Friday, 19 June 2009

Half-baked Beans - or How crazy can we get

The Price of Life on BBC2 was fascinating. It dealt with Lenalidomide for Myeloma. Initially NICE decided that the drug was too expensive, about £47000 for each QALY saved. After the initial NICE decision the drug company Celgene offered a new deal. If the NHS will pay for the first two years of treatment then the company will pay after that if the patient survives. As a result of this seductive offer NICE has approved the drug.

If the drug does not work and the patient dies before two years are up then the NHS pays. Usually when I buy something that does not work I expect to get my money back, in other words the company pays. This deal is thus the opposite of normal commerce.

If the drug does work the company will pay after the patient has survived two years. Presumably they still expect to make a profit so how much must they be making in the first two years in order to afford to give it away after that?

There are a variety of estimates available as to how long patients might expect to live but one paper that was touted by supporters of the drug last year said 5.6 years (Abstract #0441 European Haematology Association 13th Congress June12-15 2008 Copenhagen Denmark). So that means that when the NHS pays for 2 years the company must still expect to make a profit when it pays for another 3.6 years. Assuming that they have built in a bit of a margin for error we have to assume that at least half of the current price is profit. Isn’t that a bit steep? If they had aimed at 10% profit instead then the price would have fallen below NICE’s threshold.

If that is not bad enough, there is an even more dire possibility. Maybe the company knows that the drug doesn’t usually achieve much; in which case they can breath easy that they will make a fortune on the majority of patients who die before the two years are up, and they will pay for the occasional patient who survives against the odds.

This deal must be about the most crazy that the NHS has ever done. The NHS will pay for drugs that don’t work and the company will pay when they do. Is that how we mean to go on? In effect it encourages drug companies to make drugs that don’t work and charge ridiculous amounts for them. Surely we should have done the deal the other way around and offered to pay after two years if the drug company would pay for the first two. That way the drug company only make money if the drug really works.

One thing the TV programme does make clear is that it wasn’t NICE’s idea to do this deal, the offer was made by the company and the Government told NICE that they could not negotiate, so it was the Government who said yes to this half-baked scheme.

You might think that the secret that the drug does not save many people would come out. Think about it, the only people who will live to tell the tale are the occasional patients in which it does work. Of course those who do survive will think it is a miracle and no doubt we will see them in the media telling everyone about it. We won’t see interviews on the TV from the patients who did not survive. I suppose it could get even worse if the survivors thank the drug company for giving them their ticket to life and at the same time the relatives of those who die sue the NHS for providing them with a drug that didn’t work.

I now plan to market a new kind of baked beans, called half-baked beans, which I will say are a great cure for terminal disease. I will charge a great deal for my half-baked beans. When people take them, there are three possible outcomes: (1) they will die; (2) stay the same; or (3) live. If they die, I will say, ‘If only we had started sooner’. If they stay the same, I will say ‘Keep taking the half-baked beans’ (and paying me lots of money). Eventually all these patients will fall into groups I or 2. If they get better, I will say that the half-baked beans did the trick.

I will, of course, make the government a generous offer that I will pay for the half-baked beans for anyone who survives more than two years provided that the government pays for all the other patients.

Anyone wishing to buy shares – the usual brown paper envelope will suffice.

Saturday, 13 June 2009

The night the music died

I took an online writing course with Birkbeck.  We had to submit a long piece at the end so here it is for anyone else to read.  It's quite sad so don't read it if you are depressed.

The night the music died

Rod Griffiths


I never get lost.  If I go somewhere once, I could always find it again years later until that night.  A completely alien feeling came over me as I was driving to a concert.  I had no idea which way to go.  It felt more than lost; it was as though every cell in my body was disconnected, with no idea how they worked together. 

I think if I’d been walking, I might have fallen over; that’s how it felt.  I had to think hard about driving.  I had to ask Lois the way. 

‘Am I having a stroke?’  I thought, but physically I was fine.  Something was happening to me that had never happened before.

The weird feeling lasted about twenty minutes and was finally blown out of me by the concert; Marianne Faithful singing full on, battering, hard rock, and very very loud.  It pushed you back in your seat.  Lois retreated to the safety of the coffee bar in the foyer to listen to the last five songs. 

