Monday, 19 April 2010
My friend and fellow blogger Dr. Rohen Kapur, has in a fit of splendid insanity enjoined in the UK Election Campaign. He is one of that strange breed I admire so much; an honest Doctor who wears his integrity on his sleeve. As an MP he could do so much to take the fight for OUR NHS to the palace of power. It does take money however, so dig deep and get the coppers out of the piggy bank !
Go to his site and donate http://henrynorthlondon.blogspot.com .
A brave man with not a lot, has put his money where his mouth is, lets all help.
Sunday, 18 April 2010
"Doing the same thing, over and over again and expecting different results". That statement made by my friend Rohen Kapur on his blog rang such a bell with me, I decided to use it myself. I'm sure that Rohen, now shorn of his disguise as Henry will not mind. He has, as you will see, cast his lot and a good slice of his dosh, into standing in the Election, which apparently is happening quite soon. Although I sadly cannot vote for him, I do urge those that can, to do so
It continues a theme of mine about the use of 'junk science' by the Politicians, Media and scurrilous members of the scientific community, who peddle 'advocacy research' as truth, to press home their politically correct viewpoint at the expense of both the truth and the health of the Nation.
We have been bombarded by the view, that we are killing ourselves and our children, with the wrong food and drink. Opening ourselves to Heart Disease, Stroke and Cancer, together with Diabetes and Obesity is all laid at the door of the Citizen, who it seems are all 'couch potatoes'. We are never talked to, we are only talked at, by the Agencies of the State, who, almost universally, advocate we should eat fruit and vegetables at the expense of proteins, and fat: well that's poison and is responsible, virtually on it's own for all the Heart Disease in the World. If such a simplistic view on Nutrition had any merit, surely after 20 years of peddling the same wares, we would have expected a sea change in the health of the Nation. Make like the three wise monkeys at the sight or mention of lard, of dripping or coconut oil otherwise you will die !
Fat people are now 'obese' and it is always their own fault, or in the case of their children, their parents. They are always told they are complicit in their own demise and virtually never believed when they relate how dedicated they are to their diets and their offspring. It is always assumed that the proletariat does not posses the brains they are born with. That they are incapable of adhering to simple diets, or have the welfare of their children at heart. Politicians, after seeking the vote of their electorate, whom they imbue with enough sense to make a choice between candidates, then deprive them of commonsense in the execution of the simple protocols, given them by dietitians. It seems to never occur, to these architects of the disaster of Change 4Life,that they could be getting it wrong !
Twenty years is more than long enough, for the experiment in the diet that the exercise and '5 a day' guru's propound, as being the way to a long and healthy life, to yield at least some fruit (sic). We in the West and now in the East as well (because they have listened to us) continue on a downward spiral of obesity, diabetes, and cancer. We fail to heed any of the study results that refute the 'fat-diet-heart hypothesis' as being unproven even faulty and continue as Einstein said in the quotation I started with, to do the same. We have now recruited the Food Lobby to join in the advocacy of lunacy that Change 4Life is with promotion of 'smoothie' consumption, and heart 'friendly' breakfast cereals, all of which are laden with fructose, or worse that cheap sugar substitute, High Fructose Corn Syrup.
Is it not part of this madness that they tell you to cut your sugar intake, but also advocate consumption of smoothies ? Does it not impinge on those that peddle this nonsense that they are laden with sugar: fructose. Fructose is a Sugar, worst it is a simple sugar that does not require insulin to be metabolised in the human. It does as a consequence, convert to fat more readily than almost any form of sugar available. HFCS has been attributed with other dangers, both to the liver and to high outputs of uric acid, an excess of which causes gout. There has been some small retreat from its use by Pepsico, who have stopped using it in Gatorade under consumer pressure, but as its costs are half that of sugar (sucrose), use by the soft drinks industry remains almost universal. Perhaps its most insidious trait, is it does not evoke a response in the body to 'switch off' the need to stop eating or drinking. Most 'natural' foods sate the appetite and the brain tells us to stop eating, this does not occur with fructose. We have all felt the urge to eat, very quickly after the consumption of fruit, especially sweet fruit. This is a problem, as we then consume extra calories, all of which go to fat storage.
Similar reactions take place with breakfast cereals as HFCS has almost been universally adopted as the sweetening agent. Who could complain about using corn syrup to sweeten corn ? Well er... me! Intuitive statements in science, the most intuitive of all of course being that 'fat makes you fat', are nearly always WRONG. Science knows it, most of those making the products know it, I'm sure even some in the Food Standards Agency do, but are perhaps like many. It is not in their interest to 'rock the boat' of conformity. They've been doing the same thing for twenty years and there would be a lot of egg on a lot of faces to effect such a change.
The truth is at last coming out but it's a long tunnel and as yet the light at the end is very dim. We need to rethink many things about our lives but most, of all we need to take possession of our own health and stop listening to the Food Industry Lobby it's called the Government !
