Invitations to book for an NHS Covid-19 vaccine may come from "accurx.thirdparty.nhs.uk" and are legitimate

tl;dr - the NHS is using "accurx.thirdparty.nhs.uk/r/" to send out invitations to book Covid-19 vaccines and the link is genuine. At the end of that link you'll have your own 10 digit unique code (don't share that publicly).

https://accurx.thirdparty.nhs.uk/r/ - enter the 10 digit code you receive in your text message, book your vaccination - get injected and protected, not infected :) Continue to be careful afterwards as you can still get Covid-19 though it is likely to be less severe and I think you can still transmit even if you're not affected.

 

Homeopathy 'banned on the NHS' - nearly, but not quite

NHS England is updating its guidance to Clinical Commissioning Groups (CCGs), recommending that certain items offered in primary care should no longer be prescribed. This includes homeopathy but some herbal remedies are in there too, also glucosamine + chondroitin used (ineffectively as it turns out) for osteoarthritis pain.

The document outlining the recommended changes was published on 21 July 2017 and is called Items which should not routinely be prescribed in primary care: A Consultation on guidance for CCGs. It's out for public consultation until 21 October 2017 (see pg 7 of 48 of the linked docuent on how to respond).

A. Things I want to consider in this post, the short version
1. Has homeopathy been banned from the NHS? 
No, not yet

2. Is it likely that homeopathy will be removed from the NHS?  
Seems pretty likely

3. Homeopathy costs a fraction of the total NHS costs, why do skeptics want it removed?
The evidence isn't good, also to minimise any unwarranted positive associations with healthcare

4. Are there any reasons to keep homeopathy on the NHS? 
Slightly dishonest ones

5. What's been the role of skeptics in removing homeopathy from the NHS? 
Probably helped

B. Things I want to consider in this post, the longer version
1. Has homeopathy been banned from the NHS?
Not yet. The document acknowledges that the evidence for homeopathy is poor and that homeopathy should not be prescribed, however this is a consultation document not an edict. Also this will affect England, not the whole UK.

2. Is it likely that homeopathy will be removed from the NHS?
I think so - it's widely acknowledged that it's a waste of money and there is little support for it being on the NHS. To be fair homeopathy has been declining on the NHS for two decades as this bar chart from the Nightingale Collaboration. This is more tidying up loose ends than a big new thing.

3. Homeopathy costs a fraction of the total NHS costs, why do skeptics want it removed?
While it's true that the homeopathy spend is now under £100,000 (a drop in the ocean compared with total NHS costs) it's not just about costs. We don't want money wasted on unevidenced treatments (this includes pharma drugs too), even if it is only a small amount of money. But there's also the 'halo effect': homeopathy benefits by its association with healthcare, the NHS is effectively giving its backing to nonsense. Removing it from the NHS removes this positive association. Annoyingly homeopathy also benefits from the fact that you can buy it in many highstreet pharmacists but that's a different argument.

Booting #homeopathy off NHS not *just* abt saving relatively small pot of cash, but also removes 'imprimatur' of a +ve assoc w 'healthcare'.

— Jo Brodie (@JoBrodie) July 21, 2017

4. Are there any reasons to keep homeopathy on the NHS?
Not good ones, no. Some doctors have argued that patients who are distressed about perceived ill-health, despite not actually being unwell, might benefit from homeopathy or placebo pills.

TEETH

— UK Homeopathy Regs (@UKHomeopathyReg) July 23, 2017

"TEETH" stands for "Tried Everything Else, Try Homeopathy".


The idea would involve doctors knowingly (or perhaps even unwittingly) giving patients inert medication with the aim of making them feel better (placebo effects, being taken seriously etc) without causing any side-effects. Another possible benefit is keeping a link with a patient who might otherwise withdraw from appropriate healthcare and explore unhelpful and costly options from quacks.

To be honest I do have some sympathy with this notion. The dishonesty troubles me - it's basically lying to a patient 'for their own good' but I can see examples of where I might go along with this (which also troubles me!).