I felt normal all the way home and slept well until the phone woke me.  Phones always wake me; it goes with my job.  Usually it’s because of some medical or public health emergency, but this time it was my sister-in-law, Alison.

 ‘Sorry to ring so early, I’ve got some bad news.  Laurence has been killed.’ 

Not died, I remember thinking; killed.  It’s not a word that you hear a lot, we don’t say killed by a heart attack or killed by cancer.  Killed is different.  He had been found by the side of the road, dead.  The police were investigating.  They had traced Alison from Laurie’s wallet.  Would I tell mum?  Alison didn’t think it was right to tell mum on the phone and mum lives two miles away from us.  Alison is in Southampton, over a hundred miles away. 

As I put the phone down, something clicked.  I had felt lost exactly when Laurie died.  

My first instinct was to rush down there and save Laurie.  That’s what I do, rescue people, make things safe, fix things.  There was nothing to fix, nothing to do.  Laurie was dead and had been dead for hours, no possibilities, nowhere to go, the end of the line. 

The car that hit him was wrecked, so it couldn’t be driven again.  The driver had been arrested.  There was nothing to do, nothing that could be done.

There is something awful about telling a mother that her child has died.  It feels as though there should be some way to do it, some way to make it gradual, to lead into it a bit at a time, to soften the blow, but it’s not possible.  There’s plenty of different words for death, but the one thing that’s sure is that there is a before and after.  It didn’t matter whether I said something terrible has happened or just said Laurence has been killed.  It didn’t matter if I took half an hour over it or got it all out in a minute.  Before the death word, Laurie is alive in mum’s mind; once I’ve said it, he’s gone.  It almost feels as though I’ve killed him.  In my mind, I can still see the room, where mum is sitting, me standing over her.  I feel too big, as though I’m a huge shadow, I feel as though I am a threat, breaking up her world.

I don’t know what we talked about, but now I know what they mean by ‘an elephant in the room’.  Whatever we said there was something enormous in there with us.  Not an elephant, but a sort of black cloud, an empty space, a dead space.  Now I have a different kind of lost feeling, I can feel myself and I’m all in one piece, but there’s something wrong with the world now.  I stayed with mum for a while and eventually went home.  I wished I could take the black cloud with me, but I knew it was still there.  That was hard.

The next few days were difficult; I can’t remember them at all.  I went to work, I told some of my staff and friends what had happened and I thought I was functioning normally; I found out several days later that I wasn’t.  I’d been in a meeting, an important meeting with the Chief Medical Officer, at which serious issues were being discussed, and afterwards one of my colleagues asked me what was wrong. 

 ‘You look like something terrible has happened.’  This was Mike Gill who did the equivalent job to mine in the South East.  I was shocked to discover that it was so obvious.  Maybe Mike is particularly sensitive and observant, but it was still a shock.  It made me wonder how many people who seem to be having an off day, or react badly to something, are really in the middle of some crisis that no-one else can see.

For weeks, my lost twenty minutes played on my mind.  Did Laurie lie in the hedge for twenty minutes, alive, smashed and helpless, dying in agony?  It was chance that he was found at all.  Someone who had seen the crash, or got there just after, had phoned the police and ambulance.  The two people in the car were unhurt so the police had assumed that no one had been injured, but the ambulance turned up anyway.  The paramedic on the ambulance had walked along the pavement looking around and just caught sight of Laurie lying on his back on the other side of the hedge.  He had been thrown clean through the hedge and was lying in a garden. 

Once the paramedic had crawled though the hedge he could tell that Laurie was dead but we didn’t know whether he had been killed by the impact or died in the garden.  The police assured me that he must have died instantly, but they had no evidence for this.  I had difficulty in getting across to them that I was a doctor, an experienced one at that, and for my peace of mind I needed to know what injuries Laurie had.  I simply could not accept that a policeman with no medical training could tell me how quickly he had died; I needed to know what his injuries were.  I asked for the post mortem report.  I couldn’t see any reason why I should not be given it; he was my brother after all.  The policeman said he would deal with it, but it never came.  I was fobbed off with excuses, it was about five months later when the full inquest took place that I eventually found out what the injuries were. 

