Category Archives: Psoriasis

Exposed: ‘secretive’ NHS cost-cutting plans include children’s care

Cancer diagnostics and treatment for children with complex needs are among services earmarked for cost-cutting plans considered by the NHS to plug a funding gap, according to documents seen by campaigners.

The plans, by South Gloucestershire clinical commissioning group and released under a freedom of information request, show that waiting targets for non-urgent operations are also due to be relaxed under the “capped expenditure process” (CEP) as the health service seeks to balance its books in the current financial year.

The proposals are the latest example of what critics have condemned as “draconian” measures that NHS care providers in 13 large areas of England are being told to push through, said the campaign group 38 Degrees, which obtained the documents.

They detail £5m of additional cuts to local services in South Gloucestershire as part of CEP, which is run by national NHS regulators and aims to find £250m of savings by rationing services.

Cancer diagnostics, neurological rehabilitation and children’s continuing care policy for those with complex needs arising from disability, accident or illness, are listed for proposed savings by the South Gloucestershire CCG. It aims to make a total of £4,839,000 in extra savings under CEP. The bulk could be made by “reduction in RTT [referral to treatment] performance”, which would lead to longer waiting times, and reduction in independent sector treatment centre activity.

The crowdfunded group 38 Degrees said the proposals were the first to be revealed under FOI. The doctors’ union, the British Medical Association, which has been frustrated in its attempts to gain information about the CEP through FOI requests, has previously accused NHS bosses of shrouding the process in “totally unacceptable secrecy”.

Leaked proposals from three other areas have already revealed plans including downgrading or closing A&Es and extending waiting time for operations.

Holly Maltby, a campaigner at 38 Degrees, said: “These plans shed light on just how seriously patient care in South Gloucestershire could be affected. They also begin to paint a picture for how services in other areas of England are likely to be hit too – with cancer treatment and children in need affected.”

More than 245,000 people have signed a 38 Degrees petition calling for full public disclosure on each of the 13 regions being forced to make deeper cuts. “The NHS belongs to all of us, so all of us should get a say in any changes to our local services,” said Maltby.

The 13 regions, which are among those expected to record some of the service’s biggest deficits, have been instructed by NHS England and NHS Improvement to “think the unthinkable” to balance the books. Originally they were told to make £500m of savings by March 2018, later reduced to £250m.

The South Gloucestershire CCG is part of the Bristol, North Somerset and South Gloucestershire sustainability and transformation partnership (STP). The South Gloucestershire savings amount to £4.8m, which is roughly a quarter of the £17.2m savings required from the whole STP.

The Guardian revealed in June the threat of closures and increased waiting times under proposals to save £183m across five London boroughs under the CEP programme. There is also concern that cancer treatment may be delayed if the NHS in Cheshire reduces the number of diagnostic endoscopies it undertakes by 25%, and that patients in east Surrey and Sussex may be denied angiograms and angioplasty surgery as part of the CEP savings drive.

The president of the Royal College of Paediatrics and Child Health, Prof Neena Modi, said: “The UK has previously been a champion of fair and equitable cost-containment, so secretive decisions on which services to stop providing are both surprising and unacceptable.

“Transparency is essential around what each service costs the taxpayer, what proportion of public monies go to frontline care and what proportion is wasted on the profit margins of non-NHS providers. The public has a right to know the basis on which decisions are made. These should demonstrably be based on principles of equity, efficiency and should include consultation with healthcare staff and the families of children that will be affected.

“Without such transparency there will inevitably be even greater disquiet at the erosion of children’s services at a time when metrics of children’s healthcare in the UK is a recognised cause of national concern.”

NHS England was approached for comment.

Falling number of NHS child psychiatrists provokes ‘deep concern’

The number of NHS psychiatrists helping troubled children and young people in England is falling despite the growing demand for care, new official figures have shown.

The total number of psychiatrists working in children and adolescent mental health services (CAMHS) fell from 1,015 full-time equivalent posts in May 2013 to 948 in May this year. The figure includes all doctors working in CAMHS psychiatry, both consultants and trainees.

