Diana Watch

Look, it's very simple, if you don't password protect your Wifi I will use it, hence here we all are. Hello from Kent! Come on in the water's muddy.

I think that I may be becoming a little paranoid. Every time I see a story in the press about changes to the NHS all I can see is a concerted conspiracy to dismantle it by a government that values profit over all over things. It's a subtle(ish) accumulation of things, some within the white paper and some coming from outside.
GP's, who have already been technically privatised and are run for profit, will take over commissioning from the PCT's. They already ignore standard NHS terms and conditions for their staff and, in a letter to the BMJ, it has been pointed out that Foundation Trusts will be also be able to ignore Agenda for Change but that is not really my point here.
The Government have announced this week that NICE will be stripped of it's powers to say which treatments should be available on the NHS and GP's will decided for themselves which drugs they prescribe without any guidance.
A new treatment comes on to the market and NICE review it. Does it work? Is it cost affective? Show me the evidence! If it works then you can prescribe it within the whole NHS and if it doesn't then you can't. Sounds like a good idea to me.
This simple idea has got rid of the “system” that existed before where some Health Authorities prescribed some drugs and others didn't. The press hated it, quite rightly (here for instance is the Daily Mail on that very subject. The first paragraph reads “Patients with cancer, heart disease and mental illness are being denied drugs and lifesaving treatment thanks to a postcode lottery of care in the NHS”), and it was nicknamed “a postcode lottery” i.e., where you lived effected what drugs you could have. It was agreed that this was a bad idea and we needed a centralised system and some joined up thinking and that is what we got.
NICE has been controversial in some areas of the press because they have restricted access to some really expensive, not very effective (or least not any better than existing treatment) drugs, mostly for cancer treatments. In fact, it is the same press that was critical of the postcode lottery that existed before (here for instance is the Daily Mail on that very subject. The first paragraph reads “The scandal of patients being denied drugs just because the NHS rationing body decides they are too expensive will end, ministers have declared.”).
I have a question for these people, what would you do? We don't have unlimited amount of money so we can't do everything, so give us some ideas, all you do is complain and criticise but never offer any alternatives.
Oh, as an aside, a lot of those charities/patient advocacy groups that get quoted in the papers are set up/funded by Big Pharma companies to act as lobbying organisations for certain drugs and treatments.
There are some important practical points in transferring prescribing decisions to GP's such as how do you expect them to keep up with all the new drugs that come to market? There are hundreds of studies a year and they are not always as open and straight forward as they should be. When do they think GP's have time to read all these studies? Aren't they supposed to be seeing patients? If they only read the abstracts of the articles/studies because of time pressures then they will be lead astray as many article abstracts have been shown to misleading.
Anyway, back to my rambling point. So a private company can already set up a GP consortium and now they will be able to prescribe which every drug they like, ignoring such boring, unimportant things as evidence.
This is were my worst case scenario thinking bought me. There is very little standing in the way of a GlaxoSmithKline opening a chain of NHS GP surgeries and prescribing only GlaxoSmithKline drugs. “Have you been to a Glaxo surgery before?”
OK, at the moment there are still a few hopes to be jumped though and barriers to be crossed, fords to be ummmm, forded and boxes to be ticked, but they are mostly PCT based. So we are safe at the moment because the PCT's are quite useful and no one would want to get of them, oh hang on a minute.....

That is all for this week as I'm not really supposed to be doing this.
There will definitely be no blog next Sunday (I know I said that last week but things change) as we will be in Nottingham I think for some art event or other, not sure if I'm honest but I will take pictures and if they are ok I will show you. Have a great week.

Diana Watch

2 tweets from my brother from Thursday morning.

“It's at this point of the morning I wish I'd been lazy and driven in to work rather than cycle”, followed 57 minutes later by, “In ambulance on way to hospital having been knocked off my bike. Suspected broken leg.”

He had indeed broken his leg, in several places, but the rest of him was fine. Friday afternoon for him consisted of a rather long surgical procedure to put all the broken bits of bone back into some sort of order using chisels, drills and various bits of Meccano (orthopaedic surgery is not the most delicate of affairs). And now begins, what might be but then again may not be, the long road to recovery.

I just want to say thank you to everyone who helped him. All the people that helped at the scene and to the ambulance crew. To the A and E staff, the ward staff and even the surgeons who I have been known to mock from time to time. Thank you all so much.

