Commons Public Accounts Committe – NHS evidence.

Confirmed the government is giving an extra £10bn in real terms by 2020 to the Health Service overall. There are changes to different budgets and some areas are losing out as other areas are benefitting. However the overall figure is rising as the Government says

the IFS analysis shows for example that VAT differs over lifetimes with the opposite effect to the one commonly described.

it might well do that, but if it’s the report I think it is, it’s been shown to be bollards in any numbers of ways given the assumptions it relies upon. (the poor having savings, their access to credit is the same as rich people, and they spend their money on the same things) plus they bend any measure of “tax progress” so far out of whack any conclusions it reaches are deeply questionable

but I sense we won’t agree, and this is about the NHS, so shall we park this?

Confirmed the government is giving an extra £10bn in real terms by 2020

A) extra money in 3 years doesn’t help this winters crisis

B) a lot can change in 3 years, like Brexit reducing our GDP by 2%. 😉

Agreed nick 😉

Jambas, the 10bn is as accurate as £350m. It’s very easy to understand why it is incorrect to use it.

I thought we were discussing whether it was the only solution

I think you will find that this was a discussion that you were only having with yourself.

Ultimately it’s about political decisions and priorities.

No first and foremost it’s an economic decision. How to you satisfy unlimited and growing demand with limited resources (that are growing slower than demand). After that it becomes a political one. For our current government an important once, since it is one area that they protect/ring-fence.

a lot can change in 3 years, like Brexit reducing our GDP by 2%

Which if you measure NHS spending relative to GDP, as some people advocate, will make it go up. Hooray!

Are you suggesting that earlier graphs were being misunderstood OOB? 😉

(deliberately or otherwise!!)

Cut the ‘Around 1 in 10 hospital outpatient appointments are missed every year in England’ again NHS figures

10% improvement here

I don’t know about other people who run outpatient clinics, but in ours it’s considered rather bad form to just sit there for the duration of the missed appointment twiddling one’s thumbs. I use DNA’s (shorthand for missed appointments) to catch up on everything else e.g. reports, notes, referrals, phone calls to patients. This is all stuff that doing in that missed appointment slot creates time elsewhere to see more patients again. Yes it increases waiting list times for others by 10% and yes it is a bit more time consuming than having not seen them in the first place but that is not at all the same as it actually costing us that much more to run our service.
Also outpatients is just one part of it, ambulances, crisis, pharmacy, laboratory, emergency theatres and inpatients do not have appointments as such and increasingly are run over a safe %age of capacity (you keep your intensive care ward with a couple of empty beds and spare staff for the catastrophe you can’t predict the timing of but can plan for.

I went to an outpatient’s clinic once where everyone turned up- absolute chaos 😆 Their resourcing was based on an assumed DNA rate.

(if everyone turned up for the events we run, we’d have to close the doors or cancel, we’d be way over safe capacity. Same thing really)

Tom_W1987 – Member

1) You shouldn’t recommend a treatment until there is evidence to prove that it works. So even if the studies havent been done, Lymies shouldn’t be demanding access to these antibiotics.

‘Lymies’ as you so eloquently call them are patients. They have a right to ask for their illness to be treated and the scientific community should be trying to establish which treatments do work for those 20% of infected people for whom it turns into a chronic illness. Seeing how supposed ‘scientists’ like you think about and are prepared to dismiss out of hand 700 peer reviewed papers that contradict your world view is an education in itself and the quality of your mind (and lack thereof) is clear for all here to see.

2) Many of the “doctorz” raising questions in the comments section are actually raising non questions in an attempt to discredit the paper in the eyes of those that dont know any better.

I’d trust any of these “doctorz” as you call them over a butthurt internet troll who places himself above qualified scientist who are devoting their energy to doing something productive as opposed to trolling others.

3) This study relied on quality of life indicators, not immune markers.

If people have ongoing co-infections that will not respond to antimicrobial treatment it will consequently not result in perceived improvement of symptoms, will it? And they relied on immune markers in the selection of participants without screening them for these other illnesses.

4) A placebo group that were never treated would not have passed an ethics committee for fairly obvious reasons, its still a perfectly fine contol for the studies intended question.

On a 50 point scale of physical symptoms, the average score at study onset is 33. At 4 weeks, after all groups have had ceftriaxone administered it is 37, a gain which is sustained for 50 weeks for all groups. The study has been designed to discount this improvement in favour of consider subsequent treatment of a single, different antibiotic. Again, I refer you to the peer reviewed paper discussing in vivo performance of antibiotics for borellia infections and the appropriateness of these treatments against different cell forms.

