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Hole Ousia

being and becoming in the world

  • About me
    • Artwork by Peter
    • Contact
    • Courage to Care
      • ‘Two cultures’
        • Omphatyp’
      • A Sunshine Act for Scotland
        • “This isn’t a priority for us”
        • Bring me sunshine
        • The Scottish Government has chosen not to listen to the Scottish people
        • The voices of the people really do matter
      • Curriculum vitae
      • Declaration of interests
      • Delirium screening
        • ‘Informed consent is a fundamental principle underlying all healthcare’
        • Faltering, unfaltering steps
        • Haloperidol prescribing to Scotland’s elders
        • Infusion of worldwide teas
        • NHS Scotland requires a culture that listens to all
        • Scientific progress requires open-minded enquiry
        • The benefits of clinical engagement
        • The hazards of antipsychotic treatment in elderly people
      • In support of professional values
      • Leading to the Exit door
      • Leaving a profession
      • Looks out for each other
      • Medical publications
      • Messages about my retirement
      • Testimonials for Dr Peter J. Gordon
      • The Governance of the NHS in Scotland
      • The other side of the fence: Iatrogenic stigma
      • Timely diagnosis of dementia
        • Dementia: the “epidemic” of metaphors
        • Dementia: who is in the “driving seat”?
        • I was concerned about our most elderly
        • Scotland’s approach to Dementia Diagnosis
        • The ‘Edinburgh Consensus’
          • “This House supports the early detection of dementia”
            • The result: ‘Motion defeated’
          • Back in the driving seat: Industry
          • Dementia Case-Finding: language and ethics
          • EPAD co-coordinator: Professor Craig Ritchie
          • Glasgow Memory Clinic
          • Hide and Seek
          • In a “muddle”?
          • Issues not considered in the ‘Edinburgh Consensus’
          • National Clinical Director for Dementia: Professor Alistair Burns
          • Professor says: “Classsic Pharma shill stuff”
            • absurdum
          • Snakes, ladders and Monopoly
          • The ‘Edinburgh Consensus’ – a timeline
        • Wandering, wondering and worrying
    • Deeside Tales
      • Short films about Deeside
      • To be humbled.
    • Films made by Peter
      • 3 films that almost ended my career
      • A maker of beautiful books
        • The Great Tapestry of Scotland
      • A new way of seeing
      • A Thousand Chances
      • Alive in the river of light
      • Angelology
      • Bridge of Allan
      • bridges
      • Canto two
      • Finding Cimbrone
      • Folk worth talking about
      • friendship itself
      • Glenbardy
      • Go seek adventures
      • Here is where we meet
      • I am part of all that I have met
      • Important note about my films
      • in its ending
      • incorrigibly plural
      • It was the singing
      • Language is leaving me
      • Let the anchor go
      • Little Sparta
      • living mountains
      • man with the child in his eyes
      • Marginalia
      • mathematically me
      • Mossgrove garden
      • my library-haunting self
      • of an Antiquary
      • Oor big braw Cosmos
      • Political pieces
      • Progress hardly broke its stride
      • sensitive to the faltering steps of age
      • Sheramoor
      • Stravaiging need not be lonely
      • The anatomy of emotion
      • the blue flower
      • The bright cave under the hat
      • The Cabrach
      • the Glentruim series
      • The Rebel Antiquary
      • They fell for us
      • this gifted gardener [I discovered one day]
      • Time passes. Listen
      • To see what Scott saw:
      • Trees: age and beauty do go together
      • [Series II]
    • Firrhill High School
    • Hole Ousia [what does it mean?]
    • Mavisbank
      • On Esca’s Flow’ry Bank
      • Short films about Mavisbank
    • MEDICINE
      • Films about MEDICINE
      • Films about PSYCHIATRY
      • Films and Sapere Aude
      • Films on ETHICS
      • Films on Professional VALUES
      • Films that consider ‘First Do No Harm’
    • My dissertation on hedges
    • My schooling
    • Peter’s poems
      • One-word poems
    • Publications in the “Leopard”
    • The Ageing Stone
    • The speaking hedge
    • What is in a name?
  • being and becoming
    • “A place with no quotation marks”
    • Academic reductionisms
    • Admissions of doubt
    • Ariel
    • Cell Mates
    • Medical “truants”
    • Multifarious learners
      • A fortunate man
      • Dr Anton Pavlovich Chekhov
      • Dr Arthur J. Brock
      • Dr Arthur Mitchell
      • Dr Daniel Reid Rankin
      • Dr Gavin Francis
      • Dr James Sheridan Knowles
      • Dr Leon Eisenberg
      • Dr Samuel Brown (1817 – 1856)
      • Edmund de Waal
      • Femi Oyebode
      • George Washington Wilson
      • Graham Watt
      • James Clerk Maxwell
      • James Ferguson
      • James Skene
      • John Berger
        • Here is where we meet
      • John Frederick William Herschel
      • K. J. Fowler
      • Kenneth Calman
      • Mr and Mrs Rose
      • Nadar
      • Patrick Matthew
      • Rev George Gilfillan
      • Richard Feynman
      • Scottish women writers
      • Sir Harry Burns
      • Theodore Dalrymple
      • Thomas Browne
      • William Friese-Greene
      • William Lewson Burrowes
      • William Ramsay
    • Philosophers
      • Albert Camus
      • Andrew Greig
      • Dr John Flaxman
      • Dugald Stewart
      • John Macmurray
      • John Stuart Mill
      • Mary Midgley
      • Raymond Tallis
    • Poets
      • Alexander laing
      • Caledonian Antisyzygy
      • Carol Ann Duffy
      • Daniel Abse
      • Edwin Morgan
      • Iain Banks
      • Iain Crichton Smith
      • Ivor Gurney
      • James Hyslop
      • James M Slimmon
      • John Betjeman
      • John Halliday
      • Kathleen Jamie
      • Kieron Winn
      • La Teste
      • Leonard Cohen
      • Liz Lochhead
      • Norman MacCaig
      • Patrick Deeley
      • Paul Muldoon
      • Peter Davidson
      • Rab Wilson
      • Rabbie Burns
      • Robert Fergusson
      • Robert Nicholl
      • Robert Pollok
      • Robin Hyde
      • Sylvia Plath
      • T S Eliot
      • Ted Hughes
      • Tom Leonard
      • Tomas Tranströmer
      • Wilfred Owen
      • William Carlos Williams
      • William Soutar
    • Sapere Aude
      • A bit of a prat
      • a very clever young man
      • Caroline Phillips
      • Chrys Muirhead
      • Claire Fox
      • Dr Donald Brownlie
      • Dr Margaret McCartney
      • Fara McAfee
      • Gawaine Baillie
      • Gerald
      • Hale-Bopp
      • Humpty Dumpty
      • I mistook myself for a scientific label
      • Jessie Lennox (a Nightingale)
      • Joan Eardley
      • John Aubrey
      • King Kong
      • Margaret Maberley Gordon
      • O. G. S. Crawford
      • Omphatyp’
      • Owen Jones
      • Richard Holloway
      • Richard Taylor
      • Roy Porter
      • Stanley Murray
    • Writers
      • A L Kennedy
      • A S Byatt
      • Adam Nicolson
      • Alan Trotter
      • Alexander McCall Smith
      • Ali Smith
      • Alice Hoffman
      • Andrew Greig
      • Andrew Miller
      • Annalena MacAfee
      • Anne Tyler
      • Anthony Doerr
      • Candia McWilliam
      • Cesare Pavese
      • Charlotte Peacock
      • Chimamanda Ngozi Adichie
      • David Szalay
      • Deborah Levy
      • Douglas Stuart
      • E M Forster
      • Emily Fridlund
      • Ernest Hemingway
      • Evelyn Waugh
      • Fiona Mozley
      • Ford Madox Ford
      • Fyodor Dostoyevsky
      • Gabriel García Marquez
      • Geoff Dyer
      • George Orwell
      • George Saunders
      • Hanya Yanagihara
      • Howard Jacobson
      • Iris Murdoch
      • J. D. Salinger
      • Janice Galloway
      • Jessie Burton
      • John Buchan
      • John Lanchester
      • John Steinbeck
      • Julian Barnes
      • Kazuo Ishiguro
      • Lampedusa
      • Laurie Lee
      • Madeleine Thien
      • Marcel Proust
      • Margaret Drabble
      • Matt Haig
      • Max Porter
      • Mohsin Hamid
      • Mukul Kesavan
      • Muriel Spark
      • Nan Shepherd
      • Nathan Filer
      • Oscar Wilde
      • Otessa Moshfegh
      • Penelope Fitzgerald
      • Richard Flanagan
      • Richard Holmes
      • Richard Yates
      • Roald Dahl
      • Robert Louis Stevenson
      • Robert Seethaler
      • Rudyard Kipling
      • Sara Baume
      • Thomas Mann
      • Virginia Woolf
      • Vladimir Nabakov
      • Will Cohu
      • William Boyd
      • Yann Martel
  • in the world
    • A Sunshine Act for Scotland
      • “The influence of pharma is not excessive”
      • ‘Listen, let the people petition and be heard’
      • ‘To influence others by offering money’
      • A matter for others
      • Bring me a sunshine act
      • British Psychiatry: Marketing as ‘Education’
        • “A robust learning environment for healthcare professionals”
        • “An ethical relationship with pharma”
        • “Classsic Pharma shill stuff”
        • “FULLY BOOKED”
        • “MacDonald’s to advise on childhood nutrition”
