Thursday, June 30, 2011

Defying The Gods or I.M.F.: Argentina, Iceland & Greece.

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.

Michael Lewis: The Big Short

NHS: Business Model? Spare Us Please!!!

Wednesday, June 29, 2011

Cello & Bach: Anorexia Nervosa

Cape Floristic Region (CFR) of South Africa
 ©Am Ang Zhang 2005
South Africa reminds me of my Anorexia Nervosa patient.

In The Cockroach Catcher I got my Anorectic patient to play the cello that was banned by the “weight gain contract”:

                 Jane got on well with me.

          She had to, as nobody understood that to her achieving was not a hardship but something she secretly enjoyed. She was no longer allowed to pick up her books as she had not put on any weight since her admission.
          Cello would be banned too, if her nurse was to have her way.

          For the unit to function the nurse must have her way. After all I was not there all the time to watch her. To watch if she was eating, vomiting, exercising or whatever else they did to avoid gaining weight.
          But I was determined that it would be the first privilege she would get if she put on half a gram.  Or any excuse I could think of.
          Brutal confrontation is often what happened in many adolescent units dealing with Anorexia Nervosa. The brutality is not physical.
          But these patients are intelligent and have such strong will power that confrontation generally fails and the failure can be a miserable one.  Yet it is the kind of condition that hurts. It hurts those trying to help. It hurts because these patients deserve better for themselves. It hurts because they are not drop-outs of society. 
          Was it too hard for Jane to keep at the top academically? Someone offered that as an explanation. Perhaps she should be moved to a state school.
          The idea horrified me.
          A fourteen year old non-smoking, non-drinking, non-drug taking, intelligent Audrey Hepburn look alike virgin turning up at your local comprehensive.  It sounded like a major disaster to me.
          I had to take the matter into my own hands. She did put on some weight and at the earliest opportunity I decided she should get back to the cello which had always been by her bed at the unit.

          She missed the cello, the only thing she could use to shut out her worries.

          Fourteen and carrying the burden of the world.

          Then she started playing.

          “Ah. The Bach G-major!”

          “So you know it.”

           Of course I do. The hours I spent listening to Yo Yo Ma and it was such amazing music, melancholic and uplifting at the same time.

          For a moment I forgot that I was her psychiatrist and she forgot she was my patient.

          “My grandma gave me Casals.”

          I knew Casals was even more emotional than Ma, but Ma is Chinese and he was less affecting, allowing the listener to tune in to his own mood.

She played from memory. What talent! What went wrong?”

          “I wish my dad could hear me.”

          It was the first time she could talk about her father. They had a very comfortable life in South Africa when father was alive. It was very difficult to imagine what he would have looked like. It was never clear what he did but he was involved in a number of ventures. The plantation Jane’s grandfather ran was sold when apartheid came to an end. He was involved in some private reserve and he was a photographer of sorts but my junior told me that mum started to cry when she talked about him so she did not pursue too deeply.

Read more:

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

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

A Brief History of Time: Anorexia Nervosa

Bach - Cello Suites:  Yo Yo Ma

Tuesday, June 28, 2011

Protea: Biodiversity

Not just a pretty flower!!!

Protea, Cape Floristic Region (CFR) of South Africa
 ©Am Ang Zhang 2005

Nikon 180/2.8 ED on Nikon D70(around 250mm)

Some parts of the planet with a Mediterranean-style climate have become species-rich biodiversity hotspots, a recent study reveals.

New species of flowering plants called proteas are exploding on to the scene three times faster in parts of Australia and South Africa than anywhere else in the world, creating exceptional ‘hotspots’ of species richness, according to new research published in Proceedings of the National Academy of Sciences (PNAS).

Proteas are most well-known for being the national symbol of South Africa. The international team behind today’s new study created an evolutionary ‘family tree’ of all 2000 protea plant species on Earth – the majority of which are found in South Western Australia (SWA) and the Cape Floristic Region (CFR) of South Africa.

This ‘family tree’ enabled the researchers to examine how these and other regions of the planet with Mediterranean-style climates have become so-called ‘biodiversity hotspots’.

Mediterranean hotspots
Until now, scientists have not known exactly why such large numbers of plant and animal species live in these Mediterranean hotspots. They are places of significant conservational importance which, like the rainforests, contain some of the richest and most threatened communities of plant and animal life on Earth.

The research published provides the first conclusive proof that plant species in two of these hotspots are evolving approximately three times faster than elsewhere on the planet. The study dates this surge in protea speciation as occurring in the last 10-20 million years, following a period of climate change during which SWA and the CFR became hotter, drier, and more prone to vegetation fires.

Dr Vincent Savolainen, a biologist based at Imperial College London and the Royal Botanic Gardens, Kew, one of the authors of the new study, explains its significance, saying:

“Something special is happening in these regions: new species of proteas are appearing notably faster than elsewhere, and we suspect this could be the same case with other plant species too. This study proves that the abundance of different kinds of proteas in these two areas isn’t simply due to normal rates of species diversification occurring over a long period of time.

