View from the hill

First They Came For Your Daughters.........

2012-01-28T12:26:00.000+01:00

And now for your son's.

A recent headline story in the Independent caught my eye as an example of 'disease mongering'. My dislike of HPV vaccination will have been made clear from my last post, as I feel it is a somewhat large hammer for a very small nut. The vaccine Gardasil, from Merck is seen in this light by myself and and many others. Age standardised mortality rates of Cervical Cancer in the UK stood at 2.4 per 100,000 in 2008 and falling which is a risk of .0024% if my calculation is correct. Down it seems from 1971 of 7.1 per 100,000 and in most of those years the vaccine did not exist. It is also somewhat easy to cure and in many cases no harm results from infection with even the low percentage of CIN 3 lesions detected only progressing to actual cancer 1% of the time. So why we should vaccinate against such a problem bemuses me, when we ignore many other cancers of much higher rates of incidence.

Michael Douglas, a throat cancer sufferer.

A new 'epidemic' it seems, is now being sold as a reason to vaccinate young boys as well as girls. We are told, that Oropharyngeal Cancer (throat cancer) has increased alarmingly, by some 73%! And that HPV vaccines will guard against it's further spread. It is only when you read the actual figures that the figure is put into context. A rise from 1 per 100,000 to 2.3 per 100,000. So yes, it is a rise but that's the 'actual' (rather than relative) risk which remains almost too small to measure, in scientific terms. And one must remember that the 'actual risk' of harm from the vaccine itself. exceeds that figure by some 50% (playing them at their own game), it's about 3.5 per 100,000.

The increase is laid at the door of 'yoofs' predilection for oral sex as opposed to the 'missionary position' one assumes, which does lend to them, some inclination against unwanted pregnancies. It's a pity that such a risque form of sex should be viewed as 'risky' by the Professor (honourary) who broke the story; Hisham Mehanna. This practise increases the risk of HPV infection of the throat by this 'staggering amount' (sic), sufficient for him to advocate HPV vaccination. Yet quite a number of Scientists find themselves at odds with this because the protocol remains largely unproven and in most cases the recipients would have to wait some twenty to thirty years for any evidence that it was, to come to light. And of course, the vaccines do not protect from all HPV strains so their effect is at best 70% for 4 to 10 years.

At the moment the NHS continues to roll out the HPV vaccination of young girls but not boys. This story is a 'move' by someone who combines both Private and NHS careers to frighten young women, girls and now anxious parents, to press for this vaccine to be available for all. It seems a cynical ploy to me to once more 'generate' more things to do for an already declining resource fund; the NHS. I could point out that Mehanna receives funding for some of his studies from GlaxoSmithKline, the maker of one of the two major vaccines; Cervarix. But of course I wouldn't do that, would I?

Health Misogyny

2012-01-22T22:57:00.005+01:00

Health care in general and the NHS in particular, places far too much reliance upon the notion of prevention and 'early' detection of disease, or rather the 'markers' of what is assumed to be a possible or maybe disease, or condition. This particular trait, and it is redolent of all health care models throughout civilisation, is directed more at women than men.

Perhaps the concept of women being fragile, vulnerable to all sorts of ailments diseases and conditions, that are either particular to, or more predominant in their sex than males, is where this founded. And, of course when this process of labelling all women as potential harbingers of their own doom came to pass, it was men who set about building the edifice of treatments, allocated specifically to the 'fairer' sex, to save them from their 'treacherous' hormone ravaged bodies. And what a crock of s**t, it has all turned out to be.

Mammograms, Cervical Smear Tests, Hormone Replacement Therapy, Vaccines targeted for Cervical Cancer, 'Medicalisation' of Pregnancy, Osteoporosis treatments (mainly for women) and the general consensus that women need 'protecting' from the ravages of their own predisposition to ailments arising from their femininity. Men and some women, are unable to resist the urge to prod, poke and peer into the extremities of women simply to reassure themselves, and vulnerable women, that all is as it 'should be'. A whole industry in Medicine and Health care has sprung from this, including the desire of men, often imposed upon women, to aspire to a stereotype image of the size 10 with big breasts and shapely bottoms. Culminating of course in the Breast Augmentation, Reduction and Botox protocols that has spectacularly 'gone wrong' in the case of the PIP debacle.

I have written at length about Screening for Breast Cancer in the past and more evidence has comes to light about it's futility for most, and the lie perpetrated that many are 'saved', when in fact the so called cancer found, is not really 'cancer' at all. And it would have likely responded to 'watch and wait protocols' rather than going in with the knife, radiation and chemotherapy. The 'treatment' of Ductal Carcinoma In Situ (DCIS) is redolent of this mindset. Studies conducted also continue to find that mammography seems to increase the incidence of breast cancer than reducing it. The main problem is however that women are treated as pawns, and deprived of the information needed to make an informed decision about whether or not, to submit to this 'testing' (sic) protocol.

Cervical Smear Tests are also 'sold' to women as essential to health and whilst there is little harm invoked by them, when an abnormality is detected the 'system' once more tends to 'overtreat' and frighten women into interventions that can be counter productive. Firstly the incidence of cervical cancers is quite low at 2.4 per 100,000 (European age standardised mortality) and certainly screening young women (up to 30 years) has been shown to be of little worth. The trend also has been been downwards for the past thirty years (from 7.1). As the mortality rate for Prostrate Cancer is rising and close to 10x higher at 23.9 per 100,000 it seems strange that this is not targeted, when Cervical Cancer is. But of course 'overdiagnosis' is really the problem in oncology, especially for treatment protocols directed at women and it continues, without abatement.

We now have the HPV vaccine, targeted (again) at young women to prevent cervical cancer and genital warts yet the vaccine (Gardasil/Cervarix) is only admitted as being effective against two strains of the Virus (types 16 and 18) and there are allegedly thirty strains that are cancer promoting. As the target cohort is 11 to 13 years old females (although now men are now being targeted too!) prior to likely sexual activity and protection is only afforded for ten years at most, it seems perverse to leave them without protection in the years when activity is likely to be elevated, so is it worth it? Even of course if you even think that the vaccine is any good in the first place, which viewing the evidence it seems not, to me. I personally feel that the whole concept of an 'epidemic' of HPV infections is pure hype to sell an unproven vaccine, mainly to women, for their daughters, to swell the coffers of 'Pharma' at a time when the 'blockbuster' drugs are coming off patent. Do young girls need a pretty useless vaccine for a relatively easily treated disease of very low incidence? Make up your own mind, your informed mind. This JAMA editorial may help.

And what of HRT? It was proffered as the panacea for menopausal symptoms and the retention of 'youthful vigour' in women of a certain age and although for many it did precisely that, it exacted a price; breast cancer. Even with short term use, risks of both cardiovascular disease and thromboembolism were also increased tremendously and the ovarian cancer risk increased in the oestrogen only cohorts by some 60% (relative risk). Except for extreme cases, it is used rarely for menopausal symptoms today, but that did not stop 'Pharma' from reaping tremendous profits, from an ill conceived and dangerous drug that is now seen as being counterproductive despite its benefit for the prevention of osteoporosis (but not treatment).

Way back in history we had thalidomide, that was targeted at women to eliminate or ameliorate the problems of 'morning sickness' in pregnancy. As most will know, it wreaked terrible havoc with lasting and appalling effects, but now new information is coming to light about a virtually forgotten drug called Diethylstilboestrol (DES) which seems to cause a rare form of cancer of the vagina and cervix called 'clear cell adenocarcinoma' or CCAC, in the second generation .The Independent on Sunday of today, has highlighted this, but the story has been around for some time with $1.5bn paid out already to victims. Surprisingly, this drug is still used in the UK (but rarely) under the 'Apstil' brand for prostrate cancer and advanced breast cancer in post-menopausal women. (Another crock of s**t?). It was another drug invented for the 'medicalisation' of pregnancy.

It is quite rare in fact for any women to have a home birth. They are taught to fear this in case of complications and the need to ensure their offspring are 'safe'. The truth is in fact that home is a much safer place than hospital, as many of us will know, when we went to hospital for one problem and ended up with many more. The following are some interesting statistics.

	Births ( percent of total )		Perinatal Mortality ( per 1000 births )
	1958	1970	1958	1970
Hospital	49	66	50.1	27.8
GP Unit	12	19	20.3	6.1
Home	36	12	19.8	4.3

( Statistics resulting from 1958 and 1970 perinatal surveys in Britain. Sources: Sheila Kitzinger, Homebirth and Other Alternatives to Hospital, and Marjorie Tew, Journal of the Royal College of General Practitioners, August 1985.)

Prospective mothers will be told that they are putting their baby 'at risk' if they stay at home for their birth, and I would be the first to advocate that any at risk should be hospitalised, but for healthy women, especially in their second pregnancy, with no known risks, it is cheaper, safer and less traumatic for mother and baby. Yet a whole industry has grown up in the NHS to foster the idea that no other protocol should be countenanced.

Women are continually treated as if to be female is an illness in itself and that your whole life has to be conducted under the microscope of the Health care Profession. Many of the ailments that women are heir to have their risk inflated out of all proportion to reality. many, as I have pointed out are very low; much lower than many that are completely ignored by medicine. We continue along the road of epidemiology and genetics as twin pillars of research but it is a blind alley, especially for women, who have suffered more than men in this construct of blaming their ills upon hedonistic lifestyles, stupidity, and poverty. Most if not all of the breakthroughs in medicine have been due to luck more than insight. Failed aspirations are in fact the predominant factor in Health care, and the 'expert committee' the death knell of common sense.

To treat women as the 'milch cow' of medicine is patronising, condescending and it is without doubt misogyny. Doctors and Clinicians should cease this continual search for things they can 'invent' to fill in their time before their wealth laden retirement. Perhaps they have; children. But that must wait for another day.

By writing this post I could perhaps be accused of the sin I am trying the exemplify. I really hope not.

2011; End of Term Report.

2012-01-12T18:52:00.001+01:00

2011 seemed a little like living in some sort of 'time warp'. Paranoia reigned, mainly about 'benefit scroungers' and immigrants and the need to ensure those that are financially supported by the state 'get a job'. A bit bloody difficult that if there aren't any! But of course such policies appeal to the baser instincts of the people who are (generally) misled into the view that all on the 'dole are shiftless, workshy leeches. They may of course change their mind about that, when the redundancy notice drops on the mat. And of course we had that elaborate fireworks 'jamboree' at the Thames Embankment, at the turn of the year. 'Circus' (without the bread) would be my summation of that. They'll be plenty of the circus element to take out our minds off the the 'crisis' in 2012 with the Olympics (which has just had an extra £270m added to the bill for security to pay for an additional 13,700 personnel from G4S. That works out at £20,000 for six weeks work yet the 'going rate' is about £10 an hour. Could it be that we are being 'screwed', by the Governments favourite 'Security' Co? ) and the Jubilee celebrations being the most prominent, but still, we get a day off work to pay homage to the Royals, so that's alright then!

Delving into the 'nitty gritty', this was the first full year of the Toffs Academy's rule and Edd and, err Edd's reign on the opposition benches. What a triumph it all was, with the competition for the middle ground of mediocrity almost reaching fever pitch. The cut and thrust was painful to watch, with minutiae of each of the party's doctrine being dissected and found to be - the same! The Headmaster shone through it all with aplomb, and that was just his face. But seriously, where is the difference, the defining policy, the moment of inertia that could lift us from this politically imposed state of misery in which we are living; I'm still waiting.

'Hacking' came to prominence, with News International holding up it's hands to the offence of listening to peoples voice mail messages. Well sorry, I simply cannot get worked up about a a bunch of idiots who are so stupid as to actually leave any significant personal information on a mobile phone voice mail system, which is designed to ensure that you know someone called when you were on the 'phone or off the air! Nor am I impressed by the state expending my money on an enquiry that is designed to 'up the ante' on the damages that will be paid to a bunch of self serving, publicity seeking third rate celebrities like Prezzer and 'Huge' Grant. If NI had actually listened in, to a 'phone conversation, that would be different, but they didn't. That privilege is reserved for the security services and the US Government. So get over it, go home and stop filling the media with your contrived and silly outrage; it's your own fault!

Meanwhile, back on Earth or the planet Zog, as it seems to me (or maybe 'Life on Mars' as Francis Wheen says) much more important things were happening.

The NHS was transformed from being a dangerous organisation, entrenched in mediocrity, mendacity and self interest, to a 'shining light' of health care for the people. Privatisation and Marketisation was the route being taken by the Government, but that was a step too far for the pressure groups that sprang from the woodwork. Many of these comprised of Doctors and other Health care providers complicit, even actively involved in the reforms of Tony Blair. Well wake up and smell the coffee, it's already happened! What do you think ISTC's, Foundation Trust's and Primary Care by GP's is! The last 'lot' (Labour) were already well on the way to that goal before Cameron et al came on the scene. GP's have always been private contractors to the NHS, either as partnerships, individuals or limited companies. If you want to criticise a system that allows this, then start with them. They've always stood on the outside, looking in, and however you want to cut it, GP's are not state employee's, which only makes me wonder why we are contributing to their pension's, but that's another story. And, all of the hand wringing of the 'Guardian' readers seemed to be out of step with the fact the Nu Labour had been the architects of most of the changes in the NHS, and Lansley is only continuing a process commenced by Tony Blair and Gordon Brown. So everything is different, but stays the same.

The 'bandwagon' of Pharma continued, although in somewhat abated form now that the so called 'blockbuster' drugs have gone off patent, and some of the seedier advances elicited huge payouts for the harms they had caused ($3 billion from GSK for fraud and mis-selling), but that didn't stop Andrew Witty getting a knighthood. Who says crime doesn't pay! Cameron decided that they (Pharma) were so poverty stricken that we needed to give them some of our money and a lot of our patient information, to get them to cause some more carnage by helping them develop some new drugs. We need some more 'lifestyle' drugs like a hole in the head, and the hand full of very expensive drugs thus far developed to treat relatively rare conditions have only had modest or even no benefit to society, except of course to Pharma's coffers.

The NHS remains 'broken' and all the rhetoric about 'saving it' is counterproductive. More 'marketisation' will not make one iota of difference to current appalling status of the patient in all of this. 2011 saw the exposure of terrible standards of care that have prevailed, and been tolerated for years. Winterbourne View, failure to provide adequate nursing, dignity and nutrition to the elderly and those with mental health issues and learning problems. The 'Stafford Hospital' enquiry, the appalling problems in A&E at weekends and nights, and substandard care in Trauma and Surgery; the list is almost endless. A new paradigm needs forging to bring the NHS up to a standard that is in accord with the vast sums expended, most of which has been allocated to the payment of the management, consultants and temporary staff at exorbitant rates. And of course PFI, PPP and ISTC's. Despite the fact that the ConDems criticised the finance model, they have still seen fit to go ahead with the £450m Liverpool Hospital PFI contract with a consortia of Laing, Interserve and FCC. There is also some evidence that Trusts are retaining patients on wards, to enable payment of treatment tariffs simply to 'grab the cash', when many could be discharged to home (much safer than hospital) and treated by their GP's.

All of the privatisation and commercialisation models will do nothing to advance patient care. To proffer the view that excellence will be intrinsic to allowing further private companys' to undertake treatment at Primary or Secondary level is littered with pitfalls. Thus far it certainly has not been proven, in fact costs have escalated out of proportion to the outcome. Time and time again it has been demonstrated that the private sector is only interested in 'cherry picking' those areas of treatment that are simple and straightforward and with little to no need for the 'back up' of an emergency department, and when things have 'gone wrong', which they have, patients have been rapidly handed over to NHS Hospitals to try and salvage something from the situation.

Competition has long been viewed as being the spur to excellence within capitalism by successive governments since the Thatcher days, but the proof has been sadly lacking, with greed and mendacity demonstrated just as readily as in the public sector, in fact the paradigm has been so corrosive as to be valueless. Numerous companies have been earmarked by Government as 'preffered providers' in many sectors and proven to be incompetent, target driven, purveyors of substandard products and services. The simple model of capitalism is 'buy cheap and sell dear'. There are better ways of producing a better outcome for patients than that. We only have look to Winterbourne View and to the NHS IT programme to see the failings of the unbridled pursuit of money.

The organisations too, that oversee the NHS and Social Care also continue to give concern, with the CQC failing miserably in its raison detre to protect the vulnerable and curb dangerous practise because it spent too much time on the registration of the myriad components of Health care (which yields its funding) than on the protection of patients from harm. It does seem to have raised it's game a little now but like most things in Health care it's too little and too late.

And what of the Medicines and Health care products Regulatory Agency (MHRA)? Well, they seem to have gone to sleep on job, because they were warned back in 2006 about PIP's toxic breast implants after approving them without demur years previously. Could it be anything to do with alleged opinion of many that they are a bit 'cosy' with 'Pharma'. As is usual, I could not possibly comment on such a salacious view! Perhaps if anyone had checked the content the penny might have dropped because most comprised the sort of silicone used for sealing around baths and showers (Rhodorsil) or for oils seals and 'O' rings in automotive products (Silopren). As even the (fairly lax) FDA in the US banned this device in 2000, what happened to the continuous assessment process that should have been in place?

Too often the bodies we pay with our hard earned taxes to safeguard us from harm are found wanting. and the NHS which is now consuming approaching 10% of GDP is found to be toxic for patients. When will lessons be learned? Approximately when Doctors accept a 'duty of candour', or hell freezes over (not necessarily in that order).

The Perfidy of Politics.

2011-12-06T00:20:00.036+01:00

Now that Osborne has cancelled Christmas, probably forever, I wanted to examine the the somewhat hypocritical, even treacherous view that 'contracts' with those providers in the Private Finance Initiative (PFI) are somehow 'different' from contracts with the employees of the State.

We have been told, interminably by those in power, that PFI under the last Government was sacrosanct as the contracts written were unable to be broken, despite the huge cost the taxpayer has had to bear, with little (no) reward. Ordure was heaped, quite rightly, upon the Labour Government for the veritable 'bonanza' that PFI enjoyed during these years, with outfit's like Innisfree (who they?) making huge returns on contracts, and with equity capital investors enjoying unprecedented yields, all funded by the taxpayer. In addition, these same investors were also able to take advantage of refinancing the contracts and thus receiving 'windfall' profits of many millions without any consequent reduction in charges to the client. These investors, in the main, were domiciled for tax purposes in places like Guernsey or Jersey, where they paid no UK tax on these profits (capital gains), and yet the tax yield had been part of the assessment of cost/benefit analysis by the Treasury, that allowed PFI to be used as the major vehicle for infrastructure development in the first place!

So, large and important elements of the infrastructure of this country, including Education and the NHS, were leased from a 'cabal' of financiers and construction companies at returns that were at least double the rate of the government borrowing for up to 35 years, with maintenance contracts that extracted annual increases far in excess of those available by competitive tender. In one case a return of 60% was made by refinancing the 'mortgage' on a Hospital without a penny of the profit or any reduction in the lease cost to the NHS. All of this is down to successive governments of the 'neo-liberal' persuasion (all of them in the last 30 years then!) who have wanted to abdicate all responsibility for the cost or construction of infrastructure and keep the capital spending off the balance sheet, even if it meant huge lease costs to the taxpayer.

The recent Public Accounts Committee Report makes interesting reading (although 66 pages long), with some 30 projects worth a value of £2.1 billion being signed to March 2011 despite the rhetoric of Cameron about 'poor value'. And there are some 61 projects of a value of £7 billion in the 'pipeline'. The ConDems' will quietly agree these without demure, just as all those who went before. After all the contracts are 'off balance sheet' and no one will notice the perfidious nature of the transaction, will they?

Interesting also, is the sale of equity in the PFI's by the Construction sector, which yielded between 41% and 78% to the 'usual' suspects (Carrilion, Serco, et al) compared to the sort of profits seen in building of 1.5% (1998-2010). This makes the financing and also the running of the enterprise funded, somewhat more lucrative than any other area of construction (sic) and whilst it can be important to have a vibrant and profitable construction sector these are the 'fat cats', with most of the small and medium sized enterprises (SME's) in this sector struggling to survive. This is often, against a background where SME's are being squeezed on margins for the subcontracts that are let by these same companies, and payment terms extended well beyond that which is viewed as norm (30 days). But we are 'all in this together', some of course more together than others. The view that an elite group of financiers and construction 'super' companies are running and maintaining this country at the expense of taxpayer funded contracts is difficult to believe. That they are doing so at enormous cost, but with little yield to the 'paymaster' (the taxpayer) is also a view that is inescapable. This is where the real escalation of the cost of UK plc is founded. Not in the pensions of binmen, health care assistants and nurses.

Since 1992 a large and still growing proportion of the UK's infrastructure has in fact been 'privatised', much without our knowledge or consent. This includes, prison's, roads, incinerators, the MOD's buildings portfolio, air traffic control centres, fire and ambulance control centres, (which we have not used but are committed to pay all the charges for another 25 years), schools and colleges, police stations, together with many local and central government offices. This would not be a problem if the outcome had been better buildings and services at reasonable cost, with a privatised workforce being provided with better management, pay, and conditions. But again this has not been so, with large parts of the legacy of the hard work and sacrifice of generations since the Second World War, being sold for a pittance. Sold despite the fact that the taxpayer owned and paid for these assets. Gas, Electricity Generation and Distribution, Water, Coal, Telecoms, Railways, and much else was virtually given away by successive administrations all bowing to the altar of marketisation and privatisation.

What do we get for allowing this to happen? Well the privilege of Innisfree being allowed to manage vast tracts of the NHS real estate portfolio at such cost as to be able to afford to remunerate David Metter, the CEO to the tune of £8.6 million (salary and dividends) despite the payroll covering less than 30 people. Apparently the average salary of all his employees is £268,000 each!

This 'PFI' construct is a 'bubble', albeit a laucrative and thus far sustained one. Sustained by the belief that NHS Trusts that cannot meet their commitments will be bailed out by successive governments, just like the Banks'. Does that hold true for the future and anyway, should it? The current paradigm of sustainability of the NHS is being wrought asunder by a certain Mr. Lansley who may have little choice if his back is against the wall on funding for failing components of his 'grand design'. What then for PFI when its' market becomes another 'Greece'?

Chocolate and Paracetamol.

2011-11-24T19:33:00.002+01:00

No, it's not a new recipe for pain relief, although thinking about it may have some merit.

Chocolate has been investigated for it's efficacy as a medicine, primarily as an anti-hypertensive, but also for it's possible use in many cardiometabolic disorders. This is especially good news, for those who desire chocolate almost, if not more than sex, as a number of women have told me (although that may be a reflection of my lack of personal attraction). Hey-Ho. But yes, there is at least some statistically significant evidence that even the obese can benefit. It is important that it is dark chocolate and in my interpretation, that with the highest cocoa mass would be the one to go for, although above 85%, it does tend to be somewhat bitter, although as cocoa mass increases, sugar decreases. Always remember as sucrose intake increases, so does plasma glucose and insulin.

85% cocoa mass chocolate yields (per 100grammes);-
Protein - 9.70 g
Carbohydrates - 17.00 g
(of which sugar is 5.80 g)
Fat - 51.40 g
(of which monounsaturates is 17.90 g)

Putting aside the sugar content, for the non-diabetic that is quite small and provided consumption is kept to 25 or 50 grammes per day is unlikely to yield much harm whilst at the same time providing a healthy fat intake and of course the flavanoids that produce the improved endothelial function. The study published in the BMJ seems quite convincing although as a meta-analysis and largely observational study, it does have confounding factors and the cohorts had little heterogeneity. Nonetheless for the relatively healthy it's a somewhat better 'medicine' than most of the drugs peddled by 'Pharma' and I have myself, despite my indifference to chocolate (what you say!) started to consume 25 g per day, some time ago.

In the responses there are some detractors, mainly those who are frightened of 'fat' despite the fact that high cocoa mass fats largely comprise monounsaturates with a small polyunsaturates content which the 'mainstream' generally view as healthy. I'd prefer mine with lard to be honest, but I'll leave that for frying my egg yolks and bacon, oh and my 97% meat content, organic sausages. I'll eat my chocolate with a glass of good red wine instead.

Paracetamol (acetaminophen) was in the news recently although if you blinked you may have missed it. This is largely because even in doses that are often prescribed by Doctors in Hospitals (yes really) they can be somewhat dangerous. It does have a cumulative effect especially if taken at maximum dosage for a number of days and in some cases for weeks. The effect on the liver is quite toxic and can often be fatal, especially in those with reduced function in that organ, such as those with even mild alcoholic or non-alcoholic fatty liver disease. Even mild overdose due to timing of intake can be hazardous, and the study in the British Journal of Clinical Pharmacology warned that prolonged usage presented more problems in treatment, and risk of death than did single overdoses. It is easy to forget that no more than 4 doses (of 2x500mg) in 24 hours should be taken, when those doses are taken at 4 hour intervals.

The data is not exactly new and the phenomena well known for some time, but most was for single excessive doses, a number of which were intentional, although I could think of better ways to end it all than the multi organ failure that often is the outcome. The important lesson, which was not very well reported, is that this is an easy trap in which to fall into. You do not have to be much outside the 'normal' dose parameters to cause fatal consequences, and that is for healthy people. The elderly, children, and underweight and malnourished recipients are particularly vulnerable and it is so easy for people to view this over the counter analgesic, as eminently benign. It isn't, it is potentially fatal at quite low levels. The antidote, N-acetylcysteine, (NAC) another OTC supplement used in some cough medicines, has to be administered pretty rapidly to save lives, although for this problem intravenously by rapid infusion. The window for saving lives is tight, generally eight hours.

Personally, I never take paracetamol, well not any more, as I have known of its dangers for many years. If I'm in any serious pain, which is usually due to arthritis, I use a topical NSAID, such as Ibuprofen gel and even then rarely. The lesson is plain. Over the counter paracetamol and its combination forms (aspirin, ibuprofen and codeine) can be lethal, just as lethal as some potent drugs.

The English Diet and Other Drivel.

2011-11-21T14:01:00.000+01:00

Not been too well of late, so I'm having to catch up with a few things. Quite debilitating back pain was the problem; something I've had for some years due to a 'hard life' but which responds to physiotherapy relatively quickly. My thanks once more to Robin McKenzie again for his excellent protocols, they have stood me in good stead, when my back succumbs to the disc problems I am plagued with from time to time.

Posture corrected then, I can (hopefully) satisfy those who waited with ~~breathless~~ eager anticipation for my latest post, filled with my rapier like wit and surgical dissection of the sensible from the profoundly stupid, and there's been a lot of that recently.

The 'English Diet' came in for praise, on the back of a 'study' from Oxford University, and it's pretty much 'wibble'. Based upon the 'Dietron Model' a sort of Monte Carlo simulation (more wibble). It hypothesises, that data gleaned from self reported information from people, (that no doubt told many lies about what they ate), could be in any way be useful to a scientist in his/her pronouncements about that which might make a difference to the health of each of the nations that make up the United Kingdom. House of cards built upon quicksand is the only conclusion that I can come to. It's a corruption of a meta-analysis, that's purely self-reported and observational with a huge array of confounding factors that are ignored. Why anyone takes this sort of rubbish seriously when most, if not all of the conclusions have been proven by good scientific studies, to be untrue really makes me cringe.

It is suggested that saturated fat is taxed and that fruit and vegetables be subsidised and of course salt is restricted. All in the name of better health for the nations that border England. It continues the myth that if we all eat 'healthy food' like (highly volatile) seed oils, rice, pasta, whole grains (brown food), fruit and vegetables (full of starch and sugar) we will possibly live forever! This is of course the advice we've been given for about thirty years with no appreciable benefit thus far other than an increase in the profits of the food cartels and supermarkets, and an inexorable rise in the output of 'Big Pharma' to counteract the consequences of this blatant rubbish. I have debunked most of this before and written extensively about the dogma that masquerades as science, but so long as these 'faux' studies are given air time and media coverage without challenge, ever will it be so.

