How the NHS failed me and mine.
What it did, to the most important person
in my life and how it could happen to you unless
we do something about it!

Tuesday, 31 August 2010

Big Mac, Cheese, Fries and HMG-CoA Reductase Inhibitor?

Do you want statin's with that sir? Yes it really did happen. I thought it to be one of those urban myths; a play on words of some journalist. But no, Darrel. P. Francis of the British Heart Foundation did actually do a study, with others, that suggested we take a pill with our Big Mac and fries. I kid you not!

Now Darrel seems quite a prestigious guy. He's an FRCP (Fellow of the Royal College of Physicians) and reader in Cardiology at the National Heart and Lung Institute and, he has a list of published works as long as, well, several arms. He has travelled the world lecturing and studying, it would seem, and undertakes work for the British Heart Foundation. You can, if you are really bored, read the 6 page pdf of his report here. I wouldn't if I had something else better to do, like watching some paint dry, but I would not want to be accused of not representing his view in full. But what a load of b******s. Is this really serious research? More importantly is this what our hard earned taxes and charitable donations are for?

The details of this study contradict the many recently undertaken (and many from the past) that indicate that intake of statin's do not confer any protection to low risk or indeed high risk cohorts of those likely to fall prey to CHD/CVD (see posts passim). This study confirms, that even persons admitted with heart attacks, did not have high levels of LDL, which is the reason why statin's are generally prescribed in the first place. Makes one wonder why anyone would want to take them then! Especially with the ketchup for the fries!

And what's the fat got to do with it? It's the bun (high carb plus it's wheat), the fries (high carb plus trans fat used for frying), the burger (well some saturates but more, it's cheap, lot fed beef with high polyunsaturate content from soy meal). Oh let's not forget the shake. That will be sweetened with high fructose corn syrup, bulked with protein powder and is as far away from real milk as it's possible to be! So, all in all, it's something I would not recommend eating to almost anyone. Well, perhaps a few, at the Food Standards Agency, or Diabetes UK, for instance because it fulfills their stupid criteria of 66% carbohydrates, and might rid us of a number of those who have advocated diets that cause positive harm and increase obesity.

All in all, I do concur with Darrel, that it's not a meal to be eating at any time, but to advocate it to be taken with a statin. Well that's a step too far. It plays to the gallery of stupidity embodied in healthcare at present that advocates intake of harmful substances, like carbohydrates in abundance, and to then take a drug to ameliorate the effect of such intake. Such as hypoglycemic agents for Diabetics. I suggest that Darel et al take their study and stuff it where the sun doesn't shine, along with the statin's they advocate!

People like this, do not gift the population, with the brains they are born with. They feel the need to inject fear into the populace, as a means of manipulation of diet, that flies in the face of common sense, that since low fat has been the mantra of healthcare for the past thirty years, all they have achieved is more sick, fat people, not less.

Thursday, 26 August 2010

Still No Integrity ?

Doctors have difficulty with reporting colleagues for incompetence or impairment as shown by a recent study in JAMA (Journal of the American Medical Association). In fact 31% of Doctors surveyed would not report a colleague. Yeah, OK, so 67% said they would but it's often quite easy to say when it's purely an academic situation. When polled most of the population always say they would do the the 'decent' thing in most situations about integrity, but to be a 'whistleblower' takes a lot of b***s. A lot of the time it is so much easier to cross on the other side, turn a blind eye and other such idioms because all too often the outcome is to 'shoot the messenger'.

Doctors (along with policeman), even when brought to ordure, have a knack of escaping the justice they deserve, but that is often a result of the naive belief in civilised society that the Law has anything to do with Justice, which it patently does not. We only have to refer to the bolam test to see that 'joe public' has the weight of the establishment pitched against them, if he or she questions the integrity of Medicinae Doctor. I think probably, since Hippocrates demise, doctors have contrived to cover their a**e in the event of an error of judgment or treatment and their colleagues have generally tended to back them up with an implacable wall of rhetoric, obfuscation and on occasion lies. The Management of Health care, primarily the NHS in the UK, has grasped this mettle also and we now have non-medics colluding with medics because they could also stand accused with their (often hated) colleagues.

