The Thin End

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 i...

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. Tempe...

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 ...

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...

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. ...

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;...

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 famili...

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'...

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 th...

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 ...

The following is an article I wrote in August 2011 for my sister blog Chanteur de la Vie at Le Monde. In light of the current crisis in Syria I thought it might be of interest to readers: En prenant son poste en 1997, M. Robin Cook, ancien secrétaire des Affaires étrangères au Royaume-Uni a déclaré que notre politique étrangère « doit avoir une dimension éthique et doit prendre en charge les demandes des autres peuples pour les droits démocratiques sur lesquels nous insistons pour nous-mêmes ». Treize ans plus tard en 2010 un autre secrétaire des affaires étrangère, William Hague a un but similaire pour une «politique étrangère avec une conscience». Mais est- il possible d'avoir une politique étrangère et éthique? Je pense que dans l'équilibre global, la réponse est oui, mais vu de plus près la réponse est souvent non. Les affaires étrangères son des entreprises salissantes. Les affaires étrangères doivent équilibrer les intérêts nationaux, la promotion de la sécurit...

The causal link between lung cancer and tobacco smoking has long been established. It was in the 1950s that the link was first clearly demonstrated. Since then the addictive nature of nicotine has also been shown and it is one reason why it is so difficult for smokers to stop. Despite this knowledge it took a long time for health authorities and governments to act effectively on smoking as a killer. Today, smoking is recognised as the largest single factor in preventative illness. In the UK an estimated 102,000 people die each year from smoking-related diseases including cancers . Most people start smoking as teenagers. I certainly recall my first tentative 'drags' on a cigarette when I was at school. In those days (oh dear such a long time ago!) we were able to buy single Woodbines at the local tobacconists. Fortunately I managed to stop smoking in my early twenties; others were not so fortunate. Teenage smoking remains a problem. Official statistics suggest that at ...