Wednesday, November 11, 2009
MHRA-Statins
Tuesday, November 10, 2009
Hairy Crabs & Wines
Monday, November 9, 2009
Berlin Wall, Appassionata & The Lives Of Others
“The Lives of Others has caused the most delicious trouble since winning Best Foreign Language film at this year’s Oscars. Few critics expected this modest thriller about the East German Stasi to lift such a glamorous award.
Sunday, November 8, 2009
NHS: Can we learn from Obama?
As more and more individuals are taking up private health insurance in England, would the government, have the courage to adopt some of the Obama Plan in reining in the insurance industry. This would prevent the cherry picking by the industry and the dumping of the chronically ill people on the overstretched NHS.
The following is a straight quote from the Obama Plan.
More Security and Stability
IF YOU HAVE HEALTH INSURANCE, THE OBAMA PLAN:
Sunday, November 1, 2009
Drowning and The Marathon
Related:
Ancient Remedy: Modern Outlook
Loquat, Winter Melon & Sapote
49.38 © 2009 Am Ang Zhang
Saturday, October 31, 2009
High End Photography & Wine

After tasting around the hall starting with the “lesser” wines (for want of a better word as some of the wines were very drinkable), we all drifted to the “top” table. The white Laville-Haut-Brion 2006 was one of the best whites I have tasted in recent times. It is just amazing what could be done with the right combination of Sauvignon and Semillon grapes. They told me that this white could stay in the cellar for the next 10, 20 or even 30 years! Then there were of course both La Mission-Haut-Brion 2006 and Haut-Brion 2006 in its distinctive bottle. Wednesday, October 21, 2009
SARS, Freedom & Knowledge
Wednesday, October 14, 2009
Cockroach Wine Catch: Bodega Septima Gran Reserva 2006
In New Zealand you could be paying more than $50 (US$ 38) for a bottle!
Jancis Robinson gave it a gold medal!
Elliot Essman continued:
“The Septima 2006 Gran Reserva is a blend of 58% Malbec, 33% Cabernet Sauvignon and 9% Tannat; these grapes were sourced from three different vineyard blocks, vinified separately and aged twelve months in French and American oak. In color the wine is a profoundly deep ruby. The nose has violet and rose flowers, nutmeg and black pepper spice, brambly red berry fruit, and chocolate. As in the case of its single varietal cousins, this blend is superbly balanced. The medium-body and smooth mouthfeel was the first quality I noticed; the acid is firm, the tannins round. Flavors, none of them too pushy, swirl around each other in turns: red cherry, blackberry, chocolate, sweet cinnamon. The finish is lengthy, showing restrained but lasting acidity and tannin with ripe red fruit and vanilla-laced chocolate at the end. Despite excellent flavor, however, it is the elegant feel of the wine in the mouth that catapults it into a league far beyond its $25 asking price.”Tuesday, October 13, 2009
Panama Canal: Diseases & Failures.
We learn little or nothing from our successes. They mainly confirm our mistakes, while our failures, on the other hand, are priceless experiences in that they not only open up the way to a deeper truth, but force us to change our views and methods.
In 1879, Ferdinand Marie de Lesseps, with the success he had with the construction of the Suez Canal in Egypt just ten years earlier, proposed a sea level canal through Panama. He was no engineer but a career politician and he rejected outright what the chief engineer for the French Department of Bridges and Highways, Baron Godin de Lépinay proposed, a lock canal.
The engineer was no match for a career politician:
“There was no question that a sea level canal was the correct type of canal to build and no question at all that
“The resolution passed with 74 in favor and 8 opposed. The ‘no’ votes included de Lépinay and Alexandre Gustave Eiffel. Thirty-eight Committee members were absent and 16, including Ammen and Menocal, abstained. The predominantly French ‘yea’ votes did not include any of the five delegates from the French Society of Engineers. Of the 74 voting in favor, only 19 were engineers and of those, only one, Pedro Sosa of
The French failed in a spectacular fashion.
Diseases like yellow fever and malaria played their part as a sea level canal involves a good deal more digging.
The discovery of yellow fever being carried by mosquito must be credited to one Cuban physician: Carlos J. Finlay.
