The Chair of St George’s NHS Trust warns that the NHS needs at least
£4bn more a year between now and 2020 to avoid disaster, according to a
Guardian article.
Christopher Smallwood, Chairman of St George's
University Hospitals NHS Foundation Trust in London, has described ‘an
accelerating financial disaster’ for hospitals, stating that ‘hardened
professionals who have worked in the service for decades have never seen
anything like it.’
Writing for the Guardian, he said: ‘Two years
ago a quarter of hospitals recorded deficits. Last year, this rose to
half. This year, three–quarters of hospitals are running deficits, some
of them extremely large – and 90%...expect to be in deficit by the end
of the year.’
Mr Smallwood also warns of eroding standards of
care, writing: ‘Waiting times for cancer treatment, and in A&E
departments, are now missed routinely, as is the minimum wait for
diagnostic tests. And the waiting target for elective procedures has
been abandoned.’ He added: ‘Missed targets trigger fines of many
millions of pounds, intensifying financial pressures. The queues will go
on lengthening.’
Claiming that ‘Ministers are in denial about
what is happening’, Mr Smallwood continued: ‘The past five years have
seen the smallest increase in health spending over any parliament since
the second world war – 0.8% a year. This compares with an annual
increase in demand and cost pressures of between 4% and 5%.’
Mr
Smallwood concluded that ‘Those drawing up the autumn statement need to
be aware of these realities,’ explaining: ‘Even if the efficiency gains
achieved in the next five years matched those of the past five, the
government would need to increase annual budgets by £2bn-£3bn a year
between now and 2020 to preserve standards. But since the NHS cannot
continue to raise productivity at this rate, at least £4bn a year extra
will be necessary, starting in April.
Cleaning up: Korean workers disinfecting a subway trainBill Gates says there could be one benefit from the Ebola epidemic
that has killed more than 11,000 people in west Africa since 2014. “It
may serve as a wake-up call,” says the Microsoft founder. “We must
prepare for future epidemics of diseases that may spread more
effectively than Ebola.”
His charitable foundation, the Bill & Melinda Gates Foundation,
has been at the heart of the global fight against slower-burning health
scourges such as HIV and malaria. However, few things worry him as much
as the risk of a sudden global infectious disease outbreak.
“There is a significant chance that an epidemic of a substantially
more infectious disease [than Ebola] will occur sometime in the next 20
years,” he wrote in a paper in the New England Journal of Medicine
earlier this year. “Of all the things that could kill more than 10m
people around the world, the most likely is an epidemic stemming from
either natural causes or bioterrorism.”
His paper went on to set out proposals for a “global warning and
response system” for pandemics and warned that Ebola had exposed glaring
deficiencies in preparedness. His recommendations were aimed primarily
at policymakers. But his broader point on the need for readiness should
also resonate in boardrooms and human resources departments across the
corporate sector.
In the event of a pandemic,
private sector employers would be on the front line of the battle to
contain its spread and their businesses would be highly exposed to
disruption.
The economic case for preparedness is clear. According to the World
Bank, a severe pandemic could reduce global wealth by $4tn, or 5 per
cent of gross domestic product. But the importance of ensuring business
continuity goes beyond the need to minimise lost revenues. It would also
be crucial to broader efforts to keep the economy and society
functioning.
Some 85 per cent of critical US infrastructure resides in the private sector, according to the Department for Homeland Security.
The danger of business paralysis during a pandemic became clear at
the height of the Ebola outbreak when some iron ore mines — an important
part of the west African economy — ceased production, and farming and
trade were disrupted.
Mr Gates warns that future pandemics could spread much more quickly
and widely than Ebola. “Other disease agents — measles and influenza,
for example — are far more infectious because they can be spread through
the air, rather than requiring direct contact,” he says. “People may
not even be aware that they are infected or infectious. Since a person
carrying one of these pathogens can infect many strangers in a
marketplace or on an airplane, the number of cases can escalate very
quickly.”
Public awareness of the risk has increased in recent years. Between
1997 and 2009, six major outbreaks of highly fatal zoonoses —
animal-borne diseases that can be transmitted to humans, such as Ebola,
Sars, avian and H1N1 flu — caused an estimated $80bn in economic losses,
according to the World Bank.
A clear plan should be in place before an epidemic erupts — and exercises carried out to test it for flaws
Yet
none of these was anywhere close in scale to the 1918 Spanish flu
pandemic, which infected 500m people and killed between 50m and 100m, or
3-5 per cent of the world’s population. Today, according to the World
Bank, a similarly infectious and deadly virus would kill 33m people in
250 days.