I know it's pointless because none of them read this but I think everyone should know that most people aren't twats and are actually quite nice and the NHS is fucking brilliant and I love it, warts and all. OK, maybe not the warts.

Did one of our papers some how manage to get a picture of Princess Diana on the front page? Of course they did but can you guess which one? Of course you can because it was the Express,

My question to you on this lovely Sunday morning (well it's lovely here) is, who would work for NICE? Really, why would you? You just can't win and you have to interviewed by the enormo-twat that is John Humphrys (He was born in a Welsh town called Splot apparently, I think we have discovered the seat of the Humphrys anger, his home town has a stupid name.)

Their latest kicking from the press came after they did what all proper scientists, skeptics and, to be honest, right thinking people should do, they changed their minds, and therefore advice, in the face of new evidence.

In 2007 the organisation decided, with the help of advanced computer modelling and complex algorhythms rather than the more powerful personal anecdote, that the evidence for the prescribing 3 drugs, Aricept, Exelon and Reminyl, for early to moderate Alzheimer’s disease was not strong enough for them to recommend them and so they didn't. This caused a bit of a fuss at the time because the drugs had been available before and they are not that expensive, the figure being bandied around is £2.80 per day. Some even went as far as to call NICE cruel, which was a little harsh. The evidence was weak so they were withdrawn from NHS prescribing, as it should be (they were still available privately though). We practice evidence based medicine, that is the way it works.

This week, following the consideration of 17 new studies (well according to NICE anyway so dispute this), it seems that the evidence base has shifted in favour of these drugs and so the decision was changed. Now that we know that they work and that they are safe and cost effective then now they can be prescribed. Personally I don't see what is wrong with that but, as I have complained about before, our press does not cope well when faced with a nuanced argument and they see changing your mind in the face of new evidence as a sign of weakness. It is reported that you were wrong rather than the situation has changed.

In British politics it seems that the worst thing that you can be accused of is a U-turn and the press, most of whom haven't shifted any of their ideologically views since some time during the reign of Queen Victoria, usually attach the word “humiliating” to the phrase U-turn just to reinforce their point. And so it was for NICE. The Telegraph had “Alzheimer's u-turn by Nice to allow drugs for mild cases” and the Mail went with “Alzheimer's victory for the Mail: Now just £2.50 can buy a life after U-turn on drugs banned by NICE”, in fact every paper I have looked at on-line (so not The Times then) called it a U-turn.

One of the interesting things is the wide range in the numbers that various papers said were effected by this decision. The Telegraph said “around 80,000”, the Guardian had “Tens of thousands”. The Mirror used the figure of “465,000” people, whilst the Mail claimed a rather vague “Hundreds of thousands”. The Star had something about boobs.

According to the Financial Times this change will cost the NHS £13 million per year so I ask the question that many have asked critics of NICE (including on the Pod Delusion podcast a few weeks ago, Episode 53 I think) what would you do? Rather than just carping on all the time put yourself in their shoes. It is a limited drugs budget and to spend £13 million on these drugs you would have to stop spending it on some other drugs, so which patients, who can all bring a miserable story and sad faced picture guaranteed to get them into the next round of the X-factor, would you tell they couldn't have their drugs? Come on journalists who do nothing but criticise others, what would you do? The likelihood is you will choose something that is close to you because a member of your family has suffered from it and excluded other things because, perhaps, you think that they are self inflicted and shouldn't be treated on the NHS. This is why something like NICE has to exist, to remove to emotion from decisions such as this and consider them in a purely rational, scientific way.

As usual I've rambled on, let do some awards,

The Award for Turning Out Not To Be An Arse (Possibly. Although it may have been for publicity but does that matter in the end, isn't the outcome the important thing whatever the motivation)

If you write a letter to your favourite film star you probably don't expect him to reply, after all Jim'll fix it hasn't been on television for years. You also probably don't expect that film star to turn up at your school either although that is exactly what happened to Bea Delap.

She wrote to Capt. Jack Sparrow from the Pirates of the Caribbean films asking for help with a mutiny and he, err, turned up to Meridian Primary School in Greenwich, London. Whilst he didn't help the children with their mutiny, Capt. Jack (played by Johnny Depp) did offer the children some excellent advice, always remember to brush your teeth.