        • “P R O M I S C U O U S”
        • “The place to go to” for CPD
        • “Working with the drug industry—is your reputation at risk?”
        • ‘Fees for services’
        • ‘Industry Biased Medicine’
        • ‘Medical Education for the 21st Century’
        • ‘MEDICAL EDUCATION: In the grip of industry?’
        • ‘Psychiatry without borders’
        • ‘Welcome to Pharmacare’
        • 2017 International Congress: Psychiatry without Borders
          • “Performed well”
        • 2018 International Congress: Psychiatry: New Horizons
        • ABC of Mental Health: Depression
        • BAP ‘educator’ on prescribing received $3,581,159 in payments from Pharma
        • Conflict of interest and the British Journal of Psychiatry
        • Continuing Medical ‘Education’
        • Darkness prevails: the Royal College of Psychiatrists
        • Data Protection: The Royal College of Psychiatrists
        • Is academic psychiatry for sale?
        • It’s boom time for the College
        • Latuda: vigorously marketed in The UK
        • Paid Opinion Leaders
        • Pharmaceutical influence and psychiatrists
        • Prescribing Guidelines: let’s be transparent
        • Professors A, B, and C
        • Puritanical or Platinum?
        • Rising stars: British Association of Psychopharmacology
        • Royal College of Psychiatrists: “This is a matter for the Government to decide”
        • Satellite symposia and paid opinion leaders
        • Simon said
        • The British Journal of Psychiatry and Pharmaceutical Industry advertising
          • “SPECIAL ARTICLE”
          • ‘AUTHENTICITY’
          • Are competing interests of authors sufficiently transparent?
        • The Defeat Depression Campaign
          • “Buy it, read it and recommend it!”
          • “CONSENSUS STATEMENT”
            • Managing depression in general practice
          • “Defeating depression in old age”
          • “Dista Products [for] Royal College of Psychiatrists, 1993”
          • “Fear of dependency”
          • “Fun Run”
          • “Generously sponsored by Smith Kline & Beecham”
          • “Promulgating therapeutic recommendations”
          • “The Defeat Depression Campaign is not a useful exercise”
          • “To mount a glossy campaign on the basis of this method is frankly disturbing”
          • ‘Antidepressants unlimited’
          • ‘Continuing to defeat depression’
          • ‘Costs should have been considered’
          • ‘Defeat Depression: A European Perspective’
          • ‘Dyspeptic Dinner Entertainment’
          • ‘The Influence of the Pharmaceutical Industry’
          • ‘Warm-up led by former DJ of Capital Radio’
          • ‘We cannot be in the pockets of the Pharma companies’
          • ‘Why can’t GPs follow guidelines on depression?’
          • (orders 100+ at 25p per leaflet)
          • A summary of the Educational Components
          • An ‘Educational Campaign’ sponsored by Pharma
          • How to Defeat Depression
          • Is depression a chronic illness?
          • LILLY Pharmaceuticals: the Defeat Depression Campaign
          • Mass prescribing
          • My career began with the Defeat Depression Campaign
          • One-and-the-same
          • Psychiatry in General Practice: a ‘Campaign’ begins
          • Putting caring conversations into practice
          • RCPsych archive: 5 Boxes
          • SSRIs: “Public confidence needs to be restored”
          • The ‘Chemical imbalance’ theory
          • This historical campaign has vital lessons for today
          • Video Training Package
          • What Price Depression?
        • The latest ‘Platinum Sponsor’ for RCPsych conference
        • The Law of the Few
        • The mismatch
        • Transparency and British Psychiatry: Hold the applause
        • Transparency at the Top
        • Who pays the piper?
      • Led Astray – Industry’s Influence on Drug and Device Watchdogs
      • Medicine remains as conflicted as ever
      • Prescribed drug dependence and withdrawal
        • “Attacks on antidepressants”
        • “Discontinuation syndrome”: sophistry of the drug industry
        • “Objectivity” does not come in a title
        • ‘Tens of thousands of children’
        • A timeline of missed opportunities
          • “Programme will help identify potential suicide victims”
        • Antidepressant prescribing and “fully informed consent”
          • Words and numbers should be used with equal care
        • Antidepressant withdrawal symptoms -Telephone calls to a national medication helpline
        • Collective values of an organisation in the era of social media
          • RCPsych Presidential elections [2022/23]: in support of Dr Kate Lovett
        • Coming off antidepressants
        • Cumberlege Report: First Do No Harm
          • A reply to a Lifetime Achievement Awardee
            • A loss to science
          • Cumberlege Review: what is the position of RCPsych?
          • Language and professional values
            • ‘Why all this nastiness?’: Twitter
            • 2019: Question to Presidential candidates on College values
            • 2022: Question to Presidential candidates on College values
          • Language Matters: indeed it does
          • Let us be kind to one another even when views may differ
          • Medicine’s contract with society
          • Polypropylene Mesh Implants
          • Professionalism and psychiatry: past, present and future
          • Professionalism and psychiatry: the profession speaks
          • Psychiatrist #1 on First Do No Harm
          • Psychiatrist #2 on First Do No Harm
          • Psychiatrist #3 on First Do No Harm
          • Psychiatrist #4 on First Do No Harm
          • Psychiatrist #5 on First Do No Harm
          • Psychiatry, dependent on its authority, is finding withdrawal seriously difficult
          • Social Media Policy of the Royal College of Psychiatrists
            • “Stay classy”
            • ‘outside the circle of listeners’
        • Depression: pills and dependence [a timeline following a letter in the Times]
        • Discontinuation of antidepressant therapy [1997 symposium]
        • Gilbert Farie Revisited
        • RCPsych [Prescribed harm]
          • “Another me exists”
          • “Casual false reassurances”
          • “Pill Shaming”
          • “We care about our crest and it is sad to see it used this way”
          • A letter in the Times
          • An extraordinary divide
          • Antidepressant withdrawal: why has it been ignored for so long?
          • Psychiatry, dependent on its authority, is finding withdrawal seriously difficult
          • SIBERIA
          • The other side of the fence: Iatrogenic stigma
          • unanswered
        • Realistic prescribing
          • “It’s BOOM time in Industry”
          • “That prescription figure is high”
          • ‘A generation in crisis’
          • ‘The Medical Untouchables’
          • Our own window
          • Psychiatry in Fabula
          • RSM Health Matters Podcast: Episode 1 – Antidepressants
          • Science Media Centre
          • Selective Serotonin Reuptake Inhibitors for the Elderly
          • The Narrative Controllers
            • ‘Chumcentric’
          • The Neon Yellow Preservation Society
          • Unanswered
        • Stigma and Psychiatry
        • The Scottish Government [Prescribed harm]
          • “Key Information on the use of antidepressants in Scotland”
          • “Villains and Demonisers”
          • ‘Antidepressant use: changing patterns, cost and clinical effectiveness’
          • Antidepressants (Overuse)
          • Antidepressants: ‘no good evidence’ for long-term use
      • Trial by Anecdote
      • Unrealistic Medicine
    • Architecture
      • ‘The Story of Drummond Place’
      • 18 Kilrymont Road
      • Abbotsford
      • Andrew Crosbie’s House
      • Auchinleck House
      • Bute House
      • Charles Brand Ltd
      • Dalhousie Memorial Arch
      • Drummond Place, Edinburgh
      • Edinburgh’s first Theatre
      • Forglen Mausoleum
      • Gladney House
      • Glasgow Necropolis
      • GOLDBERGS
      • Hermits and Termits
      • Hospitalfield House
      • Kilbirnie Radio Cinema Bingo Hall
      • Kildonan House
      • Kinneil House
      • Mar Lodge, Stirling
      • McCaig’s Tower, Oban
      • Moatbrae House, Dumfries
      • Monument to the Political Martyrs’
      • Muschat’s cairn
      • Old Royal High School, Edinburgh
      • Scottish architectural follies
      • SeaPark
      • Shakespeare Square
      • St Andrew’s House, Edinburgh
      • Temple of the Muses
      • TEMPLE [Cupar]
      • The galleria
      • The Red Road flats
      • The Wallace Monument
      • The Well of the Seven Heads
      • Tower of Glenstrae
      • Warriston Gates
    • Ardeer Explosive’s Factory
    • Bridges
      • Abergeldie foot-bridge
      • Boat o’Brig
      • Brewlands bridge
      • Broom of Moy
      • Broomhill wooden bridge
      • Faery Bridge, Dunblane
      • Forth Road Bridge
      • Garva bridge
      • Haugh of Drimmie
      • Kalemouth Suspension Bridge
      • Kincardine Bridge (on Forth)
      • Millhaugh bridge
      • Old White Bridge
      • Tay Bridge
