Mystery object

It's a very long time since DZ published a mystery object. Not a very good quality image I'm afraid, but if you know it you'll recognise it. DZ is old enough to have used one of these in the dim & distant past. So, any guesses?

 

Hypoxia!

 DZ has always been careful to ensure he does not identify himself on this blog, but on this occasion has decided to post a pic of himself. Here I am.

Yes, DZ has acquired a dinosaur suit as a present, and very pleased he is with it too. It's a wearable plastic inflatable. It's kept inflated by an electric fan which also supplies the wearer with an air supply, very important when wearing a large plastic bag. Like most men DZ finds the idea of reading instructions a bit demeaning. After all I can figure out something as basic as this without having to resort to patronising instructions. And so it was that I installed the fan the wrong way round. I put it on, zipped up and turned on the fan. Which promptly sucked all the air out of the costume, causing some consternation as the resultant suffocation started. Unlike some strange souls I am not someone who finds this a pleasant experience. Fortunately I was able to find the zip fairly quickly and open up. 

Lucky I didn't end up like this.

Expert quack

 

DZ opinion on medical and science journalists is not very high. Their formula for writing an article seems to be.

Scour the journals for any random article.

Sensationalise it to induce outrage/ discontent/dissatisfaction in the reader. This may require some considerable distortion of the original article, but no matter. Misrepresent results, conclusions and implications at will. Misrepresent entirely the writer of the original article one way or another.

Under no circumstances should the journalist take any steps to learn about the subject of the article. Do not verify statistics. If in doubt make it up.

Ignore the corrections offered by true experts.

A prime example is this guy, editor of, among other things, this article. One of the most sloppy, lazy, inaccurate misleading articles DZ has seen in a long time. I’ve sought to find out Mr Bagot’s background and qualifications. From what I’d read I doubt very much he has a medical qualification. Or a science degree. Or O level. I was right. He has a degree in English studies.

So let’s look at the newspaper article in question. The headline reads.”Experts call for the NHS to stop prescribing pills that do more harm than good” The gist of the article is that NHS drug prescribing is massively higher than it used to be and implies that most of these drugs are unnecessary. Apparently drug prescriptions per patient doubled from 5 to 10 items over the ten years from 1996 to 2016. That may be true, and I have no doubt that some unnecessary prescribing does happen. But not, in my perception, to the extent claimed. Also they fail to mention the two main reasons for this.

Firstly, life expectancy in UK men increased over the period quoted from 77, to 79, partly due to modern therapeutics. Since the elderly require medication more than the young this in itself will have an effect.

But far more significant are the advances made over that period in terms of medical and pharmacological progress. I remember for example when anyone having significant gastric  ulcer disease would end up with a horrific operation, the vagotomy and pyloroplasty. The advent of proton pump inhibitors effective, safe drugs, has consigned this procedure to the historical dustbin. Similarly far fewer men now have surgical prostatectomy due to the development of safe medical treatments. And when I qualified there simply were no effective treatments for acute myocardial infarct or stroke, leaving those who were lucky enough to survive these with significant, and often severe disabilities. Prophylactic and therapeutic pharmacological options for these have reduced both mortality and disability enormously.

So who are these “experts” who are promoting the beyond pills campaign. Well despite claiming that the campaign is supported by “doctors and senior politicans” only two politicians are actually named. One is Heidi Alexander, shadow health secretary for a whole year in 2015. A real expert then. Not. The other is Stephen Dorrell, who was briefly Health Secretary over 25 years ago! Another has been who knows fuck all about it.

And which medical big gun has backed this campaign. The Chief Medical Officer perhaps, or some eminent respected physician, or maybe a Professor of pharmacology. No. None of those. It’s this quack, who I’ve written about before. He chairs a pseudo college called The college of medicine and integrated health. This rose from the ashes of the Princes (Charles) Foundation for integrated health which went under amid allegations of fraud and money laundering. Dr Dixon is not an expert in anything whatsoever. I don’t know how many doctors are members of this so called college, but I bet that, if they had a conference they wouldn’t need a big venue.

There are one or two, shall we say, distortions in the newspaper article.

Firstly the article quotes the “national overprescribing review”, a real and reputable document as saying “10% of prescribed drugs are unnecessary and may cause harm” It doesn’t say that. What it actually says is that 10% of drugs prescribed in General Practice are overprescribed, which has an entirely different meaning.

They then quote the review as saying that “Adverse drug reactions now account for up to a fifth of all hospital in patient admissions”. It doesn’t say that either. The sentence quoted does not refer to “all” hospital admissions, but those of patients over 65. As a proportion of all patients the report states 6.5% as the actual figure. Still high, but definitely not one in five, and I’m even dubious about that. This government response cites  the number of patients hospitalised in 2020 as a result of adverse drug reaction as 7270. This report quotes the total number of admissions to English hospitals at 17.2 million. You do the maths.

So between them Mr Bagot and Dr Dixon have produced an article, published in a national newspaper that is misleading, inaccurate, dishonest and allows a known quack to publicise a dubious college. Nice one.

Overprescribing is a genuine issue. This article obscures, not reveals the true state of affairs. The National overprescribing review is well worth a read and sets out goals to reduce the problem and reduce the number of unnecessary drug prescriptions. Perhaps they could start with statins?

Fuel crisis again

 After my little update yesterday to a previous article I've found another that could do with bringing up to date. 11 years ago (yes, really) I wrote a tongue in cheek post about how much biodiesel we could get from liposuction of obese people.

 The prevalence of obesity in the population of the UK is still about 25%, but the population itself is much higher at 67 million. So there are 16.75 million obese people in the UK. Also you may have noticed that the cost of diesel is much higher than it was in 2011.

