Dr Neil Bacon : publishes more defamatory remarks

I looked at the front page of Dr Neil Bacon's "I want great care" website and this is what I found. Note the attention grabbing remark by the red cross.

Totally lacking in interpersonal skills...

Click on that remark, and you are taken here, to a named doctor, and you find the full remark, anonymous, but allegedly from a patient:

Added by: Patient 2008-07-16
Trust: 3%
Listening: 0% "Totally lacking in interpersonal skills. No standing up or handshake on my arrival. Didnt appear to listen. Totally lacking in kindness, manners, imaginations or sensitivity. He stopped a course of medication which was working well after 1 month, the day before I went on holiday, spoilt my holiday completely and thoroughly upset me. I had been warned about him but the doctor I wanted to see was unavailable all week and I had no choice. Well, I'll never see him again. Ever"
Recommended: 0%

I have had more emails about Dr Bacon's site than any other topic I have covered. Most are against it. Many say the site is badly designed and badly presented. Some emails are in favour of it.

"Why should we not have the opportunity to draw attention to a bad doctor, a failing doctor? Does the public not have a right to know what is going on? Doctors should provide a good service and be responsible for their actions, for their manners."

I agree with all those sentiments. There are already mechanisms in place to complain about problems with doctors. Believe it or not, most of us are decent, caring people. If you have a problem with a doctor, why not write to him and tell him? Most doctors will respond, and will try to address the problem. If you are not satisfied with the response, make a formal complaint to the practice or to the hospital.  If you are not satisfied with that, take the complaint to the PCT or the hospital chief executive. If a serious mistake has been made, you can sue the doctor, or take your complaint to the GMC. I accept that some of these processes can be drawn out, but a serious complaint about a doctor is a serious matter and requires careful consideration.

Look at the comment above in more detail:

Didnt appear to listen. Totally lacking in kindness, manners, imaginations or sensitivity. He stopped a course of medication which was working well after 1 month, the day before I went on holiday, spoilt my holiday completely and thoroughly upset me.

These are serious allegations. Bad manners, incompetence, lack of care, negligence. If they are all true, why has the patient not made a formal complaint? Maybe he has. Maybe there was no truth in it. Maybe the complaint was considered and rejected. We do not know the background. Dr Bacon is acting as judge and jury, without allowing the defendant, the doctor, to speak. Make no mistake, these remarks are defamatory. Dr Bacon has aggravated the defamation for, not only has he published the remarks, he has referred to them on the front page of his website in a manner that subjects this poor doctor not only to unsubstantiated criticism, but to ridicule.

This one complaint tells us nothing. If the doctor is a full time GP, he will be seeing several hundred patients a week, and many thousands in a year. All doctors have a few bad consultations. All doctors are human. Supposing, the previous day, this doctor's mother had died and he was distracted. One can construct all sorts of scenarios that might explain and mitigate one bad consultation. The 99% of patients who have had good consultations will not put comments on the website. It does not work like that. Mostly it will be difficult patients with personal axes to grind who use this website.

If someone wishes to make critical comments about treatment they received from a named doctor, why are they being allowed to do so anonymously? If there is merit in the complaint, if it is not defamatory, why would the complainant not wish to use his own name?

My greatest worry about this website is the effect that it might have on a doctor suffering from depression. Do not get me wrong. If you think your doctor is mentally ill, or performing dangerously, not only is it your right to make a complaint, it is your duty so to do. You must take immediate action. But not by making anonymous remarks on the internet. Talk to one of the other doctors in the practice or to the chief executive of the hospital. But do not put some anonymous, wounding criticisms on an internet website. Supposing you are the person who made the above comment. Supposing this doctor is depressed and therefore not performing well. Supposing your anonymous comment tips him over the edge. You read in the paper next week that he has committed suicide. How would you feel then? Do you remember this:

TRURO An out-of-hours GP killed himself because of fears that he might be dismissed after turning up in the wrong town for an emergency call. (full story here)

Who is Dr Neil Bacon to set himself up in judgement over the medical profession? He has no legal training. He has not completed his higher medical training. Whatever he may say, it is hard to believe that his motives are altruistic. This website is a disgrace.

Time for a break

Dr Crippen is, as usual at this time of year, off here and still looking for an answer to the problem posed here.  We have not had much of a holiday since last summer. The usual Easter week in the Lake District was not possible. Easter fell ridiculously early and did not fit in with school holidays so the Crippens did not for once meet the Wainwrights.

Time for a break

Dumbing down in the USA

As so often, I am grateful to KevinMD for pointing me towards a "dumbing down" tale from the USA. I take little comfort from the fact that this is not just happening in the UK.

Nobody dies of appendicitis these days. Don't you believe it. But they are very unlikely to die if they are managed by someone who knows what they are doing. Someone with surgical expertise; someone able to exercise discretion. A "health care professional" implementing a protocol is the antithesis of discretion.

Imagine your small daughter has peritonitis from a ruptured gangrenous appendix. She is being managed by a consultant surgeon but, when his back is turned, a "health care professional" with a cost-cutting protocol intervenes.

I operated on a little girl the other night for a perforated, gangrenous appendicitis. Laparoscopically, I removed the nasty little bugger and washed out her entire peritoneal cavity with liters and liters of irrigant fluid. The next day, she looked remarkably better (normal WBC count, afebrile, etc) but I usually keep kids in the hospital for a few days for IV antibiotics, especially for perforated appendicitis. As I reviewed her chart, I noticed that her Zosyn had fallen off the med list...

buckeye surgeon

This is happening in a hospital or polyclinic near you.

Dr Neil Bacon : offensive link to paediatrician

Dr Alastair Sutcliffe

If you go onto Dr Neil Bacon's website (as of 12.20, Friday 18 July) you will find, in the top right hand corner, a remark saying:

David Brent on a ward. Shocking.  

Click here to see where the link goes

It may have gone by now, but this is the page as stored. Why does this remark link to  an eminent and well respected  teaching hospital paediatrician?  (See here).   He does not look like David Brent. Perhaps Dr Bacon will explain. Maybe it is a mistake. A retraction and an apology is needed. Or an explanation. 

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A reader has kindly sent me a copy of the original Alastair Sutcliffe page. How can Dr Bacon make any pretence that his website is about constructive and sensible criticism when he publishes nonsense like this and, furthermore, puts the comment on the front page of the site, with a link directly to the unfortunate doctor. This is no more than pub gossip - which is where it should remain.

click to enlarge

Something wicked this way comes : getting shut of the "crumble"

No more of this on the NHS

The recent publicity surrounding a patient’s “right” to die at home has left experienced family doctors perplexed. What is going on? A myth has grow-up that so called “terminal care”, sorry, sorry, “continuing care” is a mystical science that can only be practised in hospices by Macmillan nurses.

One of the most fundamental roles of the family doctor is to care for dying patients in the home environment. All the older partners in my practice are highly experienced in this task, aided by our excellent team of district nurses. As I have said many times before, the pure physical medical side of terminal care is rarely challenging. The mental and emotional side is very challenging and, as I get older, I find it more and more of a strain. (see Removing death from Life)

God, how I hate hospices. How I hate palliative care doctors. How, in particular, I hate Macmillan nurses.

I am not being provocative. I yield to none in my admiration for the late, great Dame Cicely Saunders. As I have said before, I put her up there with Semmelweiss. She devoted her life to showing us how to treat the discomfort of dying pre-emptively. Semmelweiss taught us to wash our hands before doing vaginal examinations. We learnt both lessons. They are obvious now as, in retrospect, was the development of the wheel.

I still truly hate the whole of the terminal care industry brigade but not perhaps in the way you may think. You see, I hate death and, even more, I hate the process of death. I hate dying. It is a wretched bloody business. I hate the way hospices, and the palliative care doctors and the Macmillan nurses steal death from life. They attempt to pretty up the process of dying into some sort of clap-happy learning experience, there to be shared by all the family. I had lunch with a good friend yesterday who told me that his father in law threw a Macmillan nurse out of the house after her appalling opening gambit on her first visit of “How do you feel about dying”. What a question! What an arsehole!

Hospices are a last resort for people who have no family and for the few (very few in my practice) who cannot be managed at home. God preserve me from this, written by a patient dying in a hospice:

Now I am looking out of the window at a beautiful, little, vaguely Japanese, garden belonging to the hospice with squirrels and gulls. It has been snowing. Some day. Somewhere along the way I acquired a morphine driver pump (*), a handfull of pills a day and fulltime oxygen mask. I haven’t an idea how I got here, really. I’m not sure who I am, but I think, someone different. This has been the most difficult few paragraphs I have ever written bar none ever, despite not having any emotional content.

Some may recognise the writing. I have quoted it before. The same writer, a few weeks before her death, wrote of the unreal world of the hospice:

In the hospice a patient would have to be much worse than just badly behaved to get any opprobrium. Probably to provoke the staff a patient would have to be doing something harmful to another patient. And maybe in extreme cases not even then. Your status as a responsible adult is held in suspense. It isn’t fully revoked but it isn’t in place either. The relationship between the carers, helpers and domestics and the patients is odd. Not odd as in being unexplicable, but odd as in being outside of the norm of everyday life.

As many will know, the writer was the late Christian Jago, and all that she wrote is still preserved at auspicious dragon. You can keep your squirrels and your gulls and your Japanese gardens. I don’t want any of it, and I do not think Christian did either. I try to protect my patients from the worst of this nonsense.

The government is now trading on your deepest, darkest emotions and fears. So many wish to buy into the Macmillan nurse myth to protect themselves from the horror of dying. You think the government is talking about better home care for cancer patients. I am all in favour of that, but that is not what this is about.  The media has also been taken in. It too believes the government is talking about cancer care. See today’s spread in the Times. I warn you now that the government has a hidden agenda in announcing its recent policy statements about your “right” to die at home.

The real but hidden agenda is ominous. It is about cost cutting. About further reductions in NHS care. The government is marching fraudulently under the banner of cancer care. This is not about cancer care. This is about kicking granny out of hospital. It is about the large number of old, frail people with multiple medical diagnoses; a bit of prostate cancer; a bit of breast cancer; a bit of COPD; a bit of arthritis; a bit of heart failure; a bit of dementia; the residual weakness and slurred speech of an old stroke and so on and so forth. These people are all dying. They can be kept comfortable (if they are lucky) but they are beyond medical salvage. These people are “cluttering up” medical wards, surgical wards, and orthopaedic wards. Because they do not have precise single diagnoses like “bowel cancer” the hospices show little interest and even if they did, they do not have the beds. So instead, too ill to go home, too ill for a nursing home (even if there were a bed available) they are kept in hospital, always at the far end of the ward, as far as possible from the nursing station. If your relative is in hospital you can tell when the doctors and nurses have lost interest. Interest in a patient is proportional to the reciprocal of the distance of the bed from the nursing station. Hospital doctors call these patients “crumble”. They are all in God’s waiting room.

We used to call it “crumble” when I was a hospital doctor. “Crumble” is a derogatory word for a group of patients who have nothing acutely wrong with them, but not much right with them either. (source)

The government hates them. They are bed blockers. They are expensive. They are stopping the hospitals from hitting targets. We have an ageing population. With each day, their numbers grow larger. These are the people who are going to be given the “right” to die at home. Indeed, soon it will be their duty to die at home. The government is going to turf them out of hospital to free up medical beds. Doesn’t matter if they cannot walk and are faecally incontinent, they must have their “right” to die at home. These patients are “terminally ill” but not in the way the media understands. Too ill for nursing homes, these poor people still need round the clock nursing care, often for months on end. Nursing care that their elderly relatives cannot provide at home. Soon they will be sent home with a care “package” – a nursing auxiliary popping in for four hours a week.

You have been warned.

Breast self-examination - a waste of time

Don't waste your time

Women remain confused about the right way to check their breasts for early signs of cancer, says a charity. (BBC)

The media obsession with encouraging women to examine their breasts on a regular basis is utter baloney. A complete waste of time, indulged in only by the middle-class worried well.

