The doula's cervix : above and beyond the call of duty

The always reliable KevinMD recommends I visit a website entitled “My beautiful cervix” written by a Californian doula and student midwife. I’m always game for a laugh and, without more, the word doula makes me start to giggle. A "Californian doula..." well, too good to be true  when Dr Crippen is in pursuit of some entertaining wibble.

“One full cycle of Cervie Love..."

I am a 25 year old woman who has never given birth. My intention with this project was to better understand my cycle and the changes in my cervix throughout the month. As a doula and student midwife, I used this project to help me see how a cervix might look different throughout the cycle in the absence of vaginal infections and to understand speculum exams.

Each photo was taken at approx 10:00 pm every day starting the first day of my menstrual cycle. I re-used a plastic speculum (order one here) and macro function of normal digital camera (and a very talented boyfriend with a headlamp). For the duration of this project, we used condoms as our birth control method so as not to introduce semenal fluid into the photoshoot.

Thirty three high vaginal pictures taken on each day of a complete menstrual cycle with the help of a compliant boyfriend and a digital camera.  This surely is above and beyond the call of duty.  And yet, despite all my entrenched views, this is not wibble. Our Californian doula has produced an elegant, useful, and beautifully presented piece of genuine research. I do not think this has ever been done before.

Take a look at My beautiful cervix

Health care rationing : a bloody good try

The only decision to be made about health-care rationing is how we want to control it. Health care has always been rationed. In the UK by waiting lists; by post-code; by luck and by wealth, or, more correctly, lack of wealth. It is different in the USA where health care has been rationed primarily by wealth. Some USA citizens get virtually no health care at all. More recently it has been rationed by the insurance companies who are beginning to have the same level of control as UK government exercises over the NHS.

Now, St Obama approacheth. For it is he. And with him comes, once again, what many Americans see as the threat of socialized medicine (always with a “z”). They can relax. There is not going to be an American NHS. But St Obama may well widen the safety net to bring in many of the millions who are currently uninsured and thus without decent health care. I am grateful to a reader who advise me that, surprisingly, the Americans are casting an eye over NICE. The idea of an American journalist writing an article on NICE is about as enticing as the prospect of listening to the late Robert Maxwell lecture on pension fund management. And yet, Gardiner Harris (don’t you love American first names) of the New York Times, has written an excellent, warts-and-all but fair, assessent of NICE

For years, Britain was almost alone in using evidence of cost-effectiveness to decide what to pay for. But skyrocketing prices for drugs and medical devices have led a growing number of countries to ask the hardest of questions: How much is life worth? For many, NICE has the answer.

Top health officials in Austria, Brazil, Colombia and Thailand said in interviews that NICE now strongly influences their policies.

Gardiner Harris – New York Times

Essential reading. And a wonderful story about Frank Dobson. Good old Frank. You may not have liked his politics but you always knew where you were with council-house living, unreconstituted old Labour Frank. He created NICE because of his fear of the cost of making Viagra generally available on prescription. (see State sponsored shags) When asked if he thought NICE would work, he said:

"Probably not, but it’s worth a bloody good try.”

Can't imagine Patricia Hewitt saying that.

£5 to save freedom of speech on the internet

It’s a simple issue. Freedom of speech on the internet.

Free thinking bloggers have open comments with no comment moderation. If there are a lot of comments it is not feasible to check them all before publication.

Alex Hilton set up LabourHome a couple of years ago to provide a forum for Labour supporters and, indeed, for anyone to discuss important political matters. A comment came in that was defamatory. As soon as Alex was told, he removed the comment, and offered the front page of LabourHome to the offended person. To no avail. He is being sued. He has a strong defence and, almost certainly, will win his case. But the law is a lottery, and defending an action for defamation is expensive.

It is important that we support Alex Hilton.

Send £5. Send more. Send less. But sent something, and send it here.

The Crippen Diaries - 2008 : December (1)

What do you want to do when you grow up...

December 2008 (1)

As Jenny walked into the consulting room it was clear that she was distraught. She was in tears before she started talking. She is about seventeen weeks into her second pregnancy. She already has a two-year old daughter. Jenny is forty-two. She married late in life, at thirty-eight. Until then, although she was a full-time primary school teacher, she was also an as near as dammit full-time carer for her elderly mother. Then mother died unexpectedly and, within a year, rather to her surprise, Jenny was married to a fellow teacher, who is now fifty. Yesterday, she had the result of the amniocentesis. She is carrying a Down’s Syndrome baby.

