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Don't exorcise one Demon by introducing another.
27 March 2008 .
The clinical excellence watchdog, NICE, has given its advice that women should avoid alcohol while pregnant or trying to become so. Excellent advice, if there's a risk to mother or (especially) child.
Except that the evidence seems to be that there's no risk, after the first trimester, in having an occasional drink. NICE mentioned in passing that its advice for the later stages of pregnancy isn't based on medical evidence but on moral/social thinking (in that there is a drink problem in society).
Perhaps abstention is still wise; but is it the job of a clinical body to rule on such issues on anything other than clinical grounds?
Apart from the distastefulness of living in a society in which more and more people think it incumbent on them to tell us how to live our lives in all sorts of ways - including often in areas that are none of their business... all these pronouncements have successfully wound up mothers who did not drink heavily during pregnancy but who are desperately and unnecessarily worried that they've done their child terrible damage through the half-dozen drinks they did have.
I'm not advocating alcoholic intake by mothers-to-be; in fact I regard alcohol as a very dangerous (and seductive) drug. What I do believe is that education can only hope to succeed on the basis of honesty.
'clinical excellence' NICE
Asbestos In Schools.
15 February 2008 .
There's been a report on ITV news this evening about the failure of local authorities to deal properly with unsealed asbestos, which can become fray and airborne in classrooms, despite recent guidelines. At the invitation of the head teacher, the ITV team investigated at a school in Brent and found exposed asbestos in the fabric and alarmingly high levels of fibres in the air. The HSE is apparently considering criminal proceedings against the council, but the programme suggested that there may be another 5,000 schools at risk around the country. Asbestosis (mesothelioma?) can take forty years to kill you, and is said to be incurable and a very nasty way to go.
This posting is just for the record. It concerns the school where I was teaching during the 80s and the continuing concern in the back of my mind about asbestos-related events there.
Several times we arrived at the school for a day's work to find that areas had been sealed off with plastic sheeting while asbestos was being stripped. At least twice the sealing was pretty ramshackle and there appeared to be no negative air pressure or other containment in action. Children regularly stuck their heads through the sheeting to see what was going on. After the second or third of these occasions, I spoke to the school's health and safety officer, who assured me that everything was in hand and that anyway all the asbestos had now been removed. When yet another operation started I spoke to the union's health and safety rep. I have to say that the NAS/UWT seemed to have no interest in the matter at all, but they did eventually report back that the asbestos really was all gone now.
A few weeks later, we had a break-in (not, I'm afraid, that rare an event...); this one was unusual - the villains broke in through the roof of the music department. After some hours, plastic sheeting appeared - there was asbestos in the air, released during the break-in. This time staff were at last beginning to get worried; at a staff meeting, we were officially told that the school was, now, clear of asbestos.
When more plastic sheeting appeared a few months later, I have to admit I had given up caring. If they were going to kill the kids, and me, they'd probably done so by now.
Twenty years on, I'm beginning to wonder if alumni of the school might be beginning to feel first effects. I'm beginning to wonder if I might be in line, myself.
Nothing changes. I bet Brent councillors don't even get a slap on the wrist.
unsealed asbestos schools HSE Brent
The Causes Of Suicide.
15 February 2008 .
Despite a recent, tragic and much-reported cluster of deaths in Bridgend, suicide by young men has been falling since it peaked to a very high level in the late 90s. It was probably only a matter of time before someone suggested that Blair's Britain, gentler than the Thatcherite Britain of before, is partly the reason. Some of the papers have been offering other suggestions about contributory factors, from smaller packets of Paracetamol to catalytic converters preventing self-poisoning by exhaust fumes; they do seem mostly to be speculation.
I don't know if it's possible to find out why there has been less suicide. Since it has been, and still is, a major cause of mortality in the age group, it's certainly something it would be helpful to understand.