The Royal College of Psychiatrists, which uncovered the drop in NHS Digital’s most recent detailed breakdown of the NHS’s 1.4 million workforce, said it was “deeply concerning”. CAMHS teams are already struggling to keep up with the fast-rising number of referrals they are receiving for young people who have anxiety, depression, eating disorders or other conditions. Growing numbers of under-18s in England are self-harming, with the recent rise especially pronounced among girls.

“At a time when demand on mental health services is at its most acute, we are continuously finding that the supply is just not there. As more and more children and young people come forward with mental health problems, fewer and fewer specialists are available,” said Dr Jon Goldin, the vice-chair of the college’s faculty of child and adolescent psychiatry. “The government must show they are aware of the deficit of doctors working in mental health, and commit to a plan to address this deeply concerning imbalance,” said Goldin.

Many CAMHS teams are seeing experienced psychiatrists retire and are also having difficulty finding recruits to fill vacant posts, leading to a shortfall that is affecting the delivery of patient care.

The charity Young Minds warned that the dwindling CAMHS medical workforce could lead to children and young people waiting even longer to receive urgent treatment.

“CAMHS services are overstretched and leave many young people waiting for assessments or turn them away because the thresholds to access care are too high. So these figures showing a reduction in child psychiatrists are concerning,” said Dr Marc Bush, its chief policy adviser.

There is huge unmet need for support and treatment among distressed children. One in four children and young people referred to specialist mental health services are refused help and do not receive any NHS care, despite their mental distress, according to a report earlier this month by the Education Policy Institute thinktank. That equates to about 50,000 under-18s a year not getting vital help.

The state of children’s mental health has acquired a high profile politically in recent years. Theresa May has made it one of her main domestic policy priorities and has suggested that every secondary school could assign a teacher to help pupils with mental health needs and refer them on to NHS services. Jeremy Hunt, the health secretary, claimed last year that CAMHS was the most inadequate area of care across the whole range of services the NHS provides.

The proportion of under-18s refused help because they do not meet increasingly high thresholds for care imposed by local CAMHS teams has not fallen, despite the high-level political focus. Pushed by the Liberal Democrats, the coalition pledged to put an extra £250m a year into CAMHS between 2015 and 2020 to improve services.

Bush challenged ministers to deliver on pledges they have made. “Earlier this year the government committed to bringing in 2,000 more posts in CAHMS, as well as new jobs in crisis settings. Bringing in more staff and valuing and incentivising those who are overstretched or have left the profession is vital in improving mental health services for children and young people, and a welcome step,” he added.

The Education Policy Institute did find some evidence of recent improvements. The average waiting time for a troubled young person to be assessed fell from 39 days in 2015-16 to 33 days in 2016-17. Similarly, the delay in starting treatment fell from 67 to 56 days in the same period.

Why we are hard wired to watch pornography | Daniel Glaser

The launch of David Simon’s new series The Deuce (starting on 26 September), has thrust pornography back into the spotlight. One of the most famous neuroscientific discoveries of the last decade probably plays a role.

This is the finding of a ‘mirror neuron’ in the cortex of a macaque monkey, so named because it fires both when the monkey sees an action and when it performs it – ‘mirroring’ behaviour it witnesses.

Cells in the human brain have been shown to exhibit similar behaviour. Dancers use their knowledge of movement to help them see it: to understand and enjoy it more. The implications for pornography are clear. Without such a system in the brain, explaining why people find watching sex arousing is difficult.

There have been a few studies demonstrating a correlation between mirror-system activation and erections in men, but it’s largely escaped systematic study. It’s hard to believe that this use has evolutionary significance, although some studies have shown that male monkeys will give up a certain amount of fruit juice to look at pictures of female monkeys’ bottoms.

Dr Daniel Glaser is director of Science Gallery at King’s College London

Mental health data shows stark difference between girls and boys

A snapshot view of NHS and other data on child and adolescent mental health reveals a stark difference along gender lines.

