Monday 18 February 2013

The Promised Land

After years of inertia, a prominent representative group of the medical profession has today called for taxation on fizzy drinks. What has taken them so long? This announcement comes a couple of days following the assertion by the head of Iceland frozen food that local authorities are to blame for the current headlines relating to horse meat in beef. What interesting times we live in.

In my childhood of the early 1970s, fizzy drinks were not new. They were reserved as a treat for special occasions though. Commonplace everyday items they were not. I recall speaking to an expert in the field of osteoporosis about twelve years ago and he was unequivocal regarding fizzy drinks. He felt they should be taxed like alcohol and reserved for the over 18s in the same way. He explained to me that the evidence was overwhelming regarding their erosive capacity on teeth, bone and stomach linings. It was because bone formation is not yet complete in children that he felt so strongly about reserving their availability to the over 18s. In particular he cited the content of phosphoric acid in fizzy drinks as being the biggest danger. I don't know if they still provide the lesson at primary school, but at my school we were asked to bring in the dirtiest coins we had. The teacher produced a can of coke and poured it into a glass. The coins were put in and we all returned the following morning to witness the result. You've never seen cleaner coins in your life - they looked as though they'd just been dispatched from the Royal Mint. The lesson was simple and effective. If coke can do this to a dirty metal coin, think what it can do to you when you drink it. It certainly left a lasting impression on me. That aside, the obscene levels of sugar in many such drinks is little short of criminal. There is strong evidence that regular consumption of these drinks contributes to diabetes due to cumulative insulin resistance and osteoporosis presenting at younger ages due to bone erosion. I don't hear too many dentists calling for increased taxation though.

The comments of Malcolm Walker are somewhat surprising. He made his money by building up the Iceland empire and then selling it at great profit. He waited patiently on the sidelines while the new owners orchestrated its demise and re-purchased it a couple of years ago. He is a shrewd businessman and has a proven track record of how to make money. I was formerly a sales manager on the whole sale side of the fence and know a thing or two about the food industry. Principally, the entire industry is driven by human greed. This has seldom been difficult to exploit and some players such as Mr Walker have been very successful at this. He is just an entrepreneur seeking to capitalise on the market in front of him. Furthermore, he can only operate within the rules and regulations imposed upon him. The point I make here is a much wider one. All players within the food market both retail and wholesale only thrive if they supply what the public want. Want, not need. If they supplied the public need, the vast majority of them would have ceased trading long since. To fully appreciate this, it is instructive to compare the habits of the average consumer after the second world war with his ancestor of today. The biggest difference is choice. After the war, they ate what was available and were grateful for that because rationing continued until well into the 1950s. Thus, meat and two vegetables was the aspiration rather than the norm for many. Tea and coffee, rationed of course, and milk, if you had any left, were the main alternatives to water. A fizzy drink was a luxury whose place was well down the list. Alcohol was drunk, if at all, in the social setting of a pub where the men would drink half pints of beer and the women something equally modest. Alcohol could not be sought cheaply unless you brewed your own which many did because they had to. The working lives of the majority were such that they didn't have the time to drink too much alcohol and couldn't really afford to anyway. Given that many would have witnessed things the like of which we can barely guess at during the war, I would argue that they could have been forgiven for seeking solace through alcohol. The majority though just got on with rebuilding their battered lives. Children would drink water from the tap or milk if available although that was still rationed of course in common with other dairy products such as butter and cheese. Obesity in those days must have been something of an achievement.

During my sales career, various companies would supply large institutions such as the hospitals, prisons and schools. I can assure anyone that food quality did not head the priority list of the food purchasers. The age old saying that "you get what you pay for" is as true today as ever it was. When I was involved with supplying prisons, they worked on a budget of a pound per day to feed a prisoner. This was only about ten years ago. The budget for feeding a patient in a hospital was not radically different. All hospitals bought their meat and vegetables frozen - not fresh. Likewise the schools and colleges. When I am on the wards today in my existing role as a medical student, I often see as much food being returned to the kitchens as left them. The proof of the pudding...

