Unrealistic Medicine

This BMJ Editorial of the 30th June 2017 has had a number of responses:

The Editorial was a consideration of Academy of Medical Sciences report ‘Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines’.

The President of the Academy of Medical Sciences and the Chair of the Report, Professor Sir John Tooke, has submitted this reply:

It is most welcome for Professor Sir John Tooke to set out his further thoughts but I found that what he said did not reassure me about the future of science and so submitted this response:

Unrealistic Medicine
Written by Peter, 15 July 2017
Submitted as BMJ Rapid Response.

The further thoughts of Professor Sir John Tooke, Chair of the Academy of Medical Sciences report ‘Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines’ are most welcome.

Professor Sir John Tooke does not reassure me that an era of unrealistic medicine and the business of science will change anytime soon. Meantime the NHS is struggling across the United Kingdom and this may be in part due to the promotion of medical interventions whose evidence base lacks the objectivity that we all surely seek.

I would suggest that most of us fully understand the “reminder” from the Academy of Medical Sciences that potential conflicts of interest can come in all forms and not just financial. But like the public I share the view that we should start with potential financial conflicts of interest as evidence has determined that exposure to industry promotional activity can lead to doctors recommending worse treatments for patients  Godlee and Freer remind us that we expect this from our elected politicians and in other areas of public life.

The voluntary ABPI Register is not working. Its database is only a little more than half complete. This really does challenge the “E” in EBM.

The pharmaceutical Industry has, over the preceding year, increased payments to healthcare workers for “promotional activities” from £109 million to £116.5 million.  This is a major part of Industry budget. Furthermore, we do not know how much may be being paid by device makers and other forms of industry for promotion of their products.

It is welcome, but somewhat “after the bell has rung”, that Professor Sir John Tooke confirms that the Academy of Medical Sciences intends to “review” its approach to public transparency. But one wonders how many “houses” do we need to “get in order” to address this issue effectively? I find myself worrying that it could be like a game of Monopoly that never seems to end.

The most effective and cheapest way to address this matter would be Sunshine legislation. This would avoid multiple, overlapping and generally unsearchable databases of interests.

I would suggest that the reputation of science is at stake as is the balance between benefits and harms for us all

Roy Porter, who sadly died prematurely was considered as one of the United Kingdom’s finest historians of science and health. He ends “Madness: A Brief History “ with a teasing question: ‘Is folly jingling its bells again?’

 

Shifting light, changing skies and sudden vistas

On the 11th June 2014 I received the above message from Alexander McCall Smith. You can perhaps imagine how this affected me.

The Great Tapestry of Scotland. One of my oldest patients helped in the embroidery of one of the panels:

 

I subsequently made this film about visiting the tapestry in Stirling castle with my family:

 

Alexander McCall Smith kindly invited me to meet with him and wrote this in my grandfather’s old invoice book for his orchard:

Alexander McCall Smith: what imagination he has alongside such a natural sense of fun. McCall Smith’s laughter is the only sort of “infection” that is healthy!  I met Augustus Basil. This was a day that I will not forget.

The following sentence comes from ‘Chance Developments’ by Alexander McCall Smith (from the signed copy that he kindly gave me):

[‘The future lies in the past’ might be one way of considering my films]

How silly it may be, but I sometimes imagine myself as the Antiquary and often stamp this (in water soluble ink) on places from the “past” that I have visited today. They are generally lost places:

I was born in Edinburgh in 1967. After studying Medicine in Aberdeen I studied Landscape Architecture with the University of Edinburgh gaining distinction in every subject and the Scottish Chapter prize.

Alexander McCall Smith describes Edinburgh in terms of the light. The very light that was shared and appreciated by James Clerk Maxwell:

“This is a city of shifting light, of changing skies, of sudden vistas. A city so beautiful it breaks the heart again and again.”

Alexander McCall Smith has brought light to me (quotes from Chance Developments):

Alexander McCall Smith has a most wonderful PA. Thank you Lesley for understanding my wide-eyed self. Edinburgh’s shifting light, changing skies and sudden vistas.

REPARATION (a prequel and sequel)

Filmed at Lynedoch, Perthshire, Thursday 15th June 2017.

Peter is reading the words of Hilary Mantel (from the Reith lecture 2017)

Music is composed and performed by James Ross – “Beyond the Strath”

The lawn was white with doctors









Histories never end, but go on living in their consequences

This film is based upon Cammo House, at least what is left.

Robert Louis Stevenson has stated that the “House of Shaws” in Kidnapped was based on Cammo House on the outskirts of Edinburgh.

This film comes to a close with a lowlander in the highlands: at Gauch in Cabrach.

The film ends with Leonard Cohen’s last song.

He’s an elemental air-spirit

This post considers Ariel from The Tempest through the retelling of ‘The Fletcher Correctional Players’. I would thoroughly recommend ‘Hag-Seed’ by Margaret Atwood.

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One of my alter-ego’s is the hunched pharmacist Gilbert Farie: hag-seed-by-margaret-atwood-3 hag-seed-by-margaret-atwood-4 hag-seed-by-margaret-atwood-5


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hag-seed-by-margaret-atwood-10 hag-seed-by-margaret-atwood-11Dunkeld mortar & pestle1 (3)hag-seed-by-margaret-atwood-12

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A hopeless case

Peter first met Sian at Woodend Hospital. This was February 1991. At the time, both Peter and Sian were junior doctors working in the Glenburn Wing.

The backdrop narrative (audio) is provided by Scotland the What.