Category Archives: My personal despair

Stop buying the Daily Mail: it is not out to help you

It’s been a while since I last posted anything on this blog, or indeed have written anything about anything. Yet every now and again the Daily Mail does something that stirs up Twitter and occasionally it makes me want to make some sort of comment, but I don’t get round to it or I feel as if everything has already been said. But as it has been such a long time since I blogged about just what a terrible newspaper the Daily Mail is, I thought it worth going over again.

The Daily Mail is a cowardly newspaper. Attacking Ed Miliband through his dead father is just the latest in the long line of comment published solely in an attempt to discredit someone (without ever wanting to actually debate the points made). The argument of the press that it exists as a check and balance to the rich and powerful has long been a sick joke (too often repeated by spineless politicians of all bland and samey flavours who are too scared to court the vitriol of the industry) and the state of our society today is evidence enough that they have not provided any kind of check to the power of big business or giddy politicians.

The Daily Mail is part of a press that is largely part of the system of control, the noisy attack dog of big business and politicians bent on giving the last remnants of the state over to private firms to run into the ground for the benefit of a few shareholders – who increasingly hoover up the wealth of the planet into the hands of a few thousands of people (money does not ‘trickle down’ in the form of capitalism the world has been forced to adopt, it steadily – and increasingly rapidly – flows up; evidenced by the fact that the rich keep getting richer and the rest of us squabble around for ever smaller bites of the capitalist apple).

The Daily Mail is not a newspaper, it never has been. It is a wonderfully successful vehicle to ensure that enough people largely fear and despise one another whilst not really noticing that the people around them are, in fact, just like them; only different in some inconsequential way. The Daily Mail is brilliantly evil because it doesn’t do this by carpet bombing the nation with free newspaper drops, it actually sells this hatred to a willing public. One of the things that society enjoys repeating is the sorry cycle of electing politicians who wear different colour ties, but enact policies that are largely the same. We boot out the Tories, only to then boot out Labour for being just as bad… just to return the Tories; who are terrible, so we vote in Labour and so on.

We exist in a permanent state of limbo in which politicians only focus on short-term populism which ultimately results in bad choices and long-term decline. Politicians only attempt to make changes that they can push through in their short time in office, each competing vainly to make the biggest impact during their time on stage – a stage which they are normally ill-equipped on which to stand (Michael Gove possibly being the worst of the current very sorry bunch). Thus politicians dabble in education, bringing in sweeping changes on nothing more than a whim and a misty-eyed view of their own schooling, reorganize the NHS, safe in the knowledge that the next incumbent will only serve to twist it into a different shape anyway.

Meanwhile the country drifts towards blackout because a long-term energy strategy is expensive, unpopular and doesn’t give the politician the chance to make a noticeable mark in the same way that blaming teachers for the state of education does (hint: teachers are not the reason why education is increasingly becoming the antithesis of the word). Part of our inability to take action, to understand the problems that we face, is the constant disinformation spread by the Daily Mail and it’s sorry cohort of newspapers determined to maintain the status quo and indeed tighten the grip of the rich around the throats of just about everyone (they allow us just enough breath to watch TV and buy more shit we don’t need to distract ourselves from the misery of existing in a world in which millions die of starvation, whilst millions shovel money into the hands of false saviours to try and halt their descent into morbid obesity).

We can’t get out of this cycle unless we organise ourselves and change politics to actually work for the majority. We need a long-term energy goal, we need worthwhile jobs and decent housing for all. I sometimes feel that we look back through history at the rigid class system and extremes in wealth and poverty as if those days are gone, when clearly little has changed. It’s not enough to point to Alan Sugar and argue that the class system is dead, its just that most people born on housing estates clearly aren’t working hard enough (although the media seems intent on trying to make this case).

I guess what I’m trying to say is this: we will not move forward as a society or planet if we keep buying newspapers, or indeed willingly believe most forms of media with which we are bombarded. These organisations are not looking out for us, they are there to silence us, to bully us into submission with the their power, or cower us into inaction because we fear the fellow citizens without which we are incapable of enacting change.

Buying most newspapers is an antisocial act, reading the Daily Mail and disseminating the hate within is akin to smoking and blowing smoke into the faces of the people around you. You can’t avoid the health hazards of smoking if people smoke around you, anymore than you can avoid the poison breathed by the readership of the Daily Mail. Turning your back is not an option, the Daily Mail will not be defeated with a blind eye, it needs to be stared down.

Buying the Daily Mail should be as socially unacceptable as drink driving – we don’t care if you die from your own stupidity, but it’s the danger you cause to others that we will not tolerate.

