jay45785's Blog

Herceptin is an expensive drug

The millions the NHS spends on breast cancer drug Herceptin could be used to treat thousands of people using other therapies, a top specialist has said.

Dr Peter Kirkbride, the chief spokesman on radiotherapy for the NHS, said the NHS spent £100m on the breast cancer drug Herceptin in 2006.

But he told Radio 4's The Investigation only about 500 patients had benefited - at a cost of about £200,000 each.

If that was spent on radiotherapy, it could have a dramatic impact, he said.

There is a lot of publicity about the role of chemotherapy but the consensus is of all cancers that are cured, half are cured by surgeries, 40% by radiotherapy and only 10% by drugs Dr Peter Kirkbride National Clinical Lead for Radiotherapy

Cancer survival in the UK is still below the European average, despite recent improvements.

Herceptin was approved for use in women with early stage breast cancer in 2006 after a fast-track assessment by the National Institute for Health and Clinical Excellence.

But now some cancer doctors are concerned this focus on new cancer drugs may not be a good thing.

Dr Kirkbride said: "There is a lot of publicity about the role of chemotherapy but the consensus is of all cancers that are cured, half are cured by surgeries, 40% by radiotherapy and only 10% by drugs.

"If I was to spend £100m on radiotherapy, I could buy something like 90 machines, I could buy 30 simulators and I could probably benefit about 30,000 patients for the same amount of money."

Radiotherapy problems

Earlier this year, the National Radiotherapy Advisory Group published a report which called for a 91% increase in radiotherapy treatments in England in the next 10 years.

But the trade body for the manufacturers of radiotherapy machines has told the BBC that instead of seeing more business, it has all but dried up.

David Miles, the chairman of the radiotherapy specialist focus group of the Association of X-ray Equipment Manufacturers which formed to highlight the problem, says there has been a "collapse in critical investment".

He said: "We noticed after the government initiatives to improve the established stock of radiotherapy equipment, it actually ended in April last year. And the sales of machines then fell off drastically.

"One order has been placed in the last 20 months."

Because it takes around three years from when an order is first placed until it treats its first patient, the radiotherapy focus group at AXrEM says the NHS should have bought 20 replacements machines by now instead of just one.

'Not sexy enough'

Dr Kirkbride thinks part of the problem is raising the discipline's profile in the eyes of both the public and government.

He said: "We are not sexy enough. We don't have pharmaceutical companies backing us in the same way that some of the drugs companies support campaigns for the use of their drugs."

Professor Mike Richards, the National Cancer Director, said there should be room in the cancer budget for both.

He said: "There is no doubt that Herceptin is a good drug. There is no doubt that it has been looked at carefully by NICE and it has been deemed to be both effective and cost-effective.

"Radiotherapy is also effective and we need to make sure that it's not one or the other, but that we actually have a service that delivers both."

A haemorrhagic fever that has killed 16 people and infected more than 50 others in Uganda has been confirmed as the deadly Ebola virus.

The casualties are all in the region of Bundibugyo, on the border with the Democratic Republic of Congo.

DR Congo has been battling for five months to contain an Ebola outbreak close to its border with Angola.

Symptoms of the epidemic include high temperature, bloody diarrhoea and visible haemorrhaging.

There is no known cure for Ebola, which is fatal in around 80% of cases.

Ugandan health officials originally suspected that the Marburg virus was responsible for the deaths, but laboratory testing has shown it to be Ebola.

The authorities say they are taking steps to isolate existing cases.

"From the beginning we've been isolating cases... but we can't say it's contained," Reuters news agency quotes Dr Sam Okware, head of Uganda's haemorrhagic fever task force, as saying.

"There may be other people in those villages unknown to us," he said.

The virus is thought to be transmitted through the consumption of infected bush meat and can also be spread by contact with the blood secretions of infected people.

Contaminated water has polluted drinking supplies, the study says

Research over a two-year period found that poisonous pesticides and heavy metals had entered the food chain.

This had caused a high prevalence of congenital deformities, cancer and kidney damage, the study said.

It was commissioned by the Punjab Water Pollution Control Board, which told the BBC it was studying the findings.

Mercury and arsenic

The report - by a team of senior doctors from the post-graduate Institute of Medical Education in Chandigarh - was conducted over the past two years.

It linked contaminated water with varying degrees of DNA mutation in people in the state.

According to the study, 80% of ground water samples had mercury that was far beyond the permissible level.

Arsenic was found in 70% of samples of effluent, 50% of tap water samples and 57.7% of ground water samples.

A high degree of pesticides had contaminated water in drains in parts of Ludhiana, Amritsar, Jalandhar and Nawanshahr.

