"Weak" strategy on childhood obesity is wasted opportunity, say experts

Medical experts and campaigners have criticised the government’s childhood obesity strategy as weak and embarrassing, and accused policymakers of throwing away the best chance to tackle the culture of unhealthy eating that is crippling the NHS.

The government’s measures, centred on the sugar tax announced by George Osborne in March, rely on voluntary action by the food and drink industry and are shorn of any restrictions on junk food marketing and advertising.

The industry, which has lobbied hard against regulation for months, has undertaken to reduce by 20% the amount of sugar in products such as cereals, desserts, yoghurts and sweets. The strategy document makes clear that manufacturers that reduce sugar in their products will escape the sugar tax, which is not due to come in for two years.

The money accrued by the levy on sugary drinks will go to fund breakfast clubs and sport. Schools will be asked to give pupils an extra 30 minutes a day of physical activity, and parents and carers will be encouraged to get their children moving for a further 30 minutes.

Citing the triumphs of Team GB at the Olympics and the example of St Ninians primary school in Stirling where children walk or run a mile every morning, the public health minister, Nicola Blackwood, said: “Initiatives like this will make a huge difference to children’s health and fitness and we hope our new measures on school sport will help to create future Team GB Olympians.”

But the strategy contains neither of the two measures that Public Health England (PHE) said would have the most impact on the childhood obesity epidemic.

A third of children leaving primary school are overweight or obese and at risk of a lifetime of health problems including diabetes, heart disease and cancer. Asked to investigate the issue and make recommendations on what should be done, PHE backed a sugar tax and reductions in sugar content of foods but prioritised two other measures:

• Banning price-cutting promotions of junk food in supermarkets, such as multipacks and buy one get one free, as well as promotion of unhealthy food to children in restaurants, cafes and takeaways.


• Restricting advertising of unhealthy food high in salt, fat and sugar to children through family TV programmes such as Britain’s Got Talent and The X Factor, as well as on social media and websites.

Neither appears in the strategy.

Campaigners likened the strategy to the responsibility deal brought in by Labour and continued throughout David Cameron’s premiership, which was widely condemned as a failure. Food and drink companies were encouraged to pledge to make their food healthier by cutting salt, fat and sugar. There has been little in the way of monitoring, but health groups believe the deal has not significantly contributed to improving the nation’s diet.

“After the farce of the responsibility deal where Andrew Lansley made the food industry responsible for policing themselves, it is sad to see that this is just another imitation of the same responsibility deal take two,” said Prof Graham MacGregor, chairman of Action on Sugar and Consensus Action on Salt and Health.

“It is an insulting response to the UK crisis in type-2 diabetes, both in children and adults. This will bankrupt the NHS unless something radical is done.”

Action on Sugar called on the prime minister to rescue the childhood obesity strategy. “Theresa May launched her prime minister campaign by saying that she wanted to tackle health inequalities, obesity being a major factor in this,” said Jenny Rosborough, the group’s campaign manager and a registered nutritionist. “The UK should lead the world in tackling obesity and type-2 diabetes and this is an embarrassing and inexcusable waste of a fantastic opportunity to put the nation’s health first.”

Although the childhood obesity strategy was a flagship initiative of Cameron’s and originally the work of staff in Downing Street, May has chosen not to launch it. It has been published by the Department of Health while she is on holiday in Switzerland.

The Children’s Food Campaign, a member of the Obesity Health Alliance, which includes charities and health organisations such as the royal colleges, fought hard for tough action on cut-price junk food and a ban on TV adverts for unhealthy food before 9pm, when viewing by children tends to drop off.

“Price promotions were one of the big issues that Public Health England majored on,” said Malcolm Clark of the campaign. “It looks like the government is failing to listen to its own public health experts.

“Industry likes to paint us as nanny-statists, but PHE is not a campaigning organisation. They have done a very thorough literature review of peer-reviewed evidence and come up with a recommendation on that.”

Sir Harpal Kumar, Cancer Research UK’s chief executive, said: “While encouraging more exercise in schools is to be welcomed, the evidence is compelling that we also need restrictions on the marketing and promotion of unhealthy foods. We need stronger action to protect children from junk food advertising if we want to make a difference. So for the government to ignore these aspects is inexcusable.

“The government had a chance to protect the next generation from diseases like cancer and reduce the crippling burden of obesity on the NHS. We need the game-changing strategy it promised a year ago. As it stands, our children will witness a rising tide of ill-health from obesity well into the future.”

