Thursday, March 27, 2014
Wednesday, March 26, 2014
ADHD, Heart Risks, Kinko and Jetblue
©2012 Am Ang Zhang
On April 21, 2008 A News Release came through:
“Children with ADHD should get heart tests before treatment with stimulant drugs”
This is not from any anti-stimulant web-site but from America’s most respected American Heart Association. Full guidance is here. This did not surprise me because a couple of years ago, CNN Money, not CNN Health reported:
“FDA eyes heart risks of ADHD drugs”.
Such news would obviously affect the share prices of the major pharmaceutical companies involved.
In the same month, The American Academy of Child and Adolescent Psychiatry issued a statement :
“……The FDA voted to require black box warnings on methylphenidate (Ritalin). The committee had reviewed reports of 25 deaths, 19 of them under age 18…..”
Those who are interested can read the full FDA report.
In 2003, a BMJ article warned that:
“Europe is being targeted by the drugs industry as the next major market for increasing the use of stimulant drugs such as methylphenidate (Ritalin) and dexamfetamine, a Californian doctor specialising in behavioural paediatrics warned at a recent meeting of the President's Bioethics Council.”
The same article gave us a rough picture of the use of stimulants for ADHD round the world:
"In the 1990s the United States led the world in the use of these stimulants, with 90% of global use. In recent years this has fallen to 80% ‘That's because other countries are catching up,’ he said.”
It should not take a genius to start questioning a condition on planet earth that is mainly concentrated in North America. What about the rest of the world? Was there some specific cosmic event? Some unknown virus?
Why has Italy still not approved of stimulant use? Are they smarter than we thought? Perhaps they did not want to give up their lead position in the world of producing the most creative designers?
Why was there such a warning?
What are the risks of not using stimulants?
In the face of an unruly, over-energetic child, the parent might risk being seen as “bad” parents, and teachers as “incompetent” teachers.
The other risk is of course your child might turn out to be the likes of Kinko or Jetblue founders. As the Wall Street Journal pointed out,
“Clearly, ADHD didn't cripple such noteworthy sufferers as JetBlue founder David Neeleman or Kinko's founder Paul Orfalea.”
Here are their stories:
Jetblue founder, David Neeleman:
“Mr. Neeleman's family refused to regard his hyperactivity as an impairment. ‘We always thought ADD was a plus,’ says his father, Gary, a retired media executive. He advises ‘looking at the kid as somebody who has a different way of looking at things, and maybe a more creative way. ‘Then, put your arms around them and say, Boy, you're sure smart. You can handle this.' "
“He is credited with inventing electronic airline ticketing, he founded two airlines and is working on a third start-up in Brazil. He still has trouble sustaining a conversation for more than a few minutes, must delegate administrative tasks and ultimately got fired as JetBlue's CEO after service foul-ups.”
Kinko founder, Paul Orfalea:
“……Mr. Orfalea's mother came home in tears after he was expelled from school for the fourth time; a school official told her he'd do well to become an unskilled laborer, says the Kinko's founder, who also has dyslexia. But she didn't allow it to shape her regard for Paul. ‘My mother had a good saying: Look at your five fingers. All five are different for a reason. School wants to make you all the same…..'
……Her support instilled his faith in himself. When he got the idea, while waiting in line for a copy machine in college, to start his own copying business, he trusted it in the face of criticism from others. The company he opened in a storefront, named for his kinky red hair, later grew to the 1,200-store giant that was acquired in 2004 by FedEx……”
I will leave the last words to Judith Warner, who writes a weekly column in the New York Times on modern parenting:
“There’s a sense that greater powers, profit-driven and amoral, are pulling the strings in our children’s lives. There’s a sense that those who should best protect us — our government and our doctors — are so corrupted that they can no longer do the job. There’s a sense that childhood has, in many ways, been denatured, that youth has been stolen, that the range of human acceptability has been narrowed for our kids to a point that it has become soul-crushingly inhuman.”
Feb 19, 2013
Adult A.D.H.D. is open to faking and more so by medical students. In children, it was my experience that often parents would report symptoms in order to secure disability benefits.
