If I'm missing, or not taking messages sorry – I'm more angry about letting my friends down than YOU will ever be at being let down! Unfortunately that is sometimes a side effect of Cancer! Mea Culpa: may I blame being short fused & grumpy on it too! My first symptoms presented in Nov-1998 – Follow The Trail on >DIARY of CANCER< Immediately Below!
Big Pharma Under Attack as Europe backs biosimilar versions of drugs …
Greg Lance – Watkins
Europe’s oncologists back biosimilar versions of cancer drugs
Europe’s leading association of oncologists has thrown its weight behind cheaper copycat versions of biotech cancer drugs that have lost patent protection, saying they are effective and affordable.
Off-patent chemical medicines have for decades been copied with precision and sold as cheap generic versions, but drug regulators have only over recent years embraced copycat versions of complex biological drugs, known as biosimilars.
Even though biotech drugs, which are proteins made from genetically-modified cells, cannot be exactly replicated, biosimilars have been shown to be equivalent in terms of effectiveness and side effects.
“Biosimilars are must-have weaponry in financially sustaining healthcare systems on a global scale as well as significantly improving outcomes for an increasing number of patients throughout Europe and the rest of the world,” ESMO President Professor Fortunato Ciardiello said in a statement.
ESMO added that price discounts for biosimilars of 20 to 40 percent could be reached in Europe, with potential savings for healthcare systems of 50–100 billion euros ($53-$107 billion) by 2020.
Europe has been in the lead over the United States in opening up regulatory pathways for biosimilars.
The first biosimilar versions of cancer drugs are expected to reach the market in Europe this year, with Amgen Inc and Allergan Plc seeking EU approval of their version of Roche Holding AG’s blockbuster cancer treatment Avastin.
“Biosimilars are an excellent opportunity to have good, valid drug options that improve the sustainability and affordability of cancer treatment in various countries,” ESMO said, also publishing a paper with recommendations on how doctors should handle them.
Early Diagnosis of Cancer In USA Increased By Obamacare …
Greg Lance – Watkins
Researchers credit Obamacare with helping find early-stage cancer
FILE PHOTO – The federal government forms for applying for health coverage are seen at a rally held by supporters of the Affordable Care Act, widely referred to as ”Obamacare”, outside the Jackson-Hinds Comprehensive Health Center in Jackson, Mississippi, U.S. on October… REUTERS/Jonathan Bachman/File Photo
(Reuters Health) – The Affordable Care Act likely extended the lives of thousands of seniors who took advantage of free screening exams and were diagnosed with treatable, early-stage colorectal cancer, a new study suggests.
“I think the prevention-related provisions of the Affordable Care Act helped to detect cancer at earlier and more treatable stages and eventually will save lives,” said senior author Nengliang “Aaron” Yao, a health-policy professor at the University of Virginia School of Medicine in Charlottesville.
Before the Affordable Care Act, often called Obamacare, took effect, people ages 65 and older who were insured under Medicare had to pay $275 for colonoscopies, the report in Health Affairs says.
The Affordable Care Act (ACA) directed that colonoscopies be offered for free.
From 2011, when the law took effect, until 2013, an additional 8,400 seniors, or 8 percent more than before, were diagnosed with early-stage colorectal cancer, researchers estimated.
“The study does a very nice job of showing that when you remove financial barriers to healthcare, health improves,” said Dr. Cary Gross, a professor at the Yale School of Medicine, in New Haven, Connecticut who was not involved in the study. “When the Affordable Care Act granted more generous coverage, we were more likely to detect cancer at an earlier stage.”
“This shows that when it comes to creating a new healthcare plan, the devil’s in the details, and policymakers need to look at things like how will the proposed changes affect cancer screening,” Gross said in a phone interview.
Colorectal cancer is the second leading cause of U.S. cancer-related deaths, according to the U.S. Centers for Disease Control and Prevention, or CDC. Nearly 52,000 Americans died from colorectal cancer in 2013.
Though research shows that screening reduces the risk of dying from colorectal cancer, only 25 percent of uninsured people and 60 percent of insured people had been screened as recommended, a 2015 CDC study showed.
Both Yao and Gross would like President Donald Trump and Republican lawmakers, who have pledged to repeal the ACA, to consider the ramifications of the new study before ruling on future healthcare legislation.
“I’m very concerned that policymakers who are trying to save money by not covering cancer-prevention services are being penny-wise and pound-foolish,” Gross said. “They may save money today, but we will be paying a lot more taking care of patients with metastatic cancer down the road.”
“I’m worried on behalf of our patients and our communities that these great strides we’ve made against cancer will evaporate if the important provisions of the Affordable Care Act, which ensure that patients can access cancer screening services without additional costs, are taken away,” he said.
In the new study, researchers examined data from 18 cancer registries across the U.S. They found no change in the number of Medicare early-stage cancer diagnoses for breast cancer between the period before Obamacare, from 2008 until 2010, until the period after, from 2011 until 2013.
Mammography to screen for breast cancer became free for Medicare patients under the ACA, but before that, it cost just $9 – a significantly smaller financial barrier than the $275 cost of a colonoscopy, Yao said in a phone interview.
In addition, breast cancer screening had been marketed more successfully than colorectal screening before the ACA was enacted, he said.
Gross noted that colonoscopies can actually prevent cancer, because doctors can remove polyps during the procedure, whereas mammograms only allow doctors to see growths in the breast.
The U.S. Preventive Services Task Force found convincing evidence that colorectal cancer screening substantially reduces deaths in adults between 50 and 75 years old, it said last year. The task force recommended screening with colonoscopy, stool analyses or flexible sigmoidoscopy combined with a fecal-occult blood test.
The new study could not determine the impact of free colonoscopies on metastatic colorectal cancer rates or mortality from colorectal cancer. Gross urged follow-up studies examining those numbers after they become available.
Turmeric / Curcumin & Lemon as a Morning Drink is CLAIMED to work wonders …
Greg Lance – Watkins
Turmeric / Curcumin & Lemon as a Morning Drink is CLAIMED to work wonders controlling Inflammation!
Before moving on to discuss Turmeric, Lemon & Cucumin regular readers of this web site will appreciate that I am neither medicaloly qualified nor am I offering advice as such. Further I rarely stray far away from reportage of facts and factually based opinions – almost never venturing into the minefield of alternative medicines where all too many are money spinning quackery!
Before considering ANY alternative medicaments or treatments I strongly advise both common sense and caution and if you have ANY doubts consult your regular Physician who is both trained and insured to responsibly provide his or her considered professional opinion.
That said I do believe that there are many areas that can help, not least of all, your general health and many which may well aid with specific conditions – in simple terms consider the damage that can be done with inadequate or junk foods and the harm that is caused by failure to drink enough and control the intake of dangerous chemicals like alcohol or smoking – both of which are crippling our NHS not to mention far outstripping Class A drugs as a cost on both life and the NHS budget!
Astonishingly the not unusual average intake of sugar and saturated fats also bears a heavy responsibility for the progressive sabotage of not only our NHS but also our Health as a nation!
Therefore perhaps you should consider the following articles on Lemon, Turmeric & Curcumin & the other ingredients, mentioned in this article, as a starting point for your own research and consideration, as with the ‘Nature Cures – Asian’ CLICK HERE to which I have linked in the listed >PAGES< below the header on this web site.
As a point of interest: Many of the articles I have read on both Turmeric & Curcumin advocate that when you take it for their health benefits that you consume it, dependent on in what manner you consume it, that you include a small amount of fat/oil where either a spoonfull of coconut oil, olive oil or similar is added, or alternatively take it together with fine ground fresh black pepper.
I am given to understand that this enhances your system’s absorption of the benefits more readily, avoiding most of the beneficial Curcumin or Turmeric merely passing through the body!
In the articles below it does look as if there may well be some clear benefits, which is more than can be said for any aspect of homeopathy, which is clearly one of those money spinners promoted by charlatans to dupe the gullible, and as far as I can see there are absolutely no downside risks even if they do not deliver as hoped or claimed!
10 Proven Health Benefits
of Turmeric and Curcumin
Turmeric may be the most effective nutritional supplement in existence.
Many high quality studies show that it has major benefits for your body and brain.
Here are the top 10 evidence-based health benefits of turmeric.
1. Turmeric Contains Bioactive Compounds With Powerful Medicinal Properties
Turmeric is the spice that gives curry its yellow color.
It has been used in India for thousands of years as a spice and medicinal herb.
Recently, science has started to back up what the Indians have known for a long time… it really does contain compounds with medicinal properties (1).
These compounds are called curcuminoids, the most important of which is curcumin.
Curcumin is the main active ingredient in turmeric. It has powerful anti-inflammatory effects and is a very strong antioxidant.
However, the curcumin content of turmeric is not that high… it’s around 3%, by weight (2).
Most of the studies on this herb are using turmeric extracts that contain mostly curcumin itself, with dosages usually exceeding 1 gram per day. It would be very difficult to reach these levels just using the turmeric spice in your foods.
Therefore, if you want to experience the full effects, then you need to take an extract that contains significant amounts of curcumin.
Unfortunately, curcumin is poorly absorbed into the bloodstream. It helps to consume black pepper with it, which contains piperine… a natural substance that enhances the absorption of curcumin by 2000% (3).
I personally prefer to swallow a few whole peppercorns along with my curcumin supplement, in order to enhance absorption.
Curcumin is also fat soluble, so it may be a good idea to take it with a fatty meal.
Bottom Line: Turmeric contains curcumin, a substance with powerful anti-inflammatory and antioxidant properties. Most studies used turmeric extracts that are standardized to include large amounts of curcumin.
2. Curcumin is a Natural Anti-Inflammatory Compound
It helps the body fight foreign invaders and also has a role in repairing damage.
Without inflammation, pathogens like bacteria could easily take over our bodies and kill us.
Although acute (short-term) inflammation is beneficial, it can become a major problem when it is chronic (long-term) and inappropriately deployed against the body’s own tissues.
It is now believed that chronic, low-level inflammation plays a major role in almost every chronic, Western disease. This includes heart disease, cancer, metabolic syndrome, Alzheimer’s and various degenerative conditions (4, 5, 6).
Therefore, anything that can help fight chronic inflammation is of potential importance in preventing and even treating these diseases.
