Thursday, 29 August 2013

Is the Cameron-Clegg position on Syria crumbling?

It is perplexing. Cameron goes to the UN security council to get a resolution he  knew he had no chance of getting. He can do nothing about the veto of Russia and China. So what  then was it  all about? Once again the US administration is persuaded to go down the UN route against their better judgement. Bush would not have sought a second resolution before invading Iraq without being persuaded to do so by Blair. To help Blair, the Bush administration went for a second resolution.

What is crucial, however, is that Miliband has done what the Tory leadership should have done over the invasion of Iraq; refuse to give backing without conditions. MPs need time to reflect. 'We must act' is not itself an argument. It was repeated by William Hague today. Turning it into a mantra doesn't make it more forceful. This is followed by the slippery slope argument: if we don't act now then it would send a message that chemical weapons can be used with impunity.

In truth, we are always on such a slippery slope. Calling a particular point a 'thin end of the wedge' doesn't really advance us very far. We need more. First we need to see the evidence the US says it has that the Assad regime was responsible. What we have so far is William Hague and others saying 'of course they done it!' as if this was beyond challenge. It is a very dangerous argument.

As Tory MP Andrew Bridgen argued on Newsnight tonight, it is difficult to see for what reason the Assad regime would  use chemical weapons in that region. He is right to question the origin of the attack until evidence is produced to demonstrate definitively who perpetrated the attack. It is at this point that someone says 'come on it is obvious who did it!' But the answer to that is equally simplistic: no it is not obvious. So there we have it. It is clear what needs to be done. The evidence must be presented.

But when the evidence is presented we then need to see what military strike is proposed and consider what its likely consequences would be. It would only be acceptable, ethically and legally, if it would be more likely than not to protect the civilian population from further attacks. And there is the rub. What kind of action would do that?


Wednesday, 28 August 2013

Government’s migrant charging proposals impractical, uneconomic and could damage the NHS, warns BMA

The government’s proposals for an extended charging system for migrants and short term visitors attempting to access healthcare in UK are impractical, inefficient, uneconomic and could cause unintended damage to NHS services, the BMA said today (Wednesday, 28 August 2013)

Responding to the government’s recent consultations on migrant and short term visitor access to the NHS, the BMA has outlined serious concerns about these proposals:

  • There is no evidence that the income derived from charging short term visitors or migrants would be sufficient to cover the significant cost of the increased bureaucracy necessary to administer the system. 
  • It is difficult to see how extending charging to general practice could be implemented without ensuring every patient was checked by their GP practice when they register, resulting in inconvenience for all patients and an increased administrative burden on already over stretched GP services. 
  • There is no explanation of what documentation patients will need to use to prove they have permanent residency. There is no obligation for UK residents to hold a passport and the documentation some practices currently require, such as utility bills, would not prove permanent resident status. 
  • Forcing non-European Economic Area (EEA) migrants2, and any dependents, to make a contribution to their healthcare costs could reduce the likelihood of highly skilled migrants coming to work in the UK. 
  • If migrants and short term visitors are deterred from seeing a GP, it may become more difficult for the NHS to identify communicable diseases such as TB. This could increase public health risks for the wider population and result in increased stress on NHS services. 
The BMA agrees with the government that care should not be denied to patients who require immediate treatment, but the current proposals do raise ethical concerns. For example, charging could deter patients from seeking emergency care and could make them reluctant to bring their children to a GP practice or emergency care department.

Dr Mark Porter, Chair of BMA Council said:

“The BMA believes that anyone accessing NHS services should be eligible to do so, but the government’s plans for extending charging to migrants and short term visitors are impractical, uneconomic and inefficient. The NHS does not have the infrastructure or resources to administrate a charging system that is not likely to produce enough revenue to cover the cost of setting up its own bureaucracy. The NHS does not need more administrators; it should be spending its money on caring for patients.

