Friday, June 24, 2016

Underclass: The Old Beggar

Hasselblad/150mm lens.

Available light

Film: Kodax TMax 100

Printed on Record Rapid paper/ Selenium Toned

Selenium Toning is for archiving prints and imparts a lovely tone depending on concentration.


HyperCRYPTICal said...
Excellent portrait - you can almost hear him thinking.

Anna :o]
Cockroach Catcher said...
Sam said...
It's the light that does it Anna, but the man is actually 'blank', staring without thought ... and that's the brilliance of the photography here; capturing the 'nothingness' that comes with dispair ... and poverty

... but I never liked the word 'underclass' ... or 'subhuman', two of the same vocabulary, because of the degradation to humanity that is associated with such expressions. Surely, humanity with all it's ills, is still less vicious than that, or am I underestimating our 'exclusive' arrogance?

Well done, as usual, CC, you've made me think, and stirred some emotions :-)
Cockroach Catcher said...
With the recent debate on the UNDERCLASS I thought I would do a send up without words.

I am glad you liked the portrait. Photography portraiture is difficult as it was only a split second thing unlike painting which often takes many sittings (painting from photo is the modern way and that is why much of the BP stuff is not good in my humble opinion.

Saw One Man, Two Guvnors at the National: all the classes were bad----Public School class, butler class, mafia class, lawyer class, waiters class.
Sam said...
Sarcastic play, funny too, in parts.

... one of the most amazing, and very disturbed, paintings done from a photo, is [Gorky's mother and child]. He was influenced by Cezanne and Picasso, but that painting has something, a life of it's own, despite it's artist death long ago ... I find it scary and very disturbing ... Gorky needed you CC, check him out :-)
Cockroach Catcher said...
In Thailand and other Buddhist countries, the monks are doing a good turn to us ordinary people by begging so that we can buy our way out of hell.

It is the same with many Catholic countries and Portugal is one of them.

He was given some bread so from under his seat he pulled out some raw garlic cloves and ate the bread with it. He is going to live a long life.

My old man was doing good, much good.

COI: I did give him some money, after the photo of course.

Wednesday, June 22, 2016


On the eve of the EU referendum it seems to me that the recent strikes of Junior Doctors were light years away and the assumption is that all is well and the majority of tick box trained doctors will just tick what the likes of Jeremy and Simon wants and all is well.

Until of course a short write up in Open Democracy:

Hunt and Stevens - leaving their dirty footprints all over the NHS

Jeremy Hunt tells us he wants a '7 day NHS'. He's the only person in the country who hasn't noticed we've already got one.

Of course it would have been nice if some Brazilian friend of a Judge could have her PIP breast implant on a weekend or that varicose veins be dealt with then. The truth is that it was a planned attack on the juniors and if their pay is reduced for the same amount of work, the likes of Branson would be happier to take over hospitals. No, not Circle this time as they messed up Hinchingbrooke. Oooops they messed up Nottingham University Dermatology as well because, surprise, surprise, the consultants did not want to work for them.

While Hunt distracts us, his NHS boss, Simon Stevens, has created a plan to solve the NHS’s problems - by CLOSING more beds and more A&Es. Stevens thinks if you close hospitals people will stop using them.

Supermarkets need to sell to make money and NHS need to stop work to save money. Until, of course it is run by the likes of Branson. Assuming he provided enough Virgin Lounges and have enough Consultants, he could with cheap Juniors start making money. Not from you punters directly, but from the government which of course is still from you.

Punters flock to A&E for whatever reason and our good looking well liked Stevens is of course smart too. Simple, close A&E and for good measure close the hospitals too but sell it as providing good service nearer home.

If we look back, that was what happened to all, yes all the mental asylums, sorry, hospitals. As it is not PC to blame medication avoiding psychotic patients, we turn the killers into terrorists. Smart too. Asylums were sold and no, you cannot have them back unless you earn money like pop stars. Despite their high income, many resort to drugs and a number of them committed suicide.

Before Hunt recruited him to run the NHS, Simon Stevens worked for in the US for 10 years for global health firm UnitedHealth – where he helped lobby for the TTIP trade deal that would help US health firms take over European healthcare.

Please, TTIP is not going to be part of EU referendum.

