The BritMeds 2007 (28)

MMC and MTAS

A sad day

Hi everyone

This is a hard thing for me to say, but I think the time has come to accept that the fight is over. Even as I'm writing these words, I still can't quite take in the enormity of what's happened. We are witnessing the destruction of a system of medical education that was the envy of the world. We are witnessing the elevation of competence over excellence. We are witnessing the concept of the doctor as 'healer' replaced by the concept of doctor as medical technician. God helps us all in our old age - and God help the NHS.

The fight is over

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A doctor tries it out…

How can you ETHICALLY suggest anything for your patient without trying it for yourself? Following a long line of self-experimenting medics, I enlisted some help to make sure I was doing right by my patients….

The Daily Rhino – try before you prescribe

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When white people make brown babies

At the weekend I read something that made me really angry. I can’t remember the last time a newspaper article made me feel as angry as this article. The offending diatribe was penned by TV personality Lowri Turner for The Guardian. In it she discusses her mixed race baby and how she is “coming to terms” with the fact that her baby has a different skin colour to her.

Doing it all again

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My problem with General Practice is that I cannot cope with the uncertainty.

When asked what I had learned in my General Practice rotation, is it wrong that the first thing that I thought was "that I'm not cut out to be a GP?"

I find it really stressful. Lots of people, who can come and see you whenever they want. They fall into three main categories….

Why I don’t want to be a GP

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Having sex with Merlin : Medical students too stupid to type

Some time ago, before I left for my holidays abroad, I applied for a job as a medical secretary in a very posh looking medical practice in a very posh part of London…

….. I got a call back from a very pleasant sounding lady called Lorraine.

"...all of our medical secretaries have been on Merlin."

Of short white coats


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Today’s big myth

Don't let the government run things. The government cannot run anything well and certainly anything the government runs is never going to be cost effective because it's bound to be inefficient.

Dr Grumble

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It’s not Brown, it’s balls

The NHS financial crisis is costing us a fortune. Brown's seven years of plenty may have come to an abrupt halt, but in an organisation legendary for squandering public money, that translates into ever more, and ever crasser wastefulness.

This morning we learn of yet another huge golden goodbye for a departing NHS manager:

"David Johnson, the former head of a regional strategic health authority, was one of about 70 staff who left the organisation when it was abolished as part of a restructuring programme. The 50-year-old received a package worth £899,810 including salary and pension arrangements."

Described as "a lottery win rather than a payout"......

The Land of Golden Goodbyes

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Embarrassed by the lunatic fringe

The mind would boggle except that we know that there are Muslims in our communities who have become absolutely oblivious to common sense, religious guidance, and divine warning. What else can we possibly do with them? These brothers and sisters, indeed fellow citizens in the main, have lost total control of their senses and religious priorities and seem intent…no, in fact they are intent on absolutely obliterating the Muslim community here in the UK, and no doubt “the West.”

Tariq Nelson


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Is the NHS capable of learning from nature?

In The Times on Tuesday doctors, nurses and other employees of the NHS gave their views on what should be done to improve the healthcare system.

A Gynaecologist stated: “The service has changed out of all recognition over the past five years because of a dominating centralisation by administrators and managers who have no real understanding of medical care, and no respect for the professionals who provide it.

The major point that they fail to understand is that for patients, and for healthcare professionals, in addition to the quality of care, an important factor is the quality of the experience of that care. There is a target-driven culture now, and although clinical outcomes do improve in areas such as cardiology and cancer, the improvement is less than that which would have been achieved by medical advance and breakthroughs over the same time period.”

Mindfields

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NHS Health Space Online Booking Crap Shocker

My daughter has been referred to a consultant dermatologist by our family doctor. So far so good. We received a letter from the practice saying that our illustrious Government has introduced a system whereby patient choice is paramount: we can choose where she is seen and make appointments to suit ourselves…….

Choose and book from Captain Blue

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Getting a life

Predictions for the new Harry Potter book

Hospital Phoenix

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Money money money

Savings of nearly £11.5 million will need to be found to balance the Service’s books this year. Increased costs – including £14 million for staff pay as a result of the introduction of Agenda for Change – means that the Service’s £219 million budget will not cover outgoings over the next 12 months.

