2016

As new year approaches everyone seems obsessed with evaluating 2016 in terms of those celebrities who have died. So a couple of dozen highly (over?) paid people have died and we are all supposed to be so impoverished because of it.
Well call me an old cynic, but 55 million other people also died in 2016. 6 million of them had not yet attained their 5th birthday.

Quote

"There are more pleasant things to do than beat up people"

               Muhammad Ali.

Not sure I entirely agree with him on this. I can think of many people that I'd derive enormous pleasure from beating up. In similar vein I'm informed on Facebook that today is National "I care about YOU DAY". And I've been invited to send a virtual bouquet to a list of 20 people that I care about. Being the Grumpy old sod he is DZ can't think of a list anywhere that long. DZ is waiting in anticipation for national "I want to shoot you between the eyes day".

 He has a list for that as long as the Greater London Telephone Directory.

There are more pleasant things to do than beat up people. Muhammad Ali
Read more at: https://www.brainyquote.com/quotes/quotes/m/muhammadal136677.html

Wonder drug

Last week I posted on my own experience of statin therapy. It was the second time my GP had arm twisted me into taking statins, and the second time I stopped them because of unpleasant side effects.

At least my GP has not yet brought up the subject of the dreaded polypill. I had thought things had gone quiet on this therapy but a google search shows that it's still out there and still has lots of proponents. Apart from the statin the polypill contains aspirin, and  2, or even 3 antihypertensive drugs. DZ has also been on an antihypertensive for a while. Frequent hypotensive episodes put an end to that. (I don't think DZ is his GP's favorite patient) Some of these episodes occurred whilst driving, and necessitated pulling over to ensure not passing out at the wheel. Bearing in mind the polypill is proposed for all over 55 year old men, regardless of whether they are actually hypertensive or not, how do you feel about sharing the roads with lots of middle aged drivers with their BP in their boots?

And aspirin of course has it's own list of side effects.

Those who would have us all on this therapy claim a number of benefits.

1. Efficacy. Various studies show a reduction in cardiovascular events, but are often dismissive of side effects. Perhaps if we knew the benefit/risk ratio there would be less enthusiasm.
2. It's cheap, since all the components are off patent.
3. Patient compliance is much better, since it's far easier to take one tablet once a day than various preparations at variable frequencies. However this has the downside that many patients will require one drug more than another, and dose adjustment of a single component is just not possible.

DZ has a better idea. There is a drug out there, a single pharmaceutical preparation which has multiple beneficial effects.

1. Cardiovascular benefits especially in congestive cardiac failure and left ventricular hypertrophy. There is also significant reduction in extent of damage in the event of an infarct. CRP is lowered and plaque formation inhibited.
2. This drug drops the blood pressure, not as potently as specific antihypertensives, but  for those who are normotensive this is no bad thing.
3. It's licensed for treatment of symptoms of benign prostatic hypertrophy prevalent in 40% of men over 50, and 75% of men over 75.
4. Early studies indicate possible benefit in type 2 Diabetes
5. It has been used to treat depression.
6. Early studies indicate possible benefits in some cancers, particularly of the throat

So what is this wonder drug? And why aren't doctors insisting it be given to all men over 55? Well cost is a factor, though it comes off patent in Autumn 2017 and should then be available generically, and much cheaper. As for compliance, it has a long half life and only has to be taken once a day. Also, it has one more effect I've not yet mentioned. It's primary licensed indication in fact. An effect which, entirely by itself would guarantee a very high patient compliance.

The drug is Tadalafil (Cialis). It's a phosphodiesterase inhibitor.

Goodness me!

Regulars here will know that DZ is not averse to using the odd profanity on this blog. When dealing with arseholes like the GMC it's difficult to adequately express the degree of contempt and disdain they deserve without resorting to swearing.

For many years those who swear have been accused of doing so because they have a limited vocabulary. That they are are incapable of adequately expressing themselves in a more socially acceptable way. This view of course is utter bollocks. This article confirms the opposite. That those who swear are in fact more articulate than those who don't. Fuck yeah!

Lost

DZ was interested to read recently that a loss of sense of direction is an early indicator of dementia. Just a few years ago DZ went through a period where this was a concern. For some months he would set out in his car to go somewhere, and after a few miles suddenly realise he was on completely the wrong road, going in completely the wrong direction. Very worrying.

