Archive for August, 2011

Looking beyond the headlines on the box

By Bob Bury - 31st August 2011 9:51 am

Well, I thought someone else was sure to write about this, but they haven’t.

Were you as alarmed as me to see the headlines telling us that every hour spent watching TV reduces your life expectancy by 22 minutes? It wasn’t the content of the headline that alarmed me, it was the knowledge that if I read further, I would find yet another example of dodgy ‘research’ and shite journalism which would raise my blood pressure to a dangerous degree, but that I would have have to read it anyway. And so it proved.

The Australian researchers had analysed the results of a large population lifestyle study (the Australian Diabetes, Obesity and Lifestyle Study), looking at data collected between 1999-2008. They concluded that watching six hours of TV a day reduces life expectancy by 4.8 years, compared with freaks who don’t watch any TV (I wonder how many of those there were? I don’t know because I could only be arsed to read the abstract).

Now that’s bad enough, given that if you’re watching TV you clearly aren’t taking exercise at the same time, unless you’re tuned in to the porn channel. If you watch six hours a day, you probably aren’t taking any exercise at all, other than trips to the fridge for more beer during the adverts, and that can’t be good for you, can it, regardless of whether you’re looking at the TV or at the empty space in the corner where any right-thinking person would put a set ?

I can’t believe that they isolated TV-watching as an independent variable, unless they had a large control group who watched no TV, but also took no exercise and had a rubbish diet. And even if they did, there’s another aspect of the results that wasn’t reported in The Telegraph (shame on you) or Mail (to be expected). If you look at the confidence limits (or the uncertainty interval as they call it, in line with recent trends), you get some idea of their data quality. That 4.8 hour figure has a 95% uncertainty interval of 11 days to 10.4 years. In other words, the TV effect could be bugger all or a decrement of a decade.

If we read a paper on the effects of a new drug with that degree of uncertainty, NICE would want to wait for a bigger, better study before approving it. Still I suppose that trying to explain confidence limits to a Mail reader would be a pretty thankless exercise.

They then piled uncertainty on uncertainty by producing that meaningless 22 minute figure. They must have known that this would be the number that appeared in the headlines. Of course, what they are saying is that if six hours per day in front of the telly has the effect they claim, then each hour of viewing would be responsible for 22 minutes of life lost for that particular cohort of sad losers. What it doesn’t mean is that if a slim, normotensive paragon of lifestyle virtue like myself sits down for an hour to watch an improving documentary on BBC2, I’ll be scything 22 minutes off my natural span. But that will, of course, be how it is interpreted by most readers.

As Jerry would say, what a load of arse!

NHS medical director wants consultations by Skype

GP - 30th August 2011 12:22 pm

Consultations may be held online to improve patient access to GP services, according to the NHS medical director.

Professor Sir Bruce Keogh said online tools such as Skype could give patients convenient access to their GP at any time.

His comments came at the launch of a call for health professionals to submit ideas for smartphone health ‘apps’, held in London last week. Sir Bruce said he was investigating how online consultations could work in the NHS.

“I am looking at how we can put levers into the system to encourage doctors to do online consultations,” he said.

“Once you have online consultations, it breaks down geographical boundaries. It opens up the spectre of 24/7 access.”

Read more at GP.

“Secularism has trashed our cultural roots”

By Tom Goodfellow - 11:33 am

I suppose I had better get on with writing this blog; it has been festering away for a week or two. I expect it will irritate quite a lot of people because it is a bit of a Peter Hitchens.

Now that the dust and flames are settling after the August riots, the various pundits are waxing lyrical on the underlying causes which precipitated the dreadful violence and criminality. The politicians are all blaming each other’s policies. Sociologists, educationalists and Uncle Tom Cobley and all are all rabbiting on about “marginalised youth” and “gang culture”, but what has shocked us deeply has been the uncomfortable fact that many of the looters were from perfectly normal backgrounds, and not just from ‘dysfunctional’ families.