“This is the first step towards understanding why some parts of the planet with a Mediterranean-style climate have become species-rich biodiversity hotspots.”

The Cape Floristic Region of South Africa and South Western Australia are two of five areas on Earth with a Mediterranean-style climate which have been designated ‘biodiversity hotspots’ by Conservation International. The others are central Chile, California, and the Mediterranean basin.

South Africa:
Nature Posts:

Monday, June 27, 2011

Shadow Elite: Public-Private Players & The NHS

It looks as though these people are everywhere! The Shadow Elite.

Are you ready to read it? 


It is scary!!!

"The new breed of players," writes Wedel, "who operate at the nexus of official and private power, cannot only co-opt public policy agendas, crafting policy with their own purposes in mind. They test the time-honored principles of both the canons of accountability of the modern state and the codes of competition of the free market. In so doing, they reorganize relations between bureaucracy and business to their advantage, and challenge the walls erected to separate them. As these walls erode, players are better able to use official power and resources without public oversight."
"That's a spot-on description of what happened with health care -- as well as a spot-on description of the totally-lacking-in-transparency bailout of the financial system. Remember how the bailout was supposed to take care of not just Wall Street but Main Street? Well, the former ended up with record profits and bonuses while the latter is looking at double-digit unemployment -- and millions of foreclosures and bankruptcies -- for the rest of the year."

Perhaps the decade!
                                            Janinie R. Wedel is an anthropologist.

"We Are Wall Street" that circulated this spring, directed at Main Street America

: "We eat what we kill, and when the only thing left to eat is on your dinner plates, we'll eat that."

The 21st century power brokers -- less stable, less visible, more peripatetic, and more global in reach than their elite forebears -- are potentially more insidious and dangerous to democracy. Their manoeuvrings are largely beyond the reach of traditional monitors. Unlike the rest of us, these players are virtually immune to accountability to voters or government or corporate overseers, because the full range of their activities and their true agendas are more difficult to detect.                                      
Janinie R. Wedel

Looks like they are here and targeting our much loved NHS.
I think there is something fundamentally scary about our democracy…. Because I think people have a sense that the system is rigged, and it’s hard to argue that it isn’t.
Michael Lewis: The Big Short

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

David Bennett is the current head of Monitor (a sort of health FSA!) He is not a medical doctor.
David was a Director at McKinsey & Co. In his 18 years with McKinsey he served a wide range of companies in most industry sectors, but with a particular focus on regulated, technology-intensive industries.

NHS & Monitor: Eggs & Enron.

Councils blamed over Iceland savings

Gerhard Schröder:
As Chancellor, Gerhard Schröder was a strong advocate of the Nord Stream pipeline project, which aims to supply Russian gas directly to Germany, thereby bypassing transit countries. The agreement to build the pipeline was signed two weeks before the German parliamentary election. On 24 October 2005, just a few weeks before Schröder stepped down as Chancellor, the German government guaranteed to cover 1 billion euros of the Nord Stream project cost, should Gazprom default on a loan. Soon after stepping down as chancellor, Schröder accepted Gazprom's nomination for the post of the head of the shareholders' committee of Nord Stream AG, raising questions about a potential conflict of interest.

He is currently the chairman of the board of Nord Stream AG.

Saturday, June 25, 2011

NHS Reform & Listening: Really!

Some of us might have been lured into thinking that they have listened. Do we have to wait for the Lords?

                                                                                                                            © Am Ang Zhang 2011

Not all of us though:

It has become very clear that on close inspection of the Government’s response to the NHS Future Forum report, the key changes that the BMA and other organisations like the RCGP have asked for have not been met:

1. That the Secretary of State should retain responsibility for ensuring provision of a comprehensive health service.

2. That Monitor’s primary role to promote competition should be removed.

3. Reducing the role of ‘Any Willing/Qualified Provider’

Thus, it is clear that the NHS will be subjected to increasing market competition and private provision and commissioning of services, which will undermine the founding principles of the NHS and drive it towards a mixed system of funding. 

Assets Stripping
In addition, the work of Lucy Reynolds from the London School of Hygiene and Tropical Medicine published in the BMJ last week also described how the bill could allow private companies to strip NHS assets “leading to more a expensive system that will deliver worse quality of care”. 

We therefore totally reject the repeated claims of the Coalition leaders that their reforms will deliver greater NHS efficiency and that there will be “no NHS privatisation”.

In conclusion, the simple fact is that the Government’s proposed changes to the bill are mainly cosmetic in nature. There are no ‘significant’ policy changes that will alter the general direction of travel of the reforms and we believe the proposals will actually create even more problems for the NHS by increasing the tiers of bureaucracy. It is at this point that we would remind Mr Clegg that “no bill is better than a bad bill”. He would also do well to listen to views of his fellow liberal Democrat colleague, Dr Evan Harris, who dismissed the NHS Future Forum’s paper on Choice and Competition as “cliché-ridden, trite nonsense” at the Social Liberal Forum last weekend.

