Measles, MMR and the Wrong Denominator

It is ten years since Andrew Wakefield had his now-discredited paper on the MMR jab, published in the Lancet. This paper sparked off a scare that the vaccine caused autism in children and many parents opted out of the jab, going for single vaccines instead, or not having their children vaccinated at all. The scare reached its peak in 2002 and it was two more years before it was thoroughly debunked by Brian Deer, a Sunday Times reporter. But the damage had been done and now unfortunate parents and their children are rediscovering that measles cause corneal scarring,deafness, croup and encephalitis(inflammation of the brain).It is one nasty disease and Andrew Wakefield bears a heavy responsibility for the new outbreaks of measles that have been recently reported.

However, there may be another element to this rise in measles, and that is the way in which data collection for communicable diseases changed in 2002. Before 2002, COVER statistics (Cover of Vaccination Evaluated Rapidly)were collected from computerised child health systems, which record what a child has been vaccinated against. These figures were then compared to the size of the health authority or trust population. This told the health authority how many children had been vaccinated, and vitally, how many had been missed or had gone unregistered. In 2002, when primary care trusts were introduced, the same method of collection was used, but the denominator changed from the size of the trust population, to the size of the population registered with a GP practice and residence for unregistered patients. This resulted in a near 100% vaccination record for measles and other diseases. However, when a researcher called Julia Granerod compared the vaccination statistics with population figures from the Office of National Statistics, she found that there was a discrepancy. She estimated that for 1998 - 2001, 10-20 000 children per annum had gone unregistered; in 2002, between 20 -40 000 children had gone unregistered and in 2003, the figures had dropped back to 2- 8000 children unregistered. This is vital information that is missing from the main statistics, and at a time when outbreaks of measles are happening, it is very worrying. Particularly worrying is the 2002 statistic. In the Granerod paper it was assumed that this blip was due to the re organisation of the trust areas, and a delay in registering people with the appropriate trust. But 2002 was the year that the MMR scare was at its height; it may be that these children were actually not vaccinated as opposed to being simply unregistered. These figures need analysed as a matter of urgency, and the Department of Health needs to re-consider how it is measuring vaccination uptake. Otherwise it could find itself in the middle of a major outbreak without the essential data to counter it.

Suffer Little Children

It has been a pretty grim week in the news as far as children are concerned. Firstly, the case of baby P is about as shocking as it gets, even for hard boiled reporters and social workers. The scenes in Parliament this afternoon at Question Time have been denounced as disrespectful to the dead child, but really the politicians could be forgiven for this; it was quite obvious that they, like us, are in shock.
The second case this week was that of Shannon Matthews, who was kidnapped, drugged and tethered to a roof beam, so that her mother could claim money from the Madeleine McCann fund to find her. She was kept at her uncle's house for three weeks,until the police tracked her down.
The third case this week,(please bear with me, because it will become clear why I'm including this), is the case of Hannah Jones who has refused heart transplant treatment, so that she can spend her remaining days at home. The local Primary Care Trust were going to raise a High Court action to force the operation, but they dropped it.

What has struck me about all these cases, is the immediate pinning of blame onto professionals and the reluctance of the media to consider the role of the parents in these cases.

In the case of baby P, the blame has been put squarely on social workers and doctors. Now, something has gone seriously wrong here and it needs to be sorted, but let's be clear about this; it was baby P's parents who killed her. No one else. We are having a discussion about the failings of the system; we are not discussing the fact that her parents killed her. Compare that with the Vicky Hamilton case, where Peter Tobin, who is a stranger, has had the blame of Vicky's murder laid squarely at his door (and rightly so.)

Next is the case of Shannon Matthews. When this case first occured and the police did what they always do; that is they checked family, relatives and friends for clues as to what had happened, they were denounced in the press for this. They were told that they should be looking further afield, that the case was not getting the publicity that the McCanns got and in some sections of the press, it was alleged that there was snobbery involved; because Shannon Matthews' parents were working class, they were not taking it so seriously. When Shannon Matthews was found, all the critisism disappeared like snow off a dyke.

The third case, which is different, is that of Hannah Jones. Now, I think the decision that this girl has taken is reasonable. The operation she would have had, would have perhaps prolonged her life, but that was the best outcome. There was a risk that the leukaemia that she had had, would come back, and she would have been on heavy medication to prevent transplant rejection. She also would have been in and out of hospital at a time when she wanted to be with family. But I do not agree with the pasting that the Trust has taken over this. This girl is twelve years old. She is very sick and looking after someone sick is very wearing. It is entirely possible, (although I don't think it has happened here) that her parents might have encouraged her in this decision, because they are worn out caring for her. It happens, as I said in this post. But the media have panned the trust for being 'interfering.' As if that isn't bad enough, some are using this as an argument for assisted suicide, whereas this is a very clear cut case of refusal of futile medical treatment.

The common thread running through all of this, is our reluctance to accept a very grim fact of life; parents hurt their children. We have not learned to accept and deal with this as a society, and so whenever a case of child abuse comes up, it's always someone else who is responsible. So we profoundly resent 'interfering' when the health care trust goes through all the proper checks as to the actual wishes of the child and her set up at home, but we bay for blood and sackings when a case of child abuse is missed as in the case of baby P. We are perfectly comfortable with a stranger like Peter Tobin being caught and convicted; we accuse the police of harassment, when they go through the proper procedure of search for someone like Shannon Matthews. We are reverting to the primal instinct of blaming the stranger.

Parents hurting their children is the ultimate nightmare. Who do you trust, if you cannot trust your parents? But we cannot turn away from it. We can't pretend that it doesn't exist. And it is not right that professionals doing their job, should become a media punchbag because we are unable to face this very ugly reality.Let us be grateful instead that they deal with child abuse day in, day out, so that we don't have to.

Your Good Health- Obama's Proposals for the American Health Service

Adulation today, a nightmare of an inbox tomorrow. Barack Obama doesn't have his troubles to seek, what with a global financial crisis and Iraq and Afghanistan to deal with. Yet there is one issue that may prove to be an even bigger challenge than these; and that is his proposals for American health care.

American health care, quite frankly, is a disgrace. America has the biggest GDP in the world, yet it is 41st in life expectancy, behind nearly all its Western European neighbours (Portugal is 42nd). Americans spend 15% of their GDP on healthcare and yet there are 67 million Americans uninsured. Drugs are prohibitively expensive, as I commented on in this post. Although there is a loose federal structure to healthcare in America, and Medicaid,(the state medical system)caters for the poorest, standards and access vary wildly.

Well, it won't be for much longer, if Obama gets his way. Here are his main proposals;

1.) Mandatory health insurance for children.
2.) Mandatory health insurance to be offered by employers to their workers. Small businesses will be exempt.
3. A set of national standards for medical insurance companies. At the moment, states have minimum requirements, but this varies a lot.
4.)Insurance companies will not be allowed to turn away people who are sick or old.
5.) The set up of a National Insurance Exchange, which will allow people on low incomes or who work for a small business, to purchase an individual plan, complete with tax credits to help them purchase the plan.

Now this looks like la-la land at first glance, doesn't it? Especially when the federal cost of this has been estimated at $1300 billion over the next ten years. But let's look at it another way.

