Friday, October 30, 2015

GSK & Banks: Free Wagner & Modern Rheingold

Looks like the modern Rheinmaidens are male and collected their gold from GSK & the banker is not so lucky:


Four former GlaxoSmithKline employees will share up to $250m (£159m) after their evidence helped US authorities secure a record settlement with the UK drug company for mispromoting drugs.

Greg Thorpe, Blair Hamrick, Thomas Gerahty and Matthew Burke are in line to receive the payout under the Federal False Claims Act, a US law dating back to the Civil War that allows whistleblowers to receive a portion of money the government recovers when prosecuting fraud.

The Banker on the other hand may have problem keeping his Rheingold. Wotan was not happy!

Sir Mervyn ordered Mr Agius to a meeting at the Threadneedle Street headquarters of the Bank at 6pm on Monday. At the meeting, he told Mr Agius that the chairman’s original offer to resign was not sufficient and that the chief executive was in the line of fire. 

It is believed that Sir Mervyn said that Mr Diamond continuing in his position could be damaging to London’s reputation.

Sir Mervyn also appeared to suggest that he was not only speaking on behalf of the Bank but also on behalf of the Financial Services Authority and the Treasury as well. The Chancellor, George Osborne, has always insisted he did not directly call for Mr Diamond to go.

By modern day standards we are still talking about a lot of money!

The Guardian: Looting

Thanks to Intermezzo we had a glimpse of the new Munich Ring Cycle:

July 05, 2012

Wagner, it would seem is as up to date as ever.

The dark side of the gods: (it is sometimes easier if one take GODS in the Ring to mean those in POWER. For the characters read here.) In fact, the gods need not work at all, the Nibelungs work almost all the time.

Disrespectful Wotan is hardly revered unanimously, and even he acknowledges higher authorities. Erda knows things he doesn't; his almost bureaucratic dominance derives solely from treaties engraved in runes on his spear, treaties to which he is subservient.

Born liarsCharacters lie as it suits them. Events are initiated by Wotan's spurious promise to the Giants to pay them by giving them Freia in exchange for building Valhalla, a promise he knows he cannot keep, as she is the indispensable symbol of love whose golden apples keep the gods alive. His shady ally, Loge, is defined as a double-dealing trickster. Brünnhilde breaks her promise to her father to allow Siegmund to be killed in combat. Mime makes dissembling a veritable life's work, ably carried forward by his nephew, Hagen, in Götterdämmerung. 

Brünnhilde disobeys Wotan, and his grandson Siegfried destroys his power. Mime, who raises Siegfried from infancy and even makes him toys, is treated with disturbingly cruel contempt by the bumptious hero. Hagen, whom Alberich sired via gold-empowered lust as a tool to retrieve the Ring for him, mutters that if he succeeds he will keep it, not hand it over to his Nibelung father.

Thieving & Misappropriation 
……. misappropriation, of persons or of things, provides much of the plot machinery. First, Alberich plunders the Rhinegold, and afterward, theft of others' possessions, including the Ring, motivates action upon action. 

Incest and other illicit sexThe teasing of Alberich by the Rhinemaidens which leads to his abjuring love--love, not lust. The definitive heroine, Brünnhilde, and her Valkyrie sisters are the offspring of an adulterous liaison between Wotan and Erda; Wotan also illegitimately fathers the Wälsung twins by a mortal. Sieglinde's infidelity is excoriated by marriage-goddess Fricka, as is her violation with Siegmund of an even more basic taboo, incest. But Wotan defends the twins ("…those two are in love") and, like most audience members moved by the ardent love music, views both transgressions kindly. 

Fafner kills his brother Fasolt, the first victim of Alberich's curse, and we are off to the homicide races. Hunding slays Siegmund, only to be destroyed by Wotan's contempt. Siegfried kills Fafner, the Giant-turned-dragon, and then, after realizing that Mime is trying to poison him, kills him as well. By the time the gods' destiny climaxes, Hagen has murdered both Siegfried and Gunther and is himself drowned by the Rhinemaidens. Eventually Brünnhilde sets Valhalla ablaze as part of her self-immolation upon Siegfried's funeral pyre ("Thus do I hurl the torch into Valhalla's proud-standing stronghold") and all the gods die.
Greed, greed, greed!Finally, "coveting that which is your neighbor's" is pretty much the whole raison d'être for the Ring story, starting with Alberich's desire for the Rhinemaidens, then for the gold they guard. Thereafter everybody seems to want what doesn't belong to him or her: the Ring, a sword, a treasure, someone else's wife, sheer power. 

