don't kids with HIV suffer enough without this?

We may have a new government but, behind the scenes, the same unelected sinister forces are pushing their agendas at our children.

HYPNet - the HIV in Young People Network - describes itself as "a multidisciplinary group of health professionals and voluntary sector representatives" working for people between the ages of 14-24 who are unfortunate enough to be living with HIV.

They've just released draft guidelines on the management of sexual and reproductive health for adolescents living with HIV 2010.

The first thing that worried me on the guidance came as early as Section 3, Definitions. In this draft document, which dealt with "possibility of having pleasurable and safe sexual experiences" for adolescents, the term "adolescence" itself is defined worryingly:

The term adolescent will be used throughout these guidelines to denote young people aged 10-24 years old, which covers the age from the onset of menarche in the UK to the upper limit of the definition of young adult...

I had to read the lower limit of that definition again: 10. This is no faux alarm - the Telegraph's Aislinn Laing reported recently that "Between 2000 and 2007, a total of 15 ten year olds and 39 aged 11 fell pregnant in England and Wales". HYPnet's somewhat abusive take on sexual health care is outlined in bold letters at point 8.1:

PHCP [paediatric healthcare professionals] need to take responsibility for seeing that Sexual Health needs, if not brought up by the adolescent, are raised in consultations, starting well before sexual maturity is reached.

Yet, although the paper states twice that in England and Wales sexual activity involving under-13's is illegal and indeed rape (under common law consent is meaningless under this age), the waters are muddied by a statement in point 6.3, which concerns the Sexual Offences Act 2003, that "this document does not advocate mandatory reporting to police or social services of every sexually active under 18 if there is no cause for concern"; the cut-off point of 13 has been dropped.

A pattern starts to emerge at point 8.3, where we read under the heading of Sexual Health Education that "Psychosexual issues may arise from cultural and religious beliefs around...female circumcision". Again, there is no comment, even to the effect that "female circumcision", more properly known as female genital mutilation, is a vicious assault on a young girl which, even if it is carried out abroad, is still an offence as if it had been done in the UK under the terms of the Female Genital Mutilation Act 2003. But the foul practice is listed as if it had no more significance than being one cultural phenomenon among many.

In 2006 Anthony Ozimic, Political Secretary of the Society for the Protection of Unborn Children (SPUC) identified that the term "sexual and reproductive health" cannot be taken within any legal framework to include abortion.

The news has travelled slowly: point 9.2 in this document about sexual and reproductive health is a "checklist for sexual history discussion", and the ninth crib-note states: "Managing an unplanned pregnancy. Options of continuing with pregnancy, adoption or termination of pregnancy; methods of termination." The thought of an adolescent girl, already emotionally fragile through the stigma many people living with HIV are still exposed to, being put at risk of post-abortion trauma is as heartbreaking as is the omission of the risk of PAT from the crib-notes. Similarly, the advice under 16.4, emergency contraception, advises not only the morning-after pill Levonelle, which is basically a form of chemical abortion, but that double the dose (3000 micrograms instead of 1500) be given, and that the dose be documented because Levonelle is not licensed to be given in this quantity. There's no mention in the paper of the patient being informed of this in the event of the drug being given in a sexual health clinic as opposed to a pharmacy.

Ironically, the one area (16.5) where the paper hits the nail right on the head is the one that workers whose fields intersect that of sexual health are asked to keep quiet about:

Condoms are estimated to prevent HIV transmission in only 13% (4-40) of cases (Davis and Weller 1999) and should not therefore be relied on alone for contraception.

I recommend that you follow the link to the Davis and Weller article, which seems to contextualise a later study in the New England Journal of Medicine that found a higher rate of protection (22% - albeit against HPV transmission) - when condoms were used 100% of the time.

Draft Guidance on the Management of Sexual and Reproductive Health for Adolescents Living with HIV 2010 is a case-in-point of how wilfully incomplete advice drawn up along ideological lines can put real, vulnerable, people right in the firing line of the slings and arrows of outrageous fortune. The nhsnetworks listing for HYPNet shows that membership is open to all, and current membership is 2 (one of whom is paediatric HIV expert Dr Simon Portsmouth, right) - who have managed to get this paper distributed throughout the world by the otherwise well-regarded aidsmap e-bulletin.

The trojan horse was an article called Numerous unplanned pregnancies in vertically-infected teenagers (the term indicating that the virus was transmitted during pregnancy or at birth), which did not appear to consider that there are numerous unplanned pregnancies in teenagers generally - Britain has the highest rate of teenage pregnancies in Europe - precisely because of abusive sex education strategies of the sort championed by HYPNet.

If you are concerned or disturbed about any of the issues in this post, please respectfully and with sensitivity towards the difficulties faced by young people with HIV email Dr Simon Portsmouth.

Maasai medical mission 2010

A friend of Maxima's had a leaving do in the Draughty Old Fen yesterday, before she goes to Africa.