It is said within the health service that the one of the best career paths to pursue as a doctor with little fear of job cuts is in hepatology. Cases of liver disease continue to grow alarmingly year on year with the age of those affected becoming younger and younger. If hepatology isn't up your street, you could pursue a career in diabetes with similarly shocking statistics. For the little that I know, I would candidly suggest to government that they have much to do ease the financial burden on the NHS. The second largest employer in the world it might be, but it is certainly far from being the best run.

So I think the assertion of Mr Walker is partly correct. Given that local government remains the arbiter of how public money is spent on such institutions, I agree that they are culpable in all of this. Fresh meat and vegetables ought to be the standard with frozen food being employed as a back up in an emergency. That said, I do marvel at the arrogance of Mr. Walker. Can he really look any of us in the eye with complete assurance and claim that his company has not retailed horse at some stage during his tenure? I somehow doubt that very much but would stand corrected if he were able to prove otherwise. As a prolific retailer of frozen and convenience food, he is every bit as guilty of contributing to detrimental health as those found to be selling horse meat. Let he who is without sin cast the first stone Mr. Walker! I suggest he would do well to keep his own house in order first before casting aspersions upon those around him.

When Harold Macmillan claimed in 1957 that "you've never had it so good", I suggest he was well ahead of his time. The diet of the average Brit at that time was infinitely superior to that of our generation if only from the standpoint of our health. We grew more and wasted less. Now we grow less and waste more. Its not too difficult to see the difference really. People are living longer not because they are healthier but rather because medical science has become more adept at treating them and keeping them alive for longer - there is a difference.With the notable exception of smoking, people were far more healthy after the war. The NHS is creaking at the seams under the strain of ever increasing patient numbers amid ever decreasing staff morale. This combination does not augur well for its future. In fact, it is hard to see how it can continue with its current "free at the point of delivery" ethos. As the song goes, "something's got to give".

The first and second world wars were fought with a promise of freedom for the civilised world at a cost of millions of human lives. Well, we have freedom but are we any better for it? Would it be too radical to suggest that local government scale down the numbers in its employ in order to provide fresh food for our public institutions? The problem is that when an empire becomes too big it also assumes power and true to human nature becomes loath to relinquish it. Horse meat? I would suggest that this is the least of our problems!          

Thursday 14 February 2013

The waiting is over!

872 days after his election as leader of the Labour party, Ed Miliband has finally broken his silence and given everyone their first insight into what he would do in the unlikely event of him becoming Prime Minister two years hence. In a statement bearing the impact of two wooly jumpers colliding with each other on a giant bean bag, he has pledged to bring in a 10p lower rate of tax. But that isn't all. He will tax people living in homes valued in excess of £2.5 million. I can't help wondering what he has been doing these last 124 weeks or so. I suppose it is merely coincidence that the Conservatives first mentioned such a policy yesterday.

As one of the advisers to Gordon Brown in the Treasury, Ed Miliband was part of the great cheque-book triumvurate of Brown, Balls and Miliband. If said often enough, it begins to sound more and more like a medical diagnosis. A diagnosis maybe but definitely not a management plan. In the company of such flagrant profligacy, even the deeds of Nick Leeson now seem reasonable. The arrogance of a man who directly contributed to the largest budget deficit in history is truly breathtaking. His solution to address the perilous state of the country he left behind is to cut tax. Perhaps he seeks to finish the job off properly. If in doubt, cut tax and spend more was the rallying cry of New Labour and has now been adopted by New Old Labour. Same old Labour though isn't it?

When the Tories were ousted in 1997, they had become stale, arrogant and bankrupt of new ideas. Like Achilles though, they retreated to their tent and questioned themselves and their legacy. People such as Iain Duncan Smith and William Hague were at the forefront of those who held their hands up and admitted the failures of their party. It would still be thirteen years before their time would come again. This time was employed wisely conducting careful research to underpin strategies in social care, justice, health and public spending. The current government is far from perfect but they are doing the difficult thing and sticking to their course. We are all feeling the pain but not because of the coalition as the unionists and Labour Party would have you believe. It will take a lot of time and no small amount of good luck to once more balance the books of this country. Labour ought to be apologising for their policies in office rather than sitting on the sidelines berating the efforts of coalition who strive to address the mess they were left with.

