"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.

The grotesque Chinese take away

15 minutes with…the Canadian foreign minister turned campaigner against illegal organ transplants

“Warning to all transplant patients”

Need a transplant? Order the organ by phone, the donor will be killed, and the part will be brought to you. If the stories are true, it would be the ultimate, grotesque Chinese take-away:
Human rights groups have long alleged that China harvests the organs from executed criminals to use in patients elsewhere, without their or their families’ consent.
But recent allegations go a step further. Campaigners are saying that large number of members of harmless spirituality movement Falun Gong – banned in China – who have been hauled off the street or parks for practising their belief system and are being hoarded in labour camps indefinitely for no other purposes than as live sources for organs. When their organs are needed – by a rich foreigner or Chinese – they are taken into hospital, killed and have their organs harvested.

All the useful internal organs - kidneys, livers, hearts, corneas – are
allegedly removed in sequence by a team of doctors. The bodies are thrown into large incinerators to obliterate all traces of them. Their families do not know where they are, since they were taken off the street without warning.
The organs are then transplanted into rich Chinese and overseas patients, who have communicated their need for a transplant via Chinese websites offering organs. A kidney can costs 60,000 dollars. A large number of rich
foreigners, including British people, are said to travel to China every year for transplant operations.

The stories have circulated since April, when the Falun Gong practitioners in the west started to raise the alarm. There was considerable scepticism in the western media, but the dapper, patrician David Kilgour, 65, a former Canadian MP and deputy foreign minister with responsibility for Asia, decided to investigate further, accepting an offer to do so from a Washington NGO specialising in human rights abuses in China.
Along with another Canadian lawyer, respected human rights specialist David Matas, co-director of the Canadian Helsiinki Watch human rights monitoring organisation, they conducted their investigation independently from Falun Gong – neither is an adherent - and have travelled around world capitals in the last few weeks to present their findings. We caught up with him after speaking to MPs and peers in the House of Lords, where Lord Thurlow, a former British high commissioner to New Zealand and Nigeria, a diplomat with 40 years’ experience, introduced the former cabinet minister as a “man of rare integrity”.

What evidence is there that this is happening?

It is in the nature of the allegations that they are difficult to prove or disprove. The best evidence is eyewitness testimony, yet for this alleged crime there are unlikely to be any eyewitnesses. The victims do not survive, and the perpetrators are unlikely to confess! Those reporting on human rights in China are thrown into jail, and the Red Cross is not allowed to visit prisoners.
Proof can either be inductive or deductive. Criminal investigation usually works deductively, connecting bits of evidence to form a coherent whole. We did have some deductive evidence – from investigative phone calls to Chinese hospitals, but there was a whole, bigger picture.

Like what?

There has been an official policy of prosecution, harassment, arrest and detention of Falun Gong members since 1999.
Falun Gong was founded in China in 1992; it is a peaceful spirituality and exercise movement, often called Chinese yoga, which grew quickly in popularity. Before the movement was banned in 1999, its millions of adherents gathered regularly in parks and streets to do their exercises. Then, in 1999, president Jiang Zemin banned the movement. Though avowedly non political, the movement was seen as a threat to the Communist party’s control over Chinese hearts and minds. The head of the so-called 6-10 office set up to deal with the movement told 3,000 officials in the Great Hall of the People that the new policy on Falun Gong would be to “defame their reputations, bankrupt them financially, destroy them physically”.
According to the US state department China report of 2005, the police run hundreds of detention centres, with 340 re-education through labour camps alone having a holding capacity of 300,000 persons. The report also estimated that the number of Falun Gong practitioners who have died in custody is at least several hundred but could be as many as several thousand. Local government everywhere was given the authority to implement Beijing’s orders to demonstrate to the Chinese population that practitioners committed suicide, killed family members and refused medical treatment. There have been reports on practitioners were shocked into standing for hours on end with electric truncheons and forced to undergo re-education classes for 16 hours a day for weeks in order to renounce the movement.

What other inductive evidence do you have?

In recent years, China has been carrying out many more transplants than identifiable sources. There are very few voluntary donations in China; because of the culture surrounding death. Assuming that every executed official death row prisoner has organs removed - with or without consent being given – that still leaves a shortfall of 41,000 transplants in the last six years. You have to combine this with the fact that Falun Gong prisoners are officially blood tested, unlike other prisoners – this is a prerequisite for transplants. They are not told why. There is also the fact that Chinese organ transplant websites advertise to customers that suitable organs can be had within weeks. Because compatibility rates are so low, the waiting time in Canada for an organ is months or even years, suggesting that, in China, there is a large available pool of live donors.

