Tuesday, 31 December 2013

New Year Honours and all that nonsense

I have never been a fan of the honours system. It is the establishment's way of keeping us in order by the potential dispensation of patronage. Frankly the system stinks.

One example of the absurdities of this year's honours is the absence of any recognition given to Andy Murray's Olympic Gold and Silver medals, the US Open and winning Wimbledon. These are no mean achievements. We are told that it is because he already has an OBE awarded only recently. Well we are not actually told anything. That is simply the explanation accepted by the media. Throw a man a penny in order to deny him a shilling!

Perhaps Andy Murray should have adopted the same logic. 'I won't bother to win Wimbledon this year because I only recently won the US Open'.

I suppose I shouldn't get too angry about it. It is the 'great and the good' rewarding the 'great and the good'. But does it matter? I wish I could say it doesn't, but it does.

It seems that in Medicine the best way to get knighthood is to 'deliver' a royal baby. Was it really such a remarkable medical exploit that it should be rewarded with a Knighthood? Apparently so!

My new year's honours go to all those who have worked tirelessly to help those affected by the injustices of Ian Duncan Smith's welfare reforms. Well done all and Happy New Year to you.




Monday, 30 December 2013

Posthumous pardon of Alan Turing

It has been a while since I published an article. For that I apologise. I have been unwell. But as we enter 2014 I hope to once again give the world the benefit of my observations, for whatever they are worth!

I am struck by the diversity of views about the posthumous pardon of Alan Turing. Some have said it is wrong because it does nothing for others who suffered the same injustice under the same laws against homosexuality. No, that does not make the pardon of Alan Turing wrong. It highlights the injustice not just to Alan Turing but to all convicted under the same obnoxious laws. It is right that Turing should be pardoned. It is wrong that all others so convicted have not been pardoned.

The pardon has been given to Turing because he was an exceptional man. It should have been said that it was given because the law was wrong and unfairly persecuted those who we now recognise should not have been criminalised because of their sexuality. The simple thing to do now is to apologise and pardon all those so convicted.

Friday, 1 November 2013

Grayling's Fetish with prison uniforms and televisions.

The Justice Secretary, Chris Grayling,  has instituted a new regime in our prisons. Prisoners will have to 'earn' privileges. In the new regime they'll start off with very few 'perks' and work their way up. For the first two weeks male prisoners will wear uniforms. 

I always feel there is something rather fetishistic about Tory approaches to crime and punishment. Remember the "short, sharp shock" of the boot camp days? But this is rather more a pandering to public  perception,  and the need to be assured that prisoners are 'punished'.  It is not enough that they are deprived of their freedom; no we must be sure they are humiliated as much as possible. We must see them beg for mercy, pay for their crimes. Perhaps, no certainly, when they are in the prison yard they should not only have a uniform with spots on but also be in leg-irons. Their exercise should be pacing up and down like caged bears. 

I suspect there are a few, perhaps many, who would love to bring back the stocks and throw eggs and rotten vegetables at wrong-doers in the town square. I confess to thinking that would be good, but not very civilised. I also have no doubt there are a few 'floggers' too who yearn for a few public floggings.

 Grayling defends his changes by saying: "For too long the public has seen prisoners spending their days languishing in their cells watching TV, using illegal mobile phones to taunt their victims on Facebook or boasting about their supposedly easy life in prisons. This is not right and it cannot continue."

Personally I have never seen prisoners spending their time doing any of these things, although I am sure they do. It would be like watching paint dry spending days watching prisoners do such things. I really wonder how many people have spent such time. Clearly Mr Grayling does have such a past time. I suppose that is what justice secretaries are meant to do, watch prisoners languishing in jail. 

I asked my neighbour how many times she had seen prisoners watching TV. "What?" she responded incredulously. "What do you mean?" she continued, somewhat suspiciously, as if I had accused her of something rather dreadful. Anyway, the upshot is she hadn't seen any prisoner doing such a thing, ever, although she did confess to having seen prisoners watching TV on TV. 

So what did she think about it? I asked her. "Think about what?" She replied. Prisoners watching TV, I pressed on. "Oh, well I haven't really thought about it at all." She said. "Why are you asking?" Again rather suspiciously. She didn't know anyone in prison she went on to say, rather suspicious that I was 'accusing' her of doing so. "Anyway, Ray, I imagine they watch an awful lot of TV."  Why is that? I asked. "Well what else is there for them to do?" 

The new regime is all a bit of ill-thought through nonsense. But it is also dangerous nonsense. It is more likely than not to create boredom and frustration, increased tension and violence. It is plain stupidity. 








Thursday, 24 October 2013

NHS trusts buckling under extreme financial pressure

There is more evidence today that that NHS savings are putting patient care at risk. A review by the Care Quality Commission (CQC) suggests that quarter of hospital trusts in England are at raised risk of providing poor care.

The findings are based on monitoring by the Care Quality Commission (CQC) of a host of data, including death rates, serious errors and patient surveys. It found 44 out of 161 trusts fell into the two highest risk categories.

Responding to the CQC’s review of hospital trust data in England, Dr Mark Porter, Chair of BMA Council said: 

"Having this array of information in the public domain is an important step towards improving transparency across the NHS, informing and empowering patients and shining a light on hospitals which are not performing to the standard we expect.

"Hospitals are large, complex organisations so we need to avoid oversimplifying or reducing vast amounts of data to a simple band or rating.

"It goes without saying that where trusts are found to be operating below par we urgently need to identify where the problems lie and find a solution."

But what is the basis of the problem? The BMA point to the acute financial pressure resulting from savings cuts imposed on the NHS. 

"The fact is many trusts are buckling under extreme financial pressure. The NHS is having to make £20bn of savings, leading to increasing pressure on staff and resources and, most worryingly, affecting patient care and outcomes." Dr Porter says. 

"Many hospitals are stretched to breaking point. If we are to deliver the improvements patients and doctors want to see, the government needs to address the significant funding gap in the NHS. 

"All hospitals should be meeting the standard of high quality care which patients expect and front line NHS staff want to deliver. But the reality is that the NHS simply cannot continue to meet rising demand with reduced funding."

The government cannot simply wash its hands of the effects of the cuts and the effects of the unnecessary reorganisation it has imposed on the NHS. 

The coalition promised to ring-fence the NHS from austerity. It hasn't done so.

David Cameron promised voters there would be no top-down imposed reorganisation of the NHS. He reneged on that commitment. 

Reorganisation and cuts are putting lives at risk. 

Monday, 21 October 2013

Doctors warn government that lobbying proposals could limit public health campaigning.

There has been much concern expressed that the Lobbying Bill could limit the campaigning activity of charities. Now, doctors’ leaders have warned that the Government’s proposed legislation lacks clarity, is excessively bureaucratic and could severely limit organisations, such as the BMA, campaigning on public health issues, including smoking, during an election year.

The warning comes in a new BMA House of Lords’ briefing, released today (21/10/13) ahead of an important debate in the second chamber on the Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Bill on Tuesday 22 October 2013. 

The Lobbying Bill would severely limit the ability of charities to campaign in a year in which there is a general election. The proposals have received widespread criticism and most recently from the Joint Committee on Human Rights and Lords Constitution Committee amid concerns that the proposals will curtail public debate by preventing charities, pressure groups, think tanks and other organisations from presenting information in the run up to an election. 

Some of these concerns have been recognised by the government, but the Bill still lacks clarity.  

Key points from the BMA’s briefing include:

Potential adverse impact on freedom of expression: The combined effect of vastly reduced spending limits and continued uncertainty around what activities fall foul of the Bill, such as production or publication of material made available to the public, would have a ‘chilling effect on freedom of expression.’

Lack of clarity: Despite the Government’s changes, it is still not evident from the wording of the Bill whether or not apolitical organisations, like the BMA, will be unduly restricted in what they can do. Absolute certainty is needed on whether and when the cost of activities will count towards ‘controlled expenditure’.

