Belatedly, I joined the craze and had a go on one of my friend's Wii games the other weekend. Terrific stuff: I played the golf, tennis, ten-pin bowling and shooter games. Bloody marvellous. You do need to get a large-enough television to make it work; unfortunately, I don't really want to mess up my sitting room by putting a huge plasma screen on the wall, but some of my friends seem to be less squeamish.

The main downside, I find, is that if you are playing this game and have not stretched and warmed up properly first, you can actually do a bit of damage. The next morning, when I woke up, the left side of my back was quite painful. This is what happens to a 41-year-old wealth management geek who has not spent enough time doing sport for real. Time to turn off the technology and put on the training shoes.

A link to some Wii-related injuries. I wait for the first politician to try and bleat about the "Wii menace".

William H. Stoddard of San Diego, California has some interesting commentary on the state of the debate between Clinton and Obama on what they want for US health care policy

Health care policy is a major issue in the Democratic Party's choice of a presidential candidate. The final debate between Hillary Clinton and Barack Obama, in Ohio, spent a reported 15 minutes on it. Yet the mainstream news media in the United States consistently report that there are only very minor differences between the positions of the two candidates. Given this, the argument looks like little more than semantic quibbling over the meaning of the word "universal," all too typical of Clinton's struggle to contest Obama's unexpected rivalry for the nomination.

But the mainstream news media have it wrong. There is, in fact, a vitally important difference between the two positions, though one that their worldview makes them ill equipped to recognize. The difference is that Clinton would compel everyone to purchase health insurance; Obama would not. The standard label for this difference in health policy debates is "mandate," for what Clinton wants.

Clinton has been evasive about exactly how she would compel the purchase of insurance - which is not surprising, as talking about punishing voters is not a good selling point in an election. The state of Massachusetts, which has a mandate, imposes fines on adults who do not have health insurance. Clinton has not talked about fines, but has suggested garnishing wages or making enrollment compulsory on admission to any hospital.

Of course, Clinton promises to make health insurance affordable to everyone, through subsidies and through massive new regulation of the insurance industry. So does Obama. But what if their plans do not work out? Under Obama's plan, adults who thought even subsidized health insurance cost more than they could pay would remain uninsured, and at least be no worse off. Under Clinton's plan, they would be forced to sign up, or penalized for not doing so - and either way they would be hurt. And given that Clinton predicts that fifteen million Americans would remain uncovered under Obama's voluntary plan, it seems that she anticipates that fifteen million people would have to be hurt financially to make her plan viable - or, perhaps, simply to justify her in calling it "universal."

Obama, in fact, has fairly clearly called attention to this difference. In the debate, he said, "We still do not know how Senator Clinton intends to enforce a mandate, and if we don’t know the level of subsidies that she’s going to provide, then you can have a situation, which we are seeing right now in the state of Massachusetts, where people are being fined for not having purchased health care but choose to accept the fine because they still can’t afford it, even with the subsidies..."

For libertarians, of course, which plan is less bad is a fairly straightforward question: the one that allows a measure of free choice is a lesser evil than the one based on coercive social engineering. And a non-trivial part of the electorate may feel the same way; where hard-core Democrats often favour Clinton's views, independent voters are reported as less supportive of mandates.

But there are hard questions about mandates even from the perspective of the Democratic Party itself. On one hand, people between fifty and sixty-five (where Medicare comes into effect) consume substantially more health services than younger people. Younger people are more likely to decide their low health risks do not justify paying for insurance. So forced enrolment would compel many younger people to pay for insurance they would not purchase voluntarily - but the benefit of enlarging the pool and lowering insurance costs would go disproportionately to older people. And on the other hand, those same older people are much more likely to own houses, to have savings and investments, and in general to be able to afford health care. So what Clinton is proposing is a regressive redistribution of wealth, from the worse off to the better off. It is hard to see how this makes sense within the publicly announced ideology of the Democratic Party.

It does make a kind of sense, though, within a different framework - the version of class analysis propounded by the libertarian economist Murray Rothbard, which emphasized conflict between the people who pay for taxes and redistributive schemes, and people who benefit from them.

Who supported the two candidates? Leaving aside the obvious "identity" politics (blacks favoured Obama; women favored Clinton; Hispanics, a group often in conflict with blacks, favoured Clinton), Obama had unusually strong support from younger voters, and Clinton from older voters; that is, Obama from Democrats who would be hurt from Clinton's scheme, and Clinton from Democrats who would profit from it. And Obama was favoured by Democrats with incomes above $100,000 a year, Clinton by Democrats with incomes below $50,000 a year. This is less obvious, but higher income people are more likely to be self-insured (so that forcing them to buy insurance would be to their disadvantage as they see it). So it looks rather as if Obama has managed to put together an insurance proposal that is more favourable to the very people who have been voting for him all along, and Clinton one that similarly appeals to her base. And the conflict between the two is a struggle between net victims and net beneficiaries of Clinton's redistributive scheme.

