Occasional reflections on Life, the World, and Mathematics

Posts tagged ‘health policy’

Health choices

From the Guardian:

In February Prof Dame Sally Davies, the chief medical officer for England,… told a parliamentary hearing: “Do as I do when I reach for my glass of wine. Think: do I want the glass of wine or do I want to raise my own risk of breast cancer? I take a decision each time I have a glass.”

Umm… Wine or cancer? Are those really the options? Seems like an easy choice to make…

Fat and spinach

There’s an old joke — I’ve seen it attributed to Clarence Darrow, but I have no confidence in this attribution — that goes

I don’t like spinach, and I’m glad I don’t, because if I liked it I’d eat it.

I thought of this in reflecting on the lessons of Nina Teicholz’s book Big Fat Surprise, about the sorry history of public health recommendations about dietary fat, mainly in the US. This will surely go down as one of the most embarrassing disasters in public health history, so Teicholz’s efforts to uncover how a supposedly self-correcting process was able to go so badly wrong holds important lessons for all of us who care about either science or public policy. (It’s sort of The Innocence Project, with observational studies in place of eyewitness misidentification.) (more…)

The magic of markets

I find The Times fascinating, as a peek into the id of the British establishment. Thus, it usually seems sort of objective and reasonable — and I find its science coverage excellent, for a daily newspaper — until some event hits the nerve of class interests and establishment ideology, such as on the day after Jeremy Corbyn’s election as Labour Party leader. Then the news and editorials fall into line with a kind of mirthless sarcasm that astonishes in its combination of vituperation and simplemindedness. I find myself then reading it, like the scripture of some weird sect — I’m not naming names here — wondering, does anyone really find this either amusing or insightful. With the extra frisson of remembering that those who find it both amusing and insightful are running the country.

Today there was an editorial bashing the NHS. After one of those it-was-probably-clever-the-first-time-someone-said-it quips about how at current growth rates, the NHS will exceed 100 percent of the British economy by 2100, the writer (Ross Clark) refers to one of today’s news items:

A new threat to NHS financial stability has emerged: thanks to the increasing complexity of drugs it will cost a lot more in future to produce generic versions.

At present, drugs typically fall in price by 95 per cent once their patents expire. But new drugs that rely on biological agents are expected to fall in price by only 25 per cent, drastically cutting the £13.5 billion  the NHS saves every year by using generic drugs.

The NHS should have cottoned on much faster to the fact that generic drugs cannot be relied on indefinitely. It should be using its power in the marketplace much more to push prices down.

I bet there are heaps of overpaid NHS managers slapping their foreheads, thinking “power of the marketplace, why didn’t I think of that?!” The whole point is that these new drugs are expensive to produce, so no pharmaceutical company is going to rush in to sell it for 5% of the original cost, regardless of whether it is protected by patent rights. We’re seeing a change in the relative cost of development and production. (It’s the reverse of the change in the music industry from the early days of CDs when the physical production of the CD cost several dollars to now when the marginal cost of an album is infinitesimal.)

No amount of “cottoning on” by the NHS is going to change this fundamental reality.

Unavoidable chaos in the NHS?

A BBC headline announces that

Migration rules ‘may cause NHS chaos’

The problem is, a rule introduced in 2011 requires that foreign workers must return home after 6 years if they are not earning over £35,000. This is presented a disaster that can only be averted by the government granting an exemption to the rules.

The union says that by 2017 more than 3,300 NHS nurses could be affected. And by the end of the decade the numbers could be double that – a potential waste of nearly £40m when all the costs of recruitment are taken into account, the RCN says.

RCN general secretary Peter Carter said: “The immigration rules will cause chaos for the NHS and other care services.

“At a time when demand is increasing, the UK is perversely making it harder to employ staff from overseas.”

He told BBC Radio 4’s Today programme the move was “totally illogical” as there is currently a “major shortage of nurses”, leading to many NHS trusts spending “tens of millions” to recruit from overseas.

Dr Carter also stressed that most nurses earn “nowhere near” £35,000, with most on salaries of between £21,000 and £28,000 a year.

I don’t mean to defend the Tory policies, which combine the Conservative view that the non-rich are inherently undesirable with the usual British political one-upmanship on bashing foreigners, but this doesn’t look to me like an inherently unsolvable problem. There is a method known for increasing the supply of labour: raise wages. If there is a “major shortage” of nurses when you pay between £21,000 and £28,000 a year, I’m willing to guess that there would be less of a shortage if they were paid between £25,000 and £32,000 a year. It probably wouldn’t solve the problem completely, in the short term, but it would bring in marginal resources — some part-time workers would work more hours, some would delay retirement, and so on — and it would pull more young people into the profession. And if they raised salaries to £35,000, that would solve their international recruitment problem. (more…)

Will small hospitals kill you?

Disquisition on medical statistics in The Guardian

A recent front-page article in The Guardian claimed to show that small NHS hospitals are killing people. “Huge disparity in NHS death rates revealed” was one headline. “Patients less likely to die in bigger hospitals“. “Safety in numbers for hospital patients” is another headline. The article makes no secret of its political agenda: “The results strongly suggest that smaller units should close. This presents a major challenge to the health secretary, Andrew Lansley, who has stopped all hospital reorganisation.” Online, Polly Toynbee decries “Hospital populism”, saying “Local hospitals may be loved, but they can kill.” Wow. That’s pretty bad. Here’s the schematic of the story: Smart and selfless experts want to save lives. Dumb public clings to habit (in the form of community hospitals). Evil politicians pander to dumb public, clings to campaign promises. “The health secretary, Andrew Lansley, has now put the project on hold, in line with his election promise to halt hospital closures, to the dismay of experts who believe that lives will continue to be lost.”
(more…)

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