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Contested? Really?

I am that rarest of creatures, someone who enjoys rugby union (RU) and rugby league (RL) equally. I have therefore watched many hundreds of games in each code over the years.

Fans of RU will have noticed that there has been a lot of soul-searching concerning the current status of the game in recent months, and in The Times sports pages at least, the arguments have acquired Jesuitical intensity. Almost all of this relates to the refereeing of the breakdown, and most of it goes straight over my head. But it seems to me that the journalists are ignoring a very large elephant in the room, namely, the scrum.

As a RL supporter I have become used to the derision of one-eyed RU fans concerning uncontested scrummaging. For those not familiar with the game, if a scrum is awarded in RL, the opposing forwards just lean on each other without pushing, the scrum half feeds the ball into the second row and then nips round the back and passes it out to the speed merchants. It takes about 30 seconds from the referee whistling for the offence to the ball arriving in the  in the back line (well, perhaps a bit longer towards the end, when the forwards are knackered). RU aficionados take a lofty attitude to this behaviour, claiming that the scrum is a worthy centrepiece of their superior game; a battlefield for real men, not a bunch of wimps leaning on each other for a rest.

And that might once have been true, but now?  When RU fans talk of contested scrums, what exactly do they mean? It used to be simple when I were a lad; the scrum was a way of restarting the game after an offence, giving a significant but contestable advantage to the team putting the ball in. But surely no one believes that there is any contest for the ball in the modern professional scrum – when was the last time a hooker actually hooked? The scrum half, like his RL counterpart, is allowed to feed the ball into the feet of the second row, and winning the ball against the head is almost unheard of. If the ball is actually allowed to leave the scrum (a rare event – see next paragraph), the scrum half will almost invariably opt for a box kick rather than doing anything interesting with it. And of course, none of this happens until the scrum has been set and reset several times; in fact, when I watch a match, I usually record it and start watching about 30min post kick-off, so that I can fast forward through the interminable interruptions.

No, if the modern scrum is a contest at all, it is a contest to see which team can con the referee into giving them a penalty, the direction of the resulting award apparently as much of a mystery to the commentators as it is to the respective forwards. This is why, even with the ball at the feet of the back row, it seldom emerges, because the team in possession is hanging on for the penalty. From the spectator’s point of view, the only good thing about the current scrum fiasco is that it gives them a chance to go and get another round of beers in, secure in the knowledge that the referee will still be resetting it when they return.

It seems to me that if the desire is to increase the speed of the game, and reduce time-wasting, the answer is simple. Just be honest about the situation and make scrums genuinely uncontested, with no pushing, just like RL. The reason that RL is a better spectacle than RU (OK – in my opinion) is just this; that the game flows almost non-stop. The result of using uncontested scrums in RU would be less of the frustrating time-wasting and it would also speed the existing trend towards more mobile, ball-playing forwards. What’s not to like?

To end with, another conundrum of modern professional sport, and this time, it’s something that both codes of rugby get right – namely time-keeping. When the action stops in rugby, so does the clock (although it’s a pity it doesn’t stop every time a scrum needs resetting, only restarting when the ball goes in), which means that everyone knows that once the clock is in the red, the next time the ball goes out of play, the game is over. So why can’t they do this in professional soccer? The amount of time added on by referees seems to be as much of a lottery as scrum penalties in RU. In addition to keeping time, they have to decide if they dare blow the final whistle when the home team is closing in on goal. Using rugby’s approach, the ref would be relieved of the need to keep looking at his watch and keeping track of stoppages, and a team with a potential scoring chance when the clock goes red would be allowed to play it out.

There – major improvements to two professional sports in the space of one blog. I shall hold myself in readiness, awaiting an approach from their governing bodies.

Silly seasoning

There’s no point having a blogging facility if you don’t occasionally use it to mount a hobby horse, no matter how trivial or pedantic the result may appear to be.

So, today, I want to talk about salt. We all like a bit of salt on our chips don’t we, but it won’t have escaped your attention that in all but the most proletarian of eating houses these days the  salt provided is crystalline rock salt (or sea salt). This comes (usually, at least, – see below) in a grinder, which simply enables you to render the lumps slightly smaller. It’s almost as if this is seen as a sign of the restaurant’s upmarket pretensions; a suggestion that ordinary granulated salt in a shaker is too common to merit consideration in the context of haute cuisine.

As you may have guessed, this really hacks me off. The shards of salt produced by the grinder are too large to adhere to the food, and end up on the plate, where they do nothing at all. Occasionally, of course, a chunk does make it into your mouth, where it results in a nasty, gritty saline explosion that does nothing to season the bulk of the food.

Granulated salt, on the other hand, can either be sprinkled over the food, or deposited in a little pyramid on the side of the plate, to be eked out, mouthful by mouthful, as required. I have an awkward feeling that one of these two options is so non-U as to mark me out forever as irredeemably working class, but the point is that the salt can be deployed as required, and actually achieves the aim of seasoning the food without giving the impression of eating gravel.

To summarise: rock salt is fine for treating the roads during a cold snap, but I don’t want it on my plate, thank you.

