Posts tagged with Coercive Healthism


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.

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.

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).

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.

The Hair of the Dame

After the season of good will, the season of bad omen. More Blu-Tack than tack sharp, Dame Sally Davies, the Chief Medical Officer, stuck at the end of last week to her message that there was no such thing as a safe limit to alcohol consumption, but if you wanted to live dangerously, then she supposed up to 14 units a week was tops. On the Today programme, she was the worthy teacher cajoling the dull child, only to be out-smarted by J Webb, who popped the public health message balloon by pointing out that normal drivers face a similar lifetime risk of death as that implied by the new alcohol limit, yet the Government has yet to advise us that there is no safe level of driving, or that drivers should limit themselves to 14 miles a week. The balloon popped so far above Dame Sally’s head that she missed it. When Jay repeated the point, the response was of the ‘oh no, we don’t need to bother with that sort of nonsense round here’ kind, followed by more chugging rhetoric on the risk of dying from breast cancer.

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.

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.

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.

Bitter Pill for Sugar Tax

Britain and sugar go back a long way, and the history is not that glorious. Sugar, or white gold as it was known, was the reason for the infamous trade triangle, the round trip that took slaves from Africa to the American colonies, sugar from the colonial plantations to Britain, and goods from Britain back to Africa to buy more slaves. By the mid 18th Century, the trade was so lucrative that the then British Government, blissfully unaware of yet to come concepts of coercive healthism and the nanny state, did the fiscal thing, and slapped a tax on sugar, making it a luxury item. The situation was turned on its head in the mid 19th Century, when the Free Breakfast Table movement, an early Liberal free school meals idea aimed instead at the working classes as a whole, brought about the abolition of duties on sugar and other breakfast table commodities, and the masses were freed to shovel ever larger quantities of sugar down the cake hole. Every Little Helps, as they say at Tesco. Even today, The Great British Bake Off, when it isn’t about the BBC showing off its ethnic credentials, is all about devising yet more elaborate ways of getting yet more sugar through the cake hole.