P.S. it would also help if millions of people slapped themselves firmly around the face and realised that the lives of celebrities are a pointless distraction and stopped making the Daily Mail website one of the busiest on earth.

Just imagine a world in which people spent time informing themselves about the things that matter instead of reading celebrity drivel. The things we might achieve.

A sad day for palliative care

Three weeks ago I wrote about my dismay at the Daily Mail’s attack on the Liverpool Care Pathway. This week Baroness Neuberger’s team has published its report: “More Care, Less Pathway.” Amongst its recommendations is this:

The name ‘Liverpool Care Pathway’ should be abandoned, and within the area of end of life care, the term
‘pathway’ should be avoided. An ‘end of life care plan’ should be sufficient for both professionals and lay
people.
Unsurprisingly the Mail is gloating over its victory:
  • Ministers order Liverpool Care Pathway to be ditched within a year,
  • Review by Baroness Neuberger reveals how end-of-life treatment was used as an excuse for appalling levels of care
  • Families were not told their loved ones were on the ‘pathway’ to death

The Mail has been leading a campaign against it…

I stand by every word I wrote three weeks ago. I am quite disappointed by how much the report has pandered to the Mail. If you read the comments sections of my last post, you will see many of the commentators are strongly opposed to the LCP. Whilst I think many of the comments are misguided, and just plain wrong I have not moderated any of them. (Unlike the Mail website which always blocks all of my comments posted as ‘alienfromzog’). I want to take this opportunity to respond to the comments, to the report and to the Mail. My main frustration is that when you read what people think caring for the dying should involve, it’s often words like “Caring,” “TLC” or “Individual” are used. Similarly many relatives say they want good communication. What is so frustrating is that this is precisely what the LCP is. What it’s for. If you don’t believe me , read this: Marie Curie Example LCP documentation.
It took years to recover from the damage done to the vaccine program by the Mail’s irresponsible reporting – and we’re still not there yet. This is why the Mail is so malevolent. And yes, I do blame the Mail in part for the children who have died of measles. Years of hardwork, research, evidence and education – all undone by Melanie Phillips and her malicious publication. And who suffers? The most vulnerable in society. There have been various articles and blogs written to defend the LCP. In all of them that I’ve read, they begin with an acknowledgement that the LCP used inappropriately has led to many of the problems reported in the press. I have not done that and this is deliberate. I am not pretending that bad practice does not occur. It does – in all areas of healthcare and all healthcare systems. I will always condemn bad practice but the idea that not using the LCP pathway properly means there’s a problem with the LCP is ridiculous. Moreover, by beginning with such acknowledgements I believe that all these articles and also the Neurberger report has conceded too much ground – allowing the LCP critics to claim victory.
Perfectly preventable problems of communication between clinicians, relatives and carers
appear to account for a substantial part of the recent controversy and unhappiness
surrounding the LCP.
I care about quality of care. Abolishing the LCP will make the Daily Mail happy. It will make the government look like they’re doing something and will almost certainly lead to less-good care. Almost without exception, the critics have said “Care of the dying should be….” and what follows that, as I said above, is in the LCP. So, in order to improve care we plan to abolish a tool that works when used properly rather than addressing the issues that lead to it not being used properly. This is insane. But then, that’s what government by tabloid press always is. My great fear is that scrapping the LCP will mean a return to ad-hoc, ‘hit and miss’ palliative care. This is a major backward step.
I do want to address a couple of specific points as well; firstly the LCP is not euthanasia by the back door. Secondly the payments for use of the LCP to hospitals have been presented as money for killing off patients and this is a gross misrepresentation.
I am against euthanasia. I think giving doctors the power the kill is a grave error – even when people are suffering horribly. Good palliative care is the very opposite of euthanasia. My professional experience – and this is especially true in children – is that we over-treat to the nth degree. We are not good in the profession in acknowledging that we cannot cure and fix everything. Most of us in medicine are ‘fixers’ by nature. A lot of what we do in medicine is nasty and invasive. I have no problem with doing nasty and invasive things to people who will benefit from them. I have major issues with doing nasty and invasive things to people when it will not help. This is about not having another round of chemotherapy when we know it won’t help. This is about not force-feeding people with artificial nutrition as their body shuts down. This is about not doing endless – and increasingly difficult  – blood tests just so we can chart the dying process. Integrating care pathways for dying patients mean we provide comfort and care for people in their last hours and days. This is vital.
The way the NHS funding works is quite complicated. Since the early 1990’s there has been a so-called purchaser-provider split and hospitals then get paid for providing specific treatments. One of the parts of this is so-called ‘quality-care indicators’  (or whatever they’re called this week). Essentially a portion of the money paid by primary care trusts / GP consortia is dependent on meeting the quality indicators. One such indicator was the use of the LCP in dying patients – x% was the threshold for payment. This actually makes a lot of sense; Let us assume that the LCP provides an excellent framework for caring for dying patients. Secondly, all patients who die in hospital are categorised as ‘expected’ or ‘unexpected.’ Death is often not a surprise – i.e. medical staff know that a patient is in the last phase of illness. The internal audit process simply reviewed what percentage of the ‘expected’ deaths were on the LCP when they died – i.e. had the medical team stopped doing invasive procedures on someone or were they still trying to cure? Nothing is absolute and some patients will die unexpectedly. Some people will have a theoretically reversible condition and it is right to keep on treating and yet we still fail – but the evidence is clear, in the majority of cases, we know someone is dying and the focus of care should change. A simple audit of whether the LCP is used of not is a good marker of this. The use of money to drive things is an inevitable consequence of how the modern NHS is structured – a perhaps cynical view that NHS trusts will only do things for financial incentives. On a more practical level, the trusts used this money to pay for specialist palliative care teams to support the use of the LCP and help the other clinical teams use it effectively. The abolition of such payments is a sensible political move but will probably also result in trusts not focusing on palliative care.
Speaking as the son of someone who died in an excellent hospice; speaking as a doctor who has worked on the wards where integrated care plans for dying patients have been used – and as someone familiar with LCP specifically I say this:

