Unintended consequences

The hazards of smoking to health have now been recognised for over 50 years and I am amazed that the practice is still going strong. The prevalence of smoking seems to have levelled off at a little over 20% in the UK and various measures such as the smoking ban in public places, and high taxation seem to have little deterrent effect on this last hard core.

The tobacco companies have long been in denial about these health hazards but initially they thought that cigarettes could be made safer by the use of filter tips, invented in the early fifties.

Here is a typical example of an ad of the day assuring consumers that their “micronite” filter afforded a degree of protection against the hazards of smoking.

Kent cigarettes used this type of filter tip for about five years, on a total of 13 billion cigarettes. Unfortunately the micronite filter was made, among other things, of 30% crocidolite, also known as blue asbestos. If we want to further reduce the number of smokers in the population, perhaps we should reintroduce these.

Oops

Here is a little story sent by one of my readers, who, for reasons which will become obvious wishes to remain anonymous.

Dr X is an anaesthetist. It is the end of a long day. Dr X has been on an eye surgery list, putting in peri bulbar or sub tenon blocks, as well as the odd general anaesthetic.

He quickly and efficiently puts a peri bulbar block into the last patient. As is often the case the patient finds this a brief, but unpleasant experience, but tolerates the procedure with quiet stoicism. Dr X finishes and asks if the patient is OK.

"Yes" replies the patient, "but they are operating on this eye" he says, pointing to the other side.

" Oh yes" thinks Dr X. "The eye with the dilated pupil, and the big arrow over it"

"Bollocks!"

PFI again

Regarding my last post it has been pointed out that a third explanation is that it was the policy of successive governments to use PFI for major NHS projects. While I accept that this principle was heavily promoted by government this still does not account for why such appallingly bad deals were negotiated and accepted.

They may have been forced down the PFI route but surely they could have employed normal business practices, encouraged a little competition, and driven a harder bargain.

Most of us could do far better as individuals. As an example, if you were after a personal loan would you take this one at 7.2% APR or this one at 4214% APR. Those who negotiated PFI deals seem to have had the mentality to take the latter.

PFI

The government have cottoned on to how we have been taken to the cleaners by the PFI companies and are looking into retrieving some of the misspent money.

They don’t seem to have much idea though about how to go about it, saying only that they are “looking for ways to claw back money for taxpayers. “ 

One of the avenues they could possibly explore would be to look at the original contracts. Right at the bottom they will find the signature of the individual who originally entered into the deal. Those who signed these contracts off have in my view some explaining to do. I can see only two reasons for their actions. 

The first is that they simply did not bother to sit down and do the sums, and were so incompetent that they simply did not realise or care what they were getting the taxpayer into. 

The second possibility is that they received some inducement from the PFI company. If there is any hint of such corruption that would make things easier as the law allows confiscation of the proceeds of crime, and we could get our money back, and confiscate the hospital. There would be the added advantage of prison for the guilty. Some may think the possibility of corruption unlikely, but the MPs expenses scandal shows that such a culture definitely exists in our administrators.

And if it is found that the scandal is down simply to incompetence, then at least we can remove such people from positions where they can repeat their actions.

Or is there a third explanation that I have missed?

Fortune telling

The Royal College of Surgeons has been tuning in to it’s crystal ball again, or perhaps they are using astrology. They, and other colleges are making dire predictions about reductions in patient care if the NHS changes go ahead. 

But if you look at the article reporting this, it is plain that the colleges are talking out of their arses. The article uses such phrases as “could”, “likely to” “may”, no fewer than 13 times. Not a single hard fact or reasoned logical argument is put forward, just unsupported opinions of a totally speculative nature. One gets the feeling they want the whole project to fail so they can claim “told you so”

Now I am as dubious as anyone about the coming NHS reform. In particular I am appalled at the seeming blind determination of government to allow the involvement of the private sector, in the face of emerging evidence that this will allow vast amounts of taxpayers money to be creamed off.

But shroud waving speculation masquerading as “expert opinion” is going to be seen by the government for what it is, and ignored. Are the colleges so lost for genuine argument that they are resorting to this drivel?

And perhaps by taking this totally negative approach they are playing right into the government’s hands. It seems inevitable now that the changes will go ahead. If the medical profession approach it in a totally negative manner and the project fails we might, with some justification, be given the blame for sabotaging the project. Despite our misgivings, when the reform comes we have to do whatever we can to make it work. At least then we can secure the moral high ground and ensure the blame goes where it belongs. 