Why did it take so long to get such a simple piece of information?  The matter was the subject of a police investigation; they might charge the driver with dangerous driving, so all the evidence had to be kept secret until the Crown Prosecution Service had made up their mind.  I have no idea what heartless idiot dreamed up that particular nuance.

You might think it would be obvious how fast someone dies.  You might think it would be easy to tell, but it depends a lot on the kind of injuries that they have.  Five months later this is what I learned.


Laurie was walking along the Avenue, a big road coming out of Southampton.  He was walking north along the pavement, what the Americans call the sidewalk.  There are four lanes on the roadway, separated by white lines, no central reservation.  It’s in a forty miles an hour zone.  The Maserati was travelling in the same direction coming up behind him.  It moved out into the third lane, the outside lane coming south, as it overtook a line of cars.  At some point, the driver swerved back across to the northbound lanes and lost control of the car.  It came at an angle, crossed both northbound lanes and hit the curb.  That made it bounce up and fly through the air above the sidewalk until it hit a tree.  It made a big dent in the tree, bounced back and spun in mid air so that it was now travelling along, a foot above the pavement where Laurie was walking, and spinning around in mid air.  It was behind Laurie when it hit the tree.  It flew along spinning around anticlockwise in mid air so that what hit Laurie was the off side rear wing, just behind the back window.  It was still spinning in mid air and turned right around before it hit the ground and finished sideways on, back in the road way.

When it hit Laurie, the side of the car was going north and swiping sideways simultaneously.  Laurie would not have known anything about it.  If it had been travelling at the speed limit of forty miles per hour then it would cover around sixty feet in a second.  All the witnesses at the inquest said that they thought the car was speeding but even at forty it covers sixty feet in a second. 

The tree was about twenty feet behind Laurie, as far as we can tell.  When the car swerved across the road, it was probably sixty feet away.  At that point, a second before it hit him, Laurie had an average life expectancy of 17 years, if he were an average Englishman, though he was a fit 57 year old who had never smoked so probably he had at least 20 years of normal life ahead of him. 

A second later the shiny blue paint hit Laurie’s right side and smashed his thighbone and his pelvis.  The wreckage of those bones and the tissues underneath them did massive damage; if he could have been got to hospital quickly at that point he might still just have lived.

If you break a long bone, like the femur in the thigh, it can kill you because you might lose so much blood that there isn’t enough to keep the rest of your vital functions going.  The thigh is thick, if the bones are smashed you can lose several pints of blood into your thigh and pelvis and that’s enough blood loss to kill you.  The more broken bones, and the more places they are broken, then the greater the loss of blood.  Of course, it takes time, if someone got to him and put pressure on it to slow up the bleeding and if they could quickly give a transfusion then he might have been saved.  It takes time to die; he might have lived half an hour, but the Maserati wasn’t finished with him yet.

As it spun in the air and hit Laurie he must have rotated over against the car, as his legs were hit from under him he would fall towards the car as it carried on spinning towards him.  Bits of his clothes were embedded in the paint.  His chest hit the side of the car, and it smashed most of his ribs and it tore his lung in three places. 

The lung is like a massive sponge, but weaving between all the air sacs are blood vessels, they run very close to the air sacs so that the gas in the air can diffuse across into the blood, oxygen comes in and carbon dioxide goes out.  Tear the lung apart and blood will leak out, filling the air spaces and drowning you.  How fast you die depends on how much damage is done.  As long as the air passages are still connected and some blood can still circulate, life is possible. 

The wreckage of his chest wall would be a bigger problem.  The ribs make the chest stiff so that when the muscles pull it outwards to breathe the space inside gets bigger and that sucks air in.  The diaphragm pulls downwards and that makes suction as well, so air is pulled into the lung.  Laurie’s chest wall was smashed to bits; any suction that his muscles could manage would collapse the smashed chest inwards rather than sucking air in.  He wouldn’t even be able to cry out because if he tried to force air out through his voice box, the pressure would just blow his shattered chest wall outwards and no sound would come out of his voice.  Life would still be possible if someone were there to give him mouth-to-mouth respiration, to blow air into him, and eventually connect him to a respirator, but he couldn’t shout out. 

