Saturday, 2 June 2007
Skrabanek (II)
Petr Skrabanek
Petr Skrabanek quotes the writers of the past who seem to have regarded doctors as little better than charlatans and frauds and, if anything, mere facilitators of death. Nicocles, an ancient Greek poet, wrote that physicianjs wre a happy race, because the sun shone on all their successes and the earth hid their failures.
Montaigne was sceptical of their cures: "The left foot of a tortoise, the urine of a lizard, pulverised rat turds and other money tricks." And added: "When the weakness of their arguments come to be revealed to everyone, a man would have to be preternaturally blind not to feel that he runs a great risk in their hanads."
But are they any better today? Yes, but there are several reasons why their prescriptions are open to question.
One source is the science journals. while they produce a lot of good science - true science - there's also a lot of bad science related to human nature of scientists trying to make a career, and scientific publishing.
What happens is that a correlation is considered statistically significant - rather arbitarily inthe scientific community - if there is only a five percent chance it could have happened by chance. But medical science there are an enormous number of potential causations and a large number of hypotheses tested by researchers; given the large number there will be false positives - effective interventions, informative predictors, risk factors and associations which are not in fact the case.
The cases of faulty science are numerous Hormone therapy, initially said to reduce "coronary artery disease events" in women, is now believed to increase the risk of such events. Vitamin E therapy, touted as a heart protector for men and women, was later found to be ineffective.
These studies are refuted because their claims are bold enough. But other studies become part of the wisdom - because who wants to devote their career to second a proven positive - and stay there.
Another possibility leading to a wrong prescription is not bad science handed down, but internal: the doctor's own psychology, his culture, might err him in his diagnosis. A diagnosis that worked spectacularly on one rare disease in his youth which foxed others and which earnt him some approval he will continually reapply even though this may be inappropriate for new situations.
A third possibility is that he may get the right diagnosis but prescribe the wrong medicine. This will depend on the nice dinner he received from the drugs companies, who educated him in one diagnosis that – surprise – will be cured by their drug. In America, a large number of drugs are prescribed off label; and the average person has 14 types of pill ins drugs cabinet. American lifespans are the lowest in the western world.
A fourth instance is the confusion between illness and disease: the former is cultural, vague and amorphous. Ilnesses can be multicausal, and it’s hard to say when they begin and end. There is no on off switch; obesity is one ailment. High blood pressure is another. What is the meaning of high blood pressure when 70 per cent of the Western world’s population over fifty has it. Is this high blood pressure curable by medicine, or simply best dealt with by redefining high blood pressure as to be at a much higher level than currently?
Perhaps redefinition is the best solution.
There have been studies – they are not all useless - that show that while very high diastolic blood pressure is advisedly treated, low hypersensivity treated with diuretics such as propranolol shows no benefit in reduction in mortality while causing a whole host of other side effects, such as gout, diabetes and impotence. Those who took placebo tablets did not escape side effects, suggesting that attaching the label hypertensive has, in itself, deleterious consequences. Many doctors prescribe medicines for high blood pressure.
The lesson is that medicine, even today, is not a monolithic subject, but a mixture of more or less sound practices. Some medicine is excellent science, other bits of medicine the consequence of poor or untested scientific method; and the application of these are at the whims of a doctor whose human nature plays an important part. Doctors are not scientists or scientific thinkers who assess evidence, but people of broad scientific and medical education who apply what they know to the best of their ability and put their considerable authority behind it.
Is this authority essential to their job, or are patients best served if the chaos that happens off stage - scientific process - is exposed to all? The authority has a its own placebo effect, which is why there is no little in the medical literature on the subject; the importance of it being unexamined is often hinted at a during the ward round. On the other hand questioning authority is the natural scientific mode of enquiry, and who knows how stagnant pools there are of out of date wisdom held up by the walls of your house doctor's perceived impotence.
Petr Skrabanek quotes the writers of the past who seem to have regarded doctors as little better than charlatans and frauds and, if anything, mere facilitators of death. Nicocles, an ancient Greek poet, wrote that physicianjs wre a happy race, because the sun shone on all their successes and the earth hid their failures.
Montaigne was sceptical of their cures: "The left foot of a tortoise, the urine of a lizard, pulverised rat turds and other money tricks." And added: "When the weakness of their arguments come to be revealed to everyone, a man would have to be preternaturally blind not to feel that he runs a great risk in their hanads."
But are they any better today? Yes, but there are several reasons why their prescriptions are open to question.
One source is the science journals. while they produce a lot of good science - true science - there's also a lot of bad science related to human nature of scientists trying to make a career, and scientific publishing.
What happens is that a correlation is considered statistically significant - rather arbitarily inthe scientific community - if there is only a five percent chance it could have happened by chance. But medical science there are an enormous number of potential causations and a large number of hypotheses tested by researchers; given the large number there will be false positives - effective interventions, informative predictors, risk factors and associations which are not in fact the case.
The cases of faulty science are numerous Hormone therapy, initially said to reduce "coronary artery disease events" in women, is now believed to increase the risk of such events. Vitamin E therapy, touted as a heart protector for men and women, was later found to be ineffective.
These studies are refuted because their claims are bold enough. But other studies become part of the wisdom - because who wants to devote their career to second a proven positive - and stay there.
