Tuesday, February 13, 2007

If bird flu grips Britain, NHS doctors will need guns

The NHS will be unable to handle a pandemic

Towards the end of the film Dr Strangelove, Peter Sellers discusses who will go into the mines to survive. A surreal echo came for myself and colleagues recently when we were in discussions about planning for a bird flu pandemic in the UK as part of an ethics committee. If a true pandemic of bird flu hits these shores then our notions of what we can expect from the National Health Service will have to change. Some people will have to be denied potentially life-saving treatment: there simply will not be enough beds.

Managing such a pandemic is unimaginable. While it is possible to work out what will happen if a bomb goes off in central London - we can empty intensive care units, mobilise extra staff and stop elective work - what we cannot plan for is 200,000 extra patients who need a life support machine. Arnie Schwarzenegger, the governor of California, says his state will buy thousands more machines, but who will man them? A gut reaction is to blame the government for underresourcing. It is true that we have a chronic underinvestment in intensive care compared with the United States, Australia or other European countries. In any normal situation such a criticism would be valid, but in a pandemic it becomes a statistical irrelevancy.

Who will decide, and on what criteria, those getting the chance of survival? If you and a friend get bird flu and you both end up in hospital, the estimates are that within 48 hours one of you will need life support. At conservative estimates the need for intensive care will be about 2 times more than we can provide. Allocation of such resources will have to be either on a first come first served basis or on an explicitly utilitarian basis of capacity to benefit. This shift from an egalitarian free access to a limited one based on expected outcome represents a profound shift in how we deliver healthcare.

Exclusion criteria have already been drawn up in Canada and the United States and include such contentious issues as restriction based on age or on preexisting disease such as cystic fibrosis or metastatic cancer. Saying "no" to a desperately ill child with cystic fibrosis or to a previously fit 85-year-old is not something we are morally or emotionally prepared for. By an ethical analysis it may be the correct thing to do, but will patients or their relatives be prepared to accept it?

Such arguments may, of course, be purely academic. Assumptions as to what we can do are based on the doctors and nurses, porters and technicians turning up to work. But if we do not have enough masks to protect staff dealing with infected patients, then do the staff have a moral duty to turn up for work and get infected themselves? It may be that they go to work but only once - who will want to return home and potentially infect their own family?

In Victoria, Australia, it was suggested that patients would not go to the GP but to a "flu centre". The idea that patients would go to where flu is concentrated displays an astounding lack of comprehension of human nature. Similarly, staff will be reluctant to put themselves at risk. HSBC, the banking group, was accused of scaremongering when it announced that perhaps 40% of its staff would not turn up for work in the event of a pandemic, but the NHS may suffer just as badly.

It is not only the risk of infection that may stop staff turning up to work. With such limited access to intensive care, it would be expected that hospitals might not be safe places at all. If I decide not to ventilate someone, his or her relatives might not be too happy. Threats to staff are all too common and many are worried about personal security. Consequently it has been suggested that the decision as to who gets the intensive care bed should be taken away from frontline staff in order to protect them.

At a discussion over how we would react to a biological emergency, where casualties would be decontaminated before we resuscitated them, it was asked who would protect the staff. The answer given was hospital security. Pleasant and helpful as they are, these guys are hardly equipped to deal with an angry mob. One doctor said that the most useful thing staff could be given in such an event was a gun.

Another concern is the legal position of staff who refuse treatment. In the absence of any measures put in place to protect them, one can imagine a raft of legal actions being taken out against them. If attempting to allocate resources on the basis of capacity to benefit is the right thing to do, then those making the decisions need to be protected, otherwise people will not make the decisions required. Perhaps the only equitable and fair way is to shut the intensive care units and limit treatment to the best we can achieve without artificial ventilation.


Is breast milk a ‘junk food’?

The British Food Standards Agency's clumsy new and allegedly 'scientific' model is demonising perfectly healthy food

‘If breast milk were a commercially available product you wouldn’t be able to advertise it, though you could still advertise Diet Coke. That doesn’t make sense, does it?’

Nigel White, secretary of the British Cheese Board, is more than a little cheesed off by the UK Food Standards Agency’s new attitude to various foodstuffs. Next month, the Office for Communications (Ofcom) will enact its ban on TV advertising of junk food to children. But first, a model had to be constructed whereby foods could be judged ‘unhealthy’, and therefore subject to the ban, or ‘healthy’, and therefore not subject to the ban. The arbitrary and clumsy model conjured up by the Food Standards Agency (FSA) will mean that foods such as cheese, raisins and bran flakes – as well as breast milk, if it were available in shops – will be branded ‘unhealthy’ and thus banned from kids’ TV.