We have no gold reserve now because of the Labour party. This was a national scandal unforgivable in its naivety and temerity. To speak of 10p tax rates at a time when we can barely afford a tin of baked beans is stupidity taken to a new level. Wales alone now boasts the highest rate of new food banks being opened. This is because their country has been allowed to be so utterly dominated by the Public Sector. Jobs will come to Wales and their Celtic cousins but it is going to take a long time and careful planning. Successful companies in the Private Sector have little incentive to want to come and set up shop here. There are barriers of language, poor roads, poor rail links and social deprivation the minute they arrive. Having worked in the Private Sector, I know what drives it - accountability. Accountability to share holders and boards of directors. They are efficient because they have to be to make money. It is that simple. What a contrast with the Public Sector whose watchword is unaccountability. Answerable to nobody, they do as they please and their tumour-like empires are now out of control. Put simply, if you can't get a job in the Public Sector in Wales, you'll be a long time finding a job elsewhere. What utter nonsense then to propose a 10p tax rate when the only beneficiaries this side of the border will be the Public Sector employees. They alone enjoy a living the right side of the bread line - it is the others who go cap in hand to the food banks. The food banks are often being run by the churches in the locality. There is no surprise here of course because when the chips are down, the church is all that remains for many people.

What really scares me is that Labour have not hidden their view that the only way out of this mess is to spend even more. I once read that the definition of insanity is to do the same thing over and over again and expect a different result. I rest my case.

I have said that the incumbent government still has much to do and can suggest several areas where they need to start. They need to scrap all final salary superannuation schemes with immediate effect. The maths underpinning these schemes is straight out of Alice in Wonderland. People are living longer and longer and taking more and more out of their ever decreasing pension pots. This is patently silly and needs to be stopped. People are retiring on sums of money the like of which they couldn't hope to spend even if they tried. The dead wood in the Public Sector needs ditching sooner rather than later and the money saved not spent.

The unchallenged growth of the supermarkets in the UK over the last thirty years or so has been a scandal. This has been borne out this week with the "shock" revelation of horse meat in processed food. These retail behemoths have become bigger than the communities in which they reside and show no accountability. Why should they? Their shareholders are happy and their boards of directors are suitably renumerated. It matters not that the High Streets they superceded have become a retail grave yard. These same High Streets were the centre of the community when I was growing up and need to be so again. Only then will employment prospects be enhanced in the Public Sector dominated Celtic countries. Such employment will underpin community in a far more meaningful way than your "local" supermarket.

The NHS is buckling at the seams as recently evidenced in the report into the appalling standards of care at Stafford hospital. That has been well covered elsewhere but what has not been addressed well is the growing morbidity of the population. Certainly people are living longer but in what state of general health? It is little wonder that the NHS is at breaking point. It is faced with a slowly diminishing number of staff and a relentless increase in the numbers attending. Such a burden is unsustainable in the long term and something has to give.

The provision for the elderly and the mentally ill is not good. The bad news is that neither are going to go away. On the contrary, I foresee them both growing. Provision for the mentally ill and elderly must be at the forefront of health care if the burden on the NHS is to be addressed. Of course, much of the mental illness in our society today is being driven by unemployment and the bleak future it brings. Everyone needs a reason to face tomorrow and services to address the needs of those who have given up hope are simply not good enough. This is where resources should be being allocated. The present system is a fire-fighting system, which places a burden of stress on all involved. Far better to address the cause of the fire. The definition of insanity is doing the same thing over and over again and expecting a different result! An easy step would be to follow the lead of the Scandinavians and price alcohol as a luxury item rather than the everyday staple it has now become for so many. The detrimental effects of alcohol on mental health are well documented so why not act upon the evidence?

As for the Labour leader, I think he is in for a shock at the next election if the introduction of a 10p tax rate constitutes the sum total of his thinking. If he really wants to be taken seriously, he needs to acknowledge the folly of his past decisions and give the electorate some serious policies to consider. Historically, existing governments are voted out of office in this country. New governments are seldom voted in - particularly if everyone can easily remember the rotten fruits of their policies from last time. It is perhaps fitting that he has chosen St. Valentines day to make such an announcement because it really will be a massacre for lots of people if we cut tax now and start a spending spree. A poison arrow indeed.     

