Ship of Fools: Conflicting Advice & The Overuse of the NHS

Thread: Conflicting Advice & The Overuse of the NHS Board: Oblivion / Ship of Fools.

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Posted by Doublethink. (# 1984) on :

I am moved to think about this via a combination of reading the news and having a cold.

I have a cold, I know it is probably a self-limiting viral infection - that may last slightly longer than average owing to the fact I also have asthma. It is winter, this condition is not surprising.

So - the conflicting advice:

Part 1: stuff that is meant to be true

A) I know a cold will typically last one to two weeks (7-14 days)
B) In theory I know my employer doesn't want me at work sick

Part 2: policy

A) Over the counter cold medication recommends seeking medical advice if you take it for longer than 3 days
B) I can report for sick for only up to 5 working days without a doctors note
C) NHS advice is not see yur GP with cold symptoms unless they are still present after three weeks - 21 days

Part 3: outcomes

A) No employer accepts you being off sick with a cold for two weeks - so basically they want you to work if you're not *too* sick, result you struggle in then potentially end up with more shorter absences and take longer to recover (and infect others who end up in the same position.). If you are going to work whilst not *too* sick, you are going to manage that by using over the counter meds - the ones that tell you to go to the doctor after 3 days.
b) If you do take sick leave for a whole cold you will need a doctor's note and the doctor will a) not be able to fit you in a timely appointment to get one and b) feel their time is being wasted if you manage to see them, as you have a viral infection that should be treated with self-care
C) If you follow the advice written on the medication, the GP will also be pissed off at you turning up at the surgery after 3 days

Do we think some pressure on the NHS could be eased if some effort was made to co-ordinate on these issues ? Millions of people get colds every winter nevermind the rest of the year, how much time and resource could be saved iff all three sectors, NHS, Meds manufacturers and employers worked to the same timescales ?

[code fix -Gwai]

[ 14. January 2015, 18:12: Message edited by: Gwai ]

Posted by Beeswax Altar (# 11644) on :

21 days?

Here people run to their doctor after a couple of days if not at the first sign of a cold. Sometimes they go to urgent care or even the emergency room. Doctor writes a prescription for an antibiotic usually a z pack. Maybe, the z pack helps maybe it doesn't. Z pack probably won't make things worse unless it does. I've started to wonder if doctors pass out z packs as Halloween candy.

Posted by Dafyd (# 5549) on :

I'd say that if your employer doesn't want you to come in sick, with lower productivity it's their HR department's responsibility to sort out their policy. You're not there to do your HR department's job (unless you're in the HR).

You probably ought to try not to infect your co-workers for their own sake. But I shouldn't go second-guessing the HR policy for the company's sake.

(I suspect that the advice on the over the counter medicine is there to cover the pharmaceutical company if they get sued, and has little to no intrinsic merit.)

Posted by Gwai (# 11076) on :

I agree about the advice on the over the counter meds being to avoid getting sued, and I agree that it's completely theoretical. But I think the advice about staying home if you are sick is completely theoretical too. No one ever stays home the entire time they are sick with a cold, and one would be considered outrageous if they did. The advice is just so that companies can say they are taking being decent/protecting our health. Sure they are.

Posted by lilBuddha (# 14333) on :

Simply go in to work every day that you are sick and sneeze on your boss.

Posted by Doublethink. (# 1984) on :

quote:
Originally posted by Beeswax Altar:
21 days?

Here people run to their doctor after a couple of days if not at the first sign of a cold. Sometimes they go to urgent care or even the emergency room. Doctor writes a prescription for an antibiotic usually a z pack. Maybe, the z pack helps maybe it doesn't. Z pack probably won't make things worse unless it does. I've started to wonder if doctors pass out z packs as Halloween candy.

Why are they giving out antibiotics for a viral infection [Confused]

Posted by Garasu (# 17152) on :

Anything for a quiet life . Some of them will give out homeopathic remedies instead...

Posted by no prophet's flag is set so... (# 15560) on :

I am an employer of 12 people. I agree that sending people to doctors for sick noted for work is an abuse of a publicly funded health system. Both employees and employers should have reasonable expectations of each other. Sick notes and coughing on customers or co-workers is not okay, and nor is goofing off by taking a sick day when you're not ill. These things need to be dealt with elsewise than going to a doctor's office and/or getting a note from the doc.

The medical association here discourages employees being required to obtain doctor notes. The issues are:

waste of physician time; we all know it is a cold
exposure of everyone in the waiting room to virus-shedding coughing & sneezing sick person
no you cannot have antibiotics, and stop trying to pressure docs to get them (as noted by Doublethink.)

They made it 'non-insured service' and thus require payment of $35.00 by the patient to get such a note. The workplace is specifically prohibited from having any diagnostic information, so $35.00 gets a note that reads "I have examined <name of person> on <date> and advised them to be off work for <amount of time>."

I think that if the HR dept or boss has trouble with an employee's absenteeism from work, this is the issue that needs to be specifically addressed with the frequently-absent employees, and the average worker needs to be trusted. If the workplace has issues such that basic trust is broken, it is not a workplace I'd want any part of. To suggest that all workers require treatment like children is a symptom of a distrust between employers and employees and is the problem that requires addressing.

Further, we have a publicly-funded 24 hour nurse-staffed "Health Hot Line" which anyone may call for advice whether covered under Medicare or not (the parallel to NHS). An adult child of mine who was visiting over Xmas called after she became ill and got the advice about what cardinal signs to watch for and if any emerged, then go to what we call "minor emergency clinic". (This also avoids people going to a hospital emergency dept for non-hosp types of things.) As an employer. I can ask a worker to call the Health Hot Line and in follow-up ask if they have a plan for their recovery. But I'd never ever ask what the details of the illness are, only job-relevant facts. We have employee disability insurance which would come into play if the illness is long, and their nurses can review medical info at arms length from the employer.

I'm not naive enough not to know that some employers and workers more or less hate each other. Such situations are not solved via health issues.

Posted by Leorning Cniht (# 17564) on :

quote:
Originally posted by Doublethink.:
Millions of people get colds every winter nevermind the rest of the year, how much time and resource could be saved iff all three sectors, NHS, Meds manufacturers and employers worked to the same timescales ?

It rather depends what your job is, doesn't it? If you are a nurse on a cancer ward, I don't imagine anyone wants your viruses, thank you.

If you work in a small sealed shed with a few other people, you're still reasonably likely to share your cold around.

If you work in an office by yourself, or outdoors, then you being at work probably doesn't increase anyone else's chances of getting ill much.

I don't think there can be a one size fits all solution.

Posted by orfeo (# 13878) on :

quote:
Originally posted by Doublethink.:
B) I can report for sick for only up to 5 working days without a doctors note

Which seems entirely reasonable and indeed is longer than for a lot of employers (around here I think it's common to say you need if it's more than 3 days).

Frankly, if your colds are making you unfit for work for over a week at a time, then you are an outlier (or what you've got isn't actually a 'cold'). You yourself have indicated that there's a plausible reason for this, that it interacts with your asthma.

