Doctors who evangelise

The Telegraph recently reported on a story about a doctor who is in trouble for talking about religion with one of his patients. The story is here – GP rapped for talking about God with patient. According to the Telegraph, Dr Scott shared his faith with thousands of patients in the past because he believes that there is a spiritual element to healing.

People visiting an NHS doctor are expecting to see just that, a doctor of medicine, a general practitioner who will diagnose the problem and prescribe conventional western medicine. They are not expecting prayer or to be referred to an alpha course. They didn’t choose to go to a faith healer, just as they didn’t choose to go to a homeopath or seek out traditional Chinese medicine. A person is of course free to choose those treatments if they so wish, but the point at which they are already talking to a doctor is not, in my opinion, the time to bring it up. A patient talking to a doctor is vulnerable and suffering, and may not make rational choices as a result. Since there is a trust relationship between patient and doctor, if a doctor suggests a treatment that is not within the bounds expected, that trust is violated.

The General Medical Council has said “Our guidance, which all doctors must follow, is clear. Doctors should not normally discuss their personal beliefs with patients unless those beliefs are directly relevant to the patient’s care.” Perhaps surprisingly, I believe the GMC to be wrong. I do not think that the GMC has any right to say that no doctor should ever talk to his patients about God. What I do think is that the NHS doctors should refrain from introducing any religion into the treatment. (Or anything that isn’t medicine, come to that.)

In the case of Dr Scott, it was not completely obvious that there would be a religious aspect to the treatment. In their defence, the practice stated three things:

  • The name of the GP practice, Bethesda, is a biblical reference.
  • There were Christian posters on the wall of the practice.
  • The NHS web page for the Bethesda practice states “The 6 Partners are all practising Christians from a variety of Churches and their faith guides the way in which they view their work and responsibilities to the patients and employees.  The Partners feel that the offer of talking to you on spiritual matters is of great benefit.  If you do not wish this, that is your right and will not affect your medical care.  Please tell the doctor (or drop a note to the Practice Manager) if you do not wish to speak on matters of faith.

Unfortunately, none of these reasons are adequate. The name of the surgery, Bethesda, may be obviously a bible reference, but that is only obvious to Christians. The website states that spiritual advice might be given, but even in the modern age most people would not visit the website of their doctor before visiting. Finally, although there were Christian posters on the wall of the surgery, a patient absorbed in their problems might not read or take in such posters, or might easily look down throughout their visit and miss them. In addition, someone looking for an NHS doctor would simply enquire about the nearest doctor with space on their books. An NHS helpline would happily send patients to the Bethesda doctors without anyone being aware of their religious aspects. Basically, unless the patient was read a statement informing them that they would receive Christian prayer and referrals and asked to agree to it, I would not count the surgery as having obtained proper consent.

I believe that an NHS doctor would be wrong to pray with a patient or to refer them to a religious organisation because that treatment is not within the remit of the NHS and is not funded by the NHS. An NHS doctor would certainly be wrong to introduce these treatments without consent obtained at a time when the patient is able to make an informed choice. Despite this, I disagree with the GMC in their statement that doctors may never discuss religious beliefs. If a privately funded doctor in a practice which clearly advertises their religious aspects and obtains the proper consent shares their faith with a patient, I think they are within their rights to do so. As long as the patient has had to make a conscious choice to visit that doctor while fully aware of the religious aspect, there is no problem. Because of this, I think the GMC should modify their guidance and should drop this case, but also that the doctors at the Bethesda practice must cease to offer religious treatment unless they no longer accept NHS funding and obtain full consent in advance of registration.

Acupuncture

I have already written about Homeopathy and Chiropractic. It should be no surprise to my regular readers that I am contemptuous of acupuncture too. There are several problems with acupuncture.

  1. It is based not on knowledge of biology, but on “qi” (energy.)
  2. It does not cure, but it practitioners claim that it can.
  3. Needles can damage nerves and may cause infection if not sterile.

The first point is important. With most medicines we know the mechanism through which they affect the body. We know which part of the body they alter, and we usually know how they work. Acupuncture is based on the idea of qi, pronounced chi, and meaning a kind of energy that supposedly flows around the body through channels called meridians. We have no evidence of qi or of meridians, but we do have evidence of nerves, hormones, chemicals and all the other concepts that make up the human body. Qi was an attempt to explain life before we had the modern knowledge of how the body works. Now we know better.