 So assuming as before a yield of three litres of fat per liposucked patient, and a 90% yield of this to biodiesel we could end up with 45 million litres of fuel, worth, at present prices £90,000,000. Not bad. And we could increase that enormously by flensing dead fat people.

Appraisal reappraised

 

Back in May 2018, when we were blissfully unaware of what was around the corner I did a little exercise working out how much time the process of appraisal takes, and what this means in the broader view of impact on clinical services. I did the same, separately, for mandatory training.

Then Covid came along. With the workload clinicians were taking, and the stress we were under it became accepted, even by the GMC,  that a requirement for appraisal would be unnecessarily burdensome on hard pressed doctors. Trusts also felt the same about mandatory training. Tacit admissions that both appraisal and mandatory training can be shelved when it suits them.

Covid has not gone away! The UK seems to be in yet another wave, with 25,000 new cases on June 15 2022. In addition the waiting lists for treatment have ballooned. There are now 6.5 million people awaiting treatment. Also it is estimated that the UK is understrength by 10,000 doctors.

So I decided to recalculate, but combining both processes. I assumed, as before that appraisal takes 40 hours to prepare for and endure. And 20 hours mandatory training. I also assumed, as before that a doctor works 44 weeks of the year. In may 2018 there 240,000 fully registered medical practitioners. There are now 300,000.

I’m not going to go through the arithmetic. The bottom line is that, if appraisal, and mandatory training were abolished, and the time saved devoted to clinical work it would generate extra work equivalent to employing an extra 10227 full time doctors. At zero cost. That would address the shortfall at a stroke. I believe that the benefits would actually be greater. These calculations assume that doctors would be prepared to do an extra 15 sessions a year if the requirement for appraisal and mandatory training, both utterly worthless exercises, were lifted. I would be perfectly prepared to permanently change an SPA to a clinical session if this were offered, and I’ve no doubt many of my colleagues would feel the same. In addition we know that these processes are demoralising. They contribute to doctors emigrating and retiring early.

They are both, in the current circumstances, and for the foreseeable future, unwanted luxuries we can not afford.

Malice

 

I have often written on this blog about the tyranny and vindictiveness of the GMC, and of their arrogant view that the law somehow doesn’t apply to them. The GMC themselves are overseen and regulated by the Professional Standards Authority for Health and Social care. It is rare indeed for this body to take the GMC to task. The annual reports on GMC performance are little more than congratulatory whitewash exercises for their mates up the road. Even on those rare occasions when the high court finds against the GMC, this is not examined by the authority.

But when the opportunity arises to challenge the GMC in a way that enable the Authority to get the knife into an individual doctor they’re in their like a shot, showing a degree of malice and vindictiveness that makes the GMC look benign.

As in this case. A Belfast Neurologist was the subject of a GMC fitness to practice hearing. I don’t want to go into the allegations. They may be substantial, or the GMC may just be bullying, to which they’re not averse. The Doctor in question decided, understandably, to quit the profession entirely, and applied for voluntary erasure. Any registered medical professional has the right to do this. DZ looks forward to doing this in the near future. Once that happens I may reveal my identity. And then again I may not. Once erased the GMC have no more authority over the practitioner, who from then on has escaped their tyranny for ever. And to give the GMC their due they granted the request, erased the doctor, and the fitness to practice hearing then became moot, and was terminated. The Dr and the GMC went their separate ways. For once the GMC are not the villains of this peace.

The Professional Standards Authority weren’t happy with this. They went so far as to go to court to force the GMC to reregister the doctor, so that the fitness to practice hearing could proceed. Now, the ultimate sanction available to the GMC in a hearing is erasure. So the Authority wanted to  reinstate the doctor so that they could potentially erase him again. A case of. “You can’t quit, we want to fire you”. All it could possibly achieve was to subject the doctor to more stress, more humiliation, more harassment. An action so pointlessly vindictive and malicious you wonder what sort of vile cunts would want to do such a thing.

I’m pleased to say the judge told them to fuck off.

Whistleblowing and bullying

 

The NHS attitude to whistleblowing has never been cause for celebration. Going back to the Stafford Hospitals scandal it’s clear that problems had been endemic for some years, but those few staff who dared to raise concerns found themselves turned on by management, often with the collusion of the GMC. The message was quite clear. Keep your mouth shut.

And bullying of whistleblowers is not the whole story. Bullying is widespread throughout the entire NHS, and a recent report shows that things are not changing.

If you google “NHS bullying” you will find dozens of documents laying out the bullying policies of various Trusts. You might think that these indicate that the problem has been addressed but there is one flaw with that view. These policies and protocols are not worth the paper they were written on.

In the late 2000s a NHS Consultant initiated an industrial tribunal case against a former employer for bullying, harassment and constructive dismissal. The tribunal concluded that the Trust had indeed failed to follow it’s own policies and procedures, but they also stated, astonishingly, that these policies and procedures were “Not contractually binding”. So the guilty Trust won. I wonder how many NHS employees are aware that these policies are totally unenforceable.

And NHS trusts still continue to behave towards employees in a highly questionable manner. We all know now about the appalling behaviour of the Consultant Breast Surgeon Ian Paterson, who was jailed for 20 years for maiming and mutilating many of his patients. Paterson worked until 2007 despite the fact that a surgical colleague raised concerns as early as 2003. The management response was not only to ignore those concerns, but also to move the whistleblower to a different hospital. Paterson was enabled to go on maiming people for a further 4 years by the complacency of the Trust, and also Spire private hospital, where he also worked.

Things have not changed since A J Cronin wrote “The Citadel”