There are allegedly, bodies to safeguard the public against the dangers of medicines excesses but it seems they have consummately and consistently failed to achieve any measure of success in this if one examines the results. Over some years, the number of bodies tasked with invigilating over Doctors, indeed all aspects Health care have burgeoned, some would say out of all proportion to need. Most have heard of the GMC, NMC who directly license Practitioners ( Doctors and Nurses that is). But we also have the National Patients Safety Agency, Medicines and Healthcare Regulatory Agency etc, etc. In fact there are a legion of bodies all monitoring this or that, some I'm sure quite uncertain of what they are for at all, and of course many monitoring overlapping areas. They burn money (some of it mine) and produce reports in their area, of alleged expertise, with tedious content couched in the language of the bureaucrat spattered with that hated word 'facilitate'.

It is not surprising then that Doctors grow weary of the 'target culture', the spreadsheet and the top down diktats of apparatchiks that often rule their lives, if they are not Consultants that is, who pretty much do what they like most of the time. A few of them even become Management, but generally, The Management are hated by Doctors, especially the good and caring one's because they get in the way of them and their patient cohort. However, that does not excuse the Profession from a lack of integrity or individuals from spineless indifference to patient care. It does not excuse the GMC and NMC from failing in it's duty to discipline adequately it's licence holders and instead to vent it's spleen on those that care enough to stand up and be counted. Or indeed to conduct it's show trials of those who have seriously betrayed the tenets of care and then let them off with minor punishments or codicils for future conduct that are meaningless in the face of the enormity of their sin's.

The future, under the last Government was invested in the possibility of a change, and I say that not without some trepidation. Because most change in the NHS has been for the worst, with funds being squandered on pointless and tedious bureaucratic interventions and organisations that have contributed little (nothing?) to the need for justice and candour in the event of medical errors and incompetence. But, looking at it's remit and the structure of the Office of the Health Professions Adjudicator  it did seem that we might be getting somewhere. Well, now it seems that this infant body, is probably going to die at birth and then be incinerated on the conflagration of the Quangos that the LibCon's are lighting up with glee. I am not convinced. For the paltry sums involved it is worth at least a try at changing the landscape of justice for the legions of the dead and injured, sacrificed on the alter of the hubris of Doctors.

A consultation is taking place at the moment. It is important that the voice of the people is heard above the clamour of the Profession and bean counters. The NHS Justice Group has some words about this from the inimitable George Kuchanny. Have your say!

Saturday, 21 August 2010

The Study

 Much publicity today from scientists at the University of Leicester who have undertaken a prospective cohort study and found that Green leafy vegetables reduce Diabetes risk.

Well would that it was true. If it was certain I would for sure be dancing a jig (not a pretty site). But hold the front page, because I'm pretty sure that this observational study, sadly does not really prove any causation. There was much hype on the Today programme (a much admired breakfast radio programme), which pretty much allowed 'Arnold spokesperson' for said University to say what they liked, in support of this study. Including of course the inevitable conclusions that eating 'five-a-day' was good for us and should be part of a 'proven' lifestyle agenda. If one actually reads the study, or rather the extract, because you can only read the full study by buying it, the only reference to fruit and vegetable consumption was to say that NO significant benefit accrued.

This study I use as an example of the virtually worthless research that is being undertaken with my money to prove something that some pompous Medic thinks might be true, but can't really prove even when they have done the study. It is an established fact that the brassica family are a useful source of vitamins and minerals and even anti-oxidants. How much protection these can impart is still somewhat in conjecture, although it is some. What is proven, even by this study is that fruit and vegetables generally or even in isolation do not impart any protection against Diabetes. Earlier studies have proven that fruit and vegetable consumption imparts little, to no protection, from cancer and heart disease (see posts passim). The protection that is claimed in this study was of a 14% reduction in the risk of becoming diabetic; not a huge amount one might say but nonetheless worthwhile. And, whilst I am convinced that leafy greens are good for you, I do not feel that this rather poor study does anything  to advance the cause of that particular food group because it has been linked to an opinion about fruit and vegetables that is not evidence based.

