Hubris, Dominance and Radicalisation.

The Patient Experience.

In my recent relating of the experience of my partner's sojourn at the 'dark fortress' that passes for our local teaching hospital (sic), I spoke of the 'loss of innocence'. It's a concept that is perhaps a little hard to grasp, but is the factor that is the springboard of the radicalisation of many patients and the birth canal of advocacy groups. It is worthwhile then to examine what drives this and why a significant minority of patients find themselves at loggerheads with Medicine.
 
Many of us go through life, with little to no contact with Doctors', or if we do it is for simple and easily remedied needs that are adequately fulfilled by the primary care GP. Some, generally with little in the way of understanding of Healthcare, accept what they are given because of the adherence to a thought process that is still (surprisingly) in vogue, that 'Doctor knows best'. Well that used to work for my mother, and over the years to an extent for me too, but once we have a bad experience, some although not all, begin to question the veracity of that paradigm. My friend, the Registrar once said to me that one Doctor who treats a patient badly and causes harm, shames the whole profession and initiates an alienation of that patient to Doctors' often for the rest of that persons life. That is true, and summarises my feelings about the various shortcomings of the care J' received, but it's more complicated than that. In fact the patient versus doctor warfare that has taken place over the years since the NHS came into being can be characterised by the overt coercion, disempowerment, objectification, and devaluation of the patient as their own moral agent.

These problems arise from a lack of courtesy through to actual harms, and inculcate in many an aversion to the profession as a whole, some of whom do not deserve it, except of course to say that they allow it go on with little demur. Keeping patients waiting, for a pre-arranged appointment is the beginning, characterised by the practise of 'over bookng', common in the NHS.  This sows in the mind an attitude of contempt; a devaluation of the time of a patient as being worthless and that of the Doctor as precious.

Domination.

Then there is then the dominance of the Doctor in the relationship, with very little adequate understanding of the anxiety they inculcate within the patient by the (often) overbearing and overcomplicated language they use to describe both conditions, and the  protocols invoked for treatment. There is often a failure to impart information about the side effects and dangers attached to many of the treatments advocated and indeed an often patronising stance by the Practitioner that the patient does not understand what is being done and this often diffuses and even negates the the concept of 'informed consent'. This is the stance assumed by many Doctors, that they should not tell the patient too much, so as not to frighten or baffle them, especially if they are women (covert misogyny).

Many treatments even tests, carry a burden of danger that is almost always withheld or 'glossed over'. Radiotherapy, Mammography, HRT treatment, many drug therapies and even anaesthesia is often portrayed as benign and patients who complain are often treated with disdain or even hostility.  In truth, most if not all aspects of medicine or surgery carry risks, some serious others less so, and often these are different in some recipients more than others. Many of these protocols are now seen as counter productive, dangerous, and even fatal in some  cases, but the patient has often been coerced, covertly or overtly to accede to them. So then domination takes from the patient their autonomy, that essential sense of  'self' that guides and governs most of our actions. Removing this takes away the option that one should always have; not to follow the path advocated because of prospective harm, whether perceived or real, because not accepting a course of treatment is a patients inalienable right. Withholding information of harm can guide a patient down a road that they would have otherwise have not taken. It also breaches the ethical code of Doctors' and that of their (piss poor) governing body, the General Medical Council (GMC).

Hubris.

Most Doctors' hold the view that they generally act in the best interest of patients' and that they are guided by science. They focus upon the good that they do. In doing so they often neglect the harms implicit in the drugs and protocols they champion as efficacious because they view most of these harms can be balanced against the overall good they achieve. They turn a 'blind eye' to iatrogenic (doctor induced) harm because it does not fit with their ideology of acting in the best interest of their patient. This hubristic attitude extends to many areas of Medicine and is part of the self delusion that comes about from power; power over the patient.

The primary example I would cite is that of the practise within Primary Care of the adherence to the Quality Outcomes Framework (QOF). Doctors get paid for fulfilling protocols that generally are political in origin, rather than being steeped in any sort of evidence based medicine, such as the lowering of cholesterol, reductions in blood pressure, avoidance of saturated fat, five portions of fruit and vegetables a day etc. Few if any, have any real belief that they are doing any particular good, and a significant minority are convinced that they are actually contributing to harm. Yet GP's continue to undertake the various tests to prove adherence to these protocols, that are only 'surrogate' markers of disease. These have largely been proven as worthless  But they garner fee's for the GP's practise. Can this be called indicative of patient care?