Hélène Evans (right), a nurse from Cambridge, is leaving next month to work with a two-week medical outreach to the Naroka district of Kenya called the Maasai Medical Mission, which has been led by GP Dr Richard Scott since 2002, (before which he'd went to Kenya with Through Faith Missions) at the invitation of Pastor David Kereto.

I have to admit, to my shame, that I was ignorant of the Maasai people of East Africa until they touched my world in 2008. Six of the tribesmen from across the border in Tanzania - wearing recycled car tyres as shoes - came to run the Flora London marathon in order to raise money through sponsorship to instal a fresh-water well in their village. (The next year, the marathon was won by Kenyan runner Sammy Wanjiru, setting a course record).

Hélène writes:

The Maasi is a true pastoralist. Farming is anathema to them. They are hospitable, generous and affectionate, love their children, unbelievably domestic and gentle, and religious. They are firm believers in the one God - Engai, but are plagued by a fear of evil spirits. Bravest of the brave, a warrior tribe living the life they have lived over hundreds of years.

They see Engai as a creator-god associated with a mountaintop who gifted all the world's cattle to them. As well as travelling around the area to provide midwifery advice, dress wounds, treat malaria and the after-effects of polio, they will be bearing witness to another Creator God who was originally associated with mountains (see the experiences of Moses, Elijah and Jesus).Again Hélène writes:

Who is my neighbour in today's global village?

99% of all maternal deaths, 98% of all child deaths and 80% of all AIDS deaths occur in the developing world, yet this is the place where resources and workers are fewest. In Sub-Saharan Africa, 3% of the world's health workforce cares for 10% of the world's population bearing 24% of the global disease burden - with less than 1% of the global health expenditure.

The Good Samaritan helped a stranger because he saw this desperate need. How can we respond to the enormous needs we see in other parts of the world? There are many ways we can get involved - going, giving, praying, partnering, teaching, training - and more. Maasai Medical Mission aims to play a part in bringing God's love and care to some of the poorest people in the world.

Hélène is asking for three things:

First, pray: for Dr Scott, Pastor David Kereto (right), Hélène, and the rest of the Maasai Medical Mission 2010 team.

Second, if you can contribute financial aid (towards eg flights/food/water/petrol/staff costs etc) or medical supplies, please contact Hélène on penhydd1740@yahoo.co.uk.

counting the cost of creating our future

One phrase that has stuck in my head since training for my stint in geriatrics as a student nurse is that "when we create the care that older people receive, we define our own future".

Newsreader, broadcaster and dancer Angela Rippon has been appointed Alzheimer's Society Ambassador alongside businessman John Hughes, and both appeared on ITV1's This Morning to mark the launch of an AS report called Counting the Cost. This looks at the reasons why people with dementia tend to be kept in hospital longer than people who are not suffering from a dementing process, and at the costs to both individual and Health Service of this.

It's not uncommon for somebody to show first symptoms of dementia only when they spend some time in an unfamiliar environment - for example if away on holiday or visiting friends. Thereafter, the environment should change as little as possible: in other words, hospital stays should be as short as possible.

I'm not trying to make carers feel guilty for going off for a much-needed break and putting their loved-one in respite-care, as this would be a nursing home specialising in the care of older people, some with dementia. What the report's saying is that hospital stays should be as short as possible, so that the person with dementia can then recover from their hospital stay in familiar surroundings, whether that be the family home or a nursing home.

The report's findings are compelling: while 97% of nursing staff and nurse managers report that "they always or sometimes care for someone with dementia", "47% of carer respondents said that being in hospital had a significant negative effect on the general physical health of the person with dementia, which wasn’t a direct result of the medical condition" and "54% of carer respondents said that being in hospital had a significant negative effect on the symptoms of dementia, such as becoming more confused and less independent".

The best-known example of this is inappropriate prescription of medications, predominantly antipsychotics, but also others. On my second night as a patient in a psychiatric ward, I found I'd been prescribed a sleeping tablet because, I think, my tossing and turning on a clanky hospital bed had been quite loud: the prescription had no bearing on my condition. How much more would people with dementia, who might not be able to tell the difference between night and day, be vulnerable to inappropriate prescription? (I'm on an antipsychotic, appropriately prescribed for manic depression, that can knock me out - I wouldn't like to see its effect on a frail older person who wasn't alert to all the cues warning of danger of falls, etc.)

I've got a lot of time for the Alzheimer's Society, as when Baroness Warnock, former chairman of the Committee of Inquiry into Human Fertilisation and Embryology, proclaimed that "dementia sufferers should consider ending their lives through euthanasia because of the strain they put on their families and public services", the Society's president, Neil Hunt, expressed his horror that somebody in a public position could "disregard the value of the lives of people with dementia so callously...that they should feel that they have some sort of duty to kill themselves is nothing short of barbaric".

