The future of the NHS is in our hands

I’ve been pretty worried about the future of the NHS recently, so I’m currently volunteering with Just Treatment – a campaign led by NHS users. I’ve been helping to develop a set of demands for a stronger and better supported health service after this crisis. � We want to hear people’s experiences of coronavirus and the lockdown and their views on the future of the NHS. Would you help out by completing this short questionnaire? � https://justtreatment.typeform.com/to/SVLkQVv5 It will only take you 2-5 minutes to complete. We’re aiming to speak to at least one person in each of the 650 constituencies in the UK. We’ve all been affected by the pandemic in one way or another, and all have a stake in the future of the NHS, so please do share your insights. It would be great if you could forward this message to your friends too. Thanks! �

Breast cancer screening – time for change

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…

…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

A better type of pandemic fame!

The Schoolhouse Gallery ‘Ideas of Home’:  ‘We have been asking people to share their ideas of ‘home’ during the global pandemic. This is the gallery of contributions – it’s continuously evolving so keep checking back – and keep scrolling, as there’s lots here. And if you haven’t done so already, please do take part!’

https://schoolhousegallery.org/ideas-of-home/?fbclid=IwAR2fbtFXB6NWgIdO-Ea_ksTc86dlw5mtcxkpiWC-4s260XZ_6xfWG5J5AM0

Although I’m not a real poet, it’s great to see these scribblings posted among real art! (Local magazines, eg village newsheets and U3A newsletters might well welcome themes around the pandemic too.)

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

……………………………………………………

Lockdown uplifted

Nobody’s going to call!
I’ve tidied
I’ve dusted
I’ve hoovered the hall
The whole house is unnaturally clean and now thanks to Covid 19 even the manicured lawn won’t be seen
The cat’s skating on tiles with a double gloss shine wailing this polished home is no longer mine and her bottle-brush tail says it all as she swishes on past down the length of the hall and I simply have to agree

All this housework stuff just isn’t me

As the TV spouts Updates-of-Doom
everywhere echoes my gloom
all my friends are locked down – I can’t go into town – I’m going stir-crazy with nothing to do
– and the cat’s high-tailed it

Mid-ravings I started to cook (it all looked so good in the book) though I followed whatever the recipe said my bread was an unrisen pudding of lead

Unchanging grey days never stop and my waistline’s about to go pop self-discipline’s gone by the board so I comfort-eat chocolate and cake from my hoard…

‘Go, get a project’ you said so I dug up the lawn and grew veggies instead

now I’ve runner beans high as my head and where flowers once bloomed super-foods share a bed

Forsaking Nigella I no longer bake but I’m shuffling weeds with a hoe and a rake

as the cat chases froglets through grass isolation is all in the past now this Techno-Gran clicks for a virtual meet and round-the-world-Zooms are her regular treat
(and our street’s become reet friendly!)

Grim lockdown’s no longer a pain
Now for the plants’ sakes I welcome the rain
And on grey days when there is no sun I’m having fun
playing with words

And I no longer bother to hoover the hall
And I’m so very glad no-one’s going to call

Mitzi Blennerhassett

Official Support for Homeopathy Persists

Majikthyse

One thing leads to another, and with each step I am angrier. It started with a Twitter tip-off about a video on Facebook recommending homeopathy for coronavirus symptoms. Of course, homeopathic remedies are prescribed totally on the basis of symptoms, as homeopaths have no way of knowing any better, so nothing remarkable about that as such. But the video was made by Dr Elizabeth Thompson, a registered medical doctor, and apparently a consultant at University Hospitals Bristol NHS Foundation Trust. I am not on Facebook and have no desire to be, and the video may have gone now. But it popped up at the same time at the National Centre for Integrative Medicine. At this point I need to explain a bit of history.

View original post 2,026 more words

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