For twenty years of his professional life, he stood at the center of a vigorously debated medical controversy: the etiology of yellow fever. Finlay believed that it was waterborne and carried by common mosquitoes: Stegomyia fasciata.
Finlay's advice and experiences proved invaluable to the United States Army Yellow Fever Commission. When the Commission decided to test the mosquito theory, Finlay provided the mosquitoes and Walter Reed of the Commission wrote triumphantly after the success of the experiments of inducing yellow fever by mosquito bites, ‘The case is a beautiful one, and will be seen by the Board of Havana Experts, to-day, all of whom, except Finlay, consider the theory a wild one!’ The
Reed acknowledged that ‘it was Finlay's theory, & he deserves much for having suggested it.’
William Crawford Gorgas wrote of Finlay:
"His reasoning for selecting the Stegomyia as the bearer of yellow fever is the best piece of logical reasoning that can be found in medicine anywhere."
Links
Confucius & A Tale Of Two Cities

Confucius taught that one must look after oneself, then family, then nation before one can rule the world.
“Mr Brown used his expenses to pay his brother Andrew Brown £6,577 for cleaning work at his
Also:
“An inquiry was launched into Miss Smith's expenses claims after it emerged that she had designated her family home in the West Midlands as her second home for expenses purposes, while listing a room at her sister's London house, where she lodged, as her main home.”
Oh dear: Blue Peter
Saturday, October 10, 2009
Noctors, Piano, Golf & ADHD
For now, just as the west is abandoning classical music training as part of the school curriculum, parents in China are paying for their children to have piano lessons. By some reckoning, North America probably consumes 90% of Ritalin and similar stimulants, whereas China is probably consuming 90% of the pianos produced. One factory in the south of China is currently producing 100,000 pianos a day.
Some will argue that such pressure on children is not good. Yet we have to look at Michael Phelps, whose parents abandoned drug treatment for his ADHD in favour of swimming. The modern Chinese parent may indeed have stumbled upon something similar to Michael Phelps’ swimming in dealing with problems of concentration. Many parents actually believe that the discipline of learning the piano is helpful in building a more rounded person, although some may have aspirations that their offspring might be the next Lang Lang.
As China now moves into a new era, the piano practising child may have something else to practise: golf.
The Independent reported that it is the new game that is the game of choice for China’s new elite.
My friend told me that when he was at the Spring City Golf & Lake Resort, a nine year old just won a junior tournament. The boy was only 9 and he scored 71 on his final round playing from the red Tee
He may well be the next Tiger, a piano playing Tiger.
A Book Review: Knowledge, Ginkgo, Software & Brain Fitness
Old and New: Multiple Sclerosis & Elgar
The Ring: Child Psychiatry & Human Behaviour
Nobel: Kandel and Lohengrin
Lohengrin: Speech Disability, Design & Hypertension
Easter Passion: Bach, Beethoven and Mahler
'The Knowledge' and the Brain
Golf Posts:
Golf & Neuroplasticity: The Open 2009
Golf and Disability
Golf, Cholera and Tiger Woods
The Open and The Brain
Tiger Woods and Breathing
Ancient Remedy: Modern Outlook
Monday, October 5, 2009
Curiosity & Nobel
5 October 2009
The Nobel Assembly at Karolinska Institutet has today decided to award The Nobel Prize in Physiology or Medicine 2009 jointly to Elizabeth H. Blackburn, Carol W. Greider and Jack W. Szostak for the discovery of "how chromosomes are protected by telomeres and the enzyme telomerase"

Associated Press, European Pressphoto Agency, Associated Press
From left, Jack Szostak, Carol Greider and Elizabeth Blackburn.
"This year's Nobel Prize in Physiology or Medicine is awarded to three scientists who have solved a major problem in biology: how the chromosomes can be copied in a complete way during cell divisions and how they are protected against degradation. The Nobel Laureates have shown that the solution is to be found in the ends of the chromosomes – the telomeres – and in an enzyme that forms them – telomerase.
Telomeres/NIH File Material
"The long, thread-like DNA molecules that carry our genes are packed into chromosomes, the telomeres being the caps on their ends. Elizabeth Blackburn and Jack Szostak discovered that a unique DNA sequence in the telomeres protects the chromosomes from degradation. Carol Greider and Elizabeth Blackburn identified telomerase, the enzyme that makes telomere DNA. These discoveries explained how the ends of the chromosomes are protected by the telomeres and that they are built by telomerase.