The Society, in its paper, gives a powerful incentive for NHS trusts to consider giving dementia patients as short a stay as possible - the bottom line. The full report goes into detail what savings could be made in which circumstances, but the executive summary delivers the money-shot:

This report finds that supporting people with dementia to leave hospital one week sooner than they currently do could result in savings of at least £80 million a year...It would not be unreasonable to assume that there are savings to be made in care for people with dementia running into hundreds of millions of pounds, which could be more effectively reinvested.

And, as Angela Rippon, proof (if it were needed) that one can be 65 and glamorous, said on This Morning of the art and science of caring for older people: "We're all going there".

Baby RB and the misery of medics

Bones stares at the grim scene lifted out of his memory by Spock's wayward brother Sybok: the young doctor reluctantly switches off his father's life support system at the latter's pleading. Now back in the present, he turns to his companions and informs them that a cure for his father's disease was discovered shortly afterwards.

Faith that the future will provide something we lack at present is a defining characteristic of our species. For example, this month's Reader's Digest tells the story of how Professor Graham Hughes, founder of the London Lupus Centre, noticed a biochemical similarity in patients suffering from an inexplicable paralysis in Kingston Hospital, Jamaica, and patiently tracked down the cause: an antibody that attacked phospholipids on an autoimmune basis, causing a coagulation disorder, which he called antiphospholipid syndrome but has been renamed Hughes' Syndrome by the medical profession.

When he first presented his findings, a surgeon sitting next to him, recognising the symptoms, whispered "my first wife died of this", then both listened to the testimony of a woman who, having been the first to be diagnosed with Hughes' Syndrome and treated, had given birth to her first child after nine miscarriages.

Sometimes miracles happen: in June, six-week-old Grace Vincent continued breathing after her life-support system was switched off to let her "incurable" meningitis take its course, and she defied odds of survival that doctors had put at less than one percent.

So it's sad to see a court battle over the future of Baby RB, who was born with congenital myasthenic syndrome which, explains the Muscular Dystrophy Campaign, is "a muscle weakness that limits the movement of his limbs and his ability to breathe on his own". His father wants his life-support to remain on, and his mother wants it to be switched off on the basis that she would rather cope with a mother’s grief of losing a child than to see her son’s "intolerable suffering".

Michael Mylonas, representing the NHS Hospital Trust representing Baby RB, stated "Clinicians at the hospital are against this because in their view even with a tracheostomy, the quality of Baby RB’s life will be such that in fact he has a miserable, sad and pitiful existence". He added the following astounding statement:

The argument before you is the fact that he has normal cognitive function and normal brain would weigh in his favour.

But the Trust is concerned that his awareness will simply make his own plight all the more unbearable - not so much now, but as he gets older and catches glimpses of what others can do.

His reasoning puzzles me: is there anybody who hasn't looked jealously at others' abilities and compared them to their own? Failure, misery and pain are so bound in with the human condition that the above argument does not so much rationalise extinguishing a baby's life as provide grounds for genocide.

Baby RB is unable to move his limbs but can wiggle his body to indicate, his father asserts, pleasure, and has been filmed enjoying toys. The Muscular Dystrophy Campaign said in a statement,

"Baby RB's parents find themselves in and that unfortunately the resolution of this case will inevitably be devastating for all parties involved...The Muscular Dystrophy Campaign is here to provide support for all families affected by muscle disease through our freephone information support line and care team. We also continue to invest over £1million each year into pioneering research to find treatments and cures for muscle disease."

Its rather ambivalent stance may be due to the chairmanship of Professor Martin Bobrow, non-executive director at Cambridge's Addenbrookes Hospital, Deputy Chairman of the Nuffield Council on Bioethics and a member of the Human Genetics Advisory Commission, who has declared himself in favour of pre-implantation genetic diagnoses. This would prevent such messy court cases by preventing the birth of babies with neuromuscular disorders, and would also render the many wonderful services provided by the Muscular Dystrophy Campaign unnecessary.

I don't wish to demonise Baby RB's mother with all this, Heaven knows she must be under enough pressure as it is, for example with a marital split whose "amicable" nature may be the good cop to the trial's bad cop. But she's not being helped by doctors who predicate "a miserable, sad and pitiful existence" of a 13-month-old child. Doctors are there to perform medical and surgical interventions, not to use their eminence in order to misrepresent their opinions as facts. (I'm reminded of the case of Baby OT, whose life support was switched off this March, in spite of legal protests by both parents, by doctors who spoke of "empathy" and "distress" instead of doing medicine.)

John Smeaton, Director of the Society for the Protection of Unborn Children, quotes the society's communications manager, Anthony Ozimic, on the matter:

Whenever there is doubt about life-sustaining medical treatment, everyone should act with a presumption in favour of life. The value of a person's life, and the protection due to that life, should never be judged according to opinions about the person's quality of life. An ill or disabled person's life should never be regarded as not worth living. Doctors should not confuse the possible burdens of a medical intervention with the priceless worth of a person's life.