So what measures should companies have in place to protect their businesses and employees? Recommendations issued by the US Centers for Disease Control and Prevention during the 2009 H1N1 swine flu outbreak provide some pointers.
To begin with, businesses should start with a good understanding of
their normal seasonal absenteeism. Every winter, nearly 111m workdays in
the US are lost due to flu, according to the CDC. Identifying when the
usual level of infection and illness becomes something more unusual is
an important first step.
Much of the CDC’s advice involves commonsense measures little
different to best practice during the regular flu season. Sick employees
must stay at home, with plentiful supplies of soap, water and hand rubs
provided in the workplace to promote good hygiene.
Other recommendations are more specific to a severe pandemic. These
include “social distancing” strategies, such as banning non-essential
travel and meetings, increasing physical space between employees in the
workplace and allowing people to work from home. IT systems should be
checked to make sure they are robust enough to support large numbers of
remote users.
Screening of employees when they arrive for work should also be considered and people with symptoms of flu sent back home.
Close communication with employees, business partners and local
authorities would be crucial. A clear plan should be in place before an
epidemic erupts and exercises carried out to test it for flaws.
Mr Gates says the world’s readiness for an epidemic compares
unfavourably with its preparedness for other strategic threats such as
war. “NATO countries participate in joint exercises in which they work
out logistics such as how fuel and food will be provided, what language
they will speak and what radio frequencies will be used. Few, if any,
such measures are in place for response to an epidemic.”
The absence of this kind of planning caused delays in the world’s
response to Ebola, says Mr Gates. “In the next epidemic, such delays
could result in a global disaster.”
03 November 2015
FINANCIAL TIMES
Oliver Sacks, neurologist and writer, 1933-2015
Popular books illustrated the workings of the human mind through vivid case studies
Oliver Sacks, who has died in New York aged 82, became the world’s best-known neurologist through
popular books published over more than 40 years, illustrating the workings of the human mind through vivid case studies.
In works such as The Man Who Mistook His Wife for a Hat (1985) and The Mind’s Eye
(2010) Sacks described case histories from the borderlands of
neurological experience, showing what scientists could learn from
patients. The struggles of people living with illusions and
hallucinations, autism and dementia, schizophrenia and epilepsy were all
treated with warmth.
From individual cases of neural abnormality
he drew brilliant lessons about the workings of brains in general. In
the last years of his life Sacks wrote movingly about his own battle
with cancer and partial blindness. He died at home on Sunday after
saying in February the disease had spread from a tumour on the eye.
Although
Sacks stood out as a writer and populariser, he also made notable
contributions to research as a professor of neurology successively at
Albert Einstein College of Medicine, Columbia University and New York
University. He was an expert on phantom limb pain, the effect of music
on the brain, epilepsy and colour vision — among a wide range of
academic interests.
Sacks was born on July 9 1933 into a medical
and scientific family in the Orthodox Jewish community of Cricklewood,
north-west London. His early years feature in the autobiographical book Uncle Tungsten (2001).
He
studied medicine at Oxford university and Middlesex Hospital in London.
As soon as he qualified as a doctor in 1960, Sacks moved to the US,
where he was to spend the rest of his life. After five years in
California at San Francisco’s Mount Zion Hospital and the University of
California, Los Angeles, he took up a fellowship at Albert Einstein
College of Medicine in the Bronx.
Sacks was captivated by New York
City life and by the study of neurology. In 1966 he started working at
Beth Abraham Hospital in the Bronx, where he encountered an
extraordinary group of patients, many of whom had spent decades in
frozen states, like statues, unable to initiate movement.
He
recognised them as survivors from the “sleepy sickness” pandemic of the
early 20th century and treated them with L-dopa, then an experimental
drug, which brought some patients back to life — at least for a while.
They became the subjects of his 1973 book Awakenings, which inspired a play by Harold Pinter and an acclaimed feature film starring Robert De Niro and Robin Williams.
Although
he wrote extensively about his own experiences, Sacks remained
remarkably reticent about his personal life until this year. Then, with
the author terminally ill, some of the secrets came out. In his final
autobiography, On the Move, and searing articles in The New York Times, Sacks confirmed what many readers had suspected: he was gay.
As
a teenager he confessed his homosexuality to his father, who then told
his mother, despite being asked not to. Sacks saw her harsh reaction —
“You are an abomination. I wish you had never been born” — as being
rooted in Judaism and made him “hate religion’s capacity for bigotry and
cruelty”.