This is a very sad day for the healthcare in the UK. There is not a problem with the LCP – there is only a problem with poor practice – rarely. The number of patients who have received excellent care far outweighs the few who haven’t. Not that those don’t matter, they really do but I am sure that the bad practice was worse before we had integrated care for dying patients and will probably be worse again. What’s most annoying is when you read the comments sections or listen to radio phone-ins people talk about what they want end-of-life care to look like and it is precisely what is in the LCP. It is worrying to me that the Daily Mail wrote a couple of sensational and misleading articles and forced this change of policy. Deeply worrying. I know that a small group of people in the late 90s worked very hard to put together the research and develop the LCP. I suspect they are very demoralised. I know a lot of people work in palliative medicine and I expect they are depressed and despondent. All because a lying, evil rag – not even fit to be fish ‘n’ chip wrapping – calls itself a newspaper and constant prints streams of lies and sensation. A sad day.

Dr alienfromzog BSc(Hons) MBChB MRCS(Ed) DCH

Liverpool Care Pathway – The Daily Mail vs Care for the Dying

An inevitable philosophical question:

I’ve been occasionally contributing to Angrymob for a few years now. Kevin (aka Uponnothing) very kindly gave me a login. I write because I care about the truth. I write because I believe that the lies and agenda of the Mail are pervasive and damaging. I write because I hope to share my thoughts with enough people to help change the story – to help people realise what the media in general and the Mail in particular are doing. To provide the facts – as best I can – so that people who know the Mail is lying have the ammunition to respond.

I have no idea really if I’m achieving anything.

But the question that I’ve pondered for sometime now – especially when I read stories like this one – is what is going on within the Mail? I wonder if they believe what they write? I wonder if they just want an agenda to push? And I wonder what level of research they do before holding a particular position?

Either way, what they publish is demonstrably false and often deeply poisonous. This is why I have written about vaccines so much. The recent events in Wales with measles have shown the real-world effects of the Mail’s agenda. And this is moreover true is so many areas – immigration, race relations, the Welfare State, the NHS, our attitudes to poverty…etc. etc.

So, whilst I continue to ponder that question, which I admit does intrigue me greatly, I will try to continue to respond when I have the time. For the most part I write about healthcare issues as this is what I know about.

On the subject of poverty I invite you to read this from my personal blog. (I make no apology for the theology).

 

The Liverpool Care Pathway

I think I should begin with a confession; I am not a big fan of the LCP. I will explain that comment in a moment but first I need to alter it slightly. My feelings have changed and I have become very keen to defend it because the attack by the Mail seeks to (well maybe not, see above, will- ) damage the way we care for the dying in this country. If you want to read about the pathway itself and to understand what it is and how it works, here is a good place to start.

Simply put, the LCP was designed to consolidate best practise in the care of dying patients. In the UK we have a hospice movement to be proud of. Most people, however don’t die in hospices – most people die in hospitals. Historically (by which I mean the last 30 years) and culturally, hospitals are not conditioned to best care in the process of dying. Hospitals are places for curing. Modern medicine particularly is built on the notion of curing everything. Trust me, doctors know this to be a lie. Most of us have had enough humbling experiences with meeting death to know that we can’t cure everything and that the old saw about medicine being the art of delaying the inevitable is not without its truth. However, and this is a vital and massive ‘however’ – we are in the business of healthcare. Providing curative treatment when possible and appropriate and dignity, compassion and comfort when not.

