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The lurking fear in Tredinnick’s Integrated Health Care debate

Posted: June 9, 2010 at 8:16 am

Last week I mentioned that David Tredinnick, Conservative MP for Bosworth, was being a bit silly in the lead up to his adjournment debate on integrated healthcare.  At the time I boldly suggested that if Tredinnick was the best ally alternative health had in the Houses of Parliament then it was in a great deal of trouble.  Sadly I may have been too confident.  The transcript of the debate is now available and Tredinnick’s contributions are as fanciful as you would expect.  However, it is not these that cause me concern, the man is not a credible figure and his voice carries little wait in tilting the healthcare debate one way or another, it is Anne Milton, the Under Secretary of State for Public Health, whose replies are troubling in many respects.  Readers may be interested in her pronouncements about ‘service providers’, and changes to the structure of NHS healthcare, which suggest some hard questions about their commitment public healthcare need to be asked of the new government.  My focus though, as usual, will be on those replies more pertinent to quackery and its regulation.  While Milton is clear and sensible on the need to defer to NICE and the evidence base, especially in these uncertain economic times where finite NHS resources are already strained and further threatened by the enthusiastic swishing scalpels in the Treasury, there are nevertheless some arguments that offer succour to alternative practitioners.

From her second paragraph:

My hon. Friend may be interested to know that although I trained as a nurse and worked in the NHS for 25 years in conventional medicine, my grandmother trained at the homeopathic hospital in London, and was herself a homeopathic nurse. Later, she became a Christian Scientist. I am therefore not without my own roots in alternative therapies. My hon. Friend may also be interested to know that my grandmother never, until her death at the age of 89, took any conventional medicine.

While this may be an opening gambit of flattery, designed to lessen the rejection of Tredinnick’s ideas, the claim about her grandmother does not seem particularly appropriate.  While good health, of the sort that lets you live until 89, may not require conventional medicine so much as luck, in both genes and environment, it is undeniable that many lives are saved by its use.  To imply by anecdote, not the most reliable of measures, that homeopathy may allow one to live long in the absence of accepted healthcare is unbecoming of a health minister upon whose decisions the health of millions rests. Worryingly the following paragraph suggests the the Minister may indeed have some mistaken opinions about the benefits of an agitated sugar pill.

My hon. Friend raised the issue of homeopathic hospitals and his concern about them. I understand that there are five such hospitals in the United Kingdom, based in London, Bristol, Tunbridge Wells, Liverpool and Glasgow. However, the Tunbridge Wells homeopathic hospital stopped providing services in March 2009 owing to the primary care trust’s decision to end funding. All the hospitals have experienced a reduction in the number of referrals over the past three years, and it has been claimed that all of them are now in a precarious position as a result of such significant funding losses. That is a matter of concern, given that they have clearly offered valuable treatments to patients.

I would like to know the evidence that showed clear benefit from these relics.  It certainly isn’t in the Science and Technology Committee report on homeopathy, which the Minister claims to be considering:

I note my hon. Friend’s comments on the Lords [sic] Science and Technology Committee report on homeopathy, and I am aware that it caused quite a lot of concern. It was published on 22 February, and we are still considering it and will formally respond in due course. He raised considerable concerns about the report, and highlighted the low cost of many alternative therapies and the important contributions they make. He also made reference to experiences from around the world-he mentioned Australia in particular, and also the USA-and he made an important point about the open-mindedness of some countries to alternative therapies.

In considering outcomes, patient-reported outcome measures must be an important factor. As my hon. Friend rightly said-and as I mentioned-individuals’ own experiences are very important, and if we want to achieve the best outcomes, one step we must take is to ask the patient whether they actually got better.

In conclusion, I wish to thank my hon. Friend for his contribution to the debate and to suggest that perhaps the picture is not as bleak as he fears-I noted a certain weariness in his voice; he feels that he has raised this issue on so many occasions and it has fallen on deaf ears.