Another possibility leading to a wrong prescription is not bad science handed down, but internal: the doctor's own psychology, his culture, might err him in his diagnosis. A diagnosis that worked spectacularly on one rare disease in his youth which foxed others and which earnt him some approval he will continually reapply even though this may be inappropriate for new situations.
A third possibility is that he may get the right diagnosis but prescribe the wrong medicine. This will depend on the nice dinner he received from the drugs companies, who educated him in one diagnosis that – surprise – will be cured by their drug. In America, a large number of drugs are prescribed off label; and the average person has 14 types of pill ins drugs cabinet. American lifespans are the lowest in the western world.
A fourth instance is the confusion between illness and disease: the former is cultural, vague and amorphous. Ilnesses can be multicausal, and it’s hard to say when they begin and end. There is no on off switch; obesity is one ailment. High blood pressure is another. What is the meaning of high blood pressure when 70 per cent of the Western world’s population over fifty has it. Is this high blood pressure curable by medicine, or simply best dealt with by redefining high blood pressure as to be at a much higher level than currently?
Perhaps redefinition is the best solution.
There have been studies – they are not all useless - that show that while very high diastolic blood pressure is advisedly treated, low hypersensivity treated with diuretics such as propranolol shows no benefit in reduction in mortality while causing a whole host of other side effects, such as gout, diabetes and impotence. Those who took placebo tablets did not escape side effects, suggesting that attaching the label hypertensive has, in itself, deleterious consequences. Many doctors prescribe medicines for high blood pressure.
The lesson is that medicine, even today, is not a monolithic subject, but a mixture of more or less sound practices. Some medicine is excellent science, other bits of medicine the consequence of poor or untested scientific method; and the application of these are at the whims of a doctor whose human nature plays an important part. Doctors are not scientists or scientific thinkers who assess evidence, but people of broad scientific and medical education who apply what they know to the best of their ability and put their considerable authority behind it.
Is this authority essential to their job, or are patients best served if the chaos that happens off stage - scientific process - is exposed to all? The authority has a its own placebo effect, which is why there is no little in the medical literature on the subject; the importance of it being unexamined is often hinted at a during the ward round. On the other hand questioning authority is the natural scientific mode of enquiry, and who knows how stagnant pools there are of out of date wisdom held up by the walls of your house doctor's perceived impotence.
Follies and fantasies in medicine
Petr Skrabanek
This is a great book, recommend you at least to read final chapter.
He demolishes many shibboleths of modern medical practice, in fact it is different only in a matter of degree from faith healing. Medicine is not science, it is an art of diagnosis resting on authority. The royal college of physicians quoting Popper is only so much rhetoric.
What's worse, while there is of good science - true science - there's also a lot of bad science related to human nature and scientific publishing.
What happens is that a correlation is considered statistically significant - rather arbitarily inthe scientific community - if there is only a five percent chance it could have happened by chance. But medical science there are an enormous number of potential causations and a large number of hypotheses tested by researchers; given the large number there will be false positives showing ineffective interventions, informative predictors, risk factors, or association - connections that do not fact exist. It may be that these studies have been replicated, but because they are show negative results they are never put forward for refereeing to the science journals: a bias towards tabloid journalism, even here.
For personal or career reasons, who wants either to replicate someone's positive - no prestige for being second - or, only slightly better, refute it. And so you have all these "links" between chocolate eating and cancer, mobile phones and brain tumours etc etc.
The difficulties arise when bad science meets the scientifically untrained doctor. A true scientist is humble. His subject is always subject to revision. He is a sceptic.
Many medical researchers are not as sceptical as they should be.
And the house doctor the least of all: not even necessarily trained in scientific method, at med school, even though he acquired a lot of scientifically-based knowledge.
Instead the doctor is a member of the new clerisy, a dispenser of authoritative gospel based on what many common people think is the new infallible dogma. This gives the doctor great power. He is not a searcher of wisdom or truth. He is an authority on providing solutions.
Some solutions work better than others. It will depend on a number of less than scientific factors. His solution is modified by personal events - a diagnosis that worked spectacularly on one rare disease in his youth which foxed others and which earnt him some approval he will continually reapply even though this may be inappropriate for new situations. It will depend on the nice dinner he received from the drugs companies, who educated him in one diagnosis that – surprise – will be cured by their drug. On the good science but sometimes the bad science he has read in the medical journals. Above all, perhaps, from the body of clinical medicine learnt from med school and which contains a surprising number of received wisdoms that haven’t sufficiently been put on trial.
An example of how follows habit, custom, received wisdom is on the issue of high blood pressure, which affects 70 per cent of the Western world’s population over fifty. Becuase it "above acerage" the reponse is that it has to be cured.
But in fact there have been studies – good, if unheeded science ths time - that show that while very high diastolic blood pressure is advisedly treated, low hypersensivity treated with diuretics such as propranolol shows no benefit in reduction in mortality while causing a whole host of other side effects, such as gout, diabetes and impotence. Those who took placebo tablets did not escape side effects, suggesting that attaching the label hypertensive has, in itself, deleterious consequences. Many people take medicines against high blood pressure on the advice of their doctors.