      • The bridge to nowhere
      • The Glenfinnan Viaduct
      • The Old Bridge of Livet
      • Twa Gables
    • CITIES
      • Films about ABERDEEN
      • Films about DUNDEE
      • Films about EDINBURGH
      • Films about GLASGOW
      • Films about PERTH
      • Films about STIRLING
    • D.L.R.O.W
      • The mild cigar
    • Dunaskin Iron and Brick works
    • Earl’s Hill radio transmitter
    • landscapes (time held green)
      • ‘Hill of the Resurrection’
      • Carsebreck
      • Cliff House
      • Dunbuy
      • Duncryne
      • Garden Archaeology
      • Gardeners
        • ‘Gardener Found Insane’
        • A high summer garden
        • A new generation of gardeners
        • A Nursery Manager
        • Abergeldie’s gardener
        • Alexander Marr
        • Alexander Walker
        • Arbigland’s gardener
        • Boghead, Bathgate
        • Carnbroe’s gairdener
        • Charles Bell, Ormistoun Hall
        • Charles Frampton
        • Charles Webster
        • COREHOUSE
        • David Pringle Laird
        • Davina, Lady Stair
        • Eagle and Henderson
        • Glassingall Gardener
        • Glentulchan gardener
        • Helen Carmichael
        • James Hossack, Castle Cluny
        • James Ironside
        • James Sutherland
        • John Halliday
        • John Wright Paton
        • Last of Horse Wynd
        • Miss Hope
        • Monty Don
        • Ninian Niven
        • No.1 Shrub Place
        • OLDEST GARDENER
        • Patrick’s garden
        • Peter and Sian’s garden
        • Peter Gordon, gardener
        • Peter Rankin, Glen Creran
        • Peter Thomson, a ‘practical gardener’
        • Peter Thomson: ‘the patient art of fieldwalking’
        • R E E K I A N A
        • Return to the seed
        • Robert Graham of Tamrawer
        • Robert Murray, West Princes Street Gardens
        • Robert Rust
        • Scotland’s Silver Glen
        • Teri and Paul Hodge-Neale
        • The Abbotsford gardener
        • The Astronomical Gardener
        • The auld gardener
        • The gardener of Finca Vigia
        • The gentle gardener
        • The Queen’s Gardener
        • The Sisters’ Garden
        • Thomas Cleghorn
        • Tom Spence
        • Under Gardener [D U N I R A]
        • Volunteer gardener
        • Wellington Dauncey
        • William Rutherford
      • Garrel Glen
      • Gauch
      • Glen Girnoc
        • Abergeldie castle
        • Bovaglie
          • Joseph Gordon’s journal of a voyage to Australia (1841-1842)
          • The Bovaglie manuscript
        • Loinveg
        • The Camlet
      • Glenbardy
      • ISLANDS
        • Alloa Inch
        • Eilean Fhianain
        • Eilean nam Faoileag
        • Eilean Subhainn
        • Inchcolm island
        • Linga Isle
        • Lismore
        • Lucky Scaup
        • Samalaman
        • St Kilda
        • Vallay
      • Jock’s Road
      • Kilmadock churchyard
      • Leckie Glen
      • Little Sparta
      • Lochnagar
      • Stronmilchan
      • The Devil’s Pulpit
      • The Dragon’s Hole
      • The Hill
      • The John Muir Way
      • The living mountain
      • The Lost Garden of Dunira
      • The lost garden of Penicuik
      • The suicide graves
      • Wanzie
    • Mental Health Tsar
    • Mortar and Pestles
    • Necessity Brae
    • Rogues’ Gallery
      • Duncan Paton
      • Helen Nicholson
      • John Grovenor
      • John Moir
      • John Yates alias John Hewitt, Patrick Hines, John Miller, John Roy
      • Peter [alias John]
      • Philip Hughes
      • The Highland Hotel Robbers
      • William Slater
    • The Great Globe
    • The Jam factory
    • Trees
      • Beauly’s Wych Elm
      • Goodnestone chestnut tree
      • One way of measuring a tree
      • Sir Walter Scott’s Tree
      • The bicycle tree
      • The Lanrick stone tree
      • The Wallace Oak
      • Yew trees
        • Adam and Eve Yews
        • An incredibly ancient child
        • “When Harry met Mary under the Yew tree”
        • Chapel of the Yew Trees
        • Craigend Yew
        • Earlshall [shapes abandoned]
        • I Vow Yew
        • Rockingham elephants
        • Scientists chop years off ancient yew trees
        • St Columba’s Yew
        • Stow on Wold Yews
        • The Abbotshall Yew
        • The Auchendrane Yew
        • The circular Yew hedge
        • The Culfargie Yew
        • The Fraser Yew
        • The Inchbrakie Yew
        • The little loch of the yew grove
        • The Ormiston Yew
        • The Raploch Yew
        • The Somerleyton Yew
        • The Wallace Yew
    • Waverley
  • Mind The Gap
  • where time passes (listen)
    • Bridge of Allan
      • ‘Quote of the week’
      • A bridge over the Allan Water
      • Chemists and Apothecaries
        • Charles Neil Rutherfoord
        • Gilbert Farie
        • Oswald Robertson
      • Drumdruills
        • Beware the Fly!
        • Memoir of Adam Baird (junior)
        • Millad
        • Miss Jessie lennox
        • Orchard House, Bridge of Allan
        • Rab Scott
        • Stevenson’s cave
        • The Wharry Glen
        • The Wrights of Loss
      • Films about BRIDGE of ALLAN
      • Fire Brigade
      • Fountain of Nineveh
        • A dry fountain that once gushed and sparkled in the sunlight
      • History
        • ‘Modern Bridge of Allan and some of its makers’ (1927)
        • ARCHIVE [old photographs and writings]
        • Craig Mair
        • Glimpses of Local History
        • Landmarks of Bridge of Allan
      • Lecropt
        • ‘A Lecropt Girl’
        • Keir Estate, Stirling
        • Keirfield
          • David Rutherfoord
        • Lecropt and Larger Scotland
        • Ten summers fade
        • The Rutherfoord letters
      • Mossgrove
        • Arborglyphs
        • Diary of a house
        • FAMILY films
        • Hale Bopp
        • He cannot unlearn the feeling
        • MERRYTHOUGHT
        • Mossgrove garden
        • Our cats
        • Our graffiti bench
        • The Medicine is in Aberdeen
        • The son of a Bank Manager
        • This is not yesterday
        • Tillybin
          • VANDAL
        • Wally Mint and the Wobblisks
        • We follow them, as they are us
      • Photographs of Bridge of Allan
      • Robert Louis Stevenson
      • Sheriffmuir
      • Shops, buildings and houses
        • 105 Henderson Street
        • Fernfield
        • John Cullens
        • Museum Hall
        • Music Hall
          • Mrs Hamilton
          • Professor Ewart
          • Professor Whitworth
        • Our first village shop
        • SPA CLEAN [ZERO WASTE]
        • St Ann’s
        • The Cleopatra needle
        • The Olympic torch comes to Bridge of Allan
        • The Well House, Bridge of Allan
      • The Ochils
        • Ashintrool
        • Hercules
        • in a SERIES II Land Rover
        • Jerah
      • Village doctors
        • Dr Alexander Wilkie Paterson
        • Dr Andrew S. Biggart
        • Dr Balbirnie
        • Dr Eric Dow
        • Dr John Hosack Fraser
        • Dr John Stewart Rutherfoord
        • Dr Mary Baird Hannah
        • Dr William Eagleson Gordon
        • Dr William Haldane
        • Dr William Halliday Welsh
      • Villagers [old and new]
        • A poet as well as a gardener
        • Bridge of Allan villagers of the 1830s
        • Finn Russell
        • Hector Dove
        • Holed out in ONE!
        • John McCaig
        • Old Village Worthies
        • Remembering Ian and Malcolm
        • Rev Charles Rogers
        • The Owl Man
        • The Tufty Club
        • Waller Hugh Paton
    • Dunblane
      • Andy Murray
      • Dunblane Cathedral reopens
    • Folk worth talking about
      • “Dr Frederick Adair”
      • ‘Big Kate’
      • ‘Black’ John Skirving
      • ‘Bob Dragon’
      • ‘Dr William Brodum”
      • ‘Whistling Willie,’ the LION MAN
      • A Big Burd
      • A Railway-Porter Astronomer
      • Agnes Mary
      • Alexander Ormiston Curle
      • Alexander Stevenson: first President of the SFA
      • Allison
      • Aloysius
      • Andrew Wilson
      • Angus John Campbell
      • Ann Shaw
      • Anne Grant of Laggan
      • Annie Graham Baird
      • Arthur
      • Aubrey Beardsley
      • Betty Mouat
      • Burrish Lyons
      • C. P. Snow
      • Captain Alexander Morrison
      • Captain Michael Slater
      • Captain Peter Gordon
      • Captain Phillips
      • Carol Colburn Grigor
      • Caroline Stuart Clarke
      • Charlotte Skinner
      • Clive Wright
      • Colin McWilliam
      • CYNICUS
      • Dandie Dinmont
      • Dani Garavelli
      • David Bowie
      • Davina Gordon
      • Diana Rigg
      • Doddie Weir
      • Dr John Stuart
      • Dr Pat Beausang
      • Dr Quackleben
      • Drue Heinz
      • Elijah Wood
      • Elizabeth and Ada
      • Ella Rae
      • Emma Raducanu
      • Ena Scott
      • Eric Redmond
      • Esmé Gordon
      • Felix Feneon
      • Florence Taylor
      • Francis Moncrieff
      • Fynes Moryson
      • Geoffrey Jellicoe
      • Gregory’s girl
      • Gunnar Jungner
      • Hannah Ann Stirling
      • Hector Dove
      • Henrietta
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HomeAbout meCourage to CareDelirium screeningScientific progress requires open-minded enquiry