Jenny is going to have an abortion. You can call it a “termination” or a TOP if that makes you feel more comfortable. Jenny does not feel comfortable. She feels dreadful. She feels guilty. She has been thinking of little else since the blood test and the nuchal thickness scan first raised the possibility of Down’s syndrome. She feels particularly bad about it because she too has read and listened to the recent ill-informed media barrage which alleges that more and more parents of Down’s babies are deciding not to have abortions:

…many parents felt that life and society had improved for people affected by Down's. Some said their decision was influenced by the fact that they knew people with Down's.

Carol Boys, the [Down’s syndrome] association's chief executive, said: 'We are all very surprised by this. It seems to show that parents are thinking more carefully before opting for termination. When I and others had our babies it was a very different world - those with Down's syndrome were treated very differently. Now there is much greater inclusion and acceptance, with mainstream education having a huge role. We think this plays a part in the decisions parents make - there's even been a baby with Down's syndrome on EastEnders.'

Daily Mail

Ben Goldacre took a look this media outburst a few days ago.

More than 9 out of ten women who have an antenatal diagnosis of Down’s syndrome decide to have a termination of the pregnancy. This proportion has not changed since 1989. This is the “decisions” that Felicity Finch, Radio 4, the Mail, the Times, the Mirror, and the rest are claiming more parents are taking: to carry on with a Down syndrome pregnancy. This is what they are taking as evidence of a more caring society. But the figure has not changed.

Crass and insensitive moral reasoning helps nobody.

Ben Goldacre – Bad Science

I challenge you to think of anything more cras than the Daily Mail reporting someone suggesting that Eastenders is some sort of moral yardstick for the country.

“There’s even been a baby with Down’s syndrome on Eastenders”.

Dear God. So what? Carol Boys of the Down’s Syndrome Association should be ashamed of herself.

“parents are thinking more carefully before opting for termination”

Carol Boys – Down’s syndrome association

Carol implies that if only parents thought “more carefully” fewer of them would opt for terminations. The Down’s Syndrome Association live in the same cosy world of politically correct half-truths as the para-olympics. Oh! Dear me, how dare you suggest that watching people play tennis in wheelchairs is not just as exciting as watching Wimbledon? How dare you suggest that Down’s Syndrome sufferers cannot lead a completely normal life?

Let’s just look at some hard, home truths. Watching wheelchair tennis is at best boring, at worst cringe-making and in both cases makes most of us feel profoundly uncomfortable. And however much you want to pretend otherwise, people with Down’s Syndrome can never live entirely normal lives, and very few of them (I have never met one) will achieve complete and total independence as adults. The Down’s Syndrome Association (DSA) would have you believe otherwise.

Of a potential workforce of approx 15,000 adults with Down's syndrome in the UK, less than one in five will ever have the chance to prove that they are capable of contributing successfully to the nations economy. With appropriate training and support, people with Down's syndrome can and do make a huge contribution to their workplace. The Down's Syndrome Association wants to give people with Down's syndrome the same choices and chances as the rest of the population. We would like you to help us make this a reality.

Down's Syndrome Association

I’m sorry, guys, it is not "a reality". Down's syndrome sufferers can never have “the same choices and chances as the rest of the population” any more than the Para-olympic gold medal tennis winner can win Wimbledon. The DSA has done some wonderful and much needed work to reduce prejudice and increase opportunities but this subliminal message that Down’s syndrome sufferers are not in someway disabled is misleading.

Jenny knows a thing or two about children. She is a teacher. And, for much of her adult life, she has been a carer. She does not want to be a carer again for the rest of her life. Her biggest fear (a fear that those who have not been faced with this agonising choice tend to overlook) is that she does not want her two year old daughter to be brought up in an environment in which a possibly severely disabled younger sibling monopolises the family. Jenny and her husband are teachers . They are not rich. Bringing up a disabled child would likely take all their resources, mental, physical and financial, for the rest of their lives. And then, when they die, their daughter would have to take over.

Like ninety per cent of other Down’s syndrome parents, Jenny is going to have an abortion. You can argue that it is a selfish decision. Maybe so. Jenny certainly thinks it is. But I don’t think we should make her feel bad about it.

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I do not often recommend NHS websites. Most of them are a complete waste of time (see here if you don’t believe me) but Behind the Headlines is always worth a look when the main stream media goes overboard on some implausible medical story.

Turning Erin into Simon

I’ve just come across a new nursing blog. It’s seems to be tied in with the Nursing Times as it has the cumbersome title of Nurses’ Universe – the blogging community for nursing times

I always worry that blogs like this are pseudo-blogs, there only to represent the “establishment”, which in this case would mean promulgating the views of our dear friend, the ever well-nourished Dame Christine Beasley. But no, to be fair, this is a real blog, written by real people, and the comments have not been turned off.

