2006

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Contents

Chancellor's son has cystic fibrosis

The unlucky Browns' 4 month old boy has the most common serious genetic condition, cystic fibrosis. Numbers in the UK were reported as "more than 7500" which is perhaps a little low, or the adult count. CF survival has steadily lengthened and life to 40 is expected.

Polonium-210 assassination weapon

An investigator looking where he shouldn't according to someone with access to polonium whose radiation was found after spy's death The thallium original theory is now discarded see: Probe into ex-KGB agent poisoning

Open Knowledge meeting in London November 28th.

This may be of some interest to Ganfyd author/editors. At UCL. http://www.okfn.org/okforums/civicinfo2/

Prof Meadow's appeal against GMC ruling - over-ruled by appeal court

26 Oct 2006. The Appeal Court has overturned a ruling that expert witnesses should be exempt from disciplinary action by their regulatory body. See EWCA Civ 1390 Case No: CO/5763/2005. However, the three Appeal Court judges also ruled that the High Court decision that Sir Roy was not guilty of serious professional misconduct should stand. See also more detailed DNUK posting (available to Doctors net uk members only). Further details may be posted here

Genetics of eczema made more firm

The Irish and English Times newspapers report that researchers lead by Irish doctors, or at the University of Dundee, have improved understanding of the genetics of eczema. The gene involved codes for production of filaggrin, a protein that keeps the surface watertight. Homozygotes for a duff gene get ichthyosis vulgaris and the 10% of the UK population heterozygous get dry and flaky skin. The report is in Nature Genetics and mentions the Dundee team led by Professor Irwin McLean working with teams from Glasgow, Seattle and Copenhagen. And Dublin, of course. (March 2006, further reported in September)

Largest UK medical indemnity organisation in turmoil

The independent directors of the Medical Defense Union (MDU) resigned after the board rejected its audit committee's advice to improve transparency. The issue involved the income that the chief executive of the MDU received from MDU Services Ltd which has separate accounts. The Times reports that the MDU has increased membership in Britain by 25% in the last 5 years. The Times 15 September 2006

TRIP Database now searches ganfyd

The TRIP Database, run by User:Jb now searches the ganfyd knowledge base. The TRIP Database provdes a method of collating data from multiple evidence-based resources into one handy search engine, and should be on the favourites list of every clinician.

Hospital patients need feeding, noticed, again

The BBC took notice that nutrition in hospital patients may suffer for quite simple and basic reasons.

GSK criticised over ropirinole in RLS

"The Prescription Medicines Code of Practice Authority, set up by the Association of the British Pharmaceutical Industry, ruled that GSK broke the authority’s rules by promoting an unlicensed drug. “GSK was, in effect, directing patients to a website that contained misleading messages about the safety of ropinirole, which might indirectly encourage patients to ask their doctors to prescribe it,” the authority said." The Times August 2006

Dr Des Spence is the Glasgow GP who raised the complaint, describing Glaxo's support of the Ekbom Support Group (administrative help, paying for headed stationery and broadband access) as hijacking the group. Pharmaceutical companies in the recent decade have been exploring the envelope of direct to consumer (D2C) advertising or promotion, with the indirect promotion of terbinafine being the first obvious example of the type. Alternatives to commerically interested parties funding support and lobby groups include their funding entirely by parties with an interest in avoiding increased (spending on) treatment of the conditions, and funding by people identifying themselves as patients who would benefit from such treatments.

Carter review of pathology published

See Carter review of pathology

Pneumococcal conjugate vaccine added, and other changes to routine childhood immunisation schedule

A vaccine protecting against Pneumococcal meningitis, septicaemia, otitis media and pneumonia was added to the routine childhood immunisation schedule on 4 September 2006.

At the same time, routine boosters for the other conjugate vaccines in the schedule (Hib and group C meningococcus) were added after the age of one year.

See 2006 for more details.

Hypertension drug order advice changed again

NICE issued interim advice again on the order in which to add drugs to treat hypertension. Beta-blockers deprecated.

Avian Influenza

Avian influenza is an ongoing news story. See the ganfyd Avian influenza article for reliable sources of up-to-date information about avian influenza; and the influenza article for information about 'flu in humans.

Sept 2006: A (whole virus) vaccine is showing some promise.

