Sunday, 1 April 2012

No mosquitoes in UK so our healthcare is costly

No Mosquitoes in Great Britain, hence our healthcare is costly

A groin hernia is surgically repaired by placing a synthetic mesh on the weakness and fixing it in place. In UK the mesh currently costs from £20 to more than £100.

This is obviously a significant cost which the rural areas in the developing and poor countries cannot afford. The doctors face an ethical dilemma. Should they refuse to operate since the mesh is unaffordable? Should they do a non-mesh repair which is generally thought to have a many times the recurrence rate of the hernia compared to mesh repair?

Tongaonkar and Reddy, doctors from two small towns in India innovated by cutting mosquito net cloth to shape, sterilised it by autoclave and used it on patients ( They had very good results that compare well with standard international/western results for groin hernia repair. They also had the mosquito net cloth mesh analysed by labs which generally showed it to compare well with commercially manufactured meshes like the ones we use in UK. 

The mesh costs a few pennies; it was 3688 times cheaper than the commercial mesh.

Of course surgeons in India accused the Indian Journal of Surgery of blasphemy for publishing Tongaonkar's paper.

Now here is the good news, a UK surgeon Prof Andrew Kingsnorth uses the mosquito cloth net mesh for hernia repair. The not so good news is that he does not use it in the UK, he uses it in a hernia charity in Ghana which he leads/supports  

One of my friends who has interacted with this blog wrote to Andrew Kingsnorth and the conclusion was that red tape will prevent us from using it in UK. I have discussed this with a number of people, at the very end of the discussion we always wondered why we in UK would not take this up even if we save money. Groin hernia mesh is only a £5million market with already many fingers in the pie. £5 million for the NHS is possibly small change. Our discussions normally end at that point.

We are a developed, rich economy, it may well be that our development and our wealth which prevents us from taking up innovations that save money. You would have never guessed that the lack of mosquitoes in UK was one of the reasons for our healthcare being costly!



Anonymous said...

You've obviously never lived in Cambridge, if you think there are no mosquitoes in the UK! :-)

In fact, it wasn't so many decades ago that autochthonous malaria was still a concern.

Combined with the dearth of air conditioning in the country, even in modern buildings, this made the lack of screens (mesh) in the windows one of the most perplexing differences I noted when I moved to the country.

It was right up there with the separate hot and cold taps in the bathrooms (where you can either freeze your hands or cook the meat off them, but where you can't do anything in between).

More on topic, however, I think the real problem is that the prospect of selling a piece of mesh for a few pennies is not worth the investment to get it through the regulatory process. Nor is it worth the legal liabilities attached to any medical device. I think the only way cheap solutions like this can get to market in wealthier countries is if some well-funded non-profit organization takes up the development process.

Anonymous said...

can you also catch April fish with the mosquito net ?

Unknown said...

Very Nice topic of discussion and one of my Associate prof Dr Minu Patel from Baroda medical college try to use same in 1998 and had success. Used in Lot of patient i do not remember the figure.
I think its all industry/market driven, and industry will not let in any cheap thing. I worked with one of surgical consultant, and always try to mention the history of Gold Standard treatment of hernia repair, and all came from USA. I might be wrong as i have not got any concrete evidence. Even Hartmann procedure in diverticular perforation came from USA which was mainly for cancer surgery rarely for benign pathology.
So I personally feel comercial aspect is very important aspect of health and so many time its affect clinician decision.
Even Some rep come to introduce some new gadget all rep mention some big name that he so so is using this and make you feel that only you lagging behind.
So I think even this mosquito net will used only where there is no market and no big company involve.