The lesson is that medicine, even today, is not a monolithic subject, but a mixture of more or less sound practices. Some medicine is excellent science, other bits of medicine the consequence of poor or untested scientific method; and the application of these are at the whims of a doctor whose human nature plays an important part. Doctors are not scientists or scientific thinkers who assess evidence, but people of broad scientific and medical education who apply what they know to the best of their ability and put their considerable authority behind it.
Is this authority essential to their job, since the comforting consultation has a genuine placebo effect, or are patients best served if the chaos that happens off stage - scientific process - is made public?
There's a lot of food for thought in this book, and one possible article I would like to write is how the author, Petr Skrabanek, a Czech, a Lancet leader writer and academic, had his reputation posthumously blackened by the medical establishment for his alleged links with the smoking companies. The heretic, like his countryman Jan Huus, the first protestant, burnt at the stake.
This is a great book, recommend you at least to read final chapter.
He demolishes many shibboleths of modern medical practice, in fact it is different only in a matter of degree from faith healing. Medicine is not science, it is an art of diagnosis resting on authority. The royal college of physicians quoting Popper is only so much rhetoric.
What's worse, while there is of good science - true science - there's also a lot of bad science related to human nature and scientific publishing.
What happens is that a correlation is considered statistically significant - rather arbitarily inthe scientific community - if there is only a five percent chance it could have happened by chance. But medical science there are an enormous number of potential causations and a large number of hypotheses tested by researchers; given the large number there will be false positives showing ineffective interventions, informative predictors, risk factors, or association - connections that do not fact exist. It may be that these studies have been replicated, but because they are show negative results they are never put forward for refereeing to the science journals: a bias towards tabloid journalism, even here.
For personal or career reasons, who wants either to replicate someone's positive - no prestige for being second - or, only slightly better, refute it. And so you have all these "links" between chocolate eating and cancer, mobile phones and brain tumours etc etc.
The difficulties arise when bad science meets the scientifically untrained doctor. A true scientist is humble. His subject is always subject to revision. He is a sceptic.
Many medical researchers are not as sceptical as they should be.
And the house doctor the least of all: not even necessarily trained in scientific method, at med school, even though he acquired a lot of scientifically-based knowledge.
Instead the doctor is a member of the new clerisy, a dispenser of authoritative gospel based on what many common people think is the new infallible dogma. This gives the doctor great power. He is not a searcher of wisdom or truth. He is an authority on providing solutions.
Some solutions work better than others. It will depend on a number of less than scientific factors. His solution is modified by personal events - a diagnosis that worked spectacularly on one rare disease in his youth which foxed others and which earnt him some approval he will continually reapply even though this may be inappropriate for new situations. It will depend on the nice dinner he received from the drugs companies, who educated him in one diagnosis that – surprise – will be cured by their drug. On the good science but sometimes the bad science he has read in the medical journals. Above all, perhaps, from the body of clinical medicine learnt from med school and which contains a surprising number of received wisdoms that haven’t sufficiently been put on trial.
An example of how follows habit, custom, received wisdom is on the issue of high blood pressure, which affects 70 per cent of the Western world’s population over fifty. Becuase it "above acerage" the reponse is that it has to be cured.
But in fact there have been studies – good, if unheeded science ths time - that show that while very high diastolic blood pressure is advisedly treated, low hypersensivity treated with diuretics such as propranolol shows no benefit in reduction in mortality while causing a whole host of other side effects, such as gout, diabetes and impotence. Those who took placebo tablets did not escape side effects, suggesting that attaching the label hypertensive has, in itself, deleterious consequences. Many people take medicines against high blood pressure on the advice of their doctors.
The lesson is that medicine, even today, is not a monolithic subject, but a mixture of more or less sound practices. Some medicine is excellent science, other bits of medicine the consequence of poor or untested scientific method; and the application of these are at the whims of a doctor whose human nature plays an important part. Doctors are not scientists or scientific thinkers who assess evidence, but people of broad scientific and medical education who apply what they know to the best of their ability and put their considerable authority behind it.
Is this authority essential to their job, since the comforting consultation has a genuine placebo effect, or are patients best served if the chaos that happens off stage - scientific process - is made public?
There's a lot of food for thought in this book, and one possible article I would like to write is how the author, Petr Skrabanek, a Czech, a Lancet leader writer and academic, had his reputation posthumously blackened by the medical establishment for his alleged links with the smoking companies. The heretic, like his countryman Jan Huus, the first protestant, burnt at the stake.
Thursday, 31 May 2007
Raymond Tallis and the patients who know too much
There are things that make you despise humanity – going shopping at IKEA on Saturday afternoons, or attending one of the European parliament’s stagiaire-feeding Tuesday evening buffets, come to mind.
Talking to Professor Raymond Tallis, a geriatric specialist at Manchester University, makes you despise patients.
It is the view from the other side, as it were. I am not saying the highly intelligent, thoughtful prof Tallis, named by Prospect magazine one of Britain’s top 100 thinkers, perhaps the UK’s top medical philosopher, is a misanthropist but, reading between the lines, sand removing his caveats, one gets the sense of frustration put on consultants feel about the behaviour of patients to a greater or lesser extent – even, perhaps, you.
