Friday, 31 December 2010

Thought for the new year.

The best anti-depressants on the market are not made by Pfizer, GSK or Lilly. They are made by Cadburys, Fullers, and Harley Davidson.

Happy new year.

How much!?

Other bloggers out there have commented on the media tendency to doctor bashing, and the usual inaccuracy involved. Well the Independent is joining in today having a go at NHS Consultants. Apparently the average salary of an NHS Consultant is £120,900 pa. That is news to me and all the colleagues I have shown this article to today. Now I know we have a pretty good rate of pay but none of those I asked gets more than the top increment of £100,446, and many of them do not even get that. Still we would not want accuracy to get in the way of a good story now would we?

Thursday, 30 December 2010

Herbal medicine

There is a commonly held belief that herbal remedies are somehow safe because they are “natural”. There is also some confusion between homeopathy and herbalism which reinforces this view. Homeopathy is of course totally safe as it does not have anything in it, but that does not stop some people believing it works. For possibly the most extreme and deluded view on what it is effective for look at this, and weep.

Herbal products however often contain active pharmacological substances some of which can be toxic. You would think therefore that those who favour herbal medicine would approve of measures to make the practice safer. Testing to ensure quality and safety of herbal products is to become mandatory next year, although there will still be no requirement to show efficacy. 

These are fairly basic and desirable requirements I would have thought, but the advocates of herbal medicine disagree. They feel that the standards applicable to pharmaceutical products should not apply to them. They feel they should continue to be able to dispense potentially toxic substances, with little or no efficacy and potentially serious side effects without regulation.

If you read the comments to these two articles (1) (2) it is clear that there is a great deal of utter ignorance and stupidity out there. The usual ill informed views are peddled, including the accusation that this is all a conspiracy by the pharmaceutical companies, and doctors are all in their pay.

Now I know the pharmaceutical giants are not without fault, and I will be posting in the near future on one of their nastier practices. But by and large they deliver the goods. In just 100 years their products have transformed the practice of medicine and contributed enormously to the huge increase in life expectancy. An increase not found in the days when CAM practices were all there was to give patients. 

And at least I know if I take a modern drug what is in it, what is not in it, it’s exact strength and how it might react with other medication I might be on. I know the company has spent millions on testing it and that they are not allowed to promote it for conditions for which it has no license. 

Which is more than you can say for herbal medicine.

Tuesday, 28 December 2010

Cosmetic surgery?

In one of my previous posts I commented on some of the medical conditions now treatable on the NHS that were perhaps not quite what Bevan had in mind when he brought the NHS into existence.

To the list of these conditions I think can be added the operation of hymenoplasty, an operation to restore  a ruptured hymen, in order to convey the illusion of virginity. My use of the word illusion is quite deliberate. You can restore the anatomy but virginity, once gone is gone forever.

This is not an uncommon procedure in the private sector, with a typical cost of £4000, but it is also increasingly being done on the NHS, most commonly on moslem women who need their husband to believe in the wife’s virginity on the wedding night.

Before my stance is misinterpreted I have to say that I am entirely in sympathy with this procedure being done on the NHS. I disagree totally with those who feel that this is a purely cosmetic procedure. Bearing in mind that many of these women live in a situation where “honour killing” is a very real threat, even in the UK, I think there is a strong argument that this is in fact a life saving procedure.

Honour killing is a strange term. I don’t see much honour in a group of armed men targeting and murdering a single defenceless woman. Is there a similar sanction against a man who is not a virgin on his wedding night? Presumably he is taken to one side and told he is a very naughty boy.

Friday, 24 December 2010


It is many years since I published any research and the thought of ever having to do any again fills me with loathing, usually. But here is a project I wouldn't mind getting involved with.

Tuesday, 21 December 2010


“A man is not finished when he is defeated. He is finished when he quits.”

Monday, 20 December 2010


One or two people in the past have criticised me for my choice of language. In fact it appears that I have been using one of the most versatile and expressive words in the English language.

Sunday, 19 December 2010

A rock and a hard place

There is no doubt that patients’ lifestyles influence their state of health. Their dietary habits, alcohol consumption, smoking and sexual practices are the main, but not only factors in this. To doctors this is of limited relevance. Certainly we should adopt a preventive role in advising our patients of their lifestyle practices that can potentially impinge on their health, but even this has it’s limits. While no-one would argue that we should encourage our patients to stop smoking, how many doctors would advise patients to give up horse riding (128 deaths/yr per 100,000 participants) or other risky sports.

By the time patients present to us with the consequences of a lifetime of bodily abuse however lifestyle becomes unimportant when it comes to treatment options. At this stage we simply have to treat to the best of our ability. This is crystallised by the GMC good practice guide at para 7; “You must not refuse or delay treatment because you believe that a patient's actions have contributed to their condition.” and “You must not unfairly discriminate against them by allowing your personal views to affect adversely your professional relationship with them or the treatment you provide or arrange.  This includes your views about a patient's age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.”