It turns out that curcumin is strongly anti-inflammatory, it is so powerful that it matches the effectiveness of some anti-inflammatory drugs (7).
Curcumin actually targets multiple steps in the inflammatory pathway, at the molecular level.
Curcumin blocks NF-kB, a molecule that travels into the nuclei of cells and turns on genes related to inflammation. NF-kB is believed to play a major role in many chronic diseases (8, 9).
Without getting into the gory details (inflammation is extremely complicated), the key takeaway here is that curcumin is a bioactive substance that fights inflammation at the molecular level (10, 11, 12).
In several studies, its potency has compared favorably to anti-inflammatory pharmaceutical drugs… except without the side effects (13, 14).
Bottom Line: Chronic inflammation is known to be a contributor to many common Western diseases. Curcumin can inhibit many molecules known to play major roles in inflammation.
3. Turmeric Dramatically Increases The Antioxidant Capacity of The Body
Oxidative damage is believed to be one of the mechanisms behind aging and many diseases.
It involves free radicals, highly reactive molecules with unpaired electrons.
Free radicals tend to react with important organic substances, such as fatty acids, proteins or DNA.
The main reason antioxidants are so beneficial, is that they protect our bodies from free radicals.
Curcumin happens to be a potent antioxidant that can neutralize free radicals due to its chemical structure (15, 16).
But curcumin also boosts the activity of the body’s own antioxidant enzymes (17, 18, 19).
In that way, curcumin delivers a one-two punch against free radicals. It blocks them directly, then stimulates the body’s own antioxidant mechanisms.
Bottom Line: Curcumin has powerful antioxidant effects. It neutralizes free radicals on its own, then stimulates the body’s own antioxidant enzymes.
4. Curcumin Boosts Brain-Derived Neurotrophic Factor, Linked to Improved Brain Function and a Lower Risk of Brain Diseases
Back in the day, it was believed that neurons weren’t able to divide and multiply after early childhood.
However, it is now known that this does happen.
The neurons are capable of forming new connections, but in certain areas of the brain, they can also multiply and increase in number.
Many common brain disorders have been linked to decreased levels of this hormone. This includes depression and Alzheimer’s disease (21, 22).
Interestingly, curcumin can increase brain levels of BDNF (23, 24).
By doing this, it may be effective at delaying or even reversing many brain diseases and age-related decreases in brain function (25).
There is also the possibility that it could help improve memory and make you smarter. Makes sense given its effects on BDNF levels, but this definitely needs to be tested in human controlled trials (26).
Bottom Line: Curcumin boosts levels of the brain hormone BDNF, which increases the growth of new neurons and fights various degenerative processes in the brain.
5. Curcumin Leads to Various Improvements That Should Lower Your Risk of Heart Disease
Heart disease is the biggest killer in the world (27).
It has been studied for many decades and researchers have learned a lot about why it happens.
It turns out that heart disease is incredibly complicated and there are various things that contribute to it.
Curcumin may help reverse many steps in the heart disease process (28).
Perhaps the main benefit of curcumin when it comes to heart disease, is improving the function of the endothelium, which is the lining of the blood vessels.
It is well known that endothelial dysfunction is a major driver of heart disease and involves an inability of the endothelium to regulate blood pressure, blood clotting and various other factors (29).
Several studies suggest that curcumin leads to improvements in endothelial function. One study shows that is as effective as exercise, another shows that it works as well as the drug Atorvastatin (30, 31).
But curcumin also reduces inflammation and oxidation (as discussed above), which are also important in heart disease.
In one study, 121 patients who were undergoing coronary artery bypass surgery were randomized to either placebo or 4 grams of curcumin per day, a few days before and after the surgery.
The curcumin group had a 65% decreased risk of experiencing a heart attack in the hospital (32).
Bottom Line: Curcumin has beneficial effects on several factors known to play a role in heart disease. It improves the function of the endothelium and is a potent anti-inflammatory agent and antioxidant.
6. Turmeric Can Help Prevent (And Perhaps Even Treat) Cancer
Cancer is a terrible disease, characterized by uncontrolled growth of cells.
There are many different forms of cancer, but they do have several commonalities, some of which appear to be affected by curcumin supplementation (33).
Researchers have been studying curcumin as a beneficial herb in cancer treatment. It can affect cancer growth, development and spread at the molecular level (34).
Studies have shown that it can reduce angiogenesis (growth of new blood vessels in tumors), metastasis (spread of cancer), as well as contributing to the death of cancerous cells (35).
Multiple studies have shown that curcumin can reduce the growth of cancerous cells in the laboratory and inhibit the growth of tumours in test animals (36, 37).
Whether high-dose curcumin (preferably with an absorption enhancer like pepper) can help treat cancer in humans has yet to be tested properly.
However, there is some evidence that it may help prevent cancer from occurring in the first place, especially cancers of the digestive system (like colorectal cancer).
In one study in 44 men with lesions in the colon that sometimes turn cancerous, 4 grams of curcumin per day for 30 days reduced the number of lesions by 40% (38).
Maybe curcumin will be used along with conventional cancer treatment one day. It’s too early to say for sure, but it looks promising and this is being intensively studied as we speak.
Bottom Line: Curcumin leads to several changes on the molecular level that may help prevent and perhaps even treat cancer.
7. Curcumin May be Useful in Preventing and Treating Alzheimer’s Disease
Alzheimer’s disease is the most common neurodegenerative disease in the world and a leading cause of dementia.
Unfortunately, no good treatment is available for Alzheimer’s yet.
Therefore, preventing it from showing up in the first place is of utmost importance.
There may be good news on the horizon, because curcumin has been shown to cross the blood-brain barrier (39).
It is known that inflammation and oxidative damage play a role in Alzheimer’s disease. As we know, curcumin has beneficial effects on both (40).
But one key feature of Alzheimer’s disease is a buildup of protein tangles called Amyloid plaques. Studies show that curcumin can help clear these plaques (41).
Whether curcumin can really slow down or even reverse the progression of Alzheimer’s disease needs to be studied properly.
Bottom Line: Curcumin can cross the blood-brain barrier and has been shown to lead to various improvements in the pathological process of Alzheimer’s disease.
8. Arthritis Patients Respond Very Well to Curcumin Supplementation
Arthritis is a common problem in Western countries.
There are several different types, but most involve some sort of inflammation in the joints.
Given that curcumin is a potent anti-inflammatory, it makes sense that it could help with arthritis. Several studies show this to be true.
In a study of patients with rheumatoid arthritis, curcumin was even more effective than an anti-inflammatory drug (42).
Many other studies have looked at the effects of curcumin on arthritis and noted improvements in various symptoms (43, 44).
Bottom Line: Arthritis is a common disorder characterized by joint inflammation. Many studies show that curcumin can help treat symptoms of arthritis and is in some cases more effective than anti-inflammatory drugs.
9. Studies Show That Curcumin Has Incredible Benefits Against Depression
Curcumin has shown some promise in treating depression.
In a controlled trial, 60 patients were randomized into three groups (45).
One group took prozac, another group took a gram of curcumin and the third group took both prozac and curcumin.
After 6 weeks, curcumin had led to improvements that were similar to prozac. The group that took both prozac and curcumin fared best.
According to this (small) study, curcumin is as effective as an antidepressant.
Depression is also linked to reduced levels of brain-derived neurotrophic factor and a shrinking hippocampus, a brain area with a role in learning and memory.
Curcumin boosts BNDF levels, potentially reversing some of these changes (46).
There is also some evidence that curcumin can boost the brain neurotransmitters serotonin and dopamine (47, 48).
Bottom Line: A study in 60 depressed patients showed that curcumin was as effective as prozac in alleviating the symptoms of depression.
10. Curcumin May Help Delay Aging and Fight Age-Related Chronic Diseases
If curcumin can really help prevent heart disease, cancer and Alzheimer’s… then this would have obvious benefits for longevity.
For this reason, curcumin has become very popular as an anti-aging supplement (49).
But given that oxidation and inflammation are believed to play a role in aging, curcumin may have effects that go way beyond just prevention of disease (50).
Starting the day with your morning routine may suit your needs just fine. A bit of yoga, maybe meditation, a shower, a healthy breakfast with organic coffee, and then out the door. Does this sound familiar? If so, your morning routine is already exceptional. But we have a mighty elixir that can compliment your regimen wonderfully.
You may have heard that warm lemon water will get those pipes working in the morning and optimize your health. You may even drink warm lemon water with Himalayan salt, or warm lemon water with honey in the morning. However, have you heard of warm lemon water combined with honey, cinnamon, and the most essential ingredient to this morning elixir, turmeric? If you have yet to try this one, you may be missing out on an excellent way to begin your day. All-natural lemon and turmeric are especially powerful ingredients that boast a wealth of beneficial properties.
Lemons offer a tasty, tart flavor with many health-promoting properties. According to a study published in the Chemistry Central Journal (2015), lemons possess a treasure trove of natural metabolites. The study authors state, “Citrus fruits exhibit plentiful bioactivities including antioxidant, anti-inflammatory, anti-cancer, antimicrobial and anti-allergy activities, as well as cardiovascular effect, neuroprotective effect, hepatoprotective effect, obesity control, etc.” Lemons are indeed a healthy ingredient to enjoy at the beginning of the day. However, when you couple lemon with turmeric, your health and wellness benefits increase significantly.
Turmeric (Curcuma longa) is a yellow-orange spice that is part of the ginger family. Native to tropical South Asia, turmeric is well known in traditional Asian medicine and cuisine. More recently, its health benefits have been recognized in Western medicine. According to a study published in the Journal of Nephropathology (2012), “Turmeric, a neglected Asian traditional drug might reemerge as remedy and/or preventive tool for various illnesses including different type of cancers, obesity, type-2 diabetes, hyperlipidemia, hypertension, CKD [chronic kidney disease] and ESRD [end stage renal disease], which are steadily increasing globally, claiming many lives and tremendous amount of resources worldwide.”
One active ingredient in turmeric, curcumin, has been the focus of several academic studies.
