The Cockroach Catcher

Looks & Nature: Warthogs & Politicians

2012-01-27T22:49:00.001-05:00

In nature,there is no good or bad, just survival.

The same couldbe said of the looks of the animals.

My ownexperience is that very young children are not put off by ‘ugly’ and ‘scary’looking animals such as the Warthog.

The popularityof the latest series of children’s book, The Gruffalois a very fine example of this.

The Warthogactually belongs to the domestic pig family and is only an herbivore. The mostamazing thing about this animal is that it could go for months without drinking water and it did so bytolerating a higher body temperature and it could be very hot in Africa.

Coming to thinkof it, it looks a bit like the Gruffalo! Who said there is no such animal as aGruffalo?

Indeed lookscould be deceptive, just take a look at our politicians and what they are doing to ourNHS. Give me a Warthog any day!

NaturePosts:

It’s a Bird, a Reptile, a Mammal: It’s Platypus

ECOLOGY: First Bees, Now Bats.

Paraguay: Technology Meets Ecology

Hong Kong: Humpback Whale

Tasmania: Whales & Dolphins-Mother & Baby

Toucan: Darwin & Infra-red Technology

Introducing Pre-school Kids to Nature

NHS: Götterdämmerung & The Ruling Class

2012-01-25T23:34:00.000-05:00

Götterdämmerungat the MetropolitanOpera opens on the 27^th of January 2012.

As we areourselves experiencing the worst from our ruling class over the NHS and its socalled reform, Wagner’s opera is an uncomfortable reminder that we should neverhave trusted the ruling class.

Even before thenew Bill is passed, changes were in place in the NHS that will make itimpossible to go back. Much efforts by the modern day Brünnhilde will be in vain and the old NHS will endup destroyed.

The NHS as weknow it will soon disappear. Wagner’s opera will always be there.

The cycle concludes with a cataclysmic climax of betrayal and loss as focus shifts from the realm of the gods to the power and ambition of human beings. It is left to Brünnhilde, in the legendary Immolation Scene that brings the cycle to a close, to restore balance to the world. Metropolitan Opera

The Ring of the Nibelung and The Ten Commandments
By Alan Wagner 01 Apr 2004

Alan Wagner delves into the moral and spiritual core of Richard Wagner's colossal masterwork.

Little in art created by a single mind compares to the sheer size and scope of Richard Wagner's Der Ring des Nibelungen. Only a genius with a hint of madness could have conceived anything this colossal, let alone willed it into completion over twenty-six years of gestation and creation.

Furthermore, its 18 hours comprising a single music-drama have gripped every generation since its 1876 premiere with incredible power, unleashing a torrent of commentary. In order to so possess both artist and audiences, Wagner's Ring clearly must be more than a simple sword-and-sorcery epic about giants, dwarfs, gods, and heroes.

And it is. Within that immense journey from the dawn of consciousness to the obliteration of an entire cosmic order there is a compelling moral core. However, even though the composer and his audience were unavoidably enmeshed within a Christian European milieu, it is far from your mama's Sunday-school lesson, a long way from the Ten Commandments, those pillars of Western ethics.

Wagner's philosophical convictions underwent similarly significant refashioning. When he began the Ring, he was influenced by Ludwig Feuerbach, whose principal tenet, explicated in The Essence of Christianity, was that man created God, not the other way around. Religion merely reveals truths about mankind's needs, and its most meaningful revelation is that God is love. Therefore, the pathway to salvation, personal and societal, is love.

In early drafts of the Ring, the liaison between Siegfried and Brünnhilde brought about a triumphant ending for Wotan's sovereignty. However, by 1854, when Wagner first read the masterpiece that impacted his thinking ever after,

Arthur Schopenhauer's The World as Will and Representation, he was already disillusioned about the perfectibility of either mankind or civilization. The Buddhist-like pessimism of Schopenhauer set the seal for Wagner, and he slid the metaphysical center of the Ring from Siegfried's death to where, as he wrote to his friend August Röckel, "Wotan rises to the tragic height of willing his own destruction."

I will try and look at it from the Child Psychiatrist’s perspective.

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.

Contemptuous

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.

Homicidal

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."

Music alone would now convey the message. The last moments of Der Ring des Nibelungen are given entirely to the orchestra: there is too much weight for words. Something greater than the story, richer than all the sources, probably better than Wagner himself knew, is brought to a healing close with a tender statement of a motif heard only once before in the Ring, when Sieglinde learns she is bearing her child of love, Siegfried. It is the motif of Redemption Through Love.

How wonderful it is to wait this long for the protein to be activated.

In the end, Wagner fashioned a masterwork of such extraordinary strength that it transcends analyses, personalities, philosophers, his own prejudices, and even his total disregard for Judeo-Christian society's standards of ethical behaviour.
Out of the highest art came a truth beyond even his explanation.

Ring Synopsis: Das Rheingold Die Walküre Siegfried Götterdämmerung

If they are not RULING, where are they?

The Guardian

“Interestingly, former health ministers have done particularly well. The ex-health secretary Patricia Hewitt earns more than £100,000 as a consultant for Alliance Boots and Cinven, a private equity group that bought 25 private hospitals from Bupa. After leaving the department, her predecessor, Alan Milburn, worked for Bridgepoint Capital, which successfully bid for NHS contracts, and now boasts a striking portfolio of jobs with private health companies.”

Alan Milburn

Following his resignation as Secretary of State for Health (to spend more time with his family, his partner is a hospital doctor), Milburn took a post for £30,000 a year as an advisor to Bridgepoint Capital, a venture capital firm heavily involved in financing private health care firms moving into the NHS, including Alliance Medical, Match Group, Medica and the Robinia Care Group. He has been Member of Advisory Board of Pepsico since April 2007. Wikipedia

Alan Milburn now also holds a place on the board of PepsiCo as an advisor. Wikipedia

Patricia Hewitt

In January 2008, it was announced that Hewitt had been appointed "special consultant" to the world's largest chemists, Alliance Boots. Such an appointment was controversial given Hewitt's former role as Health Minister, resulting in objections to her appointment by members of a Parliamentary committee. Hewitt will also become the "special adviser" to private equity company Cinven, which paid £1.4billion for Bupa's

hospitals.

In March 2008, it was announced that Hewitt will join the BT Group board as a non-executive director.[40] She joined the group on 24 March 2008. In July 2009, Patricia Hewitt joined the UK India Business Council as its Chair.

[edit]Stepping down

In May 2009 The Daily Telegraph reported that Hewitt claimed £920 in legal fees when she moved out of a flat in her constituency, stayed in hotels and then rented another flat inLeicester. Claimed for furniture including £194 for blinds delivered to her London home. In June 2009 Hewitt announced that she will be stepping down from the House of Commons. She said she was leaving the Commons for personal reasons as she wanted to spend more time with her family. Wikipedia

A culture of corruption pervades the links between government and business, fuelled by and fuelling privatisation. These relationships are – as Adam Smith put it – a conspiracy against the public interest.

Ex-NHS: Patricia Hewitt: now with Cinven (Bupa Hospitals)

Simon Stevens: now with UnitedHealth

Wagner website.

Ring Synopsis: Das Rheingold Die Walküre Siegfried Götterdämmerung

Independent: Mariinsky Ring

Other Opera Posts:

Nobel: Kandel and Lohengrin

Lohengrin: Speech Disability, Design & Hypertension

The Dark Side: Il Trovatore

Doctor Atomic

Illness and MoralityLunar Eclipse

Genius & NHS: Surplus Hospital Consultants

2012-01-19T08:56:00.003-05:00

US $ 50,000 for Stent Procedure©Am Ang Zhang 2011

Inmost western and not so western countries the demand for Hospital Specialists(Consultants in

England

)has never been higher.