So what do you do when your Trust proposes to engage in precisely that sort of discrimination as is happening here, and is going to require your co-operation to apply it. To co-operate puts you in breach of GMC good practice guidelines, while to defy puts you most definitely in the firing line as far as your employer is concerned.

The GMC does seem to have this covered as they state; “If inadequate resources, policies or systems prevent you from doing this, and patient safety is or may be seriously compromised, you must follow the guidance in paragraph 6.”
So what does it say at paragraph 6? This is where suddenly the crystal clarity suddenly deserts the GMC and they are a little more wooly” you should draw the matter to the attention of your employing or contracting body. If they do not take adequate action, you should take independent advice on how to take the matter further. You must record your concerns and the steps you have taken to try to resolve them.”  Firstly you are supposed to stick your head above the parapet and start making a fuss. And when, inevitably, your expressed concerns are ignored then what. Then all of a sudden it is for someone else (unspecified) to advise you. What a cop out. The logical next step of course is whistleblowing but as I have pointed out before this is likely to have catastrophic repercussions, despite the presence of legislation supposed to protect you. 

And when your Trust turns on you like a rabid psychotic dog, because you have followed GMC guidelines, just how much support do you suppose you will get from the GMC?

Friday, 17 December 2010

Ring fencing

Despite the promises of the new government to ring fence the NHS budget it now appears inevitable that financial cuts are on the way. And not small cuts either. Although various figures are being predicted there is no doubt that we are talking in the region of billions of pounds, possibly in the region of 10% of the whole NHS budget. (1) (2) (3) (4)

In fact financial difficulties are nothing new for the NHS and Trusts have been quite imaginative in how they have managed to extract extra funds directly from the punters to help balance the books. Parking fees for example, and the rip off that is patientline.

In addition there is the use to which charitable donations are put. I remember when donations from the League of Friends and WRVS were used to buy amenities for patients. TVs, radios, hair dryers, that sort of thing, to make patients’ stay more comfortable. These days these donations are increasingly used to buy essential medical equipment, that should come out of the Trust budget. In addition whereas in the past premises for these charities were provided free of charge by hospitals, many Trusts are now charging rent, and if the charity can’t afford the rent they find themselves replaced by private sector commercial traders.

Increasingly desperate Trusts are even asking already hard pressed staff, especialy nurses, to do extra unpaid work.

Yet in spite of all this difficulty the NHS are still able to fund “pastoral services”, estimated by the National Secular Society to cost the NHS in the region of 40 million pounds a year. Even the most cashed strapped Trusts still seem to find money for these services. That 40 million would pay for a lot of extra nurses, or support staff to enable the nurse to concentrate on nursing duties.

I have no doubt that some will misconstrue this as a suggestion that pastoral services should be removed from the NHS altogether, but it is not. I am simply questioning who should be paying for it. If we are charging rent on the charities who actually give all their profits to the NHS, is it too much to ask that the religious institutions pay their own way?

Thursday, 16 December 2010

Wednesday, 15 December 2010

Colleagues, Neurosurgery

NHS reforms

The NHS is going to be alright. The solution was blindingly obvious and it is nice to see our present masters have seen this and are going to make everything better.


I think that this article from The Onion strikes a chord with more people than would care to admit it


I have been asked to say where I stand on the present Wikileaks revelations, and have given it some thought. Trying to articulate my standpoint I find that one of the comments to a previous post does the job perfectly and I will simply quote that contributor.

""They too were done under that Free speech banner, but could've caused chaos on a global scale that would've perhaps even caused lots of killings and heartache everywhere, or damage to the trust between allies, or enemies" - I simply do not accept such rationalisations as a good enough reason to argue against the likes of WikiLeaks.

All of the conditions that you describe (global chaos, killing, heartache, loss of trust, etc) - all long predate Wiki.
For far too long we have trusted leaders (such as Blair) when the record shows time and time again that a healthy skepticism would have been far more appropriate - for example, remember all that tosh about WMDs - the 45 minute strike capability, etc?

In my opinion political factions might develop a more creative approach to solving various conflicts if there was MORE rather than less openness.

If we look back at the 'cold war' for example, we can see that paranoia was driven by secrecy, and all for what, eh - for the Russians to be hosting the 2018 world cup (sobs silently)

the a&e charge nurse

Tuesday, 14 December 2010


I have no objection to those who disagree with me making reasoned arguments in my comments and until now all comments submitted have been unmoderated. But there is always one who abuses the privilege and my resident troll has been getting steadily more abusive and strident. So much so that his last two comments have been deleted.

For the time being therefore I have reimposed comment moderation, because I can. Apologies to everyone else. Please don't be put off.

