Sunday, March 29, 2009

Mid-Staffordshire: Media Media Media.

Time was when our newspapers can be relied on to expose great scandals and injustice. Remember Thalidomide and The Sunday Times?

Mid-Staffordshire as far as I could work out could have been exposed a good deal earlier in the good old days of the Thalidomide affair. What has happened to the media in the new Millennium?

Has the Daily Telegraph taken that role over?

In a previous post:
Mid-Staffordshire: Unbelievable! Unbelievable! Unbelievable!
I mentioned the film Rashomon. Here is how it ended:

“As the film ends an abandoned baby could be heard crying as the rain stopped. The priest who was probably going to kill himself for how bad the world has become regained his faith in humanity when the woodcutter offered to look after the baby.

He had 6 children and he was struggling; but he decided to keep the abandoned baby as one more would not have made his life any more difficult.”

Are we going to have a similar ending: one of hope, hope for humanity.

Read the full Daily Telegraph article:
Ten NHS trusts have worse death rates than 'shocking' Mid Staffordshire
March 29, 2009

“A damning watchdog report detailed a catalogue of failings at Mid Staffordshire NHS Foundation Trust, including dehydrated patients being forced to drink out of flower vases while others were left in soiled linen on filthy wards. The scandal of poor care at Mid Staffordshire was only uncovered when unusually high death rates at the hospital triggered secret NHS alerts.
“The Health care Commission has not investigated any of the 10 trusts that currently have worse scores than Mid Staffordshire, and the Care Quality Commission, which takes over from the Commission this week, has no plans to do so either.”

10 other trusts worse than Mid Staffordshire. Unbelievable.

Links: Cynthia Bower : April Fool NHS Blog Doc
See also:
Jobbing Doctor
Previous Post: Mid-Staffordshire: Unbelievable! Unbelievable! Unbelievable!
Mid-Staffordshire: Where Are The Doctors?
Other Posts: House M.D. : 95% vs 5%
Mid-Staffordshire? Not Just Mid-Staffordshire!


Mid Staffordshire: The Modern Witch Hunt

Heal Our Hospitals: Telegraph


NHS & Francis Report: Master Plan & Mid Staffordshire

Saturday, March 28, 2009

Bipolar Disorder: Biederman Einstein God.

Prediction is often the domain of Quantum Physics and the most spectacular prediction of all time has to be Einstein’s theory of General Relativity regarding gravity and light. The 1919 eclipse on May 29 proved his theory and made Einstein famous overnight.

Historic picture Royal Observatory Greenwich

To quote the NASA site: "extraordinary claims require extraordinary evidence"!

It was unusual to find prediction being used in modern medicine let alone Child Psychiatry.

San Francisco Chronicle
March 27,2009

“Dr Biederman appears to be promising drugmaker Johnson & Johnson in advance that his studies on the antipsychotic drug risperidone will prove the drug to be effective when used on preschool age children.”

And we do not have to wait for an eclipse. Wow! I have to declare that I have heard him at a conference and I reported this in a previous blog: Bipolar and ADHD: Boys and Breasts.

The San Francisco Chronicle article continues:

“Biederman's status at Harvard and his research have arguably made him, until recently, America's most powerful doctor in child psychiatry. Biederman has strongly pushed treating children's mental illnesses with powerful antipsychotic medicines. Diagnoses like ADHD and pediatric bipolar disorder, along with psychiatric drug use in American children, have soared in the last 15 years. No other country medicates children as frequently.”

No other country medicates children as frequently!

“Reports from court actions, along with an ongoing investigation of conflict of interest charges led by Sen. Chuck Grassley, R-Iowa, threaten to topple Biederman from his heretofore untouchable Olympian heights. Biederman has cried foul.”

“He says the drug company dollars (declared and undeclared) have not influenced him or his research. He had agreed temporarily to sever most of his financial ties with the drug industry pending the outcome of the ongoing inquiry.

“He claims his science and publications are pure, supported by a peer-review system that is supposed to verify accuracy and authenticity. Finally, he challenges as office gossip reports of his legendary anger and intolerance of those who disagree or don't support his proposals.”

The New York Times:

"In a contentious Feb. 26 deposition between Dr. Biederman and lawyers for the states, he was asked what rank he held at Harvard.