As reported earlier this week, the results of a study by University College London and the University of Liverpool show a discrepancy between the emotional problems perceived by parents and the feelings expressed by their children. Researchers asked parents to report signs of emotional problems in their children at various ages; they also presented the children at age 14 with a series of questions to detect symptoms of depression.

Graph showing that there is a discrepancy between self-expressed emotional problems in teens and problems reported by their parents


The study reveals that almost a quarter of teenage girls exhibit depressive symptoms. Data from NHS Digital, which examines the proportion of antidepressants prescribed to teenagers between 13 and 17 years old, shows that three-quarters of all antidepressants for this age group are prescribed to girls.

More than two-thirds of antidepressants prescribed to teenagers are for girls


Eating disorders are one of the most common manifestations of mental health problems, and are in some cases closely related to depression. A year-by-year breakdown of hospital admissions for eating disorders indicates that, while eating disorders in both boys and girls are on the rise, more than 90% of teens admitted to the hospital for treatment are girls.

Graph showing the difference between girls and boys admitted to hospital for eating disorders

Records also show hospital admissions dating back to 2005 for individuals under 18 years old who committed self-harm. While the numbers for boys have seen a smaller amount of variation with a general upward trend, the figure for girls has climbed sharply during the last decade, with the most significant jump occurring between 2012/13 and 2013/14.

Hospital admissions for self-harm are up by two-thirds among girls


Two of the most common methods of self-harm are poisoning and cutting. Self-poisoning victims are about five times as likely to be girls, and the number of girls hospitalised for cutting themselves has quadrupled over the course of a decade.

Most self-harm admissions involve cases of self-poisoning, which has risen drastically among girls
Self-harm hospitalisations involving girls cutting themselves have quadrupled since 2005


Although self-harm, depression, and other mental health problems are more commonly reported and identified in girls, suicide rates are far higher among boys. This data is consistent with research on differences found between men and women in methods used to commit suicide, the influence of alcohol, and other social or cultural factors.

Teenage boys are more than twice as likely to kill themselves as girls
  • In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

Get up, stand up: including exercise in everyday life healthier than gym, says study

Incorporating physical activity into our everyday lives, from taking the stairs to holding “walkaround” meetings in the office, is more likely to protect us from heart disease and an early death than buying a gym membership, according to the author of a major new global study.

The study, published in the Lancet medical journal, found that one in 20 cases of heart disease and one in 12 premature deaths around the globe could be prevented if people were more physically active. It compared 130,000 people in 17 countries, from affluent countries like Canada and Sweden to some of the least affluent, including Bangladesh and Zimbabwe.

While 30 minutes of exercise per day for five days a week, which most guidelines recommend, reduces heart disease and deaths, one to two hours a day is the optimal amount of physical activity, said lead author Professor Scott Lear, of Simon Fraser University’s faculty of health sciences in Vancouver, Canada.

Most people will think they cannot incorporate that much physical activity into their life, he said. “They will think ‘I’m stressed out and have to make dinner – and then do exercise for two hours!’” he said.

But the study showed that those people who have the highest activity levels are those for whom it is part of their everyday working lives. In developing countries, more people still have physically taxing jobs but as they become more economically prosperous, their activity levels fall.

“They are going from sweeping the floor to buying a vacuum,” said Lear.

He does not advocate selling the vacuum cleaner, but we could all incorporate more activity into our lives rather than relying on occasional forays to the gym or swimming pool. “It becomes routine as opposed to an endeavour,” he said. “Sitting for hours is not good for hearts or the physical body. Getting up every 20 to 30 minutes for a walk around is beneficial. I have a cooking timer.

“We spend a lot of time in meetings. If it is just two or three people, why not have a walkaround meeting?”

He also suggests playing with children in the park rather than sitting watching them, increasing the walk to work by getting off the tube or bus early and taking the stairs rather than the lift.

The authors found that the more physically active people were, the lower their risk of heart disease or an early death.

“Participating at even low physical activity confers benefit and the benefit continues to increase up to high total physical activity,” says the study. People who did more than 750 minutes of brisk walking or equivalent activity per week reduced their risk of death by 36%.