The Award for Best Line of the Week,

One of the rescue teams has managed to break through into the underground chamber where the Chilean miners have been trapped for the last 66 days. A Journalist excitedly asks Chilean mining minister Golborne "how are the miners?", who replied "a lot calmer than the journalists." Nice.

That will do I think. The usual degree of rambling has been achieved and now I must stop, there are sick people to visit. Off to Devon now to visit our god daughter who's not been well either but the NHS made her better also, damn they are great and not just because they employ me.

Have a super fun week.

Diana Watch

I want to begin with a bird feeder update. As you know, because you read this nonsense every week and I thank you for that, I have a birdfeeder and it was being ignored by my local feathered friends and I was wondering how long I should wait before being offended by the tiny little feathery, ungrateful gits.
Well I no longer have to worry about this most modern of dilemmas as I have seen one bird on my new bird feeder; it was a Robin thank you for asking. Of course, just because I have only seen one bird on it doesn't mean that others have not been flocking around it whilst I'm not there or when I’m looking the other way (they are sneaky you know). Now, you may think that I am slightly deluded but just ask any good religious person and they will confirm that, just because no one saw it and there is no evidence for it, in fact there is evidence against it, does not mean that something didn't happen.

I am still keeping up with the “Diana Watch” element of this blog and I have for you one Daily Express front page photo of Princess Diana.

So NICE says we can’t have a bowel cancer drug that seems to work (a bit). This is an emotive subject and I can see both sides of the arguments. If you were dying you would want any chance of increasing the length of your life but is infinite cost ok? Of course it isn't. (Interesting side point, when NICE said no to the £30,000 a year drug the company that makes it offered to renegotiate the price. So that's not how much it costs then? Was it just a number you made up?)
You can't have this drug that has been shown to work (in some cases) on the NHS but you can have some homoeopathy at the Royal London Homoeopathic Hospital if you like.
The rest of us use evidence based medicine (but what's the evidence for that?) and we only use treatments and medicines that have been shown to work but one part of the Health Service is allowed to give it's patients little vials of water and sugar pills claiming that it will make them better with no evidence to support that statement. There is actually quite a lot of clear evidence to show that it really, really doesn't work and it's just silly.
So you can't have real drugs that have been shown to work but the NHS is more than happy to fund Quackery.
On the subject of Homeopathy, there was a Parliamentary Science and Technology Select Committee hearing this week that discussed this subject and you can watch it here if you like.
Boots the Chemist were represented at the hearing because they sell some homoeopathic products. Under questioning the representative from the company admitted that they had no proof that it works (not a great surprise there) but they sold it because their customers wanted it and believe it works. Well that's ok then, it not as if you are a trusted Pharmacy that is known for primarily selling medicines that have been shown to work then is it? Oh no, wait a second, you are! Even the anti-dandruff shampoo has to be shown to work before it can be advertised and sold as anti-dandruff shampoo but not so homoeopathic “remedies”.
Pure consumerism in action there. Sell stuff that is known not to work just because some people think it does and completely forget any moral element of separating people from their cash for a useless product. Here is an open letter to Alliance Boots for the Merseyside Skeptic Society.
If it works then let's test it, independently, with double blinded trials and then it can be regulated properly. I'd want in then because the money you can make from selling this stuff would be massive, it's so cheap to produce.


