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Tuesday, April 1, 2014

DEMENTIA AND ALZHEIMER'S - WHAT ARE THE VESTED INTERESTS BEHIND THE PUSH FOR OVERDIAGNOSING? - The case of Britain where doctors are pushed to overdiagnose

Just a few weeks ago we heard about a new blood test that is an "almost" sure way to predict Alzheimer's.  It claims a 90% accuracy.
 
Problems:  some of the patients involved were given an inaccurate or false positive result. Even if patients receive an accurate result, the test could present a slew of complications, from not being able to get life insurance to being unfairly dismissed from a job – or the simple worry of knowing that a debilitating disease awaits, years down the road.
 
And in Belgium they have approved euthanasia for patients of all ages with "chronic ailments". 
 
Will Alzheimer's and dementia diagnoses be eventually grounds for euthanasia  - as a cost-saving measure?   

Today's news comes from Britain:

DAILY MAIL -
Doctors 'leaned on' to diagnose dementia cases: GPs are told they will lose money if they don't meet their NHS targets

Leading GP Dr Martin Brunet: GPs with few cases will be desperate to escape a low ranking.  He argues 'naming and shaming' could lead doctors to  'up the numbers' .  But this raises concerns the patient-doctor relationship is being undermined, he warned

Health Secretary Jeremy Hunt has prioritised increasing dementia diagnosis rates in those patients who don’t have obvious symptoms. He believes GPs are reluctant to carry out tests because there is no effective cure.  But this has raised fears that unnecessary diagnoses will be made for fear of losing funding.
 
Mr Hunt has endorsed new  targets for diagnosis rates of Alzheimer’s and other forms of the disease. In November, he published a ‘dementia map’ of rates for different clinical commissioning groups (CCG).
 
But Dr Brunet said the video accompanying the website features Mr Hunt ‘lambasting the laggards for poor performance’.  As a result CCGs are piling on the pressure on GPs to raise dementia diagnosis rates ‘with financial strings attached’, while ‘leaning on you heavily to make any diagnosis to get the numbers up’, he claimed. At least one CCG has told its GPs the area will lose money if they don’t increase rates, Dr Brunet added.  And he warned that ‘naming and shaming’ makes the worst performers desperate to get off the bottom of the league table and so may unnecessarily ‘upgrade’ the diagnosis to dementia.
 
Dr Brunet, from Binscombe Medical Centre in Godalming, Surrey, is among growing medical opposition to the strategy. He said there was deep concern that the patient-doctor relationship was being undermined.  The setting of target rates for the diagnosis of any condition is unprecedented, says Dr Brunet, in a personal view in the British Medical Journal.  He said: ‘Dementia is big business and there are many vested interests that stand to benefit from a rise in the number of diagnoses.’
 
One in three older people has some form of minor cognitive impairment, which can be picked up in tests but may never lead to full-blown dementia.  Meanwhile, figures used to estimate how many diagnoses each practice should make are often wrong and fail to take into account local circumstances, such as dementia care homes in the area, Dr Brunet added.  And he warned: ‘Working towards targets can lead to perverse behaviours and outcomes, because the needs of patients are secondary to the requirement to fulfil quotas.’
 
The UK National Screening Committee said in June 2010 that screening for Alzheimer’s Disease ‘should not be offered’ because there was insufficient evidence of the benefits.  CCGs, which comprise groups of GPs collectively responsible for commissioning local services, can attract a quality premium payment as a reward for improving a range services.  Hertfordshire CCG has chosen the dementia rate target as one of the qualifying measures. If they miss it they will lose out on extra money for the area.
 
Dr Brunet said: ‘The idea that doctors should be motivated by self interest, such as personal or corporate gain, is abhorrent.’ 
 
The Health Department said in 2011 there were 250,000 dementia patients registered by GPs. It now exceeds 300,000.  A Department of Health spokesman said: ‘A timely diagnosis can make a significant difference to a person’s quality of life.  'We would always expect doctors to act in the best interests of their patients, to assess them appropriately when they show the signs of dementia, and refer them to a specialist for diagnosis.
 
Source
 
 
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RELATED
 
New blood test for Alzheimer's - 90% accurate?
 
2014: Pharmaceutical firms accused of falsifying data in major Alzheimer’s study
Japan’s health ministry said Friday it was probing claims falsified data was used in an Alzheimer’s disease study involving major pharmaceutical firms, a day after filing an unrelated criminal complaint against Swiss drugs giant Novartis.
 
Belgium law allows for euthanasia for people of all ages, including children, who suffer from chronic illness (not just terminal illness, but "chronic" diseases)
 
How the elderly are locked up against their will in the UK
 
EUTHANASIA ALREADY EXISTS IN BRITAIN - often without relatives' consent.  They call it the "Pathway". 
The National Health Service of Britain has a policy of removing seriously ill patients from hospitals and placing them in especially designated clinics to be deprived of food and water until they died.  They call it the Liverpool Care Pathway.  But with Pathway or not - patients are still left to starve.
 
Read more:
  
It was murder, says son of woman starved to death under Pathway "care"

July 2013 - The killing of patients will continue - under a different name
(Care and Support Minister, Norman) Lamb, struck an ominous note, for example, when he said the LCP’s replacement would not be called a ‘pathway’ — which suggested that these practices might continue under a different name.  He says that end-of-life care will now be tailored for individual patients. But this fails to identify the very confusion at the core of this problem. This arises over the issue of medical staff being able to identify correctly when someone’s life is about to end. For the advice at the core of the LCP is, in fact, nothing other than basic

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