Yet in spite of Wagner's wholesale abandonment of the Decalogue, the bastion of Western morality, Der Ring des Nibelungen generates explosive ethical and metaphysical impact. He started with the absorption, fusion and reinvention of myriad legendary sources, and layered Schopenhauer's philosophy upon Feuerbach's. In Art and Climate Wagner wrote, "there is no true freedom except that which is common to all mankind... The redeemer is therefore love… starting with sexual love, [it] strides forward through love of children, brothers and friends, to universal love of humanity." The emphasis is his. Yet, some years later he wrote to Mathilde Wesendonck, "I can conceive of only one salvation. It is Rest! ...The stilling of every desire!" 

Wagner once wrote to Röckel, "I have come now to realize how much there is, owing to the whole weight of my poetic aim, that only becomes clear through the music." He later described the discontinuity between his "rationally formed ideas" and "the exquisite unconsciousness of artistic creation… guided by wholly different, infinitely more profound intuition."

Free Wagner:

The Bavarian State Opera are to stream Andreas Kriegenburg's new production of Götterdämmerung live on their website on 15 July. Free of course.

On July 15, the Bavarian State Opera will present another full opera performance live and free on the website with the transmission ofGötterdämmerung, the fourth installment of Richard Wagner’s Der Ring des Nibelungen. For the sixth time (after live-streams of FidelioL’elisir d’amoreDon CarloEugen Onegin and I Capuleti e i Montecchi) opera lovers can enjoy another outstanding production from the Bavarian State Opera in Munich free and in full length. 

The premiere of Götterdämmerung opened the Munich Opera Festival last weekend and is the conclusion of the new production of the Ring, which is being staged from February to June by Andreas Kriegenburg under the musical direction ofKent Nagano leading the Bavarian State Orchestra.

In Götterdämmerung the American tenor Stephen Gould as Siegfried, Wolfgang Koch as Alberich, Iain Paterson as Gunther and Nina Stemme as Brünnhilde will be appearing, amongst others, on the stage of the Bavarian State Opera. 

The live transmission of Götterdämmerung is part of a pilot project by General Manager Nikolaus Bachler in presenting opera online. The only requirement is a broadband internet connection such as DSL, the newest version of the flash player and speakers. There is no charge to the viewer for using the live stream.

Richard Wagner
5 P.M. CET – 11 A.M. EST – 8 A.M. PST 

Intermezzo Update: Just one of those Rings

 The world of Götterdämmerung is the 21st century corporation, featuring an anonymous mass of business-suited Gibichungs in a flashy glass and steel edifice.

Production photos can be seen hereherehere and here.

Thursday, October 29, 2015

How to save the NHS: Control Health Insurers!

It must be very obvious that all the talk about medical cover for visitors to England never mention the need for health insurance.

Could this be because insurers have managed not to cover for everything. One need to ask the question on how one ever travel to the US where cost of medical care is extremely high.

It may well be prudent for government to insist that non EU visitors to this country must have mandatory Health Insurance as part of the admission requirement. This should apply to students and tourists alike. After all no body in their right mind would dream of going to the US without proper insurance.

We have managed to get people to insure their cars, why not their bodies.

There is of course the need to fully control Health Insurers for those that live in England if they want cover. 

Let people opt out of the NHS if it is so bad! But Insurers need to cover every thing. 

Citizens could be given a tax break and yet have the insurance policy incorporated into their NI/NHS number so that those with the tax break, the insurer will be charged for every kind of medical care they receive if they were within the NHS.

A very personal view indeed: 
 Fynbos©2005 Am Ang Zhang


Summary of a popular post:

·                     Ends discrimination against people with pre-existing conditions.
·                     Limits premium spread to normal, high risk and healthy risk to say under 20% either way of normal.
·                     Limits premium discrimination based on gender and age.
·                     Prevents insurance companies from dropping coverage when people are sick and need it most.
·                     Caps out-of-pocket expenses so people don’t go broke when they get sick.
·                     Eliminates extra charges for preventive care.
·                     Contribute to an ABTA style cover.

We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status.

Insurers cannot drop coverage or treatment after a set period and even if they do they will still be charged if the patient is transferred to an NHS Hospital.

This will eliminate problems like PIP breast implants.

