After the season of good will, the season of bad omen. More Blu-Tack than tack sharp, Dame Sally Davies, the Chief Medical Officer, stuck at the end of last week to her message that there was no such thing as a safe limit to alcohol consumption, but if you wanted to live dangerously, then she supposed up to 14 units a week was tops. On the Today programme, she was the worthy teacher cajoling the dull child, only to be out-smarted by J Webb, who popped the public health message balloon by pointing out that normal drivers face a similar lifetime risk of death as that implied by the new alcohol limit, yet the Government has yet to advise us that there is no safe level of driving, or that drivers should limit themselves to 14 miles a week. The balloon popped so far above Dame Sally’s head that she missed it. When Jay repeated the point, the response was of the ‘oh no, we don’t need to bother with that sort of nonsense round here’ kind, followed by more chugging rhetoric on the risk of dying from breast cancer.
Britain and sugar go back a long way, and the history is not that glorious. Sugar, or white gold as it was known, was the reason for the infamous trade triangle, the round trip that took slaves from Africa to the American colonies, sugar from the colonial plantations to Britain, and goods from Britain back to Africa to buy more slaves. By the mid 18th Century, the trade was so lucrative that the then British Government, blissfully unaware of yet to come concepts of coercive healthism and the nanny state, did the fiscal thing, and slapped a tax on sugar, making it a luxury item. The situation was turned on its head in the mid 19th Century, when the Free Breakfast Table movement, an early Liberal free school meals idea aimed instead at the working classes as a whole, brought about the abolition of duties on sugar and other breakfast table commodities, and the masses were freed to shovel ever larger quantities of sugar down the cake hole. Every Little Helps, as they say at Tesco. Even today, The Great British Bake Off, when it isn’t about the BBC showing off its ethnic credentials, is all about devising yet more elaborate ways of getting yet more sugar through the cake hole.
Those who are smug about data security have this week had their assertions torn asunder once again. The Ashley Madison hack – Dr No rather liked Henry Tudor’s tweet ‘Cromwell was my Ashley Madison. He got hacked too’ – reminds us that data said to be impregnable is in fact all too pregnable, if in the circs that’s the word Dr No is looking for. High profile hack after high profile hack tells us there is no such thing as secure data, just data yet to be hacked. Those signing up blithely to care.data may want to wonder whether the day will yet come when they will sheepishly tweet ‘care.data was my Ashley Madison. I got hacked too.’
Writing in the well-known Blue Top, the BMJ, Margaret McCartney, a fellow scourge of Bad Medicine, recently described the 16% higher chance of death if you are admitted to hospital over the weekend as a zombie statistic. The essence of a zombie statistic is not necessarily that it is wrong, but that it won’t go away, even when it is shown to be at least spurious, possibly wrong, and almost certainly misleading. Zombie politicians, who tend likewise to be at least spurious, probably wrong and almost certainly misleading, but still wont go away, love zombie statistics, as does the zombie press, which attracts zombie stats as a dunghill attracts flies. Shortly before the election, David Cameron, increasingly the zombie party leader as BJ hots up the mustard, pumped up the 16% higher mortality statistic, and true to form it just won’t go away. Today the zombie minister Jeremy Hunt will use the 16% zombie statistic to prop up his case for seven day zombie working in the NHS.
In the ’70s and early ’80s, in his outstanding TV criticism in the Observer, Clive James had an unfailing ear for the peculiarities of American pronunciation. Facing David Frost’s sing-song questions, Henry Kissinger fell bag on swapping his DTs and CGs. Meeting Frost’s aria-ettes on Vietnam with the sound of gravel being forced through a hand mincer, Big K conceded that ‘manipulading the domesdig affairs of another gountry is always gombligaded’. On Chile, where the Americans had been up to their usual tricks, Kissinger explained it was down to a certain ‘peculiaridy of the consdidution’. On another occasion a year later, asked what he and Reagan had discussed pre-election, Kissinger revealed the devastating charm of his verbal dricks. ‘I jusd wished him good lug’. No wonder Hopalong won.