“Full professor,” he answered.
“What’s after that?” asked a lawyer, Fletch Trammell.
“God,” Dr. Biederman responded.
“Did you say God?” Mr. Trammell asked.
“Yeah,” Dr. Biederman said.

Latest: 3 Researchers at Harvard Are Named in Subpoena

Related Posts:
Lithium Bipolar and Nanking
Bipolar Disorder in Children
Bipolar and ADHD: Boys and Breasts
Bipolar Disorder: Biederman Einstein God.
Antipsychotics: Really?
Bipolar and ADHD: Boys and Breasts
Grand Round: Medicine and War
Bipolar Disorder: Lithium-The Aspirin of Psychiatry?

Tuesday, March 24, 2009

Conflict Of Interest: Lexapro JAMA BMJ

NHS Blog Doctor :
“And these days the BMJ itself is not to be taken too seriously. It has long since forfeited its place amongst respected medical journals. It is more of an in-house comic now. Were it printed on more absorbent paper, it would most likely be found in a smaller room than the library. The BMJ has become the Daily Mail of medicine.”

Given the well known views of Dr John Crippen on the British Medical Journal (BMJ), it takes a very brave blogger to be quoting from the
BMJ again.

But this is just too good not to share.

Lexapro (escitalopram)-SSRI antidepressant (S-enantiomer of the racemic Citalopram-Celexa)manufactured by Forest who licenses the rights for both Celexa and Lexapro from Lundbeck, which is based in Denmark. Celexa is known as Cipramil in Europe.

JAMA: Journal of the American Medical Association.

BMJ: British Medical Journal.
WSJ Health Blog:JAMA Editor Calls Critic a ‘Nobody and a Nothing’
March 13, 2009, David Armstrong

“Jonathan Leo, a professor of neuro-anatomy at tiny
Lincoln Memorial University in Harrogate, Tenn., posted a letter on the Web site of the British Medical Journal this month criticizing a study that appeared in JAMA last spring. The study concerned the use of the anti-depressant Lexapro in stroke patients. In addition to identifying what he said was an important omission in the paper — that behavioral therapy worked just as well as the drug when compared head to head in the study — Leo also pointed out that the lead author had a financial relationship with Forest Laboratories, the maker of Lexapro, that was not disclosed in the study."

It is amazing that the Big Pharmas are moving their psychiatric drugs into the "not strictly psychiatric" arena. Perhaps they are learning from the
Biederman experience.

Leo faced criticism from editors at the Journal of the American Medical Association!

“When JAMA editor in chief Catherine DeAngelis was asked about Leo by the WSJ Health Blog on March 12, she expressed her displeasure with him. ‘This guy is a nobody and a nothing’ she said of Leo. ‘He is trying to make a name for himself. Please call me about something important.’ Read the posting here.”

Catherine DeAngelis, M.D., M.P.H., Receives AACAP Catcher In The Rye Humanitarian Of The Year Award:
"Dr. DeAngelis was chosen as AACAP's 2009 Catcher in the Rye Humanitarian of the Year because of her leadership on discussions of conflicts of interest in medicine."

“Leo says he received an angry call from JAMA executive deputy editor Phil Fontanarosa last week, shortly after Leo’s article was published on the BMJ Web site.
“He said, ‘Who do you think you are,’ ” says Leo. “He then said, ‘You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry.”
This is from Jonathan Leo’s statement:
“Over the past several years, I have written about the potential impact of conflicts-of-Interest in medicine (COI). I have also watched how the mainstream media reports the results of medical research with great interest.”

“The financial relationship with Forest Laboratories was well-documented and easily discoverable via a Google search, as evidenced by Dr. Robinsonπs previous self-disclosures in varied sources such as here, here, here, here, and here.”

Having forewarned the JAMA a letter to the BMJ was published after the BMJ checked with its own legal department. They are worried about JAMA too.

In the latest editorial of the JAMA: March 20, 2009

“Leo is certainly ‘somebody doing something’ very important.”

But wait for this:

“JAMA continued to ask that the entire piece be retracted.”

Did they not know that once it is out there on the web, it is out there? It was a sure way to give it publicity. Perhaps the JAMA editorial team should start reading blogs.

Two different issues here: the influence of Big Pharmas on research and JAMA, why?! It is only the BMJ!

Latest: AMA/ JAMA to Investigate. Chicago Tribune.