Monday, 13 December 2010

Yet more defiance

This is the now famous picture drawn by the Swedish artist Lars Vilks for which many believe he should be murdered. I have reproduced it because the more people reproduce it, the more targets there are for this vile intolerance. Then the true absurdity of the overreaction becomes more apparent. The picture is now widely available on the web on many sites and blogs. It has received far far more publicity than if it had been ignored.
What are they going to do, kill us all?

Saturday, 11 December 2010

More Defiance

Regular readers will know that I have a soft spot for the ice cream manufacturers Federici , not only for their rather nice ice cream but also for some of their advertisements, which, rather gently in my view, mock catholicism. A (very small) number of complaints have resulted in the advertising standards authority banning two of their adverts, bans which can only be considered as a gross, excessive and unjustifiable restriction of freedom of expression.

Well Federici have refused to sign an undertaking not to run further advertising which might offend catholics and are challenging the ban. Good for them and I hope they win. If you agree then you can communicate your views to the ASA here.

And then we might get more pictures of the nun in the stocking tops.

Friday, 10 December 2010


A few posts ago I repeated a quote that was a little rude to the French. This film clip should make amends. One of the finest pieces of cinema ever made.

Tuesday, 7 December 2010

Prostate Cancer

Prostate cancer has been getting an increasing profile lately. Apparently among the reasons why many men present late with this condition are;
1. An innate tendency among males to ignore symptoms of any kind which might indicate something serious, while at the same time making an oscar worthy performance over anything actually trivial, such as flu.
2. A knowledge among men over what will happen to them as part of the examination for any complaint below the waist. This latter might possibly be addressed by a new blood test for prostate cancer, as featured here.

Monday, 6 December 2010

CEAs again

The ball keeps rolling in the direction I have previously predicted, and frankly advocated. And also as I have previously predicted the rank & file of Consultants are making very little protest.
Perhaps I will change the name of the site to Dr Nostradamus.

Sunday, 5 December 2010

Working time directive

I have posted before on the working time directive and the working conditions my generation endured that masqueraded as training. To those who think I am exaggerating (my on call room was a hole in't ground covered wi' a tarpaulin) have a read of another's experience. And another.

In the same post she also talks about the involvement of doctors in torture and what they could possibly have been thinking to allow themselves to do this. I think here she misses the most likely motivation, To quote from another of my previous posts

"Some of my colleagues only differ from prostitutes in one respect. There are some things prostitutes will not do for money."

Saturday, 4 December 2010


Deer aren't capable of that kind of thinking. All they care about is, what am I going to eat next, who am I going to screw next, and can I run fast enough to get away. They are very much like the French." 

Thursday, 2 December 2010

Job Interviews

In my time I have been on both sides of the table at job interviews and I am sometimes asked what to expect by trainees at the end of their training. I have always found the question difficult to answer, but this picture I think gives a good idea of the experience from the point of view of the applicant.

Wednesday, 1 December 2010

Freedom of speech

Regular readers will be aware that I have a particular obsession with freedom of speech, and I am incensed by efforts to suppress this, either by individuals or institutions. The right to freely express our opinions has just been strengthened, and quite right too.


I have risked criticism in the past for my views on midwives, (1) (2) (3) but you don’t have to make up stories about them being stupid, some of them will quite happily confirm that with their own words and deeds.

I have personally known one who thought reflexology potentially useful in labour, and, more seriously, another who thought that prayer was a suitable alternative to resuscitation in a flat, blue newborn.

This article is another illustration. The opening phrase “Having a medical background as a qualified nurse and midwife is an extremely useful tool for being a homeopath” Says it all I think.


Thus that which is the most awful of evils, death, is nothing to us, since when we exist there is no death, and when there is death we do not exist.


I commented recently on the media reporting of death rates being at an all time low. Well someone agrees with me.

Tuesday, 30 November 2010


An impromptu day off today due to the snow. I have never known it like this in November. Inconvenient though it is this sort of weather brings extraordinary beauty. This picture was taken on Sunday just a few miles from my home.

Thursday, 25 November 2010


For the first time in it’s history the NHS is to allow a private company to run one of it’s Hospitals. I do not think I am a closed minded individual and I will not say that this is in principal a bad thing, though I do not think that, even among tory voters, this will sit well.

What does strike me however is the dishonesty and deceit which is already being employed in presenting this extraordinary precedent to the public. 

Dr Stephen Dunn, director of strategy at the strategic health authority, said, among other statements “This is not privatisation” 

Dr Dunn, you fucking blatant liar. Yes it fucking is! Whether, as a tactic, it succeeds or not, it most definitely is privatisation. Denying this fundamental fact reminds me of the saying; “Don’t piss down my back and tell me it’s raining”
Denial of this is simply an insult to the intelligence. If Dr Dunn came clean on this we might be more inclined to give this experiment a chance. Treating us like fools Dr Dunn can only generate hostility and resistance, and the view that you are trying to hide something.

