COVID nutters

 The reality of the pandemic is clearly hard for some to accept.  It was always one of those existential fears that I had, having read lots of science fiction and studied biology and then medicine at university.  I'd read a lot about pandemics in the past.  I knew they were bad and that we were due one.  I knew it would probably happen.  It's just a bit of a shitter that it actually happened.

COVID has happened.  It's almost everywhere and it kills tons of people.  Accept it and deal with it.

Some people can't or won't accept it.  Some reach for a comfortable conspiracy theory to protect them from the brutal truth that humanity is sometimes insignificant in the face of nature and a wee virus could wipe us all out.  COVID-19 isn't going to eliminate the human race but it's still nasty.  We need to do what we can to reduce and avoid infections.  Vaccines, washing our hands, social distancing, wearing masks - all small personal sacrifices to reduce infection rates and reduce deaths.  Some people can't so this.  Idiots like Ian Brown of the Stone Roses and various quack doctors post mad shit on the internet and people believe them and that has consequences.

The UK government haven't helped.  Initial standard Eton arrogance quickly followed by bewildered blind  panic bolstered by exceptionalism from Dominic Cummings and standard avarice has muddied the water creating a fertile breeding ground for the conspiracy theory nutters.  We need a government of adults and the UK does not have this.  

We will be living with COVID forever.  We will probably need yearly COVID vaccines for some time and normality will take some time to return.

The big lesson is don't eat random wild animals.

Dystopian reality

 Over the years I've read a lot of dystopian science fiction, I've watched the movies and I've read the comics.  I never dreamt that I would be living the reality in 2021.  This morning I was out in the freezing cold queuing to get my first shot of the COVID vaccine, wearing a face mask.  I got on buses that were near empty and saw crazy people hanging around central station.

It's fucked.  On top of this, Donald fucking Trump continues to be the president of the united states of america, at least for the next couple of weeks and he basically incited an attempted coup that involved the storming of the capitol building in Washington D.C. by a bunch of freaks including fucking Ariel Pink.  In the UK we have an evil Tory government with Boris Johnston as out prime minister and cunts like Jacob Rees Mogg causing as much badshit as they can.

10,000 people in the UK have died with COVID-19 since Christmas leading to a grand total of 80,000 deaths related to a new disease in under a year.  Shit is majorly fucked up.

I miss my dad and some of my friends who are dead but in a way I'm glad they don't have to live through this shit.  I'm ok, I have a comfortable middle class existence but Scotland right now is fifty shades of bleak thanks to idiots voting for things like Brexit and the Tory party.

I hope the vaccine works at least a bit.  Not sure if anything will fix the damage to the UK after Brexit and COVID.  Hoping for Scottish independence but suspect that is unlikely.

Narconomics: How To Run a Drug Cartel by Tom Wainwright

I enjoy popular economics books and economics is one of many things that I wish I had a greater understanding of.  Much of economics is witchcraft and pretension papering over bullshit but it is useful to use different models to try to understand the world.  As part of my holiday week reading I decided to delve into the economics of drug dealing.

Wainwright is a British editor for the Economist and he writes well.  He decided to study the economics of the narcotics industry and he follows the journey of illegal drugs from farming to end user.  I've read a lot of this before in books like Freakonomics or the Undercover Economist but Wainwright does add some additional colour and detail to the scenarios.

Of particular interest to modern readers are sections on the use of legal highs in New Zealand, the legalisation of cannabis in Colorado and the impact of internet retailers (on the dark web) on the distribution and sale of drugs in the modern world.

The extent of the black economy and the massive potential gains in tax suggest that legalisation of narcotics may be a good way forward although the damage done by these substances cannot be underestimated.  It is also important to note that there is no such thing as 'fair trade' cocaine.  People who buy and use cocaine are partially paying for murder.

Legalisation, taxation and careful regulation are surely the way forward.

It's All in Your Head: Stories from the Frontline of Psychosomatic Illness by Suzanne O'Sullivan

Functional Neurological Disorders (FND) are hard to understand, both for people affected by FND and doctors involved in their care.  Functional Neurological Disorders are essentially real neurological symptoms which exist when damage to the nervous system cannot be detected with tests or on clinical examination.  The symptoms are real and disabling but the function of the nervous system is intact.  Many of these symptoms may be due to stress or psychological symptoms, some can be due to other non-neurological diseases or an exaggerated response to a neurological disease process and at times no cause is found.

