Placebos

I was interested to see the reports that half of German doctors prescribe placebos. Presumably not all the time no matter what, only when they feel appropriate.

These doctors say the treatments often work, and I cautiously believe them, particularly when they were used instead of anti-depressants. The placebo effect is a documented fact, even if we don't quite know how it works - but it raises interesting ethical and legal dilemmas.

Is it right for a doctor to 'trick' their patients, even if it may help their condition? Is the doctor immune from prosecution if he or she prescribes a placebo and the condition worsens?

These placebos even include injections and sham surgeries, which seems a bit much, but I'm probably being squeemish.

The German equivelent of the BMA advised that better training should be given on the use of placebos and, most importantly, for international guidelines on their use. That seems quite sensible to me.

South Korea disease outbreak

I've not seen this reported in the English press at all. You have to go to Cattle News (!) to find out that there is a massive animal disease outbreak in South Korea, and they are only reporting it because of the impact it's having on US markets.

As things stand 16% of the entire pig and cow herds have been slaughtered (2.1 million animals). Obviously the markets think this is great because it has seen a jump in the future's markets. “The movement of animals is completely paralyzed,” said Dennis Smith, a senior account executive at Archer Financial Services Inc. in Chicago. “They basically are not producing any meat for their retail counters. They’re going to have to come to other people, primarily us.”

At the same time they are suffering a bird flu outbreak. Considering how much the press used to go wild over bird flu stories the fact this is passing them by seems perverse. The bird flu immediately prompted the authorities to cull half a million birds and we will have to see if this has contained the outbreak.

The Wall Street Journal blog reports that "people involved in the months-long containing operation are reported to be suffering from psychological damage. The National Emergency Management Agency said in a statement today it started a program to support approximately 6,500 people involved, including farmers, vaccinating and culling officials, with a psychological program."

In addition to this the outbreak may have spread to North Korea and they are currently suffering their coldest winter for some time. Not good news, but it is, I think, news which has been almost entirely ignored in the British press.

CSR special: Ring-fencing NHS, schools and aid

There are a number of departments that the government has protected from themselves (which is obviously very merciful). To much headlines the NHS, schools and DfID are all areas where the Comprehensive Spending Review has not bitten... or did it?

The NHS budget is protected with an extra ten billion over the next four years, the schools budget retained and to much trumpeting aid is, in fact, increasing. However, this is not the whole story.

Many health campaigners are understandably confused at the way the coalition say the NHS is safe in their hands but they still seem force to fight to retain services and fight privatisation. roughly one in five trusts admit that they have closed down a major service or department in the last few months. The privatisation is ongoing Tory/Labour policy but why should services be closing down if the money's protected?

The answer is three fold. First of all the overall budget is ring-fenced, not individual services and the rise (of 2.5%) is actually less than the increase needed to preserve services. That means if the money is moved into one area it inevitably has to move away from another. The government is very keen on an extraordinary overhaul of the structures of the health services which, in itself will cost money that would have been spent on other services, leaving aside whether that reorganisation would be a good idea.

Secondly the capital expenditure is being reduced by 17% and there are twenty billion pounds worth of 'efficiency savings' already in the pipeline.

Thirdly, the increasing cost of drugs in particular (as well as additional strain of obesity and an aging population) mean that certain areas of spending are eating up more than their fair share of the cake.

Public sector union UNISON was very clear on how the ring-fencing will still mean cuts when they said that; "Patients and staff will soon see through the facade that the NHS is being ring-fenced, when at the same time it has been told to make £20bn worth of savings.

“The NHS is not safe. Some hospitals are already cutting back on vital life-improving operations such as cataract, hip and knee replacements. The NHS needs extra funding just to stand still. It will not be able to keep up with the demands of a growing elderly population and the cost of increasingly expensive treatments and drugs.

“The Government’s latest NHS “reforms” will intensify the market and introduce more private sector provision. They will cost £3bn to implement and create havoc and instability just when the NHS can least afford it.

“Staff are facing a two year pay freeze, many vacancies are being left unfilled, pensions are under review and the number of managers will be cut by 45%. Another Tory broken promise – the NHS is under siege – it is not being protected."

So what about schools?