Freedom of expression

A teenage girl in Birmingham has been arrested for posting a video on YouTube in which she allegedly burned a copy of the Koran. The police may be charging her with incitement to religious hatred. 

I don't see at all how expressing disapproval, or even contempt, of a religion or belief constitutes incitement to religious hatred. To quote West Midlands police "West Midlands Police will investigate and monitor any crime reported by individuals who may have been targeted because of their disability, gender, race, religion or belief, sexual orientation or transgender."

Which individual has been targeted here? It seems to me that the only person who has been targeted is the girl herself, presumably because of her religious disbelief. 

To quote again from a previous post about freedom of expression “Article 10 applies not only to information or ideas that are favourable and inoffensive but also to those that offend, shock or disturb the State or a sector of the population.”

I think that W Mids police are acting like bully boys here and should be resisted and defied with all vigour. By their logic I too am committing an offence by expressing my view that Islam is a nasty, intolerant, oppressive, tyrannical, misogynist delusion, though it is not the only religion I would describe in this way.

So come on coppers, come and get me.

Extra bank holiday

So April 29 is to be an extra bank holiday so we can all sit round a TV watching a fairy prince and princess get hitched. It is not my idea of fun and I will be volunteering to work that day in the hope of steering clear of a TV set. If my offer is not taken up I will probably take off into the hills where anyone else I meet is likely to be of like mind

Unfortunately the next 5 months is going to be nothing but build up as the whole affair is going to be treated as some vast ghastly soap opera by the media.

The daily mash as usual has a refreshingly different slant , reproduced below

Royal engagement newspaper bullshit round-up:

Each and every one us will be deeply affected by the looming royal marriage... (Peter Oborne, Daily Telegraph)

In an important sense, this betrothal has far more to teach a new generation about relationships - and fidelity, too. (Bel Mooney, Daily Mail)

For Kate and William, their engagement has profound national significance. They will help form our collective imagination. They are now part of what we are as a nation, how we define ourselves as individuals. (Peter Oborne, Daily Telegraph)

As somebody whose business it is to study the human heart.. (Bel Mooney,Daily Mail - she actually wrote those words)

Today we are wiser and perhaps more humane. The unrealistic expectations that destroyed Charles and Diana have gone. (Peter Oborne, Daily Telegraph - he's playing a blinder)

It is rare these days that we glimpse broad sunlit uplands, but this is one such moment. (Daily Telegraph editorial - sweet fucking Jesus)

And the winner is (obviously)...

Diana, the bride at every royal funeral and the mourner at every royal wedding, was present in more than just the engagement ring which sat so heavily on the hand of this young woman who must now walk a mile in her bloodied shoes, on a road leading who knows where. (Julie Burchill, The Independent)

Pass the sick bowl someone.

Tuesday, 23 November 2010


The Public Disclosure Act became law in 1999.  It is the so called “whistleblowers law”, and applies to all employees. In the NHS specifically it is supposed to allow employees to draw attention to failings on the part of their employer, without having to fear any retribution from that employer.

Unfortunately it does not work.  It would be illegal for any NHS employer to pursue an employee specifically for such  an act of disclosure. What happens in practice however is that employees who have made an act of disclosure can find themselves the subject of disciplinary proceedings for all sorts of other reasons and can find themselves suspended or even dismissed on the vaguest, and most insubstantial of reasons. This is a loophole in the act big enough to drive a tank through.

A few examples of this can be found here, where the cases of two doctors and one nurse who endured exactly this sort of underhand treatment can be found. 

I have written about the case of Sharmila Chowdury before, and it now looks certain that she will win her case. Ramon Niekrash has already won his, and Henry Fernandez has had a large out of court settlement, or as it is otherwise known, a total admission of wrongdoing.

With medical staff, for these things to happen requires the collusion in bullying and harassment of two principal individuals, the Chief  Executive and Medical Director. Although others may be involved these two are key. Such targeting of victims can not occur without their malign and dishonest intent. But in all the media reporting on these cases these people are not named, responsibility being attributed to the Trust. 

These people should be named and shamed, and in the case of the two doctors involved this not too difficult.

So here is the bullies roll call.

In Ealing Hospital those responsible for the underhand and disgraceful treatment of Sharmilla Chowdury were the CE Julie Lowe and the Medical Director (and Deputy CE) William Lynn. 
In Woolwich Ramon Niekrash was apparently targeted by one man. David Robson was Medical Director until February 2008 and then became Chief Executive, raising the possibility that Dr Niekrash was the victim of a grudge by one unscrupulous, ambitious  malicious and shameless individual.

These are people manifestly unfit to hold the positions they do. Sadly they are not the only such self serving millstones we have to carry in the NHS. 