And who knows, maybe it can be made to work, or don’t people want that?

Woo

If you haven't seen this before, enjoy it now.

Naughty naughty

A GP, Dr Graeme Elvin is before the GMC, accused of having a sexual relationship with not one, but two of his patients. He is not the first Doctor to do this, and I don’t suppose he will be the last.

The Telegraph article on this case however made me smile a little. The reporter at one stage describes one of the affairs as “Two years of ups and downs” Yes no doubt.

The other small smile came when I read that the offences occurred while Doctor Elvin was working at a surgery called Hardwicke House.

Astrology is bollocks

I am a great Fan of Dara O'Briain. He is not only funny, he is also a first class sceptic, quite vociferous about all sorts of woo. Unlike many celebrities he is not remotely taken in by this nonsense. In this clip he, together with Prof Brian Cox neatly rubbish the deluded practice of astrology.

The comments made at the end of the clip have incensed the stargazers who are organising a petition demanding an apology from the BBC for deprecating astrology, and insisting that in future it be dealt with in a "balanced" manner.
It is clear that these people do not understand the meaning of the word "balance"

A balance is not a device for intentionally indicating equal weight to both sides. It is a device to ascertain which side carries more weight.

In the argument in question astrology carries no evidential weight whatsoever, and the astrology debunkers have all the weight of evidence.

To say that astrology is rubbish is therefore a perfectly balanced view.

However I do not expect anyone witless enough to believe the utter shite that is astrology, to understand a word of what I have said.

Not only is astrology as a concept complete rubbish, astrologers are without exception either charlatans or mindless idiots.

Another man with his head up his arse.

This is Mr John Black, president of the Royal College of Surgeons. He believes that the working time directive should not apply to surgeons in training, and that they should work a 65 hour week.

He does not believe that adequate training can be achieved in 48 hours a week, that is six eight hour days a week.

In the past ten years with the massive expansion in dedicated CEPOD and Trauma theatre sessions the great majority of all emergencies are dealt with in normal working hours, yet Mr Black does not think that this is enough.

Despite evidence that excess working hours detracts from performance, and adversely affects the health of the worker, Mr Black clearly knows better.

Mr Black states “It is a matter of regret that all the adverse effects we predicted have come about.” and yet he presents no evidence to support this statement. Since the 48 hr week has only been with us for 18 months it is far too early to make any meaningful statements about any consequences.

He further states “The ability to opt out of the EWTR should stay, We live in a free country after all..” All freedoms are subject to legal restrictions. Airline pilots, and lorry drivers have no such freedom to opt out, and there is no reason why the man rummaging around your insides should have such a “freedom” either. And there is little doubt that surgical trainees who choose (wisely) not to opt out would find themselves treated harshly by dinosaurs like Black.

Mr Black obviously feels that the modern trainee is not up to his illustrious standard. I think his view is arrogant, conceited and wrong. 

What a fucking fossil.

Altmed

One of the many aspects of quack medicine that I find incomprehensible is the sheer persistence and tenacity of patently absurd beliefs and practices. No matter how implausible the theory it still gets churned out as pseudoscience. And it does not matter how much evidence demolishes these beliefs, the proponents get more and more entrenched.

I am constantly bemused that practices such as homeopathy, reiki, chiropracty and all the other weird and ludicrous practices can just keep going, in the face of logic and reason. It is enough to make you despair of humanity.

In fact there is hope. If you look back you can find other quack practices which have died out completely, where people have come to their senses and recognised the nonsense for what it is. 

One such is this one. Like other quack practices it has a philosophy claiming that all disease is due to one specific cause, rather like chiropractic subluxations, only in this case it is asserted that all your ills are due to a tight arsehole. 

The logical treatment therefore is anal dilatation, using some of these.

Absurd, but no more so than the altmed practices prevalent today. 

I can envisage the exchange between a practitioner of this technique and one of his uncured and disappointed patients. “Dr Quack, those dilators you gave me did me no good at all. For all the good they did I might as well have shoved ‘em up my arse.”

Mystery Object

No guesses at all on the mystery object. It was an instrument called an algometer, which was supposed to measure pain threshold, though I doubt it gave consistent or useful results. The instrument was applied to the skin and the needle advanced using the sliding knob on the side. When a certain level of pain was reported the position of the knob on a scale gave a reading supposedly indicating pain threshold.