Monday 11 February 2013

Memories

Like many people, I was surprised today to learn of the decision of the pontiff to give up his ministry at the end of the month. Just after the announcement was made, I was drawn to a forom on the BBC news page which was being dominated by the views of an atheist mass intent on drawing people's attention to the child abuse which has so dogged the Catholic church in recent years. They also alluded to the fact that the incumbent pontiff had been a member of the Hitler youth in his younger years. Some people were at pains to draw attention to the repeated condemnation of condoms in Africa and pleaded with the church to recognise the health implications of such advice.

Considering their pronounced atheism, it was heartening to see so many people engaging in a faith based debate. As for Pope Benedict joining the Hitler youth in the 1930s, why wouldn't he? I'm obviously not condoning Hitler or his facist regime, but every young person at that time joined the Hitler youth just as many joned the Scouts or Guides in other countries. I think it is to the great credit of Pope Benedict that he has decided to recognise his fading limitations and make way for new blood. It is hard to imagine the difficulty in making such a monumental decision. To be the spiritual leader of any faith group brings enormous expectation and we may only guess at the sacrifices he has made. We will also never know the personal pain he has felt as each successive scandal has emerged to drag his beloved faith through the mire. Nobody can ever change the past but everyone can learn from it if they really want to. Only the strongest of men could face such an onslaught with the humility and dignity which he has shown. I am not Catholic but greatly admire the way in which he has handled the future of both himself and his church. They will do well to procure the services of someday with a fraction of his talents and I pray that the new Archbishop of Caterbury can seek to emulate such a shining example.

The passing of an era is never easy and this will take time. Just as when one of our loved ones passes away, the memories shine brightly for many years afterwards. Today of all days, my thoughts return to our daughter Thea who died so suddenly in 2006. Tomorrow would have been the occasion of her eighth birthday and she is still missed painfully by us all. Unlike the Catholic church, we had no warning of our loss and this arguably makes it less easy to come to terms with. The outgoing pontiff is now eighty-five years old and can look back on a life of fulfillment and great accomplishment. Thea was cut short on her journey at just fifteen months of age to meningococcal septicaemia. Every cloud has a silver lining and I was so happy this year to see that a vaccine for Meningitis B has now been approved. I hope and pray that it is made available without undue delay and look forward to seeing a reduction in cases of meningitis in infants and children of all ages. For all that though, it is still very hard to understand why she was taken from us in such cruel fashion and so we must comfort ourselves with memories and the good times.

If the church is once more to have its day as in years gone by, it needs to reach out to everyone. Only then will people come together as they once did. As I see it, community is sadly lacking in our society today. The press seem fixated at present with the story of horse meat in processed food and I can't help thinking how silly it all is. It is processed food which is affected. When people return to the joys of home cooking being shared by the whole family, the notion of processed food (and whatever the all-conquering supermarkets can get away with putting in it) will hopefully become a thing of the past. If communities re-appear from the doldrums, society will be all the richer in so many different ways.

As we approach Thea's eighth birthday, I am reminded of the song "Who knows where the time goes?". It will forever be synonymous with the matchless voice of the late Sandy Denny and I often think of this song when I think of Thea. We none of us know what tomorrow has in store so must cherish every day. Goodnight all and love the one you're with.  

Friday 8 February 2013

And another thing...

It was with no small degree of mirth that I read of the latest example of equine intrusion into our pampered western diets. I hasten to add that I respect the love of some people for the trusty steed and the revulsion they feel for the consumption thereof. That said, a number of things struck me about this case.

The horse meat had been identified in a processed meal the nutritional content of which is probably not too different to the packaging whence it came. I wonder how many of us could honestly hold our hand up to being able to differentiate with any reliability between horse and beef?

A few years ago, I was holidaying with my wife and we decided to sail over to Sardinia for a few weeks. I was rather surprised when I first encountered the meat counter in the butcher's shop because it was more difficult to find meat which wasn't horse. Hence, as stereotypical carnivores, we gorged on horse for a fortnight and jolly nice it was too if a trifle sweet in comparison to beef. I a lasagne though, I would defy anyone to spot the difference.