"If the telomeres are shortened, cells age. Conversely, if telomerase activity is high, telomere length is maintained, and cellular senescence is delayed. This is the case in cancer cells, which can be considered to have eternal life. Certain inherited diseases, in contrast, are characterized by a defective telomerase, resulting in damaged cells. The award of the Nobel Prize recognizes the discovery of a fundamental mechanism in the cell, a discovery that has stimulated the development of new therapeutic strategies." Nobel Press Release
Carol Greider told Associated Press that the research was aimed at understanding how cells work, not with the idea for certain implications for medicine.
“Funding for that kind of curiosity-driven science is really important,” she said, adding that disease-oriented research isn’t the only way to reach the answer, but “both together are synergistic.”
It was comforting that Nobel chose to reward this kind of research as any breakthrough in Medicine and indeed Science could only come from fundamental research. It would not be a discovery if you knew what you were looking for.
The New York Times noted that:“Though Americans have once again made a clean sweep of the Nobel medicine prize, two of the three winners are immigrants. Dr. Blackburn was born in Tasmania, Australia, and has dual citizenship; Dr. Szostak was born in London. Dr. Blackburn came to the United States in the 1970s because it was ‘notably attractive’ as a place to do science.”
Nobel Posts:
Kandel & Doidge: Neuroplasticity & Memory.
Nobel: Kandel and Lohengrin
Chinese Shared Nobel Prize in Chemistry
Papaya and Nobel Prize
Tuesday, September 22, 2009
C. G. Jung: Memories, Dreams & The Soul
“The purpose of analysis is not treatment,”
“That’s the purpose of psychotherapy. The purpose of analysis, is to give life back to someone who’s lost it.”
STEPHEN MARTIN, Jungian.
I have picked out the various bits in Sara Corbett’s account of the publication of The Red Book that may be of interest. The Red Book may turn out to be the most important publication on the human psyche. We all struggle to understand our own lives and it is reassuring to see that one of the greatest thinkers of our time struggled too.
“Jung soon found himself in opposition not just to Freud but also to most of his field, the psychiatrists who constituted the dominant culture at the time, speaking the clinical language of symptom and diagnosis behind the deadbolts of asylum wards. Separation was not easy. As his convictions began to crystallize, Jung, who was at that point an outwardly successful and ambitious man with a young family, a thriving private practice and a big, elegant house on the shores of Lake Zurich, felt his own psyche starting to teeter and slide, until finally he was dumped into what would become a life-altering crisis.
"What happened next to Carl Jung has become, among Jungians and other scholars, the topic of enduring legend and controversy.
“It has been characterized variously as a creative illness, a descent into the underworld, a bout with insanity, a narcissistic self-deification, a transcendence, a midlife breakdown and an inner disturbance mirroring the upheaval of World War I.
“Whatever the case, in 1913, Jung, who was then 38, got lost in the soup of his own psyche. He was haunted by troubling visions and heard inner voices. Grappling with the horror of some of what he saw, he worried in moments that he was, in his own words, “menaced by a psychosis” or “doing a schizophrenia.”
“Had he been a psychiatric patient, Jung might well have been told he had a nervous disorder and encouraged to ignore the circus going on in his head. But as a psychiatrist, and one with a decidedly maverick streak, he tried instead to tear down the wall between his rational self and his psyche.
“For about six years, Jung worked to prevent his conscious mind from blocking out what his unconscious mind wanted to show him. Between appointments with patients, after dinner with his wife and children, whenever there was a spare hour or two, Jung sat in a book-lined office on the second floor of his home and actually induced hallucinations — what he called ‘active imaginations.’ ‘In order to grasp the fantasies which were stirring in me underground, ‘ Jung wrote later in his book ‘Memories, Dreams, Reflections,’ ‘I knew that I had to let myself plummet down into them.’ He found himself in a liminal place, as full of creative abundance as it was of potential ruin, believing it to be the same borderlands traveled by both lunatics and great artists.
