For very many years making a medical diagnosis was based loosely on the application of the principle of Occam’s Razor otherwise known as diagnostic parsimony—look for the fewest possible causes to explain a patient’s symptoms. However, with the increase in longevity of the background population, Occam’s Razor was eventually superseded by the Hickam’s Dictum which states that “patients can have as many diseases as they damn well please.” Here the idea is to consider that multiple symptoms are more likely explained by a collection of common diseases rather than a single rare one. more…

Should doctors avoid fame or notoriety? More than 10 years ago I achieved a modest mixture of both after being asked to leave a public house one Sunday evening for no other reason than being a member of “a group of men.” In the immediate aftermath of the event whilst shopping in the local supermarket, there were the inevitable nudges and winks from people who (like me) found the incident somewhat amusing. However one elderly gentleman did approach me to offer his two-pennyworth. After agreeing on the peculiarity of the pub’s behaviour the same gentleman proceeded to ask me for specific medical advice in relation to his diabetes related foot problem, but only in a whisper so as not to be audible to the person working behind the counter. I had never met him before. more…

The Department of Health has just written to GP’s to encourage them to stop being so mean when it comes to providing blood glucose testing strips to people living with type 1 diabetes. Part of the reasoning for sending the letter relates to guidance from the UK Driving and Vehicle Licensing Agency for patients which states that, “you must always carry your glucose meter and blood glucose strips with you,” and “you must check your blood glucose before the first journey and every two hours.” more…

Taxpayers in the UK fund the NHS but are rarely asked directly about how the money should be spent. A few years ago local patients with diabetes were asked what our diabetes centre should do if for some reason they were bequeathed a pot of money. Options included screening for diabetes, treating obesity, early detection of  complications, increasing the number of doctors and specialist nurses, reducing waiting times, or providing better car park facilities. The overwhelming “winner” was to spend the money on clinical research even if this meant rationing other aspects of the service (Practical Diabetes International, June 2000). more…

More than 200 years ago, the English artist, William Hogarth produced two prints depicting the evils of gin in contrast to the benefits of drinking beer. The inhabitants of Beer Street were portrayed as happy and healthy, nourished by English ale in contrast to the residents of Gin Lane. Gin Lane contained scenes of infanticide, starvation, madness, decay and suicide due to the overconsumption of the “foreign” gin. Its also worthwhile pointing out that the inhabitants of both Beer Street and Gin Lane are drinking rather than working—in Beer Street the workers are resting after their labours, while in Gin Lane the people drink instead of working. What has been less well appreciated is that many of the characters appearing on both prints, as well as being intoxicated, are also overweight or obese. more…

When I was growing up in Scotland, celebrating Halloween was a major event in the calendar and something to look forward to at this grim time of year. Everyone got dressed up (to go “guising”) and participating households carved lanterns out of turnips (a Scottish turnip is an English swede) rather than the now ubiquitous pumpkin. more…

So David Cameron does not know the meaning of the phrase Magna Carta (The Great Charter) or who composed the music to Rule Britannia (Thomas Arne). The prime minister was appearing on the David Letterman show in the US following in the footsteps of his political adversary, Boris Johnson who also made a similar appearance back in the summer. On social media sites the overall impression of Cameron’s performance seemed to be mildly positive with the general impression being that it was slightly dull and wooden with a few light hearted moments. For politicians dull is probably perceived as good. However, one American wit commented the following day on Radio 4 that most Americans wouldn’t have a clue who he was anyway as they were still under the impression that the UK prime minister is Tony Blair or Margaret Thatcher. more…

Over the next few weeks more than 14 000 athletes from 205 Olympic teams and 170 paralympic teams, and 4 million spectators are expected to attend the London 2012 Olympic Games. For the athletes the British Olympic committee has advised against too much hand-shaking in case they pick up some performance damaging infectious disease. The rest of us have to face the prospect of London becoming a potential centre of communicable disease this summer due to the sudden influx of tourists from around the world. more…

Hospitals can be dangerous places. Two things happen to everyone admitted to hospital for more than a few hours—they are put to bed and are fed. Over half a century ago Richard Asher highlighted the obsession hospitals have with beds and the dangers of being confined to bed (BMJ 1947; doi: 10.1136/bmj.2.4536.967). Asher’s description of the dangers of lying in bed still has resonance today—“the blood clotting in his veins, the lime draining from his bones, the scybala stacking up in his colon, the flesh rotting from his seat, and the spirit evaporating from his soul.” In a sense not a lot has changed in that beds are undoubtedly the main currency in discussions with managers.  Hospitals compare themselves by the number of beds under their control and performance is assessed by length of stay—in other words time in bed and doctors are compared by their bedside manner. Richer Asher appreciated the positive effects of going to bed when unwell but riled against the negative impact of overdose—prolonged length of stay which would have resonance with hospital mangers today. more…

Could the e-bra save the NHS? Recently researchers at the University of Arkansas announced that they had developed a remote monitoring system that could be integrated with an individual’s underwear. The “e-bra” consists of a series of nanostructured, textile sensors integrated into clothing using a wireless module that communicates wirelessly with a smartphone, which then can transfer data to the appropriate hospital or clinic anywhere in the world. The researchers claim that the device will be able to monitor blood pressure, temperature, respiratory rate, oxygen consumption, an ECG and neural activity among other parameters. As well as the potential for improving health, the e-bra concept could be of value to athletes and the military. more…