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Less Inequality

Sprinter Sacre Photo: Carine06, Flickr

Papworth Hospital postscript

On 25 March 2014 George Osborne in a visit to Cambridge said:

There are three parts to that plan – backing scientific clusters; helping scientists make the transition from the lab to the market; and committing long term funding to science.

First, we’re backing Britain’s scientific clusters. Clusters like Cambridge.

Because you are showing just how much Britain can achieve when we turn scientific ingenuity into commercial success.

Cambridge has long been home to one of the world’s greatest universities. And you have some of the world’s greatest laboratories – including this one.

But on the back of that, over the last generation you have built a cluster of innovation that has been phenomenally productive.

Your work has resulted in some of our most important scientific and commercial successes...

And later today you will be breaking ground on an exciting new graphene and electronics building here. That’s funded with £17 million from the Engineering and Physical Sciences Research Council. This will be a place for cutting edge research to be translated into everyday uses for this astonishing material.

I know there has also been a long debate about bringing together our world-class heart and lung centre at Papworth hospital with Addenbrooke’s hospital on the site of the Cambridge BioMedical Campus – and Papworth is working closely with the Department of Health to make sure that its plans are affordable.

But I can see myself a strong case in favour of bringing these two great institutions more closely together, creating a hub of leading-edge medicine, research and pharmaceutical development.

What you’ve achieved here has been called ‘The Cambridge phenomenon”. I want it to be the British phenomenon.

So the government is backing clusters across the UK…

On 30 April 2014 HRH The Duchess of Gloucester officially opened a new state of the art CT scanner at the hospital.

On 1 May 2014 it was announced that the business case for the hospital to move to the Cambridge Biomedical Campus had been approved by HM Treasury.

New Papworth Hospital

20 November 2015

Sprinter Sacre is back and winning again with a 14-length victory in Cheltenham's Shloer Chase.

16 March 2016

Sprinter Sacre did visit the Newmarket hospitals for tests but he is back to reclaim his crown better than Napoleon could have done winning the 2016 Queen Mother Champion Chase at Cheltenham.

Played right, Newmarket and the hospitals will love the publicity when the film is made.



5 January 2014

What is good enough for a Sprinter....

Why the national school education system is 26th in the international league table is not clear but the attitude transmitted in a large number of classrooms and an even larger number of playgrounds that what is good enough for me or good enough for them is good enough for you hardly helps.

In private hospitals patients used to be able to tell quickly who were the not terribly good doctors. They were allowed to take blood, perhaps do an ultrasound and a few other procedures but not much else. Nonetheless, patients were happy they were there. They could ask them all sorts of questions about medicine and get thoughtful answers whilst these procedures were underway. There was not much wrong with the doctors' education just that they were not good at diagnoses or wielding the knife. The hospitals had the good sense to put them in these roles. Good management is not about blaming people for what they cannot do but finding them something they can do.

Given the choice one would rather have more doctors paid less on average and fewer nurses than more nurses and too few doctors. Britain currently ranks 24th out of 27 in the number of doctors per patient in Europe yet spends 9% of GDP, about the European average, on medicine. There are far too many nurses in the NHS who obfuscate, make things up or are committed to denying the patients any meaningful information in contrast to the doctors who did the routine tasks. The NHS culture and training has a lot to answer for.

When you go to a medical establishment you want to see a doctor. That is the point. When you consult an architect you do not get a draughtsman. More doctors from countries in the EU with high performing health systems are needed to help introduce better ideas. The old complaint of specialists was that they would have liked to work in Britain but there were no jobs for them. A case of NHS insularity in insisting people had NHS experience.

The obsessive blood pressure taking in the NHS annoys many doctors. Watching television footage of nearly any GP surgery in the UK you see this going on because it is a centrally imposed requirement. Since you do not see this in other healthcare systems I must admit the first question I ask is what incompetence is this show meant to cover up and then look for it (likewise with obfuscation). In practice, this does cover up - any doctor, nurse or other authorised person can be made to look competent by doing this but competence is not so uniformly spread. Blood pressure rises with age so unless the readings are way out of line this testing is near pointless and certainly so at this frequency.

The news that the racehorse Sprinter Sacre passed his ECG in Lambourn yesterday with flying colours (if indeed he was carrying any colours to fly behind him), after being pulled up in a recent race and being diagnosed by a racecourse vet as having an irregular heartbeat, is good news. For it he had seven pads attached to his underside and then went out for a six furlong canter with data readings being transmitted back by bluetooth to the vet specialising in equine internal medicine. From the readings before, during and after this canter it was clear that the fibrillating heartbeat had gone away. Apparently, the horse in the opposite stall kept a keen eye on what was going on when the pads were being attached which is as it should be (bring your relatives - all thoroughbreds share bloodlines so all are related).

The way GP surgeries (not all) take blood pressure on site can offend against principles of good metrology so having seen what is good for Sprinter Sacre, patients might do well considering not accepting a high blood pressure diagnosis without having worn an ambulatory monitor for at least a day. Not that they are likely to have or need bluetooth transmission of data like Sprinter Sacre.


30 January 2014

Raising the pressure

In science most hypotheses are eventually disproved. So dogmatic adherence to them is unwise.

The overprescription of drugs for high blood pressure and cholesterol is beginning to resemble the scandal of the prescription of arsenical remedies in the 19th century - supported by hypotheses that are destined for the waste bin.

