Past Posts...


All Watched Over by Behaviourists of Cognitive Grace

Last week, as yet more errors were piled on the statin comedy, and antibiotics got it in the neck from Red Dave, another it’s time we put-it-in/took-it-out of the water story caught Dr No’s eye. An economist – economists seem to get all the top health slots these days – and a psychologist – he was on the Today programme, sounding worryingly like Peter Cook’s classic amiable psychiatrist - want Cognitive Behavioural Therapy (CBT) to be much more widely available to treat mental health problems. It is what airheads call a no-brainer. As Bush Lite might have said, CBT is where wings take dream (it works), and it makes the pie higher (it more than pays for itself: lower healthcare costs and folks back at work). Yet not just folks but our government have misunderestimated the power of CBT. NHS provision has increased in recent years, but from a very low base, and still only one patient in eight who might benefit gets the therapy. That’s one helluva misunderprovision for something that has if not wings then legs.

Word-Stir-Fry

Powering a juggernaut through a minefield of metaphors, Professor Sue Bailey last week achieved a spectacular pileup. Describing the dire state of mental health services, the outgoing Chief Pongo of the Royal College of Psychiatrists said, ‘It’s a car-crash that we are sleepwalking into’. Never mind the grammar being of the kind up with which we will not put, the utterance revealed what psychiatrists once called a word salad is now so old hat; instead, word-stir-fry is the new black. Bailey then took a punt at Health Secretary Hunt, but Punt was saving his powder for later in the week, when his chum Cammers was scheduled to get up in a crate, pop over the Brussels, and take a shufti. In the best English losing tradition, Punt reckoned that crashing and burning with only a Hungarian in tow was a swell show. Cammers himself appealed to an inverted – and so imploded - Pyrrhic logic, averring that sometimes one has to lose a battle to win the war. In the political fallout, only one thing was certain: Cinderella was still out in the cold.

Zombie Lawyers

Established readers of Bad Medicine will know that Dr No takes a dim view of m’learned friends, considering them to be a verminous infestation in the lives of normal folk. In Dr No’s ideal world, lawyers would be deported to burrows on the fringe of an unknown desert, where they could live out their wretched litigious lives fighting each other, while the rest of us get on with our lives, unimpeded by lawyerly interference. For the time being though, back in the real world, lawyers are still with us, an inconvenience to be lived with, like a pimple on the bum that won’t go away. The day before yesterday, the 18th, Dr No had occasion to email one such pimple, only to get back one of those pesky out-of-office auto-replies. The reply, of course also dated the 18th, stated “I am away from the office until Monday 16th June.” The pimple, it appeared, was a zombie pimple, stuck in a limbo the Devil knows where. Dr No was left with a worrying thought: if lawyers don’t even know where they are, how on earth can we be confident they know what they are talking about?

Assisted D-Day

Yesterday, BBC One’s News at Ten saturated itself with D-Day coverage, and rightly so. Hu Wedwards was on hand in Normandy to anchor clips of dignified talking berets, many spry despite their ninety years, cut with long vistas of white tombstones. Obama, naturally, outbarmed his own high standard of excellent oratory. Yet the tone was at once both sombre and urgent: sombre with remembrance, yet urgent with the certainty that this, the seventieth, would be the last decennial commemoration attended by many who had been on those blood stained beaches in 1944, beginning the fight that would erase the dark stain of Nazi tyranny from Europe. Liberation, as Churchill foretold, was sure, but at a cost of so many lives. Yesterday’s urgency, as Prince William told us, was to ensure that the baton of remembrance is passed to future generations.

How Many Chambers Full?

For richer or poorer, for better or worse, Dr No is a smoker. And like most smokers, he knows he should quit. And – since you ask – no, it isn’t that easy. If it was, Dr No would now be an ex-smoker. Instead, even in the face of all the evidence, the cost, and a family history that includes a father and a grandmother who died from smoking related diseases, will-power time and again fails. He has managed smoking holidays, but sooner or later the nicotine magnet draws Dr No in again. In his orbits of despair, Dr No is as likely to escape the nicotine magnet as the moon is to escape the earth’s gravitational field.

