Category Archives: medical

You May Have Missed …

Another in our series highlighting articles you may have missed …
Unfortunately top billing this week has to go to Prime Minister David Cameron’s desire to impose a “porn block” on every internet connection. Needless to say the internet has been awash with people decrying the scheme as unworkable censorship. Some has been the usual squealing about anything we don’t like but much has been sensible commentary on the abhorrence of censorship and the practicalities of why the system won’t work. Those of you who know me, and who follow here, will be able to guess my view. Here is a selection of articles:
Original news item from the Independent: David Cameron cracks down on online pornography with ‘porn block’ option
The anotherangryvoice blog shouts against David Cameron’s “national wank register” although the article is more rational and practical than that sounds.
Meanwhile in measured fashion New Statesman asks 10 questions about Cameron’s ‘war on porn’
While in PC Pro the smaller ISPs are resisting.
Another blogger maintains the proposed UK porn filter is a threat, not a safeguard.
Milena Popova looks at the proposals from the perspective of an abuse survivor.
Finally there is the inevitable e-petition on the government website: Do Not Force ISP Filtering of Pornography and Other Content. At the time of writing it has just over 25,000 signatures. Whether you agree or not I’d urge everyone to sign as 100,000 should ensure a parliamentary debate, which is about the best we can do in exercising our full democratic power.
Now let’s return to the usual rather more amusing and esoteric fare.
Big ears! Yes ears (and noses) really do grow as we age.
Here’s an interesting, if slightly contentious, article on why we should fight back against those who are determined to kill off obesity. Yes, we know there may be risks (for some) in obesity but moral blackmail isn’t the answer and quality of life does matter.
At last an explanation for all those tales of werewolves. Apparently sleep quality declines around the full moon.
Still on things medically orientated, scientists are increasingly demonstrating that there are links between faulty body clocks and mental illness although it should be stressed that a correlation doesn’t prove causation.
Well who would have guessed? Bottlenose dolphins use names to identify each other. Wolves too it seems. You mean all animals don’t? I bet they do; just because we can’t understand what name our cat or dog calls itself!
A couple of writers for Practical Fishkeeping magazine go snorkelling in an English river and are surprised by the amazing biodiversity.
Oh dear, here we go again … More sleight of hand in the finance industry. Nationwide Building Society is working out how to issue shares and remain mutual. Ho hum …
Meanwhile some fun … I love it when eccentric, guerilla ideas take off. Apparently campaigners have planted cannabis seeds all over a German town and the authorities are struggling to keep up with destroying the resulting sudden growth.
More fun, but more seriously … apparently the Tory party’s plans to claw back EU powers have been thrown into disarray after an official study describes the London-Brussels balance as ‘broadly appropriate’. As usual though, I bet they ignore their advisers.
And now for a true British eccentric. Obituary for the 7th Marquis of Anglesey, historian of the British Cavalry, who died last week.


And on British eccentricities, here is a series of photographs of Britain’s listed historic signal boxes.
Finally one close to my heart. Biologist Rob Dunn investigates the roamings of his cat, and despite her age gets a surprise.
More anon …

Aromatherapy Awareness Week

Aromatherapy Awareness Week runs from Monday 10 to Sunday 16 June and is promoted by the International Federation of Aromatherapists.

Although like many “complementary” therapies it is much decried by mainstream science, aromatherapy is an ancient therapeutic treatment used in many early civilisations to relieve stress, other ailments and rejuvenate the mind, body and spirit, by the use of pure essential oils from plants, chosen for their therapeutic benefits, specific to the needs of the individual.

Smell is a much more important sense that we often realise. Scents are some of the most powerful triggers for the recall of past events: the smell of the sea bringing back those idyllic childhood holiday memories, for instance. That’s why supermarkets so often use the smell of baking bread, or coffee, to entice us. So why should aromatherapy work too?

The medical sector too have recently started utilising the benefits of aromatherapy — for instance in cancer units as supportive care for their patients and pre- and post-operations — and they have seen benefits to the patients which help to speed recovery.

You can find out more about aromatherapy over at www.ifaroma.org.

Walk to School Week

Monday 20 to Friday 24 May is Walk to School Week.

The aim of Walk to School Week, which has been going since 1995, is simple: to encourage all parents, children and young people to make walking to school part of their daily routine.

I know when I was a kid I lived a mile from my junior school and subsequently a mile in the other direction from my grammar school. And I walked to school; in fact for much of the time I came home for lunch so walked about 4 miles a day. (OK, I admit I was a lazy teenager and sometimes got the bus to school, but that depended on being in funds as I didn’t get extra allowance for bus fares.)

