocrity. If you saw the film [Itzhak] Perlman in Russia – about the supreme violinist's 1990 tour of that country – you will probably have been struck by his great discomfiture when asked to perform a piece spontaneously on a visit to the Moscow Conservatory. "But I haven't practiced today," Perlman says; and yet when you watch the Israeli play in concert, he can make even the most appallingly difficult pieces seem like a bit of fun, or as easy as drawing breath. It is, as the saying goes, the art that disguises art.

Perhaps the idea of the effortless genius is partly born of the need to reassure ourselves in our relative laziness: if genius is simply something innate, God-given and unimprovable, then perhaps we can also do as well as we are able without making extraordinary efforts. Unfortunately, this is not so: and we must recognise that what the greatest musicians and sportsmen have which the rest of us lack is not just an aptitude, but a fierceness of desire and a commitment to self-improvement which we can scarcely begin to comprehend. Nowadays, Federer seems a serene spirit, but as a young, up-and-coming player, he was a noted racquet hurler, with no less of an inner rage to succeed than, for example, John McEnroe.

In the purely cerebral sport of chess, the one living player most often described as a genius is the Norwegian Magnus Carlsen – who at 19 became the world's highest-ranked grandmaster. Yet his father Henrik told me that what had first alerted him to Magnus's possibilities was the fact that as a toddler he would spend hours doing 50-piece jigsaw puzzles; the very young Magnus had an astonishing capacity for hard work and concentration– which is, after all, the very essence of learning.

Francis Galton, the slightly creepy founder of eugenics, sought to define genius by reference to an inherited form of intelligence, which he thought could be measured via the analysing of a person's reaction time and sensory acuity: this Galton referred to as "neurophysiological efficiency". You might think that, within sport, the activity most requiring preternaturally quick reactions would be Grand Prix motor-racing. Yet viewers of the BBC1 series Top Gear might recall Jeremy Clarkson engaging in a competitive test of reaction times with Michael Schumacher,: the lumbering Clarkson demonstrated that his reactions in a hand slapping contest were the equal of the then Formula One champion's.

This is actually what one should expect: we all have the same basic reaction times, which are determined by the nervous system rather than the brain – as evidenced by the fact that we all pull our hand away from a flame with identical suddenness. The difference between us and the champions is that they have trained their minds to process information with astonishing speed in situations requiring complex assessment. Watch how Federer reacts in the less than half a second it takes for a first serve from Murray to reach the opposing baseline and you see just what a special talent honed by obsessive determination and hundreds of thousands of hours of practice can achieve.

Conducting the on-court interview after his victory, Sue Barker began: "Genius tennis?" "Yes," Federer replied, deadpan. If only it were so simple; and the fact that it looks so simple is the strangest thing of all.

Is it OK for celebrities to hog the best seats in the house?

By Jemima Lewis in The Telegraph

While my husband was chewing on the sofa cushions in an agony of doomed hope, I was busy spotting the celebrities at the Wimbledon final. “There’s Posh and Becks! Doctor Who! Ronnie Wood! One of the Middletons! And another one! And another one!” There were so many famous faces – from the Prime Minister to the merest boy band singer – it made Elton John’s annual White Tie and Tiara Ball look like a quiet night at the bingo.

Nor is this just a Wimbledon-related phenomenon. At any fun-packed event of national importance (or not), you’ll find celebrities hogging the best seats. At the Queen’s Jubilee pop concert, the royal box was so packed with stars that one newspaper provided a numbered chart to help us identify them all.

It does seem that the rich and famous find it mysteriously easy to come by tickets that other mortals couldn’t get if they removed their right arm and handed it over at the box office. Yet the strange thing is, most people don’t find this annoying. They accept the superior rights of the famous as meekly as previous generations deferred to the aristocracy.

A couple of years ago, my husband and I managed by circuitous means to get VIP tickets to a children’s musical, based on a hit TV show. It was a revelation.

We – the VIPs and our Very Important Toddlers – were given seats in the front rows, cordoned off from the proles who’d actually had to pay for their tickets. Before the show began, we were plied with cupcakes and party bags, and invited to bring our children on stage to meet the cast.

The Unimportant Persons at the back had to sit and watch for the best part of an hour, while their agitated toddlers demanded to know why they couldn’t have their photos taken with their favourite furry characters. Why indeed? “I’m sorry, darling: it’s because neither of your parents have ever presented breakfast TV.”