The FSA aimed to formulate a scientific schema for judging the healthiness or otherwise of food products. It devised the ‘Nutrient Profile Model’, a complicated system based around overall energy (number of calories) and the percentage of salt, sugar and saturated fats in a product per 100 grams (regardless of the average serving size). According to this model, cheese, alongside honey, certain cereals, marmite and a host of other pretty nice and healthy foods, will be classified as junk foods to be hidden from children. And according to the same Nutrient Profile Model, chicken nuggets, microwaveable curries, oven chips and diet fizzy drinks – which are seen by many today as ‘junk’ – are healthy foods and therefore it’s okay to show them on kids’ TV.

So sweetened carbonated water will be promoted to children, but cheese, which has been part of children’s healthy diets for decades, and which is packed with calcium, phosphorus, potassium, zinc and A and B vitamins, will not. Some mistake, surely? Not according to the FSA, which, despite protests from food representatives, is standing by its model.

The model was supposed to take total calories, saturated fats, sugar and salt per 100g and balance these ‘negative’ aspects against the ‘redeeming features’ of the food, which may be in ‘the form of fibre, fruit and vegetable content, or protein’. But the Cheese Board’s Nigel White tells me: ‘We think they tried numerous iterations of this model, whereby for different levels of calories per 100g they had different bands, so between 0 to 100 would be one point, and over 1,000 would be 10 points, and then they would calibrate this for salt, sugar and fats.’ These points are then used to work out if there’s ‘too much’ of these things in a certain food product, and whether that makes it unhealthy. ‘But the bands where you score between 0 and 10 points have almost been plucked out of the air because they bear no relation to anything. They have been designed to hit certain foods and to make sure they come into that zone’, White argues. Items such as cheese, raisins and bran flakes have, he says, been ‘caught in the crossfire’.

Cheese should not be demonised, he says. He points out that in other EU countries they eat on average 10 to 15 grams more cheese per head than Britons do, and they don’t have any grave health or obesity problems. ‘The frustrating thing for me and my cheese makers is that the FSA has dressed this up as being a science-based approach to nutrition and changing people’s diets. But it isn’t science-based. It’s flawed. It’s scientifically weak, and it comes up with obtuse results.’

White argues that the FSA’s strange model doesn’t take into consideration the size of the serving – so yes, cheese does have a high number of calories, due to the fact that it is an energy-dense foodstuff, but it is typically served in ‘matchbox-sized’ 30 to 40g portions. So measuring cheese on the basis of a 100g chunk, as the FSA has done, ends with skewed results. White points out that a 30g serving of cheese provides around 30 to 40 per cent of a growing child’s daily calcium needs, and according to government figures 45 per cent of children in the UK have diets deficient in calcium.

Here we can see how today’s obesity panic ends up eating itself: arbitrary measures of the health content of cheese will mean it is banned from advertising on TV by the government bodies Ofcom and the FSA, while elsewhere the government worries that children aren’t getting enough calcium, which is prevalent in cheese.

Is the ban, supported by the FSA’s model and enforced by Ofcom, likely to have a detrimental impact on the sale and consumption of cheese? White says it will. The amount of cheese advertising on TV is minimal, but this is ‘the thin end of the wedge’, he says, because once a product is categorised as ‘unhealthy’, branded as junk, then other restrictions can quickly fall into place. This might include ‘communicating anything about your product… what a company can put on the packaging… whether it can say “this product is naturally high in calcium”, which cheese is…. All these things will fall into line and cheese will just be regarded as a junk food’, he says.

‘And it’s not. If you asked a hundred nutritionists whether they think children should be eating some cheese, they would all say yes.’

The Cheese Board is raising the issue in parliament and winning support for its cause. Why aren’t the raisin board and cereal board, and the food industry in general, following suit and taking a stand against the FSA’s seemingly mad model? Andrew Leyland, editor of The Grocer, a prominent trade magazine for the food and drinks industry, says it is because ‘every time [food representatives] put their head above the parapet they’re gunned down by various factions within the media and the public watchdogs’.

Leyland’s magazine has launched a campaign called ‘Weigh It Up’, which also challenges the FSA’s Nutrient Profile Model. Leyland tells me that the food industry has been cowed into submission by officials and lobbyists, who seem to treat food like it is tobacco, and the food industry as if it’s the new tobacco industry. ‘The FSA is constantly briefing against the food industry as if it sees them as the public enemy number one’, he says. According to Leyland, the FSA fails to take into account the efforts made by industry to promote healthier eating, and when anyone else tries to point this out they are accused of being ‘apologists’ for the industry and its alleged untold crimes against the nation’s arteries.