Moving swiftly on, I note that illustrious body the British Medical Association (BMA), the Doctors Union has pronounced on smoking in cars, especially with children in them. The eminent Dr. No has done a first class 'hatchet job' on the evidence, so I don't need to, except to say that the BMA would be better expending its time and its members funds on other pursuits such as protecting patients, and their membership from attacks by the GMC than involving itself in this sort of support for the Neoliberal agenda to curb personal freedom. This attempt by Vivienne Nathanson to once more proselytise, using the 'child harm' card is typical of most of the 'politicised' class of Doctor, invoking the hysteria that allows the actual evidence to be forgotten, in the face of the dogma. This is the ethos of medical ethics 'at the top'; ignore the vast harms that are perpetrated every day in health care in favour of a distraction to grab a cheap headline in the Sun or the Daily ~~Fail~~ Mail.

Salt, specifically sea and rock salt, is in the news and has been shown to be little different to 'normal' salt. Except of course for the additives, which they obviously didn't include in the analysis. Pretty much the same the conclusion arrived at when organic food was debunked in the media as being no different than say McDonalds'. Of course if one blasts things in a bomb calorimeter all you are doing is analysing the basic constituents and ignoring micro nutrients, which are an important constituent of the human diet that are generally lost in processed food. The same of course is true in salt.

Sea salt, is generally lower in iodine and richer in magnesium than is table salt, but the main thing is that it's natural product used by man for eons, both as preservative, condiment and ingredient, even as a means of payment ( 'sal' means salary). Iodised table salt, whilst having some advantages for thyroid function is also full of additives to make it 'free-running', and anti-caking agents so it doesn't 'stick'. My personal view is that sea or rock salt is better (rock salt is 'old' sea salt), and like many natural products you use less. As for 'low sodium' salt, well, we just put more on our food because you can't taste it! In fact the evidence still shows that sodium reduction has virtually no effect and can even be counterproductive for overall mortality.

And GlaxoSmithKline is having to dig deep to settle its dispute with the US Federal Drugs Administration (FDA). The largest payout in 'Pharma's' history. Even bigger than Pfizer's payout in 2009. It's unlikely to dent the drug giants A+ credit rating. Well there's a surprise then!

And finally from my new friends, over at the Low Carb Diabetic; this is priceless. They have suffered greatly of late from the sort of complaints that beset bloggers and had their blog removed/blocked on occasions and had a lot of grief from the mainstream idiots aligned with, well you know who they are.

Phones, Breasts, and Vaccines.

2011-10-24T13:31:00.003+02:00

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).

You Want To 'Save' The NHS. Why?

2011-10-16T19:59:00.001+02:00

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.

"Something Rotten In The State Of Denmark".

2011-10-11T11:52:00.001+02:00

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.

No Shit Sherlock!

2011-10-04T16:26:00.001+02:00

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.

The Road to Perdition.

2011-09-27T11:50:00.003+02:00

So as the Greek storm threatens the destruction of what is left of it's fragile democracy, and the two Ed's join together in a trip to Knotty Ash, in an attempt to rival Ken Dodd's stage presence, I look to our leaders for guidance and comfort. Cameron's not for turning; I vaguely remember that from my past. No, it's gone. Ball's will not promise any change. And Angus is pissed off with Tesco.

So, as the sun slowly sinks over the UK economy I am left to my own devices to ponder the solution for our ills, and I am reminded of something that one of my few hero's said. "The world cannot get out of the current crisis with the same thinking, that got it there in the first place." Yes it's from the wondrous Albert (Einstein that is). As is usual, that which he said about the crisis of capitalism applies equally now, as it did way back in 1949.

The British political classes, irrespective of whichever party to whom they belong, have one priority; the repayment of the 'deficit' by those who can ill afford it, and didn't cause it, rather than those that did and can. The Financial sector, basking in the sunlight of handouts and bonuses, is completely unperturbed, safe in the knowledge that Governments all, are held in thrall by their pronouncements about whole economies, and remain hostage to the fortune of diktats honed by ~~wankers~~ bankers in boardrooms throughout the Western World, despite their implication in the very crisis to which they profess to have the solution. All whilst we continue to wage wars in lands afar, support the 'Arab Spring' with strong (ish) words to the dictatorships to which we still peddle arms, and rain down Brimstone missiles on the opposing side, and the innocents, in a Libyan 'proxy' war, fueled more by the prospect of oil, than any righteous hope of the rise of Democracy. I have no time for Gadaffi, but frankly none for the self styled rebel leader Mustafa Abdel Jalil either, who is staging little more than 'coup' than any revolution, and has slaughtered thousands both in the past, and now in his pursuit of power. Not of course forgetting the Napoleonic ambitions of one Nicolas Sarkozy.

This moral bankruptcy is redolent of the paradigm in politics of the past thirty years, the Neoliberal agenda. That which espouses the 'market' as the most efficient tool of Administration and accepts, on behalf of those who vote for them, that a large proportion of the people will be condemned to both poverty and/or inequalities that spring from it's policies. It's democracy usurped by the rich for the impoverishment of the remainder. Forged by the 'Iron Lady' in concert with an aging film star who ruled the USA in the early eighty's, it has predominated Western politics ever since. This is why politics is bankrupt of any new ideas that can extricate us from the hole in which we now reside, but which nonetheless pursues the same one's anyway, as it has for the past thirty years. The word 'Socialist' has been eliminated from all the parties of power in the Western World just like 'nuclear' was expunged from the names of the power generators, and who now hold out their hands for subsidy from the people, to build a new generation of reactors, so they can charge even more for the product we can none of us live without.

Neoliberalism is the reason why the NHS is what it is now and more, what it is to become. The Paymaster once more becomes the supplicant, hoping for some crumbs that may be scattered from the 'top table' of Serco, Carillon, Crapita, and all the myriad facilities managers, management accountants, hedge funds, merchants bankers who 'leech' off the funder of their profligacy, the people. This agenda is not openly touted, so the 'paranoid indifference' of the masses is largely a myth, invented at the dinner parties of the chattering classes, and the pages of the 'Indy' or the 'New Statesman'. It is in fact a hidden agenda, an open secret that is almost the 'elephant in the room'.

It's the movers and shakers, who 'flit' through the revolving door of public service, and back again with the ease of those who know power and relish in it who have shaped this model. Heavily subsidised from the taxpayer, they feign resolute independence and ardent if not passionate belief in the 'market' to sort out all of economy's ills whilst enjoying the hypocrisy of their six figure comfort of taxpayer gold. The rest of us look on in startled incredulity that such a belief system can be sustained, but that is the supreme tenet of politicians; perverse and single minded confidence in their own stupidity, as being wisdom. It is the MP's who have never known what it is to work for a living in a 'real' job, who came straight from University, to research assistant, to PPS, or the 'Parliamentary Silk' from a lowly place in 'chambers'; all of these are responsible for the paucity of 'real people' in the corridors of power, and for the rise and rise of the Neoliberal agenda.

So then Ed and err...Ed. Try to remember you are in the Labour Party, an organisation formed from the blood, sweat and tears, all spilt on its foundations, in a world that was different from today's. We can return there if you continue with the cowardice and hypocrisy of Blair and Brown. But I cannot forget the men of my youth who recounted tales of fighting in the Spanish Civil War, of battles with mine owners, and of blood spilt to provide the children with enough food to sustain life. If you want us to return to those days then just go as before. You and your ilk will not feel the sting of poverty, wrought in the name of the 'deficit', your deficit will be in the integrity that you fail to display. Less 'bollocks' and more balls is what we need!

Lying Bastards!

2011-09-23T13:26:00.001+02:00

Writing this post on my shiny new computer, after the old one gave up the ghost and left me bereft of data, that I still have to retrieve, and of course the means to post anything. Should have gone to 'laptop savers' ie; Angus Dei's Kitchen but took it to my local poxy computer shop, where it still resides.

Andrew Lansley has been bemoaning the dreadful position of NHS Trusts who have been burdened by huge debt born of the Private Finance Initiative 'foisted' upon them by the 'previous lot' ( Blair and Brown). In the process conveniently forgetting that, for all their faults, which were legion, it was an inheritance of Conservatism of the Neo-Thatcher era, who actually 'spawned' the beast. Politics has a dreadfully short memory.

PFI was the invention of a certain Norman Lamont (with others) upon the relaxation of the Ryrie Rules in 1992. In fact a number of major projects were well under way or had even been completed prior to the victory of the Blair Administration in 1997.

The M6 Toll Road (1992)
The Second Severn Crossing (1990)
Croyden Tram link (1996)
Northern Line Trains (1995)
And many others, including the Channel Tunnel.

Blair of course embraced PFI with almost evangelistic zeal and built further upon it, to the extent that almost every public project on his 'watch' was financed in this way. Graham Allen's paper from 2003 details the position taken by 'NuLabour' in its flawed construct to sell off our childrens' futures, to finance grandiose plans, that would make them look good, but conceal the real cost. Even to the extent of selling the Army's estate along with that of HMRC, then leasing it back at guaranteed rates. The company involved was of course based off-shore so we don't even get any tax back for that which we pay. Which is that which all parties involved in PFI actually factored into the cost, so as to represent the deals as 'better', than less complex vehicles for funding that were cheaper, and at least left the taxpayer with an asset at the end.

What has happened, is that the Governments Advisers, both now and then, (KPMG) factored in the taxation element into the cost analysis for public consumption, then were retained by the PFI outfits to advise on how then, to avoid the tax. Some might call them treacherous bastards, but I could not possibly comment. What is sure is that Government, both central and local were queueing up to get deals brokered and operated by the 'usual suspects' ( Carrilion, Serco, Interserve, Capita et al) which were then often sold to offshore equity' finance outfits and they then 'pocketed' the difference, or simply refinanced once the rates got lower. After all, the new owners were looking at profit stream of the order of 15% to 17% per annum and the operators were able to charge £200 to change a light bulb, or £500 to hang a picture, (I've just hung 12 in 1.5 hours for £6 in hooks) as well as exorbitant service charges.

As all these participants were and are contributors to the Tory party 'coffers' and a number of the cabinet have either worked for them directly or indirectly, and they objected little about the use of PFI during Nu-Labours years, it seems a little hypocritical to 'cry wolf' about at this stage. And of course Gove has just sold the Governments share of the 'Building Schools for the Future' LLP, (as reported in Private Eye) which owns the 700 schools already built under the PFI scheme, he recently closed on the grounds of "massive overspends". And to whom were they sold? Yet another 'offshore' investment outfit called International Public Partnerships, based in Guernsey. So no tax there then!

This Government, despite all the rhetoric they spout about about PFI, seem to be just as hell bent on utilising this highly flawed model of financing, as the 'last lot', and they did after all both invent it and facilitated the legislation needed to allow its rise. So I would posit that Lansley's complaints are really for 'public consumption' only, with a whole different agenda, being planned behind the scenes. So is anything safe in the ConDems hands? Well probably not; they are politicians after all. A treacherous breed at best!

The Point of Departure.

2011-09-08T23:32:00.001+02:00

As the Leviathan that is the Health and Social Care Bill, lumbers inexorably to a vote, shrugging off the attacks on its content, like a Tank does small arms fire, I have pondered as to what I would like to see the NHS become. Certainly not that which it is now, so I do not want to 'save it'. And 'curing it' does not appear in any agenda for Health that I can conceive of, because the cancer within has all but consumed the host. Spectacles of a rosy hue, seem to have been donned by the 'liberals', now that their precious NHS is under threat. All the transgressions of the past seem to have been forgotten and it is now to seen as a beneficent, almost angelic body that we should strive to save from the evil machinations of the Tory's. In reality, nothing could be further from the truth.

At it's inception, the NHS was a construct based upon universal health care for all. Sadly that did not compute with Doctors of the day, so it was 'hijacked' by the Consultants and whilst the 'proles' got their boils lanced and their teeth pulled for free (well almost), there still existed a 'cabal', a 'mafia' of senior Doctors and Surgeons who dispensed their largess very much on a part-time basis, but nonetheless held sway at the BMA and called most of the shots. Several incarnations later (there were many), once a few of the miners son's had made it to Medical School and infiltrated into Hospitals it became it little less elitist, but the 'firms' still held sway, with the 'rugger playing' registrar being more the norm than a lad from the terraces of an Allan Sillitoe novel, even more unlikely a girl! So we move forward through time and seventeen major reports and reorganisations later we arrive to today, or rather the white paper of the Coalition of July 2010 Liberating the NHS (didn't realise it had been imprisoned) from which sprang the Health and Social Care Bill. But, long before then the NHS had lost it's way.

The Thatcher years saw the invention of 'fundholding' and of course the bureaucracy attached to that hugely expensive and pointless accounting system that it was, causing mountains of paper invoices to be generated and mailed to each component of the system. The invention too of the Hospital Trusts, and of course the 'internal market', providing an entry for Private Health care to the NHS, and a proliferation of 'for profit' organisations and Hospitals. Tony Blair, not wishing to be seen in any way as 'socialist' perpetuated and embellished many of these policies including privatising the 'out of hours' provision of Primary Care, Foundation Trusts, incentivisation of GP's and of course the spectacularly useless and costly IT projects, together with the expansion of the Private Finance Initiative. In fact the only good thing he did was to eliminate the internal market, only sadly to decide to reinvent it just before he left office.

In all of this we have seen the 'legacy' of the Thatcher years become the Neo-Thatcherite agenda of today which sprang from the Neo-Liberals of yesterday, all completely oblivious to the vast sums of money they were spending, to achieve little other than the enrichment of an 'elite' cartel of Accountants, Facilities Management Companies, and Consultants, not forgetting 'Big Pharma' of course and to the detriment of the 'end user', the patient, who had no input to all of this, except of course to become a 'victim'. I say victim without any hesitation, because the joint efforts of the politicians, GP's, Consultants, and all the retinue of Nurses, Bureaucrats and hangers on have done virtually nothing to improve the lot of the patient but simply improved their own. I have no desire to save anything for any of them, they are completely undeserving even of the the little patience that I have left. The GP's are more concerned about their pensions than patients, the Hospitals more interested in the preservation of their empires, even if it's at the expense of patient safety, than adopting better and less invasive protocols, or the concentration of specialist services in regional centres and thus improving mortality (childrens heart surgery?). The health care charities have been 'hi-jacked' by Pharma as patient advocates, to peddle drugs like Avastin which may prolong very slightly, the lives of terminal cancer patients, at enormous expense (and their profit) and with a whole host of side effects that can be terminal in their own right. All in the NHS and those outside it who will be 'willing providers', have an agenda that has nothing to do with patient care and everything to do with profit, with preserving power, extending control and personal gain.

Why for instance do we continue with Angeograms when we can utilise Electron Beam Computerised Tomography which is non-invasive, less dangerous and considerably less unpleasant. Because it's cheap and a lot of people will lose their jobs, power and influence if we 'can' it. Why do we continue with the 'sham' treatment of healthy people for heart disease they haven't actually got, because they have fulfilled some test criteria for a 'surrogate marker' evidenced by one of (several) computer 'risk scores' that are frankly useless and have been proven so. We also 'treat' perfectly healthy pregnant women, simply because 'we can', to ultra-sound scans, hospital births, inductions and other invasive procedures that for most are not needed, when we should be saving them for those that are 'at risk'. Why do we allow 'Pharma' to 'bribe' physicians and Surgeons with nice little 'jamborees' in exotic locations, 'free lunches', financial support for 'pet' projects and studies, all in the interest of promoting their dubious and often dangerous drugs and devices. Of course no Doctor would be influenced by such largess (and Genghis Khan was a really nice guy).

That is where I depart from the 'curers' and the 'savers'. I have seen my best friend die from stupidity and misdiagnosis. My father from neglect of his chronic illness. Almost lost my sight in one eye and watched the woman I love treated with appalling callousness, have her life endangered and her future blighted forever, for the want of diligence in simple protocols that are the foundation of medicine. Many of my friends have lost everything in their lives at the hands of those who swear to 'do no harm' and I have seen them rage at the impotence they have felt in their pursuit of justice and candour.

Denial of their incompetence seems to be the only thing at which Doctors are actually any good. So I want not to save the NHS, I wish it to be demolished like a fire gutted, dangerous building. Let the ConDems do their worst and destroy what is left whilst the Labour dissemblers snipe at the minutiae of the Bill, sure in the knowledge that they would have done little differently. Perhaps then, when we see yet again the differences and inequalities that will have been forged in England's NHS and we look North to Salmond's fiefdom where a new social democratic model is being invented, we can rebuild it as it should have been. I truly hope so, before I'm saddled with the DNAR.

Screening for Cancer Fails to Prove its Worth.

2011-09-01T13:17:00.000+02:00

I have talked at some length about Breast Cancer Screening before, and accused those involved to be more interested in perpetuating the myth that 'screening saves lives' than in providing facts for women to make an informed decision. Well, the clamour is getting louder for 'real information' to be available for this and other screening protocols and what are the advocates doing to quell the disquiet? Closing their eyes, ears and more importantly their mouths.

The recent study in the BMJ showed clearly that screening (mammography) is not responsible for the reduction in Breast Cancer mortality seen in six Eurpoean populations. In fact, in a few of these countries, mortality was reducing prior to any screening protocols being in place. The response of the screening lobby ( a powerful vested interest), has been resounding silence, to these obvious negative inputs to the argument. Displaying the trait it seems of the 'three wise monkeys', as Richard Smith explained on his BMJ blog.

Screening for Bowel Cancer too has been having some bad press as the relative risks are presented as absolute in the leaflet provided to the prospective cohort (including me). In truth the risks are quite small and the relatively 'crude' methods involved in screening lead to many false positives, waits for confirmation, and much unneccessary treatments, investigations and, the attached risks of harm involved in colonoscopy are actually higher than the likelihood of Colerectal Cancer (much higher at 1 in 150) and the risks of procedure causing perforation and the consequent risk of pertonitis is 1 in 1500. Risk of death is pretty low at 1 in 10,000, but that is close to the absolute risk anyway, which is less than 1 per 1000 in ten years of screening.

Mitzi Blennerhassett, wrote in Macmillan blogs about the dearth of information, and indeed the bias of that available and she is (thus far) a survivor of colerectal and breast cancer, so she talks from the frontline. The replies to the BMJ about the study also make fascinating reading, with much criticism of the lack of evidence and indeed the arrogance portrayed by most in the 'business' (for that is what is) when questioned as to the efficacy of mammography or indeed most forms of cancer screening.

The NHS spends vast amounts on these protocols, allegedly to save us from 'harm' and an untimely end, but fails consumately in simple areas of diagnosis of illness in so many patients, treats the elderly with appalling disdain, even cruelty. Is lacking in 'adequate out of hours' trauma provision. Trains Doctors to be patently less good at the job than in the past, then 'throws' them into the maelstrom of A&E with little or no mentoring or backup. When scientific evidence is presented that indicates that a drug or procedure is harmful, especially Primary interventions for prevention using 'surrogate markers' or end points, rather than a patient actually being ill, they ignore it!

Prof. Michael Baum with others, ( 3 pages of them) wrote to the Sunday Times about this lack of information and the virtual conspiracy of silence that exists around the harms, way back in 2009. He was ignored. He wrote again recently but that's behind a paywall now so I can't post that link. The signatories are seeking a judicial review of the screening programme because they are so incensed by the lack of information and potential harms it causes. The conspiracy of silence continues with evidence stacking up in the aisles that we do little to end the tyranny of Cancer but much to find it, where it doesn't exist and even more to treat it with questionable drugs and procedures that may in fact add to it's virulence. A scientifically informed choice is what is needed and an NHS dedicated to curing the sick and the lame, and giving comfort to the dying, not that which we have now.

Obesity (Again).

2011-08-23T14:03:00.003+02:00

Being overweight remains in the news, with bulk of opinion being slanted toward the view that people who are in this state (obesity and the UK) are largely responsible for their own predicament. I not only find that somewhat cruel, but also founded in poor or even bad science.

I've already said in my previous post that is unlikely to be the fault of the 'fatties' but more of those who are advising them to eat a 'healthy diet' which in the DH 'speak' will largely be carbohydrate based and 'low fat'. In the latter's case that will be monounsaturated fats and polyunsaturated fats instead of saturated fats. Plant based oils (generally) then, in lieu of animal fats. This last bit of advice seems to fly in the face of the fact that homo-sapiens have some problems in metabolising some fats with CIS bonds (and even more problems with fats containing trans bonds). Animal fats such as lard, tallow and dripping, also contain quite large amounts of mono and polyunsaturated fats despite their undeserved reputation for being entirely 'saturated'. Yet, it is patently obvious that this advice to avoid saturated fats and animal fats in particular, has done nothing to reduce the incidence of obesity and the associated risks of Diabetes, CHD, CVD and Cancer, because it continues to increase.

Looking in more depth at Nutrition and it's relationship with obesity we have to consider the mechanisms involved in becoming overweight. 'Hyperphagia' is synonymous with obesity, that is over-eating in simple terms. It can be a result of some genetic disorders or Diabetes, especially in Type 1's who inject insulin. It also manifests itself in Type 11's who are in advanced stages of the disease. High Carbohydrate diets typically can bring about this problem due to increased gene expression of the neuropeptide Y(NPY) in the hypothalamus, and causing a reduction in the expression of the hormone (CRH). What that means is that the brain is increasing its output of orexigenic (hunger generating) agents and decreasing output of anorectic (hunger suppressing) agents. This is how the brain stimulates our nutritional needs of hunger and satiety. So, it is evident that early stage diabetics (metabolic syndrome), Type 11 diabetics and the obese subjects will be permanently hungry. If, however we feed them a diet of fats and proteins and eliminate most carbohydrates, this phenomena is suppressed in a more 'normal' manner and appetite is curtailed at a much earlier stage in eating.

Forcing people then, to eat a 'healthy diet', two thirds of which is carbohydrate based, if we include the vegetables and fruit, is contributing to the obesity that it is meant to be reducing! Once we become 'insulin resistant' as well, we can arrive at a position where almost all intake is rapidly stored as fat, despite the fact that we are hungry, even starving, and our ability to 'feel full' is almost non-existent. Low carb diets, especially in the context of this section of society, are proven to have a considerable success in enabling obese and diabetics to attain an optimal weight and, more importantly, to maintain it. The mechanism is not fully understood, and there is considerable conjecture amongst biochemists that it may be down to ' metabolic advantage' with fats and proteins, or the satiety afforded by this food group actually reducing the calorie intake, or even the fact that increasing saturated fat intake, replaces vegetable/seed oil intake (generally Omega-6's) and that in itself helps to reduce obesity. Many hypotheses are propounded, reputations impugned, the science examined, re-examined and much that is known is based upon animal studies, not humans, but whatever the mechanism, it is certain that for most, a low or minimal diet of carbohydrates does bring about considerable weight loss and a 'normalisation' of blood sugars in most diabetics (Type 11's). Dogmatic views about diet and nutrition, without examining the science involved and ignoring outcomes, is what has brought about the ever rising tide of obesity and diabetes.

Those of us who are 'insulin resistant' respond to this more readily than any other cohort, and it is not a panacea for all, by any means, because all of us reach a plateau with our bodies, some quicker or slower than others. In fact being slightly over weight has some advantage for humanoids and was likely a defence mechanism against famine or periods when food was not abundant. The body in fact conserves energy in fat reserves and is quite loath to give them up, which is why so many dieters fail in their endeavours to lose weight because basal metabolism 'slows' as we begin to diet, especially with low fat/low calorie diets. Your body is attempting to 'save' you from yourself.

Completely Unnecessary Picture of Low Carber J- Lo

So why does mainstream advice for lowering the risk of obesity and the morbidity's that stem from it, continue to advocate measures, that are most likely to fail either in the short or long term? Well having your beliefs undermined, no matter how much evidence exists to prove you are wrong , is hard to bear, even for Doctors and Scientists.Being told what you want to hear, is comforting and reinforces preconceptions at the expense of the truth. Selection bias is something we are all guilty of at some time and I admit to it myself. We should not defend the indefensible but all too often the truth becomes clouded by hyperbole. Scientists delight in the rigour of 'peer review' often tearing quite good studies to pieces because 'they can' rather than due to any poverty of evidence. Equally as well they often lose the ability to reflect that 'correlation (and observation) does not prove causation' in the data they present. Which is why we get 'scare' stories extrapolated from views and opinions of Scientists, rather than hard evidence of harm.

It should not be countenanced and I have always believed that all of us need to be as objective as possible in our search for truth, even when that truth challenges our basic and long held belief system. 'On the word of no-one' (Nullias in Verba), only the proof, is what we need.

This post has been devoid of links thus far. I've saved them to the end. I've used some before, so don't be surprised to see them again. They all possess the 'gold standard' of trials, they are RC T's.

Brehm BJ, et al. A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women. J Clin Endocrinol Metab 2003;88:1617–1623.
Samaha FF, et al. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. N Engl J Med 2003;348:2074–81.
Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr. 2003 Mar;142(3):253–8.
Aude YW, et al. The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat. A Randomized Trial. Arch Intern Med. 2004;164:2141–2146.
Volek JS, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism 2004, 1:13.
Yancy WS Jr, et al. A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia. A Randomized, Controlled Trial. Ann Intern Med. 2004;140:769–777.
Nichols-Richardsson SM, et al. Perceived Hunger Is Lower and Weight Loss Is Greater in Overweight Premenopausal Women Consuming a Low-Carbohydrate/High- Protein vs High-Carbohydrate/Low-Fat Diet. J Am Diet Assoc. 2005;105:1433–1437.
Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and learn Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women. The a to z Weight Loss Study: A Randomized Trial. JAMA. 2007;297:969–977.
Dyson PA, et al. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabet Med. 2007 Dec;24(12):1430-5.
Shai I, et al. Weight loss with a low-carbohydrate, mediterranean, or low-fat diet. N Engl J Med 2008;359(3);229–41.
Krebs NF, et al. Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents. J Pediatr 2010;157:252-8.
Summer SS, et al. Adiponectin Changes in Relation to the Macronutrient Composition of a Weight-Loss Diet. Obesity (Silver Spring). 2011 Mar 31. [Epub ahead of print]
Daly ME, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes–a randomized controlled trial. Diabet Med. 2006 Jan;23(1):15–20.

Obesity - The Bing Crosby Approach.

2011-08-04T13:53:00.000+02:00

"Accentuate the positive, eliminate the negative!" That is the 'spin' of politicians and doctors, who wish those endowed with excessive subcutaneous fat to be nudged into a healthier paradigm for life. Yet most of their 'crooning' is patently wrong. It is said that more and more of us are getting fatter, and as a consequence, putting ourselves at higher risks for heart disease, diabetes, liver and kidney failure, together with a myriad of co-morbidity's associated with the 'obesity explosion'.

Fellow blogger the masked crusader has a rather darkly humorous solution, but his description of the obese as 'pie eating lardbuckets' is somewhat harsh to say the least, because it is the advice that many of his colleagues provide to 'fatties' that is fueling the crisis. It is also obvious that his cunning plan to recycle the result of liposuction is fatally flawed. The energy needs to enable such a 'rendering' would far outstrip that provided by the resultant product. So, put down that pie and pay attention!

Obesity is defined by having a Body Mass Index of 30kg/m2, which can be ascertained by dividing your weight in kilo's by your height squared. For someone 6ft tall (1.8mt) and 11 stone (70 kgs) that would be a BMI of 21.60kg/m2. There are, as one can imagine, quite a few people with lots of muscle who would then be called 'overwieght' (BMI of 25 - 29.90) and even obese, so the formula does not fit all. In fact, whilst subcutaneous fat is an indicator of obesity, it is visceral fat (the fat around internal organs) that is a better predictor of disease.