Here a GP writes about 'heartsink' patients (where your heart sinks as what's ailing them isn't clear, nor is the solution) in an article on the Faculty of Homeopaths website. The FoH is a society of medical doctors who are also homeopaths.

"Another group of patients for which homeopathy can be helpful is those who frequently appear in GPs’ surgeries presenting with a whole host of “functional disorders”. Despite undergoing the full gamut of blood and hospital tests, no abnormality in the body is found. Nevertheless, these “heart sink” patients are clearly suffering from pain and discomfort, which is blighting their lives. This is understandably frustrating for them, for they know full well something is awry but there is no medical evidence for this.

Sometimes conventional medicines can be useful, but once again they are symptomatic treatments which may also produce unpleasant side-effects, resulting in the patient feeling even worse. Homeopathy affords me another approach in trying to help these patients. It doesn’t work for them all, but I’m frequently surprised at how many it does help."
Source: https://facultyofhomeopathy.org/homeopathy-general-practice-2/

5. What's been the role of skeptics in removing homeopathy from the NHS?
The term 'Skeptics' is generally assumed to mean activist bloggers but obviously includes people who aren't bloggers but who are also skeptical of homeopathy - including scientists, doctors and other healthcare professionals, teachers, people who've tried it but experienced no real benefit from homeopathy, members of the public, anyone.

It's difficult to prove causality. My perception is that online skeptical activism, particularly targeted at homeopathy, really got going in the early-mid 2000s, coalescing around Ben Goldacre's Bad Science colummn and blog. Obviously scientists and doctors have obviously been skeptical of homeopathy pretty much since it was invented. Prof David Colquhoun has been blogging about homeopathy since the very early 2000s and published (in a journal) a re-analysis of some homeopathy data in a paper in 1990 - I'm sure others have too, it's just we happened to have a conversation about this recently!

The focus of skeptic activism can be both narrow and targeted (for example getting something changed, eg getting an advert taken down, getting an event moved from an academic setting etc) or wider (eg contributing to people's awareness of what homeopathy actually is) and I think both feed into each other. I think of the former as 'meat' and the latter as 'marinade' and I think skeptic activism has done both very well. It seems as if articles in the press about homeopathy are much more critical and less credulous than they have been in the past - I don't know if this can be attributed to skeptics but I know that quite a few of us have contacted journalists to point to better information.

In late 2009 the UK Government announced that it was seeking examples of topics in which a science Select Committee could "assess the Government’s use of evidence in policy-making", inviting the public to suggest topics. Homeopathy was one of many, and was chosen to be the second 'evidence check' resulting in a 2010 document recommending that funding be withdrawn.

The fact that homeopathy's been included in the current consultation is also largely due to the efforts of the Good Thinking Society which has mounted legal challenges to Clinical Commissioning Groups to get them to stop funding homeopathy, as well as trying to get it blacklisted from NHS spending.

Further reading
Skeptic successes in homeopathy (originally published 24 August 2015 but regularly updated)

Homeopathy is hardly exactly escaping the NHS 'ban'

It's Homeopathy Awareness Week next week or as we in the snark community have it 'Homeopathy Bewareness Week'. Don't get taken in by their lies ;-)

Actually homeopathy's already been having a pretty interesting week this week.

First, plenty of people noticed its absence in the list of things the NHS is considering not paying for anymore. Second, considerably fewer people noticed that the NHS has kinda already considered this, by paying less and less for it each year anyway.

There are two sums of money at issue

• the amount spent on NHS England prescriptions for homeopathy - less than £100,000 (see blue graph below) for 6,821 prescription items (red graph below) in 2016
• the amount spent on the wider infrastructure for homeopathy (staff, buildings etc) - apparently about £4m to £5m in 2016

In the mid-1990s the NHS in England spent upwards of £800,000 on homeopathy for 170,000 prescription items. This has dropped precipitously over the years, as you can see from the informative and entertaining graphs below.

Picture credit: Nightingale Collaboration, used with permish :)

Version for homeopathy fans
Well done! You began the year on 1 Jan 2016 with not a single homeopathy item prescribed but ended the year with a whopping increase to 6,281 items prescribed - an increase on a par with infinity.