But there is a huge elephant-in-the-room which all but a few are carefully ignoring. This is that over the last few decades secular society has decided to trash our historic Judeo-Christian cultural roots, and in my view has put nothing of value in its place despite claims to the contrary. Whether or not one believes in the key tenets of Christianity, its principles have underpinned our society for centuries.

Remember the Ten Commandments? Don’t steal, don’t murder, don’t be envious, respect your parents et al. Rather pertinent stuff in view of what has happened! And, perhaps more controversially, love your neighbour as yourself (i.e. don’t loot and burn his shop), love your enemy (i.e. don’t try to stab him), do good to those who treat you badly and don’t store up for yourself riches on earth (looters and bankers please note)! It will be the meek who inherit the earth not the arrogant, and if you want to be shown some mercy then perhaps you should be more merciful yourself.

“Oh no,” I hear you say. “We are about to be subjected to pious, self-righteous, we-told-you-so, finger-wagging, anti-Dawkins, God-squad sermonising!” Well you would be wrong, or at least only partly right, because the finger-wagging is in quite another direction which may surprise you. Let me explain (and it is time to get medical).

Over 40 years ago I was a fresh-faced, rather naive medical student. On my first medical firm we were asked to take a history from a young man who had reactive arthritis, or as we called it then Reiter’s Syndrome. His had been triggered by a sexually transmitted disease, gonorrhoea I think. The point at issue was that he was an ordinand and theological student at a well-known London theology college and by his own admission was deeply promiscuous with both sexes. While we waited for the consultant to turn up he entertained us with an account of a filthy ancient Greek play which he and his fellow students were producing. He appeared totally unabashed at the moral issues associated with his medical predicament.

My fellow students in the firm, most of whom were not particularly religious, expressed deep surprise that this guy was being considered for ordination into the Anglican Church since his life-style seemed so at variance with his purported creed.

As a young Christian this encounter had a profound effect on me. I subsequently came to learn from various sources that he was part of a deeply rooted culture at this college among a significant number of the students (although obviously I am not suggesting that all were like that). Morality was relative, and largely conformed to the cultural norms of the sixties. Interestingly I heard a senior Anglican cleric on the radio a year or so ago admitting (without embarrassment) that he had been part of that culture where they gave each other women’s names like Mavis and Edith. This would be pathetically funny if it was not so tragic.

Both the New Testament and the GMC tell me not to judge and I do not know what became of the patient. However I know that many of these students went on to become clergy in the Anglican Church, some achieving very senior positions.

But, as is always the case, behaviour follows belief and the rot had started long before this. Regarding their ministry as a career rather than a calling they replaced sound Christian teaching with liberal theology and relativistic morality. The clear evidence is that this stuff destroys belief and empties churches. At the end of his brilliant essay written in the fifties, Fern Seeds and Elephants C.S. Lewis, perhaps the greatest modern apologist for the Christian faith, states: “Once the layman was anxious to hide the fact that he believed so much less than the vicar; now he tends to hide the fact that he believes so much more.”

Apologies if this offends committed Anglicans, but the other historic denominations fare little better. Paedophilia, cruelty and the cover-up have badly damaged the reputation of the Roman Catholic Church. Methodism, once a vibrant break-away movement from the dead religious institutionalism of the eighteenth century, has also sunk under the mire of wishy-washy liberal theology and relativism. Is it any wonder that their congregations are fast vanishing? Of course there are traditional churches which are shining lights amid the encircling gloom (I have greatly benefited from some of these), but relatively few and their numbers are falling.

This does not mean that the church is dying out in the UK, quite the contrary. It has merely largely moved outside the institutional, and many of these independent churches are thriving and growing. But their voice is now rarely heard or listened to as modern secularism, at least for the present, holds sway.