Simon Daniels has been around for twenty-six years. He is an ex-children’s nurse, now working as a psychiatric nurse. Simon is an experienced nursey. I suppose it’s only fair that if Dr Crippen forever talks about dumbing down, Simon should talk about dumbing up. He does not much care for the medical consultants in his field (I don’t think he is talking about nurse consultants) as he says:

Simon Daniels

"There appears to be hierarchical sliding-scale bigotry and intolerance - with the majority of carers at one end providing excellent care and a selection of specialists at the other, scared witless by someone who looks and sounds (to them) like a potential serial killer."

Simon feels the consultants are not able to take a history from the patient without his help:

"They’ve made their minds up as soon as they recognise the [patient] sitting opposite them isn’t ‘normal’. But, to save themselves the added embarrassment of having to engage in a simple jargon-free conversation they choose the easiest option - which is talking to me."

Simon says here

I really don’t know why we bother with doctors at all when we have Simon.

At the other end of the scale, Erin Docherty is obviously a kind and vocationally committed student nurse, two years into her training. She has been having an end of term essay crisis:

Erin Docherty

Right now I am literally tearing my highlighted hair out. It's 4.30am and I can't sleep as tomorrow is D-day - the dreaded end-of-year essay is due. Should it fail to come up to scratch, my whole career could be down the drain.

What is with that? Here I am, two years into a course that I'm loving, and I could literally fail if I don't pass this essay. Nevermind the countless hours spent on the wards, the days and nights running around like a blue-arsed flea, making sure that every patient gets the absolute best. But no, apparently compassion, understanding and damn hard work do not make a nurse. Harvard referencing and case studies, that's what gets you your colours.

Erin Docherty here

Can you think of a better way of summing up the crap that the nursing hierarchy now insists on cramming into student nurses? Yes, yes, before all the nurseys** write in, I know about the importance of the academic side of nursing, but the pendulum has swung too far.

Sadly, it did not work out for Erin. In her next post on the blog we learn that she failed the essay. That’s it. She is out.

Three semesters from qualifying and an essay stops me in my tracks. I am now on leave of absence until May next year where I will start again.

Yes, it was upsetting - I felt lost for days. It was a bit humiliating telling all these people I had spent two years studying with that I was not going to be graduating with them. But I’m still here. I am absolutely determined to finish this course and if it means 7 months on leave then so be it. I feel even now that I have lost a bit of myself. I can no longer call myself a student nurse for the next 7 months.

I have a job in a call centre to see me through.

A sad farewell but I will be back

Apparently she is allowed to start again next year, but until then she is out. So the NHS has lost the services of a student nurse with two years training. She is going to work in a call centre. WTF is going on? What is this doing to her morale? Can Dame Christine explain why young girls, girls with obvious vocational enthusiasm, are treated like this? Why is Erin being labelled as worthless after two years training? Over to Erin:

Don't get me wrong, I'm all for nurses being educated and intelligent, but this is going to far. I may not be able to put good nursing principles on paper, but I can certainly make a bed you can bounce a 50p coin off, and administrate injections at the drop of a hat.

But these days it's all about evidenced-based research. Well, here's my contribution to the research: essays are nonsense. I spend hours and hours using a thesaurus to try and find big words to put on paper so I come out looking intelligent. Why not have a conservation with me instead, ask me my opinion on patient-centered care, ask me any drug calculation you want, or even ask me to explain the new mental health act.

If a patient needs me to explain their medication, I can help. If I'm about to finish my shift, I will stay and explain it another way so i can go home knowing I gave 100%. This is not because I wrote an essay on it - it's because I believe in it and I was born to do it.

Erin Docherty in "I was born to do it"

I tell you why this is happening. Because nurse training has become nursey training. The nursing hierarchy now wants to produce not nurses, but nurseys in the Dame Christine Beasley mold. (or do I mean “mould?) This is the way nurse training breaks young people and, once broken, they can be rebuilt in the image of Dame Chrisine.

This is the way we turn Erin into Simon.

Send your messages of support to Erin here.

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**Definitions

Nurse
A highly trained professional providing hands-on skilled nursing care to sick patients.

Nursey
A highly trained professional who considers that her/his real skills are of no value and now devotes her/his time to trying to do other jobs for which he/she is not trained and therefore can only do, after a fashion, by rigidly adhering to a predefined protocol which s/he has neither the intellect nor the training to understand at anything other than a superficial level. Because nursey is no longer doing nursing, the skilled nursing jobs are now done (badly) by auxiliaries, who call themselves nurses, even though they are not. This whole process is seen throughout the NHS and is known as the “skills' escalator”. It is the embodiment of the Peter principle. See The Witch Doctor's brilliant exposition of the NHS skills' escalator in "Is the escape to heaven closed?"

