So this is the wonderful NHS that so many people are so keen to defend is it? Nearly one in six diagnoses incorrect suggests to me a systematic problem.

If I did my job that badly people would die. Ah, yes, well I am sure they are dying in this case. No-one seems to care though, at least not those that matter. The fact is that if I did my job that badly I would be sacked well before people did die, but then I work in a heavily-regulated industry in the private sector, not in the shielded and unaccountable public sector.

Andy Burnham has written a ridiculous article called ‘Defending the N in NHS’ for the Guardian. Personally I think we should defend the ‘H’ and the ‘S’ in NHS; screw the ‘N’.

In today’s Spectator Coffeehouse David Blackburn writes a well-considered attack on Andy Burnham’s Guardian article. I would go far further than Mr Blackburn. I think that the piece shows Andy Burnham is deluded or dishonest at best, seriously detached from reality at worst. He writes,

“…the Tories would scrap Labour's three flagship waiting targets: 18 weeks, four-hour A&E and the two-week cancer target. Removal of these … would inevitably see a loss of public accountability and a return to postcode variation”

Forget that waiting four hours in A&E is not really acceptable, and read the letters page in today’s Telegraph. From Mr William Standish of Ormskirk,

“… referred by my GP to be investigated for possible prostate cancer … the earliest date available being five weeks later. I then went on holiday to France.

…

When we arrived home there were three letters. The first cancelled my June appointment. The second gave a July appointment. The third cancelled the July appointment. Three weeks later, I received a fourth letter saying I had to apply all over again to get an appointment”

So I suspect that Mr Standish, for one, is unlikely to be concerned about the removal of the two-week target. It does not appear to have done him any good. Public accountability seems to be conspicuous by its absence, and unless patients in all areas have to wait over two months for an appointment (rather defeating the object of a two-week target) the postcode variation never quite went away.

Of course a single case does not show a universal standard, but it does show that nothing else can be a universal standard. The only point to Mr Burnham’s great concentration on the ‘N’, apart from socialist dogma, is to get consistent standards for everyone. So this one case does show that Mr Burnham is deluded or dishonest.

Iain Dale pointed out on Friday that Andy Burnham was claiming the NHS had no waiting lists. Mr Dale also pointed out that this delusion was a bigger story than anything Daniel Hannan could say. Unfortunately the press never quite got the hang of treating Labour as the government, or holding them to even the same standards as the Conservatives.

There has been a huge fuss in parts of the US left-wing blogosphere and commentariat after a dumb comment in Investor’s Business Daily, suggesting that Stephen Hawking would not have survived under the NHS. For those Americans not especially familiar with scientific academia it is an understandable error – he ‘speaks’, after all, with an American accent (which he chose to keep when offered a new English-accented speech synthesiser, as he by then identified with that voice).

It seems some of the howling criticism is far more flawed than the original article, which at least had a valid point despite the erroneous example.

Hawking himself, an old leftie, makes a ridiculously claim that he “... wouldn’t be here today if it were not for the NHS”, but no apparent attempt to justify that assumption.

Ezra Klein claims that the IBD was telling lies, a truly inane suggestion; if they had known Hawking was British then they would never have published the article. It is not as if there was any chance of the error slipping by unnoticed!

Yes, the article does over-simplify the calculation NICE makes of the value of extended life or improvement in quality of life. However nuanced it might be, that calculation is still made, and the monetary figure given is roughly correct. The inclusion or exclusion of nursing care is irrelevant to those whose life (or quality of life) is dependent on drugs or surgery, and they pay the same into the system. Who is to say they should suffer?

The wonderfully-named (and it appears otherwise sensible) Donklephant* suggests that talk of rationing is an intellectually-bankrupt scare tactic. Here is where my tale is told.

I was earning in total roughly £4-6000 below average wage (depending on weather, luck and economics). I was employed part-time, paid for time I worked, so I could also work self-employed in other capacities. Therefore I was only paid as and when I worked, and simply could not afford to take time off.

I hurt my back. I could not physically work more than an hour or two in my employment, and legally was unable to work at all in the role I was hired for self-employed. I had a choice, which was to wait six weeks to see a consultant, then an indeterminate time (by previous experience a modest three weeks in that area of the country, but no guarantee) for physiotherapy, or pay for a consultation and physio, a total the thick end of £500, which I did not have spare.

Of course I paid; what did you think, I could afford to drop my pay by 70% for a couple of months?

What is that but rationing? Waiting is still rationing, whether the patients rationed out of play recover without treatment, give up and accept chronic illness, pay for private care or die. That is still rationing.

The final insult was the VAT on part of my bill (I needed an assessment to prove I could do my job, and although treatment is VAT-free that was not), 17.5% going to pay for people paid more than I to receive healthcare I could not have.

This might be only one example, but in order to destroy the entire left-wing basis of the NHS there is only need of one counter-example. How can anyone possibly justify charging me tax to pay for the NHS under those circumstances?