Thursday, 18 November 2010

That was quick

It is only two weeks since I predicted that this would happen.
Do you suppose Andrew Lansley reads my blog?
If you are reading this Mr Lansley please note that I am available for the still vacant post of CMO.

Thursday, 11 November 2010

Free Speech and libel law

This article by Simon Singh is being reproduced widely on the blog circuit, and I am pleased to reproduce it again.

“This week is the first anniversary of the report Free Speech is Not for Sale, which highlighted the oppressive nature of English libel law. In short, the law is extremely hostile to writers, while being unreasonably friendly towards powerful corporations and individuals who want to silence critics.
The English libel law is particularly dangerous for bloggers, who are generally not backed by publishers, and who can end up being sued in London regardless of where the blog was posted. The internet allows bloggers to reach a global audience, but it also allows the High Court in London to have a global reach.
You can read more about the peculiar and grossly unfair nature of English libel law at the website of the Libel Reform Campaign. You will see that the campaign is not calling for the removal of libel law, but for a libel law that is fair and which would allow writers a reasonable opportunity to express their opinion and then defend it.
The good news is that the British Government has made a commitment to draft a bill that will reform libel, but it is essential that bloggers and their readers send a strong signal to politicians so that they follow through on this promise. You can do this by joining me and over 50,000 others who have signed the libel reform petition at:
Remember, you can sign the petition whatever your nationality and wherever you live. Indeed, signatories from overseas remind British politicians that the English libel law is out of step with the rest of the free world.
If you have already signed the petition, then please encourage friends, family and colleagues to sign up. Moreover, if you have your own blog, you can join hundreds of other bloggers by posting this blog on your own site. There is a real chance that bloggers could help change the most censorious libel law in the democratic world.
We must speak out to defend free speech. Please sign the petition for libel reform at    ….”
Simon Singh


War is an ugly thing, but not the ugliest of things. The decayed and degraded state of moral and patriotic feeling which thinks that nothing is worth war is much worse. The person who has nothing for which he is willing to fight, nothing which is more important than his own personal safety, is a miserable creature and has no chance of being free unless made and kept so by the exertions of better men than himself.

John Stewart Mill (1806 - 1873)

Wednesday, 10 November 2010


It is often said that at 11 am on 11 November 1918 the guns fell silent, but this statement is deceptive. They did not stay silent for long. Since 1918 the British Armed Forces have been deployed on active service almost constantly somewhere in the world. Major actions in that time have been; 

1919/20 Military support to the Russian White Army in the Russian Civil War.
1919-23 Military action against rebels in the Turkish War of Independence.
1920 British Somaliland
1919-21 Irish War of independence
1919/20 Third Anglo Afghan War, the first had been in 1839-42, and the second 1878-80
Numerous actions on the North West Frontier of India in the Inter war years.
1936-39 Palestine uprising
1939-1945 WW2
1948-60 Malaya
1950-53 Korea
1952-60 Mau Mau war, Kenya
1956 Suez War
1962-66 Borneo
1963 Cyprus
1963-67 Aden
1969-2007, Op Banner, Northern Ireland
1982 Falklands War
1991 First Gulf War
1991-95 Yugoslavia.
2001- present, Afghanistan
2003- present Second Gulf War, Iraq.

There have also been numerous other minor deployments of varying degrees of activity, both overt and covert.

The bodies of British servicemen lie on every continent, though the traditional practice of burying soldiers where they fall has now been replaced by repatriation.

Here are a few more of their faces.

Wear a poppy.

Saturday, 6 November 2010

Mystery object 6 answer

Grumpy RN's suggestion that this could be used as an illicit drug delivery device is probably feasible but it is not the correct answer.

The answer can be found here sort of, as it does not go into details and I only have the vaguest idea of what you are supposed to do. If anyone out there knows the exact details, please keep them to yourself.

Thursday, 4 November 2010

Mystery Object 6

This is not actually presented as a mystery object. Even to non anaesthetists this is clearly recognisable as a piece of anaesthetic equipment and any anaesthetist would identify it as a Magill type Mapleson A system, once the commonest system used in the UK for delivering anaesthetic gases.

It is now all but obsolete and you would have difficulty finding one unless you knew where to look.

The question is.

This system has found a new lease of life. A new niche. What is it?

No prizes

Wednesday, 3 November 2010

Told you so

I would like to say that I hate being proved right all the time, but I don’t. When I am proved right I get a sense of superior smug satisfaction, and recent news events have given me a double dose.

Firstly my previous comments on the working time directive, where I have argued that increasing doctor’s hours will not necessarily lead to better training. Well the cynical attitude of Trusts to their trainees is highlighted here. The statement “Many employers want us to work longer hours, not to give us better training, but to fill the gaps in rotas.” sums up exactly what I have been saying.