Random Acts of Reality

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Whistleblower rewarded

Jazz Pharmaceuticals has agreed to pay $20 million in penalties and victim compensation to resolve parallel criminal and civil investigations conducted by the United States Attorney's Office for the Eastern District of New York relating to the illegal marketing practices of its wholly-owned subsidiary Orphan Medical, Inc. (Orphan).

As part of this resolution, Orphan plead guilty this morning to felony misbranding, in violation of the Food, Drug, and Cosmetic Act in connection with its illegal promotion of the prescription medication Xyrem, also known as gamma-hydroxybutyrate or "GHB," for unapproved uses.

Pharmagossip

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Consultants paid properly shock horror

The BBC is reporting that consultants now earn £110,000 per year.

But, "Earlier this year, the National Audit Office (NAO) said the new consultant contract had not improved patient care".

Let's follow what happened…..

Dr Rant

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Hospital Hooters - A new role for nurses

The Center for Nursing Advocacy will be pleased. A new computer game that features:

-Addictive puzzle game play.
-Unique levels with different nurses.
-design your own levels with your own nurses.
-Get your levels featured on boobie-soft.com.
-Slideshow feature, to view the nurses from the levels you completed.
-Each nurse wears unique underwear.
-New girls, not seen in Boobie Beach.
-Full frontal nudity when the cheat mode is enabled.

Hospital Hooters

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Four wheels good, two wheels bad

One of Britain’s biggest engineering companies has banned staff from travelling on bicycles or motorbikes after declaring them too dangerous.

Black Triangle

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Salad Days

Generally I've managed to avoid conflict with patients during my career, but this was not the case during my first few years. Of course I can't remember how I used to consult in those days but I suspect that I was more naïve and probably more intense and sure of myself. Nowadays, as Oscar Wilde remarked, I am not young enough to know everything.

A Fortunate Man

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Holiday from Hell

I'm just landed back in the US after what was, hands down, our worst vacation ever. It was supposed to be a nice week in the UK with family, a week in Normandy with the kids to speak French and then home. But everything went wrong. We knew things were going to be funky when we tried to do all the flying on frequent flier miles and could only get coach seats with extra stops on inconvenient days, including red-eye legs. And we knew that I wouldn't have Internet access in France (scary!). But it got oh so much worse.

I'll just list some of the catastrophes and you'll get a sense of my last 19 days. First, that weird rash I had on my arm just before we left turned out to be...

The Long Tail

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Myalgic Encepahalomyelitis is not fatigue, or 'CFS'

The new paper Myalgic Encephalomyelitis is not fatigue, or 'CFS' explains why M.E. is not defined by mere 'chronic fatigue' and why M.E. and 'CFS' are not synonymous terms, as well as why a diagnosis of CFS based on any of the definitions of CFS can only ever be a misdiagnosis.

A humming bird’s guide to ME

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Limes, garlic, cream and chemotherapy

I haven’t got round to [posting] recently partly because vinorelbine makes me very tired (bad) and partly because I have been involved in various interesting discussions on other people’s blogs (good). In fact, other people’s blogs have been a real godsend of late, providing just the right amount of intellectual stimulation to keep me entertained without having to put in the energy to make more of a sustained argument than a bite-sized comment. I am winding myself up to do a sort of blogroll post in due course, but I can’t be bothered with making all the links just now. (Also a post about evolutionary epiphenomena, one about personal identity and one about the evolutionary pointlessness of philosophical thought experiments. Maybe.)

“…a post about evolutionary epiphenomena, one about personal identity and one about the evolutionary pointlessness of philosophical thought experiments”

Oh dear, I fear that one may make a certain round up in Private Eye!

Potentilla speaks

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Marketing Health: Doctors, Public Health, and the Smoking Ban

...we are now used to doctors and government officials telling us what is good and bad for us, this development has only come about in the last 50 years.