America's GDP is $12,417 billion. 15% of that goes on health, which is $1,861 billion. But only half of that money is paid out by the government; the other half is what individual Americans pay. So the Treasury are in fact paying out $921 billion, or 7.5% of GDP, equivalent to the lowest percentage contributions in Europe. Barack Obama's plan is estimated to cost an extra $1300 billion over ten years, or $130 billion per year. So add that on and that takes you to $1061 billion per annum or just over 9% of the GDP. For that investment, the government will be able to add an extra 34 million Americans to the insurance books.

Next question; how are the insurance companies going to take all this? I think in the present climate, that they will actually take it quite well. Standardisation of rules will not go down well; neither will the insistance that they have to take on the old and chronically ill, thus increasing the risk. But in return, what they are going to get is far more customers and a captive market, at a time when many Americans will be opting out of medical insurance. The risk pool will be spread by the use of a National Exchange, which means that they can take on less profitable customers without too much loss.

How will Americans take it? In the land of the free market, spongeing off the state is seen as un-American. But the folk who would normally take this attitude, are struggling themselves just now, and will fall into the category of lower income earners who are eligible for tax credits. The ideal of pooling resources in a difficult time to create a public health service, will seem very attractive just now.

One group who will really like standardisation, will be public health officials. Standardisation at central government level will mean health data collection at central level. At present, this doesn't happen in America; there is no overall governmental body responsible for data collection and it makes it very difficult to plan for disease management. Do you remember how Annabel Goldie kept asking the government to establish a national methadone register? This was so that it was known how many people were on methadone, how many people had a drug problem, and therefore how important it was to set up drug rehab centres, instead of handing out methadone like sweeties. That is how important data collection is.

There are two groups that will not like these plans; employers and pharmaceutical companies. Many big employers do contribute to health plans for their employees at present, but Obama is planning to classify the employers' contributions as taxable income. This is a flaw in his plan, and it will arouse resentment. I think he should leave the contributions tax free, and take a lesson from what happened to pension plans in Britain when Gordon Brown decided to tax them at source and on maturity.

Pharmaceutical companies are really, really, really going to hate these proposals. Standardisation of insurance companies and the cost of premiums means more government involvement. More government involvement means more accountability for prices charged. More accountability for prices charged, means lower prices for drugs, and no more carte blanche. They are the group most likely to try and put a spoke in the wheel of these proposals; when Hilary Clinton tried to introduce health care reforms in 1993, they fiercely opposed her and succeeded in sinking them.

These reforms are a gamble. They are audacious, to coin Obama's phrase. But I think that if the insurance companies and pharmaceutical companies end up in opposing corners, instead of banding together, then he could get it through. And if he does, he could do more to combat inequality in America than all the civil rights movements before him. I wish him the best of luck and the American people the very best of health.

Brave New World

In the early nineties, genetically modified crops swam into the public ken. These were crops which were more resistant to disease and had a higher yield than normal crops and at first it seemed like they were ‘a good thing.’ However, as the details of the complicated technology were discussed, doubts arose. These were;

1. The DNA modification of crops, which was equivalent to several generations of the normal breeding process and the possible consequences;

2. The ‘genie in the bottle’; GM crops would cross-pollinate with non-gm crops, so if something went wrong with the gm crop, there would be no way of containing it or going back;

3. Companies claiming intellectual property rights over crops that they had developed and charging for them;

4. Companies developing crops that did not produce seed fit for sowing, so that customers esp in the third world, would have to go back to them to buy more seed;

5. People being unable to choose whether or not they could eat gm food or not.

The media did a blinder on what was a very complex subject, broke it down into simple layman’s terms and forced the issue with governments. The result was that we proceeded a lot more cautiously and hemmed in these companies on selling non-seeding crops to the third world.

How I wish, how I really wish that in the embryology debate that finished on Wednesday night in the Lords, that the media had done the same thing.

I did a post on this subject some months back, but to re-cap, stem cell research holds the ‘golden key’ to curing disease. Stem cells are the cells in the body that repair and replace diseased tissue. A number of these cells (called ‘pluripotent’ cells) can adapt to any area of the body and regrow for example, heart muscle damaged in a heart attack. It is the most promising area for finding cures to such horrors as Parkinsons’, Alzheimers and MS. There are a number of sources for these stem cells, but the two basic groups are embryonic stem cells, which come from foetuses, and adult stem cells, which are present in all of us and can be harvested and grown, (usually from bone marrow). Scientists have been using left-over eggs from IVF clinics for their research, but there are not enough eggs for their research, so the point of this bill is to allow them to create 'hybrid' embryos, using eggs from animals (cows,rabbits and pigs) and human cells. Here are the big issues surrounding the technology.


1.The effiacy (or lack of it) of embryonic technology

All the cures that have come from stem cell research, have come from the adult stem cells, not from embryonic ones. It is looking increasingly likely that things will stay this way. There are three major problems with embryonic stem cells;
1. They are not a perfect match to the patient so the patients body rejects them
2. They are cloned and have genetic defects in them from the cloning process;
3 Embryonic stem cells are not biologically compatible with adult tissue; they produce tumours when they are injected.


2. Intellectual property rights

The big brother of embryonic stem cell research, adult stem cell research, is the area that has actually produced all the wonder cures. Embryonic research has produced none. But the reason that companies want to persist with it , is that with embryonic technology, they can claim patent rights on a medicine developed from it. With adult stem cell cures they cannot, because the stem cells are taken from the patient and therefore belong to the patient.

3. ‘Therapeutic’ cloning

'Therapeutic' is used here, because the stated aim of the research is to grow stem cell lines that can be used to treat people for various diseases, not to actually clone a human being. But it is exactly the same technology and it means that we are building up a bank of experience which could very easily be switched to this use.

4. Crossing the species barrier
In this cloning process, the egg that is being used is from an animal, usually cows, rabbits or pigs, and the cells inserted into the egg are human. This bill allows the creation of cybrids, which is 99% human, to hybrids, which are 50% human. This crossing of the species barrier raises questions about the crossing over of animal diseases to humans, if medicines developed from these stem cell lines are created. At the moment, people who receive neural transplants from medicines developed from pigs have a whole set of restrictions on them; they are past child bearing age, are not allowed to give blood and have to use a condom when they are having sex. Not a whisper of this reached this debate on hybrid embryos.

5.Possible malicious use of embryonic technology

The possibility of full blown cloning and bringing a human embryo to full term, was the spectre that hung over this debate. This was supposedly dealt with in the bill, which forbids the implantation ‘in utero’; into a living being. But there was a flaw in this. The bill did not forbid the implantation of an embryo into an artificial womb. It couldn’t, because the stem cells are obtained by growing them in a laboratory. Scientists in America are developing artificial wombs that are in a different league from a petri dish, and again, this was not mentioned in the debate. And nobody picked up on the fact that doing away with the child’s need for a father, could apply to cloning.

Some might think this wouldn’t happen, but when you have a falling population and a dwindling economy to match like Britain has, or you are short of women as China is, there is certainly a possibility that someone might suggest this as a solution.

So there it is. The debate that never happened, or not in public anyway. Pandora’s Box was opened on Wednesday night, and none of us knew; we were too busy wondering if two clowns on Radio 2 were going to be sacked for making obscene phone calls. I predict that this bill in future will be seen the turning point of the 21st century and we didn't even debate it properly. Now all we can do, is deal with the consequences.

