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Over the Tarp

We are two peoples separated by a common language. Recalling on Radio 4 how his band had broken into the British market, an American moozish’n said it wasn’t until they had gartten on Tarp of the Parps that things reely took off. Travelling the other way, and now tarp of the parps in American health news, is our British NHS way of burning babies to heat our hospitals. Based on a horrific appeal to Holcaustian imagery from a Channel 4 documentary on the fate of terminated and miscarried foetuses, the anti-Obamacare American media wants its citizens clear on the dreadful consequences that await those who sup in the corridors of socialised medicine - and that’s without even beginning to mention what the Pro-Life lot had to say.

The Invisible Gorilla

Statins continue to generate more heat than light. On the Today programme this morning, the pro-statin academic Sir Rory Collins only just managed to get off at Edge Hill rather than go on to accuse BMJ editor Dr Fee of mass murder for publishing research suggesting statins for people at low risk of heart disease may do more harm than good. The bun-fight is interesting because in the heat we do in fact find some light shone on a blind sector in gold-standard drug research: we tend to see what we are looking for, which means we tend not to see what we are not looking for, an effect known as the Invisible Gorilla effect. A well known example is the sexual side effects of the SSRI anti-depressants. Because initial clinical trials were conducted on healthy volunteers (often stoodents) with male libidos the size of the Eiffel Tower, no one thought to look for sexual side effects. But once SSRIs got out into the wild, it became apparent that what had once been two foot long and hard as steel was now measured in inches and made of jelly. Once unwanted SSRI sexual side-effects are looked for, it turns out SSRIs are to your sex life what a water hose is to your bonfire.

Slit

Slit, the gash in the silk curtain BBC One legal procedural through which we get to see posh knobs with wigs on polishing each other off, is back. So too are the hormonally challenged. Leading QC Martha’s oxytocin levels are so high it can only be a matter of time before she starts lactating for her under-dog clients. Billy still plays the testosterone fuelled clerk ready to roger anything with a hole in it, despite a heartless medic telling him it’s bye bye Morning Glory hello tits for Billy, on account of his treatment for prostate cancer. In the last episode Martha’s oxytocin met Billy’s cancer head on, and the cuddle juice won. Billy coughed, and they cuddled.

Meanwhile, the show continues to tackle The Big Issues Of The Day. Increasingly these are medical. The first episode of the current series hinged on the fate of David, an undiagnosed schizophrenic charged with killing a police officer, while this week’s episode three took on maternal mercy killing. Neither, to this viewer, ended satisfactorily. The series formula – Martha gets you off – was rigorously applied, like a double mustard poultice. The schizophrenic walked free, the case against the self-confessed filicidal mother collapsed.

Staggering Catastrophes

As a doctor who has dabbled in epidemiology, Dr No is not unaware of the siren song of care.data. Greater minds, including epideiology’s Einstein, have frothed at the prospect of the data orgy to be had, only to have it dawn that theirs was a premature cigar. Yet even when left staggering at the catastrophes revealed, a hard core group still want care.data to happen, the idea being that if enough corks are inserted, then nothing will leak.

If only! Dr No remains persuaded that the call of care.data is indeed the song of a siren balanced on dangerous rocks. However alluring the song, the rocks remain; many rocks, but four stand out as especially dangerous.

Nice Try, But No Cigar

The front door, or rather back door, tactics of the shadowy Health and Social Care Information Centre have achieved a sort of slow-burn blowback over the last few weeks. Kicked off with a junk mail leaflet that aimed to be funky but turned out flakey – eye catching shape, double helix on the front, but the helix unravelling on the inside, and written by a Kafkaesque we who never said who we were, in opaque prose that bizarrely got a Crystal Mark for Clarity from the Plain English Campaign – the idea was to have patients default into allowing the NHS to hoover personally identifiable GP medical records into a vast data silo the size of Russia, generally for the purposes of improving care. But that was only part of it. Buried in the flyer, we also had plans to flog off your data, including sometimes personally identifiable so called red data, but only after the strictest approvals, you understand. Or at least we did. Whether the rest of us did was another matter.

