Tag Archives: treatment’

Obese people deserve surgical treatment, too | Richard Welbourn

One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?

For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.

The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.

The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.

As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.

I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.

Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.

Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.

To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.

All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.

Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton

Obese people deserve surgical treatment, too | Richard Welbourn

One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?

For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.

The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.

The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.

As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.

I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.

Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.

Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.

To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.

All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.

Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton

Obese people deserve surgical treatment, too | Richard Welbourn

One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?

For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.

The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.

The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.

As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.

I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.

Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.

Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.

To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.

All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.

Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton

Obese people deserve surgical treatment, too | Richard Welbourn

One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?

For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.

The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.

The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.

As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.

I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.

Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.

Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.

To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.

All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.

Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton

Obese people deserve surgical treatment, too | Richard Welbourn

One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?

For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.

The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.

The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.

As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.

I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.

Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.

Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.

To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.

All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.

Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton

I’m lucky. I can afford private mental health treatment. What about those who can’t? | Deborah Orr

Almost one in 10 14-year-old boys have symptoms of anxiety and depression. Which is awful. But almost a quarter of 14-year-old girls have such symptoms. That is such a sad and miserable statistic that one barely knows where to start. The worst thing of all is that it isn’t really surprising. There is so much in this world of ours for a teenage girl to feel worried and hopeless about – not least that the advertising of such sensitivity can easily attract the sneering epithet “snowflake”.

Twas ever thus, though. Bullies find sensitive people like wasps find jam. It’s easy to get carried away with the idea that such statistics are the creation of modernity, thereby assuming that 14-year-old girls were less anxious and depressed back in the old days when rape wasn’t legally possible in marriage, domestic violence was not a term there was any call for, reliable contraception didn’t exist, and many people thought childbirth was the extremely dangerous reason for female existence. Back then, anxious women were called “hysterical”, depressed women were called “sullen”, and childless women were called “barren” or “spinsters”. Good times.

In fact, there is even a positive light in which to view this baleful news of teenage suffering. The interior lives of 14-year-old girls are nowadays acknowledged and considered. It’s been a long time coming, but it’s progress. The difficulty now is in finding a way to address the problem. Or, as is so often the case, finding a way to recruit and retain the army of skilled professionals needed to address it. A paradox of the current era is that our understanding of how to help people with mental health difficulties has never been greater, while the infrastructure that ought to be providing such services has never been more stretched.

I’ve been sorting out my own mental health issues over the past year and a half, as long-suffering readers will know, after I was diagnosed last year with CPTSD – complex post-traumatic stress disorder. I’m lucky. I can afford – just about – high-quality psychotherapy in the private sector. Christ, I wish I’d had it at the age 14. It took me 50 years to realise that being duped and robbed of my gold christening bracelet the first time I ever left my home alone, at the age of three, was traumatic. Of that 50 years, only about 40 minutes was spent discussing the incident and taking part in the eye movement desensitisation therapy (EMDR) – a treatment aimed at expressing traumatic memories and turning them into ordinary ones – that finally allowed my ancient trauma to bugger off out of my brain’s amygdala.

The incident is a bad memory now, not a jumble of repressed feelings that fire up my fight-or-flight reaction every time they get a chance. And I count myself lucky. Early traumas can develop into pervasive personality disorders, some of them serious – such as narcissistic or antisocial personality disorder. Or a combination of both, which pretty much makes a person function as a psychopath.

Not long ago, when CPTSD hadn’t been recognised, sufferers sometimes used to be told they had borderline personality disorder (which is diagnosed far more frequently in women than in men). It’s not hard to understand why. Trauma, left untreated, tends to start colouring every emotion, encouraging hyperarousal at every turn. What’s more, you tend to keep on re-enacting early traumas in all sorts of situations, trying to replay the scene and get a better result. Which never happens. Instead, again and again, you hand over the metaphorical bracelet, along with another little bit of your selfhood. For me, a lifetime with a dodgy fight-or-flight mechanism meant a tin ear for danger and risk, leading, of course, to further trauma. EMDR continues, as and when. There’s still a big, messy pile of stuff to tidy up, and just sifting through it is a large task.

