Categories
Evidence Health Care Public Health Screening Value

Screening for cardiac risk in young adults – a poor way to save lives

This one has cropped up a lot over the years. See this thread from @CRY_UK inviting people between 14-35 to get free ECG heart screenings There’s a handy link to a website to get tested, with handy locations all over the uk. I mostly see the red mist at this point. I’ve also seen mass […]

Categories
Health Care Public Health Value

innovation is NOT the same as shiny gadget or “invention”

people keep asking me to write a blog on “innovation” I recently wrote about our idolatry of gizmos. gizmos are certainly inventions, sometimes they are innovative. Sometimes they don’t add a lot (any) value thus Im mostly unconvinced they class as “innovative” I’m not sure I can summon the will to live to write more […]

Categories
Health Care Public Health Shared decisions Value

Robotic prostatectomy. £60m capital cost on gizmo idolatry

I’ve previously had my rant about the ProtecT study. This broadly backs up earlier studies e.g. The PIVOT study suggesting radical prostatectomy doesn’t beat watchful waiting in terms of overall survival for localised prostate cancer. Surgery can do harm, watchful waiting will not. This is a development based on the hot of the press study […]

Categories
Clinical Evidence Health Care Public Health Value

Avastin in Opthalmology, after the draft AMD guideline

Christmas is here The AMD guideline is out https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0658/documents p150 odd onwards of the full guideline is the business end https://www.nice.org.uk/guidance/gid-cgwave0658/documents/draft-guideline#page155 it is largely as expected very clear (& exceptionally detailed) appraisal of the evidence base around the management of AMD. For me (and many) we were all waiting for this CG to see the […]

Categories
Health and Social Care Health Care Public Health Prevention Value

 If the NHS were better at preventing stuff. 10 thoughts.

I got asked a q today about “how might the NHS address “prevention” more strategically. 10 off the cuff thoughts.   These thoughts are NHS focused…….and medical model focused. Maybe I’ll write more about NHS and social model stuff in the future   1) In many cases screening doesn’t prevent anything. It finds disease. Often […]

Categories
Clinical Health and Social Care Healthcare Reform Inequality Primary Care Value

The GP 5 Year Forward View, the importance of inequality and the Deep End

So we are all doing responses to the GP 5 Year Forward view Who knows whether there’s any REAL investment fund. Meanwhile the world keeps revolving. General Practice, you know the bit that everyone says is the jewel in the NHS crown, gets ever more fragile. The point re General Practice in the most disadvantaged […]

Categories
ROI Value

The limits of  Return on Investment analysis

Not that long ago the world was clamouring for good evidence the return on investment for public health interventions. There was a great response and the world is now full of ROI tools, models and papers. PHE are producing excellent stuff in this space I won’t rehash those here. You can do your own googling. […]

Categories
Accountable Care Health and Social Care Health Care Public Health Healthcare Reform Public Health STP Value

Using routinely collected data to demonstrate where the NHS is going wrong

 This is someone else’s work, it’s amazing. Genuinely amazing. And deserves wide coverage.  In some ways a macro analysis of the history of NHS problems, using lots of readily available NHS data with a heavy dose of  intelligence and interpretation  It’s Scottish. Is Scotland like England – ie questions of generalisability. I think many of […]

Categories
Prevention Smoking Value

Smoking reduction and it’s link to economic issues – changing the frame 

I’d previously written about my thought experiment around being ambitious re really achieving a smoke free generation. I’d also suggested that the ambition is framed yes in terms of avoidable illness and early death (of course) but also in terms of economic concepts.  Read the blog. Another spin that I hadn’t thought of was how […]

Categories
Clinical Health Care Public Health Screening Shared decisions Value

A prostate cancer bumper edition

ICYMI here’s a suite of studies – principally the ProtecT and linked study. I’m told this is the most expensive trial ever. Which concluded that no difference in prostate specific cancer survival between three arms – active surveillance, radiotherapy, surgery. (Remember we know that robotic surgery is no better than standard surgery – study earlier […]