In fact, in a dramatic intervention, it's been announced that Baby RB's father has found a doctor willing to perform a tracheostomy on the child, but doctors have countered that this would necessitate "painful" surgery. If surgery's painful, fire the anaesthetist; I think I'd have more respect for them if they came out and honestly complained about "costly" surgery (in a research paper, Alison Davis of No Less Human refers to a British government publication that mentions that "caring for the handicapped can impose great burdens on our society").

It's not impossible that RB's condition may one day be treatable, perhaps even before the third birthday that doctors say he will struggle to reach, not stopping to think that for all of us there are times when it's a struggle to envisage getting up the following morning.

Take Baby Z (above). The Telegraph's Bonnie Malkin reports that the newborn was cured of molybdenum cofactor deficiency, which usually kills in around three months, by a medicine Professor Günther Shwarz had been working on for 15 years. Contacted by the family, he sent his entire stock of the experimental compound.

Does something like this await Baby RB, should the medical establishment suffer him to live? I don't know, but we live in hope - it's what we do.

Related post - Sympathy and distress - bad medicine for Baby OT

in memory of Kerry Wooltorton

Being a pro-lifer can take you to strange places, I've discovered.

Earlier this year, I found myself questioning why David Woods, having made several suicide attempts, was given a liver transplant without his family's consent being sought (and concluded that the "unreasonably heroic" measure had more to do with local mental health trust meeting its suicide prevention targets than Mr Woods' dignity). Before that, I supported 13-year-old Hannah Jones' decision not to have a heart-transplant that might occasion a relapse of her leukemia because of the powerful immunosuppressant drugs that would be necessary. (Now fourteen and freed from having to fight, she's had the operation.)


Unborn children can't speak for themselves and therefore we must be their advocates in the face of sinsiter population-control agendas; but, whether or not you are religious, being pro-life in the context of adults often involves making a decision on each individual case in the light of what is best for that individual, an operation Kant would not be displeased with.

This is why even those who subscribe to population-control agendas have been dismayed by the case of Kerry Wooltorton, who, being depressed over not being able to conceive, drank poison in September 2007 and called the ambulance. When this arrived, she handed the paramedics a letter she'd drawn up three days previously, saying that she didn't want to be revived after losing conscioousness. At the hospital, the doctors were so terrified at the prospect of being sued for assault under the terms of the Mental Capacity Act, which provides for living wills.

John Smeaton, Director of SPUC (the Society for the Prevention of Unborn Children) sums up the pertinent points:

The coroner's verdict in this case is disgraceful. It sends out the message that if you are depressed and attempt suicide, doctor's need not treat you. Depressed people are being officially treated as worthless. It is clear that M/s Wooltorton's relatives regarded her as having committed suicide while suffering from depression.

"At the time the Mental Capacity Act was passed, SPUC Pro-Life said Parliament should reject it because suicidal patients would be abandoned. The government dismissed our concerns and Kerrie Wooltorton is dead as a result. The Mental Capacity Act is a charter for euthanasia by neglect. Gordon Brown and David Cameron claim they're against assisted suicide. They should now agree to scrap the Mental Capacity Act before more vulnerable people die."

The coroner's conclusion that Smeaton refers to is that, as the Telegraph's John Bingham reports, it would have been 'unlawful' for doctors to intervene as she had 'full knowledge' of what she was doing"; but Bingham adds that Woolterton's parents "are considering legal action against the hospital believing that she was not in a fit state to make a decision". Her father expressed his disgust that doctors did not try to section her under the Mental Health Act, which would have provided a pathway to treatment (for example through section 63).

Andy Burnham, the Health Secretary, has said that Ms Woolterton's case " took the law into 'new territory' which he did not believe had been intended by Parliament" - and that's half the problem. In its ideological commitment to concentrate on groups it perceives to be oppressed minorities - for example people who feel they should have the right to end their lives - the Government has been drafting laws with more hope than precision and trusting the dotting of i's and dotting of t's to their millennial conviction that people will always act for the best when given a free choice.

But how free is that choice? Every day we are bombarded with propaganda originating from liberal-socialist sources, mostly academic, to the effect that the main driver of the world's ills is overpopulation. This is mostly used to promote contraception (and by unsaid extension abortion) - witness the recent soundbite in the title of research from the London School of Economics, released on the day that the Government's climate change advisors advised that an 80% fall in emissions would be insufficient: Less Emitters, Fewer Emissions, Less Cost.

The thing is, if you've been depressed, you might recognise the point at which everything starts to turn in towards you, and you feel guilty about things outside your control because they seem to be your fault. I believe that this propaganda - which is escalating from ceaseless to ubiquitous now that the hockey-stick graph laying modern climate change at the door of humankind lies in splinters - has as its secondary goal forcing down the population by any and all means.