If you've got another condition that risks interacting with a cold and making it affect your health more, it seems reasonable to me to say that you're exactly the kind of person who needs medical care to monitor the infection. Just because you've got the same virus as someone else doesn't mean it's going to affect you in exactly the same way. Just because most viral infections are self-limiting doesn't automatically mean it's incapable of affecting certain individuals more seriously, including when they have other health issues at the same time. The same viruses that can cause colds can also trigger viral pneumonia.

[ 15. January 2015, 01:01: Message edited by: orfeo ]

Posted by Barefoot Friar (# 13100) on :

quote:
Originally posted by Doublethink.:
Why are they giving out antibiotics for a viral infection

Standard operating procedure around here. They say "it's to ward off any secondary infections", but the truth of the matter is that a) Americans think that if they go to the doctor and aren't automatically prescribed something then they are not getting properly cared for, and b) Americans are largely clueless about how antibiotics work anyhow. They're told to take this medicine for so many days, and Lo and Behold! they're magically better after that time. They don't realize that they just got over it despite the antibiotic, not because of it.

I don't take antibiotics unless the doctor says that what I have is bacterial, and I don't go to the doctor if I already know what it is. I don't go for colds, or stomach viruses, or flu, or anything else I know I'll get over. Mrs. Friar thinks I'm being obstinate, and maybe I am, but I refuse to go and pay money to be told something I already know.

Excuse me, I have to go yell at the neighborhood kids to get off my lawn.

Posted by cliffdweller (# 13338) on :

quote:
Originally posted by Barefoot Friar:

quote:
Originally posted by Doublethink.:
Why are they giving out antibiotics for a viral infection
Standard operating procedure around here. They say "it's to ward off any secondary infections", but the truth of the matter is that a) Americans think that if they go to the doctor and aren't automatically prescribed something then they are not getting properly cared for, and b) Americans are largely clueless about how antibiotics work anyhow. They're told to take this medicine for so many days, and Lo and Behold! they're magically better after that time. They don't realize that they just got over it despite the antibiotic, not because of it.

In my neck of the American woods, health care providers will not prescribe antibiotics for viral infections. Doesn't stop people from nattering after them, but no, it's not gonna happen. Heck, in this neck of the woods you're luck to be able to SEE a health care provider, much less get their hands on any sort of prescription.

Posted by orfeo (# 13878) on :

Overprescription of antiobiotics is a problem in lots of places. It contributes to antiobiotic resistance.

Posted by Golden Key (# 1468) on :

Lots of people don't have any benefits, even paid sick days. So they have to figure out whether or not they can financially afford to take time off.

Posted by Karl: Liberal Backslider (# 76) on :

quote:
Originally posted by orfeo:
Overprescription of antiobiotics is a problem in lots of places. It contributes to antiobiotic resistance.

Understatement of the year. It's probably the primary cause. Overprescription of antibiotics and the resulting resistance is probably already killing thousands and will only get worse.

Posted by Golden Key (# 1468) on :

Also, AIUI, anti-biotics given to food animals.

Posted by Doublethink. (# 1984) on :

quote:
Originally posted by orfeo:

quote:
Originally posted by Doublethink.:
B) I can report for sick for only up to 5 working days without a doctors note
Which seems entirely reasonable and indeed is longer than for a lot of employers (around here I think it's common to say you need if it's more than 3 days).

Frankly, if your colds are making you unfit for work for over a week at a time, then you are an outlier (or what you've got isn't actually a 'cold'). You yourself have indicated that there's a plausible reason for this, that it interacts with your asthma.

If you've got another condition that risks interacting with a cold and making it affect your health more, it seems reasonable to me to say that you're exactly the kind of person who needs medical care to monitor the infection. Just because you've got the same virus as someone else doesn't mean it's going to affect you in exactly the same way. Just because most viral infections are self-limiting doesn't automatically mean it's incapable of affecting certain individuals more seriously, including when they have other health issues at the same time. The same viruses that can cause colds can also trigger viral pneumonia.

There is a difference between being ill, and being unfit to work. And then there is the issue of being infectious. I work in a hospital. I go into work with a cold if well enough, but don't go onto the ward and cancel appointmennts with my immunocompromised patient because
I don't want him to get pneumonia.

I may go in and do mainly paperwork.

But my basic point was - if the NHS does not want patients with mild viral infections wasting GP time, it would be of benefit to talk to the pharmaceutical industry and change the advice written on the medication, and talking to business leaders about changing the way self-certification of illness iis managed.

I would have been back at work this week if I had not taken an over the counter remedy - that turned out to interact really badly with my asthma (not noted on its side effects).

Coughing so much you vomit is really not a good look in a hospital - the one thing they really don't want you to bring in is norovirus, it shuts services it spreads so fast, so we have really concrete advice about is not turning up to work for at least 48 hours after vomiting and diorrhea.

Thing is, that advice is a lot more use than don't come to work if you're ill. Similarly, it by more use to say, don't cone to work if yu run a temp of more than x for more than y amount of time. Likewise with seeking GP advice.

All the guidance is ridiculously vague - and then they wonder why people attend (or don't) services inappropriately.

Posted by orfeo (# 13878) on :

The advice on cold medication to see someone if your symptoms persist is because your initial belief that you have a 'cold' might be wrong.

Symptoms are not at all infection-specific. A runny nose and a sore throat are not what the virus is doing, it's what your immune system is doing in an effort to remove the virus.

[ 15. January 2015, 09:56: Message edited by: orfeo ]

Posted by Doublethink. (# 1984) on :

I know, but, the advice on when to see your gp from the NHS is based on exactly the same process of you self-assessing your symptoms.

NHS says, if you are coughing, sneezing and feeling crap - take over the counter meds and don't come see us unless the symptoms aren't gone after three weeks.

Meds say, if you are coughing, sneezing and feeling crap - take over the counter meds and go see the GP if the symptoms aren't gone after three days.

[ 15. January 2015, 10:15: Message edited by: Doublethink. ]

Posted by Barnabas62 (# 9110) on :

quote:
Originally posted by Barefoot Friar:

Excuse me, I have to go yell at the neighborhood kids to get off my lawn.

On a serious point. I have asthma as well, and winter viruses (I have one now) have plagued me for 20 years as a result. A short term "48 hour virus jobby" can take a couple of weeks or more to clear up in me. I've learned there's not much to be done other than "grin and bear it". But I'm retired, so the work complications don't apply.

When at work, I talked specifically to HR about this issue and got my records noted. But you have my sympathies, DT. I got to hate the winter months.

I don't see any easy way of more generally joining up the dots, however.

[ 15. January 2015, 10:16: Message edited by: Barnabas62 ]

Posted by Jane R (# 331) on :

Barefoot Friar:

quote:
Standard operating procedure around here. They say "it's to ward off any secondary infections", but the truth of the matter is that a) Americans think that if they go to the doctor and aren't automatically prescribed something then they are not getting properly cared for, and b) Americans are largely clueless about how antibiotics work anyhow. They're told to take this medicine for so many days, and Lo and Behold! they're magically better after that time. They don't realize that they just got over it despite the antibiotic, not because of it.