Complaints against doctors about the poor communication skills are on the rise, Tallis notes in Hippocratic Oaths, his recent memoir of life in the medical profession. He tries to explain how this has come about, through explaining the constraints of the profession and the inevitable differences in the patient/doctor perspective..
The conflicts begin when, having worked on his internal narrative as to what is wrong with him, the patient encounters the doctor for the first time. The doctor is, as it were, a late entrant into the conversation between the patient and his inner self, between patient and relatives and friends. The doctor will discard some of the things the patient says – even though they will be of great personal importance to the patient. – as extraneous, and upgrade other things that patient may regard as minor.
Tension will arise. A medical retelling of the story, designed as a basis for appropriate action, might be seen as a “defoliation” of the personal tale the patient has nurtured. The passage of history taking from open to closed questions presage a physical examination where the patient ceases to become a speaking subject and becomes a proffered body-as-object.
Doubtless journalists and writers who have been giving the medical profession such a hard time over the years would see this process as a power struggle between God like consultant and powerless patient, where the patient is doomed to lose his “humanity”. But in fact, what the consultant is supposed to bring to meeting is not personal knowledge of the patient’s travails but impersonal expertise which allows the problem the patient has brought to the clinic to be solved. It is this objectivity that enables him to do his job,
If eliciting information about the patient leads to tensions enough, deciding what to tell the patient about his conditions leads to even greater difficulties. How much should the patient be told? How much technical information would he or she comprehend? How much can they cope with? How much do they want to be told?
Many patients’ interests groups, claiming to speak on behalf of patients, would say: everything. But some patients want to be kept in the dark. With other patients there is no set limit to how much they want to know – the name and the star rating of the surgeon, even though the surgeon might not be selected until a very late stage. Patients who want to know it all might have entirely appropriate demands, but this pays no heed to the unbearable time pressures consultants often suffer; there are other patients, in the waiting room, also wanting their share of attention.
Communication with the patient is often limited by his ability or knowledge to comprehend the vast new areas of biological information now relevant to him; the diagnosis is the beginning of a journey of learning – and yet it is often felt the consultant is incumbent on effecting complete understanding in the patient, in one session.
As diagnosis comes to medical action, one problem is that of consent, required for any procedure that carries significant risk. But what is significant risk? British doctors have a rule of thumb that anything with a 1/200 chance of happening, and anything with a much lower chance of happening if that side effect could cause death or serious injury. Since there are so many things that could go theoretically speaking wrong that the patient’s life – as Tallis demonstrates in an example involving his mother – is sometimes in danger as a long list these days has to be checked off before the operation can go ahead. Nevertheless, there will be operations carried out, for which there is an infinitesmally small chance which the patient isn’t told about, which then happens, and leads to a disappointed and angry patient saying they would not have had the operation had they known of this risk. One example is that of Jo Knowlesly, who ha ppened to be a Mail on Sunday journalist, and who wrote about her ordeal in her paper.
She was admitted to hospital for laparoscopy, a common procedure in which, though a small incision and through using a cleverly designed scope, the doctor is able to examine the abdominal cavity for diagnostic purposes. It is an essentially safe procedure, and a vast improvement on earlier diagnostic methods. In Knowlesly’s case there was a perforation of the abdomen, which only happens once in 2,000 cases. A larger incision had to be made to stitch up the perforation; as a result Knowlesly spent three days longer in hospital. When she woke up, despite being apologised profusely to, she was very angry because she hadn’t been told of this risk, and that she would not have consented to it – even if the probability was much lower than the 1.200 chance. Even though she fully recovered she wrote a four page article about her ill treatment by the NHS and sued the hospital.
Poor communications are just one source of dissatisfaction with the modern doctor; I will spare you for the moment the others,. Summarising his chapter, Tallis writes that the “causes range from the incommensurability of personal experience of illness with the scientific understanding of it, to the impossibility of finding the limits of what should be should be communicated.”
Talking to Professor Raymond Tallis, a geriatric specialist at Manchester University, makes you despise patients.
It is the view from the other side, as it were. I am not saying the highly intelligent, thoughtful prof Tallis, named by Prospect magazine one of Britain’s top 100 thinkers, perhaps the UK’s top medical philosopher, is a misanthropist but, reading between the lines, sand removing his caveats, one gets the sense of frustration put on consultants feel about the behaviour of patients to a greater or lesser extent – even, perhaps, you.
Complaints against doctors about the poor communication skills are on the rise, Tallis notes in Hippocratic Oaths, his recent memoir of life in the medical profession. He tries to explain how this has come about, through explaining the constraints of the profession and the inevitable differences in the patient/doctor perspective..
The conflicts begin when, having worked on his internal narrative as to what is wrong with him, the patient encounters the doctor for the first time. The doctor is, as it were, a late entrant into the conversation between the patient and his inner self, between patient and relatives and friends. The doctor will discard some of the things the patient says – even though they will be of great personal importance to the patient. – as extraneous, and upgrade other things that patient may regard as minor.
Tension will arise. A medical retelling of the story, designed as a basis for appropriate action, might be seen as a “defoliation” of the personal tale the patient has nurtured. The passage of history taking from open to closed questions presage a physical examination where the patient ceases to become a speaking subject and becomes a proffered body-as-object.
