ADAM WISHART

The Price of Life, BBC Documentary

2009-06-15T16:22:16+01:00

My film about NHS rationing will be shown on BBC2, June 17th at 9pm.

The previews thus far are pretty nice.
'Adam Wishart's extraordinary, engrossing film deserves a prize.' Radio Times
'deeply affecting... unsettling but vital and grimly fascinating' Mail on Sunday
'The documentary of the week' The Independent
'a fine if sombre film' Time Out
'balanced and thought-provoking' The Times
'Fascinating documentary' TV Times

The programme page is here.

The picture is of Eric Rutherford, one of the patients I followed in the film.

Start the Week

2009-06-15T11:23:00+01:00

listen here.

The Unbearable Cost of Living

2009-06-06T22:50:10+01:00

The Sunday Times Magazine have published an article related to my documentary The Price of Life.

Link

The picture is of Professor David Barnett in a NICE (National Institute of Health and Clinical Excellence) appraisal meeting. He is the chair, and the committee is about to decide whether or not NHS patients should get a drug called Lenalidomide.

If you're a journalist and might like to write about the film, email me at

adam (a) adamwishart.info and I'll send you a link.

The Price of Life

2009-06-06T21:52:00+01:00

Wednesday 17 June

9.00-10.00pm BBC TWO

On a finite budget, the National Health Service can't afford to offer patients every treatment on the market, so how does the nation decide which patients should be the winners – and who should be the losers? BBC Two has secured exclusive and unprecedented access to NICE (the National Institute for Health and Clinical Excellence), the controversial body that decides which drug treatments the NHS can afford. Its judgements have precipitated many bitter battles over the last decade but, for many, the people behind the process remain shrouded in mystery.

Focusing on cancer drug Revlimid, award-winning documentary-maker Adam Wishart follows those who must decide whether to approve the drug and those who will be affected by the outcome. They are: Professor David Barnett, chairman of the NICE appraisals committee, charged with assessing its effectiveness; cancer patients including Julia Gatt and Eric Rutherford, whose lives depend on the decision; Sol Barer, head of the American drug company that discovered Revlimid and profits from it; and NHS manager Sophia Christie, who has to deal with the financial consequences of the committee's decision.

The programme tells the compelling story of the people whose everyday lives are affected by this intricate process. Will Julia and Eric get the drug they need and, if so, will Sophia be forced to make cuts to her budget in other areas? The very human conflicts that arise open up for debate a bigger moral question – how much is life worth, and how much should society pay?

Grierson Award

2007-11-29T09:04:18+00:00

Pleasingly, we just won the Grierson Award for the Best Science Documentary.

Here is a link.

Link to the film.

Hooray!

Improve Performance, Rather than Search for New cures

2007-06-13T15:35:12+01:00

I’ve just finished reading Better by Atul Gawande. Like his previous book, Complications, this one is full of humane and insightful observations about the complexities of medicine.

There is one particularly fascinating chapter about performance, and how you improve performance in medicine. He tells the story of cystic fibrosis. Medicine has remarkably improved the life expectancy of patients over the last thirty years or so. In the sixties patients made it to just ten years old, now most live into theri mid thirties with some patients living much longer.

Remarkably, Gawande makes the case that this wasn't only to do with better science, it has to do with better medicine. Part of the story is here, in the New Yorker.

We are used to thinking that a doctor’s ability depends mainly on science and skill. The lesson from Minneapolis is that these may be the easiest parts of care. Even doctors with great knowledge and technical skill can have mediocre results; more nebulous factors like aggressiveness and consistency and ingenuity can matter enormously.

But in the book version of the same essay he is more confident. And bolder.

"To be sure, we need innovations to expand our knowledge and therapies, whether for CF or childhood lymphoma or heart disease or any of the other countless ways in which the body fails. But we have not effectively used the abilities science has already given us. And we have not made remotely adequate efforts to change that. When we've made a science of performance – as we've seen with hand washing, wounded soldiers and child delivery – , however, thousands of lives have been saved. Indeed, scientific effort to improve performance in medicine - an effort that at present gets only a miniscule proportion of scientific budgets - can arguably save more lives in the next decade that the research on the genome, stem cell therapy, cancer vaccines and all the other laboratory work we hear about in the news. The stakes could not be higher."

