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Cardiff University Sepsis Seminar December 2013

Cardiff University Sepsis Seminar December 2013

Last year as part of the build-up to World Sepsis Day, I approached Professor Judith Hall, head of Anaesthetics, Intensive Care and Pain Medicine to discuss how we could create links between Cardiff University and the UK Sepsis Trust. This lead to us putting on a Sepsis Seminar on the University Hospital of Wales campus.

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Election reflections

So we’ve had the results of the elections for the European Parliament. This election is a curious beast in UK terms as it’s done by a form of proportional representation (PR), yet appears superficially similar to the traditional “first past the post” (FPTP) system we’re familiar with. It’s certainly different from the PR system we use in the elections for the Welsh Assembly. In the European election you get to vote for a political party who may field a number of candidates up to the available number of seats for a region, rather than for a particular candidate (who usually represents a political party) in a parliamentary constituency. Of course, the regions for the European elections are rather larger than the UK parliamentary constituencies such that in Wales there are 4 MEPs whereas we have 40 MPs.

In the past few European elections the United Kingdom Independence Party (UKIP) has managed to gain several MEPs, partly because the PR vote counting system has enabled them to gain seats from the second/third/fourth/etc. place vote allocations. At the previous election, they had 13 MEPs despite never yet gaining a seat in the UK parliament. Hmm.

To be clear, I regard UKIP as the most abhorrent political party in the UK. True, there are parties (tiny though they may be) with more extremist views, but at least they tend to be less – shall we say – coy about their views. It seems sometimes, however, that various UKIP candidates, councillors and (now) MEPs seem occasionally to let the veils slip, revealing their true colours. In the press and social media comparisons to 1930s Germany abound.

I was, until recently a Liberal Democrat supporter. When it was announced after the 2010 General Election that they were to form a coalition government with the Conservative Party I was anxious but cautiously optimistic that they would help re-establish the economy without allowing it to overheat in the way the Thatcher government did, which culminated in Black Wednesday as a strange desire to tie the value of Sterling to the then powerful German Mark resulted in spiralling interest rates and economic disaster. I also hoped that some of their sensible policies on (for example) university tuition fees and taxation would get into law while at the same time they would prevent the more extreme policies of the Tory right wing from being enacted. Sadly, I was largely wrong. While the threshold for liability for the basic rate of taxation may have been implemented, I am struggling to name any other successful LibDem policy. Instead, we saw a referendum for a change in the voting system from FPTP to a PR system called “Alternative Vote” (AV) that, it seems hardly anywhere in the world uses. The British voting public may or may not have understood how AV works but what was clear is that it simply didn’t care as only 42% of the electorate voted and AV was blown away without a trace. The price the LibDems appear to have paid for this has been Tory appeasement as we have watched the Health and Social Care Act passed with barely a murmur. We have seen the “bedroom tax” imposed. We have seen Universal Credit being introduced and the consequences are disastrous as more people fail to pay rents and Council Tax bills – a total shambles. We have seen Legal Aid not restructured sensibly but decimated. It’s now increasingly difficult to take action at an Employment Tribunal for wrongful dismissal. We’ve seen ministerial interference with the education system in the shape of the “free school” – which is a meal ticket for cranks and extremists to indoctrinate children while simultaneously failing to provide them with an education. And then there’s the “Help To Buy” system which is already leading to overheating of the housing market. The poor, the sick and the disabled have been demonised – we’ve seen suicides as a direct result of these policies and incompetent assessments stripping desperate and vulnerable people of money. And then there’s that great government success – the rise of the food bank. What did the LibDems do to protect the British public from the rank stupidity and the sheer crassness of these policies? Policies that threaten the very existence of the NHS – the invention that the United Kingdom is rightly proud of and – despite it’s problems and oft-justified criticisms – remains one of the best healthcare systems in the world http://www.commonwealthfund.org/~/media/files/publications/fund-report/2013/nov/1717_thomson_intl_profiles_hlt_care_sys_2013_v2.pdf

So, when you see me defending the NHS, I’m not doing it out of blind faith! Yes, the NHS isn’t perfect but privatisation is not the solution. Tory politicians seem so enamoured with US-style healthcare yet it’s ranked far lower than the NHS in world terms, costing about twice as much per person in terms of GDP and with a lower life expectancy. No.

The LibDems could have stopped the Health and Social Care Act, but failed to do so. Likewise the Bedroom Tax, etc. They have paid the price at the recent Council elections, losing 310 seats in England. The Tories lost 230 seats while UKIP gained 161 and Labour gained 338 seats. However, anyone reading the papers or watching the BBC news, for example, would think that Labour had been slaughtered while UKIP were now in charge in many areas. The reality is that UKIP control a grand total of ZERO councils! The same number as before the election.

UKIP have benefitted from a disproportionate amount of media coverage, but the seats gained have been very patchy. They did poorly in London, for example. The prospect of UKIP having any MPs, let alone being in a position to hold the balance of power if there was no overall winner is a horrific one, given their stated policies. The media coverage of UKIP in the last year has not just been disproportionate in terms of volume but also in content. You won’t find much said about their policies of scrapping the NHS, abolishing maternity pay and a single flat rate of income tax (thereby affecting the poorest the most) in the mainstream media.

But the saddest fact about the council elections of May 22nd 2014 is the voter turnout – just 35% overall. In other words, for various reasons, 65% of the English electorate did not vote.

