Health: the Nocebo Effect

After my wife had a broken wrist repaired she went to see the physiotherapist, cradling her wounded wing in its arm sling. ‘Don’t do that,’ said the physio, ‘because you’re sending a message to your brain that your arm doesn’t work.’

Not all medics have that psychological insight. My GP friend told me long ago that doctors were untrained in communication and tended to deal with patients like motor mechanics fixing cars.

Yet the mind is a powerful force in health, for good or ill. We have all heard of the placebo effect, whereby a pill with no active ingredient that could help the patient physically still seems to have beneficial effects for some who believe in it; few of us will know about its negative counterpart, the ‘nocebo effect.’ https://www.webmd.com/balance/features/is-the-nocebo-effect-hurting-your-health

‘Patients, their symptoms and their healing are negatively affected by the omission of placebo effects, by nocebo effects and by negative suggestions,’ says this writer https://www.frontiersin.org/articles/10.3389/fphar.2019.00077/full , giving a counter-example of how a doctor examining an injured leg could end on a positive note by then asking about the other one that’s fine, assisting the patient to see him/her/zirself as OK overall.

Positivity is infectious. My friend said that when he was a houseman encountering one consultant in a London hospital he would greet him with the conventional ‘How are you?’ only to be blasted with an enthusiastic ‘AB-solutely fan-TAS-tic!’; the buzz he got from that would last him all day.

Negativity, on the other hand, can affect you even when you are unconscious and on the operating table. There is evidence that anaesthetised patients ‘particularly recall conversations or remarks that are of a negative nature concerning themselves or their medical conditions. The most frequently reported postoperative effects were sleep disturbances, dreams and nightmares, flashbacks, and daytime anxiety.’ https://pubs.asahq.org/anesthesiology/article/87/2/387/36215/Learning-and-Memory-during-General-Anesthesia-An Conversely, an experiment using headphones and positive messaging on anaesthetised surgery patients has yielded good results https://www.bmj.com/content/371/bmj.m4284 .

Negativity can also bias clinical decisions. My wife needed an operation for a condition that was a daily and growing misery, but the NHS consultant who spoke to her (on the telephone, of course) made dubious noises, referring more than once to her age (was the subtext, ‘you may not survive the operation’, or was it ‘not worth it, for an oldie like you’?) Having some savings, we went private and that consultant – who could see her, not just her medical records – told her ‘You’ll sail through that, no difficulty’; as she did, and her quality of life has greatly improved as a result.

If you want to know why men don’t visit the GP as often as women, here’s an example. I was getting blurred vision in the evenings – ‘tired eyes’, I don’t wear glasses and never did – but listened to a relative’s advice and saw the GP. Blood test results (‘might as well look for other things while we’re on’) showed I was officially Type 2 diabetic. Gotcha!

Next thing, I’m in with the nurse, who tells me to take off shoes and socks and starts poking my feet with a feather quill, asking me if I can feel that? Jab yes jab yes jab yes, on and on. Now you may think that if I’d lost feeling in my feet or hands I’d have noticed, but nothing was going to stop the Procedure. I was also sent to the optician, who really did give me blurred eyes; all fine. Since then, years ago, I have been repeatedly chivvied for follow-up blood tests and vision screening; I resist.

For underneath all that well-intentioned busy-ness is a subliminal message: ‘You’re on the slippery slope, chum. It’ll start with tingling (I would make a good subject for hypnosis, I obediently started to tingle for days after the poking session – then no more, as I recovered my balance); then numbness, amputation, the lot – the helter-skelter ride down to the wooden box. We’ll do all we can to help, but, you know, inevitably…’

It also helps confirm the inalienable importance and role of the Healer. I am now not an autonomous human being, but a Patient, who must have many Examinations and Interventions and may never be released.

