The lack of evidence based discussion in Parliament is rather disconcerting.
First, there was praise for Silverstar charity , who offer diabetes screening – which is not recommended in the NHS. Anna Soubry was also praising Boots for offering ‘diabetes checks’ – which is not recommended on the NHS, is likely to use NHS resources in dealing with unwarranted tests, and inveigles the private sector into seeming ‘essential’ – when it’s doing tests that are not recommended by the evidence base we should follow. The lack of knowledge displayed by Anna Soubry is disconcerting for someone seemingly in charge of this policy.
Then there was a question for her on the subject of HPV vaccination, which she followed by raising “the lack of screening for young women under the ages of 25…which concerns me”. Has she not read the evidence, or considered the harms?
As for Jeremy Hunt. He started by suggesting
“There is far too much bureaucracy in the NHS….we need to free up the time of the people on the front line to care”. I’d consider this to be the dementia screening which he is insisting that hospitals do, or be fined, on every patient admitted over the age of 75.
Madeline Moon thought that GPs didn’t understand or weren’t ‘aware’ of rarer types of early onset dementia, which Jeremy agreed with.
He then said that there was a “widespread lack of understanding” about dementia in general, “we are also looking at a major programme to engage GPs because there are still sadly some GPs who think that it’s not worth diagnosing someone with dementia at all, and there is a lack of understanding and we absolutely have to put it right.”
I think he’s talking about me. I wish he would name the dissenters and then properly debate the issues. For the facts are
– screening for dementia is not evidence based
– because all screening does harm, it may do more harm than good, and will certainly do some harm
-there has been no recognition of the fact that people should have a right to decide whether or not they wish the dementia screening question and the risk of overdiagnosis or non-timely diagnosis
– the slur that people who think that screening for dementia is so problematic and so non evidence based are therefore suffering from a ‘lack of understanding’ and somehow that they may feel that patients are ‘not worth’ the effort is offensive. It’s because I care about good medical practice that I object to this political, not clinical, management tool. And here we have the crux:
Jason McCartney MP said there wasn’t enough being spent on dementia research. Jeremy said that he was going to “catalyse the private sector companies, because they know the size of the potential market for dementia is huge, and they have been frustrated in their attempts to get a breakthrough which is what we urgently need, we have to use that interest to excite their interest and keep them focussed on this really, really tragic disease. ..There are unacceptable variations in the rate of diagnosis of dementia across the country and we are committed to driving significant improvements….”
It gets worse.
Julian Sturdy MP thought that more people should be diagnosed with dementia and thought these undiagnosed people were a “tragedy” because “drugs can stave off the condition for 1 in 3 to 1 in 4 people, can have a big impact, but also you can put in place support services for carers.”
Here we go. Jeremy’s statement is not ironic. If you are a pharmaceutical company, and you want to increase your market, you look for pre-disease – early stage disease. The problem is that early stage disease is often very unpredictable and will not always lead to the disease you think it will. So, for example, high cholesterol, or blood pressure, or breast changes on screening mammograms. The earlier you try and pick up ‘pre-disease’ on screening, the more difficult it is to know how these ‘early signs’ will behave. Pharmaceutical companies will benefit, as more people will be prescribed medication at an earlier stage – hence, for a longer time. But will the people being screened benefit? The test may pick up false positives (especially if someone is in pain or otherwise unwell and can’t answer the questions properly), or mild cognitive impairment, which goes on to produce dementia a minority of the time. The drugs on offer don’t prevent dementia for people with memory problems. As for people with dementia, Cochrane says they can produce an improvement of just over one point on the MMSE cognitive test scale (of 30 points) and a gain of 2.4 points on the PDS daily activities score (out of 100). I hardly think Jeremy’s faith in the drugs is well placed. Additionally, the idea that only a dementia diagnosis should prompt an older person to think about plans for future domestic arrangements is misleading – we all should do this as we get older, no matter what our current diagnoses are.
In short, the benefits of the drugs are being overhyped. This is not fair on patients or their families. Screening is being oversold without account for the evidence or it’s harms. People are not being allowed to make ‘no decision about me, without me.’ The debate today demonstrated ably that policy is being created by people who appear to not understand the science of screening. Worse, for all the debate about research, there was no word on how badly we treat and pay carers who do unbelievably difficult work with people with dementia every day – and who would be paid more, often, if they worked at a checkout. Why do we not value these carers more? We have this debate all the wrong way round.
It’s proof, at least, that Jeremy has not read the book my publisher sent him. So where has he got his information from – we were treated to a few tweets from his visit to Eli Lilly last month- who make the meds he wants us to prescibe more of. Surely it’s time for the NHS to be run outside party politics and given to an independent body to run, according to evidence, instead.