Deflating Dr Dan

As part of a welcome recent trend, the Today programme this morning was presented by Monty and Mish, the twin set who occasionally manage to drop pearls. Devoid of the deadweight of burnt-out testosterone that burdens the older male presenters, Monty and Mish manage at times almost to sing, but since ’tis the season for mistletoe in the house and so guest editors on Today, the links were peppered with references to “the musician P J Harvey” and “P J Harvey the musician”, who, it was said somewhat defensively, was responsible as guest editor for doing ‘something unusual’ to the programme. As doing anything let alone something unusual to the Today programme is known to provoke a mailbag the size of a mammoth, Monty and Mish were right to sound anxious, but the bigger question was could anyone really do anything unusual to the Today programme? The answer, as it turned out, was an unexpected yes.

A Serpentine Spaghetti of Words

One of the more tiresome ways of our legislators is their habit of changing law through the use of amendment clauses. You know the sort of thing: instead of rewriting the clause from scratch, and presenting it in its entirety, we have ‘In section 650 of the National Health Service Act 2006 (Chapter 5A of Part 2: interpretation) (the existing text of which becomes subsection (1)) at the end, insert—’, the end result of which is a serpentine spaghetti of words so convoluted that the eyes glaze over and the temples throb. Never mind that the apparent zero after 65 is in fact the letter ‘O’, or that the said Act 2006 appears in fact to be said Act 2009; the fog generated while trying to cobble together the parts to make an intelligible whole is a masterpiece of Sir Humphreian obfuscation.

No Profession for Old Men

Dr No made no secret of the fact that Dropping Like Flies was a quick and dirty assessment of whether the apparently very high number of deaths among doctors subject to GMC Fitness to Practice investigations was something to be concerned about. He concluded it certainly was, because on that crude assessment – crude because there was no attempt to adjust the figure for factors that might influence the death rate – it appeared that these doctors were at least fifteen times more likely to die than ordinary members of the working age population. The ratio of fifteen to one was, he believed, an approximate answer to the right question rather than a precise answer to the wrong question. It was, he argued, so gross in scale as to make it very unlikely, though not impossible, that the finding had arisen either by chance, or by a sufficient number of unadjusted for factors, such that being caught on Stilton’s prongs was not one of them.

Indicative of Tendencies Dangerous

Ploughing through General Turkey Council Fitness to Practice data with a tractor ever more bogged down in numerical mud, Dr No got distracted by another question: what do ‘erased’ – the chilling term used by the GTC in place of the plebeian ‘struck off’, chilling because where the plebeian leaves a name albeit with a line through it, erasure effects obliteration, total obliteration, for not even a name remains – doctors get erased for? In the past, one was encouraged to suppose it was the three As, alcohol, advertising and adultery, a supposition borne out by the General Medical Council’s, as it was then, 1965 ‘Blue Book’ guidance, which does indeed list the three As (alcohol comes under splendidly archaic ‘Offences Indicative of Tendencies Dangerous to Patients’ heading), along with other examples of ‘infamous conduct’ likely to bring a doctor to the Council’s attention. But over time, as two of the capital As have become, so to speak, of lower case severity, we might suppose that ‘gross neglect in diagnosis or treatment’, the 1965 heading for clinical failings, might have risen in prominence, such that today most doctors are struck off for substandard treatment. But what are the facts?

Council to Survey Turkeys about Christmas

For Immediate Release:

Council to Survey Turkeys about Christmas

GTC Press Office, London, UK

Thousands of turkeys are to be invited to take part in a survey of their views about Christmas, the General Turkey Council has announced.

The survey is part of a new piece of research examining whether turkeys think the GTC is operating in a fair and objective way and whether turkeys from different backgrounds have different views of the Council’s processes.