Alli & Orlistat : Fast-buck pharmacists are on the make

In the USA, advertisers are allowed to compare one product with another. Knocking copy is definitely the order of the day, and five minutes Alli & Orlistat research on YouTube produces some hilarious results, as seen above. What fun. I wish we had adverts like this in the UK.

The advert is, I now learn, monstrously unfair. An NHS BLOG DOCTOR reader writes in to tell me that Orlistat & Alli do work, and do not cause shitty knickers (or, as they prefer to say in the land of the free, poopy pants)

As a fat person who's tried Orlistat I would like to state the following:

Orlistat does not cause "shitty pant" syndrome. What it does cause is flatulence which is impossible to hold in. The stuff that comes out is

• a) runny 
  
• b) very fatty
  
• c) bright orange
  
• d) stinks to high heaven
  
• e) impossible to remove from clothing unless you use Nappysan and a boil wash.
  

To me Orlistat is similar to the drug given to alcoholics that makes them vomit if they touch alcohol. By taking Orlistat, I was so terrified of eating fat I virtually cut it out of my diet. So I did indeed lose weight because I had a low fat diet.

Echoing other comments on this site, there is no substitute for lifestyle change, diet and exercise.

The only things that will make me keep weight off in the long-term are psychological help, hypnotherapy, a personal chef and a personal trainer. I can't afford all of those so I suspect I will remain fat and continue to burden the NHS as I get older.

The makers of Alli are meanwhile sparing no expense to market their product to the general public. Take a look at their glossy advert here. Can anyone explain what the carefully selected, attractive model has got to do with health-threatening obesity? What do you think her BMI is? Or is she demonstrating the success story of someone who has been “cured” by Alli? This is one of the big problems. Alli could be sold inappropriately to people who do not need it. 

The Royal Pharmaceutical Society, the pharmacists'  professional organisation, is aware of the problem and has issued clear guidelines about the provsion of Orlisat to the general public
Pharmacy+Orlistat

Publish at Scribd or explore others:

Not only is it crucial pharmacists carry out a thorough consultation before deciding whether or not to sell orlistat, they must also be aware some patients may lie in order to obtain the drug.

“Pharmacists need to be alert for vulnerable people with eating disorder or body-image issues who may try to obtain orlistat for the wrong purposes

Royal Pharmaceutical Society

Sadly, the fast-buck pharmacists on the high street and on the internet (see here, here, here, here and here) have pound signs in their eyes and are continuing to promote Alli and sell it directly to the public. What a load of crooks and spivs these pharmacists are.  Is it any wonder that doctors have reservations about letting them give out medical advice? There will be comments from some pharmacists saying that they have no control over the commercial activities of Boots and Lloyds and the rest of them. Really? Have they complained? Have they blown the whistle? Has even one pharmacist resigned from Boots or Lloyds?

Britain's got Talent : bye-bye Susan Boyle and Hollie Steel

So, Diversity won Britain's got Talent. The bookies will be delighted, Simon Cowell less so. It will be hard to make a fast buck out of Diversity. But power to the people. They rejected the mawk, and went for the one act that showed real talent. Actually, the saxophonist was pretty good too, but was never going to have the global appeal. Susan Boyle was extraordinarily gracious and will now be making her way to the land of the free where talent shows were invented. Hollie Steel will be returning to Accrington. Let us hope that those pushy parents will call a halt now and let her get back to a normal life. I would hate to find her popping up in church halls in Lancashire as a supporting act for The Searchers. Neeedles and Pins, uh!

A grumpy commentator took me to task for suggesting that no child should be allowed to perform in public. That would of course be a disaster, instantly closing down Billy Elliot and all the Harry Potter films. I did not suggest that. Yes, I have a degree of unease about those pushy parents who endlessly audition their children for TV adverts and so on. But harrowing though that may be, it is worlds apart for submitting your child to the ritual humiliation of a televised "talent" show. As I said before, is there anyone who does not believe that Hollie Steel will not have been psychologically damaged by Britain's got Talent? What will it be like for her when, tomorrow, she goes back to school? Assuming, that is, that she does go to school.

There's a flaw in this, you are about to say. There are children in Diversity, possibly children younger than Hollie Steel. But somehow they do not seem exploited. They seem part of a happy and cohesive team. They were clearly there for themselves, not as a vehicle for the ambitions of others. There is a difference.

A big welcome to the Grumpy Old Twat

Why should Mrs Kirkbride have all the fun?

Just discovered the Grumpy Old Twat. Not sure how long it has been around. Not long enough. Absolutely not for the faint of heart. the GOT is a sort of Devil's Kitchen Illustrated. I know, anyone can mess about with Photoshop, but few do it well. The GOT has assembled some of the funniest art work composites around. Jacqui Smith fans in particular will not be amused.

Hollie Steel : would you let her clean chimneys?

One of the dreariest day-to-day tasks faced by family doctors is filling in forms. I stopped filling in shotgun forms soon after I started in practice. I never came across the bankers and stockbrokers with their pair of Purdeys. Most of the patients I met who wanted shotguns had pit pull terriers and Sky TV aerials. I stopped doing it. If I was based in a rural area with working farmers as patients I might take a different view. I have never filled in a form certifying a young man as fit to take part in boxing. Maybe it’s that Quaker conditioning, but I cannot accept that anyone is “fit” to be battered about the head, albeit consensually.

Frequently these days I am asked to fill in forms saying that children are “fit” to take part in television programmes. Saturday drama school. Pushy parents with one eye fixed on the next Baked Bean advert. I do not like it but, to date, I have always signed. I have not yet been asked to certify a child as fit to take part in Britain’s got Talent. If I ever am, after the events of the last few weeks, I would pause awhile.

I did not watch the semi-final last night. Three of the children did. Mrs Crippen did, I am ashamed to say. Her excuse was that we are housebound as she is on call. I watched, as I usually do if I am in, “Have I got News for you” (not so good last night) and then “Reggie Perrin”. Nothing can better Leonard Rossiter, but Martin Clunes is a wonderfully comfortable actor and a great favourtite.

“That little girl from Accrington broke down” said Mrs Crippen “but they gave her another chance. Very pushy mother.” OK, I have a personal interest in Accrington  along with Hollie Steel, Mystic Meg, David Lloyd, Jeanette Winterson, Harrison Birtwistle and lovers of Tiffany Glass. So I watched a bit more of Hollie Steel on YouTube. God, she’s thin. I hope she is eating. Her voice was a bit wobbly, and was making me cringe a little, so I turned the sound down. I stopped watching completely after the break-down bit. According to the media, she has "nerves of steel" (That’s a pun. Ha!) Why did Hollie Steel get a second chance? No one else would have done. Answers on a postcard to Simon Cowell’s accountant.

As I have written before, I am old enough to remember Lena Zavaroni (see her performing here) and we all know what happened to that poor girl. I hope Hollie Steel does not win tonight, for her own good. Trouble is, even if Hollie Steel does not win, she has achieved sufficient B List celebrity to enable her parents to hawk her round the novelty act circuit. Make no mistake, Hollie Steel is an innocent vehicle for the ambition of others. Take a look at her website. Yes, of course she has one, but I doubt she has had any input into it.

We should not do this to our children. It is just as bad as putting children up chimneys. Perhaps as doctors we should take a stand. Perhaps we should refuse to sign forms declaring that children are “fit” to appear on television talent shows.  There would be howls of anguish from the pushy parents and the libertarians would be offended but something needs to be done. Is there anyone who does not believe that Hollie Steel will be seriously psychologically damaged by this experience? I have not seen any of the other finalists or semi-finalists in Britain's got Talent apart from Susan Boyle, who is the bookmakers favourite to win. I suspect that, even if Susan Boyle does win, despite the money she will make, her overall life balance sheet will be negative.  But at least she is an adult, albeit a vulnerable one. Hollie Steel is a child. Who is protecting her?

The middle course for doctors might be to enforce a lowest age limit. Should the occasion arise, I am inclined to refuse to certify any child under the age of 16 as fit to appear in TV "talent" (sic) shows. It might be curtains for the Milky Bar Kid, but I can live with that.

What would you do?

Britain's got Talent : the Grand Guignol continues

The Grand Guignol continues. Poor Susan Boyle. Snatched from a life of unthreatening obscurity she is now being built-up, put-down, built-up and put-down time after time by a cruel and exploitative media. Even Piers Morgan, one of the Britain's got Talent judges, is having his doubts and, as an ex-tabloid editor, he wrote the book on "build-up and put-down":

One judge, Piers Morgan, confirmed that she had become so "distraught" at negative media headlines this week that she almost quit the ITV show. He said the singer from West Lothian was now relaxing with one of her closest friends from Scotland. He said psychological and medical help was available to contestants, although he could not say if she had asked for such assistance.

"She is very distraught, to the extent where she packed her bags and was going to leave the show. She just didn't see the point of continuing if every time she picked up the newspapers there was another avalanche of abuse."

BBC

Simon Cowell has offered to provide First Class air tickets to fly in Susan Boyle's most famous fan, Demi Moore. Why is Demi Moore so taken by Susan Boyle? Dr Crippen believes because facially they look alike. That may sound ridiculous, but think about it. Strip away the weight, the ravages of the different life-styles, and concentrate on the eyes and mouth. A remarkable simliarity.

Professor David Wilson, a former psychologist for reality TV show Big Brother, said Ms Boyle should be stopped from going into the final. "I am amazed by the honesty [Piers Morgan] showed in revealing the depth of how distraught Susan Boyle is. If Britain's Got Talent was an experiment in any university we would have to draw a line on that experiment because ethically we would be putting the person at the heart of that experiment through emotional turmoil. It's a duty of care, it's about a moral responsibility. The harrowing week that Piers was describing hasn't been created by the press. The harrowing week has been created by the programme."

Ibid

Susan Boyle has, by all accounts, led a sheltered life. Maybe children are more resilient. But if Britain's got Talent is having this effect on a middle-aged Susan Boyle, what effect must it be having on ten-year old Hollie Steel?

Henry and Hermione will not get malaria

They all look the same

Remember swine flu? You know, H1N1 Influenza A or whatever it was. You may have forgotten about it now, but it was all the rage last month. It was cured by MPs' expenses. And a motley crew I daresay these MPs all are, but add up the total amount philandered by our flexible friends in the House of Commons and it comes to less than the pension taken by Sir Fred Goodwin. And he was only one of the many bankers and city fat cats who had been ripping off our pension funds for years and who finally, ably assisted by Gordon Brown, brought our economy to it's knees by a level of greed that makes MPs look like Mother Teresa. But no one seems bothered. As Dizzy pointed out in his "quote of the day"

Robert Mugabe starves his population to death. Nothing. The Janjawid commit genocide in Darfur. Nothing. Gordon Brown bankrupts the country. Nothing. Then someone buys an unnecessary trouser press. Pandemonium.

Danny Finklestein

When swine flu was flavour of the month, no one put it in its real context. The rich worried-well were, as always, worried. Today, buried somewhere in the rich people's paper, there is a report on swine flu at the rich people's favourite public school. An outbreak at Tulse Hill Comprehensive would not have attracted so much attention.  As it is with swine flu and Tulse Hill Comprehensive, so it is with malaria. Last month, a grumpy doctor wrote in the Guardian:

We met at lunchtime, not to talk of heart attacks and Lego, but of flu. There have been deaths in Mexico. There has been one in the US. Our Indian partner said: "There were 2,000 deaths, mainly children in Africa and Asia, yesterday."

Our medical student looked shocked: "I didn't know swine flu had reached that part of the world." "It hasn't," said our partner. "I'm talking of deaths from malaria. But that isn't news, is it?"

We were silent for a while. Time to get things in proportion.

Grumpy doctor in the Guardian

Today, suddenly, there is a bit of a panic. Since the end of the war, and the killing, and the napalm, rich middle-class fat cats have taken to holidaying in Vietnam and Cambodia. So much nicer than the Maldives, darling, and the people are so friendly says Henry to Hermione. But just a minute. That disease that black and brown people get seems to be causing a bit of a problem in Cambodia. "There is something on the BBC about these 'arty' drugs or whatever they are called."

And so there is, here. General knowledge about malaria is so scanty that even the BBC cannot spell the name of the drug consistently. The Cochrane Library knows how to spell, and has sensible information on Artemisinin. If falciparum malaria is already showing resistance to the artemisinin group of drugs we have a real problem. Henry and Hermione will return to the Maldives.  Phew! Problem solved for them.  As for the million or so people, mainly children, who continue to die each year, well, best not to think about them.

What would happen if there really were an epidemic of a fatal infectious disease in the UK and the USA? Eight hundred thousand people dying in Massachusetts and two hundred thousand people dying in Middlesex. A million deaths in one year in the Western World. The governments would respond. A solution would be found.

It has not happened. It is not going to happen.

We ignore it because it does not affect the USA or the UK. We ignore it because the people who get malaria are black or dark brown, have unpronounceable names, speak guttural incomprehensible languages and all look the same. So it does not matter if a few thousand of them die every day. No one notices. No one cares.

Same Grumpy Doctor who wrote in the Guardian

A diagnostic test for Myalgic Encephalomyelitis (ME)

Professor Kenny de Meirleir

The Daily Mail announced today that:

Today, at a conference in London, Professor Kenny de Meirleir, from the University of Brussels, revealed a team have developed a simple urine test to test for [myalgic encephalomyelitis]. The scientists say the kit identifies high levels of the chemical hydrogen sulphate, which builds up after antibiotic use or exposure to salmonella infection, and can occur when there is too much exposure to mercury. Prof de Meirleir's research has shown that around 90% of patients with ME also have an excess of the bacteria enterococcus and streptococcus, which he believes interact with exposure to metals to produce hydrogen sulphate. The scientist, who treats between 3,000 and 4,000 ME patients a year, said his patients had been shown to excrete high quantities of the metals copper, mercury and nickel, possibly contracted through the environment or food. The new test, produced by his company Protea Biopharma and available via its website from Monday, will show whether a patient has high levels of hydrogen sulphate. The patient's urine turns a dark colour when mixed with a chemical agent in the test.