But the study notes that “the affordability of other CVD [cardiovascular disease] interventions such as consuming fruits and vegetables and generic CVD drugs is beyond the reach of many people in low-income and middle-income countries; however, physical activity represents a low-cost approach to CVD prevention.”

While the amount of physical work people do in low income countries reduces heart disease, their chances of surviving if they do have a heart attack or stroke are lower because their health services are not as advanced.

The World Health Organisation recommends that adults aged 18-64 years old do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week, as well as muscle strengthening exercises at least two days a week. But it is thought that almost a quarter (23%) of the world’s population are not meeting physical activity guidelines.

The study is the first to compare physical activity and heart disease levels in countries of varying affluence.

“The clear-cut results reinforce the message that exercise truly is the best medicine at our disposal for reducing the odds of an early death,” said Dr James Rudd, a senior lecturer in cardiovascular medicine at the University of Cambridge.If a drug company came up with a medicine as effective as exercise, they would have a billion-dollar blockbuster on their hands and a Nobel prize in the post.”

“There is a trend for more heart disease in lower income groups both within and between populations,” said John Martin, professor of cardiovascular medicine at University College London. “In the UK it has been shown that lower social class is associated with more heart disease. Walking is easy and cheap. This study should encourage governments to rebalance health budgets away from high tech treatment of heart disease to promoting simple strategies of prevention like walking.”

Professor Metin Avkiran, associate medical director at the British Heart Foundation said: “In an age where we’re living increasingly busy but often sedentary lives in the west, weaving physical activity into our daily routines has never been more important, not only to improve our physical health but also overall well-being. Increased physical activity could have an even greater beneficial impact in lower income countries, due to its low its cost and the high incidence of heart disease in those countries.”

Almost 10,000 EU health workers have quit the NHS since Brexit vote

Around 10,000 EU nationals have quit the NHS since the Brexit referendum, it has emerged.

NHS Digital, the agency that collects data on the health service, found that in the 12 months to June, 9,832 EU doctors, nurses and support staff had left, with more believed to have followed in the past three months.

This is an increase of 22% on the previous year and up 42% on two years previously. Among those from the EU who left the NHS between June 2016 and June 2017 were 3,885 nurses and 1,794 doctors.

This is the first time anecdotal evidence of Brexit fallout for the NHS has been quantified. The staff losses will intensify the recruitment problems of the NHS, which is struggling to retain nurses and doctors.

The British Medical Association said the findings mirrored its own research, which found that four in 10 EU doctors were considering leaving, with a further 25% unsure about what to do since the referendum.

“More than a year has passed since the referendum yet the government has failed to produce any detail on what the future holds for EU citizens and their families living in the UK,” said a spokeswoman for the BMA, which represents 170,000 doctors. “Theresa May needs to end the uncertainty and grant EEA [European Economic Area] doctors working in the NHS permanent residence, rather than using them as political pawns in negotiations.”

The Liberal Democrat leader, Vince Cable, called on May to take urgent action to stop a further exodus at the NHS. “Theresa May must make a bold offer to the EU to ringfence negotiations on citizens’ rights and come to a rapid agreement. We are losing thousands of high-quality nurses and doctors from the NHS, driven partly by this government’s heartless approach to the Brexit talks,” he said.

He and others, including Tory MP and former attorney general Dominic Grieve, want the issue of EU citizens ringfenced from the main Brexit talks to help staunch a potential exodus of valuable EU workers from Britain.

“It’s time for the government to take the issue of EU citizens in the UK and British nationals in Europe out of these negotiations,” said Cable.

This year it emerged that 40,000 nursing posts were now vacant in the NHS in England as the service heads for the worst recruitment crisis in its history, according to official new data.

The figures came a week after a German consultant at a Bristol hospital told the Guardian how his department would be “closed down” if its Spanish nurses did not stay. Peter Klepsch, an anaesthetist, told how he and his neuroscientist wife came to the UK 12 years ago and had planned on staying but were now questioning their long-term future here.