What about the European elections? Here we saw the combination of several factors contributing to UKIP almost doubling its number of MEPs up to 24 and being the top party of all, beating both the Tories and Labour while the LibDems were almost eliminated from Europe, retaining just a single MEP from a previous 10. They have truly paid the price for their capitulation to the Tories and face a similar situation in the 2015 General Election according to the opinion polls. Is there ANY hope for redemption for the LibDems? To me, there is only one hope by which the LibDems can regain any credibility – even though they would still lose a whole host of seats. They should pull the plug on the coalition government NOW! Only then can they start out on the road to political redemption.

The turnout for the European election was a paltry 34.19%. This is shameful. The turnout in the 2010 general election was 65.1% – still bad, but nearly double the council and European elections. Just what is it with the British public and failing to vote? There are many quotations regarding democracy and voting that seem apposite. For example, if you don’t vote you get the government you deserve and if you don’t vote you end up being governed by your inferiors. Certainly seems true regarding UK politics!

Why do people not vote? Much has been made of statements about not voting made by Russell Brand. Blaming a daft actor for your not voting is pretty pathetic and overly simplistic as an explanation for a poor turnout – his statement has had basically zero effect on the turnout for council and European elections.

For many, they feel that their vote doesn’t count or that there’s no political party that truly represents their views. Often they may like certain policies of a party but vehemently disagree with others. To those who feel disenfranchised in this way I say – I can understand your reluctance to vote but it’s surely better to vote to ensure that the worst possible candidate doesn’t get in? Surely it would be better to vote for the least bad option in the constituency to prevent you ending up with your MP being, for example, a member of the BNP? Every vote counts and those with extreme views will always vote.

Others may complain that it’s inconvenient to vote. Sorry, this doesn’t wash. Anyone who is entitled to vote in a UK election can get a postal vote. It’s a simple, straightforward process. The voting paper arrives well before the election date and the instructions on how to vote are pretty straightforward. I’ve voted by post for some years now, even though my polling station isn’t exactly far away.

So what other excuses are there for not voting? Some people say they would like to have a voting option on the voting slip of “none of the above”, suggesting that somehow any votes cast for this option should be deducted from the votes for the candidates. I have no idea as to how this could be put into practice. Of course, it’s appealing to vote against something you don’t like, but it’s not really how politics works. If there was just a single issue to consider then we’d have a referendum rather than a general election. Rarely do we see single cause political parties or independent candidates getting elected to Parliament for this very reason.

Overall, I think there’s little real reason not to vote. What this election has shown is that  – not just in the UK – voter apathy has been a major factor in determining the outcome in many European countries while parties with extreme views make major gains, such as in France. What this shows is that the supporters of extremist parties feel sufficiently motivated to vote while the moderates and mainstream voters often just can’t be bothered. The only slight hint of good news from the UK elections for the European Parliament is that the BNP no longer have any MEPs. The problem is that the rise of UKIP means that much of the UK will be represented in Europe by a political party who wish to do more damage to Europe –  and UK interests therein – than even the Conservatives wish to do. Yes, there are Tories who wish us out of the EC but – much like the NHS – the solution isn’t to quit Europe but to reform it without destroying it.

The mainstream media have much to answer for in boosting the UKIP vote. Of course the right wing rags have provided ample ammunition to supply the fear that UKIP played on, largely ignoring any evidence that shows them to be wrong. But the BBC also has a lot to answer for, with many commentators on social media suggesting that BBC One be renamed “BBC Farage” as it seems hardly an hour goes by without him popping up on our screens somewhere and Alex Salmond complaining that the rise in the UKIP vote in Scotland is due to the BBC beaming in coverage with Scotland having no control over such matters. The mainstream media seem to be focussing their attentions on the gains made by UKIP while musing as to how this could have happened (hint – look in the mirror), while ignoring the fact that Labour also made great gains, being the top party in the council elections and coming second in the European elections and having their best performance in this election for 15 years. Labour does appear to have an image problem and what portrayal there is in the media is usually negative. They did many things badly when in power, but the current government are far worse. Labour needs to get its act together before next year to not just prevent the Tories from being in power but to prevent a lurch to the right as we’ve just seen in the European election. Many are saying that people will vote differently in a General Election and that it will be difficult for UKIP to gain any MPs. I hope this is true, as for me even a single UKIP MP is one too many.

It is your democratic right to not vote if you so wish, but please consider the consequences of your inaction as you may be condemning us to repeat the mistakes of history.

 

 

Smoking in hospitals – is a complete ban essential or even desirable?

All views and opinions expressed in this blog post are my own and are in no way reflect those of my employers or any professional bodies I am associated with. I also make no claim to this article being heavily researched and evidence-based. Rather I would describe it as my considered views on a subject which has been divisive within the health professions.

Firstly, let me say that I hate smoking. I hate all forms of smoking and all substances that are smoked (not smoked fish, ham, etc!). Cigarettes, cigars, pipes, tobacco, cannabis, crack cocaine. Tobacco smoking killed my father through him developing ischaemic heart disease and affected my mother with a stroke. They are all drugs with the potential to cause great harm. Some are legal, some are not –  a distinction that, perhaps, bears further scrutiny, but this is not the time or place for a discussion on drugs policy. The health risks of smoking tobacco are well-known and include lung cancer, oral cancer, laryngeal cancer, ischaemic heart disease and peripheral vascular disease.