Daily Mail

Professor Kenny de Meirleir's hypothesis is that high levels of hydrogen sulphate in the urine are diagnostic of...well, suggestive of...well, may mean that...well, actually it is not clear exactly what his hypothesis is. Most doctors would have a lot of questions.  But he is not marketing this new test to doctors.  He is marketing his "test" directly to the general public. Send the Professor £13 and he will send you the test.

Hmmm.

What the Professor does not tell us is how accurate the test is. And "accuracy" is important before a diagnosis is made, or excluded. Doctors like to classify tests according to sensitivity and specificity.

A diagnostic test investigates the statistical relationship between test results and the presence of disease. For all diagnostic tests there are two critical components that determine its accuracy: sensitivity and specificity.

Sensitivity is the probability that a test is positive, given that the person has the disease.

Specificity is the probability that a test is negative, given that the person does not have the disease.

Professor de Meirleir has not as yet mentioned either sensitivity or specificity. Maybe more information will be revealed on his website next week. What would Dr Crippen do? He would hold on to his £13. There is as yet no agreement as to what, if anything, constitutes Myalgic Encephalomyelitis so it is difficult to know how to start testing for it. And, mark my words, as soon as a handful of people who think they have got ME test as negative, there will be howls of anguish.

Abusing the mentally ill

Medicine Balls in this week's Private Eye reveals another sorry story from Haringey. Nothing to do with Baby P this time. A mental health patient asked Barnet, Enfield & Haringey Mental Health Trust to keep his records of the IT system. A factotum from the Trust spouted a load of impenetrable guff about "Connecting for Health" and "not being able to use paper records" but the bottom line at least was easily understood.

"If a service user** refuses to have the necessary information recorded in the electronic care record...the Trust would be unable to provide treatment."

Medicine Balls : Private Eye

This is where we are all headed. And how typical, how characteristic of the way things work that some of the first patients to have their privacy invaded are those who, due to the general prejudice about mental illness, will be particularly keen to keep their medical records private.

+++++++++++

**For those not familiar with New Labour jargon, "service user" = "patient". Ironic that, due to lack of surveillance, Baby P did not become a "service user" until it was too late.

GPs "told" to treat patients with mystic mumbo-jumbo

Today the Daily Telegraph uses one of those expressions so beloved of ignorant journalists.

GPs will be told to offer their patients the traditional Chinese practice, as well as other treatments like osteopathy and chiropracty, as an alternative to conventional remedies like exercise.

Daily Telegraph

Nobody but nobody tells me how to do my job. I do my job according to my training and my training tells me to sift the evidence; it tells me to read the journals; it tells me to assess protocols and, if they are valid, use them as appropriate. Unlike the "health care professionals" my training occasionally tells me to ignore the protocols. Above all, my training teaches me not to harm my patients.

I do not and will not refer patients for

• Acupunture
  
• Chiropractic
  
• Homeopathy
  
• Voodoo
  
• Cranial osteopathy
  
• Reiki
  

If patients want to take themselves off for mystic mumbo jumbo, it is a free world, and that is a matter for them. But do not ask me to sanction it, or recommend it. Whilst we are on the subject, I do not and will not prescribe

• Rimonabant
  
• Zyban
  
• Champix
  
• The shitty knickers drug
• Appetite supressants of any sort
  

The two lists above are not exhaustive. Whilst I am getting things off my chest, let me say also that I don't do "euthanasia" and I will not be doing when, as will happen, NICE decides that euthanasia is nice.  I have looked after more terminal ill patients than I care to think about, and none has ever asked me to end his life.  If any patient of mine wants to commit suicide, that is a matter for him. I shall do my best to talk him out of it, but I accept a person has the right to end his own life. Just do not ask me to help. It is not part of my job description. In the fullness of time, when the chattering middle-classes and NICE have had their way, there will no doubt be a dedicated "health care (sic) professional" to do the job. I wonder what he will be called? "The Terminator" would be accurate, but sounds a little final. Nurses like to talk about death and dying as the start of a journey, so maybe the title could suggest some sort of celestial travel agent.  Perhaps we could call them "The Scotties."  I am not talking of ethnic origin here, I mean the word "Scottie" as in "Beam me up..."

I digress. Back to pinning the tail on the donkey  acupuncture and other wibble. Chronic back ache is a bugger. I can help a little with analgesia. I will send you to a physio, but do not expect miracles. I will talk to you about pain management strategies. If your MRI scan shows a problem that is or may be amenable to surgery, I will send you to a surgeon. I will not lie to you. I will not collude with you, or NICE, or the quacktitioners, to pretend that the purveyors of wibble and the ju-ju man have some magic answer for back ache. They do not. They do have a way of removing money from your wallet. Some are well meaning and believe in their mystical arts. Some are fraudsters. 

I am appalled that NICE has strayed into this quacktitioner jungle. It is fraudulent. It will be expensive. The patients will lose out and, as always, the taxpayer will lose out.

Pain relief in labour : ignoring the evidence

Cathy Warwick & Belinda Phipps review the scientific paper

Some common sense floods in from Sweden.

Learning relaxation and breathing techniques does not reduce the need for an epidural in labour, a study shows. More than 1,000 mothers-to-be took part in the Swedish trial, thought to be the first major analysis of the efficacy of such preparation for childbirth. They attended one of two classes: the first taught natural coping methods, the other emphasised pain relief. But the BJOG study found no difference in the use of epidurals between the women when they went into labour. Just over half the women in each group ultimately opted for the spinal analgesia which reduces or eliminates the pain of contractions.

BBC

Good to know that science confirms that all that guff spouted by a certain sort of madwife, and by the "natural" childbirth loonies, has no foundation in fact. "Natural" child birth is nothing to do with the NCT or home births. "Natural" childbirth is about squatting under a bush, pushing the baby out, smearing it with mud and getting back to hoeing turnips. Dr Crippen has always been and remains furious at the so called health care professionals who, in the name of "natural" childbirth, persist in teaching mothers-to-be that they have failed if they have an epidural. If you want an epidural, have one, and don't let anyone suggest to you that singing "Ten Green Bottles" is a substitute.

"For eight weeks I had sessions in the Lamaze technique, which distracts your mind from the pain of childbirth...In labour all the training kicked in. Ignoring the incredulous looks from the midwife and doctor, I started bellowing Ten Green Bottles when my contractions peaked. I must have sung that stupid song countless times - every time my voice faltered, my partner would sing loudly to get me back on track. Incredibly, it worked. I still felt the pain, but I never felt overwhelmed. When Dylan was born I felt nothing but happiness. It was over - and I'd remained in control."

Marina Gask 

Others interested in singing Ten Green Bottles  in labour should contact Pat Desorgher

Nothing will change.  These people ignore anything that does not fit in with their own prejudices. Professor Cathy Warwick, general secretary at the Royal College of Midwives (RCM) and Belinda Phipps, head of the NCT, are already trying to airbrush this study out of the madwives' medieval manual of pain and suffering.

When does righteous indignation become a witch hunt?

As a GP, I see a lot of patients with stress. From all walks of working life, including professionals. Nadine Dorries has been roundly criticised for suggesting the MPs are now under so much pressure that there could be a suicide. They have brought it upon themselves, you may say, and so they have. But the atmosphere that has been whipped up over three weeks by the Daily Telegraph is resembling the Salem witch hunts. The public are baying for blood. Some MPs are more culpable than others. There may be an underlying political agenda. Can someone explain why Mr & Mrs Balls been given such a soft ride when Julie Kirkbride and her husband have not? Can any MP now get a fair hearing from the media?

Today, Iain Dale mounts a defence of Tory MP, Julie Kirkbride.  Or maybe it is more a plea in mitigation than a defence.  You decide. But, whatever it is, it is persuasive. It would be even more persuasive if Iain were to write a similar post about a Labour MP. After all, this should not be a party political matter. It affects all MPs.

NICE recommends a cure for all known disease

Sufferers of chronic mental illness were celebrating today when they heard that the National Institute for Clinical Excellence (NICE) has finally recommended that the Kadir-Buxton method for treating mental illness should be made available immediately by the NHS.

Advice issued by the National Institute for Clinical Excellence (Nice) recommends that the millions of people with mental health problems lasting more than six weeks should receive the Kadir Buxton treatment without delay. Experts praised Nice's first guidance on tackling mental illness as a breakthrough in treating a problem that costs the country an estimated £5.1bn every year, including £1bn of the NHS budget, and leads to the loss of around 5m working days. Mental health issues affect up to one in three adults each year and lead to 2.6 million people visiting their GP.

The Guardian

There has been a ground swell of public opinion calling for recognition of the Kadir-Buxton method, culminating in a successful petition to Number 10, Downing Street. Ben Goldacre (BadScience) commented today that,

“the Kadir-Buxton method is a triumph for scientific method”

and Professor David Colquhoun of DC’s ImprobableScience was impressed with the wider applications of the method.

"Not only has it been successfully used to treat mental illness", he said, "but it can cure alcholism, reduce labour pains by 80% and raise the dead."

Although the medical profession does not like low tech solutions such as the Kadir-Buxton Method and Hands Free there is a place for them in an increasingly expensive medical profession. The originator of the Kadir-Buxton Method said:

"Decades ago I discovered a cure for mental health problems. The cure, which I term the Kadir-Buxton Method, has been used on a wide variety of mental health problems. The procedure stuns and resets the brain of the patient, so that the patient returns to a normal condition."


Making the world a better place with Kadir-buxton

The great merit of the Kadir-Buxon method is that it can be taught to the lowliest member of the CMHT. Even psychiatrists may be able to master the technique.

The Kadir-Buxton Method is done by making a fist of both hands, and striking both ears of the patient at exactly the same time and pressure with the soft part of the inner hand which is where the thumb joins the hand. The procedure is painless and the patient regains consciousness faster the less hard the double blow is struck. With practice, I am able to render the patients unconscious for only thirty seconds.

Kadir-Buxton method

Since today's decision by NICE to introduce the Kadir-Buxton method into all GPs surgeries, there has been excitement throughout the medical and scientific community. A spokesman for Holford Watch said that they were conducting an in-depth study into the wider applications of the Kadir-Buxton method but their preliminary findings suggested that Kadir-Buxton was "even more promising than Patrick Holford."

How many nurses can afford to buy a house?

The new plutocracy

Dr Crippen has never understood how the NHS can be described as being "in financial surplus" and yet, for the last couple of years, this has been the proud boast of the government. This year, the "surplus" is £1.7 billion. Even though that only represents about five days of total health care expenditure, it is still a lotta dosh.

The Royal College of Nursing is lobbying for this money to be channelled into front line services:

The Royal College of Nursing says the 2007/ 08 NHS generated surplus of £1.7 billion must be reinvested in frontline services. RCN Executive Director of Nursing and Service Delivery, Janet Davies says:

"While we are encouraged that the NHS is on a firm financial footing, it is absolutely vital that this surplus goes straight to frontline services. A £1.7 billion surplus is £1.7 billion which must be spent on improving patient care and the government must make clear how it plans to use this money".

The RCN says it is 'particularly important' that NHS spending is sustained through the economic downturn, and funding intended for patient care must not be siphoned off elsewhere. Ms Davies adds:

"During an economic downturn, many people are under additional pressure which can damage their mental and physical health. The NHS must be fit to deal with this.

RCN

Most trades unions might in these circumstances have lobbied for a pay rise for their members. Not the RCN.  Perhaps because it seems that nurses are now able to join the plutocracy. The downturn in house prices means that, compared with 2007, it is now nearly eight times easier for nurses to get onto the UK property ladder.

Here is your pub quiz question, directly from the Halifax Building Society.

In 2009, in what percentage of UK towns can the average nurse now afford to buy a house?

The answer is here, and may surprise you. The consequences are here, and won't surprise you. 

The charity scam : the Taxpayer is funding the Quacktitioner Royal

Scouring the sea after the loss of the Penlee lifeboat and the Union Star.

The DK is asking us all to think a little more carefully about the meaning of “charity”. "Charity" is a wonderfully protective word, conjuring up images of widows’ mites, Mother Teresa and all encompassing “goodness”. Registered charities get all sorts of breaks from the taxman and most people would say “quite right too”.

The RNLI, the Royal National Lifeboat Institute, is one of the most famous UK charitable organisations. There is probably not an adult in the country who has not given to them at some time.

In 2008 our lifeboats and hovercraft were launched operationally 8,293 times, an average of 22 services per day. 288 lives were saved, 1624 people landed and 5,700 people brought in, totalling 7,612 people rescued during the year.
 
RNLI report 2008

During that same year, their total income was £170.5 million, £52.4 million from voluntary contributions, £94.5 million from legacies, £14.0 million from merchandising, £8.5 million from investments, and other income of £1.1 million.

Odd, is it not, that something as crucial as rescuing "those in peril on the sea" is left to a private charitable organisation? God forbid, however, that the government should ever nationalise the RNLI. The bureaucracy and paperwork would mean they would never put to sea.

Like all registered charities, the RNLI does get massive tax breaks from the government. And, as we have agreed, “quite right too”.

The DK is concerned about what he describes as fake charities. Organisations which trade on the ethos of the RNLI, of the widows’ mite, but which, on close inspection, do not meet the criteria that the ordinary man in the street would consider essential to the definition of “charitable organisation”. Trouble is, of course, the ordinary man in the street does not think about it very much. If asked, he knows the RNLI is a charity, but might be surprised to hear that Addaction and Alcohol Concern are charities. He has probably never heard of Addaction. Dr Crippen had not.

The DK and some colleagues have recently set up a website called fakecharities.org.

We define a fake charity as being "a foundation or institution that receives funding from the government, does not pay tax to the government and seeks to change government policy".

This, we stress, is only our definition. In Britain, unlike the US, it is not illegal for registered charities to engage in political campaigning. Nor is there any legal obligation for charities to assist "the poor, the sick, or the helpless." Nevertheless, people tend to assume that charities are primarily funded by voluntary donations and are primarily staffed by volunteers. Because we assume them to be essentially altruistic, we give their views more weight than we would a politician or an industrialist.

So when you read about an 'independent charity' supporting government policy, asking for higher taxes or demanding "tougher action", we think you have the right to know whether that charity is funded by the government.

fakecharities.org

My law is rusty now, but I think the Charity Commissioners would take a dim view of an alleged charity set up solely to purse purely political objectives. But what may not be done overtly, can easily be done covertly. Personally, I am more concerned about charities whose objective is to support and promulgate government policy. Take Alcohol Concern.