Tuesday, 13 April 2010
There are a few adverse comments in the report, probably to convince the watching public that they are doing something, but on the whole the ex-chief's handprint seems in evidence, to cynical little me. Having only left in January, Nial Dickson's influence, is unlikely not to have been present in its compilation. Sure, there have been a number of goals achieved in thirteen long and expensive years, mainly in the reductions in waiting times and the establishment of NICE, but waiting time reductions, at the expense of quality of care, seems a pyrrhic victory to me. As for NICE; well more a defeat, snatched from the jaws of victory.
They also congratulate the establishment of the NPSA (National Patient Safety Agency), as do I. It's somewhat of a pity that most Trust's ignore its advice and fail to implement much of it's protocols Also highlighted, is the reduction in Hospital Aquired Infection, but fail to register that it is the Trusts and the Dept. of Health's fault, that they allowed these appalling infection rates, to evolve in the first place. Dirty Hospitals and over use of antibiotics fails to get a mention as the root cause. Under reporting, is mentioned as a problem, even a major one, but it only mildly states that "there is some way to go, on creating a fully open culture of reporting (of incidents) within NHS organisations". No mention of any 'whistleblowers', note, or the need to support their courage, or future livelihoods.
In health promotion and the management of chronic illness, the best they can come up with, is the ban on smoking in public places, as being responsible, in the future, for less associated ill health. But, that progress in the reduction in the harms, caused by excessive drinking and obesity has been "elusive". Might have something to do with Government failing to kurb supermarket sales of drink, at loss leader prices, but we don't mention that. Or the rubbish science of the of the Dept. of Health and the Food Standards Agency telling us to 'eat healthy and exercise', when exercise does little to reduce wieght (although it can make you a little more healthy), and the diet suggested, rich in carbohydrates, is in fact likely to increase your wieght, not reduce it. They predict, despite the applause given to the dubious advice mentioned, a future upsurge in obesity-related ill health. Well there's a surprise then! You would think that after twenty odd years, of this type of advice, that it's obvious there might just be a flaw somewhere, in the hypothesis. But no, if it's not working, let's keep doing the same!
Applause is given to GP's for responding well, to the incentives provided for chronic care, against the 'performance indicators'. But as yet, little has been achieved in avoidable admissions to Hospitals. Which translated means; we've given out lots of money to doctors to hit targets, but it's done bugger all in keeping our diabetics, COPD and CHD patients out of A and E! More rubbish protocols no doubt, that do little, if anything to advance the health of the patient, but ticks lots of boxes and makes lots of money for the cash strapped doctors.
So far as clinical effectiveness is concerned; some progress is highlighted in the areas of CVD and Cancer. Falls in mortality for both, being credited to the huge expenditure in these areas. The truth is that CHD and CVD death rates have been falling, since the end of the 2nd World War, long before any interventions by Medicine. And Cancer rates have increased substantially, but mortality from Cancer has fallen, probably due to our ability to prolong life to the point where death is no longer counted. If you have survived five years after diagnosis you are (statistically) cured. The report does touch upon the fact that our NHS is lagging quite some way behind our European counterparts in these areas, but the level of censure is quite restrained. The same applies to their verdict on cardiac and stroke care, with variations in quality between parts of England and other comparable countries. So no bouquets there then. A curious conclusion is made about mental health services, giving the NHS an A-plus it would seem, for early intervention and crisis resolution leading to reductions in acute admissions. And here's me thinking there was a paucity of treatment possibilities other than a box a of pills and a waiting list for CBT, but I must be losing the plot. Probably because I couldn't get any treatment when I needed it (except privately of course).
Moving swiftly on to Patient Experience, we enter the realm of la-la land, with the assertion that "public satisfaction with the way the NHS is run, has been increasing steadily for the past few years". Which NHS are they talking about, and in which country? There is little evidence, that I have seen of such a phenomena, in fact the converse is true. Gosport, Stafford, Birmingham Childrens; the list stretches to my horizon at least, but obviously not the Kings Funds researchers, who seem to live in some sort of 'bubble' insulated from the Internet, the Newspapers and Dr. Foster and probably the NPSA. There is an entreaty for Trusts to build a complete picture of their patient cohort to further the ends of patient centred care, or some such waffle, but the view they have is a somewhat more rosy one than I have encountered, or had related to me.
They do take the Trusts to task, about the high rates of infant mortality especially for deprived areas and overall life expectancy for the poor. But they could hardly sweep it under the carpet when the third world does better than us in many of these areas of concern. But they spoil it all by telling us we face few financial barriers to accessing services. Yes sure we do, if we are lucky, go private, or have an accident on a weekday between 9 and 5. Outwith that it's a lottery. So their view of Equity is that it represents a 'challenge'. One more statement of the 'bleedin obvious' (how much do you get for writing this drivel).
Efficiency also is viewed as a challenge, with productivity being difficult to measure and the increase in activity seems to be limited to devising methods to measure it more efficiently! It also seems to suggest that efficiency needs to be targeted at patient services rather than losing a few overpaid,. fat cat managers, of whom we seem to have legions. And mention is made of the rather alarming fact that half of all the additional funds given to the NHS since 2002, has been given over to higher pay. As the management has had increases in the order of 84% in the last ten years with chiefs at 101%, it seems my taxes have gone to keep the 'elite' of the NHS in sparkling wine and Volvo's. I would rather it had gone to fund real nurses to get back to nursing.