“I know a lot of EU doctors and nurses who are saying, ‘I’m not going to stay very much longer,’” Klepsch said during a day of protest organised by the3million grassroots campaign for EU citizens.

The government has been accused of failing to deliver on its promise to guarantee EU citizens’ rights post Brexit and instead using them as a bargaining chip in negotiations.

In May the EU offered to guarantee the rights of all EU citizens affected by the UK’s decision to quit the bloc, including the 1.2 million British nationals already settled or retired on the continent. However the offer was condemned as “pathetic” by the3million. This has led to an impasse in Brexit negotiations, with less than half the listed issues agreed after the third round of talks ended in August.

Pregabalin, known as ‘new valium’, to be made class C drug after deaths

A prescription drug described as the “new valium” is to be classified as a class C controlled substance after it was linked to a growing number of UK deaths.

Pregabalin – a substance used to treat nerve pain, epilepsy and anxiety – is increasingly being handed out too readily and being used recreationally, according to doctors and pharmacists. They say that when it is mixed with other substances it can lead to overdose. Deaths connected to pregabalin have risen from four in 2012 to 111 last year, according to the Office for National Statistics.

Data provided by NHS Digital shows that prescriptions for pregabalin have shot up more than 11-fold in the last decade, from 476,102 in 2006 to 5,547,560 last year. The government has now accepted in principle that pregabalin should be reclassified as a class C controlled substance, which would mean patients could not obtain a repeat prescription.

Pregabalin prescriptions

Yasir Abbasi, a consultant psychiatrist and clinical director for addiction services at Mersey Care NHS foundation trust, said the rising prescription numbers were worrying as, if used inappropriately, pregabalin could be hazardous.

“Doctors need to be cautious about who they are giving it to and be aware of the potential of the drug to be misused and the fact it could be addictive because there is not much information at the moment. The drug was approved for medical use in 2004 and we need more robust evidence,” Abbasi said.

Addaction, the largest drug and alcohol charity, is calling for GPs to be given guidance about how to prescribe pregabalin, particularly to people with substance misuse history. The charity noted that deaths linked to the drug had risen more quickly than those linked to new psychoactive substances.

Pregabalin deaths

Rachel Britton, Addaction’s lead pharmacist, said: “The deaths linked to it – that will be people taking a cocktail of substances that affect the central nervous system eg heroin, pregabalin and benzodiazepines. It eventually depresses respiration, controlled by the brain, and people who take these cocktails die.”

Those who use pregabalin recreationally call it “Budweiser” because it induces a state similar to drunkenness. It makes users feel relaxed and euphoric in a similar way to tranquilisers. It can also enhance the euphoric effects of other drugs, such as opiates, and is likely to increase the risks when taken in this way.

Abbasi said that those misusing pregabalin included people who took it on top of other drugs but also those who were prescribed it who, without talking to their doctor, then started taking a higher dose.

Testimony from doctors, pharmacists and drug counsellors, who were responding to a Guardian callout, suggests abuse of the drug is widespread.

One emergency medicine nurse, who asked to remain anonymous, said her department had seen five cases a month since summer 2016, when someone had overdosed. She said: “Most people who are affected are those with other addiction problems, and ‘pregabs’ is taken along with other substances.”

A family doctor working in Scotland, who also asked for anonymity, said: “Pregabalin is overprescribed by GPs and other doctors for all types of pain despite it only being licensed for neuropathic pain and generalised anxiety disorder. Others easily access it off the internet. It is used by drug users in order to enhance the effects of other drugs they are taking … This is only going to increase as the prescription of both continues to increase.”

Another anonymous respondent, who works in a hostel, said: “Pregabalin has been the cause of several residents overdosing after using this with other substances. In this environment we suspect residents who are prescribed Pregabalin for anxiety and pain of dealing it to other residents … Over the last six months paramedics have been called out over half a dozen times due to these incidents and it is only through pure luck no one has died and feels only a matter of time before this happens.”