Often, a person affected by FND can make a good recovery, especially if they engage with the diagnosis.  Others can be stuck with the symptoms forever.  The symptoms are extremely upsetting for those affected by them.

Suzanne O'Sullivan is a neurologist with an interest in functional neurological disorders and epilepsy who works in specialist neurological disorders in London.  In her book she tackles dissociative seizures, psychosomatic illness and functional neurological disorders.  Many doctors struggle to deal with patients affected by these illnesses, thinking that the patients are faking symptoms, attention seeking or trying to fool doctors.  This is not the case.  People with FND are distressed and often lead difficult lives.  Dr O'Sullivan puts a human face on these stories and tackles the issues surrounding this complicated diagnosis.  She highlights some of the mistakes she has made and the communication breakdowns she has encountered.  FND is a difficult diagnosis for both doctor and patient.

This book is a good one for neurologists to read and a good book for anyone affected by FND.  A good patient resource is the Neurosymptoms website, developed by neurologists from Edinburgh which can be used to help understand strange symptoms.  This book also helps make sense of odd symptoms and is worth some of your time.

Will the NHS still exist in 10 year time?

The NHS is a great British achievement, possibly one of our greatest ever.  It's a noble attempt to help everyone in the country, a socialist dream, treating each as they need and through tax/national insurance, taking from each of us what we can give.  The ideals of the NHS are what life should be about.

Sadly, I think it's fucked.  And I think it's being fucked on purpose.

International health care providers having been eyeing up the NHS and the UK as a potential place to make a profit for a long time.  The UK is a rich country with a fairly low spend on healthcare per head of population.  We, the UK, as a nation, could afford to spend more on healthcare.  We just choose not to.  We spend money on shiny things like Brexit and nuclear weapons instead, as our elected representatives choose to fulfil the masturbatory fantasies of our right wing lunatic fringe instead of looking after the health of the nation properly.

New and better treatments for previously untreatable diseases are becoming available.  The BBC news today carried a story about a potential good treatment for Huntington's Disease, one of the most horrific neurodegenerative conditions in existence.  This will not be cheap.  We now have several good treatments for melanoma and multiple sclerosis.  We exist in a health utopia but it is an expensive health utopia.  Rightly or wrongly, the pharmaceutical companies who help develop these drugs want to make a profit and the NHS has to pay.  But the NHS does not have enough money.

The public expects more from the NHS and healthcare than it did in the past.  The NHS is a monopoly provider in the UK.  For 99% of the population there is no good alternative to an NHS hospital in the UK if you have a medical emergency.  Out population is living longer, partly because of the NHS, and our older people are more frail with advanced age.  Frailty results in more hospital admissions and more costs.  The NHS is challenged by it's own success.  Without more money it is doomed.

Brexit has fucked the pound so European doctors and nurses who work here now earn less money.  The jingoistic shite involved with Brexit is deterring European doctors and nurses from coming to work here.  The UK does not train enough doctors or nurses to properly staff the NHS and Jeremy Hunt has done a lot (in terms of Junior Doctor contracts and removing bursaries from nursing students) to deter people from wanting to work in healthcare.  At the end of the day, who wants to do a 12 hour nightshift in A&E where drunk people swear at you and try and punch you if you are being paid fuck all for it.

The NHS is being defunded into the ground by a bunch of right wing money heads.  Artificial targets are being used to punish hospitals and cost more money.  There are multiple layers of useless managers, almost like onion skins in their ability to make you cry.  And yet we can waste money on Brexit and nuclear weapons we can never use.

For the NHS to survive it needs more money or rationing.  We will probably end up with a co-payment system or some sort of multi-tier service that will divide the rich and poor.  Out ancestors, who fought world war 2 will be spinning in their graves.

If you voted Tory or Brexit, pat yourself on your back.