Good grief, no wonder your healthcare system costs so much!

Judging by the number of hospitals that have been declaring major incidents recently, the NHS is creaking somewhat - but this is partly because GPs are no longer responsible for out-of-hours care. So anyone with a minor ailment in the evening or at weekends has to phone 111 for a non-emergency consultation, and they will often tell you to go to A&E just to be on the safe side. I had to take my mother-in-law to A&E last year because she'd had a tooth out and the wound wouldn't stop bleeding; we should have gone back to the dentist, but she'd had the tooth out last thing on Friday and if we hadn't gone to A&E (on the advice of the 111 service) it might have gone on bleeding for the whole weekend. And she's 86; if she'd spent the entire weekend unable to eat because her mouth was bleeding she could have been really unwell by Monday.

Some hospitals have minor injury clinics alongside A&E, which is a much more efficient use of resources IMNSHO.

Posted by Doublethink. (# 1984) on :

I note in the recent coverage of the 400,000. extra visits to A&E doctors stated that patients were being advised to go - and that's why they were going.

Is the problem being too risk averse ?

[crossposted]

[ 15. January 2015, 10:24: Message edited by: Doublethink. ]

Posted by Felafool (# 270) on :

ISTM that this is more of an issue with employment terms and conditions, which generally in the UK specify something like 5 days 'uncertified sick leave'....(strangely these days included non-working days e.g.weekends).

I suspect this in turn is reflecting the Statutory Sick Pay (SSP) UK policy, which means that after a specified number of days' certified sick leave, the Government pays a proportion of the wages during the period of certified absence.

That's the root that needs addressing, because that drives the cold/flu sufferer to their GP after 5 days, even though we know that there is nothing to be done (except sign a sick certificate!) [Confused]

Posted by Barnabas62 (# 9110) on :

I think the NHS problem is strapped resources and an increasingly desperate game of passing the parcel. A & E are left holding the baby.

[And that mixed metaphor is not virus-produced; all my own fault.]

Posted by Jane R (# 331) on :

I think it's a combination of several things.

First, the 111 service can only do so much over the phone. If they are not sure what's wrong with you (and they have to rely on your own description of your symptoms; if you are ringing up because your child has fallen over and is now bleeding all over the carpet and screaming blue murder you may not be in a fit state to describe what's happening calmly) they will probably tell you to go to a doctor or A&E to be assessed in person.

Second, there is no middle course between waiting to see your GP (which could take several days) and going to A&E. Some things just can't be left that long - if you have a head injury resulting in bleeding into the brain on Friday, for example, you could be dead by Monday. My mother-in-law probably wouldn't have been, but she was very uncomfortable and distressed.

Thirdly, minor problems if left untreated can develop into more serious problems which are more expensive to treat. This is particularly important for children and elderly people, who can develop problems quite quickly. If my mother-in-law had been left bleeding for the whole weekend she might have collapsed from the cumulative blood loss and/or lack of food and had to be hospitalised, thus taking up resources that ought to be reserved for acute cases.

We need better out-of-hours GP cover. If we had that, it would take some (most?) of the heat off A&E.

Posted by Doublethink. (# 1984) on :

What about if pharmacists could certify for minor illness for a short period ?

Posted by Liopleurodon (# 4836) on :

quote:
Originally posted by Barnabas62:
I think the NHS problem is strapped resources and an increasingly desperate game of passing the parcel. A & E are left holding the baby.

[And that mixed metaphor is not virus-produced; all my own fault.]

Yeah... my mental health problems reached crisis levels a couple of times in the last few months. The first time Mr Liopleurodon called the NHS advice line (whatever it's called these days) and was told to take me to A&E. So he did. They sent me home with a letter to show my GP telling her to refer me to the emergency mental health services urgently. She did. I got an appointment with a shrink a few weeks away. Before this appointment, things got really bad again, and my dad phoned the mental health centre to see what they could do. They told him to take me to A&E. He did. A&E said they'd like to send me to my GP with a recommendation to refer me to the mental health team. I pointed out that we were going in circles and my dad got irate and eventually there were phone calls to get the home treatment team round to my house and an appointment was set up with an emergency psychiatrist. In the meantime the mental health centre cancelled my original appointment without telling me and when I got there the shrink was on annual leave.

I'm going to add here that the emergency shrink changed my meds, I stabilised and I'm doing much better, but if I hadn't had the support of my dad and my husband I might well not be alive now, because I was in no state to fight for what I needed. There should have been an on-call psychiatrist in A&E. I know they're expensive, but almost everything that happened here was a waste of time and money. As the NHS gets stripped back further, it's only going to get worse.

Posted by orfeo (# 13878) on :

quote:
Originally posted by Doublethink.:
What about if pharmacists could certify for minor illness for a short period ?

They can here, now. That change was implemented a couple of years ago.

Posted by orfeo (# 13878) on :

quote:
Originally posted by Doublethink.:
I know, but, the advice on when to see your gp from the NHS is based on exactly the same process of you self-assessing your symptoms.

NHS says, if you are coughing, sneezing and feeling crap - take over the counter meds and don't come see us unless the symptoms aren't gone after three weeks.

Meds say, if you are coughing, sneezing and feeling crap - take over the counter meds and go see the GP if the symptoms aren't gone after three days.

Blame the lawyers.

And I say that in all seriousness. It's highly likely the private pharmaceutical companies don't want people suing them saying "I took your medication and it didn't cure me of (insert disastrous disease here)".

Of course, no-one ever made a serious claim that cold medication could cure you of anything, but I honestly wouldn't be surprised that they're guarding against the possibility that someone blames them for inducing a state of complacency.

So, yes to your later comment about being risk-averse.

Posted by Barefoot Friar (# 13100) on :

Do said medications contain acetaminophen? Because if so, that's likely your culprit. ODing on it is really easy, and it can really hurt (and sometimes kill) you.

Well, I say "culprit", but it's not the culprit. orfeo is right about the lawyers covering their tushies from potential lawsuit.

[ 15. January 2015, 11:31: Message edited by: Barefoot Friar ]

Posted by Jane R (# 331) on :

Doublethink.:

quote:
What about if pharmacists could certify for minor illness for a short period ?

Might help. Then again, you would probably have to pay for the privilege of being signed off work (our doctor charges £15 for sickness notes, as I discovered when my daughter's school demanded written confirmation of her migraines for bureaucratic purposes). So anyone who can't pay the charge, or doesn't want to, will still have to drag themselves into work and cough germs over everybody.

Posted by Doublethink. (# 1984) on :

I think it was the expectorant / decongestant - made me cough a lot which irritated my lungs which triggered my asthma which made me cough etc (Phenylephrine hydrochloride.)

