Hsieh Forbes Column: UK Vs US Aortic Aneurysm Deaths

My latest Forbes pieces is now out: "Patients With Aortic Aneurysms More Likely To Die In The UK Than The US".

I discuss a recent New England Journal of Medicine study which showed that if you have an abdominal aortic aneurysm (aka "AAA") in the US vs the UK, the UK patients have to wait longer for surgery, and the aneurysms don't get repaired until they are larger (and more at risk of rupture.)

The researchers conclude: "Rates of aneurysm rupture and aneurysm-related death were significantly higher in England than in the United States".

I also cover three natural follow-up questions:

1) Were US surgeons jeopardizing their patients by operating more aggressively than UK surgeons?

2) Did the UK nationalized health system contribute to the lower rates of appropriate surgery in the UK?

3) Will US government policies incentivize American surgeons towards more — or less — appropriate treatments?

For more details, read the full text of "Patients With Aortic Aneurysms More Likely To Die In The UK Than The US".

Doctors Leaving The UK

The Economist discusses the growing problem of unhappy UK physicians, "Some junior doctors consider a strike, while others pack their bags".

One possible "canary in the coal mine" indicator:

Like workers in any public service, doctors always say that morale has never been lower. But this time many are threatening to vote with their feet and practise overseas. Normally the General Medical Council, which regulates the profession, gets 20-25 requests a day for certificates of professional status, which make it easier to work abroad. From September 16th-18th it received a staggering 1,644 requests.

UK Health Coverage

From EP Monthly:

"Man in Great Britain mugged, had his bicycle stolen, and had his leg broken in the process. He called emergency services, but was told that his injury 'wasn’t serious enough' to send an ambulance. Three police officers gave him a ride home where he had to book an Uber ride to get him to the hospital. Good thing he had medical 'insurance,' though."

UK Health Strike

Labor unrest in the UK government-run health system: "Why we’re striking: NHS staff on their decision to walk out".

NHS staff in England will stage a strike on Monday in protest at a third year without a pay rise – their first over pay in more than three decades. More than 450,000 people, from cleaners and porters to ambulance drivers and occupational therapists, will be involved in a four-hour walkout.

Hsieh Forbes Column: UK To Experiment on Cardiac Arrest Patients Without Their Consent

My latest Forbes column is now up: "UK To Experiment on Cardiac Arrest Patients Without Their Consent".

Here is the opening:

Soon, thousands of UK cardiac arrest patients may find themselves enrolled in a major medical experiment, without their consent. This may be legal. But is it ethical?

As described by the Telegraph:

Paramedics will give patients whose heart has stopped a dummy drug as part of an ‘ethically questionable’ study into whether adrenalin works in resuscitation or not… Patients in cardiac arrest will receive either a shot of adrenalin, which is the current practice, or a salt water placebo but the patient, their relatives nor the paramedic administering it will know which. The trial is seen to be controversial because patients will not be able to consent to taking part and could receive a totally useless placebo injection…

First, I want to emphasize that this is a legitimate scientific question. Adrenaline (also known as epinephrine) has been a standard part of the resuscitation protocol for sudden cardiac arrest, along with chest compressions and electrical shocks. (Think of paramedics shouting “clear” on television medical dramas.) But more recent evidence suggests that adrenaline might cause more harm than good in this situation, helping start the heart but possibly also causing some neurological damage. There is a valid and important scientific question. My concern is not over the science behind the experiment, but rather the ethics...

(For more details and discussion, read the full text of "UK To Experiment on Cardiac Arrest Patients Without Their Consent".)

There are two parts of the study that disturb me the most: (1) The drug trial itself, and (2) the decision to not actively inform relatives that any patient who died had been an involuntary participant.  I cover both aspects in more detail in the piece.

Note: I'm not fully settled on what (if any) experimentation should be allowed on incapacitated patients in an emergency setting without informed consent.  But I do think this should be an issue of active discussion, especially for the people whose lives are on the line.

And for a discussion of prior US medical experiments that have been alleged to be unethical, non-consensual, or illegal, see this Wikipedia list.

Quick Links: Scribes, UK NHS

The New York Times describes how electronic medical records so diminish physician productivity that they have to hire scribes to do their data entry when seeing patients.

From the article:

“Making physicians into secretaries is not a winning proposition,” said Dr. Christine Sinsky, a primary care physician at Medical Associates Clinic and Health Plans, in Dubuque, Iowa, who also researches physician dissatisfaction.

Dr. Sinsky, who was an author of the article in Health Affairs, has visited more than 50 primary care practices over the past five years, in the course of studying ways to stem high rates of physician burnout. She has found that physicians who use scribes are more satisfied with their work and choice of careers.

