Loss of Innocence ( 7 days in June).

(Part One)

For one of quite some age such as I, it was strange to lose my innocence. The events were so profoundly life changing that I was caught up in a whirlwind of doubt, dysfunction and misery. My career, what was left of it, my control of events and even my very life became threatened by a calamitous and traumatic sequence of events that came to pass, at the hands of the NHS.

I had until that time had some respect for that bastion of Healthcare, probably because I had used it infrequently and when I had, my expectations were quite low because that which was wrong with me had little in the way of a cure. Osteoarthritis, glaucoma and cataracts can be ameliorated but completely cured, no. I never expected it and Healthcare did not let me down, especially when it came to the cataract, that was made worse by lens implant. Posterior Vitreous Detachment it was called, made all the worse by that short window before it's occurrence when I saw real colour's for the first time in years. Such a revelation; the world was so bright and vivid, well for 48 hours anyway. Then it hit, and from that day and henceforth, life was to be viewed through a mist; a fine net curtain, obscuring detail and it's recognition.

I was already quite depressed at that time, with my life already falling apart at the domestic level, as it had been for years, but I had ignored it by immersing myself in an arduous routine of work and more work, not wishing to address the pain because that way it wouldn't hurt. I did decide that any further eye surgery would likely be counterproductive so I settled down to live with what was left, and then tried to address my life before the remainder slipped through my fingers.

And I did; I found a sort of happiness, that gradually replaced the pointlessness I had felt that slowly swelled and for the first time in more years than I remembered, plans started to form. The NHS; well they had made a mistake, but it wasn't life threatening and we all make mistakes after all. I didn't bother complaining very much and accepted the explanation that PVD was always possible when ultrasound is used to remove the old lens. Pity no-one had informed me it was possible, but hey-ho them's the breaks.Then,one summer day in June I learnt that the NHS's hubris (and mine) had consequences that can reverberate throughout your life, and that colossal mendacity is practised daily, along with cognitive errors that can only be judged as incompetence (or stupidity).

She, with whom I will end my days, was off in front, pushing on up the hill, pedals whizzing round, whilst I paused, foot on the ground, gasping for the air that effort had stolen from my lungs. Then, with graceful ease, almost in slow motion, she fell from the bike and landed heavily on her side. With increasing fear, I dropped my cycle and staggered over to her, my breathlessness no longer from effort but panic. She was white with pain and emitting low screams. I tried to help her up but the pain was too great. I made her as comfortable as possible with my jacket under her head. Her pulse was racing, breath coming in short pants; she was definitely in shock. Fumbling with the damn (not so) 'smart phone' I cursed it's stupid step logic, but finally got through to the Ambulance Service and told the story almost screaming for help. It seemed a lifetime in arriving and all I could do was to keep her warm and still and feel inadequate.

I suppose I knew already what was wrong. Foot turned out, unable to move her left leg and in great pain, it had be a femur fracture and worst; probably at the top, the dreaded hip fracture. It took three of us to get her into the ambulance using a crude device of a blanket to help immobilise the joint and with blue's and two's slowly drove down the hill (yes that hill) to A&;E. All throughout the journey I found myself praying to a God I didn't even believe in, for her to be alright, that it could be a dislocation, that she would be home tonight or tomorrow at worst. I was of course wrong, and no God was listening to my prayers, as always.

At last ensconced in a cubicle, her ordeal began. It took nearly three hours for an X-ray, just after she got some Paracetamol (Acetaminophen; as if that was going to be of much use). More than four hours to even see a 'doctor' (some FY1 child), who didn't really say much, partly because her English was somewhat poor, and partly because she was out of her depth. The notes got lost, then they were the wrong ones, as I pointed out that J' was not a teenage male with a broken arm. This caused some consternation and after that I never saw any notes in evidence. Some four hours in, she was given IV morphine but not until (apparently) she had an ECG; this came to light only after perusal of the notes some six months later, but as neither I nor her witnessed any such event I very much doubt it. Also she had a 'ghost' chest X-ray, of which she has no recall as no machine was placed over her chest only her pelvis, but again that only came to light much later.

After some six hours from admission, some nurse or other (we had seen a few) informed us both that J' had a broken hip which by this time the cleaner could have diagnosed. What type she did not say. She did say that an operation would be needed to 'fix' it, but again did not say what type. So ill informed and bemused we were shown up to a ward. Through what seemed miles of corridors and one lift journey we arrived and I was placed on a chair at an unlit corner of the nurses station to ponder and stress about what was to come. My brain was racing through the likely short and long term outcomes and I was searching my memory for long forgotten learning of the human anatomy and biology from nearly fourty years before. I filled in the admission form for J', ensuring I noted her problems (she had a 'stiff' arthritic left knee from a riding accident from twenty years before) and intake of any med's, which was only a high Omega 3 supplement. An hour later, which seemed forever, I was summoned to her bedside through the darkened ward bay and into the curtained area that surrounded her.

She was in tears. Without me there to support and question anything; J' is primarily an Accountant, with no knowledge of anything remotely related to Medicine or Health, she was confused and distraught. And yet I had been excluded whilst some Surgical 'on call' FY2 had explained some of what was needed for her operation and had asked for a signature of consent. Being presbiopic and without her reading glasses she had then requested my presence, which is likely the only reason I had been called at all. She asked for my help and passed the form to me to peruse. I clearly recall it as being one sheet of paper simply requesting consent for anaesthesia and little else, this was to turn out to be critical but by that time 2 am, with no food and little water, up since 6.30 am the previous day, we were both somewhat 'punch drunk'. The very young (and very beautiful) black woman who faced me explained in halting English, what was to occur in the morning. It was garbled, almost incoherent but the word 'hemi' kept coming out. I didn't have a clue. After some patient questioning by me it transpired she meant that J' needed a half hip replacement which was some sort of repair. Thinking, in my orthopaedic ignorance, that half was better than whole I suggested that we had little choice than to concur and J' signed.