Pharmacists were originally advised not to accept requests for cheaper, generic versions of the drug, but this changed in July, when Pfizer’s patent expired. There are concerns that this has prompted a further rise in the drug’s misuse.

A statement from Pfizer said: “When prescribed and administered appropriately, pregabalin is an important and effective treatment option for many adults living with chronic neuropathic pain, generalised anxiety disorder and epilepsy.”

Earlier this year the British Medical Association (BMA) called for the drug to be made a controlled substance in the UK in the same class as steroids and valium. Last year the Advisory Council on the Misuse of Drugs wrote a letter to the government making the same recommendation. It would mean the drug could not be repeat-dispensed and prescriptions would only be valid for one month. The letter warned of the risk of addiction for both pregabalin and a similar drug called gabapentin.

The minister for crime, safeguarding and vulnerability, Sarah Newton, said: “Any death related to misuse of drugs is a tragedy and that is why we have published a comprehensive new drugs strategy to tackle the illicit drug trade, protect the most vulnerable and help those with drug dependency to recover and turn their lives around.

“We have accepted the Advisory Council on the Misuse of Drugs advice to control pregabalin and gabapentin as class C drugs in principle, subject to the outcome of a public consultation to assess the impact on the healthcare sector. We will launch the consultation shortly.”

No, a standing desk isn’t as unhealthy as smoking

A headline in the Independent today has proclaimed that standing at work is “as unhealthy as a cigarette a day”, citing a new study published in the American Journal of Epidemiology. Illustrated with a picture of a woman bent over her standing desk clutching at her back, we’re instructed to “sit back down”.

But a closer look at the research in question reveals very little to do with standing desks. In fact, the study did not look at standing desks at all. The research was conducted on a sample of 7,320 residents of Ontario, Canada, followed up for over a decade. And its findings are striking – people whose job requires them to stand for long periods of time were twice as likely to contract heart disease compared to those who do jobs that predominantly involve being seated.

So should we all lower our standing desks and recover our office chairs from wherever we’ve stashed them? I am not going to rush to do so (at this point I should fess up and say I have used a standing desk for the past three years and I love it).

Firstly, did the researchers ask people whether they stood or sat at work? No, they did not. People were categorised by the job they did. This immediately means that if you’re an office worker with a standing desk, you’ll be categorised as a sitter, because that’s predominantly what office workers do. The supplementary table of the paper lists a number of common jobs and how they were categorised for the study. Seated jobs included truck drivers, administrative officers, secretaries, professional occupations in business services and accounting clerks. Standing jobs on the other hand included retail salespersons, cooks, food and beverage servers and machine or tool operators.

Now here we get on to the classic problem with observational epidemiology. People who work different types of jobs are going to be different in loads of ways other than their jobs, all of which might also impact on risk of heart disease. This is called confounding. The authors of the study take a number of these in to account, for example pre-existing health conditions, whether the person smokes, whether they were obese, and various others. But it’s very hard to be sure that you’ve taken all of the potential confounding factors like these in to account. There could very easily be other differences rather than just whether a person is more likely to be standing or sitting. For example how much they exercise could have a big impact. Perhaps, as one person on Twitter suggested to me, after a day on your feet you’re less inclined to go for a run of an evening.

Also, as can be seen from the list of jobs they’ve included in each group, there might be socio-economic differences between people who do jobs that require standing at work and those who are more likely to sit – and these might be related to how good your diet is, how much disposable income you have, all things that sadly are associated with ill health. Even if you attempt to take these factors in to account in a statistical model, if you’re relying on self-reported or large scale data it’s almost impossible to be sure you’ve really accounted for all the variability.

So while this study is really interesting, and might indicate that jobs where you’re more likely to stand are linked to an increased risk of heart disease, personally I think there’s a little more going on than simply that we should all sit down at work if we want to protect our hearts. Not to mention that this study has absolutely nothing to do with standing desks, and didn’t actually ask the individuals included whether they did stand or sit at work, but inferred it from the type of job they did. I’m not lowering my standing desk just yet.