“Parents should be prosecuted if they give alcohol to their children before the age of 15”

Medical evidence says it’s dangerous - and it’s the government’s duty to intervene.

“Eat your five portions of fruit and vegetables each day”

‘It’s good for you,’ says the Chief Medical Officer.

And so it goes on….

OUP

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The Ministry of Untruth

The Department of Health have hardly covered themselves in glory this year, indeed some might go so far as to say that they have emphatically proven themselves to be a bunch of utter incompetents. The latest evidence of their ineptitude is revealed by this press release, demonstrating their idiocy and state of complete denial. The DoH tries to put a positive spin on events:

"Majority of NHS junior doctor posts filled in England"

The Ferret

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More outside appointments from Gordon : Jabba the Hut to speak on health



Guido is unhappy

The DK is outraged

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Experimenting on patients without consent

A MERSEYSIDE eye surgeon who used his patients as guinea pigs without their consent has been allowed to start practising again – just a year after being made to stop.

In the news

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GPs feeding at the trough

A new survey of 200 general practitioners by Which? - an advocacy group similar to Consumers Union in the US - found that, on average, they each receive four visits per month from sales reps and five promotional mailings about new drugs every week.

One in four GPs were sponsored to attend a conference, seminar or training event in the UK in the last 12 months and 5 percent were sponsored to attend an event abroad.

Pharmalot

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Simplistic colonial analysis

As evidence, Bowyer cites the recent bombing attempts in the UK, which were allegedly perpetrated by seven National Health Service doctors, along with the wife of one of the docs who also works in the medical field. All eight are immigrants from either India or the Middle East. All eight came to the UK because the NHS suffers from a chronic shortage of qualified docs and nurses (thanks mainly to Maggie and Major underfunding it for 17 years in a Tory effort to get Brits to support US-style privatization) and all eight are Muslims.

Universal Health Care

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Mirror mirror on the wall

IF new Health Secretary Alan Johnson had any doubts about the size of the task facing him, they've been swiftly banished.

After the straight-talking minister admitted there aren't many "happy bunnies" working in the NHS, we published a sobering picture of life on the health service front line.

Our selection of online blogs revealed how disillusioned and resentful staff and patients are about pay and conditions.

Your NHS replies

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Breaking the Code of Silence

Removed from other publications. I have therefore sought to republish this piece for the sake of the General Medical Council. It is time the world understood what a conceited, incompetent and arrogant organisation you really are.

NHS Exposed

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We must debate end-of-life issues, says doctor cleared of misconduct

The doctor cleared of misconduct in hastening the deaths of two terminally ill babies called yesterday for more debate on end-of-life decisions.

Times

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Death has more media appeal than birth

My wife works as a hospice Doctor at the wonderful Phyllis Tuckwell Hospice in Farnham. Its a charity rather than an NHS concern (NHS donate just 15% of funds). I mention that because by comparison to our maternity ward at St. Peter's, Chertsey, where you would expect a wealth of people to overwhelmed with joy for their new family member, you have instead a pretty miserable, bitter place that to be honest is far less preferable to her hospice where people are sadly in their final days but couldn't be in a brighter happier place. How strange.

The Dinosaur Thing

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So does that make it OK?

An Aberdeen doctor who gave a paralysing drug to two terminally-ill babies, hastening their deaths, "felt in his heart" they were suffering.

Aberdeen

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Saving the Out of Hours Service

Robots visit patients when doctors are not available

ABC Money

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The American view on palliative medicine

The doctors said we'd first have to stop infusing the paralyzing drugs, and then wait hours or even days as my fathers' failing kidneys tried to excrete what was already in his body. Only then could the ventilator be switched off. This plan would require my father to die much more slowly, increasing the chance that he might suffer.

Pallimed

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The top 5 things not to say at a funeral

In the two years since my daughter’s death, several people have asked me what they can say to a friend who has just lost a child or another loved one. My answer has always been....

Grieving with Guinever

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The 10 worst things to say at the funeral of a disabled person

Ouch!

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So what do I say when someone's died?