Scientific progress requires open-minded enquiry

In May 2014 the Executive Clinical Director for Healthcare Improvement Scotland [HIS] sent a letter to my employers NHS Forth Valley setting out formally a range of concerns about my determination to put patients first.  In practice, as a psychiatrist for older adults, I was finding as a direct consequence of  mandatory [HIS] screening  that elderly and frail patients were frequently being prescribed powerful anti-psychotics such as Haloperidol.

NHS Forth Valley

Below is my reply to Dr Peter Murdoch, Interim Medical Director, NHS Forth Valley, after I had been made aware of this letter:

To Dr Peter Murdoch
Interim Medical Director
Carseview House
Castle Business Park
Stirling

13thJune 2014

Dear Dr Murdoch,
Many thanks for sharing this letter from Dr Brian Robson.

I welcome the opportunity to respond to the points made.

First of all I would like to make it clear that I did try to use local mechanisms to feedback into the “improvement” process. The local response was that “improvements” in delirium screening (i.e. mandatory cognitive screening of all over 65s admitted to the acute hospital – see attached) were guided by HIS. I therefore contacted HIS by letter to clarify the ethical considerations and the evidence base behind changes which I could foresee would have an impact on my day-to-day clinical practice and which caused me concern for a range of reasons.

After a partial written response by HIS Inspector, Ian Smith, I was invited to take part in a teleconference with four employees of HIS. I found this experience disappointing in that none of the four appeared to be willing to answer any of my concerns. My overall experience of HIS was of an organisation which was not willing even to consider ethical points or discuss the validity of “screening tools” the use of which it is recommending across Scotland.

My approach has always been one to encourage discussion and debate. I do not expect HIS to necessarily agree with me but I do expect them to consider my concerns seriously.

“Oppressive use of social media”:
I have only ever written two blogs about delirium. Both relate to ethical considerations and also look at validity of “screening tools”. My first blog “the faltering, unfaltering steps” is based entirely on evidence and material in the public domain, all of which is cited. This is not “misinformation”. My second “blog” called “Delirium Screening” was a summary produced at the request of Professor Alasdair MacLullich. I have had no response from Professor MacLullich or anybody involved in delirium improvements on the legitimate ethical issues which were raised in it. I am of the view that the public deserves a balanced presentation of the complex issue of delirium.

HIS and OPAC use social media very extensively but it appears that only content that accords with the outlook of OPAC or HIS will be considered acceptable responses. Debate is not being allowed by HIS and OPAC and runs counter to HIS claim to be “engaging”. Dr Robson’s letter makes it clear that to be allowed to be “engaged”, one must not question anything in their predetermined approach.

It is certainly not the case that “HIS cannot engage with anyone without him sending his blog to the clinician”.

I have made no films about delirium.

“Misinformation and Scaremongering”
These are very bold words indeed and I would like to see examples of where I have quoted “out of context”. I agree that I “do not understand the improvement science” if it is a “science” which does not require evidence (e.g. internal and external validation of “screening tools”) and consideration of ethics (e.g. consultation with the population directly affected).

“Political disruption”
I have come to understand that there has been significant confusion between improvement work for delirium (which are undergoing local pilots and which target patients aged 75 years and over) and the recommendations made to NHS Scotland Boards about routine cognitive screening (which are assessed by HIS Inspection visits and generally refer to all patients aged 65 years and over). From the viewpoint of a grassroots clinician the conflation of these two processes has been unhelpful. It is unfair to say that routine cognitive screening is led by NHS Boards when in fact this is a recommendation against which they are inspected by HIS. My understanding is that this recommendation is based on the Clinical Standards for Acute Care (2002) which are more than a decade old and that the Convener of the Parliamentary Health Committee (January 2013) expressed concern that these need updated. Given this clear political involvement I reserve the right to communicate with elected representatives.

“Staff distress”
It is not my intention to cause distress to anyone. On a point of principle however, and here I would make reference to the findings of the Francis Report, it is surely essential that critical voices are not silenced because of potential to cause “upset”. There is always a power imbalance between any organisation and any individual and a number of recent examples have illustrated the risks of always assuming that the organisation is right.

The reason that I have stated that I felt “uncomfortable” relates to a specific conversation on twitter. Although HIS and OPAC use twitter extensively it has its limitations in discussing complex issues and it was my intention to move the discussion onwards using more traditional methods of communication.

“Waste and impact on improvements for patients”
Given the amount of my own time that I have devoted to “engage” with Dr Robson, Prof MacLullich, Scottish Delirium Association, HIS, and OPAC it is disappointing to hear that my contributions have been a “waste” and had only negative “impact”. This is all the more so in that the responses I have had from the above parties have not “assisted my understanding” but have comprehensively failed to address my concerns.

Dr Robson states that he fears that this formal letter to my employers might be “misinterpreted as censorship”. I think that this would indeed be the view of anyone, who like me, has struggled to raise ethical issues.

History tells us that the spirit of scientific progress requires open-minded enquiry. Any organisation which is aiming to take a scientific approach must take care to remember this. My recent experience makes me feel that the headline promise that HIS “engage” meaningfully is but a hollow sound-bite. HIS is going struggle to find more “engaged clinicians” if absolute agreement with the organisation’s approach is a pre-requisite for engagement.

I am replying via e-mail for speed but will be following up by letter to yourself and to Dr Brian Robson.

It would be helpful if you could confirm if I have breached any NHS Forth Valley Policy on the matters covered in this communication.

Yours sincerely,
Dr Peter J Gordon

cc. Dr Brian Robson, Executive Clinical Director, Healthcare Improvement Scotland


I copied my letter to Alex Neil, MSP, Cabinet Minister for Health and Wellbeing, Scottish Government. I attach the reply below:

Scot-Gov-reply


Immediately following the letter from the Executive Clinical Director for Healthcare Improvement Scotland to NHS Forth Valley  I was “invited” to an “informal” meeting by my employers. Where no minute was kept.

At this “informal meeting” the Medical Director repeatedly reminded me of my duty to the organisation. The General Manager for NHS Forth Valley repeated this reminder. Thereafter,  my professionalism, character and ethics were robustly questioned.

Within weeks of this “informal meeting” I resigned from NHS Forth Valley.


Almost two years on from the letter sent by Healthcare Improvement Scotland to my former employers, NHS Forth Valley, I have sent the following letter to the Executive Clinical Director of HIS. I have done so because I was reminded of the situation that I found myself in following the recent, and most welcome publication of “Realistic Medicine” by the Dr Calderwood, Chief Medical Officer for Scotland.

Wednesday, 2nd March 2016
To: Executive Clinical Director, Healthcare Improvement Scotland,

Dear Dr Robson,
I hope that you do not mind me writing to you to reflect, a few years on, from the circumstances I found myself in as an NHS employee who had worked in Scotland for over 20 years. My wish in this letter is to reflect and to suggest learning for all, including of course myself. In summary my experience has been that in trying my best to put patients first I did not find what Robert Francis termed “freedom to speak up”: rather that deference was first given to colleagues and to the system.

As Executive Clinical Director for Healthcare Improvement Scotland you sent a letter, dated 22nd May 2014, to the Medical Director of my former employers  http://wp.me/p3fTIB-u8  . I was not aware of this letter until I had an “informal” “invitation” to meet with my employers. A month later I resigned after 13 years as a Consultant with unblemished career with NHS Forth Valley. The feedback I had following my resignation confirmed that I was valued as a respected and professional doctor. I publicly advocated a timely approach to the diagnosis of dementia even though the universal approach was for early diagnosis. From the Health Secretary down, including senior policy makers and senior NHS staff, Alzheimer Scotland, the British Geriatric Society and the Mental Welfare Commission, there was no support for timely diagnosis. I advocated this approach as it included considerations of potential harms as well as potential benefits. Given the opposition I encountered, it was a welcome but considerable surprise when in summer 2014 the “Glasgow Declaration”, which enshrines the principle of timely diagnosis, was issued.  As of the time of writing, 203 organisations, 11613 individuals, 153 Policy Makers, and 84 MEPs, across 25 European countries have signed this declaration.

I mention this as the concerns you raised with my former employers related to my considerations and questions about Delirium Improvement work. I take delirium very seriously indeed: however my concerns about reductionist tools, whether termed “screening” or “detection” remain, as do my concerns about the ethics of consent. I also worry about potential unforeseen outcomes, which may be harmful, such as increased prescribing of antipsychotics such as haloperidol. Last month, the Chief Medical Officer put forward her proposal for “Realistic Medicine”. This document prompted me to reflect on a culture which may struggle to accommodate questioning voices. The CMO’s report has been welcomed widely and was discussed at the overdiagnosis conference held in Stirling on the 27th February 2016.  The afternoon panel was assembled to help us consider “What can policy makers do to help us?” This was the question I raised:

“Would the panel like to comment on the inevitable tension between what the Scottish Government has chosen to call “Improvement work” and over-medicalisation? The reason that I focus on the term improvement is that it makes it very easy for anyone who questions such work to be characterised as a barrier to progress.”

As a human, I am very far from perfect. I make mistakes, and find that I am always learning. However I am proud of Scotland’s fine tradition of a critical approach to science. I now feel that I have done my bit and have scars to show it. I have decided that when the time is right for me, and indeed my family, I will retire early from medicine.

If you were able to write your thoughts in response to this letter they would be most welcome.

I wish you all the very best.

Yours sincerely

Peter signature

Dr Peter J. Gordon


I received this reply from Dr Brian Robson on the 12th March 2016:

Dr-Brian-Robson,-Healthcare-Improvement-Scotland,-12-March-2016


This was my letter of response:

Bridge of Allan,
8th March 2016

Dear Dr Robson,
Your letter was carefully considered and thank you for taking the time to write it.

What I found disappointing was the lack of acknowledgment of the harmful consequences for myself and my family following your letter to my former employers. I have now come to the conclusion that there may never be any such acknowledgement. I hope that you might agree that I have contributed significantly to the consideration of potential unforeseen consequences of improvement science. I am particularly proud that the Glasgow Declaration has been adopted.