The rioters were not so much immoral as amoral. Where the institutional churches have failed, in my view modern secularism has also failed to provide any alternative moral framework for raising young people. If you hack away at the roots of a tree the leaves will soon start to wither and fall, the branches will break and ultimately the tree will crash to the ground. I believe we are seeing this being worked out on the streets today and for the present there seems to be little we can do to stop it!

Health unions set up Pensions Campaign Group

By Mike Broad - 11:16 am

Health unions - including the BMA - have set up a campaign group and are discussing the potential for NHS-wide industrial action over the government’s controversial pension proposals.

A joint statement was released following a meeting of the health unions last week which warns the government against issuing “unrealistic ultimatums” on pensions and said it would consider industrial action if talks “fail to make progress”.

The BMA said that 90% of the 1,000 responses to the Department of Health’s consultation on the pension proposals have been contributed by doctors. This, it suggests, shows the disquiet within the profession over the plans. Talks with the government are ongoing but have proved to be “limited” and “frustrating”, according to one insider.

The joint statement by the unions said: “One of the clear aims of the Pensions Campaign Group is to ensure that patient safety remains paramount. The group will look at all issues relating to the pensions negotiations, including the possibility of industrial action in the event that the talks fail to make progress.”

It added: “The unions remain committed to pension negotiations and expect the government to reciprocate and not set out unrealistic timetables or ultimatums.”

Unions attending the summit alongside the BMA included Unison, Royal College of Nursing, the TUC, Royal College of Midwives and Managers in Partnership.

In addition to proposals from the Hutton review - to raise the retirement age and replace a pension based on final salary for doctors with one based on average earnings - the government has also released plans to increase doctors’ contributions. Consultants currently contribute 8.5% of salary but this could increase to 10.9% by 2012, and possibly as much as 14.5% by 2014.

BMA modelling suggests that some doctors could end up paying over £200,000 more over the course of their careers for a worse pension deal on retirement.

Read a blog on the issue, and another.

Health Bill “will let Lansley wash his hands of NHS”

The Guardian - 29th August 2011 9:32 pm

The health secretary will be able to “wash his hands” of the NHS following forthcoming legislation which will take away his duty to provide a national health service, according to legal advice funded by campaigners.

The legal opinion, commissioned and paid for by members of the 38 Degrees website, justifies the widespread public concern about the government’s health reforms, in spite of Andrew Lansley’s assurances that he has listened and responded to criticisms, they say.

The independent legal team says the health and social reform bill removes the health secretary’s responsibility for NHS provision through a “hands-off” clause designed to give autonomy to commissioning groups.

David Babbs, executive director of 38 Degrees, said one legal opinion suggested responsibility for provision would instead fall to an unknown number of “clinical commissioning groups”.

Read more at The Guardian.

Revalidation holds opportunities for SAS doctors

By Dr Anthea Mowat, trust appraiser, BMA SASC member and LNC chair - 27th August 2011 9:53 am

In the past appraisal for SAS grade doctors has not been done well, if done at all. A common experience has been an enforced chat in the coffee room at short notice, carried out in a hurried fashion, and ignoring evidence that has been brought (should any have been collected of course).

It can leave people disenchanted with the feeling that appraisal is a pointless tick box exercise. That is a real shame as, when done well, appraisal is a useful exercise that can help us develop our careers, even if it is slowly!

Fortunately, appraisal for SAS doctors is improving and recently, I have had a much more positive experience of appraisal. I have been encouraged to develop new skills, undertake new learning, and to consider my work-life balance. When else do we get a chance to talk about ourselves, the amount of work we do, or our hopes and dreams - especially over tea and cake?

I would certainly not be doing everything I currently do without the appraisal process. It is a good way to explore plans for the future and give an undertaking to carry it out. Listing an objective of something (realistic) we want to do makes it more tangible, and more likely to be completed.

I have also experienced the process from the other side of the table as an appraiser. It has been an opportunity to learn about the fantastic work carried out by my colleagues, both SAS and consultant, some of which has been previously unseen or unrecognised by me. I have been able to encourage them, and it is very rewarding when they achieve something and I can share their pleasure in that.