I do not expect the government to fundamentally disagree with the reports recommendations, that would be a foolish fight to choose given homeopathy’s many vociferous critics, however the comment about patient-reported outcome measures intrigues.  As mentioned in the previous post on Tredinnick, these are the brain child of Boo Armstrong, ex-writer for an AIDS denialist magazine and former Chief Executive of the Prince’s Foundation for Integrated Health (FIH), and a rather curious thing for the Minister to pick up on.  While an inherently weak form of evidence that NICE would not normally consider, they are amenable to misinterpretation by those seeking to attribute what most would consider human bias to unscientific modalities, or magic if you prefer.  One wonders who briefed Anne Milton before this debate and why she considers that alternative therapies are not as threatened as Tredinnick fears?

Perhaps the answer to this lies in the new government’s views on regulation:

The issue of regulation was raised, and it is a thorny one. When I was a shadow Health Minister, I met on numerous occasions psychologists, psychotherapists and counsellors who were very concerned about the regulation of their professions. Across the professions allied to health care, there are those who are keen on regulation and those who feel regulation would be wrong and would be unable to deal with the intricacies of their work. There is no doubt that vulnerable people are often preyed upon by unskilled and unscrupulous practitioners, and I think that professions wanting to achieve the highest standards will welcome proper regulation. The issue for Government is always whether statutory regulation is the most appropriate way of dealing with that risk, or if a lighter-touch approach would be more appropriate. That is why, as I understand it, last year the Department of Health, along with devolved Departments, consulted on the regulation of practitioners of acupuncture, herbal medicine and traditional Chinese medicine. As my hon. Friend will be aware, the consultation closed in November, and more than 6,000 responses were received. The high response rate is a testament to the strength of feeling about public access to complementary and alternative medicines; I am sure I am not alone in having received a huge number of letters on the subject.

The consultation examined in detail the options for regulation, including alternatives to statutory regulation. Once the Government have considered the consultation responses, we will make clear the next steps in the regulatory process. In acknowledgment of my hon. Friend’s keen interest in the matter, I am very happy to keep in touch with him about it. In the meantime, the Complementary and Natural Healthcare Council [CNHC] provides for voluntary registration for practitioners from nine complementary therapy disciplines. I appreciate that my hon. Friend feels that that is not sufficient, but that is in place for the moment while we consider the consultation that has taken place and make a decision on what the next steps should be.

While there is no firm commitment to any particular position here there are two things the Minister needs to consider.

1) ‘light touch’ regulation does not work.

The CNHC have declared that they will ignore complaints from some members of the public, and have been utterly ineffectual in what little concerns they have considered. Not only that they have had to tolerate some outrageous conspiracy theories and false accusations widely circulated by email.

2) Statutory regulation does not work.

Consider the Chiropractors, The General Chiropractic Council (GCC) are supposed to be the statutory body that regulates Chiropractic.  However, since one of the GCC affiliate associations decided to unsuccessfully sue Simon Singh, the profession has found itself under considerable scrutiny, with many of its members subjected to professional standards complaints.  The GCC have been obstructive, inconsistent, dishonest and completely ineffectual in dealing with these.

The regulation of quackery requires some fresh thinking and if the government chooses either of the options above then there will only be chaos from quacks and complaints from skeptics.  Whatever their choice it looks like the eternal battle between reason and woo will continue.  With the collapse of the FIH, quackery is in search of new allies and its former employees may already be making contacts.  As the governments ideologically enthusiastic and economically necessary cuts bite, the temptation to favour cheap placebos may lead many astray.  Anne Milton may not yet have chosen her side, but her lack of commitment is telling, the dark mutterings of the deluded are being listened to if not yet obeyed.

Recommendation and review posted by G. Smith

Lifeblood

Posted: June 9, 2010 at 8:16 am

John Ross Lifeblood

John Ross Lifeblood

John Ross Lifeblood

Whoa now, these images are AWESOME! They were created by the design studio FARROW for the CD art of The Maniac Street Preachers album, Lifeblood, photography by John Ross. The images are totally stunning and, as mentioned on the Farrow site, were created by pouring buckets of fake blood all over a very dashing model, who was later taken out of the images in post production. That must have been an awesome/messy/fun photo shoot set! Be sure to check out both the Design firm and the photographers site for more images!