Curcumin may alleviate inflammation: According to research from the Department of Stomatology at the University of California, San Francisco, curcumin possesses anti-inflammatory properties. The research, published in the Journal of Alternative and Complementary Medicine (2004), found that curcumin, “may exert its anti-inflammatory activity by inhibition of a number of different molecules that play a role in inflammation.”
Curcumin’s anticancer potential: Curcumin may play a vital role in cancer prevention, according to a study published in BioMed Research International (2014). Previous research has highlighted curcumin’s antioxidant, antibacterial and antitumor properties, according to the study, which concluded, “Curcumin, a vital constituent of the spice turmeric, is an alternative approach in the prevention of cancer.”
Therapeutic applications of curcumin: According to a review study published in the AAPS Journal (2013), “curcumin has shown therapeutic potential against a number of human diseases,” including multiple types of cancer, inflammatory bowel disease, irritable bowel syndrome, arthritis, peptic ulcers, psoriasis, H. pylori infection, Alzheimer’s disease, acute coronary syndrome, atherosclerosis, diabetes, and respiratory tract infections.
The Turmeric and Lemon Morning Elixir 1 serving Prep Time- 5 minutes Cook Time- no cooking
Ingredients What you’ll need… 1/2 of a lemon, squeezed for juice 1/4 – 1/2 tsp turmeric 1/2 tsp honey 1/4 tsp cinnamon powder 1 cup warm water, and/or coconut milk (the coconut milk adds healthy fats, and helps absorption of turmeric)
How to make it…
Mix the lemon juice, turmeric and honey into your cup of warm water or milk. You will want to stir these ingredients well. Add cinnamon on top and continue to stir your morning elixir as you drink it — this will ensure that the turmeric does not settle at the bottom of your cup.
Turmeric with its main active ingredient, curcumin, may be that one healthy addition to your morning routine you’ve been looking for, and can help you fight inflammation in your body. I enjoy this elixir nearly every morning with fruit, which adds a sweet, delicious twist.
What healthy alternatives get your morning off to a perfect start?
It’s a great idea to use all-natural remedies wherever possible. After all, the possible side effects of over-the-counter pain relievers can be frightening. Long-term use can even be dangerous. That’s why being able to quickly whip up this pain relief tea is a great comfort. With this recipe, I know I am treating my pain in a natural way that is good for my body. There are many options out there on the market, but using a natural remedy is much more appealing.
The ingredients in this pain relief tea are powerful. There are thousands of great studies on turmeric and the amazing benefits it can give the body. Turmeric has been shown to be effective in treating stomach ulcers, kidney inflammation, Crohn’s disease, osteoarthritis and more. Lemons can help flush away toxins and enhance immune health. Coconut oil is antibacterial, antiviral and antifungal to help prevent the spread of viruses. I could go on and on, but let’s try making this pain relief tea so you feel better!
The agency has highlighted antimicrobial resistance as “one of the most serious health threats” currently facing the United States.
This latest study, published in the Journal of Antimicrobial Chemotherapy, revealed how a PPMO (peptide-conjugated phosphorodiamidate morpholino oligomer) molecule could inhibit the enzyme, New Delhi metallo-beta-lactamase, or NDM-1, that makes bacteria resistant to a wide range of penicillins.
Lead researcher Bruce Geller from Oregon State University said their research differs from previous studies that worked on only one particular strain of bacteria.
“We’re targeting a resistance mechanism that’s shared by a whole bunch of pathogens,” said Geller.
“It’s the same gene in different types of bacteria, so you only have to have one PPMO that’s effective for all of them, which is different than other PPMOs that are genus specific.”
This new molecule was tested successfully in mice and is expected to be ready for human trials in three years.
“We’ve lost the ability to use many of our mainstream antibiotics,” Geller said.
“Everything’s resistant to them now. That’s left us to try to develop new drugs to stay one step ahead of the bacteria, but the more we look the more we don’t find anything new. So that’s left us with making modifications to existing antibiotics, but as soon as you make a chemical change, the bugs mutate and now they’re resistant to the new, chemically modified antibiotic.”
The scientists believe however that this PPMO could be the answer to the crisis facing the healthcare sector.
“A PPMO can restore susceptibility to antibiotics that have already been approved, so we can get a PPMO approved and then go back and use these antibiotics that had become useless,” Geller concluded.
The World Bank released a report at the end of last year warning that human antibiotic resistance combined with the rise of superbugs could potentially kill 10 million people by 2050 and devastate some countries’ economies.
(Reuters Health) – The number of older Americans treated for prostate cancer plummeted 42 percent since health officials began questioning the benefits of screening tests, a new study shows.
The finding points to the success of efforts to curtail the use of controversial prostate-specific antigen, or PSA, screening tests, said lead author Dr. Tudor Borza.
At the same time, his team found, doctors still face challenges trying to convince men diagnosed with early-stage prostate cancer to watch and wait before undergoing surgery or other invasive treatment, Borza said.
From 2007 to 2012, Medicare data showed a relatively meager 8 percent drop in the number of men who were treated immediately after a prostate cancer diagnosis, Borza’s team reports in Health Affairs.
Borza, a urologist and research fellow at the University of Michigan Health System in Ann Arbor, said he feared the statistics might mean that too few men are being screened, and among those who do get a prostate cancer diagnosis, too few are following the strategy of watchful waiting and surveillance recommended by urologists for early-stage tumors.
“I believe more men should be screened,” Borza said in a phone interview. “A diagnosis of prostate cancer shouldn’t necessarily lead to treatment.”
A PSA test measures the amount of a protein known as prostate-specific antigen in a man’s blood. Often, however, the test falsely signals possible cancer, causing anxiety and leading to unnecessary, invasive and sometimes debilitating procedures.
Moreover, many men are likely to die of other causes before slow-growing prostate cancer harms them. But once they’ve been diagnosed with prostate cancer, men frequently elect to be treated and can suffer punishing side effects, including impotence and incontinence.
“Diagnosis has a way of begetting treatment, whether or not it warrants treatment,” said Dr. Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire. He was not involved with the new study.
“Patients think once cancer is there, you’ve got to act,” Welch said in a phone interview. “The question is whether you want to be looking for early forms of cancer.”
Borza and Welch both believe the decision should be left to individual men. But the two physicians approach the question from differing perspectives. Borza’s interest in continuing to screen men for prostate cancer with PSA tests generally aligns with other urologists, and Welch’s preference for less screening aligns with other primary-care physicians.
In 2008, the U.S. Preventive Services Task Force (USPSTF) advised against routine PSA testing of men older than 75. By 2011, the government-backed panel of independent physicians recommended against all PSA screening, warning that the benefits do not outweigh the harms.
The American Urological Association, however, recommends that men weigh the benefits and harms of PSA screening in conversations with their doctors and finds the greatest value to screening in 55 to 69 year olds.
Borza and his team analyzed Medicare data and identified more than 67,000 men age 66 and older who were diagnosed with prostate cancer between 2007 and 2012. During the same period, the population-based rate for men treated for prostate cancer dropped 42 percent, from 4.3 per 100,000 men to 2.5 per 100,000, the study shows.
Nearly three-quarters of the men diagnosed with prostate cancer had curative treatment, such as surgery or radiation, within a year, while 17 percent instead opted for “watchful waiting” or “active surveillance,” the study found.
Most of the men diagnosed with prostate cancer were between 66 and 75 years old, but nearly 16 percent were 80 and older – too old to likely benefit from treatment, according to the USPSTF guidelines.
Men are much more likely to die with prostate cancer than from it, Welch said.
“The question is whether you want to be looking for early forms of cancer,” he said. “There’s no limit to how much data we can collect, but that doesn’t mean we want all that information. It can lead people down a rabbit hole.”
Borza sees it differently.
“Information is power,” he said. “Knowing where you stand allows you to make the best decisions.”
Nonetheless, he acknowledges that deciding whether and how to treat an early-stage prostate cancer diagnosed after a PSA test can be an agonizing decision. And no one can say how many lives might be saved by treating those cancers.
Borza recommends men consider getting PSA tests at 50 years old. But, he said, “It is a very difficult decision for a man to make. There’s not a great answer.”
January 14, 2017 – Is there an increased risk of bladder cancer with pioglitazone-containing medicines? Some (most) drug regulatory agencies worldwide do think so. However, the actions taken vary considerably. The example of the French ANSM (L’Agence nationale de sécurité du médicament et des produits de santé en France) is at one end of the possibilities of actions on could take. In 2011 already, based on the results of an extended epidemiological study (published in 2012) conducted in France which suggested an increased risk of bladder cancer with pioglitazone, the ANSM suspended the use of the pioglitazone-containing medicines (i.e., Actos and Competact) in France.
At the same time in 2011 when the American Food & Drug Administration (FDA) was also fully aware of this epidemiological study conducted in France, FDA resorted to a Safety Communication on June 15, 2011, which in fact was an update of an Safety Communication in 2010 on an “Ongoing Safety Review of Actos (pioglitazone) and Potential Increased Risk of Bladder Cancer After Two Years Exposure” only. Similarly, at the same time the European Medicines Agency (EMA) was in the process of reviewing all available data on pioglitazone-containing medicines use and re-analyze the risk / benefit ratio shortly, while Germany’s Federal Institute for Drugs and Medical Devices (BfArM) at least recommended not to start pioglitazone-containing medicines in new patients. Consequently, in very big markets worldwide, patients remained on pioglitazone-containing medicines and the associated risk for bladder cancer.
And here we go again: On December 12, 2016, FDA has concluded in a Drug Safety Communication, referring to an updated FDA-review of data indicating that there exist an increased risk of bladder cancer with pioglitazone-containing medicines, which currently include, in the US Actos, Actoplus Met, Actoplus Met XR, Duetact, and Oseni. The drug labels of these medicines already contain warnings about the risk of bladder cancer, and FDA has approved label updates to describe the additional studies reviewed.
The question remains if just analyzing data and adjusting drug labels by the FDA is sufficient to protect patients from the risks of getting bladder cancer. In the light of still additional and very serious adverse effects of, for example Actos, there arises the question if FDA should not simply ban pioglitazone-containing medicines and in doing so saving thousands of patients from suffering form bladder cancer. Bladder cancer definitively is no feat. Generally, protecting patients from unintended suffering brought about by medications should be at center stage not at FDA alone, but at all registration authorities worldwide. Whether that is really the case in context of pioglitazone is at least in doubt.