Second, my previous suggestions that CEAs are for the chop have been proved right, in Ulster at least. NO CEAs at all there this year. The Government are clearly testing the water and using Ulster as a pilot. I predict they will find only verbal opposition to this and then roll it out over the rest of the UK. 

Perhaps I will do the lottery this week.

Saturday, 30 October 2010

Thursday, 28 October 2010


There has been an article circulating in the media telling us that the UK death rate is at an all time low.

Funny, I thought it was still 100%

Wednesday, 27 October 2010

Banned! again

Federici, the ice cream company are in trouble again, and, after this add was banned recently they have now had another ad banned. The picture shown above was judged to be offensive to catholics. On the basis of just six complaints in the whole of the UK. If this is offensive what would they think of this.

The Advertising Standards Authority really has lost the plot. At least the picture shows two adults, who, whatever is inferred is about to happen, are consenting. Unlike this case which, coincidentally concerned a catholic priest by the name of Federici.

I have to say that of the images produced to advertise Federici ice cream this one does not do much for me. I much preferred that picture of the nun in the stocking tops.

Tuesday, 26 October 2010

Chief Medical Officer

It is now over 10 months since the previous CMO for England, Sir Liam Donaldson resigned. Although an interim, Prof Sally Davies is supposedly holding the fort she has not been exactly high profile. The Dept of Health does not appear to be in any great hurry to appoint a substantive incumbent though I have no doubt there are plenty of ambitious hopefuls.

The question is, has anyone noticed? Does anyone give a toss? If you can do without someone in this position for that length of time, without any discernible consequences, perhaps this is yet another post that could be dispensed with altogether. Certainly Donaldson was little more than a government mouthpiece, a puppet.

Scotland, Wales, and Ulster all have their own CMOs so the UK normally has four of these expensive positions to fill. If we need one at all would not one for the UK be enough?

What a waste of money on a bunch of irrelevant sycophants.

Monday, 25 October 2010

Prize winner

Following on from the most recent mystery object you may see that I acknowledged the prize of one beer to "new kind of GP" for successfully identifying the Palm Pistol.

I have done a little investigating. If my conclusion is correct then NKGP should by now have received his prize. If I am wrong, then there is a very bemused GP somewhere in South Wales wondering who on earth is giving him a bottle of Brakspears.

Future mystery objects will not be rewarded with a prize. There are far too many smartarses out there.

Saturday, 23 October 2010


When I started this blog it was intended to be simply a vehicle for me to rant about the NHS and my frustrations with it. Some may have noticed that I also have a bee in my bonnet about freedom of speech. This preoccupation with freedom of expression has led me down another path, that of religion.

A number of my posts have made clear my views on this most pernicious of human delusions. The device at the top right of the blog indicates that this blog is now registered with the atheist blogroll, just so there are no doubts about where I stand.

Thursday, 21 October 2010


“History does not record anywhere at any time a religion that has any rational basis. Religion is a crutch for people not strong enough to stand up to the unknown without help”

Robert Heinlein

Mystery Object 5

Well I was wrong, New Kind of GP got this easily. It is a Palm Pistol, a .38 calibre single shot firearm, designed for those who have insufficient manual dexterity to handle a conventional handgun. A triumph of occupational therapy. As NKGP points out it is available on prescription in the US, and the cost can be claimed against medical insurance. It would without doubt be illegal to possess one in the UK.
I owe NKGP one beer.

Wednesday, 20 October 2010

Mystery Object 5

Now here is an interesting mystery object.
Th FDA in the USA have classified this as a Class 1 Medical Device
I would put money on nobody getting this one, and I am not a betting man.

NHS Evangelism

One of the reasons I posted the quote below of Bevan’s  was to illustrate one of the original principles of the NHS, that it’s purpose was to care for the sick.

Over the years the range of services provided by the NHS has grown out of all recognition. And with that growth there has been a blurring of what constitutes sickness, and therefore what might be obtained under the description of treatment, at taxpayers expense.

For a few examples to illustrate this;

Contraceptive services
Infertility treatment
Tatoo removal
Varicose vein surgery

I am not suggesting necessarily that these, and similar treatments, should not be available on the NHS, though I think it a fair guess that they are not quite what Bevan had in mind.

I do draw the line however at this. The active promotion of “faith and spirituality” is not in my view a proper function for the NHS. For a NHS Trust to engage in this is quite abominable, particularly when it seems to be specifically directed at those most vulnerable of patients, those with acute mental illness. No references are supplied to support the highly dubious claims made in this article. No Psychiatrist is quoted as endorsing this practice.

Richard Harlow is Sussex Partnership’s Multi-faith and spiritual care team leader, of a team that consists of 90 (yes ninety) “spirituality advocates”. Further words fail me 

Remind me never to lose my marbles in Sussex.


We ought to take pride in the fact that, despite our financial and economic anxieties, we are still able to do the most civilised thing in the world - put the welfare of the sick in front of every other consideration.