Where was I...
I don't have the breakdown for the non-prescription costs, estimated to be several million at the moment. It's great that the prescription costs are dropping but we may still be wasting millions on this non-treatment on the NHS.


Although homeopathy wasn't mentioned in the first raft of 'things to consider banning' it will indeed be included in later considerations, according to Julie Wood's tweet below (she's the Chief Executive of NHS Clinical Commissioners).

"Homeopathy is in the overall £400m of spend identified - currently not in
first wave of 10 products for review but this is an ongoing project"

In other words, skeptics are pushing at an open door. We're not really trailblazing the decline of homeopathy on the NHS, it's happening anyway. Perhaps we've contributed to the changing mood though - for example newspaper reports now seem less likely to champion it and more likely to laugh at its improbability.

Unsurprisingly the magazine 'What Doctors Don't Tell You' (they don't like me much) have regurgitated the misinformation ("Homeopathy escapes the NHS cuts") and also managed to add in another error at the end ("The Swiss health authority has announced that homeopathy is effective enough to be included among therapies that can be claimed under health insurance plans..."). The Swiss have done no such thing and explicitly acknowledged that homeopathy was unable to provide evidence of efficacy. However, bafflingly, they are continuing to reimburse its use in health insurance but only if administered by a doctor, so there's that I suppose.

---

Background reading on NHS prescription costs
Every year the costs of prescriptions in England are published. Skeptics, being amused by the drop of homeopathy spending on the NHS have kept an eye on the cost for each year, going back to 1995 (info is publicly available).

Prescription Cost Analysis, England - 2016 [NS]
Publication date: March 30, 2017
Prescription Cost Analysis, England - 2016: Data Tables [.zip]
The [NS] means a publication that is within the scope of National Statistics, the lack of a [PAS] next to it means that no Press Announcement is Scheduled.
• NHS Digital Publications calendar April 2016 - March 2017
• NHS Digital Publications calendar (future)
 
Background reading on Swiss health authority and homeopathy
The Swiss rejected homeopathy as a 'treatment' that could be reimbursed in 2005 however lots of Swiss people voted for it in 2009 to be included, among some other ineffective treatments. The health authority requested evidence of effectiveness but eventually admitted defeat and surprised everyone in 2016 with this announcement:

"In a statement released on Tuesday, the interior ministry said it had come to the conclusion that it was “impossible to provide such proof for these disciplines in their entirety”.

They will thus be treated on a par with other medical disciplines, when it comes to health insurance.

The ministry plans to continue allowing reimbursements of treatment costs by compulsory health insurance, provided they are administered by certified medical doctors." 

Bad news for homeopathy fans though, it will continue to be scrutinised...

Diabetes statistics bookmarked

We are in the process of updating our 'Diabetes in the UK 2010' document and I thought it was about time I got some of my stats-related bookmarks into a better order. They've rather run away with themselves and hopefully by putting them here I'll be able to work out what it was I was trying to find information on. This is a bit of a mixed bag (by no means complete) as we end up working on different aspects of it. If I find anything bookmark-worthy from my colleagues I'll add it here as well.

EDIT: 2 August 2011 - I've added a few more statistics resources.

If you know of a great resource that I've not put here yet, do give me a prod @JoBrodie ta :)

APHO (Association of Public Health Observatories)

• APHO Diabetes Prevalence Model for England Scotland Wales
• Diabetes Health Intelligence
• Diabetes A-Z
• Diabetes Community Health Profiles
  "In order to locate the PCT profile you require please select a Strategic Health Authority from the dropdown list"
  

Audits and general statistics (see also Children)
National Diabetes Audit
From 2003, latest data collection Sep / Oct 2010, latest report 2009 (background) (other)
http://www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/audit-reports/diabetes

National Diabetes Audit Executive Summary 2008-2009
http://www.ic.nhs.uk/webfiles/Services/NCASP/audits%20and%20reports/National%20Diabetes%20Audit%20(NDA)%20Executive%20Summary%202008-2009.pdf