Whether Clinton and Obama recognize this is not clear. Of course, neither of them discusses such issues in their speeches; they both have to present their ideas as being best for everybody. Health policy theorists certainly do not see any conflict - and most of them favour Clinton's approach. But Obama's statements suggest that he is aware that mandatory health insurance could hurt some of the worst off people in American society; that he thinks this is a bad idea; and that he is prepared to make an issue of it. In a small way, this seems to make him the lesser evil as far as health care is concerned. If nothing else, he does not seem to cherish the idea of forcing everyone into a comprehensive administrative scheme for its own sake, regardless of the cost to the people it claims to help. Health care policy experts seem to feel otherwise - and so does Clinton. This is, of course, the core position of the established Democratic Party, the authoritarian liberal party of American politics. Obama's support might represent a realignment of less authoritarian voters increasingly unhappy with the Republican Party's fall into militarism, theocracy, and big government. The Democrats could only be improved by playing for their continued support.

What is innovation? A difficult question but would this effort modestly fit?

The Inter-Faith Gown is a new hospital gown for patients who would like to be more modestly clothed....

The Problem

Some people may be reluctant to be admitted into hospital due to the revealing nature of traditional patient gowns.

The Solution

The Inter-Faith Gown is designed to preserve the modesty of patients whose culture or religion requires them to be more modestly clothed.

It is made up of five pieces – three head garments, a gown and trousers. These elements can be mixed-and-matched to enable the patient to obtain the required degree of coverage. The sleeves of the gown have elasticated cuffs to cover the patients' arms.

Pictures are added in a tasteful jade green. Is this really what our taxes should be spent on?

This article is in the LA Times titled Doctors balk at request for data:

The state's largest for-profit health insurer is asking California physicians to look for conditions it can use to cancel their new patients' medical coverage. Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," including "pre-existing pregnancies".

Firstly all aspects of medical care, including insurance, are regulated to bits in the United States (especially in California), and it is the government regulations and subsidy programs (such as Medicare and Medicaid - but in recent years SCHIP as well) that are at the root of the high price of medical cover. But to turn to the specific question:

If someone lies about their medical history when filling out a contract, in order to get less expensive medical cover, they are guilty of fraud. In an alternative world, which I am not saying I would support, they would not only be dropped by their insurance company when their fraud was exposed - they would also be prosecuted.

Of course, in our world, they will not be prosecuted and would not be convicted if they were prosecuted. It is much the same with all the political talk about "fraudulent lending" in the mortgage market. There has been vastly more fraudulent borrowing, but I doubt that the vast number of people who lied on their mortgage applications (for example claiming to have an income much greater than they really have) will be prosecuted.

However, in an alternative world (which, again, I am not saying I support) prosecution and conviction would solve the problems of customers guilty of fraud - medical cover and a roof over their heads.

Prison provides both.

Considering how many health-scare news items there are these days, it makes me want to smile in a wry way when I also read about the supposed problems caused by an ageing, greying, population. The first and obvious question is: if we are all at such risk from obesity, drugs, booze, stress, pollution or the angst of watching Jonathan Ross, why are we living so much longer than our parents or grandparents? If this is what happens when the sky is supposedly always about to fall in, then what must a healthy population be like? And yet there is something in the human psyche, or our culture, that rebels against the happy prospect of a longer life. We are told, or at least have until recently accepted, that three-score years and ten is Man's rightful due (perhaps a tad longer for women); it is almost a hangover from religion to believe that it is impious, even blasphemous, to want to live for much longer. Andrew O'Hagan, writing in the Daily Telegraph today in a moan about how the elderly are treated in Britain - a valid subject - makes this point:

Growing old is now considered more of an option than an inevitability, something to beat rather than be resigned to, something that is thought to take away from one's individuality rather than deepen it.

I don't really know how death, or its inevitability, adds to one's individuality. I think I know what O'Hagan is trying to say: We are unique, precisely because we are mortal. We cannot be replaced, or copied.

The trouble, though, is that I don't see how one's uniqueness is somehow reduced by living for 200 years rather than say, 100, or 50, or 30. Were the ancient Romans - average lifespan about 35 - more individualistic and unique than a 21st Century Brit? How on earth can one measure this? Also, the desire to keep the Grim Reaper at bay surely attests to a love of life, not a denial of its value; if one believed in a craven acceptance of the inevitable, then why do we have doctors and hospitals?. I value my life rather a lot and am in no hurry to see my hair go all grey, my face resemble tree bark, and my limbs to seize up. Sorry, Mr O'Hagan, but I'd rather not suffer that fate any time soon. I go to the gym and try to keep fit despite my enjoyment of red wine. I have not signed up for cryonic suspension or anything like that but I keep an eye on life extension research and have been greatly impressed by the work of people such as Aubrey de Grey, among others. (Don't be put off by the immense beard, he's not a nutter). I lost a good friend and intellectual mentor, Chris Tame, nearly two years ago to the horror of bone cancer - he was in his mid-50s - and I am pretty sure this most unique of people could and should have been around for many more decades among us. (I particularly miss his outrageous jokes).