For many years, the debate on how to deal with patients who smoke has continued. I can recall working as a volunteer in my local district general hospital when the day room at the end of the ward was filled with smoke. It was absolutely horrible and unbelievably unpleasant for non-smokers to go in to. In those days, however, there was no other way for patients to watch television – it was the day room or nothing. Having to go outside to smoke was never contemplated by patients, visitors or staff. Coffee rooms, canteens, offices were all places to smoke. The only thing stopping patients and others smoking in their beds was the risk of fire due to there being piped oxygen – and even that didn’t always stop everyone!
I grew up with the anti-smoking message being pushed hard through public information films in schools, in the cinemas and on the TV. I recall from my childhood the first warnings about smoking damaging health appearing on cigarette packets. It was great to see how this powerful public health message reduced the percentage of the population smoking substantially. More than half the adult population smoked at the start of the 1970s http://www.cancerresearchuk.org/cancer-info/cancerstats/types/lung/smoking/#history

The figure now is about 22% of adult males and 19% of adult females. http://www.ash.org.uk/files/documents/ASH_93.pdf

This is a massive advance, but bear in mind that the UK population has grown from approximately 56 million in 1971 to 63 million according to the 2011 Census http://en.wikipedia.org/wiki/Demography_of_the_United_Kingdom

The massive hike in taxation of tobacco has also been a major help here.

As society has changed and become less tolerant of smoking, we have moved smoking out of the working environment and hospital wards. Smoking is now banned in enclosed public spaces, an area of public health policy where Wales had to show England how to do it right 😉 We can now go into a pub or restaurant without having to endure the blue choking smog of cigarette smoke. You can now go for a night out and not come home with your clothes stinking of stale cigarette smoke. Brilliant!

Within health care, the debate about what to do with smokers has raged, with extreme views being expressed on both sides from the likes of FOREST http://www.forestonline.org/ whingeing about denial of human rights of smokers (forgetting that non-smokers human rights are being adversely affected) to the views of those who would deny treatment to people suffering from smoking-related diseases (which would make them the modern equivalent of the Bibilcal leper). Fortunately, sense has largely prevailed here – after all, why discriminate against one section of society on the basis of their own particular form of addiction? Do we discriminate against alcoholics or those addicted to heroin? No.

So we find ourselves in a situation where smoking is officially banned within hospital buildings in accordance with smoking legislation – this is a good thing. However, we now have the problem of the smokers gathering around hospital entrances, whether that be a main entrance, A&E, maternity or even the paediatric unit. Staff and visitors frequently find themselves having to “run the gauntlet” to enter and exit the hospital passing through a smoke haze reminiscent of “Stars In Their Eyes”  – without the nice treat on the other side…..

Hospitals, Trusts and Health Boards have attempted to impose more and more stringent restrictions on where smokers can smoke. Staff are now potentially at risk of disciplinary action if they smoke on work premises. While this may be the theory, it is well-known that this rule is flouted on a daily basis on the vast majority of hospital sites. Many hospitals try to deal with the issue of entrances being smoking sites by providing smoking shelters away from the entrances.

I support all moves to make the working environment, inside and out, smoke-free. NHS staff should be setting an example by not smoking at work or if wearing anything that identifies them as a member of NHS staff. However, hospitals are places where there are enormous psychological stresses in additional to the physical stresses. Everyone working at the “sharp end” of health care provision is at risk of such stress. The patients, their families and friends are, however, the ones who are more directly subjected to these stresses. Part of our job as health care providers is to help them deal with these stresses, supporting them and caring for them. When it comes to smoking – or indeed any other form of drug addiction – we should do our utmost to discourage smoking. But there are times when such discouragement is, perhaps, best put to one side in light of the bigger picture. Attempts to stop smoking are, in my opinion, best made when patients are not acutely unwell or recovering from illness but when they are well or their chronic health conditions are stable.

I work in Critical Care, possibly second only to A&E in terms of acutely stressful situations. While it’s incredibly rare for our patients to go off for a cigarette, we all too frequently find ourselves breaking bad news to the families of seriously ill patients. It would come as no surprise to find that if there are smokers in those families, then one reaction to the stressful situation they find themselves in would be to seek solace in the form of tobacco. Please note – I will say this again – I do not condone smoking. However, there is a time and a place to get the anti-smoking message across – such a time as described is not that time! So, if smoking is not permitted on hospital premises, what is the distraught relative to do? Where are they to go? Is it really justifiable to force them completely off the premises just to satisfy a desire to ban the consumption of a drug which can be bought and consumed perfectly legally?

The issue is therefore one where the need to push the anti-smoking message and prevent smoking in places where it impinges on the lives of the vast majority of us who are non-smokers has to be balanced against how we as a society treat drug addicts. We need to be clear on this – tobacco consumption is every bit as addictive as the likes of cocaine and heroin, but it’s history means that it has held an unmerited place of privilege in society for hundreds of years. In recent years we have seen an upsurge in publicity (don’t know about consumption) of so-called “legal highs”, with the evidence of harm from such agents coming to light. Imagine, therefore, what would happen if tobacco were to be such a new agent now? Highly addictive and with strong evidence of long-term harm, it would soon be banned under the current drugs legislation. But it’s not banned and neither is alcohol. (Declaration of interest here – I drink liquids that contain alcohol fairly regularly). These legal drugs are regulated through licensing and taxation and the places they can be consumed is also controlled to some extent. When people addicted to these drugs come to require inpatient health care, they are placed in an environment where their ability to continue consuming their drug(s) of addiction is severely curtailed. If they are unable to access and consume tobacco and/or alcohol they frequently experience withdrawal symptoms. This is no different to when people who consume other drugs withdraw acutely from their particular substance of addiction. The symptoms and effects of withdrawal from tobacco and alcohol can be very severe, often putting patients and staff at risk. So why are these patients being forced to go “cold turkey” in this way? It’s not the way that other drugs addicts (e.g. heroin) are treated – granted, we don’t feed their addiction but we at least try to provide a strategy to manage their withdrawal. For the alcohol consumers, benzodiazepines are frequently used to manage withdrawal with variable success. So – what about the tobacco smoker? The use of nicotine patches can be effective in helping smokers quit http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12009105929#.UpZBd8RdVMg