The following websites in China are among those offering organs to international customers. www.ootc.net; http://en.zoukiishoku.com. Here is an excerpt from the latter website: “It may take only one month to receive a liver transplantation , the maximum waiting time being two months. As for the kidney transplantation , it may take one week to find a suitable donor,the maximum time being one month. Although the procedure to select a donor is very strict,, the transplant operation will be terminated if the doctor discovers that there is something wrong with the donor's organ . If this happens, the patient will have the option to be offered another organ donor and have the operation again in one week.”
One week. Compare that to – again – the 32 month wait in Canada,

Do you have any testimonial evidence?

We interviewed one highly credible witness, a woman who worked as an administrator in a hospital in north-eastern China. She has now fled to the West. She says her surgeon husband had told her he personally removed the corneas from over 2,000 anaesthetised prisoners between 2001 and 2003. None of the donors survived since their other vital organs were removed at the same time. Although this is a second hand testimony, I talked to the woman at length and the detail and depth of her descriptions of her husband’s activities leave me in no doubt that she is telling the truth.

What about the telephone calls to Chinese hospitals that you detail in your report?

One Mandarin-speaking researcher called a number of hospitals to ask whether they had Falun Gong patients . One Dr Zhou of the Guangzhou military region hospital told her that he had some type B kidneys from Falun Gong, but would have several batches before May 1 and no more until May 20 or later. Chief Physician Song at the Oriental Organ Transplant centre said his hospitals had more than ten beating hearts. The caller asked if he meant live bodies and Song replied “This is so.” Our report has transcripts of a number of calls to different hospitals across China saying similar things.

Do you have any recommendations what to do?

Countries need to pass laws that require doctors to report patients who obtain trafficked organs. We have some support here from the British Transplantation Society. The chair of its ethics committee, Stephen Wigmore, who thinks the use of executed prisoners’ organs probably happens and condemns it.
Chinese transplant surgeons should be banned from attending international conferences. Human rights organizations should be allowed to inspect re-education camps and interview prisoners.

And what if China doesn’t comply with inspections?

The point of leverage will be the Olympics, to be held in Beijing in 2008. Should we boycott the games? Do Olympians really want to be visiting a country where these barbaric operations go on? We are convinced that thousands of innocent individuals belonging to a peaceful organisation have been in effect executed by medical practitioners for their organs, with the profits going to doctors and the local gangs whop run transplant hospitals, but ultimately sanctioned by the Chinese government which wants to exterminate Falun Gong. It is organised murder.

Junior doctors

Junior doctors' conferences are always fun, delegates being devoid of the pomposity or stand offishness of the annual BMA meetings featuring their seniors, consultants and GPs, usually held a bit later in the year, late May.
At the Marriott Hotel in Swiss Cottage, I asked the press officer, Steve Harman, what would be the main event of the day, and he said it would be the call for the resignation of Patricia Hewitt, the health secretary. In the event, the big issue of the day was the call for the resignation of the people at the top table. sitting in front of the conference and chairing it: Junior doctors' ruling committee. "A mutiny", some called it.
The JDC - headed by Jo Hilborne, an unaturally youthful, round-in-all-the right places obstetrician in her early forties - was accused of not standing up for the junior doctors interests. A series of catastrophes has befallen these prespecialisation doctors in their mid to late twenties, that much was made clear.
The application procedure for specialist training posts - the next upward career step - had been streamlined: no longer CVs and interviews, rather a standard form that had to be filled in, online. So what you might think, many organisations do that, but many juniors, the mood of the room, the quotations in BMA news, etc, felt extracurricular activities that showed their aptitude were streamlined out of the procedure., and that many deserving candidates had not even had interview offers on the basis of the blunt new application instrument.
Then there was critique that Hilborne and co had not done enough to protect junior doctors from the vicissitudes of the government's reorganisation of juniors' career progress structure. (Modernising Medical Careers, shortened to MMC) One of the aspects of modernising medical careers led to the effective release of two cohorts of junior doctors on to the market at the same time, this year, 2007, as the three year foundation programme was shortened to two years in 2005. Thirty thousand doctors will be chasing 19,000 posts. Many it seems will have to change profession, or emigrate.
Many in the media will have little sympathy that young doctors are no longer guaranteed jobs - it's life for most of us. On the other hand, there is the fact that they have trained at the taxpayers expense for five, six, seven years. One young surgeon speaker pointed out that a surgeon puts ion far more hours in training than an astronaut or a passenger jet pilot. So is that there where all the increased NHS funds are being spent, apart from feathering the nests of GPs, whose pay awards have leapt by 30% or so in the last two years?
Creating the world's best medically trained cadre of buskers and shelf stackers? One beneficiary was - well the health service of the state of Queensland had a stand outside; two wolfish looking young men in red kit refused to answer questions from this journalist. But they admitted they were recruiting.
In the end, Hilborne and co won the no confidence vote, perhaps because of a passionate intervention from Dr Johnson, the head of the BMA, a mandarin, quizzical looking man in his fifties who, like nearly all other speakers, failed to offer bullet point rationale. The level of debate was "Support them because they have protected your interests" without saying how those interests had been protected; the opposing side was equally feeble in argument. The chair of the conference, n associate of Hilborne's, would doubtless deny that the fact that the voting preferences of each delegate in favour or against Gilborne was recorded swayed the vote either way. When whether the vote should be confidential or recorded was decided on in early stages by 20 people standing up to register the former preference, several complained that they hadn't realised what they were standing for.
In the end there was the usual raucous dinner. In the day, a charity that represented alcoholic doctors hosted a stand in the corridor that saw few visitors, and young medics are known for their drinking habits. Two years ago your correspondent danced closely with Ms Hilborne, then chairwoman elect. and was allowed to play his hand up her back as they dined side by side. This time, no such luck. Perhaps she had other things to think about.