Now Hunt’s put him in charge of our NHS. He’s just carved our NHS into 44 bite sized regions, called ‘footprints’. And he’s told local health bosses that they must come up with a plan by 30th June to completely clear their massive shortfalls - within a year.

The smartest move is he picked out some very well loved ladies to work for him. I have no doubt none of them knew that Simon Stevens; who could at a stroke take off three stones or there about of body weight and moved from a multimillion dollar job to the NHS; is not in love with it and would even dismantle it. Unthinkable!

As a result there is very little negative about Simon and very little positive about Jeremy.

If they don’t come up with a new big cuts plan in a hurry, they won’t get any financial or other help, he’s told them. And he’s made clear that if they fail to deliver on the plans, they face being sacked or taken over by other – unspecified – organisations.

Has a hospital closed near you? Is one under threat?
But there’s only one way local areas can make up a huge shortfall in funding (which will otherwise rise to £22bn by 2020) – and that’s to close services and sell off NHS land and hospitals.

Listen, punters, BA, BT were all so bad. Now just look at how you all loved them.

Stevens has already made that clear he expects local NHS’s to undertake ‘radical reform’ of how the NHS works.

And now worrying details are starting to emerge of what this means. North West London’s ‘footprint’ plan is to axe a further 500 beds, on top of earlier cuts, it’s just been revealed.

We already know the government wanted to make huge cuts to A&E departments – reducing them to 40-70 nationwide.  The plans were shelved as ‘political suicide’ before the election.

Now the plans are being dusted off. Many hospitals are already threatened. Apparently to make the NHS affordable we, the public, must get used to no longer having a major hospital within easy reach, or sufficient local hospital beds. Instead, local areas are expected to provide ‘care in the community’ based around downgraded ‘urgent care centres’ – a more profitable model for private takeover.

Tuesday, June 21, 2016

Tristan und Isolde

Heading for Tristan und Isolde tomorrow!

"I fear the opera will be banned – unless the whole thing is parodied in a bad performance –: only mediocre performances can save me! Perfectly good ones will be bound to drive people mad, – I cannot imagine it otherwise."
Richard Wagner to Mathilde Wesendonck

My great love is Tristan und Isolde, and for that Wagner will have his place in the history of European culture because there he drops all his ideological bullshit, and all his dangerous sides. And finally he is really concentrating on his music and his poetry. And here he develops all his greatness. There is the Wagner that I am looking for.
Gottfried Wagner, TV documentary

"Tristan is not about 'being', it’s about 'becoming'. And it’s not an opera about love, but about death. The fear of death. This is the motor of the opera. There’s nothing more democratic than death."
Daniel Barenboim before his Met debut with Tristan und Isolde

Tuesday, June 14, 2016

NHS: The Last Cook.

 As the sun sets on our beloved NHS:
                                                           ©Am Ang Zhang 2012

Perhaps it is not that well known that the dismantling of our beloved NHS started long before the present government and the future does not bode well for those of us that likes to keep NHS in the public domain.

Child Psychiatric in-patient units across the country were closed some time after many adult hospitals were closed or down-sized.

To me, the government is too concern with short term results that they impose various changes across the board in Health Care & Education without regard to the long term consequences or costs.

After all, I have made good use of in-patient facilities to un-diagnose ADHD and that would in turn save children from unnecessary medication and the country from unjustified benefit claims.

Such units were also great training grounds for the future generation of psychiatrists and nurses. Instead, most rely on chemicals to deal with a range of childhood psychological problems.

Indeed it was a sad day when the unit closed.

From The Cockroach Catcher:

