A voice for good, listen to the evidence and stay safe

Charles Caleb Colton was a true British eccentric. Born in 1777, he became a writer, an art collector, gambler, and cleric. He collected fine wines and loved fishing and shooting, especially partridges. He once wrote that no one ever committed suicide because of ‘bodily anguish’, although thousands have done so from ‘mental anguish’. Throughout his life, he suffered with poor health. In 1832, on finding out his life depended upon a painful surgical procedure, he ended his life by suicide, rather than having the operation.

Despite how his life ended, his was a life lived to the full. These days he is best remembered for quotes from his writings. One of his most famous quotes is: ‘if you have nothing to say, say nothing at all’. Older readers of this blog might well have thought the quote first came from

Thumper, the fictional rabbit in the Disney film, Bambi. Thumper said, ‘if you have nothing nice to say, don’t say anything at all’. It was a shame that last week, the US President didn’t heed this advice and keep quiet.

Sadly, last week, we found ourselves back in Andrew Wakefield territory*. The President, and his ill-qualified Secretary of Health and Human Services, Robert F. Kennedy Jr., for reasons known only to themselves, declared that paracetamol caused autism if taken by pregnant women. In the US, paracetamol is traded as Tylenol (here it’s Panadol). Thankfully, our own sensible and upwardly mobile Secretary of State for Health and Social Care, Wes Streeting, very publicly, vigorously and unequivocally condemned the President’s assertion that paracetamol was in any way dangerous or caused autism.

Science is on Wes’s side. The World Health Organisation (WHO) is on his side. The British Medicines and Health Care Products Regulatory Agency is on his side. The National Autistic Society is on his side. Perhaps predictably, The Daily Mail and Nigel Farage sided with the US President. That said, the damage from the US President’s announcement may already have been done. He is a powerful man, an authority figure. As such, and unfortunately, many people are likely to be persuaded that there is truth in his claims.

However, as a once in a while remedy for a headache, cold relief or painful conditions, paracetamol remains a safe medication. Taken in excess, even just a few more tablets than the recommended daily dose, it can cause liver failure and death. It remains an easy to acquire medication for people contemplating suicide. Indeed, back in 1998 the UK government legislated that paracetamol could only be sold in packs of 16 tablets. Whilst someone determined to take an overdose can still purchase larger quantities simply by going to different shops, the legislation definitely had a positive impact. Analysis of mortality rates over an 11-year period, following the introduction of the law, showed significant reductions in paracetamol-related deaths.

Set against this empirical data, it is perhaps worth noting that the important issue is relying on sound, evidence-based data and information. Unfortunately, the US was a major exporter of misinformation during the Covid-19 pandemic. What was put out was not evidence-based at all. Such misinformation was directly traceable to both the US political discourse and the US media. This led to ‘vaccine hesitancy’, not only in the US, but in other countries across the world. Sadly, this erroneous narrative, completely devoid of any evidence to support it, has continued to have a negative impact on more general vaccination programmes worldwide.

The WHO estimate that vaccines have saved 154 million lives since the mid-1970s, with a hundred million of them being children. The potential damage resulting from this latest announcement from the US President is regrettable, and almost unforgivable. For example, and closer to home, it is becoming harder each year to persuade NHS colleagues to get their flu and Covid vaccinations.

Hopefully, in using my voice for good, I would strongly urge my colleagues and all those who work across the NHS, to respond positively to the evidence and take advantage of the NHS vaccination schemes. Such an action would be a powerful incentive for good, and one that would hopefully drown out the disastrous voices from afar.

*Wakefield’s article linking MMR vaccine and autism was fraudulent

Patients Progress: contracts or collaboration?

Last week was a great one for the number of different stories that caught my attention. Most folk would not have failed to see the story of the State visit of the American President. I have no interest in what he said, did or didn’t say or didn’t do. It was the news that the US and UK had signed a deal, said to be worth £150 billion, for investment in new technologies, particularly artificial intelligence (AI) that drew me in. The investment, although not real money in the bank, would, it was said, keep the UK at the forefront of AI development and its utilisation into improving many aspects of our every day lives.

I don’t know if such promises will come to fruition, time will tell. A great deal of the money is to be spent on so called data centres. These are said to be power hungry and require huge amounts of water for their cooling systems. Both appear to be in short supply in the UK. This lack of resource sustainability might eventually prove to be a deal breaker.

A related AI story last week followed the publication in the journal Nature, of a paper detailing the development of a generative AI tool named Delphi-2M. It is a tool that can predict your personal risk of ever experiencing 1,000 diseases. Likewise, it can forecast changes to population health up to 10 years into the future. At the population level, the AI tool was ‘trained’ using anonymised data from nearly 2 million patient records from two very different health care systems.

