Scientific fraud

‘A lecturer at King’s College London, Stuart is one of the early fire-starters of the Open Science movement, who has since established himself to be a versatile researcher. His talk will be on scientific fraud and misconduct, which are the subject of his new book Science Fictions: Exposing Fraud, Bias, Negligence, and Hype.’

Breast cancer screening using MRI

Breast Cancer Screening using MRI – Insights from the DENSE trial – H Gilbert Welch.

‘A comprehensive accounting of all breast cancers detected in the DENSE trial…revealing 5.4 extra cancer per 1000 screens. Where are those extra cancers in the control group? Are they growing so slowly that they are still undetectable by mammography 2 years later? Or did they go away?’

Dexamethasone – some inside information

Is THIS The Real COVID Game Changer? Doctor Explains

A massive UK study has thrown up an unlikely saviour in the form of dexamethasone, a 60 year-old, cheap steroid.

Breast screening, the Age-X trial: 2020, opportunity and need for change

BMJ – Cost of extending the NHS breast screening age range in England

‘Susan Bewley and colleagues examine the clinical and ethical implications of Public Health England’s trial of widening the age limits for breast cancer screening’ – April 2019.

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1293 (Published 10 April 2019) Cite this as: BMJ 2019;365:l1293

https://www.bmj.com/content/365/bmj.l1293/rapid-responses

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‘Conclusion

The balance of benefits and harms from breast cancer screening remains contested. Three years after AgeX began, an architect of the NHS breast cancer screening programmes argued that deaths after treatment of screen diagnosed breast cancer may exceed those from breast cancer in an unscreened population.26 In 2014, the Swiss medical board advised its government to stop recommending mammography screening.27 In 2016, an open letter from French scientists who had conducted a consultation into France’s breast cancer screening for their ministry for health called for a halt to breast cancer screening for low risk women under 50, and an end or thorough review of the programme for women over 50.28

People must be given sufficient information to decide whether they wish to participate in research, particularly when the risks are unclear. We recommend the National Screening Committee uses high quality fact boxes and icon arrays20 to support patient consent in AgeX and all screening programmes. We call on the investigators and verifiers of any data resulting from AgeX to use all-cause death as the primary outcome. An independent inquiry into the scientific quality, governance arrangements, and ethical issues arising from the trial would inform future high standards for the design and conduct of government run trials.’

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Rapid responses

1 Daniel Corcos: We are facing an epidemic of mammography-induced cancers.

2 Alexandra L Barratt: Overdiagnosis is widely described as a major risk of breast cancer screening, including by Cancer Research UK, the 2012 Independent Panel review of the UK breast screening programme (https://www.cancerresearchuk.org/about-cancer/breast-cancer/screening/sc…) and the American Cancer Society.

So it is disappointing that the AgeX protocol does not address overdiagnosis.

3 Moira E Adams: When the shortcomings of this trial are so obvious and so costly, it beggars belief that someone, somewhere, does not have the courage to call a halt to AgeX. Women deserve better and we do not need yet more non-evidence based NHS policy.

4 Sharon Batt: Patients rely for their safety on ethics committees and other oversight bodies within medical institutions and health departments to ensure that their safety is put ahead of professional hubris and the reputations of institutions. Too often, these internal mechanisms fail.

5 Hazel Thornton:  Who is there, then, who can stand in the path of those who continue to recruit unsuspecting asymptomatic people to their trial which will certainly harm more people than it helps?

6 Peter C Gotzsche: Mammography screening has no effect on total cancer mortality (3) and it does not lower advanced cancers (4), two clear proofs that screening does not work as intended. The only reasonable way forward is therefore not to extend the age range screened but to stop screening altogether, including the ongoing trial (5).

7 J K Anand: Preventive medicine today. Not consultative. Not caring. Statistics driven. Ignoring the individual.

Bewley, Blennerhasset, Payne (BMJ 2019;365:11293) examine the clinical and ethical implications of Public Health England’s “trial” of widening the age limits for breast cancer screening. They point out the shaky foundations ( evidence base), LACK OF FREE INFORMED CONSENT ( my emphasis).

Thornton ( Rapid Response, 13 April 2019) asks , “ How can we tolerate that patients’ consent is not sought, that millions of women are being duped?”