Acupuncture does not cure anything. We know it doesn’t, because there have been trials of acupuncture. The acupuncture page on Wikipedia lists many of them. Acupuncture may be effective against pain, although the findings of studies vary and there is insufficient evidence to say either way. It is likely that reported pain relief from acupuncture is largely a result of the placebo effect. This is not necessarily a bad thing, since the important thing here is relief from pain and the placebo effect can do that. Acupuncture may also help relieve pain by distraction through simulation of the nerves and the release of endorphins. This is not proven.

While acupuncture can provide pain relief, it cannot cure disease. It cannot flush out virus or bacteria infection, or cancer cells, and it cannot repair the body when it has gone wrong. The British Acupuncture Council claims that acupuncture can help with all sorts of things – colds and flu, infertility, chronic fatigue syndrome. This is of course absurd.

For the most part, acupuncture is safe, but as it is an invasive procedure there are risks. There is a danger of infection if the needles and the environment are not sterile. There is a danger of damaging a nerve. There is a danger from a needle entering a lung, kidney or other organ if the needle is inserted too deeply.

Overall, then, some people might like to use acupuncture to provide relief from pain, if it works for then. Unfortunately it does not work in enough people to produce a significant result in tests, and the results that it does produce are likely to be from the placebo effect. It certainly doesn’t cure anything, and if people use acupuncture in preference to tried and tested medicine then they may prolong their illness or endanger themselves by effectively leaving themselves untreated. Acupuncture is not entirely risk free anyway.

I know that in spite of my arguments here many people will choose to believe in the curative abilities of acupuncture anyway.  That is their right to do so, but they should understand that belief in qi and the manipulation of qi through the use of needles is not a scientific belief. If anything, it is a religious one.

If someone wishes to choose to use acupuncture instead of researched and tested medicine, I cannot stop them. If it provides pain relief for them, then I am happy for them. I think it is fair to say that of all the alternative treatments, acupuncture shows the most promise of a plausible mechanism and of tests showing a useful difference, at least for pain relief. I take issue with practitioners that make absurd claims about what acupuncture can do; if someone chooses acupuncture because they think that it will cure their viral infection or cancer then they have been conned. At the very least, we have laws against obtaining fees through false claims and against making false claims in advertising material. If someone believes that alternative medicine replaces the need to have vaccinations, then they would be putting the rest of us in danger and that idea would need to be stopped. I wrote about this in my previous blog post, Alternative medicine – a dangerous game.

Related blog posts

Alternative medicine: a dangerous game

Homeopathy again

Do you know what Chiropractic really is?

More on the placebo effect

 

Response to the attack on DLA in today’s papers

Several papers have run with a story today about Disability Living Allowance, the numbers of people receiving it and what they receive it for. Unfortunately that coverage has been highly negative and has largely complained about the increase in people claiming DLA (from 2.2 million to 3.2 million – The Telegraph) and about DLA being paid out for back pain, addiction, and mental health problems. Interestingly, the papers all cite “new figures” but give no indication of where they came from. As far as I can tell there has been no new press release from the DWP on this subject.

First of all I want to address the rise in claimants. There are many reasons for this, but the claims process has definitely not got easier. A large part of the reason is simply more awareness of eligibility for the benefit. In the early days of DLA far less people knew that they could claim it. Another reason for the increase is that medical science has advanced, and we are now able to diagnose and name many more health conditions than before. Once these problems have been recognised, people are more likely to apply for help in dealing with them.

The statements made in The Sun, The Telegraph, the Daily Mail and particularly in the Daily Express appear to be highly misleading. Here are some of the statements made from the Daily Express.

“Between May 2000 and May 2010 the overall number of people being paid Disability Living Allowance soared from­ ­2.1million to 3.1million.”

All of these people have had to go through the existing highly rigourous and extremely difficult application process, including a 50 page form, letters from doctors and specialists, and an examination by a doctor on behalf of the DWP. No one without a crippling disability or illness would have received DLA, and in fact many more that could claim have not done so through lack of awareness or through fear of the process.

“The benefit is designed to help disabled people who cannot walk, have difficulty walking or need help getting around.”