Doubtless journalists and writers who have been giving the medical profession such a hard time over the years would see this process as a power struggle between God like consultant and powerless patient, where the patient is doomed to lose his “humanity”. But in fact, what the consultant is supposed to bring to meeting is not personal knowledge of the patient’s travails but impersonal expertise which allows the problem the patient has brought to the clinic to be solved. It is this objectivity that enables him to do his job,
If eliciting information about the patient leads to tensions enough, deciding what to tell the patient about his conditions leads to even greater difficulties. How much should the patient be told? How much technical information would he or she comprehend? How much can they cope with? How much do they want to be told?
Many patients’ interests groups, claiming to speak on behalf of patients, would say: everything. But some patients want to be kept in the dark. With other patients there is no set limit to how much they want to know – the name and the star rating of the surgeon, even though the surgeon might not be selected until a very late stage. Patients who want to know it all might have entirely appropriate demands, but this pays no heed to the unbearable time pressures consultants often suffer; there are other patients, in the waiting room, also wanting their share of attention.
Communication with the patient is often limited by his ability or knowledge to comprehend the vast new areas of biological information now relevant to him; the diagnosis is the beginning of a journey of learning – and yet it is often felt the consultant is incumbent on effecting complete understanding in the patient, in one session.
As diagnosis comes to medical action, one problem is that of consent, required for any procedure that carries significant risk. But what is significant risk? British doctors have a rule of thumb that anything with a 1/200 chance of happening, and anything with a much lower chance of happening if that side effect could cause death or serious injury. Since there are so many things that could go theoretically speaking wrong that the patient’s life – as Tallis demonstrates in an example involving his mother – is sometimes in danger as a long list these days has to be checked off before the operation can go ahead. Nevertheless, there will be operations carried out, for which there is an infinitesmally small chance which the patient isn’t told about, which then happens, and leads to a disappointed and angry patient saying they would not have had the operation had they known of this risk. One example is that of Jo Knowlesly, who ha ppened to be a Mail on Sunday journalist, and who wrote about her ordeal in her paper.
She was admitted to hospital for laparoscopy, a common procedure in which, though a small incision and through using a cleverly designed scope, the doctor is able to examine the abdominal cavity for diagnostic purposes. It is an essentially safe procedure, and a vast improvement on earlier diagnostic methods. In Knowlesly’s case there was a perforation of the abdomen, which only happens once in 2,000 cases. A larger incision had to be made to stitch up the perforation; as a result Knowlesly spent three days longer in hospital. When she woke up, despite being apologised profusely to, she was very angry because she hadn’t been told of this risk, and that she would not have consented to it – even if the probability was much lower than the 1.200 chance. Even though she fully recovered she wrote a four page article about her ill treatment by the NHS and sued the hospital.
Poor communications are just one source of dissatisfaction with the modern doctor; I will spare you for the moment the others,. Summarising his chapter, Tallis writes that the “causes range from the incommensurability of personal experience of illness with the scientific understanding of it, to the impossibility of finding the limits of what should be should be communicated.”
Saturday, 19 May 2007
Shokai
Tabita Shokai is the NHS nurse who became a rebel
activist, then health minister - a black woman, a Christian - in
Sudan's predominantly Muslim Arab government.
The Sudan government is accused of killing 200,000 people in Darfur,
western Sudan. The government is said to be a UN pariah and is under
US sanctions. Discussions about whether actually to let in a UN force to
stop the killing have stalled. Meanwhile, Sudan, which has just
discovered oil, has to grapple with the worst health indicators in
Africa, where a woman is more likely to die of childbirth than complete primary school. I talked to Shokai and found her remarkably optimistic....
The government is fighting "rebels" in Darfur. You are also a rebel butpart of the government. I think people are a little bit confused......
My movement, the SPLM, is based in the Christian, black south and
fought the government until 2005. Then we made a peace agreement. The
rebellion in Darfur, western Sudan, inhabited by black muslims, is
different.
What do you do all day?
I attend the weekly cabinet meetings, I chair one of the sectors - in
charge of education and health, the first Sudanese woman to do so. I
travel around Sudan a lot. The rest of the government has many grand
schemes, but I am constantly lobbying for a bigger budget on health.
It's an investment, not an expenditure.
Aids is your special priority?
Aids has grown. We now have the highest rate in the middle east and
north Africa. The borders with Kenya and Uganda are now wide open,
the
peace agreement means people move around more. Soldiers are coming
home. Still, we have a public education campaign. People are more
honest about reporting Aids. though it is difficult to change people's
culture.
Aids is not our only problem: Malaria is big. In the past people
refused to use malaria nets although they got them free - people
didn’t seem to want that. But now they are very grateful. Malaria kills
millions per year. However avian flu gets much more attention; it's a
press disease.
What about female genital mutilation, or female circumcision; Sudan is
one of the leading countries to practise it?
It is illegal, all official bodies in Sudan have pronounced it bad, but
again it is difficult to change cultural habits. Male circumcision
could help reduce Aids, though.
Are the large number of rapes in Darfur contributing to the rise in
Aids?
Well, a lot of those rapes are exaggerated. It is the concern of the
justice ministry.
There is a lost generation, is there not? People who now would have
been in their thirties or forties, are dead. Who will take your place?
