Forever blowing bubbles

This week recognised the achievement of the OCPA (Organisation for the Prhohibition of Chemical Weapons) for its work not just recently in Syria but since its inception in 1997. Although calls to recognise the achievements of the Pakistani schoolgirl Malala Yousefzai were quite valid, her time will surely come. The award of a Nobel Peace Prize ought to reflect the enormity of the contribution to world peace. I wouldn't have minded either of the latter being awarded the prize because they have both contributed greatly albeit in rather different ways. At a time when the US and the UK wanted to go in and bomb Syria, the OCPA instead did something constructive. They worked hard behind the scenes to remove those chemical weapons. That they had been used is beyond argument. What is done is done no matter how horrific. History can't be changed but can be learned from. Removal of such weapons at least minimises the chances of their subsequent use. That is the very least we should be aspiring to. Going in to bomb the country achieves nothing - history tells us that and yet that remains the first port of call for the US and the UK. I wonder what it would take fro them to step back and learn? Malala this week urged the US President to put a stop to drone strikes in Pakistan. The argument for them is that the Taliban is terrorising people on the ground. To employ drones is not the answer. Drones will just accentuate their animosity to the West as Malala correctly points out. As unpalatable as it may be, dialogue remains the logical solution in this or any other conflict. Take away the weapons and sit around a table. Recognise and respect your differences and adopt greater tolerance to each other. It doesn't sound that difficult really. Meanwhile our Government enjoys a weekend out of the firing line as the share price for the recently privatised Royal Mail continues its meteoric ascent. Vince Cable assures us all that this will stabilise to the issue price three months hence. Sadly for him, the election isn't until 2015, so I hope he's right. I fear he isn't and this will go down as one of the greatest of all government giveaways as the private institutions queue up to relive the public of their quick windfalls. One day we will have a goverment who not only speak of peace but also act accordingly both at home and in the world community. Instead of selling of the family silver, they would be better off addressing the real issues. This is quick fix politics at its very worst and the only users will be the millions of us who rely on the post office. Those days are now surely numbered as the inevitable process of assett stripping begins. A bird in the hand? Cable assures us that the early price rise is just froth but I would say that this and successive government have forever been blowing bubbles..

The Elephant in the Room.

