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Same Story -- Two Different Papers' Reporting of It

Here's the story from CNN:

Quote:
LONDON, England (CNN) -- A leading UK hospital has defended its practice of using organs donated by smokers after the death of a soldier who received the cancerous lungs of a heavy smoker.

Corporal Matthew Millington, 31, died at his home in 2008, less than a year after receiving a transplant that was supposed to save his life at Papworth Hospital -- the UK's largest specialist cardiothoracic hospital, in Cambridgeshire, east England.

Papworth Hospital released a statement saying using donor lungs from smokers was not "unusual."

The statement added that the hospital had no option but to use lungs from smokers as "the number of lung transplants carried out would have been significantly lower," if they didn't.

An inquest held last week heard that Millington, who served in the Queen's Royal Lancers, was serving in Iraq in 2005 when he was diagnosed with an incurable condition that left him unable to breathe.

He was told he required a transplant and in April 2007 received a double lung transplant at Papworth Hospital.

Less than a year later, doctors discovered a tumor in the new lungs. Despite radiotherapy, Millington died on February 8, 2008, at his family home near Stoke-on-Trent, in Staffordshire.

The inquest found a radiographer failed to highlight the growth of a cancerous tumor on the donor lungs.

Tests found that he had received the lungs of a donor who smoked up to 50 cigarettes a day, the inquest at North Staffordshire coroner's court heard.

The hospital said in the statement: "This is an extremely rare case. Papworth Hospital has a very strong track record of high quality outcomes and this is an extremely rare case.

"Patients who are accepted on to the transplant waiting list have no other option open to them, however, we must stress that all donor organs are screened rigorously prior to transplantation.

"Using lungs from donors who have smoked in the past is not unusual. During 2008/09 146 lung transplants were carried out in the UK.

"During the same period 84 people died on the waiting list. If we had a policy that said we did not use the lungs of those who had smoked, then the number of lung transplants carried out would have been significantly lower."

The tumor's growth was accelerated by the immuno-suppressive drugs Millington was taking to prevent his body rejecting the transplanted lungs, the inquest heard.

North Staffordshire coroner Ian Smith recorded that Millington, had died of "complications of transplant surgery and immuno-suppressive drug treatment."
Here's the same story from the The (London?) Times Online: (The emphasis is mine)
Quote:
An Iraq war veteran died after receiving cancerous lungs from a heavy smoker in a transplant.

Matthew Millington, 31, a corporal in the Queen’s Royal Lancers, had the operation to save him from an incurable respiratory condition.

But the organs were from a donor who was believed to have smoked 30 to 50 roll-up cigarettes a day. A tumour was found after the transplant, and its growth was accelerated by the drugs that Mr Millington took to prevent his body rejecting the organs.

Because he was a cancer patient, he was not allowed to receive a further pair of lungs, under hospital rules. The soldier had radiotherapy but died at home in Stoke-on-Trent in February last year.

His widow, Siobhan, said: “All Matthew wanted was another set of lungs. He said: ‘They have given me a dud pair, get me another set’. He thought he could beat it, but his condition deteriorated so fast from then.”

Papworth Hospital, Cambridge, the country’s main heart and lung transplant centre, carried out the operation. It said that early X-rays on the organs did not find any signs of cancer.

Mr Millington had learnt that he had a serious lung condition in 2006 and was given two years to live unless he had a transplant.

A donor was found and the double lung transplant went ahead in April 2007. The cancer was discovered only six months after the operation, because of a lack of communication between radiographers and consultants. The tumour had grown from 9mm to 13mm in that period.

An inquest was told last week that an internal investigation at Papworth pinpointed a string of problems, including difficulties with communication, record-keeping and patient handover.

In Mr Millington’s case a radiographer had failed to highlight the growth of the cancerous tumour.

Discounting verdicts of neglect or misadventure, Ian Smith, the North Staffordshire Coroner, delivered a narrative verdict, recording that Mr Millington had died from “complications of transplant surgery”.

The hospital defended using smokers’ lungs for transplants, saying that all organs were screened rigorously.

Speaking after the inquest, Mr Millington’s father Lester, 61, said: “I have never contemplated further action. I wanted to get to the inquest but I was 99.9 per cent certain that nothing they did wrong was done wrong wilfully. It is a fact that 51 per cent of all lungs transplanted at Papworth come from donors who smoked.