5) Do you even science, bro?

Ahem, I’m not your ‘bro’ and again, the quality of your scientific mind (and your personality) is writ large. Go into real estate or become a Daily Mail reporter or something, you seem better suited to these professions.

6) I can’t be **** to check the validity of the accusation that they didn’t treat one arm of the study properly, at the moment, as Im typing from a phone. But like all the other “crticisms” I think it will end up being refutted quite easily.

You’ve not refuted a single point beyond dismissing over 700 peer reviewed papers and any dissenting opinion from qualified doctors and researchers out of hand because they don’t suit the narrative of your prejudices. Sterling job, you’ll go far.

If people have ongoing co-infections that will not respond to antimicrobial treatment it will consequently not result in perceived improvement of symptoms, will it? And they relied on immune markers in the selection of participants without screening them for these other illnesses

Ill respond to the rest in a bit, but you really dont get sample selection and statistics do you.

Someone might have already posted this but i doubt it.
Why cut anything, why not just stick a penny in the pound on tax and use that

Tom_W1987 – Member
If people have ongoing co-infections that will not respond to antimicrobial treatment it will consequently not result in perceived improvement of symptoms, will it? And they relied on immune markers in the selection of participants without screening them for these other illnesses
Ill respond to the rest in a bit, but you really dont get sample selection and statistics do you.

Says the man who hides behind the ethical reasons for there being absolutely no control group (or published baseline data of participants pre-treatment for that matter) to excuse the fact that there is in effect no placebo group. If they’d gone untreated for two years, would a 16 week wait for treatment have made any kind of difference to them at that point?

Even in a lab setting they still managed to totally subvert their study to be entirely meaningless for any practical, clinical application and at a point where discussion of Lyme treatment has moved on to considering the morphological nature of the bacteria and parallel treatment with multiple antibiotics in much the same way as Bartonella is treated.

Yet the great scientist Tom shrouds himself in a flawed study because?

“Why cut anything, why not just stick a penny in the pound on tax and use that”

Laffer curve.

They have a right to ask for their illness to be treated and the scientific community should be trying to establish which treatments do work for those 20% of infected people for whom it turns into a chronic illness. Seeing how supposed ‘scientists’ like you think about and are prepared to dismiss out of hand 700 peer reviewed papers that contradict your world view is an education in itself and the quality of your mind (and lack thereof) is clear for all here to see.

Antibiotics are a limited strategic resource, they are not a right but a privilege. Get that into your entitled western mindset – and the science community doesn’t owe the Lyme community any debt – we don’t owe it to you to do the research. There are far more pressing disease to tackle – here’s a short list – 1) Malaria 2) Malaria 3) Malaria 4) Aids 5) Dengue 6) West Nile 7) TB etc etc etc. Limited budgets, we spend our money, effort and sweat on diseases that actually kill people.

Says the man who hides behind the ethical reasons for there being absolutely no control group (or published baseline data of participants pre-treatment for that matter) to excuse the fact that there is in effect no placebo group. If they’d gone untreated for two years, would a 16 week wait for treatment have made any kind of difference to them at that point?

This makes no sense, you can’t deny people treatment with known drugs that work. The only time people don’t get a drug during a study is if all other treatment plans have failed. The placebo group was entirely justifiable for seeing whether there was a improvement in patient outcomes by lengthening treatment time. If you then non-randomly pick people who hadn’t been treated for two years because they might not suffer by being denied treatment, you bias the study.

Yet the great scientist Tom shrouds himself in a flawed study because?

You are making yourself look like the fool that you are.

You keep banging on about the fact that they should have used a different drug – cuz…in vitro tests….morphology yadda yadda yadda….they already have….guess what…long term therapy wasn’t effective.

http://link.springer.com/article/10.1007%2Fs10096-007-0340-2

Sure, there probably needs more replicated studies of the various studies that have been carried out for the nice meta-analysis gold standard to be carried out – but I get this sneaking suspicion that wouldn’t be acceptable to you either and it’s not very high up in the list of pressing importance for reputable research groups.

Tom_W1987 – Member

Antibiotics are a limited strategic resource, they are not a right but a privilege. Get that into your entitled western mindset – and the science community doesn’t owe the Lyme community any debt – we don’t owe it to you to do the research. There are far more pressing disease to tackle – here’s a short list – 1) Malaria 2) Malaria 3) Malaria 4) Aids 5) Dengue 6) West Nile 7) TB etc etc etc. Limited budgets, we spend our money on diseases that actually kill people.