For 35 years of his adult life Sacks was celibate. As
he himself recognised, an emotional involvement with his patients was
something of a substitute for personal romance: “I had fallen in love —
and out of love — and in a sense was in love with my patients.”
But in 2008 romantic life resumed. The writer Billy Hayes became his partner and survives him. Clive Cookson
01 November 2015
MEDSCAPE Robert Lowes July 10, 2015. DETROIT: Lebanese Oncologist FARID FATA sentenced to 45 years in Federal prison for giving 553 patients excessive and unnecessary chemotherapy. Netted at least $17-million from Medicare and private insurers.Had seven offices, pharmacy,diagnostic testing and`radiation therapy centres. Also received kickbacks from a hospice and healthcare agency.
Published:
18:59 GMT, 22 October 2015
| Updated:
20:19 GMT,
Fearing her husband would die
waiting for a heart transplant in Miami, Carmen Concepcion
started looking for a faster way to save his life, and found the
answer in her native Puerto Rico.
Pablo, 59, could barely walk from the family room to the
bathroom without growing short of breath, Carmen said.
She looked across the states for hospitals with shorter
wait times until a friend recommended she consider her homeland.
Carmen was hesitant but 'gave it a chance.'
In December, Pablo received his heart transplant, becoming
the first person to travel from the mainland to the U.S.
commonwealth for the procedure, said Dr. Ivan Gonzalez-Cancel,
his surgeon and the director of the heart transplant center at
the Cardiovascular Center of Puerto Rico and the Caribbean.
Pablo is now able to bike about a mile and climb four to five
flights of steps.
Puerto Rico is trying to build its medical tourism industry,
from a current level of about $80 million a year to $300 million
by 2017, as part of efforts to heal its chronically sick
economy. A component of that is to encourage more patients to
travel for organ transplants.
Patients who visit for transplants, and for more common
medical procedures such as orthopedics, dentistry and
weight-loss surgery, spend thousands on hotels, transportation
and food.
Puerto Rico's potential as a transplant center is partly
based on a macabre statistic - the Caribbean island had a murder
and non-negligent manslaughter rate of 19.2 per 100,000 people
in 2014 compared to 4.5 per 100,000 in the United States,
according to Federal Bureau of Investigation data.
+9
Nurses attend to a young patient at
the Cardiovascular Center of Puerto Rico and the Caribbean in San Juan.
Puerto Rico is trying to build its medical tourism industry, from a
current level of about $80 million a year to $300 million by 2017
+9
Puerto Rico's potential as a transplant center is partly based on a macabre statistic
+9
Puerto Rico had a murder and
nonnegligent manslaughter rate of 19.2 per 100,000 people in 2014
compared to 4.5 per 100,000 in the United States according to Federal
Bureau of Investigation data
That translates into a pool of donors in the 18-30 age range
unmatched in the mainland, Gonzalez-Cancel said. 'The donors
(are) victims of car accidents or gunshot wounds to the head,
because Puerto Rico, sadly, we have a very high crime rate.'
High-crime areas certainly exist among the U.S. states, but
Puerto Rico has recently also had organ donation rates higher
than expected by the Scientific Registry of Transplant
Recipients (SRTR), which analyses data on donated organs.
The cost of care is another attraction, at as much as 60
percent lower than on the mainland, according to the island
government. Because Puerto Rico's transplant centers are part of
the national organ sharing network, U.S. patients can transfer
there as long as doctors admit them, with few other hurdles.
Pablo and Carmen Concepcion moved temporarily to Puerto
Rico, and paid out-of-pocket for Pablo's transplant and extended
hospital stay beforehand. While that cost about $350,000, it was
far less than it would have been on the mainland.
'I'd rather have a debt and he's alive,' said Carmen, a
teacher. Pablo, who is now disabled, was a truck driver.
+9
High-crime areas certainly exist among
the U.S. states, but Puerto Rico has recently also had organ donation
rates higher than expected by the Scientific Registry of Transplant
Recipients (SRTR), which analyses data on donated organs
+9
The cost of care is another attraction, at as much as 60 percent lower than on the mainland, according to the island government
Finding a heart donor match depends on a number of factors,
including blood type, but Puerto Rico's geographically isolated
location within the national organ sharing network can give some
patients shorter wait times.
The United Network for Organ Sharing (UNOS) allocates hearts
based on medical urgency and location of the patients. Because
there are no U.S. transplant centers within 500 miles (800 km)
of Puerto Rico, candidates on the island's waiting list have the
first opportunity at an organ, according to Roger Brown,
director of the organ center at the network.