“Without using such lungs many more people would die without receiving a transplant.”
Why would CNN have chosen to not include the paragraph about the (state run) hospital regulations cutting Millington adrift because he had cancer? Isn't that a germane part of the story, especially since the British medical system is being held up as a model of what Obama, Pelosi and Reid want to change our system to? Papworth Hospital is a National Health Services hospital about which they claim "Papworth is the UK’s largest specialist cardiothoracic hospital. Our services include cardiology, respiratory medicine, and cardiothoracic surgery and we are the country’s main heart and lung transplant centre." According to Papworth's web site:

Quote:
Papworth Hospitals NHS Foundation Trust has achieved all of the core standards for better health, for the second year running. The standards are set and monitored by the Care Quality Commission (formerly the Healthcare Commission), who check whether NHS Trusts have achieved a satisfactory standard of safety, clinical and cost effectiveness, governance, patient focus, accessible and responsive care, environment and amenities, and public health.
This is what my chosen health-care plan is going to be replaced by???
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Old 10-12-2009, 02:00 PM
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John...Good for you to start this. A great example of CNN "reporting"...
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Old 10-12-2009, 02:03 PM
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I don't know why you feel that rule is a reflection of the NHS, or socialized health care in general.

IIRC current organ transplant rules in the US require any patient who has had cancer to be at least 5 years in remission before being eligible for a transplant, which unfortunately makes sense to me.

The tragedy of that story is that they GAVE him the cancer inside of his first transplant, and then refused to make an exception. That's just crazy.
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Old 10-12-2009, 02:19 PM
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The tragedy of that story is that they GAVE him the cancer inside of his first transplant, and then refused to make an exception. That's just crazy.
Bureaucracy. Would you want more of it in YOUR life?
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Old 10-12-2009, 02:34 PM
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Sadly enough, he was expected to live longer without a transplant than he did with one. The transplant actually accelerated his death. You have to ove socialized medicine...coming to a hospital near you.
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Old 10-12-2009, 08:45 PM
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Did we read the same articles...?

Some key 'facts' that are not pointed out..

1) The recipient had cancer already.. hence the need for a lung transplant in the first place... and the prognosis was 2 years...it might have been more, but equally it might have been less. With the transplant the chances were massively increased .. potentially.

2) The lungs received were cancerous.. because of the donor...now do you think that there is a vast choice of lungs out there to inplant.. and does that have anything to with the medical system in place?
The pool of potential donors here is small to begin with and has been reducing steadily over the last three decades as the use of seta belts has reduced RTA fatalities.....

3) a series of MISTAKES were made in communication between the medical specialities and record keeping.....again is that the preserve of a type of medical system or a fact of human endeavour? And imagining that the medics here are any worse than over on your side is wrong.. I have seen too many US doctors come here to recieve specialaist training..because it was the best on the planet...

The ONLY bit that may be down to the 'socialised' medicine bit is the refusal of a second transplant ... simplistically for cost/ rationing reasons.. which may well be true...but also becuase the chances of survival of a second transplant may have been evaluated as very low to zero...

So whilst it does appear that 'socialised medicine' has denied this person a second transplant there is, as ever more to the story and it is easy to take a set of edited facts and use it to demonstrate how good or bad your system is...

NONE of you, with private health insurance would have necessarily had any greater choice of donor or automatically been able to have a second transplant.... perhaps for different reasons...but the choices may not have been yours.

Our medical system does have major flaws.. as does the US one...and both could stand a massive improvement...you will swap one set of problems for another.. or more likely get both...but that is the fault of those who want to intorduce it.. not the system.
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Old 10-12-2009, 10:14 PM
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Quote:
Originally Posted by MFAFF View Post
Did we read the same articles...?

Some key 'facts' that are not pointed out..

1) The recipient had cancer already.. hence the need for a lung transplant in the first place... and the prognosis was 2 years...it might have been more, but equally it might have been less. With the transplant the chances were massively increased .. potentially.
I was curious what he had originally since neither article mentions it. While it may have been "cancer" -- was it a different form? If he was allowed to have the lung transplant the first time to replace cancerous lungs, why wasn't the same rule an impediment?

Quote:
2) The lungs received were cancerous.. because of the donor...now do you think that there is a vast choice of lungs out there to inplant.. and does that have anything to with the medical system in place?
The pool of potential donors here is small to begin with and has been reducing steadily over the last three decades as the use of seta belts has reduced RTA fatalities.....
Interesting point. But isn't a lung replacement with a set of donor lungs which are 50% likely to develop cancer themselves (as a result of the donor) a pretty foolish investment of resources? "For Profit" companies (in any industry) would rarely allow such a situation to happen. No company would ship a product with a 50% chance of a warranty replacement -- the company would be out of business in no time. Does that mean that those people who beat the odds and got a good set of lung would never have been treated in a "for profit" scenario? Of course not -- that's a silly "strawman" conclusion to draw. "For profit" companies exist to service a market and make money doing so -- they would quickly focus on the key issue. Put in place a means to acquire a "high quality" supply of donor lungs. This will be done to reduce the "warranty" costs of the lungs, specifically the costs of doing a second replacement, or the legal costs of defending the company from mal-practice suits.