Left alone he would be dead in three or four minutes, that’s how long the brain can survive without oxygen, not much of the twenty years he should have had, but the Maserati wasn’t finished yet. 

The crushing blow to his chest had torn a hole in his heart.  Every time his heart tried to pump blood, all that would happen is that it would squirt out into his chest instead of round his body.  Now he was probably beyond help, but his brain would still have been alive.

Not much longer.  If he’d flown through the air into the hedge where he was found he might have been aware of hitting the floor, of some pain as he passed into unconsciousness and died but he was spared that.  As the car whirled through the air and his smashed body was wrapped around the elegant Italian metal, it broke his arm, and then smashed his skull.  That last blow tore his brain into three pieces.  So that was where he died, flattened against the car as it spun around, and then his dead body slipped off and was hurled through the air; through the hedge and fell lifeless onto the ground, twenty feet away, eyes open, mouth open, shattered beyond life.

How long did it all take?  It took a third of a second or less for the car to get from the tree to Laurie; just long enough for him to begin to hear the bang. 

When car spins around the ends travel faster than the middle, so that the part that hit Laurie was going about seventy miles per hour, arcing sideways.  An object going at seventy will travel about a hundred feet in a second.  From when it hit his leg until his head hit, the car it can only have travelled one or two feet so it took about a fiftieth of a second to break almost every bone in Laurie’s body and tear his brain to bits.

The fastest nerves in the body conduct impulses at one hundred and twenty meters per second.  In a fiftieth of a second, a nerve impulse might just travel the distance from the foot to the brain.  There is no way that Laurie knew what hit him or even felt anything, his brain must have been torn apart and not working before any sensation could have reached it from any part of his body. 

I couldn't work all that out until I had heard the pathologists report at the inquest.  Until then I had imagined Laurie lying in the bushes, smashed but alive, knowing he was dying, helpless and alone.  I know anatomy well because I used to teach it. 

I had considered every kind of awful scene with Laurie lying there, wondering if he might have survived, if only someone had known he was there.  The policeman said he must have been killed instantly, but they gave no details, and what do they know of anatomy and physiology?  Did the policeman know the speed of nerve conduction?  I doubt it; he certainly didn’t mention it to me.  I told the police that I was a doctor; that I needed the details to make sense of it in my mind but they did nothing to help.  I didn’t say that I’d had this weird feeling at around the time he died, I didn’t say that it felt telepathic, I think that would have spooked them and might even have meant that they didn’t take me seriously.

I still resent the fact that it took five months to get the information that I wanted.  Why could they not let me talk to the pathologist?  I eventually decided that the CPS or the police must have some policies to keep relatives at arms length, perhaps so that they can’t be accused of bias. What we got was a liaison policeman who appeared to take our side, gave little information that had any value and said things that were wrong, like ‘we are going to get this guy’.  To me it felt cruel.  If there really is a policy designed to ensure lack of bias and effective justice then they should say so.


I should not have taken any notice of my telepathic premonition.  There is no evidence that such things are real.  It is all too easy to believe connections that seem to lead to something, but there is clearly a huge possibility for recall bias.  If I get a premonition that something awful will happen, and nothing does, then I’ll probably forget it; forget I even thought it.  On the other hand, if something does happen, then not only will I remember that I had a premonition, but I will tend to believe that I am psychic, and that all future premonitions will be true.  After that, I may start to see connections that aren’t there, or to re-interpret my premonition in some way so that I believe it to be true. 

If I wake up with an awful feeling and I’m planning to go on a train, I might think that the train will crash, so I go by car instead.  I probably don’t even check to see whether the train has crashed, and even if it doesn’t, I might think the only reason why it didn’t crash was because I wasn’t on it.  If you talk to people who claim to have premonitions you often find this kind of logic, or non-logic, behind the evidence that they cite to tell you they are psychic.  If I had told the police that I had telepathic messages from Laurie about his death, I doubt that they’d have believed me; although the police themselves have been known to consult so called psychics when they are stumped, though of course, those are police approved psychics, which I am not.  