Link: WSJ Health Blog: March 23, 2009
Update: WSJ Health
See also Carlat Psychiatry Blog Furious Seasons

Monday, March 23, 2009

Alaska Mt. Redoubt: Eruptions

March 28, 2009 13:44:00 Image Creator: Anderson, Dennis

March 23, 2009 19:55:58
Image courtesy of Webcam at AVO/USGS.

Mt Redoubt March 21 2009, Read, Cyrus;
Image courtesy of AVO/USGS.

Alaska Mt Redoubt Update National Geographic.

March 23, 2009--Plumes of steam rise from a vent in the summit crater of Redoubt Volcano--a glacier-covered peak 110 miles (177 kilometers) southwest of Anchorage, Alaska--on March 21, a day before the volcano began a series of powerful eruptions.

Photograph by R. Clucas, AVO

Sparked by avalanches of hot debris rushing down the Redoubt Volcano's northern flank, a mushroom cloud rises from the Alaska peak on April 21, 1990. A smaller, white plume of steam pours from the volcano's summit crater.

M. Scott Moon / Peninsula Clarion

Web Cam here.

Posts related to Alaska:

Alaska and Yellowstone: Predicting Earthquakes and Volcanic Eruptions.

Alaska Zyprexa: DOJ at last.

Alaska, Good Friday Earthquake and Zyprexa

Alaska Zyprexa: Follow Up

Alaska and Yellowstone: Predicting Earthquakes and Volcanic Eruptions.

Back to Alaska again and this time it is not about Zyprexa.

One of my earliest geography teachers was so inspiring that even those of us who did not become geologists remain interested in the subject. Plate tectonic theory was still being debated then and we have come a long way in understanding earthquakes and volcanic eruptions. Such activities of our planet we were told then were due to the Earth's general cooling. It could not explain why there are more serious ones in some years than in others. Geologists are still not good at predicting when they might occur as the Sichuan one of 2008 was a complete surprise. . They have for weeks now suspected that the one in Alaska just might erupt.
Associated Press:

March 21, 2009 Image Creator: Read, Cyrus;
Image courtesy of Alaska Volcano Observatory/USGS

Alaska volcano Mount Redoubt erupts 4 times
March 23, 2009 By MARK THIESSEN

"Alaska's Mount Redoubt volcano erupted four times overnight, sending an ash plume more than 9 miles high into the air, but the state's largest city has likely been spared from any ashfall.
"The ash cloud went to 50,000 feet, and it's currently drifting toward the north, northeast," said Janet Schaefer, a geologist with the Alaska Volcano Observatory.
The first eruption, in a sparsely area across Cook Inlet from the Kenai Peninsula, occurred at 10:38 p.m. Sunday and the fourth happened at 1:39 a.m. Monday, according to the observatory.
"The wind patterns were taking the ash cloud away from Anchorage, toward
Willow and Talkneetna,

Mount McKinley 1:31 am July 13 2005 ©2005 Am Ang Zhang

near Mount McKinley, North America's largest mountain in Denali National Park.
The 10,200-foot Redoubt Volcano, roughly 100 miles southwest of Anchorage, last erupted during a four-month period from 1989-90.
But the volcano became restless earlier this year. The observatory had warned in late January that an eruption could occur at any time.
Increased earthquake activity over the past 48 hours prompted scientists to raise the alert level for Mount Redoubt on Sunday.
On Sunday morning, 40 to 50 earthquakes were being recorded every hour.
A steam plume rising about 1,000 feet above the mountain peak was observed Saturday."

Alaska volcanoes typically explode and shoot ash upward, sometimes to 50,000 feet, high into the jet stream. The Redoubt eruption on Dec. 15, 1989, sent ash 150 miles away into the path of a KLM jet, stopping its engines. The jet dropped more than two miles before the crew was able to restart engines and land safely at Anchorage.

Was that not the year of the San Francisco Quake that caused a great deal of urban damage? It was October 17th 1989 indeed.

What is not so well known is the Old Faithful Geyser at Yellowstone changed its pattern of eruption.

It also happened before the
Denali quake of 2002.
Yellowstone in calmer days. © 1985 Am Ang Zhang
Between December 26, 2008, and January 6, 2009, several hundred small earthquakes rumbled beneath Yellowstone Lake in Yellowstone National Park.