This is true, but not the whole truth. DLA has two components, mobility and care. It pays for wheelchairs, scooters and cars, walking sticks, taxi costs for those that cannot drive, and also pays for the expense of getting someone to care, lost income, pays for more food that a disabled person can actually access, e.g. pre-prepared meals or ready peeled and chopped vegetables.

“Yet, astonishingly, the number of people claiming DLA for back pain shot up by more than 80 per cent during the decade.”

There are several problems with this one. First of all, DWP doctors often write “Back pain” as a simple summary for much more complex problems. One person that I spoke to was claiming for Hypermobility type EDS, Dural Ecstasia, rib impingement and nerve damage in hips affecting legs. This means she suffers frequent dislocations, has blinding headaches, can’t move her legs properly, severe pain in hips and… has mild back-ache. The doctor wrote down “Back pain.”

Secondly, many problems with the back seriously affect ability to walk. Crumbling spine, missing vertebrae, fused vertebrae, damaged discs and  trapped sciatic nerves can all prevent a person from walking or make walking intensely painful.

“Furthermore, there was a 250 per cent increase in those getting the benefit for drug and alcohol abuse.”

That favourite of the tabloid newspapers, drugs and alcohol. In many of these cases, drugs and alcohol is a secondary problem and addiction or use of them is a result of a primary health problem. Where NHS medicine is inadequate to treat pain, desperate people may turn to cannabis or drink.  Some of these cases, therefore, might well be misreported as addiction rather than the original problem, or addiction might have become a bigger problem than the original health conditions. I believe it is unfair to look down on these cases as undeserving of help. Someone also commented “I volunteer at a charity, most of whose clients are poly-addicted. Many of them *do* get DLA, but not for the /addiction/ but for, inter alia, collapsed veins, Hep C, HIV, renal failure etc.  Most of them either use street drugs or have a methadone regime, which is meant to wean them off heroin. Alcohol is used either as a replacement when heroin is too expensive/crap quality or because they are street drinkers: the street drinkers along with heroin addicts, are often given diagnoses of severe chronic depression.”

“There was also a 200 per cent rise in the number of people claiming for allergies over the same period.”

There has been a massive increase in allergies full stop. Is it so surprising that people need help with them? We are not given any indication of the actual numbers claiming for allergies, but I suspect the numbers of people so severely affected as to have care needs or mobility problems is low. For example, 1,000 people increasing to 3,000 people would be a 200% increase, but would still only represent a tiny part of the cost of DLA.

“Figures unveiled by the Daily Express earlier this year showed that 19,400 alcoholics and drug addicts claim the mobility component of DLA, which is meant for the severely physically disabled. It also goes to 30,900 people with asthma and 128,300 with back pain.”

I am astonished at the inability of the writer to make the connection between these conditions and severe disability. Drugs and alcohol is given as the primary reason for the claim, but there could be one or many more other health problems that are not reported in the summary, and there could be severe disability as a result of drugs and alcohol. There is also a serious mistake or an outright lie here; DLA is also NOT just for the physically disabled, it covers mental health conditions too if those conditions cause care or mobility needs.

“The handout is paid at different rates depending on how the disability affects the claimant. Many get the higher rate of £51.40 a week, which is meant to be paid to those who have the most severe difficulties walking.”

This is loaded emotive language that implies that higher rate claimants should not be eligible, but gives no reason for this implication.

“Under strict new rules, claimants will get a face-to-face assessment to ensure the benefit goes to the people with the greatest need.”

As face to face assessment already happens as part of the application, it is nothing new. Claiming DLA is already incredibly difficult, as I said at the start of this article. The DWP already sends doctors to assess those who are claiming. The new PIP benefits include a test administered by ATOS Origin instead of a doctor sent by the DWP to people’s homes. (The test is seriously flawed, but that is another article.)

“Disability Living Allowance will be replaced by the Personal Independence Payment. It will remain a non-means tested, non-taxable cash benefit paid to disabled people whether they are in or out of work.”

I am glad that they mentioned that DLA is not an out-of-work benefit. DLA is paid to people whether they are working or not. In both cases, there are extra costs incurred through disability, and DLA pays for these. In many cases, DLA allows the recipient to arrange care and transport for themselves, thus saving the local government from having to provide for these needs. DLA also provides support that allows people to work. In many cases, the loss of DLA would mean dropping out of paid employment, new requirements for care provision paid for by the local authorities, or both.