Two of the core principles required of all doctors are beneficence and non-maleficence. Beneficence simply means actions which are carried out for the benefit of others. Non-maleficence, by contrast, can loosely be translated in to "do no harm". These principles are instilled in to all medical students the world over as they prepare to embark on their professional medical careers. It was therefore with great interest that I read a characteristically thought provoking piece by Max Pemberton in the Spectator this week. In his article entitled "The battle of the bulge", Max alludes to the growing crisis of obesity as it exerts its expensive impact on our faltering Health Service. Dealing with a subject much covered in these posts, Max refreshingly tells it like it is. For too long, we have hidden behind political correctness and created an environment of sympathy for overweight people. As he puts it, why should he diagnose people with cancer but skirt around telling people they are obese. This isn't finger pointing for the sake of it. There is a valid reason why doctors should be tackling this problem head on. If obesity is swept under the carpet, its growth will continue unabated. Max spells out the uncomfortable truth; the one thing fat people have in common is that they eat more than they need to. Max also points to an imbalance in our healthcare system. There are those patients using the NHS who are seriously malnourished (as evidenced by the news yesterday that one of the leading charities is to address the issue of food for the needy in the UK for the first time since the Second World War), and there are those patients desperate to take tablets to ensure their food passes unabsorbed while the tax payer foots the bill. The stark reality is that the UK now boasts austerity and obesity in tandem. It is a sad fact that a third of children in the UK are now deemed to be overweight. The obesity epidemic (and I use that word advisedly) now costs the Health Service about £5 billion per annum and accounts directly for about 300 hospital admissions every day. More worrying still is the revelation that the East Midlands Ambulance Service thinks it needs to upgrade all 272 of its existing ambulances. Up to now, they have soldiered on with just one bariatric ambulance but now realise the true enormity of their challenge. This will cost £27 million due to the need for double-wide stretchers designed for patients weighing in at 28 stone plus. That cost of course precedes the cost of dealing with such patients when they actually reach the hospital - that is where the real cost begins. Wider MRI scanners, reinforced operating tables, longer needles, sturdier trolleys, more bariatric surgeons - the list just goes on and on. One prominent bariatric surgeon even revealed that without new bariatric equipment, enquiries would have to be made to zoos and veterinary practices to access scanners. She fears this would impact on the dignity of the patient. Believe it or not, the number of bariatric operations has increased sevenfold in seven years. Although an extreme case, the fire service in South Wales recently had the onerous task of demolishing two walls of a house so that a 63 stone TEENAGER could be taken to hospital. It is estimated that this cost about £100,000. Over the past few years, rescuing obese patients stick in baths etc has become a part of everyday life for our fire crews. Nottingham has the enviable title of Britain's fattest region as Britons "pulls on a pair of tracksuit bottoms and heads for the fridge". If you can believe this, NICE last year suggested that doctors should avoid using the term "obese" for fear it might upset patients. Instead, they suggest that obese patients should be advised to seek a "healthier weight". This is just pussy footing around the existing problem and actually does the patient a great disservice. If we are to practice non-maleficence and beneficence, avoiding terms like "obese" will ultimately result in harm to the patient. The 2% of patients who were obese in the 1960s have now ballooned to 25% and the figure shows no signs of growing as our insatiable appetites continue unquestioned and unabated. In the 1960s, three quarters of people walked for at least half an hour a day. Today that figure is just 40% ie almost half. In the 1960s 90% of people had tried to lose weight. In 2010, that figure was 50%. 40 years ago, just 7% of those who saw themselves as being overweight had failed to do anything about it. Max argues that in our increasingly consumerised world, people now see themselves as being consumers of the healthcare system rather than patients. Myself included, people have blamed the food manufacturers, their parents and even their genes. Max argues that obesity is not a disease but a mindset suggesting that it is open to change. He also points out that the hardest drug of all to deliver to our patients is arguably truth. It usually takes plain speaking and brave words to start a debate and I hope he has started one here. If we continue to avoid talking about it, it will continue its inexorable rise. The US seems resigned to its obesity problem. It does not follow that we need to follow their lead. This isn't about being judgmental. This is about dealing with harsh facts which are impacting on everybody - obese or not. Lets start to talk about the elephant in the room.

Are there no workhouses?

In a move not seen in this country since the Second World War, the Red Cross this week launches a winter food aid plan for Britain's needy. This is not really news though because the needy have always inhabited our society. The move sounds like a scene from "The Christmas Carol" and conjours up visions of the the sceptical Mr. Scrooge. The obvious question though is simply to ask why so little progress has been made since Victorian times and, indeed, the Second World War which ended nearly 70 years ago? We didn't have a welfare system during the war so things were arguably enough tougher then. Our habits were probably a lot different too in a world where marketing didn't predominate in the way it does today. Society was undoubtedly more cohesive in those days because there was no welfare state. In the end, humanity tends to come to the fore when the chips are down. One of the problems with the welfare state is that it almost removes the need for people to watch over their neighbours because that is the job of the state. It isn't the job of the state and never has been. In reality, it is the the job of all of us on just about every level you care to mention, moral or otherwise. It is not a bad thing that the Red Cross are helping in this way. What is bad is that our communities are not as cohesive as they once were. Our aspiration must be to return to those times and all pull closer together. Should we achieve this, the need for the State to do everything for us would be less obvious. We are a uniquely sociable species but have perhaps lot our way somewhat in recent times. Perhaps this is the beginning of an upturn in our fortunes form the perspective of community action. I hope so. The worst outcome in this matter would be if there was no Red Cross to help out...

Chocolate to the rescue!