I remain to be convinced of the idea that to value one's life, it must be short, or that we should resign ourselves to it meekly. Meekness did not build the space rocket, the Aston Martin DB9 or even produce modern dental surgery.

Update: Glenn Reynolds has interesting thoughts on this subject. He's been writing on this for some time. Ronald Bailey, whom I met over a year ago during a book tour of London, is also well worth reading on this and related topics. I read this Peter Hamilton novel which touches on rejuvination; it is not one of his best tales, unfortunately (the Amazon.co.uk book reviews are not very flattering).

Via the excellent engadget blog, here is a nifty item to put on the wall for all you health-freaks out there. Perhaps I should strap my arm to one of the controls the next time I read about the Archbishop of Canterbury, the eco-Leninist thoughts of Madeleine Bunting, or watch the English rugby/cricket/football team give up a lead?.

Or maybe I should stop doing all these things for a longer, happier life.

On some, if not all issues, Rod Liddle is a man of sound views. He loathes the nanny state; he is unconvinced that we need to crack down on freedom of speech in order to avoid giving offence to religious groups. He is a patriot. In this week's edition of the Spectator, where other authors rant away splendidly, Liddle rails against the six-month-old government ban on smoking in all public buildings, including privately owned ones (apart from private homes), such as pubs and restaurants. He makes a good case and some of his paragraphs are cheer-out-loud material:

Of course, one shouldn’t drop a policy simply because the pubs are having a rather hard time of it as a result. But in which case, don’t bother to pretend that they’re not, that actually there are queues all down the street consisting of shiny, happy people who wish nothing more than to drink in a new, healthy, smoke-free environment. Stop lying. Say, instead, that the smoke ban is putting pubs out of business but actually we couldn’t give a toss. Truth is, the government — and the health charities — are caught by their previous, gerrymandered poll findings which purported to suggest that the entire country was in favour of a complete ban on smoking everywhere, when — and again, do a quick vox pop if you doubt this — the reverse was true. People would like to see genuinely smoke-free areas of restaurants and pubs, for sure — but only chose a complete ban on smoking when the alternative on the poll sheet was ‘or would you like your testicles sawn off?’.

Or this:

Perhaps it is true, though, that because of the ban, I shall live for ever, for which many thanks, Dawn. But I doubt it; we will have recourse to one or another means of killing ourselves, such as driving a car (4,000 deaths per year), drinking more (40,000 deaths per year) or visiting a doctor (30,000 deaths per year through negligence or incompetence: never forget that figure. It exceeds the numbers killed through smoking-related illness. And it really, really hacks off the doctors).

But as always with Mr Liddle, the carelessness with which he chucks around numbers makes me wonder if any reader will want to get past his first paragraph:

I am still not sure what I hate the most about this government: its decision to invade Iraq and thus either effect or facilitate the murder of 500,000 Iraqis, or its decision to stop me from smoking in pubs and restaurants.

500,000 Iraqis? Is that correct? Liddle gives no source for this or attempts to do so later in the piece. Now Rod may be right to suggest that the overthrow of a power-mad, dangerous dictator was even worse than letting him stay in power (I occasionally wonder why a certain type of right-winger is so indulgent towards evil men like Saddam). But if he is going to make an argument with statistics as part of his core argument, it is probably not a great idea to kick off an argument with a massive figure based on, whatever.

Oh, in case anyone asks, I don't smoke, except on National No Smoking Day.

The European Union has its uses. While rootling around for stuff to link to from CNE Competition, I came across this:

Left-wing Labour MPs are girding themselves for a rebellion over a European Union plan which they say could spell the end of the National Health Service.

When left wing Labour MPs rebel, I at least hope for possible goodness.

The European Commission will publish its health directive next week and it is meant to make it easier for people to travel to get specific medical treatment in another EU country.

Ah, the age-old dilemma of the EUrosceptic. What do you think if the EU imposes something sensible?

British diplomats say that this is NOT the same as making sure that if you fall sick in Slovakia or have an accident in Austria you can get treatment straight away.

When British diplomats say that something is NOT something else, it means that they have been told to say that by their political masters and that the small print of their argument will be about a very small difference. The feathers on the other something will definitely NOT be the exact same colour, but the other something will otherwise waddle and quack in an identical fashion to the original something, and will in fact be just another duck. For "NOT", read " ", in other words.

It is what some people call "health tourism" and both critics and fans say it will allow people to shop around for health care.

Sounds great. So what if it is just a plan to sell Eurostar tickets; I still like it.

In the end, there is nothing like people preferring something else to whatever bogus nirvana is being peddled by the bogus nirvana peddlers. The one argument against the much vaunted Soviet Communist nirvana that the vaunters could never wriggle free from was the fact - for fact it was - that this was a nirvana that millions wanted to escape from, through minefields if need be, and with only the clothes they were wearing at the time of their escape if that was all they could take with them. A similar process is now under way with Britain's similarly vaunted NHS, the best healthcare system in the world except for all the others.