[via todayandtomorrow]

Recommendation and review posted by G. Smith

International Stem Cell Corporation’s Parthenogenetic Stem Cell Patent is Approved by the United States Patent and Trademark Office

Posted: June 9, 2010 at 8:15 am

International Stem Cell Corporation (OTCBB:ISCO), http://www.intlstemcell.com, announced today that the United States Patent and Trademark Office (USPTO) has granted ISCO patent number 7,732,202, the first of several pending patents relating to its development of human parthenogenetic Stem Cells (hpSC). Human parthenogenetic stem cells are a new type of pluripotent stem cell that allows immune matching to potentially solve critical immune rejection problems, and does not involve the ethical issues that surround the use of fertilized human embryos.

Although ISCO's creation of human parthenogenetic stem cells was first announced in a peer review publication in 2007, the formal allowance of claims by the USPTO will greatly advance the field of regenerative medicine by allowing ISCO to share its knowledge of these hpSC lines more freely with researchers in the US and around the world through partnerships, joint ventures, funded research and licensing arrangements.

The patent protects ISCO's technology platform, allowing the creation of hpSC from unfertilized eggs, exhibiting similar qualities and pluripotency as embryonic stem cells, with the added ability to be immune-matched to the donor, as illustrated in published peer-reviewed articles. Additional discoveries, also previously published in a peer reviewed journal and the subject of pending ISCO patents, illustrate the creation of 'homozygous' hpSC that can be immune matched to millions of persons of differing sexes and racial backgrounds, rather than only to the donor or her family, raising the potential of eventually creating a universal source of stem cells that could benefit most the of the world's population.

Researchers across the world work with ISCO to study different therapeutic applications of hpSC. Through previously announced collaborative arrangements, ISCO's scientists are working with major universities and private research organizations to study hpSC to treat liver disease, diabetes, Age-related Macular Degeneration (AMD), corneal blindness and various neural degenerative diseases. In one such research collaboration, internationally-recognized stem cell researcher Hans Keirstead, PhD, at the Reeve-Irvine Research Center (University of California, Irvine), recently published a paper, referring to his use of embryonic stem cells and ISCO's hpSC in work focused on the derivation of early retinal progenitor tissue.

Andrey Semechkin, PhD, CEO of ISCO said, 'Other than parthenogenetic stem cells, the three most commonly used and described types of stem cells are human embryonic stem cells (hESC), induced pluripotent stem cells (iPS), and adult stem cells, such as those derived from cord blood, adipose tissue or bone marrow. Parthenogenetic stem cells have unique advantages over each of these other cell types, and we anticipate that since our core patent has been issued, we can now accelerate the adoption of our hpSC lines by researchers in the US and throughout the world.'

'International Stem Cell Corporation is particularly proud of these accomplishments because we have been funded thus far entirely by investors, without NIH or other governmental aid,' said Jeffrey Janus, Senior Vice President of ISCO. 'However, once it is generally recognized that parthenogenetic cells have similar characteristics of embryonic stem cells and offer the potential to solve critical immune rejection issues - while not requiring the destruction of viable human embryos - we expect these cells to be increasingly used in government funded research to study ways of reducing human suffering and treating intractable human diseases.'

ABOUT INTERNATIONAL STEM CELL CORPORATION (ISCO.OB):

International Stem Cell Corporation is a California-based biotechnology company focused on therapeutic and research products. ISCO's core technology, parthenogenesis, results in creation of pluripotent human stem cells from unfertilized oocytes (eggs). hpSCs avoid ethical issues associated with the use or destruction of viable human embryos. ISCO scientists have created the first parthenogenic, homozygous stem cell line that can be a source of therapeutic cells with minimal immune rejection after transplantation into hundreds of millions of individuals of differing sexes, ages and racial groups. This offers the potential to create the first true stem cell bank, UniStemCell(TM), while avoiding the ethical issue of using fertilized eggs. ISCO also produces and markets specialized cells and growth media for therapeutic research worldwide through its subsidiary Lifeline Cell Technology. More information is available at ISCO's website, http://www.internationalstemcell.com.

To subscribe to receive ongoing corporate communications please click on the following link: http://www.b2i.us/irpass.asp?BzID=1468&to=ea&s=0.

