Dr No's Editor's Choice

A selection of Dr No's posts, ordered by number of page views. Older posts tend to have more weight because they have been around longer, and so have more time to gain page views.

Re-order by date (latest first), number of comments (desc), no particular order (random) or return to order by page views.



The Mystery of the Toothless Bearded Hag

Flogging toothpaste may be a dull business, but for once eyes must surely have shone brighter than teeth in the marketing department at Colgate this week. A gift of a study, published in the BMJ last Thursday, linked poor toothbrushing to heart disease. The media predictably flipped the message, with headlines certain to fix a smile on even the most jaded of Colgate lips. Auntie exhorted us to ‘Brush teeth to halt heart disease’, while the Daily Mail directed ‘Clean your teeth twice a day to keep a heart attack at bay’. The ping was at last back in the Colgate ring of confidence, for who needs advertising, when sparkling headlines (351 of them, according to google) say it all?

The Baby and the Bath Water

The night before last, the Section 75 Regulations slipped through The Lords like a U-boat, silent and deep. A limpet mine attached to the hull by one Lord Hunt failed to go off, and the boat got through unscathed. The crew even found time to loose off a few tin fish at 38 Degrees, but, on the whole, anyone watching the surface of events would have seen nothing remarkable. Certainly the BBC saw nothing remarkable, and reported nothing. The recent Reynolds analogy, that if the Health and Social Care Act was an aeroplane, then the regulations were the engines that would enable it to fly, failed to take off, leaving no scope for engines on fire, or jumbo-jets falling out of the sky. The health service revolution said to be so large it can be seen from space is all but invisible on earth. There has been no bang, not even a whimper, just the night time passage, silent and deep, of some regulations through the Lords. Nothing has changed - except that the U-boat is now on the inside, torpedoes armed and periscope at the ready. The lumbering ships of the health service convoy still steam across the healthcare seas, unaware of the peril that now lurks in the deeps.

Nailing Doctors

A hundred years ago, when Britannia ruled the waves, our language was high on a tide of nautical terms. Today, in the age of the automobile, it is to motoring that we turn for our metaphors. The complexities of nutrition are reduced to the simplicities of traffic lights. The rigours of medical regulation – revalidation – are simply MOTs for doctors. Latest on the bandwagon is the Royal College of Caring and Sharing, which has shared, on facebook of course, its Social Media Highway Code. There is, inevitably, a lot of caring, and even more sharing, but, for this reader the wheels started coming off the code when it likened today’s doctors to yesterday’s Wild West cowboys. Are today’s doctors really so feeble that they cannot for themselves work out how to behave online?

Be Careful What You Vote For

Next time you meet a nurse, ask him or her what the NHS reforms are about. Almost certainly the answer will be ‘I’m not really sure…I don’t really understand them’.

Next time you see your doctor, ask him or her what the NHS reforms are about. A few might know, and give their version, seen through their political prism, but from the rest, the answer will be: ‘Waterworks OK?’ Sub-text: stop asking me stupid questions I don’t know the answers to.

Email your MP and ask them what is his or her position on the NHS reforms, and nine times out of ten you will get his or her party’s standard issue response. Probe further, and it will become clear that he or she hasn’t the foggiest.

Dropping Like Flies

The Inquisition known for the time being as the General Medical Council is under fire. Its fitness to practice procedures, which for doctors caught on the sharp end of one of Stilton’s prongs feel much like being popped into a beaker of dilute sulphuric acid with a rack of Bunsen burners arrayed underneath, have come under scrutiny because of an apparently high mortality attached to being left to simmer in warm sulphuric acid. Figures available online suggest that there were at least 92 deaths between 2004 and 2012 in doctors under investigation. The denominator – which Dr No suggests should be the number of GMC cases referred to panel investigations – stands somewhere in the region of 2300 (see footnote), giving an approximate average annual mortality rate of 4%. Working age (25-64) mortality in the same period was around 200 per 100,000, or 0.2%. Something is clearly going on. If we apply some crude ‘observed over expected’ numerology to these figures, we get a (very) crude mortality ratio, on the normal 100 base, of around 2000: that is, where we would expect 100 deaths, we find 2000.

The Oxygen of Morality

Kerrie Wooltorton is dead. But she isn’t going to go away. Her sad suicide, and the aiding and abetting of that suicide by her doctors, have opened a door to a cesspit of legal incompetence and medical Eichmannship.

For those who have been frying fish for the last few days, KW was a woman with both depression and emotionally unstable personality disorder who wanted to kill herself. That’s what she said, anyway.

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.

Medical Unemployment

The Daily Hail may constantly portray doctors, especially GPs, as lazy golfing fat-cats, and no doubt more than are few are, but there are other corners in the medical universe that are not so cosy, corners closer to the dark side of the moon than the sunny terrace of the nineteenth hole; and one of those corners is that of medical unemployment: doctors who are in a position to work, but for some reason cannot find work.

To those outside the profession, medical unemployment is inexplicable, bizarre, even disturbing and unsettling. Doctors are both committed and driven individuals, trained to the highest standards (at considerable tax-payers expense, some would add), with a ticket to work in a rewarding – both personally and financially – profession. And we are, so the story goes, always short of doctors. How, possibly, could medical unemployment be a reality?

Unnatural Selection

By way of a reply to WD and Dr Boots' latest comments on Dr No's last post.

In Dr No's medical student days, most medical students were WASP males. There was a lot of rugger, and high jinks, à la Daily Hail, only in those days, having studied Latin and so Roman habits, we knew how to throw up properly.

About fifteen years later, about ten years ago from now, Dr No had already noticed a shift away from WASP medical students towards more BME and more female students. He even remarked on it during a tea and biscuits break on a ward round - and a health service fattie, a psychologist of all things, all but exploded, but thankfully didn't, because all the tea and biscuits inside her would have made a terrible mess.

Merely Potential Persons

An extraordinary paper published in that hot purple-top The Journal of Medical Ethics has ignited a storm of controversy. The naïve authors argue that a newborn is morally no different to a foetus – both being ‘merely potential persons’ – and thus infanticide – renamed after-birth abortion by the authors – should be permitted on the same grounds as those used for abortion. The pro-life lobby reacted predictably, and demonstrated forcefully that for many of them, pro-life sentiments do not extend to academic philosophers who espouse eugenic arguments. Quite the opposite, in fact: the authors, and the JME for publishing the paper, have been subjected to a torrent of hate, abuse, fire-crackers and death-threats.