NHS: Unpleasant & Incurable!

A new disease?

“Bureaucratic self-protection is not confined to state bodies. But the NHS is suffering from an especially virulent form of this particular disease.”    Andrew Gilligan writes in The Telegraph:

NHS bureaucrats care for themselves, not the patients

 “Yet it is politics which may, in the end, prove the service's undoing, because political, rather than clinical, priorities are coming to the fore. More and more cases are emerging of the malign effect on patients of highly politicised management.”

 “In my encounters as a journalist with the management of the NHS, I have found a secrecy, paranoia and defensiveness which I seldom met in my previous incarnation as a defence correspondent. Great Ormond Street, that world-famous institution with the heart-warming smiley kid logo, has twice given me statements which were provably untrue and which it was forced to retract.

Read about the new disease here >>>>

Then an anonymous consultant in the NHS wrote in the same paper:

NHS: here's the unpleasant truth

“We have assimilated a quarter of a million extras, literally supernumeraries, within the voluminous tent of the NHS.

Just outside the tent is the sand into which billions of taxpayers' money soaks without trace.

“Identification of these individuals is easy; look at the hospital telephone directory, and note how often the following descriptions occur: coordinator, commissioner, facilitator, compliance, liaison, outreach, project, regulator, controller. All of these staff require computers, salaries, paid holidays and final-year pensions.

“A responsible government must initiate a thorough review of the financial efficiency of the NHS by senior clinicians. The moral responsibility of running the NHS rests with those who know what treatment and care can be provided with the resources determined by ministers. We will accept that responsibility because someone has to lay out in front of society what is being spent in its name.

“To the current annual bill must be added the cost of the Private Finance Initiative, an enormous confidence trick played on the taxpayer, and the pension expectations of the tens of thousands of NHS staff.

“Politicians cannot continue to be economical with the truth. We treat all-comers, from malnourished infants of economic migrants to octogenarians seeking care at the end of a long hard life.

“We do our best, and we need a rapid clear-out of the non-essential bureaucracy which is slowing patient care and diverting funds needed for the care and cure of sick citizens.”

Read the full article here>>>>

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Bipolar and ADHD: Fashion & Breasts

No, it is not about the Fashion Weeks!!!

It has always been the worst nightmare for any Child Psychiatrist to be faced with a schizophrenic boy. It is such a serious condition that there is no choice but to treat with an antipsychotic. However, the risk of breast enlargement (gynaecomastia) is extremely high and for boys, this is particularly unpleasant.

Fortunately incidence of true schizophrenia in early adolescent boys is rare and it is this group that are most vulnerable to this particular side effect: gynaecomastia secondary to raised prolactin (a hormone for milk production) level.

As newer antipsychotics came on to the market, claims were made that traditional side effects such as Parkinsonic symptoms and breast enlargement were rarer or non existent. Unfortunately they were only claims.

Then the situation became more serious when antipsychotics began to be liberally used for other fashionable child psychiatric conditions.

First came ADHD. The use of stimulants benefits mainly teachers during school hours. Parents and doctors soon find a quick fix in antipsychotics, and for good measure the newer ones, believing that they have fewer side effects.

This was soon followed by Bipolar Disorder. Many believe that Dr Biederman, Child Psychiatrist from Harvard, single-handedly led the movement to diagnose Bipolar Disorder in children, many as young as 2 or 3 years old. This recent trend meant that suddenly there is justification for the use of antipsychotics in very young children.

Biederman, as I reported in a previous blog, is being paid by pharmaceutical companies that manufacture the very same antipsychotics that are now causing concern, major concern.
New York Times headline:

Use of Antipsychotics in Children Is CriticizedNew York Times: November 18, 2008
“Powerful antipsychotic medicines are being used far too cavalierly in children, and federal drug regulators must do more to warn doctors of their substantial risks, a panel of federal drug experts said Tuesday.

"The meeting on Tuesday was scheduled to be a routine review of the pediatric safety of Risperdal and Zyprexa(Olanzapine), popular antipsychotic medicines made, respectively, by Johnson & Johnson and Eli Lilly & Company. Food and Drug Administration officials proposed that the committee endorse the agency’s routine monitoring of the safety of the medicines in children and support its previous efforts to highlight the drugs’ risks.

“More than 389,000 children and teenagers were treated last year with Risperdal (Risperidone), one of five popular medicines known as atypical antipsychotics. Of those patients, 240,000 were 12 or younger, according to data presented to the committee. In many cases, the drug was prescribed to treat attention deficit disorders.