That's the other half of the problem that crushed the life out of Kerry Wooltorton, and will continue to kill until the overpopulation lie, so unsustainable that even New Scientist is questioning its orthodoxy, is dealt with by an administration whose stewardship of our legal framework will allow vexing questions to be dealt with case by case.

we'll vote on politics, not pills

Being manic-depressive, I find myself reacting more strongly than I had anticipated to speculation in the media, informed almost totally by that in the blogosphere (as Platform 10's David Skelton observes), that Gordon Brown may be taking antidepressants.

The rumour has its genesis in a blog by John Ward, in a piece called "Establishment 'colluding in plight of sick man Brown'". It's gone through various columnists like John Barr's best beef, and culminated in Andrew Marr asking the Prime Minister, on his Sunday morning political show, if he was one of the many British people who "use prescription painkillers and pills to get through":




Ward states that "Before the arrival of Prozac derivatives, [MAOIs] were the first line of attack when dealing with severely depressed patients". I started training as a psychiatric nurse in Scotland shortly before Prozac was introduced, and MAOIs were very much a last resort then as now, only to be used when tricyclic antidepressants such as amittryptilene or lofepramine or, if necessary, antipsychotic medication had failed. Also, I can't find any mention in the prescriber's "bible", the British National Formulary, of MAOIs being used to treat Obsessive Compulsive Disorder, another of Ward's claims.

MAOI stands for monoamine oxidase inhibitor. Monoamine oxidase is an enzyme found in various parts of the body that breaks down tyramine, a compound derived form an amino acid that acts to release neurotransmitters such as dopamine, adrenaline and noradrenaline ( a longer-acting version of adrenaline). So if production of monoamine oxidase is damped down, tyramine can accumulate in the body, facilitating the production of the above neurotransmitters, which somatimes can help somebody whose depression has been otherwise treatment-resistant to work towards recovery.


The reason MAOIs are prescribed with caution is that when somebody takes them along with food high in tyramine (remembering that there already high tyramine levels in the body) a hypertensive (high-blood-pressure) crisis can arise, which could lead to burst blood vessels - for example in the brain, causing a stroke. So foods high in tyramine must be avoided - the mnemonic we learnt was "nothing pickled, processed, fermented, salted or spoiled", although a whole host of foods must be avoided, not all of which fall easily under any mnemonic. This is what started the rumour - when a "senior civil servant" mentioned "the latest nonsense - a huge list of things [Brown] can't eat or drink because of the drugs he's on...most importantly, cheese and Chianti". Those are certainly foods I would avoid if I were on MAOIs, but also if I had, say, severe heartburn.

As Marr observed, Americans know all about their President's medical history - and, I have to say, when applying for a job I mention my illness in the main part of the form and not just the equal opportunities bit (so it's frustrating when I mention it and interview panels are surprised, indicating they haven't read past the front page of the form). But we don't have such a system here, and importing it would set the law of unintended consequences in motion just as surely as exporting the NHS to the US.

Revd Chad Varah, founder of the Samaritans, wrote in Samaritans in the 80s that if depression approaching the point of suicidality were a bar to political power, the House of Commons' front benches would be somewhat emptier. Marr himself wrote of beleaguered Conservative Prime Minister Anthony Eden - of Suez Crisis fame - in 2007 (the year before Blair finally gave way to Brown): "By the time he finally got the top job halfway through the decade, he was physically depleted...like a racehorse who had been trained to win the Derby in 1938 but was not let out of the starting stalls until 1955".

Whether or not Brown is on antidepressants, what he is experiencing, sometimes at the hands of those around him, may be a consequence of the medicalisation of problems that do not fall within the sphere of medicine. Sometimes we all, as flawed human beings, experience problems that, as part of our personalities and not of a pathological process, take us to places we did no intend to go. Take Lord Peter Mandelson - he gave a rousing and even excellent speech at the Labour Party Conference yesterday, but that's the point: when its all about Peter, Peter presents no problems. But when he feels the attention draining away, he acts to bring the spotlight back upon himself, and seems not to care whether he is cast in a positive or negative light.

Is Gordon Brown fit to run the country? In my opinion, no. Not because of what may or may not be happening with his brain chemistry, but because of the wholesale dismal failure across the Labour Party in 12 years of misgovernment. That's what I'll be highlighting in the time before we eventually get a general election, not a poisoned chalice of an agenda which could lead our opponents to rumble about discrimination on the grounds of disability should the antidepressant angle play a substantial part in a Conservative victory.

And what made me sit up straight was that it was that most hard-boiled of political commentators, Iain Dale, who teased out the pertinent point amid the tough days to come: If Brown is ill he deserves our compassion, not our insults.

in praise of betrayal

I'm not proposing that betrayal in general be praised, merely that some instances of betrayal can have a decidedly therapeutic effect in a manner that I can only describe as praiseworthy.

Take Billie Holiday, for example. Various motives have been forwarded for her agent, Joe Glaser, turning her over to the police in 1947 because of her heroin habit, including a suggestion that she was a "trade" and the return was blind eyes dutifully turned to the cannabis habit of Louis Armstrong, another of Glaser's acts. But Holiday got clean in prison, and almost certainly lived a little longer to enrich our lives with her music - until liver-disease took her in 1959.