“More worryingly, the proposals could have an impact on the care all patients receive. If non-EEA doctors are forced to make contributions to their healthcare this could discourage them from coming to practice in the UK and working in key services, such as emergency departments, which are experiencing doctor shortages. This could exacerbate the current workload pressures already facing the NHS.

“The government needs to rethink it is entire approach to this issue as in their current form these proposals are unworkable and potentially damaging to the NHS.”

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

“GPs, like many other NHS staff, do not have the capacity to administer a complicated bureaucratic system that is of questionable benefit to taxpayers and patients.

“Asking patients to produce documentation to prove their residency faces a number of problems. It would mean all patients would have to have their eligibility checked each time they register with their GP. This would be a huge inconvenience to all members of the public and would take up valuable time that practices could be using to treat patients. Some UK residents, especially many older people, will not have a passport or a bank account which raises the concern that some of the most vulnerable members of our society will face delays in accessing care.

“We have seen with the recent NHS 111 debacle what happens when an ill thought out policy is rushed through without proper consideration of the practical and clinical implications. Ministers need to learn from recent experiences and work with healthcare professionals to find workable solutions to this issue.“


Tuesday, 27 August 2013

What is a 'punitive' military strike against the Syrian regime?

The argument to be put to parliament by Cameron and Clegg and supported by Miliband for a military strike against the Syrian regime is that 'something must be done'. I have never really liked the 'something must be done' line of reasoning. It usually means that the end game has not been thought through. It usually represents a degree of hand wringing. 'We can't stand idly by' is often used when it might be better to do just that. It is of course a difficult choice. To do nothing. But you should only act if by so doing it will be effective in bringing about a better outcome. If it is simply to 'punish' then what really would be achieved? If it is to deter future use of chemical weapons then what kind of action would be sufficient to do so?

The use of chemical weapons by the Syrian regime is abhorrent. Of course it is. But at best what is proposed is 'punitive' action to deter future use of chemical weapons. Unless it is well targeted I cannot see it acting to deter Assad from future use unless it is carefully targeted to take out his stock of chemical weapons or his means of deploying them.

I suspect it is desperation that is driving the use of chemical weapons in Syria. Both sides are desperate to break the deadlock in a bloody civil war. An effective strike against Assad would weaken his regime further, and it is weakness, desperation that is driving the use of chemical weapons by the regime. Cameron must demonstrate how a strike against the Assad regime would achieve its objective.

An effective strike against Assad would likely tilt the balance in favour of the opposition forces. If this is part of the objective then we should be honest about it. Indeed there could be a better argument for such an objective. The problem would then be whether such 'honesty' would be equally 'legal'. And here we have the Iraq problem repeating itself.  Transatlantic differences between Bush and Blair are instructive. Blair's justification was 'weapons of mass destruction'; Bush's objective was 'regime change'. A smidgeon of difference perhaps. But in reality the later required 'shock and awe'; it is doubtful whether the elimination of  WMD justified it. (Now I know I will be jumped on for using the word 'doubtful' in such context).

France, the UK and the USA emphasise the importance of any action against Assad being proportionate. So far none have spelled out what this means.

A punitive strike against the Syrian regime begs another question. Would we be willing to strike 'punitively' against the opposition forces should it be found that they too have used chemical weapons? On the latter, the jury is out. We just do not have sufficient evidence.

I suspect that behind the rhetoric from France, Britain and the USA is a deeper seated desire to do something to tilt the balance of power in favour of the opposition forces. Red lines are usually invoked to bring about justification for action rather than as the objective itself. This is true in Iraq. Blair's current justification is that 'well Saddam was a thoroughly bad person' and his regime killed hundreds of thousands; all of which is true, but it didn't need a 'red line' to be crossed to tell us that.  I would certainly love to see the Assad regime toppled, but what will be the aftermath?

I also suspect that a strike against the Assad regime will lead to the need for further action as it is likely that the Assad regime will increase its determination to survive at all costs. The die is cast. The regime would have the hangman's noose to look forward to should they be toppled.

I will listen carefully but sceptically to the arguments presented  to parliament by Cameron and Clegg.