Walking is good for us and we almost all walk far too little (guilty as charged!). Far too many children get taken, even short distances, to school by car. Parents get scared (usually unnecessarily) of kids being molested or abducted, parents are in a hurry to get to work themselves, or I’m sure in many cases they’re just plain lazy.

But as always there are many benefits to walking: save petrol — and thus save money and the environment — improve health but getting more exercise; and parents walking children to school are spending quality time with their kids, and maybe even teaching them things about the world around them. Get into the walking habit and hopefully it will stay with you for life.

As always there is more information on the Walk to School website at www.livingstreets.org.uk/walk-with-us/walk-to-school.

Walk to Work Week

This year’s Walk to Work Week runs from 13 to 17 May.

It is generally agreed that in modern society we don’t walk enough (guilty as charged!) because walking is a great way to maintain fitness and helps keep the heart healthy. For those who work outside the home, walking to work also saves on petrol and bus fares, and is better for our planet. OK, walking to work isn’t feasible for everyone so as an alternative why not have a lunchtime stroll in the park or along the river?


You can always use walking to work as a way to raise money for your favourite charity, or just to be like Charles Dickens and Wordsworth who went on walks to get inspiration!

Find more information at www.walkingworks.org.uk.

Book Review

Mary Roach
Gulp: Adventures on the Alimentary Canal

If there is one thing Mary Roach does well it is write. Her style is light, airy and humorous while being informative. It needs to be because she has made her stock in trade writing about taboo subjects like sex (Bonk), death (Stiff) and now our guts. For instance in writing about the biblical story of Jonah and the whale she says:

While a seaman might survive the suction and swallow, his arrival in a sperm whale’s stomach would seem to present a new set of problems. (I challenge you to find a more innocuous sentence containing the words sperm, suction, swallow and any homophone of seaman.)

She takes us on a journey through the gut — from top to bottom. Well, except that she doesn’t; it’s a journey through the top half, as far as the stomach. There’s a black hole of the small intestine should be. And a fast water chute through the colon. So despite the good writing I felt short changed by Gulp. I wanted more, and I wanted a bit more in depth science.

Sure, Roach talked to all the right scientists and medics. But this wasn’t as in depth as either Stiff or Bonk — at least it didn’t feel that way. And as I say the really interesting bits (well, to me, at least) beyond the stomach were too quickly glossed over.

So I was left feeling as though I’d had a decent starter, followed by some sorbet and coffee, but without a main course. Which is a shame because Roach writes too well for this.

Overall rating: ★★☆☆☆

Listening to 'Flu

Back last September I wrote about a Scientific American article which proposed that to reduce the spread of ‘flu we should vaccinate children — because it is children, not the elderly, immuno-compromised etc., who are the super-spreaders.

Imagine my astonishment yesterday to see that the UK government is proposing to do just this! Yes that’s right, they’re going to give every child (aged from 2 to 17) an annual ‘flu inoculation. According to yesterday’s Independent report:

All children aged two will be offered a nasal flu vaccine from this September. The programme will be rolled out to all primary and pre-school children next year, with secondary school pupils starting to be vaccinated in 2015.

OK, it would be good if it could all be rolled out this year, but I guess it may in part depend on the vaccine producers’ ability to ramp up production as well as the ability to get suitably trained staff in place to do the work.

But I’m astonished that the politicians have actually listened. I’m even more astonished that they appear to be willing to find the money. Let’s hope dream turns into reality.

National Stop Snoring Week

22 to 26 April is National Stop Snoring Week. This is one of the few medical awareness weeks which I am going to mention, because snoring is usually ignored but can actually be life threatening.

National Stop Snoring Week is the annual event, sponsored by the British Snoring & Sleep Apnoea Association, promoting general awareness that nobody need suffer as a result of snoring: it is a condition that can be treated.


And indeed snoring is a condition which should be treated as it is often a symptom of Obstructive Sleep Apnoea, a condition where the airways collapse during sleep preventing breathing. If untreated, sleep apnoea not only destroys restful sleep (and thus quality of life/ability to function) but can lead to heart disease and strokes. Luckily it is easily and successfully treated in 90% of diagnosed cases.

Of course snoring may have other causes and other effects. If nothing else it often disrupts the sleep of family members. And contrary to popular belief snoring is not something which affects only middle-aged and elderly men; anyone can be a snorer.

More information on National Stop Snoring Week at www.britishsnoring.co.uk/national_stop_snoring_week.php.

Transparency: Yes, I suffer from Obstructive Sleep Apnoea which is now well controlled.

Humanity Restored?