Faith healing

When Harris arrived at Manila airport, I gave him a rundown:
"I said: 'You don't understand, George. You have to describe Zen a bit more clearly. 'If you can describe Zen, it isn't Zen,' he said. 'Oh, all right then,' I had said."
Harris, who is a first class mathematician, said: "This is absurd. If course the guru doesn't like the shafts of light that open discussion brings."
I told Harris George wasn't a true believer: he was preparing himself for death, by a gradual, slow process of self-obliteration.
George was a loner: his wife, and daughters, lived in Edinburgh. A wife is the best narcotic against night time fears, as I well knew.
"Why doesn't he just kill himself?"
"I don't know: maybe he is too afraid. He says differently, of course: that Zen is his salvation."
"Is it?"
"Well, put it this way. You know what an American general said in Vietnam: we must destroy this village to save it."

In the car, I told Harris about Imelda's hole in the sky.
We were driving past a squattter camp:
"A hole IN the sky?" he said sourly.

We took a bus up to Tagaytay town. Traffic wended very slowly through the suburbs of southern Manila. The Philippines had, until 1946, been a US colony, its only major one. Many churches were clustered next to fast food restaurants, go-go bars and gas stations.
Every highway in Luzon was an endlessly long stringy town, one shack deep, of jeepney repair centres, small holdings, mango shacks, fast food restaurants, banks, cemeteries, more squatting communities, slums, Shacks, factory zones, garbage dumps. Harris was trying to read Keynes's Economic Consequences of the Peace, but was being constantly interrupted by the sellers that jumped aboard at every junction and tried to foist their
trays of pork scratchings, peanuts, chewing gum, bananas upon all.
Harris went back to biting his nails, poring over his book, dog earing pages.
At a stop, in Dasmarinas, a newspaper seller came on board.
"Must be tough to be a journalist in this country. Or a writer."
We were back in traffic again. Right now, forty heads were moving to the action of the karate video that was playing on the bus's TV screen.
"Well," I said. "literacy is over ninety percent."
* * * *

The safety paradox: because God “protected” him, the bus driver could drive faster.
There was a lake, ringed by ridges, in which monasteries, churches, Zen schools, nunneries clustered, all looking out over Taal lake with its extinct volcano island in the middle. The town itself was centred on a small roundabout where there was a McDonalds, and one day on an earlier visit I had recognised one of George's fellow lodging friends, a Canadian clairvoyant, scarfing a Big Mac.
"What are you going to do tonight?"
"I don't know yet," the clairvoyant said sullenly.
Perhaps he had heard the taunt before.
The monastery was in a converted girls' school, and indeed you were frightened of girls turning up at the end of corridors, long dead and reproachful.

