GPs' local deals on immunisation of under-fives
A collection of local deals between family doctors and NHS managers appear in the offing following the failure of national talks designed to get under-fives immunised at GP surgeries.
A Department of Health spokesman said GPs across north east England had agreed to deliver the vaccine to children at £5.25 a dose - the same amount they are paid for doing the priority groups.
Dr Richard Vautrey, deputy chairman of the BMA's GP committee, said he expected deals to be made across the UK.
Which raises the question why a national agreement was not possible? I have already touched on the reasons for the failure of the talks.
GPs wanted targets for booked appointments to be relaxed. Government sources said doctors were asking for more money. But both sides were publicly remaining polite about the other - an acknowledgement that they know they have to make this work somehow.
Whilst it is possible to immunise children over five in school programmes, GPs are really the only show in town for mass immunisation of young children.
Both sides said they were hopeful that the breakdown in talks would not lead to delays in immunising children aged six months to under five. But where local agreements are not struck, it could surely have some impact on timing.
If you have a child under five, please let me know when you get a call-up to bring them in to be immunised.
More questions have been raised about the effectiveness of the antiviral drug Tamiflu. This is a topic that the British Medical Journal looked at in July, arguing Tamiflu was not necessary for otherwise healthy children.
Now the BMJ online said antvirals have "modest effectiveness against the symptoms of influenza in otherwise healthy adults." This is not really a surprise - it is well known that the drugs reduce symptoms of flu by only about a day.
But the BMJ also questioned the quality of the trial data - dating back a decade - supplied by Roche, the manufacturers of Tamiflu. And the researchers said a "paucity of good data" had undermined findings for Tamiflu's effectiveness in preventing complications of flu. These are more serious charges. Roche says it stands by the data.
It's worth remembering that all these studies are not looking at how effective Tamiflu is in treating H1N1 swine flu, but at seasonal influenza. We know that the H1N1 virus is mild for most people, and they will recover without the need for antivirals.
But we also know that a small minority, of mostly younger people, can get serious complications from the pandemic virus, and this is where antivirals may have a key role in reducing serious illness.
Observational data during the current pandemic from American hospitals suggests the longer the gap between symptoms emerging and patients taking Tamiflu, the greater the likelihood that they would be hospitalised.
But the researchers said there was an urgent need for research looking at their effectiveness.
New York autopsies
Finally I draw your attention to some autopsy research from New York.
Scientists looked at clinical data from 34 people who died from the H1N1 virus earlier this year. All but two of the deaths occurred in New York City. They found that as well as damage to the upper airway, in many cases the virus had caused tissue damage deep in the lungs.
Researchers said the damage was similar to that caused by the 1918 and 1957 pandemics. They also note that most of those who died were under 50 and had existing health problems and were obese.