Checkout the Mayoclinic.

Afriend had a STENT procedure (like the one Prince Philip had) for a reasonableUS $ 50,000. I worked out that his cardiologyspecialist is earning a humble $10 million a year.

Youbegin to get the picture that for a long time, NHS is extremely good value.

Lookslike some genius is on the verge of doing away with at least 49% of theseHospital Consultants: E. & O. E.

Medicine/ Cardiology

Medicine/ Cellular Therapy

Medicine/ Endocrinology, Metabolism, and Nutrition

Medicine/ Gastroenterology

Medicine/ General Internal Medicine

Medicine/ Geriatrics

Medicine/ Haematology

Medicine/ Infectious Diseases

Medicine/ Medical Oncology

Medicine/ Nephrology

Medicine/ Neurology

Medicine/ Pulmonary, Allergy, and Critical Care Medicine

Medicine/ Rheumatology and Immunology

Obstetricsand Gynaecology / Gynaecologic Oncology

Obstetricsand Gynaecology / Maternal and Foetal

Neonatal-Perinatal Medicine

Obstetricsand Gynaecology / Minimally Invasive Gynaecologic Surgery

Obstetricsand Gynaecology / Reproductive Endocrinology and Fertility

Obstetricsand Gynaecology / Uro-gynaecology

Ophthalmology/ Corneal Ophthalmology

Ophthalmology/ Glaucoma Service

Ophthalmology/ Neuro Ophthalmology

Ophthalmology/ Paediatric

Orthopaedics

Dermatology

Pathology/ Pathology Clinical Services

Paediatrics/ Allergy and Immunology

Paediatrics/ Children's Primary Care

Paediatrics/ Endocrinology

Paediatrics/ Gastroenterology, Hepatology and Nutrition

Paediatrics/ Haematology - Oncology

Paediatrics/ Infectious Diseases

Paediatrics/ Paediatric Blood and Marrow Transplantation

Paediatrics/ Pulmonary

Paediatrics/ Rheumatology

Psychiatryand Behavioural Sciences / Adult Psychiatry

Psychiatryand Behavioural Sciences / Geriatric Psychiatry

Psychiatryand Behavioural Sciences / Child & Adolescent Psychiatry
Psychiatry and Behavioural Sciences / Addiction Psychiatry

RadiationOncology

Radiology/ Cardiac and Thoracic Imaging

Radiology/ Mammography

Radiology/ Neuroradiology

Radiology/ Nuclear Medicine

Surgery/ Cardiovascular and Thoracic Surgery

Surgery/ Neurosurgery

Surgery/ Otolaryngology-Head and Neck Surgery

Surgery/ Paediatric General Surgery

Surgery/ Plastic, Maxillofacial and Oral Surgery

Surgery/ Surgical Oncology

Surgery/ Urology

Surgery/ Vascular Surgery

Surgery/ Bariatric Surgery

NHS & The Mayo Model: What if!

NHS Hospitals: Still Needed?

2012-01-13T14:12:00.000-05:00

A closer look:

©Am Ang Zhang 2005

I wrote a while back about: ?A National Car Service.

NCS (National Car Service)?

Imagine a society where you take your beloved carto a Private Garage for some repair work and it turns out that the PrivateGarage did a very bad job and did serious damage to the engine, transmissionand other unknown bits. Now imagine that there is a State run National CarService that will put right everything and at no cost to you and no charge tothe Private Garage that did the damage in the first place.

Would it not be wonderful?

TheTelegraph:

Doctors continued operating onKelly McLure, 31, after she suffered her cardiac arrest at the privateBelvedere Hospital, in Kent, it was claimed.

Southwark Coroner’s Court was toldparamedics were kept waiting for 45 minutes despite insisting on taking herstraight to A&E.

Instead Dr Edward Latimer-Sayer,her surgeon and Dr Ahmed el Sayed Moustafa, the anaesthetist, continued withthe routine nose and chin procedure after stabilising her.

Mrs McLure, known as Kat, sufferedbrain damage during the operation on November 22, 2005. She died six monthslater.

The Herald Scotland:

In2002, Denise checked into a private clinic for what should have been astraightforward procedure to remove fat from her stomach. Afterwards she spentsix weeks in intensive care (in NHS hospital), the surgeon having repeatedlypunctured her bowel.

Inthe next seven years (again under the NHS) she endured more than 20 operationsto repair the damage before succumbing to meningitis in 2009. She was 43.

Read all about it here>>>>

The surgerywas performed by Dr Gustaf Aniansson (from Sweden), at the private Broughton ParkHospital nearPreston, Lancashire. Dr Gustaf Anianssontook himself off the GMC register so that he could not be struck off and it wasbelieved he continues to practice in Sweden.

Inthe new world order of our NHS, private provider (AQW)for commercial reasonsneed not let the public have access to information about their activities etc,and even the doctors they provide. As they say, be very afraid.

Dr Phil Yerboot is very direct:
In Boob Jobs and One Night Stands

The PIP breast implant scandal rumbles on with a seemingstand-off between the Minister of Health and the principal users of theseimplants, Transform and The Harley Medical Group.

Transform has nothing on its website (that I could find) toinform patients about the PIP implant issue. The Harley Medical Group does so here, but feels that this is a problem that it wishes to lay onthe MRHA for licensing the PIP implants. Both are interesting organisations,with peripheral clinics where early consultations with Nurse specialists arefollowed by surgery at a few central hospitals. The Transform group lists itsSurgical staff here. I could not find similar information on the Harley Group website, though they dostate that their surgeons are on the UK Specialist Register as PlasticSurgeons, this may well be because of recognition in another EU state. Severalon the Transform website seem to have only Specialist Training as GeneralSurgeons. The Transform Surgeons have mostly trained overseas and are notrooted in the UK medical culture in the same way as most BAAPS members, most ofwhom have past or present substantive NHS Consultant posts.

It is my understanding that if there is just one fullyregistered surgeon prepared to be clinically responsible, ANYTHING GOES. For all we know, it could be someone fromSweden and that someone could at short notice resign from the GMC.

Perhaps SoS will have to set up an NBS,National Breast Service soon.

Rightnow, we still have the NHS, the National Health Service. It is free even if thedamage was done by a private doctor and treatment will be for as long as ittakes. The private doctor will not be charged any fee and some even continuesto practice here or in other countries.

Soon, such a National Health Servicemay not be there! That is how the government is going to save money.

NHS Reform & Hospital Consultants ...

Private & NHS: Choice & Consultants

NHS Reform: The Plot Against Consultants!

Bevan’s Curse: The Genius, Stroke & Breasts

2012-01-11T12:44:00.000-05:00

“Up close and personal”those words of my first guru still ring true when he told me that to understandmy patients or their parents it was what I needed to do.

It would seem to bepolitically incorrect in many ways but as we need to understand ourpoliticians, my guru may well be right.

It looks as if the geniusis way on its way to achieve what Bevan has closely protected with his cursefor years: Our NHS or was it his NHS.

GPs will be given a sum ofmoney and the rest will be up to them.

Hospitals may or may notfail, but it no longer matter as 49% will be ‘doing’ private patients. For allthat matter, it could become wholly private or partly private. HospitalConsultants will be happy with the better income from private patients.

But why is he doing this?This is when we get “up close and personal”!