‘Whenever we raise our point about healthy and nutritious foods being banned [such as honey and bran flakes] the FSA says, “Oh well, you would say that, you’re The Grocer, you’re supported by the food industry!”. It’s schoolboy tactics. It’s not actually having a serious debate. They’re like a student union with a big budget. But actually, what they should say is, “You know what? This isn’t working yet. We need to think again.”’

It seems that thinking again would indeed be a wise move. The Ofcom ban and its framework in the FSA’s Nutrient Profile Model appear to be ill-thought-out symptoms of the political and media-whipped hysteria over our expanding waistlines. No matter that we’re healthier and living longer than ever before, apparently we must be constantly told what to eat, when to eat it, how much exercise to take, and so on.

The latest strand in food classification, which is used to justify draconian bans on TV advertising, could lead to the development of a fetishistic attitude to food, where we see certain grub as ‘good’ and other grub as ‘bad’. Yet the idea that a particular food is evil is ridiculous; mother’s old adage that ‘a bit of whatever you fancy does you good’ should surely still hold true. The confusion caused by the FSA model and the Ofcom ban shows how silly it is to make arbitrary judgements about food and to demonise certain foodstuffs. The ban is as irrational as it is unnecessary – and it could ultimately lead to the creation of abnormal, obsessive attitudes to the things we eat when we’re hungry.

Surely that’s not the ‘message’ we want to be sending to the nation’s kids? 


Britain: "Human rights" hit lifesaving car seat law

The British police are really having fun as they politely satirize Britain's stupid "human rights" law

Police are failing to enforce car seat safety laws for children because it may infringe the human rights of the youngsters. Legislation introduced last year says that small children must use a booster seat as well as a seatbelt. But to gather evidence traffic police are supposed to take the children out of the car and measure them at the roadside.

Some forces believe this goes beyond their powers. The North Yorkshire force has refused to implement the law for four months while seeking legal advice. It said yesterday that it will start enforcing the law next week. A force spokesman said that because it was the parents, not the children, committing the offence, it could infringe children's legal and human rights to force them to be measured or give their date of birth.

The law applies to children under 12 and less than 4ft 5in tall. The Department for Transport estimates that it will prevent 2,000 child deaths and injuries each year. Phil Willis, Liberal Democrat MP for Harrogate and Knaresborough, said: "The police's time would be better spent outside an infant school advising parents."

Kevin Clinton, head of road safety at the Royal Society for the Prevention of Accidents, said: "Education is an important part of enforcement but ultimately the police do need to take action and use their enforcement powers."


The British Government won't let people take action against criminals

"Call the police"! What a laugh -- as anybody who has ever called the police knows. And the British police these days seem to be more sluggish than most. You are lucky if they do anything at all. They almost invariably arrive too late. All they do is pick up the pieces after the harm and damage is done

Here it comes - the advice you've all been waiting for. A Home Office minister is going to tell you what to do about crime and anti-social behaviour. Watch your television screens tonight and you will be given the official word on how you - being the concerned, responsible citizen that you are - can take back control of your neighbourhood in the spirit of that rousing governmental slogan, "Don't moan, take action: it's your street too." Let me give you a preview of what you can hear this evening.

Panorama presenter Jeremy Vine asks Tony McNulty, the deeply underwhelming minister for police and security, what exactly the individual should do when faced with a nasty incident in the street. Should he "step in", in the spirit of that admonition to "take action", this being his street and all?

Mr McNulty replies in a tone that sounds rather less enthusiastic than his Government's slogan: "I think the general line must be to get in touch with the authorities and make sure that, if things are as bad as you paint, the police will be there as quickly as they can."

Sorry? Who precisely should be sure that things are "as bad as you paint"? You, yourself? Or the perennially sceptical police? And is the minister implying by this jaundiced phrase - "really as bad as you paint" - that most people's concerns are not actually serious enough to merit official attention?

Mr Vine perseveres with a concrete example: suppose you, the conscientious adult, see a young man aggressively shouting at an old woman. What should you do - retreat and call the police? Mr McNulty responds rather confusingly: "I think you should in the first instance. It may well be [that] simply shouting at them, blowing your horn or whatever, deters them and they go away." So how does it go again? You should "in the first instance" retreat and call the police (who presumably will help you to decide whether things are "as bad as you paint" by suggesting that you might be exaggerating or imagining the circumstances), but then - having so retreated - you are to shout or blow your car horn in an attempt to send the young thug scurrying away like a frightened kitten. Ok-a-a-y.