There is another decongestant I know I shouldn't take - so I'd carefully checked it wasn't in these pills. After it all went to crap, looked at the side-effects leaflet and saw they can cause bronchospasm - fantastic [Roll Eyes]

[ 15. January 2015, 11:55: Message edited by: Doublethink. ]

Posted by Doublethink. (# 1984) on :

quote:
Originally posted by Jane R:
Doublethink.:
quote:
What about if pharmacists could certify for minor illness for a short period ?
Might help. Then again, you would probably have to pay for the privilege of being signed off work (our doctor charges £15 for sickness notes, as I discovered when my daughter's school demanded written confirmation of her migraines for bureaucratic purposes). So anyone who can't pay the charge, or doesn't want to, will still have to drag themselves into work and cough germs over everybody.

As a public health measure this stupid.

Posted by Jane R (# 331) on :

Oh, I agree. But schools are expected to treat children with chronic illnesses as if they were truants now; so you have to get documentary evidence that you are not making up your child's illness if his/her absences are more frequent than the government says they should be.

I can understand why the doctor charged £15 for the letter. I can even understand why the head teacher insisted on having it (it's not like she had much choice in the matter under the new rules). What I can't understand is why everyone has to be treated like a criminal because of a few people who allow their children to skip school on a regular basis.

Posted by itsarumdo (# 18174) on :

Just to throw a small grenade in the works.. The non-industry research on flu vaccines shows that people who receive them suffer less minor colds but more SARS-type infections. So why is there a flu vaccination campaign? Because ordinary flu comes and goes within a few days and there is maybe a day off work here and there, but very few hospitalisations or extended periods off work or subsequent long lasting health issues. One of the problems both for NHS admissions and funding is that the pharma industry manages to sell products that are worse than useless (i.e. on long term analysis the complication/mortality rate on taking the medication is way more than the problem that was supposed to be solved by use of the medicine). I shudder at Labours NHS policies because from where I sit it looks like another meal ticket for the pharma industry. 1% of the NHS budget is already for Statins, projected to rise to 3%, BUT the best quality independent research points out that Statins cause more health problems than they solve. So not only is there steadily increasing expenditure of £billions, but some of it is not only useless, but is also adding to the treatment load for other NHS departments.

Posted by mdijon (# 8520) on :

quote:
Originally posted by itsarumdo:
The non-industry research on flu vaccines shows that people who receive them suffer less minor colds but more SARS-type infections.

Not true.

quote:
Originally posted by itsarumdo:
BUT the best quality independent research points out that Statins cause more health problems than they solve.

Not true.

Next?

Posted by itsarumdo (# 18174) on :

quote:
Originally posted by mdijon:

quote:
Originally posted by itsarumdo:
The non-industry research on flu vaccines shows that people who receive them suffer less minor colds but more SARS-type infections.
Not true.

quote:
Originally posted by itsarumdo:
BUT the best quality independent research points out that Statins cause more health problems than they solve.
Not true.

Next?

Sorry, but your statements are not true. Hong Kong study 2013(?) on flu vaccines - one of the few studies to use a saline (instead of a ground substance) control. Peter Gotsche/Cochrane collaboration on Statins (though he was quoting a study not done by himself, but rather the largest publicly funded study carried out up to 2014).

Posted by Beeswax Altar (# 11644) on :

quote:
Originally posted by Barefoot Friar:

quote:
Originally posted by Doublethink.:
Why are they giving out antibiotics for a viral infection
Standard operating procedure around here. They say "it's to ward off any secondary infections", but the truth of the matter is that a) Americans think that if they go to the doctor and aren't automatically prescribed something then they are not getting properly cared for, and b) Americans are largely clueless about how antibiotics work anyhow. They're told to take this medicine for so many days, and Lo and Behold! they're magically better after that time. They don't realize that they just got over it despite the antibiotic, not because of it.

I don't take antibiotics unless the doctor says that what I have is bacterial, and I don't go to the doctor if I already know what it is. I don't go for colds, or stomach viruses, or flu, or anything else I know I'll get over. Mrs. Friar thinks I'm being obstinate, and maybe I am, but I refuse to go and pay money to be told something I already know.

Excuse me, I have to go yell at the neighborhood kids to get off my lawn.

The reason I've heard is that the infection might be bacterial or viral so they give the antibiotics just in case it's bacterial. So, you go to the doctor with symptoms of the cold and the doctor will give you antibiotics in case it's a sinus infection. Add a sore throat to the symptoms and more bacterial infections become a possibility.

Posted by mdijon (# 8520) on :

quote:
Originally posted by itsarumdo:
Sorry, but your statements are not true. Hong Kong study 2013(?) on flu vaccines - one of the few studies to use a saline (instead of a ground substance) control. Peter Gotsche/Cochrane collaboration on Statins (though he was quoting a study not done by himself, but rather the largest publicly funded study carried out up to 2014).

There are masses of studies showing the safety of flu vaccines (although no mortality benefit) and showing mortality benefits of statins.

Which studies are you quoting? Can you link?

Posted by mdijon (# 8520) on :

By the way on safety of flu vaccine and on mortality benefit of statins.

Posted by ExclamationMark (# 14715) on :

Employers can insist on a sick note after one day's absence if they so choose (often used on those who are on final warnings and/or those who attendance record is poor. The "number of days" issue is therefore irrelevant in this debate.

Part of the issue is the ride that some (emphasise some) employees take their employers for over sickness. Companies want evidence for a sickie and see it as the NHS's duty to provide it. A sickie with no note equates to a "conduct" issue.

As for infecting everyone else, I've always been told by medical people that colds etc. are infectious before they actually appear. So being there with a cold (which you know about)isn't much different in the infection stakes from being there developing a cold (which you don't know about).

Posted by Doublethink. (# 1984) on :

Employers demanding a sick note for minor illness effects demand on GPs - it is not a good use of medical resources. Not unlike them arbitrarily deciding something else such as, we won't believe you are ill unless you can show us an antibiotic prescription.

Posted by ExclamationMark (# 14715) on :

quote:
Originally posted by Doublethink.:
Employers demanding a sick note for minor illness effects demand on GPs - it is not a good use of medical resources. Not unlike them arbitrarily deciding something else such as, we won't believe you are ill unless you can show us an antibiotic prescription.

No it's not but it is a requirement that has been generated by the small number of people who abused the concept of self certification.

it's not really about antibiotics either - they don't make much difference to the normal cold and flu stuff around. left alone the illness goes in 7 days, treated and it will last a week.

If the illness is as minor as you say then it's presumably possible to work anyway so no note required.

[ 15. January 2015, 17:53: Message edited by: ExclamationMark ]

Posted by mdijon (# 8520) on :

quote:
Originally posted by ExclamationMark:
Employers can insist on a sick note after one day's absence if they so choose

It should be only for more than 7 days.
They need proper grounds for notes for one day absences.

Posted by ExclamationMark (# 14715) on :

quote:
Originally posted by mdijon:

quote:
Originally posted by ExclamationMark:
Employers can insist on a sick note after one day's absence if they so choose
It should be only for more than 7 days.
They need proper grounds for notes for one day absences.