Ah, so the people paying taxes towards your research grants, hospitals and healthcare have no right to expect to be treated. Imagine if syphillis, HIV, AIDS, cancer patients were treated the same way. Pretty twisted, but then you also advocate withholding medical treatment to pensioners so…

This makes no sense, you can’t deny people treatment with known drugs that work. The only time people don’t get a drug during a study is if all other treatment plans had failed. The placebo group was entirely justifiable for seeing whether there was a improvement in patient outcomes by lengthening treatment time.

it makes sense insofar that they already have a longterm chronic illness that has been allowed to go untreated for years and if you’re going to perform a study with an accurate baseline via placebo, then a judgement as to whether this 14 week extension will make any difference should be made. They opted to undermine any real relevance of the study bar showing that all groups responded positively to two weeks of ceftriaxone.

You are making yourself look like the fool that you are.

Tou keep banging on about the fact that they should have used a different drug – cuz…in vitro tests….they already have….guess what…long term therapy wasn’t effective.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006978.pub2/full#CD006978-bbs2-0005

A great scientist such as yourself Tom would perhaps temper their proclamations to the realm of known science. The paper you cited is an amalgamation of the results of seven separate studies looking at treatments at combinations of four antibiotics, which again ignores research that has already been done about their relative antimicrobial effectiveness against borellia and it also doesn’t include any studies of neurological Lyme disease which is the most common form of the long-term chronic illness, nor the presence of co-infections. Again, it would appear pretty self serving and unlikely to yield any new knowledge.

Again, the presence of co-infections is highly relevant to any study of antibiotic effectiveness in Lyme:

Co-infections can exacerbate Lyme disease through immune system modulation and are considered to be the major cause for resistance to therapy [1-17]. The importance of co-infections in the disease process, i.e. their pathogenicity compared to Lyme disease, has not been clarified. In cases with double or multiple infections, to determine which infection predominates in the pathological process is difficult. There are substantial overlaps between the clinical symptoms caused by co-infections and Lyme disease. Consequently, an unequivocal assignment of the manifestations of the disease to existing infections might be difficult. The diagnostic difficulties of Lyme disease and co-infections always concern chronic Lyme disease (late Lyme disease, stage III). The synergic-pathological mechanism requires that co-infections are also present in chronic persistent form. Anamnestic consideration of the acute form of co-infections may be helpful to recognize their persistence in the chronic stage.

For the majority of co-infections, as for Lyme disease, laboratory diagnostic tests for indirect pathogen detection, including serological tests and lymphocyte transformation test (LTT, syn. LPT (lymphocyte proliferation test)) are available. Previous infection can be confirmed with serological tests, but a positive serological finding is not proof that the infection causes the current illness. It cannot prove the presence of active infection, and in case of seronegativity it cannot exclude it. Only if the occurrence of positive laboratory findings or their deterioration occur in temporal relationship with the disease state and development assumption of chronic disease may be justified e.g. espacialy in cases with previous sero-negativity or negative LTT or significancy lower initial values.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3565243/

So, in short whilst it might simplify studies in focusing on administering x antibiotic and looking only at borellia in a lab, the presence of co-infections will always skew the results and in clinical application it subsequently has no effective use. In effect, it’s pig headed scientists such as yourself who have no nuanced understanding of the illness who are pissing taxpayers money away on poorly designed research, which I would argue is just as serious as quack doctors praying on desperate people by plying them with RIFE machines and equally hypothetical treatments.

out of hand 700 peer reviewed papers that contradict your world view is an education in itself and the quality of your mind (and lack thereof) is clear for all here to see.

I could find 700 peer reviewed papers that contradicted man made climate change, I’m still happy to laugh in the face of deniers.

There’s more to it that riffing of a list of wordy sounding papers and saying “PROOFS RIGHT THERE GUYS”!!!

Ah, so the people paying taxes towards your research grants, hospitals and healthcare have no right to expect to be treated. Imagine if syphillis, HIV, AIDS, cancer patients were treated the same way. Pretty twisted, but then you also advocate withholding medical treatment to pensioners so…

Some people are more important than you, I know you’ve been brought up on the western diet of being told that you’re a special little snowflake – so I can undersrand that being told you aren’t automatically entitled to something might hurt you.