Winston Churchill entered Parliament as a Consrvative Party MP in 1900, and crossed the floor of the House of Commons to join the Liberals in 1904 in protest, partly, at lack of rights for trade unionists; twenty years later, with experience as Home Secretary and First Lord of the Admiralty under his belt, he rejoined the Conservatives His comment?Anyone can rat, but it takes a certain amount of ingenuity to re-rat".


You can't get far in a discussion about betrayal without mentioning the Big One. Dante has Judas being eternally chewed in one of Lucifer's three mouths (between Brutus and Cassius) in a circle of Hell named for him with the anti-Semitism that besmirched much of the times: Judecca. In his 1910 article for the Catholic Encyclopedia, William Knight shows how thinking had become more subtly nuanced over the centuries by mitigating the condemnation somewhat with the assertion that the whole episode is a mystery. However, although The Passion of the Christ treats Judas' betrayal and death in the manner of reportage, most film-makers attempting a life of Jesus can't resist exploring Judas' psychological motivation - from wanting the Sanhedrin to listen to him in Jesus of Nazareth to wishing to force his hand but ultimately being used almost as a patsy in the Time-Life film simply called Jesus. Whatever, Judas' course of action had a decidedly beneficial effect.

What I'm getting to is that, in the age of "compliance" that ensures boxes are ticked to assure managers that rules are adhered to, perhaps a little more betrayal of the therapeutic sort is called for.

For example, earlier this year, former SAS officer John Wick found himself in the possession of evidence that some MPs were misleading the public as to their use of expenses - which, of course, comes from taxpayers' money. Even though he knew some of the casualties would be Conservatives (he is a fundraiser for the party), he put his country first and chose to pass the documents to the Daily Telegraph, finishing an article he wrote for the paper with "As a man who served Queen and country in the Armed Forces, I feel proud to have played my part in what the Telegraph rightly describes as 'a very British revolution'".


Not all whistleblowers are so fortunate, or perhaps as robust as a former Special Forces officer. For example, Liberal Democrat MP Norman Baker has sugested that the 2003 death of Dr David Kelly, who criticised the Government's "sexed-up" dossier on Iraq's nuclear capabilities, may have been murder; Greg Ocytko, former risk analyst for Halifax Bank of Sotland (HBOS), which collapsed spectacularly in 2008 in an implosion mirroring that of Lehman brothers, claims to have been forced from his job for making his disquiet known when he found fatal flaws in the bank's systems; and Nevres Kemal, who warned former head for Haringey Social Services Sharon Shoesmith that there was going to be another Victoria Climbié prior to the death of Peter Connelly (Baby P), suffered the fate of thorns in the side of authority since Socrates when she was investigated for abusing her daughter.

Last Thursday, the Patients' Association released a report called Patients...not numbers, people...not statistics about the "dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment" that has been visited by nursing staff upon older people in NHS hospitals, including a report on Bella Bailey, whose daughter kept a diary of the neglect with which her mother was tortured to her death in plain sight of the nursing station, and founded the pressure-group Cure the NHS to campaign for better care in the NHS.

Although members of the Patients' Association are not whistleblowers, bullying of such is so engrained within the NHS (and governmental departments generally) that the Association has been threatened with legal action by one hospital trust for revealing information about the 1-2% of patients (possibly up to a million nationally) who, for example, are left in their own excrement, have to have their toilets cleaned by relatives or are left to slake their thirst from vases.

Libby Purves reports that the reaction of Dame Christine Beasley, England's Chief Nursing Officer since 2004, has been to opine that nurses who refuse to report abusive colleagues are "as culpable as the person who did it". Although she recognises that reporting senior colleagues can be more dificult ("but that's no excuse"), she doesn't deal with a fact related to Bella Bailey: that on Dame Christine's shift Cynthia Bower, who failed to spot the massacre at Stafford General Hospital when she was chief executive of the West Midlands Strategic Health Authority, charged with checking standards are maintained, was promoted to the head post in the Care Quality Commission in April of this year - in charge of maintaining standards throughout the NHS. In a piece of staggering hypocrisy that she may come to have cause to regret quite soon, Bower told the Guardian upon her appointment that

It was not until the final months before her mother died that she understood how powerless people can feel when confronted by inadequate care.

I believe there's only one strategy through which Dame Christine can hold on to her integrity: to call for an amnesty for NHS staff who wish to report negligently poor care concomitantly with an investigation with the powers to interview staff at absolutely any level of authority, held by a body independent of the NHS and with safeguards in place to weed out vexatious complaints.