Proper grounds are pretty broad in scope - the usual reduction in requirement is applied where there has been an unexplained history of short absences and/or there are concerns on conduct and/or capability.

I guess that there's been an increase in use of GP's, hospitals etc as people recognise that they pay for this service (via taxes), so they're jolly well going to use it. It's called consumerism.

Mind you remove the admissions to A & E caused by alcohol and you'd have something close to enough space.

Posted by Amika (# 15785) on :

quote:
Originally posted by Doublethink.:
I have a cold, I know it is probably a self-limiting viral infection - that may last slightly longer than average owing to the fact I also have asthma. It is winter, this condition is not surprising.

Do we think some pressure on the NHS could be eased if some effort was made to co-ordinate on these issues? Millions of people get colds every winter never mind the rest of the year, how much time and resource could be saved if all three sectors, NHS, Meds manufacturers and employers worked to the same timescales?

I know this problem all too well. My process was usually: get a cold, keep on going to work; get a bad chest due to asthma/cold, keep on going to work. In fact, go to work even if literally blue in the face with wheeze as no one cared a jot. No doctor was harmed or even seen in the activation of this policy.

Happy days! [Biased]

A few days off to rest and recuperate would have been great. Sadly the alternative always seemed to be expedient. It wouldn't have helped me to have seen a doctor, but rest would probably have aided recovery. Once in a while I would just have to take a couple of days off, but normally I struggled through and felt awful. I even cycled to work when my lips were literally blue on more than one occasion.

I think people with colds and flu, including asthmatics, should stay away from doctors if at all possible. I cringe now when I think of my earlier days of antibiotic-seeking (as I'd been advised I needed them if ever I got a cold) and attendance at the surgery. Later experience showed me that I would recover naturally given time. Of course workplaces are even more stringent now and the ideal would be understanding employers rather than an ever-ready NHS. Dream on, I think!

I should add that in the office(s) where I worked just about everyone came in when they had colds. The pressure to *not* be off work was very strong.

Posted by orfeo (# 13878) on :

quote:
Originally posted by itsarumdo:
Because ordinary flu comes and goes within a few days and there is maybe a day off work here and there, but very few hospitalisations or extended periods off work or subsequent long lasting health issues.

Flu kills people.

Just because it doesn't kill everyone doesn't mean it's a good idea to just let the disease spread without using the means available to stop it.

Posted by orfeo (# 13878) on :

quote:
Originally posted by ExclamationMark:
Part of the issue is the ride that some (emphasise some) employees take their employers for over sickness. Companies want evidence for a sickie and see it as the NHS's duty to provide it. A sickie with no note equates to a "conduct" issue.

One of my former employers once had a policy that the number of sick days you could take per year was unlimited.

At some point, powers that be decided that this was a terrible thing, and that clearly this meant employees were taking more days off than they should, and that we needed in the next employment agreement to change this into a finite number.

They did.

The average number of sick days taken went up.

The biggest single reason why absence is a conduct issue is because bosses MAKE it a conduct issue. There are all sorts of studies that show how treating people with distrust makes them distrust you right back, and of course that applies to employees as well. Which kind of employee is going to be more motivated to work well for you - the one you've got a good, trusting relationship with who feels valued, or the one who is made to feel like a naughty child or petty criminal because you let them know you've got your eye on them constantly?

Employers who set up the workplace as a battleground rather than a collaboration are shooting themselves in the foot.

Posted by ExclamationMark (# 14715) on :

quote:
Originally posted by orfeo:

quote:
Originally posted by ExclamationMark:
Part of the issue is the ride that some (emphasise some) employees take their employers for over sickness. Companies want evidence for a sickie and see it as the NHS's duty to provide it. A sickie with no note equates to a "conduct" issue.
One of my former employers once had a policy that the number of sick days you could take per year was unlimited.

At some point, powers that be decided that this was a terrible thing, and that clearly this meant employees were taking more days off than they should, and that we needed in the next employment agreement to change this into a finite number.

They did.

The average number of sick days taken went up.

The biggest single reason why absence is a conduct issue is because bosses MAKE it a conduct issue. There are all sorts of studies that show how treating people with distrust makes them distrust you right back, and of course that applies to employees as well. Which kind of employee is going to be more motivated to work well for you - the one you've got a good, trusting relationship with who feels valued, or the one who is made to feel like a naughty child or petty criminal because you let them know you've got your eye on them constantly?

Employers who set up the workplace as a battleground rather than a collaboration are shooting themselves in the foot.

It depends where the distrust starts: if it begins with the employee being prepared to take time off for the least reason, then it will bring a responsive action from the employer. Who wants an important project to founder because you can't trust staff not to come in on a warm day?

In the UK it's those companies with more flexible approaches to absence (mainly the Government and public sector), which see more absences - alongside shorter hours (on average) and better provisions for maternity, paternity etc.

I don't see ASDA/Walmart in the UK doing too badly when, arguably, they are one of the more robust employers in the UK when it comes to absence and staff matters. On the other hand local councils are bywords for inefficiency and non delivery and have very liberal policies on absence etc - and you have no right of recourse if they don't deliver, as happened to something I was involved in recently.

Some kind of balance is best: employers trust staff to get on with the job and staff recognise that employers have certain deadlines that mean you have to work through stuff in order to finish the job and get others.

Posted by ExclamationMark (# 14715) on :

quote:
Originally posted by orfeo:
[QUOTE] Which kind of employee is going to be more motivated to work well for you - the one you've got a good, trusting relationship with who feels valued, or the one who is made to feel like a naughty child or petty criminal because you let them know you've got your eye on them constantly?

Sorry missed this before .... I agree with you - clearly the one who feels valued. But, in too many cases that trust is destroyed by other employees who take the employer's kindness and grace for a ride, alongside the good will of their fellow workers.

There's nothing more destructive to any work team, than someone in it taking everyone for a ride. Good people won't trust kind employers who let it happen. I've seen far more criticism and demand for action against people who don't pull their weight from fellow employees, than I have from employers.

Posted by orfeo (# 13878) on :

We're going off on a bit of a tangent here, but...

To me the biggest problem is that employers often respond to an underperforming employee by changing the rules for all employees, instead of managers properly dealing with the specific problem. Mostly because changing the rule is less difficult and requires less skill.

But (and to bring this back on topic), it's not actually efficient. It just ends up shifting the burden elsewhere. Instead of management having the burden of dealing with a small number of underperforming employees, you have every employee having the compliance burden of obtaining more medical certificates, the managers having the burden of processing more medical certificates, and doctors etc having the burden of writing more medical certificates.

I think this is part and parcel of the frustration that members of a team of employees feel when they think someone is underperforming. Not only do they not see management dealing with the underperforming person, they see management making their own lives more difficult.

Posted by Doublethink. (# 1984) on :

Also, worth pointing out, that one of the reasons sickness rates in the NHS are higher is that we work with vulnerable sick people. Therefore we think very carefully about infection risk, as well as having a fair chance of catching illness from the patients.