The fact that the manufacturer settles legal cases of patients (or their families) who have connected their bladder cancer condition with taking piaglitazone-containing medications for millions of dollars indicates that enormous economic interest are associated with these medicines. It it unlikely that the manufacturer pays these sums in favor of the individual patient who suffered and in acknowledgement of the sometimes fatal deficiencies of their product. Its seems more a measure to get the product out of sight of negative marketing and news.
Rubraca, A New Drug From Clovis Oncology For Hard To Beat Ovarian Cancer, Approved By FDA …
Greg Lance – Watkins
US FDA clears ovarian cancer drug for hard-to-treat disease
WASHINGTON (AP) — U.S. health officials have approved a new option for some women battling ovarian cancer: a drug that targets a genetic mutation seen in a subset of hard-to-treat tumors.
The Food and Drug Administration cleared the drug, Rubraca, from Clovis Oncology Inc. for women in advanced stages of the disease who have already tried at least two chemotherapy drugs. The Clovis medication targets a mutation found in 15 to 20 percent of patients with ovarian cancer. Women with the variation, known as BRCA, face much higher risks of breast cancer and ovarian cancer compared with other women.
The FDA also approved a companion test that screens for the mutation.
About 1 percent of women will be diagnosed with ovarian cancer in their lifetime, according to the National Cancer Institute. This year an estimated 14,240 women will die from the disease in the U.S. Currently, standard treatment includes surgery to try and remove tumors or chemotherapy.
Rubraca is part of an emerging class of drugs that blocks an enzyme that helps cells — including those affected by cancer — repair themselves. Blocking this mechanism is thought to slow tumor growth. Biotech drugmaker Tesaro Inc. is expecting an FDA decision on a similar drug next year.
“This approval gives Clovis the chance to build a market in this space before the approval of Tesaro’s niraparib,” stated Stifel analyst Thomas Shrader, in a note to investors. He has a “Buy” rating on Clovis.
Shares of the Boulder, Colorado-based company rose $3.28, or 8.8 percent, to $40.48 in trading Monday. Shares of competitor Tesaro fell $4.19, or 3.2 percent, to $127.24.
The FDA cleared the new drug under its accelerated approval pathway, reserved for medicines with promising results that must be confirmed by additional research. If the drug’s benefits do not pan out, the FDA has the option of removing it from the market.
The agency said it cleared Rubraca based on studies of more than 100 women in which 54 percent of patients saw complete or partial shrinkage of their tumors. Typically that benefit lasted about nine months, the agency said in an online posting.
Rubraca will carry a warning label about serious risks, including bone marrow problems and a form of blood cancer called acute myeloid leukemia. Common side effects of the drug include nausea, fatigue, vomiting and low levels of red blood cells.
AA Gill: “More life with your kids, … – but only if you pay” …
Greg Lance – Watkins
(Adrian) AA Gill who was born on 28-Jun-1954 died of advanced metastatic lung cancer on Saturday 10-Dec-2016 – having only been informed he had cancer in November.
Something of an object lesson to us all to ensure we present with any symptoms, which persist, as soon as possible!
Cancer survival rates in Europe The UK has the worst cancer survival rates in western Europe — a third lower than those of Sweden.
“Five-year cancer survival rates are so low in the UK because we’re so slow at diagnosing cancer in the first place. A patient must first see their GP, then be referred to see a specialist. The lag time can be months. And when each GP consultation lasts a few minutes, people can slip through the net altogether. In European countries, patients can access specialist care easily and straightaway.” Dr Conrad Lewanski, consultant clinical oncologist and fellow of the Royal College of Radiologists
Here is AA Gill’s final article, published the day after his untimely death, by way of a tribute to his courage, an example of his wit and honesty and together with a bit of an obit. as an encouragement as we all follow him into that long and inevitable goodnight in our various ways and at our various times in life, whenever that end may be:
AA Gill: “More life with your kids, more life with your friends, more life spent on earth — but only if you pay”
AA Gill used to think that being an NHS patient was like travelling second class on a train, grittier than first class, but in the end everyone ended up at the same destination. But in his farewell piece he tells of his discovery of a drug not available on the NHS …
December 11 2016, 12:01am, The Sunday Times
It seems unlikely, uncharacteristic, so un-“us” to have settled on sickness and bed rest as the votive altar and cornerstone of national politics. But there it is: every election, the National Health Service is the thermometer and the crutch of governments. The NHS represents everything we think is best about us. Everyone standing for whatever political persuasion has to lay a sterilised hand on an A&E revolving door and swear that the collective cradle-to-crematorium health service will be cherished on their watch.
When you look at our awkward, lumpy, inherited short-tempered characters, you’d imagine we might have come up with something more brass-bandy Brit: a bellicose, sentimental military fetishism, perhaps, or sport, or nostalgic history, boastful Anglophone culture, invention, exploration, banking avarice. But no. It turned out that what really sticks in our hard, gimpy, sclerotic hearts is looking after each other. Turning up at a bed with three carnations, a copy of Racing Post, a Twix and saying, “The cat misses you.”
We know it’s the best of us. The National Health Service is the best of us. You can’t walk into an NHS hospital and be a racist. That condition is cured instantly. But it’s almost impossible to walk into a private hospital and not fleetingly feel that you are one: a plush waiting room with entitled and bad-tempered health tourists.
You can’t be sexist on the NHS, nor patronising, and the care and the humour, the togetherness ranged against the teetering, chronic system by both the caring and the careworn is the Blitz, “back against the wall”, stern and sentimental best of us — and so we tell lies about it.
We say it’s the envy of the world. It isn’t. We say there’s nothing else like it. There is. We say it’s the best in the West. It’s not. We think it’s the cheapest. It isn’t. Either that or we think it’s the most expensive — it’s not that, either. You will live longer in France and Germany, get treated faster and more comfortably in Scandinavia, and everything costs more in America.
I’ve wanted to write about the National Health Service for a long time, but it’s resistant to press inquires. While the abstract of the NHS is heart-warming, the truth for patients is often heart-stopping. And junior doctor strikes, executive pay, failing departments, slow-motion waiting times and outsourcing tell a different story, and I’m regularly, ritually refused access by PRs and administrators, or they insist on copy approval or preplanned stories.
One of the doctors I approached was Professor Brian Gazzard, who has a reputation mostly for being an exemplary and inspirationally brilliant physician, but also as something of an ocean-going eccentric. He treats, teaches at and runs the Chelsea Aids clinic. I asked him what had changed most about his job.
“When I started, I told every patient that they were going to die. I could make it easier, make them live a little longer, but everyone died. Now I tell every patient they will live. They will need to do what I tell them, they’ve been silly, but they’ll live to die of something else. That’s astonishing.” He paused so I would understand the effect it has on a doctor. “Look, I really don’t want to be written about. You won’t remember, but we met once before.”
A decade ago, Gazzard diagnosed my foreign correspondent’s dodgy tummy as acute pancreatitis, the result of alcoholism. “Of course I remember. You told me I could never drink alcohol again and I said, ‘You haven’t read my notes, I’ve been teetotal for 20 years.’ And you gave a sigh and reached into a drawer and lit a cigarette and said you’d been dreading telling a restaurant critic he couldn’t have a glass of wine.”
Gazzard laughed. “You’re one of the lucky ones,” he’d said as he walked onto the street clutching an armful of patient files and raised a hand in farewell. He repeated again: “You’re one of the lucky ones. I can always tell.” It was his first misdiagnosis of the day.
What neither of us could know is that my pancreas was already a stuffed wallet of cancer, though not pancreatic — a migrated, refugee, desperate, breathless lung cancer. I stopped smoking 15 years ago and as a gift to myself, proof of the clarity of my lungs, I would spend a week stalking on Loch Maree in Wester Ross. Every autumn since, I have climbed the same hills, chasing the deer, and, trudging upwards, recited a doxology of mostly extinct snouts I no longer puff: Weights, Guards, Navy Cut, Olivier, Black Cat, Passing Clouds, Number 6, Sovereign, Gitanes, Gauloises (does anyone remember when Paris smelt alternately of Gauloises, pissoirs and Chanel?), Winston, Camel, Sobranie, my father’s pipe in the cinema — clouds of sweet latakia smoke in the flickering projection. A Greek cigarette in a red box with a lasciviously smiling girl that called itself Santé, without irony: an untipped fag called Health.
This year, for the first time, I couldn’t make it to the top of the hill. I knelt in the heather, weak and gasping. It was the first time all was not well. There was also a pain in my neck that my doctor said was probably a cervical spine thingy and I should get a scan.
He sent me to Harley Street, where another doctor said: “You haven’t got insurance, it’s going to be expensive. Why don’t you get it done down the road and send me the pictures. A third of the cost.” I said: “I’m here now, just do it.” And he shrugged. A couple of hours later I went back for the results. He had the bland bad-news face.
“That was the best money you ever spent.” He turned the screen around and there was a beautiful spiral of colour clinging like an abstract expressionist collar to my spine. “This is cancer.”
My alien was the most common cancer in old men, our biggest killer — an aggressive, nimble cat-burglar lung cancer that is rarely noticed till it has had kittens
That afternoon I was back in my doctor’s surgery. He was wearing the antiseptic face, the professional-doctor tragedy mask. I’m getting to see this a lot now. It is as much a protection against the infection of catastrophe for them as a respect for its victim. They glaze the bad news with sweet spittle. They’ll say: “The test results were not quite what we hoped. It might be trapped wind or it might be the thing that hatched from John Hurt’s stomach. Realistically, we’ll have to assume it’s more alien than fart.” My alien was the most common cancer in old men, our biggest single killer: an aggressive, nimble cat-burglar lung cancer that is rarely noticed till it has had kittens.
Guy has been my doctor for 30 years — 32 to be precise. He was the doctor who put me into treatment for addiction and he’s looked after me and my kids ever since. He’s private, so I pay. If I need a test, an x-ray, a consultant, I’ll pay. If I need anything more than a couple of antibiotics, I’m going to the NHS. Within 24 hours I have an NHS consultant oncologist and early-morning appointments, for scans, blood tests and x-rays.