Or, on the other hand, she could let her reputation and those of the individuals below her and above her be eroded by the steady drip of therapeutic betrayals as the disgust becomes unbearable and the Great British Revolution rolls on.

the British left meddles in a very American dilemma

People in the US are currently struggling with a dilemma about the future face of healthcare in their country. A lot of the arguments centre on Britain's National Health Service (NHS) with, for example, Katie Brickell, Brit bride who was told that she couldn't have smear tests until the age of 25 and who, now at that age, is dying of cervical cancer, saying she has been misrepresented in the US media debate over proposed "Obamacare" healthcare reforms.

What I think is being lost on both sides of the pond is that the NHS did not just spring fully-formed from the head of a Soviet-style committee, but rather is a femme d'une certaine âge whose first solid incarnation was as a propaganda weapon, when copies of the 1942 Beveridge report rained on leading German military/political figures' parades when dropped from bombers, because Nazis hadn't planned for the wellbeing of the Übermenschen nearly as well.

The NHS was conceived by William (later Lord) Beveridge as an essential part of the welfare state's architecture; a future Liberal MP, he was commissioned by wartime coalition leader Winston Churchill to fashion the country's social future, and this was made a reality by Clement Attlee's immediate postwar Labour government: it was a project that could be comfortably owned by people from across the political spectrum. One of the many things Beveridge realised that are now subject to mission-drift was that full employment would be essential to provide the tax returns that would fund the system, which was going to banish his five evil giants of want, ignorance, disease, squalour and ignorance.

Heaven knows that Americans looking over the sea at the NHS will see that there has been mission drift - I can see that even since I started training as a nurse in the 1980s. Then, there was a clear hierarchy of management - junior sister, senior sister, nursing officer, management board. Then, a way would have been found to give Katie Brickell her smear-test. Now, her request would have gone through so many oncological leads, champions and commissioners even before it hit a Byzantine yet burgeoning management system that it's a wonder they had time to give her one refusal, let alone three. Personally I don't agree that the NHS is socialised healthcare: rather, this is what happens when socialist masters get hold of what works and break it so they can take credit for struggling to to fix it.

There are many dangers of undertaking the journey towards universal health-care. I would like to highlight three.

1 - Healthcare "rights" are asserted that are no such thing.

The First Post's Alexander Cockburn asserts, rightly, that the great battles have already been won through, say, provision of clean water, better sanitation and the near-eradication of TB. So now we have "rights" being asserted which are in no way inalienable from the human condition. For example, I've seen the pain of women and couples who can't conceive, but to have children is, unfortunately, not a right. Neither is gender-changing surgery in the absence of being born with two sets of sexual organs. Nor is tattoo removal, which was at one point being prioritised by hospital trusts that had fallen behind in their targets prescribing how much time could lapse between GP referral and treatment.

2 - State-controlled healthcare is hostage to prevailing politically-correct ideologies.

Note I don't attack state funding here, but state control - which in the jealous eyes of socialism comes hand in hand with allocation of monies. For example, IVF treatment was once given only to heterosexual couples judged to have a strong commitment to each other, but now the liberal-socialist establishment is ticking two boxes at once by ensuring that same-sex couples have access to IVF, and that in the case of lesbians both guardians can be called "mother" because babies born through IVF treatment have no legal right to a father.

Otherwise, politicians' pet minorities can be prioritised above people with pressing needs. One example is travellers being allowed to skip doctors' queues in the South of England because they are judged to be "vulnerable"; another is an order that went out to overworked nurses to turn Muslims' hospital beds to face Mecca three times a day (while a Christian nurse is suspended for offering to pray for a patient); yet again, in Britain the roughly 80,000 unfortunate enough to be living with HIV/AIDS benefit from the efforts of affluent, articulate activists, while roughly 600,000 individuals infected with Hepatitis C, often caught in similar ways, languished almost unrepresented until bean-counters realised the cost of treatment is going to be disastrous.

3 - Sinister governmental agendas can be inserted at will.

In the UK, nurses and doctors at present have the right to opt-out of performing or assisting at abortion procedures, but this right is constantly under threat as it is perceived to interfere with a woman's right to choose abortion, although a woman's right to choose to give birth is not generally considered a priority by NHS commissioners. Technically full-birth abortion is illegal here, but the London Evening Standard notes that in one year 66 babies survived abortion for up to ten hours, because "once born no medical help is offered". At the other end of life, an unofficial policy of involuntary euthanasia is visited upon people in a coma in hospitals, especially those with no visitors (volunteers can be a great source of information).



I hope the American people look at professionally-placed stories about the NHS with caution, because one of the agendas at play here is operated by the British left who, not realising that outside their groupthink people have things called opinions, are trying to manipulate the "Obamacare" debate in order to bounce British conservatives into saying that they are not totally happy with the NHS. One current example is a smear-attempt upon MEP Daniel Hannan (involving, among other things, half-truths being fed to US commentators about Katie Brickell's views on the NHS), who gave a thoughtful interview with US talkshow host Glenn Beck starting with the prevailing social views at the NHS's inception and going forward from there. For those who are interested - and this is a fascinating insight into the socialist mindset - Hannan is actually being punished for the "crime" of delivering the following rather brilliant speech to the European Parliament on March 24 this year in response to an address by Gordon Brown on Britain's performance during the financial crisis.