Again, you are riffing off quotes without having an understanding of how statistics, control arms and sample selection work. Your point would only be valid if 100 percent of all the participants had been co-infected with other diseases. How do you think that medical studies, the world over, deal with vast ranges of indiduals with comorbid diseases, different genetics and environments? By selecting representative samples and using statistical methods to cut through the fog.

it makes sense insofar that they already have a longterm chronic illness that has been allowed to go untreated for years and if you’re going to perform a study with an accurate baseline via placebo, then a judgement as to whether this 14 week extension will make any difference should be made. They opted to undermine any real relevance of the study bar showing that all groups responded positively to two weeks of ceftriaxone.

People who wen’t untreated for two years would not be a random, representitive sample of the underlying population. They would bias the study because there could be genetic, infection subtype and environmental reasons as to why they weren’t treated. You simply do not know what you are talking about.

The row in the French Parliament today was because the government has instructed hospitals to postpone all non urgent surgery in order to ease pressure on facilities. Sound familiar ?

@graham I’d be happy with that accross the board, would raise £5bn ? Certainly a start but it would not solve the fundamental long term problem, you would need to do that every 2 years maybe even every year.

So, in short whilst it might simplify studies in focusing on administering x antibiotic and looking only at borellia in a lab, the presence of co-infections will always skew the results and in clinical application it subsequently has no effective use.

Loads of shit works in the lab but doesn’t clinically, bleach works in vitro – side effects of adminstering it intraveneously are too severe to recommend it’s use though. Although I’m tempted to wash my eyeballs with it after reading your posts. Co-infections are not the only reason why something works in the lab but doesn’t in humans, they are one of many thousands of potential reasons.

Tom – I really think you should leave this thread, you’re doing yourself no favours with the tone and unpleasantness of your posts. Be grateful that you’re healthy and able to ride your bike.

Tom_W1987 – Member
Some people are more important than you, I know you’ve been brought up on the western diet of being told that you’re a special little snowflake – so I can undersrand that being told you aren’t automatically entitled to soemthing might hurt you.

Yawn. You’re the bitter little pill that not even having attained the level of education, experience or expertise of those people’s research he’s so readily dismissing can’t stand to have his comfortable worldview contested.

I’m not arguing for automatic entitlement for anything-but based on my experience Lyme treatment is being hindered by the prevalence of blinkered and uninformed people such as yourself and given significant research implicating it in the development of other diseases such as Parkinson’s I’m certainly arguing that decisions of its research and treatment should be taken away from people like you that have no intention of revisiting or improving decades old treatment guidelines.

But good luck with your burgeoning career Tom, I’m sure you’ll do incredibly well for yourself if for nobody else.

Confirmed the government is giving an extra £10bn in real terms by 2020 to the Health Service overall.

“Five MPs led by the Conservative Dr Sarah Wollaston, the chair of the Commons health select committee, have written to the chancellor demanding the government abandon its “incorrect” claims of putting £10bn into the NHS annual budget by the end of this parliament and admit the severity of its financial shortage”

However, the MPs say that May’s £10bn claim cannot be justified. “The £10bn figure can only be reached by adding an extra year to the spending review period, changing the date from which the real terms increase is calculated and disregarding the total health budget,” they concluded.
I’ll post again
https://www.theguardian.com/society/2016/oct/30/theresa-mays-claim-on-health-funding-not-true-say-mps
Kind of disproves the figures or at least says you have to manipulate the hell out of the numbers to get there.

Yawn. You’re the bitter little pill that not even having attained the level of education, experience or expertise of those people’s research he’s so readily dismissing can’t stand to have his comfortable worldview contested.

I don’t and never have deferred to authority – I have no time for whether someone is a PhD student, a postdoc or a professor, they could all very well be a Peter Duesberg level quack for all I know. But neither will I argue against mainstream opinion if the criticism of it is as shoddy as what you have produced.

My god. 700 peer reviewed journal articles and the man still thinks he’s the voice of the mainstream. Get a sense of self-awareness will you?

@ chompy – the truth is that Tom believes Lyme is all in the head. You’re wasting your time engaging with that kind of mindset I’m afraid.

Last time I checked there were something like 1350 peer reviewed articles supposedly supporting climate skeptics…..

😀

You amuse me.

All paid for by Petrochemical companies who are able to buy off researchers with vested interests.

Are you saying something similar is happening with Lyme?