If you get breast lump, you will notice it soon enough.

Same applies to scrotums (scrota?) If you get a lump, you will notice it.

It is worth saying that, if you DO find a lump, don’t ignore it. Over the years I have seen a number of women, usually older ones, who have found lumps and ignored them, rather hoping that they might go away. Sometimes, they do. Sometimes they don’t.

I have never had a woman present saying, “Oh! Yes, I found it during my routine monthly self-examination.”

Don't bother. Watch a movie instead.

Dr Neil Bacon is a junior hospital doctor, not a specialist

Dr Neil Bacon is misrepresenting his qualifications, training, and status as a doctor.

He has been misrepresenting his qualifications, training and status as a doctor for several years.

Dr Neil Bacon , founder of award-winning medical network doctors.net.uk and practising NHS specialist in nephrology…

29th November 2004

Science Enterprise

He is not a specialist.

Dr Neil Bacon talks about the site [doctors.net.uk] with the enthusiasm of a proud father - he still remembers the moment when the first member joined in September 1998. Bacon set up the site after working as a kidney specialist in the US in the mid-1990s…

1st Febraury 2007

Goliath

He is not a specialist.

Dr Neil Bacon, a renal specialist at the Churchill Hospital…

July 15 2008
Oxford Mail

The idea for iWantGreatCare came from Dr Neil Bacon an Oxford specialist who combines a medical career with a decade’s experience of developing innovative internet services for better healthcare.

July 2008

iwanttomakealotofmoney

Well, OK, this time he doesn’t actually say that he is a specialist in medicine but the juxtaposition of the words “Dr” “Oxford” and “specialist” is close enough. And what, pray, has he done towards developing “better healthcare”?

In reality, Dr Bacon is more likely to be a failed would-be specialist. He has been qualified for 17 years. Contrary to some of the publicitiy, Dr Neil Bacon is not currently working at the Churchill Hospital in Oxford. He is, by his own admission, not currently even working as a doctor. And if he has not made it as a GP or as a specialist after 17 years, he is unlikely to make it at all. The medical profession and the GMC are fussy about the way doctors present themselves. The word “specialist” has meaning. “Specialists” have to be qualified as such, accredited as such and on a specialist register. The same applies for GPs. How do you tell if a doctor is an accredited as a specialist or as a GP? Easy. Look him up on the GMC website. This is what you get if you look to Dr Neil Bacon:

General Medical Council : Registration check on Neil Colin Michael Bacon

Results of search on: 16 Jul 2008 at 17:18:30. The details shown are valid at the date and time of the search only.

GMC Reference Number: 3332531
Given Names: Neil Colin Michael
Surname: Bacon
Gender: Man
Registration Status: Registered

Primary Medical Qualification: BM BS 1990 University of Nottingham
Provisional Registration Date: 11 Jul 1990
Full Registration Date: 01 Aug 1991
Specialist Register entry date: This doctor is not in the Specialist Register
GP Register entry date: This doctor is not in the GP Register

The truth is that, 17 years after qualifying, Dr Neil Bacon is still a junior hospital doctor and he is not currently working within the profession.

Bacon boobs : Peter Carter Ruck involved

It is not just life long readers of Private Eye, (see recurring "in-jokes" in Private Eye) like Dr Crippen who have heard of Peter Carter Ruck. They are the most pre-eminent libel lawyers in London. Today PULSE reports:

Carter-Ruck solicitors, acting on behalf of a group of 37 doctors, has written to Dr Neil Bacon, the founder of www.iwantgreatcare.org, expressing ‘grave concerns about the potential for inaccurate, irresponsible and defamatory allegations being published on the website.’

The letter details a number of concerns relating to the site’s comment-moderation policy and warns: ‘We put you on formal notice that if one of our clients is defamed on your website and instructs us to take action, a copy of this letter will be made available to the court at the appropriate stage in the proceedings.’
‘The court’s attention will be drawn to the fact that we have raised our concerns about the risks involved and have reminded you of the need to put robust structures and procedures in place to ensure that no doctor is libelled on the site at any stage.’ (Pulse – full story here)

Baconshit is trying to keep his cool and is taking refuge in the old “no comment” strategy. He needs to get his act together, though. His economy with the truth is breath taking. Yesterday, he told the Oxford Mail: "The response from the medical profession has been very high with the majority of doctors being very supportive…” (Oxford Mail)  Oh! Really, Neil? What does PULSE say about that?

The BMA has heavily criticised the site warning ‘there is a significant possibility of it being used in a malicious way.' Concerns have also been raised about the database of doctors listed on the site. Many doctors have been listed without their knowledge, while others, such as GPC chair Dr Laurence Buckman and health minister and surgeon Lord Ara Darzi, do not appear to be listed - although this may because listings attracting 'malicious' comments are automatically suspended. (Pulse)

Bacon himself does not yet appear on his own website. It’s all very cosy, isn’t it. No chance for the public to express opinions on prominent doctors or on Bacon himself. Bacon, by the way, keeps styling himself as a “renal specialist”. This is dishonest. He is nothing of the sort. Check his GMC registration. It specifically says he is NOT on the specialist register. He is a junior, a trainee. He does not have specialist accreditation. He is not yet a consultant. And, he is currently, er, “between jobs” or “on sabattical” as he prefers to say.

Bacon may be unable to comment “for legal reasons” but must be cacking himself. Part of his problem is that he has never recovered from his glimpse of the pot of gold (see here) at the end of the rainbow, and has ever after been in hot pursuit thereof. Doctors.net.uk did not deliver and, for reasons yet to be discovered, he left to form his new husband-and-wife owned dot.com company.

Bacon is on a fool's errand and by now he must be worried. Who would not be worried if Peter Carter Ruck & Co came knocking on the door? To make matters worse for Bacon, Rita is on the case, and she eats libel lawyers for breakfast.

Keeping Carter Ruck up-to-date on Bacon

Any doctor finding defamatory remarks about him or herself, or about colleagues,  on Bacon's website should first of all store the web page. This can be done by "furling" it but, as Dr Crippen has discovered, the stored page cannot be made generally available on Furl. However, jkn.com allows you not only to store the page, but also to make it available to all on the internet, with annotations if you wish. (See this example of the Oxford Mail's dreadful Baconshit advertorial). Having saved it, send a copy to Carter Ruck at lawyersATcarter-ruckDOTcom

Read about the appalling treatment of Dr Jayantilal Popat here

Dr Jayantilal Popat - abused by Dr Neil Bacon

click to enlarge

The above represents the gratuitous abuse of the unfortunate Dr Jayantilal Popat by Dr Neil Bacon. I stored it on FURL. The first comment to appear, unmoderated, and apparantly unchecked by Bacon, was the one at the bottom by the "carer, relative."

Next, the three supportive comments above appeared.

Then, the three supportive comments were removed, leaving just the derogatory one at the bottom. Unfortunately, I did not store that image. Today, on checking Bacon's website, we find this:

I have stored this away here on jkn.com and so Bacon cannot alter it again. Thus, for two days, Baconshit was responsible for publishing apallingly defamatory remarks about a family doctor without offering him a right of reply.  We assume that the remarks could not be verified, and so they have now been removed. But there is no explanation. There is no apology. Why not? This is disgraceful. That is why, truly, Bacon is becoming known as Baconshit.

Bacon scraps in the Oxford Mail

Shame on the Oxford Mail. It used to be a good local paper when I lived there. Mind you, in those days, so did the Times. It was a long time ago. They have just given Neil Bacon an advertorial for his new website. Disgraceful! Don't they have any news to report? Spot all the (as Winston used to say) "terminological inexactitudes".

"The majority of doctors (have been) very supportive"

Neil Bacon

 

It's all here, with some annotations

Unprotected Text : Grand Rounds from medical school

Grand Rounds is the pick of medical writing from the USA and around the world except that this week the choice is made by a second year English medical student so it may be the other way round.

Who knows what goes on at "Unprotected Text"

Take a look here.

Baconshit monitor (1)

click to enlarge

Dr Peter Sargent is a Consultant Psychiatrist at Oxford, and well respected within the medical profession. Baconshit rates him at 25% and describes him as a "wanger". How much of this will the GMC tolerate? Do please let me know of any of the more off- the-wall comments that get onto Dr Neil Bacon's disreputable website. The more defamatory remarks he publishes, the more likely he is to be closed down. I have of course furled it, and will pass it on to Dr Sargent.

AND, an hour later:

JUST AS WELL THAT I DID FURL IT, AS THE PAGE HAS NOW DISAPPEARED. It's still cached on "furl it" here

So what is going on? Does this mean that comments go onto the website and are only checked at a later date for offensive or inaccurate content? At the moment, there are only reports on a small number of doctors. In the unlikely event of the website taking off, they will not be able to keep up.

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A reader sends in this snapshot. Surely a spoof. No reputable doctor would allow a website to run this sort of stuff. Even Dr Neil Bacon. But it's stored on Doctors.net.uk which must be reputable as it was started by...Dr Neil Bacon. Oh! Dear

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All submissions of Baconshit rubbish to nhsblogdoc--AT--gmail--DOT--com

Skins

I grow weary of the knocking copy directed against GPs that appears on a daily basis in the newspapers and from the BBC. Today, it is a report from the dermatologists. I can’t be bothered to go through it in detail – I do not wield the knife myself – but do take a look at the response from the Jobbing Doctor who does do surgery.

The BBC reports:

A separate study of skin cancer biopsies sent by GPs to a London teaching hospital showed that 14% of the tumours involved were "high risk", and should have been referred straight to a hospital specialist.

In Norfolk, analysis of the records of 80 patients with melanoma found that 13% of them had been incompletely excised or biopsied in primary care

I do not doubt it is true. To digress for a second, I note with distaste that the currently fashionable but distinctly odd linguistic affection of describing that which should be plural as singular is spreading.

Think about the above figures a little. You could have said:

86% of tumours removed by GPs were not high risk
87% of melanomas were completely excised by GPs

That sounds good, but the media would never put it like that. Instead, the Times' headline is "GPs skin cancer operations could prove fatal". Let me tell you something else. Dermatologists do not have a much better clinical diagnostic success rate. They biopsy everything. And if the answer comes back as  “melanoma”, it is not the dermatologist who does the wide excision, it is the plastic surgeon.

Doctors tend to categorise skin lesions as 

1. obviously cancer
   
2. probably cancer
   
3. may be cancer
   
4. probably not cancer
   
5. not cancer. 
   

It is amazing how often a lesion which is clinically not cancerous turns out to be so when the pathologist has taken a look. Medicine is about judgement. If Dr David Shuttleworth wants all skin lesions to be referred to dermatologists under the “two week rule” that is fine by me. The system will break down immediately and no one will get anything biopsied for months.

There is something else this article does not tell you; something else that the arrogant Dr Shuttleworth does not tell you either; something that the PCTs are quietly implementing; something that the government is trying to hush up

Hospitals are financed by a fixed payment (tariff) for each patient that is seen or each operation that is performed. If your GP refers you to hospital, his or her Primary Care Trust (PCT), which is the body which contracts on behalf of the GPs, will be billed by the hospital when you are seen.

How these changes may affect you

Most Primary Care Trusts (PCTs) are trying to save money and reduce hospital bills by asking GPs to refer fewer patients to specialists working in hospitals. Many PCTs are setting up ‘intermediate services’ that are not covered by the Choose & Book system outlined above and which they perceive to be cheaper. Patients referred to these services will not be offered choice, nor are they likely to be seen by a fully trained and accredited dermatologist on the GMC (General Medical Council) specialist register. You may be seen by a GP with a special interest in dermatology and perhaps a dermatology diploma, a doctor trained elsewhere in Europe or perhaps a specialist nurse. Some, but not all, of the individuals working in intermediate services may also work closely with a consultant dermatologist in the local hospital department. (British Association of Dermatologists)

I don't see why we need the snotty remark about European medical training but leaving that aside it is clear that even when you are referred to a Consultant you may well end up being seen by a non-medically qualified nurse-quacktitioner or the nearly as ludicrous GPwSI. What’s the difference between a doctor and a nurse? Five years at medical school. What's the difference between a GP and a GPwSI? Arrogance.

