Tag Archives: Health

Computers aren’t doctors

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We all know Google has become the new hypochondriac diagnostic tool. All the same, it’s a bit disturbing how far the NHS has started to behave as if computers have some intrinisic sickness-curing value. And I’m not talking here about that inferior version of Google that you can find in the so-called NHS Direct high street shops. (Add a triage nurse, subtract the coffee and the wider web-surfing capability and these are NHS Internet cafes)

The general opinion on the new NHS computer system puts its cost at over £20 billion.

The National Audit Office claims that this cost will not all be borne by the taxpayer – only £12.4 billions, before factoring in the cost of the “savings” that will result from it. The companies involved – the major one of which was almost destroyed in the process – will somehow meet the shortfall. Hmm. I am definitely too sceptical. My limited understanding of the laws of the market make it hard for me to see why any company would bid for a contract that would cost them £8 billion pounds to complete. Their profit margins must be astronomical. In any case, I remember that about four years ago, this was going to be an unprecedented spend of £6 billion. So even on the most optimistic estimate, this project costs double what it was supposed to.

The Health Minister, Lord Warner, claims that the project will pay for itself. This in itself seems well nigh incredible, unless it means that huge numbers of clerical staff are to be made redundant, which begs the question of who is going to operate the new system then? My doctors and any hospitals I’ve ever visited have used computer systems for years. Were there some strange 19th century hospitals and surgeries lying forgotten in the world of the quill pen?

Correct me if Windows Calculator is wrong here but I believe that £20 billion (cost of shiny new national computer system) divided by 60 million (UK population) is £333.33. That seems to be the cost for every man woman and child in the UK

That’s approximately the cost of a cheap low-end PC isnt it? So this new system would buy everyone in the UK a low-end PC, WITHOUT any economies of scale.

How many doctors and nurses and hospital cleaners would it buy? Quite a fair number I would have thought, if we all club together a bit and put our £333.33 towards wages. A hundred of us could have paid for a junior doctor or a very senior nurse or paramedic or even two cleaners or cooks.

(Yes, I know that the blog has an excessively medical flavour this week. No particular reason, except maybe that getting a post picked up by the excellent NHS blog doctor site has skewed our thinking.)

Bad Medical Science

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Heather wrote yesterday about some woo-like nonsense published in the opinion piece of the Nursing Times. Basically, the article said that obese patients were the cause of nurses back injuries. It was one of those wonderful articles that the print media so love. It had the air of self evident logic and attacked the current social demons (fat people). I am surprised it hasn’t been syndicated out to the Daily Mail (etc).

I had two main problems with the article (obviously lots of minor ones…). First, and most basic, the author of the article makes many, unsupported, assumptions. Statistical correlations supporting their claims are not shown (if they exist) so I have no idea where they drew the data for the claim made. It is shocking that being told “there is no evidence to suggest a link” was viewed as simply meaning more research is required. While continued research into every field of human endeavour would be fantastic, the line has to be drawn every now and then. Continue reading →

Nurse gives fat patients a kicking

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This week’s guest publication is Nursing Times.
It has a Comment article with the heading “It is fair to assume a link between back injury and nurses and patient obesity.” Well, after reading it, you would have to say “it isn’t fair to assume ..etc” There is no evidence in the article to support that conclusion.

It’s getting blogged here just because the argument typifies the increasingly common demonisation of fat people on spurious medical grounds, but from a new direction- obesity isn’t just dangerous to oneself- it threatens others.

The writer refers to HSE statistics on rates of back disorders suffered by nurses and nursing auxiliaries. If one actually examines the HSE data, the rates (31 per 100,000 for nurses and 44 per 100,000 for nursing auxiliaries, in the period from 2003/2005) come with such huge confidence intervals as to be little more than generally indicative of the comparative risks of different jobs. There is no evidence presented here to suggest that these rates are notably higher than those in previous years but this would surely be the first requirement, if the figures are to support an argument that patients are getting heavier and, therefore, healthcare workers are getting injured more. Continue reading →

Everything about diets seems to be bull

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Damp down your instinctive feeling that statistics are really boring for a few moments and bear with me. On the UK Office of National Statistics web pages there is some fascinating evidence that the diet we are constantly told is good for us is probably making us fat. (Fatness being the current manifestation of everything bad that there could possibly be about a human being of course.)

Basically the ONS summary of its data says that British people are getting fatter at a rate of knots. At the same time they are eating less fat and sugar and less calories 🙂 I just have to quote some of it.

“The prevalence of obesity in England has increased markedly among both adults and children since the mid 1990s. In 2002 it was similar for both sexes; the rate for boys and girls was 17 per cent and for adults was 23 per cent. In 1995 the equivalent figures were 10 per cent for boys and 12 per cent for girls, 15 per cent for men and 18 per cent for women.

There is no evidence that the average calorific intake or consumption of foods rich in fat and added sugar has increased in the UK since the mid 1980s. Men aged 19 to 64 in 2000/01 reported a daily energy intake of approximately 2,323 kcal (a reduction of 6 per cent since 1986/87). Women in the same age groups reported 1,642 kcal, a reduction of 3 per cent.