A gallimaufry of wibble : Professor Keith Scott-Mumby MB ChB, MD, PhD, FRCP (MA)

Professor Keith Scott-Mumby MB ChB, MD, PhD, FRCP (MA) 

My approach to quackery is opportunistic and eclectic. Not for me the commendably rigorous approach of Ben Goldacre, Holford Watch, Dr Aust and DC’s Improbable Science. My interest is usually stirred when a patient, frequently with a Daily Mail tucked under their arm, asks a question. It happened last week when, to coin a phrase, I was more shaken than stirred by an elderly lady with osteoporosis who asked me if it was worth buying a “Hypergravity vibration exercizer”.

I am afraid I laughed. I suppose one should be more open minded, but “hypergravity vibration exercizer” sounded like pure wibble. The patient did not share my amusement, particularly when I had to admit that I had never heard of it. She said it had been recommended by an eminent Professor of Medicine, who had both an MD and a PhD as well as being an FRCP. A little research was called for:

Hi, I'm Dr. Keith Scott-Mumby and I'd like to welcome you to my website…

Never heard of him, but he does indeed have an impressive list of qualifications.

Prof Keith Scott-Mumby MB ChB, MD, PhD, FRCP (MA)

Wow! I wonder why he puts his MA in brackets? But just a minute. In his career details, he says:

For 20 years [I have] been a member of the prestigious Royal Society of Medicine in London (elected-only membership).

Er…Keith, you old fraud, the Royal Society of Medicine is a club. Anyone can join. You do not even have to be a doctor. ** All you have to do is pay the annual subscription. (full details here for anyone wishing to take up membership). But perhaps this is just a slip, because Keith does have FRCP after his name. Fellowship of Royal College of Physicans is only awarded to highly respected members of the medical profession who have already gained membership of the college by passing a demanding post-graduate examination.

Well done, Keith.

But just a minute. There has been a mistake. Keith is not an FRCP. He is an FRCP. If you get my meaning. Which you probably don’t. But then you are not meant to. Keith does cover this confusing issue in his c.v. -  if you can find it:

In 2005 I was elected as a Fellow of the Royal College of Practitioners (not to be confused with the Royal College of Physicians, London). This august body was founded in commemoration of the ancient healing kings of Sri Lanka. Besides a number of medical discoveries that are only now being acknowledged by Western medicine, the ancient Sinhalese are perhaps responsible for introducing the concept of hospitals to the world. According to American historians Will and Ariel Durant, King Pandukabhaya (4th century B.C.) had lying-in-homes and hospitals built in various parts of the country. According to the Chulavansa, King Sena II (851-885 A.C.) built the oldest properly excavated hospital in the world, at Mihintale. King Dutugemunu is well reputed to have built many hospitals and put dispensaries in every village of size. King Aggabodhi VII (766-772 AD) studied the medical plants over the whole island of Lanka (to find out) whether they were wholesome or harmful for the sick. This is perhaps the first recorded instance of medical research anywhere is the world. My favourite character, King Buddadasa (C. 3rd AD) is credited with the saying "If you can't be the king, be a healer*." King Buddhadasa carried out great feats of surgery on humans and animals, including brain surgery. He constantly carried a set of surgical instruments with him on his journeys.

Hence the title “Royal” College. I am proud to be elected to this meritorious body in recognition of my contributions to healing and the teaching of alternative medicine techniques.

Hi, I'm Dr. Keith Scott-Mumby and I'd like to welcome you to my website...

Keith is still a professor, though. He must be. He says he is.

In 2005 I was elected as professor of energy medicine at the Capital University for Integrative Medicine in Washington...

Lots of references to the University of Integrative Medicine on Google here , but not much meat on the bone, and no mention of Professor Scott-Mumby’s appointment. Fortunately, Keith can explain that:

...sadly, it has closed down.

Ah!

So that leaves the MD and the PhD. I could not find any information about those on Keith’s website and by now I was experiencing audiological overload. Every time you get back to the front page of Keith’s website, he starts talking to you is his calm, measured, mellifluous tones.

Hi, I'm Dr. Keith Scott-Mumby and I'd like to welcome you to my website…

It does not grow on you. If anyone has any further information about Keith’s qualifications, do send them in to NHS BLOG DOCTOR at nhsblogdocATgmailDOTcom.

Keith Scott-Mumby really does feature details of the Hypergravity Vibration Exerciser on the front page of his website:

The Hypergravity vibration exercizer


I tell you which one I definitely think is the best in this new health technology that increases growth hormone, reduces blood pressure, lowers cholesterol, REVERSES OSTEOPOROSIS and has a host of other health benefits, all without you sweating!