The late, great Sir Clement Freud who had the most extraordinary of lives, opened a restaurant after the second world war which prospered for a number of years. In the immediate aftermath of the war, things were tight to put it mildly and people made do with what they had. On one of the first nights, one of the diners complimented Clement on the meat and asked what it was. In his trademark laconic style, Clement informed him that the meat was horse. Because everybody always assumed that Clement was joking, the diners roared with laughter and continued with their meal. It was horse.

It was with no depth of fascination that I noted that a scientist has come up with the largest prime number hitherto known. This reminded me of the eternal quest to define pi during my school years in the late 70s and early 80s. It is strange to me that the concept of infinity proves so troublesome to some people. Isn't it nice to think that some things just go on and on with no end? Even though Keele Spine sometimes aspires to this on Friday afternoons, I am pleased that it remains finite albeit a little long...

Wednesday 6 February 2013

The seven deadly sins

Not for the first time, the attributes of wrath, greed, sloth, pride, lust, envy and gluttony occupy centre stage in British public life. It was ever thus.

We have had the full rainbow this week if evidence were needed of the less savoury aspects of human nature.

Wrath in the guise of fury has this week brought about the demise of Chris Huhne. Until a few weeks ago, this career ex-Trotskyite Liberal politician was being touted as the successor to the ill-fated Clegg. Hell hath no fury like a woman scorned and Chris Huhne seriously underestimated how his estranged wife would react when he attempted to foist points for a speeding offence onto her. He carried on with his deception even though he held a senior cabinet position and even though his own children were against him. Although it could be argued that several deadly sins were played out here, there is no need to pursue them because they are all to be found elsewhere.

Greed is sadly ubiquitous in society but the prize this week surely belongs to a bank. No shock there. RBS which is 82% owned by the tax payer saw fit to try and manipulate the LIBOR (London inter-bank lending rate). It is 82% owned by the tax payer because it was so badly run in the first place. If testament were ever needed of the lengths to which banks will go to make a fast buck, RBS has once again provided it in spades. That said, if you let a child run amok in a sweet shop, what do you expect? It must be Christmas every day in banking.

Sloth contributed in no small part to the catalogue of neglect documented at Stafford Hospital. I have written previously on this subject so will refrain from adding to it here.

Lance Armstrong is seemingly bereft of pride because whatever sinew he had left has now withered and died along with his sham of a record. With an ounce of pride, he would have done the decent thing and issued an unreserved apology to the many millions he has knowingly deceived. Like Chris Huhne though, he wanted to keep the charade going for as long as he could knowing very well how silly he would look when the truth was finally revealed.

The lust of Rupert Murdoch for the yankee dollar remains undiminished and, in spite of proven phone hacking allegations last year, has just announced a doubling of the net income of News Corp in North America. It goes to show that all publicity is good publicity.

It is surely envy which motivated so many MPs to vote against the bill in favour of gay marriage. Envy that non heterosexual partnerships are being considered on a par with their heterosexual counterparts. Nobody ever remembers who came second in a contest though, so their envious misgivings will soon be long forgotten.

The last place at the table belongs to gluttony. It is gluttony which stands responsible for rising levels of obesity and its co-morbidities such as diabetes, heart failure, stroke and cancer. Gluttony though, can only ever prevail if there is sufficient food to do so. I don't recall reading too much about it during the times of Dickens and confidently predict its demise in the not too distant future. Food banks don't support gluttony. They support life through basic survival and their numbers grow by the week. Whether this is a good thing or an indictment of our society will be for our progeny to judge.

So good night then to all seven of our less savoury bed fellows and doubtless we shall all meet again on the morrow. 

Tuesday 5 February 2013

The true price of accountability

Kay Sheldon is a name which ought to be familiar to all of us but I doubt if it is. To her eternal credit, she is the lady who blew the whistle on the culture of denial at Stafford Hospital. In any walk of life, it takes great courage to question those in authority. The NHS is reputed to be second only to the Indian National Railway as the largest employer in the world. This gives a good perspective of the scale of her achievement. It is her claim that the risk of victimisation awaits those who challenge poor care in the NHS. It is amazing to consider that she felt that she was just trying to do her job properly by acting with integrity and honesty. I believe she should be held up as a role model for aspiring NHS employees be they doctors, nurses or any of the other associated professions.