NHS Atlas of Variation in Healthcare
http://www.rightcare.nhs.uk/atlas/qipp_nhsAtlas-HIGH_261110c.pdf

NHS IC reports
http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/diabetes

QOF database, example Bradford & Airedale PCT
http://www.gpcontract.co.uk/pct.php?orgcode=5NY (see ‘Search’ tab to select others)
For explanation of what QOF is see http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicescontract/qof/Pages/QualityOutcomesFramework.aspx and http://www.gpcontract.co.uk/

UK National Statistics – Publication Hub on diabetes topics
http://www.statistics.gov.uk/hub/search/index.html?newquery=diabetes
see also http://www.statistics.gov.uk/hub/health-social-care/health-of-the-population/conditions-and-diseases/index.html

Benchmarking and commissioning
Diabetes Community Health Profiles
http://yhpho.york.ac.uk/diabetesprofiles/

Diabetes Data Directory
http://yhpho.york.ac.uk/diabetesdd/introddd.asp

lntroduction to the NHS Diabetes Commissioning Resource
http://www.diabetes.nhs.uk/commissioning_resource/

Children
The fifth UK paediatric diabetes services survey: meeting guidelines and recommendations? July 2010 [BMJ abstract] http://adc.bmj.com/content/95/10/837.abstract?etoc

National Diabetes Paediatric Report 2008-2009
http://www.ic.nhs.uk/webfiles/Services/NCASP/audits%20and%20reports/NDA%20Paediatric%20Report%202008-2009.pdf

National Diabetes Audit
Key findings about the quality of care for children and young people with diabetes in England and Wales Report for the audit period 2007-2008
http://www.ic.nhs.uk/webfiles/Services/NCASP/audits%20and%20reports/7189_Paediatric_Report_final.pdf

Comorbidities and other conditions
Pregnancy
CEMACH diabetes reports
http://www.cemach.org.uk/Publications-Press-Releases/Report-Publications/Diabetes-in-Pregnancy.aspx

Complications
Amputation
NASDAB: National Amputee Statistical Database (UK) http://www.nasdab.co.uk/
replaced by 'Limbless Statistics' http://www.limbless-statistics.org/
Unfortunately latest report is 2006 / 2007 http://www.limbless-statistics.org/documents/Report2006-07.pdf

Retinopathy
Number of people with diabetes who have received screening for diabetic retinopathy in England http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Vitalsignsmonitoring/DH_112536

English National Screening Programme for Diabetic Retinopathy (ENSPDR)
http://www.retinalscreening.nhs.uk/pages/

Four Nations involvement http://www.retinalscreening.nhs.uk/pages/default.asp?id=2&sID=75

2010 Annual Evidence Update on Diabetic Retinopathy - Screening for diabetic retinopathy (methodologies)
http://www.library.nhs.uk/Diabetes/ViewResource.aspx?resID=387102

NHS Evidence – diabetes: Retinopathy>Causes, Risk Factors and Screening
http://www.library.nhs.uk/DIABETES/SearchResults.aspx?tabID=290&summaries=true&resultsPerPage=10&sort=PUBLICATION_DATE&catID=5659&

Critical appraisal info
Statistics at Square One
http://resources.bmj.com/bmj/readers/statistics-at-square-one/

General
NIDDK: Diabetes populations across the US
http://diabetes.niddk.nih.gov/populations/index.htm

IDF (International Diabetes Federation): Diabetes Atlas
http://www.diabetesatlas.org/

Labour Force Survey: Employment status by occupation and sex
http://www.statistics.gov.uk/statbase/product.asp?vlnk=14248

National Statistics: Population Trends Spring 2008, No 131
http://www.statistics.gov.uk/downloads/theme_population/Population_Trends_131_web.pdf

NatCen (National Centre for Social Research)
http://www.natcen.ac.uk/

NHS Evidence – diabetes (see also Treatments)
http://www.library.nhs.uk/diabetes/

Office for National Statistics
http://www.statistics.gov.uk/default.asp

NeLM search for diabetes
National electronic Library for Medicines
http://www.nelm.nhs.uk/en/Original-search/?query=diabetes+