It could well be, after all, the biggest purveyor of lyme literate bullshit is the USA where doctors have been known to make shit loads of money shoving as many pills down peoples throats as possible….

cinnamon_girl

I think Tom believes a little too much in his own abilities-it’s called the Dunning Kruger effect…

Still, an education as to why treatment and diagnosis for Lyme is still so piss poor when you consider that people so inexplicably in thrall to their own bias or research grant givers populate the scientific community.

😆 You couldn’t make it up!

Tom_W1987 – Member
It could well be, after all, the biggest purveyor of lyme literate bullshit is the USA where doctors have been known to make shit loads of money shoving as many pills down peoples throats as possible….

It would be more likely however that US medical insurance companies suddenly confronted by the discovery of a new chronic illness have opted to avoid paying for potentially expensive long-term treatment though, isn’t it?

How much do you think a self-styled Lyme doctor is earning per year compared to a major insurer?

Get real.

Dunning Kruger

Hahahah.

ARRRRRRRRRRRHAHAHAHAH.

Coming from the person that was just trying to argue against decades and decades of statistical best practice?

It would be more likely however that US medical insurance companies suddenly confronted by the discovery of a new chronic illness have opted to avoid paying for potentially expensive long-term treatment though, isn’t it?

It would – but anti-biotics are actually pretty bloody cheap. So I doubt it, it seems to me like there’s a nice little band of quacks in the USA who have got together to make money off people like you.

There are loads of chronic diseases that they and medicare/mediaid seem happy to cover as well.

Laughing at your own posts doesn’t make them any more reflective of real life, nor increase the value of their content Tom.

For anything else, refer above to the lack of their failure to publish any kind of baseline data pre-treatment and the importance of ascertaining the presence of co-infections before trying to measure the efficacy of drugs. If some 60% of your sample group have bartonella or babesia, then your findings relating solely to borellia are pretty moot. It’s not about statistics, it’s about the clinical reality of what you’re studying and not undertaking pointless research…

It would – but anti-biotics are actually pretty bloody cheap. So I doubt it, it seems to me like there’s a nice little band of quacks in the USA who have got together to make money off people like you.

There are loads of chronic diseases that they and medicare/mediaid seem happy to cover as well.

Given that antibiotics can be sourced without having to consult a private doctor in the states, why would anyone be paying them for anything? I think everyone would much prefer their GP’s to be freed from dated NICE guidelines and for standardised diagnosis and treatment to reflect the reality of the illness.

@ chompy – agreed. The corporate paymaster rules the roost.

The corporate paymaster rules the roost.

The Donald has put the fear of God into US Pharma as he has said US Healthcare will be bidding much more aggressively on drugs as its the worlds largest buyer. Expects to save billions.

It would – but anti-biotics are actually pretty bloody cheap. So I doubt it, it seems to me like there’s a nice little band of quacks in the USA who have got together to make money off people like you.

As no NICE guidelines currently exist then exactly how are GPs going to diagnose?

The USA is streaks ahead with their knowledge which is why I have a private American doctor.

Tom – there is a lot of nonsense out there around chronic diseases and parasitic phoney medicine – however Lyme is somewhat different. At the core there is good science and consensus view is changing in the light of this. NICE has even accepted now long term effects albeit equating this to immune system damage in untreated people. Outside of this core is plenty of nonsense for sure but look behind that to see the good science being done.

The Donald has put the fear of God into US Pharma as he has said US Healthcare will be bidding much more aggressively on drugs as its the worlds largest buyer. Expects to save billions.

believe it when I see it, HC in the US maybe the largest but they are not a single buyer, they are a disprate group of public and private entities.

Given that antibiotics can be sourced without having to consult a private doctor in the states, why would anyone be paying them for anything? I think everyone would much prefer their GP’s to be freed from dated NICE guidelines and for standardised diagnosis and treatment to reflect the reality of the illness.

So if you can source them without an exensve gp why would insurance firms care?

And not even the utterly loaded oil companies, who dwarf the imsurance firms could sway scientific opinion on climate change.

Tom – there is a lot of nonsense out there around chronic diseases and parasitic phoney medicine – however Lyme is somewhat different. At the core there is good science and consensus view is changing in the light of this. NICE has even accepted now long term effects albeit equating this to immune system damage in untreated people. Outside of this core is plenty of nonsense for sure but look behind that to see the good science being done.

Sure, long term immune and neurological damage have nothing to do with antibiotics though.