Alcohol concern's activities include the development and implementation of alcohol policy; raising alcohol awareness; providing quality information on alcohol and alcohol-related harm; developing the knowledge and skills of practitioners and operating a specialist consultancy service; and delivering projects that build the capacity of the sector.

Alcohol Concern

All good stuff. A valuable pressure group no doubt. But are these aims “charitable”? The acid test the layman might apply, and one which the DK is applying,  is to look at Alcohol Concern’s accounts. Do they, like the RNLI, survive on charitable donations from the public? No they do not.

According to its 2007/08 accounts, out of a total income of £903,246, Alcohol Concern received £515,000 (57%) from the Department of Health (£400,000 unrestricted and £115,000 in restricted funds). It received just £4,991 in public donations.

fakecharities.org

Alcohol Concern is thus funded, not by charitable donations, but by the government and it is being used by the government to promulgate government policy on alcohol intake. You may agree with the policy. As it happens, I agree with much of the content, but detest the delivery, the high handedness and the dishonesty about the so called recommended "safe levels" of intake. Whether or not you agree with the objectives, do you think they are "charitable"? The public are not interested. They contribute less than one percent of the income.
 
Addaction is the country’s largest drug and treatment charity.

Its 2008 accounts show a total income of £29,561,798, of which £21,116,220 was spent on staff costs. Its CEO was paid over £100,000. Addaction's accounts do not specify individual donors but according to The Guardian: "Addaction is reliant on government contracts for more than 90% of its funding." It also received £652,286 from the Big Lottery Fund.

fakecharities.org

There are a depressingly large number of medical and pseudomedical “charities” on the list.

The Blood Pressure Association campaigns for a better understanding of the dangers of high blood pressure. They have some rabid and unsustainable propaagana on salt. Salt, they say,  is  “bad”

Salt is not "bad". Salt is essential to life. Put yourself on a genuinely salt free diet (and people try to do it) and you will die. Salt was the original and best of all food preservatives. It saved millions of lives by preserving food that might otherwise have perished. Yes, many would benefit from eating a little less salt, just as they might benefit from drinking a lot less alcohol, and loosing weight, and not getting stressed and I could go on and on.

You may approve of the Blood Pressure Association and its ideals. If you do, please sent them some money, because no one else has. The records show that they have had no voluntary contributions at all.

Most galling of all is the Quacktitioner Royal’s Foundation for Integrated Health. And here I must point out an uncharacteristic but nonetheless egregious error by the DK. He has the FIH listed under the subheading of "Health".  It should be listed under "Propaganda" or, perhaps more descriptively, under "The Prince of Wales' eccentric self-indulgences". The FIH is a collection of mendacious purveyors of wibble whose declared ends are to

...work towards a culture of health and wellbeing with people and communities taking more responsibility for their own health, and where health professionals collaborate and share learning in the best interests of their patients.

The Foundation "works with policy makers" to lobby for greater use of complementary medicine and homeopathy in the NHS and in schools. It funnels money towards organisations involved in reiki, naturopathy, aromatherapy, shiatsu and other pet projects of Prince Charles.

fakecharities.org

This is medical wibble of the highest order. It is a breach of the British Constitution that the Prince of Wales, the Quacktitioner Royal himself, should be trying to change government health policy. But did you know that you, the taxpayer, are funding this wretched institution to "advise" the goverment?

Amongst its current activities, the Foundation is "advising the Department of Health". According to its latest accounts, the DoH funded the Foundation to the tune of £332,500 (27.5% of total income).

fakecharities.org

Let us end on something more important than the frolics of the Quacktitioner Royal. Let us look at some real charity workers who continue to crew the Penlee Lifeboat. Remember the Penlee Lifeboat tragedy?  That puts it all into context. Send a fiver to the RNLI here. They will make better use of it than the Prince's Foundation for Integrated Health and, unlike the FIH, the RNLI do not get twenty five percent of their income from the taxpayer.

Britain's got Talent : "No one ever went broke underestimating the taste of the...public" (HL Mencken)

No, I didn’t watch it. Nor did the children. But I read a piece over at Craig Murray’s place this morning, so checked out the video on You Tube. Unwatchably nauseating from the beginning. I did not get to the end. Are Ant and Dec always like this? This video makes the cloying pseudo-spontaneity of Blind Date seem like the Gettysburg Address.

That image of spontaneity was manifest most spectacularly in the case of Susan Boyle, where the video made famous on You Tube pretends that the judges did not even know she was a singer or whether she would be any good. The judges then proceeded to manifest what, when you know the truth, you can see is terribly ham acted astonishment.

Craig Murray

Julia Nadienko is an attractive Latvian belly dancer, and a friend of Craig Murray’s. For reasons that escape me, she decided to go on Britain's got Talent. Predictably enough she was not allowed to perform as she wished. She was stage-managed into a  middle-aged man’s meretricious sexual fantasy package.

Today she was made to dance to Lady Marmalade, which was totally inappropriate in every way for a belly dancer, and made her look just like a Vegas showgirl.

Craig Murray

What might have been a genuinely interesting performance became instead an opportunity, right from the beginning with Ant and Dec, for overt lechery. Watch it here. The attempt to excuse the lechery with the smiling “nod-nod-wink-wink” naughty-postcard veneer failed dismally. Watch, in particular, the bum-pinching facial expressions of the men. Ant and Dec, Piers Morgan, Simon Cowell, all of them. Dreadful.

The treatment received by Julia Nadienko was unbelievably sexist, worse even than the Miss World competition if that it possible. It was certainly worse than the treatment received by Susan Boyle. Susan Boyle was exploited but will at least be made rich. Julia Nadienko was just exploited. Still, you may say, she did not have to do it. But I suppose you just get sucked into the machine.

I do not know who the other finalists were. I assume that Hollie Steel,  our young friend from Accrington, got through. In the final cornucopia of mawk it will be difficult to see who will be packaged to win. I suspect that Susan Boyle is more likely to be selected by the Cowell machine than Hollie Steel for, on the medium to long term, she will be more likely than Hollie Steel to make her new masters a fortune.

Britain’s got Talent is a fascinating study in human frailty. The frailty of the performers who allow themselves to dream the dream and tolerate unspeakable humiliation in pursuit of the impossible. Most of all, the frailty of the general public who allow themselves to be manipulated and, what is more, partially finance their manipulation by phoning in on premium line telephone numbers.

The Spartacus Defence : protecting the blogosphere

I am Spartacus

Following on from yesterday's post, Nadine Dorries is silenced, Dizzy now has a detailed report on the precise sequence of events.  Bloggerheads, meanwhile, points out that Nadine Dorries is no blogger, and no blogging hero.

There are unspoken rules to which serious bloggers adhere. The most important of those rules is that comments should be open to all and not moderated by the blog owner. Nadine broke that rule right from the beginning by not allowing comments at all and thus reducing her blog to the status of pseudoblog. NHS BLOG DOCTOR readers are familiar with the pseudoblog run by Kent Independent Midwives. Nadine did start allowing comments, but they were moderated, and who knows what did not get through.

I hold no brief for Nadine Dorries, but what happened to her is relevant to all independent bloggers. Most of us are individuals with no corporate resources. Even Guido is an individual. If big business goes after me, or the Devil, or Mr Eugenedes, or the Jobbing Doctor, or Tim Worstall, or Ben Goldacre we each face potential ruin if we decide to stay and fight. For most of us there is no alternative other than to capitulate.  

The blogosphere has hugely extended freedom of speech. The blogosphere is worth fighting for. There is one line of defence we all have. The Spartacus Defence.  The defence that the combined medical blogosphere, and others, used to shelter Ben Goldacre when LBC lawyers threatened to sue him for copyright infringement when he printed an audio-transcript of the Jeni Barnett show:

Since LBC unwisely threw their legal weight around to prevent you from being able to freely experience and ponder that astonishing 44 minute tirade against MMR, the inevitable has happened. The audio has been posted on a huge number of websites around the world, over 120 blogs so far are linking to the story, and more importantly, hundreds of thousands of people are talking and reading about the ignorance that Jeni Barnett exemplified in that worrying broadcast. It has been covered in the Times, and an Early Day Motion is being set down in parliament.

Ben Goldacre : Badscience

The threat to bloggers may come from the main stream media, as in Nadine Dorries' case, or from the government or even, as Iain Dale has suggested, from Europe.

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And see Craig Murray

Brian Jenkins MP - bully of the month

Brian Jenkins MP

Another MP has made a fool of himself, and for once it's nothing to do with expenses. Iain Dale highlights a startling bit of meanness  from Brian Jenkins, the MP for Tamworth.

Diversity in medicine

From its earliest days, NHS BLOG DOCTOR has railed against the dumbing down of health care in the NHS. The process has been so well handled by the government PR spinmeisters that nowadays it is politically incorrect to say that a health care professional who has not been to university may have neither the training nor the intellectual capacity to do the same job as a doctor. How dare you even suggest that?

The process continues.

It is now recognised that it is intellectual discrimination to insist that only qualified doctors should be allowed to apply for jobs as doctors. It is essential to get people from a broader intellectual base into medicine. From 1st August 2010 the computerised MTAS system, which matches applicants for junior hospital doctor jobs, will be using the new Mandelson-Hewitt Egalitarian Formula (MHEF) which will empower enable any comrade health care professional to apply as from a level playing field for junior hospital doctor jobs. A complicated points system is already in place. The MHEF has improved the system.  Candidates with conventional medical qualification will as always get points for results in medical finals (maximum of 50), distinctions (50), and for passing higher professional exams such as MRCP (50).

Under MHEF, nurses and others who have been deprived of the opportunity of going to medical school because they did not have good enough “A” levels will be awarded an automatic 100 points. 50 points will be awarded for being an RGN with a further 100 points for holding a BSc (Bedpan). Ability to drive an ambulance scores 50, ability to record an ECG in a van 50 points and ability to put a cannula in a vein 50 points. Health care professionals with 200 points or more will be thus be able to compete on the same level with a conventionally trained doctor who has a BSc Biochemisty, MB BS (distinction) and MRCP but cannot, for example, drive a large white van.  And there you have it. All skills are valuable. Compared to the average HCP, what practical experience does the doctor have? Why should other “clinicians” with "other" skills not compete for the same job?

So as not to discriminate further against any such applicants, those who have not been to medical school will be awarded one of the new honorary degrees in medicine from the University of Durham.  This will enable them to call themselves "Dr" but of course will still not make them as important as our old friend Heather Hawkesly who is a real doctor.

Dr Crippen and others are appalled. Trouble is, most people do not believe that it is happening. It is. Full details here. This is the reality of twelve years of New Labour touchy-feely egalitarian fantasy. Grammar schools destroyed under Harold Wilson. Universities being destroyed under Blair/Brown. One sort suits all education. One sort suits all medicine.

Nadine Dorries is silenced

Late last night I was reading reports that David Cameron was furious with Nadine Dorries for suggesting that MPs were stressed about having their venal expenses claims exposed in the Daily Telegraph. I went on to her website to find that her blog had been taken down. It was still, at the time, available in the Google cache and so I saved it. You may still catch it all here. It seemed likely that she had taken it down as a result of pressure from David Cameron. Poor old Nadine, heart in the right place, brain not in gear. I printed her last two articles and went to bed.

Early this morning, (does he not go to bed like normal people?) Dizzy revleaded a much more worrying story. Nadine’s blog had been taken down, not by Tory Central Office, but by the Daily Telegraph lawyers.

Nadine Dorries has seen the blog part of her website instantly taken down after she made allegations against the owners of the Telegraph Group, Sir David Barclay and Sir Frederick Barclay.

It is a situation that sucks, obviously, but unless something is done about it, then if you say something about someone who has the resources to instruct global lawyers against you, then you can be taken down very quickly. As I said though, in this case I think they just help feed the theory they are trying to suppress for those that choose to believe it.

Dizzy Thinks

The only reason I did not print Nadine’s article last night was that, having skimmed it, I thought it was too silly for words. We all know Nadine. When she gets a bee in her bonnet (and doctors in particular remember her outspoken views on abortion and sex-education) she does not let considerations like truth, factual accuracy and rationality hold her back. It did not occur to me that anyone reading it would do anything other than smile and say, “Oh! Dear, Nadine’s off again.”

nadinedorriesblog

Publish at Scribd or explore others:

Let's take a look in detail at the post that has now, implausibly, become controversial. I say implausibly because it is characteristic Nadine Dorries off-the-wall nonesense.

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Winners or Losers
Nadine Dorries

Just park a couple of facts for a moment, which you may not agree with but are factual. The first is that MPs have always been encouraged, by whatever means possible, to draw down their ACA allowance in full. This is because it was upped in place of an appropriate pay rise. The rules surrounding the ACA were deliberately sloppy in order to maximise the opportunity that MPs had to draw. This was always felt to be the safest political method to remunerate MPs, rather than face the media backlash of a pay rise.

Parliament is in chaos. The public are angry. The Telegraph has upped its circulation. There are 650 members of Parliament. In any walk of life, in whatever profession, you will find people who are dishonest. It will always be thus as long as we are all human. 

Nadine does not understand the utter vulgarity of "maximising the opportunity". The ACA was not part of standard remunueration. If it had been, it would have been taxed.  We have a right to expect financial integrity from our elected representatives. Those MPs who have been dishonest, and who have flagrantly abused our trust, are being cleaned out.  

The Telegraph are uncovering a few cases of fraud, but not enough, so they are more than slightly embellishing some of the stories. I write as a case in point. Enter the Barclay brothers, the billionaire owners of The Daily Telegraph. Rumour is that they are fiercely Euro sceptic and do not feel that either of the main parties are Euro sceptic enough. They have set upon a deliberate course to destabilise Parliament, with the hope that the winners will be UKIP and BNP.

One fraudulent MP is one too much. And this is not just about criminal fraud. It is about abuse of trust.  The Barclay brothers are entitled to be fiercely Euro-sceptic. They are entitled to lobby the main political parties to be "more" Euro-sceptic. Is Nadine suggesting that the Daily Telegraph should not have published the expenses story in case it "destabilised Parliament"? It is not the Daily Telegraph that has destabilised Parliament. It is the MPs who have been caught with their hands in the till who have destabilised Parliament.