Too few antibiotics in pipeline to tackle global drug-resistance crisis, WHO warns

Too few antibiotics are in the pipeline to tackle the global crisis of drug resistance, which is responsible for the rise of almost untreatable infections around the world, the World Health Organisation (WHO) warns.

Among the alarming diseases that are increasing and spreading is multi-drug resistant tuberculosis (TB), which requires treatment lasting between nine and 20 months. There are 250,000 deaths a year from drug-resistant TB and only 52% of patients globally are successfully treated. But only two new antibiotics for the disease have reached the market in 70 years.

The new WHO report, showing the paucity of new antibiotics being developed, lists 12 other pathogens that are serious dangers to health because we are running out of drugs to treat the infections they cause. Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae that have become resistant to the carbapenem class of antibiotic are all on the critical priority list. They are what are known as gram-negative bacteria, capable of causing a range of life-threatening infections such as pneumonia, sepsis and meningitis.

Hospital infections such as C. difficile and MRSA (methicillin-resistant Staphylococcus aureus) are also of major concern. They are a particular danger to patients who are already sick and have fragile immune systems.

“Antimicrobial resistance is a global health emergency that will seriously jeopardise progress in modern medicine,” said Dr Tedros Adhanom Ghebreyesus, director-general of the WHO. “There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery.”

Ed Whiting, director of policy at the Wellcome Trust agreed and said: “There is no doubt of the urgency – the world is running out of effective antibiotics and drug-resistant infections already kill 700,000 people a year globally. We’ve made good progress in getting this on the political agenda. But now, a year on from a major UN agreement, we must see concerted action – to reinvigorate the antibiotic pipeline, ensure responsible use of existing antibiotics, and address this threat across human, animal and environmental health.”

The report’s authors have found 51 new antibiotics and biologicals currently in development that may be able to treat the diseases caused by these resistant bugs. But that will not be anywhere near enough because of the length of time it takes to get drugs approved and onto the market, and because inevitably some of the drugs will not work.

“Given the average success rates and development times in the past, the current pipeline of antibiotics and biologicals could lead to around 10 new approvals over the next five years,” says the report. “However, these new treatments will add little to the already existing arsenal and will not be sufficient to tackle the impending antimicrobial resistance threat.”

More investment is needed in basic science, drug discovery and clinical development, it says, especially for those pathogens on the WHO’s critical priority list. Gram-negative bacteria are getting less research attention because they are harder to find drugs against.

Among all these candidate medicines, only eight are classed by the WHO as innovative treatments that will add value to the current antibiotic treatment arsenal. The rest are just modifications of drugs that already exist and may already be compromised.

“Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence,” says Dr Suzanne Hill, director of the department of essential medicines at the WHO which produced the report.

There is serious concern over the spread of first multi-drug-resistant TB and then extremely drug-resistant TB worldwide. Drug-resistant TB has been found all over the globe.
“Research for tuberculosis is seriously underfunded,” said Dr Mario Raviglione, director of the WHO Global TB Programme. “If we are to end TB, more than $ 800m per year is urgently needed to fund research.”

But new drugs will not be enough, says the WHO. Unless they are sparingly used, resistance will build to the new drugs as well. The WHO says it is working with countries and partners to improve infection prevention and control and to foster appropriate use of existing and future antibiotics. It is also developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.

Surgeons lacked caution in use of vaginal mesh implants, doctor admits

The corporate giant Johnson & Johnson says it acted “ethically and responsibly” in developing and selling its controversial transvaginal mesh implants, which have left hundreds of Australian women with chronic and debilitating pain.

A Senate inquiry is currently examining the impact of transvaginal mesh products, which are used to treat urinary incontinence and pelvic prolapse, common complications of childbirth.

The devices have caused life-altering complications in many cases, leaving women in severe pain and unable to have sexual intercourse.

The inquiry heard from two women whose lives have been destroyed by post-surgery complications – Gai Thompson, who had her surgery in 2008, and Joanne Maninon, who had the device implanted in 2012.

Both struggled with tears as they spoke of the impact the devices have had on their lives.