I only mention this now because yesterday, I experienced the all-time low in saline insanity. We went to try a new, upmarket steak house just up the road from where we live. Like most of these places, the decorative motif was black wood and bright chrome, but it was pleasant enough. However, the only salt available for the table (and I know, because we asked) was a bowl of rock salt crystals which you had to dip into with your fingers. Not only did the absence of a grinder mean that the chunks you had to chew on were sized more like pea shingle than road grit, but there was no way of knowing whose fingers had been grubbing about in the bowl before we arrived.

It’s that urea in the communal bowl of peanuts on the bar thing again, urban myth or not, and in the throes of a coronavirus pandemic, when we are being told to wash our hands before, during and after we do anything at all with them, it struck me a significant potential health hazard. So, we won’t be going back (although, the fact that the food was not very good and hugely overpriced also had a bearing on the decision).

Wow! – 528 words on culinary salt. Who’d have thought it?

Breastfeeding: the percentage illusion and other pitfalls.

This week, the following headline  appeared on the front page of The Times: ‘Health experts say mothers should be paid to breastfeed’. It was reporting the findings of a survey which  found that a group of new mothers offered gift vouchers as a reward for continuing breastfeeding kept their babies on the breast for longer than a control group who were given no financial inducement. This, predictably, made it on to the national radio and TV news.

There were so many things wrong with the research, and with the reporting of it, that it’s hard to know where to begin, but it does give a nice illustration of the pitfalls which exist to trap unwary readers when the mainstream media (MSM) report on science (or, as in this case, on pseudoscience).

First, as a statement of the bleeding obvious, the finding that financial inducements can affect behaviour in this way is up there with the religious leanings of popes, and the defaecatory habits of bears. Then there’s that banner headline. We don’t know which ‘experts’ it was referring to, but the only ones quoted by name in the piece both stated that the research was not sufficiently robust to have any affect on practice, and certainly didn’t support the diversion of scarce NHS resources to provide bribes to new mums. Those dissenting opinions, as is usually the case, didn’t appear until the final paragraph, and so the many readers who never got past the first couple of sentences were left with the inaccurate take-home message provided by a lazy sub-editor’s headline.

That’s my gripe about the reporting out of the way, but much more interesting is the design and results of the research project itself. Like so much of this sort of ‘soft’ research, questionnaires were used to determine the breastfeeding status of the participants. I think that most of us know how reliable questionnaire-derived information is, because we fill in so many of them ourselves. We may not actually lie (well, not always), but we do tend to put the best complexion we can on our answers. For example, when we’re asked about our drinking habits, how many of us keep a diary for a couple of weeks and religiously calculate the number of units? No, neither do I, and when I do tot up my recent intake, I tend to choose a ‘good’ week, when it was a bit less than usual.

So – data from questionnaires is always going to be potentially flaky. But if you then offer cash (or vouchers) to the study group, any tendency to give the answers the researchers clearly want will be exaggerated. In this particular case, the respondents are likely to over-report the frequency of breastfeeding, and their answers will be about as reliable as my assertion that I drink 12 units a week.

And it’s not only the data that’s a bit iffy. The first paragraph stated that the voucher system ‘improved (breastfeeding) rates by about 20%’. I think that most readers, unless they were used to critically analysing research results, will have thought that a 20% increase was a pretty good result, because they will have assumed that it meant that breastfeeding rates had risen from (say) 40% to 60%. But of course, it doesn’t mean that. It means there was a rise of 20% compared with the breastfeeding rate in the control group. The control group figure was 32%, and it rose to 38% in the experimental group, the 6% change representing 20% of 32.

The media always use the percentage increase or decrease in their reports because it’s easy, and it also tends to exaggerate the effect being reported. They do this whether they are reporting a benefit of treatment, as in this case, or the supposedly harmful effects of some environmental factor. You need to see the underlying numbers in order to assess the importance, or otherwise, of the effect – always look for the absolute figures rather than a percentage change, and if they aren’t included in the report, be very suspicious.

Take the example of a new drug to protect against heart attacks. If you were told that taking the drug every day would reduce your chance of a heart attack by 30%, you might be tempted to say ‘OK, give me a prescription’. If you were told that if 100 people took the drug for five years, one heart attack would be prevented, but two other people would suffer attacks despite taking the tablets, you might have second thoughts about embarking on lifelong treatment and risking harmful side effects from the drug. It’s the same drug, just different ways of presenting the information. This example is for a low coronary risk population taking a statin, and the reason that the percentage reduction figure is so misleading is that the pre-existing chance of any of the drug-takers experiencing a heart attack is small, so that a 30% reduction actually makes little difference to the numbers of people who suffer a cardiac event.

It’s the same with reports of the health effects of living near a mobile phone mast (or electricity pylons, or a nuclear power station etc etc). The alleged health issue is usually an increase in cancer; especially the more emotive childhood cancers. You will always be told that the adverse effect increases the risk of childhood leukaemia, for example, by, say, 25%. That sounds dreadful, but childhood leukaemia is rare, with an incidence in the order of 1:30,000. Detecting a 25% increase in such a small figure, and being certain that it is a genuine change and not just random variation, or due to some other environmental factor, is next to impossible. So, that scary 25% headline figure translates into an effect that is too small to measure accurately, even if it exists.

So the bottom line as it relates to The Times report, is that if if 100 new mothers were given a substantial bribe, at the end of the trial period 38 would still be breastfeeding and 62 would have resorted to bottle-feeding. Without the cash payment, 32 would still be breastfeeding and 68 would have given up. And that’s only if you trust the results of a self-reporting questionnaire survey.