What has been mentioned is that there has been a fourfold rise in the use of antidepressants; at the same time, elsewhere, there is pressure on GPs to reduce prescribing these: it would be nice to see some joined up thinking about this, or at least more certainty that people know what they're talking about. (Perhaps the newer antidepressants have been more effective: we may owe thanks to Prozac; perhaps even Seroxat, despite problems it has undoubtedly caused some youngsters, has on balance helped.)
One thing I'm personally certain of is that Britain did not somehow become a nicer place for young men to live in under Blair, especially since the same fall in suicides is occurring internationally; but that, too, is speculation - I may be wrong. Personally, I wonder if it might be due to the removal of lead from our petrol; but that's speculation, too.
suicide 'young men' Bridgend antidepressants
Supply and Demand: Doctors.
05 January 2008 .
On the one hand, three doctors applying for each vacancy this year. On the other, massive increases in salaries for doctors who are in work, resulting in six-figure state-dictated salaries - higher than, I believe, state payments to doctors anywhere else in the world (but I can't confirm that).
When it comes to nurses, teachers, firemen, porters, and all the other people doing front-line work at that sort of level, Parliament's argument against raising pay often boils down to supply and demand.
Interesting that there seem to be groups who are perceived as being above such constraints; among them, doctors. And MPs, of course.
salaries 'supply and demand'
It's The Way Things Are Going.
05 January 2008 .
140,000 a year coming out of our hospitals malnourished. Understandably, and properly, there is outrage - although in fact the figures have been shameful for years. Predictably, the Tories are expressing outrage, never mind that the figures were already half way there under their watch.
At first, I assumed that the figure was arrived at statistically, but it seems that it's actually the direct measure: 139,127 persons have been individually diagnosed as malnourished when discharged. That really is extraordinary: they are diagnosed and then just sent on their way? [It does rather depend, of course, on what is meant by malnourished; but some of the stories, especially of serious ill and elderly people having food first left out of their reach and then taken and thrown away without checks, seems to suggest that at least some of this problem is barbarically serious, up to the level of actual starvation.]
Unless a fair number of these people are serially mistreated, so that they're appearing in the statistics more than once, the implication of the figures is that this malnourishment is likely to happen to nearly one in five of us - not of those go into hospital, but of all of us.
In the face of all sorts of evidence, our government insists that vast amounts of money being poured into the system has resulted in a continuous improvement in the quality of healthcare in England. Certainly some doctors being paid up to L250 000 a year by the state could only be justified by that. However, this story alone puts the lie to their claims.
I am convinced that about August or September time our government claimed that about 8,000 patients a year in hospital were suffering malnourishment; the two figures are so different that I would love to know how the earlier figure was arrived at. Unfortunately, now I can't find any trace of the it.
It's tempting to ask how this can be happening in the twenty first century: I suspect that, in fact, it's going to be a template for the century.
hospital malnourishment healthcare
A Fair Bite of the Apple for Doctors.
05 January 2008 .
For doctors seeking posts this year, news reports say that there is going to be more intense competition than ever. They add that British trained doctors cannot be given any preference.
Rubbish!
The choice has been made by someone that home trained doctors should have to compete in this way - even though in many countries from which other doctors may come there is no reciprocation of that 'fairness'. Whether the choice is a right one or not is another matter; but I do hope that if home-produced doctors have to go to other countries, or can't get a job at all, they - and we - are allowed to know why the choice was made. Because I'm betting that the reasons were political, not clinical.
Be Careful When You Buy An Aspirin.
22 December 2007 .
A joke is doing the rounds (if you'll forgive the phrase, ha ha) that you had best not be caught on camera buying an aspirin - you'll lose your entitlement to treatment by the NHS.
Presumably, if you're buying it for a headache you'll be okay, but if you're buying it for the arthritis for which you're being treated, they won't treat it any more.
Would be any more surreal to punish you (which, in effect, is what they're doing) to refuse to treat you any further for an illness if you privately contribute a 50p aspirin to your treatment than if you privately contribute a L4000 cancer-saving drug? [Let's be clear that they are in punishment mode, notwithstanding the justification that for some patients to have partly private treatment would be unfair (!): in the example being widely reported, a woman's treatment costs L15000, but for one drug, costing L4000, the NHS won't pay. If she pays for it herself, they'll cancel the rest of the treatment.]