Does it mean you in power will have to rule forever?
It’s a problem. We have a programme for Aids orphans.
Isn't the Aids in soldiers a cause of the violence of soldiers - they
have nothing else to live for?
In Rwanda, where the Aids rate is 3 percent, former soldiers travel the
country as Aids counsellors, which is something we are trying to
arrange here.
I met someone who met a delegation of women coming off a plane and
realised "That's the 12 educated women in Sudan and I know all of
them".
Yes, the problem in south is very bad. But in the north, despite being
Muslim, there are still a lot of educated women who work as doctors,
judges.
So how do you reach out to uneducated women. Isn’t that part of the
health problem too?
We run illiteracy classes....it is an enormous challenge. Everything is
so difficult. But
we hope it will get better and better.
Is it true that you have secretly been phoning pharmacies in Khartoum
to tell them to stock condoms?
No, I would not do something like that secretly. In fact after a debate
about AIDS i stood in front of parliament advocating condoms. Someone
asked me if I was shy. I am not shy.
Why did you join the Sudanese people's rebel movement?
I joined it because the principal vision of our party was
non-discrimination and the the promise of equality. It wants to end
discrimination against women in public services. I also admired the
party's leader, John Garang, who was killed in a helicopter accident
last year shortly after we joined the national government. He was a
great man, much loved, and knew a lot.
After the peace agreement was signed in 2005, I became an MP in
Khartoum and was asked to be one the SPLM's three ministers in the new
coalition government. The government had set up a male candidate but I
won out. I know Khartoum well, having done my schooling here.
What is it like to be a African woman in an Arab Muslim-government,
which in the eighties was close ally to Al Qaeda and which introduced
tough sharia laws in the 80s?
Well, you know in the Nuba mountains where I come from the women are
quite free. Leni Riefenstahl, who made films about Hitler and was a
very strong woman herself, came to the mountains in the 1980s and made
films and wrote books about us. Khartoum is still male dominated, but
one of the SPLM's goals is to have 25% women in public life. Women in
Khartoum are, how to say, more laid back.
The black Christian south, where you came from, and the Muslim Arab
north have been fighting since Sudan's independence in 1956. Why?
It is a myth to say that northerners are Arabs. The Arabs came from
Egypt and mixed with the local African population; so we are all black,
one shade or another. You go to Lebanon and Syria, real Arabs, and you
can see the difference. Sudanese "Arabs" who go abroad come back and
say: "I am Sudanese!" Some of their treatment of "Africans", comes
because they hate themselves. With religion, in the Nuba mountains, it
is 50% muslim, 50% christian, but we all sing, dance, make clothes and
drink beer together.
The war was really about resources, not religion or skin colour.
About wanting a proper share of Sudan's oil?
Oil was discovered in southern and western Sudan. But it is not our
only resource. We have agriculture too
The US has declared what is going on in Sudan a genocide. Why did the
fighting start there? Is it because in spite of the generous peace deal
the government gave you and the SPLM, the rebels in Darfur wanted their
share of the oil you had?
Something like that. But it could be different. I met Minni Minawi, who
was one of the rebel groups' leaders. Two groups refused to sign an
agreement and are still fighting the government but Minni Minawi joined
the government. I See him at every cabinet meeting; he shakes
everyone's hand.
Why does your president Omar al Bashir not want UN forces to come and
make peace in Darfur. Is it because he fears the Americans will come
in, seize the oil and turn it into another Iraq?
Well, we already have UN troops in southern Sudan and they have done a
good job. It is a very political matter, for the National Congress
Party. They are very political about it.
The US does not allow its companies to do business in Sudan because it
accuses the country of supporting terror. Do you have problems with the
international health community as a result?
Not at all. A few weeks ago I had dinner at the British Ambassador's
with Hilary Benn, the UK development secretary. NGOs are very good,
very supportive. The Sudanese people just want peace in Darfur.
What is your relationship with the UK? Tony Blair has talked of
sanctions against Sudan.
My relationship with the UK is very good. I went there as a refugee,
worked in the NHS and was given a British passport, which I still
possess. There was respect. My late father was archbishop of Sudan and
the archbishop of Canterbury was present at his enthronement.
You are a woman in President Omar al-Bashir's cabinet. Bashir is one of
the most hated leaders in the world, accused of carrying out a genocide
in Darfur. What is he like as a man?
He likes children, he has a great sense of humour. He has been very
supportive. When the bird flu vaccine was discussed, he was there
straight away with $7m.
Do you miss the UK, where you worked as a nurse from 1988 - 2005 and
took a PHD in nursing?
Very much. But this is my country.
Friday, 18 May 2007
"If doctors are unhappy, let's do something"
Labour MEP Stephen Hughes, 54, talks about
working in Brussels, the controversial European
working time directive, how it might be amended, and
how to operate in the Brussels legislative scene....
You are the British MEP most heavily involved with the European
working time directive in the European parliament.
Apparently it is now subject to possible revision.
What’s happening with it?
The EWTD stipulates a maximum average 48-hour working
week for health and safety reasons.
It also stipulates a minimum 11 hours per day rest
period.