A story on the UK news last night gave statistics on trauma patients. Those are the seriously injured who must be transported from an accident site to a trauma centre. The percentages of trauma patients who die are:

UK - 43%
US - 16%

Draw your own conclusions.

I happened to be near a TV last night and was so stunned by the numbers that I pulled out my clipboard and wrote them down. The news feature also noted that ambulance first responders were insufficiently trained and often did not carry out measures such as clearing air passages. It also discussed the idea of having specialist regional trauma centre's. If any one else was watching last night, their inputs on this TV report and the data behind it are welcome. The only thing I have found so far on the net is this

The smoking ban was a mere tasty morsel. It has roused the appetite of the beast without bedding it back down again. The hungry beast has drawn blood and it wants more:

Government ministers should shrug off media accusations that they are running a nanny state and introduce tougher public health measures, experts say.

The Nuffield Council on Bioethics said the time had come to consider a whole host of interventions in the UK after the introduction of a smoking ban.

Its proposes raising alcohol prices, restricting pub opening hours and better food labelling to fight obesity....

The report by the panel of experts, which include scientists, lawyers and philosophers, said there was a balance to be struck between individual freedom and wider public protection.

Welcome to the latest phase of the old 'public choice' paradigm. You have to choose between freedom and prosperity. You have to choose between freedom and fairness. You have to choose between freedom and safety. And the wheels of the world turn round and round to the music of the rhythm of history.

Okay. let's gird our loins, saddle up and prepare for battle again but, this time, let's make sure that we don't go charging off in the wrong direction. It would be easy to lose this stage of the war and, as always, the odds are stacked against us. But lose we will for sure if attempt to fight it on the enemy's ground and what I mean by that is accepting that there is a such a thing as a choice between freedom and health and then attempting to persuade people to choose freedom and to hell with their health. If the public believes that this is the choice they must make, then they will choose to be healthy and, before we know it, we're standing around scratching our arses and wondering what went wrong while the triumphant, braying beast tramples everything in its path.

We must not make the mistake of arguing that health does not matter. It does matter. As every exhortatory elderly relative has croaked at one time or another, health is the most important thing. But that is exactly why we need more freedom and less compulsion. The healthiest societies are the the most liberal and prosperous ones, while the unhealthiest are invariably the poorest and most statist and centrally planned prescriptions for health will be no more successful than centrally planned prescriptions for the economy. The public must hear, again and again, that the "choice" being presented to them by the likes of the Nuffield Council on Bioethics is vexatious, counterfactual and perverse.

The beast will not stop. It will not change its mind, grow tired, get distracted or give up. The stakes are too high. But that is not the same as saying that it is unstoppable. We just have to make sure that we shoot its legs from under it. Nothing less will do.

Who'd'a thought we'd see two shout-outs to King Canute in as many days in the health care arena? Yet there he is, popping up again in Business Week in the service of opposing more government intervention in health care.

According to legend, King Canute of Denmark facetiously tried to stop the rising tide by simply raising his hand and commanding the waters to roll back. The tide, of course, kept rising. Yet policymakers throughout history have followed Canute's lead. From Hillary Clinton and John Edwards to Mitt Romney and Arnold Schwarzenegger, politicians across the spectrum have tried or vowed to solve America's health-care woes by enacting an individual mandate - a law requiring every adult to purchase health insurance. Despite its bipartisan support, the individual mandate is bad policy, a vain attempt to command a better result while doing nothing to achieve it.

An excellent discussion of the folly of individual mandates follows. Of some interest is the way the estimate of the size of the problem meshes with that made below.

According to an Urban Institute study released in 2003, uncompensated care for the uninsured constitutes less than 3% of all health expenditures. Even if the individual mandate works exactly as planned, that's the effective upper boundary on the mandate's impact.

If you do the math, I think you will find that Mark Steyn's number of the poor uninsured comes out to about 3% of the population.

More importantly, Whitman points out the major flaws in the individual mandate proposal - it would not work (people will still refuse to buy health insurance), and it will make the problem worse by driving costs even higher.

Even now, every state has a list of benefits that any health-insurance policy must cover - from contraception to psychotherapy to chiropractic to hair transplants. All states together have created nearly 1,900 mandated benefits. Of course, more generous benefits make insurance more expensive. A 2007 study estimates existing mandates boost premiums by more than 20%.

If interest groups have found it worthwhile to lobby 50 state legislatures for laws affecting only voluntarily purchased insurance policies, they will surely redouble their efforts to affect the contents of a federally mandated insurance plan. Consequently, even more people will find themselves unable to afford insurance. Others will buy insurance, but only via public subsidies. Isn't that just what the doctor didn't order?

His prescription for incremental policy reform strikes me as being pretty sound, as the fundamental shift that needs to be made in health care insurance is away from first dollar coverage, low deductibles and copays, etc. and toward catastrophic insurance. First dollar coverage has proven to distort if not destroy any semblance of financial responsibility on both sides of the health care transaction, and is one of the primary drivers of high costs. Catastrophic coverage fulfils the true function of insurance - protection against risks you can not afford - without creating the disastrously misaligned incentives that our current system has.