Dr Neil Bacon (2)

Dr Julia Webster is one of the senior partners at the Sleaford Medical Group. She and I overlapped at medical school, though I don’t recognise her name. Julia has just been “named and shamed” by Baconshit. It seems that she was a bit “short” with a patient who wanted to be treated by a homeopathist, or some such wibble merchant. For that “offence” she is castigated on “I want great care” Has she been consulted in advance before this defamatory material was published? I think not. Has she been given the chance to put her side of the story? I think not. One patient was upset because Julia was not prepared to discuss medical wibble, ergo Julia is not a very good doctor. What about the other 2000 patients she sees?

click to enlarge

On that basis, Ben Goldacre is the worst doctor in the UK – and Doctor Crippen will not be far behind if he is not killed in the rush from Holdford Watch, Dr Aust and all the other wibble monitors out there.

In the meantime, a little research at Companies House reveals that “I want great care” is a kitchen table company run by two directors, Baconshit himself and Mrs Fiona Baconshit who is both a director and the Company Secretary. I will not bore you with the Memorandum of Association or the Articles of Associations. They are the classic “off-the-peg” company stuff which empowers the Company to do pretty much anything it pleases.

What I am much more interested in is this:

click to enlarge

Why did Baconshit resign from Doctors.net.uk? Does anyone know the real truth?

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I was trying to find another picture of Neil Bacon, so I put his name into Google images (safety off) and found a bizarre photo in the top left hand corner. Thank goodness the children did not see it. Most distressing. Must put the safety filter back on. The picture is clearly nothing to do with Neil Bacon. What are Google playing at?

Dr Neil Bacon : a disgrace to the medical profession

Dr Neil Bacon should be ashamed of himself. Earlier today I wrote at length, with some circumlocutions, about Bacon. It is no longer necessary to mince words. The site he has set up is a disgrace. If Bacon is making money out of it, he deserves to be driven out of the medical profession. Take a look at how, in the course of one short day, he has attempted to destroy the professional reputation of a doctor, without explanation, and without giving that doctor the right to respond.

This is what I said earlier:

Look at what is already happening on the site, with this utterly disgraceful ad hominen attack on a doctor who is not able to defend himself. There are always two sides to a story, never more so than when there is a psychiatric problem. This poor doctor cannot defend himself without breaking patient confidentiality. Disgraceful! Fortunately, some of the doctor's colleagues are defending him, and it is not difficult to infer what is probably going on here. Patients with mental illness do not forfeit their right to medical confidentiality, however demanding and pushy their relatives may be.

***********

And what exactly is going on now, Dr Bacon? Some supportive comments were made about this doctor, but now they have disappeared. Without explanation. Why is that, Dr Bacon? Compare what is appearing now, with what was on the site earlier today when I first visted (and furled) it. This morning you were rating this doctor as "good" at 75%. You are now rating him at 0%. That is a career destroyed over Sunday lunch. You can't play with peoples' professional careers like this. You are a disgrace, Dr Bacon.

Baconshit has amended the record again. Now, possible as a result of this article, the record of Dr Jayantilal Popat has been amended yet again. Full story here. The derogatory remarks have now been removed. But there is no explanation and no apology. Disgraceful!

On his distasteful website Bacon says the following:

How can the ratings of doctors help me/my family get better health?
You can search iWantGreatCare to find the type of doctor with the style and approach you prefer. All doctors have met professional standards to practice safely and competently, but the 'bedside manner' and communication methods of doctors vary greatly. By reading the reviews of other patients you will be able to get an idea of how a doctor behaves towards patients, and thus choose the approach that best meets your needs. It is well reported that the quality of the relationship and communication you have with your doctor can influence the outcome of your care. Letting your doctor know what a great job they have done and using iWantGreatCare to publicly thank them will help them continue to give great care.

Bacon is an ill-prepared, mendacious little shit. You don't believe me? Try the following exercise. Search Bacon’s database for these three doctors. You may like their "style and approach" and want to sign on with them:

Dr Edmund Griffith
Dr Lisa Fook
Dr Peter Lyne

I have made it easy for you. All you need to do is click on the names. When you have done that, why not write a few derogatory remarks? It’s all good “fun”. No one is going to sue, I can assure you. Before you do though, pause a while to ask youself why I now openly say that Bacon is a mendacious little shit, and a disgrace to the medical profession.

The answer is above and, most of all,  here.

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And finally, the reductio ad absurdum. A reader points out that Bacon was rated at 1.8 out of 5.0 on RateMDs.com whereas This doctor scored 4.9 out of 5.0.

Ha! Ha! Ha!

Dr Neil Bacon

Raptors

I have always been uneasy about Doctors.net.uk. I do not visit it often and I rarely read the forums. NHS BLOG DOCTOR articles are sometimes mentioned in the chat rooms and whilst, like any blogger, I am grateful for the increased traffic, I don't usually follow up any comments. It’s a bit ostrich-like, I know. And it means that sometimes I miss the start of important medical stories.

There is nothing like a good bitch over a good pint about matters medical and that is what goes on in the Doctors.net.uk forums. Trouble is, the forums are not as private as members think. I know a lot of medical journalists and, believe me, it is not difficult to get into Doctors.net.uk despite the apparent professional security.

Bitching over a pint is one thing. But some of the serious issues that come up in Doctors.net.uk would be better aired in public. A lot of the comments made are deeply offensive about other doctors, about colleagues – nurse specialists in particular – and about patients. Easy to do that in "private" when no one can answer back. I am outspoken about dumbing down, and the damage that nurse specialists and HCPs are doing to the NHS. Yes, I write pseudonymously, but I write in public about the NHS as I see it. I represent no one but myself and I print, without censorship, all comments I receive, however critical they may be. I am more comfortable doing that in a public forum. If you think I am outspoken about certain issues, you would not believe the vitriol and poison that permeates some of the Doctors.net.uk forums.

Because I do not often visit Doctors.net.uk I am today late onto a very important story which has already been well covered by the Ferret and by the Jobbing Doctor. The story concerns the activities of Dr Neil Bacon who was one of the founders of Doctors.net.uk.

Dr Neil Bacon

He has just set up some medieval stocks into which he is going to insert the British medical profession.



The idea is simple. Want to slag off your doctor? Send your comments to Neil, and he will print them here. You will remain anonymous. Only the doctor will be named. The site is up and running. Dr Richard Pullinger at the John Radcliffe in Oxford is already rated:

Was really kind and patient when he supervised treatment of a nasty injury. Reassured us and explained everything. (I want great care)

Well done, Richard. All good stuff. Wonder why you only got 94% for listening? Other doctors scored 100%. Please do better next time. 

How do you submit comments and do doctors mind? Neil Bacon has drawn up some rules:

Will my doctor know I wrote about them?
All ratings and reviews are anonymous. The only way your doctor will know you wrote about them will be if you include something in the review that identifies you. If you would like your doctor to know what you are writing about them, you can include your name in your review.

What do doctors think of iWantGreatCare?
It varies! A few don’t like it, but far more have enthusiastically welcomed the idea. The whole area of direct patient feedback is new and for some doctors this is very challenging. However all good doctors want to know what their patients think about them so they can improve and continue to build trust and confidence with their patients. Doctors are already using iWantGreatCare to help in this, and are encouraging all their patients to rate their care.

I objectively believe this is damaging to doctors, can't you just drop this whole idea?
Respectfully, no. It is clear from the evidence base that effective communication improves clinical outcomes, improves patient satisfaction, reduces the risk of medical errors and reduces the risk of litigation. The evidence also clearly reports patients can effectively judge doctors' communication skills to this effect. If you are aware of any peer-reviewed evidence that contradicts this summary, please email details to adminservices@iwantgreatcare.org. If you are fixed in your belief that iWantGreatCare is damaging to doctors, please consider that iWantGreatCare is advised by a range of respected doctors and the emerging requirements for revalidation make patient ratings of your care fundamental to the measurement of your work. It is also clear, even with superficial knowledge of medical history, that this is not the first and will certainly not be the last new way of working that is challenging for some doctors.

The Ferret and the Jobbing Doctor have already covered this in detail, but there is more, much more to be said. For starters, the comments are all to be anonymous. Why? If you have something worth saying about your doctor in public, why not put your name under it? How can Neil Bacon possibly know that any criticisms made are valid?

Look at what is already happening on the site, with this utterly disgraceful ad hominen attack on a doctor who is not able to defend himself.  There are always two sides to a story, never more so than when there is a psychiatric problem. This poor doctor cannot defend himself without breaking patient confidentiality. Disgraceful! Fortunately, some of the doctor's colleagues are defending him, and it is not difficult to infer what is probably going on here. Patients with mental illness do not forfeit their right to medical confidentiality, however demanding and pushy their relatives may be.

***********

And what exactly is going on now, Dr Bacon? Some supportive comments were made about this doctor, but now they have disappeared. Without explanation. Why is that, Dr Bacon? Compare what is appearing now, with what was on the site earlier today when I first visted (and furled) it. This morning you were rating this doctor as "good" at 75%. You are now rating him at 0%. That is a career destroyed over Sunday lunch. You can't play with peoples' professional careers like this. You are a disgrace, Dr Bacon.

Why is Neil Bacon doing this? Why did Neil Bacon leave medicine? To make a fast buck, maybe. But I wonder if his reason for leaving was anything to do with this? You see, Dr Neil Bacon's web site is not even an original idea. RateMDs.com have been in the business for a long time. Long enough to have rated Dr Neil Bacon.  And it was thumbs down. He scores 1.8 out of a possible 5.0 That means he was a pretty crappy doctor, or that is what the people who read the site will think. It's all there on the Internet and I have furled it just in case it mysteriously disappears.

RateMDs.com looks at Dr Neil Bacon

• Unable to answer simple questions in a timely manner, ridiculous concept of what makes great care.
  
• Rather disappointing response to questions he was asked, very long delay in getting in touch. Seems not to be sensitive to colleagues concerns
  
• Rating Dr Neil Bacon

Maybe the world of nephrology was saved when Neil decided to be a business man. So, come on Neil, are you suing RateMDs.com or does the cap fit? Do tell.

The internet geeks out there may receall that Dr Neil Bacon became very angry, indeed litigious, a few years ago when a scurrilous writer set up a spoof website with a name similar to Doctors.net.uk. and used the site to make satirical remarks about the staff of Doctors.net.uk. Neil in particular did not like being compared to a "raptor" or a "dipstick". He was vindicated, but do please read the judgement as revealed by Rita (see below). It's a joy:

The Complainant is an English company whose primary business is the operation of an internet portal for members of the medical profession. Its principal URL is www.doctors.net.uk, and the URL www.doctors.org.uk also links to the site....

I have been told very little about the Respondent. She is a doctor, and registered the site under the name “KarmaWorks”. Material published on various sites with which she appears to be connected suggests that she is something of thorn in the side of the medical establishment. (Boy, they don't know the half of it)

The Complainant asserts that this is the purpose of the site; I have no doubt that the Respondent believes that the text is “fair criticism”, but in my view, on any objective reading, the descriptions of identified professional individuals as (for example) “infamous”, “dipstick”, “side kick”, “raptor like”, of doubtful fitness to advise parents and “poodle” cannot sensibly be viewed as anything but derogatory at the very least. (Doctors.net.uk v Dr Rita Pal)

Well done, Neil. No doubt you will be furious to see that another scurrilous writer has set up another spoof website called I want great bacon

Welcome to I Want Great Bacon
IWantGreatBacon is committed to providing a wonderful service for the members of the public. By rating and reviewing your bacon, you will improve the quality of the bacon for everyone else. You can recommend your bacon to other bacon lovers worldwide. Please use the list of bacons on the right to start rating! (I want great bacon)

This is satire, Neil. There is no mention of raptors, or dipsticks. Just a bit of fun. Hope you are not going to sue. But I digress. Back to serious matters.