The recent survey on health and obesity from the NHS shows some quite interesting data, especially on diet (although it will take some time to read all 112 pages), which does show that advice to eat '5-a-day' is working with the 5 to 15 year old's as consumption has doubled. All people are also eating less trans-fats, saturated fats and sugar than 10 years ago, and calorific intake has tended to decrease since 2006. Yet we are still getting fatter, have more diabetes and heart disease (despite the fatalities from it decreasing). We are as a whole also taking more exercise, with a 7% increase (absolute) between 1997 and 2008, with men exercising much more than women. Surely, it is sensible to assume then that this advice, issued to the public and taken up, should have made some inroads into the obesity epidemic, even if only small, but it hasn't, if anything things are getting worse! Could it be that the advice is wrong? Err... well yes!

Looking at the advice we have; eat less fat, eat '5-a-day', take exercise, don't smoke, drink only a little of alcohol, don't eat sweets or sugary drinks, and of course consume carbohydrates in vast quantities, up to two thirds of your food intake (when you take fruit and vegetables into account). Now that we have been doing that for about thirty years, at ever increasing frequency, we are then told that; we are all lying about what we eat and we are eating far too much, remembering of course that average calorific intake has diminished since 2006, which together with lack of exercise (or not enough of it) is the reason for the spread of obesity and disease. So by 'accentuating the positives' of low fat, exercise, and non-smoking, and 'eliminating the negatives' of saturated fat, meat, alcohol, lack of exercise etc. etc. we have achieved, well nothing!

Now we are told, that if we are above a certain BMI, we smoke, or drink above a certain limit, that we will be proscribed from various treatments on the NHS, because it's all our own fault and we are a bunch of lying, drunken, "pie eating lardbuckets", who do not deserve the largess of the NHS to help us fix the problems that ensue from our aberrant behaviour. What a crock of s**t! What about the other cohorts in society, who run in marathon's or just run in the the vain hope of 'super fitness' and end up in dedicated 'sport injury clinics' in the NHS? Or those who diet to the point of death, because society's model of beauty is a size 6, or indeed children diagnosed with ADHD, because their parents take the advice of the DH and feed them sugar laden grain products for breakfast, because it's 'healthy grains', pasta (wholewheat of course) and bread with almost every meal (brown of course). Surely all of these are equally responsible for their plight as is anyone who is said to be a chronic 'over eater'. This is Eugenics for 'fat people' and in my view is bordering on racism for adiposity.

You get fat not because you eat too much, or don't exercise but because you eat the wrong things, usually based on the advice of the Dept. of Health, or Heart UK, or Diabetes UK or one of the other self serving organisations we allow to govern our lifestyle choices, simply because they are heeded as being 'expert', when in truth they preach misguided and unscientific dogma. Despite the fact that they have been doing so since the late 1970's with no tangible proof of success, or indeed any evidence to support their ludicrous claims that they 'know best'. Often their advice is based upon Food Industry claims completely unsupported by any evidence because they want to sell you something. Or indeed some pseudo science from the USA that has long been disproved as fantasy.

There is no evidence that fat, makes you fat. None at all. Never. There is no evidence that eating saturated fat causes heart disease. In fact there is considerable evidence that the converse is true, with low carbohydrate, high fat and protein diets being the best solution for weight loss and health. There are many proofs of this but the most meaningful is the biochemistry involved in food intake. Carbohydrates are the food group that requires an insulin reaction to enable them to be metabolised, and conversion to glucose, no matter what their glycemic index is, will be extremely rapid, and more importantly virtually completely, to provide energy needs. The problem is that glucose, if not used up immediately is stored as fat and it is very difficult to utilise all of the glucose from a high carbohydrate meal immediately no matter how much exercise is taken. Fats and proteins are somewhat different in that they are not metabolised rapidly but quite slowly and not with the same ruthless efficiency as carbohydrates. Protein intake is needed for cellular generation from the amino-acids formed from their product in the body, so little is stored as fat. Fat is metabolised very slowly and with very low efficiency with nearly half of intake being 'wasted' and passed as ketones in urine. And of course, the 'calories in calories out' paradigm peddled as the 'gold standard' for diet is fatally flawed because of this.

The use of a 'low carb' diet has proved to be the most effective for weight loss for over a hundred years and it's modern equivalent 'The Atkins Diet', the 'Paleo Diet' or indeed any of the more up to date versions of diets reliant on fats and proteins in varying mixes to achieve a reductions in body fat are in the ascendant, yet the DH and Doctors generally seem hell bent on ignoring evidence of its efficacy. I find it difficult to see why.

It seems perverse to refuse treatment to any sector of society however guilty they may be of their predicament at the same time as providing it to others who are intrinsically as guilty, but worse have deliberately pursued a reckless course of exercise, or driven too fast, when drunk, or taken drugs. Fat people have usually tried hard on low calorie diets, or worse taken some of the awful, and generally useless drugs for obesity and consistently failed. If healthcare continues down the road of diets that set up the obese to fail, they are just as complicit as those they refuse to treat, indeed more so. Taken to extreme, why not have an undertaker posted permanently at A&E to wait whilst undeserving patients expire?

I seem to remember that a certain Steve Field, once head 'honcho' at the RGCP (now replaced by the excellent Claire Gerada) was a bit of a 'lard bucket' at the same time as he was selling us the idea of a 'healthy diet', didn't seem to work for him either! (Sorry, couldn't resist).

Counting the Harms (and the cost),

2011-07-10T18:44:00.002+02:00

I hold the view that the NHS is responsible for considerable harms. The cost of those harms, both financial and in lives, are often overlooked by the populace, because they hold to their bosom's a number of myths about disease, and how it can be avoided by 'screening'. That protocol is more of a political imperative than one borne out by the science. Cancer is one of these. We all want to believe that the NHS can save us from a terrible termination of our lives by 'catching' this scourge of contempory existence, in it's early stages and thus saving, or at least prolonging our lives. We are deluded. And it is 'bosoms', probably most of all, where screening concentrates it's efforts.

Breasts, define the difference between the sexes, perhaps more than any other element of appearance and they are an emotive indicator of feminism, much admired by men and cherished by women, whose fear of breast cancer and the loss of that essential feminism, seems to be a real and present danger. But, that is largely a myth. Incidence is in fact between 1 and 2 per 1000 per year, dependent upon whether you are pre, or post menopausal. In fact 80% of detected breast cancer occurs in women over the age of 50, so this cohort is the most at risk. However, if we compute that into a ten year risk analysis, then 994 women out of 1000 will not get breast cancer.

Fiona Godlee in the BMJ of March 2006 questioned the ethics of screening and came to the conclusion that it was overstated for efficacy and 'over diagnosis' was a considerable failing of the system. This is reflected in the views of Professor Michael Baum in this critique he wrote in 2008, shortly after he resigned from the programme which he had helped to set up. Principal amongst his thoughts, are that screening does not cure anything it just detects asymptomatic disease; breast cancer, well maybe. But 'catching it early' does not devolve any cure, merely a postponement of the inevitable fate of us all, for a somewhat flawed paradigm of periodic testing, that in itself has unpleasant and somewhat dangerous implications for the recipient, with no gaurantee of longer or better life than would have been the case without it.

Mammography is the current test protocol for the early detection of abnormalities, which involves quite high levels of ionising radation, being delivered in several doses, to ensure an 'allegedly' complete picture of the breast. In fact the dose is equal to 1000x that from a standard chest X-ray, so there is some considerable dangers attached to screening in this manner. This holds true when pre-menopausal women are screened, as is the current plan (coming soon to screening centre near you), because the cumulative dose will increase significantly due to the longer screening periods. A dose level of 1 rad in total is often the case, so over time this can add up to a significant risk for cancer in it's own right. In fact the estimated risk of cancer from mammography was calculated, based upon a life total of 24 screenings, of the digital type (which uses a much lower dose than film screening, usually employed in the UK) that 8.6 women per 10,000 would develope cancer as a result of screening, in itself. That, I would add is not far short of the overall risk of 1/1000 of getting cancer anyway.

The Nordic Cochrane Centre has conducted extensive research on the subject and came to the following conclusions;-

Absolute risk reduction for screening is 0.05%
.
Screening led to an absolute risk increase of 0.05% due to a 30% overdiagnosis and overtreatment.

So, for 2000 women screened for 10 years, 1 (that's one) will have her life prolonged and 10 (that's ten) healthy women, will undergo unnecessary treatment including breast removal, chemotherapy and radiotherapy, for no useful purpose. The Centre has produced a leaflet which gives an unbiased and scientific evaluation of screening to enable women to make an informed choice, as opposed to the over emotional and biased view portrayed by the NHS and indeed most Physicians.

There have been many studies undertaken to prove or disprove the efficacy of mammography, and the results have been ambiguous a lot of the time, but the the Canadian Trials are viewed as being amongst the best and it is clearly stated that screening had no impact on mortality (post menopausal women 50-59). Here is the view from the Cancer Prevention Coalition in the US who have considerable reservations about it's outcomes and the forces at work that advocate it's use. And this riposte published in the The Lancet from February of 2002 looked at the attempts to 'rubbish' the Canadian and Malmo trials which, when evaluated showed no difference in mortality between screened and unscreened women (see here for more comment). Even the quite militant screening advocates, the US National Breast Cancer Coalition, indicate that screening only reduces the absolute risk by 0.07% ( in women between 50 and 65).

So at best we can hope for a very small, numerically insignificant reduction or no reduction, in breast cancer in post menopausal women, by mammography screening, for some extremely unpleasant side effects and a 10x higher risk of over diagnosis and treatment. Many cancers detected are in fact benign or self limiting and will regress if left or simply stay the same. We do much harm and very little good by screening and for women with breast cancer, a majority will have found it themselves and screening will have played no part, or worst the lump will have appeared between screenings. In other words screening finds very little vigorous tumours but is good at finding and treating cancers that are not usually life threatening. This skews the picture even more.

And what of cost to the NHS? Well around 2 million tests are undertaken each year and rising. The cost of the tests was £166 million (in 2008) but obviously more now. If we add in the re-tests, biopsy and operation and therapy costs so that we save one women in 2000 (in 10 years) but at the same time treat 10x that number who do not even have cancer, we are talking about £500 million or more. How can the NHS justify this enormous cost without having better outcomes? And why do women tolerate this appalling invasion of their bodies with all the attendant risks, amongst which is the fact that if they have already got cancer at testing, the 'squeezing' effect of the plates is likely to cause it spread much more quickly because of the force employed which is about 200 newtons (45 lbs).

Screening is not prevention, merely the detection of a marker for a given disease, or an actual tumour in the case of cancer. We 'sell' to women the view that we are preventing their untimely demise from cancer by screening, which is of course a complete lie. It is in the interests of all involved in this 'industry' of testing that it continues and proliferates as it has done since 2008, when the 'saintly' Gordon (Brown) decided, without any scientific input, that he would fund a whole new paradigm of test protocols to enable the 'plebs' extend their life spans. As is usual Physicians and the NHS leapt at this opportunity for even more incentive payments to increase their wealth (and power).It reinforced the utilitarian principles that have driven the Neo-Liberal doctrine since Tony Blair's ascendency and for all his heirs and sucessors including the ~~tossers~~ 'toff's' who now rule.

There are other alternatives for those who are particularly 'at risk' like the genetically disposed cohort, such as MRI and/or thermographic imaging, both of which are significantly more benign, or even entirely so. There is also considerable hope for a simple saliva test that will provide a non invasive test. There is also considerable evidence that maintaining sufficient levels of Vitamin D3 by exposure to sunlight (without sunscreen) can confer protection against breast cancer.

Well ladies, I have strayed into territory that many men would fear to tread, but I feel that you are all being manipulated by the emotional baggage surrounding this issue. Mammography is oversold and is wanting of evidence to justify both it's expense and it's outcomes. It appeals to the emotional attachment you have to a part of your body that feeds your offsprings, tantalises and fascinates most of mankind, and in many ways defines your femininity. It plays to the fears we all have of the 'big C' as John Wayne called it, and gives false hope for a dubious protocol that feeds an industry without morals, and an NHS that kills 25,000 people a year due to preventable adverse events ( Ian Kennedy's report of the Bristol Heart Inquiry). Let us 'clean the stables'of that mess instead of venturing into prevention strategies of little worth.

.

Save It Or Cure It (Part Two).

2011-06-27T19:35:00.001+02:00

In my last post I went on at some length about the tenor of the debate taking place about the future of the NHS. I outlined a few of the reasons, as to why it has cost so much to achieve so little, as regards the outcomes that were planned but never bore fruit. Never, except in the febrile minds of those Doctors and Politicians who conjured the concept of saving the 'proles' from themselves, by constructing a paradigm of ill advised and incentivised protocols, founded in 'bad science' or even no science.

Well, I have no particular desire to save it, and I'm pretty sure curing it is a lost hope, much like attempting to cure pancreatic cancer. The odds are stacked against it. All this 'bullshit' about the "the NHS belongs to the people" is rhetoric for consumption by the public to conceal the truth about a bureaucratic organisation, that is inefficient, uncaring and dedicated to maintaining the privileged position of the medical profession, no matter how poor or dangerous they are. It lacks any humanity, treating those who are old, pregnant, those with disabilities, mental and physical, and often the injured, with callousness and at best indifference. Legions have been sacrificed in the A&E departments, the long stay hospitals, the orthopod wards. It almost ceases to exist at weekends and holidays, except for the ill-paid and untrained nursing assistants, locum doctors and spotty FY1's and 2's. And yet it costs more and more despite this lack of care and consistent under achievement.

The scandals that have broken over the years, constantly fade from view and the NHS is consistently held up to be precious and worthy of merit despite the fact that the very existence of these appalling debacles in care indicates the lie this is. Every politician within the ranks of every party wants rid of it and they collude together to bring about it's demise and have done so since the turn of the century. The critics of reform are just 'spinning' for appearances sake. The reforms have to be done by stealth, and creeping Privatisation or 'Marketisation' are the tools. Yet this will change nothing, except of course to make it even more expensive than it is now. The same medic's will be working for Mammon as they did for God, wielding the same indifference, stupidity and sometimes open cruelty, as before.

Sentimental and complacent attitudes abound about the NHS on every side, taking no account of it's sheer inability to fulfill any of it's promises to treat people with care and with safety. On many occasions it has lied and certainly obfuscates interminably. Not only have Doctors been proven as liars they have been given a right to do so by the lack of any law that stops them (see will powells' story). The NHS and the Doctors constantly and callously reinforce prejudice's against a large parts of society who are undeserving of their venom. The overweight, those who stray beyond arbitrary and unproven limits on the consumption of fats, drink, meat, butter, salt et al. All are stigmatised, patronised, even dehumanised by the constant vilification of their lifestyles despite there being considerable evidence that following the dogma of the DoH is at least as dangerous as not doing and sometimes more so.

The Institutions of the State set up to oversee the NHS from the Complaints system, to the Health Care Commission to it's successor the Care Quality Commission have been singularly and spectacularly unable to curtail it's worst practises and expose it's failings. Quality and Care are in fact an anathema to the NHS which not only robs its patients of dignity but on a number of occasions actually takes their lives. The culprits rarely are found let alone brought to anything vaguely resembling ordure. Medicine is the only section of society where causing death does not automatically invite investigation and prosecution (well alright the Police as well).

Some may view this as extreme but if we are ever to curtail the power of Physicians and those who invest undeserved benevolence in them we need to be extreme. So let's start all over again. Right back from the basics of curing the sick and caring for those in distress and danger, to the best of your ability. Not just to the end of the shift, nights and weekends excluded, even if you do have a private clinic to get to, or you've got a speaking engagement for 'Pharma' in Berne. Give back to the patient the respect they deserve as the paymaster, and stand up and be counted on their side, instead of just taking the money.

So let us not Save It, or Cure It, just slip in the syringe driver of oblivion you are so fond of using and kill it!
Oh, and by the way, I want my money back!

For George.

Do We Save It Or Cure It?

2011-06-23T13:33:00.000+02:00

The NHS, that is, now that the Future Forum has rendered it's report, to a somewhat baffled, bored or bemused public.

Saving it seems to be the view of the liberals (not the Liberals) who not having sampled it's wares often, (they're mainly healthy and in BUPA), but fervently do believe in it, in the sort of soft, warm and cuddly world in which they live, with their Volvo's, Labradors, wholemeal bread and 2.4 brats. Slagging off the ConDems somewhat flawed paradigm, for the NHS is almost a badge of honour among them..

The Neo-Liberals on the other hand, want to reduce it to the Purchasing Department of NHS plc, because (surprisingly) the paradigm they've constructed to prevent illness, in advance of it occurring hasn't actually worked. In truth, most of the political input to Healthcare is a 'busted flush' such as mammography, which has done nothing to reduce breast cancer incidence, and has often done more harm than good, as eminent breast Surgeon Michael Baum opined back in 2008. The position has deteriorated in the intervening years with more being spent to produce worse outcomes. And QOF (The Quality and Outcomes Framework) has assumed the mantle of a policy to keep UK 'Pharma' afloat, and reward GP's for achieving dubious surrogacy of health, than making any significant inroads into heart disease or indeed any disease of civilisation, such as Cancer, Diabetes or Stroke. In April the Kings Fund condemned it (QOF) for not having "improved health outcomes or reduced health inequalities". (please forgive me quoting from them).

Even more sadly, the health care unions have not raised the game, but generally portrayed themselves as a bunch of greedy militants, undeserving of their pensions, thus playing right into the sights of the Daily Mail assassins. When in truth the average 'coalface' worker in the NHS is poorly paid, often badly treated and gets a quite low provision in pension compared of course with the management. The 'elite' seem to be little affected by the proposed changes, and seem to move seamlessly into new roles to help forge the brighter future that we are told will be the reward for NHS reform (yeah, and the cheques in the post etc, etc).

As I have previously said the debate has sunk to a level of a 'war' between opposing armies, with Steve Field's lacklustre crew attempting to treat for an armistice, but only achieving surrender, with a few crumbs for the Dem's in the Coalition of Toff's. Little to nothing has been done to assuage the inroads made by PFI into an already 'stretched' budget. Nothing said about savings that could be made by shifting the paradigm to actually care for the sick, injured or dying, rather than medicating the population with the flawed output from 'Pharma'.

Structured targeting with science based interventions into disease, needs to be based upon evidence, not dogma and flawed or even falsified trials that pervade medical journals. Always, we are presented with a polemic by both politicians and most in health care. They will have no truck with opposition to flawed and often dangerous policies or protocols. We are patronised and vilified, lectured and harangued, always to reduce this or increase that and the net result to date has been somewhat less (health) for somewhat more (money). Just take this pill and you'll live forever (but your life will be miserable). As the funders of ... well everything, we deserve better.

Nowhere to Hide Now!

2011-06-15T09:48:00.000+02:00

Some news today that many of us have been awaiting, often with many false dawns, I might add, but always with hope that one day, Will Powell's long and damaging campaign (for him and his family) for a statutory duty of Candour, might be over. If the Condems do this one thing, they will, leave Doctors and others in Healthcare, who lie, about their failings, even on oath, with nowhere to hide. I give below the press release from the NHS Justice Group;-

"Dear Group, and our friends the Cure the NHS campaign groups,

The news I have been anticipating for ten years is upon us all. I do apologise for the gigantic text but here it is. Please circulate to your groups as appropriate:

News release from NHS Justice Group.

Mr William Powell our Lead Campaigner on the Issue of Duty of Candour who has waged an almost single handed campaign for decades is now nearing completion of his massive effort for all of us.

“Good for us, Good for the Country and Good for the Profession”.

Here are links to his story and the unflagging support he received from Diane, aka ‘The Boss’ over those long hard fought years. They are worth looking at.

http://www.nhsjusticegroup.co.uk/photos/willdianewords.html - The Story
http://www.nhsjusticegroup.co.uk/photos/willandboss.html - The BAFTA Award
http://www.nhsjusticegroup.co.uk/photos/mrandmrspowellwords.html - The Freedom of Information Award
http://www.nhsjusticegroup.co.uk/photos/robbiewords.html - Robbie

AvMA PRESS RELEASE For immediate release
GOVERNMENT APPLAUDED FOR INTRODUCING A "DUTY OF CANDOUR"
In its response to the NHS Future Forum report published today, the Government has finally committed itself to a Duty of Candour in healthcare - an enforceable duty to be open and honest with patients or their families when things go wrong. Although the detail of how the new duty will work is not yet known, it is described as a new contractual duty on healthcare providers. Additionally, the Government has said that it will give legal force to patients' rights in the NHS Constitution, which also covers being honest about mistakes.
Peter Walsh, Chief Executive of AvMA, said:
"This is great news - potentially the biggest breakthrough in patients' rights and patient safety since the creation of the NHS. The devil will be in the detail. The duty must be clearly set out in statute and organisations who fail to comply must be held to account. But we are extremely grateful to the Government for having listened. This new duty should be known as "Robbie's Law" in honour of Robbie Powell, the young boy who became the symbol of our campaign and whose family have done more than anyone to raise awareness for the need for change".

ENDS

Regards

George Kuchanny NHS Justice Group Webmaster."

I can add little to this, except to invite others especially Doctors, to join in my congratulations.

21st Century Health Care?

2011-06-14T13:43:00.000+02:00

Upon arrival back at the hovel, a few days ago I perceived that the answer 'phone was flashing a message. Pulse racing with anticipation, I scrolled through the interminable menu at BT to retrieve it and lo' it was my friendly neighbourhood Health Centre, inviting me to call them to arrange a 'health check'. How sweet, how kind, that they should be so concerned about my health and well being (sic).

This same provider of Primary Care, that fails to provide any help or support for she whom I care for, in the lack of any provision of testing strips to monitor her blood glucose, will not prescribe any Colpermin for my IBS, failed to help with my severe PTSD beyond a referral to a community mental nurse for an assessment, eight weeks down the line, when I was already in such anguish that I could barely function. Never reminds us of the need to get an HBa1c test for my loves NIDDM (Type 11 Diabetes). Looks askance when I suggest a (25)OHD test for her, to ensure her levels (Vitamin D3) are improving from the appalling low level of last year. In fact unable (or unwilling) to support any of the interventions that are useful or sustaining of health, but can find time and funds to fulfill the the needs of the prospective rewards available under the Quality and Outcomes Framework, if they can undertake a number of tests (on me) that will assist in achieving the practise goals.

I gave the matter some thought, for about ten seconds and thought 'f**k 'em, why should I help them earn some extra cash when they provide no real support, for mine and my partners problems. She will not take Diabetes drugs, and prefers to control NIDDM, with diet, exercise and supplements. Yet, to ensure that this is containing the disease, which it is, we need to undertake at least two or three tests per day. The cost of the test strips is £28.00 per 50. By buying on-line I can reduce this to £21.00 per pack, but that is still £31.50 per month. Vit D3 and Omega 3 supplements plus Vit C and ALA adds at least another £20 a month. Add to that my Colpermin at £21.00 per month and before we know where we are a £100 is gone. I do get a free prescription for the rather dubious pleasure of dosing my self for Glaucoma, which I've had for 25 years, with a prostaglandin analogue. But hey, I've been paying the State for over 40years, with taxes that make my eyes water, is it not about time I got a little back? But no, if you don't take hypoglycemic agents, you don't get free strips; it's a sort of punishment perceived somewhere in the DH, that is basically saying to those who won't tread a certain path, to the wheelchair into the dialysis suite, that we won't play ball with you. This is despite the fact that all the indicators are that a 'low carb diet' is just as effective but less dangerous than the DH recommended protocols.

No, the simple truth is that the NHS and all pretty much who sail in her, have their heads stuck so far up their own backsides and that of 'Big Pharma' that not only can they not see the wood for the trees, they lost sight of the wood itself. They are not interested in outcomes, only dubious 'surrogate' markers of alleged, sometimes invented diseases. When some 'wet behind the ears' locum GP tells me that fat (not even cholesterol), could be clogging up my arteries, and cause heart disease, and that 130/60 is a high BP, I feel like strangling her with her own stethoscope. So if they want to monitor my BP and do a lipids test, and ascertain my alcohol intake, more to make the what, £136 a point for QOF (average would be about £250,000 a practise all told) than for any regard for my health. Then I could be lectured about my lifestyle, at a level about that of a 12 year old, so I could then retort that 'I wear shoes older than you and was studying biology and biochemistry before you were born' and 'you can't change the rules of human metabolism just because of the rubbish you learned by rote a med' school'. Life is too short and I need to keep my BP down (allegedly).

IFFI, GAVI, GSK and Benevolence.

2011-06-09T22:40:00.002+02:00

Acronyms abound in the world of Medicine and Health care and these few have been in the news of late due to the statement from Andrew Witty, (current salary £2.3million) CEO of GlaxoSmithKline, that they are going to make available to the Global Alliance for Vaccines and Immunisation, their Rotovirus vaccine at 'cost price'. That is said to be £1.50 ($2.50) a dose, but they already receive 'advance market commitments' (cash up front) to develop vaccines for GAVI, so the benevolence assumed is somewhat less than the statement suggests.

My feeling is that this has little to nothing to do with the charity of 'Big Pharma' but is more likely to be linked to the need to rebuild the business of GSK, after the appalling Avandia debacle, which has wiped the last quarter profits in 2010. Witty has a plan to 'save' GSK from the decline in markets, brought about by 'Pharmas' inability to come up with any really useful drugs for some time, and the expiry of patents on some of its money spinners this year and next.

So, whilst forcing back a tear, I will move on to the infection that they are trying to prevent; Rotovirus. It is a disease of childhood generally, a type of Gastroenteritis, that responds well to simple hydration therapy and most children will have had it at least once before five. It is alleged that up to half a million deaths could be prevented by the use of a vaccine for the Type A virus, which is the one responsible for 90% of cases. These deaths mainly occur in emerging nations and this may because of poor hygiene but studies have shown that the rate of infection varies little between nations so this seems unlikely. The death rate is very low, at about 1 in 73,000 cases, provided the child is kept hydrated. This vaccine is not generally available in the UK, as a childhood vaccine.

The early vaccines used were shown to be effective but Wyeth's Rotashield, was withdrawn in 1999 after it was shown to cause serious bowel obstructions in 1 in 12000 cases. GSK produced Rotarix in 2006 which is the type being offered at this much reduced cost. This too was withdrawn in 2010 after batches were shown to be contaminated with a porcine virus but re licensed when GSK successfully persuaded the FDA that this content was 'harmless' (sic). But these problems did highlight the view held by many, that some vaccinations employed in pediatrics, are needless intrusions into the formative immune system of young children often on somewhat dubious medical grounds. We seem to feel that children should be saved from the possibility of almost any infection and are ready to dose them with myriad vaccines at very early ages, in a pursuit of this rather dubious goal. Often having an infection, so long as it is not serious or life threatening, is a better way of providing immunity than undertaking multiple vaccination protocols.

I, as many will perceive, am not a lobbyist for GSK, or indeed any of 'Big Pharma'. They have consistently failed to place patient safety at the forefront of their operations and it is said that little more than half of the supporting trials that should go on after approval, to ensure efficacy and safety, go unreported and little publicity is afforded to any information that shows a new drug to be worse than an older one. 'Picking' and 'cherry' are the words that spring to mind, or perhaps 'publication bias' would better describe it.

I would also like to throw some light upon the vehicle chosen to deliver the beneficence of the West into the Third World. IFFI (should that be 'iffy'?) is the International Finance Facility for Immunisation and is the funding vehicle for GAVI. Funds from donors are channeled into IFFI, which raises bond issues which are backed by the countries who have pledged future funding. It's a sort of Public Private Partnership, with Goldman Sachs, Deutche Bank and HSBC amongst others selling bonds which yield a return for investors. GAVI then uses the income stream to pay 'Pharma' for it's products and research to allegedly save people from the ravages of disease in far off countries, we used to colonise. To be frank I find the structure somewhat puzzling to fathom, but Bill Gates is one of the funders, so it's has to be OK then (sic).