It is about time the poor old NHS received some good news. That news has potentially arrived today from a rather unlikely source. It emerges that the price of chocolate is to rise by up to a third in the run up to Christmas. If this is the beginning of a new trend in chocolate prices, this could mean the start of a new era in moderation. Our national appetite for chocolate is mind blowing and it is arguably one of the few consumables more widely available than that other great British staple, alcohol. As a superb driver of obesity, chocolate has been a big player in the rising tide of type 2 diabetes. the 1.4 million UK citizens with type 2 diabetes in 1996 now stands at 4 million and is expected to reach 5 million by 2025. The reason why diabetes is such a big issue for the NHS is that it is known to contribute to stroke and cardiovascular disease. At a time when the NHS is really struggling with the numbers coming through the doors, anything which can alleviate that strain can only be good news. Of course, chocolate is just one manifestation of a high sugar consumable so there remain plenty of low cost options for people to indulge in. As has been seen with cigarette smoking though, continual price increases only ever have a limited effect on the people who choose to smoke. The key here of course is choice. We can do all sorts of things to try and deter people from engaging in things known to be detrimental to their health but we can't stop them. Price is a handy tool though provided it is handled in a universal fashion which is fair to all. I will explain. Alcohol is a classic example of a free for all economy. The range of booze promotions at the large supermarkets is staggering. They do this because they have been allowed to do so by a succession of governments who can't see further than the creation of a few jobs irrespective of the repercussions. The repercussions of this policy have been dire. Thousands of pubs have closed as a result, many of which served pivotal roles within rural commnities as social hubs. Pubs can't dream of offering booze at supermarket prices so many have sadly gone by the wayside. One unfortunate spin off from this disequilibrium is that people have gradually been putting away more and more booze in the confines of their own homes. Habits are notoriously easy to start but fiendishly difficult to break. The wide availability of consumables high in sugar has normalised our attitudes to sugar. The result is rising numbers with serious illness and an even bigger impact on an NHS which is financially unsutainable now. Surely the time has come to introduce minimum pricing on those items known to impact negatively on health? The prices don't need to be Dickensian - just moderate and sensible. We can go on as we are and see the emergence of a private health care system or do something about it and keep the NHS which we all pertain to value to highly. To have no chocolate is drastic. To have less is just common sense and if the price helps to achieve this, so much the better.

Alternative solutions

Brace yourselves for weeks of political bickering over consumer energy prices. The announcement this morning that SSE aims to increase bills by 8.2% is just the right sort of fuel to keep the political fire burning. They claim to be making a profit of about 5% by doing so and don't see it as being excessive. That is subjective of course. The SSE Chief Executive also points to the unavoidable costs of building new power stations and infrastructure to support an ever growing demand. On a personal note, we still haven't switched our heating on and won't until at least November unless the temperatures go below zero. I fear that might not be the case for the majority and, in some ways, this is part of the problem and the solution. Wholesale prices are rising and we can't really do anything about that. We must concentrate instead on the ways in which we can consume less energy. Aside from the money this will save us, it just makes sense anyway. As I say,the political debate will now go in to overdrive as both sides clamber for the moral high ground. Enforcing a fixed price for a few months really is just a gimmick because it doesn't address any of the real issues in this debate. It doesn't address how much we are using and whether we can consider using less. It doesn't take account of the investment needed to improve the existing infrastructure. It doesn't seek to promote greater competition and easier access to the various tariffs within the sector. In short, it doesn't do much except seek to garner a few desperate votes come 2015. This or any government for that matter should be incentivising people for using less. It should also be promoting the use of solar panels with grants being made available for more efficient boilers. There is no sense in just whinging about the energy prices. They will only rise so we must seek ways around the problem rather than letting the problem overwhelm us. The privatisation of the energy companies probably was a huge mistake but the deed is now done. As I write, the deed is now being done in respect of the post office and the story there will no doubt be similar. For all that though, we can only ever deal with what's in front of us so we need to start concentrating on the solutions rather than the problems. In the political debate so far, the coalition is winning the ideological debate but Milliband is winning the populist debate. If I told you that your food shopping would stay the same for 20 months, you'd be quite happy with that. To make such a promise though is at best shallow and at worst disingenuous. Make your own mind up and keep looking for the alternative because it's usually there if we all look hard enough..

