Saturday 12 July 2014

Assisted Dying Bill in the House of Lords

Recently a panel of nine Supreme Court Justices (the UK’s highest court) turned down a challenge to the status quo on the ‘right to die’ brought by the widow of Tony Nicklinson – the “locked-in syndrome” sufferer who fought a long campaign for assisted suicide – and Paul Lamb, another severely disabled man.

But, in a highly significant intervention, Lord Neuberger, the court’s president, said that they were doing so partly “to enable Parliament to consider the position”. He continued that if MPs and peers do not give serious consideration to legalizing assisted suicide there is a “real prospect” a future legal challenge would succeed.

At the same time, on June 5 there was the first reading of the “Assisted Dying Bill” in the House of Lords proposed by Lord Falconer of Thoroton (a former Labour Cabinet Minister). This was a formality and merely starts the process: the debate will be on July 18. In summary this is to Enable competent adults who are terminally ill to be provided at their request with specified assistance to end their own life; and for connected purposes.”

In effect this would enable terminally ill patients deemed to have no more than six months to live to be prescribed a fatal dose of drugs and is apparently largely modeled on a system operating in the US state of Oregon. The Bill will require patients to demonstrate that they have reached a “clear and settled intention” to end their life.

Clearly there are good arguments on both sides and it is unlikely that a way forward will be found that will answer them all.  Interestingly the former Archbishop of Canterbury, George Carey, has spoken out in favour of the bill saying “promoting anguish and pain, the very opposite of a Christian message of hope”. The current incumbent disagrees. It isn’t an easy subject but has to be debated.

One can only look at personal experience. My mother had cancer over many years: it was a bone cancer and she suffered a great deal of pain on a daily basis. Whether pain control is better these days (she died 30 years ago) I don’t know but it wasn’t then. She was remarkably brave and even stoic and lived life to the fullest extent possible. However, having suffered many of those dark moments when the pain was almost unbearable her greatest fear was dying in pain. 

Some months before she died, she told me that her GP had assured her that if, at some point, the pain became unendurable he would ensure she had the means to take her life. (I wouldn’t write this if both parties were still alive.)  At the time I didn’t believe that he would and wouldn’t have minded had he done so. The thought that she had the control gave her the courage to continue. She died peacefully of kidney failure so it was never tested. I never asked him the question because he would not have been able to give me the answer “yes”.

Wednesday 9 July 2014

I remember exactly where I was on July 7 2005

Iain Dale posed the question in his blog about where he was on July 7, 2005 when London suffered multiple bomb attacks on our transport system. He was prompted by the disgraceful defacing of the memorial to the victims the night before the memorial ceremony.

I remember very clearly exactly where I was: I was on the underground having just left my local station, rather later than usual, as I was going directly to a meeting out of the office.  By the time I got to the next station, still over-ground, I received a call from the office to say that there had been an explosion and they were closing stations but no one knew what had happened.

This triggered our crisis management plan – something you have and hope you never need! I don’t think that my train went any further but I was off it and on my way back home as it made more sense to be contactable. Within 30 minutes we had contacted every single member of staff.  Some were at out of office meetings, some on their way to work.  The transport system had closed down and some hardy souls walked several miles to work. Another was in lock-down at a seminar at the British Medical Association – not far from where the bus bomb had exploded.

News was confused: once we had assured ourselves that everyone was accounted for, colleagues were encouraged to assure themselves that friends and family were OK and then plans were made to get everyone home. No trivial thing as the transport system was shut down. People stayed with friends who lived close and some walked several miles home and where possible got taxis.  How much worse it would have been without the internet and mobile phones. You can read about it here.

Someone who worked in the security service once reminded me – they have to stop the terrorists every time, the terrorists only have to succeed once. So I won’t mind some extra security at the airport....

Tuesday 8 July 2014

Women are making progress in the corporate boardroom but what about sport?

Perfect timing, in the middle of wall-to-wall sport this summer (with little success from cricket, football and rugby.....) Women on Boards launched its “Gender Balance in Global Sport Report. 

I will not rehearse the common issues surrounding the lack of media coverage given to women’s sport; the difficulty of obtaining sponsorship and support, etc as others deal them with better than I can.

This report addresses the lack of female representation on governing boards be they international or national and the lack of governance. We only have to look at the shenanigans surrounding FIFA to see this in action. 

If we are to motivate our girls and young women to participate in sport at all levels they need to see the leadership coming from the top: there is nothing like a role model to inspire. I have written about gender equality in business before – particularly at a senior level - but this report neatly encapsulates how unbalanced the equation is at the top levels of sports administration.

The London 2012 Olympics had the highest participation by female athletes (44.2 per cent of the athletes who competed) yet there are few National Olympic or Commonwealth organising committees or sports federations where more than 30 per cent of board members are female, and the average is closer to, or below, 20 per cent.