Was this the start of galloping brain rot, the inevitable path to incontinent vegetativism? Or someting else. A few months previously I'd been started on a new medication by my GP, against my better judgement. As a little experiment I stopped the drug. Within a week I stopped getting lost.

Fucking statins!

unintended consequences

While studying a patient's notes today I came across the past medical history as supplied by the GP. Buried in there were two consecutive entries, as follows.

....Excess alcohol usage, many years. Stopped drinking 2007
....Depression 2007

A short, merry life, or a long miserable one?

Quote

Puppets.

That there are no depths that Hunt will not sink to in his ongoing dispute with the junior doctors is not something that should surprise anyone. That some of the high ups in our own profession should ally themselves to Hunt should also come as no surprise. So we shouldn't take too much notice of the statements by the Academy of Royal Colleges or the blatant threats of those bullying shits at the GMC too seriously. The name of the game here is to maximise the chance of a gong for various people, by seeing who can get his tongue furthest up Hunt's arse. My money is on Dickson, He's had the most practice.

The BMA has finally stirred itself, they should only contemplate one way forward.

Crows

A few days ago DZ was driving along a motorway in a rural area. The road was quiet and up ahead I noticed a small group of crows engaged in a motorway banquet, feasting on some unfortunate creature that had probably had too close an encounter with some vehicle. Just then I was overtaken by a motorcycle going at some speed.

 As he sped along the road the crows began to scatter and take off, but one was a bit slower than the rest and the biker struck him knocking him to the side of the road in a flurry of feathers. The biker wasn't in any way affected, but the crow was certainly killed instantly.
Google search will confirm the widely held notion of the "sentry crow". One crow that acts as a look out for the others preoccupied as they are with eating. He calls a warning of approaching danger.

 So why did he not warn his mates in time?  Perhaps he was just not used to vehicles doing that sort of speed. I mentioned this to a biker friend who confirmed that crows often fall victim to bikers, and he explained to me the reason.

Apparently the sentry crow, like all crows is perfectly able to say "car", but unfortunately none of them can say "motorbike"

Cupping??!!

An article in the Guardian today draws attention to the practice seen in some US athletes at the olympics of "cupping"

 The article quite rightly points out that the practice has no scientific basis, nor any evidence of efficacy, and that any benefit perceived by the athletes is likely to be pure placebo.

However, it is just possible, maybe, that there may, theoretically, be some real physiological effect.

"Oxygen flux" is the amount of oxygen delivered to the peripheral tissues per minute. Assuming no pathological physical impairment of blood flow it is very much dependent on haemoglobin value. The higher the Hb, the more oxygen the blood can carry, and the greater the oxygen flux. Up to a point.......  But increasing Hb also increases blood viscosity and thus reduces flow. There comes a point when increasing the Hb causes such an increase in viscosity that the resultant reduction in flow completely negates the effect of increased oxygen capacity, and further increase becomes counter productive. This is well known to happen in polycythaemia. So there is an optimal value of Hb at which O2 flux is maximal. The exact value comes as a surprise to many doctors. Optimal Hb for maximal O2 flux is (in old units as befits DZ) just 10g/100ml, significantly lower than the normal 14 or so.

If the bruising caused by cupping were to significantly lower the Hb level in the blood, it would improve peripheral blood flow, and possibly, improve performance. You might get a similar effect by bleeding, or applying leeches.

As this study shows, removing 500ml blood certainly doesn't seem to have a negative effect. And as far as I'm aware, unlike performance enhancing drugs, it's not forbidden.

Добрый день

Уже некоторое время 70% тех, кто посещает этот блог, 

русские.

 Добро пожаловат.

Quiet

Perhaps I should have noticed, but, tucked away in my statistics pages is the information that, at some time in the last two weeks, total page views on this blog went past one million.

 In fact, despite my not having written anything for some weeks I'm still getting quite a lot of views, though why I should currently be getting so much interest from Russia at the moment is a bit of a mystery.

It makes me feel I really should make more of an effort to put up the odd post. So why have I been so quiet? Busy with other things, certainly, but not that busy. maybe I've run out of things to say, or don't feel so strongly any more about things. Or maybe I've been plunged into the pit of despair by the failure of our new Prime Minister to banish Jeremy Hunt to some far flung backwater.

