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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…

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 p…

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 l…

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 trus…

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 tan…

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 ther…

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…

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…

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 s…

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 r…

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 …

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 har…

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 p…

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…

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 cov…

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 -…

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 pa…

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%…

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…

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 …

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' ac…

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 f…

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 momen…