Twenty five years ago the medical profession - and the NHS - were very different to how they are today. Sure there were problems, many problems, but overall Dr No believes that much of what we had then was good - and that much of what we have now - the changes we have seen - are bad. So bad, in fact, that it amounts to an un-avoidable conclusion that there is a lot of bad medicine out there. And the time has come to call it to account.

So that is what this blog is about: the dubious, bad and sometimes frankly lunatic developments in the medical world. It will cover not only the science (already well covered by the likes of Ben Goldacre on his Bad Science website), but also the human and social side of medicine. And it won't be afraid to poke fun at those who cry out to have fun poked at them.

Note - Feb 2016: the service that hosts Bad Medicine has announced it will be upgrading its software later this month. These upgrades can cause Bad Medicine to stop functioning correctly, or even at all. If this happens, Dr No apologises, and assures readers that he will do his best to get things back to normal as quickly as possible.



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A Tale of Two Thickies

Of all the reasons to end a long and bitter industrial dispute, imposing an unwelcome contract on a demoralised workforce to "end the uncertainty" has to be the most bizarre, given the inevitable outcome of the imposition will be not less, but more uncertainty. The demoralised workforce, our junior doctors, are already in bad shape, overstretched and in poor morale. Record numbers are considering – though we don’t yet know how many will pull the ejector seat lever – working abroad. Late last year we learnt that almost half of juniors completing their foundation training chose not to proceed directly with their training – a sure sign of ambivalence about the direction of their chosen career. Hospitals face unprecedented recruitment problems, winter pressures are now being mirrored by summer pressures, with the imminent prospect of all year round pressures. The health service is in a critical way, at risk of implosion. So what does the Health Secretary do when he doesn’t get his own way with the juniors? He hits them on the head. Hard.

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The Hair of the Dame

After the season of good will, the season of bad omen. More Blu-Tack than tack sharp, Dame Sally Davies, the Chief Medical Officer, stuck at the end of last week to her message that there was no such thing as a safe limit to alcohol consumption, but if you wanted to live dangerously, then she supposed up to 14 units a week was tops. On the Today programme, she was the worthy teacher cajoling the dull child, only to be out-smarted by J Webb, who popped the public health message balloon by pointing out that normal drivers face a similar lifetime risk of death as that implied by the new alcohol limit, yet the Government has yet to advise us that there is no safe level of driving, or that drivers should limit themselves to 14 miles a week. The balloon popped so far above Dame Sally’s head that she missed it. When Jay repeated the point, the response was of the ‘oh no, we don’t need to bother with that sort of nonsense round here’ kind, followed by more chugging rhetoric on the risk of dying from breast cancer.

The Last Junior Doctor

As the post nuclear option Heremy Junt/BMA contract row rumbles on behind the scenes – the top hit on google news today for junior doctor contract is a three day old blog post on Conservative Home by a psychiatrist sorely in need of Photoshop if ever there was one, and the BMA’s ‘latest update’ is weeks old, a thoughtful post by JT reminds us that the opposing comedy duo of Junt and the BMA Junta are not the only threats to junior doctors. The SPECTRE known for the time being as NICE, the National Institute for Clinician Evisceration, has produced yet more guidelines on statins. Commendably dense with the rhetoric of patient choice, the general thrust is nonetheless on upping the uptake. JT’s gripe is three fold. The first is that clinical guidelines, statistical tools, algorithms, call them what you will, become wet paper bags when they attempt to contain the complexity of real life. The second is that guidelines alongside variations of payment by result tends to get, well, results, ie more people on statins, without care for whether they want them or need them. The third, touched on more briefly, but just as important, is that, up against the hour glass of surgery time, thoughtful deliberation never stood a chance. It is the dead duck floating feet defiantly up, but head drowned in the time-hoopered barrel of clinical complexity.

The Strike That Passed in the Night

At the eleventh hour, the BMA suspended the junior doctors’ strike. It hasn’t been called off entirely, it may still happen, but probably won’t. As a conspiracy theorist, Dr No suspects the whole shebang was a clever ruse by the doctors: a strike that was not a strike, a neat foil to Absolutely Stilton’s tanks lining up in the hospital car park; as a cock-up theorist, he suspects the whole bang shoot is further evidence that, even if it wanted to, the BMA couldn’t fire a rocket on Guy Fawkes Day. Apart from some bizarre even by Daily Mail standards doctors’ leader in love nest in Neasden style hackery, not to mention its doctors on dark web exposé, media coverage has been thin for what is after all serious domestic news. At the coming up of the sun, the Today programme looked the other way, and at the going down of the sun, Hoo Wedwards and his harem of squawking reporterettes hardly ever mentioned the conflict. There was some coverage of the ‘overwhelming’ 98% in favour ballot result, but few pointed out that 98% of those who voted is about just over half of all junior doctors, though even that is still an eye-watering result. For the BBC in particular, the junior doctors’ contract was, like the Health and Social Care Bill before it, to be just another ship that passed in the night.