You couldn’t make up Charing Cross Hospital. Well, not as a hospital you couldn’t. It’s a monstrous, hideous, crumbling patched-up mess — the Elephant Building. On the way in I notice a couple of posters on the street saying “Save Charing Cross Hospital”. They’re stuck on a municipal noticeboard that’s falling over.
It’s plainly the result of dozens and dozens of attempts to make things better and, in fact, it is the physical embodiment of how most of us, trying to make our way through the teetering automatic doors, feel. It has a very good collection of contemporary British art. In some back corridor there is a series of Peter Blake’s best silk screens.
I love it: it’s how I feel. The lifts take hours to arrive, emphysemically, wheezingly opening their doors, and when they do, it’s without confidence or conviction. A man going up to the cancer ward puts his hand in front of the door and gets out. “I’m too frightened to take this lift,” he says.
In a waiting room, hundreds of us take numbers to sit like wilted potted plants in an autumn garden-centre sale, to take it in turns to meet the antiseptic face. If this were a set for a film, all the actors and extras would be pulling looks of agony and sadness and fear, but the face of real cancer wipes our expressions to a pale neutral human.
The NHS has one of the worst outcomes for cancer treatment in Europe. It’s something to be borne in mind when you’re deciding to combine chemotherapy with a safari, or want to embark on a bar-thumping argument about health tourism. It was the first question I asked my oncologist, Dr Conrad Lewanski. “Why is this such a bad place to get cancer, when we have lots of hospitals, when we teach doctors from all over the world, when we’ve won more Nobel prizes than the French?”
“It’s the nature of the health service,” he says. “The key to cancer outcomes is the speed of diagnosis and treatment.” The health service was set up with GPs separate from hospitals. The system means you probably have to wait a week or so for an appointment to see first your GP, or a clinic. The average time for that consultation will be seven minutes. Perhaps your cough isn’t a priority. And then if your doctor thinks it does need a second opinion, he’ll suggest you see a consultant, and that’s likely to take a month. If the GP suspects cancer, that referral time is reduced to two weeks. He or she will probably write a letter, often two — all doctors still carry fountain pens.
And then there are all the appointments — for tests, a cancellation, a missed x-ray, a scan — which can put months on a diagnosis. It’s not the treatment, it’s the scale of the bureaucracy and the Attlee-reverential, immovable-but-crumbling structure of a private-public doctor-consultant arrangement, which was the cornerstone laid down by the 1945 government at the insistence of doctors. That is the chronic tumour in the bowel of the system.
How do men react when you tell them it’s fatal? ‘Always the same way — with stoicism.’ Bollocks, I thought that was just me
I’m given a talk by a nurse on the consequences of chemotherapy. She uses three pens. Two of them have three coloured barrels each. The scribbling, the underlining, the stars, the acronyms, the exclamation marks become ever more emphatic and decorative. Finally she hands me a notebook that is unintelligibly runic, but says not to worry because it’s all on the computer, which she then turns on to show me a heart-warming film about sexual infections and high temperatures.
The hospital flutters with bits of paper like mayflies. They’re propped up against screens, wedged up against keyboards, stuffed into teetering files, and then there is the constant Tourette’s questions, “When’s your birthday? What’s the first line of your address?”, all to collide you with the right cancer, to go with all the forms, the signatures, the screens, the machines, the radiation disclaimers and destiny. It makes Kafka look like ee cummings.
I like my oncologist. He doesn’t have the morphine face; he looks amused, inquisitive, like a shaved, garrulous otter. All he does is lung cancer. This is his river, tumours his trout. He’s been a consultant for 15 years. Two years in, his father got it and died: “The worst thing I’ve ever had to go through. I do know what this is like — so how much do you want to know?”
“Everything, and the truth.”
I’ve never Googled cancer, but I’ve discovered that every one of my friends who owns their own house has a preferred cancer specialist and a hospital to go with them. They also have a perfect gardener, an ideal interior decorator and a masseur that they insist — insist — I use, because they are all the best and, of course, you only get what you pay for. Lots of them are astonished I’m still in this country of catastrophic cancer statistics.
Those who don’t have money for their own homes have magical diets, homeopathy and religious new-age cures, or at least a conspiracy theory about big pharma hiding the efficacy of vitamin C, kale, magnetism and mistletoe. If it doesn’t make you better, at least you get snogged a lot.
And everyone, but everyone, will have a mantra story of their secretary’s husband or a woman they used to work with who was given three weeks to live and is still stacking shelves or conducting operas 10 years later. These little homilies are handed out with the intense insistence of lucky heather, using the language of evangelical religion and locker-room encouragement.
Why is our reaction to cancer so medieval, so wrapped in fortune-cookie runes and votive memory shards, like the teeth and metatarsals of dead saints? Cancer is frightening. One in two of us will get it. It has dark memories, unmentionably euphemised. In the public eye, not all cancers are equal. There is little sympathy for lung cancer. It’s mostly men, mostly old men, mostly working-class old men and mostly smokers. There is a lot more money and public sympathy for the cancers that affect women and the young. Why wouldn’t there be?
“How do men react when you tell them their cancers are fatal?” I ask Dr Lewanski. “Always the same way — with stoicism.”
“Bollocks,” I think. “I thought that was just me.”
Actually it’s not being told you’ve got cancer that is the test of character, it’s the retelling. Going home and saying to the missus: “That thing, the cricked neck. Actually it’s a tumour, the size of a cigar.” It ought to come with a roll of thunder and five Jewish violinists, instead of the creaky whisper of fear.
People react differently to different cancers: most women think they’ll survive, and statistically they’re right. Most men think they’ll die — and likewise. “So, what’s the treatment?”
“Chemotherapy. Platinum in your case. It has a very good chance.”
Someone should write a paper on the euphemistic size comparisons for tumours. There should be an esite, Euphotumours. The images are very masculine: golf balls, cricket balls, bullets, grenades, ruminant testicles. No one ever says, “I’ve got a cancer the size of a fairy cake.”
And what about after the chemo?
“Well, there’s a new treatment, immunotherapy. It’s the biggest breakthrough in cancer treatment for decades. Cancers camouflage themselves as chemical markers that tell your body’s natural defences that there’s nothing to see here, move along. These new drugs strip away the disguise and allow your body’s natural system to clean up. It’s new and it’s still being trialled, but we’re a long way along the line and it is the way cancer treatment is bound to go. It’s better for some growths than others, but it’s particularly successful with yours. If you were in Germany or Scandinavia or Japan or America, or with the right insurance here, this is what you would be treated with.”
The doctor looks at Nicola, the missus. His otter face has grown a little sphinxy.
“You remember asking if the treatment Adrian got on the NHS would be any different from being a private patient? And I said a better cup of coffee and more leeway with appointments. Well, this is the difference. If he had insurance, I’d put him on immunotherapy — specifically, nivolumab. As would every oncologist in the First World. But I can’t do it on the National Health.”
The National Institute for Health and Care Excellence (Nice), the quango that acts as the quartermaster for the health service, won’t pay. Nivolumab is too expensive — £60,000 to £100,000 a year for a lung-cancer patient; about four times the cost of chemo. And the only way to see if it will work for an individual patient is to give it to them all, and the ones it doesn’t work for will weed themselves out. What Nice doesn’t say about the odds is that immunotherapy mostly works for old men who are partially responsible for their cancers because they smoked. Thousands of patients could benefit. But old men who think they’re going to die anyway aren’t very effective activists. They don’t get the public or press pressure that young mothers’ cancers and kids’ diseases get.
As yet, immunotherapy isn’t a cure, it’s a stretch more life, a considerable bit of life. More life with your kids, more life with your friends, more life holding hands, more life shared, more life spent on earth — but only if you can pay. I’m early for my first eight-hour stint of platinum chemo. The ward in Charing Cross looks like a cross between a milking shed and an Air Koryo business lounge. I am settled into a hideous but comfortable chair and a tap is jabbed into the back of my hand. A series of plastic bags full of combative and palliative cocktails slowly dribble into my body and every 10 minutes I have to shuffle to an invalid’s loo to dribble it out again.
I like it here. The nurses are funny and comforting, optimistic, and bear the weight of the sadness, the regret and the pity in the room on their shoulders with an amused elegance and sincerity that comes from their years of experience, or the naivety of inexperience. The other patients shuffle in with their partners to share sandwiches, talk about shopping and the cousins in New Zealand and window boxes. There are children with ageing parents, happy/sad to be able to repay an infant’s debt.
I manage to find the one dealer in the ward, or rather she finds me. Her boyfriend’s making hash cakes — they’ve definitely shrunk his tumour, I should definitely have some. I smile, shrug apologetically and say sadly I’m already a junkie. I don’t take drugs.
“Really? Even for this?” I’m not giving up 32 years of clean time for some poxy lung.
And there are the ones who sit alone, who don’t have any friends to play cards with them, to drip the will and the strength and the faith to face this. I don’t know how anyone manages to do this on their own.
An old friend sits through the mornings with me, Nicola comes with lunch and Flora and Ali, my grown-up kids, share the afternoon. If it wasn’t for the cancer, that would be a really lovely day. If it wasn’t for the cancer. There’s a natural break in the article here. It should have been finished two weeks ago, but I had a bad night, a really bad night.
Nicola called Guy, the GP, and he came round and took a look and said: “He needs to be in A&E now.”
So I’m on a gurney in Charing Cross at nine in the morning. On the other side of the blue plastic curtain, a bloke is being held down by three policemen shouting, “Don’t flick your f****** blood over here, I don’t want what you’ve got.”
A young doctor comes and asks me questions. All doctors in A&E are preternaturally young. One of the questions after “What’s your date of birth and the first line of your address?” is inevitably “Can I put my finger up your bottom to see if there’s any poo or blood?”
The other question is: “On a scale of 1 to 10 — 1 being a scratch and 10 unspeakable agony — what do you think you’re suffering at the moment?” You wouldn’t describe this as thin pain. It’s 10 out of 10. My stomach is agonised with a terrible wrenching distension. I’ve lived a middle-class, sheltered, uncombative, anti-violent life, so I don’t know how this compares to other more manly men’s pain, but this is by miles and miles the worst thing I’ve ever been through, thank you for asking.