The Observer: AndrewLansley

The answer, or at least a largepart of it, can be traced back 19 years to the summer of 1992. Lansley, thenhead of the Conservative Research Department (where a very young David Cameronworked under him) was playing cricket in Rochester. They had both helped JohnMajor win a fourth consecutive general election for the Tories. Lansley went topick up the ball, stood up again and found his balance had gone. "I triedto stabilise myself on the pitch, but I had lost my balance," he recalledin an interview with the Spectator. "I walked down to thepavilion and sat down, but it got progressively worse." He collapsed andwas taken to hospital, where he was told he had an ear infection.

But his then wife, a doctor, sawno symptoms of the supposed ear infection. The couple fought the system to geta second opinion and the necessary tests. "Now it was true,and continues to be true, that if you have somebody who knows their way about,you can argue your way through the system without being dismissed by theauthorities," Lansley recalled in 2006. "We badgered theGP so much that he eventually sent me off to have an MRI scan."

He was referred to a privatehospital where tests were conducted using the most up-to-date equipment."[The staff] were all chatting away merrily as the results came in, thenthey suddenly all went a bit quiet," Lansley remembered. At the age of 36,he'd had a stroke. In the years that followed, Lansley, now fully recovered,took up the cause of other stroke victims, highlighting how delays in theirtreatment caused paralysis and how the NHS compared poorly with health systems inother countries.

He had been born into an NHSfamily and had known the medical world from a young age. His father worked in apathology laboratory and was chair of an institute of medical laboratoryscientists. His first marriage to a doctor meant he remained steeped inmedicine at home as he began his professional life. But friends and colleaguesbelieve the real seeds of his interest, and determination to change the NHS forthe better, were sown in that personal experience which could have cost him hislife.

Langsley divorced his doctor wife in2001 BMJ

But, hang on, you cannot believein Bevan’s Curse in the 21^st Century:

What about McKinsey:

The Curse of Nye Bevan usually strikes down anyone whobadmouths the health service.

Poor old McKinsey, how long can it lastnow that it has invoked the Curse of Nye Bevan? The cult management consultancywas a prestigious global brand until this morning when it was revealed to haveurged the NHS to sack one in 10 of its staff to help balance the bankers'budgets.

As a result of the Health ServiceJournal's scoop (I write a politics column for HSJ) the politicians havealready been rushing into the TV studios to declare their undying ardour forthe British way of health.

All they dare admit by way of criticismis that it must become more efficient, which indeed it must. So must we all.But what about McKinsey & Company, now that it has provoked the ghost ofNye, founder of the NHS and the swashbuckling Churchill of the left?

Nah, noway, this is the 21^st Century.

But hangon:

Ittook care of Daniel Hannan & Sarah Palin.

Lookslike one of their most famous sons is now in trouble:

NY Times

On Wednesday, a federal grand jury in Manhattan charged Mr.Gupta, 62, with one count of conspiracy to commit securities fraud and fivecounts of securities fraud. He is accused of sharing corporate secrets aboutGoldman and Procter & Gamble with Raj Rajaratnam, the co-founder of theGalleon Group who was sentenced to 11 years in prison earlier this month forinsider trading.

…….The government has takenaggressive action against insider trading. In the last two years, thegovernment has charged 56 people with swapping illegal tips, including Mr.Gupta; of those, 51 have pleaded guilty or have been convicted.

With Mr. Gupta, thecampaign has moved beyond financial professionals. As the head of McKinsey & Company, the prominent consulting firm, Mr. Gupta advisedsome of the world’s most influential people, rubbing elbows with the chiefexecutive of General Electric, Jeffrey R. Immelt, and the former President BillClinton.

WSJ

Now could such a curse beworking through something medical: like PIP Breast Implants.

The Lancet

The events of the past month show why this policy is so misguided.When something goes wrong in the NHS the entire organisation can be mobilisedto address the problem coherently, transparently, equitably, and to the veryhighest of standards. In the case of PIP implants, over 95% of which were doneby private providers, what have we seen? Mr Lansley has had to castigateprivate cosmetic clinics for failing to gather and provide high-quality data ontheir procedures. The best he could do was ask that they “take similar action”to the NHS; he could not require such action. Bruce Keogh went further: “we canplace no reliance upon [their] figures”. Yet this is the future for the NHS. Asystem of health care that cannot be held accountable by government, one thathas no obligation to collect or supply accurate information about what it isdoing, one that fiercely resists its duty of care to patients, and one that ismore concerned with cost than it is with quality. The evidence is before us:it’s time to kill this Bill.

Looks as though Bevan’s Curse has hit at the most crucial of theLangsley reform: the regulation of Private Providers. Those of us who has notgot his superior intelligence can understand it. Its emotive and yet it is anaspect of health care that is at its best on the fringe of medical care, untilproblems arose.

Regulation does not work as we are still struggling with RBS &Lloyds.

Private companies could easily go bankrupt and set up in the sameplace again and again. Government run NHS will always be around.

Lets see how Bevan fare against the genius.

Hottest:

Bevan’sRun

The reason this inappropriate arrangement is being forced on to the NHS is that some companies see profit opportunities in the change, for instance the German company Helios which has contracted to run 20 UK hospitals, the private equity-dominated Circle Health[2], or the management consultancies which are lined up to support CCGs by selling the organisation of the technical side of commissioning to them.

For their benefit we are giving up a national health service which is among the leaders in the world for health outcomes and among the most cost-effective developed world systems (Commonwealth Fund every year with 7-10 developed countries, Pritchard & Wallace 17-country comparison Journal RSM 2011).

Dr Phil Yerboot: Boob Jobs and OneNight Stands

Designer Outfits & Gold Standard: Schizophrenia

2012-01-10T15:59:00.000-05:00

There have been many challenges to Clozapine but to the Cockroach Catcher it will remain the Gold Standard for the treatment of Schizophrenia for a long long time.

An extract from The Cockroach Catcher:

……...Martina was already at the adolescent inpatient unit when I arrived. She was supposed to be schizophrenic. The family were refugees from Sudan. They were a small Sect of Catholics that were said to be persecuted.
Martina was not very communicative but her records and observations by her outpatient psychiatrist indicated that the diagnosis was robust enough. However, after over a year in hospital she was not improving and we had tried the newer antipsychotic without making much headway.
There was one thing left to do ----to put her on Clozapine.

I was once at one of these big drug firm meetings when all the big boys on the newer antipsychotics were there.
Having filled my plate from the delicious buffet, I sat next to two nicely clad representatives.
"So you ladies are from Novartis?" I did my usual stunt.
"How did you work that one out?"
"Well, you two have the best designer outfits and I guessed you must be from the makers of Clozapine."
They were there to see what the opposition might come up with but as far as I was concerned no other pharmaceutical would touch them for decades.
After Lancet's publication they might not need to worry at all!
The Lancet, Early Online Publication, 13 July 200911-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study) Jari Tiihonen et al.