I quote from the study,"The summary estimates showed no significant benefits of increasing the consumption of vegetables, fruit, or fruit and vegetables combined". So why then did Prof. Davies state in her interview that eating 'five a day' was intrinsic to good health and implying, as a consequence that it was proven by this study, by association? Her own data actually states the contrary. She is then advocating once more, the unproven, even dangerous ( for diabetics and the obese) advice that we should eat fruit and vegetables in abundance. Root vegetables, most fruits and potatoes in particular contain an abundance of carbohydrates and fructose. Sucrose (table sugar) is made from  root vegetables. Fruits are made into 'smoothies', those appalling thick concoctions of fruits that allow all '5 a day' to be condensed into a small bottle. So that busy people can get their 'health fix' in one shot. This is madness! Feeding this, as medically sanctioned nutrition, for diabetics is madness. Telling fat people to do this is likely to make them fatter and could push them into NIDDM. This is from a Professor of Diabetes Medicine! (Whatever that means).

This is I feel indicative of the way that so much scientific endeavor is now going. Producing endless meta analyses (studies of studies), vast databases of observational material that is nothing more than correlation. Remember 'correlation (and observation) does not prove causation. It can provide one with the hypothesis upon which to conduct a proper trial. But it proves little else other than association. One astounding element is that at no point was the Professor was questioned by the journalist about this statement. Do journalists no longer do any research about the subject of their interview?  Or they all part of a conspiracy to subvert the truth? Well probably not. Just p**s poor at the job. Come back Paxman wherever you are!

Thursday, 19 August 2010

August is a Dangerous Month.

Hot on the heels of the need to reduce costs in NHS Hospitals, which will reduce the numbers of Locum Doctors and Agency nurses, used to prop up the systems inability to provide adequate patient care, come the new intake of trainee doctors. These young men and women will now begin the 'on the job' training essential for their careers. But, with less mentors to assist in this endeavour, they will increasingly be thrust into the front line and will assume roles they are ill equipped to perform. August is the first month of their many rotations in all the aspects of Medicine and will likely, in these initial months expose those they treat to more dangers than perhaps would otherwise be the case.

Particularly, at the moment, some Trusts have openly admitted they are unable, or unwilling to pay out the vast sums they have, any longer, on temporary staff to cover both holidays and the chronic absenteeism prevalent in the NHS. In fact one Midland teaching hospital with a new intake of F1's of 500, has clearly stated that the deployment of these, to all corners of the Hospital will ease their current staff shortage. So looking forward to emptying a few bedpans then, Doc or perhaps running the mop over the floor?

The current Government of the LibCons is looking for savings everywhere, irrespective it seems, of any endeavour to ensure it does not damage safety or regulation. I will be the first to applaud the demise the f**k wits at the Food Standards Agency, but that does not mean that I wish to see the end of regulation. Trusts have taken on board the softening of 'target culture' with a vengeance; getting an appointment now seems to have been stretched to an horizon of a seascape. The realisation that the PFI has cost so much is now dawning, and some will have to utilise vast proportions of their curtailed budgets simply to meet the extraordinary costs of maintaining these Hospitals and Health Centres for the next thirty years, from dwindling resources. So the youthful (mainly) intake, will be used more and more, at the front line of health care. Attached to this will be the consummate risks to the patient, whose care will be in the hands of doctors 'in training'.

Worse, their mentoring by more senior staff, already at a low, will be further eroded, perhaps to breaking point. Mistakes in Health care are in my view at an all time high. And whilst the NHS can and does excel in the area of Trauma and Emergency care most of the time, it is complete crap at aftercare, health advice and routine medicine. CHD and CVD mortality has been falling for years, but incidence continues to rise. Whilst breast cancer  mortality is falling, we still have one of the worst rates in Europe. For a country that spends over £100billion on the NHS we are achieving extremely poor results for that vast sum.