Some of Neil Bacon’s behaviour at Doctors.net.uk was controversial. Readers of the wonderful Fishgoth will recall that Fishgoth was banned from Doctors.net.uk when he pointed out to them, by demonstration, that their site security left much to be desired. He successfully joined three times under the names of Liam Donaldson, Hilary Jones and Evan Harris. You have to laugh. For this “offence” he was banned from the site for six months. Fishgoth has never liked Doctors.net.uk for the following reason:

Like many DNUK members, I felt upset that the website had sold member information to the Conservative party, an organisation I deeply loathe. I also felt that when the questions were asked on the fora as to why this information had been sold, there was no official response. To my knowledge, there still hasn't been. I accept that posting the aforementioned photograph was not an acceptable protest in the eyes of those who own the website. (Fishgoth)

Finally, Fishgoth demonstrated that Neil Bacon has no sense of humour by posting a clearly “doctored” composite photograph on a Doctors.net.uk forum purporting to depict Neil, dressed in a basque, having sexual intercourse with a Land Rover. Definitely from the “spanker” Molsey school of satire, but you have to laugh. Don’t you? Dr Crippen did.

There are more serious points to be made about Dr Bacon and who better to make them than Rita Pal, the leading British NHS whistleblower.

The problem with Dr Neil Bacon is this. He thinks everyone likes him…
Rita Pal on “Iwantgreatcare.org”

Let me finish with a quote from The Jobbing Doctor, upon which I cannot improve:

To say that Neil Bacon is somewhat unloved in the profession is an understatement. He is regarded as a pariah, and this site is thought to be a great opportunity for any cranks, or disaffected whingers to be able to destroy the reputation of any doctor, without any real recourse to comeback.
The Jobbing Doctor (Bacon and Tripe)

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A reader says Iain Dale was on the BBC News channel late last night approving of Bacon's website. Surely not. Did anyone else see him?

A word in your ear, old chap?

I arrived at page 30 of today’s Times and started to fume with anger. There is a two page advertorial for Sir Richard Branson including a half page picture of the man himself, “relaxing” in his chalet in Verbier. I fume because, in years gone by, the Times used to be a paper of record, a source of news upon which one could rely. I bear no malice toward Branson himself. He is an outstandingly successful businessman and good luck to him. He is also the apotheosis of self-publicism. For him, a two-page freebie in the Times is small beer.

The “story” was written by Alice Thomson and Rachel Seymour who forfeit their right to be called journalists. They should be working for Max Clifford.

What is this really about? It is about sanitising Sir Richard. The “story” is a nauseating encomium portraying Sir Richard as the “saviour” of the NHS. Or maybe as a more generic “saviour” for, as it is written, you might think these two naïve girls were trailing the second coming. If you do not have the Times yourself, the words without the picture are available here. Note that on the Times-on-line page, the article is placed under UK “news”.

Who knows what still goes on when the anonymous “great and the good” sit down together behind closed doors? Do not underestimate the traditional British corridors of power; the monarchy, the church, the old school tie network, the civil service, the honours system, dinner at Chequers, Prime Ministerial patronage and the Times. Who remembers Chis Mullin’s “A very British Coup”?

No, I am not being paranoid. The “establishment” is not about to overthrow Gordon Brown. The electorate will do that soon enough. But the establishment is still the establishment and “a word in your ear, old chap” is enough to make the editor of the Times run a Branson advertorial which would be more honestly placed in a Labour Party political broadcast.

And Sir Richard is such a modest man:

No job is too big for me, says Sir Richard Branson
Sir Richard is becoming more and more political. But he thinks he can have more influence in business than in Parliament. “In my 30 years as a businessman I've been to Chequers and seen seven prime ministers for dinner - they don't exactly have a very long career. I hope to have another 30 years of what I'm doing.” (The Times)

This government, this Labour government, is going full steam ahead with the privatisation of general practice. The propaganda machine has been running down family doctors for three years. Now it is turning to building up the private sector and, in particular, Virgin Healthcare. The credulous public are to be persuaded that Sir Richard is not a ruthless, profit driven businessman, but a kind, caring and benevolent man whose only interest is the welfare of patients. Who then could be better to take over from those indolent, overpaid fat-cat GPs?

Those who want to know what really drives Sir Richard Branson will visit Branson Pickle.

Those who, like me, remember what the Times used to be like will quietly weep.

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And see:

(I am) not paranoid. (I am) just observing the fag end of a useless Government being hung out to dry by big business, so that remaining public assets are stripped. (The Jobbing Doctor)

A gamble too far (Dr Grumble)

Brown's losing it  (Dr Rant)

The care of the mentally ill - USA style

One of the most dangerous places to get a serious physical illness is in a mental hospital. In the UK you get the CMHT. In the USA, you get this. A horrifying story. There can be no excuses. No mitigation.

Nothing more to be said.

Strokes - best between 9 & 5

The medical culture concerning strokes is changing, and not before time. In years gone by, doctors presented with a patient who had just had a first stroke felt helpless and frustrated. Such a serious diagnosis and yet when the reality that little could be done dawned on the patient (if conscious) and on the family the disillusionment was profound. The GP dreaded phoning the medical registrar for an admission (Can’t you manage him at home? What do you expect us to do?); the houseman’s heart sank as he was called to A & E to clerk in yet another patient who could not give a history; the nurses’ hearts collectively sank as they prepared a bed on “stroke corner” (as far away from the nursing station as possible); the hospital administrators sulked as yet another “acute” bed was blocked for months. Only the consultant was unaffected. On his weekly ward round he passed swiftly by “stroke corner” with a cheery “How are you doing, old chap?” and a sotto voce “how long has Mr Jones been with us now? Can’t we get him into Part 3” to the houseman.

A 59 year old with a blood clot in a coronary artery was straight into ITU under the care of the cardiologists. Relocate the clot to the middle cerebral artery and the same patient was off to “stroke corner” and the geriatricians. That is how it used to be. I exaggerate of course, but only a little.

Why has the culture changed? To some extent because doctors can now do something to prevent the evolution of a stroke in certain patients and in certain circumstances. If the stroke has been caused by a blood clot, and if it is caught early, it is possible to minimise brain damage by thrombolysis. By giving a “clot buster” drug, just as you do for heart attacks. The main reason for the change, though, is that for some reason strokes (I will not start using the singular. We don’t talk about “the best treatment of broken leg” do we?) have acquired a certain cachet. The government has therefore got onto the case. It has started issuing directives and has asked someone who uses English as a second language to think up some slogans. “Time means brain”; “time is brain”. So catchy. So meaningless. So very “New Labour”. Take a look at this document from a hospital near you:

click to enlarge

Note that in this area, strokes only cause brain damage during normal working hours. Note also the arbitrary “three hour” rule. OK, I know lines have to be drawn somewhere but the chances of getting the patient to hospital and getting the CT scan done within three hours are remote in the extreme. I write about this today because early this morning I saw George. George is 78, previously in good health apart from benign prostatic enlargement, and otherwise fit and active, as is Mildred, his wife. Mildred phoned about 8.15 am this morning and was put straight through. She said George had woken up feeling very unwell and dizzy. I have known this couple for a long time. I don’t think they have ever called urgently before. They only live a quarter of a mile away, so I said bring him straight down. He arrived at 8.30 am. He complained of dizzyness but actually what he meant was that he was unsteady on his feet. He was unsteady on his feet because he had weakness down one side of his body and, listening carefully, was his speech a bit slurred? I dialled 999 and the paramedic ambulance arrived gratifyingly quickly. The paramedics glanced at George, who had stood up as they entered the room. I could see from the look on their faces that they doubted the diagnosis. They started talking of drips and ECGs. Had I checked George's  BP?  Had I tested his blood sugar? Sucking eggs with paramedics who cannot resist the temptation for some protocol driven “stay and play” is always frustrating and cost twenty minutes.

Dr Johns, the consultant who runs our local MAU, is excellent. I phoned him later on in the morning. George had indeed had a stroke but it was a haemorrhagic one and, sadly, had extended. The one sided weakness was much more pronounced and he was having trouble with speech. Sad. I pulled Dr John’s leg about the “9 to 5” acute stroke service. I could feel him putting an ice-pack on his head. They do not have the resources to offer a proper service as yet. The reason they are offering a cut down service before they are properly prepared is because of top down pressure from the government.

Ischaemic stroke on CT Scan

Stroke thrombolysis sounds wonderful but there are problems. To prevent one embolic stroke causing brain damage, you need to thrombolise 22 patients. Thrombolytic treatment has dangers; it can make you bleed; you can be allergic to the drugs. No point in saving one life if you have to kill 21 patients to do it. “Funny turns” are common in elderly patients and not all “funny turns” are caused by strokes. The junior hospital doctors do not have enough experience to decide who should and should not be treated. The decision has to be made by the lead consultant for strokes.

Once again, it is resources. This service should be available 24/7 in all areas but to make it available you need a radiologist to report the CT scan, and an experienced physician to make the clinical decision. In many areas that is not possible. Such matters do not concern the government. Out come the slogans. Committees are set up. “Networks” are established. Protocols are written. Nurse specialists are appointed. Targets are set. Pictures of “happy, smiling” stoke victims are circulated. When I have my stroke I shall be really pissed off. I will not be smiling for a government PR photograph.

Don’t get me wrong. In prospect this is all good stuff. The frustration for those of us on the front line is the government’s well publicised statements implying that it is all happening. Not yet it isn’t. Or not outside normal working hours. So, if you are going to have a stroke, pick the time and place carefully.

+++++++

Thanks to PJ for some hard science on acute stroke treatment. The figure he quotes show that only 3% of stroke victims are eligible for thrombolytic treatment. More work needs to be done, but this demonstrates so clearly the difference between government window dressing and the realities of medicine on the front line. Full facts here

Death by alternative medicine : who is to blame?

Following on from the post below about urine enemas, a reader recommends a moving post from Science Based Medicine, which tells the story of a mother with three young chidren presenting with an early breast cancer. 

The case involved a woman in her early 30’s, who presented to a surgeon with a small palpable breast mass. Her primary care doctor had appropriately ordered a mammogram and ultrasound, which the surgeon dutifully presented. The odd thing was that the films were from 2002. The surgeon presenting explained that this woman had presented over three years prior to him for the evaluation of this mass. On mammogram, there was a mass less than 1 cm in diameter, which was confirmed by ultrasound. The edges of the mass weren’t quite smooth enough to consider it very likely benign. Consequently, the mass fell into that gray areay that we in the biz call “indeterminate,” which is basically a code word for “we don’t know if it’s cancer or not and the imaging doesn’t look sufficiently ‘benign’ for us just to follow it.” To put it even more bluntly, it needed a biopsy. The surgeon described how he dutifully did an ultrasound-guided fine needle aspiration of the small nodule.

The results? Adenocarcinoma. Breast cancer. Not much of a surprise, given the appearance on ultrasound. Here’s where things got interesting. Apparently, this woman was a die-hard believer in “alternative medicine.”

Find out what happened next here.

Urine enemas suggested as a treatment for acne

Wibble wibble wibble

A diet devoid of salt, topped up with six pints of water a day, is not compatible with life.