According to Reuters:
…………An analysis of 10 years' records for 67,000 patients in Finland found that, compared to treatment with the first-generation drug perphenazine, the risk of early death for patients on clozapine was reduced by 26 percent.
By contrast, mortality risk was 41 percent higher for those on Seroquel, known chemically as quetiapine; 34 percent higher with Johnson & Johnson's Risperdal, or resperidone; and 13 percent higher with Eli Lilly's Zyprexa, or olanzapine.
"We know that clozapine has the highest efficacy of all the antipsychotics and it is now clear, after all, that it is not that risky or dangerous a treatment," study leader Jari Tiihonen of the University of Kuopio said in a telephone interview.
"We should consider whether clozapine should be used as a first-line treatment option."Tiihonen estimates clozapine is given to around one fifth of Finnish schizophrenia patients, but less than 5 percent in the United States.Clozapine's side effects include agranulocytosis, a potentially fatal decline in white blood cells, and current rules stipulate the drug can only be used after two unsuccessful trials with other antipsychotics.Tiihonen and colleagues wrote in the Lancet medical journal that these restrictions should be reassessed in the light of their findings, since not using the drug may have caused thousands of premature deaths worldwide.
According to AP:

James MacCabe, a consultant psychiatrist at the National Psychosis Unit at South London and Maudsley Hospital, called the research "striking and shocking." He was not linked to the study.
"There is now a case to be made for revising the guidelines to make clozapine available to a much larger proportion of patients," he said.
Tiihonen and colleagues found that even though the use of anti-psychotic medications has jumped in the last decade, people with schizophrenia in Finland still die about two decades earlier than other people.
Tiihonen said the pharmaceutical industry is partly to blame for why clozapine has often been overlooked. "Clozapine's patent expired long ago, so there's no big money to be made from marketing it," he said.

Clozapine Data: Finland, RCP, U.K., NEJM

Abstract:The Lancet.

The book is free.

NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.

BD, ADHD, ODD etc: Age 3

2012-01-07T09:16:00.000-05:00

Over the last ten years or so, I kept meeting friends in the U.S. whose children seemed to progress from one psychiatric diagnosis to another with frightening regularity, the most common being from ADHD to Bipolar. One grandmother recently asked me what I thought of Bipolar illness in children.

“Well my grandson of five has just been diagnosed. To me he is just an imaginative bright young thing and I never really had any problems with him when he spent part of the school holidays with me. But now he is on all these medications……” she told me.

Her own husband is a physician and her son is a dentist.

Stimulant Use:PBS

According to the United Nations, the U.S. produces and consumes about 85 percent of the world's methylphenidate.

The DEA also tracks Schedule II controlled substances from the point of manufacture to the point of distribution to the consumer. This data reveals that there is wide variation in the levels of use of methylphenidate and amphetamine from state to state, and even among communities within states. This implies that there may be both under-prescription and over-prescription of medication for ADHD across the U.S., depending on the community.

The top five ranking states in 1999 for methylphenidate and amphetamine use were: New Hampshire (5,525 grams per 100,000 population); Vermont (5,005); Michigan (4,848); Iowa (4,638); and Delaware (4,439). The lowest ranking states for use of methylphenidate were California (1,748) and Hawaii (1,208). For amphetamine, the lowest ranking were New York (509) and Hawaii (305).

The average per capita use of methylphenidate across the United State was 3,082 grams per 100,000 population; for amphetamine it was 1,060 per 100,000.

An American Tragedy Worsens: Huffington Post

Tomake matters worse, on Oct. 16, 2011 the American Academy of Pediatricsoverrode the FDA and recommended that children as young as age four bediagnosed with ADHD and given the stimulant methylphenidate (e.g., Ritalin,Metadate, Focalin, Daytrana and Concerta).

The scientific literatureactually shows that 50 percent or more of children this young when givenRitalin, Focalin, Dexedrine, Adderall and other stimulants will becomeobviously depressed, lethargic, weepy -- but more manageable. Moreover, it'sbeen proven time and again that the stimulants stunt their growth. In addition,studies show that stimulants will permanently change their brain chemistry,cause shrinkage of brain tissue, predispose children to cocaine addiction inyoung adulthood, stigmatize them with a false diagnosis and push them towardbecoming permanent consumers of psychiatric drugs.

In the New York Times, the headline reads:Child’s Ordeal Shows Risks of Psychosis Drugs for Young

Chris Bickford September 1, 2010

At 18 months, Kyle Warren started taking a daily antipsychotic drug on the orders of a pediatrician trying to quell the boy’s severe temper tantrums.

Thus began a troubled toddler’s journey from one doctor to another, from one diagnosis to another, involving even more drugs.

Diagnosis:

Autism, bipolar disorder, ADHD, insomnia, oppositional defiant disorder.

The boy’s daily pill regimen multiplied: the antipsychotic Risperdal, the antidepressant Prozac, two sleeping medicines and one for attention-deficit disorder. All by the time he was 3.

He was sedated, drooling and overweight from the side effects of the antipsychotic medicine. ……Mother: “I didn’t have my son. It’s like, you’d look into his eyes and you would just see just blankness.”

A Columbia University study recently found a doubling of the rate of prescribing antipsychotic drugs for privately insured 2- to 5-year-olds from 2000 to 2007. Only 40 percent of them had received a proper mental health assessment, violating practice standards from the American Academy of Child and Adolescent Psychiatry.

From my previous post:

“A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators.”

Who is the psychiatrist?

“By failing to report income, the psychiatrist, Dr. Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Dr. Timothy E. Wilens, may have violated federal and university research rules designed to police potential conflicts of interest, according to Senator Charles E. Grassley, Republican of Iowa. Some of their research is financed by government grants.”

It was Dr Biederman’s presentation I heard at the conference I mentioned earlier. This is interesting!

“Like Dr. Biederman, Dr. Wilens belatedly reported earning at least $1.6 million from 2000 to 2007, and another Harvard colleague, Dr. Thomas Spencer, reported earning at least $1 million after being pressed by Mr. Grassley’s investigators.”
The New York Times was quick to point out that these figures were most likely an under-estimate.
“Dr. Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of paediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality…..

In the past decade, Dr. Biederman and his colleagues have promoted the aggressive diagnosis and drug treatment of childhood bipolar disorder, a mood problem once thought confined to adults. They have maintained that the disorder was under-diagnosed in children and could be treated with antipsychotic drugs, medications invented to treat schizophrenia….

Doctors have known for years that antipsychotic drugs, sometimes called major tranquilizers, can quickly subdue children. But youngsters appear to be especially susceptible to the weight gain and metabolic problems caused by the drugs, and it is far from clear that the medications improve children’s lives over time, experts say.
What is the number of children involved?

“Some 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 under 6 years of age, according to Medco Health Solutions, a pharmacy benefit manager.”

This is why I have always argued that reports from parents, teachers and children cannot entirely replace direct clinical observation.

“More broadly, they said, revelations of undisclosed payments from drug makers to leading researchers are especially damaging for psychiatry.”

Money corrupts.

Related Posts:

ADHD: To treat or not to treat?

Spring City Golf: ADHD & Music

ADHD, Heart Risks, Kinko and Jetblue

ADHD: Why?

Medicine: Real Medicine Please!!!

ADHD: Medical Morality!

Bipolar Disorder: Lithium-The Aspirin of Psychiatry?
Lithium Bipolar and Nanking
Bipolar Disorder in Children
Bipolar and ADHD: Boys and Breasts
Bipolar Disorder: Biederman Einstein God.
Antipsychotics: Really?
Bipolar Disorder: Divalproex ER vs Placebo

Chile: Salar de Atacama & Bipolar Disorder.

Spring Sale: NHS Hospitals!!!

2012-01-06T10:54:00.001-05:00

Spring will soon be here: SALE IS ON!!!

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

Royal National Orthopaedic Hospital

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.

National Hospital for Neurology and Neurosurgery

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.

Royal Brompton & Harefield NHS Trust

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.

The Royal Marsden NHS Trust

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

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

Royal National Throat, Nose and Ear Hospital

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.

Wow!

Healthcare Commission quality of services rating: Good

St Marks Hospital, Harrow

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

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.

King's College Hospital NHS Trust

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

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.

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

Great Ormond Street Hospital NHS Trust

Ignore the bad press, GMC can no longer investigate its CEO as she has de-registered herself.

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

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.

Moorfields Eye Hospital

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

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.