Hell may have no fury greater than a woman scorned, but surely Heaven can have no joy greater than a woman reformed. In a remarkable development, scientists in North America have popped not a bun but a biodegradable scaffold layered with a patient’s vulval and other cells in the oven, and after the required time at the requisite temperature been rewarded with a fully formed vagina. Four women born without a vagina have had ready-vaginas made this way implanted, and have subsequently reported normal or even atomic levels of ‘desire, arousal, satisfaction and orgasm’. This extraordinary advance may in the short term pave the way for a gruesome commerce in designer vaginas – each scaffold is individually crafted – but in time it can only end one way: the day will dawn when we pop not buns but homunculi in the oven, to be rewarded nine months later with little incubi, all of whom will go on to report normal or even atomic levels of desire, arousal, satisfaction and orgasm. Truly, science knows no bounds.
As a doctor who has dabbled in epidemiology, Dr No is not unaware of the siren song of care.data. Greater minds, including epideiology’s Einstein, have frothed at the prospect of the data orgy to be had, only to have it dawn that theirs was a premature cigar. Yet even when left staggering at the catastrophes revealed, a hard core group still want care.data to happen, the idea being that if enough corks are inserted, then nothing will leak.
If only! Dr No remains persuaded that the call of care.data is indeed the song of a siren balanced on dangerous rocks. However alluring the song, the rocks remain; many rocks, but four stand out as especially dangerous.
In his zeal to declare the NHS open for business, David Cameron announced in December 2011 that it was ‘simply a waste’ not to flog off anonymised NHS data to the pharmceutical industry, to help development of new drugs and their testing on hapless patients. Dr No has presented this somewhat tongue in cheek: the NHS does have vast amounts of data, albeit of varying quality, and there is legitimate and useful research to be done on that data. Indeed, Dr No has in the past done just such research. The red rag to Dr No’s bull was the sale of data to commercial concerns. Here, on the other side of the public-private divide, the rules such as they are, are different. We are advancing on Libor country. Profit, not patients, now rule, and it is remarkable how bendy the rules can become. Recently, the life insurance industry poked a sharp stick in GPs’ eyes by using subject access requests to obtain customer (subject) medical records, shaving the best part of £100 off the cost. It may not be illegal, but it is certainly tacky.
The title for this post arises because Dr No has idly been playing Shorter Titles, the I’m Sorry I haven’t A Clue game in which panellists are invited to submit film (or song) titles where a single letter omission changes the meaning – Oldfinger, The King’s Peech, Rear Widow, The Godfarter, The Tird Man, that sort of thing – but as Jack Dee would say, they don’t work in print – the original title here being Left Shift, the hypothetical statistical fancy much beloved of the medical Islingtonistas who favour alcohol minimum unit pricing. Left shift is the notion that in populations the body wags the tail: the mean determines the extremes. Applied to alcohol minimum pricing, left shift has it that if average consumption falls because of raised minimum unit prices, then so too will heavy consumption fall. Populations, according to this hypothesis, behave like a blancmange made with excess gelatine: a nudge in the middle, and the whole pud moves across.
Just over three years ago, when few had heard of him, Dr No wrote a post called The Collapse of the Probability Function. At its heart lies the troublesome paradox that, while we might know how a group of patients might fare, we have no way of knowing how individual patients will fare. We might know that of a hundred patients, five will die in the next ten years from a heart attack. What we don’t know is who of the hundred will be the five; and the flip side of that is, when as doctors we choose to intervene, as increasingly we do, there are ninety five souls now tangled in our medical web, with all that that entails, be it tests, treatments and general apprehension, who were never going to have a heart attack anyway, let alone die from one in the next ten years. That’s a whole lot of medical intervention without any benefit whatsoever – but what the heck – overall, we might save a handful of lives – or so the hopeful reasoning goes.