When John Sentamu stood up in the House of Lords a couple of weeks ago and spoke about the need for the NHS to concern itself with “spiritual” needs – and illustrated his claim with an anecdote about something resembling an exorcism – the response from a lot of the blogosphere was, at its friendliest, one of pointing and laughing.  It’s very easy to see why.  Not only is it slightly embarrassing that in the UK you can be made a Member of Parliament for being good at believing in the right kind of god in the right kind of way, but the NHS – and healthcare generally – is successful when and because its clinical procedures are based on science and reason, not spooky ghosty stuff.  (In fact, I struggle to see what Sentamu actually meant.  He was empatic that the spiritual is not the same as the psychological, but this just prompts a question: what, then, is it – if anything?  If you remove the psychological from the spiritual, does anything remain?  And if it does, how do we know?)

Anyway: I was prepared to go along with the pointing and laughing.  But then, on Saturday, I saw a DVD of The Exorcist for a couple of quid and impulse bought it; and, that evening, I turned off the lights and watched it.*  You’ll have to bear with me on this, but it made me wonder if there might be something interesting about the idea of “spiritual” care on the NHS.  Not that I believe for a moment that there’s such a thing as demonic possession, or such a thing as a soul or spirit.  Of course there isn’t.  But it doesn’t follow from that that such terms have no place in respect of some forms of care. more…

Stephen Latham has picked up a lead about NICE guidelines on the provision of caesarian sections:

An update of a new guidance document being developed by the UK’s National Institute for Health and Clinical Excellenct (“NICE”) would permit caesarian section on maternal request, even when there are no medical indications for the procedure. [...] The new guidelines make me worry that the official availability of c-section on maternal request in the UK will lead to some non-medically-indicated c-sections being performed for reasons other than “maternal request,” like physician scheduling convenience. But it may work differently in the NHS; and anyway, the NICE guidelines include a number of steps to be taken before acquiescing in mom’s request for CS, like counseling on fear of childbirth, and proper discussion of the comparative risks of CS and vaginal birth.

Even allowing that this is accurate, I don’t quite see why Latham is worried about a CS being scheduled for reasons other than maternal request – it’s a heck of a leap from “maternally requested” to “requested by someone else”.  What worries I do have are versions of more general worries about providing any medical intervention at all on demand; as a rule of thumb, I think it’d be hard to justify providing any procedure just because it had been requested.  On the other hand, I can well imagine that there’re lots of situations in which a CS might be a perfectly reasonable thing to request, and in which acceding to such a request is just as reasonable.

A lot still hinges on whether Latham is accurate, though.  As far as I can tell, he isn’t quite right.   more…

Right now, physicists are pondering the fallout from the collision of high-energy particles.  (Probably.)  And I, for my part, am pondering the fallout from the collision of high-energy nonsense.

Having had this brought to my attention, I’m led fairly quickly to this, then this, and, finally, this Mail on Sunday piece.  All the links refer to a story in which a hospital is apparently using £200k or so of Lottery money to fund research into spiritual healing based on Reiki.  I’m willing to bet dollars to doughnuts that the research finds that spiritual “healing” is utterly ineffective, except when it means people don’t avail themselves of real medicine – in which case, it’s very effective and its effects are undesirable.  Spiritual healing is bunk; one could reasonably think that a trial into it is a waste of money.  We oughtn’t to waste money, so, modus ponens, we oughtn’t really to be doing this kind of research.

In fact, there’re likely to be big problems with spiritual healing research of any sort, simply because participants may feel that there’s less need to continue using established treatments, and thereby end up worse off.  And when others continue with conventional treatments, it’s going to be hard to tell which of their outcomes was attributable to which – so the research’ll likely tell us nothing.  Hence I wonder whether the research will yield anything publishable: if not, then the whole thing will have been in vain, and there’s something problematic about enrolling people in trials that stand a chance of being, from a publication point of view, barren.

I’m not actually going to go down that route here, though. more…

There’s been a lot in the news over the last couple of days about the Military Covenant, and how there’s a plant to give it a legal footing as part of the Armed Forces Bill.  Some of the reportage over the weekend suggested that there would be explicit prioritisation for members and ex-members of the forces in respect of healthcare.  In the document that was published yesterday (link to 1.4M .pdf file), that commitment seems to be moderated – which is a good thing (for reasons that are basically the same as I outlined in an earlier post).

