Pernicious Anaemia Society
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Age and sex discrimination breached by failure to carry out definitive tests?

The NICE guidance on testing recognises that 20% of the elderly are B12 deficient and it is commoner in women. It raises the issues of adhering to equality legislation. In the presence of suggestive symptoms and a significant family history I believe that a failure to carry out MMA or active B12 testing could well breach the legislation provided of course that you are an elderly woman!

NICE recognises that these tests are more accurate diagnostic measures that could pick up cases earlier saving the NHS (and the patient!) from the consequences of an inadequate diagnosis and treatment.

Amazingly it then fails to recommend carrying out further diagnostic tests which appears contrary to its undoubtedly accurate observations.

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Devil's advocate: by the time people have deteriorated to a very great extent, they will be in no position to prove inadequate diagnosis at an earlier stage and it wouldn't do them much good if they could. So breaching equality legislation isn't a problem for the NHS, only for the individual and their family. (Although of course it's a problem in that the patient will need more and more medication, GP appointments, tests, hospital treatment, and social care.)

Any physical or mental issues resulting from B12 deficiency in the elderly can be put down to 'age' or 'dementia' (and stress and anxiety in younger people). I don't see how anything could be proven, unless someone's records showed untreated pernicious anaemia AND low B12 levels, as the neurological symptoms are so non-specific they could theoretically have numerous causes.

The sheer volume of people who are likely to be low enough to need B12 injections must be playing a part in this unwillingness to diagnose, the amount of testing, monitoring and nurse appointments needed I assume would be unsustainable as general practice is being squeezed and squeezed.

Another poster here today relates feedback from a haematologist who apparently believes the current volume of patients wanting B12 injections to be a 'fad', imitating celebrities who 'use' it like a drug to gain extra energy. This doesn't help much either.

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I think the equality legislation could be breached and tested at the stage of refusal to test adequately, not at the end stage of disability.

I totally agree that it is being used by celebrities for non medical reasons and that it is diminishing the case for those with an issue.

The NICE guidelines are worth reading and their argument for cost effectiveness in preventing possible pathology is persuasive but sadly has not persuaded them to recommend inclusion in the guidelines, even though they acknowledge that it would not be expensive. Definitely skewed logic!

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