The needle was not removable or disposable and would have been used on multiple patients. The risks to us are obvious. Before we congratulate ourselves on how far we have advanced in the area of sterile disposables, how many can remember the not so distant days when medical students and housemen would carry around a hatpin stuck in their lapel. This was for use in neurological examinations and was as crude and worthless as the algometer. I never saw anyone clean them between patients either.

Balance

I recently posted a clip of a fictitious exchange between an anaesthetist and an orthopaedic surgeon, casting the surgeon in a less than flattering light. Here is the view from the other side.

After the interview

I think this picture is a perfect follow up to my previous post on the experience of job interviews.

Mystery Object

Have not had a mystery object for a while. Any guesses as to what this was, circa 1900.

Commissioning

A picture of Cameron & Lansley, smiling for the camera, while steering the NHS to a better future.

Heaven

I am currently sitting in one of the finest real ale pubs in Britain, working my way along the row of pumps. Two hours till closing. Bliss.

And another thing

There is no doubt that the “miracle” referred to in my last post is part of a less than subtle process by the vatican to give the last pope the status of a saint.

That they can think this appropriate for a man responsible for harbouring and protecting child molesters beggars belief, but says all you need to know about the vatican.

Well I think this is the best response.

A miracle? Er no.

According to the vatican Parkinson’s disease can be cured by praying to dead popes. A catholic nun has claimed that she has been cured of the disease by pope John Paul 2, and the vatican are claiming it was a miraculous intercession from beyond the grave.

There is so much wrong with this I hardly know where to start. So lets start at the beginning. The original diagnosis of Parkinson’s looks to me pretty dubious. Sister Marie claims to have been cured in 2005, when she was 43. Presumably by then she had had the condition for some years. She is clearly very unfortunate as only 5% of cases are diagnosed before the age of 50. She is even more unfortunate in that one of her symptoms was “intense pain”. Correct me if I am wrong but intense pain is very rarely a feature of Parkinson's. Add to this the formal guidelines on this condition state: “clinicians should be aware of the poor specificity of a clinical diagnosis of Parkinson’s disease “

So I think first of all the diagnosis is in doubt. Next what is the evidence that the cure was effected by pope John Paul. There are three statements cited as evidence.

1. John Paul himself suffered from the condition. (as do 1 in 500 of the over 50s)

2. Sister Marie claims to have felt spiritually close to the pope.

3. The cure came on three months after his death.

Fuck me sideways, is that it??!!

I know that lots of people do not understand the difference between correlation and causation, but in this case even the correlation is stretched beyond credibility. 

Finally the nun has been declared free of Parkinson’s by the Vatican's own tame doctors. No independent doctor has been able to verify cure, or even that the condition was present in the first place.

One is left with the inescapable conclusion that the vatican is filled with complete morons. 

If you read the comments to the Independent article the vast majority are not taken in and it is obvious that the vatican has made themselves look totally ridiculous. A laughing stock. And quite right too.

Statins

One of the chapters in the book I reviewed recently focussed on the current over prescription of statins. The authors’ scepticism is not new. Questions over statin therapy have been raised before and one Northern GP, Dr Malcolm Kendrick wrote a whole book on the subject some years ago.

Well Dr Kendrick, and other like minded doctors have probably been right all along, according to the Cochrane review, reported here.

Inevitably many doctors will ignore this review as the dogma involved in statin therapy is too deeply ingrained, and many of the more senior members of our profession have made their reputations in this area.

One such individual is Professor Nicholas Wald, advocate of the polypill, who feels that all males over 50 should be taking this combination drug. I disagree with him. There are now question marks over aspirin and statins for prophylaxis in healthy individuals. The other component of the polypill is hypotensive agents, and Prof Wald does not seem to give much thought to what happens when you give these drugs to normotensive people, or perhaps he thinks that there are no normotensives over 50.

I am normotensive, and once took a single bisoprolol tablet to see what would happen. Big mistake. Within an hour my heart rate was 40, and my BP 70 systolic. I felt like shit.

I have said before that the pharmaceutical companies have and do provide products of which they can be proud. But in their pursuit of ever bigger profit they are doing much to sully their own reputation. Perhaps we as doctors should be reviewing our relationship with them which is often far too cosy.

Count to ten

Nurse Anne is rightly getting heated about the shit we have to put up with from punters and relatives, while having to maintain the restraint of a saint, but she and her nursing colleagues are not alone. There is probably not a single group of NHS front-line workers who do not sometimes have to deal with unreasonable behaviour from the public.