Aug 14, 2012
Over the last ten years or so, I kept meeting friends in the U.S. whose children seemed to progress from one psychiatric diagnosis to another with frightening regularity, the most common being from ADHD to Bipolar.
Aug 03, 2012
It has long been held that there is no alternative treatment to ADHD! Stimulant in its various forms is the answer. In life nothing is easy or indeed straightforward.
Sep 18, 2011
“According to data obtained exclusively by Education Guardian under Freedom of Information legislation, there has been a 65% increase in spending on drugs to treat ADHD over the last four years.
Sep 23, 2011
First came ADHD. The use of stimulants benefits mainly teachers during school hours. Parents and doctors soon find a quick fix in antipsychotics, and for good measure the newer ones, believing that they have fewer side ...
Sep 20, 2011
Is the piano China
Oct 21, 2008
Results: Children with ADHD concentrated better after the walk in the park than after the downtown walk or the neighborhood walk. Effect sizes were substantial and comparable to those reported for recent formulations of ...
May 15, 2008
On April 21, 2008 A News Release came through: “Children with ADHD should get heart tests before treatment with stimulant drugs”
Jul 28, 2008
I have in my travels met other psychiatrists who often ask why there is such a discrepancy in the diagnosis of ADHD in the US
Sep 26, 2011
Has everything got to be ADHD, Bipolar or psychosis. Especially ADHD for a 39 year old?! In this week's ... But why should the patient not have pheochromocytoma and ADHD and paranoid psychosis and a touch of bipolar.
Aug 31, 2012
Over the last ten years or so, I kept meeting friends in the U.S. whose children seemed to progress from one psychiatric diagnosis to another with frightening regularity, the most common being from ADHD to Bipolar.
Jul 24, 2008
So Sharon Sharon
Thursday, March 20, 2014
Wednesday, March 19, 2014
NHS & McKinsey: Monitor & Toyota!
Dawn, anyone?
©Am Ang Zhang 2011
The new head of Monitor may indeed be too busy to note that quoting the car industry may not be the wisest thing to do.
Dr Bennett: Yes. I will start with two points. First of all, the fundamental goal of all this, of course, is about providing the best possible care for patients, and indeed specifically in Monitor’s case we will have a duty to promote and protect the interests of users of the system. In a sense, it would be a contradiction of what I think the Bill is aiming to do if we finished up with arrangements that did not enable commissioners to commission the services that were in the best interests of their patients.
More specifically, I know people are concerned that the further introduction of competition, or indeed Any Willing Provider, might make it impossible or very difficult to arrange for different providers to collaborate and provide the sort of integrated care that you are talking about. I don’t see why that should be, not least because of the starting point, but also because we see in lots of other sectors, lots of other markets where collaboration is needed in order to meet the needs of the end user or an intermediate user, that it works perfectly well.
I am very cautious about using examples from other sectors, lest I be immediately quoted as saying "Health care is just like X", which, of course, it is not. Health care is different. But one example which I was discussing with a colleague just the other day is the way the car industry works. You have very effective competition between the manufacturers of different cars but, in practice, when you are making a car you have all sorts of suppliers working together collaborating in order to produce the finished product. Indeed, you will sometimes finish up with providers who are working with more than one manufacturer. You may think it is a big step to go from there to health care but, in practice, if what you are talking about in a similar sort of way is multiple providers working together, collaborating- maybe a couple of different groups working in competition with each other but nevertheless providing the sort of integrated or long term care that is needed-then that should be entirely consistent with a degree of competition.
Toyota, one of the most successful motor car companies ran into major safety problems leading to recalls and litigations:
Toyota has, for the past few years, been expanding its business rapidly. Quite frankly, I fear the pace at which we have grown may have been too quick. I would like to point out here that Toyota's priority has traditionally been the following: First; Safety, Second; Quality, and Third; Volume. These priorities became confused, and we were not able to stop, think, and make improvements as much as we were able to before, and our basic stance to listen to customers' voices to make better products has weakened somewhat. We pursued growth over the speed at which we were able to develop our people and our organization, and we should sincerely be mindful of that. I regret that this has resulted in the safety issues described in the recalls we face today, and I am deeply sorry for any accidents that Toyota drivers have experienced. Especially, I would like to extend my condolences to the members of the Saylor family, for the accident in San Diego. I would like to send my prayers again, and I will do everything in my power to ensure that such a tragedy never happens again.