I hope that Healthcare Improvement Scotland is moving in the direction where it will consider questioning voices and treat them respectfully. Scientific enquiry is after all based on asking questions.

Yours sincerely,
Dr Peter J Gordon


The following quotes are by a senior medical professional and ethicist:

"I want to make a case and I want to argue why ethics 
is as important, if not more important than quality" 
2011
"Quality is a by-product of ethics and not vice-versa"  
2011
"It is extremely important for healthcare organisations to invest 
in ethics. Who should be trained in ethics? Each and every person 
in our healthcare organisation: Chief Executive, Directors, 
Managers, medical and nursing staff, as well as support staff. 
Each and every person." 
2011

 

 

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          • Dementia Case-Finding: language and ethics
          • EPAD co-coordinator: Professor Craig Ritchie
          • Glasgow Memory Clinic
          • Hide and Seek
          • In a “muddle”?
          • Issues not considered in the ‘Edinburgh Consensus’
          • National Clinical Director for Dementia: Professor Alistair Burns
          • Professor says: “Classsic Pharma shill stuff”
            • absurdum
          • Snakes, ladders and Monopoly
          • The ‘Edinburgh Consensus’ – a timeline
        • Wandering, wondering and worrying
    • Deeside Tales
      • Short films about Deeside
      • To be humbled.
    • Films made by Peter
      • 3 films that almost ended my career
      • A maker of beautiful books
        • The Great Tapestry of Scotland
      • A new way of seeing
      • A Thousand Chances
      • Alive in the river of light
      • Angelology
      • Bridge of Allan
      • bridges
      • Canto two
      • Finding Cimbrone
      • Folk worth talking about
      • friendship itself
      • Glenbardy
      • Go seek adventures
      • Here is where we meet
      • I am part of all that I have met
      • Important note about my films
      • in its ending
      • incorrigibly plural
      • It was the singing
      • Language is leaving me
      • Let the anchor go
      • Little Sparta
      • living mountains
      • man with the child in his eyes
      • Marginalia
      • mathematically me
      • Mossgrove garden
      • my library-haunting self
      • of an Antiquary
      • Oor big braw Cosmos
      • Political pieces
      • Progress hardly broke its stride
      • sensitive to the faltering steps of age
      • Sheramoor
      • Stravaiging need not be lonely
      • The anatomy of emotion
      • the blue flower
      • The bright cave under the hat
      • The Cabrach
      • the Glentruim series
      • The Rebel Antiquary
      • They fell for us
      • this gifted gardener [I discovered one day]
      • Time passes. Listen
      • To see what Scott saw:
      • Trees: age and beauty do go together
      • [Series II]
    • Firrhill High School
    • Hole Ousia [what does it mean?]
    • Mavisbank
      • On Esca’s Flow’ry Bank
      • Short films about Mavisbank
    • MEDICINE
      • Films about MEDICINE
      • Films about PSYCHIATRY
      • Films and Sapere Aude
      • Films on ETHICS
      • Films on Professional VALUES
      • Films that consider ‘First Do No Harm’
    • My dissertation on hedges
    • My schooling
    • Peter’s poems
      • One-word poems
    • Publications in the “Leopard”
    • The Ageing Stone
    • The speaking hedge
    • What is in a name?
  • being and becoming
    • “A place with no quotation marks”
    • Academic reductionisms
    • Admissions of doubt
    • Ariel
    • Cell Mates
    • Medical “truants”
    • Multifarious learners
      • A fortunate man
      • Dr Anton Pavlovich Chekhov
      • Dr Arthur J. Brock
      • Dr Arthur Mitchell
      • Dr Daniel Reid Rankin
      • Dr Gavin Francis
      • Dr James Sheridan Knowles
      • Dr Leon Eisenberg
      • Dr Samuel Brown (1817 – 1856)
      • Edmund de Waal
      • Femi Oyebode
      • George Washington Wilson
      • Graham Watt
      • James Clerk Maxwell
      • James Ferguson
      • James Skene
      • John Berger
        • Here is where we meet
      • John Frederick William Herschel
      • K. J. Fowler
      • Kenneth Calman
      • Mr and Mrs Rose
      • Nadar
      • Patrick Matthew
      • Rev George Gilfillan
      • Richard Feynman
      • Scottish women writers
      • Sir Harry Burns
      • Theodore Dalrymple
      • Thomas Browne
      • William Friese-Greene
      • William Lewson Burrowes
      • William Ramsay
    • Philosophers
      • Albert Camus
      • Andrew Greig
      • Dr John Flaxman
      • Dugald Stewart
      • John Macmurray
      • John Stuart Mill
      • Mary Midgley
      • Raymond Tallis
    • Poets
      • Alexander laing
      • Caledonian Antisyzygy
      • Carol Ann Duffy
      • Daniel Abse
      • Edwin Morgan
      • Iain Banks
      • Iain Crichton Smith
      • Ivor Gurney
      • James Hyslop
      • James M Slimmon
      • John Betjeman
      • John Halliday
      • Kathleen Jamie
      • Kieron Winn
      • La Teste
      • Leonard Cohen
      • Liz Lochhead
      • Norman MacCaig
      • Patrick Deeley
      • Paul Muldoon
      • Peter Davidson
      • Rab Wilson
      • Rabbie Burns
      • Robert Fergusson
      • Robert Nicholl
      • Robert Pollok
      • Robin Hyde
      • Sylvia Plath
      • T S Eliot
      • Ted Hughes
      • Tom Leonard
      • Tomas Tranströmer
      • Wilfred Owen
      • William Carlos Williams
      • William Soutar
    • Sapere Aude
      • A bit of a prat
      • a very clever young man
      • Caroline Phillips
      • Chrys Muirhead
      • Claire Fox
      • Dr Donald Brownlie
      • Dr Margaret McCartney
      • Fara McAfee
      • Gawaine Baillie
      • Gerald
      • Hale-Bopp
      • Humpty Dumpty
      • I mistook myself for a scientific label
      • Jessie Lennox (a Nightingale)
      • Joan Eardley
      • John Aubrey
      • King Kong
      • Margaret Maberley Gordon
      • O. G. S. Crawford
      • Omphatyp’
      • Owen Jones
      • Richard Holloway
      • Richard Taylor
      • Roy Porter
      • Stanley Murray
    • Writers
      • A L Kennedy
      • A S Byatt
      • Adam Nicolson
      • Alan Trotter
      • Alexander McCall Smith
      • Ali Smith
      • Alice Hoffman
      • Andrew Greig
      • Andrew Miller
      • Annalena MacAfee
      • Anne Tyler
      • Anthony Doerr
      • Candia McWilliam
      • Cesare Pavese
      • Charlotte Peacock
      • Chimamanda Ngozi Adichie
      • David Szalay
      • Deborah Levy
      • Douglas Stuart
      • E M Forster
      • Emily Fridlund
      • Ernest Hemingway
      • Evelyn Waugh
      • Fiona Mozley
      • Ford Madox Ford
      • Fyodor Dostoyevsky
      • Gabriel García Marquez
      • Geoff Dyer
      • George Orwell
      • George Saunders
      • Hanya Yanagihara
      • Howard Jacobson
      • Iris Murdoch
      • J. D. Salinger
      • Janice Galloway
      • Jessie Burton
      • John Buchan
      • John Lanchester
      • John Steinbeck
      • Julian Barnes
      • Kazuo Ishiguro
      • Lampedusa
      • Laurie Lee
      • Madeleine Thien
      • Marcel Proust
      • Margaret Drabble
      • Matt Haig
      • Max Porter
      • Mohsin Hamid
      • Mukul Kesavan
      • Muriel Spark
      • Nan Shepherd
      • Nathan Filer
      • Oscar Wilde
      • Otessa Moshfegh
      • Penelope Fitzgerald
      • Richard Flanagan
      • Richard Holmes
      • Richard Yates
      • Roald Dahl
      • Robert Louis Stevenson
      • Robert Seethaler
      • Rudyard Kipling
      • Sara Baume
      • Thomas Mann
      • Virginia Woolf
      • Vladimir Nabakov
      • Will Cohu
      • William Boyd
      • Yann Martel
  • in the world
    • A Sunshine Act for Scotland
      • “The influence of pharma is not excessive”
      • ‘Listen, let the people petition and be heard’
      • ‘To influence others by offering money’
      • A matter for others
      • Bring me a sunshine act
      • British Psychiatry: Marketing as ‘Education’
        • “A robust learning environment for healthcare professionals”
        • “An ethical relationship with pharma”
        • “Classsic Pharma shill stuff”
        • “FULLY BOOKED”
        • “MacDonald’s to advise on childhood nutrition”
        • “P R O M I S C U O U S”
        • “The place to go to” for CPD
        • “Working with the drug industry—is your reputation at risk?”
        • ‘Fees for services’
        • ‘Industry Biased Medicine’
        • ‘Medical Education for the 21st Century’
        • ‘MEDICAL EDUCATION: In the grip of industry?’
        • ‘Psychiatry without borders’
        • ‘Welcome to Pharmacare’
        • 2017 International Congress: Psychiatry without Borders
          • “Performed well”
        • 2018 International Congress: Psychiatry: New Horizons
        • ABC of Mental Health: Depression
        • BAP ‘educator’ on prescribing received $3,581,159 in payments from Pharma
        • Conflict of interest and the British Journal of Psychiatry
        • Continuing Medical ‘Education’
        • Darkness prevails: the Royal College of Psychiatrists