“Hundreds of earthquakes have hit Yellowstone National Park, raising fears of a more powerful volcanic eruption.
“The earthquake swarm, the biggest in more than 20 years, is being closely monitored by scientists and emergency authorities.
“The series of small quakes included three last Friday which measured stronger than magnitude 3.0. The strongest since this latest swarm of quakes began on December 27 was 3.9.
“No damage has yet been reported but scientists say this level of activity - there have been more than 500 tremors in the last week - is highly unusual.”
Perhaps San Francisco should get ready for the big one again!

A few days ago on Mar 19, 2009

An undersea volcano erupts off the coast of Tonga (Dana Stephenson/Getty Images)
Tonga volcano spews spectacular plume into South Pacific sky
You can read about it at
Scientific America.

"An undersea volcano in the South Pacific is spewing stunning columns of smoke, steam and ash thousands of feet into the air.

"The eruption began Monday after a series of earthquakes near Tonga, a 170-island archipelago between Australia and Tahiti,
residents told the Associated Press. There were magnitude-5.0 quakes there Sunday night and Monday afternoon, according to the U.S. Geological Survey. Though the Wellington Volcanic Ash Advisory Center (VAAC) issued an advisory for the area, the plume isn’t endangering* island residents and so far hasn’t hurt fish or other animals, according to the AP.Yesterday a plume rose to between 15,000 and 25,000 feet (4.6 to 7.6 kilometers), the Smithsonian's Global Volcanism Program reported. 'It's a very significant eruption, on quite a large scale,' Tonga's chief geologist, Kelepi Maf, told the Times of London. This is not unusual for this area and we expect this to happen here at any time.

"Tonga is part of the ring of fire, an arc of earthquake and volcanic zones in the Pacific."

Recent devastating earthquakes:
Great Sumatra-Andaman earthquake on Boxing Day of 2004 caused the worst tsunami in most people’s living memory.

Sichuan Earthquake of May 12, 2008 was the worst in China’s recent history.

Even in the
UK there was an earthquake in 2008. And also in Costa Rica andPakistan.

Other volcanic eruptions of 2008:
Column of Ash Rises Over Shiveluch Volcano
February 19, 2008Eruption of Klyuchevskaya Volcano
December 11, 2008

Thursday, March 19, 2009

NHS Blog Doc: AIG RBS Obama

Dr John Crippen must be congratulated for his piece on The Act of Attainder. Looks like someone is using it. His name is Obama and he is currently the President of the United States.

The New York Times:
House Passes Heavy Tax on Bonuses at Rescued Firms
Published: March 19, 2009

"The House overwhelmingly approved on Thursday a near total tax on bonuses paid this year to employees of the American International Group and other firms that have accepted large amounts of federal bailout funds, rattling Wall Street as lawmakers rushed to respond to populist anger.

"Despite questions about the legality of the retroactive 90 percent levy, Democrats and some Republicans said the tax on bonuses for traders, executives and bankers earning more than $250,000 was the quickest way to show angry Americans that Congress intended to recoup the extra dollars. Even backers of the measure noted it was an extraordinary step.
"But the rush to curb the bonuses by lawmakers, many of whom have previously been torn about limiting executive compensation, reflected Congressional anxiety about heightened public dismay over the bailout. The Senate is expected to consider a similar tax on bonuses but has some differences with the House, which could slow final action.
"In a statement, President Obama suggested he was supportive of the legislation, urging Congress to deliver a 'final product that will serve as a strong signal to the executives who run these firms that such compensation will not be
"The legislation would apply to bonuses paid to executives at companies holding at least $5 billion in bailout money and would essentially wipe out the phenomenal paydays that have been a tradition on Wall Street, at least until the firms reduce the amount they owe taxpayers to less than $5 billion.
"According to a tally by The New York Times of bailout recipients, employees at 11 institutions — including Goldman Sachs, Bank of America, Citigroup, Wells Fargo and JPMorgan Chase — would face restrictions immediately.
The current version of the Senate bill would apply to an even wider array of companies. It would tax bonuses at companies that received as little as $100 million in federal bailout assistance, though at a lower rate.
"In response, financial institutions that have received federal bailout money mounted a broad assault Thursday on the House legislation, which was opposed by leading Republicans. But nearly half of House Republicans joined Democrats in supporting the measure, which was approved by a 328-to-93 vote.

