Perambulations

Hello again. I sort of had a day off yesterday - a trip to Sheffield (lovely city, stunning university) and then went to the theatre for Sheridan's 18th Century comedy of manners, The Rivals - beautifully done and still very witty, though the stage-Irishman is rather toe-curling.

Anyway, I'm not the only one who's been busy. That hardworking and diligent MP, Paul Uppal, has been flapping his gums in the House of Commons. As you'd expect by now, his statements are masterpieces of critical thinking, modesty and incisive political acumen.

1) what assessment he has made of the effectiveness of national and local co-ordination in cardiovascular services to ensure integrated care for patients who have an acute myocardial infarction;

(2) what recent assessment he has made of the provision of cardiovascular services in the NHS; and if he will make a statement;

(3) whether he has any plans to revise guidelines on the management of cardiovascular disease and its risk factors as part of NHS reforms.

And again:

To ask the Secretary of State for Health what assessment he has made of the availability in the NHS of cardiac rehabilitation for people after they have had a heart attack; and if he will make a statement. 

from which we must assume that this portly middle-aged man (who incidentally resents the existence of a public health service) has a dicky ticker, given the high incidence of self-interested questions on his record. The respective ministers told him to sod off, in parliamentary terms: they sent him to a website, which is pretty much the same thing given Uppal's lack of familiarity with e-comms.

But he soon turned his interests from life, to death, and more specifically, the money to be made from dealing it:

What progress has been made on his Department’s consultation on equipment, support and technology for UK defence and security.

Given the value of the defence sector to our economy, what steps are being taken to ensure that prosperity can continue to flourish, and that the whole UK economy can benefit? 

Uppal, of course, is a noted supporter of a range of revolting Middle East dictatorships, many of which are keen customers for British torture and anti-freedom weaponry. This question enabled the minister to respond that Britain's doing its best to flog this stuff around the world.

I strongly agree with my hon. Friend. Ministers in the Department are committed to the Government’s policy of export-led growth, whereby the Government are making radical steps to ensure that responsible defence exports are actively promoted. This year I have visited India, Japan and Turkey on precisely that mission, and all members of my ministerial team have made similar such visits to ensure that the outcome my hon. Friend rightly seeks is achieved.

Makes you proud, doesn't it? Funny that the Minister missed the biggest weapons sales tour this year: the one David Cameron took around the Middle East just as the oppressed masses were being massacred in the streets.

Finally, Uppal asked this question:

To ask the Secretary of State for Work and Pensions whether his Department monitors the effectiveness of Jobcentre Plus centres in providing long-term employment.

Oddly enough, I can answer this one. Over the last few years, the New Labour Government and the current Tory one tried to privatise the unemployment services. The independent reviews published said that the state Jobcentres were far, far better at finding work for people than the private corporations paid more money to do the same jobs.

Does this mean that Jobcentres will be retained and the private companies sacked? Don't be ridiculous. You and I might live in the world of facts and testing. Uppal and Co. live in the world of ideology, in which actual facts are embarrassing and need to be swept under the carpet. The only statistics relevant to Uppal's questions are these: how much money do these private companies donate to the Conservative Party?

And so you get this response from the Minister:

From June, we will implement the Work Programme where customers at most risk of longer dependency on welfare will receive additional help and support delivered through private companies. Work programme providers will receive additional financial rewards for achieving job outcomes which are sustained.

Note that the unemployed are no longer taxpaying citizens requiring help: they're 'customers', which revolts me. He avoids mentioning any facts or statistics because they're against him. Instead, the bandwagon rolls on.  2400 Jobcentre works are being sacked - ironic or what?

Love your NHS

It's ramshackle and unwieldy, but it's the best and fairest healthcare system in the world - and the Tory / Lib Dem government is ripping it to shreds to feed to the corporations which have done such a marvellous job in America and elsewhere. 

The NHS is the only health system in the industrialised world where wealth does not determine access to care – providing the most widely accessible treatments at low cost among rich nations, a key study has found.

The survey, by US health thinktank the Commonwealth Fund, showed that while one-third of American adults "went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs", this figure was only 6% in the UK and 5% in Holland.

In all countries except Britain, wealth largely determined access to health, with patients with incomes below the national average more likely to report trouble with medical bills and problems with getting care because of cost.

The NHS was also extremely cost-effective, with spending on health per person almost the lowest in the survey. A person in the UK paid $1,500 less than a person in Switzerland, $600 less than a German and less than half the $7,538 paid by every American for healthcare.

Pass this on, and defend the NHS. 

This is what the internet is for

No, not porn, racism and football.

There's a story in the Guardian today about vascular surgery death rates in different hospitals - a really serious piece of investigative work, given that hospitals don't collect statistics reliably, and certainly don't like releasing them.

The thrust seems to be that bigger hospitals do more complicated surgery, so their surgeons are more experienced and so survival rates are higher. Though there are complications - small hospitals might have high survival rates by passing difficult procedures to bigger hospitals.