Akio Toyoda, the president and CEO of Toyota
“Today, we can say for certain that Toyota intentionally concealed information and misled the public about the safety issues behind these recalls,” Attorney General Eric Holder said in a statement. “Rather than promptly disclosing and correcting safety issues about which they were aware, Toyota made misleading public statements to consumers and gave inaccurate facts to Members of Congress.”
As part of the deal, Toyota
But the whole thing may indeed be academic: see the following exchanges earlier in the same sitting:
Q114 Chair: To the Commissioning Board and then there is the question of the-
Professor Corrigan: That is what I am unclear about in the Board. The Secretary of State talks about a mandate to the Commissioning Board. Whether that mandate means I then will answer a question about a particular locality within the year, again, force majeure, I don’t think he will have a choice. But that may not be the powers the Bill gives.
Nigel Edwards: He has no powers to intervene in individual consortium areas.
Chair: Are there any other issues here?
Q115 Rosie Cooper: Yes, if I may. Under the Bill, the Secretary of State will no longer have a statutory duty to provide health services and will only have to act with a view to securing the provision of health services in relation to the Board. How accurate is it to see this as spelling the end of a state provided National Health Service?
Nigel Edwards: That is precisely what it is, is it not? That is what it says. It is there in black and white. That is my reading of it as well. In fact, when every NHS hospital is a foundation trust, apart from the fact that the state would be a residual owner of roughly £36 billion of assets which belong to the taxpayer, there is no direct state control over the provision of health care except indirectly through the commissioning process. That is my reading of it.
Q116 Chair: Can I push on that because Rosie’s question was: "Is this the end of state provided health care?" The trusts are still owned by the state and they are delivering care in response to a tax funded budget that is accountable, through the process we have been discussing, to the commissioning boards.
Nigel Edwards: I was taking a narrower view of the definition. But you are absolutely right, yes.
Professor Paton: I am not trying to be smart but that expresses part of the theology of the purchaser-provider split, expressed in 1989 to 1991, which was suspended in culture but not in structure between 1997 and 2001 and then was gradually rolled out again in a new and indeed more radical form. It is just putting the top hat on that. That is what it is saying, but the practical reality will be exactly as the Chairman says. In other words, the reality is that public money is in the providers by one way or another and the theology may not be worth more than that proverbial bucket of spit when it comes to the-
McKinsey:
Tony Blair must indeed be very proud; his people are now on both sides, private health provider side and health regulator side of a Conservative government.
Simon Stevens: was with UnitedHealth Now
back!
Stevens knows he has taken on a
non-job. The boss of the Carbuncle is just one part of a deathly trinity;
Flat-Earthers, Off-Sick and the Carbuncle. A deliberate attempt to
distribute leadership and power across one of the world's largest remaining nationalised
industries. The rearrangement cost a fortune and doesn't work; we all
know that.
I doubt Stevens, a man with a
cultivated, international management background, will have much truck with
Flat-Earth inspection and will regard Off-Sick as an ornament. He is a Balliol
scholar and former Labour Councillor and was plucked from obscurity by
old-Labour's Frank Dobson but it was with Alan Milburn that he flourished. He wrote The NHS Plan, introducing
PCGs and later PCTs, then moved to become Tony Blair's Health-SpAd.
Later he ran a chunk of US
But I do not want to give credit to Blair. According to The Independent it is McKinsey: The Jesuits of Capitalism.
“They are the modern buccaneers of the business world. They jet between cities, rack up huge expenses, and charge up to £6,000 a day to think the unthinkable for clients including big corporations and governments.
They are the star consultants of McKinsey, the élite global management consultancy. Their backgrounds are diverse - former SAS commandos, business people, aid workers - but they are drawn together by the distinct McKinsey culture. Known as "the Firm" or the "McKinsey Mafia", they are radical, zealous - and above all secretive.