Well, this is slightly different. Back to UNISON; “The coalition is being dishonest by saying that the schools budget will be boosted. Schools also get vital funding and support services from local authorities, which are being hit by drastic cuts. Many will struggle to afford to help schools support children with special needs, or run truancy units. Schools will have to dip into their own funds to pay for these essential services.

“Up and down the country schools support staff are facing losing their jobs. It all adds up to mean cuts will disproportionately hit on children with additional needs in schools.”

Essentially the 'schools budget' makes up only a portion of the total moneys that schools receive which is why specialist services, like one to one tuition are under threat. Local authorities, as we have already seen, are under a huge amount of financial pressure and it would unbelievable if their contribution to schools did not suffer.

Oh, and then there's the lost funding of the Building Schools for the Future programme which lost billions in investment for schools in dire need of refurbishment. In fact, after the fiasco of the handling of BSF scrapping (which turned out to be a hell of a lot more popular than Gove expected) it's arguable that it would have been impossible to take more out of schools than they already have.

Aid

Now, surely I should be overjoyed to hear the news that there will be a significant increase in the aid budget? 37% over four years looks pretty good, especially in the context of the cuts. Well, let's take a closer look first.

Tucked away in the Foreign and Commonwealth Office cuts it turns out that a number of their projects will now be delivered by DfID, how many and how much they will cost is left unanswered as yet. More importantly while the FCO is to "increase its focus on championing British companies to win export" they also account for a good portion of the increase in Official Development Assistance (ODA).

After all while other, much more useful, quangos went to the wall the Export Credit Guarantee Department who love the shady world of arms exports, etc, and all that entails.

I'm intrigued as to whether there will be any slippage between meeting the Millennium Development Goals and maintaining British financial interests. I should point out I'm not being artful here, it genuinely unclear so far - however - Section 2.97 in the Review states "British international development policy [to be] more focused on boosting economic growth and wealth creation".

Continuing my concern that the aid budget may be being used with an eye to British interests is that 2.97 continues that 30% of the ODA is to be used in conflict countries "with particular focus on Afghanistan and Pakistan". I'm really sorry to be cynical and I'm not down playing the fact that these two countries desperately need aid but for the British State to focus on areas where British troops are in conflict with the locals is not a coincidence.

Anyway, while an increase in the aid budget is always welcome we should ensure that aid should be used as aid not as an adjunct to business interests or the military effort.

While we're talking about DfID it's to be welcomed that a *new* quango overseeing how the money is to be spent has been set up however I'm concerned by the idea that DfID is to be a "leaner organisation with a focus on managing aid efficiently and effectively, by seriously reducing back office costs." Sorry to be picky but cutting admin costs does not automatically make you more efficient and effective.

Indeed DfId had already been streamlined under Labour and this had resulted in severe restrictions in the number of projects they could manage. The consequences of this is that aid will tend to be delivered either by the very biggest NGOs or consortiums of large NGOs.

Smaller international development organisations (of which there are many) already find it extremely difficult to work directly with DfID because they simply do not have the capacity to work with the small fry. The Coalition's proposals will simply deepen this trend driving small specialist NGOs out of business while heaping money on their super-sized cousins.

All in all what I'm trying to say is that it is not surprising that the Coalition have tried to win as many good headlines as they can amid the carnage - but ring-fencing services does not, in this case, mean that the future of those services are secure.

NHS Direct

It looks like NHS Direct is to be replaced by a different deskilling call centre masquerading as part of our National Health Service. 'NHS 111' which is being trialled in two counties at the moment may well take over the functions of NHS Direct "within three years".

NHS 111 will employ less qualified nurses but rather will train its staff to the standard of 999 operators who, as it happens, are very good. Some people are up in arms about this but I'm slightly more cautious.

I sympathetic with Luna17 when he says that "I wonder what does count as a 'frontline service' in the minds of government ministers". The phrase frontline services has always been a perplexing one as it is unthinking populism that implies that workers not involved in face to face contact with the public are less useful, essential or cost effective than emergency workers - which isn't true.

Mr Andy C says that the government "are using some of the funding for a pointless and dangerous re-organization of the NHS and to pay for it they are cutting services." Well, I'm certainly for less NHS re-organisations. As someone who worked in the NHS for eights years and underwent a number of Labour led shake-ups I can testify they are a pain in the bum, tended to lead to a worse service and when laid on top of each other disorientated and demoralised staff.