By the way, we haven't even mentioned that it's okay for the government to go private like crazy.
In the case quoted, the woman can afford L4000 (just about) but not L15000. The papers are saying that if the NHS stick to their policy, she will die very soon. Also being reported, albeit less widely, is that several people have already died prematurely, or unnecessarily, because of exactly this policy.
I assume that they wouldn't penalise you for buying an aspirin (although, who can tell, these days?) The interesting question is, where do they decide to draw the line? When they think they can save money, I assume.
I think it's all a plot by the government to make the whole system so odd that in the end we'll be glad to see the whole lot privatised and have done with it.
'Private healthcare and the NHS' 'right of access to NHS'
The Right To Commit Suicide.
22 December 2007 .
Until the 1960s, to attempt suicide was a criminal offence. Homosexuality (as we are always being reminded) would also see you banged up, as could bankruptcy (as we are not) .
Some of our more ante-diluvian fellow citizens believe that there is now, on the contrary, an active conspiracy to encourage our young to become homosexual (and actually, indeed, one could assume that it might help to keep the birthrate down); there really is encouragement - actively, in 'debt management' TV ads every day - for debtors to go into bankruptcy (and undischarged bankruptcy at that, so far as I can make out, with no intention ever to rectify it.)
Suicide, however, alone of the three quondam criminal offences, remains the subject of official censure; and aiding a suicide - no matter how awful the life of the person wanting to die, nor how rational their desire to do so - is still a criminal offence treated much like murder.
While understanding the need to avoid murder being concealed by apparent suicide, and profoundly aware of the risks of putting dangerous precedent into the hands of some perverse future authority (which even I don't think would ever actually happen in this country...): I believe in the absolute right of the individual to choose to die - and to ask for help in doing so.
I have expressed this opinion no more than half a dozen times since the 60s. Each time what I have said has been greeted with horror, at least at first; to some people, the suggestion seems to belong with eugenics or final-solution Nazism.
In the simplest terms (use of the first person is without significance!): if I wish to die, I cannot see how you, or the government, have any moral right or authority to tell me that I can't. Of course, if I have made commitments, such as by marrying, having children or voluntarily signing a contract, which I am still realistically in a position to honour, then that is another matter - I must do so. But if I have settled my affairs, then my choice to die is no business of anyone else's. I did not ask to be born, or to live in pain or hopelessness; to be allowed to die with dignity for one of these reasons or some other seems such a basic right, beyond any discussion.
A hypothesis: as a result of a nuclear war, everybody is faced with a prospect of dying, very unpleasantly, very soon (as, for example, in 'On The Beach', since I've already mentioned that book). Would the government insist that nobody be allowed to die by their own hand, come what may, not even those suffering from ghastly injury or illness? Or would it - as I assume - provide a means for people to die easily, so far as it could?
Why should the case of a person suffering alone, in today's world, be seen any differently?
Once again, I'm not sure that I'm arguing well. Perhaps it is, after all, a subject so deeply tabu that it's beyond argument.
Some notes:
I'm not trying to justify some wish of my own to die; my strength of feeling derives from suicides in my family, amongst friends and amongst students. I know precisely how hard suicide is for the survivors, and I'm still trying to come to terms with those I've known: but I have learned that each of them had the right to die, even if I'm not sure that they had the intention, or the rationality (those have to be addressed, too - but they are issues separate from the right).
Religious arguments are of no relevance whatsoever. To revert to the first person for a moment: that's your religion, not mine. If your religion forbids you to eat ice-cream, that' your business. I couldn't care less.
My feeling is: If I'm ready to go, but you (who don't even know me) tell me that I've got to stay because you want me to, or because you think I ought to, then frankly you've got a damned cheek.
I complain about the erosion of our rights. Some rights still have to be won.
'attempted suicide' homosexuality religion
a26.