Bank of England says Libor scandal may be going on in other markets too

The market for determining one of the world’s key interest rates was a “cesspit” and banks cannot be trusted to be honest in several other major markets, the deputy governor of the Bank of England has warned.

By James Kirkup, and Angela Monaghan in The Telegraph

7:51PM BST 09 Jul 2012 

Paul Tucker told MPs that Barclays’ abuse of the Libor system may be only one part of the banks’ dishonesty over crucial financial information, suggesting that other markets should now be investigated.

An official inquiry into Libor – which helps determine interest rates for householders and businesses – should be broadened to include several over markets where banks are trusted to report their own data, he said.

Mr Tucker’s evidence to the Treasury Select Committee also reignited the political row over the Libor scandal as he insisted that members of the last Labour government had not “absolutely not” put pressure on him to reduce Libor.

George Osborne, the Chancellor, has said that that the last government was “clearly involved” in the banks’ dishonest under-stating of the interest rates they were paying to borrow on money markets.

Labour last night demanded Mr Osborne withdraw his claims, but Treasury sources insisted that question remain about Labour’s direct dealings with dishonest banks during the 2007-08 financial crisis.

Barclays has been fined almost £300 million for deliberately lying about the rates it was paying during the financial crisis, in order to downplay the financial pressure it was under.

Other banks are also being investigated for distorting Libor, which is calculated on major banks’ own reports of their borrowing costs.

Mr Tucker said he could not be sure that abuse of the Libor system is not continuing to this day, telling the committee: “I can't be confident of anything after learning of this cesspit.”

The Libor scandal could be repeated in a number of other “self-certifying” markets where prices are determined, he said.

“Self-certification is clearly open to abuse, so this could occur elsewhere,” he said.

A Financial Services Authority inquiry into Libor should be extended to other self-certifying markets, he said. The Treasury said last night that the review, led by Martin Wheatley, was free to examine markets other than Libor.

An expansion of the FSA review could take in a number of other interest-rate-related data as well as some complex financial instruments measuring the difference between banks’ borrowing costs and that of the US government. Some markets in gold and oil are also based on self-certification.

Mr Tucker faced intense questions from the MPs about why the Bank had not acted on abuse of Libor earlier and had not apparently been aware of abuses until a few weeks ago.

He admitted that the Bank had been concerned about the integrity of the Libor process during the financial crisis, but did not suspect deliberate wrongdoing. “We thought it was a malfunctioning market, not a dishonest market,” he said.

The Bank had opened the door to changing the way Libor was calculated in 2008, but did not act because of the turmoil in the global financial system, he said.

“We made a judgement that moving away from the existing method of self-certification was just not feasible during a financial crisis”.

Big pharma is cut out by India's plan to bring medicine to masses

Ambitious $5bn push deals blow to global firms with focus on generic alternatives above branded drugs

NIKHIL KUMAR 

 

 

FRIDAY 06 JULY 2012

India is planning a multibillion-dollar push to bring free medicines to the hundreds of millions of its citizens who, despite the country's economic revival, still languish without access to the very basics of health care.

The $5bn initiative, which is slated to be rolled out by the end of this year, will offer 348 essential drugs to patients across the country. In a blow to the West's big pharmaceutical firms, the planned scheme will largely cut out branded drugs, opting instead for cheaper generic alternatives.

News of the plan comes as the Congress-led administration in Delhi attempts to shore up public support after a raft of corruption scandals and crushing electoral losses in state polls. A recent report confirming a slowdown in economic growth has only served to sharpen criticism of the government.

Now, Delhi is plotting a multi-billion dollar health-care drive, using its network of government-funded hospitals and clinics to deliver free drugs across a country where, despite the much-vaunted boom of recent years, more than two million young children die every year from preventable infections, according to Unicef.

Infant mortality stands at 63 per 1,000 live births, while a recent paper in the Lancet medical journal said that of the nearly five million children under five who succumbed to preventable diseases such as pneumonia, diarrhoea and malaria in 2010, almost half had come from five countries: Nigeria, the Democratic Republic of Congo, Pakistan and, notably, China and India.

All the while, the Indian state spends so little on health care as a proportion of GDP that only a handful of countries fare worse, according to the OECD.