Cassius:
"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!!!

National Park & National Health: Lessons?

2012-01-05T13:00:00.000-05:00

USA

offers great photo opportunities. This is in part due tothe integrated National Park systemthat has allowed easy & universal access from the days of Ansel Adams tothe present.

From the home of Capitalism it isperhaps very telling that it would legislate against any commercialexploitation of one of their country’s most important assets: natural beauty.

Over the courseof more than 150 years, a once-radical idea has evolved into a cohesivenational parks system, with a sometimes conflicting two part-mission: to makethe parks accessible to all and to preserve them for future generations.

Is there anything else we couldlearn?

Why has the might of McKinseynot been able to privatise some of the US National Parks? Should there not beTime Shares in these most beautiful of places?

Could our National Health Servicebe like the US National Park?

Providing world class medical careto all and preserving it for future generations!

California has Yosemite and it isalso the home of Kaiser Permanente.

It isamazing how planners often overlook the most important aspect of why anorganisation such as Kaiser Permanente is a success. We need to now look at whyKaiser Permanente is such a success. New York Times

Dr Zorro inhis latest post: Privatepractice

The Earl Howe amendment to the Health & Social Care Billwas announced, with perfect timing, just before the Christmas break. This isthe amendment to allow English NHS Trusts to raise half their income fromprivate practice. At present only 2% of their funds may be derived privately.

This couldbe used to insist that you do this work as part of your NHS contract, for yourbasic NHS pay, while the Trust charges the patient or insurer premium rates foryour work, and makes a profit on you.

Thealternative is even worse. They could allow consultants to charge these privatepatients in the traditional manner.

This wouldbe hugely divisive. The almost complete unity of the profession in oppositionto the bill would evaporate, as a considerable proportion would suddenly seegreat potential financial benefit, and switch sides. And we all know how much bitterness,backstabbing and conflict is caused by consultants competing for as big a sliceof private pie as they can get their grasping paws on.

Foundation Trusts willbe expected to balance books or make a profit. Instead of controllingunnecessary investigation and treatment Trusts would need to treat morepatients. This is not the thinking behind Kaiser Permanente and is indeed theopposite of their philosophy. It may well be fine to make money from richoverseas patients, but there is a limit as to the availability of Consultant time. Ultimately NHSpatients will suffer.

The currentthinking of containing cost in the NHS by limits set to GP Commissioning willend up in many patients not getting the essential treatments they need and GPsbeing blamed for poor commissioning.

Whatperhaps the NHS should not ignore is one very important but simple way tocontain cost: salaries for doctors, not fees.

The side effect of the current drive of GPCommissioning is that it would no longer matter if Foundation Trusts areprivate or not. Before long most Hospital Consultants would only offer theirexpert services via private organisations. Why else are the Private HealthOrganisations hovering around!!!

What can GPCommissioners do?

Do exactlywhat Kaiser Permanente is doing: integrate!!!

IntegrateGP and Consultant care. Pay doctors at both levels salaries, not fees! Infact both the Mayo Clinic and the Cleveland Clinic pay their doctors salariesas well as the VA and a number of other hospitals including Johns Hopkins.

Yes, employthe Hospital Consultants; buy up the hospitals and buy back pathology and otherservices.

Not bigenough: join up with other commissioners.

But Kaiser is not without problems:

When a person is diagnosed with anexpensive condition such as cancer, some insurance companies review his/herinitial health status questionnaire. In most states’ individual insurancemarket, insurance companies can retroactively cancel the entire policy if anycondition was missed – even if the medical condition is unrelated, and even ifthe person was not aware of the condition at the time. Coverage can also berevoked for all members of a family, even if only one family member failed todisclose a medical condition.

The government and Kaiser may well argue that its not-for-profitstatus engenders different behaviour. But in the US, the not-for-profits use thesame tactics as the for-profits when the environment gets competitive. Kaiseractively seeks younger, healthier members and imposes different rates foremployer groups based on their history and risk of healthcare.

Sometimes their competitive behaviour gets them into trouble. The California branch ofKaiser has had cumulative fines of $1.6m, 63% of all the fines levied by theCalifornian department of managed healthcare. The activities for which theyhave been fined include denial of care, use of unqualified staff and inadequatestaff-patient ratios. From: NHS-Kaiser Permanente: Which Bits?

NHS-Kaiser Permanente:Recent Posts

THE NATIONAL PARKS: AMERICA'S BEST IDEA.

It could indeed be:

The NHS: Great britain’s best idea.

French Wines & Breasts: NHS Rescue?

2012-01-02T22:20:00.000-05:00

Just as the Frenchimplant factory owner tried to get his son and daughter to continue tomanufacture Breast Implants in his old factory, our own Health Secretary isclosely studying the implications of commercialism in Health Provision ifBreast enhancement could be called that. Not only is there little control overwhat was used by the French farmer in the Implants, future private companiesneed not reveal what would be guarded as top commercial secrets when they provide for patients.

That thisshould happen in the worlds best Health Care country is perhaps an importantreminder that allowing commercialism into health is inviting disaster and costto tax payers in France and most likely in England too.

The publicityof allowing beautiful women to suffer will not be good for the SoS and so thetaxpayers are likely to be forking out £150 million or so to remove them andperhaps replace them.

The value of breast work toPrivate Plastic Surgeons is estimated to be around £100 million a year. Arethey going to be charging the NHS for removing the implants they put in?

Talk of doubledipping. In industrial silicone!

To theCockroach Catcher, he thinks the SoS will do it. If only because medical bloggers said he should not!!!

Jobbing Doctor:Breastimplants

NHS Vault: Thepriority of the worried sick over the worried well

Nothing is newunder the sun:

Altruism& Calamity: Private failure & Public rescue.

Readall about it here>>>>,here>>>>.

FrenchPresident, French Justice & French Health Care.

Best Health Care: France & TheNHS

If only they would just stick to wine!!!

More 'plastic' work on women on the NHS: TheGuardian

"....there is no regulation, no guidance and no one is following up on these women."

Update: Telegraph

Latest: Dr No, RoyLilley

NHS Reform & Hospital Consultants: Private! Private! Private!

2011-12-23T10:57:00.000-05:00

There is a good deal of time and effort wasted in discussing GP commissioning and some lip service paid to integrating Primary and Secondary Care.

Yet, those in power had little regard for Parliamentary democracy and all the signs are that Privateers are waiting in the wings like the Barracuda for its yummy meal.

Great Barracuda waiting / ©2009 Am Ang Zhang

Is it really that difficult to grasp! I wrote a little while back:

Most people in well paid jobs (including those at the GMC) have health insurance. GPs have traditionally been gatekeepers and asked for specialist help when needed. If we are honest about private insurance it is not about Primary Care, that most of us have quick access to; it is about Specialist Care, from IVF to Caesarian Section ( and there are no Nurse Specialists doing that yet), from Appendectomy to Colonic Cancer treatment (and Bare Foot doctors in the Mao era cannot do the latter either), from keyhole knee work for Cricketers to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on.

China

realised in 1986 you need well trained Specialists to do those. We do not seem to learn from the mistakes of others.

When there are not enough specialists to go round in any country money is used to ration care.

There is unfortunately little realisation that soon, a large number of consultants would no longer be working in NHS Hospitals.

Stent, Hips and others

They will be working for Private Hospitals that initially will be offering services to NHS patients. But because of shortage of the said consultants, those that are concerned that at 78% obstruction, their heart and life may not last the wait and they will pay for the job.

My friend just did in some other country: a bargain at US$ 50,000.