World Poverty and How to Solve It

Rachel Carson, an American marine biologist, published a book called 'The Silent Spring'.It had been prompted by the devastation of her friend's bird reserve, by DDT pesticide spraying going on nearby. In the book she outlined the consequences of indiscriminate pesticide use and how it could affect the whole environment through the food chain. That book prompted the start of the environmental movement and the founding of the Environmental Protection Agency.

Peter Benenson,a lawyer, was on the tube in London. He opened a newspaper to read an article about two Portugese students who had been sentenced to seven years in jail for drinking a toast to liberty. He and his friend Eric Baker, got together, sent off an article called 'The Forgotten Prisoners' to the Observer. That article was reprinted in several international papers and became the mission statement of the organisation that they went on to found, Amnesty International.

During the Bosnian war, two brothers, Fergus and Magnus MacFarlane-Barrow, drove a truck full of provisions to Medjugore in Bosnia, a place that they had visited some years previously on a religious pilgrimage. From that, they started to deliver aid to Africa and on one trip, they spoke to a girl whose mother was dying of Aids. When they asked her what she wanted, she said that all she wanted was food to eat and to be able to go to school to get an education. From that came Mary's Meals, a charity that encourages children to go to school by providing meals at the school. This breaks the poverty trap in several ways; it means those parents who are ill, do not need to worry about them getting fed; it means the children get a valuable education which will enable them to get a job; and it means the children do not have to go into prostitution to earn money for their families and run the risk of catching Aids themselves.

Richard Reynolds, who lives in a tower block in London, grew depressed with his surroundings and started planting sunflowers just outside the block. More people joined him and they launched an assault on derelict land, concrete roundabouts, overgrown planters and general ugliness everywhere. It has grown into Guerrilla Gardening, a movement that tackles urban neglect with flowers and forks.

Ok, what's this to do with world poverty, (the subject of World Blogging Day) and how is it going to solve it, apart from the more obvious example of Mary's Meals? And what has a guerrilla gardener got to do with a marine biologist?

First up, these people all understand what poverty actually is. It's not just absence of money. It's absence of education, absence of justice,absence of freedom and absence of beauty. Poverty comes in many forms.

Secondly,they knew that they could not do it on their own. Rachel Carson got info from fellow scientists unofficially and they reviewed her book very carefully so that the corporate lawyers wouldn't jump on her head;Peter Benenson relied on his contacts in the media and his friend Eric Baker, to launch Amnesty; Magnus and Fergus MacFarlane-Barrow relied on their friends at Dalmally Lodge to support them in their work; Richard Reynolds gathered friends and volunteers round him for the guerrilla gardening. Conquering poverty is something we have to do together for it to work.

Thirdly, they were all content to do one thing that played to their own resources. So Rachel Carson wrote an academic book on the environment;Peter Benenson the lawyer, studied cases of prisoners of conscience and publicised them; Magnus and Fergus MacFarlane-Barrow used their physical toughness as fish farmers to actually drive trucks to Africa; Richard Reynolds used his gardening instincts to create places of beauty. They didn't try to solve everything.

Fourthly, none of them minded that people thought them a bit crazy. George Bernard Shaw once said; '
"The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.'
All of them understood that progress means being avant-garde.

Finally, all of them understood the poverty of their own society. That does not lie in lack of resources, or skill, or money, although they all play their part. The poverty that underlies them all, is poverty of vision. We look at what we can't do, rather than what we can. We look to others to do what we could do ourselves. We belittle ourselves and the resources that we have; our material wealth, our time, our gifts, our friends. When it takes a fiver to feed someone for a year in Africa, why is anyone starving there? How many lawyers and biologists graduated the same year that Rachel Carson and Peter Benenson did? How many people could wield a gardening fork like Richard Reynolds? How long does it take to mow a piece of overgrown grass? But these people took responsibility. They didn't wait to be asked or chosen. They chose themselves and got on with it.

Go on. Do something. You don't need to save the whole world. You don't need to do something you can't. Just do something that you can. And who knows where it will take you...


Note:The lovely picture at the top is from Richard Reynolds' Guerrilla Gardening; these sunflowers are actually growing in front of the Parliament, (although at a distance). Wonderful.

Computer Says No.. Connecting for Health Isn't - Well, Connecting

The cyber disaster that is the National Programme for IT continues; Times Online reports on the Royal Free Hampstead NHS Trust, who switched on their 'Millenium Care Records Service' some months ago and had to amend 12 000 patient records in the space of three weeks. Software crashes were a regular occurence and the trust had to bring in extra staff to cope with the disruption. The trust naturally wants compensation; they have had to spend a lot of money to compensate for the faults in the programme. And this is where the fun starts. The local service provider for their area is Cerner, who actually devised the system. However, the trust cannot sue them. That is because the actual contract is between BT and the Secretary of State for Health. If the trust wants compensation, it will have to appeal to the Health Minister. Will they get their money back? I wouldn't bet on it.

Accountability, or lack of it, has been a recurring theme in this saga. In April 2006,an open letter was sent to the Health Committee by leading IT experts, asking about the feasibility of the programme and complaining that there was a lack of information and transparency regarding the project.

The costs have gone up and up. Connecting for Health was originally pitched at £2.3 billion, went up to £12.4 billion, and estimates are now £20-30 billion. An unofficial estimate, said to be in a minute to the Treasury, puts the possible final cost at £50 billion.

Perhaps the most infamous episode in this escapade, was when Accenture, one of the companies involved in the implementation, withdrew its services in September 2006. It should have been fined £1 billion for breach of contract. It was actually fined £63 million by Richard Granger, the Director General of the programme. In a previous life, Richard Granger worked for Andersen Consulting. That company later re-named itself Accenture. You join the dots.

Now, I know what you're going to say. It's a big project, they always overrun, it's the NHS, it'll be alright in a few years, once they've sorted out the software. But it's not alright. We're talking about not millions,but billions of pounds. We're talking about a bail out on the kind of pegging level of the credit crunch. And at the end of it, we don't have a system that works. We cannot afford this as a country. The health minister Alan Johnston needs to get his seriously tackety boots on and tackle this. If that means taking BT to court, then so be it. 'Computer says no,' just isn't an option anymore..

Note: this post replaces an earlier post that I did on this subject that was somewhat rushed and lacking in accuracy as a result. After a nights sleep, some comment from Sean Brennan and a nice cup of tea, this resulted. Hope this is more to your taste, Sean.

Watch the Lady - the Art of Misdirecting a Controversy

A few months ago, Mike Gray, a bowel cancer patient, gave the Scottish Parliament one of its more uncomfortable moments, as he asked for the right to be given Cetuximab, a new cancer drug, on the NHS. He had already spent £26 000 buying his treatment privately, and had been penalised for this by the NHS, who do not allow private and public treatment to run together. Yesterday, Nicola Sturgeon announced that there would be a review of whether co-payments would be allowed. This has ignited the debate about whether this would result in the thin-edge-of-the-wedge means tested payments for treatment; others chose to castigate NICE (The National Institute of Clinical Excellence) for not allowing Cetuximab to be on prescription. But the one question that hasn't been asked is; why are this new class of cancer drugs so expensive in the first place?