The advent of revalidation is driving change in how appraisal is perceived. It will no longer be possible to avoid the process, and there will be a list of evidence that will be required. I believe this should hold no fears, as the evidence that will be needed is the same as that which should already be provided for a good appraisal.

Some differences are the inclusion of multisource feedback, and the need for reflection. While some will regard this as ‘navel-gazing’, it does make you think about the quality of courses that have been attended, and how any learning can benefit us and our patients. Taking the time to think about what has been learnt on courses helps put the leaning into practice and considering care in cases that have gone well, or not so well, can help us improve the care we give our patients. Improved appraisal can also help with job planning as clear objectives from your appraisal can be included as personal objectives in your job plan.

The new appraisal system should be an opportunity to be embraced. Appraisers should be trained to ensure consistency and stop the variation between cosy chats and an inquisition. But to get the most out of appraisal it is important you have a clear understanding of the process. To help you navigate the process, the BMA has produced a comprehensive guide to appraisal, which is included in the new e-handbook for SAS doctors.

Addenbrooke’s sued over ‘do not resuscitate’ rules

The Guardian - 9:36 am

The husband of a woman who died in one of Britain’s best-known hospitals is taking its management and the health secretary Andrew Lansley to court, alleging an illegal use of “do not resuscitate” orders.

David Tracey claims doctors at Addenbrooke’s hospital, Cambridge, twice put such orders in his wife’s medical notes, cancelling the first after she objected to it only to put in a second three days later without her consent or any discussion with her.

Tracey alleges the hospital’s actions deprived his 63-year-old wife Janet of the right to life and subjected her to degrading treatment, while he was denied respect for his personal and family life.

He is also seeking to force the coalition government to draw up a policy for England on the use of Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) instructions, and claims the present system of local policies is open to abuse.

Read more in The Guardian.

‘The disappointed mother’ - a B-movie about exams

By Sarah Burnett-Moore - 26th August 2011 9:17 am

Today I am deeply disappointed.

It’s the first of those seminal parental days, when the exam results that start to count come in. We are in Crete so Perry’s GCSE results were a little late. By 11.10am I had established by text that Perry’s best friend, James, got a B in Art, five As, and four A*s. By half past I was a deeply disappointed mother.

I wasn’t disappointed by the A in Biology, or the C in French - frankly the latter was a miracle - but by the slew of Bs in between. I wasn’t disappointed that I would only have to buy him one genuine Ralph Lauren Polo shirt, the likes of which you can’t buy in Crete. I wasn’t disappointed that he won’t get in to his posh boarding school, because he has.

I was a bit disappointed that by nearly one o’clock, he hadn’t surfaced to share my disappointment. I wasn’t disappointed that somehow my mother is going to make this all my fault. I don’t know whether to be disappointed that on the way to the beach to write this I got asked if I was Norwegian.

What really, really does disappoint me is that in the eyes of bourgeois intelligentsia he will be viewed as a failure. He doesn’t want to be a doctor, or a dentist, or a vet or go into one of the tiny minority of jobs where academic qualifications actually matter. Yet the pushy mummies around me will look askance when I shamefacedly have to fess up his results.

In fact my son is brilliantly clever, just not in the way that tends to show up in exams. He’s got more smarts than his full house A* mates. He could have someone’s eye out with his wit. He’s a blond model and actor starring in music videos and Nintendo ads (my daughter is currently in a Tesco car insurance advert, you can’t have it all). He can charm the scanties off any woman he’s not related to, and he’s even clever enough to have convinced an educational psychologist that he’s dyslexic when he patently isn’t.

He has both an inquisitive and acquisitive mind. He’s brilliant at pub quizzes - in fact he’s just come over to inform me that the world’s tallest dwarf (medically) at six foot eight, is also the world’s shortest giant. Timing. The problem is that an admissions tutor is going to look at his results and think he’s thick.