But healthcare does get special mention in the document; and, though it’s too long a mention to do proper justice here, it is worth quickly noting the highlights – or, rather, lowlights.  It’s the sort of thing that seems designed to please the tabloid press, but which will, in practice, please noone – not people like me, who think that special pleading for the military is moral hokum, nor people who think that special provision ought to be made but won’t find it here. more…

A medical student from Newcastle writes:

I am currently writing an ethics assignment relating to a paediatric placement I undertook earlier this academic year.  During the placement I was involved in the care of 11-month old twins from Khartoum, Sudan, whose parents had brought them into hospital because they were suffering from recurrent generalised tonic-clonic (grand mal) siezures.  As part of their treatment, they were administered with intravenous antiepileptic medications, as well as maintenance fluids.  The day after their admission, however, the family were informed that their application for leave to remain in the UK had failed, and that they were to return to the Sudan with immediate effect.

I would like to use this scenario to highlight the ethical, legal and professional issues raised by the medical treatment of failed asylum seekers on the NHS.  The reason I am contacting you is to ask whether, as an expert in medical ethics, you are aware of any textbooks or published documents which may offer some guidance on this issue?  Given the highly specific nature of the subject, I know the best I can hope for is a chapter in an ethics textbook, but the hospital and University libraries I have visited have not yielded any results; furthermore, I am afraid the internet simply does not seem to contain many credible sources of information.

This looks like a really interesting – and important – study; but I have to admit that the best I could do was to recommend a trawl of the journals.

Does anyone out there have any more specific suggestions?  It’d be much appreciated if you’d leave them in the comments.

By far the biggest response that this blog has had came when I had a bit of a rant about Nadine Dorries a couple of weeks ago.  I’m back on her case today; she’s the gift that keeps on giving.

This video* provides footage of her speech to the Commons on Tuesday night; there’s a transcript available here.  It’s a fascinating insight into the way that the anti-abortion lobby (I refuse to call them pro-life) has appropriated the language of choice, and tries to present itself as the true defenders of women.

Dorries’ speech has two distinct parts.  The gist of the first is that the law should guarantee that women give informed consent prior to having an abortion.  On the face of it, that seems eminently sensible.  But there’s a couple of things that don’t quite stack up. more…

Xtaldave, who does things with science here at the University of Manchester, has found a vacancy for a job working as an NHS homeopath in Tayside – a trust that has just had to shed 500 real jobs.

Manchester is nice, but Tayside is nicer, and the pay is excellent.  Naturally, he’s applied for it.

Whilst I have no formal medical qualification, I believe that I am ideally suited for the job of handing out sugar pills to unsuspecting patients on behalf of NHS Scotland. My PhD level scientific training and 6½ years postdoctoral experience means that I know lots of scientific and biomedical buzz words with which I can bamboozle prospective patients like “medical biomimicry”, “postconditioning hormesis” “quantum entanglement” and “the placebo effect.”

My biochemistry degree means that I am familiar with such vagaries as Avogadro’s constant, but given the extremely attractive salary (at least compared to scientific research), I’m sure I could be convinced to overlook the fact that homeopathic remedies with a potency over 12C contain zero molecules of active ingredient whatsoever.

The original research that I have published means that I am familiar with the body of published work on homeopathy, and the many meta-analyses and systematic reviews conducted on it. The fact that these conclude that homeopathy is no more effective than a similarly administered placebo will not bother me whilst I am taking advantage of some of the excellent salmon fishing to be found in the Tayside region. Indeed, given the fact the position only calls for the successful applicant to attend two sessions per week, I should imagine I would have plenty of time to indulge in a bit of fishing.

In conclusion, whilst I may be an atypical applicant for this post, I will do my level best to help any patients referred to me to get the best healthcare the NHS can offer – by referring them straight back to a doctor who won’t prescribe them worthless sugar pills at the taxpayers expense.

With a supporting statement like that, I’d've thought he ought at least to be interviewed…

UPDATE: David Colquhoun, who has (ahem) experience with this sort of thing, is applying as well.  I’m beginning to wonder whether I should give it a go, too.  I’ve only got a disappointing GCSE in physics, but I did try nux vomica to treat a migraine when I was younger – and only a few hours and a good sleep later, I’d almost completely recovered.  Take that, science!

There’s an intriguing paper in May’s JME by Christopher Cowley in which he proposes a “retrospective QALY”. more…

… available here.

An article in a recent BMJ has caught my eye: Yates and James’ “Risk Factors at Medical School for Subsequent Professional Misconduct: Multicentre Retrospective Case-Control Study”.  Based on an admittedly-small sample, it suggests that

male sex, lower estimated social class, and poor early performance at medical school were independent risk factors for subsequent professional misconduct.

A number of comments on the “Rapid Responses” page – and the authors themselves – indicate that the survey isn’t big enough to say much of much importance, but they find it interesting nonetheless.  For the purposes of this post, I’m not all that bothered by questions of statistical significance, or even by any policy implications that such findings may have.  There’s a number of other interesting points to make. more…