The strategy document nods to the thinking underlying the focus on voluntary measures and physical activity. It aims to “significantly reduce” childhood obesity within 10 years, it says. “We are confident that our approach will reduce childhood obesity while respecting consumer choice, economic realities and, ultimately, our need to eat.”

The president of the Royal College of Physicians, Prof Jane Dacre, said: “I am disappointed that after such a long wait for the childhood obesity strategy, the government has published a downgraded plan.”

The British Medical Association described the strategy as weak. “Given the UK has the highest level of obesity in western Europe, with one in three children overweight or obese by the time they leave primary school, the government should be doing everything in its power to tackle this problem. Instead it has rowed back on its promises by announcing what looks like a weak plan rather than the robust strategy it promised,” said Prof Parveen Kumar, the BMA board of science chair.

“Although the government proposes targets for food companies to reduce the level of sugar in their products, the fact that these are voluntary and not backed up by regulation, renders them pointless. Targets are also needed to reduce levels of saturated fat and salt in products – these must be backed up by regulation.

“Poor diet has become a feature of our children’s lives, with junk food more readily available, and food manufacturers bombarding children with their marketing every day for food and drinks that are extremely bad for their health. It is incredibly disappointing that the government appears to have failed to include plans for tighter controls on marketing and promotion.”

The British Soft Drinks Association, meanwhile, said it was unhappy that the sugary drinks levy was going ahead. “Given the economic uncertainty our country now faces, we’re disappointed the government wishes to proceed with a measure which analysis suggests will cause thousands of job losses and yet fail to have a meaningful impact on levels of obesity,” said Gavin Partington, its director general.

He said manufacturers were already cutting the sugar content of their drinks.

Ian Wright, director general of industry body the Food and Drink Federation, said:
“The proposed tax on soft drinks is a disappointing diversion from effective measures to tackle obesity. Soft drink companies are already making great progress to reduce sugars from their products, having achieved a 16% reduction between 2012 and 2016.

“However the target set for sugars reduction in the plan is flawed. It focuses too strongly on the role of this single nutrient, when obesity is caused by excess calories from any nutrient. Moreover the target is unlikely to be technically practical across all the selected food categories.

Reformulation is difficult and costly: there are different challenges for each product; recipe change can only proceed at a pace dictated by consumers. We will of course do everything we can in the next six months to work towards a practicable reformulation solution while continuing to urge the government to adopt a ‘whole diet’ approach.”

"Weak" strategy on childhood obesity is wasted opportunity, say experts

Where precious cash is wasted in the NHS | Letters

I used to be involved in decision-making for funding high-cost drugs in the NHS, a process I strived to undertake systematically, transparently and justly. I was passionate about minimising waste. I recall once being forced to give up a perfectly good chair to make way for new ones bought to ensure our budget was spent, at the same time as turning down funding requests for cost reasons. This was galling. Fortunately, I left the NHS before the reorganisation – the abhorrent waste of resources in redundancy and rebranding would have broken me. The fiasco around PrEP (NHS can fund ‘game-changing’ HIV prevention drug, court rules, 3 August) has brought it all back. How much precious money will be spent on court cases, legal advice and appeals? Why does the NHS make everything so complicated, expensive and conflict ridden? And why are healthcare interventions subject to rigorous economic evaluations when other sources of expenditure are not?
Lesley Graham
Toronto, Canada

• Join the debate – email guardian.letters@theguardian.com

Where precious cash is wasted in the NHS | Letters

New Medicare Information Reveal Startling $496 Million Wasted On Chiropractors

10 days ago, the federal government released a enormous information set detailing how it invested $ 77 billion in Medicare funds in 2012 to in excess of 880,000 wellness care companies. The release of this data is part of a new transparency energy by the government, which numerous of us applaud.

The information reveal some troubling issues.

Most news organizations targeted on who the biggest beneficiaries are: the New York Occasions described how just one hundred doctors obtained $ 610 million. A Washington Post story focused on the prime ten Medicare billers, including one particular ophthalmologist in Florida who was paid $ 20 million by Medicare, mostly to cover Lucentis, a drug for macular degeneration. The Publish pointed out that Medicare would have saved above $ ten million significantly less if that physician utilized Avastin, which is equally powerful. “Medicare pays a physician a lot more for injecting the far more expensive drug,” the Submit pointed out.

But until now, no a single has pointed out an additional, far much more egregious waste exposed by the Medicare data: we are paying a huge quantity of income on the extremely dubious practice identified as chiropractic.