Early research suggests that EMDR is particularly effective in treating children. This makes sense, because you don’t really have to understand the context of your feelings too much to get them corralled off into a more sensible part of your mind. The case for timely intervention when trauma has been suffered is unanswerable, and EMDR should most certainly be part of the lexicon of possible treatments. On the NHS, however, I wouldn’t have got near EMDR, or even heard of it, and I doubt that many 14-year-olds would either. It’s very hard to get beyond your GP, for mental health issues. I know. I’ve tried. I’ve written about that before as well.

Having asked my GP to refer me to a psychiatrist, after a couple of new doses of trauma earlier this year, I was eventually seen by a social worker doing triage. He later arranged for a GP I’d never met to prescribe citalopram, an SSRI – selective serotonin reuptake inhibitor – with which I was entirely unfamiliar. I wrote about how powerfully my symptoms intensified in the first few days, and how unprepared I’d been for this, even though I’d read the instructions carefully and looked the drug up on the internet. I’m glad to say that in time the drug settled down quite nicely – as far as I know. Obviously, I didn’t keep a control copy of myself not taking citalopram, so who can say how I’d be doing now without it? I certainly don’t feel better now than I did before May, when I toppled so hard off the trauma-recovery bandwagon.

I am sure, however, that I feel entirely on my own with this drug, because I am, pretty much. The GP who referred me to the mental health team has moved on, so I have a new GP now. I still haven’t ever met or spoken to the GP who prescribed the pills. The mental health social worker did one follow-up call, said I didn’t reach the threshold for a psychiatric consultation and, with a passive-aggressive “Do you agree with us that this is the right thing to do?”, signed me off.

I said that I accepted, rather than agreed: not being privy to the full spectrum of other cases that my own was being weighed against. Because that’s the thing: the knowledge that there are so many people out there in need so much greater than mine, with resources so much less plentiful. I hope very much that I was stood down in favour of a 14-year-old girl, who is even now beginning to thrive.

Deborah Orr is a Guardian columnist

Private treatment is not the answer to the NHS crisis | Editorial

Waiting has long been the National Health Service’s chronic disease. In 1999, heart surgeons in Middlesbrough used to tell their patients that they had a 5% chance of dying while on the waiting list. Under Labour’s strict targets, waiting times fell. But lately they have risen again. For three years the health service has missed its requirement that patients be seen within 18 weeks for non-urgent surgery and this year ministers quietly relaxed the target. Now, rather than face long queues, growing numbers of patients in England are paying for private treatment instead. These one-off private patients – who do not have health insurance but might chose to have their hip or cararact operation privately – are increasing by up to 25% a year. This is not a good thing.

The NHS in England is in a bad way. In January the Red Cross said the service was facing a “humanitarian crisis”: hospitals were so overcrowded they could not guarantee patient safety. Some hospitals admit they are completely full. Exhausted and demoralised by unmanageable caseloads, many medics are retiring early or going part-time: the NHS is short of 40,000 nurses, and GPs are leaving the NHS at the rate of 400 a month. And every month of 2016-17 saw the NHS fail to treat 95% of those coming to hospital emergency rooms within the desired time of four hours.

The problem is money. NHS trusts spent more than their budgets by £770m last year, and these deficits are building up across the whole health service. Demand from an ageing population of the chronically ill continues to rise. And deep cuts to social care and public health have clogged wards with people who should not be there. Failure to deal with the cash shortage in time often means greater sums must be spent later. Last week the health service announced it will pay recruitment agencies up to £100m to find 3,000 GPs from abroad: an expensive last resort it cannot afford.