"Its backers said the companies had forced Congress to act by inexplicably handing out generous rewards to employees after tapping taxpayer funds to survive an economic calamity brought on by irresponsible and risky executive decisions. A.I.G. gave out $165 million in bonuses, saying the payments were essential to retain employees who could help the company sort out its financial problems.
"'Have the recipients of these checks no shame at all?' asked Representative Earl Pomeroy, Democrat of North Dakota. Summing up his personal view of the so-far-anonymous A.I.G. executives, he said: 'You are disgraced professional losers. And by the way, give us our money back.'"

Will the United Kingdom act in a similar fashion for RBS and others when we actually have the Act of Attainder to back it up? Would some heads start to roll?

© 2009 Am Ang Zhang

Do you think Mr. Obama will be inviting Mr. Brown to the White House soon?

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Hong Kong: Humpback Whale

© 2009 Am Ang Zhang

Humpback whale spotted in Hong Kong waters
HONG KONG (Reuters) Wed Mar 18, 2009

"A large humpback whale has been spotted swimming close to Hong Kong's famous harbor in what's believed to be the first sighting of the species in the territory's waters.

"Local television footage showed the whale surfacing in Hong Kong's East Lamma Channel leading into the city's Victoria Harbour, exhaling through its blowhole and raising its tail fin.

"Hong Kong authorities say it's the first time a humpback whale has been spotted in Hong Kong waters.

"'From observations it's healthy and we'll continue to monitor it,"' Jolly Choi, a spokeswoman for the Agriculture, Fisheries and Conservation Department, said on Wednesday.

"The whale, estimated to be 10 meters (33 feet) long, has already drawn a number of whale-watching boat trips since it was first spotted on Monday.
Some experts have warned the bustling harbor's heavy maritime traffic could pose a risk to the seemingly lost mammal.
"'I'm quite optimistic that it can swim back out to the open seas,' said Samuel Hung, the director of the Hong Kong Cetacean Research Project."
(Reporting by James Pomfret; Editing by Paul Tait)

Could this have come from the few that were saved in Tasmania?

Or could it be the one the
Japanese spared?

So it is not just
Pink Dolphins Hong Kong can boast about now!!!

Humpback whale spotted in Hong Kong waters A humpback whale is spotted swimming in Hong Kong waters March 17, 2009. REUTERS/Agriculture, Fisheries and Conservation Department/Handout
New Hong Kong Post: Hong Kong Earthquake: PCCW.

Wednesday, March 18, 2009

Mid-Staffordshire: Unbelievable! Unbelievable! Unbelievable!

This may sound like the opening of the film Rashomon when the woodcutter came back from the court hearing of the murder of a Samurai:

Unbelievable! Unbelievable! Unbelievable!

Nobody is telling the truth. Not even the ghost of the killed Samurai.

From The Independent
The Sketch: Sorry. Without even reading it out
Simon Carr Thursday, 19 March 2009
“There was something gallant in David Cameron's return to normal service. 'What a complete phoney!' he barked at Gordon, as if to signal there was no need to go easy any more. The PM was left behind the pace with a dogged sort of decency which – dammit – worked well for him. It makes him sound serious.

“Nick Clegg stood up at 12.17 and asked a brief question about the Stafford Hospital scandal. Had the "frenzied target setting" anything to do with the filth, squalor and fatal inattention to patients?

“And Gordon apologised.

“Clegg's point is a good one: bureaucrats had been ticking boxes to get foundation hospital status even as patients were suffering hunger and thirst because they were nil-by-mouth until long-delayed operations took place.

“It wouldn't happen in Soweto.”

I was there 3 years ago and a white man was driving my taxi: Honest, we did not know. He was referring to "Brotherly Love, aka Apartheid". He looked honest too.

“Gordon said the malpractice was not reported to the board. True. Everyone has their deniability in place. That too is the legacy of Blair.
"Later it was revealed the trust had reacted to the news of rising mortality in their hospital by employing more (Doctors? Nurses? Surgeons?)... statisticians. More ‘clinical coding experts’ to change the way the data looked.”


“I bet they get their expert bonuses this year.”
Good one Simon. Read Simon’s full article here.