Excessive bureaucracy: The Bill currently proposes a system that would result in new administrative and regulatory procedures that would prove an immense administrative burden.

Dr Mark Porter, Chair of BMA Council said:

“Despite some improvements to the Government’s proposals, the Lobbying Bill still threatens to dramatically curtail the ability of organisations like the BMA to speak out on vital issues during the year before an election. This would include preventing doctors’ leaders from raising key public health issues, such as those related to smoking.

“The Government should not ignore the potentially huge and damaging impact of the legislation as currently drafted on all non-party political organisations. It cannot risk limiting our ability to speak on issues of public interest.

“We urge the Government to pause, listen and think again, rather than rush ahead with this ill-thought through piece of legislation.”

The government legislation as it currently stands could have the perverse effect of allowing lobbying by major corporations whilst restraining the ability of charities and other non-political organisations from campaigning. 

Thursday, 17 October 2013

Labour joins the 'worker' versus 'shirker' poor bashing?

The political obsession with the 'squeezed middle' hurts the poorest. It is understandable. Whichever political party can appeal most to the middle income earners is likely to win the next election.

Sadly this is why some in the Labour party appear ready to abandon the poor. You don't win elections by being compassionate and understanding about poverty.

So, Labour's Rachel Reeves, Labour's shadow work and pensions secretary,  vows to be tougher than the Tories on benefits and force the long-term unemployed to take up 'work offers' or lose their benefits. Labour is now in the same unethically divisive  game played by the Tories, to portray the unemployed as work-shy  'scroungers' or 'benefit cheats'; it is the 'workers' versus the 'shirkers' divide.

It is an easy story to buy into. We all know (don't we?) people who are on the dole who don't look for work and live in a 'benefits culture'. There is work out there (isn't there?) if only they would get off their backsides and look for it.

Unemployment in the North East is twice that in the South East. Are we to believe that those in the North East are twice as lazy as those in the South East? That these North Easterners are work shy compared to their cousins in the South?

Now, there is a problem for the long-term unemployed. The longer the period of unemployment the harder it is to get back into the job market. Help is required. But also what is required is relevant skills, experience. what is also needed, and here is the rub, is jobs.

No doubt a bit of stick should go with any carrot, but let us not deceive ourselves. Labour's tough position is little more than political expediency. It addresses not the real problem of getting the long-term unemployed back to work. It address and at that same time panders to the misconceptions about the unemployed held by the 'squeezed middle'.

The Tories have been rocked by Labour's potential appeal to this 'squeezed middle'. The standard of living has become a major issue. It has now outstripped the economics of growth or no growth and 'double dip' recession. As the latter recedes the Tories would expect a bounce in the polls. That it hasn't yet materialised is put down to the decreased earnings of the 'squeezed middle'.

The YouGov London poll for the Evening Standard is grim reading for the Tories with intention  CON 32%, LAB 45%, LIBDEM 10%, UKIP 9%  a swing of 5.5% from Con to Lab since the general election. This is in spite of the fact that Boris Johnson polls well with 64% approval for his job as Mayor.

There isn't much any of the parties can do about earnings (is there?) so the next best thing is to blame the poor. We would all be better off if we didn't pay so much on welfare (wouldn't we?).

Wednesday, 16 October 2013

Massive regional variation in unemployment

The labour market statistics published today by the Office for National Statistics continue to show the massive regional variation that has become a familiar feature of this recession.

As the UK climbs out of recession the benefit in terms of jobs is largely experienced in the South East. The disparity between the South East and the rest of the country grows. Unemployment is almost twice as high in the North East.

The unemployment rate in Great Britain was highest in the North East (10.3%) and lowest in the Sout East of England (5.9%).

The Claimant Count rate in Great Britain was highest in the North East (6.5%) and lowest in the South East (2.4%).

Another familiar feature is the large numbers working part-time or with temporary employment. 

The increase in employment is welcome news and another indication that the UK is edging out of recession. But there is a caveat, and it is again the regional disparity. The increased employment is largely in the South East. And there is a regional  disparity in the unemployment rate. Unemployment in the North West increased. Unemployment in the North East and the Midlands remains high with little change. Economic activity in these regions has not picked up and growth is patchy.

The feel good factor isn't yet reaching most parts of the United Kingdom, as these figures represent a growing national divide in potential opportunities and  living standards.

BMJ journal editors will no longer consider research funded by the tobacco industry

Today there was a momentous decision from editors of some key medical journals. Editors of The BMJ, Heart, Thorax, and BMJ Open say they will no longer consider for publication any study that is partly or wholly funded by the tobacco industry.

Writing on bmj.com today, in a hard hitting editorial, they say the new policy is consistent with those of many other journals and demonstrates their commitment to ensuring that - as far as possible - their journals publish honest work that advances knowledge about health and disease.

Critics may argue that publishing such research does not constitute endorsing its findings, but the editors believe this view “ignores the growing body of evidence that biases and research misconduct are often impossible to detect, and that the source of funding can influence the outcomes of studies in invisible ways.”

They argue that, far from advancing knowledge, the tobacco industry “has used research to deliberately produce ignorance and to advance its ultimate goal of selling its deadly products while shoring up its damaged legitimacy.”

They point to extensive research drawing on the tobacco industry’s own internal documents, that shows for decades the industry sought to create both scientific and popular ignorance or “doubt” – at first around the fact that smoking caused lung cancer and later to the harmful effects of secondhand smoke on non-smokers and the true effects of using so called light or reduced tar cigarettes on smokers’ health.

And they acknowledge that journals “unwittingly played a role in producing and sustaining this ignorance.”

Some believe that new tobacco products could represent potential public health gains, and company sponsored research may be the first to identify those gains. But the editors say that, however promising any other products might be, tobacco companies are still in the business of marketing cigarettes.

“The tobacco industry has not changed in any fundamental way, and the cigarette - the single most deadly consumer product ever made - remains widely available and aggressively marketed,” they argue.

In any event, it is a major reversal of editorial position from these journals. They recall that, back in 2003, the editor of the BMJ defended publication of a study with tobacco industry funding saying “The BMJ is passionately antitobacco, but we are also passionately prodebate and proscience. A ban would be antiscience.” But they now believe it is “time to cease supporting the now discredited notion that tobacco industry funded research is just like any other research.”

A problem with this approach is where it will stop. Would they consider bans on publishing work funded by the cosmetic industry for similar reasons? And if not then how can they be certain they are not being unwittingly used as they now believe they have been by the Tobacco Industry?

And what about the food industry. There is currently a major campaign about eating meat from the meat industry. Would these editors consider a ban on publishing any work funded by the meat consortium? It is all a tricky business. 

Putting aside these concerns, they conclude enough is enough: “Refusing to publish research funded by the tobacco industry affirms our fundamental commitment not to allow our journals to be used in the service of an industry that continues to perpetuate the most deadly disease epidemic of our times.”

Monday, 14 October 2013

Care Bill leaves forgotten young generation on cliff edge

With more people living longer, much of the concern about the future of social care has been focused on a growing elderly population.  But more young people than ever before with a range of life-threatening or life-limiting conditions are living into adulthood, and the need for planned social care is vital for this transition.

Within my lifetime I have seen a fundamental shift in attitudes to and life expectation for those with life-limiting disabilities. None gives a better example than changed approaches to Down's syndrome where it is now understood that with support those affected can expect to have productive and independent lives into adulthood. 

But what most often provides the key to coping with adulthood is available support and advice.

The support charity Together for Short Lives is calling on Peers to amend to the Care Bill today (14 Oct) to ensure a generation of young people with life-limiting conditions do not have to face a "cliff edge" in their care and support.

Peers will debate amendments tabled by Lord Patel that, if agreed, would ensure a forgotten generation of young people with life-limiting conditions are able to live as full life as possible to adulthood.