Full details here.

There is lots more rubbish like this on the website and so it is not difficult to conclude that Keith Scott-Mumby is a purveyor of wibble. Take a look around the website. Probably best to turn the sound off on your computer because, as I say, every time you go back to the main page, Keith will start talking to you

Hi, I'm Dr. Keith Scott-Mumby and I'd like to welcome you to my website...

As I trawled round the website, I moved from amusement to anger. Scott-Mumby features anti-immunisation propaganda and bogus cancer cures. And he is a particular fan of chelation.

I have taken to combining it with IV antioxidants, especially brain-aid glutathione and call this intravenous anti-oxidant therapy. I believe it is the best anti-ageing intervention we have (I'm not counting diet as an intervention!)

Chelation therapy generally requires 20 to 30 treatments at a cost of up to $140 (£100) per visit, or about $3-4,000 (£2500) per patient for the whole course. While this represents a substantial amount of money when paid out of pocket, it is a tiny fraction of the cost of conventional therapies, such as bypass surgery, used to reduce cardiovascular disease, and carries none of the risks a procedure such as that entails.

Keith Scott-Mumby on chelation

The use of chelation as an anti-aging treatment is pure, unadulterated wibble. Can anyone be taken in by it? My learned friend Dr Aust tells me they can, and points me towards a website called “Breakfast with Viv”. Keith gave Viv anti-aging chelation treatment, with dramatic good effect. What did Viv think of Professor Keith Scott-Mumby?

He’s kind, sensitive, intelligent, handsome and sexy and he makes me feel a million dollars.

Wow. Put that down as a successful outcome then, Keith? But it gets better. Or worse, depending on your point of view. Read Viv and Keith’s full story:

I was 45 years old when I met the man of my dreams. I had fought marriage and commitment all of my life, for many reasons, my work, independance, to travel. But then I met Keith and everything changed. I realized that everything that I had thought I had wanted, really didn’t have any purpose if you couldn’t share it with someone.

...[a friend mentioned] Dr. Keith Scott-Mumby and how he was doing some amazing treatment for anti-aging. Next thing I know my girlfriend and I were booked in for some treatment with him. Well thats how it all got started. For 10 weeks I went for my Chelation treatments, and gradually got to know this great doctor. He was so interesting and intelligent and his world of medicine was miles away from life of Fashion. I was dreading the treatment to finish, as I thought I would never see him again. But thankfully he felt the same and we started dating, when I stopped being his patient.

That was six years ago. We got married and we have been on a constant honeymoon together ever since. We moved to America to start a new life, the land of oppotunities, and we have had a lot of ups and downs since being here.

But I wouldn’t change any of it, because I have someone very special in my life. Hes kind, sensitive, intelligent, handsome and sexy and he makes me feel a million dollars.

Breakfast with Viv, aka Mrs Scott-Mumby (full, unexpurgated story here)

How romantic! Something from the Mills & Boon ugly duckling/swan fiction genre. As the chelation progressed, plain old Viv became more and more beautiful and Keith fell in love. Or something like that. Good to know that Keith was at all times professional and did not get into a leg-over situation with Viv until after the treatment had finished. The GMC may not stop chelation treatment but it does not like doctors who become romantically involved with patients, particularly vulnerable ones. Mind you, Keith lives in California now, outside GMC jurisdiction. I searched the GMC register of medical practitioners but found no mention of a Keith Scott-Mumby. Maybe I spelt it wrong.

So what conclusions do we reach on Professor Keith Scott-Mumby? That he is a purveyor of wibble? That he embraces the lunatic fringe of alternative “medicine”? That he is a disgrace to the medical profession? He attempts a pre-emptive defence by saying in his small print:

"It's not my fault if people read my website"

In no event shall Professor Scott-Mumby be liable for any consequential damages arising out of any use of, or reliance on any content or materials contained herein, neither shall Professor Scott-Mumby be liable for any content of any external internet sites listed nor does he endorse any commercial product or service mentioned, unless specifically stated to the contrary.

Prof Keith Scott-Mumby MB ChB, MD, PhD, FRCP (MA)
Disclaimer hidden at the bottom of the page here

This makes him a wibble merchant of the worst possible kind. Not only does he proudly display every modality of quackery on his website, but he attempts to wriggle out of any responsibility in the small print. I cannot speak for the law in California but in England exclusion clauses like this provide no protection.

NHS BLOG DOCTOR challenge

Can you think of any from of quackery that is NOT mentioned on Professor Keith Scott-Mumby’s website?