Our theme for today comes from George W Bush: "Freedom is the desire of every human heart."

Whether or not freedom is the desire of every heart, I think it is abundantly clear that most people are indifferent or hostile to their neighbor's freedom, which is why a mere democracy, unencumbered by principles of limited government, is assured of devolving into some sort of Total State in short order. But the inimitable Mr. Steyn is not content with observing that most people think of freedom as "fine for me, but not for thee." No, he has in mind the apparent eagerness of so many to give up their own freedom.

A year ago, I wrote that, "The story of the western world since 1945 is that, invited to choose between freedom and government ‘security,' large numbers of people vote to dump freedom — the freedom to make your own decisions about health care, education, property rights, seat belts and a ton of other stuff."

This is what makes being a small-government libertarian so frustrating. Our patron saint should be King Canute, for it often seems like we are standing on the shore, trying to stop the tide. The reply to Mr. Steyn, if it is not couched in shallow democratism ("we are just giving the people what they want") is usually couched in terms that imply that freedom is not possible, or at least can not be enjoyed, without material security provided by the State. This inversion of real freedom (the freedom of self-ownership) was perhaps best catechized by FDR, the man most responsible for freeing demagogic democracy from the strictures of the constitutional republic, as "freedom from want."

FDR's heir is Hillary Clinton, and she is pushing (again) for nationalized health care in America. The battlecry this time is that there are "45 million uninsured" (or whatever spurious number is trotted out).

My first response is "so what?" Anyone in America can get health care simply by walking into the nearest hospital, as all hospitals are required to give an exam and emergency treatment regardless of ability to pay.

But, as always, one should not let the factual assertions of the advocates of the Total State go unexamined. Mr. Steyn continues:

So, out of 45 million uninsured Americans, nine million aren't American, nine million are insured, 18 million are young and healthy. And the rest of these poor helpless waifs trapped in Uninsured Hell waiting for Hillary to rescue them are, in fact, wealthier than the general population. According to the Census Bureau's August 2006 report on "Income, Poverty and Health Insurance Coverage," 37% of those without health insurance - that's 17 million people - come from households earning more than $50,000. Nineteen percent - 8.7 million people - of those downtrodden paupers crushed by the brutal inequities of capitalism come from households earning more than $75,000.

In other words, if they fall off the roof, they can write a check. Indeed, the so-called "explosion" of the uninsured has been driven almost entirely by wealthy households opting out of health insurance. In the decade after 1995 — i.e., since the last round of coercive health reform — the proportion of the uninsured earning less than 25,000 has fallen by 20% and the proportion earning more than 75 grand has increased by 155%. The story of the last decade is that the poor are getting sucked into the maw of "coverage" and the rich are fleeing it.

At a conference on health law last week, I predicted (only half in jest) that Hillary would be signing the bill nationalizing health care at the beginning of her second term. The more I think about it, the more likely it seems. The tide of the Total State never sleeps.

Edward Paul Brown was a premature baby whose birth and death took place within minutes of each other on February 23rd 2007 in a lavatory in Queen's Hospital, Romford.

Eighteen weeks into her pregnancy, his mother, Catherine Brown, was told that there was no amniotic fluid surrounding the baby in her womb. This meant that the baby's chances of survival were minimal and her own life was threatened. Catherine Brown took the "devastating" decision to abort. Even those (such as I) who generally oppose abortion, will see this as a hard case - and I hope that any comments do not get sidetracked onto that issue.

So. We have a woman in hospital waiting for the procedure that will abort her baby, a child she had wanted to bear and raise. Not a pleasant situation at any time, but what followed next was disconcerting to read about even for those who have grown weary of NHS "war stories".

I first saw this in the Times (Baby's birth and death in lavatory of hospital with no trained staff), but there is a considerably more detailed account in This Is London (Mother forced to give birth alone in toilet of 'flagship' NHS hospital) (A very similar account appeared in the Daily Mail.)

Both headlines understate the peculiarly modern horror of what happened. The reader gets a picture of nurses trying to help, but out of their depth because Queen's Hospital did not at that time have a proper maternity unit. That picture is wrong. The part of it that is wrong is the "trying to help." The nurses declined to help.

This Is London quotes Catherine Brown's mother, Sheila Keeling, who was present as her daughter went into labour:

"I was running around frantically trying to find gas and air for her and pleaded with nurses, who seemed very matter of fact, to assist," she said.

"The staff I did find told me they did not have the training to help. Catherine was left to deliver the baby alone with just me for help before cleaning herself up and going back to bed. It was horrific."

(Emphasis addded.)

Not just could not help, would not. Would not even be present, as far as I can see. Modern nursing has moved on, you know, since the days when the role of the nurse was to hold your hand and wipe the sweat from your brow. They don't do that any more!