“But Risperdal is not approved for attention deficit problems, and its risks — which include substantial weight gain, metabolic disorders and muscular tics that can be permanent — are too profound to justify its use in treating such disorders, panel members said.”

“Prescription rates for the drugs have increased more than fivefold for children in the past decade and a half, and doctors now use the drugs to settle outbursts and aggression in children with a wide variety of diagnoses, even though children are especially susceptible to their side effects.” The New York Times article continued and surprise surprise, the panel in the end rejected the FDA’s proposal.

The panel members spoke at length about Risperdal, but their concerns applied to the other medicines in its class, including Zyprexa, Seroquel, Abilify and Geodon.

The Problems:
In the United States:
“From 1993 through the first three months of 2008, 1,207 children given Risperdal suffered serious problems, including 31 who died. Among the deaths was a 9-year-old with attention deficit problems who suffered a fatal stroke 12 days after starting therapy with Risperdal.”

Boys and Breasts: The WSJ detailed concerns by doctors on breast enlargements in children especially boys at the same FDA meeting and reported that six teenage boys are seeking compensation from Johnson and Johnson. Two of the boys required mastectomies (surgical removal of the enlarged breasts).

Many great poets, musicians, writers and artists are believed to have suffered from Bipolar Disorder but were unrecognised. Imagine them being diagnosed as such in their formative years and treated with antipsychotics. Would they still have become great poets, musicians, writers and artists?

The question to ponder is: do children diagnosed with ADHD and Bipolar fare better with antipsychotics? What if the diagnosis is suspect in the first place?

When you look closer, many children present with behaviour problems. Parents find it easier to accept the diagnosis shared with famous people: Bipolar Disorder. Instead of using a mood stabiliser, an antipsychotic is used as a behaviour controlling drug. For good measure the drug is recommended by afamous Child Psychiatrist. That he is paid by the drug company is really neither here nor there.

So perhaps there really is no epidemic in Bipolar Disorder in children, nor indeed ADHD.

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Autism: Classic Leo Kanner

Autism: Leo Kanner---The Classic

The following is an abstract taken form the DISCUSSION SECTION of Kanner's original paper. It may be useful to have another look at what Kanner observed all those years ago. Fortunately for us, he had no other motive except for his keen medical curiosity and observational power:

......The outstanding, "pathognomonic," fundamental disorder is the children's inability to relate themselves in the ordinary way to people and situations from the beginning of life. Their parents referred to them as having always been:

“self-sufficient"; "like in a shell"; "happiest when left alone"; "acting as if people weren't there"; "perfectly oblivious to everything about him"; "giving the impression of silent wisdom"; "failing to develop the usual amount of social awareness" ; "acting almost as if hypnotized."

It is therefore highly significant that almost all mothers of our patients recalled their astonishment at the children's failure to assume at any time an anticipatory posture preparatory to being picked up.

Eight of the eleven children acquired the ability to speak either at the usual age/or after some delay. Three (Richard, Herbert, Virginia) have so far remained "mute." In none of the eight "speaking" children has language over a period of years served to convey meaning to others.

Almost all the parents reported, usually with much pride, that the children had learned at an early age to repeat an inordinate number of nursery rhymes, prayers, lists of animals, the roster of presidents, the alphabet forward and backward, even foreign-language (French) lullabies.

Thus, from the start, language—which the children did not use for the purpose of communication—was deflected in a considerable measure to a self-sufficient, semantically and conversationally valueless or grossly distorted memory exercise. 
It is difficult to know for certain whether the stuffing as such has contributed essentially to the course of the psychopathological condition. But it is also difficult to imagine that it did not cut deeply into the development of language as a tool for receiving and imparting meaningful messages.

"Yes" is a concept that it takes the children many years to acquire. They are incapable of using it as a general symbol of assent.

The same type of literalness exists also with regard to prepositions. Apparently the meaning of a word becomes inflexible and cannot be used with any but the originally acquired connotation.

Personal pronouns are repeated just as heard, with no change to suit the altered situation.

The repetition "Are you ready for your dessert?" means that the child is ready for his dessert.

The pronominal fixation remains until about the sixth year of life, when the child gradually learns to speak of himself in the first person, and of the individual addressed in the second person. In the transitional period, he sometimes still reverts to the earlier form or at times refers to himself in the third person.

Our patients, reversely, anxious to keep the outside world away, indicated this by the refusal of food. One child had to be tube-fed until 1 year of age. Most of them, after an unsuccessful struggle, constantly interfered with, finally gave up the struggle and of a sudden began eating satisfactorily.