* * *

"I would rather we went for a drink," said Harris.
"I healed someone's TB yesterday." said George.
"Really? Wonderful."
“He was taking penicillin, of course, as a back up."
"Have you ever tried healing someone who doesn't take penicillin?"
"Oh no. That would be unethical."
"So how do you know your healing makes the difference?"
"I am telling you, I healed him."
He put his shoes on, and kneeled down to collect something from under the bed. "My potty - it's full."
Harris and I exchanged glances.
"In Europe, we are so uptight. I love Filipinos - so spontaneous," George said.
There was a picture on the wall of a fat and sleazy looking man - Master Choa and dates of US lecture tour.
"Makes a bit of money then Master Choa?"
George didn't answer; he pursued his lips, and squeezed his big bottom into a pair of slacks.
We went to attend one of the healing teacher sessions. The woman, a fiftysomething Filipina called Faith, talked for two hours, and we had to produce a piece of a paper - a mission statement - which she also talked about for two hours.
"She is in love with Jesus," confided George.
Afterwards, on the lawn, the healer squealed with delight:
"Look, look. Do you see them! The little spirits dancing all around us!"
No. Later, we went to dinner where George fell asleep.

* * *
Faith healing, indeed - let's look at the bigger subject of which faith healing is a part - the influence of religion on health - should not be dismissed per se. Such an attitude is itself unscientific. Both religion and medical care go back together, of course, a long way: were usually dispensed by the same person. Today more and more US medical schools are offering courses in religion and spirituality, and there is a continuing interest both among medical professionals and the general public in the subject.
According to an informal survey conducted at the American Academy of Family Physicians convention, 99% of US general practitioners are convinced that religion can heal, and 75 % of others believe that the prayers of others can help a patient recover.
There have many scientific studies looking at religion as an antecedent to good health - assessment of religious behaviour, frequency of church attendance, the efficacy of prayer, both intercessionary and prayer for the self. There have been assessments of the comfort it can provide, as well as examinations of health differences as a correlate of an individual’s type of religion and as a correlate of the degree of religious orthodoxy.
These findings - which are that religion plays a positive role for health - have been treated by some scepticism by other medical scientists.
A Lancet journal study of studies, while not completely closed to the possibility that religion can play a beneficial role, has found methodological errors in virtually all the studies it surveyed.
For instance, consider the studies that find that orthodox Jews in kibbutz communities and monks live longer. One simple explanation could be that they smoke, drink and eat less. Then there are the surveys that show that people who go to church are healthier, for instance less likely to have strokes. The fact is, people who have had strokes are less likely to actually make it to a service. Then there is the fact that many health factors tend to be measured simultaneously, and there is the tendency to find one that just happens to sink when religiosity falls, though this is not corroborated across a range of measures and the samples are usually unscientifically small. For instance, in one survey, high attendance in church was inversely correlated with high concentrations of interleukin 6 in the elderly but this was only one of eight outcome variables and there was no attempt to control for multiple comparisons.
If for some reason, this message has failed to reach out and or failed to convinced, physicians, who are after all scientifically trained to be sceptical of the super natural, it is not surprising that there is fertile ground among the less scientifically trained population at large for proselytisers for the virtues of prayer - and indeed there is a large industry devoted to faith healing of the masses - different from the quiet prayer at the bedside, it is an industry involving large prayer meetings and a growth in superstar healers, who have their own TV stations and claim to heal dozens of strangers at a time at their live shows which tour the world. (They live, and live plenty, by their donations.)
There's Master Choa Kok Sui, based in Asia, who specialises in pranic healing, which he teaches his faithful to perform in each other. But more famous is Benny Hinn, a fiftysomething in a Nehru jacket and middle eastern accent who touches devotees - people who say they have just been healed - and who fall backwards when treated, legs shaking, all in ecstasy. However reporters found one boy in "coca cola bottle glasses” who had appeared on TV once. "William, baby, can you see now," Hinn had said; the boy told reporters later his ten thousand dollar cheque to see him through rehabilitation had never appeared and he was still, in fact, blind. He had said he had said yes on TV because he had been caught up in the hope of the occasion. Such an example is just utterly typical; one reporter wrote "We have not found one genuine case of a person in fact being truly healed!" and refutations are numerous. There are other tales of charlatanry related:self deputising watchdogs monitor his statements – including such comments that Adam was the first superman, who flew to the moon – to demonstrate his fake nature. Another healer was exposed as using staffers who mingle with the audience in the interval so that the healer’s calling out their names out of supposedly divine inspiration are anything but; and then there's the tragedies, the people who avoid conventional treatment in favour of healing - either administered by the superstars or self administered - and die as a result: four in five children who died after their parents put their trust in faith healing could probably have survived if medical treatment had been sought, according to a study published in Pediatrics, the journal of the American Academy of Pediatrics.
In one case a child choked on a banana and showed signs of life for an hour while the family around her continued to pray. A related tragic case was one woman with cancer of the spine who was commanded to walk across a stage to meet her healer, discarding her brace that held her spine to do so; the next day her spine collapsed and she died soon after.
The Philippine speciality was the psychic surgeons; it is said that there is one loosely attached to every one of Manila's bigger hotels. They pretend to plunge their hands into the patients body, pull out the offending malignant part, and close up the wound, in seconds, leaving no scars. Their successes have created a touring industry for customers from the west. But one expose showed that the surgeons used magician's sleight of hand, bending the fingers at the first knuckle to give the impression of a plunge, with chickens' liver and blood brought forth from under the arm or table at the right moment, quickly secreted away to leave only a few drops of blood - the chicken's, not a human's. The reason why psychic surgery does work for some people is simple.
The human body can heal itself. Most ailments are self-limiting and disappear in time without any treatment. Naturally, if you visit a psychic surgeon and become well, the former will get all the credit and your cash
There is a regular columnist in the Inquirer, Manila's biggest paper, propagandising frequently for the benefits of this transparent charlatanry. "They thought Galileo was wrong too," he writes, in an effort to make people believe the psychic healers are geniuses misunderstood by the many sceptics in the west .