You might argue that "high quality" donor lungs just don't exist. But that's the standard form of passive response that a government run system would result in. In a for-profit system, companies would actively apply creative thinking to the problem and come up with innovative solutions. (If I knew what these were I'd be rich right now). Why would they do this? Because they can only make money when they are replacing lungs (in this scenario). Those companies that could find a good, high-quality system would thrive. Those that could not would wither and fail.

Quote:
3) a series of MISTAKES were made in communication between the medical specialities and record keeping.....again is that the preserve of a type of medical system or a fact of human endeavour? And imagining that the medics here are any worse than over on your side is wrong.. I have seen too many US doctors come here to recieve specialaist training..because it was the best on the planet...
No the medics are no worse, and human mistakes happen in both systems. But in "for profit" systems, the health care companies exist to turn a profit doing what they do. So in a "for profit" system there are managers at all levels who are rewarded for profitable systems under their control -- so these managers will make a point to develop systems which would prevent those sort of administration issues -- because they cost money and customers.
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Old 10-13-2009, 03:59 AM
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Originally Posted by jluetjen View Post
I was curious what he had originally since neither article mentions it. While it may have been "cancer" -- was it a different form? If he was allowed to have the lung transplant the first time to replace cancerous lungs, why wasn't the same rule an impediment?.
Indeed... different type of cancer, different stage.. metastateses etc.. we simply don;t know...

Quote:
Originally Posted by jluetjen View Post
Interesting point. But isn't a lung replacement with a set of donor lungs which are 50% likely to develop cancer themselves (as a result of the donor) a pretty foolish investment of resources? "For Profit" companies (in any industry) would rarely allow such a situation to happen. No company would ship a product with a 50% chance of a warranty replacement -- the company would be out of business in no time. Does that mean that those people who beat the odds and got a good set of lung would never have been treated in a "for profit" scenario? Of course not -- that's a silly "strawman" conclusion to draw. "For profit" companies exist to service a market and make money doing so -- they would quickly focus on the key issue. Put in place a means to acquire a "high quality" supply of donor lungs. This will be done to reduce the "warranty" costs of the lungs, specifically the costs of doing a second replacement, or the legal costs of defending the company from mal-practice suits..
Interesting point and correct in many ways.. except for one...lungs of the right age/ match are not there to be creatively sourced...regardless of how much money is involved (aside from possibly illegal/ immoral organ harvesting)...
so the raw material is rare.. if not unique and is time limited. In any health care system when a pair of lungs becomes avaliable then it needs to be used 'now'.. the pool of recipients is limited and in the UK there is a national priority list..so top of the list for that age/ match gets the lungs...perhaps in the Us it goes to an 'auction'..

Quote:
Originally Posted by jluetjen View Post
You might argue that "high quality" donor lungs just don't exist. But that's the standard form of passive response that a government run system would result in. In a for-profit system, companies would actively apply creative thinking to the problem and come up with innovative solutions. (If I knew what these were I'd be rich right now). Why would they do this? Because they can only make money when they are replacing lungs (in this scenario). Those companies that could find a good, high-quality system would thrive. Those that could not would wither and fail.
.
What about the costs of not being able to acquire the lungs in time and the patient dies before the 'for profit' provider acquires the correct set of lungs.. or is unable to afford the 'best'..

A nightmare in both situations...

Quote:
Originally Posted by jluetjen View Post
No the medics are no worse, and human mistakes happen in both systems. But in "for profit" systems, the health care companies exist to turn a profit doing what they do. So in a "for profit" system there are managers at all levels who are rewarded for profitable systems under their control -- so these managers will make a point to develop systems which would prevent those sort of administration issues -- because they cost money and customers.
Interesting.. do you think that the managers in a government system are any less motivated? if you look at the NHS pay structure there are ways of gaining additional rewards of a financial nature in responsse to high productivity or high quality work...

Don't think that the medics and or managers here are sitting pretty doing the minimum and not moticvated by the potential for more money...or that they are not dismissable for groos mistakes and or being rubbish.

The issue is one that not enough information is being assimilated in this health care debate.. positions and dogmas are adopted without challenging recieved wisdom. Certainly there is a massive lakc of knowledge of how our NHS actually works that fuels the call for more private medicine which may or may not be required...
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Old 10-13-2009, 05:56 AM
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The soldier almost certainly DID NOT have cancer before the transplant. He had a restrictive pulmonary disease. That's NOT cancer. People with lung cancer DO NOT GET LUNG TRANSPLANTS.
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Old 10-13-2009, 06:27 AM
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The soldier almost certainly DID NOT have cancer before the transplant. He had a restrictive pulmonary disease. That's NOT cancer. People with lung cancer DO NOT GET LUNG TRANSPLANTS.
All I have been able to find is that he had a terminal respiratory condition....

I'll let you give us more information on what that could mean.