Posted by itsarumdo (# 18174) on :

quote:
Originally posted by orfeo:

quote:
Originally posted by itsarumdo:
Because ordinary flu comes and goes within a few days and there is maybe a day off work here and there, but very few hospitalisations or extended periods off work or subsequent long lasting health issues.
Flu kills people.

Just because it doesn't kill everyone doesn't mean it's a good idea to just let the disease spread without using the means available to stop it.

It's interesting that you have a clear proportional sense of risk when it comes to terrorism but when it comes to medical stuff you don't. One major reason (i.e. not the only reason, but this one is near the top of the list) that the NHS is in difficulty is its public health function, which is highly politicised, very expensive, and full of misinformation.

Don't take my word for it - Take a read of "Deadly Medicines and Organised Crime" by Peter C Gøtzsche (ISBN: 9781846198847). He's one of the world's top researchers into safety of medicines, via the Cochrane Collaboration. What his book doesn't touch is immunisations, and my guess that the misinformation around that is so big that it was too difficult a target - there is plenty of fodder in just pharmaceuticals. I have a research papers somewhere in my office about flu vaccinations, and typical of all medical research the literature is so flooded with industry-sponsored studies that actually finding a non-industry paper in all the literature is almost impossible just because of the numbers. So - what I remember - about 200 subjects given real vaccine and about the same number given saline. Almost all published flu vaccine trials do not use saline, but rather use the vaccine ground substance, which compromises the immune system and therefore presents a false description of the outcomes for unvaccinated populations. So, with saline, the vaccinated population suffered almost no ordinary flu but they did have all kinds of other ENT infections far more than the saline control. And they had I think 5 (? more?) cases of SARS - and in the saline control there were no SARS cases. The result was unambiguous - the flu vaccine causes more problems than it solves, making flu far more dangerous when it does occur and creating a host of side effects. This is incidentally not unlike the effect of Statins, which you will read in PCG's book. Of course, politically it is great to provide flu vaccinations because everyone likes to think that the state is protecting them from flu and that Must Be A Good Thing. Cost-wise, we have the flu vaccination itself, PLUS the additional SARS cases PLUS the additional ENT cases - so the net effect of a flu vaccination programme is reduced health and massively increased costs.

Posted by Golden Key (# 1468) on :

I'm one of those people who get flu *symptoms* from the vaccine. Probably due to my weak immune system. I tried the vaccine for several years, but it just wasn't worth the resulting illness.

Posted by orfeo (# 13878) on :

quote:
Originally posted by itsarumdo:
It's interesting that you have a clear proportional sense of risk when it comes to terrorism but when it comes to medical stuff you don't.

Sigh.

Risk management consists of several elements: the likelihood of the risk occurring, the consequences of the risk occurring, and the ease of preventing the risk occurring.

Flu vaccinations are a simple method of solving a problem that has the capacity to kill people. When you create a terrorism vaccine, let me know.

I find the claim that out of 200 people, 5 had SARS absurdly improbable. SARS is caused by a specific virus, and I've just read a Huffington Post article from 2013 that said no cases had been reported in the decade since the 2002-3 outbreak. So whatever issues vaccinated people might have had, allow me to be extremely sceptical that it was SARS.

[ 16. January 2015, 09:30: Message edited by: orfeo ]

Posted by la vie en rouge (# 10688) on :

Another thing I’m musing about – how much employers can help their employees not get sick in the first place. For several years, my employer offered a free flu vaccination to anyone who wanted one (they didn’t do it this year for some reason). I’m guessing the reason for this is that they did some sort of cost-benefit analysis and decided it would cost them less to pay for the shots than to have half the office go down with flu – exacerbated by the fact that we have the air conditioning system from hell and airborne bugs get passed around quite quickly. I don’t think it was a question of generosity.

I think the comparison with SARS is a bit of a red herring, because of the relative prevalence of both diseases in my locality. I am *far* more likely to be exposed to flu.

Posted by mdijon (# 8520) on :

quote:
Originally posted by itsarumdo:
Don't take my word for it - Take a read of "Deadly Medicines and Organised Crime" by Peter C Gøtzsche (ISBN: 9781846198847).

Your post is a demonstration of the dangers of a little information. There certainly are major dangers with pharma and lots of nefarious misrepresentation of evidence goes on. The NHS and most academic researchers are not, however, part of the cabal.

It really is not the case that Statins do more harm than good full stop. There may not be clear evidence of their benefit for very widespread use and they probably are overused. However there is extremely good evidence that they stop you dying if you have had one heart attack already or if you have had a stroke.

There is very good evidence that flu vaccines stop you getting flu and reduce transmission in the population. It is not clear cut that they are cost-effective because the risk of dying from flu for most people is extremely low. There is however no credible evidence that flu vaccines cause worse illness and the study you half-remember sounds completely implausible for a variety of reasons. If you could link to it it would be possible to better assess it.

Posted by orfeo (# 13878) on :

quote:
Originally posted by Golden Key:
I'm one of those people who get flu *symptoms* from the vaccine. Probably due to my weak immune system. I tried the vaccine for several years, but it just wasn't worth the resulting illness.

Actually, that sounds like you had a highly responsive immune system that jumped into action every time. The direct cause of most disease symptoms is actually your immune system, not whatever bug it's fighting. Basically it's your body being cruel to be kind.

Posted by itsarumdo (# 18174) on :

quote:
Originally posted by mdijon:

quote:
Originally posted by itsarumdo:
Don't take my word for it - Take a read of "Deadly Medicines and Organised Crime" by Peter C Gøtzsche (ISBN: 9781846198847).
Y...

It really is not the case that Statins do more harm than good full stop. There may not be clear evidence of their benefit for very widespread use and they probably are overused. However there is extremely good evidence that they stop you dying if you have had one heart attack already or if you have had a stroke.

...

Exactly - The context I am talking about is public health intervention and mass prescription to anyone over a particular age rather than specific prescription for a specific case. However, in the NHS that distinction (between individual and public health policy) is rather blurred, isn't it? On balance, if a doctor thinks based on his assessment and personal knowledge of a specific individual - "well, maybe it will help and maybe it won't in this case", then because there is a NICE (i.e. public health) guideline it is very difficult to put the case for not prescribing. And your comment about the NHS not being part of the cabal - it's certainly affected by it. Why has NICE recently, against all available evidence, issued guidelines that Statin use for prevention should be expanded? I bet that if overprescribing could be eliminated, the NHS would immediately save 20% of its budget, and with the knock-on effect of reduced iatrogenic effects, that might go even higher, along with less pressure on all NHS human resources.

