Posts tagged with Big Brother

Stilton’s New Prong

Earlier this week, Stilton published a new edition of Good Medical Practice, the lance of many prongs which he and his goons use to skewer hapless doctors. Stilton’s premise is that doctors are a lawless reckless lot, and left to their own devices they will get up to all manner of mischief. From their hidden position behind the net curtains, Stilton’s goons have perceived a new mischief: the menace of doctors who appear incognito on social media. A prong – a somewhat bent prong, since most content on social media is publicly accessible – has been added to Stilton’s lance. New explanatory guidance alongside GMP warns: ‘If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name’. Although framed as a ‘should’ rather than a ‘must’, this bent prong has its sights clearly set. For doctors foolish enough to carry on the anonymous caper, Stilton is coming to get you: ‘You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin’. Dr No is not entirely persuaded that GMC goons can trace their arses from their elbows, let alone trace Dr through the complex web of shared internet service provision; but, be that as it may, anonymous medical bloggers are up in arms.

The Emperor’s New Data

Some six months after care.data1, the contentious plan to upload personal medical data held by GPs to big-daddy mainframes, was stalled to allow a FF style listening exercise, care.data2 has been announced. The Information Emperor, Tim Kelsey, insists NHS England has listened, and heard – ‘heard, loud and clear’ – but it seems to Dr No that instead of hearing the waves of discontent crashing on the beach, all NHS England has heard is the wind rushing through the night. Getting on for two million patients registered at ‘pathfinder’ practices will have their GP records, including date of birth, NHS number and postcode, uploaded to big-daddy, with the default being opt-in unless the patient explicitly opts out. Since care.data1 had GP records, including date of birth, NHS number and postcode, uploaded to big-daddy, with the default being opt-in unless the patient explicitly opted out, nothing key appears to have changed. The only high profile change, which does nothing to change itself, is that, instead of a bungled central promotion, will be now be promoted by GPs, many of whom, we may note in passing, are not happy to be cast as the Emperor’s new goons.


The school most at large in government today of the science that makes numerology appear rigorous is that known as Etonomics. As much a sect as a school, Etonomics holds that austerity is the one true path. Governments, according to its theories, must grip the economy as a giant python might a fat pig, and squeeze it back into shape. Those parts of the economy that fail to get back in shape face cuts, savage cuts. Not just an ear here, or a trotter there: whole limbs have to come off. These are the teachings of Etonomics, and, strangely enough, they don’t work. The python may enjoy a snack, but the economy dies.

These musings arose as Dr No read a seriously erudite assessment of the failing of Etonomics here. The assessment is long, but a one line summary might be ‘you ain’t seen nothing yet’, perhaps suffixed with ‘and you may never, because Tory austerity is unachievable’. To reach this conclusion, Lanchester, the author, makes a distinction between ‘cuts’ and ‘austerity’. Cuts, says Lanchester, are real, and do the damage, while austerity is an orchestration, and a con.

Doing One's Duty of Care the Machiavellian Way

Dr No doesn’t really do duty of care. Instead, he just cares. When he sees a patient, he does what he does simply because he cares for his patient, just as he always has, and always will. He suspects – but isn’t over-bothered, perhaps even doesn’t care – that what he does in fact more than satisfies any duty of care baloney, which in the real world he steers clear of, finding it to be tedious, tiresome, distracting, legalistic, defensive, job-serving, and all about doing the minimum to cover one’s back, rather than aiming to go the extra mile and do the best for one’s patient. In all this, Dr No is no doubt frightfully old-fashioned, maybe even old-fashioned enough to trigger the crackle of snapped pencils in the legal offices of his professional indemnity society. But Dr No remains resolute. True care is always better than duty of care; for the former is human and comes from the heart, the latter formulaic, and from the law.

Staggering Catastrophes

As a doctor who has dabbled in epidemiology, Dr No is not unaware of the siren song of 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 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 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.

Furies and Bullies

There has arisen, it seems to Dr No, a certain class of doctor, typically female and in their thirties or forties, maybe a GP, but not in full time clinical practice, perhaps instead involved in medical education in some guise or other, or perhaps not, who number, amongst their many duties, that of patrolling the internet. They patrol other, often male, members of their profession for what they consider to be misdemeanours, great and small, and when they find such misdemeanours, they feel driven to act, in the name of decency, correctness, and the final eradication of all victimisation, bullying and harassment; and for the greater good of the name of a modern caring profession. Dr No calls them The Furies, after the Roman version of the Greek Ερινύες, the avenging goddesses of wrath, who arose, fittingly enough, from drops of blood spilt at the castration of Uranus.

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.

Creeping Towards Totalitarianism

Totalitarianism does not arise spontaneously. It arrives instead by a series of steps, each one small enough; and, like the journey of a thousand miles that begins with a single step, many small steps can take us a long way from home; until one day we arrive in a strange world where the pigs walk on two legs, all are equal, but some more so that others, and the clocks strike thirteen.

One of the tenets of totalitarianism is the central importance of the State, and it is but a short step from that central importance to move towards notions of enemies of the State, and so to traitors in our midst. And so it is that the machinery of totalitarianism seeks to know the each and every detail about the lives of each and every one of us, lest we be the traitor in the midst. We move from a liberal default position of trust, to one of mistrust, and then distrust. No one can be trusted at face value; only the State can collect the data and decide who is trustworthy and, who is not.

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.

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.

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