Also I have seen that hosptial stating that the early X rays of the lungs did not show signs of cancer.... I have assumed these were done once the transplant had occured....
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Old 10-13-2009, 06:45 AM
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All I have been able to find is that he had a terminal respiratory condition....
The vast majority of terminal respiratory conditions are not cancer.
If he had cancer, he would not be a transplant candidate.
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Old 10-13-2009, 06:47 AM
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MFAFF, you need to learn to read more carefully, also think before you comment, see post above,

and yes, the managers in a government system are almost certainly less motivated than those in private/for profit system. X ray is not how you diagnose cancer, it is a rather insensitive way to ID potential problem. It costs a TON of dough to do a lung transplant, enough to maintain a pt with COPD, or whatever he had initially, for a long time. Transplanting lungs out of a guy who smoked 3 packs a day for however long is stupid, and would almost certainly get you sued here.

Here, you get a tattoo, or go to the wrong country, or get diagnosed with melanoma or something and you can't even give blood.
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Old 10-13-2009, 06:54 AM
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The vast majority of terminal respiratory conditions are not cancer.
If he had cancer, he would not be a transplant candidate.
OK. I'll try to understand why a double transplant was considered for my lung cancer suffering FIL...

And rejected not on the fact of the cancer.. but of its stage...

Hey ho.. interesting.
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Old 10-13-2009, 06:56 AM
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MFAFF, you need to learn to read more carefully, also think before you comment, see post above,.
I do need to read more carefully.. however from direct personal experience over here having lung cancer does not seem to be an automatic non transplant scenario.. I guess that may cause a bit of confusion.

And thank you for being quite so patronising...

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and yes, the managers in a government system are almost certainly less motivated than those in private/for profit system. ,.
You know this from personal experience no doubt....
Do you know the people at Papworth? I do and to be more motivated to get it right would appear to be asking for superhuman performance...
It may well exist.

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X ray is not how you diagnose cancer, it is a rather insensitive way to ID potential problem. It costs a TON of dough to do a lung transplant, enough to maintain a pt with COPD, or whatever he had initially, for a long time. Transplanting lungs out of a guy who smoked 3 packs a day for however long is stupid, and would almost certainly get you sued here..
Agreed its stupid.. so do you sit and wait until perhaps maybe you get a better set of lungs..?

I'm guessing that if it became known that your for profit hospital had turned down the only set of lungs offered to it because they were not good enough and the patient had died the law suit would be less difficult...I don't know how that would work over there.

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Here, you get a tattoo, or go to the wrong country, or get diagnosed with melanoma or something and you can't even give blood.
Its the same here...but blood is far more 'common' than a pair of lungs.. Perhaps lungs are more avaliable in the US.. or simply because there are more donors the offer is greater...afterall there are 300+million against 60+ million...that should make a difference.

If you want to use this as a stick to bash the NHS and so Socialised medicine, I can understand it...but we could find examples of crass managerial proceedures in the US; poor organ choices.. and mistakes which lead to 'malpractice' there as well as an way of bashing the 'for profit' system.

Neither are perfect.

In Moses' experience, far greater no doubt than mine; lung cancer means no transplant.. in my extremely limited experience of that particular hosptial.. it would appear to be different.
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Old 10-13-2009, 07:26 AM
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MFAFF; It sounds like you have more experience with lung cancer and transplants than I (thankfully) do. It's not my intention to question that or the motivations of any individuals in the UK's NHS. I have no doubt that people in the UK are just as well intentioned as people in the US, and just as capable. But the point that I'm trying to make is more systematic rather than personal.

Quote:
Do you know the people at Papworth? I do and to be more motivated to get it right would appear to be asking for superhuman performance...
While I don't know the people in the Papworth, I can say with certainty that "for profit" managers in the US are far more motivated (as a group) to service their customers in a profitable fashion for the following reasons.

1) "For Profit" managers (down to a certain level) are rewarded by the profitability of their organizations. This is not the case in the "not-for-profit" government. If the manager in a "for profit" company doesn't produce results, it has a "career limiting" impact on their future roles in the organization. At least in this country, the government has awful record of keeping to a budget, let alone achieving the more difficult task of turning a profit.

2) Employees in "for profit" organizations routinely work longer than the standard business hours to achieve their objectives. In the case of "professional", salaried employees, this is done for no additional compensation. Numerous studies in the US have shown that government employees have significantly shorter work-weeks than employees in the private sector.

3) About 70% of the US workforce is not unionized. As a result they (and their organizations) are flexible in regards to responsibilities, hours and other things in order to get the job done. Once again -- in the US, about 70% of the government workforce is unionized. As a result they have far more restrictive work rules, generous vacation time, seniority advancement and tenure and many other things that result in an unmotivated, less efficient work force. So at a systematic level, "For profit" companies are far more efficient.

Another point that hasn't been mentioned is the availability of "leading edge" techniques, technologies and drugs. According to Wikipedia, the first lung transplant was done by...