With the very old, a diagnosis of having high blood pressure will often mean that they cannot get private health insurance unless they already have it and, for those who are younger, higher premiums if they switch insurer. Even regularly taking the medication will not alter this, hinting that it is pointless. More likely a ruse is afoot [amongst others: 4] to get older customers off the books for good and gouge younger ones for higher premiums.

Blood pressure rises naturally with age and the medications are usually cheap generics so follow the money for what is going on.

There is little point in GPs being private contractors if they universally have to follow orders and be rewarded for it (in the NHS only GPs and 6% of services could be said to be in the private sector - so much for claims of wholesale privatisation) and cannot change with the times without being centrally permitted.

Having helped write a few standards that involve quite a bit of metrology, I'm not particularly impressed by GPs' blood pressure measuring equipment or the way it is operated, especially when the same people measured record startlingly lower readings using more advanced equipment in NHS hospitals. (Doubtless this is rarely fed back so the record can be corrected and the medication cancelled).

This is not really about any public/private divide: are GPs in the public or private sector - who knows?

As for the cholesterol hypothesis, America is years ahead of Britain in abandoning it and moving on. Elevated cholesterol shows itself to have some deleterious effect for those with diabetes, taken as a whole, but take those with diabetes out of trials about cholesterol and almost certainly elevated levels will show themselves to be beneficial for everyone else. This, too, is a hypothesis but one worth testing.*

(Cholesterol is probably a benign substance until it is involved in oxidation and the reasons this oxidation takes place are probably nothing at all to do with the quantity of cholesterol in the bloodstream or its type).

It is about time that some large Continental insurers, mutual or private, started advertising Europe-wide health insurance policies in Britain permitting treatment in whichever European country the person wants and bypassing the serried ranks of gatekeepers selecting out certain types of risk or keeping bonus earning fodder under their control.

There are worldwide policies but either we have free movement of services in the EU or we don't.

(*To make matters even more complicated, cholesterol may be a 'fireman always at the scene but not the cause' in the case of diabetes and a short 2013 study [DOI: 10.4236/ojemd.2013.33025] finds statins make diabetes worse).


12 February 2014

Unitary, outdated, unchallengeable, undemocratic (....the model for the USSR before the fall of the Berlin wall)

Since news broke this morning that Nice (National Institute for health and Clinical Excellence) is putting out draft guidance for comment (not public comment note, but GP and stakeholder comment), emanating from a committee with the sinister title, Lipid modification, which in effect recommends that millions more take statins, the public backlash has been immense.

Look anywhere there is comment on the internet. [postscript 11 June 2014: 5]

One BMA luminary [postscript 2 March 2014: 3] said on BBC Radio Five Live today that if statins were a horse he would not bet on it at all.

Nice has been hit by a bigger, more permanent deluge than is currently dunking the Environment Agency.

It has set itself up as an immense, global, political target representing the Communist way of doing medicine - a few make a decision behind closed doors based on highly contestable science [postscript 11 June 2014: 6] and everyone has to obey, especially professional practitioners. It is far from being the best standards body in Britain [postscript 15 April 2016: 7]; a proposal to split it into two is needed.

This naturally pains those who do not believe our socialised medicine is Communist.

It gives heart to those who would say the only visible evidence of Communism in Europe is healthcare in Britain: from those who brought you the Liverpool Care Pathway, Southern Cross near bankruptcy and a slew of secret agendas because they have the fantasy that these are mainstream government imperatives.

No wonder when some Americans say they would like universal healthcare they are careful to add that it will not be like the NHS.


14 February 2014

Calling the odds

Excellence very often relies on clusters. Ideas exchange rapidly within a cluster. Competition gets a chance to develop on the basis of excellence. Alternative centres for self-expression open up which are missing without the cluster.

A few hospitals in London reach medical excellence - not because it is London but because of the cluster.

Addenbrooke's is a good hospital but not outstanding in the way the nearby university is. What it could do with is some competition, an alternative centre nearby in which people could work, with which it could exchange ideas, of a rank which it could not overawe.

Papworth is a hospital with a reputation for excellence, though smaller. It wants to relocate to a site close to Addenbrooke's.

The dominance of the state in hospital provision is fraught with dangers. A unitary system is odds on to fail a decade out not for political, demographic or financial reasons but for cultural and organisational ones.

Papworth has good medicine and good finances. It does not want to go far. Using excess NHS capacity in Peterborough, which does not belong to it, and which it appears it does not want to do, is not a good reason to prevent it doing what it wants.


26 February 2014

Good policy

There is a cluster in Newmarket. If you are a horse you have a choice of two world class equine hospitals and the food is reputed to be better, too.

Though he has been wearing an ambulatory heart monitor and doesn't quite amble along in the way you might it seems Sprinter Sacre will not be going to Cheltenham's Champion Chase this year.

He's not going to hospital either though he'd know how to jump a queue - by nineteen lengths - but even if he did it's a racing certainty they wouldn't sell his records without consent.[1]

No, despite having been written about more than that of an ailing politburo chief his ticker is just fine but he will be taking it easy for a while. It's notable, though, that nobody has dared prescribe him statins and blood pressure medication.[2] You'd place money on him knowing how to kick up a fuss if they did.

Since no doping is de rigeur in Britain, it'd probably invalidate his insurance if someone did.