Tuesday, September 2, 2008

Hip to be positive or negative?

Hands up who likes the NHS? Hands up how many of you step in to defend the NHS when the general conversation has descended down to slightly implausible anecdotes about how rubbish it is, and how just by parking near a hopital you can get a LETHAL SUPERBUG!

It shouldn't come as a big surprise I suppose, that NHS-bashing always gets the front page. The media (some more than others) are generally tilted towards printing material which will fill the preconceptions of the readers, thereby allowing them reasoning for their outrage - irrespective of the truth involved. The image we are given is of a crumbling, slow, out-of-date NHS system, filled with vermin, superbugs, 'bomb' Doctors to name a few.

Is this a true representation of what the NHS is like? I don't believe that it is - certainly (anecdote alert) in my experience I have been amazed by the speed, efficiency & cleanliness of the whole system.

Admittedly, I haven't had too much interaction, but that will change over the coming months as I'll explain below.

What happens when good news is mixed with bad news? What gets the headline and what doesn't get read because it is buried half way down in the small print?

Here's an example from the Guardian:

Hospital superbugs: Sharp rise in C difficile deaths

This was posted last week. Why is the media suddenly not worried about MRSA and now only discuss C. Diff? The article explains clearly why:

The number of death certificates that mentioned MRSA decreased from 1,652 in 2006 to 1,593 in 2007.

This is the first time the number of MRSA-related deaths has fallen since ONS records began in 1993

and so we had childish political posturing from Lib Dem Normal Lamb saying:

These are horrifying statistics.

Are they? All of them? ALL of them? Why didn't the Guardian print "MRSA on the downturn for first time in 14 years", or even seperate the two points, because the C.Diff situation is clearly deteriorating.

The impetus to write this entry came from a report out today from the Public Library of Science Medicine called Revision Rates after Primary Hip and Knee Replacement in England between 2003 and 2006.

As someone who is undergoing major hip surgery in the next 6 - 8 weeks, you can understand why I was keen to stick my nose amongst this and sniff out the result.

The basic idea of the paper was to have a look at the National Joint Registry (NJR) collected data on patient characteristics, types of prostheses implanted, and the type of surgical procedures used, since its initiation in April 2003. It covers only England and Wales. The researchers linked the records of the NJR and the Hospital Episode Statistics (HES) for patients treated by the NHS in England who had undergone a primary hip and knee replacement between April 2003 and September 2006. What the researchers wanted to compare were the patient outcomes for different types of joint replacement, to see if there is any difference in the length of time before the replacement has to be replaced. Interestingly, a number of other countries have adopted a similar data gathering system and so the NHS can be compared to other countries' health systems.

[As a nice little aside on the dubiety of the media, I thought it might be fun to see how accurate the actual numbers reported are. The report says the number of hip and knee replacements carried out in England and Wales in 2006 was 160,000. The Telegraph made no mention of the geography. The number of joint replacements included in the study was 167,076 but this was reported as 150,000 in the BBC, nearly 170,000 in the Times and the misleading (and mistaken) values of 327,000 and 327,557 from the Daily Mail & Telegraph respectively.]

From the report:

They identified 327,557 primary hip or knee replacement procedures performed during that time period, but only 167,076 could be linked between the two databases.

76,576 patients in the linked database had undergone a primary hip replacement. The overall revision rate was 1.4% (95% confidence interval [CI] 1.2%–1.5%) at 3 years, with the lowest revision rates experienced by patients who had cemented prostheses. Women were found to have higher revision rates after hip resurfacing, and the revision rate was about twice as high in patients who had had a hip replacement for other indications than osteoarthritis. A patient's age did not appear to affect revision rates after hip surgery.

80,697 patients in the linked database had undergone a primary knee replacement. The overall revision rate was 1.4% (95% CI 1.3%–1.6%) at three years, again with the lowest rates of replacement experienced by patients who had cemented prostheses. Revision rates after knee replacement strongly decreased with age.

So, about one in 75 patients required a revision (replacement within 3 years) of their joint replacement, which is considered low, when compared with other countries here - e.g. for a cemented prosthesis (hip), the 3 year revision rate in England on the NHS is 0.9% compared with 1.8% in Norway, 2.14% in Australia and 1.2% in New Zealand.

That's excellent news. Isn't it? Let's look at how the meeja attacked the story:

BBC - NHS 'excels at hip and knee ops'
The Times - ‘Quick-fit’ knee and hip replacements that can wear out in three years
The Daily Telegraph - New hip and knee replacements 'more likely to need repeat surgery'
The Daily Mail - New hip and knee replacements may wear out in just three years

In fairness, the BBC has written a pretty good account of the research, while the traditional newspapers have decided it would be much more prudent to tell their readers that things are worse than they are, and that despite being better than many other comparable countries in the world, the NHS is a bit rubbish.

The Daily Mail & The Times refused to even admit in the text that The Royal College of Surgeons had trumpeted this as a credit to the nation's orthopaedic surgeons, whereas The Telegraph gave the same positive quote as the BBC.

Where is the patient rights agitator telling us all that this is all very reassuring, and shows a health system delivering outstanding results when compared to more expensive systems in other countries? Where are the banner headlines telling the public that the NHS is really pretty fantastic at this surgery?

There is a good discussion of this disappointing media exposure on the Bad Science website - unfortunately time is not allowing me to vent my spleen fully......


With thanks to El Pollo Diablo and Little Papi. I don't think I did your comments justice.

EDITED TO ADD (4th Sept)

Another example of negative reporting here from the BBC:


Which contains this positive nugget:

However, figures for adults indicate reoffending rates have fallen to their lowest rate for at least six years.

Who cares? No-one wants to hear about the government doing well.


  1. 'Twas ever thus - bad news sells papers. This is a sort of ill-starred marriage of two great newspaper trends:

    (i) if the media conversation de jour is "the Govt is doomed", then absolutely all other stories will have a default setting to be written as "bad news of the kind that shows just why the Govt is doomed"

    (ii) for health-specific stories, the more it can be made to say "bad news", the more newsworthy it is deemed to be. This latter is a health specific version of the old line about "if it bleeds, it leads".

    Anyway, I am often reminded of one of those soothsayer figures wandering about tossing ashes over him/herself moaning:

    "Doom... doom... doom and gloom"

    Good luck with the hip surgery. BTW. You are in good company, as I'm pretty sure David Colquhoun has two. It doesn't seem to have slowed him down much.

  2. Yes, it's all about the readership's appetite for misery, complaining and scaremongering. Seems to me this phenomenon is worse in the UK than in some other countries e.g. the US, where they trumpet their achievements much better. Perhaps a bit of old fashioned propaganda is required.

  3. sad though it is, i'm afraid NHS-bashing is virtually an Olympic Sport (my favourites for 2012 have to be the Daily Mail).

    My father's a GP, and I have many relatives and friends who work in the NHS (part and parcel of being Indian...!). I keep telling them to write about their positive experiences (tons of public money flooding in to improve facilities, better clinical care than most of Europe, improving access to services in inner cities etc) but can't seem to convince them!!

  4. Hands up who likes the NHS? Hands up how many of you step in to defend the NHS when the general conversation has descended down to slightly implausible anecdotes about how rubbish it is

    [Raises hand]

    I also stick up for the Met Office - they get it more-or-less right more often than not, yet all anybody ever remembers is the time Michael Fish got it wrong.