The Pixies at the Kelvingrove Bandstand, Glasgow

I started listening to the Pixies in 1991 or 1992 around the time that they broke up.  I initially heard Doolittle on tape, borrowed from the library in East Kilbride.  A neighbour gave me a copy of Trompe Le Monde and I bought a second hand copy of Surfer Rosa, looking for Big Black style Albini kicks.

They didn't click with me immediately.  I got the REM and Velvets references on 'Here comes your man' but it took a while to fall in love with them. Eventually I got there.

I first saw them live in 2004 at T in the Park and since then I've seen them in the SECC and at Primavera in Barcelona.  Generally they deliver and I was keen to see them again at the Kelvingrove Bandstand which is a great venue and usually ned free.  Sadly there was a bit of a ned problem last night which is often an issue in Glasgow.  Drunken twats are like scabies in Glasgow and I encountered one last night.

The pixies played a great 31 song set, starting with 'where is my mind?' and including 'wintering', 'caribou', 'nimrod's son', 'broken face', 'wave of mutilation', 'here comes your man', 'gouge away', 'planet of sound' and 'debaser'. They also played a bunch of new stuff I didn't recognise.  They were tight and the new bass player did well.  We also bumped into a bunch of pals which was nice.

Sadly our personal space was invaded by a drunken twat who thinks it is ok to be verbally aggressive to women.  Another concert goer was wearing a 'rudimentary peni' t-shirt and on reflection, I feel that it should be gifted to that drunken idiot as a warning to the general public.  After some razor sharp with and repartee, we left the venue during the last song to avoid me getting my ass kicked by the aforementioned intoxicated misogynist.  We listened to the encore of 'into the white' from the car feeling sorry for anyone who needs to interact with that dude on a regular basis.

The pixies were good and assholes are, sadly, everywhere.  Even at pixies concerts.  If wankers could fly we would never see the sky.

Minimum alcohol pricing may well make Scotland a better place.

Human frailty and failings in health care

People don't last for ever.  Parts of our body fail and break.  We can survive without much of our bodies but eventually we die.  This is life.

It's difficult to watch a family member when they are sick.  In the UK we pride ourselves on the NHS but care is often poor.  There are failings in the health service that can worsen the failings of our bodies.  Most of us want the NHS to be better but right now the county has no money and the government are not interested in the health of the masses.

A bit shit really.

Is medicine in the UK fucked?

Why would a smart school kid want to be a doctor?

I didn't work hard at school.  I wasn't interested.  I was more interested in music and comic books and having fun.  Eventually I grew up, decided I wanted to do something worthwhile for society and my community and decided I wanted to be a doctor.  I wanted to help people.  So, at the age of 23, more than 15 years ago, I went to medical school.

Unfortunately I never had rich parents.  Both my parents had jobs.  Jobs working for the state where they worked hard but they were never paid very much.  Now I probably earn more than my parents did when their salaries were combined.  However at medical school I had no money.  My parents didn't have much spare to give me although they gave me what they could.  I got bank loans, overdrafts, hardship loans and hardship fund awards.  I managed to pay my rent and eat and get through medical school and become a doctor.  When I graduated at the age of 26 I was about £40,000 in debt.  It took me seven years to pay that back.

Being a doctor isn't cheap.  You give the GMC money, you give the BMA money (if you want), you pay to sit expensive exams (sometimes more than £1000), you pay your Royal College money (to train and to be a member), you pay your medical insurance and finally you pay a big chunk of money to be on the GP register or the consultant register.  Also, you get a small study leave budget so you pay a fuck load of cash to attend course, buy textbooks, buy equipment and make yourself good enough to do the job.

Also, you damage your personal life.  You travel about.  I've lived and worked in lots of cities and towns.  I've spent 3 and a half years as a doctor mainly living in hospital rooms.  I've slept on the floor at work when I'm meant to be oncall for emergency work (from home) but I don't have a car and I don't trust a taxi to get me into hospital quickly enough for a patient who needs me.  You miss time with family and friends.  You don't spend enough time on relationships.  You blink and you're nearly fucking 40.

So why do you do it?  You do it to help someone.  You might stop them dying.  You might get them out of ITU.  You might stop them becoming disabled.  You might help control their pain or their inconvenient chronic disease.  You might help.  Because you want to help people.  Because you are a doctor.