The government must act urgently to give the NHS the money it needs. So far there have been few signs it will do so. Spending on the health service is falling as a share of GDP. By the latest calculations Britain spends less than countries such as France and Sweden – which are either as rich or richer per person than the UK – on healthcare, but a similar amount to Spain and Portugal, both of which are poorer per capita than this country.

The health secretary, Jeremy Hunt, prefers to think that there’s still fat to be trimmed from the health service to pay for it. But the NHS continues to be ranked as the most efficient health system of 11 wealthy countries by the Commonweath Fund, an influential health thinktank. It is unlikely that efficiency savings can deal with the problem. Pushing patients towards private practice is not the answer. A health service free at the point of use is one of the pillars that holds up the country; should it be left only to the poor, the service will degrade. The Tories have moved away from former health secretary Andrew Lansley’s disastrous attempts to introduce competition into the service. But private care in the NHS is growing. There was a 33% increase in Department of Health spending on private providers between 2013-14 and 2015-16. Some senior figures in the NHS even worry the Tories plan to stretch the service until it breaks and can be privatised. To ensure that this does not happen the goverment must pay up.

Private treatment is not the answer to the NHS crisis | Editorial

Waiting has long been the National Health Service’s chronic disease. In 1999, heart surgeons in Middlesbrough used to tell their patients that they had a 5% chance of dying while on the waiting list. Under Labour’s strict targets, waiting times fell. But lately they have risen again. For three years the health service has missed its requirement that patients be seen within 18 weeks for non-urgent surgery and this year ministers quietly relaxed the target. Now, rather than face long queues, growing numbers of patients in England are paying for private treatment instead. These one-off private patients – who do not have health insurance but might chose to have their hip or cararact operation privately – are increasing by up to 25% a year. This is not a good thing.

The NHS in England is in a bad way. In January the Red Cross said the service was facing a “humanitarian crisis”: hospitals were so overcrowded they could not guarantee patient safety. Some hospitals admit they are completely full. Exhausted and demoralised by unmanageable caseloads, many medics are retiring early or going part-time: the NHS is short of 40,000 nurses, and GPs are leaving the NHS at the rate of 400 a month. And every month of 2016-17 saw the NHS fail to treat 95% of those coming to hospital emergency rooms within the desired time of four hours.

The problem is money. NHS trusts spent more than their budgets by £770m last year, and these deficits are building up across the whole health service. Demand from an ageing population of the chronically ill continues to rise. And deep cuts to social care and public health have clogged wards with people who should not be there. Failure to deal with the cash shortage in time often means greater sums must be spent later. Last week the health service announced it will pay recruitment agencies up to £100m to find 3,000 GPs from abroad: an expensive last resort it cannot afford.

The government must act urgently to give the NHS the money it needs. So far there have been few signs it will do so. Spending on the health service is falling as a share of GDP. By the latest calculations Britain spends less than countries such as France and Sweden – which are either as rich or richer per person than the UK – on healthcare, but a similar amount to Spain and Portugal, both of which are poorer per capita than this country.

The health secretary, Jeremy Hunt, prefers to think that there’s still fat to be trimmed from the health service to pay for it. But the NHS continues to be ranked as the most efficient health system of 11 wealthy countries by the Commonweath Fund, an influential health thinktank. It is unlikely that efficiency savings can deal with the problem. Pushing patients towards private practice is not the answer. A health service free at the point of use is one of the pillars that holds up the country; should it be left only to the poor, the service will degrade. The Tories have moved away from former health secretary Andrew Lansley’s disastrous attempts to introduce competition into the service. But private care in the NHS is growing. There was a 33% increase in Department of Health spending on private providers between 2013-14 and 2015-16. Some senior figures in the NHS even worry the Tories plan to stretch the service until it breaks and can be privatised. To ensure that this does not happen the goverment must pay up.

