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 - 1st March 2015: the software on the servers hosting Bad Medicine was recently upgraded, and this caused some technical problems which Dr No hopes have been fixed. Should you however be deluged with cryptic warnings, or get just a blank screen, it means there are still problems. Dr No apologises, and will do his best to get things back to normal as quickly as possible.

  Latest Post

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 may want to wonder whether the day will yet come when they will sheepishly tweet ‘ was my Ashley Madison. I got hacked too.’

  Recent Posts

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.

Deaths In Custody

News last week that there were 17 deaths in or following police custody in 2014/15 in England and Wales has rekindled outrage at the scandal and led to the usual political wails. Theresa May, announcing an inquiry into the deaths, said they ‘represented failure’. Well, that’s one way of putting it. Others rallied round ‘one death is a death too many’. Had Stilton been asked for comments, he would have said the deaths ‘absolutely represented failure,’ and that ‘one death absolutely is a death too many’. Sotto voce, he may have added, ‘we absolutely have been here before,’ because of course the GMC has had a hand in the death of similar annual numbers of doctors under FTP investigation, but from a far smaller population at risk. We should also note Stilton does not count year-and-a-day deaths, ie those occurring after FTP investigation. As a killing machine, or if you prefer a negligent machine that allows deaths, the GMC is far more lethal than the police. For once Stilton would be in error to say the GMC absolutely is more lethal, were he ever to admit such a thing, because in absolute published numbers the police are equal to, or slightly ahead of the GMC, but in relative, pro rata, terms, the GMC’s FTP processes are more lethal than police custody processes. If the police’s grim reaper is a scythe on open land, the GMC’s grim reaper drives a combine harvester down narrow streets.

Zombie Patients

Writing in the well-known Blue Top, the BMJ, Margaret McCartney, a fellow scourge of Bad Medicine, recently described the 16% higher chance of death if you are admitted to hospital over the weekend as a zombie statistic. The essence of a zombie statistic is not necessarily that it is wrong, but that it won’t go away, even when it is shown to be at least spurious, possibly wrong, and almost certainly misleading. Zombie politicians, who tend likewise to be at least spurious, probably wrong and almost certainly misleading, but still wont go away, love zombie statistics, as does the zombie press, which attracts zombie stats as a dunghill attracts flies. Shortly before the election, David Cameron, increasingly the zombie party leader as BJ hots up the mustard, pumped up the 16% higher mortality statistic, and true to form it just won’t go away. Today the zombie minister Jeremy Hunt will use the 16% zombie statistic to prop up his case for seven day zombie working in the NHS.

Prolapsed Participles

Good medical practice, perhaps, but bad English. Absolutely Stilton’s announcement of his latest hair shirt guidance for doctors, absolutely jointly produced with the Nursing and Midwifery Council so that it applies to nurses and midwives as well, is focused, if that is not too strong a word, on the duty of candour, more generally understood as the duty to be honest. It tells clinicians, with a ringing third degree participle prolapse, that ‘When something goes wrong with a patient’s care, doctors, nurses and midwives should: speak to the patient, or those close to them, as soon as possible after they realise what has happened.’ Wily clinicians, and those liable to be bent by their learned friends, are thereby provided with a useful loophole. So long as the patient hasn’t realised something went wrong, there is no need for the clinician to embarrass themselves. Piling Pelion on Ossa, the next point reverses the prolapse. Clinicians, the announcement says, should ‘apologise to the patient – explain what happened, what can be done if they have suffered harm and what will be done to prevent someone else being harmed in the future’. From where Dr No is sitting, it seems they absolutely don’t know who they are, and if they don’t know who they are, the what hope can there be for the rest of us knowing who we are, let alone what we should do?

Shoots You, Sir

If patriotism is the last refuge of a scoundrel, then news about news is the last refuge of a desperate editor. In an editorial in the BMJ this week, Ben Goldacre and Carl Heneghan report on ‘extensive news coverage’ of a ‘leaked letter’ from the Chief Medical Officer to the Academy of Medical Sciences asking for an enquiry into how society should judge the safety and efficacy of drugs. This is hardly the stuff of which crackling headlines are made. Dr No missed it, and so too did most of the media. According to google news, only the BBC and The Guardian covered the story in the national media, with remaining coverage confined to such erstwhile journals as the PharmaTimes of Freakistan. The leak, it turns out, was about as newsworthy as a damp patch on an incontinent’s mattress.

Ill Winds

The other day we had David Cameron getting pumped up about a seven day NHS. Pumped up is the New Tory, but a lot of old hats were still put on pegs, some hats more moth-eaten than others. JC (of the Department of Health Sunshine Band) was wheeled onto the Today programme, sounding about as pumped up as a flat tyre. Despite the ill wind blowing today through NHS General Practice, with more vacancies than currants in a bun, the government’s prescription is five thousand more GPs. Quite which wind these GPs will arrive by has yet to be explained. Historically, the NHS has outsourced, or at least gained, extra doctors from abroad. Pigs, after all, can always fly, if they are pumped up enough.

Docs Told To Stick Drugs Where Sun Don’t Shine

Despite the colour scheme, Bad Medicine is not a red-top, but sometimes a red-top headline doesn’t do any harm, unlike over-diagnosis and over-treatment. The campaign against the problem of meddlesome doctors, a problem that has been around for as long as there have been doctors, had a re-launch last week, guided by a collaboration – now there’s a modern word – between the Academy of Medical Royal Colleges and the BMJ. What was ‘Too Much Medicine’ is now re-branded ‘Choosing Wisely’, a title so generic it could apply to anything: at least with ‘Too Much Medicine’ you knew what they were on about. The language has become stifling, like the still heat of a tropical day. We are assured that ‘Choosing Wisely conversations will rebalance discussions’ between doctors and patients, who will jointly ‘be supported to acknowledge…that, sometimes, doing nothing might be the favourable option.’ Hullo? To you and me, that’s stick the drugs where the sun don’t shine.