Sadly, the reality is that she probably won't be reappointed to the ill fated Quality Care Comission after the results of the inquiry are made known. The fact is that in common with many bastions of the public sector in the UK today, empire builders find cosy little nests in which to roost safe in the knowledge that they are answerable and accountable to nobody. Sure, they can put on a show when the inspectors arrive but normal service resumes in due course. I researched life in a Victorian lunatic asylum two years ago, and, strangely enough, I found the same practices going on there. It is safe to assume little has changed then in the intervening century and a half.  It makes me wonder who the real lunatics are.

For the public sector in this country to finally shake off their long held persona of empire builders and jobs worths, they will need to show transparency, accountability and integrity. Had they done so, baby P, Victoria Climbie and Stafford Hospital to name but a few, would never have happened. This lady ought to be promoted to a position of a real authority with the brief of weeding out the NIMBYs and empire builders because the life of just one innocent patient is too high a price to pay. Trust is earned and earned over long periods of time. During my sales career before my change of direction to medicine, I learned that you can get it right ninety-nine times and nobody will ever remember. But the one time you get it wrong, nobody forgets. When you get it wrong and the it costs a life, nobody will ever forget.

Well done Kay Sheldon. You are a brave lady going against the grain in a jaundiced culture of self preservation and for that, I salute you. 

Monday 4 February 2013

The Need To Be Heard

I read with great interest today of a newly evolving movement where atheists congregate in a disused church to sing to popular music and listen to scientific teachings principally aimed at the the origins of life.

This grabbed my attention on several levels. The irony of atheists congregating in a disused church speaks for itself but the suitability of a church as a place of congregation is once more confirmed but this time by those who profess no faith. Several people who attend speak of the need to be with other people and the enjoyment they derive from that. They sing the songs of more contemporary groups whose music is known to the masses and listen thoughtfully and respectfully to a speaker who stands where the altar would have once stood.

As our society becomes progressively more insular with the old God being replaced by TV, alcohol and home entertainment, the basic human need to seek the company of our fellow man remains intact albeit simmering quietly beneath the veneer of domestic bliss. People coming together to sing is as old as the hills and easily predates Christianity and probably all the other major faiths as well. Likewise, the idea of congregating to listen to one speaker is not exactly a new concept.

The one aspect of this concept which most intrigued me is why a disused church was used. It may have just been a coincidence but I'm not convinced. The pursuit of faith is a strange process. I believe many people are seeking a faith without actually knowing it. I also believe and respect that many people are atheist and have no faith in the present. This, however, does not inform their future. For my part, I have always been quite comfortable with science and faith existing side by side. They are both hugely relevant although in rather distinct ways.

The question is this: Do these people want to be heard outside the walls of the disused church or do they merely want to come together as people and be with each other. Time will tell but I suspect that like all of us, they want to be heard. I hope so because the need to be heard is extremely important and I feel that all too often society stifles rather than encourages this. Perhaps this is because it is easier not to listen because we then feel no obligation to respond.

Do governments need to be heard? Of course they would love to be heard but first they need to listen. The tendency now is to divert things away from ourselves. It is actually far easier to address issues raised in our direction than to deflect them and dodge them.

Doctors too are often accused of not listening. The patient wants to be heard and the doctor gravitates to the facts which he or she considers important. It is easy to see where dissatisfaction sets in when you think about it. Granted, doctors are regrettably constrained by time but this is of little to consolation to the person sitting in front of them with their own ideas, concerns and expectations. Hopefully the medical schools charged with the education of tomorrow's doctors are becoming more adept at listening to the students under their tutelage. I hope that like the starchy attitudes of the Christian faith of my youth, the unfeeling paternalism of the medical fraternity is beginning to melt. Of course, it may be that the paternalism of medicine was originally driven by atheists immersed in scientific theory. Whatever the reason, I would love to be part of a society where we listen more to the person in front of us because there are few feelings more soul destroying than not being listened to. Just as Oscar Wilde rather cleverly pointed out in The Importance of Being Earnest, "The is only one thing worse than being talked about - not being talked about!", there is only one thing worse than being listened to - not being listened to.