I echo the cries of anguish of these four authors. They laid bare the arrogance of the policy makers of public health medicine in this country

8 Kushal Mansatta: By ignoring the need for valid informed consent, these patients are failed at the very first step.

AgeX is “likely to be the largest randomised controlled trial ever undertaken in the world”. Seemingly lost in this big picture, AgeX can’t see the trees for the forest.

9 Michael Baum: There is another aspect to this sad story that no one has yet commented upon. If the NHS is covertly conducting RCTs before introducing extensions for screening what else might they be up to?

10 Hazel Thornton: The UK NHS Breast Screening Programme (BSP) was triumphantly introduced on the ping of a division bell by Edwina Currie, the then Health Minister, and announced by Norman Fowler 25th February 1987. [4] Since then, numerous attempts have been made over the intervening years to expose people to the fallacies of mammographic screening.

11 Jean V Doubovetsky: Bewley et al. are right to criticize the AgeX breast screening trial for poor science and public information.

Responses to bmj article on DCIS study

Useful rapid responses from Hazel Thornton, Honorary Visiting Fellow, Department of Health Sciences, University of Leicester, Michael Baum, Professor Emeritus of Surgery and Visiting Professor of Medical Humanities, University College London, and others

Clear information offered in these rapid responses to the bmj article ‘Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study’.

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1570 (Published 27 May 2020) Cite this as: BMJ 2020;369:m1570

This pandemic gives us a chance ‘to wean the public off its dependence on searching for diseases that might never have harmed anyone’.

The BMJ Opinion

Susan Bewley: Things should never be the same again in the screening world

April 14, 2020

‘The suspension of routine breast cancer screening during covid-19 offers an opportunity to reconsider criticisms of the programme, argues Susan Bewley

Some unexpected good news has resulted from the NHS having to prioritise the needs of the sick and vulnerable over the fears of the well. In the middle of a global pandemic, we can no longer afford the politically popular luxury of needlessly making the general public unwell through anxiety and overdiagnosis. Routine mammographic breast cancer screening and the AgeX clinical trial—which was designed to generate evidence about extending screening to women even outside the current 50-70 age group—have stopped.

Although it was not obvious from national websites, or in the media, letters, texts, and phone calls have been informing women since mid March that all routine screening appointments are cancelled. Services have since been suspended in parts of Canada, Italy, Scotland, and Australia.

This recognition that breast cancer screening is non-urgent must be applauded, and the general public reassured. It suggests that stopping screening poses little overall danger (and even, by some people’s interpretations, possibly none whatsoever) to women. Anyone with a lump, skin dimpling, or other symptoms who might have an active cancer, should be encouraged to call their GP as usual, as the urgent pathways remain open. Regional breast screening services are telling women that screening is “on hold.” The intention appears to be to resume screening when, and if, the coronavirus pandemic ends. But this is a golden opportunity for the National Screening Committee (NSC) to pause, reconsider criticisms of the screening programme, and evaluate whether to modify a programme that does not impress clinically or cost effectively…’

Susan Bewley: Things should never be the same again in the screening world

Poem for these times

This poem/song with its fervour is from the collection A Coney Island of the Mind written in 1958, so apt to the times and so funny as well. (I am waiting to write anything half a percent a good!)

I Am Waiting

BY LAWRENCE FERLINGHETTI

I am waiting for my case to come up

and I am waiting

for a rebirth of wonder

and I am waiting for someone

to really discover America

and wail

and I am waiting

for the discovery

of a new symbolic western frontier

and I am waiting

for the American Eagle

to really spread its wings

and straighten up and fly right

and I am waiting

for the Age of Anxiety

to drop dead

and I am waiting

for the war to be fought

which will make the world safe

for anarchy

and I am waiting

for the final withering away

of all governments

and I am perpetually awaiting

a rebirth of wonder

 

I am waiting for the Second Coming

and I am waiting

for a religious revival

to sweep thru the state of Arizona

and I am waiting

for the Grapes of Wrath to be stored

and I am waiting

for them to prove

that God is really American

and I am waiting

to see God on television

piped onto church altars

if only they can find

the right channel

to tune in on

and I am waiting

for the Last Supper to be served again

with a strange new appetizer

and I am perpetually awaiting

a rebirth of wonder

 