You are a doctor 24 hours a day, 7 days a week, 365 days a year for the rest of your fucking life until you get to stop being a doctor.  You realise that life is precious and wafer thin.  You know that sometimes you can help and sometimes you can't.  You always hope that you won't be the only doctor on a plane (and that the other doctor is an anaesthetist and not a public health consultant).

So being a doctor is tough but you do it because it's a part of you.  The NHS is a useless monolith sometimes but it helps everyone without asking questions.  It is a privilege to be able to treat every patient without worrying about costs so I guess the monolith is worthwhile.

All this is fine and good but it's becoming more and more unpleasant being a doctor in the UK.  The current rich kid clown show of neoliberal Tory twats that is molesting this country has decided to fuck with the medical profession.  They have picked notorious fud-nugget Jeremy Hunt as their frontman for this project and he is trolling the doctors in England in a massive way.  He is aiming at a reduction in take home, spendable pay for junior doctors of approximately a third.  He is claiming that this is a pay rise and that doctors need to work seven days a week.  He's like a Bizzaro version of a health secretary from a Superman comic. Backwards and fucked up.

Nowadays medical students often have debts of about £70,000 when they graduate.  If they get paid less they won't break even till they are in their 40s.  Hard work and no money makes you miserable.  Why would a smart school kid want to be a doctor in the UK?

We won't have the best and the brightest as doctors if there is no obvious reward.  The job is horrible. It will only be worse if you don't get a comfortable wage.  Smart kids will do something easier that pays more.  They'll work in finance.  Talent will be lost.

Medicine in the UK is probably fucked.  The NHS will probably be dragged down with the medical profession.  Jeremy Hunt will laugh all the way to the bank.

Happy happy, joy joy.

Glasgow Central Station tour

I had been wanting to go on the Glasgow Central Station tour, led by Paul Lyons, for some time.  I managed to get a space on it today and I was not disappointed.  As someone who was born in Glasgow but grew up in one of the satellite suburbs to the south of the city Central Station has always been an important hub in my life, a gateway to adventure and culture.

The building itself is massive, truly much bigger than I ever really realise.  To get a true picture of its extent you need to see it from above.  It is a giant footprint on Glasgow, extending north from the Clyde.  It was build on top of an old village and even now hundreds of people work in the station and thousands more commute through it every day.

This tour gives you a chance to see behind the scenes at this important building.  You get into some of the nooks and crannies of the station and you learn about it’s construction and evolution as well as its central role in the social history of both Glasgow and Scotland itself.  Paul Lyons is a great speaker and he tells us of the massive crowds drawn here is yesteryear by the famous names of the past.  He also reminds us of those who were sadly unnamed as they passed though the station during the tragic final years of the first world war.

I could go on and on about the things I learned from Paul today but that is not really my role.  These stories should be told by Paul on the tour and at some point they will hopefully be written down and further recorded by him.

For everyone else, until that point, go on this tour.  You will not be disappointed.

The Glasgow Central Station Tour website

Luchadoras by Peggy Adam - Plan B Books graphic novel book group

I've been having a serious geek out during my annual leave this week.  After going to the Forbidden Planet book group I went to the Plan B Books group last night.  It was held in Mono again.  Mono is always a good venue for these things - there is a very low ned count.

The book for discussion was Luchadoras by Peggy Adam.  Peggy Adam is a French comic book creator who has been producing comics since 2000.  Luchadoras is the first of her books to be translated into English.  It was apparently written to raise awareness of the plight of women in the Mexican city of Juarez.  Juarez has a population of 1.5 million and according to wikipedia there was a homicide rate of 229 murders per 100,000 people in 2010.  There is also a high rate of sexual violence against women with 400 murders (described as sexual homicides on wikipedia) and an additional 400 disappearances in the past 10 years.  This occurs on a background of high rates of domestic violence.  Several books have been written on the topic but while several people have been arrested the crimes continue. 

For local comparison in 2002 Glasgow had a homicide rate of 58.7 people per million of population (approx 6 per 100,000) more than twice the level of the other Scottish cities.  If you were to move to Juarez you would 40 times more likely to be murdered.  source

Apparently there are 116.000 abandoned homes in the city  suggesting that approximately 400,000 people have fled the city.  This would suggest to me that it's a bit of a shit place to live.