Which to me doesn’t sound like an efficient way to use scarce NHS resources.

On diversity and discrimination

I haven’t posted on here for a while, largely because I’m sick of reading about Brexit, and yet it’s such an all-consuming disaster in the making that it’s difficult to write about anything else.

I’ve been prompted to break my silence by an article in The Times today (30 November 2017) pointing out that the recently released nominations for male Grammy awards did not include a single white artist. It was the first sentence that grabbed my attention: ‘Next year’s Grammy awards may prove to be the most diverse ever, with no white men nominated…..’*

You only have to substitute ‘black’ for ‘white’ in that sentence to appreciate how nonsensical it is. OK,you may say, it’s just a journalist using the wrong word – it happens. Indeed it does, but the use of the word ‘diverse’ in that sentence actually illustrates the skewed nature of the debate around inclusiveness and, in particular, the very partial way in which another ‘d’ word is used – discrimination.

It’s generally agreed, by liberal commentators at least, that discrimination is necessarily a bad thing. But of course, it’s not. We discriminate all the time. When they choose the men’s 4X100m relay team for the olympics they discriminate against people like me, who can’t run very fast (plus, I’m nearly seventy), and that’s OK, because the discrimination is being made on grounds which are relevant to the particular selection process. Discrimination only becomes bad when the criterion being applied has no relevance to the choice being made. Perhaps I’m nit-picking, and perhaps when people use the word discrimination, they actually mean inappropriate discrimination, but I’m not sure that is always the case, as I’ll point out below, when I talk about positive discrimination.

Now I can’t pretend to follow the modern popular music scene (i.e. anything more recent than Freddie and the Dreamers) but I would like to think that Grammy winners are chosen on merit, and that this black-only list is only remarkable because there is usually a mix of black and white musicians in the running (which, of course, makes this year’s selection the least diverse ever). Assuming that the selection process is based on artistic merit, this is absolutely fine, and no-one in the Times article was suggesting that it wasn’t – in which case they are raising the race issue unnecessarily, which I’m sure some equal opportunities zealots (but not me) would regard as racist.

But that brings me on to the term ‘positive discrimination’, the implication inevitably being that positive discrimination is good, and any other sort is bad. In fact, positive discrimination represents a deliberate attempt to discriminate using criteria which are not relevant to the choice being made. Equality (be it racial,  gender, or sexual orientation-based) should be just that – absolute equality – such that minorities are treated exactly the same as everyone else. This means that their success in applying for jobs, or safe Labour seats or golf club membership should depend only on their suitability for the job. The concept of quotas, and women-only lists and the like represents exactly that inappropriate discrimination that got us into this mess in the first place.

I know that some will say that positive discrimination is only a temporary measure, to get the degree of diversity in any area into balance. But I don’t necessarily buy that – who is to say what the right level is? Let’s go back to the Grammys. Assuming that the selection process was fair, and based only on artistic achievement, it’s entirely right that this year’s line-up was 100% black, and it would be quite wrong to apply a quota insisting that Ed Sheeran et al got more of a look-in. Similarly, I want the best candidates chosen to represent me in Parliament – I don’t want good applicants to be excluded from consideration because they have the wrong type of genitalia.

It seems simple to me. The answer to inappropriate discrimination is not to load the dice in favour of one group or another, but to ensure that the selection process is fair. That will then get the right people appointed, and if that results in the selection of a preponderance of one particular subset of applicants, we can assume it’s because they happen to be best suited to that particular field of endeavour. The Grammys again: I’m perfectly willing to believe that at the moment the best modern popular music happens to be produced by people of colour, and that is why we have the list of nominations reported in The Times. And back to that 4X100m relay team; for quite some time now, there has been a preponderance of black athletes performing at the highest level. And that’s fine, because they are the fastest runners. If next year we have four white athletes in the team, that’s OK as well, as long as they have been chosen for the right reason.

Sorry, I’ve gone on a bit, because this is particular hobby horse of mine. And at least it’s not Brexit.

  • interestingly, that sentence was removed in the online version of the article.

Article 50 and Labour

A reply to my Labour MP, who kindly emailed me (and many others) explaining his intentions in the vote to implement Article 50, and commence Brexit.

Many thanks for taking the trouble to explain your intentions. I’m aware how difficult this is for Labour, and I’m familiar with the arguments you put forward. However, I think we all know that this government is not going to accept any meaningful amendments, and even if they did, the right course of action would still be to vote against the implementation of Article 50.

The first responsibility of MPs is to safeguard the welfare of the country, and the only way to do that is to stop Brexit in its tracks. It was depressing to hear people like Margaret Beckett saying that although she knew it would be a disaster for the country, she would be voting for implementation. That statement alone should disqualify her from sitting as an MP. We repeatedly hear that ‘the people have spoken’, but they spoke in an ill-conceived and unnecessary referendum following a campaign characterised by deliberate lying and obfuscation. Many of those voting leave have since, sensibly, changed their minds now that they realise what they were voting for. Many Leave voters are members of Labour’s core demographic, and will suffer the most from leaving the EU.

There is absolutely no requirement on Parliament to implement the result of an advisory referendum – particularly one which results in major damaging constitutional changes based on the votes of a minority of the population, indeed, it is Parliament’s duty to refuse to do so.