Wednesday, 21 August 2013

“Why I blew the whistle on the government’s disability assessments” from former ATOS analyst.

We have argued in other articles on this Blog that ATOS work capability assessments are unethical. Now a former Navy Doctor and disability analyst at Atos reveals why he chose to blow the whistle on the government work capability assessment, on bmj.com today.

Dr Greg Wood explains that he made the decision to publicise his concerns about the Atos work capability assessment (WCA) because of interference with reports which he felt “encroached on my professional autonomy and crossed ethical boundaries”, in his BMJ opinion piece.

The system’s implementation, he says, makes it unduly hard for claimants to quality for benefits and therefore overlooks a number of limiting factors of the assessment method that might suggest otherwise.

Dr Wood argues that reports were finalised despite one in five lacking key written evidence, and also reveals that Atos auditors instructed clinicians to change their reports without having examined the patient themselves.

Contrary to the purpose of the WCA – to save money from the taxpayer being awarded in benefits to those who are in fact capable of working – Dr. Wood believes that the cost of successful tribunal appeals against the DWP from those unjustly forced to work was an additional waste of taxpayer money.

“Medical knowledge was being twisted [and] misery was being heaped on people with real disabilities”, he argues.

Since Dr Wood blew the whistle, the DWP made the decision to retrain all Atos assessors and call in external auditors to ensure accurate work capability assessments would take place in the future.

Thursday, 15 August 2013

Frankie Sandford says 'It's time to Change'.

The Saturdays singer Frankie Sandford is wearing her heart on her sleeve today (Thursday 15 August) and fronting a new campaign for Time to Change, the mental health anti-stigma programme run by the charities Mind and Rethink Mental Illness, which aims to stamp out the stigma that surrounds mental health problems.

Alongside a host of celebrities including Ricky Hatton, Russell Kane, Suki Waterhouse and This Morning’s Matt Johnson, the ‘Issues’ and ‘What About Us’ singer has been seen wearing a heart-shaped fake tattoo designed by contemporary British artist Stuart Semple, to support Time to Change’s Time to Talk campaign.

Both Frankie and Matt have talked openly about their experiences of depression to help tackle the discrimination that many people with a mental health problem still face. A recent survey commissioned by Time to Change showed that nearly half of 25-35 year olds (45%) say that people in the public eye, such as Frankie, have made them more aware of the stigma that surrounds mental health problems.

The new research also shows that over a third of people (39%) say that hearing about a celebrity talking about their own experiences in the media has made them think more positively about mental health in general.

The Saturdays’ Frankie Sandford said: “Mental health is still such an awkward subject, yet if someone was going through another physical illness we wouldn’t hesitate to ask them how they’re doing. When I experienced depression, I had the support of friends and family which really helped - being able to talk about it is really important.

“I hope by supporting Time to Change I can raise awareness about the importance of starting a conversation. If you know someone experiencing a mental health problem, you could ask them how they are, or send them a quick text to let them know you’re there – it can make a huge difference and remind them that they’re not alone. We all have mental health, so it’s something we should definitely learn to be more open about.”

Time to Change Director Sue Baker, said: ‘Mental health problems can happen to anyone, famous or not, and we all need the support of those around us when it happens. But as this research shows, celebrities like Frankie and Matt speaking out can help the public to think differently about mental health. Hearing from someone in the public eye can help others to feel able to say ‘I’ve gone through that too’.

“Through our campaign we hope to encourage people to talk to friends and family members who have a mental health problem – it’s amazing how powerful a simple conversation can be for someone who is going through a difficult time. We need to start these conversations today and realise that it isn’t as scary as we all think. The more we’re able to speak openly about mental health problems, the earlier people will be able to seek the help and support they need.”

To start your conversation and find out which other celebrities are supporting the campaign go to time-to-change.org.uk or tweet #Timetotalk


Wednesday, 14 August 2013

Children of obese mothers at greater risk of early heart death as adults

The body of evidence for the developmental origins of health and disease is growing. It has now long been established that maternal diet can influence fetal metabolic development and growth and that this has consequences for health of the offspring later in life.