My 15 Favourite Songs

With the luxury of a few free minutes I resolve to consider the fifteen songs which have made the biggest impression on me. If choosing my fifteen favourite books was hard, this has been torture. In no particular order, here goes... 1. Suite: Judy Blue Eyes - Crosby, Stills and Nash This makes the list for several reasons. To begin with, it was the first song they performed to a proper live audience and gave the world its first glimpse of the legendary CSN. The harmonies for which they are now so well known are breathtaking as is the vocal delivery of Stills. The subtle transitions which take place within the song are clever and imaginative. The lyrics are clever - as you would expect from the writer of Helplessly Hoping and the length of the song doesn't seem overly long even though it tops 5 minutes. This is a landmark song which was fitting for such an audience as Woodstock. I only wish I'd been there to see it live. 2. Maybe I'm Amazed - The Faces Although it is tempting to play it safe and go for the full blooded vocal of McCartney, I still prefer the Faces version from their album Long Player. The opening lyrics are delivered by the plaintive soulful Ronnie Lane before Rod Stewart comes in like a steam roller for the second verse. The drumming of Kenny Jones is extraordinary as is the Hammond of McLagan. Overall though, it is the blues style of the Faces which wins me over. It is loose, free and edgy. I've heard people say that they were the fore runners of pub rock but that is a little unfair - they were a lot better than that. 3. I've been loving you too long - Otis Redding I can't imagine anybody else being able to deliver this song with the grit and raw emotion of Redding. Although he gave us so many other memorable numbers, this is the stand out track for me and it drags you through the mud with it. 4. Ball and Chain - Janis Joplin Where do I start? Of all the great stuff she produced with Big Brother and the Holding Company, it is the rendition of this song at Monterey in 1967 which lingers in the memory. Her delivery is awesome and the energy like a force of nature. Credit has to go to Big Brother for their contribution but Janis absolutely nails it warts and all. 5. Barcelona - Freddie Mercury and Montserrat Caballe This song is unusual because it fuses pop with classical in a way which I've not heard elsewhere. It is a masterpiece and a masterstroke at the same time. It is a masterpiece on account of the production which is faultless and a masterstroke because who on earth would have considered pitting these two together? It was apparently the idea of Mercury and he won her over. I'm glad he did because this song just smothers you in goose bumps. 6. Whole Lotta Love - Led Zeppelin This has to be included because it is the definitive heavy rock track and pointed music in a new direction. The drumming of Bonham is a different class as is the vocal delivery of Plant which is, at times, like a foghorn straining to be heard over the din of the Page guitar. The guitar of Page is quite simply breathtaking and you just wonder where he's going to go next with it. Occasionally a song comes along which completely breaks the rules - this is a case in point. 7. Let's see action - The Who I've chosen this one because for reasons I'll never understand, it wasn't considered good enough to make the final cut for Who's Next in 1971. After Townshend conceded defeat in his Lifehouse project, he was left with the task of using the material to put an album together. What an album! I don't understand how this track missed out though. The drumming of Moon is at the very top of his game with some great keyboard driving it all along. Daltrey delivers a vintage vocal performance and the message of the song is as relevant today as it was then. There is also the small part of some sterling bass work by the legendary Ox.. 8. Astronomy Domine - Pink Floyd Most would understandably point to one of the great tracks from the '70s albums but I remain drawn to this album opener from Piper at the Gates of Dawn. Once again, this song breaks the mould and gives a pointer of things to come. Given the limited technology available in 1966, this is a really clever song underpinned by some super keyboard playing courtesy of the late Rick Wright. And the lyrics....They are from a different world! 9. Happy Together - The Turtles A great song needs to be quite simple. This song is a simple love song. What makes it brilliant is the vocal harmonies of Mark Volman and the simple, relentless drum beat and guitar. I'm not surprised its been so heavily used in adverts and films - outstanding composition. 10. I Feel Love - Donna Summer I would insist on the 12" version. This really was the sign of things to come and was way ahead of its time. Donna Summer delivers a perfect vocal against the synthesizers which came to define the song. Its difficult to describe the effect this song had on people when it first appeared and it still stands up today. 11. Tin Soldier - The Small Faces Many groups have a tendency to, produce their best work just before they break up almost as though it would be pointless to try and better it. This is a case in point. Everything about this song is great. The raw vocals of Steve Marriott are ably backed up by then girl friend PP Arnold. The rhythm section of Lane, Jones and McLagan is on fire for this one. Not heard nearly enough, this song is an absolute gem. 12. Walk On By - Dionne Warwick I couldn't let this one go. This sums up the very best of Bacharach and David. Just being good song writers isn't enough though. You still have to find the perfect voice to showcase your work. They couldn't have hoped for better than Warwick. A perfect vocal for a beautifully produced song with hallmark Hal David lyrics. 13. Take Five - Dave Brubeck It wouldn't have been possible to leave this one out. This is the Bolero of the jazz world. It stands up today as well as it did 50 years ago. Very, very clever song. Although instrumental, it shows what you can achieve with so little. The drumming is extraordinary. 14. God Only Knows - The Beach Boys It seems almost trendy to pick this because so many others have cited it in the past. For all that, it is a belter of a song which could only have been written by Brian Wilson. A long way ahead of its time, I can almost understand that he had a nervous breakdown shortly afterwards because it must have taken so much out of him. 15. That's Allright - Elvis Presley Its hard to believe that this was recorded as far back as 1955. This is absolutely brilliant. Even now it still sounds as fresh as a daisy. His voice was unique as was his backing group. The ones I had to leave out are many!

