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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.

The Blind Archer

Hell may have no fury greater than a woman scorned, but surely Heaven can have no joy greater than a woman reformed. In a remarkable development, scientists in North America have popped not a bun but a biodegradable scaffold layered with a patient’s vulval and other cells in the oven, and after the required time at the requisite temperature been rewarded with a fully formed vagina. Four women born without a vagina have had ready-vaginas made this way implanted, and have subsequently reported normal or even atomic levels of ‘desire, arousal, satisfaction and orgasm’. This extraordinary advance may in the short term pave the way for a gruesome commerce in designer vaginas – each scaffold is individually crafted - but in time it can only end one way: the day will dawn when we pop not buns but homunculi in the oven, to be rewarded nine months later with little incubi, all of whom will go on to report normal or even atomic levels of desire, arousal, satisfaction and orgasm. Truly, science knows no bounds.

Seven Seven

W1A (BBC Two) continues to amuse. Like totally. Following on from Twenty Twelve and WIA, the BBC must commission a third series, Seven Seven, being the slogan for like the new dietary advice to eat seven portions of fruit and veg seven days a week. With Lord Grantham tasked to deliver an alternative to the gruesome vision of a bloated ageing nation belching and farting its way to immortality, and the awesome perfect curves of Siobhan on hand to nail any loose puppies to the floor, Dr No SO gets it. Like totally. Give this pony some traction, guys, and we can be drinking from the fire-hose from the get go.

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.