Well, mostly I try to shut up and listen, like that nurse did. When I'm really at a loss in secular situations, I say, "I'm so sorry, and I know there's nothing else I can say." But in my capacity as a chaplain, I've learned that one of the things grieving people are most anxious about is, oddly, whether they're doing it right. I've heard a lot of people describe their feelings or reactions and then ask, "Is that normal?"

Improbable optimism

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Colonial wars:

I said: "You need to grow up a little. You can’t expect to pop into the hospital to do occasional clinics at a time of your own choosing in between school runs, parent-teachers association meetings and back packing holidays. Life is not like that. Being a hospital consultant requires commitment, dedication and long hours. There is generous provision for paid maternity leave. What more do you want? ... If you won’t do the hours, you can’t have job... Just because you are a girlie, you can’t expect medical training to be turned on its head."

They said…

Shrink Rap

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Serious illness linked to postcodes

THE risk of suffering from cancer or heart disease in Cambridge is a postcode lottery. A new website, NHS Choices, which lets people find out their own health risk, reveals wide variations in Cambridge.

It shows that 60-year-old men living in East Chesterton and Arbury are more than twice as likely to get lung cancer than those living in Newnham and Cherry Hinton.

Cambridge news

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Medical exorcisms

A Westminster family planning doctor prescribed an exorcism to a patient seeking contraceptive advice, a medical tribunal has heard.

Dr Joyce Pratt, 44, is said to have told the woman she was possessed by an evil spirit and had "something moving inside her".

PMJ

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Medical immigration

Government policies--such as the combination of disastrous health and immigration policies pursued by the U.K.--can turn some occupations into low-wage ghettos.

the Borjas blog

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Accidental Law Student cheats death

By now my throat is starting to swell up, and my tongue is feeling too big for my mouth. I return to my room and look at myself in the mirror, discovering to my horror that my right eye is about four times the size of my left. I am starting to have trouble breathing. I manage to find some anti-histamines in my room, pills and syrup. I take both.

My brother has now come into my room to ask me if I am alright. “Hospital,” I respond croakily….

Accidental Law Student

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An American in England

“However, if the website does mean that more teenagers will consider an NHS career, that has to be a good thing, even if it gives a rather distorted view of the NHS. I'm not sure the website is nearly as bad as Dr Crippen seems to think it is though.”

Step into the NHS

Maybe Americans are more used to mawk like this. I thought it was appalling.

A view from England

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Sounds like leftoid nirvana

Some 40 percent of Britain's practicing doctors were trained overseas – and that percentage will increase, as older native doctors retire, and younger immigrant doctors take their place. According to the BBC, "Over two-thirds of doctors registering to practice in the UK in 2003 were from overseas – the vast majority from non-European countries." Five of the eight arrested are Arab Muslims, the other three Indian Muslims. Bilal Abdulla, the Wahhabi driver of the incendiary Jeep and a doctor at the Royal Alexandra Hospital near Glasgow, is one of over 2,000 Iraqi doctors working in Britain.

Country Store

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Sicko

Michael Moore is a big, fat, liar.

Unfortunately, Moore is also a con man of a very brazen sort, and never more so than in this film. His cherry-picked facts, manipulative interviews (with lingering close-ups of distraught people breaking down in tears) and blithe assertions (how does he know 18,000* people will die this year because they have no health insurance?) are so stacked that you can feel his whole argument sliding sideways as the picture unspools.

Early Spin blog

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Barf alert : socialist email

Want an example of government run health care? Ask any Canadian with a real job, not the unemployed lager louts like Bob & Doug MacKenzie. Ask any Brit who seeks healthcare under the NHS. By the way, many Brits buy private insurance to cover medical care the NHS does not cover!!!

Digital farmers

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Dr Gupta’s fans turn on him

When living in the UK, I had a medical condition that wasn't extremely serious, I got an appt within 3 days (this is within the NHS, not a private doctor). In France, last year I needed to have (again, not serious) and the doctor said he could fit me in to do the surgery the following wk. Of course, sometimes there are wait times, but this is also a real problem in the US system.