Lin, J et al. Safety and immunogenicity of an inactivated adjuvanted whole-virion influenza A (H5N1) vaccine: a phase I randomised controlled trial. The Lancet, published online September 7, 2006.

Stephenson, I. H5N1 vaccines: how prepared are we for a pandemic? The Lancet, published online September 7, 2006.

NICE guideline evidence ranking scale

The guidelines on the management of Parkinson's disease and atrial fibrillation issued at the same time as the one on hypertension include a modified ranking scale for evidence-based medicine that seems useful. All three have significant implications for how some doctors in England and Wales have managed these common conditions.

Highest Level of Measles Cases in 20 Years

The Health Protection Agency report that the incidence of measles infection has been the highest for nearly 20 years.[1][2]. This increase is attributed to the decline in MMR vaccination uptake due to unfounded fears of an association with autism.

Refinement of Framingham calculations for UK populations

The Framingham calculations and calculators understimate cardiovascular morbidity in some population groups in the UK. A new version with a calculator on-line at Bristol improves on this. The effect is likely to be more use of statins. The calculator software runs on the Bristol server, so the medical algorithm implementation embodied in it is not available for general inspection. June 2006

H5N1 Avian Flu comes to the UK

H5N1 flu has (6 April 2006) arrived in the UK. See HPA press release.

Measles Death in UK

From the Times[3]. The 13 year old boy appears to be one of those who should be protected by herd immunity, but due to anti-vaccinationist activity this is no longer assured, and he had not been immunised so lacked personal protection. April 2006

Variant Creutzfeldt-Jakob Disease

The media cover the early online publication of an article in Lancet Neurology. [4] [5] [6] It was previously thought that most cases of new variant CJD occured when genetically susceptible patients were exposed to the prion agent. The work on animal models raises the possibility that all individuals may be at risk, regardless of the specific genotype. However, those without the susceptible genotype may take longer to manifest symptoms.

TB guidance from NICE

Revised guidelines on the management and prevention of TB were published by NICE on 22 March 2006. According to the NICE website:

"The NICE tuberculosis clinical guideline covers:
   * "diagnosing and treating active and latent TB
     in adults and children
   * "preventing the spread of TB, for example by offering
     tests to people at high risk, and by vaccination. 
"The guideline does not explain TB or its treatments in detail."

These are to be the new "bible", and should replace the BTS guidelines.

Us us us

About 1477 article pages, heading for 1500 by the end of the month. As well as the number, the length and precision of pages is increasing. There are several thousand other pages, of small content, or of discussion behind an article. This represents good progress. 20 March

Drug trial puts 6 people in ITU

Six men who were taking part in a drug trial on a drug known as TGN1412, an immunomodulatory humanized agonistic anti-CD28 monoclonal therapeutic antibody (i.e. active against T-cells), were admitted to the Intensive Care Unit at Northwick Park Hospital on ?12 March 2006. The trial was being run by a company called Parexel, and the drug is manufactured by a company called TeGenero AG. The severe reaction has produced critical multi-organ failure in at least two of the men. It is not clear yet whether the reaction was caused by a manufacturing problem, contamination, a dosing error or whether it was an unexpected idiosyncratic side effect of the drug, which had not been observed in animal trials. BBC News story.

An initial review of the design and procedure of the trial was reported to show there had been no deviation from that design.

Statins and Reversing Heart Disease

Several UK national newspapers carry front pages on a JAMA study on the effect of high-dose rosuvastatin on atheromatous plaques, claiming it as a major breakthrough in reversing heart disease [7] [8] [9]. However, the sensational headlines seem out of proportion to the actual results. The JAMA study was a cohort study looking at high dose rosuvastatin in secondary prevention. The study followed up a total of 359 patients with atheromatous plaque volume as the main endpoint, rather than clinically relevant end-points such as the incidence of ischaemic events or death. As one of the more potent statins, high doses of rosuvastatin were required for modest reductions in plaque size. It is therefore unclear whether this is a class effect of statins, which have been implicated in plaque stabilisation. Furthermore, although the side effect profile of the study was good, rosuvastatin has been subject to concerns about myopathy [10]. If this study had been a randomised controlled trial, in which atheromatous plaque volume was also measured in a control group of patients who received conventional statin therapy presumably the publicity machine that resulted in a 2.3% rise in AstraZeneca's share price would have been even more successful.

Prof Meadow's appeal against GMC ruling upheld

"the decision approaches the irrational"
Full details here. 17/2/06.