In a way it’s a bit like psychotherapy; yet while Freudian analysts have to undergo training so that they don’t get their egos damagingly mixed up with their patients, I’m not sure how fully this power-relationship is addressed in the rest of medicine. I know that the need to gather relevant information can lead on to nosey-parkerism: once, while waiting to see my GP, an assistant fixed me with a smile and asked whether, since I’d been to Oxford, I’d been a cannabis user. Just what I needed: to confess to a crime and have it put on my far-from-confidential medical records! What private data about you, dear reader, will be ‘scraped’ off after 23 June, and how may it be used? https://hitchensblog.mailonsunday.co.uk/2021/05/if-you-dont-want-your-private-medical-records-scraped-and-given-to-third-parties-heres-what-to-do-yo.html

Some may feel I’m over-reacting, but perhaps it’s down to a stereotypical gender difference in attitudes to health treatment. Men tend to have two states: (1) alive; (2) dead; anything else and we tend to prefer (2). When I was an IFA and Long Term Healthcare insurance came in, we were told that on average, women survive in nursing homes for around three years; men, eighteen months. Women are far more commonly on antidepressants than men, yet the latter are three times more likely to take their own lives. This will be put down to stupid machoism – in our times, any sign of stubborn, manly do-or-die go-it-aloneness is denigrated – without considering what society (throughout history and before) really, after all the PC nonsense, expects of men: to be defenders, providers, winners.

Morale is crucial. Australian aboriginals could be killed by having a curse-bone pointed at them, dying despite the best efforts of modern medicine to save them https://en.wikipedia.org/wiki/Kurdaitcha#Bone_pointing . Until we take into account the mind and the effects on it of implicit attitudes and messages, healthcare may be impaired in its efficiency and its ability to address inequalities. More widely, we need to look at how we talk to ourselves and others; cheeriness may sometimes be irritating, but negativity can sour joy in life and even destroy it.

WEEKENDER: Death of the NHS, by Wiggia

Does the NHS actually exist any more, or is it an urban myth ?

I am not alone in believing the NHS is being slowly dismantled. This was happening long before Covid and the virus has simply speeded up the process. My own and family problems are as good an insight as any; many friends and acquaintances tell the same sorry tale.

Underneath it all is a country that accepts so many things with a shrug of the shoulders; many others would not; it is our way. Yet we pay for the non-service.

The overall problem is just not the poor top down management, or the farcical contract the GPs have exploited after Blair gave them way above what they asked for, but the seemingly total lack of any plan with meaning to correct the deficiencies.

It could be the NHS has reached a stage, and many would concur, that it needs dismantling in its current form and rebuilding from scratch. Not easy when so many still believe it is ‘the envy of the world’ when it is clearly not.

There is also the overriding impression that many in the NHS believe they are doing you a favour by just being part of it, an example of which is the nurse who when I explained a couple of years back about not being able to get an appointment, said with a straight face, 'Well, it is free.' How a supposedly intelligent woman could actually believe the NHS was free still escapes me but she meant it and thought I should be grateful for any crumbs that fall from the table. Her attitude is not hers alone: quite a few health professionals believe the NHS is theirs to be apportioned as and when they think fit.

It starts at the entry point, the GP surgery: this has gone from a 24-hour, 365-day-a-year service for those that needed it, to five-days-a-week 8am-5pm (with lunch break), with access almost impossible in many cases.

Sometimes a bit of simple investigation reveals a lot more than appears on the surface: the interminable entry recording when you phone, about Covid measures, how not to waste the practice's time and 'do not press the wrong option or you will have to start again'; this is then followed by the inevitable 'we are currently receiving high volumes of calls, can you phone back later?' or be put in a queue. I did this this morning to be told I was number eighteen in the queue and I cancelled the call; not only could you be hanging on for over an hour as has happened several times but you could also be cut off after a similar time as has also happened, making the whole thing pointless; perhaps that is the object, to simply discourage people from actually using the service.

In my case this morning it was after going into the surgery, or as it is called a ‘Medical Centre’

and speaking to the person dealing with prescriptions because I need my pain killers increased in number or potency as my hip arthritis gets worse. It was explained to me that a doctor would have to speak to me to get the prescription altered and for that I had to phone in - which makes her job on the desk a bit pointless. I have three days of tablets left and no way of accessing them other than trying to phone in; phoning in later is not an option as all the telephone appointments have been allocated. 

In essence the surgery is not fit for purpose. The cries of 'lack of GPs' may well be true, but the position is exacerbated by the fact so many work three days or less as I have found out in my practice. My own allocated doctor, nice man though he is, only does Fridays in the surgery and half of that is phoning people; I have no knowledge of any other work or hours he puts in but he is not seeing sick people in that surgery in the numbers required.