Another intrusion comes from loud noises and moving objects, which are therefore reacted to with horror. Yet it is not the noise or motion itself that is dreaded. The disturbance comes from the noise or motion that intrudes itself, or threatens to intrude itself, upon the child's aloneness.

The child himself can happily make as great a noise as any that he dreads and move objects about to his heart's desire.

There is a marked limitation in the variety of his spontaneous activities. The child's behavior is governed by an anxiously obsessive desire for the maintenance of sameness that nobody but the child himself may disrupt on rare occasions.

Changes of routine, of furniture arrangement, of a pattern, of the order in which everyday acts are carried out, can drive him to despair.

Once blocks, beads, sticks have been put together in a certain way, they are always regrouped in exactly the same way, even though there was no definite design. After the lapse of several days, a multitude of blocks could be rearranged in precisely the same unorganized pattern, with the same color of each block turned up, with each picture or letter on the upper surface of each block facing in the same direction as before.

This insistence on sameness led several of the children to become greatly disturbed upon the sight of-anything broken or incomplete.

A great part of the day was spent in demanding not only the sameness of the wording of a request but also the sameness of the sequence of events.

It was impossible to return from a walk without having covered the same ground as had been covered before.

Objects that do not change their appearance and position, that retain their sameness and never threaten to interfere with the child's aloneness, are readily accepted by the autistic child.

Two patients began in the second year of life to spin everything that could be possibly spun.

The children sensed and exercised the same power over their own bodies by rolling and other rhythmic movements.

Every one of the children, upon entering the doctor’s office, immediately went after blocks, toys, or other objects, without paying the least attention to the persons present.

The father or mother or both may have been away for an hour or a month; at their homecoming, there is no indication that the child has been even aware of their absence.

After many outbursts of frustration, he gradually and reluctantly learns to compromise when he finds no way out, obeys certain orders, complies in matters of daily routine, but always strictly insists on the observance of his rituals.

There is a far better relationship with pictures of people than with people themselves. Pictures, after all, cannot interfere.

The astounding vocabulary of the speaking children, the excellent memory for events of several years before, the phenomenal rote memory for poems and names, and the precise recollection of complex patterns and sequences, bespeak good intelligence in the sense in which this word commonly used.

They all come of highly intelligent families. All but three of the families are represented either in Who's Who in America or in American Men of Science, or in both.


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Spring City Golf: ADHD & Music

As I head towards my birth place with my wining and tea drinking friend at Spring City Golf & Lake Resort in Kunming, Yunnan. I will reprint an earlier post:

One golf course was designed by Jack Nicklaus and the other by Robert Trent Jones Jr.

Spring City Golf & Lake Resort

“You have to go. The weather is perfect, and so are the courses. You can play 18 holes and not sweat.The ball goes further at this altitude and the caddies are just wonderful.”

Kunming happens to be my birth place. It is north of Vietnam and is well known for its biodiversity and superb year round weather.

China, which just celebrated 60 years of Communist rule, is now embracing golf in a big way. Most golf courses are designed by big name western golf designers or golf champions turn designers. It must indeed seem ironical, as golf is seen by many as a game for the elite. Venezuela has just banned golf for that reason.

Changes in China since the early 80s have been phenomenal. First it abandoned the “Barefoot Doctors” that was started by Mao when doctors and intellectuals were seen as the elite and sent to remote villages to farm. “Barefoot Doctors” with minimal training cannot really deal with more complicated medical cases. It is a shame that we in England do not seem to have learned from the bad experience of China and the politicians have been pushing ahead with reforms in the NHS with the result that “Barefoot Doctors” known as Noctors (Dr. Crippen) are taking over.

At the height of the “Cultural Revolution”, the piano was seen as the definitive sign of bourgeois decadence.

Petroc Trelawny wrote in The Spectator that Fou Ts’ong (one of my favourite Chopin pianists) was forced to seek exile in London, where he later heard his parents had fatally poisoned themselves. Liu Shih Kun, who came second in the Tchaikovsky Competition when Van Cliburn won, was imprisoned by Madame Mao. He survived and has now established a number of piano kindergartens across China, in response to the craze created by Lang Lang’s performance at the 2008 Beijing Olympics. Many Chinese parents now want their children to learn the piano. The BBC reported that an estimated 30 million children in China are now learning the piano.

