John Hemming's Web Log John's Reference Website
Saturday, February 26, 2005
  Interesting Health Questions (inc MRSA)
The National Health Service is an important issue for many people. One aspect of that has been the question as to how prevalent MRSA is (the "Super Bug").

The linked report from The Telegraph indicates that it appears on the death certificate of about 1,000 patients a year. The real question, however, is how prevalent it really is.

Doctors from time to time report "old age" as the cause of death. This could include MRSA. Also Pneumonia is reported which also could involve MRSA. The difficulty is that we really need an audit of the records to find out what the true story is. Even in a City Council debate about MRSA there were two examples of people where MRSA was part of the story, but did not appear on the death certificate.

The real problem is that if MRSA appearing on the death certificate causes considerable stress then there will be a tendency for it to be omitted as a cause. This makes it difficult to really know what is going on.

Regardless as to how prevalent it is, however, we really should be able to do a better job of maintaining hygiene in hospitals - which is key in terms of limiting infection. One estimate has been that 40% of inpatients get an infection in hospital. This figure is, however, from about 5 years ago.

Another interesting question is the use of drugs. What proportion of prescribed drugs are of no use (I have heard an allegation of about 15%) and what proportion of patients are being treated primarily as a result of the side effects of prescription (I have heard an allegation of 10%). This is easily equally important as the issue of MRSA and probably more so, but it depends upon the outcomes.

Issues relating to Health are probably one of the group of issues that are worst handled through a simplified televisual debate. For example a side effect of a cough that arises from a drug to deal with high blood pressure is minor in comparison to the possible heart attack or stroke that could be the alternative.

Iatrogenesis is, however, something that should not be ignored. Much can happen as a result of patient demand, such as patients demanding anti-biotics for viral infections. This is, however, a very difficult area to handle as it does not respond well to the shallowness of much of what passes for public debate.

Another debate in the health service that does not normally see the light of day is how many people are being paid the wrong salaries. The salary system is relatively complex and there are widespread allegations of people being overpaid or even paid for a long time when they have left their jobs. These issues relate primarily to the complexity of the system (and the fact that people will generally complain about being underpaid, but not complain about being overpaid). With turnover rates of 45% in some medical jobs this could result in a substantial cost to the NHS of many tens of millions a year (or more).

The report linked about on Iatrogenesis cites figures of 180,000 up to 1,189,576 deaths a year (in the USA) from Iatrogenic causes. Some of this will be caused by the growth in claims for negligence - the usual law of unexpected consequences. This has people doing more things to cover their backs whilst resulting in a situation in which more errors are made.

A similar issue which has been ignored is that up to 40 people a year are killed by mentally ill people whose care regime has failed.

Given the government's massive concentration on terrorism, one wonders whether that is causing a lack of attention to this substantial issue.
 
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