* * *

We were at the end of Tagaytay ridge, at the Palace of the Sky, overlooking the fields of Manila plain one one side, on the other side, the Taal lake, a huge caldera, 30km across, with a volcano island neatly in the middle. Over the plain, winds, and low cloud were sheeting. It was a bit like being in top of a welsh mountain - the play of light was like that.
It had once been a pleasure mansion; now it was just rusting concrete, with an empty concrete dancefloor, grass growing between the footpath stones that crossed what had once been a lawn on which 1970s celebrities and friends of Imelda’s such as George Hamilon and Gina Lollobrigida mingled and drunk cocktails. It had belonged to the Marcoses; it was left to ruin by the subsequent people power government.
"I hate this country," said Harris. "They like the Americans too much."
"You're not a typical anti-American are you? That's so boring," I said.
"No, it's the fact they worship them. They have the same faith and belief in America will sort out the problems of the world, before coming back to sort this country out as they do in God coming to solve their proiblems. But in neither case it's going to happen. They go to church to get God on their side; but all day long they live like votaries for the American dream: the baseball caps, obsession with the worst parts of US trash culture."
"You think Marcos was a solution?"
"They need a revolution."
We went down to see George: he had been done to one of the squatters' camps, where someone had died and was lying in wake in a shack. "Really interesting, like peasants in a Russian novel," he said. He politely accepted my printouts of articles from medical journals on faith healing, and took us out to lunch, where he got so excited by retelling old work yarns that he attempted to do pranic healing on a 26-year-old female stringer from an international news magazine. "Only take a minute," he said, drunkenly and stupidly and when we all tottered out of the Chinese restaurant, I noticed he had left the refuting documents behind.

***

When I finish writing, I stand up, stretch, and switch off the air conditioner, and fan: damp heat soon fills the room. I look in the mirror: the humidity has aged me in only three months. I switch off the light, which has given the shuttered room a sickly yellow diorama glow, the light of the plotting bedsit
murderer. Back in one of the rich people's subdivisions.
When the ringing in my ears subsides, as I stand in the dark, see my silhouette in
the silvery light of the mirror. Sounds outside: the thump of the hostess's son
playing basketball, the Filipino national sport, potting shots into a basket in the
drive. Voices, hoarse pubescent.
"Hey. dude - go for it."
"Go lick a dog's ass."
Thud.
"That was, like, todally COOL."
Silence. Then, a television.
Stocks on Wall Street today,..." click "Do You feel your support group is helping you get over your problems!" "MTV Asia -leave the dial RIGHT there."
But the sound is drowned by - a roaring, crumping sound, rising. I go outdoors, hoping, expecting, it to be people emerging from every house, every doorway, every side street the patter of feet, of a river of people converging, hastening, rushing forwards…
But it is only the rain.