What about your painful hips, the Consortia decided to impose a wait time to limit cost. So you too paid for it. That is what my golfing friend did in Flroida for a bargain US$90,000 as he paid a co-pay of 25%.

So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in consortia arguing about the price of Stents or Hips.

Private patients will now have priority and NHS patients will fill in the slack. Very clever indeed.

Reform will not save any money but it will make a few City people very rich, very rich indeed.

Some very clever people indeed are working for the government. Some will be elevated to the upper House soon.

Is it Conspiracy or Cockup? You decide.

Merry Christmas & Happy New Year

2011-12-22T19:07:00.000-05:00

NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.

Photography: The Vatican

Vacation: Bird Photography

Fun with Photoshop

House M.D. : Canon 5D Mk II

WPPI Las Vegas: Digital Photography & Art

Photography: Old & New
Photography: Best lens for portrait & landscape!
Protea: Biodiversity
Hello Summer

Portrait Photography: Wistfulness

2011-12-19T20:22:00.000-05:00

Hasselblad 500CM 150/F4

Ilford Pan F/Rodinal

Paper: Record Rapid Selenium Toned.

MRSA & E Coli: British Milk & Antibiotics

2011-12-18T21:17:00.002-05:00

Remember the Plague? Was it bad air? Witches? Jews?

Or is there a simpler explanation.
The Independent:
MRSA 'superbug' is found in British milk
Friday, 3 June 2011
A new strain of MRSA has been discovered in British milk, scientists report today.
The superbug, resistant to antibiotics, has been isolated from samples of milk taken from farms around the country and has also infected humans. It is the first time MRSA has been found in farm animals in the UK.
…… The discovery is the result of a chance finding by researchers at the University of Cambridge, who were investigating mastitis in cows, an infection of the udder. Their results, published in The Lancet Infectious Diseases, show cases of the new strain are increasing but account for less than 1 per cent of all human MRSA detections. Less than 3 per cent of dairy herds are thought to be affected.
Mark Holmes of the Department of Veterinary Medicine at the University of Cambridge, who led the study, said: "It is still not known for certain if cows are infecting people, or people are infecting cows. This is one of the things we will be looking into next."
Asked if the routine use of antibiotics in livestock farming was a factor in the emergence of the new MRSA strain, he said it was a "credible hypothesis".
"Farmers are under tremendous financial pressure from the super- markets. It does mean they are the most efficient milk producers but that means they have more mastitis and use more.”
E. Coli continue to dominate health news across the globe:

Chicken and other animals can grow up to twice as fast as 30 years ago when antibiotics were not in the feeds. Scary!

The use of antibiotics in farm animals is widespread and is not restricted to the treatment of infections but for the enhancement 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.)

Leeds Hospital

Hospital Infection: Quorum Sensing

Old & Young: E. Coli O157

MRSA & Antibiotics: Doctors or Farmers???

French President, French Justice & French Health Care!

2011-12-15T14:34:00.004-05:00

The French President is spared jail by the French Justice system:

The former president's doctors said he has irreversible neurological problems which cause memory lapses & is spared jail.

The Guardian:

Jacques Chirac may have hoped to be remembered as the dapper president and diplomatic heavyweight who retired from the world stage to become the unofficial grandfather of his nation. A man of "flesh and blood and principles … employed in the service of his country," as he put it.

Instead, his place in French history has been seriously tarnished after a Paris court convicted him of embezzling public funds and gave him a two-year suspended prison sentence on corruption charges.

Chirac, 79, who led France between 1995 and 2007, was not in court to hear the ruling. He had been given a special dispensation to be spared appearing at the trial in September and the reading of the verdict on Thursday after a medical report found he had "irreversible" neurological problems that had caused "an important loss of memory".

Anh-Dao Traxel, Jacque Chirac's daughter, speaks outside the court

after he was given a two-year suspended sentence.

Photograph: Bertrand Guay/AFP/Getty Images

Speaking outside the courtroom, Chirac's adopted Vietnamese-born daughter, Anh Dao Traxel, fought back tears as she said: "The justice system has been very severe, but this is a fair and independent justice system. For the family, it's a great pain we have to accept."

His other daughter did not do too well under French Health Care system:

In Ahead of the Curves, the author told of the story he heard of Jacques Chirac and his pact with West African marabouts, witch doctors. He was told to sacrifice one of his daughters if he wanted his presidency. Soon after his younger daughter, began suffering from anorexia nervosa.

So, I Googled Chirac’s daughter:

Chirac's wife tells of anorexic daughter's death wish

Telegraph: By Colin Randall

Published: 07 Dec 2004

President Jacques Chirac's wife has broken a 30-year silence to talk publicly about the anorexia that drove their elder daughter to try repeatedly to kill herself.

"A mother who fails with a child, who cannot bring a sick child back to health, always feels guilty," Bernadette Chirac said on French television. "And a father, too."

Laurence Chirac, now 46, was a promising medical student and worked for a short time after her studies with Samu, the emergency medical service, in Paris.

But she had suffered from an acute form of the eating disorder since she was 15, leading to several stays in hospitals and clinics.

Sixteen years ago, during her father's second presidential campaign, she was taken to hospital amid widespread rumours that she had died.

"Being famous can be harmful when one is faced with illness," Mrs Chirac said. "Confronting this kind of difficulty, you just want to hide from the gaze of others."

Laurence, whose younger sister Claude is a key member of the president's team at the Elysée, continued to suffer from the condition. In 1990 she tried to commit suicide by jumping out of the window of her fourth-floor flat.

A nurse assigned to her round-the-clock care was unable to stop Miss Chirac, who survived with a broken pelvis and head injuries.

Little has been heard of her since and Mrs Chirac said merely that she always kept the hope "pinned to my heart" that her daughter would recover.

Mrs Chirac has been the president since 1994 of a charity seeking to create better conditions for children and teenagers in hospital, enabling them to listen to or play music and play sports. She agreed to talk about her daughter on a France 3 discussion programme, “You Cannot Please Everyone”, to help publicise a new clinic for adolescents, La Maison de Solenn, funded by her charity.

"These children need some gaiety in their lives, to be able to see the sun," said Mrs Chirac,

She contrasted this ideal with the conditions in which her daughter was sometimes treated, "enclosed behind brick walls in a bedroom with a small window". She added: "That is why this mother wants to create a facility specific to adolescents' needs.

French Health Care as experienced by the President’s daughter.

We did not do too badly with our own Adolescent Psychiatric Units.

Related:

A Brief History of Time: Anorexia Nervosa

Anorexia Nervosa: What If!

The Cockroach Catcher: A Chapter on Anorexia Nervosa,

Reader’s views.

Anorexia Nervosa: Chirac & Faustian Pact

Germany: Bayreuth, The Ruling Class ...

Democracy: Lessons from the Commonwealth

2011-12-14T11:11:00.000-05:00

There is much the Con-Dem government can learn form the Commonwealth. Yes, lessons in Democracy.

CBC News, Canada:

Governor General agrees to suspend Parliament until January

December 4, 2008

Decision gives Tories reprieve, thwarts imminent attempt to topple government.

Gov. Gen. Michaëlle Jean has granted a request from Prime Minister Stephen Harper to suspend Parliament until late next month, a move that avoids a confidence vote set for Monday that could have toppled his minority government.

Again:

Harper to shut down Parliament

DANIEL LEBLANC

Ottawa— From Thursday's Globe and Mail

Dec. 30, 2009

Prime Minister Stephen Harper has shut down Parliament for two months, killing a pesky inquiry into Afghan detainees, stalling government bills and allowing the Conservatives to take control of the Senate.