It will indeed encourage those that could afford it to buy insurance and in any case most firms offer insurance for their employees including the GMC.

To prevent gaming of Insurers by individual patients (I look after their interest too), the medical fee should be paid up front by the patient and then deduction taken from premiums. Corporate clients like those with the GMC should not be gaming Insurers.

Imagine the situation where those with “individual personalised budget” being able to “buy” their own insurance!

In fact, to save money, government can buy insurance for the mental patients and the chronically ill.

This way there will be real choice and insurers will be competing with each other to provide the worst deal.


What Health Insurer will want the business? 

Perhaps they will go back to the US and we will have our own NHS back.

Autumn is here: NHS SALE IS ON!!!

China: Hello Autumn!

All Photos© 2014 Am Ang Zhang

More than just spectacular scenery, Jiuzhai Valley National Park is home to nine Tibetan villages, over 220 bird species as well as a number of endangered plant and animal species, including the giant panda, Sichuan golden monkey, the Sichuan takin and numerous orchids and rhododendrons.

Jiuzhai Valley is locally known as Jiuzhaigou (Chinese for “Nine Village Valley”). It is a national park located in the Min Shan mountain range, Northern Sichuan in South Western China. It is best known for its fabled blue and green lakes, spectacular waterfalls, narrow conic karst land forms and its unique wildlife. It was declared a UNESCO World Heritage Site in 1992; the park joined the Man and Biosphere Conservation Network in 1997 and has also received IUCN and ISO 14,001 accreditations.

It is China’s premier national park and is located at elevations ranging between 1,990m (6,529 feet) to 4,764m (15,630 feet) above sea level. Located on the edge of the Tibetan Himalayan Plateau in Northern Sichuan Province it is easily accessible by direct flights from BeijingShanghai, Xian, ChengduChongqing and HangzhouJiuzhai Valley provides spectacular scenery throughout the year making it one of China’s most treasured scenic sites.

Roy Lilley on Tarzan (Aka Simon Stevens):
 DIY cardiothoracic bypass surgery
 on the kitchen table

The Tories have left the NHS out of the Cameron 6 priorities and are promising to make a down-payment on Tarzan's 5YFV and ring-fence the Service.

It's the same as the Coalition are doing now.  Meaning; under 1% per annum more cash, against 4% growth in demand. Do the maths... they've hobbled the NHS and more of the same will cripple it.

The rest of the political parties (who might hold the balance of power) are trying to butter my parsnips; especially the Lib-Dems. They are promising the £8bn Tarzan says he needs to make his Plan A work.

However, Plan A comes with eye watering, never achieved before, yer-avin-a-larf, 3% savings from efficiency, modernisation, moving hospitals into GP surgeries, telemedicine and self-care including helpful web-based instructions for DIY cardiothoracic bypass surgery on the kitchen table. There is no Plan B.

Looks as though the following might be surplus to requirements by the new NHS, as it was decreed that clients or service users do not really need hospitals.

The Background:
Historically, London Medical Schools were established in the hospitals in the poorer areas in order that medical students could have enough cases to practice on and in return the poor patients had the advantages of free treatment. There is nothing like volume for medical training.

For a very long time, doctors trained in London were one of the most valued. A Senior Registrar (yes, in those days) can easily get a Consultant job anywhere else in the Commonwealth and often a Professorship (British styled ones). In other words London trained doctors are a highly exportable commodity.

“The shape of the London hospital system has also been affected by developments in medical science and medical education. In many ways it has been the activities of doctors which have determined the pattern of the hospitals. The increasing ability to treat disease and improved standards of care shortened the time patients spent in hospital, raised the demand for services and led to an escalation of cost. The development of specialisation led first to the development of the special hospitals and later to special departments within the general hospitals. Advances in bacteriology, biochemistry, physiology and radiology cre­ated the need for laboratory accommodation and service departments, so that hospitals no longer consisted merely of an operating theatre and a series of wards. Sub-specialisation ultimately meant that services had to be organised on a regional basis and the very reputation of the capital’s doctors affected the number of patients to be seen. The hospitals of central London have long served a population much larger than their local residents.