At the individual level the AI tool looks at the ‘medical events’ in your history. This includes considering your age and gender, and all illnesses and/or accidents you might have had over your lifetime. Additionally, it also looks at lifestyle factors such as smoking, drinking (alcohol) and a person’s weight (BMI). Interesting so far, but maybe worrying also; consider the ethics of accessing such a tool.

Whilst I can see some advantages at a population level, in terms of planning future service provision and where to focus future public health activities, I’m not so enamoured with the advantages at a personal level. I’m not sure if I would consider it to be a good thing (or even helpful) if the AI tool was to forecast that there could be a 40% chance that I might contract a life changing or life shortening disease in the next five years. What would I do with that information, and what if others knew this about me as well?

One of the other life sciences stories of last week made me also wonder if the NHS will have access to the pharmaceuticals it might need to treat future patients. Whilst the UK has hopefully won £150 billion worth of AI-based technology contracts, we are conversely losing much more from a series of withdrawals from international big pharma as they cancel plans to invest in the UK. Over the last year, all the major pharma companies have announced plans to invest overseas -mainly the US, rather than as planned, here in the UK. And this is despite the UK having some the best life science researchers in the world.

Cambridge University alone has won 125 Nobel Prizes. The so-called ‘Oxford vaccine’ saved thousands of lives during the Covid19 pandemic. Inexplicably, the NHS has been slow to adopt new drugs, and we can’t ignore the impact of the delightfully entitled Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG). As the NHS buys drugs in bulk, the VPAG arrangement means that pharma companies are required to send 23% of the revenue earned by their drugs back to the UK Government. Not, I suggest, a great business proposition.

However, away from these billion-pound stories, it was the wonderful story of how Finland prepares its population for the next pandemic, cyber-attack or geopolitical challenge that most intrigued me. I love Finland and have been there many times. It has a tiny population that lives across a vast geography and endures a Nordic climate. Through public/private partnerships, new agricultural technologies (crop development), national secure storage facilities and emergency fuel supplies, Finland can continue to function very effectively for at least nine months in the event of a major international supply chain breakdown (think of the Ukraine/Russia conflict).

It is not just the vital infrastructure that make Finland’s preparedness enviable, but the underlying commitment to collaboration across the political, economic and societal Finish way of life. In Finland, collaboration is not just an abstract concept, or a political policy, it is the way things are done everywhere and by everyone. A lesson for us all here in the UK methinks.

In our own way, we can all be champions

One of my brothers has been a lifelong fan of Millwall Football Club. I don’t think they have been in the Premier League, and probably never will. Currently they are 12th in the EFL Championship League. Their position in the league table, and all their various successes and failures, have never deterred him from following his team. Likewise, I have a friend on social media who is a Manchester City fan. Goes to all the games, wherever they are being played. I think it’s fair to say that the 2024 season was excruciating for the Man City fans. Did it stop my friend from going to the matches? Not a bit.

Now I don’t do football, but I do like snooker. I grew up watching the likes of Alex ‘Hurricane’ Higgins, Steve Davies, Jimmy White and Stephen Hendry. They were all great players, but for me, the absolute best player ever is Ronnie O’Sullivan. He has been simply phenomenal. Over the last couple of years, however, his game has suffered. He is now ranked fifth in the world. Despite where he stands in the snooker rankings, if I see he is playing, I will always try and watch him.

By now, regular readers of this blog will have realised this week’s posting is not about football or snooker per se, but about League Tables. Last week saw the reintroduction of league tables in the NHS. Those of you who have been around for as long as I have will remember that it was Tony Blair’s Labour government that first introduced league tables for hospitals back in 2000. They were cunningly disguised as ‘star ratings’. In 2000, the Secretary of State for Health was one Alan Milburn. Spookily, today he is the lead Non-Executive Director for the current interim NHS England, and Chief Advisor to Wes Streeting (our current Secretary of State for Health and Social Care).

The ‘star ratings’ approach didn’t work, and any gains made to the transparency of services being provided did not lead to noticeable overall improvements to NHS services. The ratings were abandoned in 2010. I argue that league tables didn’t work then, and I cannot see them working now. The UK media had a field day when the tables were published, reporting that four out of five NHS Trusts were failing. However, the financial metrics used in the league tables has (perhaps unintentionally) skewed the results, and the outcomes published don’t always reflect the totality or the quality of care being provided. Sadly, I think most folk won’t understand the nuances of the current league tables, and even if they did, they probably have limited choices when it comes to where they receive their health care.