I then spent half an hour with her, before they decided to kick me out, clinging to her, not wanting to say goodbye, with a sense of doom coming over me. I left my contact details with the nurse on duty and took the number to contact the ward stating that they must let me see her before the 'op'. I know how capricious a general anaesthetics effect can be, but despite my advice J' had said she did not want to be 'awake' when they sliced her thigh open. I explained she would not be awake as such as she would be liberally plied with tranquilisers as well as the regional anaesthesia but she would have none of it. That, I had to admit made me a little resentful (sic), but it's her body and I knew she was quite squeamish, so I pressed her no more.

I wandered through the long corridors and found an exit eventually. I found the car I had illegally parked in the empty disabled car park, with my Police ID prominently displayed on the dash. The parking Gestapo had consequently ignored it and I made my escape; well I tried to. I was so wound up, so preoccupied (and knackered) that I went round the perimeter road twice before I found an exit to the real world; where people could walk, laugh and get drunk, which is what I wanted to do, right then, more than anything.

I entered the empty flat and went straight for the Rum. I hardly diluted it at all, just tipped a small slug of Cola into the half full glass. I sat in the window, with it wide open, staring into the night, or what little was left of it. An impending sense of doom was all I could feel. Thus far my experience of the Hospital was one of confusion and incompetence; like a ship steering through a storm with no-one at the helm. I was frightened that my sight of J', in that bed might actually be my last. And I now had little confidence that the outcome would be good, whatever happened. I felt like the last man on the Planet, and I was scared, no terrified, that I could be losing her after years of letting her down. Had I let her down again? In the next few days I was to find that was the least of her problems. Because the NHS was much more adept in that than was I. And what was that the paramedic had said, "how do you control your diabete's?", what the hell was that about?

Note to reader; this is too hard for one instalment, even after three years. It would also be too long. You will find some of it so unbelievable that I could not make it up. 'On the Ward' will be posted soon.

HPV Vaccination; There's More.....

Moving on from my last post, I have looked at outcomes and costs of this protocol, and it seems to me that it is more of a ploy to give GP's 'something to do' (for which they will want paying-as always) and to make 'Pharma' richer, rather than anything of real worth.

The objective at the moment is to vaccinate young girls to 'prevent' in later life the incidence of cervical cancer and now throat cancer (and possibly genital warts). Well the cost is looking pretty staggering. If the NHS is to achieve it's goal of all teenage girls receiving Cervarix (GSK's version of the vaccine), it would cost, at £450 a 'pop', some £2.155 billion. If we add in the boys as well this goes up to £3.375 billion. And that's without factoring in the cost of administering 3 doses over six months which will be at least £5 and probably nearer £7.50 a 'go'. If some sort of 'target' payment is introduced to encourage take up, (likely-because GP's don't do anything for nothing) we're already looking at least an extra £22 million and more likely £40 million. That's an awful lot of taxpayers money, for a problem that isn't really, er... a problem. So what is?

Well, HPV Vaccines are not proven as being preventative, because the timescales involved can be as long as 40 years and generally at least 20 years, before Cervical Cancer develops. So, it will be along time before we know the real outcome of the vaccine protocol. In the majority of cases found, the lesions do not progress to cancer and those who end up with actual cancer have a quite low mortality. The incidence rate in the UK is in fact 8.5 per 100,000 (0.0085%) but the mortality rate is only 2.4 per 100,000, leading one to believe that treatments are very successful or (more likely) a lot of women are being counted who did not really have full stage 3 cancer. Both mortality and incidence have been falling (off a cliff) since the 1950's with the largest decreases in the quintile one would have expected to be most 'at risk', those sexually active in the 1960's (or 70's if not in London), the 55-64 year olds. This cohort have in fact had the most spectacular drop of all, in mortality of 79% (up to 2000). Mortality and obviously incidence increases with age unsurprisingly, but even in those over 65 the mortality is 11.8 per 100,000 or 0.0118%. These sort of percentages if seen in a clinical trial would be viewed as too small to count as significant.

There is now a view (a desperate one) that we should utilise HPV Vaccines for genital warts, (Gardasil is licensed for warts, but not Cervarix), and yes incidence has risen since the 1970's but is now slightly on the decrease. However at 148.7 per 100,000 could hardly be viewed as an 'epidemic' (1.49%). yet some clinicians advocate this for boys/girls and young men/women as a precaution against warts, which the last time I checked could hardly be viewed as 'terminal' and is eminently treatable. I feel all of this 'hype' of vaccination is counterproductive and dangerous. Good sex education and the discouragement of 'early' sexual encounters would be somewhat more in keeping with the needs of society. And, as I said in my last post the actual incidence of harm for vaccination is higher than the risk of cervical cancer.

Do we need to spend vast sums on vaccines of dubious benefit for 'so-called' cancers of extremely low incidence, such as throat, cervical and some sexually transmitted diseases generally without fatalities? Life itself is dangerous and to the best of my knowledge, no one has yet escaped alive. Whilst I would advocate cervical smear tests for women over 30 years (pap tests), I feel we are in danger of more 'disease mongering' if we continue down this road of trying to remove all risks from simply, well 'being' (alive that is). The sort of sums involved are colossal for rewards that are dubious, unsupported by any real scientific evidence, and that can cause harm, even death. The NHS has promoted mammography, DXA-scans, exclusively hospital births, hormone replacement therapy, even thalidomide in it's history (in the main for women) and some of these have turned out to be a tragedy of enormous proportion. In many ways it should take note of the old adage that 'if it ain't broke, don't fix it'.

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

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

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.

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.

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.

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.