Labour’s stance, led by Jeremy Corbyn, has been pitiful, and his insistence on loyalty to his leadership, given his past voting record, strays beyond irony into hypocrisy. What the country needs from its politicians is a clear statement that Brexit will be so debilitating for the country that they can no longer recommend leaving the EU, and will continue to argue for reform from within.

I’m pleased to know that you will vote against the third reading if there are no suitable amendments, but I believe the most likely outcome will be that Corbyn, weasel that he is, will accept any crumbs tossed to him by May et al, in the mistaken belief that it will get himself, and the party, off the hook.

Like many of your natural supporters, I will never vote Labour again. If Corbyn thinks his actions are the best bet for staving off catastrophe in 2020, he has been badly advised (but then, he has made rather a thing of surrounding himself with malicious or just plain incompetent advisers). If Article 50 is invoked with Labour’s connivance, you will have lost the support of at least two generations of voters, and will have ceased to be a meaningful force in UK politics, thanks to your actions in aligning yourselves with UKIP and (effectively) Trump.

Never did we have a greater need for an effective opposition. Never did we have such a pathetic excuse for one.

All of which saddens me – you are a very effective and conscientious MP, who would normally command my support.


Just think for once, commentators!

OK – if you’re expecting a serious piece on the current state of the NHS or anything else, don’t bother reading on –  one of the best things about starting a blog like this is that it gives you the chance to get stuff off your chest, and today I want to do just that.

Mostly, the inanities of sports commentators make amusing reading, and those of us of a certain age think fondly of Colemanballs in Private Eye. But there’s one thing they do repeatedly which really gets on my nerves and which has me screaming in frustration at the TV set, and that’s why, still frothing at the mouth, I intend to unload on you all now.

I don’t know if you’ve noticed, but nearly all commentators have a tendency to simply tot up the missed chances in a game, add them to the actual final score, and say ‘If only they’d not missed those three clear chances, they’d have won 3-2’ Spot the fallacy? Of course you did, but they never do, and no-one seems to pick them up on it.

One of the worst serial offenders is Mike Stephenson, who is a regular commentator on Sky’s rugby league coverage (RL – a rough northern game that most of you won’t have heard of). Known by everyone as ‘Stevo’, he is an ex-international RL player, and his commentating style tends to be fairly dogmatic, which leads to him taking quite a bit of good-natured stick from his fellow commentators.

Stevo regularly adopts this simplistic view of missed opportunities, and their possible effect on the final score. There was a good example in the commentary on the first game of this year’s Super League programme, in which ‘my’ team, Leeds Rhinos, were beaten 10-12 at home by Warrington Wolves. As if that wasn’t bad enough, I was reduced to incoherent gibbering by Stevo’s assertion that if Leeds had kicked their three first-half penalty goals, they would have been six points better off, and would have won.


Look – if they had indeed kicked the first of those goals rather than kicking for touch and getting no return for it, the entire subsequent course of the game would have been different, because the match would have been restarted from the centre spot. Those second two penalty opportunities would therefore never have arisen, and depending on what did happen, Leeds might have lost even more heavily. Alternatively, they might have scored three brilliant tries and/or had half a dozen other penalties awarded and gone on to win handsomely, but THERE IS NO WAY OF KNOWING.

Sorry to keep shouting, but as you may have realised, this is one of those unimportant little things that can take over a chap’s waking hours. And Stevo – just in case you’re still struggling with this, let me explain more fully. Our lives (and sporting contests) are made up of a sequence of events, each one of which leads on from, and is a direct consequence of, what went before. Change one of those events by, say, missing an open goal or converting rather than missing a penalty, and you also change what comes after. So, you can’t simply look at a series of missed chances after they have occurred, add the points/goals/runs they would have generated to the actual total and produce a number that means anything.

Of course, quantum mechanics raises the possibility that there is a parallel universe in which Leeds did kick the first of those penalties, but if we had a way of seeing into that universe, we would find that we were watching a completely different game, from that point on, to the one that unfolded at Headingley last week.

I can’t surely be the only person to have picked up on this, and Stevo is certainly not the only offender. But I wish they’d stop it.



Old dogs and new tricks

When I finally retired from my career as a consultant radiologist in Leeds, I didn’t imagine for a moment that three years later, I’d be going back in to the hospital as a volunteer, and especially not as the Trust’s first humanist chaplain.  I didn’t even realise that I was a humanist until I was in my early forties – I won’t bore you with the details of my reverse Damascus road experience now, but if you’re interested, you’ll find an account here. Discovering humanism made a big difference to my life, but not much to anyone else’s, so when I retired and had more time, I looked around for ways to give practical expression to my beliefs.

I suppose before I go any further, I should define humanism, because until I saw the light, I knew very little about it, except that it was a non-theistic view of the world and our place in it. There are two basic beliefs inherent in the humanist world view. The first is that we can explain the world around us using scientific method, evidence, and reason to discover truths about the universe without invoking the existence of a supreme being. Secondly, we believe that we only have the one life to live, and that we should make that life a worthwhile and fulfilling one by placing human welfare and happiness at the centre of our ethical decision making.