On a different level, it shouldn’t matter whether my premonition was real.  Well it wasn’t a pre-monition was it; it was a coincidence-monition, though I don’t think that’s a real word.  The point is that it happened at exactly the same time as Laurie died; it wasn’t a warning, but whatever you call it, it was real to me and because of it I wanted to know.  I suppose the policeman thought he was reassuring me by telling me that Laurie died instantly, but I don’t think he knew anything about how reassurance works.  He told me what he thought I wanted to hear.  What he should have done is found out my fears, got to the bottom of what was bothering me, and then sought information to answer my questions.

There were other things wrong with the policeman’s approach; he told Alison and Rachel, Laurie’s daughter by Alison, that the police would get the driver.  He passed on interesting information about the car; it had been ‘blown’, supercharged, in some way so that it would go even faster.  The implication of this was that the driver was even more culpable, a value set that said, ‘people driving around in souped-up sports cars are bound to be irresponsible’.  Of course, that doesn’t follow at all, and even if it did, the simple fact of being in such a car does not prove the driver guilty of dangerous driving.  It was just more of playing to stereotypes, telling people what he thought they wanted to hear.

The Maserati driver claimed that he had swerved to avoid a black Smart car that had pulled out in front of him, and then he’d lost control of his car.  In effect, he claimed that the Smart car was the cause of the accident.  Enter another stereotype; we all know that owners of Smart cars are known to nip in and out of traffic, maneuvering into spaces that the rest of us can’t do and being a general nuisance.  The terms Smart car driver, and smart-alec become interchangeable.  Actually, I’ve since bought a Smart car, a pink one, and I now believe a different stereotype, Smart car owners are environmentally conscious, responsible people who are also friendly and flash their lights and wave to me when they see my bright pink car.

What the policeman should have told us is that the Crown Prosecution Service (CPS) need to be convinced that they can win the case; there is some sort of rule that says that they have to believe there to be a better than fifty percent chance of winning before they will prosecute a case.  The Maserati driver blamed the Smart car; the policeman gave us no hint that such a story might be enough to convince the CPS that they might lose the case.  If a jury were to believe the Smart car story then the prosecution might collapse.  Was it a believable story?  Was there a fifty-fifty chance it was believable? 

Later the police would write to every Smart car owner in the UK to try to find the Smart car; and they failed to find it, failed to see it on any of the cameras on the road, failed to find any witness who had seen it.  You might think that was good evidence that it did not exist.  It doesn’t need to exist to destroy the case, there just has to be enough of a possibility that it might exist.  The policeman didn’t tell us that. 

Laurie would have been amused by my pink car, he who once owned a bright orange Bond Bug.  I don’t know whether there was a black Smart car, I do know there was a Maserati and I do know Laurie is dead. 

Laurie wrote computer programmes and played music; he also sailed, windsurfed, cycled, thought about math and physics and worried about himself; the later I only discovered when I tried to make sense of what was in his computer.  Laurie got a first in physics from Cambridge.  He worked for IBM and then Microsoft as a programmer; when you watch a video in Windows; the code was written by a team that Laurie managed.

He played the guitar.  I remember when I was fourteen, and he was twelve we had a guitar between us as a Christmas present.  My dad actually said to me ‘was I really sure that I wanted it’.  I think he had a premonition of what would happen, Laurie played the guitar constantly and I never learned.  I might have had some romantic dream of waving it about in an interesting way, whereas Laurie made it an obsession.  I got a good deal though; at least he stopped playing the oboe.

In Southampton after a while he helped found the Spike Island Band (, a group he was still playing with when he was killed.  He wrote a computer programme to help him with his music; he called it MUSE.  It was an abiding interest that had been with him a long time, first when he was at IBM and then when he moved to work for Microsoft and Sony.  He sold MUSE as shareware on the internet, it will transcribe music into different notations, if you have a piece of piano music and want to play it on the guitar, it will convert it into guitar notation, or any other instrument for that matter.  I’m not a musician, the only one in the family who is tone-deaf, so the programme just leaves me standing in wonder. 