A quick online check of the Barclay brothers and their antics on the Island of Sark is enough to give this part of the rumour credence.

The Barclay brothers have utilised existing European Law to force the Island of Sark, the last feudal government in the UK, to adopt democratic principles. Whatever their motives maybe, is Nadine criticising them for "forcing" democracy on Sark? What is more, one of their "antics" was to change the law on Sark which prohibited women inheriting land if there were any male heirs. Does Nadine not approve?

Another rumour is that the disc was never acquired and sold by an amateur, but it was in fact a long term undercover operation run by the Telegraph for some considerable time, carefully planned and executed; and that the stories of the naive disc nabber ringing the news desk in an attempt to sell the “stolen information” are entirely the work of gossip and fiction.

Who knows about the details of sourcing and timing of the story? It does not matter. Some MPs were desperate to exclude their expenses from the Freedom of Information legislation. There was even talk of prosecuting the whislteblower who leaked the information. None of this matters. The important thing is that this story is out in the public domain and it is good that the Daily Telegraph put it there.

These rumours do have some credibility given that this has all erupted during the European Election Campaign and turn out is expected to be high with protest votes, courtesy of the Daily Telegraph, or should I say the Barclay brothers. Now, if this is all a power game executed by the BBs, how would they do that? It is a fact that these men are no fools and are in fact self-made billionaires. I would imagine and believe that if any of this is true, they know the British psyche well enough to whip up a mood of public anger, hence the long running revelations in the DT.

Why should a newspaper and its proprietors not publish a story showing MPs in their true colours shortly before an election? Again, Nadine simple does not get it. We want to rid our political system of dishonesty. If that means a short term boost for minority parties so far untouched by financial scandal, so be it.

Where do I get this from? Well, at heart I am just a cheeky scouser. I like to go into the rooms of the faceless and nameless in Parliament, sit on their desk and ask pertinent questions like: who are you? What do you do? I've made friends with one or two. One in particular I am very fond of. He is a mine of very astute information; and whilst in his office yesterday, we chunnered over the 'what is this all about?' question. He reckons this is all a power game. That the British public are being worked like puppets by two very powerful men. Whipped up into a frenzy to achieve exactly what they want. His very poignant words to me were.

"If any of this conjecture is true, Parliament will become full of racists, fantasists, and has-been celebrities. We will be rendered impotent and may never again regain the authority to withstand the pressure, opinion and whims of the overtly wealthy."

Oh! Dear, Nadine. Not only have you have been gossiping with some of the tea room crustacea, you have been taking the gossip seriously. Colonel (ret'd) Sir Bufton Tufton MP probably had not taken his medication when you were listening to him. Come back down to earth, Nadine. Both political parties, but particularly the Tories, are cleaning out the worst excesses of abuse. Eventually, the Daily Telegraph story will strengthen, not weaken, Parliament. Sitting MPs are effectively being deselected left, right and centre. The odd ones who do not stand down may face a challenge from the likes of Esther Rantzen. Mostly though there will be a crop of new, young candidates sitting on the moral high ground with blank expense sheets. The furore will settle. By the next election the electorate will have returned to its old tribal loyalties.

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As I say, too silly for words. Nadine has gone off one yet another of her inaccurate and unsubstantiated rants and, as the video above now shows and  the Devil and Bloggerheads have show in the past, she needs to take a good long look in the mirror. When it comes to Nadine, few have the patience of Iain Dale.

But now a more worrying issue has surfaced. The censorship of blogs. Nadine Dorries is best ignored or lampooned. The biggest weapon needed is a fly swatter. The Daily Telegraph have, however, brought out the big guns.

Nadine Dorries has taken her blog down

Nadine Dorries

GPs frequently see patients with acute anxiety problems and sometimes it is necessary, in order to diffuse matters, to sign them off work. Over the last year I have had two patients asking for a letter to say that they are so stressed that they cannot go, not to work, but to court. Both were facing relatively minor criminal charges. It's a stressful business going to court, particularly if you are, as my learned friends would say, banged to rights.

Poor old Nadine - I do think her heart is in the right place - has once again got it wrong with her new position of the week. Last time, as regular NHS BLOG DOCTOR readers will remember, it was her idiosyncratic views on sex education. This time, it is her worries that MPs are finding the Daily Telegraph revelations stressful. Well, to coin a phrase, they would, wouldn't they? If my MP is stressed, I could sign him of work for a week, if that would help. Alternatively, he could consult dear old Ann Widdicome who was, she reveals today, a Samaritan.

But Nadine is in trouble. She has upset David Cameron. She denied it earlier today:

Porky Pies

Posted Friday, 22 May 2009 at 13:59

  

According to the Telegraph online, David Cameron has slapped me down? Excuse me? Err, no he hasn't. What a corker.

 

The Daily Telegraph has rang Central office and asked them to ask me to remove my blog and not to mention the contents of my blog on air, which I think, is very different.

 

I am about to go away, however, I will say nothing different to what I have just said on BBC News. If the Daily Telegraph wants to out every MP they can put it all in one edition.

 

What they are doing by taking out a few MPs a day, from all parties,  not allowing them to defend their position, not printing what they say, shouting over them and doing this day after day after day amounts to a form of torture which any group of human beings would find difficult to bear.

 

As an ex nurse who managed on a measly salary I know how angry people are. The system has been wrong and scandalous. But everyone in the media and political world, other than those MPs like me who came in after 2005 knew about it. Therefore they are all culpable.

 

The truth may not be palatable and hard to swallow; however, it’s the truth.

 

Treating a group of people in this almost sadistic way is as appalling and has to stop.

 

Maybe, instead of attacking me, people could focus their attention on the Telegraph and ask them to put the real issue, potential abuse of the system, over and above daily profit and what can only be described as a potential form of cruelty. Put it all in one edition, or is that not profitable enough?

http://blog.dorries.org/Blogs/2009/May/22#22

Nadine's famous blog has disappeared. It's still, for a time at any rate, available here, on Google Cache. What, exactly, did Nadine say that caused so much consternation at Central Office?

What Stephan said and Martin Bell knew

Posted Friday, 22 May 2009 at 10:22

During an interview on the R4 Today programme (and about a dozen times since) I said the following - ish:

" No Prime Minister has ever had the political courage to award MPs an appropriate level of pay commensurate with their experience, qualifications and position; as recommended by the SSRB, year after year.

 Prior to my intake in 2005, MPs were sat down by the establishment and told that the ACA was an allowance, not an expense, it was the MP's property, in lieu of pay; and the job of the fees office was to help them claim it."

Whatever opinion you may have about that, and I have my own, you cannot ignore the fact that this was the system put into place, because no Prime Minister ever, including my heroine, has had the political courage to address the issue. Everyone in the political and media world knew it.

At a drinks party the other evening, I had a conversation with Stephan Shakespeare the owner of YouGov. I put to him that MPs prior to my intake had been told for many years that the ACA was in lieu of pay.

"Yes, we have all known that" said Stephan. "Everyone knows that, the question is how do you move forward, what will be put in its place?"

When Stephan said "we all" what he meant of course, was the political and media establishment.

The BBC knew it. Every single journalist knew it. The interviewer on the Today programme this morning, who interviewed me, knew it; and Martin Bell probably knew it because he was given the same rule book as everyone else, when he became an MP 12 years ago. He was also, allegedly, the best friend of the Labour party as detailed in Alastair Campbell's diaries.

The system was a disgrace, an appalling disgrace; but it was the system and everyone knew it.

If MPs prior to 2005 were sat down and told "this is your pot of money with your name on it, and our job is to make sure you have it as it's really part of your salary," what difference does it make what it was spent on? They had been told it was their money - their salary. It was the wrong way to do things; but it was how it was done, and been done for a long, long time - MPs knew no different.

The technique deployed by the Telegraph, picking off a few MPs each day, emailing at 12 giving five hours notice to reply, recording the conversation, not allowing them to speak, shouting over them when they try to explain, telling them they are going to publish anyway, at day 15, is amounting to a form of torture and may have serious consequences.

MPs are human beings like everyone else. They have families too. McCarthyite witch hunts belong to the past, not the present. As do archaic, cowardly, methods of pay.

If MPs are guilty, so are those who knew the system was in place, including the Telegraph journalists who have now decided for their own political reasons to expose the system, in a way which profits the Telegraph, for their own reasons.

http://blog.dorries.org/Blogs/2009/May/22#22

Poor old Nadine. She just doesn't get it. She was trying to compare our venal MPs and their duck houses, moats, and plasma TVs with the Hollywood Ten who stood up to McCarthyism.

Imperial College disowns Karol Sikora

Enjoy the video? This is who made it.

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A number of emails arrive from NHS BLOG DOCTOR readers to say that the Guardian medical editor has just nicked an NHS BLOG DOCTOR story. Tush! to those cynical readers. The Guardian is an honest, reputable newspaper.  I have written articles for them. They would never do something like that.

Regular readers will remember the controversy about Karol Sikora, who is still flagrantly misrepresenting his relationship with Imperial College as he continues to mount a critical campaign against the NHS. On Saturday, 14 May, in Karol Sikora pissing into the NHS tent we looked at Sikora's disgraceful claim, written as though he is still a Professor of Cancer Medicine at Imperial College, that the NHS was killing patients by neglect:

As a practicing oncologist, I am forced to give patients older, cheaper medicines. The real cost of this penny-pinching is premature death for thousands of patients -- and higher overall health costs than if they had been treated properly: Sick people are expensive.

Karol Sikora, a practicing oncologist, is professor of cancer medicine at Imperial College School of Medicine, London, and former head of cancer control at the World Health Organization.

Union Leader

I wrote an open letter to Professor Charles Coombes, the head of oncolocy at Imperial, and even though it was a Saturday, I had an immediate reply saying that he would be speaking with senior colleagues and taking action. He confirmed that Sikora holds no post at Imperial College and does not represent their views.

In fact the opposite is the case.

I published Professor Charles Coombes' reply on Wednesday 20th May in

Imperial College confirm that Karol Sikora does not work for them and does not speak on their behalf.

Sarah Boseley

Always alert Sarah Boseley, a leading medical correspondent, sprang into action,  borrowed took up the story and, on Friday 22nd May, she published it in the Guardian with a generous accreditation to NHS BLOG DOCTOR for doing all the ground work and breaking the story four days previously. By 22 May it was old news, but this was still a good result for the NHS as Sikora had once again been put in his place.

"I can confirm that Karol Sikora is not on the staff at Imperial and does not hold the title of honorary professor of oncology," the rector of the college, Prof Sir Roy Anderson, said. "This individual has been warned before by the college for making claims that he is employed by us, or associated with us. His views are very certainly not the views of the college."

Many thanks to Sarah Boseley,  It's been a pleasure to work with you, and thanks for the cheque.

Borderline blood pressure : Dr Young or Dr Feelgood?

Michael is a 48 year old business executive who works for a paint company. He has just joined an executive gym. A lycra-clad young lovely checked his BP and found it was 150/92. So Michael bought an electric BP machine from Boots and measured his BP twice a day. The readings were lower, in the region of 142/88, 138/86, 146/90, the latter being the highest. I checked it myself, and my reading was 144/90. I was not wearing lycra. Michael is a clean living, non-smoking, moderately drinking, regular exercising paragon of middle class health. Or is he? We decided to get formal ambulatory BP monitoring to try to be better placed to make a decision. We can do this locally but, at this stage, Michael played the BUPA card and asked to see the cardiologist

Dr Young

But which one? Our local cardiology department is excellent. Dr Young has particular expertise in ablative surgery. Done all the right jobs. He treats BP aggressively. He believes in pre-hypertension. Worked in a German University for two years. An excellent opinion. He is in his early forties. He still believes in a cure for all known disease.

Dr Feelgood

Dr Feelgood is the senior consultant, clinical director of Cardiology, and is in his late fifties. He has particular expertise in stenting and the modern management of heart failure. Also an excellent opinion. Dr Feelgood is very fit for his age, indeed for any age. He is a veteran tri-athlete. He is very keen on the "lifestyle" approach to blood pressure. 

I sent Michael to Dr Young. He did not do ambulatory BP monitoring. He started him on treatment. If Michael had seen Dr Feelgood, I can almost guarantee he would not have been started on medication. He would have been advised about lifestyle, about reducing stress levels, about numbers-needed-to-treat to prevent an event and so on. And we would have monitored Michael for a year or so and maybe he would have ended up on treatment. Or maybe not. Who knows.

This week we hear that all people aged 55 or over should be put on BP medication. Don’t even need to measure their BP. Twenty years ago, we were told that all menopausal women should be on HRT. I sometimes think that Studd and Whitehead would have put it in the tap water. How things have changed since then.

Older doctors, like Dr Feelgood and Dr Crippen, tend to become conservative about medication. We have pushed so many pills over so many years that we have seen every side effect imaginable. The young turks, like Dr Young, chase the numbers and have a low threshold for prescribing. Who is right? I have not got a clue. You decide. Whilst you think about it, do remember that amlodipine is the most commonly prescribed BP medication in the world. Guess who sponsors some of the research that recommends treating lower and lower levels of BP.

So, if you have borderline BP, and your GP is hesitant about prescribing, you can chose to see a specialist. But do you want to see Dr Feelgood or Dr Young?

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The cardiologists do not really look like that. Particularly Dr Feelgood.

Imperial College confirm that Karol Sikora does not work for them and does not speak on their behalf

As we saw a few days ago, Karol Sikora continues to represent himself as a Professor of Cancer Medicine at Imperial College:

He is Professor of Cancer Medicine and honorary Consultant Oncologist at Imperial College School of Medicine, Hammersmith Hospital, London.

Karol Sikora dot com

And, last week in an article written for an American newspaper he is styled thus:

Karol Sikora, a practicing oncologist, is professor of cancer medicine at Imperial College School of Medicine, London

Union Leader

Karol Sikora's  views are outspoken and many NHS doctors disagree with him. But is he still a Professor at Imperial College and does he speak on behalf of Imperial College?  NHS BLOG DOCTOR wrote to Professor Charles Coombes, who is currently the head of the oncology department at Imperial College. He has now replied thus:

Sikora left this department in 2000 and rarely comes here now. He is not a member of IC staff and his views do not represent the views of IC, in fact the opposite!