Dubious, unproven cancer treatments, chelation and, inevitably, vaccination denial to name but a few. The list is long, and there is no excuse for a qualified doctor promoting this nonsense. The small print get out clause is no defence.

Hi, I'm Dr. Keith Scott-Mumby and I'd like to welcome you to my website...

Take a look, and have a laugh, but for God’s sake don’t take this man, and his two thousand pages of wibble, seriously. And don’t, whatever you do, waste your money on a Hypergravity vibration exercizer. Go for a walk in the park. It's cheaper.

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You can find Professor Keith Scott-Mumby's versions of his qualifications and his detailed c.v. on the internet website, but you have to look hard. Try here.

** I am grateful to a reader who advised me that in fact anyone, and not just any doctor as I originally wrote, can join the RSM.

Officer, arrest this smirking crook

source : guidofawkes

Oh! Brave New Medical World

A few days ago, I wrote about the modern, protocol-driven nonsense of forcing the families of newly diagnosed young diabetics to have a psychiatric assessment. This sad state of affairs is one of the many by-products of dumbing down. A small but significant number of such families will find that their newly diagnosed diabetic child will develop behavioural problems which impact on the whole family. They will benefit from help. For them, psychiatric help is a “good thing” and such help should be available to all who need it. Unfortunately, the lower echelons of our dumbed down health care professionals cannot distinguish between the concept of psychiatric help being available to all on a “needs” basis and psychiatric help being provided for all. If it is “a good thing” then all should have it. Whether or not they want it. Or need it. It is a huge waste resources but it avoids decision making, thus allowing the system to be managed, after a fashion, by those who have insufficient training to make decisions.

The anguished parents of a physically disabled child wrote in to describe their experiences of this brave new medical world:

At one point in time I was told that any help my family might be offered by Social Care Services would be entirely dependent on whether or not we chose to accept Social Services' offer of a referral to CAMHS for our eldest child. The child in question is very severely physically disabled, bright, determined, and at the time of referral very young and very frustrated, especially in terms of communication.

As parents, we were also frustrated, but more significantly, absolutely exhausted and unable to arrange a much-needed break from the 24-hour care of a child who, as well as being entirely dependent by necessity, would scream and spasm uncontrollably in terror at the slightest unexpected sight, sound, or touch. Hardly unusual behaviour for a small child with this particular neurological injury and related sensory/communication/medical difficulties. For the above reasons, the referral to Social Services was made through the local NHS paediatrics department, and stated that although we were excellent parents who provided a high level of care, we could not continue to cope without a break.

We were disgusted at being bullied by Social Services to accept the referral to CAMHS and adamantly refused. We felt that the buck-passing dismissal to CAMHS, carrying with it, it seemed, a label of "behavioural problems" until reported otherwise, was inappropriate, unhelpful, and downright unethical when others genuinely need to access this service. Fortunately the sizeable number of medical and educational professionals already working with our child agreed that such a referral was right off the mark, and eventually, after a fair bit of fuss was made, the CAMHS referral became a non-issue, never mentioned.

Whether such a non-issue will be exhumed and re-instated in the future remains to be seen. In any case, the child in question enjoys life, for the most part immensely, now has a useful understanding of the persistent infant reflexes that once terrorised him, is clearly mentally stable, and is successfully gaining more and more independence through communication devices. The care involved is still bloody hard work. Incidentally, we receive a minute amount of help from social services. Nevertheless, we remain certain that accepting the CAMHS referral would have had the potential to cause more serious future problems for our child than the un-doubted black mark on our family's Social Services file.

See Comments under the orginal article here

It's an interesting reductio ad absurdum to think that child psychiatric care in the NHS is not only available to to all, independent of means but also to all independent of need. If resources were not wasted in this way, perhaps the Haringey tragedy might have been avoided. Glancing at the Haringey Council Child Protection"  services webpage here,  there must be a resource issue as they have not updated the site since August. Staggering.

More maternity madness

I thought it was an elaborate spoof in the Guardian but no, it’s for real. It’s the story of a lotus birth to Gina Cox-Roberts who is a natal hypnotherapist from Telford. What is a lotus birth? Read on.

"The placenta and the child came from the same cell," she says. "Her placenta was as much a part of her as her hands or her heart." So why cut the umbilical cord? Instead Cox-Roberts decided to go ahead with a "lotus birth" - a practice in which the placenta stays attached to the baby until the umbilical cord disintegrates naturally a few days later.

This was, of course, a home birth and was, of course, conducted by an independent midwife.