However, has anyone studied acute withdrawal in those patients? Yes -sort of. A 2008 update published by the US Department of Health and Human Services entitled “Treating Tobacco Use and Dependence” covers the topic in remarkable brevity (page 149) http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/treating_tobacco_use08.pdf

It may be that we can do more to help smokers quit while they are inpatients, but is this happening? In Cardiff, there is a Hospital Smoking Cessation Service and across Wales there is “Stop Smoking Wales”. Many Trusts elsewhere in the UK also run similar services. However, the effectiveness of such services is variable according to a review published in 2009 in the “Journal of Public Health”. http://jpubhealth.oxfordjournals.org/content/32/1/71.full.pdf+html?sid=648af43e-601b-45a2-8d07-d26b346f4b33

So, it seems unlikely that we can get every inpatient smoker to quit during their stay and we might expect to see patients suffering withdrawal symptoms. We are highly likely to see relatives who are smokers feeling the need to smoke when having to deal with highly stressful situations. Should we be demonising these people? How do we balance the desirability of helping smokers to quit with the reality of not causing great distress to patients and relatives? Many hospitals have provided smoking shelters in the same way that many pubs have smoking shelters or outside areas where smokers can indulge their addiction without inflicting their smoke on others. We need to have the smokers moved away from the hospital entrances! Is it sensible to even try to have a complete ban on smoking on the hospital site? Is there any hospital site that imposes such a ban actually being 100% smoke free? I very much doubt it and I also say that such a blanket ban is undesirable. It is interesting to see how there are parts of the UK where people addicted to injectable drugs (i.e. heroin) are managed. In some, heavy-handed policing is used to drive addicts off street corners. In others, needle exchange programmes exist to reduce health risks to all. Such programmes are highly effective when combined with addiction counselling http://en.wikipedia.org/wiki/Needle_exchange_programme

Is there a risk to banning smoking on NHS hospital sites? Yes. http://www.telegraph.co.uk/health/healthnews/10478475/This-hospital-smoking-ban-may-be-bad-for-your-health.html While I may disagree with the flippancy at the start of this newspaper report, the last few paragraphs are rather better. Another article was published in the Canadian Medical Association Journal http://www.cmaj.ca/content/early/2011/10/31/cmaj.110235 also suggested that harm may result from smoking bans.

Next, let us consider the practicalities of enforcing a smoking ban on a hospital site. Whose job is it to enforce the ban? Who will patrol the hospital site 24 hours a day to ensure compliance? I would say that the majority of hospital sites simply do not have enough security staff to even have a remote chance of effecting such a ban. The security staff usually have other duties to carry out, such as protecting the safety of staff from assault (major kudos to Cardiff & Vale UHB this week – http://www.cardiffandvaleuhb.wales.nhs.uk/news/29933 ).

To my mind, a complete smoking ban is neither practical nor desirable. Of course, we must continue to educate and support those who wish to quit smoking. We must continue to emphasise the undesirability and unacceptability of smoking. But there is a time and a place to be rigid in stopping people smoking – it may well be that the time for such rigidity is not during an inpatient stay or when a loved one is critically ill.

 

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Welsh Intensive Care Society 2013 Summer Meeting

Welsh Intensive Care Society 2013 Summer Meeting

The joy of spam

I usually just delete the spam emails I get, but I thought I’d share this one for all to enjoy. This one really is a bit special….

INTERNATIONAL PAYMENT UNIT

BIRMINGHAM

UNITED KINGDOM

Good day,

I just want to inform you that I have deposited your ATM GOLD CARD of USD $800,000,00 United state dollars to the payment release officer here in London,due to I have waited enough to hear from you so that your payment funds will be transferred through HSBC BANK LONDON here, but because of the late response I now decide to deposit the ATM MASTER CARD with the Courier Services

Therefore I will advise you to fill the information below and forward it to the delivery officer in charge for safe delivery

Name:Oliver Dennis

Email: oliverdennis@globomail.com

Your Name,

your full address,

phone number,

Age,

P.O.box

country and this Parcel Number EG2272-B

This payment has been made available to you by the United nations from the unpaid fund in the united kingdom treasury which was released last year by World Bank for economic uplift.

NOTE: SEND YOUR DETAILS IMMEDIATELY TO THIS EMAIL: Oliver Dennis <oliverdennis@globomail.com> also request them to send you your tracking number that you will use to track your parcel and know when it arrives your country

Yours Truly

FREDERICK NELSON GEORGE (Director IRD)

INTERNAL PAYMENT UNIT

Where do you start???

“The Independent” makes a mess on MMR but at least tries to rectify

The Swansea area is in the grip of a massive measles outbreak, with over 800 cases confirmed to date.