Bitter Pill for Sugar Tax

Britain and sugar go back a long way, and the history is not that glorious. Sugar, or white gold as it was known, was the reason for the infamous trade triangle, the round trip that took slaves from Africa to the American colonies, sugar from the colonial plantations to Britain, and goods from Britain back to Africa to buy more slaves. By the mid 18th Century, the trade was so lucrative that the then British Government, blissfully unaware of yet to come concepts of coercive healthism and the nanny state, did the fiscal thing, and slapped a tax on sugar, making it a luxury item. The situation was turned on its head in the mid 19th Century, when the Free Breakfast Table movement, an early Liberal free school meals idea aimed instead at the working classes as a whole, brought about the abolition of duties on sugar and other breakfast table commodities, and the masses were freed to shovel ever larger quantities of sugar down the cake hole. Every Little Helps, as they say at Tesco. Even today, The Great British Bake Off, when it isn’t about the BBC showing off its ethnic credentials, is all about devising yet more elaborate ways of getting yet more sugar through the cake hole.

Poldark by Gaslight

Dr No approached last Sunday evening’s Lady Chatterley’s Lover (BBC1) in a bad mood, having just had his computer freeze up in the last moments of an ebay auction he was particularly keen to win. Maybe there’s an app out there baddies can use to freeze up other bidders’ computers at the critical moment. Any road, he hoped some good old fashioned rumpy pumpy would distract him from his ebay woes, all the more so as the BBC’s adaptation was by Jed Mercurio, once upon a time a doctor, and known more recently for dramas such as Line of Duty. He was up against stiff competition, not just in the trouser department. For Dr No, Ken Russell’s Women in Love is the defining big or small screen adaptation of DH Lawrence’s work, with a none too bad 1980s BBC adaptation of The Rainbow definitely in the running. How did Mercurio do?

Where Have All the Dements Gone?

Those who are smug about data security have this week had their assertions torn asunder once again. The Ashley Madison hack – Dr No rather liked Henry Tudor’s tweet ‘Cromwell was my Ashley Madison. He got hacked too’ – reminds us that data said to be impregnable is in fact all too pregnable, if in the circs that’s the word Dr No is looking for. High profile hack after high profile hack tells us there is no such thing as secure data, just data yet to be hacked. Those signing up blithely to care.data may want to wonder whether the day will yet come when they will sheepishly tweet ‘care.data was my Ashley Madison. I got hacked too.’

Dragons’ Den: The Commissioners

2017: Mid term and the Tories have got fed up with pesky doctor led clinical commissioning groups. The government fires all medical commissioners and appoints its own chosen panel members, often high profile individuals with no understanding of the health service. Westminster’s own clinical commissioning group, known locally as the Dragons’ Den, has a panel consisting of Alan Yentob, Lord Sugar, John Humphrys, Jo Brand and, in a nod to glamour, Siobhan Sharpe, who replaces Stilton, fired because all he ever said was ‘absolutely’. The top of Yentob’s head glows, as if there was a halo inside trying to get out, Sugar has blacked himself up and looks like the last king of a minor African state, Humph sits crumpled like a sack of potatoes with a particularly large King Edward with two eyes in it sticking out of the top, and while the other panel members have stacks of tenners on the tables to their sides, Brand has a stack of Black Forest gateaux. Sharpe is taking a selfie.

Not Entirely Appropriate

Supposed once by David ‘Hug a Hoodie’ Cameron to be the embodiment of big society in a way that say dear Joanna Lumley never could be, Camila Batmanthingy exploded last week as her charity Kids Company imploded. Boy, was it a big explosion, as if Demis Roussos, once described by Clive James as another larger than life Phenomenon having an immense reserve of inner warmth, had exploded. Appearing with a succession of ever more luminous ever larger tablecloths wound round her head and wrapped round her body, she railed and ranted against the media rumour-mongers who, she said, had caused Kids Company to come crashing down, in the space, she would have us believe, of a few days, if not hours. Other accounts have it that, like Icarus before her, Camila flew too high, and the steady heat of scrutiny melted the wax of her charity. The collapse was as complete as it was sudden.

Breaking Bad

Like a pair of blind impotent bulls, Humph and Jimbo crashed about the Today studio this morning, breaking bad, but not much in the way of news. The programme reverberated to the dull thud of blunt horns getting stuck in wooden stories. Humph deployed his standard technique of exclaiming ‘Ha!’ every time an interviewee started to answer a question, to put the interviewee off balance, while Jimbo has extended his extended question technique by inserting…long…pauses. More crotchety than ever, Jimbo has even started to avoid questions altogether, preferring instead to crochet together a long series of statements…and pauses…and…assertions, more waffle, more saccharisms, more Jimboisms…before delivering a final semi-triumphant statement, leaving the by now stunned hapless interviewee little to do except to agree.