The inconsistency isn’t lost on health care experts. In most industries, automation leads to increased efficiency, even employee layoffs. In health care, it seems, the computer has created the need for an extra human in the exam room...

Dr. Scott Atlas reminds Americans of the horrible care patients can expect in the UK socialized system (NHS or National Health Service), and how American health care is moving in that directions.

Quick Links: Roy, NHS, Friedman

Avik Roy: "Government Takeover: White House Forces Obamacare Insurers To Cover Unpaid Patients At A Loss"

Telegraph: "Inspectors carrying out first spot checks of family doctors in England find maggots in treatment rooms and queues so long that patients brought in stools to sit on"

Classic Milton Friedman talk from 1978: "Economics of Socialized Medicine"



(I don't agree with Friedman on some issues, but he was very good on this topic.)

Quick Links: UK Whistleblower, IRS, Tyranny

Express & Star: "Stafford Hospital whistleblower forced out of town by hate campaign".

David Catron: "An IRS Scandal Inseparable from Obamacare".

Milton Wolf: "Tyranny in our time"

More Lessons From the UK

Diana Furchtgott-Roth writes in RealClearMarkets: "For An Obamacare Preview, Look To England"

Quick Links: Catron, Scherz, Brase

David Catron: "Privatization Shellacs Obamacare Model".

Dr. Hal Scherz: "Healthcare and Politics Do Not Mix".

Twila Brase: "The Obamacare exchanges aren't 'marketplaces'".

A Look At The Future

Walter Russell Mead: "British Hospital Carnage a Window into US Future".

Related from NYT: "English Hospital Report Cites 'Appalling' Suffering":

The report, which examined conditions at Stafford Hospital in Staffordshire over a 50-month period between 2005 and 2009, cites example after example of horrific treatment: patients left unbathed and lying in their own urine and excrement; patients left so thirsty that they drank water from vases; patients denied medication, pain relief and food by callous and overworked staff members; patients who contracted infections due to filthy conditions; and patients sent home to die after being given the wrong diagnoses. 

“This is the story of the appalling and unnecessary suffering of hundreds of people,” Robert Francis, the lawyer appointed by the government to lead the inquiry, said at a news conference.

Right now, such conditions would be nearly unthinkable here in the US.  For now.

Quick Links: UK, FL, 2013

From the UK: "Cystic Fibrosis sufferer denied 'chance of life' drug by NHS".

From Florida: "Health Law's Promise Of Coverage Not Resonating With Miami's Uninsured"

Grace-Marie Turner: "The Avalanche Of New Obamacare Rules Will Come In January, 2013" (Forbes)

Quick Links: Takeover, Taxpayers, Wales

From Patient Power Now: "Ten Reasons ObamaCare is a Government Takeover of Health Care"

Viard: "Both Parties Defend Medicare, None the Taxpayer" (Real Clear Markets).

I look forward to the day when the debate is over how to phase out Medicare, not how to save it.

Wales Online: "Lack of doctors in Wales causing NHS systems to 'break down'" (via Dr. Art Fougner and Dr. Richard Amerling.)

UK Death Rates

In the 10/21/2012 TownHall.com, Daniel Mitchell notes "Wanna Die? Try Government-Run Healthcare in the United Kingdom".

Here is the opening:

I’m not a fan of the American healthcare system. It suffers from huge inefficiencies because of problems such as third-party payer, which is caused by government programs such as Medicare and Medicaid along with a system of tax code-driven over-insurance in the supposedly private sector.

But regardless of how much I grouse about the damage government causes in the United States, I can say with considerable confidence that the government-run system in the United Kingdom has even larger problems...

Mitchell cites recent articles on the higher death rates for patients caused by the government-run health system in the UK.

Such problems wouldn't develop overnight in the US if ObamaCare is fully implemented.  But we would move more quickly in that direction.

UK Patient Abuse

The 10/6/2012 Telegraph reported, "Patients starve and die of thirst on hospital wards".

Some of the statistics of the patient mistreatment in the government-run NHS system are appalling.

From the article:

* as well as 43 people who starved to death, 287 people were recorded by doctors as being malnourished when they died in hospitals

* there were 558 cases where doctors recorded that a patient had died in a state of severe dehydration in hospitals

...In many wards nurses were dumping meal trays in front of patients too weak to feed themselves and then taking them away again untouched.

A report by the Health Service Ombudsman last year condemned the NHS for its inhumane treatment of the most vulnerable.

Leftists like to argue that government-run medicine would ensure "compassionate" care for all.   But the UK stories show that comparisons with the DMV may be closer to the truth.

UK Doctor Brain Drain

The 8/28/2012 Investor's Business Daily reminds us, "Socialized Medicine Is Enough To Chase Away British Doctors".