That's the question that Slate, the American online magazine asked in this artice. And it was a real eye opener. Here in Britain, the cost of Cetuximab,Zevalin and Avastin are £35 000,£12 000 and £20 000 per annum. But for the US, the costs are $16 000, $17 000 and $24 000 per month! You do the math, but it's pretty obvious that these drug companies are thinking of a number and then multiplying it by how much they think they can get away with.

I never thought I would agree with NICE on anything, especially when they restricted the prescription of dementia medicines, but I am with them on this. The drugs companies are the real villains here, but the media have completely missed the target and are blaming NICE instead. It's a vile thing to hold sick people to ransom and that is what the pharmaceutical giants are doing. I can understand a high charge for a medicine like Zevalin, which is used for non-Hodgkins, a relatively rare secondary cancer of the lymph glands. But Avastin and Cetuximab are both for colorectal cancer, a very common cancer. How can they justify these prices?

As far as co-payments go, the jury is out. I have mixed feelings about where such legislation should go. But I think the media should turn a very large spotlight on the pharmaceutical companies and ask them why they are charging the prices they are and what their profit margin is. This is the nub of a controversy which is becoming increasingly misdirected. Don't watch the lady. Watch the prestidigitation of the pharmaceuticals...

Pushing them Down the Stairs - the Dark Side of Caring

Our friend Bill introduced me to his new girlfriend. She turned out to be a part-time carer in a care home, so I immediately started to pick her brains. She was cheerful,open, voluble and, it seemed to me, compassionate. You could see straight off that she was a good carer.

'Don't they just drive you mad?' she asked happily. 'The only reason I don't push them down the stairs is that I'd be found out'.

Like so many really important bits of information it was imported in the guise of a joke, and in time-honoured fashion I laughed back. It wouldn't have been in the spirit of the conversation to have pressed her on the subject. I rather wish I had. I'd have liked to have asked;

-How close to the truth that remark had been;
-Whether she had done such a thing;
-Or almost done it;
-Whether any of her colleages had;
-How she reconciled such thoughts with her caring philosophy.

I should have asked all these questions The trouble was that I didn't dare. Because I knew exactly how she felt.

Thus opens one of the darkest and bravest chapters in the Hugh Marriott's classic, 'The Selfish Pig's Guide to Caring'. I have been thinking about it for the past week, because of the case of Joanne Hill, who was sentenced to fifteen years for drowning her four year old daughter Naomi in the bath (the daughter had cerebral palsy).

My first reaction to the headline was; 'good.' I have grown sick of the rash of murders of children by their parents, the case of David Foster being only one in a growing list of these incidents. But as I read the various BBC articles accompanying the leader article, I grew more and more disturbed. This was not something that happened out of the blue. This was a gradual process over a number of years of severe depression, guilt over her child's condition and fear for her future,alcoholism and erratic taking of the medicines she had been prescribed. All the things in fact, which carers are extremely prone to and which they only avoid by those closest to them, watching out for them.

Being a carer is a different country. The gulf between the theory of caring and the practice, is enormous. It simply isn't possible to fully explain to a lay person, what it's like, and there is also a certain amount of badly concealed disdain for those who care. The phrase in the report that triggered this post was 'mild cerebral palsy.'

It's mild. What's the problem? Get on with it. Callipers are easy to manage after a while, and you'll get used to the staring. Don't worry about how your child's going to do at school,if she's going to get bullied, if she'll get a job, if she'll ever marry, what'll happen if you die before she does. And by the way, don't expect us, the taxpayer, to fund her care. Cerebral palsy isn't sexy enough for us; it makes you look funny. You should have had an abortion and saved us a lot of bother and money..

Mild.Mild. How patronising can you get?

But let's return to the subject. What did those around Joanne Hill observe about her behaviour?

- Her husband observed how she was depressed and would come home to find her drunk on the sofa and her daughter asleep.
- Her GP referred her to the local Mental Health Team after she suffered a severe relapse of her depression in Christmas 2006. In June 2007, they decided there was no need for further involvement, and batted her back to the GP.
- Her parents looked after her in Christmas 2006, when she left her own home for a while;
-Her childminders observed that she had a severe drink problem and on several occasions turned up drunk to collect Naomi.

Why could none of them see where this was going? For the same reason carers don't talk about pushing their loved ones downstairs; they didn't want to see it. They didn't want to admit that that abyss was there, looming and that Joanne Hill was getting closer and closer to it. To stop it would have involved tremendous upheaval and her removal from the house for her own sake. And it would have involved bringing up the difficult subject that Joanne Hill might at some point, harm someone she was caring for. Just mentioning it, is taboo. But to avoid the abyss, you've got to talk about it. You've got to name it and stare into it, to know where you could end up without support.

You might have noticed that this news story is over a week old. That is how long it took me to write on this subject; I never have before, it is so difficult. But I felt obliged to. The victim in this was a little girl of four, and I feel she died because no one could talk about the possibility that her carer might harm her. All carers know of this possibility. We all know that darkness. And if we could find the courage to talk about it, maybe Naomi would be alive today.

Close Encounters of the Third Kind- the Growing Dilemma of the Voluntary Sector

It's not a good time to be in the voluntary sector in health. Maybe it never is, but two stories have been rumbling on over the past few weeks, which illustrate the perils of being in this sector just now. One is the story of Kinloch Rannoch community, whose GP opted out and then retired in 2006. Tayside Health Board's solution to this, has been to attempt to bring in First Response, a volunteer service that specialises in on-the-spot defibrillation treatment, to replace the GP. Not surprisingly, this has met with a right royal raspberry from the local community. The second story is St Margaret's Hospice in Glasgow, which was asked by Greater Glasgow Health Board to admit a wider range of continuing care patients; not simply people that are at the end of their life, but those with complex mental health problems, and also nursing care patients.St Margarets has refused to do this, and is now looking down the wrong end of a £1.2million shortfall, as GGHB threatens to withdraw its funding.

What is interesting about these cases, is how each organisation has dealt with the NHS. There are three rules for a voluntary organisation that accepts public funding;
1. Know your remit.
2. Know the government's remit.
3. Do not let the two remits coincide, even if it means loss of funding.

First Response has a problem with its identity. It was set up by an RAF pilot, Scott Bateman,after the death of his father from a heart attack. The original idea of it, was to provide on-the spot emergency treatment from a trained volunteer to a patient, while waiting for an ambulance to arrive. They have a strong bias towards difibrillation treatment, and they tend to be centred round RAF posts, which are rural and the volunteers originally came from the RAF. However, things have changed as they have evolved.
First Response now recruit not just military personnel, but civilian personnel called 'community responders'.

First Response are acquiring their own set of vehicles; cars with markings almost indistinguishable from a paramedic's car. They are also setting up a scheme called 'Life Bikes' for operating in connurbations and rush hour traffic. This is a move away from their rural setting.

First Response have been granted the title of 'NHS Partner' and they display the NHS logo on their website.

I do not think that First Response is deliberately setting out to undermine the regular ambulance serices. But I think that the health boards have led them step by step into a situation where they will find themselves doing that, and it has happened because of their inexperience and because they were not clear enough on what their remit was.

By contrast, St Margarets Hospice in Clydebank has never allowed themselves to be mistaken for the health board. They know their remit; to provide specialist palliative care to the dying and judging by these minutes, they are not afraid to say so.

