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!

Monday, 24 October 2011

Phones, Breasts, and Vaccines.

The report on the dangers of using mobile phones has been published in the BMJ, and frankly it tells us very little. The cohort sample did not include those who use them for business, who would be the heaviest users, one would think. So not to include these users is a glaring error surely, as in most things, dose dependency would be a significant element of any dangers.  Considerable heterogeneity in the cohort sample also leads one to the belief that significant factors unrelated to mobile phone use, could be at play or simply that those with a subscription may not even use their phone or use it infrequently or with some device that moves it from their head. This study then proves little and reinforces the tenet in scientific study that 'correlation (and observation) does not prove causation', or in this case does not prove any absence of harm. My advice then, for what its worth, is to avoid prolonged conversations, use some form of earpiece to move the mobile away from your brain, and eliminate their use by young children.Oh and wait for some real evidence of any lack of harm, before you drop your guard.

Breast Cancer is again in the news with further evidence of the harms attendant on Mammography Screening. The cited study highlights the increased liklihood of 'false positives' in line with the frequency of mammograms. And the recent Swedish Study reports that screened women had a higher incidence of breast cancer than did those who were not screened and of course the study, published in the 'Lancet' has a pay wall, except for the abstract. Is it any wonder then, that women have little information of an unbiased nature available to them, when this important study is virtually hidden from view, with little or no publicity attached. So the impossibility of informed choice continues. Mette Kalager's  comment in the same journal is telling. Is it not time that the facts were presented to women so as to enable them to discern dogma from fact?

Vaccines rear their dubious benefit once more now the 'flu season is with us once more. Health Professionals (sic) are entreating all over 65, pregnant women and the vulnerable to get their 'jabs'. I have to confess that I don't do it  (there's a surprise then) because I feel it to be worthless. The vaccine offered is not comprehensive for many 'flu strains nor is it tested fully for safety, so I'll take my chances, keeping my Vitamin D3 levels high. Recent studies  have shown little effect for vaccines for the elderly or indeed for those less so.  To be frank, I would be loath to give these vaccines to anyone. They are symptomatic of the interfering nature of the state to govern our health by diktat or worse, 'nudging', without any foundation of the intervention as having value. Most are ( in my view) worthless or even dangerous.

I am capable of acting in my own best interests and I do not need the ambivalent support of the State to guide me toward the best outcome for me. So I told the GP, when he 'hounded' me, as to why I hadn't taken up their generous (and incentivised) offer of a 'flu vaccination, to read the science, and politely suggested that he was just trying to fill the quota and thus get the money. I was astounded when he actually agreed. I think that some Doctors are as much victims of the system that tries to turn citizens into a vulnerable client of the state bureaucracy of health as are we all. Not that I view that as an excuse. Just 'following orders' has never been a worthy defence, even for a Doctor (sic).

Sunday, 16 October 2011

You Want To 'Save' The NHS. Why?

As Thursdays report from the Care Quality Commission reverberates around the media, and adds to the mountain of evidence of misery, that is perpetrated upon that most 'captive' of all audiences, the Hospital Patient, is it any wonder that I question the motives or naivete of those who campaign to save our NHS?

This follows on from the  Royal College of Surgeons Report of only last week highlighting the appalling care meted out to patients who submit to emergency surgery, who or are admitted to A & E Departments at nights and weekends. The NHS is patently sick and cannot provide even the most basic standards of care, despite the vast sums of money extracted from the public to pay for it. 

It seems that the usually 'piss poor' CQC has followed Lansley's diktat and undertaken a number of unannounced 'spot' checks on Hospitals to formulate the report and found many Hospitals sadly wanting in the care of the elderly. Well once more I say 'no shit sherlock'. I could have told you that! Well more power to them, but I have to ponder as to whether they are an adequate provider of vigilance when they continue to be the 'licenser' of Health care Providers as well as it's invigilating body. They are funded by the very organisations they presume to police, which is a clear and present danger of potential bias and lack of independence. They have hardly covered themselves with any 'glory' in the past and the body itself is peopled by many 'refugees' from the PCT's and Hospital Trusts. It is highly likely that without the Health Secretary's urging that this report would have even been compiled. So I have to thank Andrew for that, although little else.