Ben Goldacre (of Bad Science) took the figures the Guardian made available and queried the way the statistics have been processed. Then lots and lots and lots of statisticians have reprocessed the figures in different ways. The journalist who wrote the piece is engaging in the discussion and putting Goldacre in touch with the medics who collected the data.

This is the kind of thing which occurs.

Simple linear regression is not appropriate in this case as pointed out above. You are not accounting for the fact that there is lots more random error associated with units that do fewer operations. A glm will take into account the fact that there is more precision in the rates estimated for larger units. I have performed a glm in Stata with a rather simple categorization of the number of operations into 0-50, 51-100, 101-200 and 201+.

Categorizing is generally ont a good thing to do, but as there appears to be some confusion and thus help to illustrate what is going on.

. recode ops (min/50 = 1) (51/100 = 2) (101/200 = 3) (201/max = 4), gen(ops_group)

(99 differences between ops and ops_group)

. glm dead i.ops_group, family(binomial ops) link(log) eform nolog

Generalized linear models No. of obs = 99

Optimization : ML Residual df = 95

Scale parameter = 1

Deviance = 186.5015817 (1/df) Deviance = 1.963175

Pearson = 181.6864657 (1/df) Pearson = 1.912489

Variance function: V(u) = u*(1-u/ops) [Binomial]

Link function : g(u) = ln(u/ops) [Log]

AIC = 4.721745

Log likelihood = -229.7263858 BIC = -250.0348

------------------------------------------------------------------------------

| OIM

dead | Risk Ratio Std. Err. z P>|z| [95% Conf. Interval]

-------------+----------------------------------------------------------------

ops_group |

2 | .8576235 .1563294 -0.84 0.399 .5999815 1.225901

3 | .6705549 .1181781 -2.27 0.023 .4747 .9472169

4 | .5466476 .1057056 -3.12 0.002 .3742054 .7985549

------------------------------------------------------------------------------

The mortality rate is 33% lower in units with 101-200 operstions that those with 0-50 and is 45% lower in those with 201+ operations compared to those with 0-50.

The result is highly significant.

I don't understand the stats (not much call for it in Welsh literature studies) but the gloss is useful and I'm learning all the time.

Offline, or in old print media, this wouldn't happen. No paper would be open to critique like this, and you wouldn't be able to marshal the resources of all these slackers who should be working on their day jobs. Between all these people, a fascinating (nerdy) and better story is emerging. Open data is really important, as is the wisdom of informed crowds (including the critics who've engaged with Goldacre's approach).

Good for NHS users, good for the Guardian and good for the web!

Thrills, spills and laziness

Despite having a conference paper to present in three days' time, I've done no work. I have an excuse - my 97 years-old grandmother was rushed to hospital. At this stage, apparently, even the minimal excitement of working out what might be in an egg-shaped foil wrapper is a little too much. 

She'll be fine. I've been convinced for years that she's immortal. It won't be too long before her other super-powers manifest themselves. Huge respect is due to the First Responders (rural paramedics) who turned up in 4 minutes, and the main ambulance, which arrived from the city in 10-12. The First Responders are volunteers who need cash - I'm sending them some. Do the same in your area.

I've met a lot of ambulance crew recently, and I'm friends with one. They're always cool, calm, funny, horrifyingly funny and reassuring. Also (American readers please note), it's all part of Britain's general taxation. There's no bill and no worry.

Meanwhile, the above graphics illustrate the life-cycle of the average postgrad/postdoctoral academic. They're from PhDcomics.com.

Propaganda

An election approaches, folks. Here's Labour's latest puntastic effort:

Eh? About half-past three!

I've discovered the up-side of losing my hearing. It's music. More specifically, it's not being able to hear most of the appalling gloop being pumped out in every bar, shop, lift and public space I enter. It's particularly bad at Christmas - 90% of secular Christmas music is unlistenable. Most of the religious stuff is bad too, and all of it, well, ideologically unsound, as Dan said after singing all 12 verses of The First Nowell at a carol concert the other day.

Me, I'm fine. I'm catching only one in every six words spoken. That goes down to one in ten sung words, and nothing in the high and very low end. It's just a drone. This is, obviously, a crushing blow normally, especially as I have many, many thousands of CDs and vinyl records in my home, but I'll live with it over the Christmas period. No Cliff Richard. No Little Drummer Boy. No Paul McCartney, no Frank, Bing or whoever. Peace, perfect peace.

Deafness is also making everybody's conversations sound fascinating. Catching one word in a sentence makes me feel like I'm missing out on all sorts of interesting things, when in fact they're talking about marking and other exciting and really wild things.

Heeee's back! Sort of.

Hello again. I've so much to share with you, but it will all have to wait.

In the last few days I've:
put on a dinner suit and bow tie
visited the hallowed turf of Stoke City
seen more van Goghs, Holbeins and assorted other famous paintings
confirmed that Adam's girlfriend actually exists
lost all hearing in one ear.

Thanks to that last, I'm off to a health centre rather than help with the 6th form conference I should be teaching on.