Professor Charles Coombes
Head of Oncology Department
Imperial College

That is unequivocally clear. It is time that Karol Sikora corrected his inaccurate c.v. which is still prominently displayed on the internet.

A man and his Black & Decker

Natasha Richardson & Nicholas Rossi

In Natasha Richardson and Medical Technology we looked at the tragic and premature death of Natasha Richardson on a ski-slope in North America. No one was brave enough to treat her on site. To put it in simple terms, no one was brave enough to drill. The delay turned out to be fatal.

I believe the delay was due to medical technology. CT scanners, MRI scanners and helicopters. That sounds counter intuitive, but think about it. These days, and particularly in the medico-legal climate prevalent in North America, it would be a brave doctor indeed who did not wait for the CT scan before drilling the burr holes. It would be a career making or career breaking decision. Few American doctors are brave. Defensive medicine is the order of the day. You cannot have a migraine in the USA without someone ordering an MRI scan.

Many disagreed, particularly the "nurse-specialists" who wrote in quoting reams of data about protocols and tests and machines. Some argued that there was no place for drilling skulls without scans in the modern word. Perhaps most tellingly, some suggested that Ms Richardson's celebrity meant that none was brave enough to start drilling. Compare Natasha Richardson's story with this:

Nicholas Rossi, 13, fell off his bike in the small rural town of Maryborough in Victoria and hit his head. He was not wearing a helmet, and the impact knocked him momentarily unconscious. He recovered enough to go home, but complained to his mother Karen, a trained nurse, of a bad headache. Mrs Rossi took her son to district hospital where Dr Rob Carson, a local GP, was on duty, his family told The Australian newspaper.

The boy was kept under observation, but one hour later, he started drifting in and out of consciousness. Dr Carson recognised the problem as internal bleeding in the skull and noticed that one of Nicholas's pupils was larger than the other, another sign of bleeding that was placing pressure on the brain. The injury was the same that recently led to the death of actress Natasha Richardson after a skiing accident.

Dr Carson believed Nicholas had torn an artery just above his ear between his skull and his brain, creating a large and life-threatening blood clot.In scenes reminiscent of a television medical drama, Dr Carson realised he had minutes to save the boy's life and there was no time to transfer his patient to a hospital with a dedicated brain surgery unit. Instead, he telephoned Dr David Wallace, a neurosurgeon 105 miles away in Melbourne, to help talk him through the operation - which he had never attempted before.

But there was one problem. The hospital was not equipped with a surgical drill. Instead, Dr Carson had to use the next best thing - a household drill found in the hospital's maintenance cupboard. He disinfected the drill and, under Dr Wallace's guidance, used it to bore into Nicholas's skull to release the blood clot.

Telegraph

The story has been picked up now by the main stream media across the world

"Dr Carson came over to us and said, 'I am going to have to drill into [Nicholas] to relieve the pressure on the brain - we've got one shot at this and one shot only,"' the boy's father, Michael Rossi told journalists.After the surgery, Nicholas Rossi was airlifted to a larger hospital in Melbourne and released on Tuesday - his 13th birthday.

BBC

Michael Rossi says his son would have died if Dr Carson had not acted quickly.

"He came out and he saw us and he said he's only got one shot at it, and one shot only," he said. "[He said] 'I'm going to drill into Nick's head and try and relieve the pressure'. And he said if we can relieve the pressure he's going to reach Melbourne via air ambulance in a lot better shape than if we don't try something.

"Dr Carson told me all he can remember saying is, 'Get the Black and Decker'."

"He seems to have made a marvellous recovery," he said. "It was obvious the next morning [when] they were able to take him off the ventilator and in fact by Sunday he was up and walking around."

ABC

Despite lack of equipment, despite the lack of a CT scanner and despite lack of specialist expertise, Dr Carson, a country doc, did what needed to be done and saved a boy's life. A career defining moment for a brave doctor.

More wibble from the Prince of Wales

Dr Phil Hammond, Professor Wibble & Professor Colquhoun

OK, it's time once again to put the pencils back in the nose. The quacktitioners are out and about spreading medical wibble wherever they go.

Some people will do anything for money. I was surprised to see that GP and cabaret starlet Dr Phil Hammond had lent his name and thus, by implication, provided an endorsement to HRH Prince Charles, the Quacktitioner Royal, in his latest foray into quack medicine. Phil Hammond has been chairing the First Annual Conference of the Prince's Foundation for Integrated Health. Has the man got no principles? Worrying to see that sharing the table with the Prince were "Professor" Karol Sikora and Dame Carol (don't you dare call me a shit, or I will report you to the GMC) Black. What an odd collection.

The Quacktitioner Royal knows less about medicine than he does about architecture. Trouble his, some people still take him seriously, which makes his global endorsement of medical wibble particularly worrying.

Integrated health is a response to the changing patterns of disease in the early 21st century. It recognises the role that the health service plays in promoting good health and treating illnesses and it also recognises that the answer to illness rarely lies in taking tablets alone, but rather in addressing lives in the round. This can often call for lateral thinking on the part of practitioners, finding innovative ways to bring people back to health.

Quacktitioner Royal : The Princes Foundation

Dr Crippen takes particular interest in the use and abuse of the English language. "Integrative" is a warm, cuddly word. Let's all "integrate." That must be a good thing. If medicine is "integrated" that must be even better. Professor David Colquhoun describes Prince Charles' use of the word as a euphemism. I think he is too kind. I think the word is used fraudulently. David Colquhoun was invited to speak at the Conference, but declined***. He does however report in detail upon the conference:

The Prince of Wales’ Foundation for Integrated Health (FiH) is a propaganda organisation that aims to persuade people, and politicians, that the Prince’s somewhat bizarre views about alternative medicine should form the basis of government health policy. His attempts are often successful, but they are regarded by many people as being clearly unconstitutional.

Professor David Colquhoun : DCs improbable science

The Quacktitioner Royal made a long and dreary opening speech which can be read in full here. I was going to look at it in detail, but the ever excellent Northern Doctor got their first. He concludes:

...we are being treated to the usual canards that conventional medicine is dangerous with an emphasis on the natural and holistic qualities of complementary medicine. Worse still, they are distorting the true patient-centred focus of normal medical practice. The PFIH could be advocating longer consultation times for GPs or opposing polyclinics to help foster good continuity of care. It is a shocking perversion of the real issues driven by one man; unelected, unqualified and utterly misguided. The vision of integrated care from the Prince’s Foundation is a Trojan horse to ram complementary medicines deep into the heart of the NHS.

A Royal Fisking : Prince Charles on Integrated Health

How disappointing that Phil Hammond should have done this. Medicine Balls in Private Eye will never have the same bite again. Still, we all have to make a living. Anyone  wishing to hire Dr Phil Hammond will find him here, in the £2.5k - £5k pound bracket. Ouch!

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*** See the comments. David Colquhoun was invited to speak at the conference by Phil Hammond, but it was the FIH organisers who declined to have him. David says:

"Phil Hammond asked FIH if I could speak at the conference but FIH said no. If they'd said yes, I'd have gone, despite the danger to my health of acute hypertensive episodes."

David Colquhoun

Gaviscon gets it wrong

Following an email from an NHS BLOG DOCTOR reader, I have just caught up the Gaviscon Fireman advertisement. What a joy. How can a drug company get it so so spectacularly wrong? Sian Harcourt wrote about it in the Guardian at the end of last year:

As every girl knows, firemen are the very essence of male virility and sexiness. Firemen are just brilliant, performing daily acts of derring-do mostly with their shirts off because it gets a bit sweaty putting out a good blaze. There's that big red rig with lots of hoses gushing out foamy stuff and, best of all, a chance for a bit of pole dancing back at the station.

Picture this: insatiable female is overcome by a burning desire so powerful it sears into her stomach lining. Not wanting to embarrass herself in public, wisely she reaches for the Gaviscon, but holy crap, that's not medicine! It's a bunch of moustachioed firemen slithering excitedly down her throat shouting "Go go go", holding a white hose so big and forceful it takes up to three of them to control it as it spurts copious amounts of foaming white liquid randomly around the girl's gullet. Oh what a feeling indeed. And all now available in a handbag-sized sachet. Brilliant: a blowjob in a bag. I wonder if the agency makes these ads whenever the client happens to be away on holiday? Or perhaps there are no women on the team and their focus groups are too busy wetting themselves to point it out.

The Guardian

Measles and swine flu

American Academy of Pediatrics : Vaccine preventable diseases collection

The champagne corks will be popping to night at JABs before they dance round the mumbo-jumbo pole to sing "Soomer is a-comin' in." Their MMR scaremongering has been successful. There is now a major outbreak of measles.

Health chiefs in Wales are dealing with a "massive" measles outbreak, with numbers already four times the highest figure recorded over the past 13 years.

Four nursery school children were treated in hospital as part of 127 cases across mid and west Wales, while there are another 35 cases in Conwy. The National Public Health Service (NPHS) in Wales saw 39 cases last year. Its highest figure in 2003 was 44. Officials appealed for parents to take up the MMR vaccine.

BBC

Heaven forbid that we should start using nasty inflammatory words like “epidemic” or “pandemic” about this illness that could be eradicated were it not for the gullible worried-well lapping up noxious propaganda from the Wakefield brigade.

Still, it’s a thought.

The NHS news line reports today that there are fewer cases of swine flu in the UK than there are cases of measles. And in Wales, there are two hundred times more cases of measles than of influenza.

Why is it not on the front page of every newspaper?

Tamiflu - would you take it?

It is frustrating but mildly amusing to watch the public reaction to swine flu and Tamiflu tablets. The first problem was the gadarene rush (what an apposite adjective, if I may say) to get hold of Tamiflu from somewhere, indeed anywhere.

The outbreaks, if that is not too strong a word, such as there have been to date are largely confined to posh public schools in the London and outer London area. Alleyns and, most recently, Hampton School and the adjoining and even more pukka Lady Eleanor Holles School.

Sebastian and Jocasta, Cosmo and Hermione have all returned from their transcontinental holidays and are furiously swapping viruses. They probably see more of each other in the evenings than during the days so the effect of school closures, though dramatic, may be limited.

Because this is, so far, predominantly affecting the wealthy-worried-well we now see a second problem. "What about the “side effects” of Tamiflu?" "Why should our children take it?"  "It is only being given to protect the “herd”. I would prefer Cosmo to take his chances."

Time to take a step back and think about the efficacy of Tamiflu. Given to someone who has already contracted the virus the evidence, such as there is, is that it will shorten the duration of symptoms by perhaps just over one day. It is not an “instant” cure. Given prophylactically the evidence is more encouraging. The data suggest it might be over 50% effective.

Would I give it to my children if they were a definite swine flu contact? Probably.

As to side effects, well, we will know more when a million or so of our citizens have taken it. It may not be necessary to give it out on a large scale.  I wonder if the NHS has got a "sale or return deal" with the drug company. I doubt it.

Elizabeth Munro : supremely selfish

Elizabeth Munro

Elizabeth Munro is 66 years old and single.

She has no children of her own. She does have step-children from a previous relationship but does not see them or their children. To that extent, I feel sorry for her. She is lonely.

Now she has revealed that she is about to give birth to a baby (by elective Caesarian Section) conceived by IVF carried out in a dubious sounding private clinic in the Ukraine. She could not get such treatment in the UK or even in Europe. But for £10,000 she got in the Ukraine. She has no partner, no brothers, no sisters and she will be 80 when her child becomes a teenager

This is an act of supreme selfishness.

How many would criticise local social services if they commenced action to take this child into care? How many, indeed, would criticise social services if they do not take action to take this child into care?

Take a letter, Angela

A brief interlude of pleasure presented purely to amuse Dr Crippen, Scribbler, Dearieme and and any other grammar pedants who may be reading.

Thanks, as so often, to the Amateur Transplants and also to the Junior Doctor at NHS247

The prince and the pauper

The prince and the pauper

Why is it that the "great and the (not so) good" openly criticise rule breakers and yet feel that they themselves are not only above the rules but also beyond criticism?

Details of Gordon Brown’s recent weekly meeting with the Queen have been leaked.

The Queen has told Gordon Brown she is worried that the scandalous revelations about MPs' expenses could damage Parliament. She discussed the explosion of public outrage over the scandal in what is understood to have been a candid exchange of views when she met the Prime Minister for their weekly audience at Buckingham Palace on Tuesday.

Source

Does Her Majesty not have any insight? Her income, expenditure and tax liabilities remain swathed in secrecy.  She now, grudgingly, pays some income tax, but let’s not mention inheritance tax. And she is not keen on VAT:

Included in the list of palace demands is a more generous tax treatment, specifically a call for a VAT exemption on the payment of services rendered to the Queen.

The Independent

Ian Davidson, the Labour MP for Glasgow South West and member of the powerful House of Commons Pubic Accounts committee, has always lobbied for more control over Royal Finances:

The Queen faced calls last night to start charging royal "hangers-on" who live rent-free in posh homes. The demand came from MPs trying to force the Royal Family to open the books on how they spend taxpayers' cash and pay their share of huge bills for repairing crumbling palaces. Labour MP Ian Davidson, a member of the Public Accounts Committee, said some friends of Royals lived free in luxury, while some low-paid former staff had to pay rent. He said: "The Queen Mother's former press secretary has three reception rooms and five bedrooms, and does not pay rent, whereas a former photocopy operator does pay rent."

He added: "It seems absolute extravagance to have so many hangers-on getting off scot-free."

The MP said some taxpayers' money intended for repairing palaces was being "siphoned off".