Now a new study published on bmj.com today finds that children of obese and overweight women have a higher risk of early cardiovascular death as adults.

The findings highlight the urgent need for strategies to prevent obesity in women of childbearing age and the need to assess the offspring of obese mothers for their cardiovascular risk, say the authors.

Rates of maternal obesity have risen rapidly in the past two decades. In the United States, about 64% of women of reproductive age are overweight and 35% are obese, with a similar pattern in Europe.

Many studies have shown a link between maternal obesity and disease later in life, but it is still not clear whether maternal obesity is associated with increased death in offspring from cardiovascular causes.

Using birth and death records from 1950 to the present day, a team of researchers in Scotland identified 28,540 women - whose body mass index (BMI) was recorded at their first antenatal visit - and their 37,709 offspring who were aged between 34 and 61 at the time of follow up.

BMI was defined as underweight (BMI 18.5 or less), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), and obese (BMI 30 or more).

Relevant details about the pregnancy were collated, including the mother’s age at delivery, number of previous pregnancies, mother and father’s social class and infant sex, birth weight and gestation at delivery.

Among the mothers, 21% were overweight and 4% were obese. Among the 37,709 offspring there were 6551 premature deaths from any cause and, among the deceased, 294 had had obese mothers at birth.

The researchers found that the risk of premature death was 35% higher in the adult offspring of obese mothers compared to those whose mothers had had normal weight. This was after adjusting the results for factors including the mother’s age at delivery, number of previous pregnancies, mother and father’s social class and infant sex, birth weight and gestation at delivery.

They also found a 42% increased risk (adjusted for the same factors) of a hospital admission for a cardiovascular event in the adult offspring of obese mothers compared with offspring of mothers with normal BMI.

The offspring of overweight mothers also had a higher risk of adverse events later in life.

It is thought that being overweight in pregnancy may cause permanent changes in appetite control and energy metabolism in the offspring, leading to a greater risk of heart problems later in life.

With rising rates of excess weight among pregnant women, the authors say their findings are “a major public health concern” and indicate that the offspring of obese mothers are a high risk group who should be assessed for cardiovascular risk, and actively encouraged to maintain a healthy lifestyle.

“As one in five women in the UK is currently obese at antenatal booking, strategies to optimise weight before pregnancy are urgently required,” they conclude.

In an accompanying editorial, Dr Factor-Litvak from the Department of Epidemiology in New York, says that this study leaves open two questions. Firstly, what is the role of the early post natal environment and secondly, what is the role of parental obesity? She asks what the implications of the study are, concluding that along with recommended weight gain for overweight and obese women, “interventions should begin before pregnancy”.

The editorial doesn't say what these 'interventions' should be!


Tuesday, 13 August 2013

Regular weekly portion of fatty fish can halve rheumatoid arthritis risk

A study published online today in the Annals of the Rheumatic Diseases indicates that a regular weekly portion of fatty fish, such as salmon, or four servings of lean fish, such as cod, can halve the risk of developing rheumatoid arthritis.

The benefits of a fishy diet, which needs to be kept up for at least a decade, are largely attributable to its long chain omega 3 polyunsaturated fatty acid (PUFA) content, confirm the researchers.

They collected information on the dietary habits of more than 32,000 women born between 1914 and 1948, whose health was tracked between 2003 and 2010 as part of the Swedish Mammography Cohort population based study.

The researchers were particularly keen to assess dietary intake of omega 3 PUFAs as previous evidence shows that they have anti-inflammatory properties.

The women, all of whom lived in two counties of Sweden, completed a questionnaire on dietary intake, height, weight, motherhood and educational attainment between 1987 and 1990.

In 1997, the 56,000 who were still alive were sent a similar questionnaire, requesting further information on smoking, exercise, use of dietary supplements and aspirin.

As part of the dietary information requested, the women completed food frequency questionnaires, in which they detailed how often and how much they ate any of 67 (1987) and 96 (1997) foods. This included a range of fatty and lean fish.