The same cry goes up throughout the NHS, 'we are undermanned' is the mantra. Again there is something very wrong with an organisation that is so low on the list of doctors per thousand patients, hospital beds available, a shortage of nurses, when the same organisation is the biggest employer in Europe. We all know what that suggests and is undoubtedly true. The recruitment of diversity coordinators is not going to solve the problem, or interfering in the management of parks or even (despite the small numbers involved) having health workers decide to help out in foreign countries when they are needed here; who decides to spend our money that way?

                                                                                             

Despite claimed manpower shortages you can see from the above chart there has been a 5% increase since last year and there was a 4% rise the previous year; where are they all?

NHS and social care staff burnout at an emergency level - report

https://www.bbc.co.uk/news/uk-57395232

Certain aspects of that report are undoubtedly true, but the GP complaining about being overwhelmed and burnt-out since the end of lock down is almost funny. They have been doing bugger-all for over a year, and how many in her practice work full-time, never mind overtime?

Using the pandemic as a way of prising more money out of us will not solve the problem. There has to be a root and branch change to all aspects of the NHS, starting with the GP area.

As far as myself is concerned this started way before the virus re GPs. My own tale goes back about five years when I became ill and had no idea what was going on. Because of the difficulties of getting in to see a GP I ignored the symptoms and they went away to return about three weeks later. I was really not well now so I phoned on several consecutive days over nearly two weeks with no joy at all, as they won't let you book in advance every day (the same saga) and was then told there were no more appointments.

Over the last weekend I said to the wife I was going to the surgery to demand to see a doctor on Monday morning, Monday morning came; I got up, went into the bathroom, felt terrible, came out and passed out on the bed. An ambulance was called and a paramedic did various tests, phoned the hospital and I was taken in to the emergency ward.

The long and the short of it was I had blood clots on both lungs and on the feeder arteries. There was nothing wrong with the treatment I got in hospital but I did learn a few home truths about GPs loading hospitals with procedures they should be doing; but when I was discharged the anti-coagulation senior nurse told me I was very lucky, another 48 hours and I would have been dead; so my loathing of the GP service went up a notch at that moment.

No health service is faultless. All suffer the perennial problems of new procedures and new drugs, all of which add to the bill. The difference in so many other countries is that the people who pay (you and I) have a say in how the health service is run; using an insurance element takes some control away from those who want to decide how we access medical services: you have a choice of doctors, surgeons and hospitals.

I was emailing the daughter of my oldest friend in Australia who is a psychiatric nurse, as is her husband. She could not believe how the NHS has sunk, and when I mentioned having to go private for my hip operation because of a two year wait on the NHS, she could not believe that either - plus no rebate for going private?

The price incidentally has firmed up since the virus created the waiting lists, and the private sector is using market forces in deciding how much you pay. Pre virus, depending on where you went to have the op, it could be as low as 9k; now everyone is around 15k and it is either that or a wheelchair. The time I have left is too precious for spending years suffering and not being able to walk, so I dip into hard-earned savings; and I am lucky enough to have that - many don’t and they have been left behind by the caring NHS as have so many others with different diseases and complaints.   

On the procurement level the NHS is like all national bodies: it is not their money and so what? Nobody is ever accountable, unlike in the private sector. The many billions of pounds wasted on failed IT projects is a total disgrace in its own right, never mind badly-designed hospitals and equipment fiascos.

There has to be a change in the way the NHS is run. It has to be run for our benefit. If it needs more money it has to be accountable. The taxpayer needs a say in it all by having real choice; at the moment there is none, we are at the mercy of government whims, NHS self-interest and completely inadequate entry level care. When you add to that the deity which the NHS for many has become we have a huge problem.

The BBC article linked above is largely concerned with NHS staff shortages and well-being, focusing on their stress during the pandemic. It quotes 44% of staff being made unwell during the pandemic; how is that, when most of the NHS was at home or on standby? Only a relatively small number were engaged with catering to virus victims. There is so much emphasis on the NHS staff and very little for those who the NHS is supposed to care for and has failed miserably. The numbers in other areas outside of Covid who have died or been severely handicapped by their neglect is only just beginning to surface.

Either the NHS reinvents itself soon or it would be better if it went away. On so many levels now it really is not fit for purpose.