Recognising that a patient is dying is notoriously difficult but experienced nursing and medical staff will tell you that we often know that it’s time to stop. I graduated in a time when these kind of approaches were widely accepted and beginning to be more formalised. It is about the fact that most people die relatively slowly – by which I mean hours to days  and not the seconds to minutes we see in TV and movies. Given that putting everyone in a hospice is not practicable, I think most of us will agree that providing the best kind of end-of-life care in hospital is a priority.

The principals are this: When a patient is near to death; stop unnecessary and invasive interventions (like blood tests) and treat symptoms effectively. This usually means three things; analgesia, treating anxiety and treating secretions.

The Liverpool Care Pathway codifies these in a way designed to ensure that best possible care is provided. Feeding may be stopped as in the last few days as artificial feeding does more harm than good.

So why do I not like the LCP? Well, this is not really my area of medicine and as I’ve moved into my specialty of paediatric surgery, I haven’t done any adult work for over three years now. But I was a junior doctor on the wards – and anyone who has done that job will have dozens of stories of how the LCP is a really effective way of CARING for dying patients. My objection is the same as that of a professor of palliative care I know, the LCP is a little cumbersome and involves too much paperwork and it got a lot of national attention and funding  – potentially at the expense of other areas. But is does work. Really well.

The LCP is very very good at what it does. The LCP – or something like it – is exactly what I would want for me, for anyone I love – or for any human being near to death.

 

The Daily Mail’s latest Witchhunt.

Back in November, I picked up on Melanie Phillips evil comment piece on the LCP and its effects. I do not use the word ‘evil’ lightly but something so completely dishonest that increases distress and anxiety for people who are watching loved-ones die I think is evil. If someone wants to provide me a better word, please do. Again I don’t know if Phillips is being dishonest of just not bothering to research properly – but I suspect dishonesty as she has never effectively engaged with the debate or criticism – where it has been repeatedly demonstrated where she is wrong.

And so we come to this week’s piece. The British Medical Association has been discussing the LCP and the public’s perceptions leading to this Daily Mail headline:

‘Don’t call it the Liverpool Care Pathway': Doctors admit it sounds like a one-way ticket to the grave

  • Leading doctors have admitted that there are problems with the controversial end of life care regime
  • Involves withholding food and water from the dying patient and is meant to help them die with dignity
  • Doctors admitted some patients have been left on it for weeks without having their case reviewed
As always, the culpability lies with the medical profession and not with the Daily Mail for printing misleading articles… The implications that doctors are killing patients or that they don’t care or that somehow this is a NHS initiative to save money are ———– well, I don’t know, I’ve run out of adjectives… (insulting, misleading, offensive, damaging, dangerous, horrific, indefensible, typical for the Mail, wrong, cynical, plain dishonest) – take your pick!
Well, actually I think all of those and then some more:  The implications that doctors are killing patients or that they don’t care or that somehow this is a NHS initiative to save money are insultmisleadinglyoffensivelydamaginglydangeroushorrificlyindefensiblelytypical-for-the-Mail-wronglycynicallyplain-dishonestetc!
As always the comments section provides a worrying perspective, but this is my favourite:
comment
No my dear-UKIP Supporter the reason they don’t have this ‘uncomfortable controversy’ in the States, is I suspect, because they are blessed enough not to have the Daily Mail.
AFZ

The Mail Online’s idea of a ‘New Craze’

There are lots of things that I have never heard of. The Mail Online’s latest warning is about one of them: the ‘salt and ice challenge’. The Mail Online has lifted a report from the Huffington Post (which they credit) about how some teenagers in America (one doctor in Detroit – population over 700,000 – had seen 3-4 cases in the past 6 months) have been trying this challenge and causing themselves various levels of skin burns. I can’t help but think that if the Mail had really wanted to prevent this dangerous challenge they’d probably do the responsible thing and not report on it (complete with several photos of effects and a video showing how the challenge is performed). Let’s not forget that the Mail website is now one of the most visited websites on the planet and can therefore presumably spread a ‘craze’ like few others.