Another example, in Orthopaedics, is the use of the now much criticised metal-on-metal hip implant. Now anyone with engineering knowledge would have immediately spotted the fatal flaw in the concept of such materials in an environment where even with lubrication, which is impossible unless you install a grease nipple on the outside of the hip (and even if you could the grease would be toxic) wear of some quite high order would take place. This is called 'tribology' and is the science of wear. Engineering science seeks to limit this wear by the introduction of an interface between the frictional surfaces called a lubricant which overall slows down wear. An engineer who could introduce to the world, a lubricant that eliminates it completely would be able to write their own paycheck, and it would have many zero's at the end. Yet surgeons continue to utilise this and many other implants, that inevitably wear away, some at alarming rates, and consequently put patients at risk and condemn them to further surgery. Surgery of a significant level of risk and often on multiple occasions sometimes resultant in death. 'Do no harm'?

The harms perpetrated on Diabetics is perhaps the most scandalous of all protocols practised in Primary Care. Many Type 11's abandon the advice they are constantly given, either overtly or covertly, because most aspects of their condition continue to worsen if they adhere to the drugs and diets prescribed. They exemplify, perhaps more than any other cohort in the treatment paradigm of the QOF, the poor standard of science and the dangerous and patently stupid protocols advocated. The worst of these is to advise patients to consume carbohydrate, which turns to glucose in the body in very short order after consumption. Reduction of blood glucose is precisely that which Diabetics have to achieve to be normoglycemic. Why in the name of Hippocrates would you instruct a patient to indulge in that which is to them a 'poison? So you can give them some more of those 'nice' drugs that 'Pharma' says is essential to normoglycemic levels? It is 'wibble' and dangerous 'wibble' at that. And it is more likely than anything else to spawn even worse levels of blood glucose, with the consequent elevation of other symptoms and the need to 'crank up' the volume and number of prescribed drugs.

Doctors and others in health care are often blinded to the harms the patient receives and often disbelieve them because it impinges upon their feeling of self worth; their absolute belief that they act in the best interests of patients, even when they are wrong. Their dominance and hubris is bordering on delusional and they often dismiss patients views because they do not talk the same language Fortunately a significant number of Diabetics are taking control of their own destiny and this is on the increase and the subsequent HbA1c results they are achieving is testimony to the elemental stupidity of the advice they are given. More power to them! They have been radicalised.

Radicalisation.

Since the beginning of the NHS patients', tired or traumatised by what they or those they love have suffered, have sought pathways to telling their story, seeking redress, a simple apology, or even, on rare occasions, revenge. They have found it impossible; Doctors viewed them as mad or bad. The NHS and the systems and organisations set up to safeguard them, or to allow them to seek redress have been fatally flawed because they are part of the 'establishment' of the State, and thus have a vested interest in preventing or subverting that end. Set up to fail the patient then, already radicalised, becomes even more bitter, more radical, because there seems to be no outlet, no avenue down which to pursue the perfectly reasonable need of righting wrongs or preventing further episodes of harm. They either give up in in disgust, are buried (literally), as are most Doctors major errors, or they enjoin together with others of their kind to form pressure groups.

Some of these have been successful. But some like The Patients Association or Action Against Medical Accidents, have virtually joined the very establishment they were formed to combat. Others such as Diabetes UK, or Heart UK and many others have simply become mouthpieces for the political goals of the Neo-Liberals or worse, the sales promotion teams for 'Big Pharma'. There is in fact no avenue left for the radical patient who seeks justice, candour or redress, other than their own efforts, the rapacious legal sector, or by joining a pressure group that is not part of the 'establishment'. When there are, at conservative estimates, 34,000 deaths and 40,000 serious injuries per year as a result of medical errors (National Patient Safety Agency figures), it is an appalling indictment of our political system that we have no effective means of obtaining anything more than a few weasel words of sorrow when death or serious harm is perpetrated against us the patient. And at some time in most of our lives we will all be given that title.

In writing the forgoing I wish it to be known that I do not 'hate doctors', in fact I admire quite few, but I do hate the power structure they enjoy and the virtual immunity from any ordure in the event of causing serious harm or death. We need a a 'duty of candour ' in the UK and a system of justice that allows it to flourish.

(For anyone wishing to look at the support and pressure group of which I am a member, click on the scales of justice).

This post is dedicated to Robbie, David, Catherine, Stephanie and a legion of others who lost in the gamble of placing their trust in Medicine and the NHS.

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.

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).

Show Me The Money!

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!

Lies, damned lies, and statistics.

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).