“Jung recorded it all. First taking notes in a series of small, black journals, he then expounded upon and analyzed his fantasies, writing in a regal, prophetic tone in the big red-leather book. The book detailed an unabashedly psychedelic voyage through his own mind, a vaguely Homeric progression of encounters with strange people taking place in a curious, shifting dreamscape. Writing in German, he filled 205 oversize pages with elaborate calligraphy and with richly hued, staggeringly detailed paintings.
“What he wrote did not belong to his previous canon of dispassionate, academic essays on psychiatry. Nor was it a straightforward diary. It did not mention his wife, or his children, or his colleagues, nor for that matter did it use any psychiatric language at all. Instead, the book was a kind of phantasmagoric morality play, driven by Jung’s own wish not just to chart a course out of the mangrove swamp of his inner world but also to take some of its riches with him. It was this last part — the idea that a person might move beneficially between the poles of the rational and irrational, the light and the dark, the conscious and the unconscious — that provided the germ for his later work and for what analytical psychology would become.
“The book tells the story of Jung trying to face down his own demons as they emerged from the shadows. The results are humiliating, sometimes unsavory. In it, Jung travels the land of the dead, falls in love with a woman he later realizes is his sister, gets squeezed by a giant serpent and, in one terrifying moment, eats the liver of a little child. ‘I swallow with desperate efforts — it is impossible — once again and once again — I almost faint — it is done.’ At one point, even the devil criticizes Jung as hateful.
“He worked on his red book — and he called it just that, the Red Book — on and off for about 16 years, long after his personal crisis had passed, but he never managed to finish it. He actively fretted over it, wondering whether to have it published and face ridicule from his scientifically oriented peers or to put it in a drawer and forget it. Regarding the significance of what the book contained, however, Jung was unequivocal. “All my works, all my creative activity,” he would recall later, “has come from those initial fantasies and dreams.”
“And yet, Carl Jung’s secret Red Book — scanned, translated and footnoted — will be in stores early next month, published by W. W. Norton and billed as the “most influential unpublished work in the history of psychology.” Surely it is a victory for someone, but it is too early yet to say for whom.
“To talk to Jung’s heirs is to understand that nearly four decades after his death, they continue to reel inside the psychic tornado Jung created during his lifetime, caught between the opposing forces of his admirers and critics and between their own filial loyalties and history’s pressing tendency to judge and rejudge its own playmakers.
“The Red Book is not an easy journey — it wasn’t for Jung, it wasn’t for his family, nor for Shamdasani, and neither will it be for readers. The book is bombastic, baroque and like so much else about Carl Jung, a willful oddity, synched with an antediluvian and mystical reality. The text is dense, often poetic, always strange. The art is arresting and also strange. Even today, its publication feels risky, like an exposure. But then again, it is possible Jung intended it as such. In 1959, after having left the book more or less untouched for 30 or so years, he penned a brief epilogue, acknowledging the central dilemma in considering the book’s fate. ‘To the superficial observer,’ he wrote, ‘it will appear like madness.’ Yet the very fact he wrote an epilogue seems to indicate that he trusted his words would someday find the right audience.
“In the Red Book, after Jung’s soul urges him to embrace the madness, Jung is still doubtful. Then suddenly, as happens in dreams, his soul turns into ‘a fat, little professor,’ who expresses a kind of paternal concern for Jung.
“Jung says: ‘I too believe that I’ve completely lost myself. Am I really crazy? It’s all terribly confusing.’”
“The professor responds: ‘Have patience, everything will work out. Anyway, sleep well.’”
Jung told one of his patients:
“I should advise you to put it all down as beautifully as you can — in some beautifully bound book,” Jung instructed. “It will seem as if you were making the visions banal — but then you need to do that — then you are freed from the power of them. . . . Then when these things are in some precious book you can go to the book & turn over the pages & for you it will be your church — your cathedral — the silent places of your spirit where you will find renewal. If anyone tells you that it is morbid or neurotic and you listen to them — then you will lose your soul — for in that book is your soul.”
He obviously took his own advice and we may all in the end be thankful he did.
