Editors' Blog

January 2008 - Posts

• Education trumps health: Saving schools over surgeries?

  Such was the national outcry this week, that proposals to close or merge small rural schools in Shropshire are to be reviewed. The protests over the plan were about more than were children go to school, rather they concerned the threat to village communities. Village schools are a focal point in small villages, one that brings adults together at the gates as well as children in the playground and can reduce a sense of isolation. The schools also bring people into villages which in turn means local shops and post offices remain open thanks to passing trade. But there are other village focal points which help address these issues including the GP surgery. Yet these too, and possibly branch surgeries in particular, are also under threat from creeping centralisation. The insistence that every PCT will have a large Darzi health centre may work in well populated areas with good transport links but makes less sense for rural areas. It is not difficult to imagine a scenario in which a Darzi centre is built and then has to be filled and staffed. So district nurse and other community services are moved to it – even some practices. Then it is more cost-effective to run clinics in the new centre with patients traveling to it than in surgeries around the community. As a result branch surgeries open for fewer hours, become less cost effective and even wither and die. And once again village life is undermined. Rural communities have manage to gain national attention for their protests against school and post office closures. GPs in these communities should think about mobilising these same groups where they see a threat to primary care services. Posted Jan 31 2008, 06:54 PM by Bronagh Miskelly with no comments

• Healthy, wealthy or wise?

  ‘Early to bed and early to rise Makes a man, healthy wealthy and wise.’ But health or wealth – which would you choose? This is the question posed by Steve Smith,  of Hemel Hempstead, Hertfordshire, who won £19 million in a National Lottery triple rollover. Unfortunately Mr Smith has an aortic aneurysm which he says could burst at anytime. Mr Smith says he would rather have good health than the win and I’m sure he is genuine in saying that. However, the fact is that having won such a large amount of money, he will now be able to access whatever care he wants and now has a better chance. The fact is that rather than people having a choice of wealth or health, the two are connected with poorer health outcomes occurring in more deprived areas. Mr Smith has just moved from one group to the other. I wish Mr Smith all the best but note also that he has the opportunity to promote some wisdom. By using some of his new found wealth to fund charities involved in research or screening he could help others in his situation. Sad to say but in health money still talks. Posted Jan 30 2008, 12:04 PM by Bronagh Miskelly with no comments

• Why life may not begin at 40

  It’s said that life begins at 40, but if the latest research is to be believed many of us will only get four years of fun before becoming unhappy and depressed - and we won’t perk up again until some point in our 50s. Data analysis of 2 million people from 80 countries has found that 44 is the age at which we are most vulnerable to depression – and that this pattern holds true for most countries around the world. According to the study, which is due to be published in Social Science & Medicine, the risk of depression is lowest in younger and older people and highest in middle age – for both men and women. The findings go against previous research, which suggested the risk of depression stays constant throughout life. These results seem to imply that the mid-life crisis does exist. Maybe this is not surprising. After 20-odd years of work and with 20 more to come it is perhaps inevitable that we question some of our choices, or may want something different. And at 44 many of us will have significant family responsibilities that do not apply earlier or later in life, which tends to mean more stress and worry. It’s enough to make you depressed just thinking about it. But let’s look on the bright side – apparently by the time we’re 70, providing we’re still physically fit, we should be as happy and mentally healthy as we were at 20. Despite these findings, I’m not sure that nurses and GPs would agree that they reflect what they see every day in the surgery. A huge number of practice appointments are devoted to depression and mental health problems and I suspect younger and older people are as likely to account for as many (if not more) of these as the middle aged. As for me, I’m now resolved to make the most of the next few years of happiness, before the inevitable black cloud descends and I have to wait until I’m old and grey before I cheer up again. Posted Jan 29 2008, 10:59 AM by Emma Bower with 2 comment(s)

• Honest Alan hits the headlines

  I suppose it was only a matter of time before another candidate from Labour's deputy leadership election had their accounting procedures scrutinised by the media. Last week Peter Hain accepted the inevitable and resigned. This week our very own Alan Johnson faces the questions. It may be, of course, that Mr Johnson has nothing to fear, and that his parade around the Sunday television shows was just to make sure that his claim to have been '100 per cent honest' was heard loud and clear. Gordon, too, is said to be 'pretty relaxed' about the revelations, but then it does seem to have become part of his weekly schedule nowadays, and isn't this how Mr Hain's problems started? Anyway, I'm sure everything will be fine - if there is anything untoward to discover, the British media will find it. Either way, I'm interested in Mr Johnson's idea that honesty can be graded in percentages. On this occasion he has managed '100 per cent', but does that mean he sometimes does '88 per cent honest' or, heaven forbid, 47 per cent? It's a sort of sliding scale of honesty. This is not something I remember learning at school, but it's probably something that you learn pretty quickly in politics.    Posted Jan 28 2008, 11:52 AM by Colin Cooper with no comments

• Who is Gordon Brown’s GP?