“A source close to the reforms said: “There has been a huge increase in cash payouts for things like back pain over the past decade and too often people are left on benefits without further contact with the department. We are going to bring in a new assessment and ­regular checks to make sure support is getting to those who need it.”

I am worried by this “source close to the reforms.” We are not told where this information has come from, and yet it has appeared in several newspapers at the same time. I have been unable to find a press release that correlates to this information, and therefore I must assume that the figures have been leaked to chosen newspapers with a particular political agenda in mind.

Finally, I should also point out that there are indeed people who are left on DLA without further checks. These are people with missing body parts, permanent deformities, degenerative diseases, and worse. They are NEVER going to get better. They will probably get worse. What point is there in dragging these people through more assessments which will often damage their health further and cause severe stress and worry?

 

Original Stories

The Daily Express: Anger as disability benefit claimants soar by one million

The Sun: Allergic to work

The Telegraph: Numbers paid benefits after claiming to be hyperactive rockets

Daily Mail: Drink and drug addicts on disability benefits soars by 250% in a decade to almost 23,000

Related blog posts

My dad, working through the pain

The benefit claims ordeal

Invisible illness, invisible benefits

Diary of a benefit scrounger: ESA assessments pushing mentally ill to suicide.

Existing on benefits

People on benefits? They’re all scroungers aren’t they?

Compare and contrast

 

 

 

 

 

 

It’s all go! (Personal Update)

Moving home. It’s suddenly happening.

We were supposed to move out of our current flat by the end of last month, but despite our astonishment at being allocated a flat within two months, (I was rated priority Gold Plus by the housing association) we haven’t actually been allowed to move in yet because quite a lot of work had to be done to clear up after the last tenants. Our landlord and letting agency have been rubbish about this, grudgingly agreeing to let us stay an extra week but demanding that we hand over the keys at 8am on Monday the 6th. The housing association called today to say they can give us the keys to the new flat on Monday afternoon. They still haven’t fixed the boiler because the parts won’t arrive until the end of next week, but we can move in if we accept that there is no hot water.

Since then we’ve been rushing and stressing and trying to organise everything. The house movers are booked for Tuesday. I’ve ordered a cooker and a washing machine, expecting delivery on Wednesday, only to find out that they’re actually coming a week on Wednesday! These ones are still £120 cheaper than any other supplier though, so we’re sticking with it. So in our first week there we will have hot water only from the kettle and the electric shower, and will have to cook using the microwave, slow cooker and maybe camping cookers, and can’t wash any clothes. We might as well be camping!

Right, I have to go and contact lots of people to tell them that we are moving. And to magically find some energy to get through this.

 

 

 

The story of my mental health

I had tried to write this story in just 250 words for a specific purpose. Since I utterly failed to keep the word count down, I am posting it here instead.

As someone who has suffered for years with ME, migraines and more recently, diabetes, I have been asked if I am depressed more times than I can remember. As my GP said to me a few years a go when I answered that I wasn’t depressed; “Why not?”

In 2008 I moved house and ended up with a new GP. This GP seemed convinced that my ME was actually a mental illness (The world health organisation says it is a physical, neurological illness) and referred me for a mental health assessment. After a nice discussion the psychiatrist assured me that I was sane, and suggested that I find a new GP.

Things changed in 2010 as surgery and flu left me in bed for the second half of the year, leading to an ME relapse at the end of the year. My illness contributed directly to the decline of the family business that I had set up a year previously, and by Christmas I was not only severely ill with my ME but also became suicidal. As I lay in bed on Christmas Eve I came extremely close to going outside in sub-zero temperatures and going to sleep in the snow with no intention of waking up. I did not realise at the time that I was depressed, but my wife did.

Once back home ME kept me in bed solidly for the next six weeks. I hid my depression, but spent much of the time staring at the wall or at twitter as it scrolled past, not thinking at all. Then through talking to people on twitter I realised that I had to do something about my depression. I began to talk about what I was going through. My wife was extremely supportive when she was at home, but I often had bad points when she was out at work or was asleep. At my worst points of despair I received messages of support from my friends online, and it was only those messages which prevented me from trying to kill myself.  Encouraged by my wife and my online friends, I talked to my doctor in March. She was very sympathetic and she started me on anti-depressants. Four weeks later I reported that I had got worse, and changed to a different anti-depressant. Part of the reason for my worsening is that I have been going through some serious problems with my business, housing and benefits. A major contributor to my depression at this point was problems with applying for ESA and filling in the ESA50 form. Since then we have found a house through the local housing association, and I have managed (I think) to sort out my ESA claim with the help of Worcester DIAL.