Additional information about Juarez can be found at the wikipedia page or at a page about the murders.

So Luchadoras is a book with a purpose.  It is meant to make people think about Juarez.  I guess that by way of this book group it has made me think about it a bit more.  However I am not convinced that Peggy Adam has been completely successful in the execution of Luchadoras as I had to do a bit of investigation to learn about Juarez.  Without the book group I am not sure that I would have bothered to do much additional reading beyond what I had gleaned from Sunday newspapers and Radio 4 in the past.

The 96 pages of Luchadoras offer a grim slice of life in Juarez.  It starts with Alma, the main female character speaking to a counsellor about her violent ex-boyfriend.  She is then stabbed in the street by her ex-boyfriend as her sister watches from his car.  A tourist, Alma's new boyfriend also watches from across the street.  I had to read the book twice to pick up on all the aspects of this scene.  The remaining pages continue with an atmosphere of near constant oppressive misery.  There are one or two brief moments of respite in a children's party and in the relationship between Alma and the tourist but generally everything is grim.  This grim atmosphere may be normal if you lived in Juarez.

People had varying opinions on the book.  Some people just didn't like it at all and some people thought it was great.  On a personal level I didn't really like any of the characters in  the book and I thought they  were all bad people.  Every adult character does something unpleasant.  I found the casual violence and personal betrayal a bit alienating.  Despite that I think the book is fairly effective.  It's easy  to read and it lets us clearly observe the lives of these characters.  The art is minimal and at times it is difficult to tell some of the characters apart.  Despite that there is some nice use of visual imagery - vultures and owls watching dead bodies, Alma and the tourist connecting as wrestlers, transitions between scenes.  I think the book probably would have benefited from colour as this would have enhanced the feeling of passing time  but I understand that books like this are produced with a limited budget. 

So Luchadoras is a decent comic book but not my favourite.  It is readable but depressing.  It might make you think.  I handed it to a non-comic book reading friend after the meeting and he read it in 30 minutes delivering the verdict that it was 'alright'.  I would agree.

British doctor killed in Afghanistan

Sad news over the past few days. A young British doctor was killed while doing humanitarian medical work in Afghanistan along with several other doctors of various nationalities. The doctor involved, Dr Karen Woo, used to write a blog. It's fairly well written.

http://explorerkitteninafghanistan.blogspot.com/

RIP

Parkinson's disease - patients perspective film

Here's a clip from a film about Parkinson's disease made by a girl I knew when I was younger.

Parkinson's disease is a common neurological illness that we need to learn more about. The treatments currently available for this condition are not perfect and more research is needed.

Simon Singh wins libel case

'I'm gonna sue you! I'll sue you in England!' - 'Tom Cruise' in South Park - The closet episode

British libel laws are draconian. British people don't really have freedom of speech or a free press. If you want to say something that a rich person disagrees with (even if it's just daft stuff about famous people) it is very easy for them to bankrupt you in an English court.

Laughing at famous people is one thing but these libel laws become very problematic when they are used to suppress scientific discourse. Simon Singh, a respected popular science writer, wrote about several non-evidence-based claims that some chiropractors had made. The British Chiropractic Association then sued him for libel. They could have bankrupted them.

Thankfully the nefarious ploy of the BCA backfired. Anti-libel campaigners systematically reported British chiropractors to advertising watchdogs resulting in numerous fines for BCA members (who became slightly dischuffed with the BCA). On the 1st of April a sensible judge kicked the BCA libel case out of court and Singh walked free. A victory for common sense, science and freedom of speech.

I was fairly happy.


http://news.bbc.co.uk/1/hi/uk/8598472.stm

Sir James Black - Cool dead guy

On the 22nd of March Sir James Black, the Scottish medical scientist died at the age of 86. He won the Nobel prize for medicine in 1988. He helped develop both beta-blockers and ranitidine. As I doctor I have prescribed beta-blockers on several thousand occasions helping patients with heart problems. As an individual I take ranitidine whenever I have acid reflux. Black also has a building named after him at Glasgow University. I spent a long time in that building as a science undergraduate.

Black has left an indelible mark on medicine.