Accountability gets a big mention with praise heaped upon the Government for instituting 'independent regulation' for health care organisations. Hang on am I getting this right? They have made professional regulation more responsive to public rather than their own interests. When? How? I am not making this up; honestly! The only thing they've got right, is that the arrangements for redress are yet to be developed. Too right they are! Will Powell's been waiting for redress for twenty years!
They conclude this pile of fawning irrelevent crap, with at least a few words of censure, that I have 'cherry picked' because at least I agree with them; "unwarranted variations in access, utilisation and quality of care, even where national guidlines exist". It then drones on about government needing to aspire to deliver quality healthcare, to all patients, all of the time.
It is without doubt, one of the most irrelevant, overblown documents I have read for some time. It plays to the Gallery of Government rhetoric, touches it's forelock to the NHS and makes a few slightly censorious comments about that which we all know to be defective. It's the sort of report I would expect from Andy Burnham's spinmeister, if of course I did not know any better?
If you wish to make your own decision about this report read it here.
Friday, 9 April 2010
Details of the EPIC study of the relationship with Cancer and the consumption of fruit and vegetables, has at last given its findings, to the World. And what do you know; there is little to no evidence, that consumption of these vaunted dietry components, has any effect on the rates of Cancer of all types.
Developed in 1991 by the World Health Organisation and adopted in the UK, with the usual mindless vigour associated with Government dictats since the beginning of time, we were told to get our 'five a day', on pain of every possible disease in the Medical Dictionary, especially Cancers. As overall we have all adopted this, to some extent or other, it is alarming, to say the least, that overall rates of all Cancers have increased by 21% in men and 45% in women between 1971 and 2007 (Office of National Statistics). Now after some nine years study of 400,000 people (not half a million as reported by the BBC) the relative risk is reduced overall by 4% or 2.5%, depending on the interpretation. That was across the board, men and women, and relative risk is not a valuable guide. Absolute risk, is the true arbiter of whether or not you are likely to fall prey to a particular ailment. If one takes behavioural variables into account, the protection afforded, is only shown to have any significance in women, drinkers and smokers. In addition, it seems that intake of fruits showed a much weaker association, with protection, than did vegetables alone. There is some possibility, as well that tomatoes confer some benefits, associated with their Lycopene content, which is a powerful anti-oxidant.
So everything changes again, much like the association of eggs, with high levels of cholesterol some years ago, now rescinded to the advice to eat as many as you like. Continual intervention by Governemnt, with 'bad science' based on unproven hypotheses, that later prove to be false, pervades all of our lives. True science is continually ignored for the sake of convenience, or political dogma. After all, it sounds good to tell everyone they are killing themselves with unhealthy lifestyles and advising them to moderate this behaviour, rather than looking to the true components of illness and disease. That might upset the food lobby, which is almost as bad as 'Big Pharma'. Why? Because food and diet are as important to our everyday health as is any drug or medicine and thus we need to choose with knowledge, not dogma.
I and many others, especially scientists, believe that high intakes of fruit, are as bad as high intakes of carbohydrates, because fructose in isolation (without glucose) elicits litle or no insulin reaction. Therefore it is highly likely that most will go to adipose tissue for storage. So yes, simply put, too much fruit, especially the highly cultivated, high fructose varieties grown today, or concentrated fruit juice (smoothies), can make you fat!. Vegetables conversely, of the green leafy type, are good for you, provided they are consumed in moderate quantities, and can confer considerable benefits.
It's going to take some time for any advice to change, if at all.. Most doctors and scientists in the employ of Government or Business do not want to relinquish their prejudices without a battle, even in the face of incontravertible evidence, that they are wrong. A lot of people died, as a result of giving heart attack patients bedrest, not so many years ago, but it was the accepted view, based again, on a faulty and unproven hypothesis. The truly brave scientists, are assiduously ignored for much of the time, despite a wealth of evidence in many areas of diet, nutrition and healthcare that what we are doing is simply wrong, even dangerous. As Mencken said, "for every complicated problem there is a solution that is simple, direct, understandable and wrong", (my italics).
Government and it's many agencies, live in a la-la land of myth, legend and poorly thought out theory. But when they propound those views in slick, expensive campaigns they go a step too far. No discernable improvement in the lot of the Western citizen has been achieved by promotion of 'healthy eating', in fact the converse is true. Diabetes, Cancer and some Vascular disorders, including hypertension have been steadily rising over the years, that this rubbish advice has been propounded. None of the interventions, which cost many billions in resources, that we can ill afford, are based on any sound principle. Protocols to lower cholesterol, blood pressure and cancer are defeated by the very measures invoked to reduce them. Yes, lifestyle measures can make a difference to all our lives and they are cheap; they could save billions and many lives as well. But they have to be the right one's, not the rubbish propoganda of the Dept. of Health (sic) or the Food Standards Agency.
Read this report yourself at; http://jnci.oxfordjournals.org/cgi/content/abstract/djq072