I can’t help but think that for the sake of a few more web hits the Mail website has just given more people a dangerous activity that they’d probably never have heard about otherwise. The Internet is full of crazy stuff and I have no objections to this, but what annoys me is organisations like Mail Online – which pretend to be above the trivialities of the Internet – producing such content and dressing it up as journalism and labeling the writer a ‘reporter’. One of the aspects that Leveson didn’t address what was does the label ‘newspaper’ or ‘journalism’ actually mean? Should it only refer to an organisation that seeks to deliver news in a reliable, factual and unbiased way; or is it fine for anyone to write anything with any bias or factual inaccuracies and label it journalism just as long as they work for one of the established newspapers or their various online spin-offs?

The problem with real journalism is that no-one wants it, or at least that no-one wants to pay for it. We therefore end up with newspapers that only ever chase readers, rather than actual news. What we end up with is the exact thing that socially conservative newspapers like the Daily Mail – on the surface at least – supposedly rail against: the systematic dumbing-down of ‘news’ until newspapers become little more than vehicles for celebrity PR men to create exposure and wealth for those who have some tenuous relationship with fame. We get Mail Online, one of the most soul-destroyingly popular websites on earth.

The Mail website is a cesspit of celebrity drivel, freakshow exposures of anything deemed outside the narrow norms of conservative Western culture and stories taken from across the website which are not news in any traditional sense. Again, I don’t mind that such websites exist – I love the randomness of the Internet – but for the sake of convincing me that humanity has some hope, please stop calling this journalism.

It’s been a while

Well, it’s been a while. After trying to push The New Journalist forward (and failing miserably) and messing around with other projects with mixed results I have reached the point where I seem to have the time to write, but not necessarily the motivation.

This is strange, given that the Leveson inquiry has really provided a wealth of issues to get worked up about with regards to the conduct of the media these last few years (and has basically validated my observations about the conduct of certain newspapers since I started blogging about them). I think the problem is that I have no faith in the outcome of the inquiry, or in humanity in general. Since I’ve been away it seems that it has become much clearer just how corrupt our society is. Our politicians still hunt down the poor and disenfranchised whilst simultaneously lining their own class with the wealth of the state. The corporate body goes on poisoning the world, destroying its resources and doing its best to make us fatter, dumber and more subservient to meaningless consumerism (whilst paying little tax and remaining unaccountable to the society it feeds off of). The banks stride from one Titanic act of fraud to another, only to be kept afloat by a collection of world governments who seem to think that if the banks are endlessly handed more money to pass on (at a decent %) that somehow society will kickstart itself eventually and rejoin the road the doom it was speedily heading down before the banks realised a lot of money they handed out would never be seen again.

The point is that everything is so fundamentally wrong that writing about any issue without using that realisation as the starting point seems a little futile. We cannot keep expanding the human race and consumption indefinitely, this isn’t conjecture, it’s a fact: we live in a finite world. Yet everything that is being done around the planet today is aimed at doing just that. All we are told as citizens is that at some point growth will come back and we’ll start increasing our consumption again and make shit and buy shit that we don’t need and everything will be fab. But it won’t be.

Growth in consumption is probably the worst measure of a successful society, yet GDP seems to be the only measure governments want to pursue. When corporations increase consumption, GDP grows and we’re told the economy is doing well, that we should all feel prosperous. The main problem with this is that such growth is always unsustainable because the wealth is never spread out, and it sure as hell doesn’t trickle down, instead it flows upward, leaving a few billionaires at the top, a few more millionaires doing favours for the billionaires and a wedge doing OK. The rest of the planet merely subsists in abject poverty. This, of course, can be masked (for a while) by banks issuing credit so we can all have a slice of the good life until it becomes clear that most people can’t even afford credit and it all comes tumbling down.

In my mind I have a thousand things that I want to write, but they are all jumbled and too big to pin down into a blog post or any other format. Too many things are soiled by an uncontrollable sense of despair that no matter how clear it becomes that our world society is a corrupt and hollow shell serving a tiny elite at the expense of the overwhelming majority, we’ll all still be too distracted by the TV or celebrities or anything that just is not important to actually stand up and do something.

What frustrates me is that the events of the last few years are not a series of isolated incidents (or bad apples) but actually form a coherent narrative about reality that we should all want to understand and challenge. In fact, it’s more than that: we need – for the sake of all of our futures – to understand and challenge it.

I just don’t have any belief that we will.

I didn’t know what I sat down to write when I created this blog post. It just happened and is probably largely cathartic. It isn’t some kind of personal manifesto (and it certainly didn’t set out to be), it hasn’t been months in the writing (about 20 minutes, as you can no doubt tell), it’s merely the frustrations that I may as well put out there to see if I’m alone or not in having them.

In short: I want to make a positive difference to the world, that was why I started this blog a long time ago now, and I haven’t given up; I’m just really struggling to find the words or hope these days.