FRIDAY MUSIC: Old Roots, New Shoots (2)

In 2005 the BBC showed the first of a series of music programmes called Transatlantic Sessions bringing together musicians from Scotland, Ireland, England and the USA all of whom played traditional folk music. 

A stroke of genius really because America's folk, country and bluegrass grew out of the music that immigrants from the 'old world' had taken with them to their new life in the 'new world' The music is a wonderful blend of all those traditions and it ran for six series. 

They should make some more programmes. There is a shortage of good music on TV!

https://en.wikipedia.org/wiki/Transatlantic_Sessions

Part 1 is here -

https://theylaughedatnoah.blogspot.com/2019/05/friday-music-old-roots-new-shoots-by-jd.html

COLOUR SUPPLEMENT: Sundials, by JD

A portable sundial which, when closed, looks like a leather bound book. I bought this at a craft fair in the Plaza Santa Ana one evening in Madrid after leaving a nearby restaurant called La Trucha shortly after midnight. The craft fair was not there when we went into the restaurant which is not really surprising as the Madrileños never sleep at night, it is a 24/7 city like New York.

This is the sundial over the door of Dial Cottage home of the railway pioneer George Stephenson:

http://northeasthistorytour.blogspot.co.uk/2011/02/dial-cottage-west-moor-nz274705.html

The inscription reads:

"George Stephenson. Engineer. Inventor of the Locomotive Engine. Lived in this cottage from 1805 to 1823; his first locomotive (Blücher) was built at the adjacent colliery wagon shops, and on July 25th 1814 was placed on the wagonway which crosses the road at the east end of this cottage."

The sundial itself was designed by George Stephenson's son Robert Stephenson.

And the daddy of all sundials, the Samrat Yantra, part of the observatory of Jantar Mantar in Jaipur, India:

http://en.wikipedia.org/wiki/Jantar_Mantar_%28Jaipur%29

WEEKENDER: Infrastructure and the failure to improve it, by Wiggia

For years now we have been banging on about the lack of new infrastructure in this country. From roads to reservoir, it seems that little is ever improved. Various governments have ditched state organisations while at the ame time very large sums have been needed to improve infrastructure that has been neglected for decades.

And why do we keep coming back to all this? Firstly, because those structures that have been hived off to private enterprise have had mixed results: telecommunications have seen huge improvements in both quality and service, mainly brought about by competition, but other utilities suffer from a monopoly situation and any improvements are slow to non-existent.

The railways could be said to be an improvement, yet recent events have almost reverted the railway system into a state-owned organisation; and of course the public has been subsidising the railways in one form or another throughout the privately-owned era, which rather defeats the object of the exercise, except that the government of the day has someone else to blame when things go wrong.

The water industry is another monopoly, most now owned or part owned by overseas trust funds who are in a position to milk the public whilst failing to make real improvements. With water you have no choice, you are stuck with whoever runs the regional water supply. 

Despite claims that billions are spent on preventing leakage the system still leaks. In our local area we have regular burst mains, in fact we had no water for a few hours only a couple of weeks back, while it seems there are always rivers of water running down gutters. No, you can’t replace all those old pipes overnight, but how long now have they all been in private hands? 

I related a while back the quite ridiculous letter we all got from Anglian Water asking how we should all pay in advance for improvements. As a private company they should first use money they have or raise it on the market; if you are asking customers to pay in advance we might as well go back to state owned water companies.

An article in Tuesday's Times was typical of the way things are now viewed from those who would govern or instruct us. The Royal Horticultural Society, rather like the NHS, has stepped outside its remit and is telling us to let our lawns die as water is a precious commodity; we should, they say, be showing we are doing our bit for the environment as custodians of said lawn. Perhaps they shouldn’t stop with lawns but ban all watering of plants both domestic and agricultural, then there would not be a problem: no flowers, no food, job done.

The RHS is not confining its remarks to water used on lawns, however. As seems the way now, it has strayed into politics and 'saving the planet': a ‘water scientist’ of theirs said people do not realise we use 142 litres on average per person per day; they give no comparison with water usage ten years ago or any other time post-war.

The Environment agency backs this up with a warning that England faces water shortages within 25 years unless behaviour changes. Who are they to change the way people live? What do they suggest? Going back to sharing the same bath water? Banning washing machines? You can see the way it is going, like banning meat, all to save the planet.