New heart treatment is biggest breakthrough since statins, scientists say

Anti-inflammatory injections could lower the risk of heart attacks and may slow the progression of cancer, a study has found, in what researchers say is the biggest breakthrough since the discovery of statins.

Heart attack survivors given injections of a targeted anti-inflammatory drug called canakinumab had fewer attacks in the future, scientists found. Cancer deaths were also halved in those treated with the drug, which is normally used only for rare inflammatory conditions.

Statins are the mainstay drugs for heart attack prevention and work primarily by lowering cholesterol levels. But a quarter of people who have one heart attack will suffer another within five years despite taking statins regularly. It is believed this is because of unchecked inflammation within the heart’s arteries.

The research team, led from Brigham and Women’s hospital in Boston, tested whether targeting the inflammation with a potent anti-inflammatory agent would provide an extra benefit over statin treatment.

The researchers enrolled more than 10,000 patients who had had a heart attack and had a positive blood test for inflammation into the trial, known as the Cantos study. All patients received high doses of statins as well as either canakinumab or a placebo, both administered by injection every three months. The trial lasted for four years.

For patients who received the canakinumab injections the team reported a 15% reduction in the risk of a cardiovascular event, including fatal and non-fatal heart attacks and strokes. Also, the need for expensive interventional procedures, such as bypass surgery and inserting stents, was cut by more than 30%. There was no overall difference in death rates between patients on canakinumab and those given placebo injections, and the drug did not change cholesterol levels.

Dr Paul Ridker, who led the research team, said the study “usher in a new era of therapeutics”.

“For the first time, we’ve been able to definitively show that lowering inflammation independent of cholesterol reduces cardiovascular risk,” he said.

“This has far-reaching implications. It tells us that by leveraging an entirely new way to treat patients – targeting inflammation – we may be able to significantly improve outcomes for certain very high-risk populations.”

The hospital said the reductions in risk were “above and beyond” those seen in patients who only took statins.

Ridker said the study showed that the use of anti-inflammatories was the next big breakthrough following the linkage of lifestyle issues and then statins.

“In my lifetime, I’ve gotten to see three broad eras of preventative cardiology,” he said. “In the first, we recognised the importance of diet, exercise and smoking cessation. In the second, we saw the tremendous value of lipid-lowering drugs such as statins. Now, we’re cracking the door open on the third era. This is very exciting.”

But there were some downsides to the treatment. The researchers reported an increase in the chances of dying from a severe infection of about one for every 1,000 people treated, although this was offset by an unexpected halving of cancer deaths across all cancer types. In particular, the odds of succumbing to lung cancer were cut by over 75%, for reasons the team do not yet understand. The researchers are planning further trials to investigate canakinumab’s potentially protective effect against cancer.

Dr Paul Ridker, who led the study, which was published in the New England Journal of Medicine, said it had far-reaching implications.

“It tells us that by leveraging an entirely new way to treat patients – targeting inflammation – we may be able to improve outcomes for certain very high-risk populations,” he said.

Prof Martin Bennett, a cardiologist from Cambridge who was not involved in the study, said the trial results were an important advance in understanding why heart attacks happen. But, he said, he had concerns about the side effects, the high cost of the drug and the fact that death rates were not better in those given the drug.

“Treatment of UK patients is unlikely to change very much as a result of this trial, but the results do support investigation of other drugs that inhibit inflammation for cardiovascular disease, and the use of this drug in cancer,” he said.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, was optimistic about the trial opening the door to new types of treatment for heart attacks.

“Nearly 200,000 people are hospitalised due to heart attacks every year in the UK,” Pearson said. “Cholesterol-lowering drugs like statins are given to these people to reduce their risk of another heart attack and this undoubtedly saves lives. But we know that lowering cholesterol alone is not always enough.

“These exciting and long-awaited trial results finally confirm that ongoing inflammation contributes to risk of heart disease, and [lowering it] could help save lives.”