So anyway, when I retired, the first thing I did was to enrol on the British Humanist Association’s (BHA) training course to be come a funeral celebrant, accredited to officiate at non-religious humanist funerals. I had naively assumed that I would find it fairly undemanding, because I’d done a lot of public speaking in the course of my career – not just conference presentations and lecturing, but after-dinner speaking as well – and I didn’t think that the actual presentation of the ceremony would be a problem. So when, during the first training session, the speaker emphasised the importance of careful preparation of your script, ensuring it was printed double-spaced in large font to ensure that you could keep your place and maintain regular eye contact with the mourners, I thought ‘what do I need with scripts? – if I can wing it in front of three hundred drunk doctors at a conference dinner, I can manage without a script at a funeral service’.

I  was quite wrong, of course and, you might think, even a bit arrogant. A funeral is much more important than any of the other public speaking I had done – after all, if you mess up a conference presentation, another one will be along in a couple of months, and there’s a good chance no-one’s listening anyway. A funeral, on the other hand, is the family’s only chance to get it right, and it matters. With only a couple of days to meet with them, write the service, including a eulogy which says everything the family and friends want to say while keeping within the strict time limits applying at crematoria, you can’t leave anything to chance. In fact, from being over-confident, I rapidly began to think that I’d bitten off more than I could chew, and came close to baling out of the training. I’m glad I didn’t, because working with bereaved families over the past few years has been one of the most challenging and rewarding experiences of my life so far.

Then, having gained that experience, my thoughts turned to hospital chaplaincy services. I’d had very little contact with chaplains during my long career in medicine, largely because I was a radiologist by trade, and radiologists are not involved in the long-term care of patients; we do the interesting bit – making the diagnosis – and then let the referring clinician worry about prognosis and treatment. So my ideas about chaplains were the same as those of most patients: I assumed that anyone styled ‘chaplain’ was a vicar (or priest, or imam or rabbi etc. in these multi-faith times), and I would have been right. Which means that the 40% or so of patients who tick the ‘no religion’ box on their admission form are effectively disenfranchised when it comes to accessing pastoral care in hospital

It occurred to me that there was a parallel here with my funeral work: twenty or thirty years ago, you would have been hard-pushed to find anyone offering non-religious funerals. In fact, I suspect that many funeral directors would have told you that there was no demand for them, and yet now that they are widely available, around one third of services fall into the non-religious category, and fewer than half of all funerals are conducted by the Church of England, Catholic and Methodist churches combined. Pastoral care is ripe for a similar revolution, because while it is true that many chaplains practise what is called ‘generic chaplaincy’ – meaning that they make themselves available to patients of all religions and none – the patients themselves are not necessarily aware of that.

Consequently, if a patient with no religious belief is troubled, anxious or scared and wants to talk to someone who is neither a member of the family or one of the medical and nursing team caring for them, they may well hesitate to ask for the chaplain, fearing that he or she would approach things from a religious point of view which had no meaning for them. This didn’t seem right, and I had been considering a direct approach to my old hospital to see if they felt that there was a place for a humanist in their pastoral care team, but wasn’t sure what sort of reception I’d get.

Then serendipity (or fate or the hand of God, depending on your point of view) stepped in. I clearly hadn’t been the only one thinking about this issue, and out of the blue I received an email from the BHA offering training in pastoral care to humanists wishing to work as volunteers in the hospital and prison services. To cut a long story short, I did the training, and was able to approach the chaplains in Leeds with a bit more credibility than would otherwise have been the case. It turned out that I was pushing at an open door, and Chris Swift, the Head Chaplain and a C of E vicar, welcomed the opportunity to include me on their team. I’m based on the teenage cancer unit, but make myself available to any patient in the Trust who specifically requests pastoral care from a non-religious chaplain.

It’s still early days, and of course, and as I said earlier, patients won’t ask for a non-religious chaplain unless they know that such an exotic creature exists. Still, I’m managing to publicise my presence using internal bulletins and social media, and I’m slowly becoming recognised in my new role, and receiving referrals from other chaplains and chaplaincy volunteers. Incidentally, should you be unfortunate enough to find yourself, or a family member, in hospital and in need of a bit of support, and if you are not religious, you might want to ask if there are any non-religious chaplains available. There probably won’t be, in which case you could ask why not, and just remind them of the equality agenda, because not all of those seeking to do this work have been as lucky as me, and are often rebuffed when they approach chaplaincy departments offering to get involved.

Why am I telling you all this – is it just to make myself sound like a really good person? Well, when I retired, my daughter, who has inherited my rather dry sense of humour, asked me ‘what will you do with yourself, now that you no longer serve any useful purpose’. OK, she was joking (I think), but there’s an underlying kernel of truth in her question, and while I’d like to think that altruism is the chief motivation for my voluntary work, I guess that whenever we undertake something that makes us feel good, there’s invariably an element of selfishness involved as well.  I don’t miss going to work every day, but after a busy career, and particularly in a profession like medicine, I do miss the feeling that, no matter how frustrating the job might have been, I did occasionally make myself useful to someone. The chaplaincy work has given me that feeling again, and I’m unashamed to admit that I enjoy it.

But no, that’s not the reason I’m telling you all this. I’m telling you because you might imagine that spending a significant chunk of my retirement (but not enough to interfere with the fishing) officiating at funerals and working with young victims of cancer would be fairly depressing. In fact, nothing could be further from the truth – my funeral and pastoral care work has shown me, more vividly even than forty years of medical practice did, that human beings are pretty bloody amazing, if you’ll pardon the expression.