I would strongly advise all who are planning to be sick and in need of a Hospital to postpone until at least December, to give these would be Doctors time to get a bit more experience, before you venture through their doors! And to those who are venturing down the road of becoming a healer, I entreat you to heed the words of Hippocrates, " I will use treatments for the benefit of the ill, in accordance with my ability and judgement, but from what is to their harm and injustice I will keep them".

Thursday, 12 August 2010

The Fat of the Land

Why have saturated fats  become the 'ghost at the feast' or 'the elephant in the room'? And why when it is mentioned is it vilified so much? These are questions I often ask myself, when I read the diets propounded as part of the protocols for the obese or diabetics, many of which are both (fat and diabetic that is). There seems to be a view, held by many, if not most, in medicine, that fat, especially saturated fat  can be likened to lime scale in plumbing. Circulating around our arteries 'furring' up all the veins and arteries until we succumb to CVD or CHD as a direct result of it's consumption. This also seems to be linked to cholesterol in the 'dumbed down' manner of Healthcare today, as if they are one and the same. Is this a scientific truth or not? Most definitely not.

At approximately 9 kcal/ per gram, fat is probably the most calorie dense foodstuff we can ingest. Due to this it's self regulating for intake to large extent. No one can sit down and eat large volumes of fat, even cream, without feeling sick very rapidly. The same can be said of butter or indeed any fat, even the polyunsaturates that are proclaimed as being 'healthy', specifically Omega 3's. The truth is that saturated fat has less calories per gram than say corn oil, which is the main cooking oil in use today over that of Beef fat (7.3 opposed to 8.5) so if we are merely counting calories, then 'old style' fats win hands down. However, nothing is as simple as it sounds. So fats are 'demonic' except if they are unsaturated, even though they are more energy dense. I know it gets complicated but bear with me, it may be worth it.

It all began when a Scientist called Ancel Keys, who over a number of years published his findings on studies he undertook about the link between heart disease, cholesterol and fat consumption. He changed his mind over the years many times, but the most damning report he published was the Seven Countries Study in 1953. This collated the fat consumption of seven countries with highest to lowest and observed that the highest consumers had the highest rates of CHD/CVD. This sort of study is called observational. Now we have to repeat the following mantra until it becomes understood. 'Observation does not prove causation' (neither in fact does correlation, but we'll come to that another time) The problem was, that there was data available on considerably more countries than those chosen, which actually showed no correlation between Key's study and the hypothesis, that fat intake caused heart disease. He had in fact 'cherry picked' the countries to prove his theory ( called selection bias). There were in fact seven other countries where exactly the opposite was the case. Key's study however, then became the mantra for the advocates of  low fat  and the damage had been done, despite the fact that Key's was roundly condemned a few years later for bias by the scientific community.

Almost singlehandedly Keys, brought about the birth of trans fats and the rise of margarine and other fats with a  'trans bond' (see previous post 'Kinky Fats). We of course now know that these fats are quite dangerous and are told not to eat them, just as we were told to eat them before. Pretty much like eggs then only the converse! I have discussed at length, the spurious link between fat and cholesterol and the lack of any real science in the argument for it's reduction in humans but I wanted to concentrate on fats in this post. As you will see from the graph fat invokes virtually no insulin reaction. Insulin is the fattening hormone. Fat per se will not make you fat!