Related: C. G. Jung: The Red Book
Sunday, September 20, 2009
C. G. Jung: The Red Book
Latest: SARS, Freedom & Knowledge
Saturday, September 19, 2009
McKinsey: NHS & Vogue

Snorkelling can be very inspirational. I have often wondered why so many fishes stay around the Great Barracuda, running the risk of being gobbled up before the end of the day. Perhaps these fishes have not been warned. The NHS certainly has.
I read that McKinsey, one of the leading Management Consultancy firms is expected to recommend 25% cost cuts at Vogue. They have already advised a 10% staffing cut in The NHS to achieve a saving of £20 billion by 2014.
In actual fact the NHS could have saved even more money by doing away with the likes of McKinsey. A new book was published by one insider Matthew Stewart on management consultants. The Independent had the details:
Masters of illusion: The great management consultancy swindle
Thursday, 17 September 2009
I will just pick out a few points that may be of interest.
The truth:
“Wherever I was in the world, at the beginning of every consulting project, one thing was certain: I would know less about the business at hand than the people I was supposed to be advising.”
How to impress:
“Firstly, they constructed a database of the client's customers, detailing each customer's product and transaction activity over the preceding year. Next they established a clean profit and loss statement for the whole business, including all overheads but excluding extraordinary items. Then, to allocate the revenues and costs of the business to each customer, they devised algorithms based on detailed models of each kind of product and transaction. The complexity of these algorithms, naturally, was such that they were far beyond the powers of most clients to comprehend. The result was an analysis of the exact revenue, expense, and profit to the client attributable to each of its customers. Finally, the team lined up the customers according to their profitability, thus allowing the client to see how much of its profits could be attributed to its most profitable customers, and how much to the least profitable."
The Whale Chart: "The Whale" is a graph. Its official title is "Cumulative Customer Profitability" and it also goes by the generic name "skew chart".
“I eventually came to understand that it is possible to construct a Whale chart for just about any business anywhere. It makes no difference whether the business is inherently good or bad, well-managed or in the hands of chimpanzees. It doesn't even have to be a business – it can be a football game or a population chart.”
It gets better:
“In fact, you don't even have to do the analysis. You can save 80 per cent of the effort by just borrowing data from a previous analysis. There's always going to be a skew. It isn't science; it's a party trick.”
The Clients---including The NHS and Vogue:
"The management consulting industry depends on a small number of gargantuan clients; we thought we were doing pretty well out of one of our clients who spent $12m annually on our services – until we learned that this behemoth's total spending on "strategy" consultants was about $100m per year. In order to grasp why some large organisations (but not others) spend so much money on something as ethereal as "strategy," one must dispose of the naïve idea that consulting involves the transfer of knowledge."
Communication:
"The most important of the all-too-human functions of shaman-consultants is to sanctify and communicate opinion. Like ministers of information, consultants condense the message, smooth out the dissonances, unify the rhetoric, and then repeat and amplify it ad nauseam through the client's rank and file."
Writing your own report card:
“The pretence of knowledge where none is to be had, after all, is also a licence to represent private interest as a public good. Managers of client organisations easily abuse this licence, using shareholder money to pay for consultants in order to confer legitimacy on actions that deserve proper scrutiny from truly independent sources. For consultants, the arrangement has all the beauty of writing your own report card.”
According to the Management Consultants' Association, the NHS spent £300m on external consultancy last year.
The ultimate message:
“……you will be expected to work much harder than you ever have before and your chances of losing your job are infinitely greater than you ever imagined.”
Birthday Grand Rounds: Residency Notes
Related: The New York Observer, The Guardian,
NHS: Budget 2010-£110 Billion, McKinsey
Thursday, September 17, 2009
Medicins sans Frontier: Ethiopia & Polyclinics
I woke up to read about the abolition of frontiers in
Since I now drive 120 miles to see my favourite dentist should I do the same so that I can see my old GP.
NHS Blog Doctor: GP boundaries, The Guardian
Related: The Independent, The Guardian, MPs,
Monday, September 14, 2009
First Emperor, Animal Farm & Allyson Pollock

Forty years ago, Colin Douglas, geriatrician and novelist, when on a gap year in a remote secondary school in post-colonial Ghana, was summoned by the headmaster and informed that "we had in our library a book the government didn't think we should read." The book was of course Animal Farm.
Here in The BMJ, he reviewed Allyson Pollock’s Book, NHS plc.
