Pain is impossible without a mind. The brain is where our neurochemicals tell our conscious being what is happening – and that includes the message that we are feeling pain.
So I was surprised to see a headline in The Daily Telegraph that said “Back pain may be ‘in the mind’”. The story was based on a back pain study published in The Lancet, which itself made no such claims. It is nevertheless an interesting piece of research. Two groups of people with long-term back pain were invited to have either group cognitive behavioural therapy (CBT) or basic care. After a year, the people who underwent CBT had better outcomes, according to questionnaires about such things as the impact of their pain on sleep and mobility.
Continue reading ‘The painful truth’
Is making booze more expensive the way to cut binge drinking, abuse of alcohol – and even cut deaths caused by it? The evidence is mounting that this is an efficient way to improve health.
And is does seem illogical, from a health perspective, that soft drinks are not much cheaper than alcohol either in supermarkets or bars. The Lancet publishes a very interesting modelling study - Estimated effect of alcohol pricing policies on health and health economic outcomes in England: an epidemiological model – demonstrating that increasing the price of alcohol could be a feasible and useful public health tool.
If it can be done, then should it? How far should governmental control go? I suppose the government already has substantial influence on tax already: what I’d like to see is more evidence it could work here in the UK.
Illuminating reading in the Journal of the Royal Society of Medicine this month: Mis investigating alleged research misconduct can cause widespread, unpredictable damage
When investigations into alleged misconduct do not accept the reports commissioned, trouble is afoot. The more I read, the more naive I feel.
The past few years “whistleblowing” in the NHS has been seen as a dramatic act somewhat separate to the common activities of the clinical day.
The truth about how unnecessarily high-risk situations are brought to the attention of management is rather more complex and subtle. You observe that your community child clinic is overworked to dangerous levels, and you note that notes are not arriving: you tell management.
There are meant to be 4 paediatricians in clinic; however, during the period 2006-2008, one was off sick, one was on special leave, and two resigned. Juniors were left to take on tasks that would normally have been done by consultant staff. During this time baby P was seen.
Kim Holt - Support for Baby P clinic whistleblower Dr Kim Holt – a consultant paediatrician, was one doctor who raised these concerns, well before baby Peter was seen.
Her observations were not acted on: instead, cuts were made to the service. Dr Holt was off sick when baby Peter attended - Great Ormond Street Hospital – senior management must take responsibility over Baby Peter – and while it is easy to blame a single doctor for not picking up his problems, it is more realistic to view this failure in the context of more generalised problems within the clinic structure.
Dr Holt remains on full pay but has not been allowed back to her job. A report has recommended that she should be allowed to return: regardless, she remains in an extra-numerary part time position while the shortage of paediatricians remains. A petition to support her is here: Support for Baby P Clinic Whistleblower Dr Kim Holt. Whistleblowing should not need to come at such personal cost.
Up to now, doctors have issued a small but vital piece of paper, the sick note, to confirm that a patient is unfit to work. This extends beyond the seven days which an employee can self-certify first. But now the certificate, known as a Med 3, is being replaced by a system of “fit notes”, about which I have several doubts.
Instead of highlighting an illness that prevents a certain type of work, the new fit notes will point out what a patient might be able to do instead. This has been celebrated as a great advance for everyone, most notably the economy – as if people unable to work in “sick note Britain” are lounging around in the sun, drinking beer in some kind of immoral stupor.
Continue reading ‘The sick note is poorly’
The BMJ noted the blog post – The long arm of pharmaceuticals and PR – about generic drugs and asked for a piece on it – Generic drugs: protest group was not quite what it seemed
In case anyone is interested there is also a review - Suicide Watch – published on the BMJ of an amusing Dan Rhodes book called Little Hands Clapping – on the subject of a suicide museum.
An excellent piece by London GP Iona Heath: Do not sit on the bed in this weeks BMJ.
Hospitals are forbidding doctors from sitting on the bed, in the name of infection control. But no link has been made between sitting on the bed and increased rates of infection and as Dr Heath concludes:
“can we not campaign for home within hospital and encourage flowers and sitting on the bed and every other informality, unless there is robust evidence to deter us? ‘Do not sit on the bed’ and ‘No flowers’ are injunctions that are all too similar to ‘Do not walk on the grass’ and ‘No ball games’ rules that mostly diminish the joys of life rather than enhance them, and such rules, unless absolutely necessary, have no place in hospitals, where joy is too often in short supply.”
Having seen many ward rounds conducted from a standing position at the end of the bed, I have to agree.
The politician in the internet chat room: Gordon Brown made a few interesting pledges the other day in a Mother’s day web chat on the forum Netmums.
“So this week, for example, Andy Burnham will be setting out new plans to really change and reform maternity services. Over the next few years we want to see a legal right for mums to choose where they give birth, including home births for anyone who wants one. And we want to see services changed so that not just mums but dads can have a bed if they need to stay in hospital overnight after the birth of their baby. We have also set a goal to recruit an extra 4,000 midwives by 2012.”
A legal right to give birth where you want? Is this really a good idea? Starting a discussion about where best to book in to doesn’t seem to get off on the right foot when a clinical decision has been taken by a politician and there is a legal ultimatum.
The northern council of the British Medical Association has sent out a press release opposing the central storage of certain medical records and the fact that patients must opt out rather than in: Summary care record
Nonetheless, preparations are now underway to get 9m or so records on to the database. I don’t like the opt-out system (and it is very hard to opt out) or the fact that so much information is stored. From what I’ve seen, the administration side also seems to overwhelm useful clinical data.
Martin Amis has called for “euthanasia booths” on every street corner. “There should be a way out for rational people,” he told the Sunday Times Magazine.
Sir Terry Pratchett, another bestselling author, who himself has early Alzheimer’s, campaigned in a recent lecture for the right to end life with medical assistance. He has offered to be a “test case” before a “euthanasia tribunal”, saying that no one should stand in the way of someone who has decided to die. “The tribunal would be acting for the good of society as well as that of the applicant,” he said.
Continue reading ‘First, do no harm’