*Donkey = Democrat, Elephant = Republican, for those less familiar with US politics.

Update: the Telegraph has an excellent article on the NHS with reference to US healthcare.

Suicide is not the intended effect of giving up smoking. Nor is committing the perfect murder.

My apologies for the long post. I felt that some background was needed, but there is a serious point at the end which I have not seen documented anywhere else.

Champix (or Chantix in the USA) is the trade name of varenicline. It is intended as an aid to stopping smoking, and is available on the NHS. Of course like any medical treatment it has side effects. Could those side effects lead to serious violence?

With the authoritarian stamp of the smoking ban and other government pressure there are a lot of people trying to give up smoking. There is also an increasing medicalisation of attempts to give up. Every other advert on our local radio station seems to be for the Stop Smoking Service. Fortunately Pirate FM rarely manages to finish an advert without interrupting it with the start (or even the middle) of another. Has anti-smoking political pressure allowed an unsafe drug on the market?

Varenicline is the first drug to be licensed to help stop smoking that doesn’t contain nicotine. The manufacturer, Pfizer, quotes that after twelve weeks of treatment with Champix or an inert placebo four times as many of those taking Champix are still not smoking. The figures at twelve weeks are 44% of those taking the real drug not smoking and 11% of those on the placebo. This is better than none-medical methods or nicotine-replacement therapy (NRT).

Here is where I follow Pfizer’s publicity off the path of good science, because they don’t quote figures that I can find, and I am quoting non-specifics without being able to provide a reference, as I heard this on Radio 4 some days ago. I looked in the NICE Report (National Institute for Clinical Excellence) and they have blanked out the figures.

Pfizer boasts about rates of success giving up at 12 weeks, and these are better than NRT. The problem is that giving up for 3 months does not provide great health benefits. The suggestion I heard on the radio, although the figures are redacted from the table 5, page 32 of the NICE report (lovely word, redacted; has a ring of dishonesty about it) was that at twelve months the success of Champix was almost identical to NRT, certainly within the statistical errors of the trials.

So we have a drug that is as effective as NRT. I have never smoked, but from friends I am aware that NRT can be unpleasant and quitting can be difficult, so an alternative is surely welcome, is it not? Well let us look again at the side effects.

Side effects listed as common include dizziness and hypertension, either of which can themselves be dangerous in some circumstances. However that is within the normal range of side effects of many medicines. Also listed as a common side effect is ‘emotional disorder’. The point made on Radio 4 and in the side effects link was that this can go as far as depressed moods and suicidal ‘ideation’, i.e. feeling down and having thoughts about suicide, a combination that seems to me rather dangerous.

So far this is an accepted, documented problem. Careful monitoring and warnings to patients to see a doctor or stop taking the medication at the first sign of depression or suicidal thoughts can deal with this. What about the undocumented effects? Could Champix lead to murder?

There is nothing I can find in the literature beyond warnings of ‘behavioural changes, depression, or suicidal ideation’. Even these do not get a mention in Pfizer’s adverts, although warnings against operating machinery do and all the information is on the website.

I think that “I wanted to kill ’im”, to quote a friend who was taking Champix, goes a bit beyond the usual understanding of ‘behavioural changes’. A mild and pleasant young lady, very fond of her lover, was driven to thoughts about killing him, and a desire to do so.

Of course this is more bad science, anecdotal evidence, but as I do not have the authority or capacity to do better science it will have to do. This friend had never had such thoughts before taking Champix, nor has she since giving up in fright. She was on no other medication likely to have this effect, and had no expectation of a reaction that might cause a placebo effect. Champix warnings do suggest psychological changes, and the friend said that she suffered others, being in a daze much of the time. In fact she attributes her giving up entirely to forgetting to smoke, such was the influence of the drug (of course that means the drug succeeded, as an addict would be unlikely to forget even then).

So what if my friend had killed her lover? Beyond the distress to her and others, she would have been given a life sentence, as this is not an acknowledged side effect. Her life would have been ruined. What if she had not been a pleasant person in love with her paramour, and clever enough to recognise the responsibility of the drug for her thoughts? What if such feelings are induced in a self-centred, unintelligent but otherwise harmless person? Thousands of them smoke. Will any be induced to murder?

As more is known about the drug, and this effect, if real, is documented the drug becomes a serious danger. What is to stop any smoker bored of someone close to them from starting a course of Champix, then in cold blood murdering that person? In court the murderer breaks down in remorse, blaming the medication. Manslaughter while the balance of mind disturbed milord, now given up the medication, no longer a threat. Free to go. So we are where I hinted that we would reach; the perfect murder.

Fortunately my other half cannot take Champix, due to her job, so I am safe!

Update: Mark (whose profile indicates he is interested in "smoking cessation") confirms in the comments that both Champix and NRT have overall success around 7%. Also in the comments generalsn has a link to a brief article on a financial website which does mention FDA concerns over violence in people taking the drug.