Cox-Roberts believes that this approach - which followed an uncomplicated home birth attended by an independent midwife - gave her baby the opportunity to "let go" of the cord and placenta in her own time. "After all, her entire existence until the moment of birth was next to this placenta, which she would snuggle up to. The placenta had been her companion, her plaything: its sounds had lulled her to sleep. Here she was in this alien world and we were going to cut away the one thing she knew. Why do we feel we have a right to do that?"

Cox-Roberts feels that treating the placenta with respect makes the transition from womb to world much easier for the baby.
She says that it is not inconvenient to carry the cord, placenta and baby around together. "We rinsed off the placenta so it was as clean as possible. We sprinkled sea salt over it - it's a chunk of meat quite like liver and has the potential to go off. We had some lavender essential oil to drip on it too in case it got smelly, but it never did. We wrapped it in a terry nappy, then wrapped the baby and the placenta up together in a sleeping bag. Every 12 hours we changed the nappy and added more salt. It worked fine."

Beyond the bonding, some argue that the best thing about lotus birth is that it gives you more time to decide what to do with the placenta: bury it, eat it or freeze it.

It's not a spoof - full story here

Is it any wonder that the medical profession is terrified by the activities of the independent midwives? And WTF is a natal hypnotherapist?

Finally, some people really do eat it:



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I have still not heard from Helen O’Dell of the NMC who, allegedly, commended the controversial management of a home birth of a large baby. Whilst the NMC continues to approve of this kind of midwifery practice, there is little hope of common sense prevailing.

Fifteen questions about political freedom

Do you know who this is, and what she is supposed to do?

A member of Parliament has been arrested and detained for nine hours. Even more worryingly, it appears that the police went into the Palace of Westminster and searched his office. It is inconceivable that this act could have taken place without, at some level, government sanction. It remains to be seen at what level the order was given.

DNA swabs. CCTV. Identity cards. Medical records on a centralised computer. And so it goes on. This government has collected more data on its citizens than any government in history. This latest outrage is the greatest threat to Parliamentary democracy since Charles 1 entered the House of Commons to arrest some of its members. On that occasion, the birds had flown. Damien Green was not able to fly, nor was he able to protect the contents of his office in the House of Commons.

Iain Dale raises “Fifteen questions which need to be answered”

On this occasion the bird may not have flown, but the problem will come home to roost.

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And, as so often, Guido gets it right:



See Guido Fawkes on Clunking Fists, Gordon Brown : Then and Now and Arrest Osborne next

Dying at home

The government is once again being two-faced about the care of the dying. Was it not only yesterday that they were saying that it is everyone’s “right” to die in a hospice? Now they have done yet another volte-face and are saying it’s everyone’s "right" (sic) to die at home. I have got news for this top-down, micro-managing government. It has always been a patient’s "right" to do as he chooses and to die where he chooses. What the government needs to do is fund sufficient community facilities to enable patients to die at home with dignity and with good nursing care. I can tell them how to make that possible and at the same time save some money.

As regular readers know, I feel very strongly about the care of the dying. If at all possible – and it usually is – people should die at home. I have written at length about this on many occasions.

One of the most fundamental roles of the family doctor is to care for dying patients in the home environment. All the older partners in my practice are highly experienced in this task, aided by our excellent team of district nurses. As I have said many times before, the pure physical medical side of terminal care is rarely challenging. The mental and emotional side is very challenging and, as I get older, I find it more and more of a strain.

Removing death from Life

My views on the terminal care industry are outspoken (nothing new there, then) but firmly held.

God, how I hate hospices. How I hate palliative care doctors. How, in particular, I hate Macmillan nurses.

I am not being provocative. I yield to none in my admiration for the late, great Dame Cicely Saunders. As I have said before, I put her up there with Semmelweiss. She devoted her life to showing us how to treat the discomfort of dying pre-emptively. Semmelweiss taught us to wash our hands before doing vaginal examinations. We learnt both lessons. They are obvious now as, in retrospect, was the development of the wheel.

I still truly hate the whole of the terminal care industry brigade but not perhaps in the way you may think. You see, I hate death and, even more, I hate the process of death. I hate dying. It is a wretched bloody business. I hate the way hospices, and the palliative care doctors and the Macmillan nurses, steal death from life. They attempt to pretty up the process of dying into some sort of clap-happy learning experience, there to be shared by all the family. I had lunch with a good friend yesterday who told me that his father-in-law threw a Macmillan nurse out of the house after her appalling opening gambit on her first visit of “How do you feel about dying”. What a question! What an arsehole!