Posted by itsarumdo (# 18174) on :

quote:
Originally posted by mdijon:

quote:
Originally posted by itsarumdo:
Don't take my word for it - Take a read of "Deadly Medicines and Organised Crime" by Peter C Gøtzsche (ISBN: 9781846198847).
There is very good evidence that flu vaccines stop you getting flu and reduce transmission in the population. It is not clear cut that they are cost-effective because the risk of dying from flu for most people is extremely low. There is however no credible evidence that flu vaccines cause worse illness and the study you half-remember sounds completely implausible for a variety of reasons. If you could link to it it would be possible to better assess it.

http://cid.oxfordjournals.org/content/early/2012/03/13/cid.cis307

Posted by orfeo (# 13878) on :

At least twice, that article says they did not directly observe influenza protection, but serological evidence and point estimates of vaccine efficacy based on confirmed infections were consistent with protection.

The discussion states they are not sure whether the increase in other respiratory viruses is a real effect or an artefact of reporting methods. Basically, they're not prepared to draw firm conclusions from any of these results. They suggest some possibilities, yes, but that's as far as it goes. They certainly suggest that influenza protection might be traded off by a temporary dip in other immunity a little later on through some unknown mechanism, but they most definitely do not say that the influenza vaccination offers no protection in the first place.

And there is absolutely no mention, whatsoever, of the other respiratory viruses that people acquired being SARS.

[ 16. January 2015, 11:51: Message edited by: orfeo ]

Posted by orfeo (# 13878) on :

And just to put this into perspective, the World Health Organization's estimate is that influenza kills between 300,000 and 500,000 people annually.

This is the disease you're describing as just causing a few days of inconvenience. Yes, I am well aware that the really serious cases are almost entirely confined to high risk groups such as young children, the elderly and people who are immunocompromised, and I'm equally aware that those are the groups for which the emphasis is placed for vaccination. But the fact is that immunisation of 'ordinary' adults also assists in reducing the spread of the infection.

Posted by mdijon (# 8520) on :

quote:
Originally posted by mdijon:

quote:
Originally posted by itsarumdo:
Don't take my word for it - Take a read of "Deadly Medicines and Organised Crime" by Peter C Gøtzsche (ISBN: 9781846198847).
There is very good evidence that flu vaccines stop you getting flu and reduce transmission in the population. It is not clear cut that they are cost-effective because the risk of dying from flu for most people is extremely low. There is however no credible evidence that flu vaccines cause worse illness and the study you half-remember sounds completely implausible for a variety of reasons. If you could link to it it would be possible to better assess it.

quote:
Originally posted by itsarumdo:
http://cid.oxfordjournals.org/content/early/2012/03/13/cid.cis307

quote:
Originally posted by orfeo:
At least twice, that article says they did not directly observe influenza protection, but serological evidence and point estimates of vaccine efficacy based on confirmed infections were consistent with protection.

The discussion states they are not sure whether the increase in other respiratory viruses is a real effect or an artefact of reporting methods. Basically, they're not prepared to draw firm conclusions from any of these results. They suggest some possibilities, yes, but that's as far as it goes. They certainly suggest that influenza protection might be traded off by a temporary dip in other immunity a little later on through some unknown mechanism, but they most definitely do not say that the influenza vaccination offers no protection in the first place.

And there is absolutely no mention, whatsoever, of the other respiratory viruses that people acquired being SARS.

Orfeo writes such a precise review that I wonder if he is in fact a closet biologist that has been woefully lost to the world of legislative drafting.

I add that there are much larger trials of influenza vaccine that show no such effect and so one can be completely reassured regarding the apparent temporary blip in other viral infections.

Posted by mdijon (# 8520) on :

quote:
Originally posted by itsarumdo:
Why has NICE recently, against all available evidence, issued guidelines that Statin use for prevention should be expanded?

Because it isn't against all available evidence.

Some large analyses suggest they are of benefit in primary prevention (i.e. people who don't yet have heart disease) and here's another.

In fact the Cochrane collaboration that you referenced earlier agrees as well.

There are some dissenters but "against all available evidence" is untrue.

NICE had a group of doctors on it who looked at all the evidence and their considered opinion was to recommend statins in certain circumstances to prevent disease. Many disagree with them in thinking the threshold was set a bit low, but that's a slight disagreement and I don't think anyone can seriously impugn their motives.

Posted by orfeo (# 13878) on :

quote:
Originally posted by mdijon:
Orfeo writes such a precise review that I wonder if he is in fact a closet biologist that has been woefully lost to the world of legislative drafting.

Bachelor of Science, main areas of study were biochemistry and chemistry. I know my way around a journal article.

Sometimes damn useful in the world of legislative drafting, actually. Within the office, the science-y stuff is sometimes deliberately sent my way on the grounds that I'll understand what the hell it's about.

Posted by itsarumdo (# 18174) on :

OK - memory wasn't briliant, and I've had to come to another internet connection to download the PDF

The referenced article, table page 21

Although the innoculation reduced seasonal H1N1,H3N2 and InfB by 30-50% (from 6.5% of placebo subjects in total to 4.3% innoculated), the seasonal gains were balanced by just as many Pandemic H1N1 cases being suffered by the innoculated group (4.3%) but NOT (i.e ZERO %) by the placebo group.

In addition the vaccinated group suffered over 4x as many other respiratory tract viral infections... inc Rhinovirus & Coxsackie compared to placebo.

If you can then take that data and tell me that the flu vaccine tested conferred a health benefit, please let me know how you come to that conclusion.

Also, if you can take that data and NOT imply that the immune system is compromised (or worse, imply that the immune system is not compromised at all) by the innoculations, then again, I'd like to see the reasoning.

Furthermore, p-values are usually quoted as being indicative of meaningful results in any experiment involving polulation sampling. The ONLY meaningful p-values (p<0.01) in the result set are that innoculated patients were far more likely to contract non-influenza viruses. Take a long look at those p-values and see which are more significant.

Conclusion - the NHS and its patients and the tax payer would be better off with no flu innoculations. Ask Piers Morgan.

Posted by itsarumdo (# 18174) on :

In fact, it's even clearer than my first para suggests.

Seasonal + Pandemic Influenza totals :

Vaccinated : n=6/69 (8.6%)
Placebo : n=3/46 (6.5%)

And as I said previously, the reason this experiment throws up this reault (and is at odds with many other flu vaccine studies) is that the placebo group were ONLY
injected with saline, and not injected with the chemical preservative used for vcaccines.

Posted by mdijon (# 8520) on :

quote:
Originally posted by itsarumdo:
If you can then take that data and tell me that the flu vaccine tested conferred a health benefit, please let me know how you come to that conclusion.

You can't and we weren't. There are other data. This is a fairly small experiment involving 115 children which was interesting but not definitive, it wasn't designed to be and the authors admit it wasn't in the discussion as Orfeo says.

A summary of a much larger dataset is here.

To tell the truth the jury is out -it isn't clear cut. But what is clear cut is that your version of events is unreliable - on statins, on vaccines causing SARS, on NICE - and yet being demonstrably wrong on those issues hasn't caused any pause for reflection.

Posted by mdijon (# 8520) on :

quote:
Originally posted by itsarumdo:
And as I said previously, the reason this experiment throws up this reault (and is at odds with many other flu vaccine studies) is that the placebo group were ONLY
injected with saline, and not injected with the chemical preservative used for vcaccines.