 I'm still here. Maybe I'll think of something.

Spin off

In all the political turmoil and blood letting, am I alone in fervently hoping that one of the casualties will be our detested Health Secretary?

Celebrity stupid

There is an inexplicable tendancy among human beings to look for information, not from the qualified and knowledgeable, but from the rich and famous. A prime example would be the reporting in the newspapers today of the view of the footballer David Beckham on theEU referendum. So why is he considered an authority? Not only has he spent much of the last 20 years living outside the UK, he's not actually renowned for his intelligence. These quotes will perhaps illustrate my point.

“I definitely want Brooklyn to be christened, but I don't know into what religion yet. “

“My parents have been there for me, ever since I was about seven. “

“Alex Ferguson is the best manager I’ve ever had at this level. Well, he’s the only manager I’ve actually had at this level. But he’s the best manager I’ve ever had. “

So in this vein this is Dave Asprey. A very wealthy American businessman, who, for some reason, has so far escaped an entry on the“Encyclopedia of American loons”. He has a fairly standard list of looney views, including advocating homeopathy and inventing his own, unremarkable diet. He's nonetheless considered very influential with the public in the field of health & fitness.

Possibly my favourite bit of delusional bollocks coming from him is his assertion that men should not orgasm more frequently than dictated by a special formula, Age, minus 7, divided by four. Using this formula your average 16 year old would have to wait about 2 days between events. I think most young men that age would be hard put to leave it two hours. 

And DZ at his age, should be leaving it over two weeks! Fuck off Dave, you're having a larf! Apart from anything else we have prostate cancer to ward off.

Dave has also firmly announced his intention to live to be 180 years old. Good luck with that one Dave. I think you'll find eventually that, as all Discworld fans know, when death comes to visit you he's not come for an argument.

Merry month of May

Apparently May has been designated "International Masturbation Month". Phew! And I almost missed it.

Punt

303 metres. Is that any good?

Appraisal

About a month ago I posted a copy of a German short film on basic life support. One guaranteed to keep it's audience riveted. I've been wondering. Can I claim studying this film as part of my CPD, or personal development or whatever bullshit term is in vogue these days?

Recidivist

A fascinating development in the dispute between the junior doctors and Jeremy Hunt is that it now appears that he does not actually have the authority to impose his hated new contract. Could this be true. Could it be that he is so ignorant about the limits of his own authority that he could have made such a mistake. Or, worse, maybe he knew full well and was cynically and beligerently bluffing. 

Either way he has form. He exceeded his authority once before, in the fiasco over Lewisham accident and emergency services. The high court at that time slapped him down without mercy. The likelihood is that he's about to get another kicking.

How has someone so manifestly, utterly unsuited to his position managed to cling on so long?

Blackmail

I see that the chair of the GMC, and the NHS Medical Director are both urging the junior doctors to call off their planned strike. I don't think we should take them too seriously. These two individuals have long ago sold themselves to government and it was inevitable that Hunt would wheel out these two puppets to say what they've been told they're expected to say. They're nothing more than mouthpieces.

Also inevitable is that Hunt and his puppets would hide behind the patients, warning of the consequences to them of withdrawing emergency care.

Let's be clear about this. There will be no consequences. The Consultants are solidly behind the juniors in this. The Consultants will cover the emergencies. Obviously they will. The patients requiring emergency cover will not suffer in any way.

So, Bruce Keogh, and Terence Stephenson. You've nailed your colours to the mast. Now fuck off, your strings are showing.

Thumb sucking

DZ recently rediscovered something that took him back over 50 years.

I remember quite clearly at the age of about 12 or so browsing in the children's section of our local library. In the section for young children I found a book that contained "The Story of Little Suck-a-Thumb". I remember even at that age being utterly appalled to find this, thinking at the time it was pretty much guaranteed to induce nightmares and anxiety in any child who sucked their thumb. Reading it again today I still think it's quite horrible. A story telling kids that, if they suck their thumb some lanky maniac will burst in with a pair of shears and cut off their thumbs, with the acquiescence of their mother! This is the original illustration from the book, first published in 1845

 

Snip! Snap! Snip! the scissors go;
And Conrad cries out - Oh! Oh! Oh!
Snip! Snap! Snip! They go so fast;
That both his thumbs are off at last.
Mamma comes home; there Conrad stands,
And looks quite sad, and shows his hands;-
"Ah!" said Mamma "I knew he'd come
To naughty little Suck-a-Thumb."