The Mirror

When it comes to "siphoning off" taxpayers money, no member of the Royal Family is more controversial then Prince Andrew, aka Air Miles Andy aka the Junket of York.  The Independent’s description  of Andrew’s lifestyle, much of it taxpayer funded, makes Douglas Hogg’s moat seem trivial. The Palace has tried to avoid releasing details of Andrew’s expenditure. Fortunately, only a few weeks ago, Ian Davidson was once again on the case:

Last night, after Buckingham Palace said the Duke was still deciding whether to release the findings, he faced criticism from a member of the Commons Public Accounts Committee, which carried out investigations into Royal finances. Labour MP Ian Davidson claimed that the Prince’s refusal suggested he was embarrassed by its conclusions. He said: ‘If it had been good news for him there is no doubt he would have rushed to publish it. I presume he is hiding it because PWC says he is of little value.’

Prince Andrew facing cover-up claims over foreign trips

Now some good news about Ian Davidson has been published. He is in the top ten siphoners expenses claimants.

The most expensive MPs

1. Eric Joyce (Lab, Falkirk) £174,811
The former Army major spent more on travel than any other MP (£44,985).

2. Alistair Carmichael (Lib Dem, Orkney & Shetland) £161,815
Spent £38,559 travelling to the UK's northernmost constituency.

3. Ashok Kumar (Lab, Middlesbrough S & E Cleveland) £161,049
His staffing costs were £84,400.

4. Jacqui Smith (Lab, Redditch) £158,313
The Labour Chief Whip (sic **) was the top cabinet claimant. She spent £16,458 on postage.

5. Alex Salmond (SNP, Banff & Buchan) £157,844
He claimed £5,342 for staff travelling costs.

6. Andrew George (Lib Dem, St Ives) £157,308
His office and staffing costs totalled £103,860.

7. Liam Byrne (Lab, Birmingham Hodge Hill) £156,988
The Immigration minister spent £18,212 on postage.

8. Sharon Hodgson (Lab, Gateshead E & Washington W) £156,891
The former clerk claimed £26,141 for running her office.

9. Ian Davidson (Lab, Glasgow SW) £155,521
He claimed £7,998 for 'other costs'.

10. Ian Austin (Lab, Dudley N) £155,242

The most expensive MPs

Mr Davidson is an honourable man, with nothing to hide, and so for him at least these revelations will be good news.  Perhaps, therefore, he will now provide fuller details of his expenses claims and, in particular, of the "other costs".


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**Jacqui Smith is of course the Home Secretary – but I have not altered the Independent’s report.

MPs claiming for rugs

Mr & Mrs Mackay

The Crippen teenagers have been enjoying the MPs expenses game more than most. They spotted this morning that Gerald Kaufman had claimed for a rug:

In March 2007 Sir Gerald submitted a claim for £1,461.83 for a “second-hand rug replacing 24-year-old carpet”, with an additional £389.91 for “customs duty on rug”, which was paid

Daily Telegraph

My friend Wat Tyler is also having some fun with Gerald:

And then there's Gerald Kaufman's £8 grand Bang & Olufson telly. I once saw Mr K preening himself in the First Class compartment of a train going North. He'd boarded wearing one of those white raincoats specially designed for people who want to get noticed, and he spent the entire journey being important. You can hardly expect a man like that to settle for 19 inch Alba from Argos (£99.99, home delivery for £5.80).

Wat Tyler

One of the favourite Crippen household parlour games is "Spot the rug".  Gerald has had to come clean about his rug but, as yet, nothing has been heard from Andrew MacKay.  Did a new, young wife bring a rush of hair blood to the head of an older man?

Should he claim for a rug?

The vote in the Crippen household was 4 to 1 in favour of "rug". Does anyone know for certain?

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Craig Murray is in scintillating form on Tory MP sleeze.

Karol Sikora : pissing into the NHS tent

Imperial College, London

Dr Aust has not disappeared. He is alive and well, and draws my attention to an article "Professor" Sikora wrote a few days ago for the right-wing American press.

Karol Sikora: This health care 'reform' will kill thousands

One of the more unproductive elements of President Obama's stimulus bill is the $1.1 billion allotted for "comparative effectiveness research" to assess all new health treatments to determine whether they are cost-effective. It sounds great, but in Britain we have had a similar system since 1999, and it has cost lives and kept the country in a kind of medical time warp.

As a practicing oncologist, I am forced to give patients older, cheaper medicines. The real cost of this penny-pinching is premature death for thousands of patients -- and higher overall health costs than if they had been treated properly: Sick people are expensive.

Union Leader

At the bottom of the article, Karol Sikora is styled thus:

Karol Sikora, a practicing oncologist, is professor of cancer medicine at Imperial College School of Medicine, London

If you look at the Imperial College Department of Oncolocy website, here, there is no mention of Karol Sikora. If you put "Sikora" into the Imperial College website engine, you get nothing. So what is going on? It is a free world and Karol Sikora is of course allowed to promote his opinions. But why does he not style himself as Dean of the Private University of Buckingham or as one of the leaders of the private Cancer Patners? Imperial College is of the greatest Universities in the world. Why is Sikora allowed to trade on its good name to promote his outspoken views about the NHS?

Time to find out.

The current head of oncology at Imperial College is the much respected Professor Charles Coombes.

Professor Charles Coombes

Dear Professor Coombes

Professor Karol Sikora is currently spearheading a right-wing American campaign to denigrate the British National Health Service. On his personal website he styles himself as a Professor of Oncology at Imperial College. At the bottom of his recent article in a right-wing American newspaper, in which by implication he accuses the NHS of killing thousands of patients, he styles himself as "Professor of Cancer Medicine at Imperial College, London.

Imperial College is one of the most respected Universities in the world and thus anything said with the imprimatur of Imperial College will be take with the utmost seriousness. Karol Sikora is of course entitled to his views but, as he is styling himself as an Imperial College Professor of Oncology, as head of the department, can you confirm that Imperial College supports these views?  In particular, would specifically comment on the clear implication of his article that the NHS is killing thousands of patients? Does that represent the view of your department?

Yours sincerely


Dr John Crippen
NHS BLOG DOCTOR

We shall see.

Does Karol Sikora do any work for the NHS?

Following yesterday's article, several people have written in to comment that Karol Sikora is no longer on the staff at Imperial College. If that is correct, and I think it is, I must apologise for the inaccuracy. Note that on the beginning of the video, Sikora is styled as "Professor" although it does not say where. This may of course be using the word "Professor" in the same way we use the word "President" when we talk of "President" Carter, Bush, Clinton and Bush. It would be usual for a retired eminent professor to keep a courtesy title though, in view of his recent activity, I hesitate to suggest to use the expression "Professor emeritus".

It is not clear, nor is it possible to establish with internet research, if indeed Karol Sikora still has any "hands-on" role with NHS patients. One thing does emerge, though. Whatever the truth may be, it is clear that the poor chap still thinks he is a Professor at Imperial College. That must be so, for he is not a fraudster and would not tout round a bogus c.v. If you can forget you have paid off your mortgage how much easier must it be to forget you are no longer a Professor at Imperial College? Nearly all the references to Karol Sikora on the Internet state that he is a Professor at Imperial College but most of these references have lifted their information verbatim from the "Professor's" very own self promoting website.

Karol Sikora is Medical Director of CancerPartnersUK which is creating the largest UK cancer network as a series of joint ventures with NHS Trusts. He is Professor of Cancer Medicine and honorary Consultant Oncologist at Imperial College School of Medicine, Hammersmith Hospital, London. He is Scientific Director of Medical Solutions PLC, Britain’s leading cancer diagnostic company. He has recently been appointed Dean of Britain’s first independent Medical School at the University of Buckingham.

Karol Sikora Dot Com

I doubt that Imperial College and the Hammersmith Hospital would wish to be associated with the above video. Dr Crippen welcomes any further information.

Karol Sikora makes a fool of himself

There was revulsion amongst doctors and nurses through out the NHS today as word spread that Karol Sikora had been duped by a slick American businessman into providing a “rent-a-quote” service for a notorious right-wing American organisation.



Some outside the NHS may not have heard of Sikora. When he has his NHS hat on, he is a Professor at Imperial College.** Outside the NHS he has strong commitments to private medicine. He is Dean of the medical school of the “independent” (= private) University of Buckingham - take a look at the fees here - and is medical director of CancerPartnership UK, a private organisation that puports to provide private medical care for cancer patients. Sikora is often styled as a “trailblazing oncologist” and of course has an eponymous dot com website.

Interviewed by Dr Natasha Murray he said:

“I have no hobbies whatsoever but I do like trains! I was Father Christmas on the ‘Santa Special’ train and my daughters were my little helpers!”


Dr Natasha Murray

Today, the train spotter has been derailed. Sikora has made a fool of himself. He has been suckered. He has allowed himself to be used as a vehicle to denigrate the NHS so that a fat cat American business man can con gullible Americans into thinking  that universal health care must be a disaster. Sikora has probably already had a phone call from the Department of Health because on Radio 4 this evening, he was backtracking. (Listen again here : the Sikora story starts forty minutes in, but will only be available for a few days) 

Take a look at some of the “NHS horror stories” being currently being run by Conservative for Patient Rights on American television.



Katie Brickall’s story is tragic. But hard cases make bad law. One case of cervical cancer in a 19 year old is not initself a justification for a national cervical screening programme directed at teenagers. Sikora knows that. May be there should be such a programme. May be there should not be.  But this one case is irrelevant.



Another emotive, dishonest video. Another tragedy.  But not a reason for supplying an expensive drug which offers no prospect of a cure. Think about it logically. A new drug offers, not a cure, but a possibility of extending a cancer patient’s life by three months. A course of treatment costs, say, £200,000. There are a hundred patients who want the drug. That’s £20 million. £20 million that could be spent on, for example, nursing care for patients with Alzheimer's Disease.  Heart breaking resource decisions. In the USA the problem is “solved” by depriving some forty million citizens, mainly black, Latino, and unemployed, of all medical care. In the UK we have an organisation called NICE that tries to make these resource decisions rationally. It is a job for Solomon. Do they get it right every time? Hell, no. But can you think of a better system? Shall we just provide the drug for the well-heeled middle-class as they do in America?

There are between forty and fifty million US citizens who do not have health insurance and who, therefore, cannot get proper medical treatment. They bounce round the system getting a bit of charity care here and there, but no one takes ownership of their problems. They do not get the expensive drugs. Often they do not even get a diagnosis.  The American healthcare system is business orientated. The insurance companies have no interest in universal health care. Their sole interest is profit. Now they are feeling threatened. They saw off Hilary Clinton when she, as first lady, dallied with universal healthcare, but President Obama is a much more powerful politician. He has popular support and now he is planning to introduce a system providing universal health care. If he is to do that, there will have to be some state enterprise. Those forty million citizens cannot afford to pay themselves. State enterprise? Socialized medicine?  This might threaten the bank balance of the US insurance companies, so they are mounting a cynical campaign to appeal over Obama's head and are pitching the campaign directly at the right-wing red-necks in the US flyover zone.

So who exactly are Conservatives for Patient Rights who are running this campaign with the help of Professor Sikora?

Conservatives for Patients Rights is a non-profit, 501 c(3) organization dedicated to educating and informing the public about the principles of patients rights and, in doing so, advancing the debate over health care reform. Those principles include choice, competition, accountability and responsibility. 

"Not for profit" always makes an organisation sound well-meaning and plausible. So what, exactly, is in it for them? Perhaps CPR is run by charity workers. Who is in charge of Conservative for Patients Rights (CPR)?

CPR is headed by the former chief executive of a health group who was at the forefront of one of the country's biggest healthcare fraud scandals. Rick Scott was forced out as CEO and chairman of a healthcare company, Columbia/HCA, in 1997 after the government accused it of a massive fraud through overbilling. walked away with millions of dollars in severance pay, but the company was forced to pay $1.7bn in compensation to the government, fines, interest and other payments to avoid prosecution and settle with claimants. Scott has responded to the criticism by saying: "I was never charged with any wrongdoing."

The Guardian 

More details emerge about Rick "I have never been caught doing anything criminal" Scott in the Washington Post.

"Those attacking reform are really looking to protect their own profits, and [Scott’s] a perfect messenger for that. His history of making a fortune by destroying quality in the health-care system and ripping off the government is a great example of what's really going on."

Scott, 56, seems unfazed by such criticism, emphasizing that he was never charged with any wrongdoing and that other health-care companies were also fined for overbilling problems. A lawyer with no formal medical training, Scott built Columbia/HCA into the largest U.S. health-care company before he was ousted by the board of directors in 1997. He was also once a partner in the Texas Rangers with George W. Bush. Scott now runs an investment firm and owns, among other things, a chain of walk-in urgent-care clinics in Florida called Solantic.

The Washington Post

Dr Crippen has long since stopped worrying about political doctrine when it comes to healthcare. Provided always we provide a reasonable standard of medical care for all UK citizens it matters not a jot how we do it. The monolithic NHS with all its Stalinist bureaucracy is far from perfect and, at times, drives me to distraction. Much could be done to improve it. There are lessons to be learnt from the private sector and from America. Similarly, the Americans can learn much from the NHS. There is good in both systems. 

Sikora is a talented man. But he is a Professor of Medicine working within the NHS. His behaviour in making this video is despicable. He has connections with private medicine but did not declare any conflicting interests in his interview. If he made similarly critical remarks about the University of Buckingham he would have been sacked. If he wishes to denigrate the NHS in this manner,  he should resign. 

** But see "Does Karol Sikora do any work for the NHS?"

An email from a young doctor

Not all doctors agree with Dr Crippen. That's to be expected. And fair enough too. A young F1 writes directly too me, an F1 who feels that, unlike me, he is clearly a "modern man" and is thus able to put me on the right track about one or two issues. Welcome to his world of dumpy middle aged Practice Nurses, pushy, bossy, overpaid, underworked, pill-counting, BNF monkeys and gormless chavettes from the local ex-polytechnics.

Er...is he trying to criticise me?

Dr Crippen,

I am an F1 doctor in England. You are a (late) middle-aged GP somewhere in the UK. Right?

When was the last time you spent any time with a large group of nurses? Sure, your practice may have a typical dumpy middle-aged Practice Nurse, whom you and your GP Partners foist all the boring asthma clinics onto, letting her measure PEFRs for a day, but she is hardly representative of all nurses.