Chapter 48        The Last Cook

ne of the few things I learned working in some inpatient units was to be appreciative of the ancillary staff. What a cleaner might reveal to us was often more telling than a formal interview. It could well be that often parents were unguarded and more able to reveal things to someone like the cleaner or indeed the cook.
         I was fortunate enough to experience one of the last NHS cooks when I was Senior Registrar at an inpatient unit. The inpatient unit catered for a middle age group spanning the older children to the younger adolescents. It was one of a kind in the U.K. and indeed it was the first to start a national training course for Psychiatric nurses in inpatient care, a good three years before anywhere else.
         The unit was in the middle of town and was considered to be too far from the Hospital for catering purposes.  Instead a cook was employed to cater for the needs of the children and nursing staff.  We doctors were not supposed to eat there. But we did.  Mainly for lunch.
         If we arrived at mid-morning we used to get a nice cup of tea. But that was only since I started bringing in my own tea leaves. We also got served home-made scones and the like.
         All very homely.
         I had since wondered if our great success rate was more to do with having our own cook than all the other therapies and tit bits that we did.
         You never know as people do not really research these things.
         ……I often arrived late at lunch time after the children and nurses had eaten as morning clinics had a habit of running late. With less than ten minutes to spare, the cook would still manage to serve me a bit of some of the things she knew I preferred. Often she felt compelled to sit with me to tell me about her grandchildren or about what the government should really be doing to help the likes of her, a war widow bringing up two sons in this Naval town. I always admired the resilience shining through her stories.
         She also provided me with her down to earth views of what we should do with whichever patient that had come in. I listened. I took note.  You never know.
         Sheena was the mother of two girls we had to admit. They were both ‘soilers’ and they would never touch vegetables at home or anywhere.

         Sheena was petite, worn and a chain smoker.
         But she had two lovely looking girls.
         We knew from the start there were handling issues and most likely diet ones too.
         One of the other reasons for their admission was that by and large there were very few girl ‘soilers’.  
         It was always a good sign when a child flourished in an inpatient setting, and away from home some mothers were more capable of telling you more of what went on.  Some mothers found it easier to talk to one of the non-medical staff, perhaps the cook.
         Mothers got fed too on their visits. More often than not the children preferred their mother to go home than to stay and watch them. That was a different issue. With the money spent on cigarettes and drinks not much was left for food either for the children or the parents. I knew that if we checked for vitamin and other deficiencies we would find them, a problem that had taken Public Health a long time to wake up to. Increasing tax for cigarettes and drinks did not change people’s habit one little bit.
         With a simple routine the girls were clean in no time.   At least during the week as they all went home week-ends, when the unit was closed.
         We were at a loss as to what was going on.
         The girls would get worse over the week-end and soil. This went on for quite a while.
         Then one day the cook talked to me.
         “Sheena never stays Mondays,” she told me.
         I listened.
         “Have you noticed she is always in dark glasses on Mondays?”
         How stupid of me. Now and again I saw her at the door seeing the girls off and yes, she wore huge sunglasses.
         Sheena was not a movie star.
         I arranged to see Sheena.
         She said, “You knew.”
         I nodded.

         “But I cannot leave him. I have nowhere to go and I shall not get enough benefit money if I am divorced from him. He now goes to the day hospital. Fridays he gets drunk and beats me up. It is like a routine. I try not to get hurt and hide it from the girls. If I walk out, he will find me even if I have somewhere to go. I shall still get beaten up. Now at least I know when it will happen and I can live with that.”
         I suggested that I should speak to him but she looked terrified.
         She felt he might even kill her if I did and last time he threw a chair at a male nurse who tried to say something.
         She was probably right. We often had no idea what people and particularly women put up with. It would be too easy for us to bulldoze in.  We had to think twice before intervening unless we had something better to offer. His Schizophrenia diagnosis allowed for a higher level of benefit she would not otherwise get. Who would she meet up with next?  Another violent man most likely.
         Was it such a cop-out on my part?
         Maybe it was, but in a strange way the girls stopped soiling after that one meeting I had with mum. The case left me with some unease - unease not just about what I did or did not do but about keeping patients in the community. Three other lives were affected here and who knows, one day he might go too far.  That was before Maria Colwell. 
         The unit had long since been closed.
         The last cook in the NHS retired .

The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US

Monday, June 13, 2016

Pelican & Big Waves: Dermatology & Anorexia Nervosa!

It has been a few years since The Cockroach Catcher retired and in that time, the landscape of Child & Adolescent Psychiatry has changed. Can CAMHS survive the storm like the pelican?

Without much public notice, much of this sub-specialty has shifted into private hands. Just around half the last time I looked. Now there is talk of looking at CAMHS with the offer of money! Wow! Or was the outcome going to be: lets sell the profitable parts of CAMHS such as Anorexia Nervosa and leave the rest! i think I know what it would be. Just look at Dermatology!!!