Interview with Johan Calltorp

What are the challenges and rewards of working as a foreign doctor in Sweden?
The good things are that the countryside is beautiful and empty, the cities are clean and efficient, outdoor life-styles are easily pursued; people speak good English (though for their job doctors will have to learn Swedish), Sweden has some of the best medical research traditions in the world, hospital equipment is modern and hospitals and clinics make their often Victorian NHS equivalents look intolerably shabby and chaotic. As in Australia or New Zealand, the population is fluent in British culture, yet it is only an hour away from the UK.
But the system is not perfect.
There has historically been a shortage of doctors, with brought in from abroad, but salaries are not as good as for instance the UK – the country increasingly has to attract foreign talent on quality-of-life measures. And foreign doctors will have to be aware of various challenges facing the system. Sweden’s past success came from having a highly educated, homogenous population benefiting from a great sense of solidarity, but since the 1990s, there has been an influx of largely unassimilated and mostly unemployed population of Muslim immigrant origin which is growing fast, and so there are fewer working people able to carry the burden of the ageing indigenous population – the world’s oldest. And there are healthcare management difficulties connected to the structure of its NHS-like universal access system.
Here Sweden’s top health policy academic Johan Calltorp, professor of health policy advising Sweden’s western hospital region, gives the background to the political, social, demographic challenges facing Swedish healthcare…an essential rundown for anyone thinking of working there….

How do you deal with having the world’s oldest population?

Some people think the whole thing will go to hell by 2020, with an ever lower taxbase having to pay for a growing geriatric population. I don’t think so, I am positive, but there are intense discussions going on about this at the moment.
A taxation-based health system depends on a kind of national solidarity – you pay in enormous amounts until the age of 75, then draw a lot. But twenty percent of the population is of immigrant stock, and there is high unemployment. How much they are able to pay for an ageing population – and how much next generation of Swedes is prepared to pay for ageing immigrants – is a highly sensitive issue

Is that why Sweden has the western world’s highest sick-leave rates?

Yes, partly. There is the feeling: if you are unemployed, we will take time off sick.
There is also the problem of incentivisation, when compensation for being off sick as so high as it is in Sweden. Doctors will be called upon to sign a lot of sick-leave notes…..

What other challenges are there?

The Hjertqvist report on European health systems, published last month in Brussels, rated the Swedish system the third best in Europe, but noted that Sweden performed poorly on service and access.
There waiting lists, as you have in common with all the other centrally funded systems. They are getting longer. These waiting lists are a problem of poor management, because a lot of the patients nominally on the list have recovered or died, but they are also used a political weapon by doctors to demand more money.
Partly it is just a problem of situation. The country is so huge, by European standards, with a low population density, yet there is this commitment to provide a universally high quality of healthcare, which becomes very expensive the northern, Arctic areas, which are also suffering from depopulation and an increasingly large number of elderly people. You do need an oversupply of care everywhere. But if you depopulate Lapland and resettle old people in the cities – what then? Turn it into a complete wilderness?

Do the immigrants have problems getting jobs in care?

There is a long tradition of taking in doctors from abroad; but in a broader society, the country is grappling with the problems of multiculturalism. There was a case a few days ago when a hospital banned a Muslim nurse from wearing a hijab for medical hygiene reasons, but the health ombudsman overturned this as a case of discrimination. There is a lot of ongoing debate about these issues….

Sweden doesn’t have any GPs….so what sort of environment can a foreign doctor expect?

In earlier decades Sweden had quite a good house doctor system; now there is a tradition of going straight to specialists or to emergency wards. This has meant long waiting lists for specialists and – especially old people – clogging up the emergency wards unnecessarily.
It is a matter of tradition. In the 1950s and 1960s politicians wanted to build big hospitals – it was their monument, their “Aswan dams” This is particularly true in the big towns; in smaller urban communities you have multiple doctor care centres, which are a bit like GPs’ practices.

Where else can Sweden improve?

The Hjertqvist report on European health systems, published last month in Brussels, notes that Sweden performed most poorly on service and access.
There waiting lists, as you have in common with all the other centrally funded systems. They are getting longer. These waiting lists are a problem of poor management, because a lot of the patients nominally on the list have recovered or died, but they are also used a political weapon by doctors to demand more money.
Partly it is just a problem of situation. The country is so huge, by European standards, with a low population density, yet there is this commitment to provide a universally high quality of healthcare, which becomes very expensive in Lapland, which is also suffering from depopulation and an increasingly large number of elderly people. You do need an oversupply of care everywhere. But if you depopulate Lapland and resettle old people in the cities – what then? Turn it into a complete wilderness

What is the culture of doctors like?

There is an efficiency culture of doctors – they can be a bit remote, not friendly; instead there is a premium on the role of being efficient and competent.
We are not as good as the UK as giving out information – there are no 24 hour helplines, and there is a point systems based on specialty and hospiatsl , but public awareness of this is not as developed.