RIP

http://www.telegraph.co.uk/news/obituaries/medicine-obituaries/7507080/Sir-James-Black-OM.html
http://www.timesonline.co.uk/tol/comment/obituaries/article7072983.ece
http://www.heraldscotland.com/comment/obituaries/sir-james-black-1.1015395
http://thescotsman.scotsman.com/obituaries/Obituary-Sir-James-Black.6174782.jp

Advertising standards find Lifescan Ad to be unsuitable and state that it should not be shown again

Lifescan are a company who carry out 'health scans' in asymptomatic patients. They were referred to the advertising standards agency and found to be breaching advertising standards in several areas.

http://www.asa.org.uk/Complaints-and-ASA-action/Adjudications/2010/2/Lifescan-Ltd/TF_ADJ_48050.aspx

Hopefully now they will stop frightening the public into paying money for unindicated medical investigation.

Homeopathy is pish

I'm sure most people realise that homeopathy is pure bollocks. As I passed though Central Station in Glasgow yesterday I saw an anti-homeopathy protest group. They were planning to take a mass-overdose of homeopathic medications to prove that these medicines have no effect.

Pretty cool idea.

You may think that all this homeopathy stuff is harmless but apparently the NHS spends £4million on this useless shite every year. That's £4million of my tax money. Bastards. I also object to private companies making a profit from the misery of people who don't know that they are being ripped off.

http://www.1023.org.uk/the-1023-overdose-event.php

NHS history website

This is a website about the history of the NHS - http://www.nhshistory.net/

I think it's interesting. You might not.

I hope some Americans take a page out of our 'socialist' book.

Americans slagging off the NHS

As a doctor I'm glad I've never had to worry about someones insurance before giving emergency treatment. At least everyone in Britain gets seen by a doctor and investigated appropriately unlike many in America.

It's annoying to see ignorant American politicians slagging off out NHS because they are getting backhanders from corporate health insurance companies. They should fuck right off.

Bad Science by Ben Goldacre

Bad Science is a great book. It's a book about how the media misrepresents science. It's also about how various quacks exploit public ignorance of science for profit. It's funny and it's clearly written.

Science and the modern media are not really compatible. Science is about trying to understand our world by careful observation and trying to prove that your own preconcieved ideas about the world are wrong. The modern media is about selling newspapers and little else. The press is sensationalist and science is possibly a bit slow and boring.

Over the years scientific research has been misrepresented in the press to create scare stories. Alternative therapists make money by exploiting sick or anxious people with magical explanations for their crafts. Goldacre describes several interesting cases clearly.

I enjoyed this book because I've always been interested in English and the media. When I was a kid I wanted to be a writer or a journalist. I did a BSc in Neuroscience before doing to medical school and I'm currently just starting on a research degree. During my BSc I did a course on 'Science communication' which was about explaining scientific concepts to the general public. At medical school I did a 3 week block on Alternative Therapies which was interesting. It made me realise that some alternative therapies have more in common theoretically with the works of George Lucas than scientific, modern evidence based medicine.

This book is great. I hope a lot of people read it.

see

www.badscience.net

Sicko by Michael Moore - DVD review

Michael Moore may not be the most objective film-maker in the world but I think that his heart is in the right place. Sicko (which I have just picked up on DVD from America) looks at health inequalities in America.

Health services in America are not free at the point of need. You only get essential health care if you can pay for it or your HMO will let you have it. Sicko is filled with examples of avoidable death that is due to insurance red tape. The worst example, for me, was the story of a young girl with sepsis who had health insurance. Her mother called 911 and an ambulance took her to a hospital that was not approved by her insurance company. The insurance company told her mother to drive the girl to an approved hospital but she died on arrival.

The NHS and other European health services are held up as a model of excellence which does seem odd to me as an NHS doctor. However we are a social medicine provider and that makes me feel good. I never have to tell a patient that we can't treat them because their insurance will not cover them and I hope this never happens in Britain.

The archive footage of the American Medical Association opposing state funded health care is rather offensive and I now have another reason to dislike Richard Nixon. This film may be propaganda but I like it.

For more see
http://www.michaelmoore.com/

If you are American and you want free health care you can always marry a Canadian

Try

http://www.hookacanuck.com/