Sunday, 25 January 2015

Charlie Hebdo

Last week, gunmen burst into the offices of satirical magazine Charlie Hebdo and gunned down a number of the cartoonists working there. The gunmen claimed they were doing it to avenge the publications of offensive cartoons depicting Mohammed in 2006 - they were previously attacked in 2011 for these. They published more cartoons ridiculing Mohammed and Islam in 2011 and 2012.

While we are, sadly, all too familiar with terrorist attacks of various sorts, these were more effective than many have been of late - twelve people dead. The response to this across Europe and the world has been substantial (over 2 million turned out in Paris). As I have mentioned elsewhere, this seems to be because it serves as a focus for the pain of all the suffering, all of the intolerance, all of the bigoted hatred we experience. That is not to dismiss the response to this event, because it is seen to strike against the critical media, which is one of the bastions against an oppressive and dictatorial leadership. And quite rightly too.

This is, to my mind, the core of this attack. It is an attack on the media who provide a challenge to the accepted position, to the dictatorial powers, to those who would oppress us. I may not agree with them all, I may find myself offended by some of their reporting, but I would support their right to exist and to their freedom forever, because they are the last bastions against a dictatorial rule by those in power. In truth, we are not that far from this anyway, which is why these types of media are so important today.

In the world today, we do have a number of rules who rule oppressively, who abuse their people and their power. We know many of their names, because our leaders (who hide behind the curtain of "democracy") tell us about them. But I suspect that the biggest oppressors of people - directly and indirectly - are some of the major religions. While it is easy to point to Islam, Christianity is as bad. Of course, it is not the majority of leaders or followers of these religions who are oppressive, who are dangerous. Islam, properly taught and followed, is a religion of peace. I have known all sorts of Muslims in my time, they represent the normal breadth of people, although - in my experience - they have tended to be kinder, gentler and less insanely vile as some who don't profess any faith.

The same, of course, applies to Christians - most of them are nice enough people, they tend to represent the normal variation of people. The problem comes, I think, when people take these religious ideas to the extreme, and use them to justify hatred aggression and violence. Sometimes this comes out in actions like the Charlie Hebdo attack (which was perpetrated by violent terrorists, not Muslims, whatever their claimed justification), but it also comes in some of the appalling actions that occur in countries, where people are abused, attacked and killed because they break the norms of a religious belief set.

Islam is not a violent faith, any more than Christianity is. What is violent is rampant capitalism, nationalism, and religious0inspired dictatorship. It is the likes of Charlie Hebdo that temper the worst of these, which is why we should protect them with our lives.

Tuesday, 13 January 2015

Bad Pharma

I am reading this book by Ben Goldacre, and it is a fascinating insight into commercially sponsored academic research. While his comments are insightful, very few people or organisations are actually breaking the law.

The pharmaceutical companies are doing exactly what they should do - making a profit. They are running businesses, and as a business, they have to make money.

The regulatory bodies, are, largely, taking the data they are given and making decisions about whether a particular drug has a benefit. They might not always push as hard as they could, or demand enough information. But they have a job to do, and they do that as simply as they can.

The NHS takes the information on the drugs that are approved, and uses the supplied information to make prescribing decisions. Of course, Goldacre argues that the end-point providers are not getting all of the information they need, so their decisions are not always good, but they are doing the best they can with the information they have.

The problem, Goldacre points out, is that the entire regulatory structure and system is not working for the primary benefit of end consumer - the patient. The problem is that the patient is not really represented in the process. There is nobody definitively asking the questions about what is best for the patients, because it is nobody's job to do so. The doctors who prescribe have some of this responsibility, but they do not have the information (or the time) to identify all of the possibilities, and decide on one appropriate solution.

However, the other side of this is that the government seem to desperately want to reduce the cost of the NHS, who are the major purchaser of medicines in the UK. The medicines bill is a significant part of this cost, and a portion of it is unnecessary.

Following from Goldacres ideas, if the government were to do rigorous assessments of all of the available medicines to identify the ones that provide actual benefit, and only permit those to be prescribed, then the cost overall would be reduced. If this was followed by a refusal to license anything else that does not show a clear benefit over an existing treatment. Of course there are two core problems with this:

1. The pharmaceutical companies - who are significant donors to the political process - would lose out very substantially. Lets be clear, if the medications bill is reduced significantly, then this is money coming from the pharmaceutical companies, of the order of billions (the NHS drugs bill is around £8Bn). Appearances are that this is not the sort of cuts that the government wants to make.

2. Some people would lose the medications that they are convinced are working well for them. Now I know this personally - I take a medication that is not the cheapest or simplest version, but when I moved to a simpler version, which should have been identical, it didn't work. This is a big challenge, because I will fight a long time to keep my meds, as will many others! But in many cases, as Goldacre makes clear, there is no proven benefit of one medication over another. So, while it may prove a difficult transition, it should be possible. I do think in some areas, like mental illness, there is a place for multiple forms of medication, because the response and reaction to them can vary significantly. However, there is probably a case for aa reduction even here.

So that is my challenge to David Cameron - if you are serious about reducing the cost of the NHS, then do something about the drugs bill by stopping some of the abuse of the system that people like Goldacre highlight.