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Author: VWheelock

272. Consumerisation of Healthcare

“Be responsible for your own health, says leading GP” was the headline for an article in the Yorkshire Post recently. This was based on a comment made by Dr Clare Gerada, a former Chair of the Royal College of General Practitioners (RCPG). She was advocating that patients should be encouraged to take responsibility for their own health. She commented: “The idea that you need to consult me as the GP to tell you where to go is a nonsense in tomorrow’s world. In yesterday’s patronising world where I had the knowledge and I kept it from you, fine, but you are just as responsible. “If you don’t do that I am afraid that what is going to happen is that you have all the power and no responsibility. “We are going to end up with a burnt-out system where there won’t be health professionals because we can’t take that responsibility.” She went on to say that it was not the job of GPs to provide patients with information about health, fitness and diet. Instead, people should use the internet. In her own work as a GP she was using technology as an alternative to having a face to face consultation. In any event, the technological advances available to doctors means that a 10-minute consultation is becoming very complex. A sign of the times It is now very clear that...

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270. A Critical Look at Chemotherapy

Poor success rates Despite the enormous resources devoted to the development of drugs to treat cancer, the results are less than impressive. In a recent article in the BMJ, Dr Peter Wise former consultant of Charing Cross Hospital and Imperial College Medical School in London reflects on some of the ethical issues which have a bearing on the research, regulation and practice of drugs used as chemotherapeutic agents (1). Although there have been some successes, the fact remains that for 90% of patients, including those with tumours of the lung, prostate, colorectum, and breast, the effect of drug therapy was to increase five-year survival by less than 2.5%. This means that these patients had their lives extended by about three months. Those drugs approved by the US Food and Drugs Administration between 2002 and 2014 increased the survival time by just over two months. Fourteen recent drug regimes approved by the European Medicines Agency were even worse with an increased average survival time of just over one month. In an interview, here is how Dr Wise described what this actually means in practice (2): “I discovered that as many as 75% of patients with cancer assumed that drugs were more or less likely to ‘cure’ their cancer – which is in fact a dangerous illusion. In most instances even ‘control’ is very unlikely due to the development of adaptive...

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269. The Persecution of Professor Tim Noakes

Background I am sure many readers will be familiar with the “trial” of Professor Tim Noakes by the Health Professions Council of South Africa (HPCSA), which has just been completed. Essentially Noakes has been accused of various aspects of misconduct on the grounds that he has advocated the benefits of diets low in carbohydrates and high in fat (LCHF). Anyone who would like to learn more about the background, details of the various sessions and the implications should refer to the numerous blogs by Marika Sboros that provide comprehensive coverage (1). Suffice it to say that Noakes was completely vindicated by the verdict. He and his supporters had presented a very powerful case to justify his stance and in addition had demonstrated convincingly that the evidence base used to formulate conventional dietary recommendations is full of holes. By contrast the HPCSA position was extremely weak and the legal team struggled to find credible experts to support their case, was effectively demolished by the defence advocates. After such an overwhelming defeat, one would expect that any reasonable individuals would accept the result and adjust their position. But not a bit of it. As Marika explains, the approach adopted by the Association for Dietetics in South Africa (ADSA) seems to be to carry on as though nothing has changed (2). The ADSA President Maryke Gallagher has made it clear that dietitians...

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268. Professor Jane Plant RIP

Background  I have just learned that Jane Plant passed away at about a year ago. In 1993, despite several operations, chemotherapy and radiotherapy to treat her breast cancer, she was told she had only months to live. Jane was a first-class scientist and she decided to conduct her own research into the causes of breast cancer and as a result made fundamental changes to her diet, including a total elimination of all foods related to milk and dairy. At the end of the chemotherapy treatment all signs of the cancer had disappeared. At the time of writing the book six years later, she was still free of cancer. However eighteen years later in December 2011, cancer was detected in her lungs and close to her collar bone above an old mastectomy scar. At the time she admitted that she had been quite lax about complying with the strict dietary regime that she had formulated. She immediately returned to the oncologist, Professor Coombes at Charing Cross Hospital, who had treated her in the 1990s. He persuaded her to try a low dose of Letrozole, which blocks the production of oestrogen and she reverted to strict adherence to her dietary programme. By April 2012 the fluid in her lungs had disappeared completely and the lump beneath her collar bone was’ hardly palpable’. By the end of July she was pronounced clear...

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267. The Salt Fix

The full title of this book by Dr James DINicolantonio is “The Salt Fix: Why the Experts Got it All Wrong and How Eating More Might Save Your Life”, which has just been published (1). I have been convinced for some time that the advice to reduce the intake of salt (sodium) was not based on sound science and that this is one more example of how committees of the “great and the good” produce fundamentally flawed reports. Now Dr DiNicolantonio has examined the issues in detail and reaches conclusions that confirm my worst fears. Blood pressure (BP) Those who have formulated the official line seem to have been obsessed with BP. However it turns out that 80% of the population are not sensitive to the BP raising effect of salt at all. So any possible benefit of salt lowering would be restricted to a small proportion of individuals. It is argued that the reduction in BP associated with salt restriction in people with hypertension justifies the recommendations. However the reduction is small and only happens in less than half. It also ignores any harms that may occur, many of which actually increase the risks of heart disease. These include increased heart rate; compromised kidney function and adrenal insufficiency; higher triglycerides and insulin levels, which can all contribute to the development of insulin resistance, obesity and Type 2 Diabetes...

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