Mind the gap!

What price a good education and should it be free for all? Yesterday, I wrote about the young Malala Yousafzai who is campaigning for the every child in her native Pakistan to receive a free education. I wish her luck not least because she has already shown extraordinary bravery. Being shot in the head would normally suffice to deter most people so she evidently has great fortitude. While Malala takes on the Taliban in Pakistan, it would be a trifle fanciful to claim things are perfect over here. Just today, the Vice-Chancellor of Oxford University is arguing about the sustainability of the current standard price of an Undergraduate Course. He argues that the current £9,000 per annum tuition fees can't be standardised for all institutions. He claims that an Oxford degree costs nearer to £16,000. Be that as it may, all he is actually doing here is to highlight an aspect of our society with which the majority are uncomfortable. The growing divide between the mainly privileged students who enjoy an Oxbridge education and the rest becomes more striking by the year. Surely the real issue here is to ask ourselves as Malala is doing, "Just how important is education?". The question is arguably rhetorical because nobody could possibly argue against the importance of good education. As with the provision of a good Health Service though, that requires proper investment. It should though be available to everybody in the UK irrespective of their socio-economic background. What a student makes of their opportunity is another story but at the very least, they must first be afforded that opportunity. If the gap between education in Pakistan and education in the UK is big, the gap between the privilege of an Oxford education and the rest isn't far behind. It is difficult to justify such an obvious disparity and my advice to the elitist Vice Chancellor would be this; If other institutions can provide tuition for a frankly exorbitant £9,000 per annum, what makes you so special? Aside from its name, Oxford is after all just another University albeit with enhanced selection criteria. It would be fair to say that Oxbridge Universities receive far more in the way of private investment and legacies than the others so the gap to which he alludes is probably not that big anyway. The real aim here is to aspire for equal teaching standards across the board rather than try to accentuaute an already unfair advantage for the Oxbridge elite. As a country, we invest just 1.4% of GDP on our education system. This is low compared to our neighbours who spend nearer to 2%. Given that education will ultimately dictate the future prospects of the nation, I wouldn't have thought this investment could even be viewed as optional. The job in hand is to increase funding in education and distribute the proceeds more evenly to create opportunity for all children rather than the chosen few. It isn't reasonable to overly burden students with debts before they've even started work. By all means put a price on an education but don't do so at the risk of turning people away. That is becoming a very real prospect unless real action is taken soon.