Palliative care comes under the quicksand banner of continuing care for the elderly. This can mean a dozen different things from a long term condition like Alzheimers, to cancer sufferers, to elderly with complex mental health needs. Their life span can be anything from a few weeks to a couple of years. What many hospices do to avoid confusion, is that they simply deal with cancer sufferers and neurological conditions such as Motor Neurone disease. St Margarets is different, because it will take people with other conditions as well, the proviso being that they are in the last stages of their illness.

Glasgow Health Board like other boards, has a problem with continuing care beds, and judging by the number of beds currently being discussed for the new Southern General, is going to have even more of a problem with these type of beds in the future. Hence their efforts to get the hospice to change its remit to what would amount to a nursing home. St Margarets has stuck to its guns, even although GGHB has threatened to remove funding. They have not allowed the health board to dump its responsibilities on them, and have not allowed themselves to become subsumed into a diluted version of professional services.

Perhaps the main difference between St Margarets and First Response, is age. St Margaret's has been going for 70 years; First Response has only been going for ten years. But it needs to heed the wake up call from Kinloch Rannoch if it is going to survive another ten. As for St Margaret's? Well, it's run by nuns. As Fr Jack probably didn't say; be afraid, Tom Divers. Be very afraid.

Big Brother is Watching You

First the good news. Richard Branson the bearded one, has decided to abandon his efforts to enter healthcare for the time being, Pulse reports. He says the reason is the current economic downturn and that this is the wrong time to be heading out on a new venture.

Now the bad news. The government is considering giving access to the computer records containing the postcodes, addresses and medical conditions of every man, woman and child in England. They have made the rather quixotic concession that a medic will have to have permission from the patient, but those outside the NHS will have access.

The most prized commodity in commerce is information. And this is the kind of information that companies like Virgin will need, to run private health concerns. This is already done to a certain extent through loyalty cards in supermarkets; these record what you buy and compare it to your 'customer profile'. This information is used by the supermarkets themselves and is also sold on to medical companies, insurance, holiday operaters and all manner of businesses. But at least there is a certain amount of agreement involved. You don't have to enter into the loyalty card scheme if you don't want to. And the supermarket only has access to those who already shop in their store, so it has limits.

This idea, however,is in a completely different league and completely outrageous. Perhaps the most disturbing thing about this report, is that it is short and low profile. I sincerely hope that the media give this idea the kind of bad publicity it deserves and doesn't wimp out on challenging the government on this. The information age and big brother is truly upon us..

Scotlands Drink Problem in Pictures

Do you want to know why Scotland has a drink problem? You need look no further than you r local supermarket. This is the scene that greeted me at Tesco yesterday;















Yep, right at the entrance. Three big bins that you can't miss; make it wine, because more women shop in here than men. Put it on the right hand side; most folk are right handed and it'll make it even easier.

Ok. I want to buy a wide screen telly. Oh, there's some wine that I can buy instead. What was it I wanted?
















I promised wee Jamie that I'd get him a pair of roller skates. Oh, there's some wine next to them; really convenient, that'll go well with the skates..




















Right, some bacon for breakfast and a morning snifter to wash it down..

















Nothing like a cheap lasagne full of hydrogenated fats to go with some Chasse du Pape.



















Right, I'll get some ice cubes for the Coke and lemonade that I'm buying. Oooh, wonder what ice cubes are like in wine?
















Why do we have a drink problem? Why is the number of women with a drink problem increasing? Send to Johnny Tesco Walker,The Ministry of the Bleedin' Obvious, Chardonnay Aisle, St Budweiser's-in-the-Square, Glasgow PST ASA NEWT. And the prize is a bottle of wine..

Don't Worry - Be Happy

Coatbridge, where I live, is famed for many things. It has the highest rate of heart disease in Western Europe, is the home of deep fried Mars bars (could the two be connected?) and was given >the Carbuncle award (unfairly in my opinion) for worst town. However, things are looking up. Monklands (of which Coatbridge is part) has just been named in the top five 'happy' places in Britain. So has Cumbernauld and Kilsyth.
This conclusion was reached by a research team from Sheffield and Manchester universities, who took data from the British Household Panel Survey and used it to draw a 'happiness' map of Britain. This involved questions about peoples' sense of wellbeing, coupled with data about employment and environment. I haven't been so pleased since Albion Rovers came top of the league (the third division league, that is.)

Ps Cumbernauld and Airdrie (the other half of Monklands) have also won the Carbuncle award for worst town. Is there a connection between concrete and happiness?

Take a Drink?

I was on the NHS media monitoring site, when I came across this intensely depressing article about a child with Korsakoff's syndrome, (alcohol related dementia). Scotland has the highest rate of this disease and already has two nursing homes dedicated to younger sufferers of this, in Glasgow.

There's many reasons for our national drink problem, which I have discussed in other posts. But what worries me, is that guides to how much we drink are out-of-date. For example most of them base their calculations for wine on a 125ml glass at a strength of 12%. What most people are being served, is a 175ml glass at 13%. To give you an idea of the difference, look at the picture here. The glass on the left has 125ml, the glass in the middle, 175ml, and the glass at the end, 250ml.If you drink a 125ml glass at 12%, that is 1.5 units. If you drink a 175ml glass at 13%, that is 2.3 units.

I want people to enjoy themselves. But I also want people to be safe and healthy. So I'm putting this link, Drink Unit Calculator in the blog list, so that you can check how much you're really drinking. We really need to take responsibility for our health, and watch out for those in our company who have a drink problem and help them. Only when the culture changes and it's acceptable for people to take a soft drink without it being remarked on, will we really get to grips with this problem.

And Now for Some Good News

The Vale of Leven is back in the news again, but this time for a good reason; Greater Glasgow Health Board have agreed to retain its maternity services. And the Highland doctor who said some not-nice things about Dame Carol Black has had his suspension lifted. My only regret is that I would really have loved to have heard the case for the prosecution at the GMC hearing. Conduct unbecoming? Insubordination? Using foul language? Speaking what everyone was thinking? You wouldn't have been able to hear the evidence above the roars of laughter. Oh well, merde happens, as they probably don't say in France..

When You are Old and Grey and Full of Sleep..

This was going to start out as a natty wee post about the naff 'ageism' campaign that the Scottish Government is running just now (see above). It was going to be about how dementia funding has halved, nursing homes are shutting and health visitors and district nurses are going to be merged into one, to the detriment of the very young and very old. That is, until I heard the radio equivalent of this advert, where a young man is in the post office and an 'old biddy' is holding up the queue.He is muttering about what a pest she is, until he realises that the old biddy, is in fact his gran. My stomach did a flip at this advert. Why? Because it took me back two years ago, to when my aunt was in hospital. I had been going up to visit her, and one day when I went up, she had been moved to another room in the ward. I had walked past the room without recognition; she was just another old lady. When I was re-directed,I realised with a shock that that was exactly what my aunt was; an old lady, but it was the first time that I had seen her like that. She had just always been my aunt.

There's always been a separation between the young and the old. And the old and the very young have always been discriminated against. We pride ourselves on having progressed in this area, and certainly a lot of the casual ageist comments have gone. But what is underneath? Are we progressing, or has the separation, in fact become greater?

Let's take a look at the two professions that look after the young and old; parents and carers. Now imagine that you are one of these; that is all that you do. You are in company and someone asks what your job is. How comfortable would you feel in replying? And how much would you bet that someone would say, 'So you don't work then?'