A conference, fronted by (call me Dave) Cameron is taking place in London on the 13th June, where he is expected to promise additional funding for GAVI. GSK and no doubt Andrew Witty will be there, although GSK's place on the GAVI board is now being handed over to Johnson & Johnson's Swiss subsiduary. Why they ever had one in the first place amazes me. Maybe that's why the bulk of the money from IFFI goes to Western 'Big Pharma', whilst the emergent drugs industry, in poorer nations, who allege they can make and sell most of the products utilised by GAVI at much lower prices, never get a look-in. All sounds like some elaborate Government sponsored 'Ponzi' scheme to me. Pretty much like the 'Private Finance Initiative' or 'Independent Sector Treatment Centres'. I notice the US will not back these 'bonds', nor are they allowed to be sold in the US, nor do they seem to contribute to the fund. Although most of the money in the fund, finds its way there anyway, because that's where 'Big Pharma' lives.

Why does misery always have to generate a profit?

New Idiots Guide For NIDDM Published!

2011-05-23T10:52:00.002+02:00

NICE has published it's latest guideline for the prevention of Type II Diabetes or as I call it, 'the NICE guide to the manufacture of new patients'. And yes, it's the same old drivel, regurgitating all the tired old protocols, most of which have proven pointless, counterproductive, and more based on dogma than any scientific proof.

I state that with considerable conviction, because these guidelines are unlikely to have any effect on the cohort they are aimed at; those with Metabolic Syndrome. There is still some conjecture as to how this comes about, with often touted views regarding Genetics (the medical excuse for pretty much everything 'they' can't explain) being responsible. And, it is often true that Diabetes does run in families, but whether by 'nature or nurture', there is plenty that we can do to thwart its arrival. The problem is that virtually nothing that is in these guideline's is likely to help.

Looking at the main advice, we have;-
Basing meals on starchy foods, such as potatoes, bread, rice and pasta (wholegrain of course)
(That will be the carb's then)
Fibre rich foods, oats, beans, peas, lentils, grains, seeds, fruit, vegetable etc,etc.
(Some more carbs' then)
Five portions of fruit and veg.
(Even more carb's)
Low fat. (Makes you fat, does fat, you know)
Don't increase your fat or calories. (Just starve then)
Don't have fried food, sugar containing foods or drinks, confectionery etc. (Some sense there)
Cut down alcohol (OMG!)
Watch your portion size. (As you eat it)
Eat breakfast. (?)
Be active as part of your routine. (That'll make you slim you know).
Stop lounging around you lazy buggers. (Sell the TV?).
Walk or cycle instead of driving. (And die under the wheels of the No7 Bus).

Well, that's the gist of it, but will any of that make any inroad into most people's risk of becoming overweight or Diabetic. Frankly no!

Eating excessive carbohydrates is more than likely the reason why some of us become Diabetic in the first place. Numerous studies have shown that carbohydrates are the food group most likely to add weight and increase resistance to insulin, especially refined carbohydrates and this includes 'so-called' wholegrains which are pretty much like all grains, err, only 'browner'. Carb's are converted to glucose, just like sucrose (sugar) at almost the same speed, and if large amounts of glucose flood the bloodstream then it cannot be utilised immediately. The liver will keep some as an 'emergency' supply, to smooth out metabolic need (fight or flight requirements while the body accesses glycogen). The rest will go to storage in adipose cells. If you need a more scientific explanation of the process, there's a really complicated diagram here.

Losing weight, especially if you are moving toward Diabetes is best achieved by diet. A large number of studies support this.Such as this one and yes I know the cohort was small! Well what about this one then? Or perhaps this one, and this one too. Or even this one. Increasing saturated fat intake and protein has more benefit than does lowering them and the review of the Atkins Diet came out strongly in its favour for the treatment of Diabetics and those with Metabolic Syndrome, yet mainstream views continue down the road of banning fat, extolling exercise and generally removing pleasure, all founded on virtually nothing more than dogma.

Looking at exercise, do we find that it has virtue? Well a little. It will not make you slim, but it will help to make you more healthy. But to sell intensive exercise or indeed any exercise as a means of losing weight is to raise false hope. This trial was designed to look at dose dependent exercise to see the results on a number of outcome. It will be seen (toward the end) that little to no weight loss occurred even in the upper levels of exercise, on quite fat people. In fact, intensive, long term exercise, such a marathon running, exacts a toll on the human body that costs the NHS considerably more in net cost than does smoking. Knee and ankle injuries cause the joints to wear out long before their usual time, costing vast amounts in new joints and orthopaedic repairs, without of course the financial input to the system exacted from smokers in the form of taxation. From 'runners world forum' you will see that most who exercise at the extreme, even tend to gain and not lose weight when in training. As a 'rough' rule of thumb guide, 1 mile of intensive running will burn 100 calories, so you can imagine how little is burnt in the sort of regime suggested in the guideline
.
As for 'low fat', well there is no evidence that links fat consumption to any consequence that is damaging to health. It is in fact quite helpful because it is satiating of appetite, as is protein. So those who mainly take their energy from these food groups, become 'fuller' for longer and tend to consume less calories. Anyway, calories in/calories out is a construct that ignores the second law of thermo-dynamics and is little to do with human metabolism. The human body is not a bomb calorimeter, it's a complex and often wasteful organism that utilises energy in many different ways both for immediate needs and storage for the future. There is in fact considerable evidence that Saturated Fats do not cause heart disease or indeed any other illness, in fact those society's that utilise large volumes of saturated animal fats are in fact extremely healthy (The Inuit). We can in fact live devoid of carbohydrates, but not protein. Death would result, because humanoids cannot live without it as it is the 'building blocks' of most cells.

Cutting Alcohol! Well it won't hurt if you are a bit of a lush, but if you drink moderately of high alcohol drinks it will have little effect on your progress to diabetes. If anything, alcohol tends to lower plasma glucose marginally, but if it has a high carb content like ales and beers, it will raise it. That's where the term 'beer belly' really comes from, it should be termed 'carb belly', it's probably more accurate. So the cola, mixers, fruit juice etc, should be avoided, if you want to drink. Go for spirits with water, or soda, or high alcohol wines, that are not fortified. Anything above 11-12% has had virtually all the carbohydrate turned to alcohol. But don't forget that alcohol has calories and we tend to take drink, on top of an adequate diet, so it can add weight in high volumes. It is also an anticoagulant and as such thins the blood. That daily glass of strong red wine is really medicinal, honest!

Being active is not a bad idea, but surely they don't have to patronise quite so much! Exercise, especially if you sit behind a computer every day is quite a good idea. But don't go mad, and exercise before eating, when you have fasted. What little weight loss that can be gained from exercise, works best whilst in a fasting state. However, specifically to lower plasma glucose, a walk about 1 hour after eating will help your insulin resistance and lower the level in the blood, at about the time it is peaking.

Breakfast. Well a number of experts actually recommend no breakfast at all, or at least not every day. If you wish to, then have a high fat/protein type. Yes, the old-fashioned breakfast, eggs, bacon, sausage (high meat content 90% or better), but forget the bread, toast and cereal. They will make you fat! And a cooked breakfast of this type will keep you going well into the afternoon, even until dinner. I personally fast several days until lunch, and I do eat a hearty breakfast occasionally and then eat dinner, missing lunch, because I'm not hungry. There is in fact a YouTube movie that explains some of the myths that have built up around fat and diet and the inevitable cholesterol. It's quite amusing and true. It can be viewed here.

The problem is that this type of government sponsored propaganda is 'dressed up' as being science. The references given are not studies, but other guidance, most from NICE. Worst, it simply restates that which has been refuted by forty years of trying to reduce the number of diabetics and failing! An inexorable rise that seems to confound all efforts at it's reduction. And obesity, sloth, gluttony and worse, is given as the reasons when in fact many people go to great lengths to lose weight, using such protocols and either fail or obtain a brief respite, only to regain all the weight or worse, gain a bit more!

To put things into perspective, we have evidence that the key markers utilised to indicate risk for all cause mortality, BMI (body mass index) and/or waist measurement, are in fact quite a poor guide. In this study, it was found that those with a lower BMI, were in fact at greater risk, than those with high index. So please NICE. base your guidance on real science, not junk science!

Normal Service....

2011-05-18T00:05:00.000+02:00

Will be resumed as soon as possible.

I lost two extensive documents when blogger went down, so thanks a lot guys. It constituted two weeks blogs for me. So thank you to all my readers for patience. I've also had the garage and car broken into, I'm being sued by some ambulance chaser and I've got 'man flu'. Other than that everything is fine. Oh, except for the broadband going down, no 'phone for two days, so thanks 02 you plonkers!

Welcome to Eliza, and thanks for reading my words.

Blackdog

Duped Again!

2011-05-05T12:02:00.000+02:00

Dr. No accused Today (a morning UK breakfast radio show) yesterday of being somewhat naive and short on completion of their homework, when it came to interviewing the 'shiny faced' leader of the populace. He was of course right, Humphries' title of pedant was shot down in flames by Cameron who seemed to have been given an extremely easy ride.

His female sidekick could also be accused of the same this morning, after listening to the interview conducted with one Nicholas Wald, who advocates that everyone over the age of 55, should take Statins, Anti-Hypertensives and Aspirin. Oh, and in a combined form. Now what might that be? Well, the Polypill of course! And who might be the owner of the patent rights to this concoction? Could it be one Professor Wald along with another called Law? Got it in one then.

Their latest attempt to subvert the cause of scientific study was published in Public Library Of Science,( PLos one), yesterday and examination of the study shows it to be all purely hypothetical in its content and indeed cohort, and is merely a manipulation of computational algorithms called a 'Monte Carlo' simulation. It is about as far away from the Randomised Control Trial as is possible. A little strange really when there is ample evidence already available to show that the protocols advocated are useless or dangerous even. But let not that get in the way of promotion of 'advocacy research', by the very person who might gain from its acceptance and adoption.

Where was the research; the challenge of this pathetic attempt at self publicity? Missing of course. Where have all the good journalists gone, I am wondering. Obviously not to the BBC!

Polarising Opinion

2011-04-25T19:15:00.003+02:00

The current 'listening' phase of the reform of the NHS is no doubt well under way and I cannot help reflecting how opinion has been polarised into two separate camps. One seems to want to 'save' it (the NHS), presumably as it is, and the other wants to embrace the changes with the sort of fervour usually preserved for a new lover. There is an animosity to these changes within much of the GP cohort, although they seem somewhat more agitated about having to pay more and retire later it would seem, than the reforms effects on patients, but 'nothing new there then'. There is, as Dr. No says, confusion amongst the proletariat as to what these changes may mean together with a touching belief that 'doctor knows best' so he/she would be the best one to trust to deliver that change.

He is of course correct; the patient at least until they come up against poor care, delays in treatment and being given into the care of the local ISTC, is unlikely to notice or care much about the changes. I can honestly say that until a few years ago I was much the same. Confident that all the cash I had handed over to NuLabour, had vastly improved the NHS because I had not had the need to call upon it. When I did however, horror of horrors I found it be peopled by, well ... idiots, who seemed to have been promoted well beyond their IQ and certainly their pay scale. Care or even interest, was missing. Drugs were handed out like sweeties for virtually no reason with no explanation of effect or prescribing reason. It seemed to be based on a 'just in case' protocol. Of tests there were many, but no results conveyed to the patient, (and probably to the Doctors), in fact the general status of the patient seemed to have a similarity to that of a mushroom; kept in the dark and doused (dosed?) with s**t, every day.That was the beginning of my antipathy toward the NHS and Doctors, which escalated with subsequent years of further mistreatment and lack of candour, culminating in an event of near death, that almost left me alone, and a legacy for one that I love, that continually intrudes into my life and thoughts.

For me then, the NHS was already 'not fit for purpose', long before Lansley's cynical escalation of the 'privatisation' model he learned form Kaiser, dressed up in the clothing of a 'Health and Social Care Bill' that escalates the NuLabour agenda of the NHS as a bounteous 'Facilities Manager', ordering Health care from a menu provided by Spire, Circle, Serco and all the plethora of Private Provision that expanded on Blairs 'watch'. I do not want it like this, any more than I want it to be as it is. But, a number of my friends as well as a good number of those I might call enemies, seem to feel that the reforms are so completely wrong, that they have to side with the NHS as it is, not as it should be. This model so out of step with need, with competence and any pretence of the provision of scientific treatments to promote health, now seems to be something we hold so dear that it has to be talked about with fiery rhetoric and a tearful eye. Even some of the architects of ISTC's, QOF and many other steps to Privatisation, such as the appalling Andy Burnham, the last Secretary for Health, have ranged themselves against Lansley's reforms purely for cynical political reasons. I am uncomfortable with him as a fellow traveller. Is the NHS so good that we should defend it with such passion, when before we did not, just because we don't like the new model? Well I think not.

So then, what has it achieved since the current model Circa 2004, has been in place, as regards one of it's foremost protocols, the Quality Outcomes Framework? A study from Finland shows that the actual cost and outcomes for osteoporosis are some way from the model upon which the protocol was based. And it is clear that the Randomised Control Trial bore no actual relationship to real clinical settings or the cohort for which they are prescribed. The outcome then for those who are taking a significantly awful medication was negligible. Equally as well, the study by Brian Serumaga of Nottingham University of the outcomes for hypertension in 470,000 individuals showed clearly that no discernable difference was found after the application of 'payment by results' for GP's, to reduce BP in the cohort than before. This was despite the payment of some £1.8 billion of taxpayers money to GP's!

We need to change the paradigm. Incentives for prevention have been expensive and counter productive and have actually been dangerous for a large number of people; the 'worried well' in particular. Most Doctors do not, and should not need incentives to enable them to perform. Those that do require payment, on top of an already generous salary and pension, to simply do their job, I would proffer, are not suited to the vocation. Any assumptions that Doctors are influenced by pay for motivation are flawed and should not be countenanced. The NHS is not a 'milch cow' for the unprincipled few who look to it for enrichment. These are those who continue to take the Clinical Excellence Awards, long after their achievement of any excellence was concluded, because once established there is no mechanism to end them.

The NHS is then perverse, corrupt and lacking in care, so change it we must. But the polemic employed by each camp is far too simplistic, should not the argument be better than this? And do not Doctors have have any responsibility for the appalling debacles that have occurred in the last few years, and indeed throughout history? I do not wish to share any platform of opposition with opportunists like Dr. David Owen who seems to think his No to AV stance will not close the door to electoral reform, when it patently will. We need progressive change, not another 'top down' Whitehall dictated revolution to empower cash hungry GP's and Private providers to even worse excesses than they have already perpetrated. We need no more PFI's and ISTC's because they deliver little other than profits for the shareholders. And we need to make Doctors answerable for their actions as a first priority. If we do that one thing maybe all the rest will fall into place.

For Julie and maybe Dr. No.

2011-04-15T19:25:00.000+02:00

The Pet as Predator

Felis Catus

Whilst the NHS burns, under the blinded eyes of the populous, I thought I would deviate from my rants about politicians and doctors and look closely at what we do to one of our closest companions in the this life; our cats.

As a long time lover and keeper of cats, having had ten of them, it seems we do a lot of damage to their health and well being, by foisting our own nutritional stupidity upon these denizens of the back garden. Long domesticated, they have enjoyed a relationship with humanoids that is unique, in that they often still forage for food within the environs of our (and their) homes. For an animal that is usually fed quite regularly by its owner, if we could ever 'own' a cat, this is somewhat strange behaviour and has fascinated me as to its reasons. Dogs, unless they are trained to hunt, rarely display this trait, except when perhaps abandoned in the wild and of a breed adapted to hunting.

Teeth Adapted for Hunting

Well, it seems that this trait is part of an instinct of self preservation. When fed an over abundance of the sort of diets, that we in our wisdom endeavour to feed them. they naturally, it seems, self select that which suits their metabolism and almost perfectly balance the intake of protein, fats and carbohydrate, to ensure they survive. When they hunt it seems they do so (in my view) to supplement any deficiencies in the food we provide. I well remember, that many of my cats, despite a diet that I was feeding them, alleged to be replete with all the requirements of the feline metabolism, still hunted and ate their prey. Well except of course the one's that they brought home for me! They always had a tendency to 'raid' the butter dish too, if it was left undefended by a cover!

When given the power of self selection however, it seems from a study funded by the pet food manufacturer Waltham, which seems to have been well conducted, interventional and lasting some two years, that our cats decide to balance their intake to a similar one they would utilise in the wild. As 'obligat carnivores', we do them a dis-service if we do not give them the diet that is as close to prey food as is possible. This may not sit too well with the vegans and vegetarians, I know, but we are not talking about you, but your pets. So it seems the ideal is, 52% protein, 36% fat, and 12% carbohydrate. The latter would normally be provided from the stomach contents of prey and already be part digested, because cats are unsuited to the digestion of carbohydrates because of their physical make-up.

They have no salivary amylase to metabolise starches, and they have intestines that can only take up low ratios of glucose. They also do not have any 'sweet taste' receptors, so they should not be given anything with sucrose in it. Nor they should they ever be given chocolate although they may take it offered, especially if young and inexperienced. It is poisonous to cats and dogs and can be fatal!

What then to feed them? Well as close a diet to one they would eat as a predator. That means meat, fish and organ meats with a small amount of vegetable carbohydrates. Raw is best, but to ensure parasites are destroyed, if you do go 'raw' then freeze it first for at least three days, which kills off any parasites. If your cat has been eating dried food, then introduce gradually, using lightly cooked meats initially. But cook any vegetables you add, to ensure partial breakdown of the starch and fibre and keep the content low.

A Near Eastern Wild Cat (just like yours)

Cats do not often drink, except when it's hot, or if you feed them dried foods. And dried food is well, 'dry',and as cats obtain most of their water from their prey food, the food that we feed should also be 'wet', otherwise we are storing up a lot of problems for our cats. These include, kidney and liver disorders, together with gastric problems. In addition, diets high in carbohydrates, will cause obesity, especially in older cats, together with thyroid problems, pancreatitis, diabetes, and vascular problems. And whilst this 'self selection' process will always occur to some extent, as cats get older they will hunt less and accept the diet you give them more readily, so get it right. Enjoy your cat, it's the wildest thing you are likely ever to have a relationship with, so keep it fit and healthy, not like us.

Hope you found a cat Julie!

Drugs Nemesis?

2011-04-12T13:43:00.002+02:00

And so, we say farewell to many of the most profitable drugs of 'Big Pharma' this year, with big names consigned to the bin and the 'generic' versions now being born to treat symptoms or more realistically, the surrogate marker of those. I say 'treat your symptoms' because Pharma rarely invents anything to actually make you well, or even better than you were, except perhaps for Antibiotics. However, that strand of drugs design is getting ever more difficult, ever more unprofitable, because the life span of such drugs is getting ever shorter and drug cartels are becoming ever more reluctant to pursue the goal of a new and better antibiotic because the returns are diminishing with each year.

Here is list of the more important items coming off patent during the coming year. Clicking on the name will take you to an explanation of it's use, but many of you will know them already. They are;-
1. Cozaar/Hyzaar - Merck
2. Lipitor - Pfizer
3. Flomax - Boehringer Ingelheim
4. Arimidex - AstraZeneca
5. Climara - Bayer HealthCare
6. Aricept - Aricept
7. Invirase - Roche
8. Hycamtin - GlaxoSmithKline
9. Protonix - Pfizer
10. Levaquin - Levaquin

Things are in fact getting so bad that the Investors are fleeing the market. $50 billion is the estimate of lost sales that will occur accumulating to $250 billion by 2015. And money is leaking from the coffers to settle bribery cases that have been brought to light in many areas of operation.

Pharma also faces the loss of income from the harder line now being taken by the FDA about approvals of both new and existing drugs for use outside original approvals. There is in fact a new era of stricter regulation that seems to be dawning in the USA, with bribery scandals abounding at the same time as many drugs are being 'canned' due to failure in trials.

It may mean that NICE may actually look at some of the drugs it has approved on the back of FDA approval (that's the way it works, or maybe doesn't) and review it's strategy because huge amounts of our taxes are being wasted prescribing drugs that do little or nothing to improve the patients lot and in many cases are proven to be dangerous or even life threatening, such as Avandia or Risperdal. Often newer drugs are brought to market because the old one's are running out of patent, not because the newer one's are any better and Pharma goes to tremendous lengths to 'sell' the new one which includes bribery, false reporting and trials that are 'fudged' in an attempt to reap more profit.

They undertake this in many and disparate ways, but one of the most common is to 'fund' trials. Now those who undertake these are often viewed as 'indepenent' but considerable evidence has now accrued that often these researchers are far from such. And reporting is always subject editing by the sponsor with some extremely onerous conditions applied that then prevent the academics involved from having access to the full data.

Failures are not only confined to drugs, because Pharma also does a nice line in joints and prosthetics, quite a lot of which are used by our NHS and they fail. Fail quite badly, causing the recipient much pain and distress and the horror of undergoing re-operation, often when their overall health means that such procedures can be life threatening.

I could go on almost ad infinitum, about the drugs and medical devices and I must acknowledge that modern medicine does need drugs. From time to time most of us will require some intervention that a drug can provide. My feeling about this is the same as that for penetrating radiation, 'as little as reasonably practicable' or ALARP. I do not feel that any person should be on a drug protocol, simply to fulfill some 'surrogate marker or end point' such as statin therapy, except in rare cases, because we do not need to medicate 'well' people. We also do not need to over prescribe antibiotics because by doing so we will reap a harvest of problems in the future, which is already manifesting itself in the spread of MSRA and other 'hospital born' infections. There are plenty of treatments for minor ailments that do not warrant their use and we certainly should ban the use of them in animal feeds, because by doing so we are less exposed. We should also review their use in routine surgery; are our Hospitals so filthy that we need to dose people with them on a 'just in case' basis?

Preservation of life is the most important goal of Medicine, but this is not the goal of the Drugs Industry, it's primary aim is to make money for shareholders, that is enshrined in company law. All too frequently this has overridden patient safety and the QOF protocols of 'payment by results' has seen a huge rise in the drugs bill for the NHS; see;-You Spent How Much! So far as most of the outcomes are concerned, certainly for many of these drugs, little has been achieved. Is it not time to refrain from gifting 'Big Pharma' with undeserved benevolence, when it is really little more than a corrupt pariah, that occasionally comes up with something worthwhile, but most of the time contributes little to the nation's health and often endangers it?

A Pause For Thought?

2011-04-12T01:46:00.008+02:00

Cameron, Lansley et al, have announced their intention to have a 'natural pause' in the Bill to reform the NHS. A 'future forum' including that 'porcine' (honorary) Professor, Steve Field is being launched upon the country, to listen to the views of the NHS constituent about the changes that have been proposed (excuse me whilst I choke). Once this period, which coincides of course with the Easter Recess anyway (yes more holidays for the politicos), is over, the Bill will be sent to the Lords for perusal and possible modification.

The problem I have with the current and past reforms, is that they continue to concentrate on structure instead of quality, organisational change rather than the ethos and tenor of what universal health care should be. For far too long the NHS has stood for invasive and pernicious campaigns to to persuade us (and now nudge us) into a new horizon of well being with moralistic and ill conceived measures about smoking, drinking, sex, and diet, indeed anything enjoyable. With social engineering at its heart, the anxieties of society are constantly addressed by campaigns to reduce cancer, heart disease and diabetes with little result other than a significant elevation in the Nations blood pressure.

This has in turn led to poor quality health care, dispensed '9 to 5' (weekends and holidays excluded), in Hospitals and Surgeries, to a somewhat hostile patient cohort, who are now being appealed to by the NHS constituent, to 'save the NHS'. Those who have delivered this inferior and authoritarian 'we know best' standard of that which passes for Medicine, cannot really now expect the public to 'go to the barricades' and fight for them to keep their bureaucratic temples intact.

The NHS has presided over ever increasing levels of interventions into our lifestyles and behaviour, very few of which are founded upon any evidence or indeed have had any success. Doctors have become the 'health police' rather than the healer, and as they have distanced themselves from their patients they have prospered enormously in monetary terms, but lost credibility. They are now pawns in the Neo-Thatcherite construct started by Blair and continued by Cameron and his academy of 'toffs'. An NHS that has treated society with such contempt, despite its huge cost to that society deserves to founder.

I do not like the changes proposed very much. They amount to little more than a bureaucratic reshuffle; a movement of the deckchairs, because the fundamentals remain. But the opposition that has formed against it almost worries me more. If Allan Milburn, the BMA and the King's Fund ( and David Owen for f***s sake) are against something then I'm afraid I will possibly have to review my position. In fact as the number of unprincipled and opportunistic politicians grows, who oppose this Bill, the more I become alarmed that I may have missed something! Hardly surprising in view of the number of pages it runs to (299 clauses!). Perhaps there may be some nugget of redemption in this pointless, needless and irrational Bill after all? Oh yes, the Quango's are going! But no, they are being systematically saved, if not by name then by transfer, such as the Food Standards Agency to the Dept of Health.

Doctors and the BMA never wanted an NHS, of that be certain. They wanted an elitist cohort of Physicians that dispensed wisdom and medicine to the 'proles' at a price that they set, not one set by some 'oik' in a Government Department who went to a ...Grammar School? They persisted in this view until the Thatcher years, when Maggie offered them more power and control at the expense of a bureaucratic nightmare of invoicing procedures and budget management, when they decided that it was all too much, a bit like the 'poll tax'. Then along came Blair, all fired up to change the mindset and the BMA embraced him. All at once the BMA discovered it's desire to participate in Government sponsored (and guided) health care resulting in massive financial benefits to the membership and less hours! Well that was a surprise then?

Incentivised, at a level they could not have dreamed possible, most Doctors and Hospital Consultants doubled their pay, and reduced their involvement in patient care. 'Out of hours' was handed to private companies and A & E to trainees and locums (60% of all Hospital Doctors are locums). The patient became the supplicant expecting little and rarely being disappointed. Many died, were maimed or at best received poor care and continue to do so. Yet the gravy train for Doctors, now irretrievably committed to peddling 'Big Pharma's' often substandard or even useless products, rolled on, with further and more intrusive protocols, even for the 'worried well', moving medicine further and further away from diagnosing and treating disease, to fruitless and dogmatic (usually wrong) prevention interventions that were founded in poor or even bad science.

At no point in this train of events was it thought necessary to involve the patient, save for 'patient, public involvement' rhetoric that only sought the views of an unrepresentative minority, of charities and professional middle class campaigners, with the time and money to be involved in the 'tea and biscuit' culture of meta-quango's, discussion forums and pointless conferences. Constantly harangued, largely ignored, the public in general wants little to do with the NHS or even their Doctor, now ensconced in expensive and shiny Health Centres, except when they are sick or fearful. Then they are treated to an endless list of questions, unrelated to the condition they have presented with, to ensure the practise fulfills the QOF protocol and a test regime more interested in their 'lipid profile' than their pain. Is it any wonder that as 'modern medicine' lurches toward wholly preventative measures, instead of treating "the poor and the lame, the sick and the dying" (1), that we are becoming more and more disenchanted with that which we are financing.

There now seems to be a further erosion of NHS principles, driven by privatisation of Primary Care that has more to do with dogma than need, the desire to furnish capitalism with further subsidy, and the utilisation of the latest 'mousetrap' from Pharma, whose greed continues to know no bounds. Older drugs, and medicines that were 'fit for purpose' before, keep falling off the end of the list, for no reason other than a desire to use the new and shiny one approved last week, irrespective of efficacy. Once in fact, all of those in the NHS have had their piece of the cake, there is little left for the actual patient, except indignity, poor care and nonsensical intrusion into their lives. And yet, are not all of these people there for one purpose and that purpose only, to pursue the practise of Medicine?