What caused these nurses to hang back from offering the ordinary, unskilled comfort that would once have been seen as the heart of their calling? I am tempted to simply blame it on the NHS. Certainly this case is something to set against all those stories we hear from those benighted lands where healthcare is not financed by taxation. Of course I do blame the NHS for the dreary catalogue of delays and mismanagement that Catherine Brown suffered before the birth; the wait for a scan, the further wait for pain relief, and the fact that she had to lie in a mixed sex ward and the fact that they nearly dumped Edward's dead body. But that is old hat. Things were no different a decade and a half ago when I was in labour in another hospital in Essex and the midwife was obliged to run out into the corridor and yell "Where's the fucking obstetrician?" And my would-be epidural man popped his head round the door and announced that he was ready to begin twenty minutes after the birth. I did not hold it against them. It was a difficult day, lots of births happening at the same time. At least they tried. In Queen's Hospital as Catherine Brown crouched over the support bar of a disabled person's lavatory to deliver her doomed child, they felt themselves unqualified to try. More than their jobs were worth.

No, this gutlessness is new, and although I do see it as yet another consequence of the command economy of the National Health Service, to add to the melancholy consequences we knew about already, I seek a more specific explanation as well. One major factor might well be fear of getting sued. Yet that, too, does not wholly explain it. The nurses concerned must have known that their chances of being held personally liable were tiny and they must also have known that the chances of their hospital getting sued for neglect of duty were significant. (None of the reports I have read in the press say whether this happened, although clearly some official inquisition took place and reached the verdict that press has been reporting over the last few days.)

The loss of nerve is not just seen in hospitals. One can see it in the other public services too.

Looking at the fire service, fireman Tam Brown nearly drowned saving a woman's life in the River Tay - and was rewarded by being threatened with disciplinary action by Tayside Fire and Rescue, on the grounds that he had "broken procedure" by entering the water. He was meant to use the correct ropes and poles and since his crew did not have the correct ropes and poles he was meant to watch her die. Possibly he was meant to put the down time to good use by filling in a safety report on the incident. As it happens he not only got away with his archaic belief that that was not what he had joined the fire service to do, but was belatedly praised for it by his superiors - but, make no mistake, as Squander Two says, that will be because of the publicity.

Looking at the police - Julia Pemberton was murdered along with her son by her estranged husband. She called the police as he rampaged with a shotgun through the house. You can read the transcript of her last 999 call here. "Officers are on the way," says the operator. That was moderately close to being true and the fact that the police could not even find the address of a woman whose house they had fitted with a panic button is not really relevant to this post. They got there in the end and saw the son, William, lying on the drive. At this point three unarmed officers vainly but creditably attempted to help him. Guess what? They were breaking procedure. In the words of Julia Drown MP,

However, the irony is that the officers who stand out as having done everything, and more, that the family could have expected from the police, were the ones who breached the police's policy.

What Julia needed was a firearms response, but it was more than one hour after she picked up the phone before the first armed response arrived outside the grounds. Armed units did not enter the house for almost seven hours, despite the fact that no sounds from it had been heard for more than six hours. Instead of going directly to the house, armed units were sent to a remote rendezvous point, and further problems were caused by poor communication among the police. The wrong silver commander was initially called, with the correct one not called for more than an hour after the start of the 999 call. When the silver commander finally arrived, he moved the rendezvous point and did not take command until three hours and 26 minutes after the call started.

During that time, it was not known whether Julia was dead or alive. The police priority was to preserve the lives of officers rather than the lives of victims.

The police did not actually go into the house for hours. Goodness, no. There might have been a violent criminal in there! Probably it made no difference. The victims were already dead. But for all the police knew Julia Pemberton could have been alive but desperately wounded and praying for help. Time was when the ordinary village policeman, unarmed as he was, would have gone in.

Let me say (before someone says it for me) that I do not claim that I would have the courage to go into a house where a killer might lie in wait, or that I would have jumped in the bitter, fast flowing waters of the Tay to save some stupid woman who wanted to top herself. But such were the traditions that were honoured in the police and fire services. In fact, when I talk about "gutlessness" and "loss of nerve" here I am not talking about individual physical courage. Fireman Tam Brown showed great courage. At least three of the policement in the Pemberton murders did as well and all of them showed more guts than I would. But institutional gutlessness surrounded them, was embarrassed by them, and will kill off their like eventually. Poisoned soil does not long give forth good fruit.

Going back to the Queen's Hospital example, I do not have the personal qualities to be a good nurse, though I do think I could have bestirred myself to help in this case, when even standing around being useless because untrained would not have been useless and was clearly what the patient wanted. All the training nurses have these days appears to have trained the initiative and compassion right out.

I keep asking myself why anyone wants the new way?

Perhaps, in the case of those who will not act because unqualified in that speciality, it is a fear of finally having to be the real thing. When your whole life has been one long rehersal the raising of the curtain for the First Night is not always a welcome event. So Nurse Smith listens to the howling through the lavatory door rather than act wrongly and Constable Jones watches the stripy tape flutter around the perimeter of the silent house and waits for the Armed Response Team.

Perhaps, in the case of those who make these regulations, it is a peverted delicacy. Some are offended by the eruption of death or violence into their paper world, by the bloody evidence that not everything is covered by their rules. Below that delicacy, deeper and colder than mere personal malice, is a hatred of efficacy.

