One of the advantages (or disadvantages) of being a full time carer like myself, is that you get to watch a lot of TV. At the moment I am getting hooked on ‘Deep Space Nine’ and I  also  enjoy the ham acting of Dick Van Dyke in ‘Diagnosis Murder’ in a guilty sort of way. A while ago I switched on ‘Holby City’. It was showing a two parter and the plot went like this; a prudish medic from the GUM department is putting out leaflets about sexually transmitted diseases ( STDs). He gets angry because no one is taking him seriously and the posters that he has put up get vandalised. So he pulls out a crossbow and shoots everyone.
It was at that point I thought that the NHS has rather a long way to go in persuading the great British public to go to the clap clinic.

This episode of Holby illustrates perfectly the British attitude towards discussion of STDs. In an age where sex is talked about freely, sexually transmitted diseases are seen as a taboo subject.  Anyone who mentions STDs is seen as a spoilsport at best and a prudish murdering medic at  worst. That’s why the  scheme to bring chlamydia screening to nightclubs and bars was never going to take off, as the most recent report on the project admits. No one likes going for intimate tests at the best of times, but when you’re going out to enjoy yourself at a nightclub? Who ever thought that was going to work? So far £100 million has been spent on getting people screened; last year it was estimated that £17 million of that money was wasted, nearly half the budget for that year.

There is a way to get the message across about chlamydia, and that is for the NHS to lean on the programme makers of series like Holby and Eastenders to come up with some sensible themes about STDs. A strong storyline about how someone couldn’t have children because they were infertile from the disease, would do more to raise awareness of chlamydia than any expensive advertising campaign could muster.  It would also help if TV programmes would stop portraying people who sleep around as smart and sophisticated, while those who disapprove as crossbow crazed psychos. One in ten women in Britain get chlamydia. It’s symptomless and it causes infertility.  That’s not smart and it’s nothing to snigger about.
Still on the subject of wasting money. Welsh Lib Dem leader Kirsty Williams submitted a written question to Edwina Hart the Welsh Health Minister asking if she would instigate an enquiry into the comment made by an NHS official that £1 billion of the £5 billion budget for Wales was being poorly spent. Edwina Hart’s written answer was the single word ‘No.’

That’s a smart ass answer that might be good enough for First Minister’s Question Time in the Welsh Assembly. It’s not a good enough answer to someone like Paul Davies who is one of the All Wales Directors of the NHS and who made the comment to the Welsh finance committee. The trouble with the NHS is that its budget is so big that you lose all sense of proportion. £1 billion might be 1/75 of its total budget, but £1 billion is still £1 billion and we shouldn’t waste it.

Finally, some good news from across the pond.  Barack Obama has got his healthcare reform bill through the House of Representatives by just a few votes, but that’s further than anyone predicted he would get.   Americans spend some 15% of its GDP on healthcare, yet 47 million Americans remain uninsured. Obama’s proposals should bring another 36 million people into the health care fold.  What we are watching just now is the whole political process that Britain went through just after the war when the NHS was formed, and Obama will have his work cut out to steer it(he still has the Senate to go), but he has cleared a major hurdle. If he achieves nothing else during his presidency, it would be worth it for this. Let’s wish him and America, the very best of health.

http://news.bbc.co.uk/1/hi/health/8354932.stm

http://news.bbc.co.uk/1/hi/wales/8357125.stm

http://www.guardian.co.uk/world/2009/nov/08/representatives-pass-obama-healthcare-legislation

Having sympathy for politicians is rather like having sympathy for the devil. You just don’t do it. If they don’t like the heat, they should get out of the kitchen. End of. And yet, this week I felt a bit, just a tiny bit of sympathy for Alan Johnson the Home Secretary. He is a fin de siècle politician that has been placed in one of the heaviest jobs in government to keep the seat warm. He has had little chance to master his brief and he has the tabloids snapping at his heels, ready to snatch on any mistake.