What a sweet tale to read to your little one at bedtime. I wonder what sort of deranged lunatic could write such a thing. Well I looked up the author, one Heinrich Hoffman. Believe it or not he was a psychiatrist!

I suppose we should be grateful he didn't explore what might happen to boys who've discovered wanking.

Brexit

DZ is not going to say where he stands on the issue of the UK remaining in, or leaving, the EU. Already both sides are throwing up spurious and highly speculative arguments to promote their cause and denigrate the opposition. But this one has to take the cake. Of all people Jeremy Hunt warning that the NHS is at risk if Britain leaves.

Mr Hunt. The biggest threat to the NHS...........is you.

GMC justice again

A last word on the shameful and wrong case where Christian Solomonides was victimised by the GMC, for expressing his opinion. I've already pointed out that the actions of the GMC are contrary to their own policy, and the human rights act. They also contradict the contractual right guaranteed to Mr Solomonides by his employer.

“A practitioner shall be free, without prior consent of the employing authority, to publish books, articles, etc, and to deliver any lecture or speak, whether on matters arising out of his or her hospital service or not.”

Paragraph 330, national terms and conditions for senior hospital medical staff.

I'm wondering what legal representation Mr Solomonides had. Whoever it was did a pretty shit job in my view, and almost certainly charged a level of fees that doctors can only dream of.  I'm pretty sure I could have done a better job. If I were Mr Solomonides I'd ask for my money back.

CPR

Now isn't this better than the last BLS session you attended?

A woman with her head up her arse.

I've not been able to find a picture of Lisa Elisabeth Smith. She it is who found Dr Christian Solomonides guilty of professional misconduct, and suspended him for two months. The sheer wrongness of this verdict can't be overstated. Ms Smith actually did comment on the doctor's right to freedom of speech, before, in the same breath, contradicting herself and depriving the doctor of that very right. I have no doubt that had the victim of this kangaroo court stood up and challenged the GMC in the high court he would have won, but the GMC works by intimidation and fear, designed to break down the victim's will to fight.

Not only is this verdict a breach of the Human Rights act, it is also contradictory to the GMC's own policy.
"In January 1999 the Standards Committee of the GMC met to consider issues involving the behaviour of doctors who comment in the media. It was their view that the GMC should not attempt to curtail doctors' rights to express their personal opinions. Doctors, like anyone else commenting in the media, are subject to the same constraints imposed by media regulatory bodies, and the libel laws. Furthermore, the committee considered that the professionals reputation depends principally on the standards of care and conduct provided by doctors to their patients, and not on personal opinions as put forward in published letters or articles. Whilst you may disagree with the comments Dr Y has made, we cannot take action against a doctor who is expressing a personal opinion".
In it's actions it is clear that the panel were not even aware of the GMC's own policy on the matter. How fucking incompetent can you get?

Dr Solomonides has been victimised for doing something he has every right to do. It is no different from many others' writings, including mine.

I wondered perhaps if Ms Smith is some super legal brain who has based her judgement on some legal point not clear to us lesser mortals. But not so. She has no legal training whatsoever. She was formerly a civil servant at the department of work and pensions. She is manifestly a complete fuckwit, no more fit to judge doctors than my dog. The one four feet under the earth at the bottom of my garden.

It is utterly abominable that the GMC should appoint as chairs of panels people like this, with no legal knowledge, no legal training, no legal expertise. It is a true expression of the contempt with which the GMC views doctors. That we should be judged by people so ignorant, so incompetent, so utterly unsuitable is something we should not have to put up with. Is it too much to ask that those on panels should have some relevant knowledge?

Ms. Smith. If you had a shred of integrity, shame, or insight you would apologise to Dr Solomonides, and resign your position. You are not fit to judge a pet show.

Article 7.

My last two posts highlighted further, probably illegal, action taken against a doctor. Regular visitors here may well be fed up with me banging on about article 10 of the human rights act. Though the actions of the GMC are undoubtedly in breach of this article I'm not going to comment further on that now.