How do we get our nerve back?

In his defence of classical liberalism and critique of 20th Century state welfarism, F.A. Hayek argued that one of the dangers of socialised medicine (Michael Moore, please note) is that if health care is not rationed by price and expanded by the freely chosen actions of patients and doctors, then some other means of allocating scarce resources, and making them hopefully less scarce, will be needed. That "other" way is state coercion and control. Because healthcare is delivered in Britain free at the point of use - of course it is not free at all - the individual patient does not directly see the price of the health care he or she receives, such as in the form of an insurance premium. There is no price incentive, therefore, for a person to, say, cut out smoking, cut the beer and the beef burgers, get in shape by frequenting a gym, etc.

I wrote some time ago about the scarcity of human organs such as kidneys and livers, and how much of the western world suffers from a strange form or hypocrisy: we say it is great that people volunteer to donate organs (the libertarian writer Virginia Postrel has done just that by donating a kidney to a friend) but we recoil in horror at the idea that a person might ever be persuaded to sell an organ or be paid for such a donation, even though there is, in some countries, a commercial market in the business of using such organs and the related human tissue. (There is some legitimate worry that very poor people who do not realise the health implications might undergo surgery to sell their body parts, to be fair).

I thought again about such mixed attitudes when I saw the front page of the Sunday Times this morning:

THE chief medical officer wants everyone to be treated as organ donors after death unless they explicitly opt out of the scheme.

Sir Liam Donaldson believes the shortage of kidneys, livers and hearts is so acute that the country needs a donation system that will presume patients have given consent for their body parts to be transplanted.

Those who wanted to opt out would have to register in a similar way to those who now carry organ donor cards. This could be done through a central NHS database or through other documentation, such as driving licences.

But ranting away about the presumptious tendencies of a state doctor is all very well for relieving a bit of blood pressure, but there clearly is a problem with shortages of organs and how to save the lives of people in desperate need. Donation, either for no money or for a payment (with safeguards, if need be), can work only so far. We need to encourage biotechnological fixes: and a good place to see what sort of fixes might be out there is this interesting study by Ronald Bailey.

The doctors are right to highlight that there is a problem, but how less depressing would it be if they could think about ways of solving it without recourse to asuming that your body belongs to the collective, just for once.

This comment was left by a person calling herself Jasmine, responding to Sam Leith's fine piece bemoaning the attitude of mind that led to the UK smoking ban in privately-owned places:

Has it occured to you that this is a nanny state because we need nannying? I don't think anyone can dispute that smoking is not good for you. I read somewhere that having a smoking "section" is like having a peeing "section" in a swimming pool. It's just not enough to have a partial ban and wait for the natural goodness of people who simply don't know any better, to stop. They need to be forced to stop.

A question I would put to this woman, and quite a few of the other control-freaks out there is this: what gives you the right to tell an adult that he or she should adjust their habits for "their own good"? Does Jasmine think of herself as being some sort of god? Has it never occurred to these people that their obsessive desire to regulate all aspects of existence is in fact a sign of a deep psychological problem, which needs to be fixed?

Those idiots want health. But what we need is more life.

- Tattooed Marie, a Parisian barmaid, quoted à propos smoking bans on Spiked.

"If Michael (Moore) thinks healthcare is expensive now, just wait when it's free."

P.J. O'Rourke, in a remark attributed to him in this nice takedown of Moore's latest "documentary", Sicko, a film making the case that we would all be better off in having tax-funded healthcare free at the point of use, like the magnificent British National Health Service that is the envy of the world (cue sarcasm alert, sounds of hollow laughter).

Arnold Kling has thoughts on the movie. Here is what I wrote about some of the issues arising when people want healthcare free at the point of use (ie, they want someone else to pay for it).

Do not misunderstand me: private healthcare in some countries, such as the US, is far from perfect. For a start, it does not have a lot to do with unfettered laissez faire capitalism, as anyone who has encountered the powerful American Medical Association will point out. The insurance system in the US encourages inflated prices for treatment, and there are other regulatory and legal costs which have become a lot worse in recent years. But if Moore thinks British cinema audiences will be wowed by his paean of praise for Britain's Soviet model of healthcare, he needs to have his head examined.

Mind you, I have often wondered whether Moore is for real, or a sort of performance artist secretly working for Dick Cheney.

(Update: further thoughts on whether Moore is a clown damaging the already-weak case for socialised medicine can be seen here.)

When Perry referred to the recent comments of US Presidential hopeful Barak Obama, we had another example in the ensuing comment thread of how people lazily refer to the idea that healthcare should be 'free'. Of course, unless Obama is a total idiot - and I doubt that - he realises that health care, like roads, clean water, defence or food is not free in any sense at all that matters in a world of scarce resources that have alternate uses (such scarcity and the fact they have alternate uses is a classic element of what economics is). Healthcare is not free - it must be paid for, paid out of the time and trouble of other people. The problem, however, is that a lot of people, not just socialists, think that some things in life 'ought' to be free although one often finds they are at a loss to say why. Indeed, if you challenge a person by asking, "Why should health, clean water or defence be free"? they will either change the subject, or go bright red with anger, or fail to understand the question at all.