The pharmacies are all state-run, are hardly ever open, and they seem expensive

Opening hours have been quite restrictive compared to the rest of Europe, but hours are being expanded.
The pharmacies, along with the alcohol shops, are a state monopoly, and are very characteristic for Sweden. Last year the European court of justice said the monopoly might have to be dismantled to allow competition under the single market rules.
The idea of controlled pharmacies was to en able a gatekeeper – the pharmacist – to be on hand to advise on medicine.is less relevant now that you have the internet.


What does Sweden do well?

We have very good patient outcomes.
There is good access to drugs, emergency care is so good, and we have very good public health indicators; our smoking rates are the lowest in Europe. Obesity is growing, but is still low internationally..

What makes the Swedish funding system different?

Our system is more decentralised than the UK one. It is funded through a local tax, by county councils or regions. In fact there is whole local tier of government, with its own elections, devoted entirely to health administration. These local taxes can very greatly, but the health issue as a regional political football becomes obscured by national politics – the tier above – and municipal election s – the tier below, devoted to issues like schools and public transport. . In a few years time these councils will consolidate into larger regions along the European model – we already have two, and I was the boss of one of those, for west Sweden including Gothenburg - although it is unlikely that these regions will have non healthcare political powers. Sweden is quite a centralised country and our governments are traditionally wary of the European regional power model.

What new policies were the result of the election in September last year?

Health is a very unideological issue in Swedish politics, all the parties think the same. We have this “care guarantee” policy promoted by the liberals but which has now being pushed by the ruling social democrats; it will guarantee treatment to anyone within three months, or they can receive treatment in another part of Sweden.

Or abroad?

Not yet! Though I understand EU legislation on this is in the pipeline. There are some initiatives for social and elective care collaboration with Denmark – now linked by bridge to Sweden – and Norway, in the border areas. The EU has argued that healthcare is best dispensed at a regional level, and there are a lot of cross border initiatives in Belgium, Holland and Germany. In Scandinavia most collaboration happens in research and in the pharma industry, not between hsealth systems.

Isn’t Sweden a bit too efficient at times?

The Danes are very different. They smoke more, drink more, eat less healthily and take less exercise. It is true Sweden can seem a bit over regulated. Danes die much younger; but they have more fun.

"I think too much freedom will completely upset health systems"

It is often not appreciated enough that the EU hass
wide and growing powers to affect British people’s
health. Linda McAvan MEP, 44, represents the Labour party in Europe's
party’s views on health issues - and pretty important health is in the EU too.
The rights of patients to go anywhere in Europe for treatment - putting pressure on dire domestic services. The right of health service providers - national health systems to you and me - to compete directly with their fellow systems across borders.
All is mooted and up in the air.....

Why did you become an MEP?

A colleague of mine said “If you want to be someone, go to Westminster, if you want to do something, go to Brussels.” We seldom become household names but 60 percent of national legislation is passed down from Brussels.

How did you become an MEP?

I got on my bike in 1980 aged 17 because I couldn’t get a job in England, and became a lobbyist for a youth organization in Brussels. Studying modern languages, later at university, I am fluent in French and Spanish - although today the EU institutions are increasingly English-speaking.
After working in local government back in the UK for a few years as a European specalist I was elected to the European parliament in 1998.

What do you do all day?

It is a Monday to Thursday job, the rest of the week we spend back in our home countries doing constituency work. We spend three weeks a month in Brussels, often in committee – all MEPs are members of one and they are powerful legislative bodies. Mine is health and consumer affairs. The fourth week is spent in Strasbourg where legislation is voted through in "plenary" sessions. The European parliament, confusingly, has two seats, Brussels and Strabsourg, each of which are huge, modern building complexes.
Our job is to monitor and amend – often considerably – legislative proposals that come out of the European commission. We also hold the commission to account – they can be sacked by a vote of no confidence. We control the European union’s budget.

Are British MPs jealous of what you do?

I don’t think they are aware. Their ideas about
what MEPs can do is twenty years out of date. The
growth in our powers is quite recent. We were
directly elected only in 1979, and until the mid
eighties our powers vis-a-vis the European commission
were purely consultative. In other words they could
ignore what we said; but a number of treaties in the
1990s - the Maastricht and Amsterdam treaties - have
gradually increased our powers, so that we have
codecision - equal rights to legislate - in a large
number of areas, including the environment, food safety,
public health,
transport, consumer protection and 40 or so other
areas. Many of these issues are not health-legislation per se (governments jealously guard their national health services), but they impact greatly on health.
Because this legislation passes from us to be
rubber-stamped through by national parliaments before
entering national legislation, and media tend to
report the laws as coming from national parliaments,
the European origins of much legislation affecting
British people today tends to be obscured.


