An anecdote to sum up everything that I hate about the NHS

An anecdote to sum up everything that I hate about the NHS

About ten years ago, like many other young UK graduates of MSc programs, I was working temp jobs for a short while. One contract had me working for a primary care trust, although thankfully it only lasted for about three days. The money wasn’t great and the work was dull, consisting of filing files, photocopying files and shredding files.

I found myself in the basement photocopy suite one afternoon, when, skirts swishing with officialdom, a woman barreled down the stairs, headed straight toward me and proclaimed: “Out of the way! I have to performance manage three hospitals this afternoon!”

There’s not a lot you can say to that. Of course I stood aside. Bureaucracy was about to happen, and I was the obstacle in its path.

Just think of it. Three hospitals! Only one afternoon! Performance-managed, with a photocopier, for some reason, and I’ll bet she was paid more than three nurses to do the job. Who were then fired for not performing with adequate cost-effectiveness, as determined in just one third of an afternoon by a performance-manager, and replaced with a homeopath.

I made that last part up, but you have to wonder if it is people like this behind these kinds of decisions; like the decision of NHS Tayside to sack 500 staff, but hire a £68,000-a-year homeopath instead. Maybe someone in an office building, performance managing the hell out of NHS Tayside, decided this was a cost-effective, performance-enhancing strategy for optimising the effective delivery of strategic and operational goals.

Which I’m sure is nice, but it won’t help at all with delivering actual health care.

In which I also apply for a job as a homeopath

In which I also apply for a job as a homeopath

News reaches these Canadian shores of an extraordinary job opportunity: a £68,000 per year post for a homeopath to work just two afternoons a week. I have decided to apply.

ooOoo

To HR, NHS Tayside:

Herewith, my application as candidate for the position of Specialty Doctor of Homeopathy in your hospital.

Statement of Principles

Homeopathy is an important and essential healthcare modality. No other treatment protocol has so effectively medicalized the interpersonal neodialectic discourse that is the essence of healing, or, to put it in the crude vernacular, a ‘cup of tea and a bit of a chat’. I applaud NHS Tayside for standing firm against the totalitarian paradigm of evidence based medicine, and for their willingness to challenge the patriarchal dogma of so-called ‘Clinical Excellence’.

Qualifications

I have received many years of education at the patellae of my matrilineal elder, who elucidated a profound critique of modernism via juxtaposition with her own critical Marxist theory. The class divisions inherent in hospital hierarchies are ripe for desublimation and subversion and, in accordance with cultural libertarianism, I consider myself fully qualified (that is, unqualified, or, to use a postdialetic neologism, de-qualified) to excel in the position of Specialty Doctor of Homeopathy.

I do not hold any medical qualifications, although I do have a doctorate in the biological ‘sciences’, which I hope will not be held against me; admittedly, while the extensive exposure of the self to the microfascistic paradigm of so-called ‘peer review’ and ‘scientific standards’ may be seen as an impediment to the successful practice of a pre-Enlightenment system of knowing such as Homeopathy, I believe it instead gives me the critical perspective to self analyse, deconstruct and reject the status quo of rationalism that is the abundant narrative in hospital care.

I have a lifetime of experience in making, pouring and drinking tea, both alone and with other people, and am able to, at the same time and to a very high standard, listen to other people talk about their medical issues, pets, kids or gender conflict and sexual identity in the patriarchal, neo-liberal relational terrain of marriage to the differently-gendered (or like-gendered) ‘other’.

Finally, I am able to dispense homeopathic remedies while maintaining the standards of pseudo-scientific, Enlightenment-challenging narrative and discourse that is the defining characteristic of this particular treatment modality. This application is submitted as evidence of this ability.

Availability

I do currently reside in a different country, but rest assured, for £68,000 a year and for just two work sessions a week, I would move to Tayside in a regular, non-artery-clogged heartbeat. I hear the deep fried Mars Bars are to die for, as well as standing as a marvellous symbol of the paradigm-challenging nature of this job opportunity; in a country with the worst health outcomes in all of Europe, it takes guts to de-employ 500 proper health care workers and hire a homeopath instead.

Thank you for your consideration,

Doc.

ooOoo

Bad Science by Ben Goldacre

Bad Science by Ben Goldacre

I’ve been reading Ben Goldacre’s columns in the Guardian for years, so a lot of the stories in the book were familiar, but it is still a delight to see them put together into this book. After seven years of reporting, his particular and unique role has become critic on the role of the media and how they report on practicising scientists, although that isn’t to say that the media pay any attention to what he says. They really should.

Some of the stories are truly astonishing. The MRSA superbug scare, so prevelant in 2004, is shown to have been driven by a unethical collaboration between the media and a compliant MRSA detection ‘laboratory’. Even worse, the so-called lab was a garden shed. The man that the media lauded as the UK’s leading expert on MRSA had a non-accredited PhD from the USA, but he was their go-to guy for positive MRSA swab test results.