Health surveys
Health Survey for England
http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-related-surveys/health-survey-for-england

Health Survey for England - 2008 summary of key findings
http://www.ic.nhs.uk/webfiles/publications/HSE/HSE08/HSE_08_Summary_of_key_findings.pdf

Health Survey for England - 2008 trend tables
http://www.ic.nhs.uk/pubs/hse08trends and
http://www.ic.nhs.uk/webfiles/publications/HSE/HSE08trends/Health_Survey_for_england_trend_tables_2008.pdf

Health Survey for England - 2008: Physical activity and fitness
http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-related-surveys/health-survey-for-england/health-survey-for-england--2008-physical-activity-and-fitness

Hospital admissions
Clinical and Health Outcomes Knowledge Base
Emergency hospital admissions: diabetic ketoacidosis and coma
http://www.nchod.nhs.uk/NCHOD/compendium.nsf/17b8958892856d44802573a30020fcd9/56303822d72c4ef9652570d1001cb767!OpenDocument

Nation-specific
Scotland
http://www.diabetesinscotland.org.uk/Publications.aspx

Wales
http://www.wales.nhs.uk/sites3/index.cfm?Error=200

Standards
National service framework for diabetes: standards
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002951

[Report] Turning the Corner: Improving Diabetes Care (2006)
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4136011.pdf

[Report] Six Years On Delivering the Diabetes National Service Framework (2010)
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_112511.pdf

Treatment
Insulin pumps
Scotland only
Appendix 2 Table of NHS Board planned investment in Insulin Pump Therapy
http://www.scotland.gov.uk/Publications/2010/08/17095311/10
Judging from the Hansard reports (via TheyWorkForYou) retinopathy screening seems to be discussed more by Parliament in relation to Scotland http://www.theyworkforyou.com/search/?s=retinopathy+screening

NHS Scotland: Figures are for patients with Type 1 diabetes receiving insulin pump therapy as of August 2009
http://www.theyworkforyou.com/spwrans/?id=2010-06-14.S3W-34132.h&s=insulin+pump#gS3W-34132.q0

YHPHO Insulin pump audit (2010)
http://www.yhpho.org.uk/resource/item.aspx?RID=91531

DUETS
Uncertainties about the Effects of Treatments
http://www.library.nhs.uk/DIABETES/ViewResource.aspx?resID=392331&tabID=289

NHS Evidence - UK Database of Uncertainties about the Effects of Treatments (DUETs)
http://www.library.nhs.uk/duets/SearchResults.aspx?catID=14514

Prescription costs
Prescription Cost Analysis 2008
http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/prescriptions/prescription-cost-analysis-2008

• Prescription cost analysis: England 1998
• Northern Ireland prescription stats 2008
• NHS Scotland Prescription Cost Analysis for financial year 2007/08
• Wales 2008

Prescribing for Diabetes in England: Supplement – January 2002 to March 2009
NHS IC – all prescription information

ABPI: Facts & Statistics from the pharmaceutical industry
Pharmaceuticals and the UK economy

NHS Information Centre report finds a 40% rise in cost and number of prescriptions to treat diabetes in England over the last 5 years (July 2010)
http://www.nelm.nhs.uk/en/NeLM-Area/News/2010---July/30/NHS-Information-Centre-report-finds-a-40-rise-in-cost-and-number-of-prescriptions-to-treat-diabetes-in-England-over-the-last-5-years/

GPRD: Drug Utilisation & Disease Patterns
http://www.gprd.com/services/drugutilisation.asp
(don’t think I can access this but haven’t spent a lot of time on it)

Drug Topics 2010 (US)
2009 Top 200 generic drugs by total prescriptions
http://drugtopics.modernmedicine.com/drugtopics/data/articlestandard//drugtopics/252010/674982/article.pdf

Athens passwords available for some voluntary sector organisations

******************************************************************
Edit: 3 October 2012
See also this great question, and answers, from people on Quora
How do you get access to papers online if you don't belong to any academic institution?