Are you pro-European or Eurosceptic?

Oh, I am passionately pro-European.


What do you think of recent European Court of justice
judgments that allow patients to be reimbursed by
national health systems for care taken
abroad. Would you approve of this theoretical
expansion of choice to enjoy care anywhere in Europe?
The idea that you could go to your GP, look at a
choose-and-book menu, and having, in addition to the
offer of that hospital in Sunderland, another, say, in
the South of France, or Bavaria.

It is not a free-for-all at the moment! That choice is
subject to to the condition that there are “too long”
waiting lists in the home country! Although what the
reference point as to what constitutes an unreasonably
long waiting list is a bit unclear at the moment. Be
also aware that the patient would have to pay upfront
to the care provider abroad before applying for
reimbursement by the NHS.
I think too much freedom will completely upset health
systems’ ability to plan care. How would the Belgian
health system for instance cope if suddenly a large
number of patients come from the UK. It would be very
destabilising. There is also the complications for
the patient of travelling, language differences, and
follow up care,
I do think this is more relevant to small countries
which cannot provide the whole spectrum of care
themselves, say Slovenia or Luxembourg, and of course
border areas, where it makes sense for hospitals on
either side of the border to share responsibilities.
Neither of these conditions apply to the UK. Despite
the judgments the overwhelming majority of people in
big countries will continue to have care at
home. The number of British people using these
judgements to enjoy care abroad is very low.
I think the right to care should be enshrined in
legislation though, not ECJ judgments.

MEPs are powerful, but there doesn’t seem to be a
career progression. You can’t be tempted into loyalty
to office, on the other hand, does that make you
independent of the national Labour party?

We are whipped by the Labour party, and have quite
good relations with the party back in the UK. Not as
split as the Tories.

What opportunities are there for medical graduates in Brussels?

There are about two dozen MEPs with medical background, including a few from Britain. Health is becoming more and more important in Brussels. There are so many NGOs where a health background is useful – European Men’s Health Forum, European Public Health Alliance, European respiratory society, just to give you a flavour. The big pharmaceutical companies have operations in Brussels.


What else is coming up in terms of European medical
legislation?

There is the medical devices and alternative therapies
directive - just as authorisation for medicines is
being centralised across Europe at the European
Medicines Agency, which is based in London, so will
the regulation of medical devices and alternative
therapies be harmonised. There
is a new public health programme, and there is
nutrition and health claims directive; it will be
illegal to make extravagant and general claims about
foodstuffs such as “it is good for you” “or low fat”
without specific substantiation. Surprisingly the
industry has lobbied strongly for legislation on
this, as they prefer a single regulatory regime for
the whole of Europe, even if it sometimes more
restrictive. It will also ban basically unhealthy
foodstuffs from selling themselves in
positive claim: for instance, there are high calcium
so-called healthfood chocolate sold in Belgium.
Cereals that are high in salt won’t be able to claim
they are healthy for instance by saying they are high
in fibre also. Hopefully all this will contribute to
fighting Europe’s growing obesity problem.

Health is a subject close to people’s hearts. Do you
get a bigger mailbag than your colleagues?

Not really. But I do get a lot of letters, especially
complaints about the new European healthcard. It has
not been made clear enough in the literature
accompanying the card that the free acute healthcare
applies only to public hospitals in Europe, not the
private clinics that dot many holiday resorts.
Private care can be very expensive. Also, the card
obviously does not cover transport home - one person
wrote in because her husband was killed and had to pay
thousands of pounds to bring the body home. There is a
danger that the card fosters false sense of security;
it is definitely NOT a substitute for travel
insurance. In fact, one of the proposals that might be
under discussion in the EU soon is compulsory travel
insurance for all travellers in Europe.

Do you enjoy living in Brussels? It is possible to
have quite a good life here, especially if you are on
a tax free commission salary!

I don’t really like to say I am “living” here, nor
that I “live it up”. I come here from Monday to
Thursday and stay in my office from 830 am to 830 pm.
But my home is Sheffield. To be honest I don’t really
like Brussels. Everyone is so status conscious: at
parties everyone sizes you up. ‘So what do you do? Ah,
you are an A-grade.'


Where do you stand on Indian doctors?

Well, the demand for work permits was a British
government decision. Nothing to do with the EU! The right of EU doctors to come to the UK to work is a basic EU right, though.
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