"Allyson Pollock describes her experience in November 2001 at the hands of the House of Commons Health Select Committee, then just refreshed by an influx of New Labour ultras, including one Julia Drown MP, a former health service manager. Against the advice of the committee's chairman and clerks, Ms Drown tabled a rant aimed at undermining Professor Pollock and her Health Policy and Health Services Research Unit at University College London. In the chairman's view such an attack on an individual witness was unprecedented and wrong, yet it nevertheless (by virtue of a nasty but neat little bit of committee footwork) appeared in the final report of an inquiry into the implications of the private finance initiative (PFI) for the NHS.”
Allyson Pollock must count herself lucky for not living in
“……if you are old enough, or even just curious enough, to wonder whatever happened to the British NHS as first conceived, you might find NHS plc a useful little book. An excellent early reputation—for cost effectiveness and equity based on integrated services, minimal management costs, and a vast and intensely practical pooling of risk—dwindled slowly. This was firstly because of chronic and insidious underfunding, later because a notional internal market began to take it apart, and finally (though the word may still be slightly premature) because of the current assault: a burgeoning, divisive, sometimes mendacious for-profit marketisation of a healthcare system that was once an admired public provision and a right of citizenship in the United Kingdom.”
Regarding PFI he continued:
"Since it was Pollock's views on the PFI that so upset its proponents, it is worth summarising them briefly. Costs are now intrinsically higher, because of capital borrowing at higher rates than those available to government, because of cash hungry consultancies and the vast transactional and monitoring costs of countless contracts, and because—for the first time on a large scale in the NHS—commercial profits must be made. To accommodate all these new costs clinical services have been scaled down, while matching assumptions about increased efficiency are only variably delivered. All this, along with the rigidity of a trust based strategy for building hospitals and the locking in effect of contracts fixed for decades, seems to Pollock and many others at best a bad bargain, at worst a naive betrayal that opens the NHS to piecemeal destruction and the eventual abandonment of its founding principles. And all over the country PFIs—greedy, noisy, alien cuckoos in the NHS nest—gobble up its finances and will do so for the next 30 years.”
"Foundation trusts (‘public benefit corporations’—what?) will further disrupt any attempts to build effective local health services, drive the balance of care in the wrong direction, and almost certainly get choosy about the patients they treat. All this will least benefit elderly patients, whose care as our population ages ought to be explicitly identified as the core commitment of our NHS. Will elderly people be surprised? I doubt it. Their long term care was totally abandoned by the NHS in
I have to thank Dr. Grumble for pointing me to this site that has a write up too.
Rupert Read wrote in OurKingdom:
“When I was at Oxford taking PPE 20 years ago, my best friend was Simon Stevens, who went on to become Tony Blair's key health policy adviser. Back then, he was a socialist. Now, he is Chair of United Health Europe, one of the
Why do we still have the great books of Confucious and other scholars? They have all been memorised by scholars and The First Emperor could not kill all of them. When he failed to achieve eternal life and died, the scholars just re-wrote these books again.
The last words go to Colin Douglas:
“Professor Pollock, with the help of many colleagues acknowledged in a list that reads like a roll of honour for services to the real and now threatened NHS, has written a brave, necessary book. And because you know the government thinks you shouldn't read it, you probably should.”
Sunday, September 13, 2009
Old & Young: E. Coli O157
September 13, 2009
Godstone Farm/Gareth Fuller
"Thousands of children across the South of
"Godstone Farm in Surrey, a popular family attraction where children are encouraged to stroke and touch animals, is closed while the Health Protection Agency (HPA) conducts tests to find out the cause of the outbreak which has left 12 children in hospital, four of them in a serious condition.
"Thirty-six cases, including some adults, have been reported by GPs.
"About 1,000 children, mainly from South London,
Remember
One of the first major E. Coli O157:H7 outbreak that affected mainly old people in the United Kingdom.
From the BMJ 1996;313:1424 (7 December)
E Coli O157 kills five people in Scotland
"An inquiry had been set up to examine the circumstances behind Britain's worst outbreak of food poisoning from Escherichia coli 0157, which has resulted in five deaths and left 280 people ill.