        • Data Protection: The Royal College of Psychiatrists
        • Is academic psychiatry for sale?
        • It’s boom time for the College
        • Latuda: vigorously marketed in The UK
        • Paid Opinion Leaders
        • Pharmaceutical influence and psychiatrists
        • Prescribing Guidelines: let’s be transparent
        • Professors A, B, and C
        • Puritanical or Platinum?
        • Rising stars: British Association of Psychopharmacology
        • Royal College of Psychiatrists: “This is a matter for the Government to decide”
        • Satellite symposia and paid opinion leaders
        • Simon said
        • The British Journal of Psychiatry and Pharmaceutical Industry advertising
          • “SPECIAL ARTICLE”
          • ‘AUTHENTICITY’
          • Are competing interests of authors sufficiently transparent?
        • The Defeat Depression Campaign
          • “Buy it, read it and recommend it!”
          • “CONSENSUS STATEMENT”
            • Managing depression in general practice
          • “Defeating depression in old age”
          • “Dista Products [for] Royal College of Psychiatrists, 1993”
          • “Fear of dependency”
          • “Fun Run”
          • “Generously sponsored by Smith Kline & Beecham”
          • “Promulgating therapeutic recommendations”
          • “The Defeat Depression Campaign is not a useful exercise”
          • “To mount a glossy campaign on the basis of this method is frankly disturbing”
          • ‘Antidepressants unlimited’
          • ‘Continuing to defeat depression’
          • ‘Costs should have been considered’
          • ‘Defeat Depression: A European Perspective’
          • ‘Dyspeptic Dinner Entertainment’
          • ‘The Influence of the Pharmaceutical Industry’
          • ‘Warm-up led by former DJ of Capital Radio’
          • ‘We cannot be in the pockets of the Pharma companies’
          • ‘Why can’t GPs follow guidelines on depression?’
          • (orders 100+ at 25p per leaflet)
          • A summary of the Educational Components
          • An ‘Educational Campaign’ sponsored by Pharma
          • How to Defeat Depression
          • Is depression a chronic illness?
          • LILLY Pharmaceuticals: the Defeat Depression Campaign
          • Mass prescribing
          • My career began with the Defeat Depression Campaign
          • One-and-the-same
          • Psychiatry in General Practice: a ‘Campaign’ begins
          • Putting caring conversations into practice
          • RCPsych archive: 5 Boxes
          • SSRIs: “Public confidence needs to be restored”
          • The ‘Chemical imbalance’ theory
          • This historical campaign has vital lessons for today
          • Video Training Package
          • What Price Depression?
        • The latest ‘Platinum Sponsor’ for RCPsych conference
        • The Law of the Few
        • The mismatch
        • Transparency and British Psychiatry: Hold the applause
        • Transparency at the Top
        • Who pays the piper?
      • Led Astray – Industry’s Influence on Drug and Device Watchdogs
      • Medicine remains as conflicted as ever
      • Prescribed drug dependence and withdrawal
        • “Attacks on antidepressants”
        • “Discontinuation syndrome”: sophistry of the drug industry
        • “Objectivity” does not come in a title
        • ‘Tens of thousands of children’
        • A timeline of missed opportunities
          • “Programme will help identify potential suicide victims”
        • Antidepressant prescribing and “fully informed consent”
          • Words and numbers should be used with equal care
        • Antidepressant withdrawal symptoms -Telephone calls to a national medication helpline
        • Collective values of an organisation in the era of social media
          • RCPsych Presidential elections [2022/23]: in support of Dr Kate Lovett
        • Coming off antidepressants
        • Cumberlege Report: First Do No Harm
          • A reply to a Lifetime Achievement Awardee
            • A loss to science
          • Cumberlege Review: what is the position of RCPsych?
          • Language and professional values
            • ‘Why all this nastiness?’: Twitter
            • 2019: Question to Presidential candidates on College values
            • 2022: Question to Presidential candidates on College values
          • Language Matters: indeed it does
          • Let us be kind to one another even when views may differ
          • Medicine’s contract with society
          • Polypropylene Mesh Implants
          • Professionalism and psychiatry: past, present and future
          • Professionalism and psychiatry: the profession speaks
          • Psychiatrist #1 on First Do No Harm
          • Psychiatrist #2 on First Do No Harm
          • Psychiatrist #3 on First Do No Harm
          • Psychiatrist #4 on First Do No Harm
          • Psychiatrist #5 on First Do No Harm
          • Psychiatry, dependent on its authority, is finding withdrawal seriously difficult
          • Social Media Policy of the Royal College of Psychiatrists
            • “Stay classy”
            • ‘outside the circle of listeners’
        • Depression: pills and dependence [a timeline following a letter in the Times]
        • Discontinuation of antidepressant therapy [1997 symposium]
        • Gilbert Farie Revisited
        • RCPsych [Prescribed harm]
          • “Another me exists”
          • “Casual false reassurances”
          • “Pill Shaming”
          • “We care about our crest and it is sad to see it used this way”
          • A letter in the Times
          • An extraordinary divide
          • Antidepressant withdrawal: why has it been ignored for so long?
          • Psychiatry, dependent on its authority, is finding withdrawal seriously difficult
          • SIBERIA
          • The other side of the fence: Iatrogenic stigma
          • unanswered
        • Realistic prescribing
          • “It’s BOOM time in Industry”
          • “That prescription figure is high”
          • ‘A generation in crisis’
          • ‘The Medical Untouchables’
          • Our own window
          • Psychiatry in Fabula
          • RSM Health Matters Podcast: Episode 1 – Antidepressants
          • Science Media Centre
          • Selective Serotonin Reuptake Inhibitors for the Elderly
          • The Narrative Controllers
            • ‘Chumcentric’
          • The Neon Yellow Preservation Society
          • Unanswered
        • Stigma and Psychiatry
        • The Scottish Government [Prescribed harm]
          • “Key Information on the use of antidepressants in Scotland”
          • “Villains and Demonisers”
          • ‘Antidepressant use: changing patterns, cost and clinical effectiveness’
          • Antidepressants (Overuse)
          • Antidepressants: ‘no good evidence’ for long-term use
      • Trial by Anecdote
      • Unrealistic Medicine
    • Architecture
      • ‘The Story of Drummond Place’
      • 18 Kilrymont Road
      • Abbotsford
      • Andrew Crosbie’s House
      • Auchinleck House
      • Bute House
      • Charles Brand Ltd
      • Dalhousie Memorial Arch
      • Drummond Place, Edinburgh
      • Edinburgh’s first Theatre
      • Forglen Mausoleum
      • Gladney House
      • Glasgow Necropolis
      • GOLDBERGS
      • Hermits and Termits
      • Hospitalfield House
      • Kilbirnie Radio Cinema Bingo Hall
      • Kildonan House
      • Kinneil House
      • Mar Lodge, Stirling
      • McCaig’s Tower, Oban
      • Moatbrae House, Dumfries
      • Monument to the Political Martyrs’
      • Muschat’s cairn
      • Old Royal High School, Edinburgh
      • Scottish architectural follies
      • SeaPark
      • Shakespeare Square
      • St Andrew’s House, Edinburgh
      • Temple of the Muses
      • TEMPLE [Cupar]
      • The galleria
      • The Red Road flats
      • The Wallace Monument
      • The Well of the Seven Heads
      • Tower of Glenstrae
      • Warriston Gates
    • Ardeer Explosive’s Factory
    • Bridges
      • Abergeldie foot-bridge
      • Boat o’Brig
      • Brewlands bridge
      • Broom of Moy
      • Broomhill wooden bridge
      • Faery Bridge, Dunblane
      • Forth Road Bridge
      • Garva bridge
      • Haugh of Drimmie
      • Kalemouth Suspension Bridge
      • Kincardine Bridge (on Forth)
      • Millhaugh bridge
      • Old White Bridge
      • Tay Bridge
      • The bridge to nowhere
      • The Glenfinnan Viaduct
      • The Old Bridge of Livet
      • Twa Gables
    • CITIES
      • Films about ABERDEEN
      • Films about DUNDEE
      • Films about EDINBURGH
      • Films about GLASGOW
      • Films about PERTH
      • Films about STIRLING
    • D.L.R.O.W
      • The mild cigar
    • Dunaskin Iron and Brick works
    • Earl’s Hill radio transmitter
    • landscapes (time held green)
      • ‘Hill of the Resurrection’
      • Carsebreck
      • Cliff House
      • Dunbuy
      • Duncryne
      • Garden Archaeology
      • Gardeners
        • ‘Gardener Found Insane’
        • A high summer garden
        • A new generation of gardeners
        • A Nursery Manager
        • Abergeldie’s gardener
        • Alexander Marr