This after two years of relentless winter rain, you ask what is going on? Two things: an ever-growing population expanding through immigration at a now alarming rate, and the complete failure to build any new water capture and storage facilities. We have 1950s facilities and a huge growth in population since then, the solution is quite simple but we are to blame. The only time you hear of future demographics is when they predict the population growth will slow and go into reverse; what they don’t say is that only applies to the indigenous population, not the late-comers who are rapidly expanding.

If one took notice of all the green pressure groups, and unfortunately governments give them attention way above their status, absolutely nothing would be built other than homes across the countryside. It helps governments of course in one way, as they can abandon such things as a decent road program or building nuclear power stations but will continue with projects such HS2 that will benefit very few at an enormous cost to to everyone else.

Sea defences on the east coast are to be shelved in favour of letting nature take its course. In place of sea defences, ther will be a plan for marsh land and huge areas of natural planting. Never mind that the proposal will take decades to have any effect, would the government abandon the London barrage and let the capital return to nature? I think not, though for many of us it would be a change for the better!                                                                                                                                                                            

In time nature will decide what stays or goes, there is no stopping it such is the power it has, not from climate change but from the fact the east of the country is slowly sinking as we drift further away from the European mainland. This has been going on for thousands of years, but forward planning could alleviate all that if only we had it; in the meantime flood defences are needed while decisions over the long term are made - or not, as is the case.

Government talks about upgrading infrastructure but won't spend to make it happen. They would much rather spend on short term projects as they believe it keeps the public perceiving them as actually doing something. Long term infrastructure reaps little in political reward, so is not acted upon. We are falling ever further behind our European neighbours in all things like road, rail, energy supply facilities and almost everything else, various surveys prove this.

As good an example as any in the eastern region is the A120 to Harwich. Anyone arriving from abroad for the first time could easily be persuaded they have taken the wrong road and are lost on some country lane, and there are miles of it before you get to the A12, an international ferry port that never has had proper access.

The spending in the past year on Covid-related items has shown there is no lack of cash when push comes to shove. How much of that has been wasted is still to be unearthed but it is tens of billions. Our incumbent political party has had a revolt among its back benchers who want to see the foreign aid budget returned to pre virus levels; no one voted for this so that some African despot can spend UK taxpayers' money on a new USA-built private jet, but virtue signalling wins out over the proper use of our money that could be spent on decent infrastructure.

Of course it can be said we did indeed all vote for this dereliction of their job description to represent the people. I did a George Carlin at the last election: I didn’t vote so cannot be blamed for any party's shortcomings; it would have been a wasted vote, for any of those put up would only encourage them to believe they do have a mandate from the people to hose our money into vainglorious projects - and extremely poor-value-for-money ones like the endless military items that never work properly but are never junked, yet have more money hosed on them because no one has the guts to admit failure; the latest armoured vehicle fiasco is a classic. 

https://battle-updates.com/ajax-armoured-fighting-vehicle-procurement-fiasco-by-howard-wheeldon-fraes-wheeldon-strategic-advisory-ltd/

£3.5 billion wasted! As usual no one is responsible and the pot holes round here get ever deeper. Does the government have any sound policies when it comes to spending our money or do they just stick a pin in a list of things they might like but that are of no benefit to us?

Oh and have they had that Dover rubber dinghy sale yet? There must be so many there they will be charging locals for storage soon. After all it would go some way, well a teenie way, to offsetting the enormous cost of those that used them to get here.

FRIDAY MUSIC: The Quebe Sisters Band, by JD

"Grace, Sophia, and Hulda Quebe front an innovative Progressive Western Swing band of archtop guitar, upright bass, fiddles and sibling harmony. The Dallas-based five-piece presents a unique Americana blend of Western Swing, Jazz-influenced Swing, Country, Texas-Style Fiddling, and Western music."

https://quebesisters.com

Come The Revolution

The Daily Mail has been running a series by Richard Kay on ‘vulture capitalists’, i.e. the hedge fund managers who have run out of twisty things to do in futures and options and have turned to buying up real businesses, hoping to continue making stellar profits. The social consequences may hasten the Revolution.