Quote:
James Hardy of the University of Mississippi performed the first human lung transplant in 1963.[3] Following a left lung transplantation, the patient survived for 18 days. From 1963-1978, multiple attempts at lung transplantation failed because of rejection and problems with anastomotic bronchial healing. It was only after the invention of the heart-lung machine, coupled with the development of immunosuppressive drugs such as cyclosporine, that organs such as the lungs could be transplanted with a reasonable chance of patient recovery.

The first successful transplant surgery involving the lungs was a heart-lung transplant, performed by Dr. Bruce Reitz of Stanford University on a woman who had idiopathic pulmonary hypertension.[4]
Admittedly, some of the pioneering work was done in the USSR in the '50's, but it was not until 20 years later, in 1983 that a non-US pioneer started to take the lead, after the proof-of-concept had been done and much of the technology put in place.

Quote:
* 1983: First successful single lung transplant (Tom Hall) by Joel Cooper (Toronto)[5]
* 1986: First successful double lung transplant (Ann Harrison) by Joel Cooper (Toronto)[6]
* 1988: First successful double lung transplant for cystic fibrosis by Joel Cooper (Toronto)
The same applies to new drugs. The government oversight of a socialized medical system will not support the "risky" investment in new technologies because it's expensive. Venture Capital Investors will not support it either since they know that the government will cap their returns, if not force them to give the technology away in the name of "cost reductions". So new technologies just don't happen in socialized systems. It doesn't happen today unless it's driven by profits within the US. If the US goes socialized, the rest of the world will no longer have anyone's technological coat-tails to ride on.

At a personal level, an example of the technological advancement that is near and dear to me are my contact lenses -- a technology known as Corneal Refractive Therapy (CRT). In a nutshell, it is a new form of hard-contact that I wear when I sleep at night and my vision stays at 20/20 for about 36-72 hours -- more than adequate for a full day's activities. In many cases it's a technology which is not directly carried under insurance plans. Because of the plan that I have, and the ability to take out pre-tax money to help pay for them, I can enjoy their benefits. Until recently, when I've talked to people I deal with overseas, they've never heard of the technology because it wasn't available. If it wasn't for the flexibility of the existing US healthcare system, the company manufacturing the system wouldn't exist, and I wouldn't enjoy the benefits of the technology.
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Old 10-13-2009, 10:59 AM
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MFAFF; It sounds like you have more experience with lung cancer and transplants than I (thankfully) do. It's not my intention to question that or the motivations of any individuals in the UK's NHS. I have no doubt that people in the UK are just as well intentioned as people in the US, and just as capable. But the point that I'm trying to make is more systematic rather than personal.

While I don't know the people in the Papworth, I can say with certainty that "for profit" managers in the US are far more motivated (as a group) to service their customers in a profitable fashion for the following reasons.

1) "For Profit" managers (down to a certain level) are rewarded by the profitability of their organizations. This is not the case in the "not-for-profit" government. If the manager in a "for profit" company doesn't produce results, it has a "career limiting" impact on their future roles in the organization. At least in this country, the government has awful record of keeping to a budget, let alone achieving the more difficult task of turning a profit.
I'll look at that in the following light, because this is how it actually is for non medical 'health care managers' here...

Different levels (departmental/ hospital/ Trust) exist and promotion is as 'merit based' as any private sector organisation, and renumeration is based on grade/ experience and performance....so whilst there is no 'profit' element to the institutional side of things there is a personal financial aspect that does reward directly good performance and ability.....This motivation is pretty much on a similar basis as those enjoyed by private sector equivalents (there are entirely private hospitals here against which measures can be made)...so we are looking at this somewhat differently.

Quote:
Originally Posted by jluetjen View Post
2) Employees in "for profit" organizations routinely work longer than the standard business hours to achieve their objectives. In the case of "professional", salaried employees, this is done for no additional compensation. Numerous studies in the US have shown that government employees have significantly shorter work-weeks than employees in the private sector.
If we split out medical to non medical staff then we might have something useful...
The nurses etc and medical staff on shift work will by and large work their 'shift' hours (broadly.. I know that here there are plenty of medical staff who do extend their hours to cover as required, same applies to nurses but they are 'encouraged' to stick to shift hours as the quality of care is a factor..)
Non medical staff...if they are say porters/ cleaners etc do shift work and flexibility is not their middle name... anywhere... the managerial staff will work as needed to complete their work.. see above.
I think the NHS does not generate 'typical' government workers... they are, at least over here NHS workers and have a different ethos...