Parenthood and being a carer, are two jobs that are admired in public and despised in private. Everyone acknowledges that they do an essential job, but noone wants to be the one to do it. Those who do, are regarded as losers who did it because they had no other choice in life. Who wants to look after screaming kids or old biddies, after all?

Why is it that we think this way? Why do we have nothing to offer them and feel that they have nothing to offer us? Without children we don't have a future, do we? And we all grow old, don't we? Are any of us looking forward to sitting in chairs in a home, being bawled at by nurses who think we're all deaf (and stupid?) Why do we think that's good enough for the elderly at present?

I still think this advert is naff. I do not want it to become a substitute for proper funding of care. But I do think there is a grain of truth in it. We need to look at our collective soul and ask if our society is losing its humanity, or if we can still see that life is more than food and the body more than clothing.

Fish and Flyting - the Revenge of the Bureaucrat

Flyting- an old Scots poetry tradition, where two or more poets try to outdo each other in bandying insults in verse. Usually involves copious use of scatological language.

Fish - an uninspiring, wet, flappy kind of creature, usually without a sense of humour.

Professor Elisabeth Paice - named after a fish, (but doesn't smoke)and has just reported a Highland junior doctor to his deanery for sounding off in a blog about the re-election of Dame Carol Black to the chair of the Academy of Medical Royal Colleges.

Just to give a quick bit of background; Dame Carol Black was heavily involved in promoting Modernising Medical Careers, or Mangling Medical Careers as it has now become known. She is the last person that a lot of junior doctors wanted elected to this chair. Many of them are sitting without jobs as a result of it. So you let off a bit of steam, or 'excrementous and scatological language' as Elisabeth Paice put it. She also said she felt 'compelled' to complain.(Why?)

The whole episode is petty and depressing. Leaders just ain't what they used to be.
Courts used to have their jokers, who would do their Rory Bremner about all the gossip and scandal in the court.It was considered healthy.
When a cardinal complained to Borgia that Michaelangelo had painted the cardinal in the Hell section of the Sistine frescoes (Michaelangelo was annoyed, because the cardinal said the figures were too naked) Borgia told him he was going to have to stay there, because once you were in Hell, that was it. Even Maggie Thatcher watched Spitting Image and professed to love her puppet. What's wrong with all these thin skinned bureaucrats? Why can't they turn round like Caligula and say, 'Let them hate, so long as they fear!'

Y'know, being a public figure has its drawbacks. It isn't nice to read criticism about yourself. It isn't nice when they use bad language. But it is part of the job and if you can't take the heat, you should stay out of the kitchen. And maybe what has got to the Professor, is that this doctor's criticism about Dame Carol Black is justified and that's what they really can't endure.

Anyway, to the Highland doc who is at present suspended; I'm glad to see you continue the good Scots tradition of flyting. And I hope that common sense will prevail and that you get your job back. If some of the blogs I have been reading are anything to go by, Elisabeth Paice ain't seen nothing yet..

Vale of Leven - on the Periphery

Another perspective on the Vale's problems from a Dr Constance Ross in the Herald.

T he Deadly Land of Limbo - the Vale of Leven Crisis

'Give a dog a bad name and hang it' is a time honoured political stratagem. You have to do something unpleasant,like close a hospital or a school. You know there is going to be a stushie if you attempt it straightaway. So what do you do? You go for the long game. Let the place run down, send the best staff elsewhere and when it has gained itself a bad name, close it.

That is, I'm afraid, the long and the short of the C-Difficile crisis unfolding at the Vale of Leven hospital . The Vale's problems, on the face of it, are very similar to other hospitals. Lack of space, beds too close together, a high turnover of patients; you could be talking about any hospital in Scotland. The key difference, however, is that the Vale of Leven has been in limbo for ten years over its future. This means that noone is going to stop there for long, because their future is uncertain; you come to rely heavily on temporary staff and you have difficulty providing leadership, because there is no continuity and no loyalty. It is of little comfort to the relatives of those who died, but I am pleased to note that Nicola Sturgeon has recognised this as the main problem. What is needed now, is a clear decision about the Vale. What is also needed is a firm taking to task of the health board, who were warned about the situation, but let it run. It is time for the politics to end and for the Vale to be let out of limbo. Lives depend on it.

The Write Stuff

Here's Margaret Hinds from the South East Forum, on hospital hygiene. A lot of common sense proposals, that would be relatively inexpensive, including getting people not to wear their work clothes home and regulating the behaviour of visitors. For the past couple of months I have been visiting someone in hospital and the behaviour of visitors in terms of hygiene astounds me. Sitting on beds, using patient toilets, not using the Hibiscrub wash which is at the entry of every room. Mind you, I don't think it's a good idea for the staff of the hospital to eat in the WRVS canteen that the visitors use. I think antibiotics has made us all lazy about preventing infection. Anyway, read and enjoy!

Open All Hours?

The row about evening surgeries and out-of-hours rumbles on. I think most people are wondering why GPs are making such a fuss about this. What's the matter with a couple of extra hours a week after all? I'm going to try and explain what is happening and what is the possible solution to this for both parties.

GPs are contracted to work from 8-6pm, Monday to Friday. This adds up to 50 hours. Under the European Work Time Directive, they are only meant to be working 48 hours, which means they are in breach of European law and this is going to kick in in 2009, when this comes into full force. If on top of that, they work an extra evening surgery, they will be breaking the law again. Because their contract is such that it does not allow a shift system, (they have to work from 8-6pm)there is no way round this at present.

Local GPs are already providing the emergency doctor service for NHS 24 in their area. If they are working an evening surgery, that is taking them away from the out-of-hours service, which is arguably more important than someone who just wants a convenient time to see the doctor. The government does not appear willing to employ more GPs, so a choice needs to be made.

There are safety issues regarding evening surgeries. It is one thing to be called out to a house by a specific person who can be traced; it is quite another sitting in an empty surgery, where you are a target for any ned who happens to be passing by and fancies his chances to get some drugs.

This all begs the question; why has evening surgeries become an issue? There are a couple of possible answers to that, but one of them is that NHS 24 has proved to be twice as expensive as the government expected it to be, and A&E admissions are at a ten year high. The government cannot get out of NHS 24 just now, because of contractual obligations, but if it could persuade doctors to work an evening surgery during out-of-hours time, it could save some money on A&E admissions at least.

Maybe it could work, if doctors were allowed flexi-time and if the government employed more doctors to help, so that OOH would not be left short. But the real solution to this problem is; scrap NHS 24 and go back to the old OOH cooperative system, properly funded and with sufficient numbers of doctors. It'll be cheaper in the long run.

Building Bridges?

Ok , I'm back. And what brought me back was this article today in the Herald. Nicola Sturgeon and her Irish and Welsh counterparts have written a letter to Alan Johnston, asking why he has gone ahead with negotiations about pay deals with NHS workers, without referring to them, and asking him to hold back from any major decisions until they have been consulted. Now, some might see this as political posturing. But I don't see it that way. This is the nub of a far more complex and troubling problem that is the NHS.