I have been working as a doc for a year now (and I know my career is brief compared to yours), and I ahve experience of modern nurses which is more accurate, current and varied than yours - working with a multitude of them, of all levels of experience and seniority, every day and night, on the wards. And I agree with Vicky Pollard, that nursing is a back-breaking, dirty, thankless, shit job. It is disgustingly low paid also, and I don't blame anyone for not wanting to go into it.

My feelings on the new nurse specialists are split. In favour of them, they make my life easier as a junior because they are much easier to access than a SpR/Consultant if I need advice about a specific area, and are often friendly and approachable. For example, the Diabetes Specialist Nurse, able to spare the time to educate the patient about insulin pen choice, dosing regimes, how t use the BM self-test machine etc. I could do all she does, but I would never, ever leave work if I took on all the jobs of the specialist nurses (TPN nurse, Diabetes nurse, Pain nurse, Stoma nurse, ad infinitum), and, as great as my job is, I really, really enjoy having a life too. So, let them do their Specialist Nurse roles, they help the doctors and the patients. When things become complicated or dangerous, it's up to the doctors to sort it out, which is fine. Most of the specialist nurses I have met recognise when a problem exceeds their expertise for whatever reason, and usually advocate calling the appropriate SpR. They are super-helpful in managing SPECIFIC conditions, that aren't too complex and don't feature multiple co-morbidities. They help patients and doctors. They are important, now that doctors are permitted to have a life outside work. Thank you, EWTD! I do have a problem with a rare breed of specialist nurse who doesn't know that not having a full medical education and apprenticeship can sometimes blinker her expertise and make it irrelevant in the greater picture, or who is overly bossy (a common trait).

Essentially, I appreciate the nurses for doing a really gross, crappy job fairly well, and the patients do too. On my current ward, they are without fail, phenomenal, and their efforts are appreciate by all the medical team. I don't blame school-age people who dont want to do it, especially with the appalling pay. And I don't blame nurses who want to specialise and progress, as long as they are well-trained and aware of their limitations (as should we all be). I don't like it when they boss me about, but oh well, I boss them about too.

Pharmcists, now that's another matter. Pushy, bossy, overpaid, underworked, pill-counting, BNF monkeys, with no clinical experience at all. They are the ultimate protocol/algorithm-driven automatons. We have independent prescribing pharmacists in my hospital, who know drugs very well, but I seriously doubt could tell you a normal BP, could interpret a TFT, could read a chest x-ray, or examine an abdomen. Yet these people are effectively allowed to prescribe anything. A lot work on the medical admissions unit, where they'll be encountering allsorts of presentations. I doubt they have a chance to sticky to their area of prescribing competency, given that literally any disease in the world could walk in.

****

Incidentally, the nursing students from the 'real' university locally are far brighter and interesting than the gormless chavettes from the local ex-polytechnics. I value the degree nurses from the real degree-awarding institution, rather than the diploma/faux-degree blank-starers from the old polytechnics. That's by-the-by, just a vote in favour of the degree nurses who I don't have to explain everything to twice. The degree nurses have a greater understanding of physiology, pharmacology etc, and tend to be generally brighter and more focussed on their jobs. I like them.

Great stuff, doc!

Solving the nursing recruitment crisis

We do not have enough nurses. There is a recruitment crisis.

According to the RCN, 200,000 nurses are due to retire in the next 10 years, which could lead to a staff shortage if young people do not enter the profession.

 A poll of more than 8,600 seven to 17-year-olds found that only one in 20 thought nursing was the right career for them, despite ‘helping people’ being one of the most important factors in choosing a career.


The RCN found that nursing was the least preferred public sector job, behind police officers, teachers, doctors and firefighters. We should consider why this once popular profession in now in the doldrums. First and foremost, something needs to be done about the pay rates. Not in the upper echelons of nurse-specialism, but down on the front line, on the wards.

RCN

Ward staff nurses barely earn a living wage. In a different age, when all nurses were girlies, and regarded nursing as a vocation rather than a career, nurses survived by being married to someone earning a higher salary. Nowadays, rightly, nursing is both a vocation and a career. Men and women going into nursing have a right to expect a living wage, independent of whatever their partner, if they have one, earns. I work in a middle-class, semi-urban area. Houses are not cheap. The young people I know who are training to be nurses are reliant on support from their parents and that support is needed even after they qualify. That is wrong.

I do not believe, however, that poor pay is the main thing keeping young people out of nursing. It is the reason why many leave nursing but, by and large, teenagers are idealistic, vocationally orientated and do not at this career-planning stage in their lives think too much about salaries and mortgages.

Most young people considering nursing have the old fashioned view that nursing is a hands-on, caring profession, involving day to day contact with people. At the risk of sounding simplistic, they see nursing as a career which will involve…er…nursing; providing personal care for the sick, the elderly and the dying. A little research soon shows them that the profession has changed. The only way to advance within the nursing profession, the only way to make a difference, is to give up the nursing, and pick up the clip-board.

Julie Burgess is chief executive, Birmingham Women’s NHS Foundation Trust. She used to be a nurse. Julie says:

Julie Burgess : "I stopped clinical practice because I wanted to make a difference"

Throughout my career as a nurse, I had always wanted to make a difference. Maybe arrogantly, I had believed that no-one could do this better than frontline clinical staff. I stopped clinical practice because I wanted to carry on influencing the agenda so I could make a difference at a more strategic level.

Julie Burgess

Not many nurses have the skills and ability of a Julie Burgess, but that does not mean that most nurses do not want to progress beyond the level of staff nurse.

Janet Scott, an experienced older nurse, writes:

The ambition of most of my generation of student nurses was to be a ward sister. Specialist and consultant nurses did not exist and there was only one matron in a hospital.

The sister was the ward expert, an advanced practitioner who ensured that patients received excellent care from ‘her nurses’. She – there were few male charge nurses in general hospitals at the time – set the standard of care on her ward.

With the introduction of general management in the NHS in the 1990s, sisters have become ward mangers. Consultant and specialist nurses – rarely part of the ward staff – have been introduced along with matrons.

Janet Scott

The trouble is that the modern ward sister is no longer a real nurse. That is not to say that her new job is not valuable. It is. But it has become an administrative job. As a result, few want to do it. Janet Scott continues:

In practical terms, ward managers’ jobs are not popular. Anecdotally, staff nurses are reluctant to apply. Evidence suggests that trusts are having increasing difficulty in recruiting to these posts, and Wise (2007) found that only 10% of nurses and midwives wanted line managers’ jobs.

Janet Scott

Wannabe nurses do not enter the profession to become administrators. Some, like Julie Burgess, will discover hidden talents and abilities and rise up the administrative hierarchy, and good luck to them. But this is not the career ambition of new nurses. Young people who want to be administrators tend to do degrees in business studies, and law and economic and so on. They do not start out doing nursing.

Many young people who would make excellent nurses are now put off entering the profession by the increasing emphasis on higher qualifications. The RCN has gradually turned nursing into a graduate profession. I will leave for another time the discussion as to the content and value of the nursing degrees but the fact is that a degree is becoming essential for nurses who wish to progress within the profession. Many young people who would make excellent nurses find this too daunting.

Finally, the bureaucracy and paperwork. New Labour has a lot to answer for but, even without New Labour and top down management and targets, there is no group of people in the world that spews out more meaningless, repetitive, mind-numbing, distracting, tedious, dull, humdrum, deadly, dreary, wasteful, monotonous, superfluous, lackluster, wearisome paperwork than the upper echelons of the modern nursing profession. Old-fashioned nurses, who just want to get on with the job, have been professionally emasculated. The great conundrum of the nursing profession is that on the one hand they are demanding more and more clinical responsibility and yet on the other hand are forever crying out that they are “not covered” to do tasks that in years gone by they would have done without comment. It drives doctors to distraction.

Watch the video at the top. Yes, it's from Australia, but the message is generic. The modern nursing hierarchy sees this kind of presentation as something that will attract young people into nursing. Dr Crippen thought it was an advert for a tablet lap top computer company sending out their salesperson to visit her clients.

If the RCN wants to increase recruitment, they need to get the nurses back to nursing.

Ungrateful bastards

Find a burglar in your house in the middle of the night and you have to be careful. For your own safety of course, but also for his. You owe him a duty of care not to use unreasonable force. If you hit him over the head with your old cricket bat, and kill him, you could be in trouble.

We live in a strange world.

Doctors, of course, owe a duty of care to their patients. And quite right too. But sometimes you do your best and even, occasionally (yes, it does happen), save a life. Dr Grumble saved a life recently but he is still being sued.

It’s enough to make us all want to retire.

Swine flu news : update (3) "Greater love hath no man..."

When the chips are down, and the swine flu pandemic takes hold, we will run out of Tamiflu. There is not enough to go round. Let's hope it does not happen. If it does happen, some interesting decisions will have to be made. At the moment, we still have a few precious bottles of last year's flu vaccine left. It does protect against some H1N1 flu viruses but no one knows for certain if it covers the swine flu. It might, so these few bottles of vaccine are precious. But who should get them?

Dr Grumble reveals the decision made by a hospital in his area who had to decide who should get one of the 18 remaining immunisations they still had stored away in a dusty cupboard:

If you were to ask Dr Grumble he would say the infectious diseases staff should get it. Or maybe the intensive care staff. Or perhaps they could do the decent thing and offer it to local GPs who are the ones that have to go into people's homes and take the swabs. Any of these would be a reasonable choice.

To whom would you have given them? See what the hospital decided here.

The expenses scandal : decisive leadership from David Cameron

This is impressive and decisive leadership from David Cameron. Action not words. Action not consultations. The MPs expenses scandal is one of the most difficult problems a party leader has ever faced. It is hard to know what more he could have done. A full and frank apology. No prevarication.  Conservative MPs instructed to pay back all excessive claims immediately or face the sack. Dr Crippen is impressed. Heavens, even the DK is impressed.

Compare it with this:



and then this



Then chose your leader.

Can people with ME be mentally ill?

Imagine this.

You are a doctor. You have a patient who has a delusional belief that the only way he can cure an illness from which he suffers is by drinking huge quantities of water. Quantities so huge that he is endangering his own life. It may sound implausible but water intoxication can kill you. Remember Barbara Nash, the quack nutritionist, who nearly killed a patient with the Amazing Hydration Diet?

Your patient refuses to stop drinking water so you arrange an urgent compulsory psychiatric admission so that he can be looked after in a place of safety whilst his delusion is treated. Few would disagree with that course of action. Sadly, amongst the few who do disagree, are the militant wing of the ME brigade. For this is a real case.

Writing under the pseudonym of Dr Speedy, a doctor who is himself currently bedridden with ME, highlights the case of Brian Nicholson who is currently detained on a mental health ward with precisely this problem. A short digression to say that, whatever your views on ME may be, “Dr Speedy” writes an excellent and at times very funny blog about his own experiences. Well worth a read. But back to Brian Nicholson. Dr Speedy says:

Though of no danger to society Brian has now joined the ranks of those patients whose human rights are flouted and abused. Brian is now imprisoned in a secure psychiatric unit because he has ME. The psychiatrists treating him consider this to be "an abnormal illness belief".

Dr Speedy

Dr Speedy has let himself get carried away. Brian Nicholson has not been sectioned because he has ME. He has been sectioned because, in a delusional state, he is behaving in a way in which he is likely to kill himself. He is a danger to himself. He is drinking vast quantities of fluid to try to control his POTS. POTS is a well recognised medical condition of uncertain aetiology. It is not just found in people who think they have ME. Brian’s delusional state leads him to believe that he can control his POTS by drinking vast quantities of fluid.

Sadly, you cannot have a rational discussion about such an issue with the militant ME brigade. They have sprung into action. There is already a Facebook site run by a teacher who considers that being a teacher gives him as much knowledge and experience as a psychiatric nurse. Teacher/nurse says:

Brian was drinking dangerous amounts of water in an attempt to treat his POTS but this was only because he had been abandoned by the medical profession in London. Now he is told light and sound sensitivity is an "abnormal illness belief" and that his sitting for hours with the TV turned off is crazy

Facebook.

This a golden opportunity for the ME politicos. Nasim is in already, plugging her book:

This is APPALLING and INHUMANE. Where can I read more about Brian's plight? What more can we do to support him?I have had virally-induced ME for 25 years, I am the author of 'The State of Me', a novel about a young woman with ME.

Andrea, meanwhile, wants to plug her new website

I run the Blue Ribbon Campaign for me/cfs. I am not well enough to write a "news story" but would like to put Brian's story and updates on website?

It's a shame. Brian Nicholoson's best interests will not be served by this blinkered, agit-prop, self-publicising lunacy. He needs the services of an Independent Mental Health Advocate. It is an even bigger shame that the activities of people like Teacher/nurse and Nasim and Andrea only end up in all ME sufferers being labelled as mad. They are not. There are some people with serious hitherto undiagnosed medical problems who have had the ME label stuck upon them. They are genuinely ill and they need help. And by help, I do not mean an offer of CBT.

As regards Brian Nicholson's mental health section, there are two simple issues. Is it right that someone who is likely to kill themselves whilst in a delusional state can be compulsorily admitted to hospital for psychiatric treatment? If you accept that it is, do you think that such patients should not be compulsorily admitted if they think they suffer from ME?

Is Polly Toynbee ill?

Galileo

Gordon Brown must go – by June 5

He made the rich richer and the poor poorer. The Labour party can't go into the next election under Brown's leadership

Polly Toynbee

Poor old Polly. I wonder if she is ill? Every word of this piece must have hurt. Still,

"I say unto you, that likewise joy shall be in heaven over one sinner that repenteth, more than over ninety and nine just persons, which need no repentance.

We can now expect Polly to be a guest writer at the Devil's Kitchen; and meanwhile my ageing Greek friend has imploded.

Stephen Fry : bi-polar broadcasts

Wat Tyler exposes a piece of fulminating hypocrisy from our much loved national treasure, Stephen Fry.

Which Fry do you prefer? This one, or this one?

The two Frys neatly bookend twelve years of New Labour government. The first, young and suave, but the second…well, what can I say? He looks shagged out. As is the government.

Dr Crippen likes Stephen Fry. Who does not? But I do wish he would shut up about bi-polar illness. He seems to portray it as really rather fun. Maybe it is when you are a multi-millionaire celebrity and are being seen and treated by the private psychiatrist of your choice.  Life is not like that for my patients who suffer from this disease. How many of them get a routine head scan?