As it stands, the new law fails to set out when local authorities should assess the future needs of young people before they turn 18 years old – meaning that for thousands of young people with life-limiting conditions, plans for this important life-step may not be made in time. Badly planned transitions are currently leaving many of these young people “standing on the edge of a cliff, about to fall into a black hole” – facing a reduction in the support they receive and the range of services they can access.

Lord Patel’s amendments, supported by the Together for Short Lives Transition Taskforce, would ensure that children who need services at the age of 14 (and are likely to continue to need services as an adult) have a well planned transition of care initiated by their local authority. They would guarantee that a young person over the age of 16 years old would have a five year rolling transition plan.

Lord Patel said, “Much of the focus on the Bill has been about reforming the way we pay for our care as our population gets old. However, at the other end of the spectrum there are a growing number of young people living longer with critical, incurable conditions who are being overlooked. More young people with a range of different conditions are living into adulthood than ever before thanks to medical advances. Current failures to plan for their transition to adult care mean that many young adults with life-limiting conditions die before they can realise their ambitions to live independently. The need to ensure timely and well planned transitions for these young people is now more pressing than ever before.” [4]

In his speech today Lord Patel will focus on the story of 20 year old Lucy Watts whose case clearly demonstrates why good transitions to adult care are essential. Lucy’s has Ehlers-Danlos Syndrome, a condition which means she has to be fed straight into her bloodstream via a tube. Lucy can only sit up for up to five hours every day – she uses a wheelchair, but has to spend the majority of her time in bed.
Lucy’s mum, who also juggles a full time job, carries out the majority of her care - and all of Lucy’s day-to-day medical care.

Lucy’s transition to adult services was excellent because there was timely and well-planned joint working between children's and adult services. Lucy’s transition gave her control over decisions about her care for the first time – an essential factor for Lucy as she is not in control of many areas of her life.

Lucy herself has said, “Transitioning from children's to adults in the medical and social world is a huge step. You are moved into a world where you must make decisions about your life and your care – if you are able. The people involved in my care were brought in before I started the transition, so I had time to get used to them, which gave me the confidence to be open and honest. This is your life, so speak up and make your life, and your end of life, the way you want, and need, it to be.”

David Strudley, chair of the Together for Short Lives Transition Taskforce said, “Turning 18 years old should be a time for celebration, especially for those young people who have not expected to reach adulthood. Instead for many families it is the cause of great anxiety, not knowing whether they will receive the vital support they rely on every day. Lucy’s story shows that a successful, well-planned transition to adult care is possible - Lord Patel’s amendments would make that a reality for all young people with life-limiting and life-threatening conditions.”

Let's hope Lord Patel's amendments are passed and accepted by the government.

Wednesday, 9 October 2013

Busting the myth that economic growth is always good

The International  Monitory Fund (IMF) have adjusted estimates for economic growth. Whilst growth worldwide is projected to fall, the IMF now predict UK growth to rise faster than its previous forecast.

The IMF says it expects the world’s economy to grow by 2.9 percent this year—below the 3.2 percent recorded last year. Growth is likely to be driven by advanced economies, while the performance of emerging markets will be weaker than expected.

Osborne has seized on these new projections as further evidence that the UK is on the right track, and as a justification of the governments austerity programme. But is 'growth' the best measure of social and economic well being? Isn't it time we learnt the lesson that the answer to that question is that it is not?

Economic growth is 'good' because it leads to increased jobs and wealth. But distorted growth can lead to greater economic inequality and increased social injustice.

There is an argument that if the wealthiest get richer then the poor benefit from some kind of trickle down effect. It was an argument deployed in Thatcher's time. Look after the rich and somehow the poor will benefit. It doesn't work. The poor simply get relatively poorer.

In a sense this is obvious. Consider housing. There is more to be had from building houses for the richer middle classes than providing decent housing at low cost for the poor. As the middle get richer, house prices rise and push homes out of reach of the poorest. This is why we need more social housing.

I should make it clear that I am not advocating an equality of poverty; that we should all be equally poor. But the wealth of the few based on the poverty of the many should not be justified. The headline figure for economic growth will be good for the coalition in the UK, but their austerity programme has been divisive and ethically questionable. The poorest and most vulnerable have been made to pay the most for the sins of the banking crisis.

Lessons not learned

There is little in the economic statistics to suggest the lessons of the banking crisis have been learned and acted on by the government. We seem once again to be on course for a boom and bust approach. Little has been done to readjust the economy. As before, growth will be predicated on increased demand fostered by increased personal debt.

Social Justice as an economic goal

We need a strategy for growth that puts social justice  as its prime objective. This is signally lacking in a government approach that seeks to drive the poorest from their homes with a 'bedroom tax'.  The austerity approach has been indiscriminate and hits the poorest and most vulnerable.

Growth in employment has been achieved largely with more people working part time for wages that are often below the minimum. This is what drives 'welfare dependency', not a feckless work shy culture as the government would have us believe.

Growth must also be sustainable environmentally.  The government's message on the environment is mixed at best with the apparent abandonment of 'green' targets for energy. And this leads me to the greatest warning about 'growth'.

Good growth has to be sustainable and environmentally sound. Yet forecasts suggest a looming energy crisis with the energy supply regulator Ofgem predicting energy shortages by the middle of the decade. This is not the stuff of sustainable growth.



As energy prices are set to rise, the government will have difficulty persuading consumers of the benefits of forecasts for growth.

Figures issued by Ofgem (see diagram) show the increasing gap between wholesale energy prices and the price to the consumer.  The energy companies are ripping off their customers. Since 2010 fuel bills have risen disproportionately to the wholesale costs. So much for the benefits of growth for hard pressed families!


Wednesday, 2 October 2013

Exercise as effective as drugs for treatment of many diseases?

Coronary heart disease now costs the NHS £1.6bn a year to treat and costs the UK economy around £10bn. Yet when was the last time your doctor told you to take more physical exercise? 

Your GP may weigh you, take your blood pressure and pulse. You might be on repeat prescriptions for drugs. But a new review of evidence published today on bmj.com suggests that physical activity is potentially as effective as many drug interventions for patients with existing coronary heart disease and stroke.

Are we overdependent on drugs?

The researchers argue that more trials comparing the effectiveness of exercise and drugs are urgently needed to help doctors and patients make the best treatment decisions. In the meantime, they say exercise “should be considered as a viable alternative to, or alongside, drug therapy.”

Physical activity has well documented health benefits. Our sedentary lifestyles may be killing us, yet statistics from the British Heart Foundation show that in the UK only 14% of adults exercise regularly, with roughly one third of adults in England meeting recommended levels of physical activity.  

In contrast, prescription drug rates continue to skyrocket sharply rising to an average of 17.7 prescriptions for every person in England in 2010, compared with 11.2 in 2000.  We are becoming a nation on medication when exercise might be the best 'treatment'.

But there is still very little evidence on how exercise compares with drugs in reducing the risk of death for common diseases.

In the current analysis researchers based at the London School of Economics, Harvard Pilgrim Health Care Institute at Harvard Medical School and Stanford University School of Medicine set out to compare the effectiveness of exercise versus drugs on mortality across four conditions (secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure and prevention of diabetes).

Secondary prevention refers to treating patients with existing disease before it causes significant illness.

They analysed the results of 305 randomised controlled trials involving 339,274 individuals and found no statistically detectable differences between exercise and drug interventions for secondary prevention of heart disease and prevention of diabetes.

Among stroke patients, exercise was more effective than drug treatment, while for heart failure, diuretic drugs were more effective than exercise and all other types of drug treatment.

The need for more evidence

So is exercise as effective as drugs in treatment of diseases? It is probably too early to say with certainty. The authors point out that the amount of trial evidence on the mortality benefits of exercise is considerably smaller than that on drugs, and this may have had an impact on their results.

They argue that this “blind spot” in available scientific evidence “prevents prescribers and their patients from understanding the clinical circumstances where drugs might provide only modest improvement but exercise could yield more profound or sustainable gains in health.”

