Dave Curtis - archived blogs

My paper on cost to patient of medical interventions got published. So I suppose I may as well mention it here. Patient experience – the ingredient missing from cost-effectiveness calculations

Arizona is proposing fining obese Medicaid recipients who do not comply with a diet. People are complaining that this represents a "nanny-state" mentality but if the state is providing your healthcare and you are behaving in a way which makes this more expensive, why shouldn't the state try to recoup some of that extra expense? Fining non-dieters sounds impracticable but it would be fairly straightforward to allocate a specific cost to a wide range of activities which would tend to make people less healthy and hence to require more expensive healthcare. One could assign such a cost not only to each cigarette or each unit of alcohol but also each calory of food consumed. Thus there could not only be components of tobacco and alcohol duty which were badged as related to healthcare costs but also a health tax on food and drink related to calorific and salt content. As an example this would either make diet drinks cheaper than their sugar-containing equivalents or else the ma...

Seriously ill people will clutch at straws. Homeopaths are in the business of selling those straws.

Here is the response you get from the ASA if you complain about a homeopathy website. Seems fair enough to me. Dear Sir/Madam ADVERTISING CLAIMS ON HOMEOPATHY WEBSITES Thank you for your recent complaint. As you may know, the Advertising Standards Authority (ASA) has received over a hundred and fifty complaints about over a hundred different websites for homeopathy. Complaints cover a range of issues from specific claims made by individual advertisers to general concerns about the sector as a whole. Because of the volume of complaints, we are sending this letter to everyone who contacted us on these issues to let you know what action we intend to take. The ASA has an established position on claims that can be made, and those claims that are not likely to be acceptable for homeopathy, based on the requirements set out in the CAP Code and previous ASA adjudications. Although we have not historically received many complaints about advertising for homeopathy, the Code has general requi...

There was an invitation to respond to this consultation. Here's the email I sent: Hi. This whole project is lunacy. Why are you wasting tax-payers money on it? Why don’t you waste your time licensing sunlight and lettuce? Even thinking about thinking about licenses for homeopathy is an insult to every hard-working NHS professional trying to alleviate people’s suffering using evidence-based practice. Anybody involved in such an endeavour should go take a long hard look at themselves in the bathroom mirror and then flush themselves down the toilet. There, that’s what I think. Regards -         Dave Curtis -- Professor David Curtis Consultant and Honorary Professor in Psychiatry Dept Adult Psychiatry 3rd Floor Outpatient Building Royal London Hospital

Here's an email I sent my MP, for all the good it will do. She's a LibDem minister so she'll most likely just toe the party line. From: Curtis David (East London NHS Foundation Trust) Sent: 27 December 2010 17:28 To: 'Lynne Featherstone - Liberal Democrat MP for Hornsey & Wood Green' Subject: Government plans for the NHS Dear Ms Featherstone. I am writing to express my extreme concern at the government's plans for the NHS. The major reorganization proposed has not been properly thought through. The very process of reorganization will certainly strain the NHS in the short term and is being carried out at a time when the NHS is under extreme pressure for other reasons. It breaks the pledge which the Conservatives made not to subject the NHS to new reorganizations. The eventual outcome of the reorganization is quite likely to be deleterious for the NHS. There is no reason why GPs are likely to do a better job of commissioning than professional commissioners. It...

A study in the Lancet seemed to imply that large chromosomal deletions could cause ADHD - children with ADHD were found more often to have such deletions than control subjects. However there is a flaw in the argument because according to the paper the children with ADHD also had lower IQ than controls. It is already known that large chromosomal deletions are associated with intellectual impairment. So a plausible explanation is that by selecting children with ADHD one obtains a sample with low IQ and such subjects can be expected to have more large deletions by virtue of their lower intelligence rather because of any specific relationship between deletions and ADHD. Of course, at one level it is true that ADHD is associated with large deletions. But if the effect is mediated by IQ then this is somewhat different from the notion that "deletions cause ADHD". To test this, one would need to study a sample of subjects with ADHD compared with controls who had been matched for IQ....