To be precise, the 2012 Medicare data reveals that in 2012, Medicare paid $ 496 million for chiropractic treatment options in all 50 states.

This is a beautiful quantity. It dwarfs the funding that NIH wastes on substitute medicine through NCCAM, which is itself an egregious waste of funds.

Chiropractors are not medical medical professionals. They primarily deal with back ache, but they claim to treat a broad selection of other problems, which some of them believe are related to mis-alignments of the spine, referred to as subluxations. This belief has no scientific basis. However, chiropractors have succeeded in convincing the government to cover their treatment options through Medicare.

Now we know how productive they have been: half a billion dollars a yr spent “adjusting” the spines of sufferers, all funded by Medicare.

(And they have recently been lobbying furiously, as I wrote final summer, to force personal overall health care suppliers to cover chiropractic and other alternative practices beneath Obamacare.)

But wait, you might request, really do not chiropractors give ache relief? And do not they have health care degrees? Well, on the 2nd query, the response is that they have unique Medical professional of Chiropractic (D.C.) degrees, which are offered out by just 15 specific chiropractic colleges in the U.S. The whole area was invented out of thin air by D.D. Palmer in 1895, and later on popularized by his son. In his guide-length expose Chiropractic Abuse: An Insider’s Lament, chiropractor Preston Lengthy lists “20 items most chiropractors will not tell you,” like

1. “Chiropractic theory and practice are not based on … understanding connected to health, condition, and well being care.


2. A lot of chiropractors promise too considerably.


3. Our training is vastly inferior to that of health-related medical professionals.”

These are just the first three: you can see the complete listing in a evaluation of Long’s book by physician Harriet Hall, or go through the guide itself.

Sam Homola, a retired chiropractor, summarizing his considerations about chiropractic in a recent post at Science-Based Medicine, wrote that

“There is no credible evidence to support the use of spinal manipulation for anything at all other than uncomplicated mechanical-variety back discomfort and … no evidence at all to assistance chiropractic subluxation concept.”

Maybe most alarming, specifically provided that Medicare is paying out for hundreds of thousands of therapies per year, is that chiropractic manipulation can result in a stroke, by creating a tear in the major artery running by way of the neck. As reported recently in the Journal of Neurosurgery:

“Chiropractic manipulation of the cervical spine can produce dissections … of the vertebral and carotid arteries. These injuries can be serious, requiring endovascular stenting and cranial surgical treatment. In this patient series, a considerable percentage (31%, 4/13) of patients were left permanently disabled or died as a end result of their arterial injuries.” [Albuquerque et al., J. Neurosurg 2011 115(six):1197-1205]

If this weren’t enough to lead to concern, several chiropractors are also anti-vaccine, a issue that is apparently severe enough that some chiropractors themselves have spoken out against the anti-vaxxers in their own ranks.

Over a century ago, D.D. Palmer believed, mistakenly, that he cured a man’s deafness by manipulating his neck. His son created Palmer’s beliefs into a rewarding company, but neither of them would have dreamed that the U.S. government would 1 day invest half a billion bucks per yr on chiropractic manipulations.

If we want to start off controlling the cost of Medicare, here’s an simple very first step: end covering chiropractic. We will conserve $ 496 million a yr, and people’s well being will enhance.

New Medicare Information Reveal Startling $496 Million Wasted On Chiropractors

Scientists say United kingdom wasted £560m on flu drugs that are not verified

Roche HQ: the business disputes a report by independent scientists questioning the effectiveness of Tamiflu. Photograph: Bloomberg/Getty

The government has wasted half a billion lbs stockpiling two anti-flu drugs that have not been proved to end the spread of infection or to avert individuals turning into seriously unwell, according to a staff of scientists who have analysed the total clinical trials information, obtained after a 4-yr battle.

The government has invested £424m acquiring stocks of Tamiflu and £136m on Relenza in situation of a flu pandemic. For the duration of the swine flu outbreak of 2009, the World Wellness Organisation advisable that all nations need to stock up on supplies.

But the Cochrane Collaboration, a group of independent scientists who investigate the effectiveness of medicines, says that the ideal Tamiflu can do is shorten a bout of flu by approximately half a day – from all around seven to six.three days.

They also identified worrying side-effects in men and women taking it to avert flu, which had not been completely disclosed, which includes psychiatric and kidney troubles. “There is no credible way these medicines could stop a pandemic,” said Carl Heneghan, professor of evidence-primarily based medication at Oxford University and a single of the staff. They are now calling for the WHO to assessment its tips to nations and for the United kingdom government not to renew its stockpile when the medication go out of date.