BBC

Is the piano China’s answer to the problem that is facing many parents in the west, i.e. ADHD? Could it be a novel substitute for Ritalin and other stimulants? With the advent of unproven modern approaches to education at all levels, very few subjects require memory work. Yet in the last decade or so, memory work has been shown to be beneficial to “brain power”, leading to a whole new approach to neuroplasticity. Learning a musical instrument is one way to give the brain the right amount of training. 


For now, just as the west is abandoning classical music training as part of the school curriculum, parents in China are paying for their children to have piano lessons. By some reckoning, North America probably consumes 90% of Ritalin and similar stimulants, whereas China is probably consuming 90% of the pianos produced. One factory in the south of China is currently producing 100,000 pianos a day.


Some will argue that such pressure on children is not good. Yet we have to look at Michael Phelps, whose parents abandoned drug treatment for his ADHD in favour of swimming. The modern Chinese parent may indeed have stumbled upon something similar to Michael Phelps’ swimming in dealing with problems of concentration. Many parents actually believe that the discipline of learning the piano is helpful in building a more rounded person, although some may have aspirations that their offspring might be the next Lang Lang.
As China now moves into a new era, the piano practising child may have something else to practise: golf.


The Independent reported that it is the new game that is the game of choice for China’s new elite.


My friend told me that when he was at the Spring City Golf & Lake Resort, a nine year old just won a junior tournament. The boy was only 9 and he scored 71 on his final round playing from the red Tee
He may well be the next Tiger, a piano playing Tiger.

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ADHD: To treat or not to treat?

A reprint:

As I drove into work this morning the radio was playing Green Green Grass of Home. Must have been years since I heard it. Tom Jones!

As soon as I stepped into the clinic, my trusted secretary asked: Have you heard, the new Health Minister is banning ADHD and its benefits!

“Wow! Andrew Lansley?”

“That’s it. He is banning the diagnosis made by private clinics. Diagnosis can only be made by NHS Child Psychiatrists and those on medication would not get benefits. Only those not on medication might be considered for some benefits. And only for school holiday time!”

“So the Daily Mail can no longer rant and rave about it!”

“Parents are up in arms because of the benefit thing. But you have always said that a third of our patients are fakes!”

“Don’t quote me or I will get the sack”

Then I heard Tom Jones again! Strange! We do not have a radio at the clinic!

“Then I awake and look around me, at four grey wall surround me

and I realize that I was only dreaming.”

Yes, I have retired! 

Then I read in The Guardian

“According to data obtained exclusively by Education Guardian under Freedom of Information legislation, there has been a 65% increase in spending on drugs to treat ADHD over the last four years. Such treatments now cost the taxpayer over £31m a year.”                          More>>>>

Ritalin: no long term benefits

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Defying The Gods: IMF, Greece & Iceland

The Yangtze River:


The Yangtze River is rising. Man is on the roof. A traditional pigskin boat rowed along: let me get you off.

“No, Buddha will protect.”

Man is now knee-high in water. Naval boat came along: old man, let’s get you off.

“No, Buddha will protect.”

Man is now up to his neck in water. Rescue helicopter came along: let’s winch you off, stubborn old man.

“No, Buddha will protect.”

Man died and saw Buddha. “Why didn’t you come when I needed you most?”

I did, I sent pigskin boat, Naval boat and even my best helicopter, but you refused!

So first the Gods sent in Antigone:

So Antigone had a part in this tragedy too. That's ­Antigone Loudiadis of Goldman Sachs, who ­arranged a complex ­currency swap deal that helped Greece to conceal the scale of its debt, in what the Financial Times delicately calls "an optical illusion", as the country snuck into the eurozone. 

Then God showed how it could be done in Argentina: defy the I.M.F.

When the Argentine economy collapsed in December 2001, doomsday predictions abounded. Unless it adopted orthodox economic policies and quickly cut a deal with its foreign creditors, hyperinflation would surely follow, the peso would become worthless, investment and foreign reserves would vanish and any prospect of growth would be strangled.

But three years after Argentina declared a record debt default of more than $100 billion, the largest in history, the apocalypse has not arrived. Instead, the economy has grown by 8 percent for two consecutive years, exports have zoomed, the currency is stable, investors are gradually returning and unemployment has eased from record highs - all without a debt settlement or the standard measures required by the International Monetary Fund for its approval.

He even took out the head of I.M.F. just to be on the safe side.

Then came Iceland:

Unlike other disaster economies around the European periphery – economies that are trying to rehabilitate themselves through austerity and deflation — Iceland built up so much debt and found itself in such dire straits that orthodoxy was out of the question. Instead, Iceland devalued its currency massively and imposed capital controls.