To some, perhaps the majority of the population, measles is no more than one of those childhood infectious diseases that everyone used to get, making the victim feel fairly awful for 10 -14 days, a red rash and then full recovery. As a child, I remember having measles aged 11 or 12. I recovered fully, never expecting anything else or being aware that there could be any other outcome. I certainly never knew anyone in school permanently damaged or killed by measles. As usual, Wikipedia provides some excellent articles on measles http://en.wikipedia.org/wiki/Measles

It was only when I went to medical school and starting learning about the potential damage that measles could cause that I looked back and realised that it could have turned out so differently. Measles can lead to complications and long-term damage. Some of the complications can be fatal. A good summary can be found on the NHS Choices website http://www.nhs.uk/Conditions/Measles/Pages/Complications.aspx

One of the greatest developments by medical science has been the development of vaccination as a means of preventing infectious disease. As a result of vaccine development and immunisation programmes, smallpox has been eradicated and polio is close to being eradicated. The first measles vaccine was licensed in the USA in 1963 and in the UK in 1968. The MMR vaccine was developed in the late 1960’s and early 1970’s but it wasn’t until a 1988 trial funded by the Medical Research Council had been carried out that the MMR vaccine became widely available in the UK. For a history of measles vaccination, there’s an excellent article at http://www.mrc.ac.uk/Achievementsimpact/Storiesofimpact/Measles/index.htm

The graph of annual incidence of measles and the impact of vaccination is particularly striking http://www.mrc.ac.uk/consumption/groups/public/documents/content/~export/MRC004005~3~DC_MS_Word~DC_Snippet_Layout/12381-2.jpg

Like any medicine, vaccines can have side-effects and MMR is no different. http://en.wikipedia.org/wiki/MMR_vaccine

The key question is therefore to compare the benefits of any vaccination against the risks. For MMR, while mild side-effects are relatively common, it’s impact on morbidity and mortality has been overwhelmingly positive. Excellent comparisons are available via the NHS Choices website.http://www.nhs.uk/Conditions/vaccinations/Pages/mmr-why-needed.aspx

http://www.nhs.uk/Conditions/vaccinations/Pages/mmr-side-effects.aspx

In 1998, “The Lancet” published an article by Andrew Wakefield and a group based at the Royal Free Hospital in London which made a link between the MMR vaccine, autism and a bowel disorder they entitled “autistic enterocolitis“. Somewhat unusually, Wakefield held a press conference prior to publication where he stated that he couldn’t support the MMR vaccine but suggested that single vaccines should be used. At the time, the issue was largely ignored by the mainstream media. Given that this was a very small study of just 12 children, that was reasonable. It was later work by Wakefield that fuelled the controversy, particularly when there seemed to be a debate about whether the (then) Prime Minister Tony Blair had or had not had his son, Leo, vaccinated with the MMR vaccine. Press interest escalated rapidly and the suggestion that MMR causes autism gained momentum, despite the lack of any real evidence. Misguided and factually incorrect articles were written and published, such as *Warning – Daily Mail articles, but not links to their site* this, this and this. There are many other such articles. Scaremongering, scientifically illiterate and just plain wrong.

MMR vaccination rates fell and took several years to recover as eventually Wakefield’s work was rebutted and disproven. Work conducted by investigative journalist Brian Deer exposed the multiple problems with Wakefield’s research. The Lancet partially, and then fully, retracted Wakefield’s paper. Wakefield was struck off by the General Medical Council in 2010. By this time he was already regarded by the mainstream medical community as persona non grata. A series of articles by Brian Deer was subsequently published in the British Medical Journal, detailing the multiple problems of Wakefield‘s work. Wakefield’s science also seems pretty ropey.

What has all this got to do with “The Independent“? On Saturday, 13th April 2013, in the midst of a massive measles outbreak, it published a front-page article where the headline used a quote from a press release by Wakefield in which he boldly proclaimed “I was right”. Oh dear! This article was also available on its website. The response from the science and medical community was swift and to the point. Martin Robbins wrote a short post on the website of “The New Statesman”, slamming The Independent not just for giving Wakefield the oxygen of publicity but for using that front-page headline. At the time, a conference called “Question, Explore, Discover” was taking place in Manchester – I was at this excellent conference. One of the speakers there was Dr. Rachael Dunlop. Dr. Dunlop is a prominent campaigner against pseudoscience and quackery, with a particular interest in countering misinformation spread by anti-vaccination campaigners, such as the (hopefully soon defunct) Australian Vaccination Network. In her excellent talk, she described how to effectively counter the misinformation spread by groups such as the AVN by, amongst other steps, educating the media against the provision of false balance in science and medicine articles. A great article by Dr. Dunlop on this topic can be found here.

The article in The Independent caused a great deal of consternation in the scientific, medical and skeptical communities. It would have been bad enough for this article to appear at any time, but the timing in relation to the Swansea measles outbreak only served to magnify the wrongness of giving Wakefield a voice to continue to promote his discredited and disproven nonsense about the MMR vaccine. The article may have attempted to provide a more accurate description of how wrong Wakefield is, but it seems it took quite a long time to make those points, having given Wakefield many column inches beforehand and a large article on inside pages based on a press release made by Wakefield. It seems that The Independent had made the classic error of giving false balance in a science/medicine story. Of course, a Twitter shitstorm erupted. As one Tweeter commented “why do the media give a lone, discredited voice in the darkness an equal platform as the whole body of scientific evidence? Is that balance?”. Of course, the answer is no.

