Sunday, 22 January 2012

Saluting Foucault and Our Access to Information

Possibly Foucault will have turned in his grave this week. At the very least he might have considered adding a further chapter to his work The Archaeology of Knowledge. I can imagine his despair might have resulted from the stories regarding gaining access and using information or not that made up much of the news this week. One story that dominated was of the arrest and seizure of assets of one Kim Dotcom, also known as Kim Schmitz, the flamboyant entrepreneur who founded the site Megaupload. The site had some 150 million registered users, and was one of the biggest file-sharing services in the world before it was shut down this week. It was reportedly the 13th most frequently visited website in the world. Megaupload is now the subject of one of the largest cases of copyright theft ever, after the US authorities ruled that it violated a host of piracy laws. The closure sparked retaliatory protest attacks by hackers focused on US government sites.

An access to information story of a different scale,was the news on Thursday that all NHS and social care staff in England will now have open access to the online version of The Lancet, thanks to an agreement between NICE and Elsevier to fund a national subscription. Such a move will save the NHS time and money. NHS organisations, and individual members of staff, will no longer need to take out their own subscriptions. The Lancet was founded in 1823, and is one of the oldest medical journals in the world. Access is via use of an Athens password – and as I have one, I thought I would see what was available.

There were some surprisingly interesting papers, although I felt there was a bit of 'my RCT is bigger than your RCT' feel to the journal at times. A number of what were very serious papers appeared to have very creative titles, and there were some papers where I found the content amusing, not because the focus was in itself funny, but because of the possibly unintentional juxtapostion of topics. My eye was drawn for example to the paper: Mortality in relation to oral contraceptive use and cigarette smoking which reported upon a study undertaken by the Oxford Family Planning Association study, which compared mortality in relation to contraceptive use and smoking. This was a big study (17032 women, aged 2539 years at entry) which ran for some 32 years (now there’s research funding for you!). The findings were interesting, as it appeared there was no harmful effect of oral contraceptive use on overall mortality. By contrast, death from all causes was more than twice as high in smokers of 15 or more cigarettes a day as in non-smokers. The harmful effect was already apparent in women aged 3544 years. 

However, it seemed to me that the authors had missed a unique health promotion opportunity. And of course where there is a market niche someone will come forward to fill it. Possibly without the benefit of a free subscription to the Lancet, the Swedish company Pharmacia Latex, have developed a condom that has a nicotine infused lubricant. Their claim is that as nicotine is a natural stimulate, in using these condoms smokers will feel less inclined to light up after sex. Now I bet such covert population control would have made Foucault smile!

I wasn’t smiling at my colleagues from the Nursing Standard who once again were using the Freedom of Information legalisation to gather information about University nursing lecturers involved in pre-reg nursing programmes. They chose to send out the request at late on the afternoon of the 23rd of December, starting the clock ticking just as everyone left for Christmas. The deadline for compliance was this week. I am sure in the fullness of time an article will appear that reports (almost predictably) a negative view of nurse education today. As someone from the DoH (possibly a kindred spirit) said recently for the important things in life we have credit cards. For everything else we have the Freedom of Information Act’.

Of course our access to information that is presented in many different media can be a cause for good. I was pleased to learn that Paul Burstow the Minister for Care Services reaffirmed the Government’s commitment to 3millionlives at a parliamentary reception this week. This event celebrated the work of the Whole System Demonstrator Programme (WSD). The WSD programme is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients, 238 GP practices across three sites in the UK (Newham, Kent and Cornwall). The research aims to explore the cost effectiveness, clinical effectiveness, organisational issues, and effect on carers and patients of the use of telehealth. The study has focused on 3 conditions, diabetes, COPD and coronary heart disease. Outcomes to date show that if delivered properly, telehealth can substantially reduce mortality, reduce the need for admissions to hospital, lower the number of bed days spent in hospital and reduce the time spent in A&E. Its estimated that in the UK at least 3 million people with long term conditions and/or social care needs could benefit from using telehealth and telecare. Not sure what Foucault would have made of this modern day intrusion by the state into our everyday lives, but I bet he would have preferred to it to what is going on in the US with Megaupload.