Quote:
Originally Posted by jluetjen View Post
3) About 70% of the US workforce is not unionized. As a result they (and their organizations) are flexible in regards to responsibilities, hours and other things in order to get the job done. Once again -- in the US, about 70% of the government workforce is unionized. As a result they have far more restrictive work rules, generous vacation time, seniority advancement and tenure and many other things that result in an unmotivated, less efficient work force. So at a systematic level, "For profit" companies are far more efficient.
Agreed the nurses here are unionised, as are the support staff and this does have downsides.. in terms of strike action etc... has upsides as well in terms of nursing ratios, retention of staff long term and so forth.. so its a bit of a wash here.
The generalisation of a less motivated work force I feel is incorrect when applied to medical staff. As for the support staff then indeed there is a point..
"More efficient'.. until 15 years ago I'd have said the NHS was far more efficient than ANY for profit health care system as were very few non medical managers etc.. but the introduction of certain systems nationally has increased the non medicla staffing greatly.. it now matches the private medical institutions.....

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Originally Posted by jluetjen View Post
Another point that hasn't been mentioned is the availability of "leading edge" techniques, technologies and drugs. According to Wikipedia, the first lung transplant was done by...



Admittedly, some of the pioneering work was done in the USSR in the '50's, but it was not until 20 years later, in 1983 that a non-US pioneer started to take the lead, after the proof-of-concept had been done and much of the technology put in place.



The same applies to new drugs. The government oversight of a socialized medical system will not support the "risky" investment in new technologies because it's expensive. Venture Capital Investors will not support it either since they know that the government will cap their returns, if not force them to give the technology away in the name of "cost reductions". So new technologies just don't happen in socialized systems. It doesn't happen today unless it's driven by profits within the US. If the US goes socialized, the rest of the world will no longer have anyone's technological coat-tails to ride on.

At a personal level, an example of the technological advancement that is near and dear to me are my contact lenses -- a technology known as Corneal Refractive Therapy (CRT). In a nutshell, it is a new form of hard-contact that I wear when I sleep at night and my vision stays at 20/20 for about 36-72 hours -- more than adequate for a full day's activities. In many cases it's a technology which is not directly carried under insurance plans. Because of the plan that I have, and the ability to take out pre-tax money to help pay for them, I can enjoy their benefits. Until recently, when I've talked to people I deal with overseas, they've never heard of the technology because it wasn't available. If it wasn't for the flexibility of the existing US healthcare system, the company manufacturing the system wouldn't exist, and I wouldn't enjoy the benefits of the technology.
This is way too dangerous ground to tread on....having spent the last four decades living and breathing the medical research labs at Oxford University the list of cutting edge innovations in medical technology, science and so forth that emerges directly from government funded labs and research programmes would provide ample support for a government funded system.

However there is no doubt that the commercial system provides a massive impetus to drug and technological research and much is absolutely the result of the profit that can be derived from this process.

The global medical knowledge base would no be the same without it... nor could it be replaced by a government funded system...but they are inter dependent, not independent or replaceable one by the other.

It is very hard, from the US perspective to understand the freedom that government funded science and research gives, when it can be undertaken with no direct view to application or profit. This provides US medics that I have known with the opportunity to join studies that are 'impossible' to do in the US as funding is simply not there to carry it out.

I think that basing the notion of a government run health care system on the overall government employee model in the US (I spent five years living in Alexandria VA, so met a few!) is misleading....health care does attract a type of person who does work at a professional level...regardless.

Do we regard the government employees who wear a US Army uniform as work to rule, union lead slackers? Or dedicated professionals? Do we think that the VA medics are any less professional than those at the Mayo Clinic? Is a surgeon doing cardiac surgery at Walter Reed any less diligent and motivated to do the job as well as possible?

Viewed in that light then perhaps a different view of the issue is revealed.
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Old 10-13-2009, 12:13 PM
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How about this story:
Quote:
A grandfather who beat cancer was wrongly told the disease had returned and left to die at a hospice which pioneered a controversial 'death pathway'.

Doctors said there was nothing more they could do for 76-year- old Jack Jones, and his family claim he was denied food, water and medication except painkillers.

He died within two weeks. But tests after his death found that his cancer had not come back and he was in fact suffering from pneumonia brought on by a chest infection.

To his family's horror, they were told he could have recovered if he'd been given the correct treatment.

Yesterday, after being given an 18,000 pay-out over her ordeal, his widow Pat branded his treatment 'barbaric' and accused the doctors of manslaughter.

Mr Jones was being cared for at a hospice which was central to the contentious Liverpool Care Pathway under which dying patients have their life support taken away, although the hospice claims it wasn't officially applied in his case.

The scheme is used by hundreds of hospitals and care homes, and is followed in as many as 20,000 deaths a year.

Supporters say it brings dignity to a patient's final hours, but critics fear that some are placed into it incorrectly.

Mr Jones, a retired bricklayer with two daughters, was diagnosed with stomach cancer in May 2005. After undergoing chemotherapy, he had his stomach removed by surgeons at Royal Liverpool Hospital that September.

He was told he was in remission from cancer, but the grandfather of two continued to suffer pain following the operation as well as difficulties in eating, and on January 3, 2006, he went to the city's Marie Curie hospice for respite care.