More rubbish. In 5 minutes I can find this trial and this trial that show effectiveness of influenza vaccines in trials with saline placebo. I think very few trials would use the chemical preservative.

(And lets not get into the reasoning explaining why that might matter).

Posted by orfeo (# 13878) on :

quote:
Originally posted by itsarumdo:
In addition the vaccinated group suffered over 4x as many other respiratory tract viral infections... inc Rhinovirus & Coxsackie compared to placebo.

You appear to basically be arguing that I should treat your interpretation of this figure as deeply significant when the actual authors of the paper don't. And when the actual figures involved are such that half a dozen people with a cold causes a huge swing.

quote:
If you can then take that data and tell me that the flu vaccine tested conferred a health benefit, please let me know how you come to that conclusion.

Because a vaccination that gives me immunity from the flu but increases my risk to some rhinovirus floating around in a couple of months time is a good trade.

This comes back to your minimisation of the flu (and your contrast of it with SARS, of all things). I continue to be disturbed by your description of influenza as something that "comes and goes within a few days and there is maybe a day off work here and there". What is this based on?

People who say they have "a touch of the flu" frequently don't have any such thing. They have some other respiratory viral infection and call it "flu" because it gives some of the collection of symptoms that result from your immune system trying to clear a respiratory infection.

When I've had actual flu, it's always caused days off (not always work, my first infection happened when I was 11 - the delirious fever the first night was the most delightful experience of my life thus far) and left me feeling pretty darn crappy. But hey, maybe I'm just a sissy weakling and they build them tough in your part of the world.

Posted by Moo (# 107) on :

Even if someone does not die of the flu, it can leave them with an impairment which may or may not go away eventually.

I knew a woman in her late eighties whose flu turned into pneumonia. The doctors weren't sure she would survive. Her body eventually got rid of all the germs, but she was much more frail after that than she had been before.

Most flu statistics don't mention this kind of situation.

Moo

Posted by itsarumdo (# 18174) on :

It's very significant because it highlights the compromise decisions that are made in public health policy. The fact is that there is NO long term study of secondary effects of immunisation on any population, and this study shows that there is a negative effect on the immune system. Same with Statins - benefit vs risk. The question never asked in public is - at what point (i.e. I'm not arguing against all interventions) - at what point does saving several lives due to one intervention be a bad decision because the shotgun intervention negatively affects the health of many other people who would otherwise not have been affected? The answer is partly to do with how marginal the benefits are and the risk [b]to an individual[\b]. And risk to individual is likewise very poorly if at all related to population risk. I'm saying that many public health interventions made "because they look good" are a) having at best a marginal effect, and b) there is a knock-on completely unquantified negative effect on general health, which then plays back into the case load being handled by the health system. Nobody is interested in even attempting to quantify it - we just keep on making up new medicines we can use to treat more and more marginal cases "because its a good idea".

It's an interesting question - given any one mass immunisation or other mass medication, how do you quantify the net benefit of one persons life saved against (making a figure up) 1000 people with compromised immune systems or other problems which will in turn possibly shorten a number of their lives? If you stated it openly - who will volunteer to take this X medicine? We know X% of you will as a result not die from Y illness, but also as a result of taking the medicine, Z of you will have lives shortened in other ways? Would marginal medical interventions be taken quite so freely?

And I also stand by the statins statement - it's just that I do not have access to my papers at the moment to be able to reference the publicly funded study.

Posted by orfeo (# 13878) on :

The authors of the study don't agree with you. I'm going to leave it at that.

Posted by mdijon (# 8520) on :

quote:
Originally posted by itsarumdo:
The question never asked in public is - at what point (i.e. I'm not arguing against all interventions) - at what point does saving several lives due to one intervention be a bad decision because the shotgun intervention negatively affects the health of many other people who would otherwise not have been affected?

More bollocks. That question is asked in public all the time and the medical literature is full of discussion on it. The papers I quoted up-thread evaluate that very question.

quote:
Originally posted by itsarumdo:
And I also stand by the statins statement

Really? You said in the face of all the evidence. I provide lots of evidence which in fact support NICE's position. Yet you maintain in the face of all the evidence. By all means take your time to find some private papers, or whatever excuse you care to produce, you might find some contrary evidence since there certainly is some, but you can't support your statement "in the face of all the evidence" because a very substantial part of the evidence is clearly against you.

You also cannot stand by your statement regarding lack of flu vaccine studies using normal saline placebo since there are clearly plenty of them.

I'm not going to play whack-a-mole argument with more daft assertions of yours when you won't admit that you were demonstrably wrong on the previous daft assertions that I took the effort to reply to and show you evidence.

Posted by Leorning Cniht (# 17564) on :

quote:
Originally posted by orfeo:

To me the biggest problem is that employers often respond to an underperforming employee by changing the rules for all employees, instead of managers properly dealing with the specific problem. Mostly because changing the rule is less difficult and requires less skill.

Are these same employers the ones that are faced with wrongful dismissal lawsuits when they fire the slacker? If the employee's slacking behaviour isn't explicitly against the rules, there's more room for lawyers to wriggle.

Posted by no prophet's flag is set so... (# 15560) on :

quote:
Originally posted by orfeo:
We're going off on a bit of a tangent here, but...

To me the biggest problem is that employers often respond to an underperforming employee by changing the rules for all employees, instead of managers properly dealing with the specific problem. Mostly because changing the rule is less difficult and requires less skill.

But (and to bring this back on topic), it's not actually efficient. It just ends up shifting the burden elsewhere. Instead of management having the burden of dealing with a small number of underperforming employees, you have every employee having the compliance burden of obtaining more medical certificates, the managers having the burden of processing more medical certificates, and doctors etc having the burden of writing more medical certificates.

I think this is part and parcel of the frustration that members of a team of employees feel when they think someone is underperforming. Not only do they not see management dealing with the underperforming person, they see management making their own lives more difficult.

I've mentioned that I'm an employer. I also consult to other employers who are dealing with 'problematic employees". One of the difficult issues is that usually an underperforming employee knows that something is emerging about their performance, and gets some form of medical attention about stress or other psychosocial issue, which derails the employer's steps surrounding employee improvement and/or discipline. The problem of course is that if the focus is on discipline, rather than actually assisting the employee, then the employee legitimately has a stress issue. There's more to say about this, but from the experience we have, the personal stress issues/mental health issues / health issues and performance issues are often rather tangled.

On the vaccination issue for the flu. The vaccine is free to the public here, everyone can have it. The local health authority requires its employees to have it or medical certificate of inability to have it. It is a matter for discipline to be noncompliant, though an employee can agree to wear an approved surgical mask at work. What I've found in my workplace is that there's never a controversy. People respond to good info about vaccination and follow through, though we're based on the honour system and don't check formally into compliance. Vaccination isn't the whole answer to control of infection. Not touching your face (eyes and nose in particular) and washing hands with soap and water is probably equally important. It probably sounds odd to have lessons in handwashing, but they actually taught me something.

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