We Brits should not have the arrogance to assume that a shared language involves a shared culture - Britain and America are different countries with many shared values, but many more divergences involving geography, history and worldview, to name but three. At the end of the day, the American adult population - like the British - is composed chiefly of grown-ups, and they will choose what they choose to resolve this very American dilemma, either through Town-hall meetings or at the ballot-box.

swine flu - is it time to panic yet?

At work, I took a call from somebody who wasn't going to be able to make it in because she was displaying symptoms of swine flu. I replied it was a shame that she couldn't come and breathe all over us, so that we'd get the bug and hopefully emerge alive and immune to the predicted more serious outbreak later this year; she commiserated with me. When I related this to colleagues, wiser heads breathed a sigh of relief that the effective ban on joking about the bug had been lifted.

And it was real relief - visiting various workplaces, I've met some very tense people who would not need an especially hard shove to tip them over into panic.


The stampede of folk who sought to have themselves diagnosed (or otherwise) with swine flu that crashed the new Government website, for example, smacks of panic; in April, a newspaper forecast 20,000 deaths in the southern English county of Hampshire (population 1.75 million); and Professor Steve Field, chairman
of the Royal College of General Practitioners, has accused the National Childbirth Trust, in its instructions to woman who want families to try not to conceive at the moment, of "a completely disproportionate reaction...because it adds to the sense of hysteria and panic that seems to be engulfing the nation".

The Telegraph's Jon Swaine reports that the Government has had to deny giving mixed messages to pregnant women, as it originally (wisely) told them not to travel on, say, London's tube at rush-hour, then said that good hand hygeine is sufficient.

I wouldn't wish to minismise the importance of handwashing - the RCGP's Pandemic Planning document states "The good news is that flu viruses are easily deactivated by washing with soap and water or alcohol handrub and by cleaning surfaces with normal household detergents and cleaners" (my italics). But Cambridge University, like others, is taking the eminently sensible step of formulating a "swine flu action plan" should the beastie get bad around the time of the next intake, having learnt from the phenomenon of "fresher flu" (not to mention fresher mumps, glandular fever and sexually transmitted diseases). Likewise, it was reassuring to see that the city's Addenbrooke's hospital is remaining calm in the face of mounting dissatisfaction.

When this outbreak was beginning, something that might have helped could have been a strategy which, although now frowned on, saved many of us over a certain age from the more serious consequences of catching childhood diseases in adulthood - the "chickenpox party" (or measles party, mumps party, etc). That wouldn't be a very clever thing to do now though, because the virus has changed already.

So what's the problem?

The problem is twofold. Firstly, overprescription of Tamiflu, a medication manufactured by Roche that is said to take the edge off the illness and sometimes even shorten its duration. Two years ago, Swedish researchers found that not all oseltamivir, the active ingedient of Tamiflu, is broken down in the body: some passes into the sewage system, thence the water supply, unchanged. The researchers concluded that "there is a risk that [antiviral medications such as Tamiflu] will be ineffective when most needed, such as during the next influenza pandemic". In June, mutated swine flu was detected in Brazil; early in July, a strain of Tamiflu-resistant flu was reported in a teenager in Hong Kong who hadn't taken the drug, and later in the month another mutation was found in London: all responding, no doubt, to evolutionary pressure exerted by the inappropriate administration of anti-flu medication.


Secondly, at the recommendation of the World Health Organisation, we used to have a policy of vaccinating vulnerable groups against ("ordinary") influenza - older people, children with illnesses like diabetes, people who are immunocompromised, etc. Some years ago, the Government changed this to a manipulative campaign pushing flu vaccination to just about everybody, and this was backed up with documentaries detailing the attritions of the so-called Spanish Flu of 1918 and the chances of another pandemic. The intended effect of mild hysteria provided perfect fodder for the incipient panic we are now seeing.

We do need to keep a sense of perspective, however. For example, over here in Blighty, thirty-one people are said to have died of the flu, but the figure is constantly being revised as people are found to have died alongside their flu from a third cause. Case in point: poor six-year-old Chloe Buckley had swine-flu, but actually died from toxic shock as a result of a tonsillectomy. The World Health Organization's table charting the progress of Influenza A(H1N1) - swine flu - shows, as of the end of June, 2,506 cases diagnosed, and precisely one death confirmed by laboratory analysis. (21,449 and 87 respectively in the US, which of course borders on Mexico, the country of origin.)

The title of the Telegraph's editorial captures it exactly, quoting an undistributed WWII poster that would have been published had the Germans invaded: Keep calm and carry on. Or, as a wise old boss of mine once said: "Don't worry - when it's time to panic, I'll tell you to panic."




related posts

Swine flu and the hazard of hysteria

Happy birthday Charles Darwin