Physical activity potentially as effective as many drugs

Despite this uncertainty, they say that, based on the available data, physical activity is potentially as effective as many drug interventions – and call for more trials to address the disparity between exercise and drug-based treatment evidence.

“In cases where drug options provide only modest benefit, patients deserve to understand the relative impact that physical activity might have on their condition,” they conclude.

Changing lifestyle may be more effective at treating and preventing diseases. But experience demonstrates it is more difficult to achieve than it seems. We have known for decades that regular exercise is beneficial yet so few of us do it. We live increasingly sedentary lives. Increasing awareness of the importance of exercise is insufficient to bring about an effective change.

Read also:

Something isn't right in the world of pharmaceuticals. Alarm bells are ringing.
Hilary and Steven Rose lift the lid on modern biomedical science.

The price of a loaf of bread

It is of course the standard interviewer ambush, what is the price of a loaf of bread or a pint of milk? Few politicians can answer such a question unless well-prepared. On its own the answer or lack of it reveals little of substance.

Yet it matters in a time of austerity, when the poorest are being pressed the hardest and made to pay for the financial sins of others.

A hard pressed mother or father watching the pennies is very much aware of the price of a loaf of bread. I should say they know the price of loaves of bread and they know the price of having to choose the least nutritional option.

So when politicians demonstrate their inability to answer, it demonstrates their distance from the hard realities of life. They clearly do not understand the pain and suffering of the poorest.

If there is an economic recovery, it isn't yet being experienced by people in general who are still feeling financially squeezed. And this is the problem for the coalition. The feel good factor is hard to find. Millions can find only part-time employment, often at wages lower than the statutory minimum. Their rents are rising as is the cost of living in general.

Far from being sympathetic, government ministers brand the poor feckless and work-shy and in 'welfare dependency'. Not only are the poorest on low earnings, but their benefits have been cut. The poor know the price of a loaf of bread or a pint of milk!

It isn't so much whether a politician 'knows' the price of a loaf of bread that matters. It is whether they can demonstrate by their response an understanding of the difficulties faced by the poorest.

Members of this government signally fail to demonstrate such understanding. Boris Johnson brushed the question off as if it didn't really matter, or that it was some kind of funny business on a panel game show. Ian Duncan Smith blames the poor for their poverty.

The poor suffer from some kind of Victorian disease called 'welfare dependency' from which they need to be shaken. The unemployed need to be forced into slave labour in return for their benefits. The story is told of the unemployed failing to look for work. This is nonsense of course because many do find work, but for the majority it is either part-time or at best temporary.

The rich get richer and the poor get poorer, yet the government not only behave as if this doesn't matter, but that it is something about which we should rejoice. Let's not blame the rich for the mess we are in, rather we should admire them for making money. Yet, for the rich to make money is pretty easy stuff compared to the difficulty of raising a family on the minimum wage and still finding time to help others.

It is time we readjusted our values. It is time we knew the price of a loaf of bread.


Tuesday, 1 October 2013

Tories bring back Victorian Poor Law without the workhouse

The attitude and policies of this government to the poorest and the least fortunate takes us back to the days of the Poor Law. Putting the poor to work is possessed of an attitude that the poorest are feckless and work-shy and must be put to work for their own benefit.

It is not only a divisive approach, setting the more fortunate against the least fortunate, but it is profoundly unethical and counter-productive. It has its populist appeal. But it is profoundly wrong. It tars the majority of unemployed with the brush of the minority.

I hear it said commonly in radio phone in programmes 'there's plenty of work out there if only they were willing to look for it.' And that about sums up as much as they 'know'. They know if for sure; there is work out there. Of course there is, but where is it?

Unemployment is said to be falling. The headline figures demonstrate this. But it is not falling uniformly across the country. In some regions it has risen and not fallen. One problem for the unemployed is that it is impossible to move from regions of high unemployment to find work. Costs are simply too high for such a move. So families are stuck.

But the Tory government adopts the old 'get on your bike' mentality, which suggests that somehow those who were in work before the recession suddenly became work shy during it.

The government says it wants to make 'work pay'. What they really mean is that they want to give the unemployed less in the mistaken belief that this will drive them back to work.

Now it may be true that for some there is little incentive to take employment when earnings will be less than that received in benefits. But to suggest this is the main reason for unemployment is to blame the poorest for the recession and assume that somehow they are masters of their own fate.

The poorest and least fortunate are being made to pay for the mess that the banking sector got us into. But the reason is that the Tory attitude to the poor isn't driven by understanding of the recession, it is driven by ideology. If IDS had the chance he would bring  back the workhouse. Driving people into 'work for their benefits' simply makes the low pay problem worse.

For the wealthiest this is great. We are heading for an economy based on virtual slave wages. Millions of decent, hard working people take home insufficient to meet their basic needs. That is the definition of poverty. To solve this problem we need to create an economy that pays wages that at the least meet basic needs of housing and feeding a family.

Mr Duncan Smith talks of 'fairness' without understanding what it means. He assumes it means 'treating people the same'. But this leads to the kind of indiscriminate cuts in benefits this government has imposed, such as the bedroom tax that takes little account of real need.

Meanwhile Osborne says he will create a budget surplus. This becomes a goal for which there is little need. Running budget deficits is not in itself a problem. If you run a budget deficit because of increased spending on health and welfare, the economy benefits from a healthier and more productive  workforce. This is something that enlightened Victorians realised, which is why they set about investing in infrastructure, public works that improved the health of the nation.

It would be better for Osborne to adopt three goals: 1) to create a full-employment economy based on 2) a living wage and to 3) improve housing and health of the population. These are real goals; running a budget surplus for its own sake  is a foolish goal that can only be achieved through austerity. In any event, if you want to run a budget surplus then full employment and increased productivity, a healthy sustainable workforce, is more likely to be successful because it increases revenue.

Postscript

The way government ministers talk about the unemployed suggests that they haven't been looking for work, and that somehow they have slipped into a 'culture' of 'getting something for nothing'. This really isn't born out by the figures supplied by the Office for National Statistics (ONS). Of the nearly 2.5 million unemployed people,  less than 1 in 5 (18%) had been looking for work for over 2 years. This is the 'hard core' of the long-term unemployed.  The largest group (47%) have been unemployed for under 6 months. There is very little here to suggest the unemployed wish to remain on benefits, or that they are feckless and work shy.

A feature of this recession is that more people than ever before are only able to get part-time employment, or their jobs are temporary leading to further periods of unemployment. Again there is little to suggest that these people are feckless and work shy or adopting a culture of dependency! 

On the contrary where we have a culture of dependency is for businesses who depend on paying low wages to workers. It is business that is being subsidised by welfare payments. Businesses needs to adjust to paying a 'living wage' to their workforce. Currently we have a labour market that is distorted and fosters low pay.

Read also:

The unethical language of 'welfare dependency'
The Conservatives brand the unemployed as 'shirkers'

Saturday, 28 September 2013

One telephone call may seal Obama's place in history

For many, the Obama presidency has been a disappointment. The 'Yes we Can' mantra has faded into a distant memory. But in many ways he was bound to disappoint. Voter expectation for change wasn't predicated on an agreement on what that change would be. Change meant different things to different people. 

But change there has been, and nothing reflects that change more than a simple act; a telephone call.

When Obama lifted the phone in the Oval Office to call Iranian President Rohani it represented a different way of thinking about world affairs. It said 'Yes we can' to solving issues in a way that doesn't require a resort to military intervention. 

Of course it required the biggest change of all. A change in the Iranian Presidency. But it takes two to tango and the first tentative steps have been taken in a fifteen minute telephone call. 

It is of course too early to say what a rapprochement with Iran will lead to. But if there is rapprochement it may make Obama's mark in the history books. If it creates a new atmosphere for resolving the problems of the Middle East the world will be a safer place. 