Aneurin Bevan    9 Feb 1948

Monday, 18 October 2010

Money again

I have commented before on how some of my colleagues can lose their moral objections to something if there is enough money involved. Bevan knew this, buying off the doctors who made objections to the formation of the NHS, which he described as "stuffing their mouths with gold".

This article caught my eye this morning. Wherever you stand on the issue involved, one thing is clear.
They had no problem finding a surgeon to perform the procedure.

Friday, 15 October 2010

Tredegar General Hospital

A fairly small item in the news is that a new hospital has opened in Ebbw Vale, in the Welsh valleys.

What makes this of significance is that it is replacing two old hospitals, one of which could be considered to have been the model for the entire NHS itself.

Tredegar General Hospital was built in 1904, 44 years before the NHS came into being. The land it was built on, and the money for it’s construction were all charitably donated, and it’s running was funded in part by contributions from the pay of the local mining workforce. A sort of mini, local NHS.

A J Cronin worked at the hospital in the 1920s and the experience undoubtedly contributed to his novel, The Citadel.

The Chairman of the Hospital Management Committee in 1929 was one Aneurin Bevan and his experience in this position was used later, when, as minister of health he introduced the National Health Service.

Now that Tredegar Hospital has been replaced it’s future is most uncertain. It is unlikely to continue as a hospital, and may even be demolished. This would be a great shame. 

South Wales has in the past capitalised on it’s history by making museums of it’s old buildings and industries, as at Big Pit, and St Fagans.
Wouldn’t it be nice if Tredegar General Hospital could become an NHS museum, charting the NHS history of the past 60 years.

Or maybe it’s passing and disappearance will epitomise the passing of the NHS itself, which was rooted in Tredegar.

CEAs again

More negative publicity for Clinical Excellence Awards in this article. I was aware that CEAs could be withdrawn if the holder was no longer doing the "extra" work for which it was awarded, but I was not aware that withdrawal was only on paper and the extra money continues to be paid regardless.

Professor Maynard is of the view that ”It is going to be difficult for the Government to stop the payments altogether as doctors will put up a strong fight."
I think I can reassure the Professor that this is not true. The profession has long been divided into the haves and have nots when it comes to CEAs. Why would the have nots fight to retain a system they despise? There may be a lot of vociferous resistance from the BMA and the eminent, ie recipients, but there will be far less support from grass roots. The likely halving of awards made proposed for 2011 has generated precious little interest, let alone opposition

Go on Lansley, call their bluff.

Thursday, 14 October 2010


Science and technology today have delivered all sorts of incredible devices that previous generations could not have dreamed of. Iphones, computers, 3D HD TV, and a host of highly sophisticated electronic wizardry available to all.

But if we look back in recent history we see equally, if not more exciting achievements. Probably the most exciting year in the latter half of the twentieth century was 1969. In that single year Britain & France first flew a supersonic airliner, and the USA landed the first man on the moon. Both extraordinary achievements that stretched and advanced the technology of the time beyond imagination. These feats seem to have been forgotten, and we can not even equal them today. Passengers are no longer able to fly beyond the speed of sound, and no man has walked on the moon since 1972.

Forty years ago the best minds in science and engineering were engaged in tasks to advance the frontiers of human capability. Now they are engaged in making toys for adults.

Quangos to go

Here is a list of all those Department of Health Quangos that have today been given their death sentences.
Most of these will resurface as minor committees within other major organisations such as MHRA so whether this delivers real financial savings remains to be seen. The prestige associated with sitting on these committees will however inevitably decline, and membership will presumably carry far less weight with CEA committees. Oh dear.

Is your favourite here?

DH Advisory Board on the Registration of Homeopathic Products
DH Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections
DH Advisory Committee on Borderline Substances
DH Advisory Committee on Dangerous Pathogens
DH Advisory Committee on the Safety of Blood, Tissues and Organs
DH Advisory Group on Hepatitis
DH Alcohol Education and Research Council
DH Appointments Commission
DH Committee on Carcogenicity of Chemicals in Food, Consumer Products and the Environment
DH Committee on Medical Effects of Air Pollutants
DH Committee on Medical Aspects of Radiation in the Environment
DH Committee on Mutagenicity of Chemicals in Food, Consumer Products and the Environment
DH Committee on the Safety of Devices
DH Council for Healthcare Regulatory Excellence
DH Expert Advisory Group on AIDS
DH Gene Therapy Advisory Committee
DH General Social Care Council
DH Genetics and Insurance Committee
DH Health Protection Agency
DH Herbal Medicines Advisory Committee
DH Human Fertilisation and Embryology Authority
DH Human Genetics Commission
DH Human Tissue Authority
DH Independent Advisory Group on Sexual Health and HIV
DH Independent Review Panel for the Classification of Borderline Products
DH Independent Review panel on the Advertising of Medicines
DH Joint Committee on Vaccination and Immunisations
DH National Information Governance Board for Health and Social Care
DH National Joint Registry Steering Committee
DH Scientific Advisory Committee on Nutrition


It is hardly a revelation that morale amongst NHS staff is low, and steadily falling. Posts on various blogs reveal the frustration and resigned despair afflicting staff in all areas. One of the greatest frustrations is that there seems to be nothing we can do to stop the slide.