Mr. Harper called Governor-General Michaëlle Jean yesterday morning to ask her to give a Speech from the Throne on March 3 – delaying Parliament's return by 22 sitting days – and allowing the government to table a budget on March 4.

Walk & Chew Gum:

CANADIAN ministers, it seems, are a bunch of Gerald Fords. Like the American president, who could not walk and chew gum at the same time, they cannot, apparently, cope with Parliament’s deliberations while dealing with the country’s economic troubles and the challenge of hosting the Winter Olympic games.

Mr Harper is a competent tactician with a ruthless streak. He bars most ministers from talking to the media; he has axed some independent watchdogs; he has binned campaign promises to make government more open and accountable. Now he is subjecting Parliament to prime-ministerial whim. He may be right that most Canadians care more about the luge than the legislature, but that is surely true only while their decent system of government is in good hands. They may soon conclude that it isn’t.

He won the election with an overwhelming majority!

Elsewhere:

The Independent:

The most scandal-ridden government ever known?

Friday, 25 March 2011

The Labor government of Australia's largest and most populous state is facing an epic defeat after 16 years in power, following a string of scandals possibly unrivalled in the Western world.

Corruption, pornography, drugs, gay sex romps, marital infidelity – the government of New South Wales (NSW) has had them all, and more, in the past two years alone. Now long-suffering voters are determined to wreak revenge, and not even a photogenic premier related to a Booker prize-winning author will be enough to save Labor from its worst post-war electoral drubbing.

No matter: voters would rather elect a stuffed monkey than endure another five years of Labor sleaze and incompetence.

She shut down Parliament two months early so that the upper house could not investigate her government on the matter of the Government's power sell-off.

Wagner warned the Germans and the rest of the world a long time ago:

Disrespectful
Born liars

Contemptuous

Thieving & Misappropriation

Incest and other illicit sex
Homicidal

Greed, greed, greed!

OCD: Life & Art

2011-12-12T12:07:00.002-05:00

From a doctor friend:

The Cockroach Catcher has evoked many images, memories, emotions from my own family circumstances and clinical experience.

My 80 year old Mum has a long-standing habit of collecting old newspaper and gossip magazines. Stacks of paper garbage filled every room of her apartment, which became a fire hazard. My siblings tricked her into a prolonged holiday, emptied the flat and refurbished the whole place ten years ago. ……My eldest son was very pretty as a child and experienced severe OCD symptoms, necessitating consultations with a psychiatrist at an age of 7 years. The doctor shocked us by advising an abrupt change of school or we would "lose" him, so he opined. He was described as being aloft and detached as a child. He seldom smiled after arrival of a younger brother. He was good at numbers and got a First in Maths from a top college later on. My wife and I always have the diagnosis of autism in the back of our mind. Fortunately, he developed good social skills and did well at his college. He is a good leader and co-ordinator at the workplace. We feel relieved now and the years of sacrifice paid off.

Your pragmatic approach to problem solving and treatment plans is commendable in the era of micro-managed NHS and education system. I must admit that I learn a great deal about the running of NHS psychiatric services and the school system.

Objectively, a reader outside of the UK would find some chapters in the book intriguing because a lot of space was devoted to explaining the jargons (statementing, section, grammar schools) and the NHS administrative systems. Of course, your need to clarify the peculiar UK background of your clinical practice is understandable.

Your sensitivity and constant reference to the feelings, background and learning curves of your sub-ordinates and other members of the team are rare attributes of psychiatric bosses, whom I usually found lacking in affect! If more medical students have access to your book, I'm sure many more will choose psychiatry as a career. The Cockroach Catcher promotes the human side of clinical psychiatric practice in simple language that an outsider can appreciate. An extremely outstanding piece of work indeed.

In psychiatry, sometimes patients do not want any help. Often they positively refuse help and family members collude. At other times the “help” may not be all that good.

As a result many children grow up in very “unusual” environments. Yet we sometimes get very “unusual” outcomes as some individuals can turn such an experience into something ……well, something quite extraordinary.

Obsessional Compulsive Disorder (OCD) is one such condition that many families prefer to cope with secretly and often for many many years.

In a chapter in The Cockroach Catcher called: Who Is The Real Patient?

Wayne is a teenage boy I had been seeing because he could not face school:

“……After nine months, Wayne finally opened up to me.

Mother never threw away anything. Nothing at all!

Except wet waste, which was a relief.

This was a serious case of OCD (Obsessional Compulsive Disorder). It was still a great shock to have the full extent of the things that were kept detailed to you. Even a five bedroom house soon ran out of space.

Wayne told me that as far as he knew, mother had always been reluctant to throw away anything but it seemed to get out of control about five years ago when she discovered that father kept a woman in a port in the Far East. She moved out of the master bed-room and the rubbish moved in. Everything was neatly put in big rubbish bags and properly tied up. Some were in apple or other supermarket boxes. Even vacuum cleaner bags were kept.

Mother did a good job of it so that there was no bad smell at all, Wayne would reassure me. Just no space.

All these months, I had been thinking that the bullying was the cause of Wayne’s problem. Did I get it wrong? All the time I spent trying to improve his self esteem, was it time wasted? Was there something I could have done earlier? Why did he take nine months?

Perhaps he needed that time to find out if I was going to send his mother to an asylum. Perhaps he needed all that time to trust me enough to talk about the sickest person in the family. Perhaps he never had any plan but the secret just came out.

Perhaps these were all valid explanations, but what could we as a clinic do?”

Chapter 19 The Cockroach Catcher

Recently, I visited The Museum Of Modern Art ( MOMA) in New York and saw something that reminded me of my patient’s mother.

Mr. Song Dong is the artist and his mother is called Ms. Zhao.

Here is a write up in The New York Times:

“Mr. Song was born in Beijing in 1966, on the very eve of the Cultural Revolution, a period of ideological danger and economic want. His mother came from a wealthy family that lost everything after one of its members was jailed as an anti-Communist spy. His father, trained as an engineer, spent seven years in forced labor after being accused of counterrevolutionary activity.

“When Mr. Song’s father died, in 2002, his mother was inconsolable. She continued to live in the jammed Beijing house, throwing nothing away and obsessively bringing more stuff into it, as if continuing to feather a nest for a now-absent family. And despite the threatened destruction of the surrounding area, she would make no move that entailed parting with her possessions.

“Finally, in 2005, Mr. Song proposed that they turn the accumulated junk into an art project. In this way, he argued, nothing would be discarded and lost; everything would be meaningfully recycled and preserved. His mother agreed to this and together, with the help of Ms. Yin and Mr. Song’s sister, Song Hui, they emptied the premises.

“Seen in the museum’s immaculate surroundings…….it is disturbing to imagine anyone growing up, as Mr. Song did, in so smothering a physical environment. Finally, it is deeply moving to see the span of one person’s life — his mother’s — summed up, monument style, in a work of art that is every bit as much about loss as it is about muchness.

“And five years after the piece was conceived……..mother agreed to collaborate with her son, empty her home and effectively let go of her past, she moved into the more manageable setting of a Beijing apartment near a park, where she died last winter after falling from a step ladder while trying to rescue a wounded bird in a tree.”

Life could be cruel.

Waste Not: Projects 90: Song Dong

June 24, 2009–September 7, 2009

The Donald B. and Catherine C. Marron Atrium

MOMA

The book is free too.

NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.

Review on Amazon

Readers' views.

The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US

HyperCRYPTICaL:

Dr Zhang had a common sense approach to the children in his care, intuitively finding the answer to their problems, cases ranging from sleep and toileting problems to those of anorexia, autism and psychosis - although towards the end of his career, red tape and ‘guidelines’ were to impact on his practice.