FORWARD-LOOKING STATEMENTS

Statements pertaining to anticipated technological developments and therapeutic applications, and other opportunities for the company and its subsidiary, along with other statements about the future expectations, beliefs, goals, plans, or prospects expressed by management constitute forward-looking statements. Any statements that are not historical fact (including, but not limited to statements that contain words such as "will," "believes," "plans," " anticipates," "expects," "estimates,") should also be considered to be forward- looking statements. Forward-looking statements involve risks and uncertainties, including, without limitation, risks inherent in the development and/or commercialization of potential products, uncertainty in the results of clinical trials or regulatory approvals, need and ability to obtain future capital, application of capital resources among competing uses, and maintenance of intellectual property rights. Actual results may differ materially from the results anticipated in these forward-looking statements and as such should be evaluated together with the many uncertainties that affect the company's business, particularly those mentioned in the cautionary statements found in the company's Securities and Exchange Commission filings. The company disclaims any intent or obligation to update these forward-looking statements.

Key Words: Stem Cells, Biotechnology, Parthenogenesis

International Stem Cell Corporation
Kenneth C. Aldrich, Chairman
760-940-6383
[email protected]
or
Brian Lundstrom, President
760-640-6383
[email protected]

Recommendation and review posted by G. Smith

Oral factor Xa inhibitor apixaban – more effective than enoxaparin for thromboprophylaxis after knee replacement

Posted: June 8, 2010 at 8:17 am

Low-molecular-weight heparins such as enoxaparin are preferred for prevention of venous thromboembolism after major joint replacement. Apixaban, an orally active factor Xa inhibitor, might be as effective, have lower bleeding risk, and be easier to use than is enoxaparin.

The primary outcome in this Lancet study was the composite of asymptomatic and symptomatic deep vein thrombosis (DVT), non-fatal pulmonary embolism (PE), and all-cause death during treatment. The primary outcome was reported in 15% of apixaban patients and 24% of enoxaparin patients (relative risk 0·62), absolute risk reduction 9·3%.

Major or clinically relevant non-major bleeding occurred in 4% of patients receiving apixaban and 5% of treated with enoxaparin.

The authors concluded that apixaban 2·5 mg twice daily, starting on the morning after total knee replacement, offers a convenient and more effective orally administered alternative to 40 mg per day enoxaparin, without increased bleeding.

References:

Image source: Apixaban, Wikipedia, public domain.

Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.


Recommendation and review posted by G. Smith

IGERT NSF panel on Digital Science

Posted: June 8, 2010 at 8:17 am

On May 24, 2010 I was part of a panel in Washington for the NSF IGERT annual meeting. As I mentioned previously, it is encouraging to find that funding agencies are paying more attention to the role of new forms of scholarship and dissemination of scientific information.

My co-panelists included Janet Stemwedel, who talked about the role of blogging in an academic career, Moshe Pritzker, who made a case for using video to communicate protocols in life sciences and Chris Impey, who demonstrated applications of clickers and Second Life in the classroom.

We only had 10 minutes each to speak so the presentations were basically highlights of what is possible. Still, it was enough to stimulate a vigorous discussion with the audience. There was a bit of controversy about the examples I used to demonstrate the limitations of peer review in chemistry. People can misinterpret what we are trying to do with ONS - it certainly doesn't include bringing down the peer review system (not that we could anyway). But we have to face the situation that peer review does not validate all the data and statements in a paper. It operates at a much higher level of abstraction. Providing transparency to the raw data should work in a synergistic way with the existing system.

My favorite part of the conference was easily Seth Shulman's talk on the "Telephone Gambit". Ever since reading his book, I have been using the story of how carefully reading Bell's lab notebook has forced us to revise the generally accepted notion of how the telephone was invented. Seth's presentation was truly captivating because he explained not only what was done but also what motives were at work to deceive and obfuscate. This cautionary tale is still very much relevant to science and invention today - and highlights how transparency can mitigate against this type of outcome.

Recommendation and review posted by G. Smith

The Hairy Collection

Posted: June 8, 2010 at 8:17 am

Hairy underwear by Nutty Tarts

Hair leggings by Nutty Tarts

Hairy undershirt by Nutty Tarts

Hairy collection by Nutty

The Hairy Underwear set from Nutty Tarts includes:
- Hairy Panties
- Hairy Leggings
- Hairy Undershirt
- Bad Face Day paper bag
for €95.00

umm… Yikes!

Recommendation and review posted by G. Smith


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