It is not helped by management who do not stand by us, but are all too ready to jump on us when the abusive and the violent complain.

I remember two episodes that illustrate this.

1. A plaster technician witnessed an attack on a nurse, and weighed in, using the blunt end of a large pair of these on the assailant to remove his hands from the nurses throat.

2. A medical colleague who was attacked and successfully defended himself.

In both cases guess who found themselves in the shit. No prizes.

Futile gesture

Psychiatrist Dr Peter Rowan, who is 62, has recently been struck off by the GMC, principally (but not exclusively) for accepting the sum of £1.2 million from a deceased patient. Looking at the inheritance in isolation I was not aware that accepting money left in patients' wills was an offense. I can't see it ever happening to me but I am sure I am not the only person who would be tempted to cash the cheque.

If I were past retirement age, and with £1.2 million in the bank, acquired perfectly legally, why would I give a stuff what those tossers at GMC think or do.

Softening up

Further to my previous post, I find it odd that we NHS consultants should now be the focus of attention for the media. For years we have been left alone, our GP colleagues being the favoured prey. Even when our new contract delivered a very generous new salary it did not attract the ire of the media anything like when exactly the same thing happened to GPs.

So why all of a sudden have they turned on us, giving the public the impression that we all rolling in easy money? Note that the Telegraph article refers to our “bonuses”. Could they mean CEAs? 

As I have said before I think CEAs will be abolished, and good riddance too. If the consultant body is stupid enough to fight this, then we are going to look like the public sector equivalent of the bankers.

These articles spreading misinformation about our pay are perfectly timed to give the public a certain jaundiced view, and fighting the loss of our bonuses is going to confirm that view in the minds of the punters. Protesting over their loss is going to do us no favours at all.

Then again, I am sure that it is all just a coincidence.

How much!? again

After the recent claim in the media that NHS consultants earn an average of £130,000 pa along comes another bit of inaccurate and misleading consultant bashing. It is now claimed that “some” consultants “can” earn £100,000 on top of their basic salaries, in overtime. 

In fact this is the same trick as the “GPs earn £300,000” con. Find out the single GP with the highest income in the UK and then imply that we are all getting that much. Below the headline the details show that only a handful are earning anything like this much, and there is also the admission that average basic pay for consultants is of the order of £90,000, which is far more believable.

The figure of £100,000 extra appears to relate to just one individual and by my calculations that means he is doing an extra 4 sessions a week. If this guy is already on a full time contract he must be dead on his feet, and I would say he deserves every penny. He runs a serious risk of becoming the richest man in the graveyard. 

You wonder how he finds time to spend any of his money, and in the knackered state he must be in what he would spend it on. It reminds me of a quote attributed to George Best when he was asked where all the money he had earned went. “I spent most of it on booze, fags & women. The rest I wasted.”

Don't laugh

It will be apparent from some of my recent posts that I have been looking at and criticising the blog site of the homeopath John Benneth. I have found it difficult to credit the sheer ludicrousness of his long rambles, but the more I look the more I am drawn to the inevitable conclusion.

A commenter on another site has said “Benneth is an everlasting source of high hilarity” I disagree.

There is nothing funny about what we can all see on Benneth's blog. The long rambling paranoid and self aggrandising posts. His portrayal of those who criticise him such as these depictions of James Randi and PZ Myers.

But the clincher here is how he sees himself. This is posted as a self portrait of Benneth.

What we are seeing here is not funny but immensely disturbing. It is the steady descent of a human being into insanity.

Science denial

I have recently been asked to share a number of educational videos, which can be found here. One certainly I am glad to reproduce. It is worth watching.

CEAs

The Academy of Medical Royal Colleges (AMRC) have produced a report insisting that Clinical Excellence Awards (CEAs) are essential to prevent consultants leaving the country, and to incentivise them to do all that stuff that gets them the award.

These two points are, I think, particularly weak, and easy to refute. They are contrived to cover blatant self interest.

Firstly they assert that consultants will leave the country in droves if CEAs are abolished. Does anyone seriously believe that? Consultants stay or go for all sorts of reasons. By the time most of us attain consultant status we have domestic and family commitments that would make emigration a major disruption. Most of us stay here because it is home.