        • Alexander Walker
        • Arbigland’s gardener
        • Boghead, Bathgate
        • Carnbroe’s gairdener
        • Charles Bell, Ormistoun Hall
        • Charles Frampton
        • Charles Webster
        • COREHOUSE
        • David Pringle Laird
        • Davina, Lady Stair
        • Eagle and Henderson
        • Glassingall Gardener
        • Glentulchan gardener
        • Helen Carmichael
        • James Hossack, Castle Cluny
        • James Ironside
        • James Sutherland
        • John Halliday
        • John Wright Paton
        • Last of Horse Wynd
        • Miss Hope
        • Monty Don
        • Ninian Niven
        • No.1 Shrub Place
        • OLDEST GARDENER
        • Patrick’s garden
        • Peter and Sian’s garden
        • Peter Gordon, gardener
        • Peter Rankin, Glen Creran
        • Peter Thomson, a ‘practical gardener’
        • Peter Thomson: ‘the patient art of fieldwalking’
        • R E E K I A N A
        • Return to the seed
        • Robert Graham of Tamrawer
        • Robert Murray, West Princes Street Gardens
        • Robert Rust
        • Scotland’s Silver Glen
        • Teri and Paul Hodge-Neale
        • The Abbotsford gardener
        • The Astronomical Gardener
        • The auld gardener
        • The gardener of Finca Vigia
        • The gentle gardener
        • The Queen’s Gardener
        • The Sisters’ Garden
        • Thomas Cleghorn
        • Tom Spence
        • Under Gardener [D U N I R A]
        • Volunteer gardener
        • Wellington Dauncey
        • William Rutherford
      • Garrel Glen
      • Gauch
      • Glen Girnoc
        • Abergeldie castle
        • Bovaglie
          • Joseph Gordon’s journal of a voyage to Australia (1841-1842)
          • The Bovaglie manuscript
        • Loinveg
        • The Camlet
      • Glenbardy
      • ISLANDS
        • Alloa Inch
        • Eilean Fhianain
        • Eilean nam Faoileag
        • Eilean Subhainn
        • Inchcolm island
        • Linga Isle
        • Lismore
        • Lucky Scaup
        • Samalaman
        • St Kilda
        • Vallay
      • Jock’s Road
      • Kilmadock churchyard
      • Leckie Glen
      • Little Sparta
      • Lochnagar
      • Stronmilchan
      • The Devil’s Pulpit
      • The Dragon’s Hole
      • The Hill
      • The John Muir Way
      • The living mountain
      • The Lost Garden of Dunira
      • The lost garden of Penicuik
      • The suicide graves
      • Wanzie
    • Mental Health Tsar
    • Mortar and Pestles
    • Necessity Brae
    • Rogues’ Gallery
      • Duncan Paton
      • Helen Nicholson
      • John Grovenor
      • John Moir
      • John Yates alias John Hewitt, Patrick Hines, John Miller, John Roy
      • Peter [alias John]
      • Philip Hughes
      • The Highland Hotel Robbers
      • William Slater
    • The Great Globe
    • The Jam factory
    • Trees
      • Beauly’s Wych Elm
      • Goodnestone chestnut tree
      • One way of measuring a tree
      • Sir Walter Scott’s Tree
      • The bicycle tree
      • The Lanrick stone tree
      • The Wallace Oak
      • Yew trees
        • Adam and Eve Yews
        • An incredibly ancient child
        • “When Harry met Mary under the Yew tree”
        • Chapel of the Yew Trees
        • Craigend Yew
        • Earlshall [shapes abandoned]
        • I Vow Yew
        • Rockingham elephants
        • Scientists chop years off ancient yew trees
        • St Columba’s Yew
        • Stow on Wold Yews
        • The Abbotshall Yew
        • The Auchendrane Yew
        • The circular Yew hedge
        • The Culfargie Yew
        • The Fraser Yew
        • The Inchbrakie Yew
        • The little loch of the yew grove
        • The Ormiston Yew
        • The Raploch Yew
        • The Somerleyton Yew
        • The Wallace Yew
    • Waverley
  • Mind The Gap
  • where time passes (listen)
    • Bridge of Allan
      • ‘Quote of the week’
      • A bridge over the Allan Water
      • Chemists and Apothecaries
        • Charles Neil Rutherfoord
        • Gilbert Farie
        • Oswald Robertson
      • Drumdruills
        • Beware the Fly!
        • Memoir of Adam Baird (junior)
        • Millad
        • Miss Jessie lennox
        • Orchard House, Bridge of Allan
        • Rab Scott
        • Stevenson’s cave
        • The Wharry Glen
        • The Wrights of Loss
      • Films about BRIDGE of ALLAN
      • Fire Brigade
      • Fountain of Nineveh
        • A dry fountain that once gushed and sparkled in the sunlight
      • History
        • ‘Modern Bridge of Allan and some of its makers’ (1927)
        • ARCHIVE [old photographs and writings]
        • Craig Mair
        • Glimpses of Local History
        • Landmarks of Bridge of Allan
      • Lecropt
        • ‘A Lecropt Girl’
        • Keir Estate, Stirling
        • Keirfield
          • David Rutherfoord
        • Lecropt and Larger Scotland
        • Ten summers fade
        • The Rutherfoord letters
      • Mossgrove
        • Arborglyphs
        • Diary of a house
        • FAMILY films
        • Hale Bopp
        • He cannot unlearn the feeling
        • MERRYTHOUGHT
        • Mossgrove garden
        • Our cats
        • Our graffiti bench
        • The Medicine is in Aberdeen
        • The son of a Bank Manager
        • This is not yesterday
        • Tillybin
          • VANDAL
        • Wally Mint and the Wobblisks
        • We follow them, as they are us
      • Photographs of Bridge of Allan
      • Robert Louis Stevenson
      • Sheriffmuir
      • Shops, buildings and houses
        • 105 Henderson Street
        • Fernfield
        • John Cullens
        • Museum Hall
        • Music Hall
          • Mrs Hamilton
          • Professor Ewart
          • Professor Whitworth
        • Our first village shop
        • SPA CLEAN [ZERO WASTE]
        • St Ann’s
        • The Cleopatra needle
        • The Olympic torch comes to Bridge of Allan
        • The Well House, Bridge of Allan
      • The Ochils
        • Ashintrool
        • Hercules
        • in a SERIES II Land Rover
        • Jerah
      • Village doctors
        • Dr Alexander Wilkie Paterson
        • Dr Andrew S. Biggart
        • Dr Balbirnie
        • Dr Eric Dow
        • Dr John Hosack Fraser
        • Dr John Stewart Rutherfoord
        • Dr Mary Baird Hannah
        • Dr William Eagleson Gordon
        • Dr William Haldane
        • Dr William Halliday Welsh
      • Villagers [old and new]
        • A poet as well as a gardener
        • Bridge of Allan villagers of the 1830s
        • Finn Russell
        • Hector Dove
        • Holed out in ONE!
        • John McCaig
        • Old Village Worthies
        • Remembering Ian and Malcolm
        • Rev Charles Rogers
        • The Owl Man
        • The Tufty Club
        • Waller Hugh Paton
    • Dunblane
      • Andy Murray
      • Dunblane Cathedral reopens
    • Folk worth talking about
      • “Dr Frederick Adair”
      • ‘Big Kate’
      • ‘Black’ John Skirving
      • ‘Bob Dragon’
      • ‘Dr William Brodum”
      • ‘Whistling Willie,’ the LION MAN
      • A Big Burd
      • A Railway-Porter Astronomer
      • Agnes Mary
      • Alexander Ormiston Curle
      • Alexander Stevenson: first President of the SFA
      • Allison
      • Aloysius
      • Andrew Wilson
      • Angus John Campbell
      • Ann Shaw
      • Anne Grant of Laggan
      • Annie Graham Baird
      • Arthur
      • Aubrey Beardsley
      • Betty Mouat
      • Burrish Lyons
      • C. P. Snow
      • Captain Alexander Morrison
      • Captain Michael Slater
      • Captain Peter Gordon
      • Captain Phillips
      • Carol Colburn Grigor
      • Caroline Stuart Clarke
      • Charlotte Skinner
      • Clive Wright
      • Colin McWilliam
      • CYNICUS
      • Dandie Dinmont
      • Dani Garavelli
      • David Bowie
      • Davina Gordon
      • Diana Rigg
      • Doddie Weir
      • Dr John Stuart
      • Dr Pat Beausang
      • Dr Quackleben
      • Drue Heinz
      • Elijah Wood
      • Elizabeth and Ada
      • Ella Rae
      • Emma Raducanu
      • Ena Scott
      • Eric Redmond
      • Esmé Gordon
      • Felix Feneon
      • Florence Taylor
      • Francis Moncrieff
      • Fynes Moryson
      • Geoffrey Jellicoe
      • Gregory’s girl
      • Gunnar Jungner
      • Hannah Ann Stirling
      • Hector Dove
      • Henrietta
      • Ian Collins
      • Ivor Gurney
      • J. J. R. Macleod
      • James Ferguson
      • James Maxwell Glover Wilson
      • James Muir
      • James Woodburn Dunlop
      • Jane Creighton
      • Janet B Wood
      • Jenny Nettles
      • Joan Eardley
      • John Byrne
      • John Glen Parker
      • John Mackenzie Bacon
      • John Marshall Scott
      • John Ramsay of Ochtertyre
      • John Wilson
      • Johnston Shearer
      • Joseph Gordon
      • Kenneth Kuanda
      • Lord Esher
      • Margaret Mary Risk
      • Mary Melvill
      • Mary Wollstonecraft
      • Miss Christina Gib
      • Mr Perpetual Motion
      • MRS H B B Paull
      • Mrs Picken
      • My Great Uncle Peter
      • Nancy Prentice
      • Octavius Morgan
      • Oswald Bates
      • Patrick Geddes
      • Peter Pan
      • Professor Cairo