However, I wont be signing the Save NHS Direct petition. I'm opposed to the slash and burn cuts of the coalition government, I'm not going to make it a point of principle to be opposed to any reorganisation or more efficient use of resources.

As far as I'm concerned when the service was set up it was part of an ongoing process of deskilling the professions. So we have PCSOs, teaching assistants, and call centre workers instead of police officers, teachers and doctors. All of the former do good things, but as a trend it undermines the quality of public services. It restricts the number of professional jobs that command professional wages available. Many teaching assistants and PCSOs actually want to be in fully qualified positions but find the opportunities closed.

When NHS Direct was set up Socialist Worker said "Advice line NHS Direct, one the flagship proposals of the government's health service "modernisation", is endangering people's lives... by giving wrong advice and not recognising emergencies" and reminded us that "New Labour touts schemes like NHS Direct, where patients ring up for advice on the phone or, as announced this week, on the internet. But these schemes do not substitute for the lack of resources and facilities."

At the time NHS Direct was set up (1999) doctors criticised the new service as misdirecting resources, creating its own demand and described it as a substitute for adequate "frontline" resources. There's been a consistent criticism, that substandard advice was being given - for example see Earwicga today - and in those all important emergency cases it can delay the time from when the first call is made to when the ambulance arrives.

More recently, the British Medical Journal reported that the BMA had recommended scrapping NHS Direct along with other costly initiatives like PFI and the NHS Database. This is not because the BMA want to scrap the NHS, but because they want the money used in the most efficient way possible.

If NHS Direct goes it does not mean that suddenly there will be no medical advice available, it means it will be provided in a different way. I'm perfectly happy to believe that people have been given good advice and even some lives have been saved when calling this service - but this does not mean we shouldn't find better ways of doing things or forget the numerous problems. Private doctors save lives but it does not mean I have to be in favour of a privatised health service.

As far as I can see the NHS budget is still ring-fenced and, while I don't trust the Tories with the NHS, I'm not against value for money or scrapping services that aren't that great. I am against a slash and burn economic policy but I'm not so sure this is an example of that and the reaction against smacks more of tribalism than anything else.

Doctors to break confidentiality

I was disturbed to see the news that doctors are to be given leeway to break patient confidentiality. The BMA has agreed with the police to share patient information where gun owners suffer from mental health problems.

I'm uneasy about this on a number of levels, whatever benign thinking lies behind the idea.

In general there has been a lack of knee jerk responses to the Cumbria shootings from the political establishment, despite the fact that the press felt unable to stop itself from page after page of unseemly rubber necking coverage for day after day. This proposal however could have serious implications.

The BMA has said that "Where doctors know that a patient has a firearm and, in their view, as a result, presents a risk of harm to themselves or others, both legally and ethically, this information can be disclosed without consent."

Part of this new move means that the gun ownership register will be linked up (in some way) to patient records where all medical records of gun owners will be 'flagged'.

There are two key problems with this in my view. Firstly, it could well prevent gun owners from seeking help from their doctor, actually increasing the probability that they will pose a future risk to themselves or others. If the consequence of having mental health problems will be that police officers, who are not properly trained in these issues, are informed that you are a public risk it's a fairly large disincentive from telling your doctor about your problems, not to mention the unpredictability of the actual response of the police when given this information.

The intention may be that doctors only inform the police in the clearest possible circumstances (although this is not explicitly stated) but it is introducing an onus upon doctors to correctly identify when mental health issues are likely to lead to murder or suicide and when they will not - which is a heavy and impossible responsibility.

The second point is that many services find it difficult to get people to come forwards and give confidential information. A slippage in confidentiality creates a problem for every service that relies on the public having absolute confidence that information they give will go no further because it means that there is a redefinition of our terms taking place.

Confidentiality ceases to be an absolute, where a patient or service user can confide information without things going any further, and turns it into a grey area where, generally, no one will be told but sometimes they will be. That's socially dangerous and could well undermine the ability of the mental health services to do their job.

Green Party conference: Animals, science and health

For those who've been following these things there has been an ongoing "re-evaluation" of Green Party policy around scientific evidence. This came about mainly due to a few journalists helpfully letting us know that there was some deeply dodgy stuff in policy. It certainly came as a shock to many of us who had not thoroughly read our voluminous policy documents.