When it was signed, in 1993, the Conservative
government in the UK secured the right of companies
across Europe to get an opt-out. In most areas of
work, employees could - only if they wanted to -
sign an agreement with their employers permitting them
to work more than that. Although the stated reason
was to give businesses flexibility and boost British
economic growth, there were several reasons why this
was unacceptable - one being the matter of whether it
was truly voluntary, since many workers were asked to
sign the opt-out at the same time as they signed their
contracts. There might be an element of invisible
coercion involved. The opt-out has been extensively
used by UK firms, less often by German, Luxembourg and
Spanish companies.
Several governments have come around to the view that
the opt-out is unacceptable
and are negotiating for it to be abolished.
There was for long a complete deadlock among the EU’s
employment ministers about this: Sweden, France,
Italy, Spain and others want the opt-out to go. The UK,
Ireland, Germany and Poland wanted to keep it.
But now things are changing; Poland has signalled it
will be changing sides, because it wants to see introduced some of
the uncontroversial provisions in the amended directive, so in the
next year I expect, with the UK and others losing their blocking
minority, the opt-out will be abolished in return for which there
will be greater flexibility in the reference period
over which the 48-hour week is calculated, from four
months to a year, a concession to economic
flexibility.
How does all this relate to doctors?
Doctors in training were brought into the provisions of the EWTD in
2004, with a phasing in period. Today they work 58 hours a week, from
2009 it will be 48 hours a week.
But doctors could still opt out on an individual basis. That loophole
will now close.
What do you say to the controversial allegations being levelled at the EWTD: that the rest requirements
of 11 hours a night impose a straight shift system
where doctors work 13 hours a day, often 7 days in a
row, with no rest in those 13 hours. That less time
spent in hospitals means they have less training under
their belt when qualifying. That a shift system means
no continuity of care, and so on....
I have talked to consultants about this. One, a few
weeks ago, said that whereas when he qualified as a
consultant it took him about two years to find his
feet, it now takes a consultant five years because he will have had
less time training in hospital up to qualification. I am
sympathetic to this argument and am happy to receive
petitions.
Are British doctors good at lobbying Brussels?
The BMA junior doctors’ committee and the Royal
College of Nursing have done some lobbying. But
generally they are not as effective as they might be.
My advice is to get into the process early, and
upstream. Find out what is going on - the commission
is now discussing proposals that haven’t seen the
light of day yet but could become law in a decade. And
that will affect doctors.
Who should they lobby?
The commission; MEPs, especially on the employment and public health
committees; doctors’ organisations in Europe,
such as the CPME. Incidentally, if you are a qualified doctor and
want to work in medical politics and in Brussels, the
CPME is a good place to start looking for a job
So when you as an MEP have been “lobbied” , what do
you do.
It is not like national politics. There is a lot of opportunity for
lobbyists to change legislation at the parliamentary level. Unlike
British backbenchers, perhaps, MEPs have great freedom in shape
legislation, able to suggest amendments that are completely at odds
with a commission’s original proposal. When we have inserted
an amendment, you have to get support from it, first
in the relevant committee and then in parliament as a
whole. You have to build cross party alliances with individuals who
support your ideas in other parties, and hope they can
deliver block votes from their side. Brussels is all about building
alliances, coalitions.
Do you get lobbied by the pharmaceutical corporations?
All the time. They have big resources, instrumental in their success
in getting their views taken into account in the recent patent
extension legislation; they overwhelm us with information; and our
own research facilities are under-resourced by comparison. We have
access to fewer researchers than the Houses of Congress. Hopefully
this will change soon.
Why should health and safety at work issues be a
European competence?
Because of the European single market: there has to be a level
playing field. It is unfair if some countries have a competitive
advantage by having their workers subjected to worse health and
safety regulations.
Isn’t there too much legislation coming from Europe?
A lot of problems come from “gold-plating” - the
adding of clauses by national civil servants when
EU directives are transposed into national law.
Britain has the second biggest health and occupational
safety manual in Europe after Germany. It is also true
that Britain is more zealous than other countries at
implementing laws - including the EWTD.
What other health and safety at work legislation is going through at the moment?
Legislation on repetitive strain injury. A ban on unsafe needles in
Hospitals. Experiments in Manchester have shown that safe needles
reduce needlestick injuries by 95 percent. Since safe needles cost
the same these days, and each needlestick injury costs health systems
thousands of pounds in compensation and time off work, it is a good
idea to introduce safe needles across Europe.
Do you enjoy Brussels, having been an MEP here for 22 years?
There is a lot of travel, but the place has a great buzz.
Even though not nearly enough people know what we do.
Minstry of charlatanry
Faith healers, shamans, have, by invoking gods or spirits, for thousands of years been mankind’s defence against sickness, a fact often forgotten in the era of modern western medicine.
Now faith healing appears to be on the rise again.
It’s faith healing with a difference. The modern shaman uses the techniques of modern technology – to reach millions through syndicated TV programmes; hundreds of thousands through large stadium events where the healers, like rock stars, prance about, sing and, climactically, invite the chosen sick to roll up in their wheelchairs or limp up on their crutches to be “touched”, and cured.
Benny Hinn, perhaps the world’s best known faith healer, will be appearing this summer at London’s main conference centre, the Excel, on 27 and 28 July, to perform before thousands of Britons – and will proclaim, on past form, to have healed hundreds.