But now, it seems, McKinsey is becoming the problem rather than the solution. After almost 80 years as the most prestigious name in the management consultancy world, these "Jesuits of capitalism"are under attack.
McKinsey stands accused of cronyism, greed and arrogance, as a result of associated scandals that stretch from the offices of Enron in Houston, Texas, to the corridors of 10 Downing Street.”
“You can’t get fired for hiring McKinsey & Company.”
It often goes unmentioned, but McKinsey has indeed offered some of the worst advice in the annals of business. Enron? Check. Time Warner’s merger with AOL? Check. General Motors’s poor strategy against the Japanese automakers? Check. It told AT&T in 1980 that it expected the market for cellphones in the United States
A thought-provoking new book called “The Firm: The Story of McKinsey and Its Secret Influence on American Business,” which comes out next Tuesday, offers a fascinating look behind the company’s success.
The book, by Duff McDonald, chronicles McKinsey’s rise but also raises an important question about it that is applicable to the entire netherworld of consultants, advisers and other corporate hangers-on: “Are they worth it or not?”
The answer amounts to hundreds of billions of dollars annually. Indeed, the army of advisers whispering into the ear of Verizon and Vodafone (its C.E.O. is a former McKinsey partner) over the weekend for their work on the $130 billion deal stand to make over $200 million alone. And, perhaps most important, they don’t have to give the money back if the deal turns sour.
Mr. McDonald’s book explores the remarkable and intriguing disconnect between the advice McKinsey offers and the ultimate results.
Saturday, March 15, 2014
NHS & PFI: Please do not cry!
Please, do not cry!
Last year the NHS underspent its budget by £900m, returning much of it to the Treasury. This raises serious questions about stewardship of public funds, at a time when hospitals with PFI-associated deficits, such as Hinchingbrooke, have been franchised out to companies such as Circle, and other PFI hospitals in southLondon
Third, it is PFI deficits that are driving service closures, not patient demand or an ageing population. Service closures have nothing to do with service redesign.
Fourth, the government has now embarked on a new path, bringing in an Act that effectively abolishes the NHS, and which allows hospitals both to enter into more joint ventures with industry and to raise up to half their income from private patients. Two monsters are now unleashed – PFI and Lansley's Health and Social Care Act 2012.
Colin Douglas
©2012 Am Ang Zhang
Margaret Hodge, M.P. did not shy
away from pointing out that:
“Every single one of you has failed to do proper due diligence
about this and no one has been brought to account.
“There is
an issue of negligence here and one that I have not felt with a health report
to this committee before.”
Who were they that
failed?
Dr. David Bennett (not a medical doctor and seemed less
confident for someone from McKinsey)), Una O’Brien, permanent secretary for the
Department of Health, who looked the most confident of the lot she did not know
that Hospital Trust Boards are not to be trusted and of course the Trust CEO
(well there has been 5) and Head of the Strategic Health Authority.
MPs were also outraged at the apparent failure of trust bosses,
the health regulator Monitor and the Strategic Health Authority to take
responsibility for the crisis.
The PFI Hospital
This is about the 611-bed Peterborough City
Hospital
The solution:
millions again! Not on nurses or doctors!
MPs were also told that
over the last few years, some £14 million has been spent on a range of
consultants as well as five chief executives, to try and resolve the crisis.
A further £3 million is to
be spent on setting up a new team of consultants, which was announced by
Monitor today, and which will go into the hospital next year also in a bid find
a solution to the trust’s woes.
Free advice from Bloggers etc: why not just buy the
companies that own the PFI shares and if necessary by compulsory purchase?
Allyson Pollock:
How PFI is crippling the NHS
How PFI is crippling the NHS
Last year the NHS underspent its budget by £900m, returning much of it to the Treasury. This raises serious questions about stewardship of public funds, at a time when hospitals with PFI-associated deficits, such as Hinchingbrooke, have been franchised out to companies such as Circle, and other PFI hospitals in south
Failure is a product of
successive governments' policies since 1990: Kenneth Clarke's introduction of
capital charges and trusts, New Labour's PFI policy, foundation trusts and
payment by results, and now Lansley's new funding regime and policies.