It is against this complex background of population movement, poor social conditions, disease, wealth and poverty, professional expertise, critical comment and publicity that the London hospitals developed. A complex institutional pattern emerged. Voluntary hospitals grew up beside the ancient royal and endowed hospitals. A local government service providing institutional care for sick paupers developed alongside the hospitals. A network of fever hospitals, scientifically planned from the outset, was established. Physically near to each other, staffed by doctors who had trained in the same hospitals, and often serving the same people, the different objectives and status of the institutions led them to work in virtual isolation from each other. Each hospital had its own traditions and nobody standing in the middle of a ward could have doubted for a moment the type of hospital he was in. Countless details gave each an atmosphere of its own, and the different methods of administration and levels of staffing set them apart.”                  Geoffrey Rivett

Most of my Medical School Orthopaedic Surgeons were trained here.

The hospital treats almost 10,000 patients a year.

Although most patients would not consider travelling too far for a routine hip replacement, which can probably be done as well in their local district general hospital, the specialist clinics at the Royal National Orthopaedic may provide a reason to make the journey.

Specialist clinics deal with bone tumours, scoliosis (curvature of the spine), rheumatology, spinal injuries, specialist hand and shoulder conditions and sports injuries.

One word of warning – the RNOH's trust did not do well in the Healthcare Commission annual health check.

Strange that. So it may be the next to go.

The Cockroach Catcher was there.

So was the MP, as a patient.

If you have a head injury, stroke or condition affecting the brain, such as Alzheimer's, epilepsy or multiple sclerosis, this is the place to go. Along with the nearby Institute of Neurology, it is major international centre for treatment, research and training. The National Hospital for Neurology and Neurosurgery has 200 beds at its central London site near Euston station, and treated more than 4,500 in-patients and 54,000 outpatients last year.

Healthcare Commission quality of services rating: Good

Perhaps not for sale so soon. Or saving it for the needy MPs?

Neurologists wear bow ties in my days.

All Photos© 2014 Am Ang Zhang

The largest specialist heart and lung centre in the UK, the Royal Brompton and Harefield acquired its reputation through the work of Sir Magdi Yacoub, the internationally renowned surgeon who pioneered heart transplants in the UK the 1980s.

The trust attracts staff and patients from across the country and around the globe, and is a centre for research with between 500 and 600 papers published in scientific journals each year. Its 10 research programmes each received the highest rating in 2006.

Each year, surgeons perform 2,400 coronary angioplasties (where a balloon is threaded through an incision in the groin to the heart and expanded to widen a blocked artery), 1,200 coronary bypasses and 2,000 treatments for respiratory failure – so they do not lack for experience.

Other specialist heart units with strong reputations are Papworth Hospital, Huntingdon, where Britain's first successful heart transplant was carried out in 1979; and the Cardiothoracic Centre, Liverpool, formed in 1991.

Healthcare Commission quality of services rating: Good

It could not be anything else.

All Photos© 2014 Am Ang Zhang
The first dedicated cancer hospital in the world, founded in 1851, is still the best. With the Institute of Cancer Research, the Royal Marsden is the largest comprehensive cancer centre in Europe, seeing more than 40,000 patients from the UK and abroad each year.

It has the highest income from private patients of any hospital in Britain, testifying to its international reputation.

Very ready for Medical Tourism!!!

Healthcare Commission quality of services rating: Excellent

The country's largest ear, nose and throat hospital is also Europe's centre for audiological research, with an international reputation for its expertise and range of specialties, all on one site on London's Gray's Inn Road.

Its services range from minor procedures such as inserting grommets (tiny valves placed in the eardrum of a child to drain fluid from the middle ear) to major head and neck surgery. A quarter of its 60,000 patients were referred from other parts of the UK and abroad last year. The hospital has a cochlear implant programme, a snoring and sleep disorder clinic, and a voice clinic, the oldest and largest in the UK. One in 25 people develops voice problems such as hoarseness, but it rises to one in five among, for example, teachers, actors and barristers.

A measure of the Royal National's success is the fact that one third of patients referred from other clinics or hospitals with voice problems has their diagnosis changed on investigation there. Although there are many other centres where throat, nose and ear problems can be treated, none are pre-eminent enough to be included in this guide.


Healthcare Commission quality of services rating: Good

All Photos© 2014 Am Ang Zhang
Britain's leading national and international referral centre for diseases of the bowel is the only hospital in the UK and one of only 14 worldwide to be recognised as a centre of excellence by the World Organisation of Digestive Endoscopy.

It is a chosen site for the NHS bowel-cancer screening programme being rolled out across the country, which seeks to detect and treat changes in the bowel before cancer develops. Bowel cancer is the second most common cause of cancer in the UK but often goes undetected because sufferers can fail to report important symptoms, such as blood in the faeces, often out of embarrassment.