It seems that all you read in the press may not be true. There have been several stories recently that seem to have been, let's say, a little exaggerated. Well, maybe even untrue.
We can start off a little gentle “misreporting”. MP Sir Peter Viggers got a duck house on House of Commons expenses didn't he? Well, no. I know it is only a technicality but he only claimed for it. He filled in a form and asked “might you pay for this?” and the Commons Authority said, “Umm, no. No we won't.”
But that was not how the story was spun in the papers. Ok it was a silly claim but it wasn't paid. When the Express reported it they admitted that the claim was refused but only sort of. They wrote “However, it is not clear whether he was in fact reimbursed for the duck home, as a Commons official wrote "not allowable" by the side of the claim.” So it was not allowed but they tried to insinuate that it might have been paid anyway. Nice.
Then there was that incredibly indecisive Gordon Brown (if you want to see indecisive hand me a menu. Get yourself a snack; this is going to take a while). He was asked about his favourite biscuit on a webchat he did for Mumsnet (for some reason this has become the communication medium of the moment as David Cameron has done it several times) and he didn't answer the question. The press laid into him. All of them. “He can't even decide on a biscuit. This man is a disgrace.” was pretty much what they went with.
The thing is it didn't really happen. Someone on Mumsnet did, indeed, ask Gordon about his favourite biscuit but he didn't receive the question. There was an IT problem at No. 10 and the question didn't get through so he didn't see it and so couldn't answer it. Not many of the papers reported that bit but the lady who runs the website/chatroom confirmed the techy problem.
Do you remember Russell Brand and Jonathan Ross? They rang an old man and left messages on his answering machine. There was a little bit about in the papers, I'm not sure that you would have seen anything about it.
Well it turns out that they probably didn't leave any messages on his machine. Well according to Comedienne Richard Herring who claimed to have heard this when recording “Never Mind the Buzzcocks”.
And then there are the things that they don't tell you. The News of the World was fined £800,000 this week at an industrial tribunal in a case bought by a former Sports reporter for that paper.
If you read most of the UK's daily papers you probably don't know this because they haven't printed it. This little interesting tit-bit is explained here by Alan Greenslade in the Guardian, the only paper that printed the story.
What isn't pointed out in that article, but is in the rest of their coverage of this story, is that the man at the head of the paper when this bullying was taking place is the same man who was in charge whilst the paper was hacking the mobile phones of people that you may have heard of. That man was Andy Coulson. He is currently the Tories Director of Communications & Planning. So he was fired from his paper for mobile phone hacking and now is found guilty of bullying, just the sort of person David Cameron wants to have around.

This is a plea really. Articles in most of the papers this week report that people in the UK is still not donating enough organs. Why not? You don’t need them, you’re dead!
There has been a very large rise, a doubling in fact, in Surgeons using organs from donors that are described as “marginal”. These include the elderly, cancer victims and those with a history of drug abuse. Now, I have nothing against any of these groups of people, actually some of my best friends are elderly, tattooed (higher hepatitis risk), cancer suffering drug addicts, (not fun to be with but they tick so many boxes), but I wouldn’t want their organs.
So to those of you who are not on the donor register, click here and go and do it.

The Award for Heart-warming Sports Story of the Week,

We have joint winners for this as I couldn’t decide between them.
Firstly Gretel Bergmann has had her German National high jump record restored after 73 years. On June 30, 1936, in Stuggart, she jumped 5ft 3in but this record height was removed from the record books by the Nazis because she was Jewish. She was also barred from the German Olympic team. She left Germany in 1937 and emigrated to America.
Whilst it has taken a little bit of time the German track and field association has decided to reinstate her record.

The other story is about Wigan Athletic (who are a football team, sort of). They played last weekend and they lost 9-1. That is not the heart-warming part, unless you are a Spurs fan (the team that beat them). No, the nice bit is that, after this thrashing, the players have said that they are going to reimburse all of their travelling fans who came to the match and who saw their team get royally spanked.


The Award for I’m Not Sure How I Feel About This,

In Nepal they have started their festival to the goddess Gadhimai. The celebrations included fortune-telling robots, a ferris wheel and stalls broadcasting music and offering tea and sugary snacks. Oh and they also sacrifice 250,000 animals. Yes, you read that correctly, I didn’t add any extra numbers. 250,000 animals will be slaughtered, including 10,000 buffalo. That is a lot of buffalo.
I’m not sure how I fell about it because whilst a lot of the animals will just be killed, at least the buffalo will be sold on and used for their meat and hide etc, so they are not going to waste.
If you are going to kill an animal in this coming week, the least you can do is eat it all up.

The Award for Changing It Everytime You Say it,

This goes to Radio 4 and the BBC in general. The family of Jean Charles de Menezes have accepted an undisclosed amount in compensation from the Metropolitan Police. I hope this helps to soothe their pain some what and that they understand that the entire country is sorry for the death of their son. I hope that they feel that they can move on with their lives. I also hope that news reporters can go back to not trying to think up new ways of pronouncing his name. I’m pretty sure that every time I have heard them try, they have said it differently.


Sorry to go on a bit this week. Hope you enjoyed my rambings and are going to register on the Organ Donor thingy, I'm off to obsess over my bird feeder.