Meanwhile, I just want to check on two people. Winter and Stupid Fat Hobbit: give me a sign of life.

More later, if I'm not having my ears amputated.

Kneel before Steve Bell

As usual, Bell captures the horror of the Tories' hypocrisy perfectly. He's one of the justifications for The Guardian's existence.

I had a patient in the back of my cab. Very rude man

I forgot to mention the highlight of my hospital trip. We took a taxi back. The driver opened the conversation with 'which one of you's been to the hospital then?', which I thought was a) obvious in one sense - both of us and b) nosy in the other sense. We curtly indicated which one of it was, in a 'that's very intrusive, this conversation is now over' tone, only for the cabby to follow it with 'what's wrong with you then? Is it a fever?' and shake the subject as a greedy dog might with a meaty bone.

As for his opinions on Indian partition… inaccurate, bigoted and gruesome.

Public health messages

Ben Goldacre points out these Thai health messages, from which we can all learn:

Vacuous, intellectually bankrupt government: a case study

A silly rumour has swept the world of conservative tabloids and local newspapers that the coloured bracelets currently being worn by children signify the achievement of particular sexual activities, according to the colour. Or, as The Sun puts it, 'BRACELET which means YOUR KIDS are HAVING SEX!', which in this jurisdiction, is admissible evidence in a court of law.

Now a moment's thought should demonstrate the stupidity of such a claim. Is there a company marketing Blowjob Bands? A club? A Fellatio Federation solemnly awarding these things? Ridiculous. Even if there was once a link, it's surely broken once the bracelets are being worn on a mass scale: all cultural items are appropriated and hollowed out. The bracelets are signifiers without a signified.

Now, normally, I'd just sigh at the desperation and stupidity of the press, but now a minor government whip has got involved, calling on the government to ban the bracelets. What an utter, utter moron Mary Creagh is. Seriously, the only way to associate these bracelets with forbidden activity is to demand they be banned. They're just bits of plastic - and meaning can be transferred to any other item. Should the kids start wearing odd shoelaces to denote what they've been up to, will she demand they be banned?

This country has the highest teen pregnancy and teen STD rate in the world. Not coincidentally, we have the worst sex education (it wasn't mentioned at my schools) and most prurient media. Perhaps Creagh, a minister in the department of health, should ask herself why these facts are so, and why her government, despite trying hard, hasn't done much to improve these things.

She's out of a job in a year or so, and in any case, New Labour is obsessed with a) bashing the poor, b) grovelling to the rich, even now and c) pleasing the Daily Mail, so I'm afraid we're not likely to have a serious, considered, enlightened policy any time soon. Instead, we'll have silly, petty, headlines like this, dreamed up by a policy adviser to please an MP hooked on hits of publicity without regard for logic, rationality or simple humanity.

We expect this rubbish from the rightwing and local newspapers: they abandoned news in favour or scaremongering and conspiracy theories long ago (cheaper, more profitable): regrettably, we expect it from MPs. But ministers, even at the fag end of a failing government (and I'm a member of the Labour Party, by the way), have a higher duty, which this idiot has utterly failed to uphold. She's actually proud of her idiocy - her website features links to radio shows on which she's demonstrated her vacuity.

Her record is appalling: only moderately for open parliament, strongly in favour of new, improved, more-millions-of-child-deaths-per-warhead-nuclear-onslaught-from-above, very strongly in favour of government legislation to imprison anyone not smiling while wearing shalwar kameez (i.e.the terrorist until proven innocent bill), very strongly against an inquiry into how our Messianic leader managed to get the UK into an illegal war on faked evidence, and swings back and forth on climate change - great Zarquon, I'm stunned this puppet has the synapse coordination to blink regularly, let alone consider the great issues of the day. Poor, poor Wakefield. Still, at least she's on the case with Shag Bands. We can all rest easy.

Taxi for Mary Creagh.

Things I've learned from the cleaners while they borrowed a pen

First in an occasional series.

1. If you start urinating through your belly-button, you'll need a big operation and a month in hospital.

Health Solutions

I'm still gutted by Stoke's 94th-minute defeat by Chelsea the other day - I doubt we'd ever get those extra minutes from a referee should we need them. But it's put me in a sporting frame of mind. Neal thinks that Monkey Tennis should be an Olympic Sport. Perhaps. But my money's on the Obesity Olympics. I'd make participation compulsory for anyone seeking medical help for weight-related health problems, unless it's genuinely a genetic disease. I'd televise it, and the medals would carry with them enough medication for a fixed period. 

I'd also ban the obese from car ownership and short trips on public transport. I'd repeal all laws covering abusive behaviour so that you could hurl epithets at plus-sized citizens (of which I am, shamefully, one, though in remission). I will also gradually ban luxury accessories on private vehicles. I'd start with stereos, DVD players, air-conditioning, tinted windows, then move on to heaters, cushioned seats, seatbelts, ABS, lights and windows, doors and key-ignition. Eventually, if you own a car, you'll be sitting on a board and pedalling it along.