******************************************************************


Top line: Charities / voluntary sector folk may be able to register for an NHS Athens password from NHS Scotland

I wonder if I should now be registering with all the other NHS Consortia to increase my access...

More detailed information
I have spent a very pleasant morning with my new Athens password which gives me some / limited access to some of the items below (see further down).

In June we came across "The Knowledge Network: Scotland's source of knowledge for health and care" and discovered that to access it more fully we needed an Athens password.

When I previously worked in academia I had an Athens password which opened up an entire universe of literature and databases to me and when I left, and the password stopped working, a little bit of me died with it.

For a number of years I believed that it was the Athens password which had brought me these fortunes, and I tried in vain to get another one - before someone explained that the Athens password is merely a way of accessing the subscriptions that you already have, it's not a magical 'open sesame' sort of thing.

Because I slotted into one of these categories I thought I might as well apply.

You can apply for an NHS Education ATHENS username and password if you
belong to any of the following groups :

• Staff of NHS Scotland (including contractors such as general practitioner staff, community pharmacy staff, dental surgery staff
• Undergraduate or postgraduate students working or training with NHS Scotland
• Social services, public library staff and other local authority staff working in partnership with the NHS
•Other partners including staff in higher and further education, Scottish Government staff, voluntary sector organisations, nursing homes, the armed services and patient/public representatives on NHS groups

Others may also be eligible. A full guide to who is eligible can be found here. If you are unsure which group you fit into, or feel you need access and don't belong to one of these groups, please get in touch with your local ATHENS administrator for advice.

Our charity works with the NHS and we are clearly in the voluntary sector, so I was pretty delighted to see that I might be able register for an Athens password that would give me access to some NHS resources - and so it does. It's not a very quick process to register (presumably they had to check my story out as I expect lots of people try to sign up to get an Athens password, and who can blame them).

I should add that in addition to working for a health charity I also work at UCL and so I do already have a magic open sesame password - but I wanted to see what I could get for charity purposes.

I can now access ScienceDirect which I couldn't really get at before (without using my UCL account) and it looks like I can access more databases on OVID than with our current subscription.

In short, while it's not giving me everything, it's also giving me, for free, quite a lot of what I already subscribe to (which may mean that I can save the charity some money by not renewing some subscriptions) and giving me access to a few extra diabetes journals among other things.

It's definitely worth investigating if you use academic literature and databases and work in a health charity or other voluntary sector. I'm thinking specifically of the medical research charities which are members of the AMRC (Association of Medical Research Charities).

Here's the full list, although I've not managed to get anywhere with Nature.com

Barbour Index Online Services
Best Practice
BMJ Journals Collection
BNF for Children
British National Formulary
Clinical Evidence
CSA Illumina
ebrary
EBSCOhost databases
EBSCOhost EJS
Emerald Management eJournals
GOODPRACTICE.NET
INFORMAWORLD
IngentaConnect
internurse.com
MD Consult
Medicines Complete
METAPRESS
Nature Publishing Group (www.nature.com)
NetLibrary
Ovid Online
Oxford Journals
Pier Professional
ProQuest
RefWorks
SAGE Journals Online
ScienceDirect
SilverPlatter Arc2
SNOMED BROWSER
SwetsWise
The Learning Exchange
Wiley Online Library
Wounds-UK Journals
ZETOC - BL Electronic Table of Contents

EDIT: Friday afternoon 5.30pm 10/09/2010
I've heard from Graham Steel who found in 2008 that he could access the service as someone who works in patient advocacy in a personal capacity. He also pointed me towards another blogger who commented on his being able to access literature.

The concept of an NHS Education Athens appears, from Google, to be Scotland based but searching for NHS Athens brought up this registration page for England. It seems to want you to be either at university or working in a GP surgery, so it might be a bit tougher to gain access - and of course I don't know if it's offering anything different from the NHS Scotland version. The registration page for the England one is here NHS England Athens Registration.

From Graham's blog post I also spotted that there's such a thing as the Directory of Open Access Journals.

I've also heard from @chibbie that the service has gone "out to tender for national ejournal collection".

Almost every time I write a blog post I learn something useful from commenters either here or on Twitter.