  Who is Gordon Brown’s GP? And who, for that matter is Alan Johnson’s? Is there a practice in the land that will have them? Surely there could be no grumbles from a PCT once a practice explained why they were removing a politician from their list? Indeed, it should be an accepted reason for automatic removal, as soon as it becomes clear that a parliamentarian is about to destroy general practice. By the way, I’m not asking for patient confidentiality to be broken here – it’s a rhetorical question – I can find out everything I need to know from the NHS spine. No, the reason I ask the question is because I was wondering, as the BMA prepares its ballot on the unilateral contract changes, just how sheepish Mr Brown and Mr Johnson might feel if they had to pop into their local surgery (assuming it was open) for a little health advice. Actually, they probably wouldn’t think twice about it. They are, no doubt, ‘conviction’ politicians, the type who are quite sure that they are right about everything (even when convicted). And, of course, you have no choice - you have to provide care. But whatever happens, don’t ask them to fill out a patient satisfaction survey. Posted Jan 25 2008, 10:59 AM by Colin Cooper with no comments

• Alan Johnson ate my lunchbox

  This could become a familiar cry in playgrounds across the land as Mr Johnson starts sticking his fingers in to children's lunchboxes to confiscate chocolate bars, crisps, fizzy drinks, and anything else that parents use to blackmail their children on the way to school. It's all part of the government's jolly new anti-obesity initiative, that could see the health secretary earning the sort of notoriety that Margaret Thatcher enjoyed as education secretary in the early 1970s - though 'Thatcher Thatcher Milk Snatcher' was nothing compared to what she was called in the 1980s. (I can't think of any lunchy things that rhyme with 'Johnson' in a derogatory fashion, so please leave suggestions below). So the media is buzzing this week with talk of food, drink and cooking, and it seems there is now virtually nothing left that is safe for us to chomp on or chug. Even fruit is not as good as the scientists first said, although no one has yet managed to deprive us of the many good reasons for eating cabbage. Even the refuge of the coffee house is being taken from us, following a Which report that reveals the huge amounts of calories in fancy coffees, and sandwiches that are even fattier than a Big Mac. On Monday I was welcoming the media spotlight on a refreshing new perpsective on healthy eating (Eat Food. Not too much. Mostly plants). But by Thursday it's turned in to a bun fight and I have no doubt that by the weekend there will be millions of bewildered consumers chucking in their new diets and heading for the comfort food. In the mean time I'll keep trying to think of something that rhymes with 'Johnson', or maybe 'Alan'. Does he have a middle name? Posted Jan 24 2008, 09:29 AM by Colin Cooper with 1 comment(s)

• Cardboard staff are better than none

  Hard-pressed Northumberland GPs fighting swingeing PMS cuts have found themselves with an extra nurse or two about the place this week. Sadly they fit neatly into the chocolate fireguard category. The new figures in the surgery are smiling, uniformed – and cardboard. The cardboard nurses are part of a £5 million DoH campaign to encourage hand-washing which has been launched in the North East. It is not clear how much of the budget this papier-maché army has accounted for but it would probably have paid for some real nursing. On the other hand, if the DoH values cardboard clinicians perhaps we should be thinking about other uses for them. Perhaps a kindly but firm cut out explaining that little Johnny doesn’t need antibiotics for a sniffle. Better yet, collect up a few of these helpful figures, and a couple of shop window dummies for good measure, distribute them artfully about the surgery and leave the lights on. To any passing PCT manager it will appear as if a busy extended hours session is in full swing. Posted Jan 23 2008, 10:57 AM by Bronagh Miskelly with 1 comment(s)

• Cookery is back on the curriculum

  I was pleased to see today's announcement from the government that cookery lessons are to become compulsory in secondary schools in England. Surely if the UK is to turn the tide of rising childhood (and adult) obesity levels it is imperative that children understand about nutrition and know how to cook? Of course it is important that young people get these messages at home as well, but schools have a vital role to play in equipping children with the skills for a healthy and successful life – cooking is one such skill. There will be problems to overcome if this plan is to succeed. For starters more food technology teachers will have to be trained and schools will need to install the necessary equipment, both of which will require significant funding. The issue of subsidies for families on lower incomes who will also need to be considered. Many schools that dismantled their kitchen classrooms when food technology/home economics went into decline some years ago will have to reinstate them. According to schools secretary Ed Balls, speaking on BBC Breakfast this morning, this is a particular issue for boys’ schools, many of which have never had kitchen facilities. But, hopefully the government will remain committed and these obstacles can be surmounted. Helping children to become interested in cooking, along with giving them an understanding about where their food comes from and how it affects their health and wellbeing is an important first step in improving the nation’s health. Posted Jan 22 2008, 10:34 AM by Emma Bower with no comments

• Change your life. Eat food.