Heart disease  is not linked to fat consumption as most studies show, so why do those in the establishment continue with the outmoded advice that we cease or at least reduce it's consumption and worse, suggest it's replacement with large volumes of carbohydrates? The chair of the Royal College of General Practitioners, Steve Field, only a few days ago was propounding his view that we must all exercise, 'eat 5 a day', and stop eating fat to lower our risks of ill health. Steve (a bit of a 'fattie') was pretty much telling the obese it was all their own fault. Their own fault for what? Heeding his advice? For certain if he's heeding his own it's not working! Cut the carb  then Steve and cease being the pompous p***k that you obviously are, and read some science before calling the 'waistline challenged' names when they are doing the best they can, based on your dogmatic and incorrect 'me too' diatribe about diet and nutrition! I know you need the publicity, as your term as chair, ends soon and you have an eye on Liam's vacant position, but please, stop climbing over the bodies of the victims of your p**s poor advice to get there! If we had listened to you and others like you in the treatment of J's Diabetes she would probably be on a host of drugs even insulin by now!

Thursday, 5 August 2010

Procrastination (the thief of time)

I kept saying I would do it, but as each opportunity arose, it equally easily slipped by once more. Each time I had visited the events in the past, to rail once more against the appalling care meted out to J' by the NHS it had hurt. Hurt deeply and profoundly to the extent that I had become ill. But equally well, not to continue down the road was also eroding my well being. The guilt bore down when my thoughts strayed into that place and time I hated so much.

I had not viewed the file for months. It grew dusty from my lack of attention and the day came, when I had at least to check how much time was left, and so I did. As the date came into view my pulse began to race and my chest grew tight. I had only ten days left before the case would be time barred! All thoughts of leaving it any longer fled from my mind. I could not let my love down. I had at least to make some sort of attempt at it, to ensure at least that those who might escape from exposure, from censure, would be made uncomfortable or even heaped with ordure. The experiences of my fellow travellers did nothing to inspire any confidence of success, but at least I had to try. Another windmill to tilt at maybe, but I knew I would have to saddle up the donkey, pick up the lance and travel that road again.

As I went through the protocol from the Ombudsman things got a little difficult. I had to download the forms and hand write the details in capitals! Why could I not fill it in and print and attach the file correspondence? I tried to convert the forms to a format I could use but the software wouldn't load. Vista strikes again! So I filled them in neatly in black capitals and made separate continuation sheets in Word, that way, I could at least print and file. I wrote down all those things that had gone wrong, caused pain and likely lasting harm. I reviewed the case file and entered all that should be done to prevent some other poor soul from enduring the misery and dangers my love had had to. I told them what we wanted to achieve and what we needed to make the future at least less bleak. It seemed so much less than I had wanted. But I had made sure that I was not raising any points not already presented to the Trust as being deficient or dangerous. I had a bibliography of all the studies, all the protocols, all those things that the Institutions of Medicine and Healing say must happen in the treatment of Trauma Orthopaedics. I also determined that in the event of failure, and however much I hated the GMC, and it's show trials of  Doctor's I would take the negligent git who caused all this to their halls. If nothing else it would make him sweat, even if only for a little while.

I copied everything. Neatly bound it and sealed it into an envelope. Knowing time to be ever closing in on me, I sent it by Special and it got there with three days to spare. I had done it! I felt ill for days after, but gradually the bloody IBS subsided a little and the panic in my soul began to wane. The tightness in my chest eased and I started to give up smoking, again! Two days later the acknowledgement arrived, together with a letter stating that an investigation would be made to see if a formal investigation was warranted. I guess they would have to have a meeting, to arrange the meetings, where it would be discussed as well.

So we are in limbo once more. I still feel guilty I left it to the eleventh hour. It hadn't been as difficult as I had imagined, the trauma is not so vivid, quite so painful. The passage of time and the purposeful revisits that became part of the rehabilitation protocol my therapist prescribed, have healed some of the damage. I still avoid the Hospital, although not so much. I can drive by so long as I do not look directly at it. But I am scared of going there; fearful as I get older, that something will mean I will be taken there, or worse my love will. Their hubris is undiminished, their rhetoric intact. They continue to maim and even kill and although I never fail to add my condemnation in any media I can, it becomes tomorrows chip paper or falls off the end of the comments postings. I have resolved that I have to convert, to educate people one by one. I only hope there is enough time left to achieve moderate numbers.