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Showing posts from February, 2013

Prime Minister is wrong to fight an EU cap on bankers bonuses.

The news that Prime Minister, David Cameron, intends to 'fight' EU plans to cap bankers bonuses is perhaps not surprising. He failed to take any action or position on excessive bonuses two years ago. It simply demonstrates that his hand wringing over excessive bonuses bankers give themselves is just that,  gesture politics.

The government are concerned that a cap on bonuses would affect the position of the city of London as a financial centre competing for top talent globally. But this is why action must be taken at an international level and the EU move is a step in that direction.  Precisely what level the cap should have and what conditions should be subject to debate and decision.

There is always the argument that if you seek to restrict greed, and it is greed, then the wealthy will find other ways to satisfy their avarice. We mustn't increase taxes, else they will move their money elsewhere etc. We cannot go on allowing these greedy people to blackmail us in this way.…

There is an alternative and the British Chambers of Commerce spell it out.

Today the Prime Minister, David Cameron, adopted the strategy of economic madness. Whilst his Business Secretary, Vince Cable, has described the loss of the triple A status as being largely 'symbolic', Mr Cameron once again nailed his colours to its mast. It is a bit like crashing a car into at a tree and then declaring that it indicates they were travelling in the right direction. Mr Cameron continues with the line that there is no alternative. This is wrong, blind, foolish, obstinate and rather arrogant. It rejects advice from those economists who call for a change in direction.

The economy is in a bad shape. It is insufficient to point to the odd 'green shoots', the odd indication that things might turn out all right in the end. The coalition is missing its targets by a wide margin, and with the current strategy, austerity is set to last at least until 2017 and beyond. A decade of austerity will leave the economy considerably weakened, the poor poorer.

Nor is this a…

Economical with the truth on cutting the deficit.

It is unworthy of coalition ministers to repeat the absurd claim that the government has cut the deficit by a quarter. I hear it repeatedly. It is untrue, or in as much as it has any truth it is an unethical manipulation of statistics; unethical because of the consequences of misrepresenting the financial situation to the public. So where does the claim come from and does it stack up?

The claim comes from a comparison of Public Sector Net Borrowing (PSNB). It is convenient to choose the periods of comparison, for example a low year with the  high year. This is an old statistical trick. The problem of doing this is that the years chosen might contain elements that were exceptional and not typical of the underlying trend or position. This is why it is better to compare longer periods to iron out anomalies, exceptional one off items of expenditure or revenue. Furthermore, running deficits in a given year or period is not necessarily bad. Cutting PSNB is not in itself 'good'.

And …

There is an alternative

I am always suspicious of political arguments that suggest there is no alternative. There is always an alternative; the question is which is the best alternative. When the 'no alternative' argument is deployed it usually suggests a fundamental weakness of the position; it is an argument from weakness, not strength. And so it is with the arguments deployed this weekend by the government in the wake of the loss of the triple A rating for the economy.

All governments whether Labour or coalition would have to 'tackle the structural deficit' Mr Cable told us. As if this suggested there was no alternative way to deal with it. What we know is that the coalition adopted a savage strategy of cutting spending to 'deal with the deficit', and they did so without a clear strategy for growth. The alternative would have been to make growth the priority rather than cutting the structural deficit; such a strategy if it worked would have cut the deficit by increasing revenue. As…

Something isn't right in the world of pharmaceuticals. Alarm bells are ringng.

Something is not right in the world of pharmaceuticals. But it isn't reflected in the number of new drugs coming to market.

The widely held belief that the UK supply of innovative new medicines has conspicuously dwindled in recent decades, is not borne out by the evidence, or at least this is what is suggested by research published in the online journal BMJ Open.

The prevailing view is that pharmaceutical industry innovation has been in decline, with fewer new drugs launched in recent decades than before—despite more cash being pumped into research and development—prompting a good deal of hand-wringing, say the authors.

They tested whether this view was justified, by looking at all new medicines added every year to the prescribing and dispensing drugs bible, the British National Formulary, or BNF for short, over 30 years. The BNF is updated every six months.

In terms of the drugs industry, the UK punches above its weight. After the US, the UK is the second largest source of new …

The government's proposals for social care are neither fair nor sustainable.

The government have missed an opportunity to establish a consensus on the reform of funding social care. They are ignoring the key financial recommendation of the Dilnot Commission.  By focusing on the 'scandal' of people 'losing' their homes to fund their social care, they have missed the point, and by setting the cap at £75,000 they have missed it by a large margin.