From The Independent again
Scandal hospital chief's £45,000 rise

By Jeremy Laurance, Health Editor Thursday, 19 March 2009

“Health Secretary Alan Johnson: 'We should be spotting these issues earlier and getting rid of incompetent executives'”

“The chief executive of Stafford Hospital, which was condemned yesterday for ‘appalling’ emergency care that may have cost hundreds of lives, took a pay rise of up to £45,000 while the hospital was being investigated.

"Martin Yeates, who was suspended on full pay by the Mid-Staffordshire NHS Trust on Monday, was told in a letter on 23 May 2008 of the initial findings of the Healthcare Commission's investigation, detailing the chaotic conditions in the A&E department, with unqualified receptionists assessing patients, a shortage of nurses and doctors and a ‘complete lack of effective governance’.

“The letter was copied to the Department of Health but Mr Yeates remained in his post for nine more months, until he resigned two weeks ago, before being formally suspended by the trust.”

We didn't know! Like the Soweto Taxis driver.
He had a raise instead. Unbelievable!

“The shadow health secretary, Andrew Lansley, said the chief executive, chairman and non-executive board members should all have been sacked or suspended last year when the Department was first informed of the concerns by the Healthcare Commission.”

And replace them with someone from another trust?

“Mr Lansley cited a speech by Mr Johnson in October 2007, after publication of the report of an earlier NHS scandal at Maidstone and Tunbridge Wells hospital, where at least 90 patients died in an outbreak of Clostridium difficile. The Health Secretary had said: ‘We should be spotting these issues much earlier and getting rid of incompetent chief executives or chairpersons ... rather than waiting for a report such as this, by which time, frankly, most of the damage has been done.’”
The Commission began to have concerns about Stafford in 2007 and formally began its investigation in May 2008.

"Mr Lansley also protested at the failure of the West Midlands Strategic Health Authority to intervene. It is headed by Cynthia Bower, who is to become first chief executive of the Care Quality Commission, which will replace the Healthcare Commission from next month.

New Links: Cynthia Bower : April Fool NHS Blog Doc
Previous Post: Mid-Staffordshire: Where Are The Doctors?
Latest: Mid Staffordshire: The Modern Witch Hunt

Other Posts: House M.D. : 95% vs 5%
Grand Rounds 5.27: Code Blog

Tuesday, March 17, 2009

Mid-Staffordshire: Where Are The Doctors?

Patients die in 'third-world' hospital
The headline in The Independent, 17 March 2009

"If patients were dying shouldn’t the doctors be there to save their lives?"

So The Cockroach Catcher asked the most naïve of questions and I am sure the answers are somewhere at Jobbing Doctor:

……“You haven't listened to doctors who pointed out failings. Look what the establishment did to
Dr Rita Pal. Just read militant nurse Anne. I'll wager that there are trusts up and down the country just like Mid-Staffordshire.”……

Or Dr Crippen:

……“Allowing this appalling lack of care to continue should be grounds for disciplinary proceedings against any doctor who was involved. So why did the Staffordshire doctors not complain? Once upon a time, one of them did.
A courageous doctor then working in a hospital a few miles away in North Staffordshire NHS Trust complained about the appalling medical care she had witnessed in her hospital. Look what happened to her. She was treated by the GMC in the way that Stalin used to treat political dissidents, including being accused of being mentally ill.”……

But perhaps the GMC knew something was not right with NHS hospitals as they all
have full PPP Health Insurance.

“Previous medical conditions are covered under the scheme? What kind of premium do you have to pay to insure your house once the fire had started?Having stuffed their faces with roast swan and swilled their 1961 clarets, our masters at the GMC must be relieved to know that they can have their heart attacks in a private, HCP free hospital, rather than having to mix it with the common folk in an NHS hospital.”
Dr Crippen.

From the

“Between 400 and 1,200 more people died than would have been expected in a three-year period, the head of the investigation for the Healthcare Commission said.

“Families have described ‘Third World’ conditions at the trust, with some patients drinking water from vases because they were so thirsty and others screaming in pain.

“The Commission launched an inquiry after concerns were raised about higher than normal death rates in emergency care, in particular at Stafford Hospital.

“The trust argued the anomalies were due to ‘problems with its recording of data and not problems with the quality of care for patients’, the report said.”

How creative, perhaps they should help save the banking crises.

“The investigation found heart monitors were turned off on wards because nurses did not know how to use them and some patients were left dehydrated because nurses did not know how to work intravenous fluid systems properly.”

Where were the junior doctors, perhaps they were all suspended?! And the consultants?!