More Stackery

stackery n., – the art of confounding people about statins.

Just when you thought it was safe not to take your statins, another report hits the fan. Or rather three. The Oxford academic Sir Rory Collins, who does for statins what Viagra does for old men, has been banging on BMJ editor Dr Fiona Godlee’s back door – curiously he declined to provide an open letter for publication - demanding she retract two articles published in the journal recently. Both articles claimed, as part of their arguments, that statins had high rates of side-effects, affecting up to 20% of all patients taking the drugs. The gist was that not only were statins pretty useless for primary prevention of cardio-vascular disease (folk with no prior history of CVD: NNT’s in the high tens if not hundreds), they also caused unacceptably high rates of side-effects, some of which were serious. The implication, though not stated in such lurid terms, was that peddling statins to low-risk folk was little short of institutionalised quackery.

The Core Option

Writing in the Guardian last week, Simon Jenkins had a Big Idea, that small is best. Correctly concluding that central political meddling in the NHS has failed, he opted for the nuclear option. The core of his idea, which like the core of an apple had both rough bits and voids in it, but sadly unlike an apple no seeds, was that, since every other conceivable option has been tried and seen to fail, that left but one course of action: the NHS must be broken up. In prose that crashed about like a driverless juggernaut, the final jack-knifing when it came was curiously more hanging whimper than decisive bang: ‘Denationalisation is now the only version of a public health service not tried’. One fancies a Churchill bell may have been tolling in Jenko’s head. ‘It has been said that democracy is the worst form of government except all the others that have been tried’…‘denationalisation is the best arrangement except all the others not tried’ (sic).

Better Read than Dead

It emerged last year that doctors facing General Medical Council Fitness to Practice hearings have a remarkably high death rate. Over the last decade, these doctors have been dying at between fifteen and thirty times the expected rate, depending on the comparator group used to do the calculations. Some of these deaths are known to be suicides, with others suspected but not so recorded. A groundswell of grassroots objection grew to a chorus of high profile outrage, culminating last September in the discreet – it was all but buried in Council papers - announcement by Stilton, the GMC’s Chief Pongo, of an enquiry into some of the deaths. In a faux pas on a par with appointing an Anti-Terror chief to enquire into the Muslim school plot, Stilton appointed a National Patient Safety Agency chief, one Ms Horsfall, to enquire into the suicides.

Farce of the Marb

In the ’70s and early ’80s, in his outstanding TV criticism in the Observer, Clive James had an unfailing ear for the peculiarities of American pronunciation. Facing David Frost’s sing-song questions, Henry Kissinger fell bag on swapping his DTs and CGs. Meeting Frost’s aria-ettes on Vietnam with the sound of gravel being forced through a hand mincer, Big K conceded that ‘manipulading the domesdig affairs of another gountry is always gombligaded’. On Chile, where the Americans had been up to their usual tricks, Kissinger explained it was down to a certain ‘peculiaridy of the consdidution’. On another occasion a year later, asked what he and Reagan had discussed pre-election, Kissinger revealed the devastating charm of his verbal dricks. ‘I jusd wished him good lug’. No wonder Hopalong won.

Raising the Bar

Justin Wood, the Today programme’s Useful Idiot, was let out of his play-pen this morning to tackle a story with real numbers in it. He promptly crashed and burnt. So spectacular was the crash and burn that the erudite Prof McManus’ erudition flat-lined and later all but crashed and burnt too. At issue was the distinction between pass mark and pass rate for the Professional and Linguistic Assessments Board test used to assess clinical and English language skills in the - as the media would have it - foreign devils more formally known for the time being as International Medical Graduates. In Woodie’s upside down world, the great secret was to up the pass rate, the better to weed out those with forked tongues. In the real world, of course, upping the pass rate, rather than the pass mark, would have the effect of letting though not fewer but more IMGs.