Dermatology shows how NHS being decimated

By Dr David Eedy, President of the British Association of Dermatologists - 15th December 2014 11:24 am
The news that a third of NHS contracts in England have been awarded to private sector providers since the service was reorganised in 2013 is a fact that dermatologists and their patients are all too aware of.
In fact, some estimates put the figure at 70% of NHS contracts going to private providers in just the first year.
Dermatology is a prime example of how government meddling is decimating the NHS, despite the fact that each year, 54%of the population is affected by skin disease, and 23 to 33%of the population at any one time has a skin disease that would benefit from medical care.
Nottingham Univeristy Hospital Dermatology : BBC: 'Ridiculous and incomprehensible'
Problems occurred when full control of Nottingham Treatment Centre was handed to Circle, with staff transferred to the private firm last year.
The majority of the consultants refused the transfer and left.
Circle had to recruit overseas locums working as Consultants but not registered as such, some being paid £300,000-a-year (over 3 times average consultant pay), and were not qualified to teach.
As a result, the Queen's Medical Hospital (QMC), home of the East Midland's major trauma centre, can no longer treat the most severe emergency patients, instead having to send them to Leicester.
Dr David Eedy, president of the British Association of Dermatologists, said: "It's inconceivable that an acute and ill patient would have to be moved from one of the largest centres in the UK to another hospital, 25 miles away.
"It seems ridiculous and incomprehensible... and would not be optimum care."
Check out the full report: Final Report.

I have personally dealt with "gaming" by private insurers. Now, it looks like the gaming is over as the payer is the NHS. You only need to look at the papers to realise that Anorexia Nervosa in particular is a growth industry. They are difficult to treat, recovery is not guaranteed and when the payer is the NHS: WOW!

©2014 Am Ang Zhang 

In the field of medicine, to promote something one needs to publicise something that is not directly related to what you want to promote. Vitamin D deficiency is one such item in recent times. Instead of promoting limited sunshine, the tablet or capsule is being promoted, everywhere! We have for a long long time various hints of Statin and its various beneficial effects. Yet a close friend had dementia and diabetes and another had double vision. The latter recovered 6 weeks after stopping the Statin, not so my friend with diabetes. She could no long remember me.

Another friend had open heart surgery and her surgeon told her to throw away the Statin.

There may indeed be some good doctors left, in the NHS.

Looks like the attack is now on Anorexia Nervosa. The Cockroach Catcher had to face a team from a private hospital wanting to make money from the NHS by asking the NHS to continue to fund anorexia treatment as she has USED UP her health insurance money. Now the situation is much worse in our beloved NHS as there is a number of closures of NHS Adolescent Psychiatric inpatient units and many such In Patients are sub-contracted to the private sector even before the term AQP emerged.

Has it not occurred to anyone that there are some very clever people working for the so called AQPs.

As we move into the gaming era of the NHS, The one diagnosis that will be on AQP's list will be Anorexia Nervosa. Unlike hip replacement, the variation of the condition is such that it is ripe for Private Providers to make a case for a fairly long drawn out treatment. AQP will not worry as "the longer, the better". Of course the patient must not die and if you think I am skeptical, I am as I have seen it even before all this Reform or Deform.

That is why I have argued that where there is such an incentive, "gaming" will happen and Mr Cameron. Don't say that nobody told you.

Sunday, June 12, 2016

Nuremberg & Thalidomide: The Good The Bad & The Ugly.

It is not really the first time we visited a place that has a rather haunting history. St. Petersburg is one such place especially when one re-visited the whole sordid saga of the murder of the small children of the Russian Tsar family.

Now we are starting our high school reunion on our river cruise. The journey starts at Nuremberg. All of us of course remember the Judgment at Nuremberg. I decided to watch it again. The principle that just because your boss told you to do things in a certain way did not absolve you from the greater humanitarian aspect of what you do. This is most important for doctors and if you think we have shied away from the Nuremberg era, think again. In one way or another, those that dare speak out against what management in our beloved NHS does were met with some of the worst fates unimaginable in any democratic society.

Nuremberg of course was the famous setting for one of Wagner’s well known Operas, Die Meistersinger von Nürnberg which was in 2011 performed at Glydnebourne for the first time ever to much international acclaim. 

But Nuremberg was sadly linked to one of the worst drugs disaster of our time. This was uncovered by none other than Newsweek.