A woman who suffered brain damage after she was allegedly put on a detox diet by a nutritional therapist yesterday (July 3) won £810,000 in compensation. Dawn Page, 52, from Coxwell Street, Faringdon, told London's High Court she had suffered uncontrolled vomiting and a fit after consulting Barbara Nash, of Old London Road, Holton, near Wheatley, about losing weight.  Mrs Page's legal team alleged Mrs Nash advised her to increase her water intake by six pints a day - and to avoid salt. They also said that when informed of Mrs Page's symptoms, Mrs Nash said "what was happening was not unusual" and "was part of the detoxification process".

Barbara Nash D.N.N.

Mrs Page, through her husband Geoffrey, sued Mrs Nash and today agreed the six figure settlement with Mrs Nash's insurers. Dennis Matthews, speaking for Mrs Nash, said she was a "privately trained nutritionist", and emphasised she continued to deny she was in any way to blame for what happened. (Oxford Mail)

Despite the court's finding, and the size of the damages, Barbara Nash denies liability. If you look at her website she is still practising as a “nutritionist”, whatever that is, and purports to have some qualifications, in particular a D.N.N. Dr Crippen has never heard of the D.N.N. Apparently it stands for the Diploma in Natural Nutrition. Barbara Nash does not tell us on her web site where she acquired the qualification. A little searching soon takes us to the College of Natural Nutrition. Who knows if Barbara is an alumnus but the College certainly offers a broad training in "nutritionism" (whatever that is). There is a variety of courses for both "undergraduate" and "post-graduate" nutritionists. The Advanced Practitioners course is particularly impressive:

The Advanced Year also features energy work showing how perfectly Natural Nutrition works with all of the healing energy therapies. Astrology is brought in as an understanding of universal energies influencing us as individuals and collectively. The college also uses an energy camera to help in our awareness of how we function energetically. (College of Advanced Nutrition)

Great stuff. I thought I would look first at the college forum, to see what sort of advice the College was offering.  And there I met the very lovely Hayley Mcalinden. Hayley already has an intermediate certificate in hygiene, is an experienced model and would like to try catwalk, fashion and lingerie. The multi-talented Hayley is currently studying for a diploma in nutrition.

Hayley Mcalinden

Hi! Hayley. Hayley, helped by Paul, is already giving advice on the College of Advanced Nutrition forum. Alex has written in to ask how best to treat his acne.

Alex asks:
I've been treating myself using natural nutrition for a year and a half now. As my more serious symptoms have faded I am left with very pernicious acne (which I've had since I was seven). I'm pretty up-together with the diet and techniques and was wondering if anyone has any perspectives on acne. As far as I can see I need to work on the endocrine system via oils, and the colon via hydration. The Weston Price website also recommends eating plenty of saurkraut to aid bowel flora. If anyone has any other tips as to healing or causes it would be much appreciated

Whilst idly rummaging around in his drawer for some tetracycline, Dr Crippen is trying to remember when he last saw a 7 year old with "pernicious" acne. But tetracycline is old hat at the College of Natural Nutrition. The dialogue continues:

Hayley: Hi Alex: Urine enemas work a treat, do one a day for a week. Good luck

Alex: Cool! Fresh or old?

Hayley: Old or fresh whatever you’ve got.

Paul: Perhaps on a general note r.e. acne I would focus on healing your gut. I'm reading the Healing Psoriasis book that Kate recommended recently (I think it was Kate). This includes things like acne which according to the philosophy that we're learning here I think is basically an indication that our normal elimination pathways are either over taxed (a.k.a. cells releasing to much at one time), damaged, blocked so the toxins back up into blood and lymph and then use the skin and lungs to get out - result acne, etc... You could also try drinking your fresh first morning urine, which is good for lots of things.

Now you are beginning to think that Dr Crippen is taking the piss, aren’t you? But he isn’t. It is all here. And if it disappears, I have furled it. How can the professors and academic staff of the College of Natural Nutrition allow advice like this to remain on their web site? Are they psychiatrically unwell? It seems that some of them were. All fully recovered now, I trust. Let’s take a look at them.

Barbara Wren, Principal

Barbara's first contact with the medical profession was as a student nurse at St Mary's Hospital, Paddington, at the age of 18. During this time she developed Anorexia Nervosa which continued to be a problem for many years. After nursing, Barbara worked at University College Hospital, London, with thyroid cancer patients. The next ten years were spent having a family of 4 children. It was after the birth of the 4th child that Barbara developed M.E./M.S. symptoms and became almost dysfunctional. The medical profession had no answers for these problems and so she started to take full responsibility for curing herself. In order to do this she read a great deal of conventional literature from which she was able to extrapolate and create her own philosophy around healing. After moving to Devon, Barbara became involved with the foundation of the Natural Health Network Clinic. She also began practising as a dietary therapist in a local G.P.'s practice. From these involvements she developed her philosophy even further and began to see the larger picture, displaying a series of connections rather than isolated incidents.

The real test for Barbara's philosophy was to heal herself. She began to put all her ideas into practice and embarked on the road to recovery. This was a very successful process culminating in a years pre-conceptual work before having her fifth child at 43. During this pregnancy Barbara co-founded "The College of Dietary Therapy" where she started to share her concepts with students. This college ran from 1982 to 1989 and trained many of todays Dietary Therapists.

From that point on she has been in great demand to share her concepts with organisations around the country, including The National Child Birth Trust, Well Women Clinics, The Informed Parent, M.E. Groups and Colleges of Kinesiology, Polarity, Osteopathy and Acupuncture. She has also had several articles published in the national press on her philosophy.

As well as teaching, Barbara continues to practice in the South West. She tends to attract patients who have tried various therapies without success and are desperate to get better. She puts emphasis on educating her patients to see why they have arrived at their current state and then gives them the means to take control of their own healing process. Running a college, a busy practice, and a family of five children, she has proved that her philosophy really does work.

Barbara is absolutely right that the medical profession does not have an answer to MS. Dr Crippen is delighted to hear she cured herself. Has she written up how she did it or is it a secret? Is she offering to "cure" other MS patients? That is the obvious inference.  Kinesiology is wibble. Cannot comment on the College of Polarity as I have never heard of it.  I wonder if it involves magnets?

Kate Curnock

Kate's journey to improve her own health began while taking a degree in politics and philosophy. Chronic ill health and a feeling of total disconnection led her to a yoga class and from there to learn about healing. As well as practising Natural Nutrition in Devon, Kate practises Yoga and The Metamorphic Technique.

Kirsten Chick

Kirsten was instinctively drawn to nutrition for support at one of the most decisive turning points in her life, when diagnosed with cancer in her late twenties. Although she hadn’t then come across the philosophy of Natural Nutrition, the experience started a journey that helped Kirsten reassess her life on many levels and then to her training at the college.

The philosophy appealed to Kirsten’s methodical, scientific side, whilst remaining an art that encourages creativity and sensitivity. "Natural Nutrition, for me, represents an ongoing dialogue with my body and an ever deepening relationship with myself. The more space I clear within, the more I allow myself to be nourished and the more in touch I become with who I actually am. It's a very special way of supporting and enabling healing and growth”.

I love the last paragraph. Can anyone translate it? Does this mean that eating a slice of wholemeal bread (surely natural nutrition) represents an ongoing dialogue with one's body?

Sally Holman

...following the breakdown of her marriage, Sally became anorexic and suffered from total allergy syndrome. She became familiar with the unsatisfactory response of the medical establishment, and explored the alternative scene for over 10 years. It was a when a friend introduced her to Barbara Wren, and she took the Natural Nutrition route, that she regained her health. Within 6 months she felt well enough to take the attendance course, and qualified with distinction as a therapist in 1985.

Richard Norris

Richard is a psychological astrologer. Through his medium he seeks to guide people to reconnect with a deeper sense of personal wholeness and understanding, from this will emerge a clearer recognition and validation of the purpose of their unique journey in this lifetime. In his 23 years as a practising astrologer he has studied extensively with Liz Greene and The Centre for Psychological Astrology and at The Faculty of Astrological Studies. He has also trained and practices as a Humanistic Psychotherapist, Re-Birther and Past Life Regression. Richard finds his person-centred approach is mirrored by the college's emphasis on informing and empowering the individual to realise their own potential

Sara Wheater

Having struggled to find an understanding for herself on a physical level around bulimia, weight and the health issues that accompany it, she finally arrived at The College of Natural Nutrition. It was here that she found a way of living and being that embraced the whole person was being taught. The course teaches how to listen, understand and work with your own body and from doing this she reached a high level of awareness concerning the body's cycles and rhythms. It has now become her passion along with her many years of personal development and trainings in N.L.P. and Voice Dialogue (the psychology of the selves) and the importance of lifestyle which she brings to her practice and teaching.

Caroline Brett

Having always been interested in health and inspired by some further time spent living in the U.S.A., she wanted to learn about healing and yet still be able to incorporate her own extensive knowledge of food. She enrolled with The College of Natural Nutrition and found the topic to be extraordinarily inspiring: revealing the connection between our bodies, the stars, the seasons and the earth. Wanting to somehow manifest this, to help people re-discover how to feel better by reconnecting to the earth, eating well, enjoying local, seasonal, healthy food; she opened an organic restaurant and juice bar in 2000. She is passionate about seasonal eating, dogs, life between the wars and making preserves for afternoon tea.

Nick Bennett

Nick graduated from Nottingham University with a BSc (Hons) in Nutritional Biochemistry. While still studying for his degree he became involved with a Home Office Project on the links between Nutrition and Criminal Behaviour, the findings of which were published in the journal "Nutrition and Health". This field still remains an important part of Nick's research.

For seven years Nick worked in the technical departments of two leading U.K. supplement companies finishing in the position of "Technical Director" before leaving in 2002 to set up a consultancy with his wife Sue. Nick now works from home where he can spend more time with his two children advising supplement companies on technical, regulatory and product research matters.

Do study the detailed c.v.’s of all the faculty here. Ask yourself which member of staff  you would choose as your personal tutor. The only University qualification that Dr Crippen recognises here is the degree in nutritional biochemisty that is indeed taught at Nottingham Univeristy. I wonder if Nick Bennett, who has some conventional scientific training, would feel able to justify the use of urine enemas to treat acne? Nick Bennett also works for Boots the Chemist helping to flog CoQ10, a currently fashionable example of expensive wibble. Take a look at the excellent DC's improbable science for more information.

The concept of urine enemas makes me giggle. It is of course wibble. Pure, unadulterated wibble. As is most of the stuff coming out of the Centre for Natural Nutrition.  Do you really want to study with a psychological astrologer so that you can reconnect with the earth, be passionate about jam making, learn about re-birthing and have an on-going dialogue with your body? Perhaps you do!

We can all laugh but, underneath the laughter, there is a serious problem. I think of the teenage children I see, their lives made miserable by severe acne. The medical profession does not have a complete answer to acne but there is a lot we can do. Trouble is, these days, teenagers trawl the internet looking for "alternative" cures for acne. I am horrified to think that they might arrive at the College of Natural Nutrition site. Imagine walking unexpectedly into your teenage daughter's bedroom to find her self-administering a  stale urine enema. Not funny.

And then think of poor, brain damaged Dawn Page. Not funny at all.

The cynical betrayal of junior hospital doctors continues

Doctors' Mess

Ging gang gooley, gooley, gooley, gooley, watcha

Ging gang goo, ging gang goo

Ging gang gooley, gooley, gooley, gooley, watcha

Ging gang goo, ging gang goo

Heyla, heyla sheyla, heyla shey-la heyla ho

Heyla, heyla sheyla, heyla shey-la heyla ho

Golly wally, golly wally, golly walla, golly walla

Um-pa, Um-pa, Um-pa

++++++++++

After five or six years at medical school, most newly qualified doctors have educational loans far higher than other students. And when they start work, most of them have no alternative but to live for at least part of the week in hospital accommodation.  The hours may not be as long as they were but the shift system still means unsociable start and finishing times and that makes commuting difficult. Rotating jobs means it is impossible to settle in one area. Buy a house in Birmingham and then your next job is in Manchester. It was hard enough for a newly qualified doctor to buy a house in the first place. Now (s)he is forced to pay huge sums of money for tatty hospital accommodation, it is impossible.