But the GMC are also I think in breach of article 7. "Under this right crimes and penalties can only be prescribed by law." Contrary to what the GMC likes to think, it's not a law to itself. Their counsel Shirley Duckworth, who should know better, has stated. "the postings could cause offence". Well Ms Duckworth, much as I hate to tell you your job, causing offence is NOT illegal. In fact it's pretty much impossible to open your mouth on any matter without offending someone somewhere. Perhaps you should go back to law school. Or listen to this guy.

GMC again

I'm not the only one who's noticed the GMC's latest stunt. See this from Rita

GMC gets it wrong again

I see the GMC is playing it's game of censoring a doctor again. It seems to me that the doctor in question is airing his views, as he has every right to do. Some of his views I think many doctors would agree with. There doesn't seem to be any suggestion that any patients were specifically identified. Some of the offensive comments are worth repeating.

“Ambulance for a broken nail, an earache, period pain, not being able to sleep are all REAL. What’s going on with the people of the UK…”  I think most A & E and ambulance staff would verify that this statement is factually correct.

“I’m sure ADHD is merely a polite term for a child who is just a little shit.” DZ would agree with that one!


“I’m sick of busting balls to ensure that a patient with a broken fingernail (who called an ambulance) is seen within four hours." Seems pretty reasonable to me.

What are the GMC playing at? Their council stated. “He recognised he had overstepped the mark, the postings could cause offence" I know I keep hammering on about this, but he's perfectly entitled to express opinions, even if they do cause offense.

Ooooooooooooh I've just realised I've repeated the Doctor's unacceptable comments. Woe is me. Perhaps the GMC will read my blog and get nasty. Well here's a message for you boys.

                 Fuck off!

What a nice man.

This is Christopher Chope, Conservative MP for Christchurch. He is the one responsible for the proposed bill to exclude all health care professionals from the protections of the working time directive. He's also known as "Chopper" Chope, for his ruthless cutting of council spending whilst a councillor. He has also called for the abolition of the minimum wage, whilst in one year claiming £136,992 in expenses, for such essentials as repairing a sofa at a cost of £881. Fuck me, my entire suite didn't cost that much to buy. He's also campaigned to reintroduce National service, and the death penalty. See here for a fuller roundup of what sort of an MP he is.

What a prime cunt!

Sneaky!

In all the furore over the junior doctors' contract something else rather nasty has been going on, very quietly, behind the scenes.

When the working time directive became law initially it excluded doctors. It's taken something of a struggle but this anomaly was eventually rectified.

Well, it looks as if the clock is about to be turned back.

So, so very glad I've retired. What next? A bill to call up retired doctors and force them to work?

Article 4

Just a thought here, but doesn't imposing a contract on workers without their consent or agreement constitute forced labour? If so it's a breach of article 4 of the Human Rights Act. "A person is subjected to forced labour when the person does not voluntarily consent to perform work but does so because of threats made, either physical or psychological."
It seems to fit the bill to me. After all Hunt in attempting to pave the way to a return to exploitative work practices, is trying to force us to perform work we haven't consented to. Not exactly slavery I know, but the thin end of the wedge?

Guilty

Occasionally the GMC get's it right. Although when you read what this guy did it's difficult to see how anyone could have come to a different conclusion. Quite a catalogue of misdemeanours. A shame the media make a big thing over whose brother he is, which is entirely irrelevant. He got what he deserved entirely by himself.

Bring it on indeed

DZ expressed a sentiment in his last post that seems to be shared

"Screw you Jeremy Hunt. ................. Well you've picked a fight with the wrong crowd. Go on, announce imposition, and just see what the most resilient, driven, passionate, intelligent group of people in Britain do next. Bring it on."

Another man with his head up his arse.