I am waiting for my number to be called

and I am waiting

for the Salvation Army to take over

and I am waiting

for the meek to be blessed

and inherit the earth

without taxes

and I am waiting

for forests and animals

to reclaim the earth as theirs

and I am waiting

for a way to be devised

to destroy all nationalisms

without killing anybody

and I am waiting

for linnets and planets to fall like rain

and I am waiting for lovers and weepers

to lie down together again

in a new rebirth of wonder

 

I am waiting for the Great Divide to be crossed

and I am anxiously waiting

for the secret of eternal life to be discovered

by an obscure general practitioner

and I am waiting

for the storms of life

to be over

and I am waiting

to set sail for happiness

and I am waiting

for a reconstructed Mayflower

to reach America

with its picture story and tv rights

sold in advance to the natives

and I am waiting

for the lost music to sound again

in the Lost Continent

in a new rebirth of wonder

 

I am waiting for the day

that maketh all things clear

and I am awaiting retribution

for what America did

to Tom Sawyer

and I am waiting

for Alice in Wonderland

to retransmit to me

her total dream of innocence

and I am waiting

for Childe Roland to come

to the final darkest tower

and I am waiting

for Aphrodite

to grow live arms

at a final disarmament conference

in a new rebirth of wonder

 

I am waiting

to get some intimations

of immortality

by recollecting my early childhood

and I am waiting

for the green mornings to come again

youth’s dumb green fields come back again

and I am waiting

for some strains of unpremeditated art

to shake my typewriter

and I am waiting to write

the great indelible poem

and I am waiting

for the last long careless rapture

and I am perpetually waiting

for the fleeing lovers on the Grecian Urn

to catch each other up at last

and embrace

and I am awaiting

perpetually and forever

a renaissance of wonder

 

‘Less is More’ medicine – article in European Journal of Internal Medicine discusses barriers and challenges

Less is More aims to tackle overuse in medicine.

•

Several anti-waste campaigns published “top-five lists” of low-value medical interventions.

•

Barriers for implementing Less is More medicine have been identified in several European countries.

•

Simple awareness of these recommendations is insufficient to change physician behaviors.

•

Multiple interventions and quality-measurement efforts are necessary for widely implementing these recommendations.

The Challenge of implementing Less is More medicine. A European perspective. Omar Kherad et al. https://doi.org/10.1016/j.ejim.2020.04.014

https://www.sciencedirect.com/science/article/pii/S095362052030128X#bib0042

Result of self-isolation

Strange Times

Lean times are no fun

No loo roll for your bum

Empty streets echo, it’s like a film scene

Once-fussy kids now scrape their plates clean!

– And Nana’s guarding the allotment with a gun

…………………………….

Observations

Bare boards

Used to mean poverty

Now laminate flooring’s ‘on trend’

 

Loo rolls

Were quilted and scented

Now newsprint is flushed round the bend

…………………..

War footing

Mum’s sewing kids’ new clothes out of curtains and old sheets

Grandpa’s cutting up old tyres to shoe their feet

We had a lovely meal the night two hamsters disappeared

And our Dad called it rabbit stew

(As you do)

But the cat’s keeping her distance

Cancer care

A lone gull makes its way across the sky, battling against the wind. Unremarkable enough, yet it’s enough to whisk me back through time. Along with certain words and phrases, this bird has assumed a particular significance in my life with the power to endure through sixteen years; to mock my defences; to open old wounds.

The day that brown envelope dropped through the letter-box was similarly unremarkable, but it was the butterfly that would create a tornado. True, my stomach tightened as I read the hospital letter, but that was to be expected. I was on unfamiliar ground. But there were no warning bells as I noted down the appointment in my diary. No omens. No ‘signs of ill portent’. Not a black raven in sight! Yet it heralded the most momentous event in my life. Soon, a spattering of red-ringed reminders would deface the calendar, prophetically resembling red-rimmed eyes. The world would tilt, a chasm would open and for a moment time would stand still. There would be mind-battering aftershocks; life-shattering changes. Memories would become re-categorised ‘before’ or ‘after’. And a year that should have been ordinary would become a milestone, a memory gauge more powerful than birthdays, marriages or deaths.

You’d have thought the gods might at least have given me a hint of what was to come.

CH 1, p 8. Nothing Personal, disturbing undercurrents in cancer care, Radcliffe Publishing 2008.

Winner, Medical Journalists’ Open Book Award 2009; Royal College of Nursing essay prize 2009.