While there, however, his family were told the cancer had returned by Dr Alison Coackley, a palliative medicine consultant who played a key role in drawing up the Liverpool Care Pathway.

Despite the fact that no tests were carried out to confirm the diagnosis, his family say doctors instructed nurses to stop giving him food and fluids.

The only medication he was permitted were painkillers, and he slipped into semi- consciousness without the chest infection being diagnosed and died on January 14.

But a post-mortem examination found he was free of cancer and had in fact died of pneumonia.

Reports commissioned by Mrs Jones's solicitor concluded that with antibiotics and a rehydrating drip he could have made a full recovery and survived for at least another two years.

The hospice and the doctors who treated Mr Jones continue to deny liability, but his widow has now accepted an 18,000 out-of-court settlement after being told she would otherwise lose her legal aid.

Yesterday she said: 'If they'd only treated his chest infection, my husband could well still be alive today.

'We fought in the hospice to get Jack the right treatment and they blocked us, making us feel we were a nuisance.

'I was worried it was pneumonia, I wanted them to check his chest, but they wouldn't.'

Mrs Jones and the family want to know whether her husband was treated under the Liverpool Care Pathway.

She added: 'Jack was the life and soul of the party. He was a true gentleman. As far as I'm concerned, his death was manslaughter. It's barbaric and I don't want any other family to go through what we've had to.'

The 75-year-old, of Childwall, Liverpool, plans to report Dr Coackley and another doctor to the General Medical Council. Dr Coackley, 45, worked with Professor John Ellershaw at the hospice in Liverpool at a time when he was heading the writing of the LCP policy.

One article they published together last year said: 'Futile treatments should . . . be discontinued at this time and consideration should be given to the discontinuation of antibiotics and blood tests.'

Mrs Jones's solicitor, Michael Danby, said: 'This is a particularly sad case as it was entirely preventable. If they had examinedhis chest, they would have diagnosed the infection, and he could have been treated.'

The hospice's lawyer, Dorothy Flower, said it had settled the case to enable Mrs Jones to grieve for her husband, but did not accept liability. 'Some things are done for economic reasons, and a case like this costs a huge amount of money, which would do nobody any good,' she said.

Marie Curie Cancer Care said it could not comment on Mr Jones's case due to patient confidentiality. However, it insists that the Liverpool Care Pathway requires doctors to monitor patients regularly.

Read more: My husband had beaten cancer, then doctors wrongly told him it had returned and let him die | Mail Online
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Old 10-13-2009, 12:58 PM
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I think that basing the notion of a government run health care system on the overall government employee model in the US (I spent five years living in Alexandria VA, so met a few!) is misleading....health care does attract a type of person who does work at a professional level...regardless.
If that's the case -- what happened here???

Quote:
Doctors left a premature baby to die because he was born two days too early, his devastated mother claimed yesterday.

Sarah Capewell begged them to save her tiny son, who was born just 21 weeks and five days into her pregnancy - almost four months early.

They ignored her pleas and allegedly told her they were following national guidelines that babies born before 22 weeks should not be given medical treatment.

Miss Capewell, 23, said doctors refused to even see her son Jayden, who lived for almost two hours without any medical support.

She said he was breathing unaided, had a strong heartbeat and was even moving his arms and legs, but medics refused to admit him to a special care baby unit.

Medics allegedly told her that they would have tried to save the baby if he had been born two days later, at 22 weeks.

In fact, the medical guidelines for Health Service hospitals state that babies should not be given intensive care if they are born at less than 23 weeks.

The guidance, drawn up by the Nuffield Council, is not compulsory but advises doctors that medical intervention for very premature children is not in the best interests of the baby, and is not 'standard practice'.

James Paget Hospital in Norfolk refused to comment on the case but said it was not responsible for setting the guidelines relating to premature births.

A trust spokesman said: 'Like other acute hospitals, we follow national guidance from the British Association of Perinatal Medicine regarding premature births.'

Miss Capewell, who has had five miscarriages, said the guidelines had robbed her son of a chance of life.

She said: 'When he was born, he put out his arms and legs and pushed himself over.

A midwife said he was breathing and had a strong heartbeat, and described him as a "little fighter".

I kept asking for the doctors but the midwife said, "They won't come and help, sweetie. Make the best of the time you have with him".'

She cuddled her child and took precious photos of him, but he died in her arms less than two hours after his birth.

Miss Capewell, who has a five-year-old daughter Jodie, went into labour in October last year at 21 weeks and four days after suffering problems during her pregnancy.

She said she was told that because she had not reached 22 weeks, she was not allowed injections to try to stop the labour, or a steroid injection to help to strengthen her baby's lungs.

Instead, doctors told her to treat the labour as a miscarriage, not a birth, and to expect her baby to be born with serious deformities or even to be still-born.