Then the horror started, a text from pushy mummy numero uno: “How did perry do? (sic)” Perry asked me to lie. “Not very well,” I replied. “All Bs apart from one A and a C.” Response: “I would be pleased, george got all b’s (sic).”

Maybe I don’t feel so disappointed after all.

Concern as doctors’ community sold to US company

Pulse - 25th August 2011 2:03 pm

GPs have raised ethical concerns after the online community Doctors.net.uk was bought for a reported £13 million by the US marketing company M3 USA.

Doctors.net.uk was created ‘for doctors, by doctors’ in 1998 and now has 184,000 members, but was bought by M3 USA this week.

Aki Tomaru, CEO of M3 USA, said: “The addition of Doctors.net.uk is a powerful expansion of our commitment to providing the pharmaceutical industry full global access.

“The demand for pharmaceutical digital marketing services in the UK market is expected to grow rapidly in the coming years and this acquisition will place M3 at the leading position to benefit from the growth. This acquisition will also be a nice stepping stone for M3 to expand into the countries in the European Union.”

But the announcement has caused concern among GPs. Dr Una Coales, a GP in Stockwell, South London, said Doctors.net.uk users were annoyed that they didn’t give their consent before the forum was sold.

She said: “The sale means only one thing; the obvious. Big Pharma want access to 180,000 UK doctors to perhaps influence prescribing.”

Read more at Pulse.

“Speak out over Health and Social Care Bill”

By Mike Broad - 10:39 am

Doctors are being urged to make their feelings known on the NHS reforms as the government’s advisory forum is reconvened and the Health and Social Care Bill goes back in front of Parliament.

With the Bill set to have its third reading on 7 September in the Commons, before going on to the Lords, the BMA is urging doctors to lobby their MPs and Peers over the controversial reforms.

In April, the government halted the parliamentary progress of the Health Bill amid mounting criticism from academics, health unions and MPs. The Bill’s intention to give patients more choice by encouraging competition between health providers from the public, private and voluntary sectors had proved controversial.

The Future Forum canvassed views of the public and professionals over a two-month period before producing a list of recommendations that included more multi-professional involvement in commissioning and the dilution of Monitor’s role as a promoter of competition.

The amendments are still considered unacceptable by the BMA and NHS Consultants’ Association, which are writing to all MPs calling for the Bill’s withdrawal.

Chair of BMA council Dr Hamish Meldrum said: “The more individual doctors who contact their MPs about the problems with this Bill, the better, and the more it will support our efforts to get the current bill withdrawn or, failing that, significantly changed.”

Other senior physicians hope the government’s reconvening of the NHS Future Forum heralds a further climb-down on competition. It is to undertake a fresh round of consultation with professionals and patients on the reforms, with a particular view to how different health providers can be integrated.

Sir Richard Thompson, president of the Royal College of Physicians, commented: “The RCP supports the increased emphasis on quality, collaboration and integration, and the removal of references to ‘promoting competition’ in the Health and Social Care Bill as a result of the previous listening exercise.

“However changes in tone and wording must be backed up by a regulatory and pricing system that also values quality and collaboration over competition and choice of provider and ensures hospital doctors retain a strong voice in the new system.”

The Forum will also investigate education and training after the government shelved controversial proposals to scrap deaneries.

“The functions of postgraduate deaneries, including essential quality assurance, must be retained over the long term,” said Thompson.

The BMA continues to be concerned about the ‘inappropriate reliance on market forces’. The government bowed to pressure to remove aspects of the Bill that would have enforced competition in the NHS but has not yet abandoned plans to strengthen market forces through its policies on patient choice and ‘any qualified provider’, it says.

It is also concerned about complexity and bureaucracy. The BMA fears changes to the Bill following the government’s listening exercise have introduced further processes that could complicate the NHS. There is a lack of clarity about the roles and responsibilities of clinical commissioning groups, clinical senates, health and well-being boards, local authorities and the NHS Commissioning Board, it says.