This is Chris Hopson, the chief executive of NHS Providers, which represents over 90 per cent of NHS Trusts. He it is who has stated“If the BMA won’t accept a fair and reasonable offer then, yes, it is legitimate and sensible for the Secretary of State to consider imposition.”
So who's to decide what constitutes a "fair and reasonable offer"? In his mind I think that that decision would fall to people like him, and Jeremy Hunt.
DZ worked in the NHS back in the days when there were no safeguards for doctors when it came to working hours and remembers working work patterns which were grossly exploitative and dangerous. It has taken us many years to rectify that situation to a point when safeguards do now exist, though various governments resisted strongly along the way. Remember, when the working hours directive first became law doctors had special treatment. It didn't apply to them.
So having won these safeguards, weak as they are, against exploitation and servitude, Hunt now wants to abolish them. Now why would anyone want to do that do you suppose?
So what is Hopson's experience working in the NHS. Well prior to his present position he was a glorified tax collector. And before that he worked for independent television. So he's obviosly well qualified for his present job, pontificating about how to run the NHS, and riding roughshod over the staff.
I don't know how much he is paid for his invaluable contribution, but judging from the chins cascading over his oversized shirt collar I imagine it's substantial. And I don't suppose he works Saturdays either.
This ignorant fat lardbucket has no insight at all into the determination of, not just the medical profession, but all the others working in the NHS who stand to get screwed if the doctors, the first domino, fall.
Ok then Hopson, you utter prick, and Hunt you mendacious bell end. Impose a contract. And we'll see what happens shall we?

Question answered

In my last post I questioned whether the health secretary was either, devious and dishonest, or just plain stupid. Having seen this latest from him today I think that question is answered.

Bad or thick?

Jeremy Hunt is very fond of highlighting the apparently poor prognosis of patients admitted to NHS hospitals at the weekend, and (mis)using this data to push his agenda. Those who work in the NHS however know full well that, because weekend admissions are disproportionately emergencies, that mortality is inevitably bound to be higher. A recently published study has confirmed that patients admitted at the weekend tend to be older and sicker than those in the week. This may seem like the bleedin' obvious but it's important to have factual data to refute Hunt.

So what do you suppose are the chances that Hunt will mention this study? I wouldn't hold your breath.

To my mind there can only be two possible reasons why he persists so tenaciously with his factually flawed pronouncements. The first is that he is deliberately mendacious and deceitful, and that he is pursuing his own agenda with a complete disregard for factual reality, and a staggering contempt for the intelligence of the medical profession, and the public. That is, he know's full well that he's wrong, and that we all know that he's wrong, but he just doesn't give a fuck.

The other possibility is that he really is pathologically stupid.

Whiplash

Britain is apparently the "Whiplash capital of Europe".

No not like that unfortunately, like this.  DZ was once involved in such a claim. While reversing into a parking space he very gently knocked the front of a car behind. The lady driving took details and then flounced off to her aerobics class, and subsequently submitted an insurance claim for whiplash injury. The Insurance company simply paid up rather than fight the obviously spurious and opportunistic claim. So DZ is more than happy to see that Aviva fought this time and won, sending the claimants packing.

But there is a medical issue here. Apparently the claimants were "able to supply medical evidence to lawyers in support of their claim." So some of our colleagues were perfectly prepared to collude with this blatant attempt at fraud, in order to line their pockets. What greedy dishonest fuckers they must be.

DZ makes no apology for repeating something he's said before.

The only difference between some doctors and prostitutes, is that there are some things prostitutes won't do for money.

Reflection

DZ once had a close friend, a German. She used to have a saying "Mann denkt man ist was selbst er ist". A rough translation would be that people assume others are as they are themselves.

If this is true take the following situation. Our glorious leader dear Jeremy wants to introduce weekend elective working in the NHS. Nothing wrong with that in itself. After all much of  NHS hospital facilities stand idle at the weekends. But this would represent an increase in workload of 40%. Logically then it would require a corresponding increase in all staffing, resulting in a 40% increase in costs.

But Jeremy isn't keen on that cost thing. He wants to increase the throughput without any financial input. The only alternative to increasing staffing levels is to get the existing staff to increase their hours by 40%, but this would cost even more, and has the added disadvantage that, under the terribly inconvenient working hours laws, and current contracts, this is not allowed. Totally verboten!

The solution is easy. Unilaterally change the doctors' contracts so as to remove those safeguards so hard won over the years, and take us back to the days DZ remembers well, when we worked over 100 hours a week.

That this is how his mind is working is obvious. As plain as the nose on Pinochio's face.

So how does he think he can get away with this. He must think we're incredibly stupid, imperceptive and unthinking.

And by my friend's philosophy perhaps that tells us something about him.