On Sunday, 14th April, while on the train home from Manchester, I saw that someone had tweeted a link to the paper’s complaints form. I decided to add my voice to the complaints sent direct to the paper, in addition to a number of Tweets. I didn’t mince my words:-

“You gave a platform for discredited former doctor Andrew Wakefield to air his views on the MMR vaccination. Firstly, you should recall that Wakefield was struck off the GMC Register as a direct result of his fraudulent and unethical research practices which led to the now-retracted publication of his paper in The Lancet. Despite this publication, no-one has ever shown a link between autism and any vaccine, let alone the MMR vaccine. There is no controversy about this except in the mind of Wakefield himself.

Despite this, your newspaper gave him carte blanche to express his views even though he presents no new evidence but merely churns out the same long-discredited and disproven theories. To do this at any time begs a serious question about journalism standards at The Independent. To publish this at a time when there is a massive measles outbreak in the Swansea area is, quite frankly, unconscionable.

Please issue a retraction of this article and remove it from your website. This is not a case of publishing a contradictory report from genuine health/vaccination expert. To do so would merely serve to provide a false balance when the scientific evidence is overwhelmingly in support of the safety and efficacy of the MMR vaccine. If this retraction and removal is not done, I (and I suspect many others) will have no hesitation in reporting this matter to the Press Complaints Commission and to my Member of Parliament.

Publishing this article has to my mind brought your newspaper into disrepute. You have the opportunity to recover at least some respect. I advise you take it.”

Late on the afternoon of Monday, 15th April, I received a reply from Mr. Will Gore, Deputy Managing Editor for The Independent.

“Dear Mr Morgan

Thank you for contacting us via our online complaints form.  We are always glad to hear from our readers and I am grateful to you for taking the time to get in touch.

With Swansea in the grip of a measles epidemic, the intervention from Andrew Wakefield – the man behind the original MMR scare – was extraordinary and, we felt, worthy of prominent reporting.  We made it absolutely clear from the beginning that Wakefield’s latest claims were noteworthy precisely because they are so wrong and yet he is unrepentant.  In the sub-heading to the main article we set out how experts had condemned his ‘outburst’ and in the opening sentence we explained the background to readers by referring to Wakefield as the “discredited doctor who triggered the MMR scare 15 years ago”.  In the second paragraph we described how Wakefield was struck off the medical register and noted that there is a “widespread consensus” that it was the panic created by his flawed research which has led to the surge in the disease .  We went on to refer to Wakefield as “the chief author of the now infamous and discredited 1998 Lancet paper that first linked the MMR vaccine with bowel disease and autism”.  Later in the article we quoted Adam Finn, professor of paediatrics at the University of Bristol, who challenged Wakefield’s recent remarks in stark terms.

In this context, I do not believe readers would be misled into thinking that Andrew Wakefield’s latest, bizarre statement (or his earlier research) carries any scientific weight.  It may cause distress to those who have suffered as a result of his past actions – but that is because of its delusional and offensive nature.  We carried the statement in full in order to show quite how staggering his defiance remains – in the face of overwhelming evidence against his conclusions and the censure of the medical establishment.

Our leading article went on to dismantle his latest claims one by one, referring in its headline to his “baleful legacy”.  It went on to record how: “his research has been discredited; he has lost his job; his reputation is in tatters and his licence to practise medicine has been withdrawn.  Efforts to confirm his findings have failed.”  We argued that Mr Wakefield “occupies a parallel universe in which his arguments appear internally consistent but which conflict with reality”.

We had no intention of promoting Andrew Wakefield’s discredited hypothesis about the MMR vaccine and I do not believe that our coverage on Saturday will have had that consequence.  I have arranged this morning to add an extra link from our online version of his statement to our leading article in order more clearly to signpost readers from one to the other (it appeared in the ‘related articles’ section but I think it appropriate to give it additional prominence, since it effectively rebuts Wakefield’s statement).

Ultimately, I do not agree with your analysis of our coverage but your feedback is very welcome (we published other critical letters in today’s paper).  We are among many who very much regret that the lower take up the MMR vaccine some years ago has now resulted in these epidemics.  We hold no brief for Mr Wakefield.  Rather, as our leading article concluded, we believe simply that “an understanding of why he is wrong will help to ensure he does not do more.”

I hope you won’t hesitate to come back to me if you have further queries or should cause arise in the future.

With kind regards

Will Gore

Deputy Managing Editor

London Evening Standard, The Independent, i & Independent on Sunday”

Hmm. Tricky!

While I was glad to see that the paper thought it had tried to provide a full rebuttal of Wakefield’s claims, it seemed to me that Mr. Gore had missed the points that a) it should never have published the articles in the first place, b) if it did feel a public interest need to publish the story, it should not have used the headline it did, and c) he hadn’t fully grasped the problem of false balance. I emailed back:-

“Dear Mr. Gore,

Thank you for your prompt response. I appreciate that you may well have been flooded with complaints regarding the front-page article on Wakefield, given the highly inflammatory nature of the subject. I’m grateful that your newspaper has endeavoured to provide the reader with an overview of the issue. However, the real questions here have to be :-

  1. Why publish an article based on a press release from Wakefield, particularly given facts of how he and his work have been totally discredited and disproven?
  2. Why publish the article where the headline is basically saying “I was right all along”?