It is a brilliant vision of a different kind of medicine, one that deals with the here and now, rather than hoping that there is a miracle cure in the future that we should all be waiting for.

Too Much Health

2007-06-06T15:31:32+01:00

There is a fascinating and timely report about Hormone Replacement Therapy in the Guardian today.

Survey after survey has linked hormone replacement therapy to cancer, strokes, blood clots and heart disease. Why, then, are so many women so relaxed about using it? And why do some doctors insist that the dangers are exaggerated? Sarah Boseley investigates

What it reveals is the continued attraction of HRT, more than a million women continue to take it in the UK, although for some of those women its pretty clear that taking HRT is not the optimum intervention.

What I find interesting about this is how compelling medical solutions can appear and how enduring they can be once the public first accepts them to be true. Once an idea like HRT has been promoted in the public realm, and once there is promotion of various sorts floating around, then its very difficult to get the idea our of the public imagination. None of us seem very attracted to the idea that actually medical intervention is bad for you.

I think many of us are afflicted by it. We go to doctors because we think they can help us. And they sometimes fob us off with placebos or what they think is more or less harmless sorts of drugs and interventions, such as HRT.

Its linked to my favourite piece of commentary of the year. Published on January 2nd, some of the best analysts in the business simply state,

For most Americans, the biggest health threat is not avian flu, West Nile or mad cow disease. It’s our health-care system. You might think this is because doctors make mistakes (we do make mistakes). But you can’t be a victim of medical error if you are not in the system. The larger threat posed by American medicine is that more and more of us are being drawn into the system not because of an epidemic of disease, but because of an epidemic of diagnoses.

LINK

Although this is a particularly American problem, UK patients are also afflicted. We demand and demand and demand in some situations where doing nothing might be the right thing to do.

Royal Society Book Prize

2007-04-26T22:12:51+01:00

ONE IN THREE is on the shortlist of the Royal Society Book Prize.

Its great.

I especially like it because the Royal Society has such a heritage. Newton was its president, after all.

There is an article about it here.

And a comment piece here

THE TERRIBLE STORY OF HOO LOO

2007-02-15T10:21:08+00:00

This is one of my favourite stories from the book. Its also one of the goriest, the rest of the book isn't quite as bloody. The picture is from the original article - unfortunately it was never included in the book. So now the story has been mentioned in the NY Times seems good to publish it here.

On Saturday 9 April 1831, a year before the passage of the Anatomy Act, but a few months after the opening of the world’s first purpose-built passenger railway, a crowd of men in top hats and coat-tails showed their ‘hospital tickets’ and entered the operating theatre of Guy’s Hospital in London. Hundreds of others jostled on the street outside. An attempt had already been made by the hospital authorities to prevent a scrum by moving the date forward by three days, but the tight, gossiping community of London’s doctors had defeated the ruse.

The patient in question was a 32-year-old Chinese labourer called Hoo Loo, who had disembarked at the Royal Docks from a sailing ship, a so-called East Indiaman, with some difficulty three weeks previously. He was carrying an enormous tumour four feet in circumference, which hung from his lower abdomen, enveloping his penis, to below his knees. It was ‘of a nature and extent hitherto unseen in this country’. Although the size of Hoo Loo’s growth made it exceptional, lumps, boils and malignancies were often seen to disfigure the human form in the age before routine surgery. Hoo Loo’s had been growing for ten years, but his doctors in Canton had refused him treatment. Because it had continued to grow, he had travelled for six months to London in the belief that there the art of surgery was somewhat more advanced and that the profession would have no such qualms in operating on him. On arriving at Guy’s Hospital he must have been aware of the excitement, for as he lay waiting for the operation his days were interrupted by ‘a great number of persons of all ranks’ keen to examine this oriental curiosity.

Because of the swelling crowds, it was announced that the operation was to be held in the ‘Great Anatomical Theatre’. A ‘tremendous rush’ ensued as 680 gentlemen pushed their way into the auditorium. Fifteen minutes later, Hoo Loo was carried in and laid on the dissecting table, which was still stained black with blood from previous guests. Two nurses tied his limbs to the table so that he would not be able to flinch from pain – there being no such thing as anaesthesia then – and Hoo Loo looked on, seeming to contemplate the operation with a fortitude ‘never exceeded in the annals of surgery’. The nurses then covered his face so that he might not see the imminent procedure.