And lets not forget Matthias Rath. After being the subject of a critical Bad Science column, Rath took The Guardian and Ben Goldacre to court for libel. Eventually Rath lost the case, and an entire chapter of this book, devoted to the topic, could finally be included in the later editions after being excluded from the first print. If ever there was a good argument for guaranteeing the rights of journalists to criticise providers of health care, this chapter is it.

There is the usual supporting cast of bonkers homeopaths, peddlers of machines that turn water brown when you put your feet in them, and that awful poo lady Gillian McKeith. But the real villains are their water carriers, the compliant media that don’t seem to have even half a clue when it comes to science. Alternative medicine practitioners are celebrated while scientists are treated like eccentrics unable to make up their minds. All this matters because the public places far too much trust in what they read, and no greater example can be provided than the drop in public vaccination rates after the media-driven MMR hoax. Getting it wrong can, and does, cost lives and harm health. We should all be smarter, and this book can help.

A final note, to Ben Goldacre and his editors. I read a story as a child, possibly in Reader’s Digest, about a reporter who had developed the habit of peppering his prose with colons and semicolons. Despite his editor’s exhortions to cut back, he just couldn’t. The solution? One day, the editor took a pair of scissors and cut the colon and semicolon keys right off his typewriter. Forced to live without them, he found that his prose greatly improved. It is a lesson that I recall every time I want to reach for a colon or semicolon: do I really need to use them; and would the prose be clearer if they were not there? I err toward not using them, for the purposes of clarity. With that in mind, and maybe this is entirely my own complaint, reading Bad Science was somewhat like bicycling in a North American suburb. You are getting up a good rate of speed when you encounter an inexplicable stop sign. Even if the road you are on is busy, and straight, and the only junction is to a lane with just a few houses on it, there’s a stop sign. You can see the destination ahead, but to get there will take three or four stops and restarts before the road – like the sentence – ever ends.

It’s a minor complaint, and Ben Goldacre’s unique prose style certainly hasn’t stopped me purchasing three copies of the book, two of which were to give away. I find that I think of Bad Science as a bit like the A-Team of critical thinking books: “If you have a friend knee deep in woo, and no one else can help, and if they read books, maybe you can buy them Bad Science.” It wouldn’t hurt.

BCA vs. Simon Singh: a letter to an MP, and the responses

BCA vs. Simon Singh: a letter to an MP, and the responses

Back in June, I wrote the following letter to my MP, and received a reply, also printed below.

I encourage anyone who is concerned about the chilling effect and consequences of the BCA’s libel case against Simon Singh to contact their Member of Parliament. MPs that are aware of this case, and are made aware that it is of concern to their constituents, will be much more likely to do something about it.

Representative democracy is responsive democracy, but MPs first need something to which they can respond. So, write!

Dear [M.P.],

I write to express my deep concern regarding the recent libel case brought by the British Chiropractic Association (BCA) against Simon Singh, and the implications for English libel law.

In 2008, Simon Singh wrote a comment piece in The Guardian newspaper on the evidence for and against chiropractic. The BCA took offense at one line in particular, on the lack of evidence for the use of chiropractic in treating babies. Simon Singh had recently written in depth about the evidence for chiropractic in his book ‘Trick or Treatment?’ and so knew well of which he spoke in the comment piece. He is, as am I, a scientist, and therefore is used to the scientific method: in the face of scrutiny or disbelief from our peers, we endeavour to defend our work on its merits and on the evidence. This is how science progresses, and it is how advances in medicine are made. It is how the public good is protected. Yet the BCA, rather than provide a robust defence of their practices and claims, chose instead to sue. What was an earnest comment, written in the public interest and for the public good, was pulled by The Guardian as soon as the writ was served.

The implications are profound. You are surely aware of the concerns that many have regarding English libel law, but with this case, English libel law has taken a turn down sinister new paths. For anyone considering writing about the evidence, or lack thereof, for a treatment, the threat of a libel action will have a chilling effect on that intention. The public good is poorly served when scientists or health professionals cannot write freely about evidence and fraud in medicine, for fear of damages and costs that can run into well over 100,000 pounds just for a preliminary hearing.

In the field of public health, it should not be open for any provider or promoter of treatment to sue for defamation in respect of their provision or promotion of those treatments*. There must be a balance between the rights of the individual to protection of reputation, and the rights of the public to hear discussion of the merits of treatments provided by said individual. Defendants should be protected by qualified privilege in such cases, as are journalists under the so-called “Reynolds Defence”, or we may see further erosion of the rights to free speech and comment in England.

I note that the Commons Select Committee on Culture, Media and Sport has been considering libel law. I hope that by bringing this particular case to your attention you will be more aware of the serious and chilling directions that libel law has been taking, and will be able to offer whatever appropriate support you can toward moderating these tendencies. Additionally, the charity Sense About Science has been campaigning for a change in the law, and your colleagues Dennis MacShane, Michael Gove and Dr Evan Harris have put their names to a statement of support that you will find attached to this letter**.

Yours, [name here]

*{h/t to JoK}

** see here and here.

A few weeks later, I received the following reply.