The use of university halls-style rooms in their first year after graduating has been used as an excuse to keep the starting salary of junior doctors low, just £21,000 this year, compared to the average graduate's first salary of £24,000. But the provision of free accommodation has been removed without any compensatory pay rise. (source)

Remember also that newly qualified doctors are not “average” students. They are la crème de la crème. How do other high-flying graduates fare?

As a trainee solicitor in London you will earn £37,500 in year 1, and £41,500 in Year 2. Once you're qualified, this rises to £66,000 plus a bonus scheme. (CMS Cameron McKenna)

Graduate Starting Salaries
STARTING SALARIES for graduate Lawyers have shot through the £60,000 mark for the first time – more than twice the level they were a decade ago. But some graduates can expect to earn less than £15,000 per year in their first graduate role. Newly employed solicitors from London’s top firms have seen salaries rise by sixteen percent in the last twelve months to £64,000. Many trainee solicitors can expect to earn ‘only’ £35,000 – the same amount as trainee accountants. High-earning graduates often see their pay packet swell with a £10,000 Golden Hello on top of their annual earnings.

Investment banker £33,000
Management consultant £24,000 – £35,000
Junior doctor £20,741
Police constable £20,397
Teacher £20,133
Nursery manager £20,000
Nurse £19,683
Civil service administrator £19,387
Paramedic £19,195
Electrical engineer £17,000 – £27,000
Soldier £15,700
Library assistant £15,000
Full-time shop assistant £13,000 – £16,000
Teaching assistant £11,000 – £14,000
Fashion model £10,000 – £15,000
Regional newspaper reporter £10,000
Part-time nursery nurse £7,500 – £10,400 (Student Direct)

So a newly qualified doctor thus earns little more than a nurse or a paramedic. Why bother to train as a doctor?

The Blog that ate Manhattan

"I practice medicine, cook and wax prolific in New York City"

The Blog that ate Manhattan chooses the best of this week's medical writing from the USA and around the world.

Gordon's feast

Families facing spiralling shopping bills were told by Gordon Brown yesterday to stop wasting food, as a government report said that Britons were throwing away groceries worth more than £1 billion a year. The Cabinet Office inquiry into food policy, ordered by Mr Brown soon after he became Prime Minister, accuses families of wasting an average of £420 a year on food, The Times has learnt.

Mr Brown reinforced its message yesterday, calling on people to stop throwing food away as he travelled to the G8 summit in Japan. “If we are to get food prices down, we must do more to deal with unnecessary demands, such as by all of us doing more to reduce our food waste,” he said. (The Times)

Quite right too, Prime Minister, says Dr Crippen. But what, you may ask, is the Prime Minister eating on his Japanese junket? In a delicious coup de theatre, Guido has found a copy of the prime minister’s menu

Luncheon

White asparagus and truffle soup

Kegani crag almond old foam and green olive tapenade

Supreme of chicken served with its stuffed thigh, nuts

Orange savoury with beetroot foam

Special cheese selection with half-dried fruits

Peach compote, ice cream and raspberry coulis

Those wondering what Gordon will be supping on this evening can find the full day’s menu at What is Gordon eating today.  I'm not sure about “chicken stuffed thigh, nuts” and Guido does not explain. Not to Dr Crippen’s taste.

Poor old Gordon. It’s all a question of timing and he doesn't have any. Maybe he has taken a "doggy bag" to Japan! According to Guido, things are now so bad in the Labour Party that serious consideration is being given to this politician taking over. Really! Soundings are currently being taken. Dr Crippen had not realised it was as desperate as that.

The case against co-payments in the NHS

From the home of two-tier medicine

There is a particularly unpleasant piece of mischief in today’s Times from the normally reliable Stephen Pollard. It’s the usual doctor bashing stuff which is now sadly de rigueur from journalists who have swallowed all the government propaganda. I expect this sort of stuff from Polly, but not from Pollard.

Hamish Meldrum, the BMA chairman, has just expressed his concerns at the idea of allowing co-payment within the NHS.

“My gut instinct is that this goes against the sort of NHS I believe in, which is free at the point of use, fair and equitable to all.” (Hamish Meldrum)

Stephen Pollard does not like this at all and finishes Meldrum’s statement thus:

And which, [Meldrum] didn't add, would let patients die rather than use a drug their health authority will not supply. Equity it may be; but it can be the equity of death. But no one should be surprised at the sheer callousness of Dr Meldrum's position. The notion that an organisation which represents doctors ought somehow to have the patient's interest in mind is attractive. But it is also naive. When it comes to the public, the BMA sees us as little more than a cash cow. (Stephen Pollard)

Does the general public really think that doctors see patients only as a cash cow? God, I hope not. I find that truly upsetting. But, whether or not Pollard is right in making that statement, the article as a whole is both credulous and naïve. Banning co-payments would not increase doctors' income. If anything, it would decrease it as there would be less not more private practice. Pollard is thus merely indulging his need to make some gratuitous and unfounded criticisms of doctors.

The recent cases of patients being banned from the NHS for buying drugs only normally available to private patients caused a furore, and understandably so. The decisions were outrageous. But hard cases make bad law.

Let me try to explain what Hamish Meldrum and many other doctors, including Dr Crippen, are worried about. If the right of NHS patients to make co-payments, in other words their right to “top up” their NHS treatment with some form of treatment deemed to be superior, becomes a routinely acceptable option, how long will it be before it becomes compulsory?

• For a co-payment of £1000 you may have your hernia repaired now rather than in nine months 
  
• For a co-payment of £500 you may have your MRI scan now rather than in six months
  
• For a co-payment of £500 you can be guaranteed an appointment with the consultant rather than with the nurse-practitioner
  
• For a co-payment of £100 you can have the branded drug rather than the generic version imported from the third world

Co-payment structuring in the USA

The potential is endless and would be a real cash-cow for an over-borrowed government. It would be a short cut to a two-tier or even a three-tier system. To some extent it goes on already. As any GP in the country will tell you, many patients already pay for a quick private consultation with a specialist, or for a private MRI scan. In my area, the waiting list for a “routine” MRI scan is currently sixteen weeks. A long distance lorry driver off work with lumbago may well choose to pay for a private scan.

It goes on all the time on the quiet. It should not have to, but it does. Best not talked about in company for, let it become formalised, it will become the rule rather than the exception. That is what doctors are worried about. I am surprised that Stephen Pollard cannot see that.

Liver transplants and Cadbury's Dairy Milk

Scott's liver

Scott Hull has a rare disease called PSC (very long name that won’t mean much unless you are a doctor). Basically, over time the bile ducts leaving his liver are squeezed closed which causes fluids to back up into the liver and evenutally, cirrhosis (liver damage). This is not caused by drugs, alcohol, or anything else he did. Although the symptoms are treatable eventually it will get worse, and the only long term cure is a liver transplant. To make matters worse, there is a 15% increase in the chance of liver cancer - which also goes back to normal with the transplant. (If he does get the cancer, the chances of getting the transplant before it spreads are unlikely). - Martha (Scott’s wife)

++++++++++++

There is a waiting list for liver transplants. 

I have a patient who is waiting for one. I have three patients who have had liver transplants and so far, touch wood, and who knows what tomorrow brings, they are all doing well.

I have this vague, wishy-washy, feeling (the DK is now reaching for his revolver) that the EC is a “good thing” – you know, nation talking to nation and all that. And yet, every time that I have a specific example of what the EC does, I don’t like it. For example, I know what chocolate is. We invented it. Chocolate is Cadbury’s Dairy Milk Chocolate. It’s not that nasty, bitter, black slabby stuff that European’s like. This is chocolate:

Note that because of Eurocracy, the word chocolate no longer appears on the wrapper. That makes me cross. They have stolen British chocolate. It gets worse. Now they are stealing British livers. Literally:

A London hospital has been referred to health watchdogs after concerns that too many liver transplants are being given to foreign patients. The Healthcare Commission was alerted after 72 non-British EU nationals were given new livers in four years at King's College Hospital. In a statement, King's College Hospital, Europe's leading liver transplant centre, said it carried out 210 liver transplants in the year to this April, including 24 on patients from other EU countries. Eighteen of them were from Greece and Cyprus.

It said: "King's carries out liver transplant surgery on non-UK EU patients, as it is required to do so in accordance with NHS guidance and European Law.

"In accordance with current NHS guidelines for transplantation and European law, all EU patients awaiting liver transplant surgery at King's are assessed and prioritised according to clinical need only.
A Department of Health spokesperson said: "The transplantation of donated livers into non UK EU residents who qualify for NHS treatment is lawful. This is guided by European law which effectively regards such patients as having equal access to the NHS. (BBC)

I know, I know, I am going to be criticised for xenophobia, for being a little Englander, for being anti-European, for discriminating against poor old Johnny-Foreigner. I don't care. This is wrong. It is more than wrong, it is a scandal. It is a betrayal of the British taxpayer who funds the NHS.

I want my chocolate back. I want our livers back. If I am killed in an road traffic accident, I want to keep my liver in the UK. Can I put that on my donor card? Of course I can. But would anyone take any notice?  I doubt it.

Time to leave the EC.

Happy 60th birthday, NHS : your very good health!

The NHS was set up to provide comprehensive, high quality health care for all, without regard to means or status. In one of his finest posts, Dr Rant looks at what is left after sixty years

Comprehensive coverage

The NHS provides great comprehensive coverage unless:-

• It’s a dental problem.
  
• It’s dementia: your needs are social and not medical you see, and be a good taxpayer and sell your house to fund your nursing home bill.
  
• Fertility- we’ll pay for contraception and abortion…but we don’t to create new babies.
  
• It’s a new cancer drug.
  
• You need rehab rather than curative treatments.
  
• You need adaptations to your house.
  
• You don’t want to wait.
  
• You have a mental health problem.
  
• You want a permanent and recognisable psychiatrist.
  

High quality service

The NHS provides high quality service except that:-

• It ignores foreign comparisons.
  
• It actively manages against its staff achieving this.
  
• It sets targets for quantity not quality, and refuses to admit that there is a trade off to be made here.
  
• The criteria for high quality are poorly defined.
  
• It pretends that “excellence comes as standard” which, as any fule (except Alan Johnson, Ed Balls, Darzi, Bradshaw and Donaldson) kno, is an oxymoron.
  
• It pretends that guideline implementation and measurement and compliance is an assurance of quality.
  
• It dreams that a computer (or nurse drone) could replace a thinking human being.
  
• It believes that rationing is merely a technical issue rather than a moral issue.
  
• NHS direct still exists (see below).
  

Full details from Dr Rant in “The NHS at sixty: it’s great, but…”

It's those "naughty nurses" again!