Change is in fact needed and drastic change at that. Justice for the harmed, together with Candour. Genuine scientific protocols to improve lives, not the treatment of symptoms for the enrichment of a pernicious industry that no longer is fit for purpose; 'Big Pharma'. A cessation of intrusive, patronising and ultimately fruitless endeavours to engineer social change, with fear. Medicine without the boundary of 'out of hours', peopled by real physicians, who actually know what they are doing. Yes let's have a real and vibrant 'Big Society' in the NHS that recognises its goals are set by its patients, not by its political masters and I include in these the BMA, the GMC and the bloody 'think tanks'. In fact I'd rather like to put a tank on their lawn, and see if I could get Niall Dickson, John Appleby and Penny Dash with just the one round. That would be fiscally responsible would it not?

So whilst you politicians are are all pondering, as to what cosmetic changes you can make to a Bill that is widely reviled, and the GP's squeal about how they will be able to cope with all the extra work, without some extra payment (again!), spare a thought for the poor sodding patient, because they're the reason we have an NHS. They aren't the one's that fucked it up, you are!

"Perfection of means and confusion of ends seem to characterize our age."
(Albert Einstein)

(1) Quotation courtesy of Morton Thompson - 'Not as a Stranger' C1954.

Show Me The Money!

2011-03-27T23:21:00.001+02:00

QOF Losing Steam

In the matter of GP's, and indeed Doctor's, much has been said about their future role as the new Guardian's of Primary Care. Unfortunately, that seems to becoming a bit of a 'poisoned chalice', as it is clear that they will probably be damned if Lansley's 'experiment' doesn't work and probably if it does, because in achieving the goals of Government they will become both the provider and the arbiter of provision. It will no longer be the PCT or NICE who will be on the receiving end of patient wrath, it will be the GP's themselves.

It is also important to examine how this unique 36,000 or so Doctors structure their relationship, with the State, because it is singularly different from the rules and practises that rest of society lives by and with. Most GP's are in fact 'small businessman' or indeed not so small. They are 'contractors' paid fees for the provision of Primary Care services to their patients. Quite a few are Limited Liability Companies, and some are already 'Consortia' in a loose coalition of practises, working out of Health Centres provided by Local Government, for which they pay rental. So how come we (the taxpayer) contribute to and manage their pension fund within the NHS? No-one that I can think of, has this sort of 'special' relationship with their client or customer. 'Bob the builder' would dearly love someone to pay a sizable chunk of his pension contributions and guarantee him a good percentage of his final income from 60, but it ain't gonna happen, because he's a 'subbie', just like you. Difference is he will be incapable of working after 60, because he's 'knackered'! You can retire at 60, alright if you don't commit suicide first, with a gold plated pension, we (the prole's) can only dream of!

This is all part of the relationship that doctors have with society. All take, no give, 'loads a money' for their business, especially payment by results for s**t protocols that do not produce any real reduction in the ultimate end point (that's death!), but bags of surrogate end points like slightly lower BP or worse; lower LDL, that prove absolutely f**k all! Oh and don't forget the virtual exemption from any likelihood of ordure if you cause a patient to die, (although if you s**g one, watch out!). Some, albeit it a few, are making in excess of £250k, for office hours! Most make £105K or more. Some single handed practises in remote areas make up to £300k.

Almost all of you GP's, either couldn't be arsed to turn up to the recent BMA special conference or bother even vote for action, against reforms and took the 'easy' route. But, you were all up in arms about the idea of working to 65 as us poor mortals are going to have to, and even prepared to strike, or retire from the battlefield, on the grounds of self interest! As Pulse revealed, lots of GP's are already on the boards of Private Health care providers and will have a vested interest in supporting their own Commissioning ambitions. This highlights some of those in the Profession's, constant desire to command and control the situation for their own pecuniary advantage, whilst trotting out the usual rubbish about 'putting patients first'. A significant minority of GP's it seems, are looking forward to Commissioning as a vehicle to advance their careers and their pay.

Well, since Nye Bevan "stuffed their mouths with gold" in 1948, Doctors have been overly concerned with the money rather than the welfare of their patients. In 2004, when they were able to 'palm off' the out of hours responsibilities to the PCT's, they could hardly believe their luck in getting away with this for a mere 6% of fees. This led to almost all of the call outs being handled by the Private Sector providers, who got away with murder, by the recruitment of foreign or newly qualified doctors, in an attempt to maximise profit at the expense of good care provision. In addition, the deal brokered by Blair's cronies with the BMA, launched on a 'clueless' public the Quality Outcomes Framework, which boosted pay so much that an additional £1.7 billion more than estimates, was expended for the somewhat dubious outcomes I highlighted earlier.

So GP's are extremely good at managing their finances, but not quite so good at managing their clients health, unless of course it's ensuring that said patient is adhering to the QOF protocol they have been placed on, which is the management of their finance because of the 'payment by result' they receive for this duty. And what is the method of 'measuring' the outcome? It is called a surrogate end point; so if a GP 'statinates' a patient, achieving a lower LDL level, will elicit the payment. Quite a few Doctors are aware that this will not make a difference to;

Any Woman
Any Man who is not a high risk or has had no CVD/CHD.
Any Man who is at risk but has had no CVD/CHD.

In fact there is very weak evidence to support the use of statin's with patients, even at high risk, but with a previous CVD/CHD event, but the reduction is almost not significant and a large body of scientists actually believe that statin's are working in a different way from their mechanism design. Many Doctors know all about the risks and the lack of evidence for statin use, but cynically do not do anything about it. Dr Phil Whitaker, who is also an author, recently said " My GP colleagues and I have become press ganged into the role of pill-pushers, the tyranny of QOF subjecting patients to bewildering and sometimes injurious choices of drug, irrespective of circumstances". Doctors can 'exception code' patients, and some do. But do this with more than few and the PCT 'Stasi' will be onto you.

If you really want to upset Lansley's dream of an NHS peopled by 'right thinking' private consortia, guided by the Kings Fund, Kaiser et al, then commit some acts of disobedience like exception coding all your patients and tell the 'thought police' to take a hike, or refuse to cooperate with the ConDem's grand plan. Just do something that isn't related to your personal wealth. Just for once!

We're All Idiots!

2011-03-15T20:19:00.002+01:00

So we're all so stupid and self destructive to the point where we have to be protected from ourselves, or so it would seem. Now we have the spectre of cigarettes no longer being allowed to be in sight of customers in shops, or indeed for the packets to have any colour other than white, so as to ensure we will not be seduced by the pretty colours, to take up this evil habit. This is despite the fact that this same Government sees fit to rest some £11 billion a year from smokers wallets, who then go on to cost society a mere £3.6 billion in health care. Seems pretty much a bargain to me!

No, I do not encourage smoking, it is dangerous and destructive of health. It has been established that smoking can and does cause lung cancer, that I accept. It also causes Chronic Obstructive Pulmonary Disease, probably more often than Cancer, but that is not the point. Banning the display of anything, has no foundation in the evidence of prevention, be it Tobacco, Alcohol or indeed anything, and has been counter productive or even dangerous. One only has to look at the Prohibition of Alcohol in the US to form that opinion. Placing things 'under the counter' has usually created a vicarious desire to obtain said things whatever they may be. Not gifting people with the brains with which they were born is worse. But more, personal freedom is curtailed. We no longer have any liberals in Government only a few Liberals.

Politicians, especially the draconian regimes we have enjoyed since 1979, have not been able to resist the pleasure of forbidding things, they feel to be injurious to health, despite the fact that they often continued in those same pleasures (sins), behind the closed doors of Government themselves. Maggie herself liked a few whiskies and without doubt John Major, enjoyed pleasuring Edwina, despite his public condemnation of others who enjoyed extra marital 'hobbies'. There is of course considerable evidence, that drinking moderately is in fact healthful (and sex is both good for the mind and body) but politicians seem to feel it essential to regiment the behaviour of the 'proles' just because they have it in their gift to do so. Most of the time their efforts not only have been in vain, but wrong.

They have preached that 'fat' is bad and makes you fat and gives you heart disease, unless of course it is a fat sanctioned by the 'health police' at the Food Standards Agency (now DH), which will be a vegetable oil then. That helps get rid of the enormous surplus of this Government subsidised crop extract, that is only fit for biodiesel, not human consumption. In fact, look only to the arable farming lobby to see that we are entreated to eat. Grains, or extracts of grains, with some more, err... grains.

Red Meat, well that's bad too, but it isn't of course. It just isn't part of the Farming Lobby (anymore) because that has been 'hijacked' by the arable crop magnates, who can run several thousands acres of heavily subsidised grain producing land with two men and a vast array of machinery. Look to where the money is, and where it isn't, you will find that which is 'bad' for you. So the livestock producers, of lamb, beef, pork et al, are all struggling to make ends meet.

As for milk, well the same goes. Producers of high quality grass fed (the cows that is) milk, especially high fat Jersey, Guernsey and Buffalo milk are dwindling, because the Dairy magnates just want cheap, bulk milk with low nutritional value, to process into that 'white water' that is stacked on the supermarket shelves, all because we are told not consume dairy fat.

There is always an agenda, always motivation beneath the surface, even if it seems benign or co-incidental. We no longer have any liberal minded politicians, just the Neo-Thatcherites, the inheritors of the Blairite agenda. There is little 'real' opposition, just arguments about the position of the deckchairs on 'Titanic' UK, between a bunch of bickering 'toffs' and academics, who cannot resist the temptation to micromanage the lives of their people. Trouble is, they're s**t at it.

Nullias in Verba

2011-02-28T18:03:00.005+01:00

Much has been made of the view that red meat, including processed and preserved meats, causes Colon Cancer, in the press and television this week. The advice from the DH, is that we should reduce our intake to take account of this. This is based on the recommendation of the Scientific Advisory Committee on Nutrition (SACN). But this report is on Iron and Health, so what's that got to do with it? Moreover this report has been in gestation since 1998, yet was only published in February of this year. So it was pretty urgent then?

When you get to the report itself you will see it's pretty long and full of data, all 374 pages of it! But hang on, this report refers back to the Committee On Medical Aspects of Food and Nutrition Policy called COMA, and is likely what you will get trying to follow this trail! However let's persevere. We then find that data used by the SACN, was that provided by COMA for the survey of the Food Standards Agency (yes, that lot again!). And the data used, was from the 2000/2001 survey. Pretty up to date then!

Now we're getting somewhere! So the report on Iron and Health from the SACN, based on data from COMA via the FSA, from the 2000 National Diet and Nutrition Survey, recommends we reduce intakes of red and processed meat. OK, but where's the evidence? All the SACN say is, there is a "possible link" between high intakes of this food group and Colerectal Cancer (CRC). This report from the BBC, links the 'scare' to the World Cancer Research Fund data from 2007 and at the same time casts doubt, both on that report and on the evidence both utilised in the compilation of the advice and more importantly that ignored! Nothing like 'cherry picking' the data that supports your preconceptions then?

Most of the information about CRC and meat actually stems from the EPIC report of 2005. This is a longitudinal study and it's fourth from the top of the list with regards to evidence, the Randomised Control Trial being the 'gold standard'. EPIC is also observational and 'observation does not prove causation' as I have said many times before. If you actually look at the data, it can be seen that there are some anomalies, not supporting the view of the authors, of CRC being positively associated with red meat intake (they talk like that in 'science'). In the hazard ratios reported, and 1.00 equals no effect, we see that Italian meat eaters are in fact protected (0.96) and we in the UK have an increase in risk of about 3% (1.03).

Remembering of course all of the data is self reported, it is spread across ten EC countries with many different cultures, types of meat with both traditional and modern methods of preservation and cooking, all intermingled with other nutrients. Thus I do find it difficult for any real credence to be given to the view, that meats causes CRC. The authors seem at a loss as well to explain the mechanism, but there is allusion to excessive iron or nitrosamines (from the preservatives) which are carcinogens. I would hazard that they have far too many confounding factors, within the diet of the cohort to draw any real conclusions. There are no details of which meat (beef primarily) was fed on grass, silage or corn and wheat. What you feed to animals is critical to the meat you produce, with considerable difference in the fatty acid constituent as well as micro nutrients. So grass fed Angus Beef, has much higher n-3 than n-6. Omega 3's are said to protective against cancer, and it is certainly better to ensure that the 3's are higher than 6's, both for human intake generally, or in the meat we eat.

Is it likely as well that the meat we have consumed for thousands of years, lamb, beef, pork and game, has suddenly become toxic in the last forty years? Except perhaps by man's intervention in the form of feeding animals unnatural diets, preserving it with various chemicals that were never used traditionally, or mincing it up with other products. There are I would suggest far too many variables, to have any certainty as to whether meat consumption is the sole positive indicator for CRC.

I am not the only one with a sceptics view of this. From the Netherlands we have a study that has a contrary view. A number of scientists were unhappy about conclusions as can be seen here. This Japanese study found no connection, but also came out strongly in favour of n-3 as protective. And they were very honest in their interpretations and about the cohort size. I found many studies that did not support the view that red meat caused CRC, but found much that supported the view that processed meat and sausage did have a slight association. So what to believe then for self protection?

Well going back to EPIC, the overall risk was only increased by 1%, which is a small risk, and is not borne out by other studies, or even commonsense. Quality meat with a good content of saturated and other fats enables humans to keep their carbohydrate intake low and their level of satiety high for a given calorific load, without getting fat. To suggest that this is going to give them cancer, when we almost never had any cancers at all when society consumed a diet almost completely of meat is perverse. It is backed by the recorded good health and lack of disease in every study of 'hunter gatherers' undertaken. I posit that any association that has any foundation would be the intake of processed meats from animals that are 'lot fed', steeped in preservatives and cooked in hydrogenated oils. These can usually be found in eatery's with Scottish or Royal elements to their name and that are on every high street in the land.

So what then is the average citizen to make of all this? Constantly harangued to eat this but not that, most of which is changed somewhere down the line and then often reinstated. The bulk of this is not 'scientific' in it's true sense, because most of the research is too poor, inconclusive, or perverse. And for many years directives from Governments and it's Agencies seems to be founded in the view, that the 'proles' are too thick to have any idea of what's best for them. The scientists have held a similar view about the politicians (can't say I blame them).

Scientists in fact, are often dogmatic in their views, even in the face of contrary evidence that bursts the bubble of their hypothesis. They will biasly select that which does not confound a theory and conceal data that does. This is not peculiar just to 'Big Pharma', but to many individuals within science especially medicine, who are prepared to dance to the tune of the master or of their own ill founded dogma, for what ever motivates them. They are intolerant and even abusive to colleagues who are sceptics, about views often held for no other reason than laziness or stupidity. So at the end, we arrive at the beginning; the motto of the Royal Society; it means "on the word of no one". And so it should be.

Curing the NHS (A Rebels View).

2011-02-23T14:16:00.003+01:00

Of What? By whom? Well one thing is certain, it won't be by Andrew Lansley and the cabal of warlock millionaires, headed by ("call me Dave") Cameron. Their proposed acts of vandalism are likely to make the chances of a 'cure' even more remote.

One, who has a pretty good idea as to what is needed, is one Dr. Vernon Coleman. Vegan, (well you can't be right about everything), author, 'cross dresser', columnist, publisher, libertarian. Author, amongst many of "Medicine Men" and "How to Stop Your Doctor From Killing You", both of which intimated how much of a rebel, he really was. He has kindly consented to allow republication of his view of how to cure the NHS on the website of the NHS Justice Group.

His views, almost exactly coincide with mine. We need to rid ourselves of that which is not needed; that which is not affordable, or even desirable, on the NHS. Give power to GP's, but not all Commissioning, they are neither equipped, nor are they as yet competent to fulfill such a role. Rid ourselves of the pariah's that suck the blood of patients and clinicians; the 'Management' and their lackeys. Stop 'private' medical care being provided in NHS Facilities, and oust the Consultants who control it. Provide 'proper' Nursing, with real Nurses, not the poor quality Nursing Assistants, who have no more idea about 'nursing' than they do about quantum mechanics. Not surprising really, as the qualifications to become one are, err, none! 'Peanuts, Monkeys' are the words that spring to mind.

And Doctors, well they need to realise both their importance, but also their lack of it. It is not possible to legislate for empathy or compassion, but it is possible to enshrine in statute, the 'duty of candour', in the event of harm, being done to patients. It is perverse, that Doctors are the only section of society, that can lie under oath, without any consequences being visited upon them, but they can, as my friend and tireless campaigner Will Powell will attest. Twenty one years is far too long to wait for justice, both for him, and for any society, 'Big' or otherwise. But 'Dave' would have us believe that it would be step too far.

So far as 'by whom', well there's the rub. The ConDems seem unable or unwilling to effectively change the NHS, beyond pathetic attempts to 'privatise' most aspects of it, in the blind hope of saving money. My experience of privatising public bodies and duties has been one of more bureaucracy, less transparency, considerably higher costs due to the additional layer of management required, together with the need to extract a 'profit' from every transaction. And of course, the continuous desire by all parties involved, 'to pull up the flowers to check if the roots are growing'! So then it is left to us, the people, to clamour for effective change, not the 'window dressing' of this and successive Government of the NeoThatcherite persuasion, which they have all been, of "no decision about you, without you" and other such PR platitudes, forged on the playing fields of Eton and in the slick offices, of the campaign managers.

Lies, damned lies, and statistics.

2011-02-15T18:00:00.003+01:00

Attributed to Mark Twain, about Disraeli, this phrase has received considerable use, in decrying statistics as a means of bolstering an argument, and indeed, sometimes in the support of one. However, when statistics are used, in the support of a drug or treatment in Medicine, or a lifestyle change or recommendation, we are into a different 'ballgame' altogether. It is best policy then to treat them with healthy scepticism.

The The Jobbing Doctor recently referred to the increase in oesophageal cancer, from an anecdote about his own practise. This is in fact borne out by the statistics. In the period between 1995 and 2008 there has been an increase of nearly 50%! But that only means, an absolute risk of 14.4 persons per 100,000 as opposed to the previous 8.8 persons per 100,000. That's no consolation to those with adenocarcinoma of that organ, but the risk is still quite low. And that brings me to the crux, of my railing against, studies that prove very little, but grab headlines and frighten and confuse the populace by mixing up relative and absolute risk, often to sell us a drug, a lifestyle change or a treatment protocol that has little to no effect on survival, or the progress of an illness.

There has been much publicity, about the trials of various drugs recently, highlighting the pro's and the con's (literally) of their worth. The use of statin's, for example, was initially believed to be a panacea for low risk (should that be no risk?) patients in the prevention, of future heart disease. But this has been clearly shown to be of little benefit, whilst at the same time as increasing risks for other diseases such as diabetes. The use of statin's in primary prevention is now pretty much a 'dead parrot', but will GP's stop prescribing them for the achievement of a highly dubious surrogate end point? Well, err, no, because they are paid to achieve them by the QOF (Quality Outcomes Framework). And let not the science, get in the way of a nice little earner!

Trials, generally have been the basis of evidenced based Medicine since 1946, when Austin Hill designed the 'randomised control trial', for tuberculosis treatment with antibiotics, which were in their infancy. I suppose it was easier then, because there was not much in the way of groundbreaking science or drugs around, but as 'Pharma' became bigger and richer, the stakes got much higher, and the opportunities for 'massaging' the results became ever easier, especially once the baffling science of statistics, became a science in itself. So we are today, beset by statistics, that are 'mangled', to produce the right outcome, for a drug, a lifestyle or dietary change, or the cessation of something, that may be vaguely enjoyable.

Until only relatively recently, there was no compulsion to reveal all the results of a particular trial, but now 'Pharma' is compelled to do so, bringing to light a number, that showed particular drugs, to be less effective than previously thought. 'Pharma' had been guilty then, of 'hiding' from public (and other scientists) view, those trials that showed some drugs, had little to no effect, or did harm. This is termed 'selection bias' and has long been used to influence outcomes, in favour of that which was needed to justify, a particular protocol or drug's use. But, random chance, has a part to play, and as most RCT's are designed to ensure at least a 5% success ratio, then 1 in 20 completely useless one's will register as positive. These and others, are those they did not wish us to see, but no longer, they are now compelled to show all.

Another trick, often used, especially when, you can hide the data behind a 'paywall' such as the BMJ, or 'The Lancet' or many of the other journals, is to mix up relative and absolute risk within the 'abstract'. For example; I can double your chance of winning the Lottery. How; buy another ticket! Your relative chance has doubled, but only to 2 in 14 million, your absolute chance. If one extrapolates that into scientific study, as is often done, a somewhat distorted view, is given to the unsuspecting reader (journalist usually). As I have also said, many times, in my posts, correlation does not prove causation. And, as many trials are observational they simply correlate facts about the cohort under observation. The whole of the vegetarian revered book, 'The China Study', was no more than a complex and detailed correlation of observed data. Denise Minger wrote an extremely well researched and devastating critique of that testament to a vegan diet, that blew it out of the water, in my view.

This co-relationship (correlation) between several factors can be co-incidental. For example; many fat people are diabetic, but not all are, and in fact quite a few thin people are also diabetic. But it is not an absolute fact that all diabetics are fat; unless of course you ply them with drugs from 'Pharma', when they almost certainly, will get fat. That was a hypothesis, by the way, borne out by a considerable amount of evidence, and more importantly, the proof implicit, in the biological mechanism of insulin, which is generally enhanced by hypoglycemic drugs, of being an agent of fat storage.

An example of how society has been hoodwinked by both 'Big Pharma' and the GP's is the ever lowering of blood pressure targets, both for those at any risk, and those at 'allegedly' known risk, ( people with a history of CHD/CVD), who are prescribed anti-hypertensives of one kind or another. This is yet another 'surrogate end point', viewed as a possible marker for heart disease, but not actual heart disease. Well, the QOF for prevention, is for GP's to prescribe these appalling drugs, to lower blood pressure, in the targeted cohort, for which they get paid, on a 'payment by results' system. However, it turns out that the QOF for this had no discernible effect at all, on outcomes for the lowering of BP in patients being treated in primary care. There is even an implication, if you click on the whole study (amazingly free), that other 'payment by results' treatment protocols, for other diseases of society are also not effective, except for the pay of GP's. Some Doctors say, that they were already achieving high levels of compliance prior to QOF's institution, so these rewards are simply retrospective. I think that's a cynical manipulation of the facts to suit events. Either way, it's hardly value for money, or indeed of any real use to the patient, who is taking medication to fulfill a 'tick' list, often at cost to their well being.

Have then Doctors, taken the money, despite their efforts having produced no tangible result, or is the whole exercise pointless anyway? Because, further study will show that although the various drugs do lower BP to an extent, in some, but not all patients, the outcomes for the cohort taking them remains unchanged. Exactly the same number die, whether they take drugs or not. This review from Cochran highlights the inadequacies of both the studies and interventions in use, and is pretty damning, in its conclusions.

So, long suffering reader, I would urge scepticism in all data, that is presented to you as 'proof' of anything, especially a drug or treatment, that has been provided as a preventative measure by your 'hard pressed' GP. Was the study an RCT? Was it reproduced in a number of trials ( at least three), with a significant time scale (at least a year), for each? Was it interventional (the drug or device/protocol being designed to change an outcome)? Was it 'blinded' (the cohort and the trial personnel have no knowledge of who is getting what)? Was it longitudinal (over a long time) and if so the time must be long and the cohort large, such as the Framingham Study (60 years). This latter study, interestingly, has been criticised by many as both observational, self reported for many of its facts (by the cohort) and that much of the adverse data was suppressed. However, Michael Eades found that it was reported, just not very prominently.

Finally, be a sceptic, and believe only that, which is proven by real science, not Daily Mail headline drivel, or advocacy research, or perhaps worse, what your Doctor tells you (if it's QOF'ed).

NHS plc?

2011-02-08T23:07:00.004+01:00

Sicko.

As Andrew Lansley's 'brave new world' of GP Commissioning takes shape, I would like to examine the substance of that which will prevail in the future, and the effect it will have on all of our lives, yes, even the rich!

I have made no secret, of my view that, this is a covert plan, to 'privatise' the majority of services that are provided by the NHS, although a surprising number already are, such as Care UK and others, who almost exclusively contract for Prison Healthcare in the UK. There in fact, seems to be a 'model' forged to an extent by the last Government and continued by this one but at a more accelerated pace. It is the US Healthcare model.

Numerous consultations took place between the 'last lot', 'this lot' and US Healthcare giant Kaiser, to provide advice on the structure of the NHS. The concept of making Hospitals into Trusts especially Foundation Trusts, is a construct largely inspired by them, together with the enforced change upon all Hospitals to become the latter by 2014. As such these bodies will have to be in surplus, or fold. So the prospect of a Hospital closing because it is bankrupt moves ever closer, with Lansley clearly stating that there will be no 'bailouts' (don't remember him saying that about the Banks). This makes them a 'ripe fruit' to pluck, at rock bottom price for an aspiring Private provider.

Primary in this role will be the FESC (Framework for procuring External Support for Commissioning), who will be ideally placed to design the procurement 'tools' for the GP cohort, flung into the maelstrom of designing a system about which they have little knowledge, or even desire to engineer.In this body we have a list of Private providers, including BUPA, Dr. Foster, KPMG, McKinsey, Tribal, United Health and others, all poised to take a slice of the cake. Close on their heels is the Cambridge Health Network, fronted by Dr. Penny Dash, which provides " Health Leadership and Enterprise", which is a euphemism for promoting the sponsors, which include; Halliburton (of Gulf Oil fame), General Electric, Virgin, BUPA, GlaxoSmithKline and of course, Carillion, to the DofH. Dr. Dash is of course, a McKinsey partner, and ex Head of Strategy and Planning at DofH, and now enjoys the ear of many in Government. Copperfield has this view about her in Pulse in 2009.

Many ex-Government politicians and advisers will be found within this organisations companies, including Patricia Hewitt (BUPA), former Blair adviser Simon Stevens (United Health), Mark Britnell, former DofH, head of commissioning (KPMG), Penny Dash (McKinsey), the list is almost endless, of those employed in Healthcare who have exited by the revolving door between, Public and Private Healthcare Providers. Is it likely that these and others, will be able to exercise influence in directing commissioning toward the 'private' model. Well do bears s**t in the woods?

Would this exercise to bring Private Medicine into the NHS be a bad thing? Well if we are to judge it by simple maths then let's work on Healthcare costs as a percentage of GDP, because the US has a larger population than do we, but is used by many as the model for Western Medicines excellence. It cost slightly more than 15% of US GDP in 2008, but only 9.2% in the UK to provide healthcare universally, but of course healthcare is not available to all in the US, only those who pay, so that comparison is even more favourable than it seems. In world terms we are 20th for life expectancy, yet the US, for all this expenditure, only ranks 36th and whilst we ought to be higher, if the belief that privatising the NHS is to bring benefits, then surely these figures must explode that myth.

The likely result is that cost savings will be heralded, certainly at Commissioning stage, as it was with ISTC's, but the results a little further down the line will be one of reduced services, 'cheap' operations, based on dumbing down the staff cohort, and doing production line procedures, such as Arthroplasty, and leaving the NHS to take care of Trauma, until it goes broke, because it cannot compete. The end result will be, without doubt, less for the same, or eventually, as in the US, less for more.

You Spent How Much!

2011-02-02T13:05:00.002+01:00

£8.5 billion to be precise; that is, on Drugs for the NHS in 2009. Or as some of us know it; the 'Pharmaceutical Industry Benevolent Fund'. This is for prescriptions, not Hospital Drugs, which are accounted for elsewhere, and it is an enormous sum.

£33.9 million was spent on aspirin (generic) and £18.8 million on paracetamol (acetaminophen), no doubt which would have been bought at the usual high prices, charged to the NHS. Why not tell people to buy their own, and just recommend the dose?