I wish Fry would do a documentary on an “ordinary” citizen with bi-polar depression and surreptitiously film him as he is bounced round his local CMHT.

Acupuncture : more wibble from The Times

Emeritus Professor of Wibble

The mainstream media’s love affair with alternative “medicine” has always puzzled doctors. Acupuncture in particular has a huge fan base, even though there is not a jot of evidence to show that it is anything more than an elaborate placebo. Has something changed? Today, the Times reports on a research paper from the respected Archives of Internal Medicine:

Scientists find acupuncture can help to relieve chronic back pain

Not really. That is not what the paper shows.

If you look at the paper itself, rather than The Times treatment of it, the conclusion is that:

It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.

Annals of Internal Medicine

Quite. Pseudo-science. It does not matter where you stick the pins. Put them in at random. It will still "work". Elaborate placebo. Wibble. 

Comrade news (2)

The BMA has drawn up a list of all the current healthcare professional titles in alphabetical order. Of course they are all necessary, comrade. The NHS is a big organisation.

Academic (doctor)
Advanced critical care practitioner

Ambulance care assistant technician

Anaesthesia practitioner

Art therapist

Art tutor

Assistant critical care practitioner

Assistant practitioner (radiography)

Assistant theatre practitioner

Associate specialist

Audiologist

Auxiliary nurse

Cardiac clinical scientific officer

Cardiac physiologist

Cardiological technician

Charge nurse

Chiropodist

Clinical academic (doctor)

Clinical academic fellow (doctor)

Clinical gastrointestinal (GI) physiologist

Clinical lecturer (doctor)

Clinical manager


Clinical nurse specialist

Clinical perfusion scientist

Clinical psychologist

Clinical research fellow (doctor)

Clinical respiratory physiologist

Clinical support worker

Community matron

Consultant (doctor)

Consultant nurse

Counselling psychologist

Deputy ward/unit manager

Dietetic assistant

Dietician

Drama therapist

Emergency care practitioner

Endoscopy technician

Foundation year 1

Foundation year 2

GP general practitioner

GP specialty registrar

Group worker

Health care assistant

Health visitor

Health visitor specialist

Health visitor team manager

Hearing therapist

Hospital doctor

Hospital play staff

House officer

Imaging support worker

Junior doctor

Lead nurse

Lead specialist

Lecturer (doctor)

Maternity care assistant

Maternity support worker

Medical care practitioner

Medical student

Midwife

Midwife consultant

Midwife team manager

Modern matron

Music therapist

Nurse

Nurse advanced

Nurse associate practitioner

Nurse associate practitioner acute

Nurse consultant

Nursery nurse

Nurse specialist

Nurse team leader

Nurse team manager

Nursing auxiliary

Occupational therapist

Operating department practitioner

Optometrist

Orthopaedic technician

Orthoptist

Orthotist

Paramedic

Perfusionist

Perioperative specialist practitioner

Pharmacist

Phlebotomist

Physician assistant

Physiotherapist

Plaster technician

Podiatrist

Practice nurse

Pre-registration house officer

Professor (doctor)

Prosthetist

Psychologist

Psychotherapist

Public health doctors

Radiographer ' diagnostic

Radiographer ' therapeutic

Radiographer assistant

Radiotherapy radiographer

Reader (doctor)

Registered nurse

School nurse

Senior doctor

Senior house officer

Senior lecturer (doctor)

Senior specialist nurse

Senior staff nurse

Sister

Specialist doctor

Specialist nurse

Specialty doctor

Specialty registrar

Speech and language therapist

Staff and associate specialist grade

Staff grade (doctor)

Staff nurse

Surgical care practitioner

Theatre nurse

Theatre nurse specialist

Therapy assistant

Therapy helper

Trust grade (doctor)

Ward manager

Ward team leader

The Prozac Generation : it's all the GPs fault

When I started in general practice I, like most new GPs of my generation, started climbing the mountain of weaning my patients off benzodiazepines. I did not audit the numbers (wish I had done now) but I must have inherited a hundred or more people on mail-order prescriptions for these drugs. The "big three" were diazepam, nitrazepam and chlordiazepoxide. (Valium, Mogadon and Librium). There were plenty of others. They are all listed here. Lorazepam was always difficult but the one I learnt to dread most was oxazepam.

I started by taking all these drugs off repeat prescription. I issued a polite letter saying that I wanted to see all patients who took these drugs regularly. A handful of patients were outraged. One or two took their business elsewhere. The majority were, I think, grateful for some input, and were prepared to work at the various quitting strategies. Most were successful but I am left with a handful who remain on one of these drugs on a regular basis (two on diazepam, one on lorazepam and three on oxazepam). I have tried, and they have tried, but together we have failed.

The drug companies do not stand still. The benzodiazepines became unfashionable and so along came the “Z” drugs (zopiclone….). You can pretend they are harmless and not habit forming if you like. I try not to prescribe them.

The impact of the “Z” drugs was as nothing compared to the impact of Fluoxetine (Prozac). The new wonder drug. Harmless. Not addictive. Everyone in California is on it, darling. Lots of “me too” variations appeared. The current UK favourite is citalopram, but relatively new mirtazapine, a tetracylic antidepressant, is coming up fast on the outside rail probably because it helps you sleep.

Do these new drugs work? Mostly they do not because, mostly, they are prescribed inappropriately. Are they addictive? Not in the way that the benzodiazepines were, but there is a huge psychological dependence.

Today we hear that:

The use of anti-depressants in Scotland has continued to rise despite a promise to tackle overprescribing. Health boards last year recorded 3.9 million prescriptions, up from 3.6 million in 2006, official figures said.

BBC

Figures vary, but it seems that approximately ten per cent of Scotland is on anti-depressants or, more correctly, have had them prescribed. Some will not take them. Something wrong here. Do you think that ten percent of the population in Scotland is mentally ill? Certainly not. This must be the fault of the Scottish GPs who use a prescription pad to get the customer out of the room. If only GPs knew what they were doing. If only there was more “talking therapy” available.

Is it the GP’s “fault”? I’m sure that a few do reach for the prescription pad more quickly than they should. But most, I believe, do not. It is not as simple as that.

Jane is a young, unmarried mother with two small children and no partner. The two fathers of her two children are long gone. She lives in a pokey one bedroomed ‘bed and breakfast’ flatlet whilst she waits (and waits) for more suitable accommodation. Her own mother is also a single parent, still looking after Jane’s youngest brother who is not much older than Jane’s own children. Jane gets no support from anyone. She cries a lot. She has recently started some self-harming. Her doctor referred her to the CMHT who gave her a self-help book entitled “Depression : coping strategies” and arranged for her to attend the BICS. (Brief interventional counselling service). Jane did not feel the BICS was helpful, and did not turn up for the last two of the six sessions she was offered.

One day, she presents to her GP. And sits and cries and cries and cries and says “please, please give me something, anything to help”.

Jane needs decent accommodation, a supportive partner with a well-paid job, and a caring mum and dad living round the corner. Her GP listens to her, and runs half an hour late, and brings her back two days later for a longer appointment, and still she whimpers and cries and begs for help.

Jane is not psychiatrically ill. She is not depressed in a medical way. She is stressed, lonely, hard-up and, most of all, she lacks support from her family. She will not respond to “talking therapy”. She is not likely to respond to an antidepressant but, sooner or later, she is likely to get one. It may have a placebo effect but that is all.  The GP feels uncomfortable and slightly dishonest prescribing it, but he is human, and caring, and wants to do something, anything, to help.

That is how it happens. Cast not the first stone.

Corruption, dishonesty, fraud and cover-up.

Professor Allyson Pollock

The proper and productive use of public money is an indispensable element of any modern, well managed, and fully accountable democratic state. The evaluation and monitoring of a contract between the public and the private sector should be relatively straightforward—payment given for services rendered—but our analysis raises four main issues, which are supported by other commentators:

• First, lack of access to data... 
• Second, incompleteness of data...
  
• Third, in this instance the contract…departed radically from normal reporting and costing…
  
• Fourth, the government’s failure to release the value for money methodology means that the claim has no basis in evidence… 

Professor Allyson Pollock

Professor Pollock might be talking about MPs expenses. In fact she has been investigating a far more important matter. Whilst the country is obsessed with the greed and venality of our elected representatives, far greater sums of money than even MPs could spend are squandered every day on the NHS. The RCN has just reported that the government spent a staggering £350m on external management consultants in the last financial year.

How can they get away with this? Maybe Dr Grumble has the answer, for today he reveals that he has had to sign the Official Secrets Act, presumably to try to stop him from drawing our attention to yet more proven example of waste within the NHS.

It is easy to understand and thus be outraged about taxpayers’ money being spent on pornographic videos and patio heaters. When doctors start talking about ISTCs and PFIs, however, even though the sums of money wasted thereon dwarf the excesses of our MPs, some background explanation is required.

Since 2000, the Department of Health has had an explicit policy of using NHS funds to contract out some elective surgery and associated clinical services to the private for profit sector. This policy of commercialisation is known in England as the Independent Sector Treatment Centre (ISTC) programme

Professor Allyson Pollock

ISTCs are Independent Sector Treatment Centres. They are the road to backdoor privatisation. Now Dr Crippen has long since given up worrying about the doctrinal approach to health care. If it works, bring it on as far as I am concerned. Nontheless, let it be noted that ISTCs have been actively promoted by a Labour government. ISTCs have not been a success. Because of that lack of success and also probably because of doctrinal embarrassment the government has clothed the whole ISTC operation in secrecy.

The government sold ISTCs thus. There is a long waiting list for cataract operations and the NHS does not have the capacity to do the necessary operations within a reasonable time scale. So let us ask private clinics to do the work. The private clinics said they would only set up shop if the government guaranteed them a good income even if there was no work to be done. The government agrees to that stipulation. Can you imagine Sir Stuart Rose offering to pay M & S subcontractors even if he placed no orders with them? Is it any wonder NHS is losing money?

That is a gross over simplification, and there are many other issues. Quality control and the deskilling of NHS trainee surgeons who are deprived of work experience to name but two. 

It gets worse. The government did not do the groundwork properly. Some of the ISTCs were set up in areas where they were not needed. Needed or not, the government still had to pay the private clinics to sit and twiddle their thumbs. 

The House of Commons reported on ISTCs three years ago. They concluded:

ISTCs have not made a major direct contribution to increasing capacity, as the Department of Health has admitted. It is far from obvious that the capacity provided by the ISTCs was needed in all the areas where Phase 1 ISTCs have been built, despite claims by the Department that capacity needs were assessed locally…We are concerned that the Department has attempted to misrepresent the situation

House of Commons ISTC report

How do you cope with government dishonesty and secrecy? The same way that you cope with the dishonesty and screcry that surrounded MPs expenses. You use your rights under the Freedom on Information legislation. And that is exactly what Professor Allyson Pollock, Director of the Centre for International Public Health Policy, University of Edinburgh, has done. Some will already know Allyson Pollock for her excellent articles in the Guardian. She takes no prisoners.

The government's new white knight has come to the rescue of the NHS. The newly appointed labour peer and surgeon Lord Ara Darzi has just published his latest unevidenced, planning-free, interim review. It reveals a return to pre-1940s thinking and the launch of US-style healthcare - deserts of poor quality or no healthcare for the many millions (primary care polyclinics) and a few little islands of excellence for the lucky few.

The New Profiteers : Allyson Pollock

Lord Darzi, the unelected health minister, has signalled that Labour will continue to dismantle and privatise the NHS delivery system, its staff and services – handing taxpayers' funds to multinational companies, and remodelling the service along the lines of US healthcare. It is all a far cry from their 1997 manifesto pledge: "Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working cooperatively for patients not a commercial business driven by competition."

Markets introduce new costs that do not occur in integrated public services: billing, invoicing, marketing and profits. All these divert resources and funds away from the service, creating enormous inefficiency. So what is the government up to?

Farewell to a free NHS : Allyson Pollock

IN the BMJ this week, Professor Pollock, discusses the information she has been able to gather by using the Freedom of Information legislation. It was like getting blood out of a stone. It reveals a tale of duplicity, incompetence, fraud and secrecy as, once again, the government tries to cover up the way in which billions of pounds of taxpayers’ money has been squandered.

No wonder Dr Grumble and his colleagues are asked to sign the Official Secrets Act.

Health ministers have been feeding at the expenses trough too

Ben Bradshaw and Phil Hope with colleagues

Much sport is to be had looking at MPs' expenses. It is always easy to attack the status quo, but this is a turkey shoot. They are all “at it”, some more than others, and even the saintly Dennis Skinner has made some claims.

Two junior health care ministers, Ben Bradshaw and Phil Hope, feature in tomorrow’s Daily Telegraph story. Tories should enjoy it whilst they can, for next week they will be under the microscope. And then, before the furore dies down, it will be the Lib Dems. What has been done has been done within the rules. The rules are flexible and allow for much feeding at the trough.

For sure, the rules need to be changed. Secretarial and administrative support should be provided but not be a back door through which MPs’ families can access the trough. Build a block of flats – decent ones – for MPs to use when they are in London but let us stop subsidising their property speculation.

Ben Bradshaw, the Health Minister, switched the designation of his second home to a property he shares with his partner in west London. Although the couple initially split the mortgage costs, Mr Bradshaw now claims the entire interest bill on the property – despite owning only half the property.

Daily Telegraph

Whilst I shall not be weeping crocodile tears about Ben Bradshaw taking a pasting from the media, it is hard to avoid the conclusion that there is latent homophobia underlying that comment. Were there a mainstream, "conventional" Mrs Bradshaw, who would have raised an eyebrow at the fact that he pays the whole mortgage himself?

Good sport it all may be but, overall, I do not take much pleasure from it. MPs are woefully underpaid and they have to rely on the fringe benefits. It’s vulgar and venal and undignified but this is what people do and MPs are people.

We need to pay our MPs a decent salary, commensurate with the responsibilities of the job they do. There will be howls of anguish and disagreement, but I would suggest £100,000 a year. Provided always that the expenses trough is closed.

+++++++++

For a predictably more...er robust approach to the problem, take a look at the DK, here and here.