Since the policy was
launched in 1992, report after report over almost two decades has shown how
each wave of PFI has been associated with trust mergers, leading to 30%
reductions in beds; staff lay-offs; and closures of hospitals, accident and
emergency departments and an untold number of community services – all because
of lack of affordability. PFI, once trumpeted as the largest hospital-building
programme, was in fact the largest NHS hospital and bed closure programme.
Metronet calls in administrators: Cost to Taxpayers £410 million
Metronet calls in administrators: Cost to Taxpayers £410 million
Allyson Pollock again:
The debt is toxic.
However, the government
will not allow hospitals to default on the debt (it would threaten all the
other PFI schemes and result in the banks taking legal action). Moreover, PFI
is a Treasury policy for the whole of the public sector and it is a policy that
the Treasury is exporting abroad. The Treasury and health department signed off
all the PFI deals in the full knowledge that affordability had been an issue
from the very beginning. The Treasury stuck to the line that there was no
alternative.
This is what the public
needs to know and is not being told.
First, the high costs
of PFI debt charges means that the NHS can only operate anything from a third
to half as many services and staff as it would have done had the scheme been
funded through conventional procurement. In other words, for every PFI hospital
up and running, equity investors and bankers are charging as if for two. Edward
Leigh, the chair of a Treasury committee report into PFI, called investor
returns the unacceptable face of capitalism.
Second, we can still
afford to pay for universal healthcare – but only if we stop using NHS funds to
prop up banks and equity investors.
Third, it is PFI deficits that are driving service closures, not patient demand or an ageing population. Service closures have nothing to do with service redesign.
Fourth, the government has now embarked on a new path, bringing in an Act that effectively abolishes the NHS, and which allows hospitals both to enter into more joint ventures with industry and to raise up to half their income from private patients. Two monsters are now unleashed – PFI and Lansley's Health and Social Care Act 2012.
Colin Douglas
Here in The BMJ, he
reviewed Allyson Pollock’s Book, NHS
plc.
"Since it was Pollock's views on the
PFI that so upset its proponents, it is worth summarising them briefly. Costs
are now intrinsically higher, because of capital borrowing at higher rates than
those available to government, because of cash hungry consultancies and the
vast transactional and monitoring costs of countless contracts, and because—for
the first time on a large scale in the NHS—commercial profits must be made. To
accommodate all these new costs clinical services have been scaled down, while
matching assumptions about increased efficiency are only variably delivered.
All this, along with the rigidity of a trust based strategy for building
hospitals and the locking in effect of contracts fixed for decades, seems to
Pollock and many others at best a bad bargain, at worst a naive betrayal that
opens the NHS to piecemeal destruction and the eventual abandonment of its
founding principles. And all over the country PFIs—greedy, noisy, alien cuckoos
in the NHS nest—gobble up its finances and will do so for the next 30 years.”
The private finance initiative was devised to get schools, hospitals and roads built without swelling the government's overdraft. Critics discerned a conjuring trick. Instead of the state borrowing, private consortiums did, and then the public paid – at a premium rate. It has often been likened to sticking a mortgage on a credit card; but Whitehall always resisted that charge.
It was just too important to flatter the books, especially to Gordon Brown. His twin obsessions were constructing temples to New Labour's social policies and establishing his prudence: PFI appeared to further both. But the trickery was too flagrant. Friendly thinktanks were tasked with devising a rationale couched in the language of public-private partnerships. It was said that City expertise would somehow foster efficiency. Henceforth PFI was all about improving the allocation of risk. Beautifying the books had nothing to do with it.
PFI: The Enron of the NHS
“PFI makes me particularly angry. It is a guaranteed loan to property
investors, where high-rate mortgage payments are kept off-balance to reduce the
country’s declared debt. In other words, it’s the Enron of the NHS. This is money
the NHS has committed to leave frontline healthcare for the next 35 years.”
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