The bulk of the cash for the free medicine plan will come from central coffers, while state governments will be asked to shell out an additional third of the required funds. The Ministry of Health and Family Welfare said it had put forward proposals worth around $3.64bn. The additional funding – from the states – will boost the investment to around $4.9bn, signalling, if approved, "a giant step in vastly expanding the access to medicines", the Ministry said. A template already exists in the western state of Rajasthan and Tamil Nadu in the south, where health schemes are reported to have been successful.

The focus on generic medicines chimes both with the need for affordability and the dynamics of India's pharmaceutical market. Generics – or cheaper copies of expensive branded medicines whose patents have run out – accounted for around 90 per cent of the total drug sales in the country in 2010, according to Reuters data.

The gulf between the cost of branded drugs and generic alternatives is often vast. The Rajasthan state government, for instance, buys the generic version of a popular cholesterol drug for just over 6 rupees (7p) for a strip of 10 tablets, according to official figures quoted by India's Economic Times newspaper. In contrast, consumers opting for a branded alternative face costs of 103 rupees.

Although reports indicate that doctors participating in the planned scheme will be able to use 5 per cent of the sanctioned funds to buy medicines absent from the approved list of 348 generic drugs, the initiative presents a fresh challenge for global pharmaceutical giants such as GlaxoSmithKline and Pfizer.

Big pharma, as that end of the industry is known, is already struggling to forge new avenues for growth. Being locked out of a major initiative in a key emerging market won't help.

"Without a doubt, it is a considerable blow to an already beleaguered industry, recently the subject of several disadvantageous decisions in India," KPMG's European head of chemicals and pharmaceuticals, Chris Stirling, told Reuters.

"Pharmaceutical firms are likely to rethink their emerging markets strategies carefully to take account of this development, and any similar copycat moves across other geographies."

Big Pharma buying their way out of criminal charges

Rema Nagarajan in Times of India

05 July 2012, 04:19 PM IST

The record-setting settlement has raised several questions about the system of justice. What can the $3 billion fine for GSK mean to people who have been affected adversely or have even lost loved ones because of the side effects of drugs, which GSK failed to report? Is justice served in allowing offenders to buy their way out? 

What about the people in GSK who took the decisions to not report safety concerns or to bribe doctors to push the drugs for uses not approved by the regulating agency, the Food and Drug Administration (FDA)?

The hefty fine settles criminal and civil charges of unlawful promotion of certain drugs including failure to report safety data and concerns about side effects, and for alleged false price reporting practices.

While $3 billion might be a record settlement, is it that hefty? Is it really hard on the company? Take the case of Avandia, an oral anti-diabetic, one of the drugs GSK is charged with marketing illegally. Avandia marketed since 1999 raked in over $2 billion annually. GSK is also charged with unlawful promotion of Paxil, an anti-depressant. On the market since 1994, Paxil too brought in over $2 billion annually. These two drugs alone helped GSK rake in several billions every year for over a decade. This is not even counting all the other drugs that are part of this settlement such as Wellbutrin, Advair, Imitrex, Lotronex, Flovent and Valtrex and the billions they must have earned for GSK. For being able to net sales worth so many billions, a one-time settlement of $3 billion does seem like a small price to pay to do big business.

Most major pharma companies have been accused of bribing doctors, hiding side effects of drugs and promoting drugs for uses not approved by the FDA, called off-label marketing. In 2009, Pfizer had set the record paying $2.3 billion fines for illegal marketing of 13 different drugs. In the same year, Eli Lily had to pay $1.4 billion over the marketing of Zyprexa, an anti-psychotic. Astra Zeneca and Novartis too have had to settle charges with huge fines. Over 180 pharmaceutical fraud cases, covering more than 500 drugs, are now under investigation by the U.S. Department of Justice.

Obviously, the continuing violations by pharmaceutical companies, despite such huge fines, shows that these fines are no deterrent to the companies. It is said that, to the industry, the hefty fines have simplybecome  a cost of doing business.

Director of the Public Citizen’s Health Research Group, Dr Sidney Wolfe pointed out that the settlement was nothing new for GSK, which like many pharma companies has been a repeat offender. “Until more meaningful penalties and the prospect of jail time for company heads who are responsible for such activity become commonplace, companies will continue defrauding the government and putting patients’ lives in danger.”

In this context, unctuous statements by the US administration about the “historic” multi-billion dollar settlement being “a sign of the US government’s firm commitment to protecting the American people and holding accountable those who commit health care fraud ” merely masks the fact that companies and the executives are being allowed to buy their way out of punishment for willful and deliberate harm they cause to people.