      • Prophet Peden
      • PUDDIN’
      • Rashiebog
      • REDCAR
      • Rev. I. M. Jolly
      • Robert Atkinson
      • Robert Hutchison
      • Saad F Ghalib
      • Sally Scott
      • Scipio
      • Shane Mac Thomáis
      • Sian Fiona Williams
      • Simon Sutherland
      • Sir John Sinclair of Ulbster
      • Snibs
      • Sophia Jex-Blake
      • Tam Dalyell
      • The Buchanites
      • The Lass o’ the Lecht
      • The Lighthouse Georgesons
      • The Odd Dr Todd
      • The Red Lady
      • The Wizard of the North
      • Thomas Hastie Bryce
      • William Borthwick
      • William Friese-Greene
      • William Hay Leith Tester
      • Winifred Roberts
    • Ruins
      • A modern ruin
      • Aberdeen
        • 142 King Street, Aberdeen
        • Royal Cornhill Hospital
      • Aberdeenshire
        • 20 Main Street, Buckpool
        • Auchtavan
        • Bridgealehouse
        • Brodie’s cairn
        • Brucklay castle
        • Castle Newe
        • Clinterty
        • Croy House
        • East Lodge, Aberlour House
        • Glen Girnoc
          • Bovaglie
          • Loinveg
          • The Camlet
        • Glencowie, Strathdon
        • Kingseat Hospital
        • Knowsie House
        • Largue, Glenkindie
        • Lessendrum House
        • Nether Buckie: covered water reservoir
        • Pennan farm
        • Pitfour Estate, near Mintlaw
        • South Milton Cottage
        • the Cabrach
          • Auchmair
          • Bank
          • Blackwater Lodge, Cabrach
          • Buck, Cabrach
          • Cabrach Shooting Lodge
          • Gauch
          • Glenfiddich Shooting Lodge
          • Largue, Cabrach
          • Powneed, Cabrach
          • Tombain, Cabrach
          • Upper Cabrach School
        • The Temple of Polmona [or fame]
        • Thornbush, Gourdon
        • Tollafraick, Glenkindie
        • Whitehaugh Mausoleum
      • Angus
        • Aldbar castle
        • Aldbar Chapel
        • Fishtown of Usan
        • Fraser Mausoleum and Mortuary Chapel
        • Kincaldrum House
        • Knowegreens Inn
        • Lindertis
        • Maison Dieu, Brechin
        • Maulesden
        • Meigle steading
        • Panmure House
        • Rossie castle
        • Strathella
        • Torwood Cottage
      • Argyllshire
        • Badnaiska, Loch Awe
        • Barbreck Mausoleum and Folly
        • Bathwell, Rosneath
        • Dalmally Tabernacle
        • Glen Fruin Schoolhouse
        • Kilneuair Chapel
        • Oban Hydropathic
        • Rosneath Castle
        • The Clock Lodge
        • Turnalt
        • W A T C H M A N
      • Ayrshire
        • ANGEL Inn
        • Auchinleck Summerhouse
        • Caldwell House
        • Catrine House
        • Cleikum Inn
        • Craigends House
        • Dalquharron
        • Fullarton’s Folly
        • Glenure [Glenover]
        • Greenock Tempietto
        • High Dalblair
        • Oswald’s Temple
        • The Dutch Gable House
        • The Macrae Monument
        • The Viking Cinema
        • Whigham Inn
      • Bardrill farm
      • Clackmannanshire
        • Alva Ice House
        • Cherryton Brick Works
        • Hartshaw Tower
        • Sheardale House
        • The Garlet
        • Tullibody House
      • Dumfriesshire
        • Barnbarroch
        • Carnsalloch
        • Cormilligan
        • Gelston castle
        • Kenmure castle
        • The H E R M I T A G E [Friars’ Carse]
      • Dunbartonshire
        • Dunglass Castle and Bell’s Memorial
        • The Friends of Truth burial ground
        • Woodbank House, Balloch
      • Dundee
      • Edinburgh
        • Allan Ramsay’s House
        • Cammo House and Estate
        • Dryden, Bilston Glen
        • Edinburgh’s Orphan Hospital
        • Edmonstone house and park
        • Falcon Hall
        • Gilmerton House
        • Hawkhill Villa
        • Patriothall Laundry
        • PIPE Lane
        • Rockville, Edinburgh
        • Shakespeare Square
        • St Leonard’s
        • The Drummond Scrolls
      • England
        • Blackborough House
      • Fife
        • Abdie Curling House
        • Balyarrow
        • Castle Cottage, Newport on Tay
        • Castlehill Colliery
        • Corston Mill
        • Craighall castle
        • Crawford Priory
        • Dunbog House
        • Kilmaron castle
        • Largo House
        • Lucky Scaup
        • Siberia
        • St Fort, Newport, Fife
        • The Binn
        • The Temple of Decision
        • Thornton Fever Hospital
      • Forth Valley
        • Alloa Inch
        • Avondale House
        • Bandeath armaments depot
        • Bannockburn House
        • Carnock House
        • Carron House
        • Club’s Tomb
        • Cowiehall
        • Dunmore House
        • Glenhove tomb
        • Jawhills
        • Kennetpans
        • Lathallan House
        • Lochgreen
        • Orchardhead, Bothkennar
        • Scotland’s Close, Bo’ness
        • Stockiemuir Anti-Aircraft Battery
        • Tamrawer
      • Glasgow
        • Balmoral Crescent
        • Dreghorn Mansion, Glasgow
        • Ewing’s Harmonium Emporium
        • Garngad House
        • Glasgow Green Station
        • Petershill
        • SINGER Factory, Clydebank
        • Walkinshaw House
      • Highlands
        • An Dachaidh
        • Dalnawillan Lodge
        • Helen’s Well
        • Mains of Ulbster
        • Poltalloch
        • Vallay
      • Invernesshire
        • Allt Catanach
        • Badnambiast
        • Ballachroan
        • Blaragie
        • Easter Limekilns
        • Glenbanchor
        • Heatherbell
        • Moy House
        • Ruichlachrie
        • Sronphadruig Lodge
      • Lanarkshire
        • Boathouse, Blantyre
        • Carmichael House
        • Carnbroe
        • Carstairs Mausoleum
        • Douglas Support
        • Dykehead, Strathaven
        • Eastend, Carmichael
        • Gilbertfield castle
        • Keeper’s House for Hamilton Mausoleum
        • Rawyards Cotton Mill
        • Shark’s Mouth, Coatbridge
        • Smyllum Park
      • Lochery
      • Lochrosque
      • Lothian
        • Amisfield, Haddington
        • Gosford Mausoleum
        • Hatton estate
        • Mavisbank
          • Mavisbank (as Clerk’s “villa”)
          • Mavisbank (maps and plans)
          • Mavisbank (newspaper cuttings)
          • Mavisbank (the Asylum years)
          • Mavisbank: Repeats its Love
          • Mavisbank: Talk to the Civic Trust Conference
        • Roseberry steading
        • Roslin Curling Pond
        • STOBS Gunpowder Mills
      • Perth
        • Custom House, Bridgend, Perth
      • Perthshire
        • Apollo’s Temple
        • Argaty House
        • Arnhall castle
        • Arnmore House
        • Auchloy
        • Auld Fossoway
        • Balboughty Dairy
        • Bardrill
        • Bishopsfauld
        • Blackford Farms Ltd
        • Boreland Cottage
        • Boreland Farmhouse
        • Braes of Doune
        • Broadley
        • Buttergask
        • Charlotte’s Cave
        • Craigmill cottage, Inverpeffray
        • Dillot
        • Duke’s Tower, Colquhalzie
        • Dunalastair
        • Duncrub house
        • Dupplin West Lodge
        • Eilean nam Faoileag Folly, Loch Rannoch
        • Evelick castle
        • Feddal castle
        • Gascon Hall
        • Glendevon castle
        • Glenside
        • Glentulchan
        • Haldrick
        • Holmehill House
        • House of Nairne
        • Inchbrakie
        • Invermay – ‘The Guzebo’
        • Inverpeffary castle and library
        • Keirwoodhead
        • Kilmadock old churchyard
        • Knowehead, Blackford
        • Lairhill
        • Lanrick castle (demolished)
        • Little Tullybelton
        • Lynedoch
        • Maidsmill
        • Millearne
        • Muir o’Gill
        • Newton of Condie
        • Pitmiddle village
        • Rosecraig, Strathbraan
        • Side of Balhaldie
        • Straid
        • Stronhavie
        • Stronvar House
        • The Esher-Stank mausoleum
        • The Mercer Obelisk
        • Topfauld farm
        • Tullybeagles Lodge
        • Upper Quoigs
        • West Dron Hill Farm
        • Wester Bow
        • Wester Clow
        • Whaick
        • Williamsfield cottage
      • Renfrewshire
        • Balrossie
      • Skye
        • Gesto House, Skye
        • Kingsborough, Skye
        • Totarder
      • Stirling
        • Borrowmeadow Farm
        • Carim Lodge
        • Haugh of West Grange
        • Heathershot
        • Keir Home Farm
        • MARIEVILLE
        • Polmaise castle
        • Shielbrae
        • Steuartfield
        • Wanderwang
      • The Borders
        • Ellemhaugh
        • Haughhead
        • Hundy Mundy
        • Huntershall Inn, Dun Law
        • Lion Gate, West Lodges, Ladykirk House
        • Roxburgh House, Kelso
      • West Lothian
        • Almond or Haining castle
        • Auchengray House
        • Balbardie
        • Duntarvie castle
        • Grovemount
        • Kipps
        • Kirkhill Astronomical Pillar
        • Leadloch farm
        • Polkemmet Mausoleum
        • The REGAL Cinema
        • Waterloo Tower
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