More x-rays and blood tests and the surgeon returns with the complete granite face and says: “Well, it could be a burst ulcer, but of course it isn’t. The tumour in your pancreas has increased in size very fast. It’s as big as a fist.” And he shows me a fist in case I’d misplaced the image.
I’ve decided to call the pancreatic tumour Lucky, as a nod to prophetic Professor Gazzard. So the chemotherapy isn’t working. I ask my oncologist what’s next.
“It’s a bugger,” he says. “It looked so hopeful, but you’re right, it isn’t working. The pancreas is a bad place. We can’t operate and the side effects of radiation aren’t worth the risk.” And there’s pancreatic pain, which is famously in a league apart, so at least I can be stoical about that.
“Well, on the NHS we can give you another round of chemo, a bit rougher with slighter outcomes … but there is really only one treatment for you: nivolumab.”
From behind the blue curtain, the nurse asks the policeman: “What do you want to do with him?”
“Oh, let him go,” says the copper.
“I thought you’d arrested him?”
“No. Let him go.”
That evening I’m sitting in bed on the cancer ward trying to get the painkillers stabilised and a young nurse comes in.
“There you are. I’ve been waiting for you all day. You’re supposed to be with me down in chemotherapy. I saw your name. Why are you up here?”
“Well, it turns out the chemo isn’t working.” Her shoulders sag and her hand goes to her head. “F***, f***, that’s dreadful.” I think she might be crying.
I look away, so might I.
You don’t get that with private healthcare.
Cancer survival rates in Europe The UK has the worst cancer survival rates in western Europe — a third lower than those of Sweden.
“Five-year cancer survival rates are so low in the UK because we’re so slow at diagnosing cancer in the first place. A patient must first see their GP, then be referred to see a specialist. The lag time can be months. And when each GP consultation lasts a few minutes, people can slip through the net altogether. In European countries, patients can access specialist care easily and straightaway.” Dr Conrad Lewanski, consultant clinical oncologist and fellow of the Royal College of Radiologists
THE “REVOLUTIONARY” LUNG-CANCER DRUGS
What is immunotherapy? This is a treatment used in cases where chemotherapy hasn’t worked. The drugs involved strip cancer cells of the “camouflage” that stops the immune system from attacking them as it would other diseases. Only 20% to 30% of people with non-small-cell lung cancer — which accounts for 85% of lung cancers — respond to the therapy, but researchers have found it to be remarkably successful among those whose tumours were caused by smoking.
How is it administered? Immunotherapy drugs are injected into the patient’s bloodstream via a drip or Port-a-Cath: a plastic tube leading into a large chest vein. Patients tend to receive the treatment for an hour every fortnight, but this depends on the condition.
Who has access to nivolumab? The pioneering drug nivolumab has received its licence for use in the UK and is under review by Nice, which says: “We do not have the full picture yet and we are still working with the company to see what we can do to answer the uncertainties in the evidence.” This means patients in England and Wales will have to wait to find out if they will be able to get it universally on the NHS. In Scotland, which has its own drug-approval system, nivolumab is already available.
What is pembrolizumab? This immunotherapy drug, similar to nivolumab, is also licensed in the UK. Ten days ago, Nice announced that it will finally be available to patients with non-small-cell lung cancer on the NHS. This is not the drug AA Gill’s oncologist recommended for him.
How much does nivolumab cost? The approximate cost for treating non-small-cell lung cancer is £5,700 a month or £68,400 a year.
What is Nice’s role? Nice makes recommendations on whether the NHS in England — and in some cases Wales, Scotland and Northern Ireland — should fund new drugs so they are available to all patients. Their review process is based on a treatment’s cost effectiveness and efficiency. It takes into account the patients’ life expectancy and quality of life after the treatment.
AA Gill began taking nivolumab after writing this article
To view the original article CLICK HERE but it is hidden behind Rupert Murdoch’s pay wall.
My thanks to the friend who supplied his paid for copy, thus bringing AA Gill’s profound and moving article to those amongst my readers who may benefit from it – I know I have!
How much does nivolumab cost? The approximate cost for treating non-small-cell lung cancer is £5,700 a month or £68,400 a year.
As this drug is administered as a drip into a vein often via a ‘pic-line’ once a fortnight this would indicate each dose costs £2,850!
As the EU insists on tampering in every area as it imposes UN, WTO, CODEX etc.s diktats why are they so indifferent about the drug companies’ profiteering from fatal illness, when they crow about such irrelevancies as forcing mobile phone companies to standardise roving rates – surely that is upto the consumer and no business of the EU!
Adrian Gill’s first wife Cressida Connolly, they married in 1982 & divorced in 1983
with his ex wife Amber Rudd who he married in 1990 & divorced in 1995,
with whom he had two children
In better times with Nicola Fornby his long term partner & mother of his twins, with whom he had been since 1995 until his death, though only becoming engaged in the November of his final weeks!
As everyone, save the few he berated or made fun of, Adrian Gill, who styled himself AA Gill after his treatment for alcohol and joining AA, was honest and professional in his writing expressing his beliefs and opinions humorously and well, without pandering to fashionable PC, as Wikipedia shows in this selective extract:
Gill’s acerbic style led to several media controversies. In 2010, The Sunday Times disclosed that Gill had been the subject of 62 Press Complaints Commission complaints in five years, none of which had been upheld.
In The Sunday Times, Gill described the Welsh in 1998 as “loquacious, dissemblers, immoral liars, stunted, bigoted, dark, ugly, pugnacious little trolls”. His comments were reported to the Commission for Racial Equality. and used as an example of what was described as “persistent anti-Welsh racism in the UK media” in a motion in the National Assembly for Wales.
[It is my opinion that he left out humourless and lacking in self confidence!]
Isle of Man
Gill’s feud with the Isle of Man began in 2006 with a review of Ciappelli’s restaurant in Douglas. Gill wrote that the island:
managed to slip through a crack in the space-time continuum […] fallen off the back of the history lorry to lie amnesiac in the road to progress […] its main industry is money (laundering, pressing, altering and mending) […] everyone you actually see is Benny from Crossroads or Benny in drag…. The weather’s foul, the food’s medieval, it’s covered in suicidal motorists and folk who believe in fairies.
The review was attacked in the Tynwald, the Manx parliament, with House of Keys member David Cannan demanding an apology for the “unacceptable and scurrilous attack”.
Gill made further comments regarding the Isle of Man in his Sunday Times column on 23 May 2010, when he described its citizens as falling into two types: “hopeless, inbred mouth-breathers known as Bennies” and “retired, small arms dealers and accountants who deal in rainforest futures”. His comments were made in the aftermath of Mick Jagger‘s suggestion that drugs should be legalised in the Isle of Man. Gill added that “If … they become a hopelessly addicted, criminal cesspit, who’d care? Indeed, who could tell the difference?”
In February 2011, Gill described the county of Norfolk as “the hernia on the end of England”.In December 2013, his column just before New Year’s Eve, was the result of a night on the beat in Grimsby and Cleethorpes and was heavily critical of both towns where Grimsby is “on the road to nowhere” and Cleethorpes is full of “hunched and grubby semi-detached homes”. Humberside Police and Crime CommissionerMatthew Grove described Gill as “A tweed-suited, Mayfair-based writer, whose only experience of the North of England was his visit to Cleethorpes and his regular trips salmon fishing in Scotland”.
In a review of Clare Balding‘s 2010 Britain by Bike TV programme, Gill referred to the presenter as “a big lesbian” and “a dyke on a bike”. Gill’s Sunday Times editor, John Witherow, responded to Balding’s complaint: “In my view some members of the gay community need to stop regarding themselves as having a special victim status and behave like any other sensible group that is accepted by society. Not having a privileged status means, of course, one must accept occasionally being the butt of jokes. A person’s sexuality should not give them a protected status”.
If you enjoyed AA Gill’s style and wit above here is an article he had published the day after his 60th. birthday on 29-Jun-2014, 2 years before his diagnosis of cancer and his untimely death – enjoy:
Life at 60
How does the former alcoholic drug addict AA Gill feel about reaching this milestone? Surprised, mostly, but happy to ruminate on sex, travel and friendship
AA Gill Published: 29 June 2014
Young Gill at school (A A Gill)
Every morning, after taking our twins to school, Nicola and I read the papers over breakfast and I recite the birthday list and she will guess the ages. She’s uncannily accurate. Yesterday The Guardian will have said: AA Gill, critic and baboon-murdering bastard, 60.
I share a birthday with Henry VIII and the shot that started the Great War. I’ve always read the anniversary roll and over the years I’ve watched people my age go from rarely mentioned as sportsmen and pop stars to more commonly as leading actors and television presenters and now ubiquitously I find myself in the thick of captains of industry, ennobled politicians, retired sportsmen and character actors. You only notice the accumulating years in relation to other people.
Last week an editor breezily mentioned that as I was coming up to a milestone decade would I perhaps like to write something about it? You know, is 60 the new 40? Why do you make those little noises when you get out of a chair? Am I considering getting a shed, or a cruise, or Velcro? And what about sex?
The only people who ask about significant birthdays are younger than you. No 70-year-olds are inquiring about my insights on being 60. Age is the great terra incognita. But then, all the people who tell me to do anything are younger than me now.
And please, can we stop this “60 is the new 40” thing? No one is saying 20 is the new 10. And who wants to be 40 anyway? An insipid, insecure age.
My generation, the postwar baby-boomers, are over the meridian of our vital parabolas. We’ve done our best and our worst, overachieved and underperformed, are either preparing to bask on the sun loungers of our success or suck our bruised fingers in the waiting rooms of failure. So 60 is both a personal summit from which to look back, breathing heavily, hands on my knees, and a generational one.
AA Gill as a young man
I was born in 1954 in Edinburgh. Winston Churchill was prime minister, there was still rationing, we were the first generation that would grow up with television, pop music, central heating and a National Health Service. As a child, every old man I knew had fought in the First World War and every young man in the second.
War still hung like the smell of a damp, grim nostalgia over everything. We played Spitfires and Messerschmitts in the playground and you could, as Kingsley Amis pointed out, walk into any pub in the country and ask with perfect confidence if the major had been in. London was still moth-eaten with bomb sites and black with coal smoke. One of my earliest memories is of the last pea souper fog.