During the monitoring period, 205 women were diagnosed with rheumatoid arthritis. Across the entire group, there was a fourfold difference in omega 3 PUFA consumption between the 20% eating the most and the 20% eating the least.

Women who consumed the least included the highest proportion of smokers and the lowest proportion of alcohol drinkers and aspirin takers. Smoking is a risk factor for rheumatoid arthritis while moderate alcohol and aspirin are protective.

Among those who developed the condition, more than one in four (27%) had a dietary omega 3 PUFA intake of less than 0.21g a day, compared with one in five women across the entire group who consumed this amount.

Some 61% of the women consumed the same amount of omega 3 PUFAs and 64% the same amount of fish at both time points.

Those whose intake of omega 3 PUFAs exceeded 0.21g a day, equivalent to at least one serving of fatty fish or four servings of lean fish a week, in both 1987 and 1997, had half the risk (52% lower) of rheumatoid arthritis of women who consumed less in both years.

And regularly eating one or more servings of all types of fish every week for at least 10 years was linked to an overall 29% reduced risk of developing rheumatoid arthritis compared with eating less than one portion a week.

“The inverse association between fish consumption and [rheumatoid arthritis] can be attributed mainly to its content of long chain [omega] 3 PUFAs,” conclude the authors, who add that their findings indicate a potentially important role for these substances in the development of the disease.

Sunday, 11 August 2013

Oxford Trobadors: an evening of Occitan songs

Here I go again; another plug for the Oxford Trobadors. The Oxford Trobadors had a great rehearsal this morning in preparation for our Oxford Proms concert tomorrow (Monday evening), an evening of Occitan and Italian songs.  The rehearsal reminded us how beautifully crafted is the medieval troubadour poetry, and no poem demonstrates this better than La Sestina (The Sextine) by Arnaud Daniel (circa 1180).

A difficult poetic challenge: six verses, six lines each, six rhymes, used in each verse. His erotic song, proclaims his firm love (lo ferm voler qu’el cor m’intra) to his unreachable lover in her unreachable bedroom, before he finds paradise, and his joy is doubled (qu’en paradis, n’aura doble joi). The song contains the line tant fina amors com cela qu’el còr m’intra (such noble love as in my body enters). Fin amor is a persistent trobador theme. The Oxford Trobadors arrangement of this song includes the beautiful chorale composed by leading international guitarist Christoph Denoth

The medieval poems are beautiful enough, but the modern, contemporary songs in the Oxford Trobadors repertoire demonstrate that Occitan is a living, vibrant language and culture. 

Nadau ta Baptista  (Christmas for Baptiste) is still a favourite of our audiences, even when it is not Christmas. We simply love performing it! It is a gently lilting Pyrenees lullaby composed by the renowned group Nadau. Baptista sleeps while father Christmas (lo pair Nadau) flies through the night  (qui vola la haut) and gentle snowflakes fall on the lovers (sus los amoros). From the depths of his heart (Jo tot au dehens) he loves the child always (que t’aime, tostemps).

Other popular songs include L’aiga de la Dordonha (Waters of the Dordogne) and Arron d’Aimar (After Love), another Nadau song.

Tomorrow's concert will also feature Italian arias such as Mmiezz’o’ ggrano and Accarezzame (Caress me) beautifully sung by Trobador Soprano, Rossella Bondi, who also sings Ventadorn's (c.1150)  Quan vei la lauzeta mover. 

It should be an enjoyable evening!

Ray Noble is Lead vocalist with the Oxford Trobadors.

Details of the concert at the Holywell Music Room can be found at the Oxford Proms website.


Thursday, 8 August 2013

Narrower range of helpful bacteria in guts of C-section infants

Increased rates of C-section births has long been a concern, particularly where it is thought to be unnecessary. Now a new study suggests that crucial development of gut bacteria may be delayed in babies born by C-section. 