Dear [me],

Thank you for your letter regarding the recent libel case brought by the British Chiropractic Association (BCA) against the journalist Simon Singh, and the implications for English libel law. I apologise for the short delay in responding. Your concerns about journalistic freedom of speech and the UK’s current libel law are duly noted.

Freedom of speech is essential in a functioning democracy and indeed is recognised in international and human rights law. The right to freedom of speech is particularly important to the media, which plays a special role as the bearer of the general right to freedom of expression for all.

I have therefore written to the Rt. Hon. Ben Bradshaw, Secretary of State at the Department of Culture, Media & Sport about this issue and have asked him to comment. I will let you know as soon as I receive a response.

In order to get the reply to you as quickly as possible, I may forward it to you directly. However, if there are any issues arising from the response which you wish to pursue further, please do not hesitate to let me know.

Thank you again for bringing this issue to my attention.

Best wishes,

[M.P.]

In August 2009, I received the following letter from Bridget Prentice, the Parliamentary Under Secretary of State, to my Member of Parliament. He was good enough to forward it on.

From: Bridget Prentice MP. Parliamentary Under Secretary of State.

Thank you for your letter of 26 June to Ben Bradshaw at the Department for Culture, Media and Sport, about a recent libel case brought against Mr Simon Singh. Your letter has been passed to this department and I am responding as the Minister responsible for civil justice issues.

As a Government Minister I am unable to comment on individual cases which are or have been before the courts. In that context, I understand that this case may be subject to appeal. However, it may be helpful if I begin by explaining the law in this area in general terms.

It is important that people have an effective right to redress through the law of libel where their reputation as been damaged as the result of the publication of defamatory material. Whether material is defamatory is a matter for the courts to determine based on all the relevant circumstances. The main tests established by the courts in determining whether material is defamatory are whether the words used “tend to lower the plaintiff in the estimation of right-thinking members of society generally”, “without justification or lawful excuse [are] calculated to injure the reputation of another, by exposing him to hatred, contempt, or ridicule”, or tend to make the claimant “be shunned and avoided and that without any moral discredit on [the claimant’s] part.”

Your constituent is concerned about the effects of the libel laws on freedom of speech. The Government firmly supports the right to freedom of expression, which is protected by Article 10 of the European Convention on Human Rights (ECHR). In addition, section 12 of the Human Rights Act 1998 requires courts to have particular regard to the importance of the right to freedom of expression, particularly in relation to freedom of the press. Of course, the exercise of this right carries with it duties and responsibilities that are expressly recognised in the law. It is not an absolute right, and can be restricted for a number of reasons set down by law, such as public safety, the prevention of crime, or respect for the rights or reputations of others. Often, the right to freedom of expression may need to be balanced against other rights, like the right to respect for private and family life, home and correspondence, which is protected by Article 8 of the ECHR.

As you may be aware, the Department for Culture, Media and Sport Select Committee is currently conducting an inquiry into Press Standards, Privacy and Libel and is considering a wide range of issues in this area of law. The Justice Secretary gave evidence before the committee on 19 May and the Government will consider carefully any recommendations that the Committee may wish to make in its forthcoming report.

I hope you find this information helpful, and I enclose a copy of this letter for you to forward to your constituent, should you wish to do so.

Bridget Prentice.

Beware the spinal trap

Beware the spinal trap

What follows is a reproduction, with a slight modification, of an article published in The Guardian in 2008. Written by Simon Singh, that article prompted a libel action from the British Chiropractic Association. The ensuing court case has resulted in much focused critical attention on chiropractic in the UK and around the world, and a campaign to change the libel laws in England. This article has had the ‘libellous’ sentence removed.

Read more about Simon Singh’s court case and the Sense about Science campaign here.

Beware the spinal trap

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that ‘99% of all diseases are caused by displaced vertebrae’. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: ‘Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.’

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher. If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial. This is an edited version of an article published in The Guardian for which Singh is being personally sued for libel by the British Chiropractic Association.

Brits wary over cancer advice

Brits wary over cancer advice

As Ben Goldacre once said,

“[T]he Daily Mail does have an ongoing ontological program to divide all inanimate objects into ones that will either cause or cure cancer.”

The result?  Brits are now “‘wary over cancer advice'”.

The YouGov survey of 2,400 people for the World Cancer Research Fund (WCRF) found more than half thought scientists were always changing their minds.

More than a quarter said health advice changed constantly and the best approach was to ignore it completely.

Here’s looking at you, Daily Mail.

Seriously, readers of British newspapers can be forgiven for not having a clue about cancer advice. The WCRF has to compete on a daily basis with stories about cancer-causing and cancer-preventing chocolate, red wine, red meat, lipstick, and on and on and on.

But it isn’t all that complicated. As the WCRF put it,

“The fact is that WCRF and other cancer charities agree on the best ways of reducing cancer risk and this advice has stayed broadly the same for quite a long time.

“A decade ago, we were recommending that people eat a plant-based diet, be physically active and maintain a healthy weight and this is still the case today.”