Michael Moore

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Moore is better

Did any of you see Mike Moore yesterday, live on Wolf Blitzer’s The Situation Room? It was a smackdown….

Political Waves

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Life Long Learning

Here are five things that I learned from my patients today

The Junior Doctor

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Wakefield/MMR/Autism/GMC roundup

The Wakefield GMC hearing starts next week and we can expect a huge amount of publicity. I present a small selection of the vast number of articles available to the medical blogosphere, including some from Wakefield supporters. Read, in particular, the article from a mother who has been so suckered in by pseudo-science that she is not giving her children any immunisations. Not even polio or diphtheria. Madness. Utter madness.

How can intelligent people behave like this?

Is there a case for social services to be involved and force these parents to have their children immunised? Too totalitarian for me...and yet, if parents refused to educate their children, they would be compelled so to do.

How is that different?

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Dr Wakefield’s disaster

Public health doctors are bracing themselves for a further decline in public confidence in the MMR jab as the long-awaited hearing into alleged serious professional misconduct by Andrew Wakefield and two other doctors gets under way at the General Medical Council on Monday.

Well, he is not “Mr” unless and until he has been struck off

The Grauniad

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Andrew Wakefield: The Galileo Gambit writ large in The Observer

I just don't understand it.

I just don't understand how anyone can take discredited antivaccination loon Andrew Wakefield seriously anymore. In particular, I don't understand how any reputable newspaper can actually take him seriously anymore, given how thoroughly he and his "work" have been discredited.

Respectful Insolence…

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MMR scare pair acted ‘dishonestly and irresponsibly’

Sunday Herald

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Autism: The Truth Plus Sensitivity, Specificity and All That Is Decent to Reveal About Predictive Values

The Times is tremendously pleased with itself: Autism: the truth. In rather a classy way, they manage to include all of the flaws in the Observer's recent coverage of a leaked, unpublished report from the Autism Research Centre; they do all of this while refraining from criticism of either its rival or the benighted journalist responsible for the story. Nonetheless, they land some telling blows…..

Shinga

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Cancelling subscription to the Guardian

I've run a number of posts here about how badly our newspapers report on certain subjects. Yesterday, however, we reached a new low, with two sickening articles in the Observer about MMR and autism, including a cringing interview with the person who has done most to spread FUD, and consequently led to increased deaths and serious disabilities via higher (perhaps quasi-epidemic) measles and rubella infection rates. The main article was the front page headline.

I almost cancelled my Guardian/Observer subscription on the spot, but then how would I get my regular dose of ire?

Hob’s Blog

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Autism and the MMR; bovine excrement.

It was to be an MMR story. I was fully expecting the testimony from the USA vaccine litigation to be revealed, since it's so recent and so relevant. The expert testimony of Dr Stephen Bustin (blogged so well by Autism Diva), destroyed the credibility of those claiming to link MMR to autism, via the 'evidence' of measles virus in the tested children's guts. Dr Bustin examined the lab responsible for analysing the samples, and was able to prove that they had only ever detected false positives. There was no evidence of measles in any of the samples, whatsoever.

The Voyage

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Killing autistic children

The full set of charges against the people responsible for the death of Tariq Nadama have been posted online.

In particular, DAN! (defeat autism now) ‘doctor’ Roy Kerry has to face some very serious charges indeed.

Left Brain/Right Brain

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Thiomersal in vaccines

While Andrew Wakefield over here faces the GMC over his allegations about the MMR vaccine and autism, a small story of the effects of the concurrent US scare,

Tim

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The loony tune analysis

So, you will not be surprised to know that my daughter did not receive the MMR vaccination. In fact, she has not received any vaccinations whatsoever, because at the height of the MMR scare I did some serious research on vaccinations in general and was left feeling extremely uneasy about both their safety and efficacy. You might want to do some research yourself if you are pregnant or considering having children.

Trust your doctor

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The Scientific analysis : autism increases in Japan despite MMR ban

Parents need have no more fears about the triple vaccine against measles, mumps and rubella. A study of more than 30,000 children in Japan should put the final nail in the coffin of the claim that the MMR vaccine is responsible for the apparent rise in autism in recent years.