Prof Meadow's appeal against GMC ruling - over-ruled by appeal court

26 Oct 2006. The Appeal Court has overturned a ruling that expert witnesses should be exempt from disciplinary action by their regulatory body. See EWCA Civ 1390 Case No: CO/5763/2005. However, the three Appeal Court judges also ruled that the High Court decision that Sir Roy was not guilty of serious professional misconduct should stand. See also more detailed DNUK posting (available to Doctors net uk members only).

Originator of Coombs Test died

Prof. Robin Coombs FRS died on 25 Feb 2006. He invented the Coombs test which was valuable for Rhesus negative women and their babies, and also in blood transfusion. He was a founder member of the British Society of immunology and of the discipline. He was one of the few non-physicians to be an honorary fellow of the royal college of physicians. (Obit in Independent 6 March 2006)

"Our Health, Our Say" white paper published

Published 30/1/06. See the press release, or download the white paper in full or in part. According to statements made around the launch of the paper, it proposes that there should be regular "health MOTs" throughout life, at which screening can be undertaken. It is as yet unclear whether thes proposals for additional screening are politically motivated, or based on solid science.

Short of Money at year-end

Overall the NHS is heading for an overspend by about 1% on the year - not bad actually for most organisations - but because the highest priority for NHS management is to balance the books on the day the year ends the greatly increased numbers of managers are having to shut down services and talk about closing hospital buildings. Like every year. In one sign of financial normality, Trusts are instructed to build up a small surplus as a contingency reserve. Previously any NHS organisation that did this would either have had it raided to bail out a less provident neighbour, or have had it demonstrated that it was sequestering money that belonged to for example GPs. This year they have assurances the first won't happen. [11]

ganfyd blogged

Pneumococcal conjugate vaccine added, and other changes to routine childhood immunisation schedule

A vaccine protecting against Pneumococcal meningitis, septicaemia, otitis media and pneumonia was added to the routine childhood immunisation schedule on 4 September 2006.

At the same time, routine boosters for the other conjugate vaccines in the schedule (Hib and group C meningococcus) were added after the age of one year.

The changes were trailed by minutes of the Joint Committee on Vaccination and Immunisation (JCVI), and an initial report in The Independent, on 3 Feb 2006. A CMO fax cascade was sent out 8 Feb (it can be accessed via this Department of Health page; and there is a Northern Ireland press relese here).

A CMO letter was published on 12 July 2006 giving details about the changes to the routine childhood vaccination schedule that were announced in February. It starts:

From 4th September 2006, the following changes will be introduced:-
  • Pneumococcal vaccine will be introduced to the routine childhood immunisation programme, and the schedule for MenC and Hib vaccines will be modified.
  • The new routine schedule given in Annex 1, Table 1 will be introduced. This schedule requires an additional immunisation visit at 12 months of age.
  • A pneumococcal vaccination catch-up programme will be carried out for children aged under two years.

The letter can be downloaded from the DH website, and details of the changes and materials for professionals and the public are available from the NHS immunisation website.

To support the changes to the paediatric vaccination schedule, new "draft" versions of a number of the Green Book were published on or before 7 August 2006.

HON search Engine Entry

ganfyd is now listed in the very senior Web medical resource search engine at the Health on the Net foundation. The HONcode badge requires certain things less obviously useful for ganfyd than for sites aimed at patients, but we expect to comply with those requirements soon. (...ish) 18 January

Liberal Party Leader Declined: Drink

January: Excess and insufficiently controlled Alcohol consumption has been blamed for a sub-optimal performance in the leader of the third-in-size UK political party. Treatment for Alcohol-related problems has not been so easily amenable to political fixes as some other diseases in recent years.

Israeli PM starts Warfarin, has Haemorrhagic Stroke

January: From various media: Warfarin was started in preparation for a cardiac procedure. Shortly afterward he had a large intra-cranial bleed. The INR is not reported. wikipedia:Ariel_Sharon

Meningitis in the news

Meningitis hit the news on 11 January 2006, following the publication in The Lancet of an article about "new" signs and symptoms of meningitis and (meningococcal) septicaemia. (Most of these would probably not be considered "new" by people specialising in dealing with the condition, but it may that some clinicians were unaware of, for example, the significance of cold extremities in the context of e.g. a febrile illness).

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