Patients on the island from 2009 to mid-2014 waited a median
of 1.3 months for a heart transplant, versus 8.1 months
nationally, according to the SRTR. For livers, the island had
the shortest median wait time in the country at about three
weeks, compared to over a year nationally, according to the
SRTR.
Dr. Juan Del Rio is one surgeon eager to attract more
patients. He completed Puerto Rico's first liver transplant in
2012, after moving to the island from New York because of the
greater availability of organs.
+9
Surgeon Juan Del Rio poses for a photograph at the hospital Auxilio Mutuo, that houses liver and kidney transplant centers
He originally projected completing around 100 liver
transplants a year, but is now doing a little less than half
that and he sees attracting people from the mainland United
States as one way to achieve full capacity.
Surgeons prefer to transplant organs from nearby, but since
the late 1980s, more than 60 percent of the approximately 4,000
organs donated in Puerto Rico have been shared off-island,
according to UNOS data. Those are organs surgeons would like to
use in Puerto Rico.
Liver transplant candidates should consider Puerto Rico, Del
Rio said, 'instead of waiting in New York and (waiting) to be
really, really sick with a high risk of dying before
transplant.'
+9
Tomas Velez (L), manager of the Howard
Johnson hotel at the Cardiovascular Center of Puerto Rico and the
Caribbean talks to a guest in San Juan
+9
The hospital Auxilio Mutuo, that houses liver and kidney transplant centers, is seen here
Representatives from Auxilio Mutuo, the hospital that houses
the liver and kidney transplant centers, also suggest mainland
patients enlist in their kidney program, though the waiting time
for a transplant is far longer than for hearts and livers.
The island's government will have spent about $3.3 million
on developing the medical tourism industry by mid 2016. Still,
some people would be reluctant to travel to the island for such
serious surgeries.
'People draw the line at cardiology, (saying) "I can't see
myself on an operating table in a strange land,"' said Josef
Woodman, the CEO of Patients Beyond Borders, a medical travel
information publisher.
Puerto Rico has to show it can offer quality care to compete
for heart transplant patients, he said.
Island officials say Puerto Rico's status as a U.S.
jurisdiction is an indication of quality. Survival rates for
heart transplants match the national figures, while for kidneys,
the numbers are slightly higher than nationwide statistics, and
for livers, the rates are slightly lower, according to SRTR
data.
'Over there, it might be super clean, super sanitized, a
little bit older, maybe things not as renovated as we have over
here,' Carmen Concepcion said of her husband's care.
Gonzalez-Cancel, the heart surgeon, said the island should
show it can excel in complicated surgeries like heart
transplants to stoke interest in simpler procedures that are the
bread and butter of medical tourism.
'If you do what is big, then you can do what is small,' he
said.
+9
People walk in a corridor of the Bone
Marrow Transplant Center at the hospital Auxilio Mutuo. Because Puerto
Rico's transplant centers are part of the national organ sharing
network, U.S. patients can transfer there as long as doctors admit them,
with few other hurdles
Lymphocytic meningoradiculitis probably due to
infection by Borrelia burgdorferi, the cause of Lyme disease.
Description
Lymphocytic meningoradiculitis probably due
to infection by Borrelia burgdorferi, the cause of Lyme disease. It is
an illness characterized by intense pain, mostly in the lumbar and
cervical regions, and radiating to the extremities; migrating sensory
and motor disorders of the peripheral nerves, peripheral
radiculopathies, and cerebrospinal fluid abnormalities in the form of
lymphocytic pleocytosis indicating blood-brain barrier damage. The
symptoms may include facial paralysis, abducens palsy, anorexia,
tiredness, headache, diplopia, paraesthesias, erythema migrans, and
other disorders.
Bibliography
Ch. Garin, A. Bujadoux: Paralysie par les Tiques. Journal de médecine de Lyon, 1922, 71: 765-767.
A. Bannwarth: Chronische lymphocytäre Meningitis,
entzündliche Polyneuritis und "Rheumatismus". Ein beitrag zum Problem
"Allergie und Nervensystem". Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1941, 113: 284-376.
Zur Klinik und Pathogenese der "chronischen lymphocytären Meningitis". Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1944, 117: 161-185, 682-716.
We thank René Dreuille for information submitted.