Bastard! One year I’ll learn not to put anything in my diary for at least two days after I have my ‘flu jab. Yep it always gets me, usually for only 24 hours.

This year it hit me hard. GOK why it should.

I had the injection about 9.30 on Friday morning. By 9.30 that evening I was huddled under the duvet feeling like death — the full ‘flu symptoms: fever, aching bones, crashing headache, don’t like bright lights, unable to stay awake but sleeping fitfully and just so depressed.

Saturday’s plans had to be abandoned. But heroically Noreen managed to mop up the couple of bits we couldn’t entirely avoid. Meanwhile I slept the day away. And although I felt rather better by the evening I then couldn’t sleep last night. That’s pretty normal for me when I’m ill: sleep well all day and badly at night.

Humanity is present again today, but only just. I’m still weary and aching; still depressed. Still not functioning properly in the brain department. (Yeah! OK!)

Hopefully normal service will be fully restored tomorrow; there’s too much to do for it not to be.

It’s true what they say about ‘flu, even the after-effects of the injection: it hits you fast and hard, and floors you. If the symptoms come on gradually and you can still function at all, then what you have isn’t ‘flu. If you get hit by a train and can’t function even if you need to, it is ‘flu.

Yes, I usually get some reaction to the injection. I never expect it! But it isn’t usually as bad as this. The only previous year I remember it as bad as this was two years ago when the inoculation contained swine ‘flu (or was it bird ‘flu?) vaccine. That knocked me out for a week! Clearly my body hadn’t seen that before.

What’s interesting though is that not everyone reacts the same. On Friday morning in the supermarket we met a couple who also go to our doctors and who had their jabs several weeks ago: they both said they had had no after-effects at all; not even a sore arm. And my mother says she never gets any after-effects. But I do, and I know several others who do.

Lesson: In future keep at least a couple of days clear after the ‘flu jab, and be prepared to be hit hard. I did neither this year and have only myself to blame. Even Noreen tried to warn me! But did I listen?

But the after-effects of the inoculation, however horrid, are way better than actually having ‘flu properly. One really doesn’t need that, especially if you’re at all immune-compromised (elderly or with a long term condition like diabetes, respiratory problems, etc.) or a carer because ‘flu can really knock you out, possibly even terminally.

So if you’re offered a ‘flu shot by your doctor, I’d say take it. Yes, it may make you feel rough for a day or so, but that’s better than the 1-2 weeks real ‘flu will last.

Good Doctor, Bad Doctor

As some of you may know I’ve managed to get myself embroiled (at a local level and from a patient perspective) in some of the health service reforms which are now happening.

Partly as a result of this I’m reading Ben Goldacre’s latest book Bad Pharma: How drug companies mislead doctors and harm patients.

Even if only 25% of what Goldacre alleges in the first quarter of the book is true (and that seems conservatively low) there is a scary, systematic and unethical ethos pervading the whole of the pharmaceutical industry which emanates from both the drug companies and the regulators.

At the end of the first chapter [p.99], where Goldacre has discussed the problem of missing drug trial data, he issues this challenge:

If you have any ideas about how we can fix this [the missing drug trial data], and how we can force access to trial data — politically or technically — please write them up, post them online, and tell me where to find them.

What follows is my small response to Goldacre’s challenge.

— o O o —
As patients there is not a lot we can do to address these issues; they’re just too big for the man on the Chapham omnibus to be able to make, individually, a difference. Given that the drug industry, the academics, the medical professional bodies and the regulators have singularly failed to adequately address the issues, the major thrust of the resolution probably now has to come in the form of primary legislation across all territories — something for which sadly few politicians are likely to have the stomach and no government the priority. However that doesn’t mean we patients can (or should) do nothing. This is what I think we can do, at least in the UK.

  1. Through our doctor’s Patient Participation Groups (PPG), and through our local LINk/Healthwatch/Health & Wellbeing Boards, we should be putting pressure on the medical world and specifically the local Clinical Commissioning Groups (CCGs, replacements for the PCTs) to force GPs to act ethically and without bias.

    One way to do this would be for GPs to be given guidance on what patients expect of them. This is likely to be way beyond the minimum acceptable standards required by legislation and regulation. And indeed I’m involved at my local level in drafting just that. I can’t say more about it at present as the work is still in draft form, uncompleted by the authors, unapproved by the sponsoring group and of course not yet delivered to its expected recipients. (That it is being done is in the public domain as it is referenced in publicly accessible meeting minutes.) However we are committed to it being published, and publicly accessible, when completed. With luck this will be before the end of the year, so I hope to return to it in a later column.