This conference saw the first swath of re-orientating our policy on a more science friendly footing. As one of the Party members who've been quite heavily involved in trying to change party policy the experience has been instructive and, I think because we were friendly and open minded in our approach - taking our time rather than just trying to crush anyone who looked like they were in opposition to us, the whole process has been quite effective.

I've already mentioned this but conference started well, as conference passed the motion on abolition of the science pledge. A policy so offensive to scientists and 'technologists' that it makes me wince just to think of it. Anyway, it's gone. Hurray.

This was quickly followed by the passing of the science chapter enabling motion which means that the party has officially endorsed a review and rewrite of our entire science and technology section of the PSS, our core policy document. That's going to take some hard work and we'll be looking for people both inside and outside of the party to help us with that process.

Health

However, some of the key problem areas were in the health chapter which is why a review of this section was prioritised and we voted on this new document on Saturday and this morning. There were a whole number of improvements made and it's to the great credit of the health group that these went through relatively smoothly.

Many of the amendments to policy were on subjects like patient empowerment, the way private medicine feeds off the NHS and breast feeding but I'll stick to the science stuff for the time being.

The headlines in this are that we state that we "will not make judgements on individual treatments or medicines" as that is the job of regulators and scientists which replaced a very specific and somewhat rigid list of treatments we, apparently, like in favour of others.

In HE312 we have removed the idea that health research will have a "particular emphasis" on "holistic treatments" and "complementary therapies". We removed the statement that "vivisection is of questionable value and incompatible with ecological philosophy" replacing it with a section calling for "a thorough evaluation of animal tests" which seems difficult to disagree with as it happens already.

In HE314 we previously had the difficult situation where we appeared to state that alternative therapies did not require the same kind of regulation as more conventional medicines. Conference amended this to ensure that all medicines are properly regulated and subjected to the same controls "based on the best clinical evidence available". We also deleted a long section on "natural medicines", whatever they might be.

Importantly HE315 now states that "We recognize that the assessment of treatments... should be driven by clinical need rather than either political or commercial influence."

Bizarrely, we did have a policy that opposed some stem cell research (but not using adult stem cells) and appeared to be, and maybe even was, the sort of thing George W. might have approved of. This was also problematic because it clashed with our 100% pro-choice agenda on abortion.

Now the policy reads that we look to the "benefits to humans and other animals from stem cell technologies, using both adult and embryonic cellular material. These benefits include direct medical advances, improved non-animal testing methods for new medical treatments, and the advancement of knowledge." What a relief!

Animals

As a last part of this process this conference we also took a look at the animal rights section and although the motion, C9, that I proposed was not passed the animal experimentation policy has been improved by removing direct reference to "scientific" grounds for opposing animal experimentation and the rather blanket reference to "superior non-animal technologies" which implied all animal tests had an already existing superior alternative that did not involve harm to animals.

However, my ambition to strip out all reference to scientific grounds for opposition to animal testing was not approved by conference. I had hoped to stick to the ethics of animal rights within this section and leave the policy on the utility of animal testing to the health section, which seemed more appropriate, but I think members thought this was a step too far and they wanted policy to reassure them they were objectively right on a moral stance. I'm determined to see the positives of this but secretly I'm gutted at this (single) conference defeat.

The debate itself was conducted in a very friendly way and I'm grateful to those who disagreed with me (us) for the open, honest and political way they debated the issues as sometimes these things can get very fraught.

When push comes to shove the Green Party has made great strides forwards at this conference and the focus is now to pull apart the science policy and make sure it's strong, evidence based and relevant to a campaigning political party that wants to see progressive change. All help much appreciated.

Ben Goldacre on Placebos

I thought this was a very interesting short talk from Dr Ben Goldacre on the placebo effect.



The thing that surprised me the most was when he described how even animals feel the benefit from the placebo effect. I'd love to see the proof of that because it sounds absolutely bonkers.

I particularly like the way that he describes how placebos work but, because it's unethical to lie to patients we should not use them - but we should use the fact that they work in order to make pre-existing, proven treatments even more effective.

(h/t Neil)

An aside

Last night I was listening to someone talking about healthy eating and how important it was. They mentioned pies three times as an example of things that are bad for you.