  This weekend I finally got around to reading a book serialisation that I’d been tearing out of The Guardian last week. But on reading the first seven words of the introduction I began to wish that I’d saved my energy (all that tearing can be so tiring). The offending words, out of which the author had managed to fashion three whole sentences, were: ‘Eat Food. Not too much. Mostly plants.’ This apparently is his guiding philosophy. But isn’t that just totally obvious? How did he manage to make a book out of that? Surely that’s what everyone does? Well, maybe he’s got a point about not eating ‘too much’, but ‘eat food’? Anyway, I persevered and am now very happy to eat my words. What Michael Pollan has managed to do for me in those few short extracts from his book, In Defence of Food, is to sum up everything that’s wrong with the so-called ‘food’ that we eat in the 21st century, and then suggest a few simple ways to put things right. Now you may think that you’ve heard it all before, and so did I. But the power of this work is that he really does nail down his arguments in to conclusions of inescapable truth. He argues that much of what we eat nowadays is so heavily processed that it’s difficult to actually describe as ‘food’ – certainly not what our grandparents would have recognised as something to eat. So he wants us to eat more real, simple, and ideally homegrown, food. But what really struck me were his comments on the demise of food, and the rituals of preparing and eating food, as a significant part of our daily lives – rituals which for generations have bound together human beings. His solution to this problem is characteristically short: ‘eat at a table’. And very fine advice it is, too. Posted Jan 21 2008, 11:20 AM by Colin Cooper with 3 comment(s)

• Is this 'Frankenstein science'?

  After a series of u-turns and months of intense pressure from scientists, the UK government's regulator for embryo research, the HFEA, has finally allowed researchers to create and use human-animal hybrid embryos. The two research teams have been waiting for over a year to get the green light - they applied November 2006 for a licence to derive stem cells from human embryos, created from animal eggs instead of human eggs. Stem cell research has become a high-profile and contentious area of science over the past few years but this is the first time that scientists in the UK have the permission to create embryos in a research project which contain both human and animal DNA. While the HFEA's decision was described as "disastrous" by campaigners, some more extreme compared embryo experimentation to vivisection. And a report last week quoted a Northern Irish lord who slammed the technique calling it "Frankenstein science". Hybrid embryos are created by transferring human DNA into animal eggs from animals such as cows or rabbits. The resulting embryos are more than 99 per cent human. Those embryos are only created for research purposes and have to be destroyed after 14 days – it's actually a criminal offence to transfer such embryos to a woman. Scientists hope the process will avoid the ethical dilemmas conducting research using human embryos. But the issue remains highly controversial, as the idea of mixing human and animal DNA raises itself a number of social and ethical questions - such as whether these types of research should be permitted at all, and if they were where the boundaries should lie. So I guess I belong to the group of people who are thrilled by the progress British science is making but can't help but wonder if all these protester groups outside Parliament are just trying to warn us... Posted Jan 18 2008, 08:15 PM by Emilie Reymond with no comments Filed under: embryo research

• Why the NHS can pay £300 for a new electrical socket

  There used to be a time when GPs could compare themselves to their local plumber and justifiably complain that they were underpaid. Now it seems that electricians would provide a more appropriate comparison. The National Audit Office has revealed that there is huge variation across the public sector in what trusts are paying for contractors to perform basic maintenance, as part of PFI contracts. So we find that in 2006 the cost of supplying and fitting an electrical socket ranged from £30.81 to £302.30. Locksmiths were on an even better deal - supplying and fitting a lock could cost anything from £15.09 to £486.54. It is truly soul-destroying to see NHS funds thrown away in this manner. The operation of PFI has too often been an embarrassing waste of public money, with civil servants apparently incapable of negotiating sensible contracts. But the government has a seemingly insatiable appetite for private sector involvement at any cost. So don’t expect ministers to start briefing the media against lazy, greedy electricians, in the way that they do every time statistics are published on the income of GPs.   Posted Jan 17 2008, 10:05 AM by Colin Cooper with no comments