    But such guidance could contain clauses like (all my wording will need tightening):

    • Clinicians are expected to behave in unbiased and ethical ways. They must declare annually and publicly on their practice’s website all benefits received (services, goods, money) worth over [[name some modest value like £50]] received from any pharmaceutical company or healthcare provider (public or private). They should demand the same transparency from those who they themselves consult or to whom they refer patients.
    • All clinical trials/research in which a clinician is involved must be publicly registered and defined prior to starting and be referenced by the practice’s website. All clinical trial data (including anonymised patient-level data) and results must be published within 12 months of study completion. Again clinicians should demand the same transparency from those who they themselves consult or to whom they refer patients.

  2. All members (medical and lay) of CCGs, Health & Wellbeing Boards, etc. must also make declarations as in 1 above.
  3. Is it possible to find an MP who is willing to put down an Early Day Motion (or Motions) in Parliament demanding legislation to:
    • require all clinical trial data and documents (including anonymised patient-level data) be made publicly accessible, without hindrance, within 12 months of the completion of the study, and within 3 months to the appropriate regulatory bodies.
    • make all clinical trial data, whoever performs the studies, funds or sponsors them, subject to Freedom of Information requests at no charge, and with no exceptions, worldwide and retrospectively.
    • make gagging and other “interference” contracts illegal?

    We should then be encouraging our MPs to support the motion.

  4. There doesn’t appear to be an e-petition to the government. What about it? The partition should require that the actions outlined in 3. above be passed into primary legislation during the lifetime of the present parliament. I guess this would need someone more skilled than I am at drafting to write the petition effectively and without allowing wriggle room.

    According to the government’s own rules 100,000 signatures on an e-petition should trigger a parliamentary debate. That ought to be achievable if everyone buying Goldacre’s book signs and gets another couple of signatures. Create a Facebook page and it could attract even more signatures.

No that isn’t actually a lot in terms of fixing a worldwide, pervasive problem with Big Pharma. But we have to start somewhere and it is probably as much as we patients can realistically do initially, at least initially. Items 1 and 2 should start a trickle up of activity. Hopefully 3 and 4 will start a hammer down.

Thoughts from anyone?

Shaping a Healthier Future

There’s a big brouhaha going on in NW London at the moment over the proposals to reorganise the way our hospitals work.

Needless to say all the local agitators and pressure groups are out in force, mostly peddling totally inaccurate messages like “Save our hospitals”, “You won’t have A&E services”, “Major cuts to your health service”.

Needless to say most of this is totally fictional and they have not understood the actual proposals, which are contained in an 80 page consultation document. I even wonder if any of them have read it.

I have been to several public meetings recently. I am appalled at the inability of people to understand the proposals, the way in which everything is parochial, angry and internalised, and their inability to step aside from “it might be inconvenient for me” and see the bigger picture. People are being angry and frightened, because they dislike change and they cannot (or will not) make the effort to understand.

Nevertheless, and although my GP is one of the team responsible for the proposals, in fairness I have to say they have not been well presented, in clear and straightforward messages and in a way which Joe Public can understand. Joe Public does not listen to detailed arguments (he never did!) but needs sound bites and simple statements. The NWL NHS team may be excellent clinicians, but they have not got good PR/marketing/presentation skills — and it shows. I’m no expert but a lifetime in business (including training) has put me ahead of the pack.

As a working thinker I have therefore made it my business to get involved. Having read the consultation document a number of times I have now distilled it down into a 10 slide, simple presentation for my doctor’s surgery patients’ group. And I have tried to help the NHS team to hone their messages.

Here is a copy of my presentation slides, which are on Slideshare. If you are in NW London then please read the presentation.

[slideshare id=14342271&style=border:1px solid #CCC;border-width:1px 1px 0;margin-bottom:5px&sc=no]

NWL NHS Hospital Consultation, 2012 from Keith Marshall

The bottom line is that this is roughly a 10% change in what the patient will see. In other words for every 10 people who go to hospital, one may go to a different hospital. All these hospitals are within something like an 8 mile radius — it’s not like we have to travel 30, or even 60 miles to hospital as is the case in many other areas of the country.

Now I’m not pretending the proposals are flawless; of course they aren’t. There are currently some big gaps like the lack of appropriate public transport services — something he NHS team are well aware of and are already discussing with Transport for London. However ultimately we have to stand aside from our parochial feelings and do what we know is right. In my mind, and regardless of the business case, these proposals are clinically, logically and logistically the right ones and should have been done years ago.

If you can, please also read the Shaping a Healthier Future consultation document.

When you’ve done that please have your say on the proposals; there is an online questionnaire.

The consultation runs until 8 October.