How do I feel having reached 60? Well, surprised, mostly. And grateful. When I was 30, a doctor told me that I had a dangerously damaged liver and, all things considered, I probably wouldn’t see another Christmas. I am an alcoholic and a drug addict but, with a lot of help, I stopped. I haven’t had a drink or picked up a drug since. My grandfather died at 59. He was a tooth-puller in Leith. My mother says it was anxiety about the coming of the health service that killed him, which is a braw example of Scottish humour.
Globally, I can expect to live to see another two World Cups. But by living in the south of England I should make it for another four. I tell people too quickly that I am 60 and wait, like a needy toddler, to be told I don’t look anything like that. One of the surprising symptoms of getting to be 60 is that I now can’t tell how old anyone under the age of 40 is; you all look 16. And don’t believe the beauty page gush that you are in fact only as old as you feel. It’s a nonsense, based on the assumption that ageing is primarily a physical process. It isn’t, it’s a maturing one. It’s not a feeling, it’s an experience. You are as old as you can remember.
Smiles from younger days
I dictate these articles to clever overeducated colleagues who are much, much younger than me. They constantly and consistently don’t get references to things that to me seemed to have happened only a couple of months ago. They’ve never seen black-and-white films or known the difference between 78, 45 and 33⅓.
So, if you know who Jan Palach, Gary Powers, Gary Gilmore, Squeaky Fromme, Adam Adamant, Albert Pierrepoint, the Piranha Brothers, Harry Worth and Fyfe Robertson are, then you must be 60.
A contemporary of mine, after a number of marriages, found a girlfriend less than half his age of a transcendent pneumatic beauty who hung on his every word — and dumped her after a couple of months. Why, I asked — she was perfect! “Too many things we didn’t have in common,” he said sadly. Like what? “Well, the Eighties.”
Which brings us to sex. Nicola has just exclaimed with unusual force that she has never slept with a 60-year-old and she’s not planning on starting now. Nobody wants to think about 60-year-olds doing it, least of all 60-year-olds. Another contemporary pointed out that it wasn’t finding the first grey pubic hair on yourself that was the doom-laden shock, it was finding it on the person you were sleeping with.
After a certain age it’s best not to have mirrors in your sight line. And lighting is important: the less the better. But you must have some, because everything sags and moves about. The pale, flickering glow of the television is the illumination of choice for most middle-aged couples.
I’ve been making a list of the sex that I’m now too old to consider. I will probably never have sex again on a jiggling sofa with her parents asleep upstairs. Or in a skip. Or in the back of a stationary 2CV or the front of a moving Alfa Romeo.
I won’t do bondage, sadomasochism or erotic yoga or miss them. Neither will I partake in role play. I am too old to be a pirate, a policeman, a Viking or the Milk Tray Man (they don’t know who the Milk Tray Man was either).
And I realise with a sudden shock that I’m probably too old to sleep with anyone for the first time. The thought of having to go through the whole seduction, will they, won’t they, can I, can’t I, is far more terrifying than it is exciting.
Sex definitely changes. It is less athletic, more romantic, more intense, more a special event. Not because it’s rare, but because it’s finite. There is a point in your life when you stop counting up and start counting back. It’s not the laps run, it’s the laps that are left.
This is one of the biggest changes in ageing. The continuous heartbeat rhythm that tells you your experiences are now rationed. How many more Ring cycles will I get to? How many more times will I see Venice emerging out of the lagoon? How many cassoulets, English cherries? How many summits in the Highlands? How many long lunches with old friends? How many old friends are left to me?
That sounds maudlin, but it doesn’t feel like that. It adds to the pleasure, a sentiment to everything, an extra gypsy violin to life. I linger over things now: flowers, moonlight, Schubert, lunch, bookshops. Also I mind less about standing in queues, sitting in traffic, waiting for a bus or my call to be answered. Everything has a pinch of piquancy, a smudge of melodrama, and I like that.
There are other things to which age adds an imperative. I’m pretty sure that when I’m lying on the gurney and the children are searching for the off-switch while telling me sweetly to go towards the light, the thing I regret won’t be, as John Betjeman said, not enough sex, and it won’t be not enough caviar or cakes. It will be, I think, that I never got to see Timbuktu or South Georgia. Never saw the northern lights. Never travelled up the fjords by boat.
The abiding pleasure of my life so far has been the opportunity to travel. It is also the single greatest gift of my affluent generation. We got to go around the globe relatively easily, cheaply and safely. Postwar children are the best and most widely travelled generation that has yet lived. We were given the world when it was varied, various and mostly welcoming.
Whether we took enough goodwill with us and brought back enough insight is debatable. But today the laziest gap-year student has probably seen more and been further than Livingstone, Stanley and Richard Burton.
One of the things that surprises and dismays me is how many of my contemporaries spend their time and money on travelling to sunny beaches. All beach experiences, give or take a cocktail, are the same experience. My advice to travellers and tourists is to avoid coasts and visit people. There is not a view in the world that is as exciting as a new city.
So I regret places and I will also regret not being a better friend. My generation has been profligate with friends. I look at how my parents husbanded theirs, thought about them, wrote to them, talked about them. Because they had lived through the war their friends were innately more precious than ours have been to us. Our friends are not disposable, but they turn out to be forgettable. I regret not making more of an effort to keep up, keep hold and keep close the people I loved. Now their absence and my casual wastefulness upset me.
Gill with his father, who died of Alzheimer’s
I noticed in last week’s paper that if I were in the army (something, thanks to my father and my grandfather, I’ve never had to do), being in the 55-59 age bracket I would be expected to do 21 press-ups and 27 sit-ups within two minutes. Now that is down to 17 and 23 as I’ve reached the end of the tick-box line. I will now be for ever in the 60 and over category, after which there is just the margin.
Last year, for the first time, a young girl, French, offered me her seat on a crowded bus. I was surprised at how deeply I resented her. Health looms over the elderly like a threatening monsoon. No ache is innocuous. No lump or discoloured, sagging patch of body is ignorable except our toenails, which become the most sordidly repellent things in all nature. We covertly examine ourselves and our effluvia for the premonition of the dark humour that will carry us away. There is no such thing as a routine checkup. They are all life-or-death appointments.
Doctors start all their sentences with “It’s only . . . ” But we’re not fooled. This generation is also the one that lingers longest over its departure. Death came to our grandparents with a clutched chest and a searing pain. For us it’s a slow, humiliating series of it’s onlys. What we worry about is dementia, a condition that did not exist in the popular lexicon when I was a child. Mind you, we also thought cancer was as shaming as divorce. Now Alzheimer’s is our abiding fear, the thing we can’t forget.
My chats with contemporaries are like bridge games where we try to fill in the gaps in each other’s sentences to make one coherent conversation. My dad died of Alzheimer’s. I once asked him how he was feeling: “Oh, quite well, except you know I’ve got this terrible disease, what’s its name?” So we go to the gym, we have trainers, I do Pilates. But it’s only maintenance. I’m not looking for a beach body, there’s no New Me in the cupboard; I just want one that’s supple enough to put on my own socks.
After giving up drink and drugs, I continued to smoke about 60 a day until 12 years ago and then I stopped. And people said, “Well done! How did you manage it? What willpower!”
It didn’t feel like well done. It felt like a defeat — the capitulation to fear. When I started smoking at 14 I was golden, immortal. I smoked around the world; I took pride in my ability to smoke with elegance, panache and skill. Smoking was my talent and I gave it up because I lost my nerve.
I don’t miss the cigarettes, but I do miss the me that smoked so beautifully.
Oddly, the one thing that does improve with age is our teeth. Old people get perfect, white, even, marvellous grins. Paradoxically, we simultaneously lose our sense of humour.
I’ve had four children in two batches. It’s not for me to say if I’ve been a good father; that’s between the kids and their respective therapists. But I think I’ve been more benign second time round. With the first two, now 21 and 23, I was a cross between a Butlins Redcoat and Savonarola. I had plans and theories; I thought children were blank and malleable. I was brought up in the Sixties by Sixties parents who drank Sixties Kool-Aid. Much as I loved them I didn’t want to be like them, just as they didn’t want to be like their parents.
I had no plan or ambition for my kids and no Tiggerish belief in education. I know all the competitive insecurity that infects parents around schools, exams and universities. I’ve seen too many desperate kids becoming extensions of adults’ vanity, insecurity and desire for a second chance. And I told my children I had no interest in seeing their reports or knowing their exam results. Nothing they achieve will ever make me prouder of them than the day they were born. Nothing they do or don’t do will make me love them an iota less.
With his partner Nicola
Through empirical trials I have discovered there is no intergenerational conflict that can’t be sorted with a tenner. Just say sorry and I’ll give you a tenner. Clean your room — there’s a tenner in it. Get your aunt a birthday card; keep the change. It’s not money; it’s a MacGuffin, a prop that allows everyone to back down without losing face or temper. And oddly I’ve managed to produce four of the least miserly and acquisitive children.
How did my generation do? Well, we get blamed for being selfish and self-obsessed and soft and pushing up house prices and saddling the next generation with hideous debts and nowhere to live and I suppose that’s not entirely unfair.
We are ridiculously obsessed with food, buy too many things and have too many clothes. But we didn’t start a war. Well, not a big one. And we didn’t nuke anyone. We defused the Cold War. We believed in the collective good. Although we came to confuse gestures with actions and we think going on a march and writing a letter are the same as doing something, making the world better.
We were the generation that were relentlessly for civil rights, human rights, gay rights, disability rights, equality, fairness. We were implacably against racism and censorship. We defended freedom of speech, religion and expression. We will leave the world better fed and better off than when we arrived in it.
Britain is a far happier, richer and fairer place than it was 60 years ago. And if you think that’s wishful self-promotion, you have no idea how grim and threadbare Britain in the Fifties was. You weren’t there, you don’t remember.
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Chronic Urinary Tract Infections as addressed by House of Commons 28-Oct-2016
Greg Lance – Watkins
it does rather seem that the House of Commons has displayed a very notable disinterest in Urinary Tract Infections relative to the NHS budget; but of the 4 Labour MPs who had an interest in the subject, you will note, was the current leader of Labour – Jeremy Corbyn!