Something wicked this way comes : getting shut of the "crumble"

Most of you will remember Christian Jago who wrote under the pen name Potentilla. She was one of the great intellects on the blogosphere and also wrote with insight and humour about her own struggle with breast cancer. When, finally and sadly,  she was in a hospice, she wrote:

Now I am looking out of the window at a beautiful, little, vaguely Japanese, garden belonging to the hospice with squirrels and gulls. It has been snowing. Some day. Somewhere along the way I acquired a morphine driver pump (*), a handfull of pills a day and fulltime oxygen mask. I haven’t an idea how I got here, really. I’m not sure who I am, but I think, someone different. This has been the most difficult few paragraphs I have ever written bar none ever, despite not having any emotional content.

More tellingly, a few weeks earlier, Christian wrote of the unreal world of the hospice, and of the patronising, transactionally inappropriate way the patients are treated:

In the hospice a patient would have to be much worse than just badly behaved to get any opprobrium. Probably to provoke the staff a patient would have to be doing something harmful to another patient. And maybe in extreme cases not even then. Your status as a responsible adult is held in suspense. It isn’t fully revoked but it isn’t in place either. The relationship between the carers, helpers and domestics and the patients is odd. Not odd as in being unexplicable, but odd as in being outside of the norm of everyday life.

All that Christian Jago wrote is still preserved at auspicious dragon. You can keep your squirrels and your gulls and your Japanese gardens. I don’t want any of it, and I do not think Christian did either. I try to protect my patients from the worst of this nonsense.

Many who support hospice admission are in reality just trying to sweep a difficult problem, a problem with which they cannot cope, under the carpet.

The first problem with hospices is that they have cloaked terminal care in a load of spurious pseudo-science and medical mythology now avidly practised by nurse-specialists, and medically qualified terminal care specialists, who purport to “help people on their voyage through their illness.” We cannot call it terminal care any more because that suggests the patient may be dying. It is “continuing” care. (Bullshit. It is not going to “continue” by definition.) Or it is “palliative” care. Well, OK, that is a little more honest.

There is a danger that the hospice movement will steal death from life.

Stealing death from life.

Take a look at some of the hospice internet sites. Put "hospice" into Google. I did so and entirely at random came up with this:

I thought Hospices were depressing places where there are lots of dying people. Is this true?

A lot of people think this until they get to know us! Then they find the Hospice is homely, bright and cheerful. Our staff and volunteers are friendly and welcoming. We have single rooms with en-suite facilities and shared rooms for people who prefer them and there’s a lovely garden that patients and their families use.

Source

What a load of dishonest crap. Look at the logo. Life changing? Dear God, what do they mean by that? Hospices may be "bright and cheerful" (cheerful??) but they are not homely. All the patients at hospices are dying. Every one of them. No exceptions. That is what hospices are for. This advert reads like a hotel brochure. They even have videos of “happy” patients. Hospices are not hotels. They are institutions that care for the dying. I don’t care about the en-suites and the garden. Hospices are deeply, profoundly depressing.

Whilst you are all alive and well, you can try to pretend that dying is fun if want. But you are in for a shock when your turn comes.

Dying is a bugger.

It is unpleasant. It often involves discomfort. It is the loneliest experience you will ever go through. It is heart-breaking for you and your family.

It is a real bugger.

But let us not sweep it under the carpet and rush you off to the hospice where death can be processed and packaged. Out of sight. Out of mind.

Hospices remove death from life. They sanitise it. We have already removed birth from life in the UK. Obstetric medical services are currently set up so that no one in their right mind has a home delivery. It does not have to be like that. Now the same is happening to death.

Be realistic about dying. It is not pleasurable. It is not fun. There may be some physically painful times, though these can nearly always be controlled medically. There will be some emotionally painful times. These can not be controlled so easily. You will be sad. You will be lonely. Ideally, you will be at home, surrounded by your family, supported by the family doctor, the district nurses, the Marie Curie nurses and the local vicar or priest. If that is not possible, you will be in the hospice.

There will be some bad times. Times of deep sadness and despair. There will also be some good times, some quality times. Not in any transcendental and philosophical way, but in terms of precious time spent with family and friends.

Whatever else is going on, that is too good to miss. Do not throw it away. And do not ask me to help you throw it away.

The terminal care industry

Like the Jobbing Doctor, I visit all my terminally ill patients frequently, sometimes several times a day, and they have my home phone number. It is in the phone book under Crippen, John Dr. There are not many of us left. Like the Jobbing Doctor, I regard it as a failure when I do have to send patients into a hospice. The commonest reason I do have to send them in is lack of round the clock nursing care in the community. In the last few days of life, patients often need a constant nursing presence. And by nursing, I mean by a nurse, not a nursey. Remember, those well meaning MacMillan nurseys do not do hands on nursing. Someti