Mr Vine goes on with his vivid picture of life on the mean streets of Britain: the aggressive-looking young man is hitting the elderly woman, and the police still haven't turned up. What do you do then?

Mr McNulty is now reversing away at full speed from the Government's advice to take action rather than moan. What should you do about the woman being beaten up by the thug? "The same, the same, you must always." What? Wait for the authorities? In desperation, the minister advocates what most of us, in fact, do end up doing under such horrifying circumstances: you must "get back to the police". That is, ring them up again and again, reporting the worsening agony you are witnessing only to be told that they (a) haven't got a car in the area, (b) don't have the manpower to deal with small incidents, (c) will get there as soon as they can (which turns out to be anything from an hour to a day later).

But the minister does have some ideas about what you might helpfully do while the poor woman is being beaten senseless and you are waiting that interminable length of time for the police to show up to do their sympathetic but hugely ineffectual counselling. You can "try some distractive [sic] activities". Such as? Mr Vine offers, presumably not without a hint of sarcasm, "jump up and down", and Mr McNulty replies in the best Blairite demotic style: "I would say you know sometimes that that may well work." And while you are jumping up and down, and repeatedly ringing the police from the position where you have retreated, a safe distance from the thug who is ruining the quality of life in your community, you may wish to contemplate what an absurd mess we are in. When a society is helplessly bullied by its own juveniles, it can only be because that society has chosen to abdicate its responsibilities. It has been the rightful business of grown-ups to control and instruct the young for as long as human beings have lived in organised communities.

So politicians are quite right to say that this is not simply a matter for government: that it is the business of the adult population as a whole to confront the problem. What they seem to have forgotten is that it was government that made it virtually impossible for neighbourhoods to protect and police themselves. "Children's rights" legislation - which in practice amounts to the right of children to behave as badly as they like without fear of interference - has made it a potential offence for any adult to intervene effectively when a minor is misbehaving.

Even strong verbal chastisement can constitute unacceptable victimisation, let alone physical restraint. The adult who attempts to put a stop to destructive or delinquent activity among local thuglets will face the immediate danger of being attacked by the thuglets or by their vengeful and unapologetic parents, and the later one of being charged with assault. So the minister must counsel "retreat", and the helpless summoning of the police to every incident that is threatening to turn nasty. The police, as hamstrung as everybody else by the legal minefield of controlling minors, would rather spend their time on something less thankless and more glamorous, such as "organised crime". But it is disorganised crime - the anarchic, opportunist delinquency of barely pubescent children - that ruins more lives on a daily basis than elaborately planned bank heists.

There was a time, within living memory, when virtually all self-respecting members of society - parents, teachers, police, magistrates and politicians - believed that we were in this together: that there was a confederation of grown-ups who all took responsibility for inculcating social morality and civility in the young.

But then politicians and the criminal-justice establishment were persuaded by social scientists that deprivation was to blame for misbehaviour rather than individuals: never mind that the honest poor had once been very effective at controlling youngsters in their own streets. Out went "judgmentalism" and the enforcement of what a generation of teachers was taught to call "middle-class" standards of behaviour. So this is where we find ourselves - jumping up and down as we retreat from the thug who is beating up an old woman.


An experiment that hints we are wrong on climate change

Writing in London's "The Times", Nigel Calder, former editor of New Scientist, says the orthodoxy must be challenged












The only trouble with Svensmark's idea - apart from its being politically incorrect - was that meteorologists denied that cosmic rays could be involved in cloud formation. After long delays in scraping together the funds for an experiment, Svensmark and his small team at the Danish National Space Center hit the jackpot in the summer of 2005.






Below is the abstract the latest paper on the matters referred to above:


(From arXiv, December 2007)

By Henrik Svensmark



A perceptive Letter to "The Times" below:

Sir, I listened on Thursday to Melvin Bragg's excellent programme on Karl Popper. Afterwards I heard of David Milliband's remark that the scientific debate on global warming was now closed.

I am not sure if Popper would have laughed or raged - probably both. For him no scientific debate was ever closed, and he pointed out that the Newtonian "consensus" had lasted several centuries when Einstein came along and reopened the debate. Whether the "climate consensus" will last more than a few years before the debate needs to be reopened seems doubtful.

As I understand it, the climate modellers are using Newtonian mechanics to simulate a coupled nonlinear chaotic system. This raised questions as long ago as the early 1960s, and even the Intergovernmental Panel on Climate Change's own Third Assessment seemed a little concerned. The debate is clearly not closed at all.

Popper was the author of The Open Society and its Enemies. He would surely have numbered among these enemies those who attack scientists who express doubts about the conventional view of global warming.

TOM ADDISCOTT, Harpenden, Herts


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