They assert that pay can be better overseas but in fact NHS consultant pay is one of the highest in the world. We are the best paid consultants in Europe. They cite the USA and Australia as offering higher pay. The US of course can be lucrative but it is not easy getting work in the States, and the high salary is eaten away by massive malpractice insurance premiums. Their example of Australia is just plain wrong. Anyone who has looked into going there will confirm that, usually, the rate of pay is lower  there than here.

So what of incentivisation. If you read the report what they are saying is that no-one would do the other (not extra) work if it were not for the money. This is an assertion that consultants are all totally mercenary, and that all current award holders have only done what has earned them their award for financial gain. In fact I would to a certain extent agree with this, but I am astonished that they have admitted it. Bearing in mind that the individuals involved in this report almost certainly to a man get a high end award, they are essentially admitting that they are all in in for the money alone. And they expect the rest of us to sympathise with, and support them.

I have no doubt that if CEAs were abolished all the extra work would still be done, by different people, with different motivations. People motivated by a desire to make a contribution to research and development rather than self confessed money grabbing greedy bastards. To paraphrase J F Kennedy “ask not what the NHS can do for you, ask what you can do for the NHS.”

So if the AMRC is right, and all the research and development within the NHS is subsequently done, not by the mercenary, but by the dedicated, then that is another excellent reason to get rid of CEAs. And perhaps the money saved could be used to unfreeze pay and increments for all of us.

Quote

Freedom of speech is central to Britishness and should be preserved even if it offends people. 

Sir Trevor Phillips.

Chairman of the Commission for Racial Equality

Clean Conscience

So, fresh from infecting your parishioners with the blood of Jesus, how does your average catholic priest relax and unwind?

Carry On Homeopathy

I have posted a link to this page before as an extreme example of the sheer deranged lunacy you can find in the alt med nutjobs, but I have only just now noticed what he says in his very first line. “In one year 14,000 Americans were killed on the job,”

Well that’s the best way to go.

Justice

I don’t normally do politics on my site but today is a big day. The expenses cheat David Chaytor is due to be sentenced in a little over two hours for making fraudulent expense claims. 

It would be an outrage if someone in such a high position of trust, who betrayed that trust for sordid financial gain, were to get off without a custodial sentence.

One thing in his favour is that he at least pleaded guilty of his crimes once it became clear that his guilt was plain for all to see. Unlike his fellow expense cheats Morley and Devine he at least saved the taxpayer the expense of a trial. Those two seem to be determined to bluff it out to the bitter end.

Morley puts me in mind of an old old advert for tea. The slogan was “Ty Phoo puts the T in Britain”. 

Morley was MP for Scunthorpe. Work it out. 

Advertising

I have just seen an advert on TV which is a perfect example of the technique described in my book review two posts ago.

The ad is for a milk formula for older babies. You may have seen it.

The ad starts by making the suggestion that children of this age run a significant risk of dietary iron deficiency, something I suppose would never have occurred to the vast majority of parents. It then points out how little iron there is in ordinary cows milk, while scaring people with the terrible consequences to the development of the child if this “problem” is not addressed.

Fortunately the solution is at hand in their product, a milk formula fortified with iron.

And there you have it. Problem condition invented, child medicalised, problem solved. 

What utter bastards, setting out to profit from a groundless fear, planted by them.

Could any of my GP readers advise how often they see iron deficiency in older babies, and toddlers.

Life is cheap

There is a row going on at the moment over the supply of drugs to the USA for use in judicial execution. Apparently these drugs are being supplied by a British supplier.

I know there are some big issues here but my eye in the article was drawn by two points.

Firstly one of the objections being raised to the use of these drugs for this purpose is that they are not licensed for this indication. Is it just me or does that argument have a vaguely Monty Python ring to it.

Secondly it is reported that the state of Arizona paid over £4300 for the supply of these drugs. Now I have looked up the cost of these drugs in the BNF, and they are as follows.

Sodium Thiopentone  £3.00 per amp

Pancuronium Bromide  £1.20p per amp

KCl                               ££0.48p per amp.

So by my calculation the cost of drugs is about £5-00 per execution. So how come they spent £4350. There are only two possibilities. The first is that the State of Arizona is planning to execute 870 prisoners. The more likely explanation is that their British supplier is grossly overcharging. Someone in this country is making a killing.