Here lies the crux of the matter:- many people seeing the newspaper in the shops or visiting the website will have seen the front page headline and read no further. It is therefore likely that the headline may have been taken as a statement of truth. Anti-vaccination campaigners will wilfully ignore scientific evidence and are likely to take that headline as a picture or screenshot and post it online, claiming it as evidence that Wakefield really was right, irrespective of the fact that the context will be completely distorted by doing so. This sort of action is typical of groups around the world such as the Australian Vaccination Network (really an anti-vaccination network). The Australian media, however, in recent years, has become well-versed in how to deal with such groups by avoiding the presentation of false balance. I note that you quoted Adam Finn in the article. This gives a perfect example of the false balance issue I’m talking about here, and sadly it is a common failing in the UK media. You have presented two views – Wakefield’s and Finn’s. To many readers these may well come across as simply two diametrically opposing views of equal validity – false balance – when the scientific evidence is so clearly against Wakefield that any attempt at appropriate evidence-based balance would have necessitated publishing interviews with thousands of doctors and scientists.

I, and others, believe that much of our issues with the front-page article could so easily have been avoided by use of a more appropriate headline, pointing out that Wakefield is discredited  and disgraced rather than reader having to sift through the article to find out that he is disgraced and discredited – it took several paragraphs before that was mentioned. I’m sure by now you will have read the responses to the article by (amongst others) Tom Chivers, Martin Robbins and Ben Goldacre – if not, you really should. I would also suggest you read the blog post on this subject by Mark Henderson, Head of Communications at the Wellcome Trust :-

http://geekmanifesto.wordpress.com/2013/04/14/five-things-not-to-do-if-you-must-write-up-an-andrew-wakefield-press-release/

Therefore the gist of my complaint remains. If a headline such as Mark Henderson suggested in Point 2 on this blog had been used, the article would be perceived as having a much better tone based on the scientific evidence.  Overall, it is far better to handle the likes of attention-seekers such as Wakefield by starving them of the oxygen of publicity. Wakefield is still apparently trying to raise funds to help him continue an ill-conceived defamation action against Brian Deer and the British Medical Journal in a Texan court (although I think the case against the BMJ may have been thrown out). Articles such as this will be used by Wakefield and supporters in fundraising efforts to support such actions which are brought purely in an effort to promote his own discredited work as somehow still having validity when it clearly does not.

I trust you will consider my points made via the complaints forms and in this email further. I await your response.

Yours sincerely,

Dr. Paul Morgan”

On Thursday, 18th April, I received a reply from Mr. Gore:-

“Dear Dr Morgan

Thank you for your further email; I’m sorry for the slight delay in replying.

I absolutely take on board what you say and I can assure you that we have given serious thought to the response our article has generated.  As I’m sure you realise, we went into this piece of coverage with the best of intentions and so the criticism from some readers – and others within the scientific/medical community – is not something we take lightly.

In particular, I hear what you say about the headline not being focussed in the right direction – concentrating on what Wakefield said in his statement, rather than on the criticism of his remarks and on him being discredited.  With that in mind we decided to change the online headline on Tuesday.  I appreciate that such a step does not exactly answer the concerns that have been raised but I think it was the right thing to do.

I am very conscious of the background to the MMR scare and the issues raised by our piece on Saturday have thrown into sharp relief the fact that it is a subject in relation to which we must all remain vigilant.

I do appreciate you taking the trouble to engage with us directly.  It is enormously important that readers are able to feed back to us in a meaningful way and I hope you will feel reassured that we are not ignoring the points you and others have made.

With kind regards

Will Gore

Deputy Managing Editor

London Evening Standard, The Independent, i & Independent on Sunday

will.gore@standard.co.uk

020 3615 2409″

Thus it seems that the multitude of complaints made to the paper have had a positive impact on the editorial staff. Whether the article’s author, Jeremy Laurance, their Health Correspondent, has taken the criticism on board and learned from it remains to be seen. However, the web version of the original article by Laurance does now appear on the website with a rewritten and far more appropriate headline.

I cannot claim any responsibility for the changed headline – I’m pretty sure my voice was just one amongst many. It would be interesting to know how many complaints The Independent received about these articles. What this does show is that sometimes you can get mainstream media to at least partially rectify the problems inherent in publishing stories with false balance. Not every complaint you make will be acted upon, but it is gratifying to know that sometimes you can help make a difference.

I emailed Mr. Gore back to express my thanks. Hopefully, the paper, its writers and editorial staff, will be more careful in future to not provide the likes of Wakefield with unwarranted publicity and be more careful about providing real balance in stories about science and medicine. It’s role in society is to inform, not mislead – however unintentionally.

In summary, The Independent screwed up but has realised it screwed up and has taken steps to remedy this, so well done to them. If only some other sections of the media would learn such lessons…..

The School Reunion

On Saturday night (October 27th, 2012) I went to a school reunion. I have to say it was an event I approached with mixed feelings. I left school after my ‘A’ levels in 1980, and apart from one person I’d not kept in contact with people from my 6th form until I joined Friends Reunited a few years ago. Here I was able to see information about some of the people I’d been in school (and elsewhere) with. However, it had the possibility of getting a bit confusing as the information you could find was determined by putting in the name of the schools you attended and then filtering according to the year you left. This created a bit of a problem! While I stayed on to 6th form and left in 1980, most people didn’t and so left after ‘O’ levels and CSE’s in 1978 (we were pre-GCSE although there were moves already happening leading to the change). Some people I knew well stayed on in Lower 6th dropped out at various stages. So, in order to catch up with everyone I knew I had to look at 1978, 1979 and 1980. I then had a load of names from those years who weren’t in my school year but left at the same time, so that were a large number of people I didn’t recognise. Oh well, it was entertaining to plough through the lists of names. I also looked for names of people I knew in the years above me to find out who’d signed up. Of course, one of the biggest problems with such a social network is that membership is largely self-selecting although you could invite people you knew to join but that meant knowing how to get in touch with them in the first place…….