His book also gives insight as to how we as parents may influence the mental health of our children and how childhood is being medicalised when behaviours are due to lack of parental authority and/or guidance and are not psychiatric illness at all.

Hello Rainbow!

2011-12-11T23:14:00.002-05:00

Technical Details:
Nikon D7000
Lens Nikon 18/200 VR at 200 mm
Total photos: 5 in total. All on manual focus and exposure.
Stitched.

Comment: Not as good as the old manual 180/2.8 ED.

Photography: The Vatican

Vacation: Bird Photography

Fun with Photoshop

House M.D. : Canon 5D Mk II

WPPI Las Vegas: Digital Photography & Art

Photography: Old & New
Photography: Best lens for portrait & landscape!
Protea: Biodiversity
Hello Summer

OFT & Health Cartels: Monitor & Naked Truth

2011-12-11T12:54:00.003-05:00

Naked truth & in black and white!!!

Dr No in his usual sharp-eyed post alerted The Cockroach Catcher to the OFT report.

…… perfused as it with the kind of unmellifluous jargon that would have had Dr Crippen’s eyes watering – how about drive time drive time isochrones (equal journey times), solus hospitals (no nearby rival) and fascias (Dr No is still baffled by this one, but wonders if it means the hospital equivalent of ‘shop-front’) – is not a read for the faint-hearted. So, after a stiff-hearted read, it seems as though the OFT’s chief – and of course provisional – concerns are:

Information asymmetries: not telling punters about the small print, or hidden extra charges (including ‘shortfall payments’

Concentration (more accurately, market concentration): is the big boys squeezing out newer or smaller competitors.

……Almost half of private anaesthetists belong to ‘Anaesthetists Groups’ - apparently to save on administration and marketing costs. In practice, they operate as thinly disguised gasser cartels that rig prices, jump patients moments before surgery, and then bag the money.

Barriers to entry: blocking out newcomers.

Well CARTELLING is what business is about. Or what big business is about. They must have a secret course at business schools to teach that. Or was going to the famous business schools the start of CARTELLING!

The world’s most famous cartel must indeed be that of ADM. It was later turned into a film: The Informant. ADM stands for Archer Daniels Midland, a company not many might have heard of but its products not many could avoid. The film was not the best of its type but the story is too unbelievable. Read about it here or here or here.

Good or bad company?

In the world of big business, good or bad does not come into it.

So CARTELLING is everywhere:

Let us see what competition led to in the Airline industry: Cartels, cartels and more cartels!!!

Yahoo: 21 airlines fined for fixing passenger, cargo fees

According to federal prosecutors, when the airline industry took a nose dive a decade ago industry executives tried to fix it, with a massive price-fixing scheme among airlines the world over, that artificially inflated passenger and cargo fuel surcharges to help companies make up for lost profits. Convicted airlines include British Airways, Korean Air, and Air France-KLM.

The Lufthansa and Virgin Atlantic mea culpas allowed them to take advantage of a Justice Department leniency program because they helped crack the conspiracies.

Perhaps Vigin Health would do the same for OFT.

BBC: Airlines fined over cargo cartel

The European Commission has fined 11 airlines almost 800m euros (£690m) for fixing the price of air cargo between 1999 and 2006.

British Airways was fined 104m euros, Air France-KLM 340m euros and Cargolux Airlines 79.9m euros.

The fines follow lengthy investigations by regulators in Europe, the US and Asia, dating back to 2006.

The EU said that the airlines "co-ordinated their action on surcharges for fuel and security without discounts", between early 1999 and 2006.

Singapore

Airlines 74.8m

SAS 70.2m

Cathay Pacific 57.1m

Singapore

, SAS & Cathay Pacific : three of the most respected name in the airline industry!!!

Lets go back to Dr No:

The OFT, Monitor’s big brother, have been investigating the £5 billion

private healthcare market, and – provisionally – it does not like what it saw.

The Cockroach Catcher has always maintained that Monitor is the biggest threat to the NHS as with most regulators here or elsewhere.

In The Guardian:

“……Tom Clark our leader writer says the real problem with the bill is the fact that the new regulator has a duty to promote competition where appropriate. He points out that in a previous life as a special adviser the regulator used his powers to squeeze state bodies in order to open up the space for private providers. It's why he is so against competition.”

For my money, the most important line in the whole of the health and social care bill is found – if I have the chapter and verse citation system right – at clause 56 1(a). It lists the first duty of the regulator Monitor, which is being transformed from the Foundation Trust hospital's overlord into being the economic regulator of the whole healthcare market, as being "promoting competition where appropriate".

The "where appropriate" sounds reassuring, but we've been here before, not least with the privatisation of the utilities, which Andrew Lansley worked on as a young civil servant, a time in his career from which he continues to draw conscious inspiration. In the beginning the 1980s utilities regulators focused on tight price regulation (RPI - X as it was called back then) to stop the former state monopolists from ripping customers off, but in time the orthodoxy changed. Particularly in electricity, market minded regulators soon made it their business to cut their charges down to size. Regulated markets, they reckoned, were never as efficient as competitive ones, so they saw it as their primary duty to restrict the market share of the old players.

Royal Mail & PostComm

When Labour set the Royal Mail on a new commercial footing, around a decade ago, it set up a regulator, PostComm, which was also charged with promoting competition to the extent it was desirable, and as a special adviser at the Department for Trade and Industry in 2005-06 I saw the miserable consequences up close. Instead of straightforwardly capping stamp prices, as one might expect, the regulator warned Royal Mail not to cut prices in those markets too aggressively in those markets (notably bulk market mail) where it faced stiff competition from new commercial entrants. The aim was to lever these new players into the market until they achieved a truly significant slice of the pie, and the Mail's hands were tied to ensure that this happened. Only then, the regulator reasoned, would competition become real, and so only then would the magic of the market work.

Well, perhaps there have been benefits for bulk mail customers, I am in no position to judge, but I don't think many would claim that there have been many benefits for the Royal Mail itself. It has limped from one crisis to the next, and then on to bailout and now finally towards privatisation.

Pro-competition mania at Monitor

There have been troubling noises, including at one point from Vince Cable, about how the universal one-price tariff can be protected. But these problems are of nothing compared to what would happen to our hospitals if the pro-competition mania got entrenched at Monitor.

Unelected Regulators

The unelected regulators, who regard themselves as beyond the reach of elected politicians, might turn out to be sensible people. But if they turned out to be the type to dance with dogma, then they could end up making it their mission to give new private players some particular percentage of the new healthcare market, which would of course mean denying the same volume of work to NHS hospitals. And that would have the unavoidable corollary of forcing a good number of them to the wall. NHS training arrangements, the integration of care and a decent geographical spread of provision could all go to the wall with them in tandem. No doubt there are safeguards, but wouldn't it be better to recast the bill, so that the regulators were charged merely with "overseeing" competition where it exists, as opposed to actively promoting it? After all, as any medic can tell you, prevention is better than cure.

McKinsey Rules OK!

Can it be so simple that David Cameron is ignorant of the pitfalls of competition in matters that concern our health or perhaps more appropriately our ill-health? Can he not see it at all or was there a different plot? Does he rule?

The greatest threat to the NHS is perversely that of its regulator and in turn it is a threat to our democracy as the regulator is not elected and therefore not accountable to the electorate.

Can we really think that McKinsey could make mistakes and put the wrong person in the wrong place? They invest in people and they are everywhere.

Dr No again:

……is this really the best way to ensure an open, comprehensive health service for all, and at the same time ensure value for money? Somehow, he suspects it is not.