When I meet families to arrange a funeral, I’m repeatedly struck by the extraordinary lives that have been lived by outwardly very unexceptional people. There was, for example, the elderly gentleman who had lived in Bradford for seventy years despite an eastern european name, and whose life had seemingly been a pretty mundane one, working in a factory, enjoying a weekend pint in the working men’s club and not doing anything remarkable. It turned out that at the age of seven, he had, with his parents, walked pretty much the length of Europe, fleeing first the Russians, then the Germans. Then there was the elderly lady who had been living a quiet life in her neat little house since her husband died a few years previously.  While talking to her family to get material for her eulogy, I discovered that she had been a stalwart of the early trade union movement, and a friend and colleague of the Labour Party leaders of the fifties and sixties. Singing The Red Flag at her funeral was a first for this ageing small ‘c’ conservative. I could give many other examples.

More importantly perhaps, I’ve been impressed by the amazing resilience that people demonstrate in dealing with the most distressing events, and here I think of the young couple, barely out of childhood themselves, who had just suffered the loss of their first baby at fourteen weeks gestation and wanted me to conduct a funeral service. They were just the most together and composed pair you could imagine; tears had been, and continued to be shed of course, but they were determined to provide a service that would mark their child’s all too brief life and establish her place in their family unit, and had very clear ideas on how to go about it. When I met their relatives and friends at the service, I realised where some of that strength came from. I’ve seen the same thing again in my early dealings with the patients and families on the teenage oncology unit. Their lives have been turned upside down by a disease which highlights the random unfairness of life, but they are just getting on with it and coping.

So here’s the take away message, and I’m sorry I’ve rambled on so long in getting to it, but I thought you needed a bit of background.  I have belatedly realised what humanism is all about:  my experience over the past few years has convinced me that when it comes to human behaviour, belief in a supreme being is an irrelevance. If you feel inspired by the example of Jesus (or any other prophet or teacher) to live your life in a certain way, that’s fine, but we can take responsibility for our own lives and the lives of those around us without ascribing any good we do to God, and blaming all the bad stuff on estrangement from Him, or, worse, to the Devil’s promptings. We are gradually chipping away at the apparently mysterious workings of the universe, using rational processes of enquiry without resorting to the cop-out that ‘God did it’ every time we get to the difficult stuff like dark matter or quantum entanglement (sorry, showing off a bit there – I don’t actually know what they are either, but I’m delighted that someone, somewhere is getting to the bottom of it all).

Everywhere, I see ‘ordinary’ people living as if this was their only life, getting on with things under the most adverse circumstances, and enriching the lives of those around them in the process. They do this because they think they should, and because it makes life better for everyone, not because they are told to do it by supposedly sacred texts written at a time when the sun was still thought to be hauled into the eastern sky behind Helios’s chariot every morning.

Meeting people like this at critical stages in their lives has been a privilege, and is the polar opposite of depressing, so I just wanted to say this. If anyone ever tells you (and they probably will) that a sense of awe and wonder, feelings of joy, and hope for the future can only be experienced in the context of religious faith and a belief in the world to come, politely tell them they are wrong. Tell them Bob said so.


The strange case of FGM and the CPS

You will have seen the reports of the case brought against Dr Dhanuson Dharmasena for alleged female genital mutilation (FGM). The accusation was that, in suturing the perineum post delivery in a patient who had previously undergone FGM in Somalia as a child, Dr Dharmasena had restored the previous status quo, thus effectively performing FGM himself. The employing hospital had found that he had no case to answer, but someone reported him to the Crown Prosecution Service (CPS) and the General Medical Council (GMC), and he was suspended from practice almost a year ago.

The High Court jury took less than half an hour to find Dr Dharmasena not guilty, and we can see why they found it so easy to come to that decision if we look at the following points made  by the Royal College of Obstetricians and Gynaecologists (with some explanatory additions by me):

  • Dr Dharmasena did not perform deinfibulation (repair the results of previous FGM) or reinfibulation (re-perform FGM) on his patient, known as AB.
  • In fact, AB had already been deinfibulated at Kingston Hospital before the pregnancy.
  • As a result of her repair at Kingston, there were no difficulties with vaginal examination in labour.
  • The urethra was obscured by a band of scar tissue which Dr Dharmasena incised in order to insert a catheter as there were signs that the baby was in distress
  • After delivery, Dr Dharmasena repaired the bleeding edge of the scar tissue with a single figure of eight suture. The vagina was not closed by the single stitch.
  • AB had a further baby within the year without need for further deinfibulation (in other words, Dr Dharmasena’s repair had not produced any obstruction, confirming the assertion that it did not represent a re-establishment of the patient’s previous FGM).

So, while there may be some argument about the technical details of the repair Dr Dharmasena performed, this would, at most, be a case for some re-education by his consultant, which is what the hospital recommended, and which subsequently took place.

FGM has been illegal for a number of years, but shamefully,  no cases had previously been brought against those performing this mutilation. So why on earth would Alison Saunders, the Director of Public Prosecutions, choose to break her duck with this very atypical case, one which would seem to be doomed to failure? There have been suggestions that the fact that she went public with the decision to prosecute just three days before she was due to be interrogated by the Home Affairs Select Committee over her previous abject failure to act might be of some relevance in determining her motivation. While that may be an unworthy suggestion, how else else to explain the failure to go after one of the many back-street practitioners who butcher women in insanitary premises, rather than an obstetric registrar who was simply doing his best to stop the bleeding after a difficult delivery?