Statistics on the rise of the global phenomenon are hard to come by, but Hinn’s income is estimated to have doubled to US$200m in the last two years, quadrupled since 1997.
And there is such fertile ground: a poll of 1,000 US adults by USA Today suggests that 79 percent of the population believes prayer could help them to better health.
But faith healing is not just about rich gurus healing the masses. In a growing number of churches and healing centres across the States, small groups of lay healers and priests are getting together in churches and healing centres to pray for and heal neighbours, friends and local people.
But regular doctors shouldn’t have to hang up their stethoscopes just yet.
Several organisations have campaigned against faith healing, arguing that the hopes healers instil prevent people from seeking proper medical treatment. The Dallas-based Trinity Foundation – which is Christian, but which feels stadium faith healing besmirches Christianity’s name – says the big faith healers make fortunes from donations collected at meetings. Benny Hinn lives in $5,000-a-night hotel suites; his tax-free “parsonage” is a multimillion dollar mansion in an exclusive estate overlooking the Pacific. Meanwhile the people they “heal” actually get worse because they then reject proper treatment. Trinity says the mass healings - kinetic performances that involve invocations of God and symbolic laying of hands on the sick onstage - don't actually work.
Investigations into Hinn’s case history have revealed the story of one ten-year-old Indian boy with two brain tumours attending Hinn's rally. Despite the healing pronounced a success and a pledge by his impoverished parents to give thousands of dollars to Hinn’s ministry, the child died seven weeks later.
For all the numerous calls to show evidence for the success of his miracles, dispensed at his Prayer Meetings around the world, Hinn has failed to so convincingly, say researchers – even when presenting evidence on his own terms.
At one typical stadium prayer meeting, in Oregon, where the usual three score miracles were proclaimed, Hinn's habitually secretive ministry, when asked to provide verifiable evidence for these miracles, first stalled for months, then eventually provided only five names. When these cases were checked out, one woman “cured” of lung cancer had died nine months later, an old woman’s broken vertebrae hadn’t healed after all, a man with a logging injury deteriorated because he refused medication and a needed operation, a woman claimed to have been healed of deafness had never been deaf (according to her husband), and a woman complaining of "breathlessness" had stopped going to the doctor on instructions of her mother.
British readers would surely like to know all this before they book their rendez-vous with God in Docklands this summer.
Now faith healing appears to be on the rise again.
It’s faith healing with a difference. The modern shaman uses the techniques of modern technology – to reach millions through syndicated TV programmes; hundreds of thousands through large stadium events where the healers, like rock stars, prance about, sing and, climactically, invite the chosen sick to roll up in their wheelchairs or limp up on their crutches to be “touched”, and cured.
Benny Hinn, perhaps the world’s best known faith healer, will be appearing this summer at London’s main conference centre, the Excel, on 27 and 28 July, to perform before thousands of Britons – and will proclaim, on past form, to have healed hundreds.
Statistics on the rise of the global phenomenon are hard to come by, but Hinn’s income is estimated to have doubled to US$200m in the last two years, quadrupled since 1997.
And there is such fertile ground: a poll of 1,000 US adults by USA Today suggests that 79 percent of the population believes prayer could help them to better health.
But faith healing is not just about rich gurus healing the masses. In a growing number of churches and healing centres across the States, small groups of lay healers and priests are getting together in churches and healing centres to pray for and heal neighbours, friends and local people.
But regular doctors shouldn’t have to hang up their stethoscopes just yet.
Several organisations have campaigned against faith healing, arguing that the hopes healers instil prevent people from seeking proper medical treatment. The Dallas-based Trinity Foundation – which is Christian, but which feels stadium faith healing besmirches Christianity’s name – says the big faith healers make fortunes from donations collected at meetings. Benny Hinn lives in $5,000-a-night hotel suites; his tax-free “parsonage” is a multimillion dollar mansion in an exclusive estate overlooking the Pacific. Meanwhile the people they “heal” actually get worse because they then reject proper treatment. Trinity says the mass healings - kinetic performances that involve invocations of God and symbolic laying of hands on the sick onstage - don't actually work.
Investigations into Hinn’s case history have revealed the story of one ten-year-old Indian boy with two brain tumours attending Hinn's rally. Despite the healing pronounced a success and a pledge by his impoverished parents to give thousands of dollars to Hinn’s ministry, the child died seven weeks later.
For all the numerous calls to show evidence for the success of his miracles, dispensed at his Prayer Meetings around the world, Hinn has failed to so convincingly, say researchers – even when presenting evidence on his own terms.
At one typical stadium prayer meeting, in Oregon, where the usual three score miracles were proclaimed, Hinn's habitually secretive ministry, when asked to provide verifiable evidence for these miracles, first stalled for months, then eventually provided only five names. When these cases were checked out, one woman “cured” of lung cancer had died nine months later, an old woman’s broken vertebrae hadn’t healed after all, a man with a logging injury deteriorated because he refused medication and a needed operation, a woman claimed to have been healed of deafness had never been deaf (according to her husband), and a woman complaining of "breathlessness" had stopped going to the doctor on instructions of her mother.
British readers would surely like to know all this before they book their rendez-vous with God in Docklands this summer.
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