In the UK surveys show that the public at large believe that, within carefully delineated safeguards, doctors should be allowed to assist intellectually competent adults with terminal illness to die when and where they wish. At present such action would be illegal. With this in mind, on Wednesday 13th October, a healthcare group was established to lobby for change. At the launch, the three objectives of the group, which is called “Healthcare Professionals for Change” and is chaired by Dr Ann McPherson who herself has a terminal illness, were set out. more…

Everybody now knows that while the outbreak of swine flu reached pandemic proportions, the disease itself was less severe than first feared. Illness and death certainly occurred but the original figures never materialised. Despite early estimates suggesting deaths in the UK alone of between 3,100 – 65,000, recent evidence indicates that the figure will be closer to around 400. more…

Whatever else, arguments for and against assisted dying must include the notion of cruelty. In my view there can be little more cruel than to decline the request for help in, or advice on, dying from patients of sound mind, who are competent to make decisions, who are suffering unbearably from a disabling disease for which there is no prospect of improvement, and who have made it clear that they no longer wish to live. On grounds of cruelty alone, we as doctors should be campaigning for change, for the introduction of laws that permit us to assist. Yet overall as individuals there seems little interest in the fight, while our leading medical organisations (British Medical Association, Royal College of General Practitioners, Royal Society of Medicine, Royal College of Physicians) actively oppose change.  more…

For those who follow elections closely, party manifestos are compulsory reading. In some policy areas they set out very specific intentions, in others they offer an overall feel, and in yet others there is a veil of silence. The manifestos of the three main UK parties, as they relate to the future provision of medicines, are no exception. more…

In a recent blog I suggested that relationships between students and teachers will have been changed in those medical schools where students address the staff by their first names. As I saw it, the practice of addressing teachers using surnames and titles will have provided some sort of barrier between teachers and taught. Where this barrier has been lifted (first name terms are standard at my medical school), the greater equality that it will have brought will have been accompanied by a new closeness, and inevitably this will have brought new challenges. In my own experience the new relationships can lead to there being less respect, with rude and aggressive comments. Another outcome might be a greater ‘intimacy’ with the risk of suggestive behaviour and excessive familiarity.  more…

With seven members of the Advisory Council on the Misuse of Drugs (ACMD) resigning in the last few months, and its chair, Professor David Nutt, being sacked, there must be something very wrong with the circumstances in which this group of experts find themselves. more…

A key component of medicine is the diagnosis. The principle process we use for reaching a diagnosis is to identify the patient’s signs and symptoms and then look for a unifying explanation. Based on the explanation, we then label the disease. So, where an illness has three key features (viz oedema, albuminuria and hypoalbuminemia as in nephrotic syndrome), the unifying process can expressed mathematically as 1 (oedema) +1 (albuminuria) +1 hypoalbuminemia) = 1 (nephrotic syndrome), or more simply 1+1+1=1.  more…

Recently I attended a debate on aspects of the pharmaceutical industry. The venue was prestigious as was the audience. There were two speakers and each was given twenty minutes for presentation followed by ten for discussion. The first speaker addressed his title with a talk clearly prepared for the occasion: he entertained, used well-chosen illustrations, masterfully avoided some of the more controversial but relevant issues (as debaters do!), paced his talk well and finished at the allotted time, and finally answered questions professionally. more…

Over the Christmas period the UK had its snowiest, iciest winter in years. It brought with it the obvious medical problems: deaths from hypothermia, breaks and strains and other injuries from falls and accidents, and the disruption caused by hospital closures. It will also have caused countless patients to miss their appointments for starting chemotherapy or radiotherapy or for receiving treatments as part of courses already established.  more…

I strongly believe we are heading for one almighty battle. Millions and millions of pounds have been spent by the drugs industry in the fight against Alzheimer’s disease. Much more money is being reaped as drugs (often of marginal benefit) are used in its management worldwide. With this scenario all was looking secure for the drug manufacturers but then, on 6 January, there was a seismic change in the landscape. more…