It is also too early to say  how the Syrian crisis will resolve, but Obama backed away from a military strike to 'give peace a chance'. At one point it looked as if a military strike had momentum. But popular will said a resounding 'no'. First it was rejected by the UK parliament; then Obama backed off to seek congressional approval.

Some saw this as weakness. But it takes strength to think again. As Obama has said in response to criticism that he was dithering 'I am much more concerned with getting the policy right'. 

How different history might have been if the Bush administration had taken time to think again about invading Iraq or at least thought through what the end point was likely to be.

If the Syrian regime gives up its chemical weapons it will be a major achievement. Russia will take great credit for brokering the way forward. But Obama has shown real courage in stepping back and supporting the process. It is surely better than military intervention in a messy civil war. 

There will be those who are sceptical. Perhaps they are right to be. But when I heard the news of the telephone call made by Obama I was full of hope and optimism. A great deal more now needs to be done. But it is the first bit of optimism I have felt in international affairs for a long time. A cloud has lifted and the sun might shine. 

Thursday, 26 September 2013

Is Ed Miliband right on freezing energy prices?

Is Ed Miliband right to challenge the energy industry on pricing? It is a populist move. At a stroke he has outflanked Cameron on an issue the prime minister once had a go at when he questioned the complexity of tariff choices. But is a price freeze a sustainable policy?

It hasn't taken five minutes before energy company bosses were parading in the media with doomsday scenarios. The lights would go out if a Labour government freezes energy prices for two years.

It is of course a load of piffle. The lights will not go out. Not, that is, if there is sufficient investment in energy production. The energy industry will argue that it is supply and demand operating in the market for energy that should and does determine prices.

The truth is that energy markets are complex. Supply depends on the capacities of power plants, their current technical state and planned refurbishment, or on supplies from abroad. On the demand side the weather  plays an important role. Temperature and cloud cover influence consumer behaviour directly. Severe winters add to demand.  It is also affected by changes in the state of the economy and industrial output. Instability in the Middle East is a major factor on world energy markets. Other factors include consumer behaviour.

Nevertheless, energy production and prices operate in a highly distorted market. Costs of production and prices in relation to supply and demand don't operate unfettered. Investment in 'green' energy is heavily subsidised. So much so that in June this year David Cameron was threatening to cut green energy subsidies.

Cameron blamed these subsidies for pushing up energy bills. So the market is distorted and some argue that it needs sorting out. The political wind is turning against green energy. In any event, around 100 Tory MPs are unhappy about wind farm proposals in their constituencies, and this will influence energy policy. We in the countryside don't like wind farms peppering our landscape. Politics plays a major role in determining future energy supply.  It isn't at all clear what the government strategy is.

In his 2011 autumn statement George Osborne effectively abandoned environmental targets saying "If we burden [businesses] with endless social and environmental goals – however worthy in their own right – then not only will we not achieve those goals, but the businesses will fail, jobs will be lost, and our country will be poorer."

The government is right in one sense and that is that the subsidies for renewable energy distort the supply side market. Turbine owners received £1.2 billion in support last year. My point here then is that government already interferes with the energy market through these subsidies. It is a bit rich for the energy industry chiefs to cry foul and threaten to turn the lights out when Labour promise to control prices to the consumer. The government claim that without the subsidies, householders would be paying an average of £60 more for their electricity bills. 

We need a sensible debate about how the UK can meet its energy needs. What consumers experience is that prices go up but rarely come down and whilst energy company profits rise.

But there are two problems with the Miliband populist approach. Once government interferes with prices it is difficult to see how it stops interfering.

What happens when the freeze ends? The most likely scenario is that prices will increase. The 'market' will readjust. This has always been the problem in the past with prices and incomes policies.  They store up problems.

I suppose it is possible that prices could be linked to a clearly understood index by a toughened regulator. But  what would  be that index? Unless Miliband has answers to this question Labour spokespersons will have difficulty making the case. The easy part is saying prices are too high; the hardest part is saying what they should be and why.

Miliband has a bold policy. But the devil may be in the detail. It needs to be fleshed out.

Postscript

Predictably, David Cameron has hit back at Labour's new policy on freezing energy prices. He knows, however, that the public are angry about rising energy bills. We remember his own fumbled attempt at taking on the energy companies last year when he insisted that energy companies would be 'forced' to offer customers the lowest tariff.

David Cameron declared ''I want to be on the side of hard pressed, hard working families who often struggle to pay energy bills.''  Ed Miliband has now outflanked him.

It makes it difficult now for Cameron to attack Labour's interventionist plans directly.

So what is Mr Cameron's strategy for lower energy prices? Not surprisingly his policy is to push 'new technologies like fracking'. We will recall that Lynton Crosby, Cameron's recently appointed election guru, controversially has links with the fracking industry.  But, hey, I'm sure they never discuss it...it never comes up in conversation...no lobbying scandal here then.

Post-postscript

There are already signs that the Tories have adjusted their position in response to Labour's plans to freeze energy prices.



Wednesday, 25 September 2013

GP income falls as costs rise

Have you ever wondered what your GP earns? The truth is of course that GPs compared to most of us earn a good whack. But that isn't the point. It is a high pressured, high skilled job and average GP income has been falling steadily for several years.

Figures released by the Health and Social Care Information Centre (HSCIC) show that average income before tax of contractor GPs was £103,000 in 2011/12, a drop of 1.1 per cent on the previous year, representing a continuation of the gradual fall in contractor GP incomes from their peak at £110,000 in 2005/06, the year after new contracting arrangements were introduced. Contractor GPs form the majority (around 80 per cent) of the GP workforce.

Today's report shows that average gross earnings for contractor GPs were £267,900, a 0.5 per cent increase on 2010/11. So how is it that GP income has fallen? The answer is increasing costs.

Contractor GPs pay for expenses such as premises and practice staff wages out of their gross earnings - and these costs increased more than earnings, rising by 1.6 per cent to £164,900. Almost 62% of Contractor GP earnings is taken by expenses of running the practice.  

But average statistics don't really tell the full story.

Around half of contractor GPs (50.3 per cent) had an income before tax of less than £100,000, roughly the same proportion as in 2010/11 when 48.9 per cent fell into this bracket. Just 2 in 100 contractor GPs (2.0 per cent or 670) had an income of more than £200,000 before tax.

Average incomes before tax were £106,100 in England, £93,300 in Wales, £92,800 in Northern Ireland and £88,700 in Scotland. Average income before tax for contractor GPs in 2004/05, when the current contracting arrangements were introduced, was £100,200 in cash terms and £119,300 in real terms.

HSCIC Chair Kingsley Manning said: "This report provides a detailed insight into the income of GPs and their practice expenses, showing that the average income before tax of a contractor GP is £103,000.

The data confirm a continued gradual decline in average GP incomes and will provide a useful contribution to discussions over the remuneration of the family doctors."



GPs "a demoralised workforce"

Responding to the new figures  which show a decline in average GP income, Dr Chaand Nagpaul, Chair of the BMA’s GP committee said:

“GPs are already demoralised by ever increasing and unmanageable workloads. This further pay cut for GPs while running costs increase, and the failure of the government to ensure that pay is frozen as it is with other NHS staff, will only add to this.

“Despite claims that pay is out of control there has been a 11 per cent drop in GP income since 2008, which along with increased bureaucracy has led to the current recruitment and retention crisis facing general practice.

“GPs are working harder than ever before to maintain high quality services and carry out 340 million consultations a year. However, ever increasing costs of care without adequate funding to match is unsustainable and means quality of patient care will inevitably be hit.

"The government needs to address the economic and bureaucratic straitjacket that many practices are now finding themselves in so GPs can be enabled to provide the best quality care to their patients.”

Tuesday, 24 September 2013

Hospitals fall short of standards on post mortem consent

Many hospital trusts in England and Wales are falling short of the recommended standards on obtaining consent for a post mortem, indicates a snapshot survey of practice published today online in the Journal of Clinical Pathology.