Laurie took early retirement from Microsoft because they moved the work he did back to Seattle; he took his stock options, which made him a millionaire, paid a vast amount of tax, and started on the next phase of his life.  That included writing MUSE mark two.  It was almost done; he had been working most of the night to finish the final edits and bug fixes the night before he was killed.  He wrote emails to that effect in the early hours of the morning.  Some time in the late afternoon, he took a break.  He left his computer on when he went out.  We think he went to buy a puncture kit to repair his bicycle because he was carrying one when he died.  One way or another he wound up walking along the avenue when the Maserati hit the tree and smashed him to bits. 

‘He was just in the wrong place at the wrong time’ said the policeman, ‘ten seconds either way, and it would have missed him.’

‘It was the Maserati that was in the wrong place at the wrong time’ I said.  We had that sort of conversation over and over with different people; I had great difficulty making clear how insulting it is to imply that Laurie did anything he should not have done.  People mean well, but somehow putting it like that implies that Laurie was doing something wrong.  The wrong place, so where was the right place?  The wrong time, so when was the right time?  Laurie was doing what anyone is supposed to be free to do.  He was walking along the pavement, minding his own business.  What was wrong was that a car that was out of control flew through the air and attacked him from behind.  Cars and car drivers do not have rights that over-ride everyone and everything else.


I guess every sudden death leaves loose ends.  What should we do about MUSE?  It seemed such a terrible thing to waste all that work, but none of us understood it.  When we went to Laurie’s house, the computer was still on.  None of us were sure if there was a password needed to get back in if we turned it off, so we left it on.  I met my other brother, Gareth, at the house and we set about trying to get information off the machine in case it crashed.  I took my laptop and we guessed where the important files were for MUSE and copied a version onto the laptop; it seemed like the right thing to do. 

We really missed Laurie, whenever I have had a problem with computers I’ve phoned Laurie; he phoned me about anything medical.  It was a fair swap.  Laurie who worked at Microsoft, knew Windows backwards, he helped write it after all.  We struggled.  Although we made copies of MUSE and got it to work, we had to stop selling it because none of us could have fixed a problem. 

I found letters on the computer from people who had bought MUSE.  They loved it.  They told great stories about how it had helped them with their music.  There was a network of enthusiasts across the world that used the programme.  We had to write and tell them that Laurie was dead.


Digging my way through Laurie’s computer was harder than I imagined.  The technology was bad enough, because he’d taken advantage of everything he knew about computers, but worse was seeing into his mind.  He used the PC to make notes to himself, to work through problems, almost self-counseling.  Now I know what dead letters are.

Every time I opened a file, something struck a chord.  In some respects, we weren’t alike; but in other ways we were.  That’s what it’s like going through someone else’s life, chords everywhere, but no rhythm and no music, the music’s died.