Years ago as an IFA I attended a presentation that explained we were passing peak pensioner prosperity: hordes of companies were closing ‘final salary’ pension schemes and loading the risk onto private individuals through alternative, ‘defined contribution’ arrangements. Ordinary people are now facing a standard of life in retirement that depends on the vagaries of the stock market (so very volatile in recent decades) and annuities (now crippled by ultra-low interest rates as the country’s debts pile up so that we cannot afford to raise bond yields again.)

 

Like the worm Ouroboros, capitalism has begun to eat itself. Once, a business would increase its profits by attracting more customers through offering a quality product. Also, employers enlightened by Christian values would experiment with better pay and conditions for their workers (I know that other religions urge similar ethics but we are discussing this country as it was, historically.) 

However, in the 1980s, business management began to preach a new doctrine, that of maximising shareholder value. How to achieve this profit maximisation? By externalising costs – de-risking pension schemes (and grabbing the fund surplus, if any) and downsizing the labour force (to be supported by the public purse); by arbitraging labour and materials costs through globalisation; and even by trying to short-change the customer (think of the cheapening of ingredients in Cadbury’s Fruit and Nut; what happens when you take quality away from a product that sells on quality ? Who cares? This year’s dividend and this year’s executive bonus are all that matter.)

 

A touchstone for this bottom-line, presbyopic madness is the case of Southern Cross Healthcare, a chain of care homes that saw a management buyout and then a sell-off to an American fund that set up a sell-and-leaseback scheme requiring upwards-only annual rent reviews. This converted the prospective future income stream to immediate capital, and by the time that – inevitably – the concern collapsed financially, the foreign speculators were away, free and clear, leaving the dependent elderly to face the consequences; like Conrad’s Lord Jim jumping ship to leave his passengers heading for the rocks.

 

This model cannot go on forever. As the rich get richer and the rest poorer, domestic demand and the taxation yield on work are doomed to decline, and the welfare state will need increasing debt financing until it gives out under the strain. Readers will have seen stories about how the elite are conscious of where this is going, and have begun preparing boltholes in faraway places such as New Zealand (though perhaps they will fall foul of the old Pacific tradition of cannibalism – poetic justice, if so.)

 

It’s not only insane greed that threatens society. For the doctrinaire revolutionary, the suffering of the disadvantaged represents an asset. When John DeLorean set up his car factory in Northern Ireland, thinking locals would be grateful for the chance of employment, he was visited by representatives of the IRA who explained that they wanted it to fail in order to intensify support for their subversive cause. Similarly, in 1965 Labour’s Minister for Education and Science Tony Crosland (educated privately at Highgate School and then Trinity College, Oxford) swore to close every last grammar school  - he was not the only figure on the Left who wanted to block working-class advancement so as to keep hot the fires of resentment.

 

This takes us right back to Lenin and his 1902 pamphlet, ‘What Is to Be Done?’ As a recent essay about resurgent support for Leninism explains, social democrats wanted ‘to reduce working hours, improve working conditions, and raise wages’ whereas Lenin wanted the workers to revolt, not to be bought off with trades-union-negotiated concessions. Revolution looks for opportunities in chaos, as with the end of the Great War that cursed Russia with a Communist government and powered similar dangerous movements in countries from Austria to Australia.

 

I was struck by a recently-rescreened episode of the ‘Hairy Bikers’ TV cookery series, in which the motorcyclists visited Russia. A man they met there said he would go back to Communism if he could; people said they used to feel 'supported’ with health treatment, education, housing and so on. We read of the real, horrible tyranny and oppression in Russia and China, but not so much about the millions of peasants whose standard of living improved, and who supported the grisly autocrats.

 

For now, the British people have been distracted by Covid and their perceived salvation by jab (complications yet to come ?) plus the conversion of the Magic Money Tree that PM May said didn’t exist, into a Niagara of cash. The same narrative is now playing in the USA, even as audiences flock to see the Oscar-winning movie ‘Nomadland’ with its story of multitudes made ‘houseless’, ground by the upper and lower millstones of low pay and soaring rent. Here in the UK, 3.4 million people have never had a paid job; residential owner-occupation by 16-24-year-olds dropped from 25% to 10% in the twenty years after 1996; increasing numbers of young people (aged 15 – 34) are living with their parents.

 

The fuel load under the trees is increasing, and awaits a spark.