A Brief History of Lyme Disease in Connecticut DPH Conn. The
history of Lyme disease in Connecticut began in 1975 when a cluster of
children and adults residing in the Lyme, Connecticut area experienced
uncommon arthritic symptoms (1976 circular letter). By
1977, the first 51 cases of Lyme arthritis were described, and the
Ixodes scapularis (black-legged) tick was linked to the transmission of
the disease. During 1982, Borrelia burgdorferi, the bacterium that
causes Lyme disease, was discovered and the first brochure addressing
Lyme disease was developed by the Arthritis Foundation. Serology testing
became widely available in Connecticut during 1984. In 1987, Lyme
disease became a reportable disease. All physicians were required to
report any and all cases of the disease. By 1988, the news of Lyme
disease spread and national media attention began. The first federal
funding for Lyme disease surveillance, education, and research became
available in 1991. The first Lyme disease vaccine became available in
1997. To help determine the efficacy of the vaccine, Lyme disease was
made laboratory reportable in 1998. However, the manufacturer
withdrew the vaccine from the market in 2001. In 2002, the vaccine
efficacy study ended, and Lyme disease was removed from the list of
laboratory reportable findings; however, it remained a physician
reportable disease. Initially, with little known about Lyme
disease, studies and surveys were conducted to determine the occurrence
of the disease in Connecticut and factors that favor acquiring the
disease. This work was done by the Connecticut Department of Public
Health in collaboration with the Connecticut Agricultural Experiment
Station, the University of Connecticut, Yale University, local health
departments, and the federal Centers for Disease Control and Prevention.
The current focus of the Program is on prevention.
The emergence of Lyme disease in
Connecticut is attributed in large part to changes in land use. That is,
land at one time used for farming has become reforested and
increasingly developed for suburban residential use. These changes favor
expansion of habitat that supports ticks and wildlife and therefore
transmission of tick-borne diseases from animals to people in
residential areas and among those who work or recreate outdoors. With no
vaccine currently available, prevention is based on avoidance of tick
bites through a combination of personal protection and environmental
measure.
To help meet the program's mission, The
Epidemiology and Emerging Infections Program will continue to maintain
surveillance for Lyme disease. Public health surveillance is one of
the tools that infectious disease epidemiologists use to monitor the occurrence
of diseases of public health importance and assess the effectiveness of control
measures. In the United States, the system for reportable diseases works best
for diseases that are either rare in occurrence, involve hospitalized patients,
or for which there are definitive diagnostic laboratory tests. The system works
less well for diseases that are common, diagnosed in outpatient settings, and
for which there are no definitive diagnostic laboratory tests. The
under-reporting of these diseases, including Lyme disease, is common. Over the years, epidemiologists from
the Department of Public Health (DPH) have used a variety of epidemiological methods
-- including active surveillance, population-based surveys, and case-control
studies -- to augment the information obtained from the traditional passive
surveillance system for Lyme disease. The limitations of the traditional
passive surveillance system to monitor the public health impact of Lyme disease
are well documented. In February 2012, DPH epidemiologists published an article
on the “Effect of Surveillance Method on Reported Characteristics of Lyme
Disease, Connecticut, 1996–2007” in the journal Emerging Infectious Diseases (http://wwwnc.cdc.gov/eid/article/18/2/10-1219_article.htm). On average since 1998, the DPH has
reported about 3,000 cases annually to the Centers for Disease Control and
Prevention (CDC). Recently, the CDC estimated that there are approximately 10
times more people diagnosed with Lyme disease than the yearly reported number.
Using the CDC estimate, approximately 30,000 people are diagnosed with Lyme disease
each year in Connecticut.
The
history of Lyme disease in Connecticut began in 1975 when a cluster of
children and adults residing in the Lyme, Connecticut area experienced
uncommon arthritic symptoms (1976 circular letter). By
1977, the first 51 cases of Lyme arthritis were described, and the
Ixodes scapularis (black-legged) tick was linked to the transmission of
the disease. During 1982, Borrelia burgdorferi, the bacterium that
causes Lyme disease, was discovered and the first brochure addressing
Lyme disease was developed by the Arthritis Foundation. Serology testing
became widely available in Connecticut during 1984. In 1987, Lyme
disease became a reportable disease. All physicians were required to
report any and all cases of the disease. By 1988, the news of Lyme
disease spread and national media attention began. The first federal
funding for Lyme disease surveillance, education, and research became
available in 1991. The first Lyme disease vaccine became available in
1997. To help determine the efficacy of the vaccine, Lyme disease was
made laboratory reportable in 1998. However, the manufacturer
withdrew the vaccine from the market in 2001. In 2002, the vaccine
efficacy study ended, and Lyme disease was removed from the list of
laboratory reportable findings; however, it remained a physician
reportable disease.