Then entered Sir Astley Cooper, the greatest physician of his day, renowned for helping to embalm the body of King George IV, for stealing a dog for the purpose of vivisection and for having boasted to a parliamentary committee of his close relationship with bodysnatchers. Having been reprimanded once for arriving at the royal chamber wearing a morning coat still covered in someone else’s viscera, he was probably similarly attired on the day of Hoo Loo’s operation. Together with the surgeon, Charles Key, he decided that the operation should attempt to preserve the genital organs.

Mr Key stationed himself in front of the tumour and made the first incision just below the right side of Hoo Loo’s abdomen. With barely a groan or a gasp from the patient, Key continued for six inches down the right-hand side of the penis and around the tumour. ‘The quality which is considered of the highest order in surgical operations, is self possession,’ Sir Cooper had once lectured. ‘The head must always direct the hand.’ Key repeated the manoeuvre on the patient’s left side, connecting the two cuts below the base of the penis. Then Key lifted the tumour up, and cut around the urethra. The audience was silent, craning to see and hear Hoo Loo. Cutting veins, Key reached for silk threads to tie them, possibly holding the bloodied scalpel in his teeth, as was the practice. The patient ‘firmly set his teeth and resignedly strung every nerve in obedience to the determination with which he had first submitted to the knife’. After each incision, Hoo Loo was given some time to recover from the ‘fits of exhaustion’, as without anaesthetic the trauma of the knife was often almost as dangerous as the cuts themselves. Then, with ‘great neatness’, Key attempted to cut around the penis in order to separate the tumour. As more than a hour had passed since the first incision, cooper began to worry that its protraction was detrimental to the patient, most other operations being over in a few minutes. So he insisted that the operation be completed as quickly as possible by sacrificing the genitals.

Hoo Loo was drifting in and out of consciousness. The nurses rubbed his toes and injected brandy into his stomach in a bid to keep him awake. But already a pint of Hoo Loo’s blood had been lost, some of it congealing around the operating table. Students in the audience offered to give their own blood for Hoo Loo’s life, and a transfusion of a quarter of a pint had been attempted. Key continued to cut and, one hour and forty minutes after beginning, he freed the tumour from the body. It weighed fifty-eight pounds. With a final gasp, Hoo Loo collapsed into unconsciousness. The doctors sensed his heart ‘gradually and perceptibly’ sinking. Then he died.

The following week, the medical journal The Lancet criticised the surgeons for killing Hoo Loo, reasoning that his operation had taken place too early – before he had the opportunity to acclimatise to the British weather – and because his vital force had been constricted by the lack of air in the room. In the following weeks, its correspondence columns also criticised sir Astley cooper’s recklessness. ‘I think that this operation could neither advance science of surgery,’ wrote W. Simpson of Hammersmith, ‘nor be otherwise beneficial to the human race; that it was neither sanctioned by reason, nor warranted by experience.’

Hoo Loo was an extreme example of the brutality, and often futility, of surgery in the early nineteenth century. Even the relatively simple excision of a breast tumour created a ‘terror that surpasses all description & the most torturing pain,’ wrote the novelist Fanny Burney. ‘When the dreadful steel was plunged into my breast – cutting through the veins, arteries, flesh, nerves – I needed no injunctions not to restrain my cries. I began a scream that lasted un- intermittingly during the whole time of the incision – & I marvel that it rings not in my ears still!’

In general, operations were to be avoided, and were only carried out when a tumour had become so enlarged or was bleeding so profusely that it was imminently threatening life.

JANET MASLIN REVIEW - NEW YORK TIMES

2007-02-15T09:50:06+00:00

"Mr. Wishart reports that during his years of writing and talking casually about cancer, he had a horrifying effect on others. Hearing him, listeners would shiver or quail or walk away. But his book does not prompt that kind of response: Mr. Wishart has done copious research and used it to shape a story more gripping than frightening ... [he] remains too erudite and civilized to succumb to fear."

How good is that?
LINK