Active informed consent became a key tenet of post mortem exam procedures following the organ retention scandals at Bristol Royal Infirmary and The Royal Liverpool Children’s Hospital, which prompted the enactment of the 2004 Human Tissue Act.

At Bristol Royal Infirmary the hearts of children were taken without the knowledge of their  parents. Collections of hearts and other organs were held in hospitals across the UK without relatives knowing.  A public outcry resulted when it was revealed that Dutch pathologist Dick van Velzen had systematically ordered the "unethical and illegal stripping of every organ from every child who had had a postmortem" during his time at Alder Hey Hospital regardless of whether the parents had consented and also where parents had specifically stated that they did not want a full post-mortem.

The 2001 report on Alder Hey revealed that over 104,000 organs, body parts and entire bodies of fetuses and still-born babies were stored in 210 NHS facilities.

The presumption by clinicians at the time was utilitarian in nature; the greater potential benefit obtained from retention and research was considered to outweigh other considerations including the fundamental principle in modern medicine of informed consent. This fundamental principle has a high threshold and would require an equally valid but conflicting principle to justify its breach. In this case no such conflicting principle exists.

The argument that patients may benefit in the future from research and/or medical education is little more than an ethically invalid open cheque. A cheque that bounces on a number of grounds, not least of which is how such a balance can be made. Furthermore, were it to be justifiable on such grounds, it should not be clinicians and scientists who are the arbiters of such a balance. It should be the patients or their relatives who make such a choice. It should not be a decision made by clinicians alone. Informed consent is central to the 2004 Human Tissue Act and guidance is laid down on how it should be obtained in practice. One key element in practice is that informed consent in such cases should be obtained by staff appropriately trained.

The 2004 Act stipulates that consent must be actively sought from either the individual while alive, or when this is not possible, from a nominated representative or close family member. Such is the importance of this fundamental principle that breaches of the law attract a prison sentence and a fine. But how well are hospitals adhering to the principles of the Act?

In the current survey, the authors obtained staff policies on post mortem procedures from 26 hospital trusts in England and Wales. They compared the content with guidelines set out by the regulator in this area, the Human Tissue Authority (HTA).

They focused particularly on whether the policies explained: the law behind consent to post mortem; the consent process; which staff members should take consent; and training requirements for consent takers.

The HTA guidance states that every hospital should provide staff with a documented consent procedure, and have relevant experience and understanding of the procedures involved.

The guidance also says that staff should be trained in dealing with bereavement and have witnessed a post mortem themselves, and specifies that responsibility for obtaining consent “should not be delegated to untrained or inexperienced staff.”

Out of the 26 post mortem policies scrutinised, one failed to explain the legislation governing consent to a post mortem; more than one in 10 (12%) of policies did not outline a clear process for how consent for the procedure should be obtained.

Furthermore, 12% of policies did not specify which staff members should take consent for a post mortem, and almost one in four (23%) of policies failed to state the training requirements of those responsible.

One in three (35%) trusts did not stipulate any requirements for the consent taker to be sufficiently experienced; over half of trusts (58%) did not specify that consent takers needed to be trained in bereavement; and over two thirds (69%) did not recommend that consent takers should have witnessed a post mortem.

Some 12% of policies failed to outline the consent process in full, including failing to describe when families should first be approached, or which staff members should talk to families before they are presented with a consent form.

“Given the sensitive nature of consent discussions, it is vital that the process is conducted in an appropriate manner,” write the authors. Adequate and clear guidance for this is therefore essential they add, highlighting “the significant shortcomings” their analysis revealed.

They point out that hospital post mortem rates have been falling steadily, despite the importance of the procedure in understanding disease and enhancing medical education. And a clumsy, poorly informed approach to families when a loved one has just died is unlikely to reverse that trend.

The authors acknowledge that policies do not necessarily reflect actual practice, and some of the trust policies may also have subsequently changed.

But they emphasise that in the current climate of financial cutbacks, “it would be feasible for trusts to see [post mortems] as an easy target to limit investment to the detriment of the medical profession. Hence it is vital for the HTA to uphold standards and continue to ensure that the consent process is always carried out in a satisfactory manner for all concerned.”

Friday, 20 September 2013

Bureaucracy and box ticking are compromising NHS primary care

A new BMA survey says that GPs need to be freed from increased bureaucracy, box ticking and administration so they can spend more time meeting the needs of their patients.With that I suspect most of us would agree. 

As I get older, and now suffering from age-related illness, I use my GP more than I ever did before. I have become one of the 'burdens' of 'an increasingly aging population'. When I visit my local GP clinic I am struck by how many of us in the waiting area or in the queue at the reception are over 60s. Until a year ago I rarely visited my GP. I certainly couldn't tell you the names of any of 'my' doctors. Now it is different. I am rooted in that cycle of being regularly poked and prodded. I have become a NHS statistic.

The survey of GP opinion is the largest since changes to the GP contract took effect in April 2013. In total, 3,629 GPs completed the survey, just over 10% of all GPs in England. I worry that only 10% of GPs responded. Perhaps 90% of GPs who didn't respond were too busy ticking other boxes. It does question the representative value of the survey.  But let's for the moment at least take the findings at face value. 

Key findings include: 

97% said that bureaucracy and box ticking had increased in the past year while 94% said their workload has increased.
82% felt that some of the new targets were actually reducing the number of appointments available to the majority of patients.
89% said that more targets will not improve patient care.
90% said their practice’s resources are likely to fall in the next year.
45% of GPs said they are less engaged with the new clinical commissioning groups (CCGs) because of increased workload.
86% of GPs reported a reduction in their morale in the past year.

These results are similar to those of the the seventh annual report into “GP Work life”, funded by the Department of Health, and published this week

The level of overall job satisfaction reported by GPs in 2012 was lower than in all surveys undertaken since 2001.

In the Department of Health Survey, GPs reported most stress due to ‘increasing workloads’ and ‘paperwork’ and least stress due to ‘finding a locum’ and ‘interruptions from emergency calls during surgery’. Reported levels of stress increased between 2010 and 2012 on all 14 stressors, generally by 0.2-0.4 points on a five-point scale. Reported levels of stress are now at their highest since the beginning of the National GP Worklife Survey series in 1998. 

Dr Chaand Nagpaul, Chair of the BMA’s GP committee said:

“GP practices are already struggling with declining funding and rising patient demand, especially from an ageing population. Recent changes to the GP contract have created additional and unnecessary workload that is diverting valuable time away from treating patients. Worryingly 8 in 10 GPs report a reduction in morale, and nearly half of GPs are less engaged with their Clinical Commissioning Groups due to workload."

The government promised to sweep away red-tape and targets. Yet the government recently introduced new targets which include encouraging GPs to carry out a large number of "lengthy and clinically dubious questionnaires" that ask how many hours patients spend on gardening, cooking and DIY.

Absurdly they also introduce a programme offering appointments to all healthy 35-40 year olds simply to check their blood pressure. GPs are very worried that the time taken for this programme and questionnaires is resulting in fewer appointments for other patients who are in need of care.

As Dr Nagpual says, despite this difficult environment, GPs are working harder than ever before. There is a wealth of experience and talent in general practice that could be harnessed positively for patient care. 

“The BMA wants to work with the government to deliver real benefits to patients and remove the administrative burden that is putting pressure on already overstretched GP services. We particularly need to see how we can free up more time to deliver the personalised care that patients deserve and meet the challenges from an increasing number of older patients who need coordinated and effective care.”

GPs should be able to concentrate on ensuring good patient notes and treatment, not filling in forms that are not directly related to patient care.

See also:

Patient safety put at risk by long hours for Junior Doctors
Broken pledges and the crisis in the NHS
Deepening crisis in the NHS

Wednesday, 18 September 2013

Homeopaths Without Borders: exploitation or humanitarian?

Today on bmj.com a senior researcher from the Institute for Biomedical Ethics criticises the campaigning group that wants to help the world’s most vulnerable people with homeopathy.