Some years ago I was in a NHS hospital other than the one I work. On one of the upper floors there was something you don’t often see other than on the ground floor, a door leading outside. It led on to a flat roof area only, and from there, nowhere else. Management had put a sign next to this door to inform people that they could not get out that way. It was only two words, which seem to epitomise the NHS today. It said simply “NO ESCAPE”

Sunday, 10 October 2010


My fellow blogger jobbing doctor has recently blogged about music. We clearly have different tastes.
Now this is music. I wish I had US$180,000 to spare.

This machine is real

Saturday, 9 October 2010

A man with his head up his arse

This is a picture of Dr Mark Porter, Chairman of the BMA Consultants & Specialists Committee. His task is to represent the interests of NHS Consultants and Staff Grades.........all of them.

So, what major issue of the day is Dr Porter concerning himself with? Is it perhaps the loss of child benefit for all those families who pay higher rate tax? This is something that will affect well over a million households, but it will affect every full time NHS Consultant and Staff Grade with children in Britain. Or is it perhaps the almost certain changes to our pension arrangements, where we will be working till 65 at least, paying more and receiving less. No it is neither of these.

What seems to be preoccupying Dr Porter and the BMA is the likely loss of the clinical excellence award. I say likely. To quote the Health Secretary Andrew Lansley, who wants to bring the scheme “up to date” and in line with other public sector pay schemes.” Bearing in mind that no other public sector pay scheme has anything remotely resembling CEAs Mr Lansley’s intentions are clear.

Dr Porter is not alone in defending the scheme, and is supported by other prominent members of the profession, mostly of course people who are in receipt of a CEA.

These people appear to me not only to be acting mostly in self interest, but also are acting under the influence of “bunker mentality”. They appear not to have noticed what is going on outside the citadel.

The truly staggering scale of the financial catastrophe that has engulfed this country is starting to become clear in the actions of the government. In addition to child benefit loss and pension cuts every other area of the public sector is suffering, leading to desperate measures. What is happening to our nursing colleagues is a good example within the NHS. There are cogent responses from nurse bloggers here and here.

But to grasp the true enormity of our financial predicament one has only to look at how the axe is falling on our armed forces. The Royal Navy looks set to lose half its fleet, the RAF may be abolished altogether, and the Army too is set to be slashed out of all recognition. All this at a time when our armed forces are more committed than at any time in the last 65 years.

And with all this desperate economising going on Dr Porter thinks he can persuade the government to retain a bonus scheme which arbitrarily benefits a minority of the highest paid public sector workers in Britain. 

There are in my view only two possible explanations for Dr Porter’s view that NHS Consultants alone in Britain should be protected while everyone else in the country bears the financial pain. The first is that he is a man of so little perception that he has not noticed what is going on, in which case he is too small minded to be considered a fit person for his position. Alternatively he is fully aware of the circumstances and is pressing on anyway, in which case he is a man with no shame whatsoever.

Thursday, 7 October 2010


There is an increasing awareness in medical practice of the medicalisation of essentially healthy individuals. One of the best examples of this is that ultimate panacea, HRT, promoted heavily as the cure all for post menopausal women. 

It is no surprise that the drug companies feature prominently in campaigns to identify, and treat new conditions that in the past were not considered illnesses at all. A good example of this is “female sexual dysfunction” where any women who does not have the sexual appetite of a bonobo is claimed to be in some way lacking, and requiring treatment with the latest female equivalent of Viagra.

The medical profession, encouraged by the pharmaceutical industry, is starting to act like the alt med frauds, convincing the worried well that they have a diagnosis that requires “treatment”. This is reinforced by articles in the media that are little more than advertising for the drug companies.

This “pseudo medical advertising” has been criticised before by a Dr R E Dawson in a letter to the BMJ. To quote from his letter;

“.....spate of pernicious pseudo-medical advertising which daily screams at us from newspapers, placards, and television screens, telling us that we are One Degree Under.; that we need this to give us deep relaxing sleep and thus solve all our psychosocial problems, that unless we use that product our children's cerebral cortexes will never put on the spurt needed.......”
“One feels off-colour, sickly, and grumpy with the children. Unless one immediately takes large rations of "X," a product of no therapeutic value at all , one's husband will instantly pay attention to a pretty girl over the road, or an underling will win promotion over one's head, and so on.

What is interesting is when Dr Dawson wrote this. It is from the BMJ of June 21 1958.