The unfairness of the current arrangements for funding social care is not the 'scandal' of people 'losing their inheritance'. That is not where the 'scandal' lies. The scandal lies in the arbitrary and unpredictable impact the need for social care has, and the lack of coherent and sustainable ways to meet it.

There is nothing inherently unfair about having to use equity invested in our homes to fund our care. For several decades we were encouraged to buy our homes rather than rent them; we were encouraged to see it as a relatively secure investment for our hard earned savings.  For…

Passive smoking stunts fetal growth and harms unborn babies.

Smoking bans are associated with a “consistent pattern of reduction in the risk of preterm delivery,” finds a study published by bmj today. The study supports the notion that smoking bans have public health benefits from early life and protect unborn babies from the effects of passive smoking.

It has often been argued that prohibition of smoking in public places is an attack on civil liberties. Some leading public figures have campaigned for a lifting of the ban in pubs and clubs.  In 2011 TV chef and publican Antony Worrall Thompson launched an e-petition calling on the government to review the smoking ban.

The publication of this new study today should lead them to reconsider their position.

A key argument in favour of bans on smoking in public places is the potential impact of secondary smoking, or passive smoking, on the unborn child. 
Maternal smoking during pregnancy is associated with a decrease in placental function and can lead to intrauterine growth restriction. The fetus s…

Poor public understanding of HIV is costing lives.

Stigma and discrimination may be preventing people with HIV coming forward for diagnosis and treatment.

A report published today in the online journal Sexually Transmitted Infections suggests a significant proportion of HIV positive patients may not be disclosing their infection to NHS staff, when turning up for treatment at sexual health clinics.

If the findings reflect a national trend, this could have implications for the true prevalence of undiagnosed HIV infection in the population, which is based on the numbers of “undiagnosed” patients at sexual health clinics, say the authors.

Currently, it is estimated that around one in four people in the UK who is HIV positive doesn’t know s/he is infected with the virus.

It is thought that a proportion of patients who do know their HIV status nevertheless choose not to reveal it to NHS staff when attending for services elsewhere, so the researchers set about trying to find out whether there is any basis for this belief.

The reasons why the…

Calcium pills could more than double risk of heart disease and death.

Taking calcium pills could more than double your risk of heart attack, a study published today in the British Medical Journal suggests.  The risk of death from cardiovascular disease is doubled in women with high calcium intake who are also taking calcium enriched supplements.

There isn't a month goes by without publication of new research that demonstrates a link between some dietary factor or supplement and increased risk of cardiovascular disease and mortality. The information in the end I suspect is so confusing it is little wonder that for the most part it is ignored. It is the problem of information overload.

Nonetheless there are good reason for taking this new study seriously, not least because experts recommend a high calcium intake for women in middle age and increasingly people are turning to calcium supplements.

As a result more than 60% of middle-aged and older women in the USA now take supplements and it is estimated that up to 5 million people in the UK take them. W…

Saving sick fetuses may have bad outcomes

Growth restriction in an unborn child is the single largest risk factor for stillbirth, yet it is currently missed in most pregnancies. The authors of a report published in the British Medical Journal last month say spotting it early could substantially reduce the risk, and this needs to become a cornerstone of safety and effectiveness in antenatal care.

You might think that with modern ultrasound scans growth restriction would be easy to spot. Yet the report shows that detection ranges from 12.5% to 50% in different maternity units. Such a wide disparity is worrying and according to the authors it depends on staff training and adherence to protocols.

But before we rush into investing resources and rescuing poorly growing fetuses, I think we should consider the implications more carefully. In recent times there has been a trend to 'demedicalise' pregnancy. After all, pregnancy is not an illness. Attention has focussed on the birthing environment and where possible keeping obs…

Compassion and patient experience needs to be the focus of NHS reform.

It will take time to digest all the 290 recommendations of the Francis report on the failings at Stafford Hospital. Failings at the hospital were root and branch, from top to bottom of the NHS. For me, however, one recommendation stands out and it isn't one of the more legalistic or organisational ones. It is simply that there needs to be an increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors.

The imperative to put patients needs back at the heart of decision making and care in the NHS was highlighted last year by Ann Clwyd's experience of the shameful way she and her dying husband were treated in hospital. It should inform us that something awful has gone badly wrong with health care provision.

The report is right to point to target driven decision making as being one source of the problem. It drives management to consider patients not …