Another four weeks later and I have switched to a stronger anti-depressant and have been referred for a mental health assessment, which will take place in two weeks time. Altogether it was two weeks from my referral before I received an appointment with the psychiatrist, and four weeks until the appointment, which I don’t think is a terrible waiting time. I was very pleased to find that the person who called me to make this appointment also offered help with finding a house and applying for benefit, although this help was too late.

The DWP and my benefit applications have been a major contributor to my continued depression. My family, friends online and off, and the NHS, on the other hand, have all been excellent and supportive. I know from talking to others that I am very fortunate to be able to say that.

Gender identity

What defines gender? Whether you have XX or XY chromosomes? The physical manifestation that your genitals and internal organs take? Your sexuality and who you are sexually attracted to? (And their gender!) Is it the way that your brain works? The games that you played and the toys that you played with as a child?

The concept of gender identity has been in the news this week because of a couple in Canada that are refusing to tell anyone the sex of their child. You can read the original story here: Parents keep child’s gender secret. The couple have called the baby “Storm” and announced “We’ve decided not to share Storm’s sex for now — a tribute to freedom and choice in place of limitation, a stand up to what the world could become in Storm’s lifetime (a more progressive place? …).” As the baby’s mother later explained, they have a 5 year old boy called Jazz who does not fit the stereotype for his gender. “Jazz’s love of colour (especially pink) and fabric (especially dresses) continued, and he wanted to grow his hair. The older he became, the more he met with pressure from peers and adults to “act more like a boy.” (From The Star: ‘Genderless’ baby’s mother responds to media frenzy)

It seems that the baby’s parents want to keep the sex of their child secret to allow their child to make choices about gender for itself without pressure from people around it.

As you can see in the paragraph above, I have had to use the word “itself” and modify my language to refer to a child without knowing its sex. This, I think, is reason enough alone for the fact that the first question asked about every child is “Is it a boy or a girl?” The fact is, without knowing this, the English language does not allow proper conversation about the child! We feel uncomfortable using the word ‘it’ but we cannot use ‘he’ or ‘she’ without knowing sex.

In fact, a slight controversy was stirred up by FHM magazine yesterday. It seems that they have included a man in their “100 Sexiest Women in the World” this year. (Telegraph: FHM names Andrej Pejic 98th sexiest ‘woman’ in the world) Andrej Pejic is an androgynous model who appears in men’s or women’s clothing to suit what the fashion industry wants at the time. Unfortunately FHM didn’t seem particularly enlightened in dealing with this situation, refering to Andrej as a ‘thing’ in their write-up. (Styleite: Andrej Pejic Called A ‘Thing’ By FHMMagazine)

Gender identity is not a straightforward issue. As I alluded in my opening paragraph, biological sex is difficult to determine and the results of checking chromosomes might be different from checking genitals. Sex can be confused, neither one nor the other, or perhaps both.  Typically women have two X chromosomes, while men have one X and one Y chromosome. Kleinfelters syndrome may leave a person with both two X chromosomes and a Y chromosome. Swyer syndrome, or XY gonadal dysgenesis, results in a person that looks female, but has male chromosomes. de la Chapelle syndrome results in a person with female XX chromosomes but with male genitals. Chromosomes are obviously only a rough guide to sex, and even less of a guide to gender identity.

Historically, however, it is only the type of genitals that have been taken into account to determine biological sex and gender identity. This is woefully lacking as a method of working out whether someone is male, female or other. Take, for example, runner Caster Semenya. There was a controversy in 2009 because she was competing in the womens races, but she was accused of being a man because she didn’t look feminine enough. After a number of tests, she was found to have no ovaries, but she did apparently have testes, albeit small and hidden internally. (Sydney Daily Telegraph: Runner has no ovaries: report) We have not been told the results of final tests made. Semenya has lived as a woman all her life and I do not think she had any reason to think she should live otherwise.