I am grateful for the opportunity to open this debate on the inadequacies of the current testing regime for people suffering from chronic urinary tract infections. I am happy to have been joined by other Members, and in particular by my right hon. Friend the Member for Islington North (Jeremy Corbyn), my neighbouring Member of Parliament, who has a long track record in defending services for patients with those conditions, and has worked closely with the Whittington hospital in that regard.
This subject has been neglected for too long, although it affects far too many people. Some 33% of women are expected to suffer from a urinary tract infection before the age of 24, and one in 10 girls and one in 30 boys have a UTI by the age of 16. The issue first came to my attention through the work of Professor Malone-Lee in his lower urinary tract symptoms clinic, which is run from the Hornsey central health centre in my constituency. Many of his patients are my constituents, but many others travel from all over the country and even from abroad to seek his expert help with complex, chronic bladder conditions that have made their lives a misery for many years. Some of them are in the Public Gallery today, including some who have travelled across the country to be here, so this is an important debate for all of us.
The devastation of those patients when Professor Malone-Lee’s clinic was closed temporarily last year and the ongoing concern that I and many others have over the clinic’s future have brought his unique methods into the spotlight. One patient told me that before she saw Professor Malone-Lee, she suffered every single day in pain, leaving her unable to function. Another told me that her life had not been worth living after 32 years of terrible pain and invasive treatments that failed to solve her bladder problems.
I am aware that the long-term future of Professor Malone-Lee’s clinic is the subject of a review by the Royal College of Physicians, so I do not intend to focus specifically on his work today. Instead, I will talk about the wider issue, which my contact with the professor and, more importantly, with so many of his current and past patients has highlighted: the inadequacies of the current testing regime to diagnose urinary tract infections.
The gold standard for diagnosing urinary tract infections over the past 60 years has been to culture a mid-stream urine specimen and identify a pure growth of a known urinary pathogen within a range. However, such dipstick tests have been known to be deficient for many years, with data as far back as 1983 casting considerable doubt on the veracity of their findings due to the lack of sensitivity. Such tests cannot exclude acute or chronic urinary tract infections and do not take into account differences in bacterial strain virulence, host genetic variability, intracellular bacterial reservoirs or even the dilution of the urine specimen due to high liquid intake before the test. The standard laboratory culture will miss 50% of infections. That matters, because these are real people with real symptoms.
Too many people have told me that they have spent years reporting horrendous symptoms and suffering terrible pain, but that they have been dismissed and told that they do not have an infection because the culture was negative. That is to confuse the absence of evidence of disease with evidence of the absence of disease, when those are two wholly different things. What happens to the poor people whose symptoms are dismissed based on a test that experts know to be inadequate? Some will recover and others will find that a short course of antibiotics cures their symptoms, but far too many others will enter a cycle of repeated acute infections, exacerbated by sex, exercise, alcohol, certain foods, stress and many other of life’s normal occurrences, causing devastation to their lives.
As many as 20% to 30% of patients fail to respond to the current recommended antibiotic treatment, whether it is prescribed for three or 14 days. That is not an insignificant number of people when one considers that the Cystitis and Overactive Bladder Foundation estimates that the condition affects about 400,000 people in the UK. Despite that, doctors are not being given the basic tools to inform them how to treat these symptoms differently, and they will not be until the health service revises the inadequate guidelines for testing and treatment. Professor Malone-Lee’s clinic has clearly shown that there are different and more effective ways of testing. Many patients who have not responded to conventional treatment have seen their lives transformed by antibiotic treatment over a prolonged period.
I am well aware of the understandable anxiety among many clinicians and inspectors about antibiotic resistance and the evolution of superbugs. That is clearly something that cannot and should not be ignored, but it is not a reason to fail to question the current guidelines for the treatment of chronic urinary tract infection or to ignore their clear inadequacies. Neither is it a reason to fail to manage the care of those who do not respond to so-called conventional treatment options and to leave them in distress for months and, all too often, years. What evidence is there about the consequences of partially treated urinary infection in the long term? Safe strategies should be developed for helping people who present with particular problems that do not respond to the so-called guidelines. Data show that the NHS spent £434 million on treating 184,000 patients in 2013-14 in unplanned admissions associated with urinary tract infections. Failing to adequately treat these patients is expensive for our NHS and devastating for the patients themselves. The testing and treatment methods employed through the lower urinary tract symptoms pathway under Professor Malone-Lee are estimated to cost approximately £409,000 for 1,000 patients compared with a cost of approximately £5.3 million for 1,000 patients using conventional methods.
I urge the Minister to give this neglected subject the attention it deserves, and I would be grateful for answers to the following questions. Why are people with symptoms and signs being told that they have no infection on the basis of discredited tests? Why are the existing guidelines and policies so didactic when the published evidence implies that there is considerable uncertainty about our knowledge of the condition? Why do these guidelines base their conclusions on the results of quantitative urinary culture which has been so discredited? What is the NHS provision for adults and children with long-term chronic urinary infections? Finally, why is there no tertiary care facility for recalcitrant cystitis in the NHS?
I ask the Minister to meet me and other MPs with constituents who have been affected by the inadequacies of the existing guidelines so that we can discuss this issue in more detail. This is a cause of immense suffering for many people across the country who struggle to be heard and to be taken seriously. I know that I also speak on behalf of MP colleagues who cannot be here today—many have sent apologies—when I say that many of those affected would be very keen to meet the Minister in person to share their experiences. Will she today agree to have a meeting with representatives from patient groups?
I thank the hon. Member for Hornsey and Wood Green (Catherine West) for securing this important debate and for all the hard work she, alongside the Cystitis and Overactive Bladder Foundation, or COB, does in campaigning on behalf of people with urinary tract infections. I know that this issue concerns colleagues from across the House and I am pleased to see a number of them here, and welcome the right hon. Member for Islington North (Jeremy Corbyn) to the debate. It demonstrates the importance of this subject for so many of our constituents.
Interstitial cystitis, often referred to as painful bladder syndrome, or PBS, is a debilitating and lifelong condition which affects over 400,000 people in this country. Its effects not only cause great and often frequent physical pain, but, as those affected often have to urinate up to eight times an hour, it can also threaten their ability to sleep, work, attend school and maintain a social life. This in turn can, of course, have an adverse effect on the quality of life and even the mental wellbeing of those with the condition. It is therefore clearly crucial that those presenting with symptoms consistent with PBS are diagnosed as quickly and accurately as possible in order to receive the most effective treatment to minimise the devastating effects of the condition. We are alive to that.
I understand that PBS can be a challenging condition to diagnose and that both the hon. Lady and COB have concerns over the effectiveness of the NHS tests for diagnosing urinary tract infection using dipsticks in the urine and mid-stream urine specimens. I am also aware of the work of Professor Malone-Lee and the research that he and his team of researchers at University College London have carried out in this area. I know that she recently invited Professor Malone-Lee to speak to MPs on this matter and I am grateful to her for raising awareness of his findings, as this is one of the most effective ways of sharing best practice and changing behaviours.
I am the first Minister for public health and innovation, and I am always interested to hear of any new developments that could lead to more effective diagnosis and better outcomes for NHS patients. Enhancing the quality of life for people with long-term conditions is hugely important to this Government and an overarching indicator in the NHS outcomes framework. The earlier a condition such as PBS can be identified and receive the appropriate treatment, the more the patient will be able to manage their condition and maximise their quality of life.
Our National Institute for Health Research invests around £1 billion each year, and finding innovative solutions to help patients better manage chronic conditions is a vital part of this investment. The NIHR recently awarded about £l million to the University of Newcastle to run a trial looking at alternatives to prophylactic antibiotic treatment for recurrent UTIs. Another study is looking at the effectiveness and acceptability of urine collection devices to reduce contaminated urine samples in women presenting with symptoms of UTI. That is designed to improve accuracy of diagnosis.
We know that UTIs can be a serious burden for individuals and for the healthcare system, and we believe that clinician-led NHS commissioning should be responsible for making decisions about individual treatments on the basis of the available evidence, taking into account the relevant guidance from the National Institute for Health and Care Excellence as appropriate. NICE publishes quality standards to define clinical best practice for the diagnosis and treatment of conditions. These standards are designed to help those commissioning and providing services to understand what a good quality service looks like and to identify where improvements can be made. NICE published a quality standard on urinary tract infections in adults in June 2015. The quality standard comprises quality statements concerning the diagnosis, treatment and management of urinary tract infections. Quality statements 1 and 2 offer specific guidance on ensuring more accurate diagnoses of UTIs in adults. However, I understand that NICE has not yet addressed the specific issues relating to detecting UTIs raised by Professor Malone-Lee and his team of researchers.
As hon. Members will no doubt be aware, NICE guidance is kept up to date through periodic assessments of new evidence. The evidence surveillance team at NICE has been asked to take into account any publications emerging from Professor Malone-Lee’s work when it next considers the relevant guidance for review. I would encourage Professor Malone-Lee, the Cystitis and Overactive Bladder Foundation and the hon. Lady to take this opportunity to ensure that NICE is kept updated with the latest research, whether it is existing work or research that is produced in future, as I have no doubt that it will be helpful in improving guidance in this area. Furthermore, NICE is an independent body—fiercely independent—and if there are any concerns about an existing NICE quality standard or other guidance, I would encourage those concerns to be taken up with NICE directly.
In more general terms on continence care, NHS England published new guidance in November 2015 to help to improve the care and experience of people with continence issues. This includes the most up-to-date evidence to support commissioners and providers. Once again, I am grateful that this important matter has been brought to my attention, and I hope that any further research will be considered by NICE in any future guidance so that we can continue to make improvements in the diagnosis and treatment of people with such a painful and debilitating condition. I will of course be happy to meet the hon. Lady and patient representatives to ensure that we can make the necessary progress in this area.
I know from personal experience the impact that a chronic, difficult-to-diagnose and hard-to-manage condition can have on a patient’s quality of life. An early and clear diagnosis and a clear treatment pathway can truly be the light at the end of a very dark tunnel for many who are suffering with PBS. I hope that, as a result of the dogged championing of this cause by the hon. Lady and many others, and of the more robust evidence of innovative treatment options that NICE can evaluate, we will be able to offer the genuine hope and certainty that is clearly so urgently needed.