Dr Fiona Godlee, editor of the British Health care Journal, which is publishing papers authored by Cochrane on Tamiflu and Relenza, stated the determination to stockpile the medication was politically understandable at the time, but added: “When one thinks of what half a billion lbs could have been spent on in the NHS, allow alone about the globe, one particular has to be pretty scathing about that decision.”

The findings come at the finish of a gruelling battle with the drug businesses to see the real data produced in the course of all the trials, rather than the usually ghostwritten and usually organization-funded scientific papers selectively published in health care journals. In a watershed growth, they have put all the business data on the internet, to permit anybody to interrogate the supply materials.

The team and the BMJ, which has backed their fight all through, throw down a gauntlet to drug organizations and to the regulators to be transparent about the positive aspects and harms of medicines. Whilst the EU is bringing in new principles to guarantee all potential drug trials benefits are published in full, information relating to the effectiveness and security of present medicines is nevertheless shrouded in secrecy. “Potential decisions to buy and use drugs, specifically when on a mass scale, have to be based on a total picture of the evidence, each published and unpublished,” mentioned Godlee.

“We want the dedication of organisations and drug businesses to make all data offered, even if it indicates going back 20 years. Otherwise we danger an additional knee-jerk reaction to a likely pandemic. And can we really afford it?”

Heneghan and Dr Tom Jefferson, two of the Cochrane team, refused to lay blame solely on the drug businesses – GSK finally agreed to hand in excess of all the information on Relenza without circumstances final year and Roche, maker of Tamiflu, followed a handful of months later on. “I’m not a conspiracy theorist,” said Jefferson. The European Medicines Agency, which regulates medicines in Europe and grants licences, “have the legal electrical power to demand the total set and accessibility something they want,” he explained. Nevertheless it routinely regarded as only part of the dataset.

The assessment located that although Tamiflu shortened an episode of flu slightly in grownups, there was less certainty in young children and none that the medication assisted kids with asthma – a group for whom flu can trigger breathing troubles. There was no evidence it reduced hospital admissions, pneumonia, bronchitis, sinusitis or ear infections in adults or young children. The reporting of these occasions in the trial data was unreliable – pneumonia situations were occasionally recorded only because the patient informed the GP they had suffered from it, not as a consequence of tests.

The Cochrane staff found that the drugs could also result in harm. Some patients on Tamiflu suffered nausea and vomiting. When it was taken to stop a bout of flu, it was often linked to headaches, and kidney and psychiatric troubles. No enhanced chance of adverse occasions for adults inhaling Relenza was reported and the evidence on harm in kids was sparse.

The Department of Overall health said it looked forward to acquiring the report, but insisted that the stockpile was crucial.

“The Uk is recognised by the World Health Organisation as getting one particular of the ideal-prepared countries in the world for a likely flu pandemic. Our stockpile of antivirals is a key portion of this,” mentioned a spokesman. “Tamiflu is licensed about the world for the therapy of seasonal flu and is a licensed item with a established record of safety, top quality and efficacy.”

Some other scientific experts stated that absence of proof did not always mean that the drugs did not lessen complications or prevent hospitalisation. Prof Wendy Barclay, an influenza virologist at Imperial School London, said the drugs have been not constantly given to men and women soon enough right after infection to perform.

“It would be terrible if, in attempting to make a point about the way clinical trials are performed and reported, the review ended up discouraging physicians from employing the only successful anti-influenza medicines we presently have,” Barclay said.

Roche said it fundamentally disagreed with the review and maintained that the medicines have been a crucial treatment option for flu individuals. Cochrane had received it incorrect, the company stated. “The report’s methodology is typically unclear and inappropriate, and their conclusions could probably have severe public-wellness implications,” mentioned United kingdom healthcare director Dr Daniel Thurley. “We’d definitely defend [Tamiflu] for therapy and prevention.” A latest research of 30,000 sufferers given Tamiflu in the swine-flu pandemic, published in the Lancet, found it saved lives.

GSK mentioned it was committed to transparency. “We carry on to believe the information from Relenza’s clinical trial programme support its effectiveness towards flu and that when used appropriately, in the appropriate patient, it can lessen duration of flu signs and symptoms,” mentioned a spokesman.

Scientists say United kingdom wasted £560m on flu drugs that are not verified