Book review; Selling Sickness, Ray Moynihan & Alan Cassels

There is no doubt in my mind that over the last hundred or so years the contribution of the pharmaceutical industry to human health and longevity has been staggering and wide reaching. Time and time again, in every area of medicine they have delivered the goods that have revolutionised the practice of medicine. They deserve recognition for this and no-one should begrudge the living they make from their efforts.

There is however a less commendable side to the pharmaceutical industry. In their drive for ever greater profits many of them have turned to highly dubious practices in which perfectly healthy people are persuaded, together with their physicians, that they have a medical condition that requires “treatment”

This is done in a number of ways. If the condition is one which can be measured, such as cholesterol level or blood pressure they can attempt to persuade the medical profession to accept a successive lowering of the level at which to initiate treatment. This has been particularly successful in the case of statin therapy. In the 1990s the number of Americans potentially felt to require statins was 13 million. By 2004 this number had been increased to 40 million simply by the lowering of what was claimed to be the upper limit of normal. 

In other conditions it is even easier for them. Simply plant the idea in peoples minds that there are conditions that are massively under diagnosed and under treated by “education” and “disease awareness “ campaigns. Then provide figures that the prevalence of these condition is high and that common experiences are in fact symptoms of a disorder. This practice is not new, but has, over the last few years, led to the following claims of “disease” prevalence being made by various drug companies.

Mental disorder of all types 30%

Juvenile Attention Deficit Disorder 10%, with an increasing assertion that the condition persists into adulthood.

Pre-menstrual Dysphoric Disorder (WTF?) 7%

Social Anxiety Disorder (?????)13%

Osteoporosis/Osteopenia 50% of the over 50s

Irritable Bowel Syndrome 20%

Female Sexual Dysfunction 43% (43%???!!!)

Presented like this, it is obvious that these figures are complete bollocks. Not just false, but absurd and ridiculous, an insult to the intelligence. And yet by clever, persistent and assertive advertising they have persuaded the public and the medical profession to swallow it. It has been particularly successful in the USA where drug companies are allowed to advertise their products direct to the punters, and spend $3 billion per year doing just that.

The full extent and range of these disturbing practices is laid out in the book Selling Sickness, by Ray Moynihan & Alan Cassels.

I have reviewed a book once before. On that occasion I was asked to do so by the publishers. I bought my own copy, read it, enjoyed it, and said so.

No-one has asked me to review or promote this book. But I do recommend it, most strongly, to anyone who ever writes a prescription, and anyone else for that matter.

Freedom of expression again

One or two comments in the past have criticised me for hiding behind my anonymity. Articles like this however make it clear to me that I am doing the right thing.  When the mohammed cartoons were originally published in the Jyllands Posten only two publications in the UK reproduced them, one a parish magazine, and the other a student publication, both very obscure and with very low circulations. In this bastion of freedom of expression, the UK, both publishers were forced to recall all copies and pulp them. 

Once they make the internet however the more objection is made, the more circulated the material becomes and the cartoons are now widely and freely available.

So the only way to exercise real freedom of expression is to remain a secret person. Otherwise not only are the religious fanatics likely to come and lob bricks through your window, you may also incur the displeasure of your employer, and even the security services. 

Dubious benefit

There is a lot of medical research carried out which is in my view a waste of time, and many papers published which I think are totally pointless. In most cases though I suspect the authors’ of these papers could at least make a stab at justifying their work and would be able to argue their point with me.

However once in a while someone’s research stands out as an example of sheer waste of time, talent and resources. Research which no reasonable person would accept is going to make any significant contribution to the health of mankind. Research whose sole objective seems to be to find a way of enriching unprincipled doctors.

This is just such a project.

Full circle

DZ is lucky in that he entered medical school in the seventies. In the field of education this period was probably the most egalitarian in the history of the UK. It was a time when those of very ordinary backgrounds could get a first class state education. The grammar schools were not perfect but were the equal of almost any public school and were potentially open to all regardless of background.

Medical school was not a financial burden then. Our fees were met in full and we had a (very) modest grant to live on, not a loan. Consequently my year at medical school was remarkable for the diversity of background in the students.

Despite my parents not contributing a penny to my med school education I qualified with a debt of just £400. And I would not have had that debt if I had not chosen to run a car.

Thirty years earlier it simply would not have been possible for someone of my background to enter medical school. Now thirty years on we seem to have come full circle. Read this article and reflect on how increasingly medicine is again becoming the preserve of the privileged, and wealthy. 

Orthopaedics vs Anaesthesia

                                          In case you have not seen this already