New Scientist

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Wakefield and his lawyers

We have come to know that Richard Barr, a solicitor worked with Andrew Wakefield. I asked Richard Barr for an interview recently and this is what he said

"Thank you for the thought. I am not, for the present, prepared to gopublic with my views on Dr Wakefield. I am assisting his solicitors inconnection with the CMC hearing and I may yet be called as a witness, soI do not want to make Andy (or myself) a hostage to fortune.

NHS Exposed

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Wakefield and Why The Edith Piaf Routine Is Baseless: Part 1

When Andrew Wakefield went through his deeply-affecting Edith Piaf routine for Denis Campbell of the Observer, did his voice suddenly take on husky gallic overtones in contrast to "the deep green polo shirt, chinos and outdoor jacket" that seem to have so impressed Campbell and made him come over all descriptive? Edit update, July 9: Wakefield has a history of insisting that he should be interviewed by journalists who know little about MMR or medicine (Brian Deer postcript).

Shinga

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MMR quack doctor Wakefield suspected of recruiting NHS terrorists

Er...what?

Spoofnews

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Wakefield and Why The Edith Piaf Routine Is Baseless: Part 2

Over on Scienceblogs, the brothers Hoofnagle write an extraordinary and thought-provoking blog: Denialism. They caution that we should never mistake denialism for debate:

Denialism is the employment of rhetorical tactics to give the appearance of argument or legitimate debate, when in actuality there is none. These false arguments are used when one has few or no facts to support one's viewpoint against a scientific consensus or against overwhelming evidence to the contrary. They are effective in distracting from actual useful debate using emotionally appealing, but ultimately empty and illogical assertions...

Shinga

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The Maverick

A maverick British scientist who now works in Austin has completed a new study on autism that links the disease to a novel intestinal illness. The research, which will be published in this month's issue of theJournal of Clinical Immunology that is expected to come out today, opens thedoor to testing treatments for some autistic children, including a diet thatforbids dairy products and certain grains.

Dr. Andy Wakefield, whose earlier work caused a furor by suggestingan association between a common childhood vaccine and autism, said heconsiders the latest research groundbreaking.

The study by Wakefield and three collaborators builds on previousresearch connecting autism and the gut.

Autism Today

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If you can’t blame MMR let’s try Wi-Fi

Maybe we are witnessing the death throws of the MMR controversy. The arguments that autism is caused by the triple-jab have been shown to be without merit and only the foaming go on about mercury in vaccines anymore (MMR never had any mercury in it). Andrew Wakefield is scrabbling with his last gasp of PR before his GMC disciplinary meeting.

The Quackometer Blog


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What the Observer left out

Ever since Saturday night when I first read the Observer article on “new health fears over big surge in autism“—in which an “as yet unpublished” study of children in Cambridgeshire, UK, was reported to show that “as many as one in 58 children may have some form of the condition”—I have been bothered by two paragraphs of the article…..

Autism Vox

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Wakefield witch hunt

Even as new research indicates that 1 out of every 58 children in Great Britain have autism or Asperger's syndrome, the researcher who first blew the whistle on the link between the condition and the combined Measles-Mumps-Rubella vaccine is facing persecution for daring to criticize the medical establishment. Dr. Andrew Wakefield is facing a July 16th disciplinary hearing before the General Medical Council, the British organization that investigates alleged malpractice.

Bending the twigs

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Link between autism and triple vaccination questioned again

According to a new but as yet unpublished study, the number of children in Britain with autism is far higher than previously thought.

News Medical Net

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What do parents attribute regression to?

If you search the VAERS database for reports filed in all of 1997 on MMR-attributed autism, you will find 16 reports of adverse events. If you do the same search in all of 2002, you will find 120 reports. That gives you an idea of the effect of MMR hype on what parents attribute autism to. Thankfully, the number of such reports appears to be declining in recent years, with only 40 in all of 2005.

Aviv Drake review

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