Close to £360 million was spent on the branded (expensive) and generic (cheaper) versions of HMG-CoA Reductase Inhibitors (or statins), with some £322 millions going to Pfizer's Lipitor. Generally, to treat patients for no scientific reason, other than a target for cholesterol lowering (a surrogate end point), which is considered now, to be of dubious benefit in primary care, especially for the worried well. Hopefully the 25 year long 'gravy train', enjoyed by Pfizer, will end, when the patent expires in June this year, on Atorvastatin (Lipitor), but they have enjoyed years of it being, the top selling drug in the world, at $12.4 billion sales in 2008. Duane Graveline (the space Doc) has a few points about this drug worth reading.

The other 'so called', cholesterol lowering agents figuring quite highly in the league table of costs is the Merck drug, Ezetimide at £73.5 million. This is despite the ENHANCE trial giving it a conclusive 'thumbs down', for its primary role, way back in 2008. NICE hasn't yet caught on to it's rather limited efficacy, and it's dangers, but GP's still seem ready to prescribe it.

Doctors, spent £106 million on anti-hypertensives, with some £68 million of that going on Merck's Losartan an Angiotestin 11 Receptor Antagonist, and the balance on generics. Well, this is down to the continual, ever lowering of the thresholds, for hypertension, both for the 'at risk' element of the patient cohort, and the belief amongst many, that we should all be treated, if we exceed certain levels irrespective of risk, simply because, being above that level confers risk in itself? Well, NICE, who set these guidelines, also calculated the 'absolute benefits' for this, at an increased life expectancy, of 8-11 months if you're 50, and 3-5 months, if you're 70. Wow!

Now to the drugs for Diabetics. Leaving aside the £71.5 million on the Type 1's, we spent £650 million on drugs for the Type 11's, amongst these, of course we have have the drug (now withdrawn) Avandia, from GlaxoSmithKline. I highlighted it's dangers, on the back of the Panorama investigation, back in September, but, despite the fact, that there had been doubts about it, as far back as 2007, £30 million was still spent on it! Drugs for Diabetes have risen in cost, during the last 5 years by 40%. But Diabetes, despite it's inexorable rise, has only risen from 3.3% to 4.1%, in the same time frame. So, one has to assume that more drugs, and more expensive drugs at that, are being prescribed. So, long as we continue with 'barmy' diet protocols for Diabetics, and for the population as a whole, this bill will never get smaller, and it is now the largest cost, for all drugs, across the NHS!

Of course, we do have some really expensive drugs. Eculizumab, costs £3150, a pop! And that works out for the patient with PNH, to about £400,000 a year! At about an incidence of 1 to 2 per million people, it's unlikely to bother many people. Why drug companies, can't be a little more benevolent, with highly specialised drugs, in view of their exorbitant profits, I cannot understand. Well, unless of course they are greedy, manipulative git's, but of course, I would never take that view.

So then Mr. Lansley. If you really want to save some money in the NHS, perhaps you should review the science behind these profligate and counter productive, prescribing protocols. And should you really be pinning all your hopes, on the 36,000 or so GP's responsible for this huge bill, to run the NHS of the future? You really ought to have better insight, with a Cardiologist brother-in-law, and an ex-wife as a GP.

And The Winner Is!

2011-01-27T11:17:00.002+01:00

Dr Irvine Stuart. This is what he wrote. Read it, and see that which is of real value.

Mandate, What Mandate?

2011-01-26T14:06:00.005+01:00

The current ConDems have launched the Health and Social Care Bill, onto a largely unsuspecting public, who did not vote for them, and did not vote for almost any of the elements of this tawdry piece of 'Privatisation'. During the election, Cameron promised to ring fence the NHS, "I'll cut the deficit, not the NHS", was the clarion cry. He was going to stop "top-down reorganisation". He also promised to not raise VAT, and not to raise tuition fees, but that's another story (lying b*****d), but it displays the treachery, of an unholy alliance, of politicians, without any mandate from the people, to attempt to invoke such policies, completely contrary to their hollow promises.

This Bill takes an axe to the NHS, where a surgeons scalpel was needed. It gives the responsibility for Primary Care into the hands of a somewhat bewildered bunch of Doctors, who have little experience of Commissioning health care, and will be placed in the position of both poacher and gamekeeper. Under the requirement to allow 'any willing provider', to provide services, it will become illegal, not to allow the likes of Tribal, Circle, Virgin, Serco et al, to tender for services, which will be decided on price, at the expense of quality, due to the ability they have, to provide care, at less than 'tariff prices'. They will manage this, by 'dumbing down' the staff cohort with, nurse practitioners, salaried GP's and the Health Services versions, of the 'Polish plumber'.

We do need some perspective on this, I think, because I am not one who holds the NHS in reverence, in fact I have often treated it with contempt ( which it deserved), and described many aspects of it with unguarded venom. But this was because of the many within it, who have meekly accepted substandard levels of care, turned a blind eye to their colleague's incompetence, and worse lied, to protect them, and thus, deny legitimate complainants, justice and candour. But was it ever the same? Doctors have been hiding behind the protection of the 'Bolam Test' for generations, on the simple principle that they are above the laws, that us mere mortals have to abide by. This is the unacceptable face of health care, both in the past and in the 21st century. As the paymaster of physicians, we deserve better.

But, the concept of 'free' health care for all (which is far from free), remains steadfastly my abiding belief. I spent a good part of my youth, and indeed my life, fighting for this goal, both for myself and for others. I became jaded by the actuality, many years ago (politics that is), after years of smoke filled rooms, far from the public eye, where the real decisions were made. The chamber was just the 'window dressing', for public view. 'Real Politic' was conducted always, behind closed doors. I gave it up, to wield my talents, for what they are worth, as someone in the 'real world', where you are judged by your peers, as competent, or having integrity and is the abiding tenet, I live by.

The NHS is important. But it has been flawed. A concept, conceived in the aftermath, of a war that was to change everything, was taken over by the self aggrandising, elite Doctor cohort, who began to manipulate the 'system' for their own ends. This was a construct, that within a few years, became a self perpetuating 'gravy train' for senior Doctors, Surgeons, and Consultants who had a foot in both the Public and Private camps. Manipulating the system, to enhance their income by 'cherry picking' the patients who could pay. Government stood by without demur, simply to keep them 'on side'. Thatcher ended some of that, probably, with an even worse system, that typified the excesses of the USA, where the concept of 'invoicing' everyone, for well, everything, was born. Another 'top down' re-organisation' conceived in an era, that was to provide a legacy for the future, we have yet to shed; Neo-Thatcherism.

Blair et al, pursued this ideal, with PFI, PPI, Darzi and all the rest of the 'slieght of hand' that attempted to hoodwink, the populace, that 'World Class Commissioning' was the legacy we were to enjoy, by gist of the huge additional funding deployed, to bring the NHS to a 21st century health care standard. De-regulation, privatisation and draconian social policy, was continued with renewed vigour. Like many before him, he bought off the GP's with new contracts, that they could only have dreamed of. The private sector boomed and management blossomed, together with the 'new era' of measuring everything, except care. NICE was born, the Quality Outcome Framework, was born, and we became gripped by surrogacy in our designs for measuring outcomes, instead of preventing disease or death. We believed the rhetoric peddled by 'Big Pharma', spurred on by that benign presence, in many of our lives, since childhood, our GP, who also bought into this, or retired (many did).

But what a betrayal! That same GP was being paid, quite considerable sums, to achieve these dubious, and often unrelated goals of lower LDL, increased HDL, lower BP, lower fasting plasma glucose, all founded in a flawed, even 'barmy' concept, with little or no scientific evidence to back it's goals. My masked hero has complained about this himself, here and here.

The public bestow, far too much benevolence, on those employed in Healthcare generally, and 'the hard pressed GP' in particular. Yet we are treated, with these appalling protocols, that are costing the earth, to no real effect, except of course the lovely money that accrues to GP's practise, and 'Big Pharma'. This is where real and meaningful cuts, should be made. And I do believe that QOF,s, ISTC contracts, and PFI's that are eating up the NHS budgets to a far distant horizon, and 'rubbish', protocols that do nothing to advance the health of the Nation, is a folly we will live to regret, and will bring us closer to the 'NHS' plc of nightmare proportion.

Well Don't Say I Didn't Warn You!

2011-01-20T12:09:00.001+01:00

Under the Blair and Brown Governments 'watch', over the NHS, more services both for Health care and for Government generally, were outsourced. A revolving door, between the DofH and many of the 'Big Four' accountants and consultants, was established with ex NHS Commissioning czar, Mark Britnell, becoming a KPMG Partner in October 2009.

We now hear, that KMPG Health has won a contract with NHS London, worth.... well who knows? You see, even though, some of that cash, is mine (and yours), it is now a commercial 'secret', between the new 'pathfinder' consortia, and those with whom they contract, for services. If I believed for one moment that this would be a helpful development, or one that would yield cost savings, or efficiencies, I would be applauding. But I am not.

The involvement of management accountants, in Health care (or anything, if it comes to that) has done little or nothing, to make it better, or save money. The converse is true. The expansion of 'the management', in the NHS, was almost always preceded, by some Consultant report, demonstrating it's need. Then of course, offering to recruit the needed 'management', or often providing it, as a service. A very large proportion of the ever burgeoning budget in the NHS, was consumed by these pariahs.They were responsible, in the main, for the stupid and expensive, PFI and PPI Projects, that delivered, less. Less beds, nurses, care (fill the rest in yourselves); all for more than it cost before.

The concept, that involving 'any willing provider' and invoking the profit motive, will drive down costs is highly flawed. Witness the view from 2006 of Allyson Pollock of the huge cost of PFI projects in the NHS, which has driven up costs for Trusts out of all proportion to the benefits involved. Or indeed the £12.4 billion squandered on the NHS IT project that never worked, and likely will be entirely cancelled. The 'big four' were heavily involved in the design and execution of all of these failed policies, reaping enormous fees for them and 'bugger all' for the NHS and the taxpayer. Only last June, Gary Belfield, Mark Britnells successor at the DofH also left to join KPMG, no doubt rubbing his hands with anticipation of Lansleys plans and how he might ' turn a dollar' from the opportunities that were now available to commercial providers, in the 'new dawn' of GP Commissioning.

This is just one of the 'buzzards' circling, to see that which they can pick off from the, dying carcase of the NHS, to their own advantage of course. Serco, the company that provides services for Government and the Military, formed a partnership only last year, with Guys and St Thomas' Hospital, to undertake pathology work for itself and other Hospitals. A year down the line, concerns are being voiced about governance, security, and other problems, especially one of cost increases, that had to be paid to the new body as a result of increased demand, amounting to some £2 million (as reported by Private Eye). Increased demand, is endemic in hospital laboratory testing, simply due to the nature of the beast. So long as the NHS, continues to treat for prevention, with surrogate end points and markers, it's patient cohort, it will have to test to prove they are being achieved. It's the climate that surrounds QOF protocols, that drives this. A sort of convoluted, payment by results system, that eats money and will continue to do so, for as long as health care is tied to this barmy concept.

Only yesterday, it was revealed that the estimated cost of overhauling the NHS, to favour GP Commissioning, over that which exists, will be £1.5 billion. This vast sum, will no doubt go to largely to the 'big four' because it always seems to. They will be heavily involved, without doubt. The revolving door between Government and them will see to that. Oh, and of course, we should not lose sight of the fact, that the 'big four' were complicit in the Banking crash, we are all paying for. They helped to design some of the models of profligate lending, and audited the results without demur.

Polypill Trials- Oh My Gawd!

2011-01-17T19:31:00.000+01:00

Law and Wald, strike again! Not content with inventing a pill to treat the 'worried well' after their famously flawed 'teleoanalysis', these pair of opportunistic 'researchers', who are obviously gifted with great integrity, because they patented this pill as their own, have now persuaded the Wolfson Institute to begin a small trial to test a modified version of the original. The results will no doubt be promoted as being proven, despite the fact that such a small trial of 12 weeks duration is unlikely to reveal any result that could be viewed as conclusive. It is not being helped either by the next step, which is then to treat all the cohort after 12 weeks, as well as the control group, with the 'polypill' for some two years.

This is junk science, in my book and in the eyes of the esteemed Malcolm Kendrick, who posits that teleoanalysis is (and I paraphrase) trying to prove my aunt is actually my uncle without the benefit of a sex test, or even sight of the wedding tackle! This is the original study from 2003, and it's 'wibble'! Do we really want commence to treat people on a 'just in case' principle, especially when the foundation of the of the hypothesis is so flawed. This is just about as bad as a previous idea to hand out statins with Big Mac's. The BMJ paper, Kendrick, amusingly derides, is here.

This pair, I believe, typify those in health care, who are prepared to compromise integrity for the sake of turning a fast buck. It shows us the bright new tomorrow that we can look forward to, going forward with the ConDems. This will be a new shiny world of spin, hype and the delivery of surrogate end points, instead of real health. The markers laid down, are unlikely to bring about a sea change in the Nation's health. But we will be told they will. And of course, being told, by those with letters after their name in abundance, that it will revolutionise, all of our lives, and make them a lot of lovely money, as well, will only be tested by history, some generations later. If that inheritance, mirrors the results, of the surrogate end points, promised when we started down the road of Statins, then we will, as always, be waiting in vain.

Orthopedics vs Anesthesia

2011-01-12T23:35:00.015+01:00

Hot on the heels of Dr.Zorro, my masked hero, comes another but similar YouTube offering. My reason for sharing is because it pretty much mirrors life (well for me anyway). This really did happen, with a few slight differences, the first one being it was a real trauma emergency and the patient did not know she was Diabetic.

Sadly neither did the Surgeon. Obviously he did not understand long words, of a medical nature, but also on this occasion neither did the Anaesthetist. Makes you wonder why they keep a Lab Technician available, day and night and even weekends. Obviously DKA and 19.5 mmo/L (351mg/dl) does not compute, so we'll ignore it.

The Great Swapathon (Change4Life Strikes Again).

2011-01-11T13:15:00.002+01:00

More drivel from Government, only this time with support from the 'food cartels'. Yes, under Cameron et al, we now have to endure Government's insane advice, about diet and health, funded largely now, by the Architects of our society's current ills! Nestle, Mars, Kellogg's etc will pay for, along with others, including some of the worst purveyors of fast food, a campaign, to provide vouchers for so-called 'healthy food'. These vouchers will be for £50 to enable participants to purchase, from Asda (Walmart), food that has little to no fat, cereals, and other healthy options (so called) that will galvanise them into a process of being active (nudge,nudge) and eating in a healthy manner.

As well as being condescending, and patriarchal, this is an opportunity for the sponsors to gain new customers at very low cost; £250m is pretty cheap for a national, Government backed campaign, but the slug in the salad, is obvious to any, that have a background of science, or an understanding of nutritional needs; it's puerile nonsense! Five a day continues as one the mainstays of the apparatchiks, who wrote this nonsense despite the fact that it has been categorically denounced, as ineffectual for protection from Cancer, Heart Disease or Diabetes, see here and here and my previous post. Worst, it provides the opportunity for the the food 'giants' to place themselves in a position of advantage over others, who may actually be producing the components of a healthy diet, without much of the kudos attached to one with a Government 'stamp of approval'.

Cornflakes for instance, are processed maize, patented by that Seventh Day Adventist, John Harvey Kellogg as a palatable source of carbohydrates for a vegetarian, along of course with other 'barmy' protocols such as yogurt enemas (yes really). His flakes of corn, not immediately a popular breakfast choice, became popular in the 1950's and 1960's and infiltrated the UK eventually as almost the sole source of an easy breakfast, for the modern humanoid.. In modern times this, was built upon with numerous variants, generally, laced with sugar and today, my pet hate High Fructose Corn Syrup.

That one example, of the diet, symbolised by the Change4Life protocols, does in my book epitomise the stupid and dangerous view expounded by most of the Government Agencies and Health Charities, that we should consume very high intakes of carbohydrates, especially wheat and other grain based products. But all of these promote high insulin reactions to every meal with this composition. This can and often does lead, after a time, to insulin resistance, the precursor to Diabetes in Homosapiens. With certain exceptions, we are not adapted to heavy intakes of carbohydrates, especially, dwarf wheat and other grain products as William Davis will attest (endlessly, but he has a point) as he does again here. I don't agree with everything he says, any more than I would adapt completely, to a 'paleo', 'ketogenic', or carb free diet. I have however adopted a low carb diet, because it is overall, somewhat more healthy, than the stupid alternative propounded by the successors to the Food Standards Agency (the DofH). I would however, embrace it completely if I was Diabetic.

Since we have adapted to a diet of mainly carbohydrates, laced with seed oils, small quantities of very low fat dairy products and fructose, it is patently obvious that, society's health has declined. In fact, the rise of industrialised food manufacture has almost exactly coincided with this decline. We have much higher rates of Diabetes, Heart Disease and Cancer, than 50 years ago when this transformation commenced. For Government to enjoin with manufacturers, in an endeavour, to 'nudge' us into a better horizon, based upon the poorly documented and unscientific premis that it is 'healthy', is founded in spin and hype at the expense of truth.

Are these 'suit and tie chic' politicians so blinded by the 'hype' of their co-conspirators, in this cabal they have formed as to not understand, simple biology, or is it a purely cynical exercise in marketing, founded in the need once more to save money? I do not know the answer. None of our current masters, and I include in this NuLabour, who would have done little different, seem to have much in the way of brain cells. They have 'bought' the sales pitch of the 'food giants' and 'Big Pharma' without demur. This is despite the view of the great (late) Albert, who is said to have coined the phrase 'doing the same thing, over and over again, and expecting a different result'. This is, once again, a prime example of futility, laced with danger.

Little Black Cat.

2011-01-06T01:22:00.016+01:00

A while back, in another time and place, Blackdog fell in love, in love with Little Black Cat. Maybe now, it's time, for me to tell her story.

"Small and black with belly so rotund and swollen, it almost dragged on the ground, she came to me; crept into my life. Willful and sleek, but most of all tiny, she let me share in the birth of her kittens, with a trust that was almost conspiratorial. She purred, mewed and growled herself into my life and affections, and then left me when she felt the call of the wild. Bringing back to me on her return, gifts of birds, mice and worse; parts of them. Sometimes still alive, I tried to rescue these unfortunate victims of her hunting, without offending her; not always succeeding, I must add. But she came back, squirmed onto my knee, digging into my thigh, with razor sharp claws, and then my chest, until I stroked her shiny, course coat. She often looked into my face, as if to say, 'why so miserable, so serious', I guess she knew.

She left me often, sometimes for long periods, and I fretted, searched for her, questioned neighbours and made sorties into derelict allotments. She always came back, looking askance at my effusive welcome, but devouring the 'fatted calf ' with relish, that caused my tear filled eyes to dry, and contentment, of a sort to be re-engaged. I was pleased that something so wild, so free could like me, even need me sometimes. It was a love affair; I worshiped her and she, well tolerated me. Her absences were painful; like those of an indifferent lover, but sometimes in the depths of my personal despair, she was a shining light of freedom.

Myriah was brave almost to the point of foolishness. With little regard for her own safety, she would take on opponents, so large as to dwarf her. Like a mongoose with a snake, she usually was victorious, due mainly to the ferocity of her attack, and swiftness of movement. When she became ill, I instinctively knew, though others chided me that little was wrong. It seemed to me she was dying; I could not let that occur.

I rushed to the Vet, and it soon became apparent that she had succumbed to that scourge of many cats; hyperthyroidism, making her heart race, and kidneys to flaunt their imminent failure. Fruzemide together with Carbimozole, brought her back from the brink, and after a short stay for intensive care, I brought her home. A regime of medication to keep her thyroid in check, then became the daily battle. Those tiny Carbimozole pills lent themselves to concealment within a small prawn, so I was OK mostly, but sometimes I did have to force them into her tiny throat, feeling awful at the need. Until the establishment of the regime, I had to keep her indoors and she hated it, constantly fighting against her incarceration, then disaster, she escaped!

I searched, the sun drenched summer streets, the byways and woodland nearby, for days, knowing that without medication, the hyperactivity would re-establish and she could die of heart failure. She was a hunter so I knew she would not starve, so I went out in the cool summer night to try and entice her to me. Once I almost succeeded, only for her elude me again. Then one day in late summer, word reached me that she had been seen in the nearby allotment gardens. So through the day, I searched long and hard. Through the nettles and weeds, of abandoned dreams of self sufficiency, I looked, calling her name. As the rain started to fall, that growly mew, so familiar to me, came back. At the base of an overgrown thorn bush, she lay, looking wild and unkempt.

It took many tries, but I caught her up in my arms finally. I held her tight and made for home, in fear of the squirming black bundle escaping again. With blood streaming from my arms and chest, I made it home. Capture complete! Imprisoned once more and with medication in place she calmed at last and ceased attempts to escape. The weeks turned to months and my shame at the incarceration grew; I had curbed this free spirit, but loved that she was safe.She often cried at the door to be freed, and one day, heart beating fast, mouth dry, I let her out, into the outside world again.

She ran out, and then stopped, just a few feet away, and commenced grooming herself. She seemed bewildered to be outside once more, and sat in the early summer sun, then wandered off to inspect her domain, without urgency. I watched her, pleased that she was calmer, less frantic, but slightly sorry that what I had done, was to tame her wild spirit. Freedom had been her essence and I had taken that away, but I had done it, to save her life. That did not sit too well with me. I knew that in humans, this protocol, was slightly resented, by recipients, because it robs them of their tendency to high activity. Many preferring to feel as they did before.

Myriah seemed to thrive, but one sunny Saturday morning, on arising I could not find her, and then heard her plaintive cries from the bathroom. She lay on the cold tiles, in a pool of her urine, her back legs unresponsive to her efforts of movement. A stroke! Holding back tears I dressed and rushed her to the Vet, in the vain hope that it may be temporary or curable. It was not to be; I should have known.

Almost in a trance, I listened to my voice, agreeing to end her life, to avoid the misery she was in, and then held her as the life slipped from her, as the drug infused into her tiny black body. I had loved her so much, but it was over. I dug the grave, beneath the oak my children had planted, from an acorn, years before. I let no-one else touch the spade, this was my duty, my penance, my tribute. Wrapping her gently in a clean towel, I laid her in a hole deep enough, lest she ever be disturbed, and stood back. It was a long time before I eventually filled the hole, wracked with sobs, misery uncontained, unashamed of my tears.

It was a long time, before the sobs subsided, and months before my grief was controlled. Tears would sting my eyes, whenever I thought of her for months even years later. She was just a cat, but had touched something in my soul. She had seemed to have sensed my misery, the depression that had stalked my life at that time. Tried, I mused, to show me a better way to live; freedom. I had loved her so much because she had been such a free spirit, unburdened by guilt or doubt, as I had been for so many years. Perhaps all these years later it would be fitting epitaph, for me to be free and to live life to the full. And so I did. Or at least I try to, every day for those that are left. I will never forget her."

I wrote these words, five years ago, as a tribute to my cat who died two years before. I have had nine cats and three dogs in my life and loved every one, and stayed with all to the very end. But none was quite the same as Myriah. I will have no more, lest they outlive me.

Broken Promises Cost The NHS An Extra £250 Million

2011-01-04T13:20:00.001+01:00

It was trumpeted widely by both arms of the ConDems at the recent election, that VAT would not rise. That was a lie, because today it has. The vacuous Osborne, has increased it to 20%. It is also significant to remember that only Tory Chancellors have done so, Geoffrey Howe in 1979 raised it from 8% to 15% and Norman Lamont then increased it to 17.5%. It has been the 'milche cow' of successive Tory Governments since it's inception, who in general, and quite wrongly view it as 'progressive'. As the poorest will be hit hardest, it is difficult to see it as anything other than regressive.

Osborne has stated, that he views this increase as "unavoidable", so as to raise £13.5bn towards the deficit, but this is due to the reluctance of this and the previous Government, to increase Corporation Tax or a levy on the Banks who caused the deficit (largely) in the first place. This increase will cost the average household in the UK some £425 per year and likely cost an additional 47,000 jobs in the retail industry. As we have been hit hard by recent increases in the cost of energy, just at the time of the worst winter since records began, together with ever rising cost for motor fuel, partly due to the rise in duty, which in turn then has Vat applied to it (a tax on a tax?), which will now rise again with this increase, it is somewhat hard to see any economic logic, in the increase.

This rise will also add an estimated £250m to the costs of the NHS at a time when they are supposed to be looking for a saving of some £20bn over the next few years. In addition the issue of VAT in general, is going to figure quite highly in the proposal to allow GP's to commission all NHS services in the future. Most GP's are not VAT registered because their Practises are exempt, unless they are dispensing practises (with a pharmacy attached) and even then, most of their output is exempt. This will change however when then they become commissioners of services and providers of that same service, because they will have to bill it somewhere and be billed for many aspects of it themselves. This of course creates an opening for the need for more 'bean counters', to assist in this endeavour and the 'big four' accountants, who already have a stranglehold on both NHS and Government accounting and audit, will no doubt be ready to fill this gap (despite their piss poor record). NHS Trusts and PCT's seem to find it impossible to account for their money, especially VAT, so they employ outside bodies such as these to do it for them and pay the exorbitant fees for the privilege.

So then, the 'law of unintended consequences' comes into play. Costs will rise in the form of VAT that cannot be reclaimed, and the 'big four' will flourish as a result, GP's will flounder in a welter of bureaucracy and the Government will reap the consequent tax benefit. And, of course the poor old taxpayer will be caught in the middle, paying for it all, at a time when they can ill afford it. Cameron and his millionaire cabinet will not even notice. Maybe that was the plan?

And Now For Something Completely Different.

2010-12-23T12:09:00.000+01:00

The Snow!

Yes it's all the fault of the Government. And the Railways and the Councils and the Airports! The Knobs we've now got in power (literally) should have seen this coming. We had a bad period in late winter of 2009, again in early winter, of the same year (at least where I am) and again early this year. Sufficient to provoke the then Government, to produce a report, about which stuff all was done. This lot are now having another one. We should have had more salt available, but we haven't, despite importing from as far away as, Peru? (You would think, that since we all stopped eating the damn stuff, we'd have a surplus).

According to many investigations, it would cost about £1.5 billion to have the country 'snow proofed', which is, well, not a lot. That would allow people who are vulnerable to at least get out of their house, such as the elderly or disabled without fearing for their lives. Yes it is that dangerous! People fall over in ice and snow and injure themselves. Those injuries can be life threatening, well there's a surprise! Perhaps that's why we have those big buildings, full of people in white coats, in most major towns and cities, d'oh!

Well maybe, if we spent the sort of money, we spend in one week in the NHS to prevent this annual toll of broken limbs, specially hips, in the elderly, and often less elderly, we might have more resources to expend on people who are genuinely ill, not simply the victim of short sighted Government and Local Authorities. Loss to the Exchequer, without computing in these costs, is alleged to be in the order of £1 billion a day! Surely the bunch of shiny faced twats in suits, in power currently, most of them millionaires, can see that! We don't need yet another report, from some 'tame' scientific adviser, who will no doubt tell the Cabinet exactly what they want to hear. We actually need someone to take action to curtail this misery by taking action!

Earlier this year, County Durham NHS, actually gave the Highway Authority a £1 million to carry out extra salting operations, in an attempt to diminish the toll of breakages they had to deal with. It was controversial, and prompted the resignation, of one of the Hospital Governors, but at least they were trying. We spend £2.5 billion to fix broken hips alone in the NHS each year. Surely any politician with even half a brain can work out that we could likely save a good proportion of that by judicious allocation of resources to prevent this or at least ameliorate it. That of course does not reflect the misery and death that ensues from broken limbs, often simply due to the trauma or the operation to fix the problem.

I personally, become extremely nervous, for my bone density challenged love, when snow hits the ground, because I know, one fall could be enough to end her days. And, those with prosthetic hips, break them more easily, because of the greater mass of the metal implants breaking out of bones, factor in the Diabetes and a potential exists for disaster. I therefore buy my own salt, and use it with profligacy, in my immediate vicinity. But, I can't precede each of her steps with a sprinkle of rock salt; clear a path with a snow shovel. I just have to live with the stress. I would like it to be diminished.