David Shaw says that although the movement Homeopaths without Borders has received a “great deal of criticism in recent years for unethical practices”, it has gone “entirely unmentioned” in medical literature. He says this is surprising given that the campaign is “engaged in activity even more dubious than that of most homeopaths”.

Research and modern medicine

It has often been said that medicine is an art as much as it is a science. It is certainly a craft that requires understanding of the needs and circumstances of the patients it treats. Modern medicine is 'evidence based', which means that it progresses through research and new treatments are soundly tested in randomised controlled trials (RCTs). The two approaches, medicine as a craft and evidence based medicine are complementary; ideally they work together. Whilst modern medicine isn't simply the application of science, it isn't hocus pocus either.

When modern medicine offers humanitarian assistance throughout the world, as it does through organisations like Medicin sans Frontieres,  it brings this evidence based knowledge, skill  and understanding to help those in need. Those being helped assume that what is being done is tried and tested and approved. They trust the skill of those who are treating them. Homeopathy offers little or none of this.

Homeopathy not evidence-based

Homeopathy is a 200-year old system of medicine that seeks to treat patients with highly diluted substances that are administered orally. Homeopathy is based on two principles: "like-cures-like" whereby a substance that causes a symptom is used in diluted form to treat the same symptom in illness and "ultra-dilution" whereby the more dilute a substance the more potent it is (this is aided by a specific method of shaking the solutions, termed "succussion"). It is claimed that homeopathy works by stimulating the body's self-healing mechanisms. There is a paucity of evidence that it works.

Homeopathy is not part of mainstream medicine because it is not evidence based.  The Royal Pharmaceutical Society of Great Britain has concluded that homeopathy is based on a false premise and that "no plausible scientific reason has yet been proposed as to why it should work". Put bluntly, the overwhelming body of evidence is that it doesn't work, and if it doesn't work it is unethical to suggest that it does.

As the UK House of Commons Select Committee on Science and Technology concluded from its long consideration of the evidence "there has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious".

In response to this criticism, advocates of homeopathy argue that much of modern mainstream medicine isn't strictly based on evidence. That may be so; there is more to medicine than the appliance of science. But modern medical practice evolves in the light of ongoing audit of what does and does not work and it seeks to understand why through research. None of this underpins homeopathy.

For the most part through physiological and pharmacological research we can say how drugs work in the body. We may not always be correct but science is an ongoing process of challenging established ideas. None of this is part of homeopathy the basis of which is 'not understood' after 200 years of history.

Homeopaths without Borders

Homeopaths without Borders seeks to promote itself in countries where it does not already have a foothold. Shaw says the Kenyan example, which implies that homeopathy can save lives, is “shocking” and something which no mainstream organisation has claimed for several years.

The Homeopaths without Borders North American group sent several homeopaths to help the people affected by the Haiti earthquake but according to Shaw, “people affected by massive earthquakes cannot benefit from homeopathy any more than people living safely in London”. He adds that it might even harm patients by making them believe that they do not need to seek usual treatment for injuries or disease.

Shaw says that following the earthquake, more Haitians will believe in a “discredited system of ‘medicine’ making long term harm more likely than if the campaign had not got involved in the first place”.

He believes that Homeopaths without Borders North America “exploit developing countries” and is happy to suggest that homeopathic therapies can also help in pregnancy care and delivery.

Homeopaths without Borders also ask for monetary donations, which Shaw believes seems “somewhat pointless” given that there is no evidence for its efficacy and as such it may be diverting money away from “genuinely humanitarian organisations”.

Dr Shaw concludes that “homeopathy is neither helpful nor humanitarian” and is exploiting those “in need of genuine aid”.

In an update on their Haiti mission in 2011 Homeopaths without Borders reported on worsening conditions.

"The team reported that conditions in Haiti remain difficult; piles of rubble still sit in the streets, roads are filled with potholes and rebuilding is extremely slow. Potable water is scarce as is sufficient food, and fear of cholera is evident.

"Haitians continue to demonstrate symptoms of trauma and grief from an earthquake that took place a year and a half ago. Skin problems such as ringworm are prevalent as are gastrointestinal problems including severe diarrhea; some of the latter are related to poor nutrition. Vaginal infections persist. Sadly the group treated several very ill infants who were malnourished, dehydrated, underdeveloped, feverish and covered with rashes from head to toe.

Although a great variety of remedies were used, following were the most frequently administered: Arnica, Aconite, Ignatia, Causticum, Nat mur, Sepia, Phosphorus acid and Sulphur."

Significantly missing from the report was any account of the effectiveness of the 'treatments' given. Nor is it clear how the 'like cures like' principle was at work. Arnica cream has a record of use in treatment in  medicine, but a systematic review of clinical trials shows that homeopathic preparation of Arnica was no more effective than a placebo. Onions can certainly stimulate tears, but it is difficult to see how they can be a cure for the common cold or influenza, yet a homeopathically prepared 'onion solution' might be prescribed by a homeopath.

Homeopath claims

Homeopath organisations claim that research published in medical journals such as the Lancet and the British Medical Journal "have confirmed the effectiveness of homeopathy". This is disingenuous at best. I doubt whether the editors of these prestigious medical journals would agree. On the contrary, the Society of Homeopaths has been censured by the UK Advertising Standards Authority for making unsubstantiated claims that homeopathic remedies can cure depression, bronchitis, osteoarthritis, and vertigo. Most controlled clinical trials show no beneficial effect yet these unsubstantiated claims continue to be made.

Homeopathc preparation of Ignatia continues to be pushed as a remedy for bereavement, heartache and pain.  With little or no evidence it is also suggested as a remedy for headaches, sore throat, nervousness, insomnia, heart palpitations, gas, indigestion, mood swings, menstrual irregularities, irritable bowel syndrome, painful hemorrhoids, or a dry, tickling cough.

I am sure Dr Shaw's hard hitting opinion piece will spark considerable debate.  Many of the arguments have been well rehearsed. Much of the debate will be vituperative; sadly, it usually is. But the central question will be whether there is evidence that homeopathy works and if so why. If there is no such evidence, or the evidence is slim, then it is unethical to suggest otherwise.

There is much that is wrong with the pharmaceutical industry. I believe we need a more holistic approach to understanding disease and treatments.  Homeopathic practitioners have a belief in their approach. This I respect. But it stretches truth and is unethical for them to make claims that cannot be substantiated.

Postscript

The adjudication of the UK Advertising Standards Authority makes interesting reading. The body found the claims of the Society of Homeopaths to be misleading and not substantiated.

"The Society of Homeopaths provided three studies to substantiate the claim that there was sufficient research evidence to support the use of homeopathic treatment for allergies and upper respiratory tract infections. Our expert advised us that the first paper concentrated on effectiveness, safety and cost effectiveness rather than efficacy. The second paper concerned 24 studies, but those with the highest patient numbers showed only non-significant effects in favour of homeopathy or no effectiveness over placebo. The third paper concerned 27 trials and studies and some evidence suggested in some conditions, homeopathy showed some benefit. However, the authors noted that there were general weaknesses in the evidence due to the lack of independent confirmation of reported trials and the presence of conflicting results. Our expert considered that the evidence was not sufficient to support efficacy claims for homeopathy for the treatment of allergies and upper respiratory tract infections. We therefore concluded the claim was misleading and had not been substantiated."

You may also be interested in these articles:

Hilary and Steven Rose lift the lid on modern biomedical science.
Something isn't right in the world of pharmaceuticals. Alarm bells are ringng.

Thursday, 12 September 2013

UK employment figures all smoke and mirrors?

As the UK unemployment rate falls, Ed Miliband is right to point to the disparity in unemployment between the north and south. If there are signs of economic recovery, it clearly isn't uniform across the country.

The headline figure of falling unemployment masks the real problem for an economy that is still sluggish and for a patchy recovery.

The unemployment rate is highest in the North East (10.4%) and lowest in the South East (5.8%). The disparities are illustrated in an interactive map showing the distribution of people receiving job seekers allowance produced by the Office for National Statistics.