The study says that blood samples collected from people in the area showed that in 65% of the cases the DNA had mutated.

Recommendations

The chairman of the Water Pollution Control Board, Yogesh Goel, told the BBC that the recommendations had to be "debated an discussed".

Mr Goel said that the "industry was not just to blame, the overuse of pesticides was another reason. We have to ascertain reasons for it".

Apart from studying the quality of water close to major drains in which effluents were discharged, the study also looked at the health profile of people in settlements close to these drains.

The pollution control chief said the board would study the report and make its recommendations to the government.

He said the study had recommended constant monitoring of water supply and sewerage, involvement of village councils in the treatment and disposal of solid waste, and the need for industries to adopt new technology in extracting ground water.

The state has begun implementing a World Bank project to improve water supply and sanitation in the state.

Analysts are predicting that the euro will be on top for some time

The US dollar slid to a new record low against the euro, as investors bet that the Federal Reserve would cut interest rates to help the economy this week.

The dollar hit a record low against the euro in early Monday trading at $1.4438 - before pulling back to $1.4423 by late trade in New York.

Lower interest rates can weaken a currency as investors move funds to assets that enjoy a higher return.

The dollar's slide helped drive oil prices to a new record above $93.

It also contributed to gold prices rallying to a 28-year high.

The US central bank, the Federal Reserve, is widely expected to cut interest rates by at least a quarter of a percentage point to 4.5% on Wednesday to limit economic damage from the housing market downturn.

Dollar 'heading south'

The dollar has been sliding since the Federal Reserve slashed rates from 5.25% to 4.75% in September in a bid to boost confidence in the world's largest economy.

"Regardless of the size of the cut anticipated by the market, all roads would appear to point south for the US dollar," said Neil Mellor, currency strategist at Bank of New York.

The euro was not the only currency to benefit from the dollar's woes. The Australian and Canadian dollars also hit their strongest levels in over two decades against the US currency.

Meanwhile, the pound hit $2.0627 before falling back slightly to $2.0591.

At the heart of the dollar's decline have been problems in the US housing market, caused by the Fed increasing interest rates in order to slow accelerating inflation.

As a result of the higher borrowing costs, an increasing number of borrowers have defaulted on loans, especially in the sub-prime mortgage market, which specialises in lending to people with poor credit histories.

This, in turn, has spread to global credit markets, as many of the sub-prime mortgages were repackaged and sold on to European and UK banks as investment assets.

The Fed cut its main interest rate in September to ease the pressure on consumers and reassure the global markets but last week's run of weak economic data raised expectations that further cuts were needed to rejuvenate the economy.

Most transfusions are not given in life-threatening circumstances

Red blood cell transfusions given to heart surgery patients could increase their risk of heart attack or stroke, research suggests.

The transfusions are designed to improve the delivery of oxygen to the body's tissues.

But researchers found patients who received a transfusion had a three-fold increase in complications linked to lack of oxygen.

The Bristol Heart Institute study is published in the journal Circulation.

This study suggests that such transfusions may cause more problems than they solve Professor Peter Weissberg British Heart Foundation

The researchers examined data on over 8,500 patients who underwent cardiac surgery over an eight-year period.

They found the risks associated with transfusion occurred regardless of the patients level of haemoglobin - the oxygen-carrying substance in red blood cells.

Lead researcher Dr Gavin Murphy said the problems were probably linked to changes in the red blood cells which took place while they were in storage, and which affected their capacity to carry oxygen.

In addition, toxins can build up in the fluid in which they are stored.

Dr Murphy said there was evidence to suggest that the cells suppress the immune system, but also increase the risk of potentially damaging inflammation.

However, it was very difficult to pinpoint their effect in patients who were usually already extremely sick.

Untested theory

Professor Peter Weissberg is medical director of the British Heart Foundation, which funded the study.

He said: "Red blood cells carry oxygen around the body to supply vital organs.

"Not unreasonably therefore, heart surgeons have assumed that patients who have low red blood cell counts after surgery - as a result of blood loss during or shortly after surgery - would benefit from a 'top up' transfusion of donated red blood cells.

"This study shows the importance of putting such widespread beliefs to the test since it suggests that such transfusions may cause more problems than they solve."

Professor Weissburg said the results would help to make heart surgery safer.

In the UK over half of all heart surgery patients are given blood.

However, only about 3% of these transfusions are given because of life-threatening bleeding.

The remainder are usually given on the basis of a low haemoglobin level, regardless of whether the patient has physical symptoms to suggest they need blood.

The researchers now intend to carry out a larger study to see if changing transfusion guidelines could improve patient outcomes.

For the time being it is suggested that surgeons think twice before giving their patients a transfusion.