One excerpt:

More than 8,000 doctors have left since 2008, said the Financial Times. And it's not Britain's problem alone. Nearly 10% of Canadian-trained doctors end up in the U.S...

Yet it's obvious that Britain's socialized medicine is one of the chief reasons doctors are leaving, if not the top reason. The Financial Times reports that physicians have complained of "extensive 'goodwill hours' and coming in on days off." Younger doctors also "feel abused by the long hours" they put in.

When a government declares that it will provide "free" health care, there is no escaping the fact that such a system will one day be overwhelmed by demand and the providers -- the doctors and other professionals who are extensively and intensively trained -- won't be able to keep up. They will be overworked, underpaid and frustrated with the difficulties in performing the task they feel called to, namely healing the sick.

And what does this mean for those in the US?

While ObamaCare might not drive America's doctors elsewhere -- given that the U.S. is the world's last hope for freedom, opportunity and prosperity, there isn't any place to go -- it will cause deep problems. Rather than leave, today's U.S. physicians will simply retire early or change careers and tomorrow's will choose another profession, one less regulated and more remunerative.

(Read the full text of "Socialized Medicine Is Enough To Chase Away British Doctors".)

Fortunately, we still have time to change this.

(Via Dr. Evan Madianos.)

UK National Health Service Branch Bans Paperclips

Although it sounds more like a headline from The Onion, this story is apparently real: "NHS health and safety chiefs ban 'dangerous' metal paper clips".

From the article:

Manchester NHS Trust officials made the decision to stop the use of the metal stationary item after a member of staff cut their finger using one.

In a memo to staff, it was warned that the use of metal fasteners was 'prohibited' and the offending clips must be 'carefully disposed of immediately'.

'Due to recent incidents, NHS Manchester has decided to immediately withdraw the use of metal paper fasteners,' explained the memo featuring an accompanying picture of a paper clip - just to avoid any confusion.

   

'Please ensure any that remain in use be replaced by similar plastic fasteners. 'The use of metal fasteners is prohibited and must be carefully disposed of immediately. Thank you for your co-operation.'

The ban applies only to the employees of that NHS branch, not to the general public.

In other words, the NHS staff aren't considered competent to use metal paperclips safely. But they are deemed competent to make life-and-death medical decisions for UK residents.

Let's just hope no one tells NYC Mayor Bloomberg about this.

(Via @debbywitt.)

Quick Links: Minton, Cochrane, UK

Michelle Minton: "More FDA Control Does Not Mean More Safety" (CEI, 7/18/2012)

John Cochrane: "Forget About the Mandate. Let’s Fix Health Care" (Bloomberg, 7/12/2012)

UK update: "Thousands could lose their sight as NHS cuts cataract surgery by a quarter" (Daily Mail, 7/15/2012)

Quick Links: UK, HSA, TX Medicaid

UK rationing update: "Hospitals 'letting patients die to save money'" (Telegraph, 7/8/2012).

Flopping Aces: "ObamaCare – Killing Health Savings Accounts", 7/8/2012. (Via Dr. Art Fougner.)

Medicaid update: Fewer Texas doctors willing to accept Medicaid (Fort Worth Star-Telegram, 7/8/2012)

Backdoor Euthanasia in the UK?

If this story is accurate, it's very disturbing: "Top doctor's chilling claim: The NHS kills off 130,000 elderly patients every year" (Daily Mail, 6/19/2012).

The article discusses findings by Dr. Patrick Pullicino (a neurologist) regarding:

[T]he Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country.

It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.

It can include withdrawal of treatment -- including the provision of water and nourishment by tube -- and on average brings a patient to death in 33 hours.

Of course compassionate end-of-life care for terminally ill patients is a good thing, when voluntarily chosen by the patient and/or their designee.

But Dr. Pullicino notes (and has reportedly seen first-hand) cases where patients with treatable conditions are put on the LCP pathway against the family's wishes because "because they are difficult to manage or to free up beds".  In other words, this is becoming an involuntary "equivalent of euthanasia of the elderly".

For example:

In the example he revealed a 71-year-old who was admitted to hospital suffering from pneumonia and epilepsy was put on the LCP by a covering doctor on a weekend shift.

Professor Pullicino said he had returned to work after a weekend to find the patient unresponsive and his family upset because they had not agreed to place him on the LCP.

'I removed the patient from the LCP despite significant resistance,' he said. 'His seizures came under control and four weeks later he was discharged home to his family,' he said.

(Read the full text of "Top doctor's chilling claim: The NHS kills off 130,000 elderly patients every year".)

If these reports are true, this is an alarming breach of medical ethics and a gross violation of patients' individual rights.

Fortunately, the US health system isn't at that point yet.  Yet.

(Via Dr. Richard Amerling.)