The NHS in Scotland, Wales and Northern Ireland has always had a life of its own. But the idea of the NHS was that it was just that; a national health service that delivered an agreed standard of health care across the UK. Over the past few years, England and the rest of the UK have moved further and further apart. England is much further down the road to privatisation than its UK counterparts, whereas the devolved parliaments have largely steered away from this. Wales in particular took a scunner to PFI deals; its parliament shut its Private Finance Unit in 2004. So the question is; is there any point trying to influence what is happening in England, or should we just burn the bridges and keep privatisation out at the border? Judging by this letter from the three health ministers, they have opted to go for influencing the English, rather than leave them to their own devices.

There may be a couple of reasons for this decision. Westminster controls the budget for Scotland (and NI and Wales) through the lump sum that it gets every year. Therefore it still controls Scotland's health budget, although indirectly. If the Scottish Government takes the decision to use central funding for things like the Southern General, it will have to take a bite out of the cake slice that Westminster gives it. Therefore, it cannot ignore what is going on down south.

Secondly, companies such as United Healthcare and Atos are no respectors of borders. If Scotland decides simply to put up the shutters, it might not be enough. Perhaps the fight does have to be taken to them.

The main difference between England and the rest of the UK at the moment, is that England is the only part of the UK that still has first-past-the-post. Consequently, things move much slower politically in England than they do here; there is no room for independents to jouk in and shake things up as the St Johns Livingston crowd did in Lothian. There is not a party in England that you could call the friend of the NHS at the moment, and it is extremely worrying that there is an agreed deafening silence on privatisation of health in England.

So should we burn the bridges or should we cross them to invade? I would go for a third option. England badly needs proportional representation, so that the voice of the ordinary English can be heard on this issue.I don't think the English want privatisation any more than we do. But the people who have not spoken yet, need to find their voice.

Is it That Time Already?

Gee whizz!

My last post was on 18th February(!) Reminds me of someone I bumped into and I said,' John, I haven't seen you for ages! I thought you were dead!'
'And you never came to the funeral,' he said without blinking..

GP Plc

Dr Rant draws our attention to this video on You Tube about GPs working for private companies. Well worth a watch..

She Must Be Mad

Ok, I admit it; I write letters to the paper. I got one printed today about GP hours and the threat from private companies to GP practices. Click here to read.

They've Forgotten Something- Funding of Dementia Research

If you want to know how old people are esteemed in our society, you only need to look at this article in the Daily Express about Alzhiemers. £289 per head is spent on cancer research; only £11 is spent per head on dementia research. This is despite the fact that there are more than 700 000 sufferers in the UK and rising. Can I give you all a word of advice; don't save money, don't buy your house, don't pay National Insurance, don't work; instead blow it all on a trip round the world just before you're 60 and then defy the government to do something about it.

Trains, Planes and ..GP Practices?

My dad always warned me against men with beards. 'They're trying to hide something,' was his advice. Richard Branson, the bearded one (and one of those chummy type jumpers) is planning to open a string of GP practices, starting with Nottingham in 2009.

I am totally speechless. I think I'm going to go for a brandy and a lie down..

When a Moral Dilemma Ain't a Moral Dilemma - The Strange Case of Stem Cell Research

Last week a bill that goes by the very unsexy name of the Human Tissue and Embryology Bill got its third reading in the House of Lords . It now goes to the Commons and should be decided on by the end of the month. This bill has many things in it, but one of the most controversial is regarding stem cell research, in particular, embryo stem cell research.

Basically, the argument goes like this. Stem cell research holds the ‘golden key’ to curing disease. Stem cells are the cells in the body that repair and replace diseased tissue. A number of these cells (called ‘pluripotent’ cells) can adapt to any area of the body and regrow for example, heart muscle damaged in a heart attack. It is the most promising area for finding cures to such horrors as Parkinsons’, Alzheimers and MS. There are a number of sources for these stem cells, but the two basic groups are embryonic stem cells, which come from foetuses, and adult stem cells, which are present in all of us and can be harvested and grown, (usually from bone marrow).

Now comes the dilemma. The most promising path for therapies, according to scientists, is embryo stem cell research. But they have a problem. They cannot get enough leftover eggs from IVF treatment centres to continue their research. So what they want to do is to create hybrid embryos called ‘chimeras’ which are made up of either a cow or rabbits egg, and human cells injected into the egg. This is, of course crossing the species barrier. But this research is the only chance of finding cures for uncurable diseases. So, do you listen to all those loonies going on about how destructive and dangerous this research is, or do you take a deep breath and allow it to go ahead for the greater good? Not an easy choice, or so it would appear.

There’s just one thing wrong with all of this; what is being said is totally, utterly, untrue.

Human embryonic stem cell research has been going for 17 years, during which time it has not come up with a single treatment for any disease. It has not got past the animal trial stage and it is looking increasingly likely that it will never be used for human treatment. This is because of two major problems;

1. Embryonic stem cells cannot be used to treat adult tissue; they are not biologically compatible. What happens when they are injected, is that they produce tumours.

2. Embryonic stem cells are not identical to the person being treated, so you have the same problem that you have with transplant, of host rejection. If they ever did manage to treat anyone with these, they would have to receive drugs to counter this for the rest of their life.

Adult stem cell research by contrast, is forging ahead. More than 80 cures and treatments have resulted from it and about 300 more are being researched. Here are some of them;

Dr Dennis Turner, who had Parkinsons’ disease, had an injection of stem cells into his brain. He almost completely recovered, and stayed in remission for four years. The symptoms have now returned, but it is a huge step forward.


A man who had cardiac disease, found that not only did he recover, but that the stem cells appear to have replaced some of the damaged heart muscle.

People with diabetes no longer have to take daily injections of insulin, after treatment from stem cells obtained from their own blood.

Experiments on mice with stem cells from new born mice,are showing promising signs for Alzheimers.


Now, you would expect discoveries like this to be trumpeted from the roof tops, wouldn’t you? But here’s the strange thing- they haven’t. Most of them have appeared on inside pages of papers or in science section of the paper that nobody reads. By contrast, embryo research has been given masses of headlines.

When Ronald Reagan died in 2004 of Alzheimers, it was used as an opportunity to promote embryo stem cell research, which it was said, could offer a cure to a disease like this. Nancy Reagan and others in the American Senate took up this cause. Just a couple of weeks after this, the Washington Post printed this article, which refuted the idea that embryo stem cells could produce a cure for Alzheimers. Alzheimers is what is known as a ‘whole brain’ disease; that is, many different brain cells are affected and the brain is also physically damaged. Embryo stem cell treatment is thought to be only viable for single cell diseases. Unblushingly, one scientist said that people needed a fairy tale to believe in.

Again, last November, Professor Ian Wilmut, creator of Dolly the sheep, withdrew his application for a licence for embryo research,because a new research technique became available in Japan that enabled him to study the same things that he would have done with embryos. Despite this ringing endorsement, other researchers say they don't want to use this research path because there is a problem with the production of cancer tumours. They have not mentioned that there is a similar problem with embryo research, nor do they mention that the new technique overcomes the problem of host rejection that they have been beset with.