New heart treatment is biggest breakthrough since statins, scientists say

Anti-inflammatory injections could lower the risk of heart attacks and may slow the progression of cancer, a study has found, in what researchers say is the biggest breakthrough since the discovery of statins.

Heart attack survivors given injections of a targeted anti-inflammatory drug called canakinumab had fewer attacks in the future, scientists found. Cancer deaths were also halved in those treated with the drug, which is normally used only for rare inflammatory conditions.

Statins are the mainstay drugs for heart attack prevention and work primarily by lowering cholesterol levels. But a quarter of people who have one heart attack will suffer another within five years despite taking statins regularly. It is believed this is because of unchecked inflammation within the heart’s arteries.

The research team, led from Brigham and Women’s Hhospital in Boston, tested whether targeting the inflammation with a potent anti-inflammatory agent would provide an extra benefit over statin treatment.

The researchers enrolled more than 10,000 patients who had had a heart attack and had a positive blood test for inflammation into the trial, known as the Cantos study. All patients received high doses of statins as well as either canakinumab or a placebo, both administered by injection every three months. The trial lasted for four years.

For patients who received the canakinumab injections the team reported a 15% reduction in the risk of a cardiovascular event, including fatal and non-fatal heart attacks and strokes. Also, the need for expensive interventional procedures, such as bypass surgery and inserting stents, was cut by more than 30%. There was no overall difference in death rates between patients on canakinumab and those given placebo injections, and the drug did not change cholesterol levels.

Dr Paul Ridker, who led the research team, said the study “usher in a new era of therapeutics”.

“For the first time, we’ve been able to definitively show that lowering inflammation independent of cholesterol reduces cardiovascular risk,” he said.

“This has far-reaching implications. It tells us that by leveraging an entirely new way to treat patients – targeting inflammation – we may be able to significantly improve outcomes for certain very high-risk populations.”

The hospital said the reductions in risk were “above and beyond” those seen in patients who only took statins.

Ridker said the study showed that the use of anti-inflammatories was the next big breakthrough following the linkage of lifestyle issues and then statins.

“In my lifetime, I’ve gotten to see three broad eras of preventative cardiology,” he said. “In the first, we recognised the importance of diet, exercise and smoking cessation. In the second, we saw the tremendous value of lipid-lowering drugs such as statins. Now, we’re cracking the door open on the third era. This is very exciting.”

But there were some downsides to the treatment. The researchers reported an increase in the chances of dying from a severe infection of about one for every 1,000 people treated, although this was offset by an unexpected halving of cancer deaths across all cancer types. In particular, the odds of succumbing to lung cancer were cut by over 75%, for reasons the team do not yet understand. The researchers are planning further trials to investigate canakinumab’s potentially protective effect against cancer.

Dr Paul Ridker, who led the study, which was published in the New England Journal of Medicine, said it had far-reaching implications.

“It tells us that by leveraging an entirely new way to treat patients – targeting inflammation – we may be able to improve outcomes for certain very high-risk populations,” he said.

Prof Martin Bennett, a cardiologist from Cambridge who was not involved in the study, said the trial results were an important advance in understanding why heart attacks happen. But, he said, he had concerns about the side effects, the high cost of the drug and the fact that death rates were not better in those given the drug.

“Treatment of UK patients is unlikely to change very much as a result of this trial, but the results do support investigation of other drugs that inhibit inflammation for cardiovascular disease, and the use of this drug in cancer,” he said.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, was optimistic about the trial opening the door to new types of treatment for heart attacks.

“Nearly 200,000 people are hospitalised due to heart attacks every year in the UK,” Pearson said. “Cholesterol-lowering drugs like statins are given to these people to reduce their risk of another heart attack and this undoubtedly saves lives. But we know that lowering cholesterol alone is not always enough.

“These exciting and long-awaited trial results finally confirm that ongoing inflammation contributes to risk of heart disease, and [lowering it] could help save lives.”