"The outbreak, in central
"The deaths have all occurred among elderly people, two of whom were among a group of pensioners who shared a meal at a church in Wishaw on 17 November. They had eaten a steak pie supplied by John Barr, and tests have since confirmed the presence of E coli bacteria in the gravy. It soon became clear, however, that the problem was not confined to Wishaw when people from a wider area began reporting symptoms."
E.Coli O157:H7 can be very virulent and it is believed that as little as 5 individual germs can cause serious damage especially by causing kidney failure. We have little understanding still of how bacteria act but it is now known that E. Coli O157: H7 uses Quorum Sensing. The condition at the farm must have been ideal for them.
We also need to understand about the proliferation of bacteria such as E. Coli and MRSA and C. difficile in our farm animals.
New Pathways for Transmission: Farm Workers
Microbial Drug Resistance 13(1):69-76.Akwar et al. 2007.
Risk factors for antimicrobial resistance among fecal Escherichia coli from residents on forty-three swine farms.
"Akwar et al. found that people living and working on swine farms where antibiotics were used in feed had increased chances of carrying resistant E. coli. In some cases, the risk of resistance for the farm workers was higher than if they had taken antibiotics themselves. Once farm workers are colonized by resistant bacteria they can transfer them to family members and others in their community."
The use of antibiotics in farm animals is widespread and is not restricted to the treatment of infections but for the enhancment of weight gain. In business terms it is the conversion ratio of feed to weight that matters. The Obama government may well be taking steps to control it due to the rising incidents of Hospital Infections. (See MRSA & Antibiotics: Obama & Farmers.) Chicken and other animals can grow up to twice as fast as 30 years ago when antibiotics were not in the feeds. Scary!
It may therefore require more than "washing hands" if we do not want more outbreaks like this and other ones.
Latest: Twins
Other recent outbreaks: Mother in coma as E coli outbreak strikes
Related Post: MRSA & Antibiotics: Obama & Farmers
1996 Report: Pennington Report
Thursday, September 10, 2009
NHS & McKinsey: The Professor & 10%
Professor Allyson Pollock
The NHS is about care, not markets
The Guardian Thursday 3 September 2009
Downsizing the workforce is a business response to loss of profit – but it doesn't account for the NHS goal of universal healthcare.
I will attempt to look at Professor Pollock’s article in detail especially as we come up to the anniversary of the failure of Lehman Brothers.
Healthcare in the market place:
The core goal of universal healthcare and services planned on the basis of need and not ability to pay is being jettisoned by the turnaround teams and management teams brought in to manage anticipated reductions in NHS budgets. Downsizing the workforce is a traditional response of business to loss of profit where businesses have to pay the costs of operating in a market and earn surpluses for shareholders. Unlike
Administration costs:
The diversion of health spending from patient care to paying for a market are not apparently McKinsey's concern. Take for example the costs of the new market bureaucracy; for more than 40 years administration costs were in the order of 6% of the total budget a year, they doubled overnight to 12% in 1991 with the introduction of the internal market. We have no data today for
Different to
So why hasn't McKinsey advocated making savings along the lines of Scotland and Wales by reintegrating trusts into area-based planning structures and thereby abolishing billing, invoicing, the enormous finance departments, marketing budgets and management consultants, lawyers, commercial contracts? In this way one could project savings of anything from £6-24bn a year for
PFI:
A second set of savings would be the high costs of PFI where the taxpayer, having bailed out the banks, is now paying almost twice as much as it should for some PFI hospitals through high rates of interest and returns to shareholders. The total money raised from private finance so far is £12.27bn but the NHS will pay out £41.4bn for the availability of buildings and a total of £70bn over the life of the contracts. The irony is that the patient and the public are rebuilding the banks' balance sheets using scarce NHS funds intended for patient care and staff, especially in community-based services.
ISTC:
A third saving could be made by cancelling the contracts for the £5bn ISTCs programme – research in Scotland extrapolated to England has shown as much as £1bn has been wasted by giving money to for-profit ISTCs for work that was not carried out in the first wave.
Then there are all the other contracted out services including the pharmaceutical bill of £14bn. Are these contracted out elements part of the McKinsey scrutiny? It is doubtful since the company travels the world advocating market solutions.