I don’t pretend to understand the reasoning, if any, of the CPS in this case, but it would be good to think that Ms Saunders will face her own disciplinary inquiry following such a senseless decision. I won’t be holding my breath, though – when interviewed about the verdict on the Today programme, she seemed to imply that Dr Dharmasena had received the benefit of the doubt due to the fact that the criminal court requires a high level of proof (beyond reasonable doubt) before convicting. But presumably she knew of this requirement before she brought the case?

And of course, it isn’t all over for Dr Dharmasena. He still faces the GMC disciplinary hearing. Now you might think that they would simply abandon the case in the light of the High Court finding? Not a bit of it. Experience tells us that they will probably bumble on in their inefficient way, taking months to actually convene a hearing, then as long again to produce a verdict. And, worryingly in view of Alison Saunders’s comments on Today, the level of proof required by the GMC before they take away a doctors self-respect, reputation and career is the lesser one of  ‘on the balance of probabilities’. Derek Keilloh’s case linked to earlier in this paragraph tells us that their disciplinary panels can be quite cavalier in the way they interpret this, sometimes reaching their apparently capricious decisions on the basis of evidence which boils down to ‘he said; she said’.

So in a case which no-one other than the CPS wanted to see brought, the only people to suffer have been Dr Dharmasena and the patient. The patient (who had no complaint about her treatment) at least enjoyed the anonymity provided by the requirement for medical confidentiality. Dr Dharmasena has been publicly vilified, lost a year of training, and now faces the trauma of an unnecessary GMC hearing, with no assurance that he will not be struck off despite the High Court declaration of innocence.

Clearly the CPS need to be free to prosecute cases where they believe a crime has been committed, without the fear that they will be taken to task every time a defendant is found not guilty. In this case, though, their insistence on proceeding despite professional advice has set back the fight against FGM and potentially destroyed the career of a good doctor.

Alison Saunders should be considering her position this morning.

Suicidal doctors lack resilience

One of the recommendations of the report into the fact that 28 doctors have committed suicide while under investigation by the GMC is the institution of an ’emotional resilience’ training scheme for those subjected to its disciplinary processes. While this has been welcomed by the Chairs of the BMA and RCGP – and it is clearly a good thing that the GMC is at least recognising that a problem exists – there does seem to be a suggestion that the fault lies with the doctors (not ‘resilient’ enough) rather than with the GMC’s own procedures.

To be fair, there are other recommendations too, including the fairly startling statement that doctors should be made to feel that they are innocent until proven guilty – startling because the author of the report clearly felt that it needed to be said, thus confirming the impression of many doctors that the regulator tends to assume the opposite when complaints are made against them.

Of course, some doctors do come before the GMC’s disciplinary panels (or, more accurately, the Medical Practitioner Tribunal Service panels, which are supposed to operate at arm’s length from the GMC) as a result of mental illness. This may predispose them to thoughts of suicide, and it must be right to ensure that they have the appropriate support not only to get them through the disciplinary process, but to address their mental health issues and enable them to return to their careers. However, mentally ill or not (and most are not) any doctor subjected to disciplinary procedures will find themselves experiencing dark moments of the soul – especially when they are innocent of the charges brought against them, and even more so when panel hearings are beset by unnecessary delays, dithering and incompetence.

At the risk of boring those who have already seen my previous blog on the issue, I’ll use the case of Derek Keilloh as an example, because the timeline is instructive.

1. September 2003. The date of the alleged offence: failing to recognise signs of ill treatment of a detainee in the heat of battle in Iraq.

2. July 2007. A complaint is made about Dr Keilloh to the GMC. They wish to wait for the outcome of the public inquiry into the Baha Mousa case before deciding whether to investigate, and in the meantime he carries on working with the threat of proceedings hanging over him.

3. October 2008. Baha Mousa Enquiry opens.

4. September 2011. Enquiry report issued. Over four years since the initial complaint, and despite the fact that the report does not accuse Dr Keilloh of lying, the GMC decide to instigate proceedings.

5. June 2012. After another nine month delay, the MPTS hearing begins. After six weeks, in mid-July, the panel decides that they have run out of time, and postpone the hearing.

6. December 17, 2012 after another three months of agonised waiting for the Keilloh family, the hearing resumes, and lasts for a week.

7. December 21, 2012. Four days before Christmas, and with his excited young family looking forward to the festivities, the MPTS inform Dr Keilloh that he is being struck off the register, and no longer has a career. He has 28 days to decide whether to appeal, with many of those days blighted by the official inactivity which accompanies Christmas and New Year holidays.

8. In January 2013, a depressed and exhausted Dr Keilloh decides that he can’t subject himself and his family to the trauma of an appeal. In any case, he has no job and no support from his medical insurers to cover the considerable costs of such an appeal.