Oh well! Through Friends Reunited I was able to see information on people I’d know back in school and actually got in touch with a few of them. In some ways, finding out a little of what was going on with so many people I’d been in school with did make me think about my reasons for wanting to find out what was going on with them. Was I simply curious? Was I wanting to find out about their successes and failures? Did I want to see people I liked and got on with in school succeeding and those I didn’t get on with failing (and was that genuine loathing or being mean-spirited on my behalf)? It’s fair to say that before 6th form, there were just a handful of people I’d call friends and even in 6th form there were some I wouldn’t count as friends. At least there weren’t people in 6th form that I really didn’t like……..

Was it the prospect of a reunion that possibly worried me? No. I’d been to reunions from my year in medical school and was even involved in organising the last one in 2010, the 25th anniversary of qualifying as a doctor. TWENTY-FIVE YEARS as a doctor!!!! Add five years on to that and that’s how long since I left school. So, by now, it was 32 years since I left school and 34 years since I’d seen those who left in 1978. I think mainly it was the possibility of meeting up with people who I’d not got on so well with at school and wondering what the reaction was going to be, both their reaction to me and my reaction to them. Of course, I’ve changed enormously as a person and so has everyone else. After thirty-odd years we’ve all experienced something we call “life”. As teenagers, we may have thought we knew what it was all about and had all the answers and had our lives mapped out. Aww! The innocence and naivety of youth. I wonder how many of us actually ended up doing exactly what we wanted to do in the way we wanted to do it and without any sort of mistakes, bad luck etc. Probably very few, if any!

So, how did the idea of a reunion come about and was it worth it? The idea was proposed by someone who I was in 6th form and taken up by several others. However, Friends Reunited seemed to have become somewhat passé. Facebook had taken over as the major social network for getting in touch with former friends and organising events, so it was over to Facebook! Several former members of the school year were already there and so connections were established. The idea was mooted that the reunion should be for those who had reached the grand age of 50 +/- 1. It was always going to be somewhat unpredictable as to the level of response, so opening up had the opportunity to get bigger numbers of people to attend. As is the way with these things, an initial flurry of activity was followed by a quiet period before someone else took up the challenge to get the details sorted out to actually ensure that the reunion actually took place. After many weeks and months of ideas going around, eventually the plan was to meet up at the Central Hotel in the Trallwn area of our home town of Pontypridd. I think the last time I went there was probably around 1981 or 1982, so of course it had changed enormously since then. Most of the building seems to be taken up by an Indian (Bangladeshi) restaurant, so the plan was to meet in the upstairs function room before eating later in the restaurant. This was good – I do like a nice curry and have even been known to make a few myself.

It wasn’t really clear as to how many were going to turn up to the reunion. It seemed that while there were many people keen to meet up, there would only be about 20 or so wanting to eat. Maybe they knew something about the restaurant………

The night of the 27th October arrived, so my wife and I set off on the short journey to Pontypridd. When we arrived at the Hotel, there were around 20 or 30 people there, but this gradually filled up so that I would estimate that there were around 70 or 80 people there. The biggest challenge was trying to identify people I knew! Some were easy, as I’d seen their pictures on Friends Reunited or Facebook. There were several people there I hadn’t known in school, so I had no chance of knowing who they were. One person took the sensible step of wearing a badge with his name on and a picture from school! Maybe we should all have done that!

I did spot a few people I recognised and got chatting, reminiscing about school days and catching up with what they were up to now. A few people had moved around and were living away but there were many who were – like me – living in Cardiff and many who were still in the Pontypridd area. It seemed that quite a few of those still in Pontypridd were in regular contact, whereas those who’d moved away had mainly lost contact, even if only in Cardiff. Social networking has, however, allowed many of us to re-establish long-lost connections.

So, how was the reunion? Was it enjoyable or just painful? I have to say, in spite of my anxieties, I really enjoyed the evening. I chatted to people I’d been good friends with and others who I wasn’t so friendly with. It was good to hear what people were doing with their lives. Sadly, some people had suffered ill health (one had a  bone marrow transplant for leukaemia, another had a renal transplant – both doing well now). One guy had apparently choked to death in a restaurant – grim! Many of us had changed in appearance. Some said I had changed the most – maybe that’s true! I used to wear black plastic-framed glasses in school (from the age of 9) and didn’t get “trendy” metal frames until well into medical school. I finally shed the specs about 18 months after qualifying. What was gratifying was being one of the few with a full head of hair, albeit going somewhat grey! Sorry, guys!

The food turned out to be a bit disappointing and the service was poor, but at least it was cheap! You get what you pay for. The chief organiser did apologise, but it wasn’t her fault and at the end of the day it’s doubtful if the reunion would have happened (at least not by now). The social aspect of the evening was far more important than a curry which was adequate if nothing special. I don’t think I would necessarily choose that restaurant again unless I was drunk and there was nowhere else to go. However, if another reunion is organised, I’m definitely up for it. Bring it on! Somewhere in the depths of my attic are a whole bunch of photos from school – I was an avid photographer and member of the school Camera Club. I must try to get to them soon and scan them in to post on Facebook. One girl I was in school with (and fancied like crazy!) went on to win the “Miss Wales” title – perhaps all those pictures I took of her somehow inspired her to start modelling. School wasn’t all bad – was it?