Failures:
And here we run up against the fundamental problem of retaining marketeers to advise on healthcare. Markets mean reducing the capacity of the NHS to pool the costs of care across the whole service, substituting instead hospitals, clinics and practices that have to pay their way like businesses and, like businesses, can fail. Needs-based planning, once the hallmark of the NHS in
Solutions are sought from outside consultants and turnaround teams using unsubstantiated assertions that the NHS is inefficient and can increase productivity. What the selective use of data and evidence mask is the failure to view the system as a whole and to remember that its core goal is universal healthcare, not concocted operating surpluses.
Winners and losers should not be what universal healthcare is about:
In contrast to
The moral is that if the Department of Health in
From the Book by Allyson Pollock: NHS plc
“The NHS is being dismantled and privatised. Very soon every part of it will have been ‘unbundled' and commodified...a new business dynamic is taking charge of the ways in which services are provided and patients are responded to. The dramatic costs involved - in terms of loss of equal access and universal standards, as well as of money - are concealed by claims of ‘commercial confidentiality' and by tearing up the once-exemplary systems of NHS accounting”
I just hope the Professor will not be one of the 10%.
Grand Rounds: Vol. 5 No. 52 Suture for a Living
What is wrong with the market approach:
Cars: Rover-MG, GM Europe, US Cars
Related: Corruption: Three Doctors and a Professor.
Others:
NHS & the Repeal Of The Glass-Steagall Act
To Intervene Or Not: A Colossal Failure Of Common Sense.
Article: The Guardian
Thursday, September 3, 2009
Pfizer, Geodon (Ziprasidone ) & The Twist
From Reuters:
“Geodon is FDA-approved only to treat patients ages 18-65 diagnosed with schizophrenia or acute manic or mixed episodes associated with bipolar disorder. However, according to the whistleblower suit unsealed today, Pfizer illegally promoted the sale and use of Geodon for a variety of off-label conditions,
including depression, bipolar maintenance, mood disorder, anxiety, aggression, dementia, attention deficit hyperactivity disorder, obsessive compulsive disorder, autism, posttraumatic stress disorder, and for pediatric, adolescent and geriatric patients.”
That sounds like every known condition!!!
"Pfizer targeted pediatrics and adolescents to expand off-label use and maintained on its payroll an army of more than 250 child psychiatrists nationwide." Kenney stated that, "Pfizer regularly paid generous speaking fees to these child psychiatrists to give what were basically promotional lectures about the benefits of Geodon to their peers, who were naturally also child psychiatrists, despite the fact the drug is not FDA-approved or medically indicated to treat children at all."
"……the purpose and intent of paying so many child psychiatrists is clear-- to gain a foothold within the fastest growing market for antipsychotics --children. The practice of expansive off-label use is dangerous, particularly in children because the drug has not been evaluated for its safety for the unique physiological make up of children."
"……less than 5% of the United States population is diagnosed with schizophrenia or bipolar disorder, yet in 2008 Geodon surpassed the blockbuster benchmark of $1 billion in sales."
"……after drug makers obtain initial FDA approval for a specific use, they often don't bother with expensive testing that would allow them to request a label extension for other uses. They just market the drug off-label."
Danger:
"……among Geodon's most dangerous side effects is its potential to affect the heart's rhythm, a condition known as QT prolongation, which increases the risk of sudden cardiac death."
Antibiotic as well?
As part of the overall settlement, Pfizer agreed to pay $100 million to resolve allegations that it engaged in the marketing of Zyvox for a variety of off-label conditions beyond the methicillin-resistent Staphylococcus aureus ("MRSA") infections for which Zyvox was FDA-approved.
Is anything sacred anymore? The twist: this is better than a John Grisham Novel
“Authorities called Pfizer a repeat offender, noting it is the company's fourth such settlement of government charges in the last decade. The allegations surround the marketing of 13 different drugs, including big sellers such as Viagra, Zoloft, and Lipitor.”
“In an unusual twist, the head of the Justice Department, Attorney General Eric Holder, did not participate in the record settlement, because he had represented Pfizer on these issues while in private practice.”
“Eric Holder, has a net worth of $5.7 million and lobbied on behalf of three companies in the past five years, according to a questionnaire filed by Holder with the Senate Judiciary Committee.
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