All of which means that he should listen to his expert advisers instead of sacking them.

The unfortunate in question was Professor Nutt, the chair of the Advisory Council on the Misuse of Drugs. Professor Nutt had done a very professory thing, which was that he had produced an academic paper on which drugs were the most harmful in society. Unsurprisingly, he had come to the conclusion that alcohol and tobacco were more harmful than LSD, esctasy and cannabis. He said that cannabis should not be reclassified from a C drug to a B drug, because it was sending out the wrong signals about what was more damaging to your health. For doing this, he was accused of overstepping his brief and sacked. Two of his colleagues resigned in protest and the whole affair has snowballed. There is now talk of a march on Parliament in support of Professor Nutt.

Anyone who works in health knows that Professor Nutt is right about this. Alcohol and tobacco are powerful drugs which happen to be legalised. The trail of destruction that they leave is far in excess of the harm that other drugs cause. But those who are politicians know that it is political suicide to appear to be soft on illegal drugs. Alcohol abuse is accepted as part of the culture and those who call for the heads of drugs dealers are the same people that complain about the nanny state every time the government tries to do something sensible about alcohol and tobacco consumption. So Alan Johnson couldn’t really win.

Having said that, Alan Johnson could have chosen simply to ignore Professor Nutt. He could have brushed him off as an ivory tower academical who didn’t deal with the sink council estates and the misery caused by illegal drugs. There is a suspicion that the government maybe wants to get rid of the ACMD and this was the opening shot. It’s more than a little convenient at a time when the debate on minimum prices for alcohol and advertising restrictions are being debated and the drinks and tobacco industry are rattling sabres in an election year. And if Alan Johnson got caught in the backlash; so what? It’s seven months to the elections and he’s not important anyway. But if the government doesn’t want advice, it shouldn’t ask for it. There’s no point in hiring a dog and then barking yourself.

This week’s round up could not pass without a mention of the death of one of the greatest figures in twentieth century medicine. Sir John Crofton, pioneer of the Edinburgh Method which practically eradicated TB in Europe, died yesterday aged 97. His discovery was that using three drugs together for TB ( streptomycin, PAS (p-Amino salicylic acid) and isoniazid) instead of the three separately, guaranteed a 100% success rate. At first people could not believe that a cure had been found; even when Crofton’s team cleared out the TB wards in Edinburgh, medics were still sceptical. But his method was tried in other European cities and within a few years, TB became a disease of the past.

What is extraordinary about this man is that he was not really known outside medical circles. In the week when we think of the ten million people that died in the First World War, maybe we should also remember the estimated ten million people that Sir John Crofton saved through his discovery.

Finally it was wacky races time at the A&Es last night. Yep, last night was Guy Fawkes night, when we burn an effigy of the only honest man to walk into Parliament. Maybe that’s why people keep getting hurt; there’s a curse on the whole thing. However, the DoH has dutifully put out its annual ‘you-could-put-an-eye-out-with-that-sparkler’ advert. It’s worst kind of ‘we’re chummy and cool, but keep the firework rool’ thing, with a Raymond Chandler private eye wandering about and his dog safely shut at home. The DoH quite frankly, has lost its mojo. What has happened to the blood and thunder public info adverts of the seventies that actually showed people getting hurt? The fireworks one pulled no punches; it actually showed someone falling onto a bonfire. And quite right too. It isn’t the government’s business to be liked; its business is to inform and warn. Hope you had a Happy Fireworks night. And spare a thought for Katie Price, whose effigy was being burned by a bonfire society in Kent instead of Guy Fawkes...

http://www.guardian.co.uk/politics/2009/oct/30/drugs-adviser-david-nutt-sacked

http://www.heraldscotland.com/comment/obituaries/sir-john-crofton-physician-1.930516

http://www.youtube.com/watch?v=QdN9XdwIdqw

http://itn.co.uk/5897f6475fba7647d1abaf54d0e5da0d.html