Counting the Harms (and the cost),

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).

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?

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!

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?

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.

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!

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!