Posts tagged with Coercive Healthism


Left Shit

The title for this post arises because Dr No has idly been playing Shorter Titles, the I’m Sorry I haven’t A Clue game in which panellists are invited to submit film (or song) titles where a single letter omission changes the meaning – Oldfinger, The King’s Peech, Rear Widow, The Godfarter, The Tird Man, that sort of thing – but as Jack Dee would say, they don’t work in print - the original title here being Left Shift, the hypothetical statistical fancy much beloved of the medical Islingtonistas who favour alcohol minimum unit pricing. Left shift is the notion that in populations the body wags the tail: the mean determines the extremes. Applied to alcohol minimum pricing, left shift has it that if average consumption falls because of raised minimum unit prices, then so too will heavy consumption fall. Populations, according to this hypothesis, behave like a blancmange made with excess gelatine: a nudge in the middle, and the whole pud moves across.

The Royal College of Pharisees

That smuggest of colleges, the Royal College of Physicians of London, already infamous for its part in the MMC/MTAS disaster, has of late been cozying up ever more closely to the Department of Health, and its chief pongo, Sir Liar Liar Pants on Fire Donaldsong. Earlier this week it moved still closer, issuing an right-on report damning callous smokers who kipper their kids.

The report, featuring a cover photo of a prole caught in the hideous act of kippering a bairn, contains shocking figures and urgent recommendations in bountiful supply. Passive smoking, it estimated, caused children over 300,000 UK GP consultations and almost 10,000 hospital admissions every year, at a cost to the NHS of about £23.3 million. An alarming list of childhood illness caused by passive smoking includes old favourites such as asthma and wheeze (22,000 extra cases) and middle ear disease (120,000 extra cases), as well as the reliable media magnets meningitis (200 extra cases) and cot-death (40 extra deaths).

Through a Glass of Amber Nectar, Darkly

Earlier this month, the House of Commons Science and Technology Committee lived up to its name, and beamed a professor into one of its hearings. G’day Gilmore was down under, in the land of amber nectar and rich red shiraz, and by a miracle of technology he was also present in Westminster. Asked by the committee Chair whether he could hear those stuck in good ol’Blighty, G’day assured him that he could. ‘Yes, Chairman, very clearly thank you,’ he said. It was probably the clearest statement of the day.

The occasion was the taking of oral evidence by the STC in the matter of alcohol guidelines, and as ever the troupe of temperance tut-tutters headed up by G’Day were in on the act.

Supping With a Short Spoon

Just as there is gold for drug companies in them thar pills, so there is gold for GPs in them thar patients. Historically, GPs were paid chiefly on a patient head-count basis, topped up with item of service fees for ‘extras’ such as vaccinations and contraception. The simplest way for GPs to boost income under this system was to increase list size, sometimes to absurd levels where the GP could not hope to provide adequate care for all the patients on the list. Some even gamed the system, by sneaking ghost patients on their lists. Governments disliked crude head-count based pay, not least because it offered no scope to influence GP activity. Item of service payments were an attempt to change that, but the capitation fee was still paid whatever the doctor did, or didn’t, do. The below par golfing GP trousered the fee in equal measure to his more conscientious colleague on the other side of town.

Tick Box Medicine

Dr No’s mother, a fit 80-something year old, recently attended an ophthalmology clinic, on the advice of her optician, and was told – out of the blue, by a nurse – she hadn’t even seen a doctor - that a bed had been arranged for her to come in two days later to have her cataract removed. The nurse was most put out when Dr No’s mother – who knows her mind very well – said she had no intention of coming in for an operation she neither knew about, nor did she need. Yes, she does wear reading glasses – but otherwise her eyesight is fine.

Gluganomics

Today’s announcement by Scotland’s Minister for Emesis, Nicola Stugeron, that the Scottish government intends to set a 50p minimum unit price for alcohol reminds Dr No that a similar bell is set to toll South of the Border. Forty-eight hours after Porgie’s boomerang budget, the one that keeps on coming back to tap the Tories where it hurts, Theresa May was pushed on to the floor of the Commons, in a reckless bigger-the-pushed’un-the-better-the-cushion move, to zap hostile media coverage of the budget, by announcing the Westminster government’s own Alcohol Strategy. Needless to say, that strategy also contains proposals for minimum unit pricing, and, needless to say, both governments are equally deluded in their expectations that this daft policy will do any good. In fact, Dr No predicts it may even do harm.

Most Drugs Don’t Work

Just over three years ago, when few had heard of him, Dr No wrote a post called The Collapse of the Probability Function. At its heart lies the troublesome paradox that, while we might know how a group of patients might fare, we have no way of knowing how individual patients will fare. We might know that of a hundred patients, five will die in the next ten years from a heart attack. What we don’t know is who of the hundred will be the five; and the flip side of that is, when as doctors we choose to intervene, as increasingly we do, there are ninety five souls now tangled in our medical web, with all that that entails, be it tests, treatments and general apprehension, who were never going to have a heart attack anyway, let alone die from one in the next ten years. That’s a whole lot of medical intervention without any benefit whatsoever – but what the heck – overall, we might save a handful of lives - or so the hopeful reasoning goes.

Negative Pressure at the Anus

As a medical student, Dr No was greatly impressed by a particular surgeon. This surgeon was that rare thing, a surgeon whose mind was even sharper than his scalpel. He taught Dr No perhaps the most important surgical lesson of all: that surgery is not about how to operate – any competent surgeon can do that – it is about when to operate; and it is fidelity to that decision that distinguishes the great surgeon from the average surgeon. That same great surgeon taught Dr No much else, often in the vernacular, and none more certain than that which holds that the only sure-fire way to advance one’s medical career is to apply regular and consistent negative pressure at the anus of one’s superiors.

British Professional Medicine: RIP 2013

Everyone, but everyone, is a professional these days. Even benefit scroungers like Dr No are professional benefit scroungers. Sociologists over the years have woven so many strands and threads through the social construct of professionalism that the term has become so broad and debased as to be meaningless. To borrow from a line attributed to the poet John Lydgate and later famously adapted by Abraham Lincoln, you can professionalise some people all of the time, perhaps even others some of the time, but you definitely can’t professionalise all people all of the time. If everyone is a professional, then no one is.

Shrinking Your World

One of Dr No’s retired medical friends, not teetotal, but almost, inherited an adequate wine cellar, mostly reds, from a relative. Given a science backed consensus that small amounts of red wine would be good for him, he decided not to dispose of the cellar on favourable terms to Dr No - Dr No is always happy to help an old friend out - but to indulge in a spot of self prescribing: ℞ vinum rubeum, 1-2 glasses nocte.

Elsewhere, an old biddy friend of Dr No’s mother, bereaved last year, has taken to keeping a bottle of sweet sherry in with the tea cosies, and of an evening she warms her soul as she dozes in front of the television with a tipple or two. Not so long ago, a grandad patient of Dr No’s asked: ‘No harm in an evening sharpener? Just scotch and water, you understand.’ Dr No knew it would be a large tumbler, and a generous slop, but still he answered ‘not at all’ - and didn’t even caution against excess. This chap had survived the not only the horror of Burma in the Second World War, but the long years of following memories as well, and the last thing he needed was a ticking off from Dr No.