When all the talk is about trying to emulate Kaiser Permanente in the NHS reform up and down the country, my observation is that unless there is some radical rethink, the new NHS may end up as removed from Kaiser Permanente as imaginable.

Ownership and integration
Ownership and integration has undoubtedly been the hallmark of Kaiser Permanente and many observers believe that this is the main reason for its success, not so much the offering of choice to its members. Yes, members, as Kaiser Permanente is very much a Health Club, rather than an Insurer.  Also, a not so well known fact is that Kaiser Doctors are not allowed to practise outside the system.

Sacrifice choice:
It is evident that the drive to offer so called choice in the NHS, and the ensuing cross-billing, has pushed up cost.  The setting up of poor quality ISTC (Independent Sector Treatment Centres) that are hardly used is a sheer wastage of resources.  When Hospital Trusts are squeezed, true choice is no longer there.  Kaiser Permanente members in fact sacrifice choice for a better value health (and life style) programme.

Covert Rationing rather than true integration:
The push for near 80% of GP commissioning is to lure the public into thinking that they are going to be better served.  In fact this is a very clever way to limit health spending and at the same time leave the rationing to the primary care doctors in a very un-integrated system. Adding a nurse and an unrelated consultant is not the same as integrating GP and Consultant services. A truly integrated service should have equal representation from Primary & Secondary Care and no cross charging.

It is certainly not how Kaiser Permanente would run things: all integrated and no such thing as “cross charging”. In fact the doctors are not on a fee-for-service basis but like Mayo Clinic, Cleveland Clinic and Johns Hopkins Hospital, doctors are paid a salary.

A & E:

Look at major hospitals in England: Urgent Care Centres are set up and staffed by nurse practitioner, emergency nurse practitioners and GPs so that the charge by the Hospital Trusts (soon to be Foundation Trusts)  for some people who tried to attend A & E could be avoided. It is often a time wasting exercise and many patients still need to be referred to the “real” A & E thus wasting much valuable time for the critically ill patients and provided fodder for the tabloid press. And payment still had to be made. Currently it is around £77.00 a go. 

But wait for this, over the New Year some of these Centres would employ off duty A & E Juniors to work there to save some money that Trusts could have charged.

Integration indeed!!!

It must be hard to believe that with the numbers of highly paid management consultants working for the government that any apparent oversight is due to cock-up rather than conspiracy. Yet reading through the Select Committee reports one begins to wonder.

Could it be that for too long, accountants dominated the NHS reforms and somehow nobody took any notice of what the doctors are saying anymore?

On the other hand, could the need to pass health care provision to private providers before anybody could raise enough objections be the reason or was it simply a means to contain cost and let the patients blame their GPs?

The Internal Market:
There is no better illustration to the wasteful exercise then in all of this internal market and cross charging during recent years and one must be forgiven for concluding that the purpose was to allow private involvement in our National Health Service.

We must be forgiven for not believing that all these AWPs are not great philanthropists and are all there not for the profit but for the common good.

So even if those politicians in power today are not planning on moving into Private Health Care soon enough, the citizens do have a right to know why. In a strange way, it is easier to understand it if it were a conspiracy.

For us, it is our money, our health and our right too.

Until, now Consultants are to be excluded from the consortia. Most are not making too much noise for a very good reason.

There just are not enough of us Consultants and the reform is really COVERT rationing by any other name.

How else could the government continue to claim that competition will improve standard and bring down cost.

Private or NHS, they are the same Surgeons, Anesthetists and  Physicians. Yes, the same consultants. Only in Private Hospitals you may get free cappuccinos.

It is so simple: Private Providers need to make a profit so there is going to be less money for patient care, not more.

Mark Porter: Chairman of the British Medical Association's consultants committee.

NHS services in some parts of England could be "destabilised" by private firms taking advantage ……….to win contracts for patients with easy-to-treat conditions. This could lead to some hospitals no longer offering a full range of services and ultimately having to close.

The worst-hit patients would include those with chronic diseases such as obesity, diabetes and heart failure, Porter added. They would have to travel longer distances for treatment.

The government is taking unnecessary risks by imposing market measures on the NHS, as competitive healthcare cannot deliver high quality treatment to everyone.

The NHS could become "a provider of last resort" for patients whose illnesses are of no interest to private firms, added Porter. Once independent providers have signed contracts with the consortiums of GPs they could deny care to patients who would be costly to treat, Porter warned.

Lord Owen:

Health is not just a commodity to be bought and sold in the market. It is not a utility in which everyone should be treated as if they are commodity managers. We must understand that and the fundamental issues which are being challenged by this Bill. 

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

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