I’ve talked about the injustice of the GMC’s verdict and sentencing of Dr Keilloh elsewhere, and won’t go over it again now, but I think the outline of his case, involving five years of constant and increasing anxiety, may explain why so many doctors appearing before the GMC have been reduced to taking their own lives. It is to his credit that, after selling the family house and accepting the loss of the career which he loved and for which the country had trained him at great expense, he has managed to rebuild his life. It wouldn’t have been surprising, though, if at some point in the sorry course of events outlined above he had begun to wonder if it was worth going on. He was fortunate in having the support of a strong and loving family and of his patients, who continue to lobby for his reinstatement. It is easy to imagine how much worse it would be for a doctor going through the process without that support structure.

And Dr Keilloh’s case is not an isolated one. Colleagues called to give evidence before one of these panels have told me of the capricious way in which hearings are cancelled or rearranged at the last minute – in one case, when all those attending were already on their respective trains to London. A hearing was also held up when it transpired that one of the panel members had not read the papers relating to the case.

There is little doubt in the minds of most doctors of my acquaintance that the GMC is a dysfunctional organisation which fails either to protect patients or to ensure fair treatment for doctors appearing before its disciplinary panels. Paying a compulsory annual subscription of £400 for the sort of treatment received by Derek Keilloh and others does not seem like a good deal, and I for one would far rather take my chances before a properly constituted and publicly-funded quasi-judicial body than face the lottery of an MPTS hearing.

In his response to the report on suicides, Niall Dickson, Chief Executive of the GMC said:

we want to handle complaints as effectively as possible and ensure our processes are as quick, simple and as low stress as we can make them. We have made some progress on this but we have more to do.’

You do indeed, Mr Dickson, you do indeed.







An easy death – whose job is it?

The vexed issue of ‘assisted suicide’ has surfaced again in recent weeks, thanks to the media reports of the elderly lady who starved herself to death, in the absence of any state-sponsored mechanism for achieving her desired end.

Some of these reports once again bemoan the fact that doctors are not allowed to assist people to commit suicide (I say ‘people’ advisedly, because they won’t all be ‘patients’ –  we actually need a name for those who wish to take advantage of any relaxation of the regulations around euthanasia, perhaps ‘departees’ would fit the bill?). Why is it always doctors who are put forward as the appropriate profession to pull the plug on those who have decided they have had enough? It’s no longer necessary to give lethal drugs by injection – and even if it was, you don’t need to be medically qualified to get a needle into a vein. ‘Ah’ you say, ‘even with orally-administered drugs, you still need a doctor to provide the prescription’. Well no, you don’t actually – nurses and other paramedical professionals are already authorised to prescribe and administer drugs under controlled conditions (see below).

Of course, it’s true that doctors will be involved in the treatment of many of the departees, because they will be suffering from terminal illnesses. They will therefore be responsible for their treatment, and for advising them on prognosis and on the options available for terminal care, but that doesn’t mean that they should be the ones to pull the metaphorical trigger should their patient opt for early release.

Then there are all the applicants who are either not suffering from any identifiable illness, or who have conditions which are non-terminal. It’s worth noting that the lady identified in the recent reports was complaining of back pain and fainting attacks, both of which are eminently treatable conditions, and which would not have qualified her for assisted suicide under the terms proposed by the supporters of a change in the law. To involve doctors in the killing of these people gives them the status  of state-sanctioned executioners.

Why does any of this matter? It matters because medical practice is based on trust between patient and doctor. Patients who are suffering need to know that their doctor’s one concern is to ease that suffering, something which is nearly always possible, but which occasionally requires doses of drugs that may hasten death. This is an accepted part of medical practice, and is qualitatively of a completely different order to the termination of those who have simply decided that they have had enough, regardless of the presence or absence of treatable disease. Patients need to know that their doctor will not be involved in any abuse of the assisted suicide legislation aimed at achieving their premature departure.

Because, however carefully any new law is drafted, it will be abused. If you don’t believe me, look no further than the 1967 abortion legislation. It was never the intention of David Steele and his colleagues to make abortion available on demand*, but that is what we now effectively have. The same will happen with changes to the law on assisted suicide, and the medical profession should refuse to be involved.

And they don’t need to be involved. If, after they have received any relevant medical treatment and advice, a person wishes to take advantage of relaxed regulations concerning  assisted suicide, their care would pass from the medical into the social sector. After receiving the appropriate counselling (which would hopefully be part of any new legislation) and filling in the necessary forms, they would then qualify for state-assisted suicide. This could be carried out in purpose-built (or converted) premises – I have always thought that ‘thanatorium’ would be a good name for these, although I suppose it might result in a premature end for the patients of short-tongued doctors who really intended to refer them to a convalescent facility.

For those wishing to die at home, there would be flying squads who could bring the necessary drugs and expertise to the departee’s bedside – I wonder how long it would be before someone (probably the Daily Mail) christened them the ‘angels of death’? And one of the consequences of qualification for the service would be that those drugs could be prescribed under an appropriate Patient Group Direction,  the legislation having added employees of the new service to the list of those authorised to administer drugs covered by a PGD. Then all that remains is for someone to hand the tumbler of poison to the departee, assisting them to drink it if necessary.

So there – job done! If society wants  assisted suicide, then society, through its politicians, must devise the necessary legislation and infrastructure. The proponents of a relaxation in the law must not be allowed to get their way and then wash their hands of any responsibility for or involvement in the killing  by offloading it on to the medical profession.

* I use abortion as an example of the ‘mission creep’ which can subvert even the best-intentioned legislation, I’m not expressing an opinion as to the desirability or otherwise of abortion on demand.