The NHS costs the taxpayer just shy of 8% of GDP in 2009/2010 (just over £100 billion) up from its initial cost in 1949/50 of less than £500 million (£11 billion at today's prices). The greatest volume increase being some £46 billion in the 'Blair' years (1997-2008). Yet we have seen very little improvement (er.. none) in the standards of care or the safety of patients despite this vast increase in expenditure. Under staffing and 'dumbing down', yes we have seen much of that. Vast increases in the apparatchiks and their enforcers and huge increases in pay for GP's and Consultants. Intensive 'marketisation' including PFI and the ISTC's, which even though some patients have been happy with (in the main due to short stays and hotel style accommodation) , does not detract from the view that a properly organised and adequately funded public health service, should be able to do better than the 'private sector', because there is no profit margin to factor into the equation. Hip replacement in the NHS, say £6000. In the 'private sector' £6000 + profit of 25% = £7500. And of course no 'backstop' in event of an adverse incident except to rush the inconsiderate sick patient to the nearest A & E of the NHS.

'Marketisation' then is likely to do little more than bankrupt many Hospital Trusts in the 'brave new world' of the HSCB with the large cohort of  'privateers' extracting ever more from an already creaking budget. But more; the growth of 'disease mongering' in the Primary Care sector will grow at an even faster pace, driven to new heights by the involvement of  'Big Pharma' in the provision of service as well as drugs. There is an already unhealthy relationship between the drug industry and many Doctors and Clinicians as Fiona Godlee stated in her recent BMJ Editorial, citing this study from the US and Canada as evidence of  'less than honest' dealings. I would cite more but the BMJ will not dispense with the 'paywall' on many occasions, thus actually adding to the censorship of that which goes on in the world of medicine, without the knowledge of those who are ultimately paying for it!

I actually find the original NHS model of universal health care as being a fine and principled concept that I supported for many years. I do not do so now, not from any perverse hatred of that concept but that it no longer ticks any of the boxes of its founders. Since 1979 it has been guided by the politics of greed and stupidity, most largely imported from USA. It has received huge increases in funding that have been 'squandered' on flights of fancy that did nothing to improve or even alter patient outcomes. The NeoLiberals gave most of it away to private sector companies who frankly would have no more idea about 'competition' than flying to the moon! Most would not survive at all but for the largess of the taxpayer, they have no other clients! Like the Banks, they have grown fat and lazy on our money, often without having to tender for anything. Like the Banks they have given us little in return, except another bill for our offspring's to pay.

What I would like to see is a new NHS. One that fulfils its original criteria without all the bureaucracy, hypocrisy and reverence afforded to Doctors and Clinicians as if they are some sort of superhero's. There are plenty of good guys out there, they just seem to have lost the ability of shouting louder than the bad one's. Instead of talking 'ball's' they need to find some.

Tuesday, 11 October 2011

"Something Rotten In The State Of Denmark".

So said Marcellus in Hamlet. The same seems to be the case today, with the imposition of a tax on the sale of foods containing saturated fat in Denmark, the home of Lurpak and Danish bacon. But, that any civilised society sees fit to 'ban' anything says quite a lot about that society, especially a foodstuff, that has figured in the human diet, since the beginning of, time, says even more.

There are many strands to this, not the least is that to ban anything needs for that ban to be right. Society's that ban things have done so often at their peril, often inculcating a desire that was only weak into one that becomes an absolute need. We only have to look to alcohol or religions see this as historically inevitable. The 'fight' against drugs is a prime example, where we have squandered billions to achieve little. So to ban 'fat' seems perverse, but of course, like most Neoliberal regimes, the ban allows taxation to be invoked which will then swell the exchequer, so despite the inherent hypocrisy of a nation whose primary exports are (poor quality) pigs and butter (laden with saturated fats) they can still make money from their people and those of other nations whilst at the same time feeling the warm glow of moral superiority.