Profit in Healthcare- Coming Here Soon.

2010-12-10T18:58:00.001+01:00

The ConDem's are forcing us toward a profit based model for Healthcare and Hospital Services, with their policy of 'any willing provider' as discussed in Pulse. Well actually, it did exist before under our old friend Andy Burnham, but he had a bit of change of heart, er, sorry, mind (he allegedly has a swinging brick where that organ should be). AWP is welcomed by some in Medicine although I'm sure, not by my masked hero. Equally not by the journeyman doctor, whom I also admire greatly.

This is likely to be the result, in a country where Healthcare is always lauded as being better for having to be paid for. You may also find the export of another aspect of US health care, the 'pushing' of particular drugs by Doc's who are paid by Pharma. Great, really looking forward to it. Cheers Andrew, can't wait. You ******* ********!

Phew... that must be my shortest post, ever!

Aspirin and Cancer, Will it Help?

2010-12-08T19:27:00.001+01:00

Much has been made of the recent meta-analysis of studies that were originally undertaken on the use of Aspirin for the prevention of heart disease. It has been hailed as a cheap and effective method of reducing all types of Cancer and in particular Colorectal Cancer.

So, what is Aspirin? Not a silly question because it has many uses, and is in fact the most prescribed (mainly self prescribed), medicine in the world.

It is an analgesic, so eliminates or reduces pain, usually mild pain. It is also classified as an NSAID, so it is a non-steroidal anti-inflammatory drug, because it's primary mechanism is to inhibit cyclo-oxygenase products in the body (inflammatory agents like prostaglandins). It also has antipyretic properties (reduces fever). In recent years it has been used at low doses as an anti-platelet agent (it 'thins' the blood) in the treatment and prevention of CHD and CVD. Pretty useful then it might seem, but it has been linked to gastro-intestinal and stomach bleeding and is contra indicated for hemorrhagic stroke, all due to this last mechanism.

Patented in 1897 by Bayer, as the synthetic form of the original white willow bark extract, it is acteylsalisylic acid (C9H804), it's patent has long expired but Aspirin as opposed to aspirin, is still a Bayer patent nonetheless. It has been an OTC (over the counter) medicine since 1915. The world uses about 35,000 tonnes of the stuff every year, so despite its low cost, it still turns a dollar for the generic pharmaceutical companies. It should not be given to children, because it can cause Reye's Syndrome which is potentially fatal and is only used for the treatment of Kawasaki Disease, which has nothing to do, with the penchant for riding motor cycles at an early age, but another problem altogether, or for certain types of post operative care, for which it is a useful product, to prevent DVT (deep vein thrombosis). Throughout its long life it has been over and under used, and recently used almost only for heart disease prevention. Many foolishly, I feel, self prescribe it for this purpose, to their cost, as long term use can cause ulcers. Before the widespread use of Acetaminophen (Paracetamol) and Ibuprofen, (when I was young), it was the only analgesic available over the counter. Except of course for Codiene, which was then widely available over the counter; now stopped of course due the possible addiction problems of opiates.

Cutting to the chase, what then is the 'break through' in its use that causes it to be hailed as a cheap and simple Cancer drug?

Well yesterday, the Lancet published details of a study (of studies), undertaken over some twenty years, of the use of aspirin as opposed to a placebo, originally for the prevention of heart disease. This meta-analysis highlights the preventative effect of aspirin for a number of Cancers, but the effect was not apparent for at least five years or even longer for colon, rectal or prostrate cancers. The effect seemed to be better the longer it was taken and the older you were. However, a number of quite large reductions in risk are quoted for this cohort (the one studied) of some 25,000 or so, for various cancers. I have reservations however, as the implied rather than actual, reductions are somewhat lower than described. Relative risk being used, rather than absolute. This paper provides a better explanation of the research involved. The abstract url I have given for the study is in fact pretty brief, and as usual, despite it's importance, one has to pay a fee, both to access all the data, and even more to publish it. Let not medicine, and science, miss an opportunity to make a few quid (bucks) extra, even when we have paid for the research, probably the Institution doing it, and the wages of those involved.

One thing stands out, and that is the length of time you need to take this drug before protection is afforded; between five and seven years. The reduction in 'absolute' risk is also quite minimal too; with a 2% reduction in the twenty year risk for colorectal cancer, from 3.5% to 1.5%. Overall life time risk for this Cancer is in the order of 5%.

I personally view the enthusiasm with which this was greeted with some alarm. It is being sold as a 'get out of jail free card' for humans, so they can go forward without changing their lifestyle. That's pretty much the same concept, as taking statin's if you're healthy. Lets medicate everyone, in the hope we'll catch all. Every time we've done this in the past things have gone badly wrong. You used to see bumper stickers in the US, that said " Kill em all and let God sort it out". Well it's the same mindset. Not one I aspire to.

The other problem, and this is true of all meta-analyses, is which of the many studies to include, to ensure there are no paradoxes or selection bias ( such as Simpson's Paradox ).They do have some strengths, but without more reference data to examine it is a little difficult to afford it the credibility of a long term, double blind placebo trial, which may have been too expensive or may have thrown up ethical problems. Also, the usual caveat has to apply; this study is observational and 'observation does not prove causation'. And finally, much has been made recently of 'what the placebo actually chosen is'. If, for instance one included as a placebo, in a trial of diabetic hypoglycemic agents, the obvious thing we believe placebo's to be; a 'sugar pill', we would for sure, get good results for the drug on trial. Although I'm certain that no Pharma company would stoop so low. Well reasonably certain; well maybe there's doubt. Thing is, we simply don't know.

There are plenty of other steps we can all take to limit our risks for Cancer, most of which relate to lifestyle and diet (see my many previous posts) and frankly, they are likely to lower risk, far more than the use of aspirin. But, if you have a family history of Cancer especially bowel cancer, then look at the risks. Maybe it would be worth it, for someone with a robust gastro-intestinal system and no history of problems, such as ulcers, IBS, gastritis etc.

Aspirin is a fairly simple chemical medicine, and I do applaud the use of simple solutions to complex health problems, because there are plenty out there. I have considerable doubt however, that this is one to adopt universally. There are many more, even simpler that work. I will write about these soon.

The Things They Do To Women. Part Two - Osteoporosis.

2010-12-04T01:56:00.001+01:00

Is it 'disease mongering'. An unholy alliance between the WHO, 'Big Pharma', the FDA, and the Medical Machinery Cartels, or is it a genuine desire to better the lives of post menopausal women? Let's look at the evidence.

First of all, let's define what the problem is. If you or a loved one has had a DXA-scan any reading below -2.5 is seen as osteopenia not osteoporosis. You have the precursor to osteoporosis. Your bone mineral density is low but even if it's 2.5 (that's -2.5SD) you are not ill, you are just getting older (unless you have hyperparathyroidism that is). Most will be women and postmenopausal. Why? Well, the menopause alters the hormone level and that to some extent governs the levels of osteoclasts and osteoblasts. The former remove density and the latter build it, in a natural process that lasts most of our lives. As the repository of calcium, the bones will give it up, when the body needs it elsewhere, and reabsorb it when it does not. Largely the process is governed by the parathyroid, but also the levels of Vitamin D3 and intake of calcium from the gut have a part to play. As we get older, our ability to keep our bones strong naturally declines, so it happens to us all, with very few exceptions.

Men are somewhat less susceptible, as they do not suffer from the loss of hormones in the same way as women, but men do get it, but it is less severe or predominant than in women. So none are ill, just getting older. Why then is any importance attached to it? Well, it can be crippling to a very small cohort, who have repeated fractures or their spine starts to crumble. These are rare, but becoming less so. But all of us lose some bone density, as part of the ageing process, it is inevitable. Calcium supplements are often prescribed, or they, were until a scare about these being contributory to MI (Heart Attack), in women went about, but on the whole western populations do not suffer from any scarcity of calcium, in the diet. We do suffer from a dearth of both Vitamin D3 and magnesium however, which can be contributory to bone density and is hypothesised by some to be part of the reason for density loss.

However, if we all lose some density as we age, do we need to diagnose it as an illness? We don't, unless our careers are determined by looks, do much to hide wrinkles, or hair loss or the myriad symptoms of ageing. What's so special about bone density? Well, it can make money, a lot of money. Both for the makers of dual Xray absorptiometry machines and 'Big Pharma', who produces various drugs which are alleged to halt it's progression or even increase density. Largely targeted at women (of course) these machines measure the absorption of radiation and via an algorithm and express this as a T-score. If you are thin or heavy the measurement can be 'skewed' as the algorithm is based on thickness of the bones and averaged out. So thicker/thinner than average can alter the true result.( If you do get a scan, then try to have any repeats done on the same machine, to ensure differences are measured against the original). But overall the scan itself, is not really dangerous as it uses very low levels of radiation.

"Bone mineral density testing is a poor predictor of future fractures, but an excellent predictor of the start of drug use."said Barbara Mintzes, in the BMJ, not so long ago. She was referring to the alliance between Merke and the makers of DXA scanners, formed at the outset of the Osteoporosis 'Industry' (1995). Their drug, Fosamax, was the first in the market. It suppresses the action of Osteoclasts and as a result, bones become harder, but, not necessarily stronger. Tensile strength tends to be lost and bones becomes harder but more liable to shatter. Like glass or an eggshell.

Biphosphenates have been linked to the very problem that they were designed (allegedly) to prevent. As well as thigh bone fracture they have also been linked to Necrosis of the jaw bone. Frankly they are also pretty awful to take as well, requiring that you do so on an empty stomach, with copious amounts of water, stand or sit upright for half an hour, all to prevent damage to the oesophagus, for which it is alleged they can cause cancer. What are they? Well, pretty much a type of washing soda; in other words a pretty caustic product and you drink this? Would any man do this? I think not. This information might help in any decision. but the overwhelming evidence is that Alendronic Acid (Fosamax etc) will only decrease the risk by some 1%, at the expense of exposure to some quite horrific side effects, let alone the misery of taking the damn stuff. A simple but scientific explanation is detailed in the link that may help.

As may be realised, I am a little partisan about this problem and there is little science available in the form of any real studies. Most available, were undertaken way back in the 1990's, and by 'Big Pharma', who had much to gain from sales of a new product for a new 'illness'. The bone the drugs strengthen, is cortical bone (the outside layer). They do little or nothing to strengthen trabecular bone (the internal core). So an overall increase in density will show up on a DXA scan (although not a lot) but it will be predominantly cortical density, which will do little to nothing, to reduce your chance of fracture (absolute reduction of 0.5%). A warning, although a somewhat low level one has been issued from the FDA about the use of these drugs causing fractures. It seems to be related to the length of time of use, but my feeling that time should be never.

The intake of Cola drinks has been associated with bone density loss, so it's a good idea not to drink them. They're pretty toxic any way as I have related previously, so it's not a loss. Drinking milk, won't really help although many will tell you it will. But dietary calcium is abundant, the trick being to boost absorption, without any associated heart problems, so Vitamin D3 intake needs to be increased especially in winter when the sun is low and you're wearing lots of warm clothing. So supplementation is needed. At least 1000iu but maybe a lot more. So get a 25(OH)D3 test to ascertain levels. Take load bearing exercise and indeed, any exercise that helps to maintain suppleness (Pilate's?). Asian women suffer somewhat less than Western women, in general, which is attributed to their intake of fermented soy products. Soy is said to boost or even emulate Oestrogen, but I emphasise 'fermented' soy, not that Soy, the Food Cartels sell; that is not what the Japanese consume, so leave out the appalling soy milk. You need fat, to metabolise Vitamin D3, because it's fat soluble, so 'low fat' is not a good idea if you want to boost bone health. Oh, and fortified dairy products use inferior synthetic D2 not D3, which is poorly absorbed. Best use full fat 'real milk'. You know, the one with the cream on top, preferably Jersey, Guernsey of Buffalo.

It should also be understood that a DXA scan result is a 'surrogate end point'; that is, a marker chosen by those, who wish to sell a drug, that alters that end point. It does not guarantee you will not get a fracture, or indeed reduce the risk by more than 1%. The 'clinical end point' would be an actual fracture. But intake of a toxic substance that largely does not do 'what it says on the tin', is merely to line the pockets of 'Big Pharma', to no useful purpose. It is likely, that if we screened every woman over 50, for bone density, the overwhelming majority would be found deficient. You see, the starting point, the zero on the T-score is a woman in good health at 30. So set the score impossibly high so most will fail to meet it and you have the largest cohort to treat, all of womankind.

The ConDems NHS (What Do We Make Of It So Far).

2010-11-23T14:26:00.002+01:00

Well er... not a lot!

Six months down the line from the lack of any decisive victory over, well anyone, lets look at what has been achieved and what is planned.

GP Commissioning has been lauded, as the only way forward for the majority of Healthcare within the NHS. It is the Lansley answer, to all the previous 'top down', centralised decision process, that hallmarked the reign of NuLabour, but is largely the path that had already been ordained by Andy Burnham, before his demise as Health Secretary (and what a piss poor one he was). There is some 'spin' to this. GP's are the front line of all Medicine and Healthcare. The first point of contact (except for A&E), where the public becomes patient. Thus, it is posited that they should control the purse strings and commission any services, or treatments that, spring from that Primary Care role. In the process, we largely rid ourselves of the cumbersome and expensive, Primary Care Trusts (PCT). Except of course, that for all their faults the PCT's did most of the Admin, the Commissioning and Governance. And of course they provided the 'out of hours' cover the GP's wriggled out of for 6% of salary.

If then, the GP's are to cover all of this, they will have to undergo a step change in roles. One that they have little or no experience of, and, judging by the lack of enthusiasm displayed by many, one they have very little desire to fulfill. They will likely have to engage some of the Managers they have expressed considerable disdain for, or another organisation to undertake all the 'back office' work. Step forward the Private Sector, be it in the form of the 'Big Four' accountant/management bodies, or one of the many Private providers (Welcome to the Boots - Price,Waterhouse,Coopers, Healthcare Consortia, operated on behalf of NHS UK plc). I do not wish to be a merchant of neither doom nor gloom, but a void tends to be filled by the one who is quickest on their feet, and these people are pretty damn quick. When you ( a GP) are floundering in a mire of bureaucracy and red tape; have no real idea of the ramifications of what your new role needs, to give it credibility, with the National body that approves your Consortia; if someone offers you a 'model' that removes the doubt, many will grasp it.

Maybe some will gravitate toward the 'not for profit' social enterprise model, which could be a good thing, but the pitfalls and dangers, not the least of which is the very real possibility of 'inheriting' the debt and forward contracts of the existing PCT's, which Lansley has said he will not cancel or guarantee, may well put you off. Put you off, without the sort of financial 'clout' and dubious, but successful creative accounting capability of a well known Accounting LLP (remember the inspired auditing of the Banks that got us here in the first place).

And what about assuming the role of procurer of the drugs and supplies, now that NICE is to be emasculated? How do you evaluate the claims of 'Big Pharmas' products and devices, in a world of pitfalls and dubious trials, all proclaiming much, but generally delivering very little, except possible death in a bubble pack? How do you evaluate and procure an out of hours service for your patients? Do it yourself? There is a singular lack of enthusiasm to go back to that, I'm sure. Certainly from the sigh of relief that emanated from BMA Towers, when the Government gave it to the PCT's to provide, would lead one to that view. And, I'm pretty sure that giving GP's their 6% back will be met with howls of derision as an inappropriate value for such an onerous task.Will you spend your hard won budget at the local trust Hospital or contract with the ISTC or even BMI for routine operations?

I am not certain that such decisions should, or even could be made effectively by GP's. I am certain that many will not even want to. This is the largest change in Healthcare since the birth of the NHS. Whilst consultation is taking place, it is largely with those organisations, that most feel have failed to deliver a just and fair NHS that addresses inequalities; the GP bodies (see last post). I do have hope; not a lot, because I have little faith in any breed of Politician, especially those that are trying to make me happy, whilst removing hope of any prosperity in the next, how ever many years. I'm not at a time in my life, like many others, where there are years available to me, to observe these policies through to any conclusion.

I despair of the much that is happening. The complete madness of a 'responsibility deal' with the major fast food retailers (McDonald's, Pepsico etc) is akin to placing regulation of game keeping with the poachers. As is enjoining with the major food and drink suppliers, to promote 'health'. That any of these, will actively pursue a policy based upon any motive, other than self interest and profit, is somewhere between naivety and lunacy. They already produce products laced with the toxic, man made, chemicals that have likely caused much of the ailments that modern flesh is heir to. To devolve even more power of damage to these architects of high carbohydrate diets, infiltrated with High Fructose Corn Syrup, Soy fed meats, Hydrolysed Vegetable Protein and other injurious additives is madness of a scale only to be found in the USA. Do we wish to emulate a society where the food lobby guides Government Policy and the Drugs Industry then feeds off the damage? Because that is where we are going. If Lansley and Cameron have their way, that is where we will arrive.

PS This is one view. That from the Black Tower. If nothing else it is amusing.

The Dept. of Health in the Dock (again).

2010-11-18T13:17:00.001+01:00

The Editorial in the Lancet this week upbraids both Politicians and Doctors (mainly GP's) for failing to address Healthcare inequalities. It's is not very kind to Health Officials, and targets the Permanent Secretary particularly. In less than edifying language Margaret Hodge, was scathing about the failure to deliver the promise of NuLabour to remove these inequalities, despite the vast increase in the NHS budget and thirteen years of power.

The editorial was particularly strong in it's condemnation of the Profession and GP's in particular, for the vast rewards they have reaped, since 2005, when they took on the new contract. This saw income rise to an average of £105k, with some making £250k, by virtue of the bonuses paid for the achievement of goals within the Quality Outcomes Framework (QOF). These were mainly politically motivated objectives, that saw routine Healthcare reduced to a target culture, whereby GP's could derive payments for taking and recording things like blood pressure, or BMI, for certain patient cohorts. Worst of course, was the need to attain certain levels within QOF to reap a reward, which heralded the 'lipid' testing of perfectly healthy people, and the subsequent dosing of them with statins, or antihypertensives (whether they needed it or not).

Substantively, I agree with the sentiment of the Lancet article, although some of the detail is a bit 'overblown'. After all, some the GP's, who stand accused of indifference to their patients plight, may just have been exercising some scientific 'triage' of the goals set by various QOF's, and found them wanting of evidence of efficacy, and simply ignored them. Well more power to them, but why don't they stand up and be counted? As for Hodge, well she has an appalling record, in voting for all the Blair reforms in Healthcare, including the setting up of Foundation Trusts, yet she has obviously now 'seen the light' and wishes to align with the patient. The report is here.

When the 'blessed' Tony came to power in 1997, he was in a unique position. The majority of the country saw him as a reformer, with an evangelistic zeal, to drag Healthcare and Education into a new dawn, with reforms that were purported to be based on scientific agenda, not the thinly disguised and hugely expensive, 'privatisation' of these core needs of the populace. Instead, he failed to carry through his promises but gave us the 'spin' of his continuation of the previous lot's desire to sell off the assets we all owned, for a handful of beads and a sack of corn. Neo-Thatcherite to the core, he embraced private sector solutions to the urgency of improving Health (and Education) that were hugely expensive, and with it spawned legions of highly paid management cadres, who sucked up most of the money, building 'empires' to justify their ludicrous elevation within Healthcare.

He fostered many of the 'Quangos' that the ConDems are now pulling apart, on the premise that Governance was all about measuring process, at the expense of outcomes. The disenchanted Doctors, many of whom hated the rhetoric, failed to champion their patients and saw the chance to better their position by negotiating a new deal that placed them as financial equals to the Consultant cohort. Some at the time (2005) could not believe that they escaped from out of hours cover, for a paltry 6%. One of the senior negotiators for the BMA, even said he thought they were "having a a laugh". And, of course they were, all the way to the Bank! This single act alone hugely increased costs, but more; the outcome of QOF was to elevate costs even more, as the tests to prove it's effect spiralled.

So, money was spent that achieved little of any substance, other than the enrichment of most within the NHS, except the 'coal face' workers, who found themselves more and more, isolated from the patients they were there to serve. Management found ways to cut costs, that deprived patients of standards of care enshrined in that contract we all have with those we pay to help us when we need it. Emerging from this, large numbers of complaints began to arise, that then gave birth to a whole new Bureaucracy, given the task of 'managing' these. Not, I must add resolving them, because that does not seem to have been the objective. Obfuscation, delay, and even lies, were then employed, to prevent the delivery of truth, justice or candour.

Well, that was then, and this is now. The Coalition has suggested, even promised to change, all that has gone before. But Neo-Thatcherism is not dead, and now lives on in all politicians, with little to separate any from all. Practice Based Commissioning was already being rolled out by Brown's lot, before he lost the election. Calling it GP Commissioning does not change it, although at least it was not wholesale, it was a slow 'rollout'. Wholesale change, may be a good thing, although trying to cut a ludicrous 20% in the process is both unrealistic and unattainable. It will be just the same as before; figures will be produced to prove it's happening, that some Select Committee in five or ten years time, will tell us were untrue. Some very good people will lose their jobs and evidence based Healthcare will continue as before, without any evidence to back it's ludicrous policies. We'll all get fatter, get Diabetes, Heart Disease and Cancer and interventions to allegedly reduce the incidence will fail, just as they have for the last thirty years. The good Doctors will retire early, the bad one's will become leading lights in GP commissioning. Everything will be different, but stay the same.

Oh, and patients; you thought you had been screwed already, now you're really going to be f****d.

Is This How To Run A Railway?

2010-11-11T12:47:00.000+01:00

No, this post is not about the appalling Railway system of the UK. It is an analogy for the NHS.

As the ConDems savour their power, with increasing confidence, imbued with the enthusiasm of born again Christians, maybe we should compare it to that which occurred, when the major transportation system of the UK was sold off to the highest bidders, ( the lowest, in truth) for each region, or service. The end result of the Tory plan was a disjointed 'mish mash', of competing companies, supported by ever increasing volumes of Taxpayer Gold, that made millionaires of some, bankrupt a few, and produced a worse service than we ever saw under the old British Rail. We also saw the rise and demise of Railtrack and its substitution with Network Rail, the governing body of the Industry and owner of the Infrastructure. It is a Company Limited by Guarantee and thus has no Shareholders. The DfT is a member, but does not own it. It pretty much does what it likes because Blair, who set it up, did not want the sort of Governance that had plagued him with other bodies. The result has been a huge increase in accidents, poor or even absent maintenance, overcharging, overcrowding, lack of any real democratic input or control.

So what has this to do with the NHS, one might ask. Well we are going down the same road. NICE is to lose its role of cost benefit analysis and negotiation with 'Big Pharma' the (piss poor) Care Quality Commission will be replaced by Monitor, because all Trusts will become Foundation Trusts. PCT's will become no more, being replaced with GP Consortia in the role of the Commissioning bodies; poacher and gamekeeper under the same hat. ISTC's, the 'Big Four' accounting and management bodies (PwC, KPMG etc), will be handed roles on a plate, to organise or even provide services,despite their complicity in the debacle of Banking Audit, and the Private Healthcare companies, are 'to be encouraged' (bribed), to bid for contracts, to provide and commission services, for Healthcare. And the useless Complaints System will become a battleground of even more complexity and futility, being hamstrung by the lack of any Public Scrutiny brought about by the constitution of the changes.

Just as in the Railways, there will be a bewildering array of bodies, organisations, some spawned from 'Big Pharma' themselves, all trying to make a profit out of misery and accident. The rigid safety mechanisms overseen by the military precision of the engineers who ruled British Rail (nearly all ex REME engineers) was supplanted by companies who lost lives due to lack of safeguards and planned maintenance. The result has been escalating costs, obscene profits, lack of forward planning and danger to the passenger.

For passenger, substitute patient and you will see what I am getting at.

The Things 'They' Do To Women.

2010-10-21T14:40:00.008+02:00

As many who read this blog will know, I am a critic of the current and highly flawed practises perpetrated upon women by Medicine. It is my belief, that many interventions, alleged to be for their good, are in fact counterproductive, and include in these, breast cancer screening, with mammography and the use of HRT (hormone replacement therapy). I'm also pretty convinced that most of the treatments persued in 'curing' cancer, especially breast (and prostrate cancer), are ineffectual to a large extent, but I'll save that last bit for another day.

Postmenopausal HRT, was hailed as a breakthrough in assisting women adapt to life after child bearing years were over, both in maintaining their femininity and easing, or eliminating the symptomatic 'hot flushes' (flashes for the yanks). This is obviously something many women prized as an outcome, because it seemed like an 'elixer for youth'. Well, it turned out to be something completely different, and for some it was a death sentence. In JAMA yesterday, the results of an 11 year study of a very large cohort of women was published that concludes, that combined HRT increases breast cancer significantly; well, in the cohort study, it was nearly doubled. Worst still was the fact that the type of cancer was node-positive, not the 'benign' type that 'Big Pharma' had already acknowledged was more likely when on HRT. How any breast cancer can be viewed as such boggles my mind but hey-ho, drug companies often use such terms as their stock in trade. Highly regarded (by me anyway) Paul D. Maher also highlghts this study in his blog today, which may mean great minds think alike, (would that I was as credentialed or clever as he) but maybe not.

Well, it was already known in 2002, that the Women's Health Initiative Trial (WHI) was halted due to evidence of harm, and that many advocates ('Big Pharma'), refuted this as being purely observational and as such inconclusive. Whilst I still hold to the view, that observation does not prove causation, at the same time, observed harm, is a serious problem.worthy of urgent and serious investigation. After all whilst the use of 'extract of pregnant horse piss' may have afforded women comfort in menopause, it was hardly something worthy of risking one's life to eliminate. Amongst the many charges leveled at HRT in both the 'combined' form and Oestrogen only types are;-

Heart Disease
Stroke
Lung Cancer
Blood Clots

Insulin Resistence is also attributed as being a highly possible side effect, which may throw some light on the high incidence of Type 2 Diabetes amongst post menopausal females. That's a hypothsesis only, but there does seem to be some anecdotal evidence for this. Once more the drugs industry stands charged with producing dangerous products that do much more harm than good. Well, no change there then!

Acedemic Arrogance in the Matter of CAM.

2010-10-15T01:08:00.000+02:00

In the matter of Complimentary and Alternative Medicines (CAM), much has been said by both medical bloggers, Doctors and Clinicians. Such words as 'wibble', 'mumbo-jumbo' and other derogatories, have been usefully employed to deride CAM. And, sections of the protocols employed within CAM, have been highlighted to prove the point. Homeopathy and Acupuncture particularly, have been held up to the light of day, and pronounced as worthless, and without any scientific proof of efficacy. I heartily agree with this view, and would apply it to quite a few other aspects of CAM. But, I do think, that to classify everything outside of mainstream drug protocols and the medical 'mainstream' as useless, is nonsensical, counter productive and further, it is arrogant in the extreme.In many ways, it also flies in the face of a number of treatments already adopted by many Clinicians.

Physiotherapy has become an essential part of recovery protocols, or even primary interventions for many, both in Hospital and in the Community. Yet, it is, in strict terms 'complimentary', to Medicine and Surgery. So get your terms right Doc'. If the use of specific vitamin supplements by Medics is invoked, again you are venturing down this road again. Some will recommend or even prescribe fish oil concentrates, to certain patients (Amcor). This is of course despite the fact, that the NHS will be paying through the nose for an expensive version, of that which can be obtained, 'over the counter' from quality sources. But that's the problem we have with NICE; they often recommend (or don't) the use of particular products based upon flawed or skewed evidence, or simply price.