And a strange thing has happened: although Iceland is generally considered to have experienced the worst financial crisis in history, its punishment has actually been substantially less than that of other nations.

For good measure Iceland’s god huffed and puffed.

 AP Photo/Brynjar Gauti

But no, the Greeks have not learned anything.

This was written last year:

Germany will agree to some form of eurozone bailout. However, it will only support the minimum needed to ­placate the gods, and only with the most astringent, Creon-like conditions being imposed on Greece. It is an ­important but ultimately secondary question whether this help comes in the form of bilateral loans, loans from the European Investment Bank, purchases of Greek government debt, EU ­spending transfers, jointly issued eurobonds or any of the other mechanisms ­suggested. EU leaders will deny that this is a ­bailout and everyone will know that it is a bailout.                                                           Guardian.

The Greeks will do well to go back to their own Gods and not the I.M.F.

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ADHD: Medical Morality!

“There’s a sense that greater powers, profit-driven and amoral, are pulling the strings in our children’s lives. There’s a sense that those who should best protect us — our government and our doctors — are so corrupted that they can no longer do the job. There’s a sense that childhood has, in many ways, been denatured, that youth has been stolen, that the range of human acceptability has been narrowed for our kids to a point that it has become soul-crushingly inhuman.”


                                                Judith Warner      New York Times

In my book The Cockroach Catcher, I told the story about this boy with hydrocephalous who was referred to me. He had just started school and his teacher considered him hyperactive and wondered if he had this new disease called ADD/ADHD and should he be on Ritalin. This is what I wrote about the ADHD phenomenon in that chapter:

“A treatment that had a history of over fifty years, starting life under fairly relaxed FDA rules, was approved for a different purpose in 1980 under fairly dubious circumstances, based on minimal research data on some very small samples. The treatment never caught the imagination of the child psychiatrists of the time and was so rarely used that in 1986 the drug was withdrawn from the British market. Then suddenly it took off and if I say anymore about my personal view on how and why it took off, I might be faced with libel action from the main parties concerned.

The drug concerned is still hardly prescribed in France, a country well endowed with child psychiatric services and the French are rather fond of their medicament. There is no market yet in China which has a fifth of the world’s population and presumably also roughly a fifth of the world’s child population. It probably would not take long for China to adopt it though. Contrary to popular belief, admiration for all things American is endemic in China if not epidemic. You may not think so considering the rhetoric of the leaders. On a recent visit, I noticed one of their bottled water advertisements proudly saying “using the latest US reverse osmosis technology”. For now there are countries both in the first world and in the developing world that have not found it necessary to use the drug.

Most research showed that Ritalin would eventually lead to addiction; but there are some who prefer to insist there is no truth in that. The U.S. is the world’s No.1 prescriber of Ritalin and is also the world’s No.1 consumer of Cocaine. The other listed use of Ritalin is for Cocaine withdrawal.

Why then is there such a renewed demand and interest in diagnosis and drug treatment of ADHD.

It is a sad reflection of our times that we demand fast responses. Being patient is no longer seen as a virtue. Have you not noticed that with faster and faster computers we still consider them slow and therefore manufacturers can continue to sell us “faster” ones? TV and computer games have conditioned kids so that they can rarely hold their concentration for more than three seconds. Even the term “three minute culture” is now out of date – no modern day television or film scene must last longer than ten seconds. How many children nowadays can withstand five hours of waiting at the fishing rod without catching anything? How many mothers have to cope with lines like: I am thirsty, mummy, I want my juice now, please. Are they really going to die of dehydration if mother makes them wait a bit?

Concentration like most other things in our modern society is no longer something that is packaged by our Maker. People need to acquire it and one way is by taking a stimulant such as Ritalin.

Ritalin has also become popular because it takes the blame away from those responsible for the child – the parents and often the teachers as well. Some parents who do not wish for their child to go on Ritalin are often put under tremendous pressure by the teachers. Very few have even bothered to find out if there is any non drug related method at all.”

The Guardian

“According to data obtained exclusively by Education Guardian under Freedom of Information legislation, there has been a 65% increase in spending on drugs to treat ADHD over the last four years. Such treatments now cost the taxpayer over £31m a year.”                          More>>>>

Ritalin: no long term benefits

Related:

Please don't poison our children with stimulants

Bipolar and ADHD: Boys and Breasts

ADHD: Back To Nature?

ADHD: Why?

The File Snatching Sign

ADHD, Heart Risks, Kinko and Jetblue


The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US