See also for news reports


Friday, 12 June 2009

Swine Flu

I've been reading some of the posts to the BBC about Swine Flu. The predictability is awesome, mostly along the lines that this is a media hype.
I looked at the figures from CDC in the USA. As of today just over 13,000 cases and 27 people have died, in other words about 1 death in 500 cases. At the moment in the UK, as I understand it, we are still trying to contain Swine Flu. That means each time there is a case then all the possible contacts are traced, and given antiviral drugs. Classes or whole schools are closed, people sent home from work, whatever it takes to try and stop each case giving it to lots more people. So far this has kept the numbers down to 800 cases.
It also means that all these cases are going into hospital as needed and no doubt getting the best possible treatment. It also helps that it's summer, a time when Flu viruses don't usually spread in the UK.
If the numbers increase faster then it won't be possible to contain it because there will be just too many contacts to trace, and not enough health workers to do it.
You might think contact tracing is easy, but for Flu it is made more difficult because the incubation period is short, and new cases are often infectious before they have symptoms. Even if everyone is being very responsible (how likely is that?) and not going out when they have symptoms, they may still give it to lots of others before they know that they have it. Plus of course there will be very mild cases who don't even realise that they have flu, and they can still spread it.
Make a list of everyone that you met three days ago and then see if you can find them all in the next two days, and see if you can find all the people that they met in two more days, and all the people that they met in two more. You get the idea?
Once it gets out of hand, in other words when it is spreading faster than the health workers can keep up with it then we will move to the next stage of the strategy. I think what is supposed to happen then is that if you think you have symptoms then there will be a number to phone in order to collect your antiviral pills. You'll probably have to send someone to collect them and while they are there they might as well get some for themselves because they will catch it off you when they bring you the pills. If you don't start taking the pills within about a day of symptoms starting then they don't work as well, so make sure you have your pill collecting volunteer handy.
If we are lucky, and sunshine still works then we might well contain it until next autumn, let's hope so. Once it gets out of hand then probably 20% of the population will get it, possibly more, which is about 10,000,000 cases and if 1 in 500 die then that's 20,000 deaths. Of course if it gets to that, then probably they won't all be treated as well, and those who are already ill may find it harder to avoid because there will be so much more virus circulating, so we might have more than 20,000 deaths.
On average there are just under 10,000 deaths from all causes each week in the UK; so a mild flu outbreak which adds 20,000 deaths over a 10 week period will increase deaths by about 2000 per week, a 20% increase. At that rate the funeral service should cope and we won't have bodies in freezer vans waiting to be cremated or burried or need to have funeral pyres like the foot and mouth outbreak. It wouldn't take much more than that to cause a problem, the funeral market is pretty stable so there is not a lot of competition and over capacity. If the virus got a bit more lethal and particularly if it killed younger people who were not about to die anyway, then queues to be burried will develop, and once they get behind then they will get more and more behind over the period of the epidemic. Well I suppose we could cremate people two at a time or have church services in the middle of then night (so long as the preacher doesn't have flu).
So, to sum up, for all those cynics saying it's all media hype, I suggest that they get out there and catch it as quick as they can. If they are right, and it's mild then they will soon be immune, and able to collect pills for everyone else, and if they are unlucky and die, at least they won't have to queue for a funeral.

Wednesday, 10 June 2009

Noises in my head

When I started this blog I had every intention of trying to write something most days.
Life intervened pretty quickly. 

I've had tinitus for many years, I think it came from using electric polishing machines making boats out of fibreglass many years ago.  OK so I've got used to it but it's changing.  Maybe I'm just getting old, but I am beginning to think I have Meniere's disease.  Occasionally and the last two days were an occasion, the tinitus gets louder and takes on a pulsating chatacter.  So imagine a high pitched white noise that getes louder in time with your pulse.  That lasts about four hours, maybe six, somtimes and then I begin to notice the giddyness.  The world keeps moving gently across and downwards to the left.  After that it's probably an hour before I'm sick and then it gets better, the pulsating stops but I feel wiped out and don't do much for a while.  
Hence no blog, and what better subject to return to than Meniere's or whatever it is.
In the event that anyone else with the condition, or anything like it, is reading this then I'd love to compare notes.  Seriously I would.

Apart from that it's been a good day, I didn't even get very annoyed with the Today programme. It's only a matter of time before I start ranting about their lack of optimism and lack of numeracy but it can wait.  One bout of giddyness and vomiting will do for now.

Saturday, 6 June 2009

Inspiration from Jenny Murray 

I heard a good piece by Jenny Murray on women’s hour about an Asian mother’s-in-law.  Apparently this woman has been jailed for keeping her daughters in law as slaves.

When I was in general practice back in the late ‘70s it was not uncommon for young, recently married Asian women to turn up at my surgery complaining about mistreatment almost as bad as the situation described by Jenny.  Of course they usually said they had a cold or a headache.

I used to subtly arrange for these beleaguered women to come back to see me on Wednesdays, which at the time tended to be light days.  I could take longer with the patients, but also by asking all these women to all come on the same day I was able to create an informal support network so that they at least did not feel alone.

The other important thing was to remember to give them a prescription, because mother-in-law would ask to see it as proof that the visit was genuine.

I remember saying to one of them, “Why don’t you go to night school and get some qualifications?’

She just laughed.  ‘My mother in law would never let me,’ she said.  ‘We all know what happens at night school.’

I have to say that was a surprise to me, I thought people studied to get on rather than get it on.  I should have listened more carefully, several years later my wife went to night school, with encouragement from me and of course ended up having an affair with the teacher, and ultimately leaving me.

It seems to me this is absolute evidence that doctors should listen to their patients.