• Extending the hours of the Polish flyer

  As with all good mainstream media scandals, the story of the Polish GP who flies to Scotland twice a month to cover out-of-hours shifts fails to recognise a few facts. Yes, the doctor did have a long trip from his Polish home, but he hopefully has a nap on the plane before his four hour drive. Meanwhile, his UK colleagues may have worked a full day before their out-of-hours shift. Who is the most tired? If it is bad for GPs to cover out-of-hours if they are tired, where are all the extra out-of-hours GPs going to come from? It also raises the question of what will happen if the new extended hours targets are pushed through. Consider a GP who does a couple of weekend or night shifts in the months. Now she is going to have to do an extra Saturday morning or a couple of evening surgeries a week. This will eat into her time with her family and thus she may decide to give up her out-of-hours shifts. And then what – the return of the Polish flyer? Posted Jan 16 2008, 08:02 PM by Bronagh Miskelly with no comments Filed under: out-of-hours, extended hours

• The fight against superbugs

  American researchers have discovered the emergence of a deadly strain of the MRSA superbug, which appears to be particularly prevalent among gay men. Only two cases of the new form of the USA300 strain of the bug have been recorded in the UK, but research published today in the Annals of Internal Medicine discovered that around 1 in 3,800 people in San Francisco’s general population carried the bug. This figure rose to about 1 in 588 people in the city’s gay district. According to scientists this particular strain of MRSA is extremely good at spreading between people through skin-to-skin contact and is resistant to treatment by many antibiotics. Antibiotic-resistant infections are a huge problem for healthcare systems around the world – they also cause great concern for patients who require hospital admission. Just last week health secretary Alan Johnson issued another plea to health professionals to stop prescribing antibiotics for coughs, colds and sore throats. Mr Johnson was announcing a £270 million campaign to target the spread of superbugs, which will be launched next month. As part of this, all hospitals will be given a ‘deep clean’ (although the evidence to support this move is already being questioned by some managers and cleaning companies) and more infection control nurses and antibiotic specialist pharmacists will be employed. If Mr Johnson really wants to curb inappropriate prescribing of antibiotics then perhaps some of these funds could be put towards a campaign to educate patients about why antibiotics are not always necessary? Of course doctors and nurse prescribers should not issue these drugs willy nilly to all who request them, but educating the public about when antibiotics should and should not be prescribed would certainly help busy clincians when faced with patients demanding a prescription.  Posted Jan 15 2008, 11:03 AM by Emma Bower with no comments

• We can now grow hearts - so forget the diet

  I thought I had stumbled across the script of an old Hammer Horror movie this morning when I read the story about a heart being brought back to life with a few bits of new rat stuck onto it (New Organs Hope). Why didn’t Peter Cushing and co think of that? It would have been far less messy than taking all those maidens from the village, no need to wait for a stormy night, and he could have grown his creations to specific sizes rather than always having to put up with lumbering great monsters. And he would have made considerable savings on nuts and bolts. Anyway, the heart-growing revelation tied in nicely with the latest government plan to boost the number of organ donors. It’s quite simple really – just put everyone on the donor list until they find out and remove their name. Once again the government shows its huge respect for patient confidentiality and data protection law. But of course it does mean that there will be more human hearts to go round and, coupled with the ability to grow hearts, will mean that none of us ever have to worry about eating healthily again (does that mean I can abandon my new diet?). Posted Jan 14 2008, 07:34 PM by Colin Cooper with no comments

• Play less, chew more

  This week, I was forwarded an article from a colleague where McDonald's UK boss is quoted blaming computer games for being a main catalyst, amongst other factors of course, of obesity in children. I had to read the introduction a few times to make sure we were talking about McDonald's the fast food giant that sells burger meals at 1,000 calories a pop… Talking about the issue of obesity in children, the company's UK chief executive Steve Easterbrook told The Times: "There’s fewer green spaces and kids are sat home playing computer games on the TV when in the past they’d have been burning off energy outside." He also added: "How can we better communicate to individuals the importance of a balanced diet and taking care of themselves?" Hmm… Let me think… His argument is that the issue is not about healthy or unhealthy 'food' but more about healthy or unhealthy 'diets'. Maybe that's just the answer. Meanwhile, research published this week show that chewing sugar-free gum (well lots of it) can really make you thin, unsurprisingly. Indeed, excessive intake of sorbitol, a sweetener commonly used in sugar-free chewing gum can lead to weight loss and diarrhoea, a team of German doctors has warned. The laxative effects of a high consumption of sorbitol are widely known and sweets and gum containing the substance have a label on their packaging. But the big news is that taking more than 20 grams per day of the sweetener may lead to severe weight loss – up to a whopping 20 per cent of body weight, according to the research published in this week's British Medical Journal. Keeping in mind that to reach that level you would have to chew over 15 gums a day… The researchers reported that patients regained weight after starting a sorbitol-free diet though. I am picturing children binging on Big Macs while ingesting entire packets of sugar-free gums at once to compensate… Posted Jan 11 2008, 08:35 PM by Emilie Reymond with no comments Filed under: obesity