It is also a distinctive feature of this recession that increasing numbers are working part-time because they are unable to find full-time employment. In 2008, just 16.6% of the male workforce had part-time employment, now it is 32.6%. For women the percentage in part-time employment increased from 7.1% (2008) to 13.5% (2013).

Millions of hard-working but hard-pressed families have seen inflation outstrip any increase in earnings, a trend that is set to continue. A real feel-good factor may be hard to conjure.

The right wing think tank Centre for Policy Studies warns the Chancellor against complacency. It makes the points that the deficit is still 'extraordinarily high', unemployment is still 'way above its pre-crisis peak', productivity performance has been poor, and many underlying structural problems persist.

Postscript

A defining and continuing feature of this long recession is perhaps 'underemployment' rather than simply unemployment with a massive increase in those working part-time. There has been an unprecedented fall in earnings while inflation has increased. Many of those with part-time employment have been unable to increase their income by increasing hours worked.

The price of petrol has increased by 54% since 2008. Hard working families have seen the cost of living increase across the board. Changes in welfare funding means that the poorest and the disabled have born the brunt of the recession caused by the banking crisis.

See also:

The disgraceful falsehood of Mr Osborne's spending review
Failure to act on corporate tax avoidance is a disgrace.

Tuesday, 10 September 2013

French resolution at UN on Syria is mischievous.

The resolution proposed by France at the UN following the Russian proposition that Syria put its chemical weapons beyond use is unfortunate if not disingenuous.

France knows that by including a condemnation of the Syrian regime for the chemical attack of 21st August it would be unacceptable to Russia and thus courts rejection. Indeed, Russia has already called it 'unacceptable'. The French resolution promotes division in the security council at a time when it could be moving towards unanimity. It is inept at best; at worst it is mischievous. What is needed now is  for the UN to move forward on setting up a viable process for decommissioning Syria's chemical arsenal.

None of this will be easy in the middle of a civil war. It has been suggested it would require a cease-fire to ensure safety for the inspectors and to ensure the weapons did not get into the wrong hands or go missing. The Obama administration is also not short of mischief making. It calls for 'swift' action, when it knows this is not possible.

It will take time to prepare the ground, to broker a cease-fire, to install a decommissioning team. It is not at all sure the opposition in Syria will be willing to play ball and nor are the opposition forces united. Such a process will be far from 'swift'. And even supposing a team can be put on the ground in Syria, there will be setbacks. The process will stumble at some stage. That is par for the course in such matters. Nevertheless it is the best proposition on the table.

Meanwhile, Obama is rapidly losing credibility on his 'red line'. He has lost the initiative which passed to Russia via an inept remark by Secretary of State, John Kerry. It appears now that the idea was first mooted in discussions at the G20, and yet the Obama administration still appears to have been wrong-footed on it.

Nevertheless for Obama it is a way forward. All sides must now work hard for its adoption and implementation. Finally the UN may be able to play a worthwhile part in ensuring safety of the Syrian people and ensuring chemical stockpiles do not get into the hands of terrorists and a regime mindful to use them.

Postscript

Obama and Hollande rightly say that the threat of a military strike against the Syrian regime has played a major part in the positive response of the Assad regime to the Russian proposal. Equally, it has to be said, that Russia would not have been able to approach the Assad regime without retaining close relations. Political solutions to seemingly intractable problems most often require a willingness to engage with 'the enemy'. Setting unattainable conditions as laid out at the UN by France is unhelpful and obstructive to a diplomatic solution.

Post-postscript

We can only hope that the road map to eliminating the Syrian stock of chemical weapons is a success. It is a difficult task and some experts consider it to be an unrealistic time-table for the stocks to be destroyed by September next year. In a war-torn country this may not be possible, and so what then? The US and its allies, France and the UK, want a military strike to remain a possible response. With a military strike still on the table, it will not be in the interest of the opposition forces to cooperate in allowing chemical weapons decommissioning to progress. A lot will depend on how much security the Assad regime can provide and on the location of the stockpiles. There are a lot of 'ifs', although it is a step in the right direction. Russia and the USA are at last working together on the Syrian conflict. How much agreement can last will depend as much on domestic US politics than on the real situation in Syria.



Monday, 9 September 2013

Let's stop the gagging law

You might have heard about the “gagging law” currently being voted on by MPs. If you haven’t heard of it, it’s really bad news. If it goes through, it will have a chilling effect on British democracy and on our right to speak up on the issues that matter to us.

Basically, the law slashes the spending limits on campaigning for the year before any election. Campaigns that have impact don’t cost the earth, but they aren’t free.

Community groups, charities and campaigning organisations would all be hit. Election time is when ordinary people have the most influence on our politicians. On the big issues of the day – whether or not to go to war, the future of our NHS, the environment, welfare, immigration, etc. – we'd all be gagged.

The problem is that this law has come out of nowhere and not many people have heard what’s going on. If we’re going to defeat it, we need to get the word out further. If every single person who’s ever joined a local campaign group or taken action with their favourite charity knew that they could be stopped from doing that again, the outcry could explode.

How can we leave political lobbying in the run up to elections to big business? Charities represent millions of individuals whose voice would be lost. Let's stop this undemocratic bill.

Here’s a simple five minute video you can watch for more information. Can you take a look, and then help get the word out by passing it on to your friends and family?




Afterword

The Bill passed its second reading with 309 MPs voting in favour, 247 against. The Bill now moves to the committee stage where detailed examination takes place.

Certainly the Bill lacks clarity. This was indicated in the debate by Mr Lansley for the government:

"I had conversations yesterday with the National Council for Voluntary Organisations, which helpfully supplied us with a copy of its legal advice, which of course illustrates that, technically, the uncertainties that are being talked about could in large part be construed to relate to existing legislation rather than the Bill that we are bringing forward. In truth, it is the responsibility of the Charity Commission, where charities are concerned, and the Electoral Commission for all third parties, to work together to ensure the soundness of the definitions in the Bill." 

No clarity there then!

John Kerry should be careful how he uses history to justify a strike against Syria

We cannot solve the problems of today by belatedly acting on the problems of yesterday. Yet a key pillar of John Kerry's justification for a punitive strike against the Assad regime is that the world stood by in the past when other atrocities were committed in previous conflicts. 

"We need to hear an appropriate outcry as we think back on those moments of history when large numbers of people have been killed because the world was silent," he said today when meeting British foreign secretary William Hague. "The Holocaust, Rwanda, other moments, are lessons to all of us today."

I am afraid history is rarely a good argument for the USA, or for Britain and other former colonial powers. History reveals a very dirty business when it comes to support for nasty regimes. The USA at best looked the other way and at the worst supported the use of chemical weapons by Saddam Hussein in the war with Iran in the 1980s. I suppose this must have been one of the 'other moments' in history referred to by John Kerry.

Without further sanction by the UN security council a punitive strike would not be legal. Only a strike that could demonstratively protect civilians would be legal. As far as I understand it there is no legal sanction for punitive action. But I confess I am no expert in international law. What I can say, however, is that the ethics of punitive action is dubious.

John Kerry is right when he says that "the end of the conflict in Syria requires a political solution." It would be better if the Obama administration worked to that end. It is difficult to see how a punitive military strike against Assad facilitates a political solution. If it weakens the Assad regime, the opposition forces would be unlikely to want a negotiated settlement. No, it is a very contradictory position for the Obama administration to hold.

The USA has now given the Assad regime just one week to hand over all its chemical weapons. Why
just one week? It is an empty gesture as John Kerry himself says; Assad will not comply with such a demand.

Afterword

Russia today also called on Syria to put its arsenal of chemical weapons under international control for destruction. It is clear John Kerry's ultimatum was made with some degree of cynicism and the US administration has been caught on the hop by Russia's move. Nonetheless, should Syria comply with Russia's request then this clearly would be a way forward to avoid a military intervention.