Ever since I've not been able to concentrate for thinking about those naughty pies. Just a few minutes ago I finished a deliciously greasy steak and kidney pie, something I've not eaten for months.

Let this be a warning to others who wish to make me eat a balanced diet - you may do more harm than good!

Vaccination and the media: Correcting the damage

We've seen a lot of coverage this week of how a young woman of fourteen tragically died after receiving a cervical cancer jab. It turns out that she had a very serious tumour which was the cause of her death, not the jab.

Due to the media coverage which is always up for a scandal to sell a few extra units, there is a real risk that many parents will be very worried about the safety of the jab which will save hundreds of lives every year.

If those parent use Google to research the topic they will currently be inundated with dangerously sensationalist media stories that may cause them to think twice about getting their child vaccinated. Ironically that would put their child at risk from an actually existing threat out of fear needlessly generated by some sections of the press.

Online journalism recommends that we all boost more reliable information, by linking to it, so that concerned parents will at least arrive at more informed opinion as their first port of call. That information can be found at cervical cancer jab and cervical cancer vaccine and cervical cancer vaccine Q&A.

(h/t Dogwood Tales)

In memory of George Tiller

Murdered by a member of a right wing militia yesterday as he served as an usher in church, Dr George Tiller was no stranger to suffering violent attacks for providing women the choice over their own reproductive health.

Anti-abortionists (sometimes misnamed pro-life) had picketed his clinic for years, there was a bomb explosion at the clinic in the 80's and he was shot twice in 1993 at a time when a whole number of people involved with reproductive health had been assassinated. Anti-abortionist activists even turned up to a service in remembrance to him today (right) even whilst paying lip service to the 'love of Jesus'.

Despite the intimidation he continued to provide this service to the community having been inspired at an early age by the case of a woman who had died during a back street abortion. He was fully aware that he was in danger by doing what he was doing but he had the courage to continue and it is impossible not to admire him for that.

The anti-abortion movement in the US, which is also opposed to sex education and freely available contraception, is overwhelmingly right wing in nature and is based upon intolerance rather than any religious teaching. Everyone should reject it, religious or atheist, for the hypocritical and hate filled movement that it is.

President Obama, who was heckled by 'pro-life' students earlier this month, has sent in US Marshals to protect other clinics round the country. The following news report covers the community remembering Dr Tiller;



George Tiller, in his own words;




Other physicians murdered in this sick cause include David Gunn, Barnett Slepian, and a whole number of others. You may also like to visit Physicians for Reproductive Choice and Health.

It's an epigemic!

I'm sorry. I just can't take this seriously. I do apologise but the British press are just going bonkers over this - where's your stiff upper lip guys? Some random person on the radio just said they were "calm"... urgh.... good? Unless you have a reason to think you're going to die of swine flu you have no reason to think you are going to die of swine flu. End of.

For example, I think the normally sane and rational Daily Mail is guilty of irresponsible fear mongering when it says 40% might die by the weekend and that "Face masks could prove useless in combating the killer swine flu virus, experts have warned." Please, please, please get back to the high quality journalism Mail.

The Guardian coverage has been mixed. Tanya Hyde was rather interesting, placing the flu outbreak in some sort of context. Whilst Mike Davis writes one of the stupidest articles I've seen for some time, and I can assure you there's a lot of competition! I suppose they are trying to cater to everyone - from people interested in the news to facile idiots who enjoy end of the world scenarios. The whole spectrum.

Gold star goes to The Independent who not only have the best coverage today (both in tone and content) but are also the only national newspaper not to have the porcine plague as a lead story on their front page. Kudos.

On the other hand Aaron has written a great post giving everyone sensible advise on how to cope with the aporkalypse. James points to a great 70's swine flu propaganda film they could re-use. Classic.

XKCD has the illustrated guide that no one should be without and this photo shows how swine flu got into the human population. It is "safe for work" but still disgusting!

Interesting bit of news: Israel has said it should be renamed Mexican flu because it's better to offend Mexicans than pigs, or something.

Phil writes a much more measured and level headed piece that doesn't down play the seriousness of dying of flu but heavily critiques the way the press has dealt with it. Too sensible by half in my book.

Many a happy hour did I spend listening to the Subhumans in my teenage years. Never has their song The Pig Man (3 mins 46 secs) seemed more appropriate. Enjoy.