Maninon said she was told the mesh would make her feel like a “16-year-old virgin” and that she would be back at the gym in 10 days.

“To this day, I can’t sit upright on a chair for longer than 15 minutes at a time due to the searing, burning pain that travels across my lower abdomen and into my pelvis,” she said.


I describe my pain as being cut open and set alight

Joanne Maninon

Maninon was completely bedridden for 14 weeks due to the agonising pain. She wasn’t able to leave the house for months. To get to the doctor, Maninon lay down on a mattress in the back of a station wagon.

“I describe my pain as being cut open and set alight,” Maninon said. “A deep burning, searing ache that intensifies with movement.”

Later on Monday, the inquiry heard from Gavin Fox-Smith, the managing director of Johnson & Johnson Medical Australia and New Zealand.

Fox-Smith offered an apology to “patients who have not experienced a successful outcome from their treatment”.

But he said he believed the current Australian class action against the company would vindicate its actions.

“We believe the evidence will show we have acted ethically and responsibly in the research, development, and supply of the products that are the subject of the proceedings,” Fox-Smith said.

Asked whether the victims’ stories had affected him personally, Fox-Smith replied:

“Thats a pretty personal question senator, so I’ll give you a personal answer,” Fox-Smith said.

“It’s really, really hard to even conceptualise the challenge that the patients are facing. And for me, honestly I’ve had the privilege of working in this industry for 30 years. Our job is to make patients better, so for me it’s really tough, it’s nowhere near as tough as what the patients have to deal with,” he said.

Earlier, Urogynaecological Society of Australasia director, Jenny King, told the inquiry there had been a lack of caution around the use of the devices. Surgeons, she said, thought they were “magic”.

But King labelled any attempt to ban the controversial devices as “hysterical”, saying they had positive outcomes for women who were unable to undergo other major surgery. She instead said doctors should be more careful in their use, avoiding operations on younger and healthy women.

“The impacts that these have had on these women – we have seriously let them down,” King said.

“But what phases me about this is the suggestion that the solution is to ban vaginal mesh products so that other people don’t suffer,” she said.

“I don’t want to defend all of my colleagues, but we’re not really callous. We don’t like it when we can’t fix everyone, we’re really bad at that.”

Estimates vary on the number of women who have experienced problems with the implant. King said about 5% of cases caused problems. Other estimates suggest a higher rate of 10-15%.

The use of the mesh had dropped by 90% in recent years, since concerns became public.

King said the controversy had made her “timid” in her use of the devices. She regretted not using the mesh in some circumstances, because it required women to eventually undergo multiple surgeries.

The cases, seen across the western world, have prompted significant criticism of manufacturer, pharmaceutical giant Johnson & Johnson. The company is currently being sued in a class action in Australia.

The Australian trial has heard the company embarked on an aggressive marketing campaign to sell the products to surgeons, promising they were easy to insert, inexpensive and therefore lucrative. Advertisements associated the products with Lamborghinis and trips to the Swiss Alps.

The risks of the devices were downplayed and controlled trials were either nonexistent or insufficient, the court has heard.

The court also heard the company tried to stop French health authorities publishing a report warning against the use of its untested pelvic mesh devices, two years after they began giving them to Australian women.

Senator Derryn Hinch, who has campaigned against the mesh devices, asked King if Australian surgeons were offered incentives to use the devices.

“No love, truly I’ve never seen anything like that,” she responded. “Nobody’s ever given me one. I would hate to think that had happened, and I don’t know of it, truly.”

The inquiry is considering several courses of action on the mesh. One is to ban the device outright. Another is to introduce a mandatory reporting regime, which forces doctors to report adverse impacts on patients. The inquiry heard there was significant under reporting of adverse consequences on women.

A third is a credentialing system, which would ensure surgeons were appropriately qualified to conduct such surgeries.

It is also considering a recommendation to build a tracking database to monitor the use of different mesh products on patients.

This week it was revealed that Johnson & Johnson pulled two controversial pelvic mesh devices from the Australian market.

The decision came after Australia’s Department of Health required further evidence of the devices’ safety.