If businesses are boasting about their gender balanced policies and their good governance - perhaps they need to be challenged about enquiring a bit more deeply about how balanced the organisations they sponsor are and look at their governance? My experience in charity/business partnerships is that they look very closely as to how your governance and ethics mesh with theirs.  They need to look beyond the corporate hospitality box in sport.

Have a look at the report – free to download from their website under “Featured Reports”  Women on Boards - report

Friday 4 July 2014

Complementary therapies – should you tell your doctor?

Billions are spent annually on complementary and alternative medicines (CAM) -  vitamins, herbal remedies, homeopathy etc.  These may be prescribed by a so-called health practitioner (I use this term advisedly as there is no equivalent of the medical register so there is no regulation) or self-medicated. Most of them are harmless (and probably useless) but some can be harmful, especially when combined with other medication.

I attended a presentation at the American Society of Clinical Oncology (ASCO) meeting in the USA a few years back where scientists from Sloane Kettering and the Mayo Clinic presented research on CAM: hard-headed scientific research some of which proved efficacy but most didn’t. They gave a statistic that 70% of patients being treated for cancer were taking some form of CAM – this could be as simple as vitamin C or as complicated as Black Cohosh – the latter could have interactions with common treatments for breast cancer. What was worrying was that the majority of patients did not tell their doctor because they were afraid of being disparaged or being told to stop. The former is real but the latter is irrational – if there is evidence (and I repeat evidence) that this will negatively impact a proven treatment, why wouldn’t you stop?

I was reminded of this by a recent blog by Professor Edzard Ernst. He is never afraid of controversy and has had run-ins with various branches of the CAM industry and people in high places..... read the link above. However, he is always worth reading – his research focuses “on the critical evaluation of all aspects of alternative medicine. Unlike most of my colleagues, I do not aim to promote this or that therapy, my goal is to provide objective evidence and reliable information.”

The article is What consumers should know about potentially dangerous interactions with St Johns Wort .  This is also covered in the Sloane Kettering database. Just because it is “natural” doesn’t mean it can’t harm you. Many of our current drugs originate from plants – digitalis (from foxglove) may be a useful drug but wrongly used it will kill you. *

The problem with researching CAM is that you can’t always account for the placebo effect and some trials use CAM without a control group. Just doing something, no matter what, might impact how you feel and we still don’t know enough about how what goes on in our brain affects the working of our body. 

I can be as irrational as the next person though (surely not?) – if I feel the symptoms of a cold, sore throat etc I immediately start taking Vitamin C, even though there is no evidence to show it is effective. It tastes OK and will be excreted if surplus to requirements and I haven’t had a cold in years – probably more due to the fact that I don’t travel on the Underground in the rush hour on a daily basis any more.....

* you should probably also know that humans should not eat the liver of the polar bear – the concentration of vitamin A is so high that it is dangerous.  The Inuit know that......

Tuesday 1 July 2014

My doctor should have known....

There was recent press coverage of a possible plan to name and shame GPs who repeatedly fail to spot the signs of cancer in their patients or patients have to make repeated visits before being referred for tests.  Here is the article that was in the Daily Telegraph

I am very ambivalent about this: I do know (anecdotally) of friends who subsequently were found to have cancer or other serious illnesses, but who had been fobbed off by their doctors. When I was involved in a medical research charity we would hear regular reports.  But no one ever told us about how good their doctor was or how quickly they were referred because that was an expectation and not news.  I am also reminded that my own GP (now retired) told me that in 20 years of practice she had only had two patients come to her with symptoms that proved to be breast cancer – she had many patients with the disease who had been picked up through the screening programme.  Also, what this doesn’t take into account are the people who delay and delay going to the doctor with a worrying symptom.

Many years ago I sat on a disciplinary panel for GP’s who had had a complaint referred.  One was from a woman who complained that when she went to the doctor with a lump in the breast, the doctor told her she couldn’t feel anything but to come back in two weeks.  When she came back the doctor said that she still couldn’t feel anything but referred her immediately. She proved to have breast cancer and the doctor had acted perfectly properly – lumps can come and go and two weeks is not a delay.

The second was from a patient who had visited the doctor with a lump.  The doctor had told her it was not cancer and to leave it. She subsequently had to undergo a medical and cancer was found.  The GP’s rationale was that he had once spent six months in a breast clinic so he “knew” so didn’t need to refer her.

Cancer is not always easy to diagnose and I would rather be safe than sorry so I do feel strongly that doctors need to eliminate the worst case first, especially with symptoms that are troublesome but perhaps not specific. We know that, for example, ovarian or pancreatic cancer can have different symptoms, not always clear cut and I would rather they were eliminated before a series of treatments were prescribed for, say, irritable bowel syndrome or constipation.

Will red-flagging a practice on a web-site help – I am not sure and the people least likely to be referred are often the ones less likely to do the online research.