In the matter of evidence, a lot outside of the 'mainstream', is viewed as being without any evidence of efficacy or safety, when the truth is that there is wealth of well constructed trials, just as good, if not better than those conducted by, or paid for by 'Big Pharma'. It's just that Clinicians pronounce judgement without even bothering to look for them. It used to be a widely used protocol in coronary heart disease, to utilise magnesium both in IV form as well as orally. It is also viewed as a major deficiency, especially in the elderly, and with the concentration in the diet, of 'industrial foods', is also becoming a deficiency in the wider populace. Supplementation, is now the only way to ensure an adequate intake due to it's depletion in the soil and consequently the food grown, and animals who live on it. It is essential for human metabolism and a deficiency, is linked to many diseases as well as CHD. But prescribing it, and taking it is CAM. Yet it is embraced by many, both within and without Medicine. It is also the subject of much research as shown here and and here too.

Moving onto drugs; there are number currently in use that owe their existence to CAM, which of course embraces herbs, vitamins and supplements. Metformin, the drug almost of first use, for Diabetics, is the synthetic form of French Lilac. Statin's, for what use they are, are the result of a poison found in China called Red Yeast Rice, and of course many, if not most of the older drugs in use, especially analgesics, are all based on, or made from natural sources (Opiates). In fact in the early days of medicine there was nothing else, as anyone who has studied its history can attest. In many ways, some herbs can afford results to patients, that are better, or as good as drugs, and usually (but not always) with fewer or no side effects. The problem arises, that treatments, based on this type of medicine, yields little or no benefit to the Drugs Industry.' They' love to 'patent' everything, so as to make money; lots of money. It seems in fact that 'Big Pharma' and some Doctors view disease as an income stream, rather than something to cure, and patients as a means to a handsome livelihood.

Doctors also advocate diets. Diets are part of CAM. Most of that, which they tell the patient, is counterproductive, because they do not keep up to date with research, or slavishly follow the advice of vested interests of the Drugs Industry, which requires dietary input to legitimise its drug protocols. This often flies in the face of common sense (high carb diets for Diabetics) or legitimises heavily flawed, or unproven hypotheses such as 'fat causes heart disease' (see last post), but diets however, are part of CAM, so curb the hypocrisy, Doc' you recommend diet all the time! Just because it's the wrong one does not change this.

There is much within CAM that is wrong, so wrong it boggles the mind. It is full of 'snake oil salesmen', some legitimised (they think) by being actual Doctors, MD's that is, not simply graduates of some obscure institute on the 'net. Some will flog you a pendant, that will change your life, or a bracelet to cure your arthritis. Others will promise you explosive sex if you take their herbal concoction. But beneath it all are some good and honest practitioners, who utilise the best of both schools of thought and will resort to drugs when needed. One particular area dear to my heart, as a Diabetic carer, is the reckless use of antibiotics for Urinary Tract Infections.

A simple treatment with a sugar derivative, called D-Mannose, cures the bulk of UTI's that stem from E-Coli, but by a different mechanism. It simply attaches to the bacteria preventing it adhering to the bladder wall and is flushed out. It cures about 80% of common UTI's

Closed minds. Hubris. They all contribute to the arrogance displayed by many in Medicine. The dismissing of everything outwith drug protocols peddled by 'Big Pharma', or the politicised advocacy of useless or even harmful diets, displays the lack of any real pragmatism in Healthcare. There is some light; some are now looking to supplements such as Vitamin D3 and CoQ10 as a means of supporting patients immune systems. Some will even advocate lifestyle changes as a means of curing rather than simply treating symptoms with spurious drugs that prove to be more dangerous to the patient than the ailment with which they present. More power to them.

There is a place in Medicine for all that is science based, but sometimes a gamble has to made. You can't do a double blind placebo trial in humans for UTI's with D-Mannose. It would be unethical. But I can attest to it working. And I became very seriously ill with it, and had three courses of antibiotics and was diagnosed with possible cancer. It wasn't I'm pleased to say, but I and many others (not all) could be spared that and the NHS much cost if this simple protocol was invoked. There are many others; most inherently benign. Is it not time at least to try a middle road?

Andrew Lansley, Evidence Based Nutrition and the NHS.

2010-10-05T13:32:00.001+02:00

Chis Kresser aka the healthy sceptic highlights the fact, that the new 'Dietry Guidelines for Americans' is not an evidence based document in any way. Considering it is the first complete update since 1977, with the intervening years being significant, in that despite the uptake of low fat, high carbohydrate diet, both CVD, CHD and Diabetes have increased dramatically. The Committee, seems to have conveniently ignored this fact in its deliberations and closed it's mind to any view, outwith conventional one's peddled by the moron's that govern Healthcare in the US and of course, in the UK as well. Because it is certain, that these guidelines will form the basis for those recommended for UK citizens be they Diabetic, Obese or suffering from heart disease

Some scientists, so affronted by the lack of science displayed by the report and its lack of evidence in its conclusions, have seen fit to write a critique. You can read this here. It is important to do so, to realise the depth of stupidity that is often displayed in advice handed down to the populace by this or indeed almost any Government.

In the UK, we will soon see, the closure of the Food Standards Agency (hurray) with the role being assumed by the Dept. of Health (boo). And we are told by the Secretary of Health, one Mr Lansley that; “I am committed to improving the public’s health by providing evidence-based advice to support people in making healthier choices. The transfer of nutrition policy in England to the Department of Health means we can give the general public more consistent information".

I do not know, whether to be pleased to hear this or not. It depends greatly, which evidence he will base this policy upon, and whether there is any real desire by the current coalition, to make a sea change in policy that will effect real improvements in Health, for the populace and at the same time save money, because there is little doubt in my mind that basing criteria for nutrition upon real evidence based guidelines, will indeed achieve significant cost savings and real improvements in health.

If we are to view some policy decisions already made, such as the 'scrapping' of the piss poor Private Finance Initiative for Schools, which would have seen huge, but 'off balance sheet' costs being borne by council tax payers to fund schools, planned by 'NuLabour', then there is hope. So far this model, for Hospital building has created worse constructs, than would otherwise have been the case, together with huge costs to the Taxpayer. For instance, the new Birmingham 'super' Hospital, as reported in Private Eye, will cost some £2.6bn over 35 years for a build cost of £627m. However in that same journal we learn that despite the criticism leveled at 'NuLabour' for their "flawed PFI model" by a Mr. Osborne, that there are now "no plans to review the use of the private finance initiative, as a procurement vehicle in the National Health Service".

The future looks even bleaker for justice and candour too. With the emphasis on GP commissioning and Foundation Trusts as the future of Healthcare, we will no longer have any sort of public scrutiny of , well just about everything. Public access, to what will be Private Consortia, in the case of GP's and closed meetings, as is the case with Foundation Trusts, will make the public even less informed than now. Which is little hard to contemplate. As 'social enterprises' they will also be immune to Freedom of Information requests. If the LibCons, really want enjoin with people in discussing our futures, this decidedly seems the wrong way to go about it. Nothing new there then!

More Drugs for Diabete's - Back to the Future?

2010-09-29T13:13:00.000+02:00

Way back in the mists of time, chemists discovered a glycoside compound from the bark of apple trees that had a profound effect on glucose disposal in Diabetics. This extract, called Phlorizin, brought about glucosuria, which is the excretion of glucose in the urine. It also to some extent also caused polyuria (excessive urination). As these are often symptoms of Diabetes itself, and as it was only 1835, it took a while for it to be viewed as anything that could be useful. As time went by experiments were undertaken to find a use but it was not until the 1970's that the mechanism of the compound was discovered and named. Sodium-Glucose Co Transporter-2 inhibitor (SGLT2) is what it became and is the current theme of most research, for yet another drug for Diabetes.

I say yet another, because rather than using the original compound, which was in fact poorly absorbed in the gastro-intestinal tract, 'Big Pharma' needed to come up with a better 'mousetrap' in the form of a synthetic compound that could be patented, so that money could be made. Frankly, I find it a little alarming as the way it works is to inhibit the capability of the kidneys to 'save' glucose from being excreted in the urine. This a process discovered, that the kidneys perform, to conserve vital energy in the body and functions at a certain level. In Diabetics with high circulating glucose in the blood, the kidneys filter out the excess and do not conserve it all, as with normal humans, hence both glucosuria and polyuria are symptomatic in the Diabetic with low level control of hyperglycemia. What these new experimental drugs aim to achieve, is to enhance this phenomena, outwith the normal kidney function, so that the process 'kicks in' at lower levels of concentration. It does this by inhibiting SGLT2 in the kidneys.

Astra-Zenica are conducting trials of their contribution to this wonderful idea at present; it is called Dapaglifozin and is being developed in conjunction with Bristol-Myers Squib.What is important is the unintended consequences that may ensue from this, and the effect it may have on kidney function in the longer term. These may be obvious to many Diabetics with a grasp of their problems and the primary one is the enhancement of urinary glucose. All Diabetics are prone to urinary tract infections and genital fungal infections. This is largely because of the high glucose content of their urine, as bacteria and fungi feed on this. Low levels of glucose and acid urine inhibit this but Diabetics struggle to maintain this and, as a consequence get this type of infection and use antibiotics regularly as a result. This of course adds to the problems most already have and exposes them to long term or repeated incidents of UTI's for which ever more drugs are prescribed adding to the polypharma to which they are all subjected. To expose them to even more risk in this area seems somewhat counter productive.

In addition these drugs thus far have not displayed a great deal of success and are viewed very much as an 'add-on' protocol, for use with other hypoglycemic agents, such as metformin. They do enhance the performance of of these agents and lower HbA1c a little, but nothing startling. They also do enhance weight loss to a small extent, which is usually a good thing for a Diabetic, but, is it not about time, that science stopped its constant search, for a fix for something that is easy to stop. Reduce the glucose level at source, by stopping eating carbohydrates to any extent and Diabetics ease the burden on their already overburdened pancreas, and both the need or at least the volume of drugs needed is reduced or even eliminated.Of course that presents a problem for healthcare and especially 'Big Pharma'. So much money is at stake, both for them and for the NHS, which spends in excess of 10% of it's entire budget on Diabetics. The gravy train would halt and quite a few employees would no longer be needed. Turkeys voting for Christmas, I think not!

It also goes to show the panic in the Industry at the moment to come up with new ideas for drugs because patents are fast expiring and little is in the pipeline. There has been nothing of any significance, discovered in Medicine in nearly twenty years, except more 'me too' drugs or new strains of the old one's. So they are turning once again to the old favourites such as cancer or diabetes. They've peddled useless or near useless and dangerous drugs to these cohorts for years, without any glimmer of a cure and it's costing them billions in compensation for some, such as Avandia, the cost of which has virtually wiped out GlaxoSmithKlines profits for the whole of the last year. Makes your heart bleed does it not?

It would be nice for a change to see research being directed at a cure, for some of these ailments or at least some acknowledgement that lifestyle changes can be just as effective as taking a store cupboard full of dangerous and often self-defeating drugs. Perhaps that is asking for the impossible.

At Last, Some Real Evidence of Efficacy of Omega 3's

2010-09-28T11:46:00.000+02:00

This study , at last gives credence to the view that Omega 3 oil, in the right quantity and mix, alleviates some of the worst elements of depressive illness. (Sorry about the quality, but the cached version is free).

There have been a number of previous studies that were inconclusive from a scientific standpoint, but such interventions were viewed as relatively benign, except where high levels were consumed, when gastro-intestinal problems ensued.. The difference here is that the effect was dose related, with a high EPA to DHA level. And in a relatively low dose. It was also a high quality study conducted as a double blinded placebo trial. This is the 'gold standard' we all seek to give proof to a hypothesis. In addition, the cohort was suffering from major depression, not the "I'm feeling a bit low", type, but full blown serious depression, that can challenge life itself. Patients with co morbid anxiety symptoms were not shown to improve, however, so this group derived little benefit from the trial.

It ticks every box of study protocols, It was long term, of a size to be significant, but most of all the scientists involved went to great lengths to ensure even the placebo tasted the same as the genuine oil capsule. Sure, it was supported by the makers, in that they supplied product, but there is no patent on fish oils, so no real axe for them to grind, other than the satisfaction of proving a hypothesis, long held anecdotaly, but always never quite proven categorically. It is also significant that the cohort using other antidepressant drugs in addition to Omega 3's also derived little benefit.

Omega 3's have long been associated with a number of health benefits, quite numerous in fact. They are viewed as an anti-coagulant, an anti-hypertensive and have been associated with pain relief in arthritis. A number of studies for all uses have been undertaken, but most owe their origin to the study of nutrition in the Inuit of Greenland in the 1970's, when it was found that the Eskimo (Inuit) consumed large quantities of polyunsaturated fatty acids from their diet of fish. They also consumed even larger quantities of saturated fats as well, but that's another story. This diet even if confounded slightly by this, did seem to confer a protection from heart disease, stroke and hypertension. Consequently these long chain fatty acids became a 'must' for health.There are a few downsides, perhaps with consuming very large quantities, in that those prone to bleeding, say into the brain (hemorrhagic stroke), or with Type 2 Diabetes could worsen their symptoms by consumption, but on the whole it is relatively benign and is attributed with health improvements.

It is important that the EPA (eicosapentaenoic acid) content is somewhat higher than is found in most proprietary capsules with a ratio of 1050mg/d EPA to 150mg/d of DHA (docosahexaenoic acid) so some addition of EPA to a standard capsule regimen may be needed. But pure EPA capsules to enable this are now widely available. I also, personally feel, that 8 weeks is quite a short time for full benefit to be derived, as I found, certainly with my arthritis that real relief was not felt for almost three months. but that is my anecdotal experience. It seems, again anecdotaly, that the lessening of depressive episodes that I had been having, was more a side effect of taking Omega 3 for arthritic pain. The underlying problem of osteoarthritis, of joint deterioration, is of course not improved by this regimen, it is merely a means of pain control without the use of NSAID's.

Any one wishing to follow this protocol should engage with a medical practitioner, if at all possible, prior to commencement, and ensure that it does not, reduce or enhance the effect, of any medication already in use. This is especially important for people on Warfarin or Heparin protocols as the anticoagulant properties of Omega 3's can be pronounced in this cohort.

Evidence (or lack of it ) Driving Healthcare Objectives.

2010-09-17T14:41:00.000+02:00

Healthcare has always been a Political subject. Back to the founding of the NHS, when Doctors railed against the deprivation of their 'Demi-God' status, by a State funded machine, to the Quality Outcome Frameworks of today, the Government, of the day, has tried to manipulate the public, and to some extent Doctors too, to achieve 'goals' that they feel are cost effective or laudable. Some were self evidently beneficial, such as the, largely, but not entirely, elimination of killer diseases such as polio. But as time has elapsed and various Governments have come and gone, the systems that guide and govern the protocols for health, have been corrupted by the concept, that Medicine has the answer to all of mankind's ills; that a 'pill' can always be devised that will fix virtually any and every problem that humanity faces.

Science itself, has been corrupted in many ways. Studies are now undertaken almost exclusively by makers of drugs, prosthetics and diagnostic machinery. Very little 'peer review' of the outcomes or dangers is undertaken, except by those same makers. The manufacturers are now corporate entities that span the globe and have sales in excess of small (and not so small) countries. Their influence in our everyday lives has become both persuasive and pervasive and sadly, Medicine and Healthcare slavishly follows the hypotheses propounded by various segments of the Public Health Community, the Regulatory Bodies, the (so called) Charities, all, who stand to gain, from the perpetuation of a disease, condition or ailment, because elimination would hail their demise.

Each feeds on the other, perpetuating the appearance of scientific unanimity, about a health benefit for which there was probability, which becomes a certainty. Drugs only prescribed for seriously ill cohorts, then become beneficial for the 'worried well'. Protocols are invented to guide what we eat, drink, spend our leisure time embracing, all guided by dubious healthcare benefits, for which there is weak evidence of any good or useful outcome. Powerful tools and organisations promote goals for which there is no real opposition, because it is not brooked, even in the face of incontrovertible proof that it is of no benefit, or worse, that it does harm. Possibility, becomes probability, and then certainty. Everything is presented as such; rational discussion is absent. Advice becomes diktat and all dissent is marginalised.

National policy currently advises us all that;-

Fat makes you fat and causes heart disease - not proven.
Cholesterol gives you heart disease - not proven, in fact proven to be false.
Statin's lower the risk of heart disease, in everyone - proven to be false.
Statin's lower heart attack risk in men with heart disease - now viewed as unlikely.
Hypertension (high blood pressure) is caused by salt - contradictory evidence therefore not proven.
Regular Mammograms save lives - in fact they do more harm than good.
Cancer rates are falling - not true, we are just better at extending the lives of those with it.
Heart disease rates are falling - as above.
Five-a-day lowers heart disease risk - in fact no benefit accrues.
Five-a-day lowers cancer risk - in fact there is little to no benefit except a small one for the vegetables only.
Green leafy vegetables lower diabetes risk - very little benefit.

The list is becoming too long, so I will stop now to save boredom setting in, but I can prove everyone of these tenets of healthcare to be either wrong or of so little benefit as to be virtually worthless. So how come the public doesn't know this and the bodies for whom we look to guide our health continue to peddle this worthless drivel? Well it's complicated. 'Big Pharma' and the food and drink industry have permeated all the agencies of the state and Politicians are so busy perpetuating power that they are indifferent to reason or dissent. Conclusions about healthcare are presented to the public with such forceful conviction that no balance now exists with the strength of the evidence that guides them or any that opposes it. There is a view that only the Politicians and the professionals that guide them, can weigh the evidence and they often view these protocols as inherently benign. So no harm then? Well er .. yes, but let not the truth guide you, if you are a Politician or 'Big Pharma' or the Food Standards Agency etc.etc.

Continuity of Care in the NHS (Joined up Medicine).

2010-09-10T19:04:00.000+02:00

This tenet of Health care has long been regarded as the ideal, by most if not all Practitioners. It is the best way of safeguarding the patient from errors and mismanagement, be it in Hospital or the Primary Care Unit, such as the GP's practice. Most Trust's trumpet it as the pathway they all adhere to, but the reality is far from the rhetoric.The Kings Fund views it as being essential to the patient experience, whatever that is, and is researching and asking for input to achieving this goal. So what is it that is going wrong that prejudices patient safety and causes the almighty 'cock ups' that occur with alarming frequency in some of our alleged 'best' (sic) hospitals?

Well we do not have enough good Doctors or probably not enough Doctors at all. That is Doctors, who are either prepared to follow a patient through treatment to discharge, or ensure an adequate handover to another at the end of shift. And by good I mean adequately trained and motivated, not some 'wet behind the ears' youngster, virtually straight from medical school, tasked with the job, of taking care of numbers of wards, and patients on the night shift, with only a 'phone number to obtain Consultant backup. And of course with the knowledge, that it would take a major disaster to drag him/her off the Golf Course or away from the dinner guests.

Not 'joining the dots' seems to be the biggest problem. Looking at symptoms in isolation without looking at the history, making judgements about treatment, without reviewing the notes and tests, that some lab technician has worked through the night, to deliver in time for the operation to be scheduled, or not? Not bothering to see the patient prior to treatment, and failing to provide sufficient information for patients to provide informed consent, due to the unbridled hubris that many display in their protocols and procedures. It is this lack of a continuous care pathway that leads to the sort of disaster that has befallen heart patients at the Nottingham University Hospitals NHS Trust, who failed their patients due to lack of diligence, in ensuring that information about serial episodes of endocarditus was not passed on to others, which in turn allowed lives to be lost without need.

It is far from the first time that this Trust, which is a major Teaching Hospital with intake of 500 F1's per year, has made the headlines. It is in fact rarely out of them, as my friends at National Death Service will attest. This is just in one week! Joining it all together, so that bewildered patients actually get to see a Doctor more than once, during their Hospital stay would be a first step. Actually reading test reports prior to giving dangerous general anaesthetics to people without first knowing, if that act alone might kill them might be the next. Acting on the results of tests, with knowledge of the patient history, is the foundation of treatment. It is not something you should leave to some half baked F2, at midnight on a Friday, whom you have conversed with on your mobile, and directed them to list a trauma patient, for operation, without seeing them, reading the notes, reviewing the tests and discussing informed consent. Yet it happened. And lives were irretrievably changed, and one almost lost.

Was there any contrition, any meaningful attempt at redress or even candour. Was there even any honesty in providing a prognosis for the future or information of any improvement intervention. Was there b******s. The attitude seems to be, that one should be grateful for having one's life threatened, when you entered their halls, without a life threatening injury; be grateful for surviving. Such compassion. Such empathy!

And there was Peter Homa, standing in front of his Gulag, apologising profusely for the death of the innocents who consigned themselves, to his and others care at his Trent Heart Unit. Only he doesn't care and he never will. Otherwise he would resign, and let someone else take the helm of this graveyard of unnecessary deaths.

So far as the NHS is concerned, it is getting worse as the statistics for Complaints attest. And the bulk of most harms are down to errors. And errors occur most of all when the simple stuff goes wrong. Not the heroic interventions, the open heart surgery, because it was not that, that killed the patients. It was a simple bacteria, that could have been guarded against by protocol. But only if the information had been pieced together. The evidence chain is important, but it is not being given the emphasis needed in today's NHS. Everyone is so busy filling in the screen, the report, the check sheet, that they then fail to read, or take action about. The Doctors can all howl as much as they like, but they are too callow and spineless to do anything about it. They are usually too busy working out the superannuation, and the date of their retirement.

Panorama Highlights Drug Danger to Diabetics

2010-09-06T14:23:00.000+02:00

The controversy over Avandia continues to rumble on, and the BBC have at last picked up, that it can cause heart failure in patients, despite the fact that it's makers continue to defend its use. John Briffa, as you see, has warned about this before. But as usual, the machinery of control in the UK, the Medicines and Healthcare Regulatory Agency is once more on a 'go slow' as regards it's withdrawal. Meanwhile more Diabetics may die or be harmed by it's use and Diabetes UK sits on it's hands (Some surprise).

The sad story of Avandia started in 1999 and it was approved for EC use in 2000. It belongs to a group of drugs in the usual 'me too' ranges marketed by 'Big Pharma', called rosiglitazones. They are thiazolidinediones or TZD's (a lot quicker to say, so let's do that). TZD's are PPAR-gamma angonists, which simply put, increase fat cell generation, as means of increasing glucose disposal. Pause a moment there, because are we not always told, that glucose, is not responsible for fat, but that fat is? So the excess of glucose, probably borne of the excess carbohydrates, you are told to consume as a Diabetic, is being metabolised, more rapidly by gist of this medication, and the mechanism it uses to achieve this is to make you fat! And this is to lower the risks associated with being Diabetic?

At this point I and my few readers may wish to lie down in a darkened room and ponder the logic of such a protocol. So I did and I still cannot see the sense in such a stupid idea, but 'Big Pharma' seems incapable of going beyond treating symptoms, with measures that bring about others, usually to the detriment of the poor souls who consume the drug. Well, as far back as 2004 there have been rumblings about the drug, with calls for the US FDA to ban it, and 'black label' warnings have been applied to the packaging, warning of the possibility of fluid retention (oedema) which in turn can cause heart problems, but an outright ban has not been invoked

The NEJM of June 14th 2007 (New England Journal of Medicine) highlighted the fact that Avandia was associated with a high risk of MI, which was some time ago but as usual little to nothing was done and millions of prescriptions continue to be filled, both in the US and Europe including the UK. The ACCORD Trial was halted due to safety concerns over this, and similar drugs and a number of clinicians are at last raising serious doubts about the validity of all drugs trials, due to the incestuous nature of the (often) authors links with the drugs industry, the grants paid, structure of trials and the withholding of essential data to enable proper independent peer reviews. Well, no shit Sherlock! An increase of 43% of heart attacks, in people that took Avandia for 24 weeks seems pretty conclusive to me!

I also find it unprincipled and alarming, that in most trials, the only way that the full data can be accessed is by paying for for it! The BMJ has a lot to answer for in this by having a pay wall between it and most data other than the (often) 'piss poor' abstract. This is often manipulated to give a 'slant', that is not borne out by the data in the full document. Most if not all trials are in fact paid for directly or indirectly by the drug companies who have vested interests in specific outcomes, and adverse results are often 'buried'. Some principled Doctors and Scientists have condemned this. Perhaps tonight's Panorama programme will delve more deeply into this aspect of 'Big Pharma's' persona. I'm not holding my breath however.

Freedom (well of a sort) Maybe

2010-09-02T14:29:00.001+02:00

She cupped her hands, lifted them high, and said "it's time to fly free!". I told her she was a sarcastic bitch, but I knew from the smile, she was just joking. And so we parted. It was the end of an era; an episode in my life that had been perhaps the hardest I had to endure. But she had helped me come to terms with a life less ordinary, that has taxed my identity, my very being at times.

She came to be, that very significant 'other' in my life, someone I became dependent on to help me find a path through the swamp of misery and self loathing I waded through. Someone who became my emotional crutch, my guide, mentor, teacher and so much more. She was all that I did not believe therapy was all about. I have always been a sceptic, a doubter, but this woman treated me with respect, with kindness and did not hector, condescend or in any way act like that I had assumed a therapist would.

She gave me permission at first, to be this incoherent wreck who almost lost the last thing left in his life, and then went about destroying himself in blind rage at the iniquity of it all, and in sorrow for all my failings, as a father, husband, son, and much more. No one had ever done that before, especially for me. I was the serpent, the destroyer of lives. I was not worthy, so I set about proving just how pointless, it all had been, and in the process, nearly lost, that which I had sacrificed much of my wealth, my status, my self worth, for.

Over quite a long time, she set about restoring my soul. That essence of life within us all, that lets us get through each day. With kindness and humility, she teased out, all the horrors, in the Stygian corners that harboured my bleak outlook, were laid bare. I came to depend on those hours; one a week. Sometimes with tears, often with black humour, and eventually, some laughter. She fortified my well being sufficient to face each day. I relapsed many times, but as time went by she tasked me with visits to my worst fears, the place, the time, the events that had shaped my life, and had brought me to her in terror and misery.

I think I owe her my life, and yes, it did get that bad. I had experienced much stress in life, and trauma, as have we all. But I had no idea of what Post Traumatic Stress was about, except that battle scarred soldiers sometimes suffered from it. I really had no idea that I could get it. But I did. It's a dark and terrible place to be. Those who visit it's halls are always left with scars, often worse one's than those that brought them down in the first place. She taught me to honour the experience, that it was not a weakness, merely a symptom of strength that had been stretched beyond it's limits.

Then, she said one day, not too long ago, that we had to part; my time was over. It was her job to impose her own redundancy upon our relationship. I viewed this with some trepidation; fear even. It seemed again that she had trumped the stereotypical view I had held, that this does not happen, that therapy goes on for years. Keeping the fees coming, the subject held to dependence, always seeking new areas of one's psyche to explore, was my cynical take. Well, I had been wrong, and now it was a bit scary to be alone again, responsible for negotiating my own way across the swamp, without a guide!

I kept putting it off, saying I was not ready, that I still had issues we needed to address, but she pressed me, hard. Implying if I did not do it, she would have to. All of course, in the nicest possible way. I have a backstop, an escape route, if all goes wrong. I can ring her for help, talk again in a few months time. In some ways our relationship had changed, with me preempting some of her strategies, even teaching her a few things about my knowledge of the side effects of drugs. I even think she humoured me sometimes to cajole me into taking the reins, not being lead.

It has been a journey. Some of it even a saga related. But. it's over, at least for now and she has my gratitude, my thanks, for leading me into a slightly less dark tomorrow. I hope to be able to walk again without that crutch. I wish I could tell her name, but that would betray all the tenets she lives by. But thank you, you know who you are, and hopefully now, I know who I am too..

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

2010-08-31T14:31:00.002+02:00

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.

Still No Integrity ?

2010-08-26T13:06:00.002+02:00

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!

The Study

2010-08-21T20:58:00.001+02:00

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 showedno 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!