Another well-known case is that of David Reimer. This is a tragic story of a boy who was reassigned to live and grow up as a girl following an accident during circumcision. His penis was destroyed and his parents and doctors made the decision to remove his testes too and raise him as a woman. Despite being given female hormones and made to wear girls clothing, he always identified as a man, and began living as a man at the age of fifteen. He killed himself at the age of thirty-eight.

Going back to the case of Storm, then, the child of unknown sex, are Storm’s parents doing the right thing? I personally think not. I can understand the logic that a person must be allowed to find their own gender, but I don’t think that this is the best way in our society. So many aspects of life require knowledge of sex; toilets are seperated by sex. Clothing is determined by sex. Sometimes classes at school are split by sex. Even the language we speak relies on knowledge of sex.

Certainly it is a vast never-ending problem for people to re-assign their gender later in life. Although we have positive examples such as some governments now making allowances for transgender people to travel and to have a passport with their new identity, a large chunk of the world persecute trans people and make life hell for them. From something as simple as which toilets they are allowed to use, up to problems with getting married. In Texas lawmakers are trying to overturn the rights of transgender people to marry. (Huffington Post: Texas May Strip Away Transgender Marriage Rights.) A person may also be trapped by their social group, religion or culture and unable to reassign their gender.

I think that Storm’s parents would do better to raise Storm as a boy or a girl all while making it clear that whatever Storm turns out to be, there will be parental love and support. What do you think?

ESA assessments pushing mentally ill to suicide

I wanted to write something about this myself, but Sue Marsh from Diary of a Benefit Scrounger has said it far better than I could and so I repost her article here with her permission.


Isn’t it an awful thing when you know all about something terrible, but at the same time you know you’re at least a year or two ahead of general opinion?

Regular readers will know my endless horror at the system of “assessment” in place to now determine whether or not someone is “Fit for Work”.

Run by ATOS, a private company charged with making impersonal decisions, the system uses a computerised, tick box questionnaire of just 15 questions that take no account of variable conditions, no account of consultant or GP based evidence and no account of pain or most symptoms.

Today, the Chief Executives of the most prominent mental health charities in the country have published an open letter in the Guardian, begging the government to halt the deeply flawed scheme because it is costing lives. They are not advising or asking, they are begging.

They rightly point out that “invisible” illnesses are woefully let down in the current system and this includes not just those with mental health problems, but also those with long term variable illnesses such as MS, heart disease, cancer or bowel disease.

In a recent survey, Mind found that an enormous 95% of respondents don’t think that they will be believed at assessment. Evidence abounds of mentally ill people being found “fit for work” simply because they manage to turn up at the assessment centre dressed and washed.

But the most shocking, disgusting shameful part of the accompanying article comes at the end. In a quote from the government, we are assured that

“In consultation with charities including Mind, Professor Harrington is now looking at the way mental health is assessed in the work capability assessment and we look forward to receiving his recommendations later this year.”

How dare they carry on with this until these problems are resolved? How dare they continue to roll out a programme that is costing lives and will claim many more? Why is my blog constantly repeating these points to a society willing to turn away?

Some days I write and I think “Am I the one who’s wrong? Am I the one over-reacting?” and there’s a kind of comfort to that. When the Chief Executives of the nation’s charities are reduced to begging in even stronger terms than I have dared to use, I feel a little desperate.

It’s not just me and http://thebrokenofbritain.blogspot.com/ and the blogosphere and the Guardian shouting about this issue, it’s Scope and Rethink and Mind and even the Professor who designed the system itself.

It must be stopped now, today. These problems must be solved before 1.8 millionmore people are put through this kind of harassment and driven to these levels of despair.

There is clear evidence that Work Capability Assessments for the sick and disabled are costing lives. Please help us to stop it.

** Write to your MP about this by clicking on this link http://www.theyworkforyou.com/ . It will only take two or three minutes, but the Welfare Reform Bill is on the verge of passing through parliament and into the Lords. We simply must stop this and the time-limiting of ESA before it does. The introduction of PIPs as a replacement for DLA must also be halted until further evidence is gathered. If you don’t know what to say, feel free to use anything from my blog – Welfare reform that must not go Ahead is a good summary of the situation.

Beg them. Really plead with them to listen, before it’s too late.