Reductions over the same period were also observed in the contribution of total fat to total energy intake (from 38 to 34 per cent in men and from 39 to 34 per cent in women) and saturated fat (from 15 to 13 per cent in men and from 17 to 13 per cent in women).”

After the “obligatory five pieces of fruit a day injunction – an old moan on this blog – (for which it produces no evidence but shows how many people at different ages eat it) the food page says that people are eating less saturated fat and replacing red meat with chicken.

Now, this stuff bears a good few explanations:

First, it seems a fair guess that many of these people were lying. I think people are more likely to lie about what they eat now than they were fifteen years ago, as we have all got more and more neurotic about our food. So, I wouldn’t becessarily take this at face value.

However, if it’s even partly accurate, the majority (the MAJORITY) of people are clinically obese or overweight*. I don’t know what it’s like where you live but I can’t see that around me.

But, taking the definition of clinically obese as having come to mean a bit plump and above – doesn’t this suggest that eating less fat and eating fewer calories are utterly doomed strategies for staying slim? Eating chicken with the skin and fat trimmed off appears to be more likely to be associated with fatness than eating old-fashioned meat. And so on.

Let me repeat – eating less fat doesn’t seem to make you thin. Now I know fair amount of the blame here goes with the use of hydrogenated fats that are stuffed into all those “healthy low fat” spreads that people still choose over butter, in the belief that they are better for them.

Eating fewer calories doesn’t seem to make you thin.

The website mentions that people eat many more prepared ready-meals and get less exercise. Well, hmm, now that seems more like it.

** Men were more likely than women to be overweight (or obese), 67 per cent compared with 58 per cent. This compares with 58 per cent of men and 49 per cent of women ten years earlier.

(The references are this page and this one)

Why 5 pieces of fruit & veg anyway?

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I am all for hammering the fake nutritionist tosh. “Doctor” Gillian McKeith “PhD (Intenet)” is an obvious charlatan. It’s very hard to see how anyone gave her any credence but – from Channel 4’s point of view – she rifled through human crap on tv, in the presence of its manufacturers even. This was always going to draw audiences. Actual nutrition qualifications would have just been icing on the poocake from the Channel 4 point of view.

I’m not a hundred per cent convinced by more official nutrition advice either. Everyone “knows” we are supposed to eat 5 pieces of fruit or vegetables a day. The government tell us so. There are posters in my doctor’s surgery. I am not disputing that we should eat fruit and vegetables (I’m a vegetarian. I would be going very hungry if I didn’t.)

I just want to know – Who said it? Where is the evidence? How big is a serving anyway?

Well, it turns out that original recommendation came from the World Health Organisation. The 5 a day is a UK version. The USA is more demanding. It wants you to eat 9.

The U.S. Department of Agriculture Food Pyramid recommends three to five servings of vegetables and two to four servings of fruits per day University of Iowa .

Are US fruit and veg weaker in their healing powers? Do American need higher standards of health than we do because of lacking an NHS?

Where does this advice come from? The UK Department of Health has some referenced links to evidence, on its site. Most of these actually turn out to be links to other DOH documents that repeat the same advice. There are however some links to research papers that report lower rates of heart disease and a couple of other reduced risks in those who eat more fruit and vegetables.

So far, fine. The researchers are scientists, so I am sure they will have adjusted the figures for other things that are correlated with living longer – apart from eating more fruit and veg – like being better off & more health conscious generally. I am perfectly capable of working out that fruit and veg are good for you, from any evidence they can produce from their research (plus a lifetime of imbibing this apparently “common sense” message.)

I would like someone to show me where the number 5 came from – was it just a think of number game? Is there any evidence?

I would also like someone to show me where the obscure rules came in – potatoes don’t count; juice only counts as one even if you drink litres of different kinds of juices. Where does the portion size of a serving come from? How can it apply to everyone from a 6’6″ tall heavy set man to a slight 5 year-old?

Unless someone shows there is a real scientific basis for this stuff, it strikes me as government promoted woo. It seems we won’t respond to messages like “It’s probably good for your health to eat a lot of fruit and vegetables.” We aren’t intelligent enough to understand that message. We need to be directed, like the good 1984-in-2007 public we are, in terms that are simple and direct and very prescriptive. It doesn’t matter if the instructions are assembled from guesswork and back of an envelope calculations. As long as we have some rules to follow. With numbers.

Rather like “Doctor” McKeith’s approach to nutrition, really. Oh hang on, she’s an obvious quack.

It seems a disturbingly short step from this nonsense to deciding that vitamins do cure AIDS. I think you’d probably find that most people in the world who have malaria don’t eat 5 to 9 portions of fruit and veg a day. (A lot of them probably are lucky to eat. )

I bet the research shows that most people in the world with HIV infections don’t have cars or travel on planes. I suggest that you drive 10 miles a day and fly 200 miles every 6 months, to lower your chances of catching it.