My local Acute Trust is Blackpool Teaching Hospital NHS Foundation Trust. It was ranked 125th out of 134 acute providers nationally. I have been a Non-Executive Director there, and yes it does have its problems. However, when Jane and I had to use its Urgent and Emergency care services earlier this year, the care and treatment we got was simply brilliant, and truly lifesaving.

That episode of care ended with a transfer to Lancashire Teaching Hospitals Foundation Trust, over in Preston. They are ranked 127th out of 134 acute trusts nationally. Jane spent nearly two months in their neurological high care unit and the treatment she received was first class, and the care given was a brilliant example of what compassionate person-centred care looks like. In both cases, Jane had nowhere else to go to receive her health care.

A bigger potential problem than a lack of patient choice, might be that health care professionals might avoid seeking employment in a ‘failing’ health care organisation. Likewise, unless Wes introduces a ‘transfer’ scheme similar to how football clubs operate, I don’t think financial incentives will persuade leaders of high performing organisations to take on a failing organisation. Other than moving to Taiwan it’s always good to keep an open mind with changes such as these league tables come along. Time will tell if they do better than the previous ‘star ratings’. As for Manchester City, Millwall and Ronnie, I wish them, and those who support them all the very best for this year’s games.

Making Descartes smile, I think?

Now I’m not going to pretend I understand Latin. I don’t. However, I do know that Cogito, ergo sum is the famous Latin philosophical assertion by Rene Descartes – meaning ‘I think, therefore I am’. It means that in doubting your existence proves your existence. He asserted that you cannot doubt unless you are a thinking being that actually exists. It was the foundation of Descartes’ philosophical work, and the basis for what became to be known as Cartesian teaching.

Although I have never been a pure Philosophy scholar, I have long been interested in Descartes’ approach to the question of promoting knowledge acquisition, and how I might bring this into the classroom. Whilst many books have been written about Cartesian teaching, it is fundamentally based on the idea that all knowledge begins with doubt, and that the best way to acquire knowledge is through systematic questioning – and in particular questioning our assumptions. 

Simply put, (and this is a 750-word blog after all), it involves asking four basic questions: what, how, why and what if? Answering these questions in a systematic way will often allow you to truly understand the problem or issue, identify potential solutions and make better and informed decisions. I did say it was simple. Over the years, students have approached these questions in many ways, but not always successfully perhaps.

When I was working towards my doctorate, I would spend many an hour in the library reading and making notes. I was completely unsystematic in my search for knowledge, too easily seduced by the rabbit holes I fell into, while reading papers and books. That said, I did gain my PhD. It’s safe to say that teaching and learning have been something I have enjoyed being involved in, all through my various careers, but in particular, when I was working at the University.

Much of my writing and research has been around preparing nurses for practice, both the stuff they need to know and the knowledge they acquire, but also the bit in between, how to deal with what it is they don’t know. These days I still keep a watchful eye on nurse educational development. Last week I saw a post on the Mental Health Nurse Academics UK (MHNAUK) group. It was from a colleague at the University of Huddersfield; a colleague who has been in nurse education for many a year. His concern was the student use of Artificial Intelligence (AI) in higher education.

Whilst being aware of the many benefits AI can bring to healthcare and our lives in general, his concern was about students using AI to write their assessments and the over reliance on theoretical knowledge gained in this way. It is a fair challenge. Using AI in this way can be very seductive. I’m not sure limiting its use by students is necessarily the best way of dealing with the issue. AI provides another repository of knowledge, and it’s how this is engaged with, that is the real challenge for teachers and students.

The debate on the MHNAUK group is heating up, and as there are some very wise heads in the group, I will continue to watch with interest. One contributor from the University of Ulster sagely noted that ‘Wikipedia was predicted to make teaching obsolete, and before that, the internet itself. Even the calculator had its detractors. However, none of these brought an end to teaching’. I’m in this camp.

I don’t use AI and have no desire to. For teachers and students, however, perhaps there is value in thinking about AI as being simply yet another development in how we all might acquire knowledge, pursue truth, and find certainty in the truest Cartesian tradition. We already help prepare students for their studies by using introductory courses to critical thinking, research, and academic writing - why not an introductory course on how to effectively use AI?

Most of the common AI programmes note, albeit in the small print, that all answers to questions posed are dependent on the data that has been collated, or is readily available to the AI search engine. They all suggest that answers therefore might be inaccurate and should be checked. The best way of doing this is by posing different versions of the original question. Wise advice, and I think (therefore I know), Descartes would be proud.