She told how she begged one paediatrician, 'You have got to help', only for the man to respond: 'No we don't.'

As her contractions continued, a chaplain arrived at her bedside to discuss bereavement and planning a funeral, she claims.

She said: 'I was sitting there, reading this leaflet about planning a funeral and thinking, this is my baby, he isn't even born yet, let alone dead.'

After his death she even had to argue with hospital officials for her right to receive birth and death certificates, which meant she could give her son a proper funeral.

She was shocked to discover that another child, born in the U.S. at 21 weeks and six days into her mother's pregnancy, had survived.

Amillia Taylor was born in Florida in 2006 and celebrated her second birthday last October. She is the youngest premature baby to survive.

Miss Capewell said: 'I could not believe that one little girl, Amillia Taylor, is perfectly healthy after being born in Florida in 2006 at 21 weeks and six days.

'Thousands of women have experienced this. The doctors say the babies won't survive but how do they know if they are not giving them a chance?'

Miss Capewell has won the support of Labour MP Tony Wright, who has backed her call for a review of the medical guidelines. He said: 'When a woman wants to give the best chance to her baby, they should surely be afforded that opportunity.'
What the medical guidelines say...

Guidance limiting care of the most premature babies provoked outrage when it was published three years ago.

Experts on medical ethics advised doctors not to resuscitate babies born before 23 weeks in the womb, stating that it was not in the child's 'best interests'.

The guidelines said: 'If gestational age is certain and less than 23+0 (i.e at 22 weeks) it would be considered in the best interests of the baby, and standard practice, for resuscitation not to be carried out.'

Medical intervention would be given for a child born between 22 and 23 weeks only if the parents requested it and only after discussion about likely outcomes.

The rules were endorsed by the British Association of Perinatal Medicine and are followed by NHS hospitals.

The association said they were not meant to be a 'set of instructions', but doctors regard them as the best available advice on the treatment of premature babies.

More than 80,000 babies are born prematurely in Britain every year, and of those some 40,000 need to be treated in intensive care.

The NHS spends an estimated 1 billion a year on their care.

But while survival rates for those born after 24 weeks in the womb have risen significantly, the rates for those born earlier have barely changed, despite advances in medicine and technology.

Medical experts say babies born before 23 weeks are simply too under-developed to survive, and that to use aggressive treatment methods would only prolong their suffering, or inflict pain.

The guidelines were drawn up by the Nuffield Council on Bioethics after a two-year inquiry which took evidence from doctors, nurses and religious leaders.

But weeks before they were published in 2006, a child was born in the U.S. which proved a baby could survive at earlier than 22 weeks if it was given medical treatment.

Amillia Taylor was born in Florida on October 24, 2006, after just 21 weeks and six days in the womb. She celebrated her second birthday last year.

Doctors believed she was a week older and so gave her intensive care, but later admitted she would not have received treatment if they had known her true age.

Her birth also coincided with the debate in Britain over whether the abortion limit should be reduced.

Some argued that if a baby could survive at 22 weeks then the time limit on abortions should be reduced.

The argument, which was lost in Parliament, followed a cut to the time limit in 1990 when politicians reduced it from 28 weeks to 24 weeks, in line with scientific evidence that foetuses could survive outside the womb at a younger age.

However, experts say cases like Amillia Taylor's are rare, and can raise false expectations about survival rates.

Studies show that only 1 per cent of babies born before 23 weeks survive, and many suffer serious disabilities.

Read more: Premature baby 'left to die' by doctors after mother gives birth just two days before 22-week care limit | Mail Online
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Last edited by jluetjen; 10-13-2009 at 01:02 PM..
Old 10-13-2009, 12:58 PM
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OK. I'll try to understand why a double transplant was considered for my lung cancer suffering FIL...

And rejected not on the fact of the cancer.. but of its stage...

Hey ho.. interesting.
Cedars Sinai guidelines for lung transplantation specifically list any malignancy, including lung cancer, as an ABSOLUTE CONTRAINDICATION to transplant.
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Old 10-13-2009, 01:09 PM
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John,

Not certain what point you are making or trying to make with those two posts...

The first post illustrates that a mistake was made...and does your post therefore imply this is the fault of a socialised medical programme... do mistakes of this mature not occur in the US? Are mistakes eliminated by the 'private' nature of the health care.. if so the levels of malpractice insurance would be far lower.. because far fewer mistakes are made and hence less cause to sue.... or are mistakes an inherent risk...

The second is even more confusing... the policy is dreadful.. yet it would seem that save of a mistake on the age of Amillia Taylor in Florida she too would not have recieved the life saving treatment afforded by Neo Natal ITU.....

On the face of this article it would appear that on both sides of the Atlantic the 22 week policy is applied.. or have I mis read this bit?
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Old 10-13-2009, 01:18 PM
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