Time to move away from the horrors of diphtheria, and the mendacity of Ben Bradshaw. Time for a little Friday afternoon light relief. And there is no better place to visit for light relief than those dear, dear ladies at the Centre for Nursing Advocacy. I had not visited for a while and so there was a bumper crop of hilarious paranoia awaiting me.  First the new ABC documentary on Johns Hopkins:

Based on the first episode, "Hopkins" will deliver the same basic messages viewers have heard a thousand times: Physicians are brilliant life-saving demigods and they are increasingly diverse, but their work requires great personal sacrifice. Note we said demigods, because as on other Hollywood dramas, the physicians will display flaws that make the overall portrayals all the more persuasive. TV Guide's preview piece on "Hopkins" went so far as to call the show the "real Grey's Anatomy," and to actually line three of the profiled physicians up against their supposed "Grey's" counterparts. The only mention of nurses in that story was in the profile of an attractive cardiothoracic surgery fellow. (Cinema Faux)

They don’t like Desparate Housewives either. (Does anyone? – yes, Dr Crippen’s daughters do)

Tonight, ABC's "Desperate Housewives" gave us a hospital nurse as mousy, pathetic physician lackey who can be bribed into revealing sensitive patient information with free lunch at a French bistro, and who has time to leave the hospital mid-shift to eat that lunch. Yeah, we know--it's just Wisteria Lane. We're sure that the episode's 16 million U.S. viewers can all separate the serious (even pretentious) voiceover-related themes and ostensibly realistic drama from this contemptuous portrayal of a nurse.  (Desperate Nursemaids)

ABC's "Private Practice," the only new health drama of the 2007-08 TV season, is another prime time soap about smart, pretty physicians from "Grey's Anatomy" creator Shonda Rhimes. But in addition to the seven physician characters who dominate here, the show's LA "wellness clinic" also has cute surfing receptionist Dell Parker. The earnest Dell just got his "nursing degree" and is studying to be a midwife. He seems to be a young, network version of "Strong Medicine"'s Peter Riggs--except Dell uses his nursing skills to be a receptionist. Despite good intentions and an intense interest in the clinic's patients, Dell seems to be the least knowledgeable major nurse character in the last decade of prime time US television. The show's early episodes suggest that his clinical studies consist of whatever ad hoc assistance he can give to clinic physicians. "Is that even a word--midwifery?"

They don’t approve of what is going on in the UK either

Recent U.K. press articles have highlighted the "naughty nurse" video for pop singer Kavana's comeback single "Automatic." The video stars actress Suranne Jones (from the U.K. soap "Coronation Street") as a sexy half-dressed "nurse" who flirts with Kavana while tying him to a chair with tape. Kavana told one writer that the video was inspired by the film "One Flew Over the Cuckoo's Nest." The video isn't likely to match the cultural impression that film made, but it still reinforces a damaging stereotype of nurses--as do January press pieces gleefully promoting it in The Daily Star and The Manchester Evening News. Let’s pretend we are nurses

Whilst not totally critical of the film Atonement, they are still not happy:

The movie adds visuals to the book's nurse-centered account of hospital care, showing the courage required of nurses in mass casualty events and the formidable authority of senior nurses. Wright's movie does not match the force of McEwan's vision of the trauma the nurses face, the full rigor of their training, or Briony's growing skill. The film, like the book, also conveys little of the technical expertise nursing requires, and may suggest that nursing is more a vehicle for atonement than a modern scientific profession. (Atonement)

And they certainly do not like the soar-away sizzling Sun:

The Sun (U.K.) published an article and online multimedia presentation of the 2008 Babes and Boys calendar that features real nurses dressed in lingerie.

The Sun article is most distasteful. I can barely look. You don't see front pages of semi-clad "naughty solicitors" - well, not in the magazines I read, anyway. But then, they pay solicitors properly. It's a shame that the Center for Nursing Advocacy does not concentrate on something more productive - like the fight to get decent pay for nurses. But then, they would not be funny, would they?

Does the Center for Nursing Advocacy like anything? Well, yes. They like this:

A first step to repair some of this damage is to make more images like the "Male Nurse" from Archie McPhee. The accompanying x-ray doesn't symbolize much of a staff nursing role, so we'll assume he's a nurse practitioner. Our "male nurse" (as if we can't tell he's male from his appearance) is described by the creators as such:

"Armed with a stethoscope and a clipboard holding an X-ray, this 5-1/4" tall, hard plastic Male Nurse Action Figure is ready to treat your symptoms and fix what ails you. Male nurses make up six percent of the nurses in the United States and only slightly more in Australia and the UK, but this number is growing. These men are blazing the trail as role models and mentors for generations to come. Thank a male nurse today!" (Increasing the public understanding of nurses)

Love it. "Armed with a stethoscope and a clipboard this tall, hard plastic male nurse is ready to treat your symptoms and fix what ails you." Could be the epitaph for the NHS.

Daily Persaud covers the diphtheria vaccine shortage

NHS BLOG DOCTOR first reported the shortage of vaccine for routine childhood immunisations on 11th June in "More good news from the Department of Health" and followed up with "How long before a British baby  dies of diphtheria" on 1st July. The most recent post was "Death from Diphtheria" earlier today, pointing out that, contrary to my original suggestion, there has in fact already been a death from diphtheria.

Over the last day or so, Dr Crippen has been talking to a reputable journalist from a reputable paper who was about the give the story some wide publicity, with acknowledgement of sources. It was not to be. The Daily Persaud has already published without, of course, mentioning the original source of the story.

One of the frustrations of blogging.

Death from diphtheria

Princess Alice of Hesse

In November of 1878, tragedy struck Alice's home. Her eldest daughter Victoria came down with diphtheria, and the girl's fever was extremely high. Four days later, Alice sent her mother a telegram stating another daughter, Alix, had also contacted the disease, and it appeared the child would die. Not soon after, May also became ill. Eventually all the children with the exception of Ella were infected with diphtheria. As it turned out, all but little May pulled through. The disease had resulted in a painful choking death for the little girl. Alice kept the news of May's death a secret from the others for as long as she could. Eventually the children started to question their mother about May's absence, and she finally confessed that their sister was dead. Ernie, still recovering from the illness, was extremely grieved. In an attempt to comfort him, Alice kissed the boy, and she contacted diphtheria as a result of this action. Weak from sleepless nights of nursing her family through the ordeal, Alice had no strength left to fight her illness. On December 14th, the 17th anniversary of her father's death, she passed away. She was only 35. (source)

___________________________

Like Dr Crippen, you probably thought this sad story was of historical interest only. I hope that is correct. But the shortage of vaccine is worrying. I must apologise to readers for implying that there has not yet been a death from diphtheria in contemporary England. A reader points out that I was wrong:

Death of a child infected with diphtheria in London
8 May 2008

The Health Protection Agency has been responding to the death of a child in London. The most likely explanation for the child’s death is an infection with diphtheria. The Agency is recommending that people ensure that they are up to date with their routine immunisations. Diphtheria is extremely rare in the UK due to the success of vaccinations children receive as part of the childhood immunisation programme. The few isolated cases that are seen are usually in unvaccinated people who have travelled to countries where the disease is still common. These cases do not usually spread the infection to others in the UK because the population is well protected through immunisation. Professor Peter Borriello, from the Health Protection Agency said, “It is rare for people to die from diphtheria as severe infection is prevented by immunisation and the majority of children are routinely immunised against diphtheria in the UK. This child had not been immunised. (Health Protection Agency)

Meanwhile the government dishonesty and doublespeak about the shortage of vaccine continues. My practice is currently cancelling baby immunisation clinics because we cannot get enough of  the appropriate vaccines.

Ben Bradshaw gets it wrong

Ben Bradshaw might be forgiven for hating GPs. He fought his first general election in Exeter against the appalling, self-promoting, god-bothering, pole-dancer hating, homophobic GP Dr Adrian Rogers.

Dr Adrian Rogers

Prior to the 1997 general election Ben Bradshaw, the openly-gay Labour candidate in Exeter, faced a sustained campaign to ‘Stop the Pink Flag flying over Exeter’. Opposing candidate Dr Adrian Rogers distributed leaflets at schoolgates and Exeter FC deriding homosexuality as: “sterile, disease-ridden and God-forsaken”. Bradshaw secured a higher than average 11.91 per cent swing to Labour on polling day. (Stonewall)

The victory in Exeter was welcome but there is little else to recommend about Ben Bradshaw. He has now risen to his level of incompetence and survives only because he is an oleaginously compliant prime ministerial acolyte.

GPs have been attacked by a minister for operating "gentlemen's agreements" whereby they promise not to accept other doctors' patients. In a BBC News website interview, Ben Bradshaw accused family doctors in some areas of blocking patient choice. Mr Bradshaw said the lump sum "dampened the incentive" to attract new patients and meant some doctors were able to survive with very few patients. He said government research had found one practice in the south of England with just two patients, but he refused to say exactly where that was. Nor could he say how widespread the issues were. He added the introduction of choice in GP care could drive up standards in the same way it had for hospital care. (BBC)

Patients have always had the right to register with the GP of their choice. Nothing new there, Ben. The MPIG is designed to support doctors with small lists. If you abolish it, Ben, the GPs working in rural areas with large practice areas and small lists will go out of business. So what will happen in the Orkneys, in the Shetlands, the Lake District, Bodmin and the North Yorkshire moors? The patients will be left without a local doctor and will have to commute fifty miles to the nearest “competitive” nurse-run polyclinic. That will save the government a lot of money, but is that what we really want?

Mr Bradshaw made the comments ahead of publication of the government's primary and community care strategy on Thursday. The strategy, which builds on the Darzi review published on Monday, is expected to set out a vision for a more personalised GP service. It will call for more use of e-mail and telephone GP consultations - these only happen in rare cases currently. (BBC)

Oh dear God! Telephone consultations? Email consultations? We all do a few of these and it is not unreasonable for the “I have run out of hayfever medication” sort of problem. But doctors are not clever enough to make diagnoses over the telephone. Only nurse-specialists can do that, and it is the nurse-speciaist you are going to be seeing at the new “competitive” polyclinics.

And what of the allegation that GPs do not compete for each others’ patients? That we have a gentleman’s agreement not to “poach” each others’ patients?

Laurence Buckman, chairman of the BMA's GPs committee, said he was not opposed to phasing out the lump sum and putting more weight on the size of GP lists. But he added: "It is absolute nonsense to suggest there are gentlemen's agreements - it just doesn't happen.

"Nor are we going to compete for patients, that is not the way general practice works." (BBC)

Laurence is only half right. We are certainly not going to start “competing” for each others’ patients. We are doctors, not soap powder salesman. Doctors who tout for patients risk being struck off. It is right and reasonable and proper to make clear what services one’s practice offers. A practice booklet and a website is acceptable. But offering inducements – for example free gym membership – is unethical. It is part of the “pile ‘em high and treat ‘em cheap” big business ethic. It is not what reputable doctors do.

But – and I speak for my practice area now, I cannot generalise on the whole county – we certainly do have a “gentleman’s agreement” not to take on patients from other local practices. We are a big group practice. There are three single handed GPs within the area as well. We don’t routinely take their patients and they don’t routinely take ours. This is not to try to strangle competition. Far from it. It is because the patients who try to change practices are usually heart-sink, difficult people who are trying to move because their doctor will not do as they want.

"I want to change because Dr Smith never gives me antibiotics and my neighbour who is with you says you always do.”

So, when we are approached by such patients, one of us always sees them personally to ask why they want to change. If it is because there has been one of those occasional breakdowns in the doctor-patient relationship (it happens to all of us) then we probably take them. It is a difficult area, and difficult to predict what we will do in any individual case. We may not get it right on every occasion.

But let us put the problem in proportion. We get one or two such request a month. Never more. Usually less. Ben Bradshaw gives the impression that nationwide this is a huge problem. It is not. There is and always has been complete freedom of choice of doctors and, once they have signed on with a practice, very few patients wish to change.

Sir Richard Branson, Virgin Healthcare and BRANSON Pickle

Help is about to arrive

The man in the street is not going to lose sleep about the impending abolition of the MPIG. He has never heard of it. Few have. Even some GPs – the ones who don’t get involved in practice finance - do not know what it is. The MPIG is the “minimum practice income guarantee.” You are probably not much wiser. You probably think that GPs are paid a sum of money proportional to their list size. A “capitation” fee. That would be logical, and simple and indeed has considerable merit. However, if GP pay were based solely on capitation, it would encourage a “stack ‘em high and treat them cheap” mentality. It would discriminate against rurual GPs with large practice areas but small lists and it would reward GPs who took on large numbers of undemanding patients and refused to take on older patients with chronic illness.