The range of helpful bacteria in the guts of infants delivered by caesarean section, during their first two years of life, is narrower than that of infants delivered vaginally, indicates a small study published online in the journal Gut.

This has implications for the development of the immune system, say the researchers, particularly as the C-section infants had lower levels of the major group of gut bacteria associated with good gut health, Bacteroidetes phylum, as well as chemicals that help curb allergic responses.

It is already known that infant gut microbiota diversity increases during the first years of life. It is also known that microbiota composition differs between infants born by caesarean section (CS) or vaginal delivery with a delayed colonisation of the genus Bacteroides. Bacterial colonisation is necessary for the development of the immune system and immune regulation.  An association between CS delivery and the development of allergic disease has been observed in several studies.

The researchers assessed the patterns of bacterial colonisation of the guts of 24 infants, nine of whom had been born by caesarean section one week, and then again at one, three, six, 12 and 24 months after birth.

They also took blood samples at six, 12 and 24 months to test for levels of immune system chemicals known as Th1 and 2 associated chemokines. Excess Th2 chemokines have been implicated in the development of allergies, which Th1 responses can counteract, say the authors.


The results showed that babies delivered by caesarean section, and who therefore did not pass down the mother’s birth canal, either lacked or acquired late one of the major groups of gut bacteria, the Bacteroidetes, compared with the babies born vaginally.

In some C-section infants acquisition of Bacteroidetes did not occur until a year after birth. The total range of bacteria among those born by C-section was also lower than that of their vaginally delivered peers.

The differences in bacterial colonisation between the two groups of infants were not down to their mums having been given antibiotics during C-section or after the procedure to prevent infection: the levels and range of bacteria sampled from both sets of mums were similar, the analysis showed.


Bacteria are important for priming the immune system to respond appropriately to triggers, and not overreact as is the case in allergies, diabetes, and inflammatory bowel disease, say the authors. This includes the development of immune system T cells and the correct balance between their chemical messengers, Th1 and Th2.

The C-section infants had lower circulating levels of Th1 chemical messengers in their blood, indicating an imbalance between Th1 and Th2. “Failure of Th2 silencing during maturation of the immune system may underlie development of Th2-mediated allergic disease,” write the authors.


They point out that previous research has indicated that Bacteroides fragilis, one of the many Bacteroidetes, strongly influences the immune system, which ultimately enhances T cell activity and the Th1-Th2 balance.

“Thus, the lower abundance of Bacteroides among the C-section infants may be a contributing factor to the observed differences in the Th1-associated chemokines,” they write.

Improved knowledge of the impact of delivery mode on microbiota composition and immune regulation may lead to improved allergy preventive strategies.

Friday, 2 August 2013

Oxford Trobadors, Occitan: la lenga de l'amor, la lenga de cancons

Occitan is often described as the language of love (la lenga de l'amor). It is also a language of songs (una lenga de cancons) and today I have been working on Peire Vidal's Na Vierna for the Oxford Trobadors  concert for the Oxford Proms on 12th August.  As with so many medieval troubadour songs the poet sings of an inaccessible love, in this case Na Vierna who Peire Vidal had to leave behind when he was banished from Tolouse.

The poets have a closeness with their surroundings which often inspires them to sing. On hearing birds singing (La lauzet'e.l rossinhol...comenson premier lur chan) the poet is inspired to sing of his love (ieu chant d'amor de ma dona Na Vierna).  It is also typical of many troubadour songs in being inspired by nature.

This is also true of many Occitan songs such as Se Canta  (it sings). Se Canta is a major feature of Oxford Trobadors concerts. It is one of the most well known songs in Occitan (la cancon mai famosa). Our audiences will often join in singing the chorus.

Se canta, que canta - it's singing, ever singing
Canta pas per io - singing not for me
Canta per ma mia - singing for my loved one
Qu'es al leunh de io - who is far from me




Ray Noble is lead Tenor with the Oxford Trobadors

You may also be interested in the following articles:

The Oxford Trobadors, Occitan poetry and song
Battle for Regional Languages in France