As many that have read my words know, I'm a convinced 'low-carber' with a predilection for fat and protein and have produced a considerable body of evidence that proves it's lack of any danger, over many of my posts. I have a hatred of dogma, cant and hypocrisy. The Danes have proscribed a number of foodstuffs, in the past few years including a ban on 'transfats' (trans-isomer fatty acids) and a tax on sweets, together with products high in sugar, and I would endorse the sentiment but I'm sorry, I can't endorse the legislation. If any society is to ban anything, it has to do so from a viewpoint of absolute morale integrity based upon complete and unequivocal evidence that considerable danger is invoked by indulgence in the item(s) or protocols involved. It is clear to me that Denmark is unable to do this; the evidence denies it. Yet nonetheless they have. Chris Masterjohn has an interesting and somewhat philosophical viewpoint about the Danish 'fat tax', it's worth a read. He is somewhat more credentialed than am I but comes to similar conclusions.

Sadly, it is highly likely that such a tax/ban may be invoked by the current Government (the 'toffs') who cannot grasp the concept of reading the evidence prior to rushing to legislate, especially if their efforts yield some more of  'our cash' for them to squander in the pursuit of some pointless policy or other, or to hand to their favourite consultants or offshore equity capitalist. Denmark's death rate from CHD also seems to be one of the lowest in Europe. France of course still manages to be the country with the lowest events per 100,000, despite the fact that it has the highest intake of saturated fat in it's diet! So once more science is traduced by dogma, integrity by greed. Politicians, what can you do with them. Wall and firing squad appeals to me.

Tuesday, 4 October 2011

No Shit Sherlock!

The Royal College of Surgeon's (RCS) recent report on the appalling death toll of patients admitted for out of hours and emergency surgery is to be commended. It has been a long time in coming and highlights the dangers associated with being admitted to Accident and Emergency in the evening, or worse, at the weekend. It sheds light on the dangerous and often fatal, lack of care imposed upon patients who present with, often simply diagnosed conditions, who then become even sicker than on admission due to lack of manpower, facilities and very basic care that all of us hope to avail ourselves of, should we be unfortunate enough to have an accident or become ill outwith the Primary Care pathway.

The NHS is quite good at the provision of elective surgery, especially cardiac surgery. It is however significantly lacking in safety when it comes to major general and emergency surgery, with both higher mortality and complication rates than are acceptable in the setting of modern hospital care. Of 170,000 patients treated for non-cardiac surgery we manage complication rates of more than half at 100,000! And of those, we actually manage to kill 25,000! Mortality rates for emergency surgery in England and Wales is over 25%, with early discharge and subsequent re-admission being a significant factor in these statistics. The other horrifying figure is that our chances of dying is 10% greater if it's a weekend!

Well I'm no stranger to this situation, when she, with whom I have have decided to end my days, became part of these same statistics. Delays, both in pain management, diagnosis and treatment at a very basic level were missing, possibly because it was early on a Friday evening. No Consultant on duty, just a few nurses or rather 'healthcare assistants'. Of Doctors, well none until some five hours into admission. Tests, well there were plenty of those, in fact it seemed to be a goal rather than any sort of pathway to treatment, as hindsight indicated that none of the results were followed up! An X-ray was eventually carried out, but nonetheless a a treatment protocol was then pursued that was contraindicated and injurious and resulted in an outcome she still lives with to this day and which will blight her life until it's end.

Weekend surgery did take place, 'squeezed' into the list between the 'elective' private patients who had the surgical suite given over to them for some Saturday 'bunce' for the Consultants. Postoperative care was poor to non-existent with severe hypotension ignored, as was the diabetic keto-acidosis, and very low oxygen saturation that kept triggering alarms ( to my alarm).

So, this report does not surprise me in the least. The apathy and stupidity demonstrated to me by my personal involvement in this event did at the time. Up to then (2008) I had not had any chance to witness first hand the terrible position in our hospitals especially in emergency care. Any contact I did have had faded, like most bad memories do; part of that 'defence' mechanism our minds have to retain sanity. Despite my many ailments, and a minor wound in my early history with firearms, none was dependant on a hospital stay and I hope that it remains so. So dear reader, I would suggest that you plan for any emergency you may have in health care for you and yours, on a weekday between 0900 and 1700hrs. Or of course join with me and others to press for a whole new paradigm in health care and medicine, that is patient centred and based on scientific treatments. I want to tear it all down, rip it to shreds, along with many of those that perpetuate it by virtue of vested interest or hubris or worst, apathy.