So what the hell is going on? I wish I could tell you, but a I am unhappy about several things;

1. A very successful technique in treating disease is being sidelined in favour of a very unsuccessful technique.

2. Scientists have requested to cross the species barrier in pursuit of embryonic research. This has been banned in every European country apart from ourselves, Sweden and Spain. Mother Nature put the species barrier there for a reason; to stop disease spreading from one species to another. Remove that barrier and you are creating a bridge over which disease can cross. For example, the last disease to cross the cow- human barrier was BSE, becoming CJD in humans. If it goes wrong, we can’t just reverse it; we will have to live with the consequences. The worst case scenario is that it could wipe us out.

3. On the subject of embryo destruction, 2.2 million embryos have been created and destroyed so far. That figure, even for the most liberal of us, is pretty grim reading, and it has produced nothing. Why does this have to go ahead, especially when there is viable and ethical alternatives?

4. Government funding of stem cell research is split 50:50 between embryo and adult stem cell research, despite adult stem cell research being far more productive.

5. Scientists are not being straight with us. Whatever this research is for, it is not for the treatment of disease. Futhermore, those of us affected directly or indirectly by things like Alzheimers’ have not been asked for our opinion of where this research should go.


It is time for scientists to tell us just exactly where they are going with this. Embryonic stem cell research involves cloning, and if it is not being used for disease, then the most likely possiblity is that it is about cloning. If this is the case, there should be a debate about it. Until then, this research should not be permitted; there is no medical justification for it.

In the meantime, if you have read this and want to stop this bill, write to your MP soon. You have about two weeks to stop this becoming law.

Oh brave new world..



PS Can I say one last thing. This was not an easy article for me to write, because opinion is so prejudiced against anyone objecting to embryo research. We are portrayed as uncaring and narrow minded. Can I just ask one thing of anyone who might think this of me; please read all the links before you come to a judgement and bear in mind that I care for someone with Alzheimers, which is why I think it is so important that I should speak out on this.

Sometimes Wishes Come True

Yesterday, I said 'I wish that we had an opposition mature enough to say to the Labour Party 'Do your blood letting yourselves.'

Today, Jim Sillars, former deputy leader of the SNP, said just that. He thinks that Jim Dyer, the Standards chief, owes Wendy Alexander an apology.

Good on you Jim. It's nice to see a politician with some sense.

Frogs, Gods and Politicians

There is a story by Aesop that goes like this.

Once there was a pond which a colony of frogs lived in.They had enough food and were pretty happy, but they got bored. They decided that what they needed was a bit of glamour,so they prayed to the frog god for a king. The frog god threw down a log into the pond and the frogs were happy with it for a while, but they got bored with it because it didn't do anything.So they prayed to the frog god again. This time he sent down a stork, who promptly set about eating up all the frogs in the pond.

I thought of this story this morning when I heard about Wendy Alexander and the fuss about the £950 which may or may not have been donated illegally. Jim Dyer has reported the matter to the Procurator Fiscal to decide. Regardless of the legal technicalities,the ghouls in Scottish political community are gearing up for yet another leadership blood fest a la Henry McLeish and David McLetchie. Do I like this?
No. Why not? Because a) the amount of money involved is small and it is really about a legal technicality and b) nobody has asked who we are going to get in Wendy's place if she goes.

Take Henry McLeish. Henry McLeish was one of the few heavyweights that Labour had in the Scottish party. He also had a social conscience, which is why he pushed forward personal care for the elderly. This was actually his undoing. Westminster did not want him to do this, because it would put pressure on England to follow suit. Shortly after he defied them, the whole fuss about his constituency office and who it was hired to, blew up. I wouldn't mind betting that most of you cannot remember the details of this and care less. Nonetheless, he was removed from office and we lost a fine politician as a result.

Now it's Wendy's turn. She's only been in four months as leader and peoples' chief objections to her seem to be a) that they don't like what she looks like and b)they don't like her voice. Believe me, there are far worse things to dislike in a leader than their looks and their voice.

Which brings me to Andy Kerr. For those of you who have forgotten, Andy Kerr was the Health Minister last session. Andy Kerr was the one pushing through all the hospital closures (including Monklands). For the past couple of months in the new session, he has been claiming that the abandonment of this closure plan will endanger lives. If Wendy goes, he will be the most likely candidate for Labour leader. It will be very bad for health if this happens.

All politicians are not the same. This is something I learned over the course of the Monklands campaign. Some were very helpful. Some were very unhelpful and it did not depend on which party they belonged to. It actually depended on them as a person, how they behaved to us.

The worst thing that I saw was the party political system at work. It is not the best that are picked as candidates. Those who get picked tend to be a grade below the office bearers of the association and are groomed to be totally dependent on the party. Their campaign is generally arranged for them by others esp the fund raising. If they step out of line at all, they are severely punished. There is one politician I know, whose party members did not speak to them for two years, because of an abstention on a vote in Holyrood. This is the brutal reality of party politics in Scotland and the bullying underlying it. And that is why in the whole campaign, I stuck to issues. I did not want to get caught up in personalities or the general blood letting that passes for politics in this country.

I am sure the press will have a field day or week, with this story. No doubt Wendy Alexander will resign. If Andy Kerr manages to side step the issue about £1000 gift from McDonalds (and he will manage it), he will be next Labour leader. Then it's on with the show.

I wish we had politicians in the opposition mature enough to say to the Labour party,'Do your blood letting yourselves.'

I wish we had a press mature enough to say, 'This is not a story worth the paper it's written on.'

But most of all, I wish we had an electorate mature enough to say, 'A pox on all your houses.'

A Very Good Day - Monklands Reprieve is Rubber Stamped

Some days it's all worth it.

I was at Lanarkshire Health Board's meeting today at Almada St. The last time I was in there, it was for four hours with a set of papers the size of a telephone directory and Monklands A&E was condemned. Today, it was two hours, (with a set of papers the size of a telephone directory) and this time Monklands was reprieved.

The devil as always, is in the detail, although there was nothing really surprising.

130 patients are to go to Hairmyres re cardiology. Ok, they have the main speciality for the authority, so won't quarrel with that. Touch any of the other departments and we will. We have not forgotten what happened to paediatrics, when the department moved into Wishaw for six weeks while refurbishing took place in Monklands, and was still there seven years later.

Six haemotology beds masquerading as a cancer centre for Monklands, in a hospital that has no MRI scanner. Still, no surprise; I never believed that there would be a cancer centre at Monklands. I just hope that Maggie's is going ahead.

Airdrie Resource Centre to go ahead; no surprise, this is vital to the Board's plans to place most of Airdrie's GP practices in one place. But please don't try to bring in any private companies or salaried GPs to run the staffing.

Mental health is being prioritised for funding. Is this a first? Still, rather short on detail and I'm wondering how £300 million for primary care, became £100 million today in the words of one of the board members. Where's the other £200 million, guys? Make sure it doesn't end up in that PFI middle management black hole now, will you?

A call for parity of funding under Arbuthnott. Lanarkshire receives £97 for every £100 that other health boards receive. Guess what; I actually agree with the Board on this. Wouldn't it have been nice if you had said two years ago, that this was a funding problem and we could have worked together to put pressure on the government to cough up the cash, instead of spending two years arguing about a shortage of consultant anesthetists? Still, no hard feelings; so long as we get there in the end.

When will the end be? That is what I was asked by one of the reporters and I said without thinking, 'I can see myself here in five years time.'

I hope it wasn't a psychic moment..

PS To any nosey parkers from NHS Lanarkshire looking at this, there's a wee message contained in the picture above. Geddit?