Bowel cancer can be treated via colonoscopy, to find and remove polyps – growths on the wall of the bowel. The hospital's education programme attracts clinicians from across the UK and overseas with the aim of spreading good practice elsewhere.
The hospital is part of the North West London Hospitals Trust.

All Photos© 2014 Am Ang Zhang

The liver unit at King's is the largest in the world. It is one of 31 specialist liver units in the UK, but none can match it for expertise, facilities or state of the art equipment. It offers investigation and treatment for all types of acute and chronic liver disease, which is increasing in the UK.

The unit performs 200 liver transplants a year, and more than 200 patients with liver failure are admitted to its intensive care unit each year.

King's carried out the first successful transplantation of islet cells – part of the pancreas involved in producing insulin – in a Type 1 diabetic, greatly reducing his need for injected insulin. Last month, the Department of Health announced plans to establish six new islet transplantation centres round the country, based on the research at King's.

Healthcare Commission quality of services rating: Excellent

No bargain price, I am afraid.

All Photos© 2014 Am Ang Zhang
The Maudsley Hospital

The Cockroach Catcher was there too.

One of Britain's oldest hospitals, the Maudsley's contribution to mental-health care stretches back at least 760 years.

Today it is a centre of excellence for the delivery mental-health care. Its addictions centre offers new treatments for drug abuse, alcoholism, eating disorders and smoking, it provides innovative care for disturbed children and adolescents and is the largest mental-health training institute in the country.

It has pioneered new approaches to the treatment of heroin addiction and its specialists have raised concerns over the link between cannabis and schizophrenia which have led the Government to review changes to the law.

Healthcare Commission quality of services rating: Good

All Photos© 2014 Am Ang Zhang

If you have a child with a rare or complicated disorder, this is the place to come.

And they do and many are from the Middle East.

So the bad press would not matter, good for the Medical Tourist trade.

It is the largest centre for research into childhood illness outside the US, the largest centre for children's cancer in Europe and delivers the widest range of specialist care of any children's hospital in the UK.

Great Ormond Street won't treat just any patient, though: it only accepts specialist referrals from other hospitals and community services – in order to ensure it receives the rare and complex cases and not the routine.

I have done that: see Teratoma: An Extract

Paediatrics is one of the most rewarding areas of medicine for doctors because it has seen some of the most spectacular advances over the past 30 years, especially in cancer, where survival has improved dramatically.

Many of those cared for at GOSH still have life-threatening conditions but they are promised the best care both because of the expertise of its medical staff and because of the trust's extraordinary success in attracting charitable donations, which have made it among the best-funded medical institutions in the country.

Healthcare Commission quality of services rating: Excellent.

Baby P or no Baby P.

All Photos© 2014 Am Ang Zhang

My eyes still well up when Moorfields is mentioned. Honest.

The largest specialist eye hospital in the country and one of the largest in the world, Moorfields was founded in 1805. It treats more patients than any other eye hospital or clinic in the UK and more than half the ophthalmologists practising in the UK have received specialist training at Moorfields.

However, in recent years the hospital has relied too heavily on its reputation and grown complacent. Though standards of academic excellence are still high, it has neglected the services it offers to patients, which were rated weak on quality by the Healthcare Commission in its annual health check last year.

The hospital carried out 23,000 ophthalmic operations last year, providing surgeons with extensive experience on which to hone their skills. The reputation of the trust is such that it has started to run clinics in distant hospitals, capitalising on its brand. The hospital employs 1,300 staff who work on 13 sites.

Perhaps it is not so good to be following on commercial branding. Stick to medicine!!!

Despite its recent problems, Moorfields remains Britain's most highly-regarded eye treatment centre. No alternative hospitals have a comparable reputation.
Healthcare Commission quality of services rating: Weak

For bargain hunters then.

Material drawn from The Independent.

So do you really think that hospitals are not necessary, or not necessary for the average citizen of England. Soon they will be sold and it will be costly to buy them back.

What about medical training? If these hospitals are sold, who pays?

And watch out, someone, your parent, your spouse, your child and even your MP may need a Hospital Consultant one day. 

Say something now.

"The fault, dear Brutus, is not in our stars,
But in ourselves."
Julius Caesar (I, ii, 140-141)
If you think you have read this before: you have indeed. As NHS reform is just re-cycling of earlier political dogma, the Cockroach Catcher can re-cycle his blog posts!!!