It seems the MPIG is to go. My Lord Darzi thinks this will enourage “patients’ choice”. Postman Pat has bought into that belief:

But MPIG ‘mitigates against people exercising that choice, and is a barrier to tackling health inequalities’, health secretary Alan Johnson said. ‘That needs to be tackled.’
 (source)

I will let The Jobbing Doctor sort out Johnson’s execrable use of English. Dr Crippen is in favour of choice and also in favour of tackling health inequalities. So is the Jobbing Doctor. Who is not? Unfortunately, the abolition of MPIG will have precisely the opposite effect. It will open the door to Fradd the Destroyer, to Dr Peter Smith OBE and to all the “GP entrepreneurs” (if you will pardon the oxymoron) who see the opportunity of making a fast buck out of the NHS. Why employ one doctor when, for the same money, you can have five nurses? Enter the polyclinic where patients will indeed be “piled high and treated cheap”. No MPIG to encourage rational medicine, only the capitation fee to encourage large numbers. List sizes of 10,000 managed by a group of HCPs with Fradd the Destroyer and his clones somewhere in the background, notionally overseeing the nurses, but in reality carrying the money (the taxpayers’ money) to the bank.

These “GP entrepreneurs” (pardon the oxymoron) are but midges in the economic firmament. Somewhere, in a balloon near you, Sir Richard Branson is casting his eyes toward the NHS honeypot. Sir Richard is the country’s most successful branded venture capitalist. He eats people like Fradd the Destroyer and Dr Peter Smith OBE for lunch. Virgin Healthcare is tooling up for battle. Sir Richard and Virgin Healthcare are in business to make a profit. There is no other motive. There is nothing wrong with that motive, either. What you have to ask, however, is whether the profit motive alone is sufficient to run healthcare efficiently. Most doctors think not, but few will listen to us.

Successive governments have waged a PR war against the medical profession successfully portraying doctors as lazy, overpaid and avaricious. Nye Bevin started it with some obiter dicta about GPs, Ken Clarke did the same, and the current Labour administration has continued the propaganda war. Although on the front line GPs remain the most respected professionals of all, the BBC in particular and the media in general have swallowed the government propaganda. Any doctor now suggesting that he/she has the welfare of the patients at heart is met with howls of laughter from the likes of multi-millionaire, champagne-socialist journalist Polly Toynbee.

Let's get that nice Sir Richard Branson to take over. He has the best interests of the patients at heart. You think so? You think that a Virgin Healthcare polyclinic with its 50,000 patients and its hordes of HCPs is going to provide the same level of care as your GP? Is going to be governed by the same ethical code as your GP? Is going to have your interests at heart as your current GP does?

Come with me now to BRANSON Pickle. It’s a whistleblower’s website. It is written by John Spencer, who was a Virgin employee:

John Spencer

I worked for Virgin Healthcare from 7th January to 21st February 2008. In my time there I made my concerns known regarding the ethics of some of the discussions that were being had by Senior Management. I did this in a professional and courteous manner but I felt my input was not really considered helpful by senior management. Nevertheless I continued to make my concerns known in a discreet and polite manner. In fact I was a much-appreciated employee who worked very hard for you and had nothing but excellent feedback. Out of the blue, on 20th February, seven weeks after I raised my initial concerns, Sarah Clarke, the commercial director (in relation to a perfectly decent report that I produced), called me ‘unprofessional’. Inevitably, I offered my resignation, which was accepted with some haste by senior management. Later, when I asked for the claim of ‘acting unprofessionally’ to be substantiated it was completely and readily withdrawn - but my resignation stood.

It is difficult to be a whistleblower, particularly when you are taking on the might of Sir Richard Branson’s empire. And it may be that John Spencer is nothing but a dissatisfied ex-employee who could not hack it in a successful business. All whistleblowers have to deal with that accusation. It may be that there is not a shred of truth in anything that John Spencer says. You will have to make your own mind up about that.

My Concerns - John Spencer

During my time at Virgin Healthcare I brought several ethical issues to the attention of Senior Management at Virgin Healthcare. I know you are already aware of all these issues as I bought them to your attention in a letter sent by recorded delivery to Necker Island on 22nd April. As you have made no response to these concerns I have no choice but to raise them here. Details of each concern and evidence for them can be read below.

1. Attempting to circumvent regulations on patient confidentiality
   
2. Planning to reward 'independent' NHS GPs for sending private patients to your clinics
   
3. Financially coercing GPs to offer 'little emotional resistance' to your plans
   
4. Virgin's relationship with the PCT
   
5. Seeking out lucrative patients who are healthy at the cost of treating patients who are ill and therefore ‘put a great strain on resources’.
   

If you dismiss everything that John Spencer says, then you will be signing on at the first Virgin Healthcare polyclinic to open in your area. It is a free world, and it is your choice.

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A reader draws my attention to this:

Medical businesses profit from young patients
If you're in business, the ideal patient is not someone with a rare and interesting condition, it's the young male professionals.

Is the ideal patient someone with a rare and interesting condition? Not if you're in business. Then it's the young male professionals who are of “particular interest”, says a report by Goodstuff, a market research firm. The document was commissioned by Virgin Healthcare, reports Pulse (June 25).

“From a business point of view, this audience [is] the most lucrative to recruit,” says the report. “They help [to] fulfill a quota without putting a great strain on resources.”

Virgin Healthcare says in a statement that “the advice has not been used or considered by any of the current management team”. Mark Adams, CEO of Virgin Healthcare, tells Pulse: “The Goodstuff report was commissioned in 2006, and I can hand on heart say [that] I haven't even seen it.”

Other documents from February 2008 show the breakdown of patients at the first practice Virgin Healthcare plans to open in January - Taw Hill Medical Practice in Swindon. The practice has a “growing population of affluent professionals with young families” and about 75 per cent of the list is under 40, with just 4 per cent aged 60 and over. (The Times)

Covert rationing in the USA : Grand Rounds

Dr Rich is one of my American colleagues, a cardiologist by training and a writer of repute. He writes, inter alia, "The Covert Rationing blog". Yep, you got it. It's happening over there too. Dr Rich has just selected his pick of the best of medical writing from the USA and around the world.

How long before a British baby dies of diphtheria?

Greetings comrades and good news as we join together to celebrate the 60th anniversary of our glorious health service. Our esteemed leader is continuing the work of the late Comrade Bevan. Meanwhile Comrade My Lord Darzi has produced a health care plan for the next sixty years. Every local soviet will commission comprehensive wellbeing and prevention services personalised to meet the specific needs of all our comrade patients.We continue to focus on the immunisation of our children. There is no shortage of vaccine. All children will be immunised on time. Appropriate supplies of vaccine have been despatched. Any comrade doctors who have received too many vaccines are free to ask for a reduction in their allocation.

Meanwhile, back at the coal face, Dr Crippen is trying to advise the two practice nurses who run our baby immunisation clinics. We have run out of vaccine. We have ordered and re-ordered. We have emailed, faxed and written to the suppliers and to the Department of Health, all to no avail. I have just cancelled the next two immunisation clinics. There is no point in bringing babies down to the health centre on a wild goose chase. Today we had this letter from the vaccine supplier:

click to enlarge

Ok, you may say, Movianto UK is a private sector company. The government will do something about this. Yes they will, but you will not like it. They are refusing to admit that there is a crisis. They are telling lies. Flagrant, brazen lies.

“we are currently distributing more (vaccine) than is needed to vaccinate all infants…”

“…in order to maintain stability in matching deliveries to supplies, we will introduce ‘allocation’ of the above vaccines…”  (DoH Vaccine Newsletter June 2008)

How will the allocation be decided?

It will be "based on your previous use of these vaccines and cannot be increased". (ibid)

But our list has grown. We have more young, fecund families, and thus more babies who need their immunisations. For the first time in my practice life, I am having to turn away small children who need routine immunisations. I cannot offer them protection against diphtheria This is the reality of eleven years of Gordon Brown's health service. We no longer have enough vaccines to provide routine immunisations for our children. 

Sacrilege by juxtaposition : how dare they?

Pictured in today's Times

sac·ri·lege ((skr-lj)
n.
Desecration, profanation, misuse, or theft of something sacred.

[Middle English, from Old French, from Latin sacrilegium, from sacrilegus, one who steals sacred things : sacer, sacred; see sacred + legere, to gather; see leg- in Indo-European roots.]
sacri·legist (skr-ljst) n.

Lord Darzi : offensively inoffensive

Alan, Ara & Gordon

Lord Darzi is a clever guy. Of that there is no possible doubt. He is a highly accomplished, pioneering laparoscopic surgeon. That does not make it intuitively obvious why he should be able to provide what is being trailed by the government as the single most important NHS master plan since 1997. I suspect he has been picked for his voice. There is something enormously relaxing about his mellifluous tone and his gentle Irish cadences. Such a shame, then, that his report is a load of meaningless drivel.

It was always going to be so. This report is, more than anything, about front line NHS services; about what you will get when you walk into your local general practice, or your local accident and emergency department. Lord Darzi knows nothing of general practice. He knows nothing about front line nursing care, or physiotherapy, or of the Community Mental Health Care Team (God help us all). Next the government will be asking Dr Crippen and the Jobbing Doctor to write a report about “Future developments in laporoscopic surgery”.

The best way to cover up lack of knowledge is to brazen it out, to lie. And so Darzi starts with a whopper:

In previous reviews of the NHS, frontline staff have been on the fringes or bystanders. This Review has been different. We and our colleagues in the NHS have been at its core.

Utter bollocks. Frontline staff? Look at the list of the eleven names attached to the report. There is only one GP. The rest are academic or administrative hospital doctors and managers. Not a single representative of the Royal College of Nursing. No psychiatrist. No physiotherapist. No one who can advise Darzi about what is really going on. This is not a consensus report. This is unadulterated Darzi. Count the number of times you see the word "I" in the document.

Darzi is going to tell NICE to make its decisions about new drugs more quickly. The Jobbing Doctor is impressed. We shall see. Dr Crippen is more cynical. I suspect this is sleight of hand. If NICE decides that most “new” drugs are too expensive to be cost effective, we have not progressed.

The report taken as a whole is offensively inoffensive. Colour photos of Ara, Gordon and Allan. Soundbite after soundbite

high quality care for patients and the public

Think about that. What does it mean? Patients and the public? Extraordinary. And so it goes on. There is lots more where that came from:

Change : locally led, patient centred and clinically driven
Quality at the heart of everything we do
Freedom to focus on quality

You begin to lose the will to live as you wade through this morass of focus-group soundbites. Is there any meat on the bone?

Every primary care trust will commission comprehensive wellbeing and prevention services, in partnership with local authorities, with the services offered personalised to meet the specific needs of their local populations.

Our efforts must be focused on six key goals:

• tackling obesity,
• reducing alcohol harm,
• treating drug addiction
• reducing smoking rates
• improving sexual health
• improving mental health.

Don’t eat, don’t drink, don’t smoke, don’t take drugs, don’t have sex and don’t go mad. All good stuff. You can’t fault it, can you? You can’t criticise motherhood and apple pie. Trouble is, you cannot build a health service on soundbites.

The biased BBC just produced a report saying:

The government has been accused of acting like a nanny state in the past over some of its public health initiatives. But the survey of 1,040 people in the UK revealed most wanted ministers to take more responsibility for getting people to make healthier choices. (BBC)

What questions were asked? "Do you mind the government trying to persuade the people to drink less alcohol?" Most might well say "no" to that. But try this question. "Given that we have limited resources, would you spend more money on eradicating MRSA from hospitals even it that meant there was less money to spend on health education?"

In Dr Crippen's experience what most patients want to know is that, when they are ill, they can have quick access to a doctor they trust and to a hospital service that is clean, efficient and free from MRSA. They may not mind being nannied about preventative health care but it is not their main priority. In any case, the drive to improve public health, commendable though it may be, is not best done by doctors. We are not very good at it. We find it boring. Let the epidemiologists, the sociologists, the advertising industry and the nurses concentrate on preventative medical education. Let us concentrate on what we do best. Seeing patients who are ill, diagnosing them and treating them.