“The report also found that the Government's target for patients to be seen within four hours at A&E meant patients could be taken to ‘dumping grounds’ to avoid breaching the target.”

Poor managers, trying to save £10 million, meet four hour targets and a whole range of other ones on a £120 million Annual budget all set by central government.

“Chief Executive Martin Yeates, stepped down and has now been formally suspended on full pay, while chairman, Toni Brisby, resigned.”

On full pay!!! No details of compensation and no charges either reported!!!

In Japan, the Health Minister would at least go to the Emperor and offer to have his little finger chopped off.

"Between 400 to 1200 patients died unnecessary and that is only at this Trust."
This surely is culpable homicide. What about other trusts?
You will need to read the details in The Independent

The official report is here. I wonder what the cost of the whole report is including all the legal representations of all the parties concerned. Money is again diverted from direct health care to lawyers and others as with child abuse enquiries over the years.

The Climbie enquiry: a cool £3.8 million.

Jobbing Doctor thought:
“Isn't it time for the bottle of whisky and the pearly-handled revolver?”

He is naïve too like The Cockroach Catcher. Whisky, yes they drink a lot at the
Westminster bars; but revolver, I don’t think so.

Leading Article: The Independent

Monday, March 16, 2009

Mysterious Psychosis: One Patient One Disease

I have often wondered if the government is right after all: most of the time we do not need doctors.

What is the point of spending years studying about some fairly rare conditions and then when the time comes we still miss it. This was covered in the recent uproar about the boy with Addison’s disease by Dr Crippen and Jobbing Doctor. Then we have the X-Factor boy with a 2 Kilogram tumour that remained undiagnosed till late, the inquest hearing continues so I cannot comment any further.

I remembered graduating from medical school quite worried about treating patients as we seemed to know all the rare conditions but little about coughs and colds.

We all know about Hodgkin, Von Recklinghausen and Rett.

Have they done such a good job dumbing down the new generation of doctors or were they too busy with Hemlock to have time for much else?

Even in the US were they too busy working for the big drug firms to have time to teach them real medicine?! Has everything got to be ADHD, Bipolar or psychosis. Especially ADHD for a 39 year old?!

In this week’s Sunday New York Times:

March 15, 2009

“She was 39. Divorced. Lived alone. She took two medications for high blood pressure, as well as an antidepressant and a stimulant, Concerta, a long-acting form of Ritalin, for a diagnosis of attention-deficit disorder.”

Psychosis and mania were rare but documented side effects of Concerta. Was that the cause of her symptoms or was this simply a manic episode in an underlying bipolar disorder?”

A mysterious psychosis!

The consultant stopped the stimulant and tried to start the patient on antipsychotic and mood-stabilizing medications.

“She refused to take them, so he gave the medication by injection. Slowly her behavior began to change. The wild swings of emotion and outbursts of anger became less frequent. But strangely, her disordered thinking and paranoid delusions persisted. Usually these symptoms improved and worsened together.”

The psychiatrist was called because the nurse could not get her blood pressure.
No, she was not in shock. It was so high it went off the scale.

The Internist was called and she got a high reading of 240/110 and the patient was put into ICU.

I hope by now you have guessed what the diagnosis was.

PHEOCHROMOCYTOMA: the one we all know about. Used to!

But why should the patient not have pheochromocytoma and ADHD and paranoid psychosis and a touch of bipolar. She was after all suicidal and she thought the police came after her seven times!

Perhaps the psychiatrist was still brought up on ONE PATIENT ONE DISEASE.

The Sunday paper continued:

“The psychiatrist had taken her off Concerta, the stimulant, because he knew that it sometimes causes psychosis and mania. That drug works, in part, by causing an overproduction of adrenaline.

“If the drug could sometimes cause psychosis and mania, could this adrenaline-producing tumor do the same thing? He found several papers describing patients who, like this woman, had pheochromocytomas as well as mania and psychosis. The symptoms resolved once the tumor was removed. It was unusual, but it had been reported.”

“And finally, after a year and a half, she was medication free and remains so to this day, three years after her surgery.”

You can read the full story here. New York Times, Lisa Saunders, M. D.

Pheochromocytoma: One Patient One Disease.

Narrowing of the renal artery.


Top: CNRI/Photo Researcher
Bottom: ISM/Phototake.

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