As they opened a new Waitrose across from my clinic, I find myself shopping there most days after work. It was one of those de-roling activity that is important after a whole day being involved in the mad of sad world of child psychiatry. John Barnes in Swiss Cottage was the first local store that was very close to the Tavistock Clinic where I trained. It was there that I saw the wooden escalator that my father reminisce about of the ones in Shanghai in the 40s. John Lewis and Waitrose remained my favourite haunt for all these years.

One day, at one of the specially designed check outs, sat a girl on a special raised mechanical chair was a girl with arms a quarter the size of ours and a few minute fingers. Yes, a Thalidomide victim doing a proper check out job.

Yes, we tried our best not to notice and our best not to treat her any differently as we well know that that is what she would want. I raised my hat to Waitrose for treating her like any of their partners. That is how the world should be.

But I never knew that there was any link between Thalidomide and Nuremberg. O.K. I knew Thalidomide was developed by a German Company, Grünenthal.


Adding to the dark shadow over the company, it is increasingly clear that, in the immediate postwar years, a rogues’ gallery of wanted and convicted Nazis, mass murderers who had practiced their science in notorious death camps, ended up working at Grünenthal, some of them directly involved in the development of thalidomide.

 What they had to offer was knowledge and skills developed in experiments that no civilized society would ever condone. It was in this company of men, indifferent to suffering and believers in a wretched philosophy that life is cheap, that thalidomide was developed and produced.

Perhaps the best known of Grünenthal’s murderous employees was Otto Ambros. He had been one of the four inventors of the nerve gas sarin. Clearly a brilliant chemist, described as charismatic, even charming, he was Hitler’s adviser on chemical warfare and had direct access to the führer—and committed crimes on a grand scale. As a senior figure in IG Farben, the giant cartel of chemical and pharmaceutical companies involved in numerous war crimes, he set up a forced labor camp at Dyhernfurth to produce nerve gases before creating the monolithic Auschwitz-Monowitz chemical factory to make synthetic rubber and oil.

In 1948 Ambros was found guilty at Nuremberg of mass murder and enslavement and sentenced to eight years in prison. But four years later, he was set free to aid the Cold War research effort, which he did, working for J. Peter Grace, Dow Chemical, and theU.S. Army Chemical Corps. Ambros was the chairman of Grünenthal’s advisory committee at the time of the development of thalidomide and was on the board of the company when Contergan was being sold. Having covered up so much of his own past, he could bring his skills to bear in attempts to cover up the trail that led from the production of thalidomide back through its hasty trials to any origins it may have had in the death camps.

Dr. Kelsey is honored by President John F. Kennedy in 1962. (Courtesy of FDA)

The tragedy was largely averted in the United States, with much credit due to Frances Oldham Kelsey, a medical officer at the Food and Drug Administration in Washington, who raised concerns about thalidomide before its effects were conclusively known. For a critical 19-month period, she fastidiously blocked its approval while drug company officials maligned her as a bureaucratic nitpicker.

Freedom of Speech: Truth & Thalidomide!

Case 5 – The Truth about Thalidomide Given the lack of a constitution enshrining free speech, we do need some protection against frivolous libel actions and injunctions which try to prevent the truth from being revealed. Otherwise the truth about thalidomide would never have been told.

“Thirty-eight years ago,” he wrote, “I sat through days of hearings by the Law Lords deliberating on whether I and the paper I edited were guilty of contempt in 1972-3 in campaigning for justice for the thalidomide families. All five Law Lords voted to ban publication of our report. Only a 13-11 victory in the European Court of Human Rights removed the gag order” – and thus, I add, enabled The Sunday Times to expose one of the great scandals of that time, and subsequently win compensation for the families with young children born damaged or deformed, often without legs or arms, because their mothers had taken the drug, thalidomide, which was marketed as a mild sedative that would relieve morning sickness in pregnancy.                                                                                             Telegraph

Luckily, the 
European Court eventually ruled for The Sunday Times:

“The newspaper then decided to fight the injunction on its investigation into the origins and testing of the drug. The case went right through the British legal system and up to the European Court of Human Rights, which decided that the injunction violated the right of ‘freedom of expression’. The full story of thalidomide could eventually be told in 1976, revealing that both Grünenthal (the maker) and Distillers had not met the basic testing requirements of the time.”

I mentioned thalidomide also because in 2002 Gordon Brown, the then chancellor, attempted to tax the benefits payable through the Thalidomide Trust.