To attack the idea that certain services and resources should be 'free' is not, alas, all that easy in today's politically dumb climate. However, I think I have a partial solution in how to frame the point. If you ever encounter a person who says that healthcare should be free at the point of use, and it should be a 'right', then point out that this means that someone else has a corresponding duty to be a doctor, a nurse, a hospital orderly or an administrator. Unless people can be forced to perform these roles, then all talk of health as something that ought to be free is meaningless. Of course, at this point the socialist will blather on about incentives and so on, but what if no one wants to be a doctor or a nurse, regardless of pay? Does this mean that anyone who shows an inclination to like medicine should, at an early age, be conscripted into a hospital like a draft for the Army?

I ask these rhetorical questions because I think that when we try to frame our arguments, it is sometimes easy to lose sight of the fact that actual flesh and blood human beings are involved in talk about "the right to free health care". Most people these days oppose the idea of military conscription so it ought to be possible to make the case against medical conscription. If we can point out that medical conscription would be a bad thing, then it would be a step in nailing the nonsense that healthcare is a 'right'.

Here is a book I highly recommend about the whole noxious doctrine of 'welfare rights' and how they erode respect for the original, far more coherent rights doctrine of classical liberalism.

I just saw Barack Obama on television saying that he would introduce Universal Socialist Medical Care in the USA and for people who already have insurance policies, the only difference would be such people would pay less in premiums... everything else would be just as good. Yes, you too in the USA can have something as 'wonderful' as our decrepit National Health Service. You lucky, lucky people.

And presumably this conjuring act of creating wealth out of nothing with government impositions will come to pass purely via the Triumph of Barack Obama's will.

Talk about delusional.

He [Michael Moore] travels to London to show off the beauty and brilliance of the British National Health Service. He talks to an unstressed doctor who has a four bedroom house in Greenwich and a £100,000 salary from the NHS. He films empty waiting rooms and happy, care-free health workers. He even talks to Tony Benn about how this wonderful marvel came into existence in 1948.

What he hasn’t done is lie in a corridor all night at the Royal Free watching his severed toe disintegrate in a plastic cup of melted ice. I have.

- James Christopher, reviewing Michael Moore's film Sicko in the Times.

Continuing in movie-talk vein, one force that has swept through the western film industry to greater and lesser degrees is the current hatred of tobacco and the tobacco industry. The Michael Mann film, The Insider, starring Russell Crowe and Al Pacino - with a fine performance also by Christopher Plummer - is a good example. All the pieces are in place: a big, evil ciggie firm makes its products more addictive by dark scientific means; Crowe, who plays a scientist, leaves said evil organisation and blows the whistle on its practices. He is hounded, threatened, his marriage and career collapses. Pacino, as the hero-journalist, tries to expose all this, and in the process gets leant on by his big-bucks media empire bosses. The viewer comes away from the production in no doubt that cigarette companies are just a few inches short of being Nazis.

If you take a random look at any major Hollywood production these days, you seldom see stars light up a cigarette, except possibly some of the more dubious or "troubled" characters. When I watched Steve Martin's hilarious spoof film of 1940s film noir, Dead Men Don't Wear Plaid, I was reminded of how in the movies of the time, everyone smoked. Even the pet dogs would have smoked, given half a chance. And the cinema audiences smoked like chimneys as well. This is now a distant memory. The modern James Bond in Casino Royale does not smoke his Morland Specials, whereas Connery smoked and of course 007's creator, Ian Fleming, puffed away heroically. Bogart got through several packs of Luckies in a movie, and so did the various hot dames who acted with him. Spencer Tracy was unusual in that he did not smoke. Can you imagine Hugh Grant smoking, or George Clooney?

Of course, there is a bit of a backlash from time to time, creating wonderful satire. Thankyou for Smoking, the film based on the humorous novel by Christopher Buckley, is one such. And the great Denis Leary tries to keep the flag flying. But for real defiance of the health-obsessives, the French cannot be beaten. Last night I watched the French cop film 36, starring the usual roster of craggy-faced Jules and Jacques with their Galoises and Gitanes attached permanently to their lower lips. I counted, or tried to count, the number of cigarettes smoked in the film and gave up at about the 200 mark.

If Sarkozy is to be a great president of France, he needs to smoke.

In the beginning God covered the earth with broccoli, cauliflower and spinach, with green, yellow and red vegetables of all kinds so Man and Woman would live long and healthy lives.

Then Satan created Dairy Ice Cream and Magnums. And Satan said, "You want hot fudge with that?
And Man said, "Yes!" And Woman said, "I'll have one too with chocolate chips".
And lo, they gained 10 pounds.

And God created the healthy yoghurt that Woman might keep the figure that Man found so fair.
Satan brought forth white flour from the wheat and sugar from the cane and combined them.
And Woman went from size 12 to size 14.

So God said, "Try my fresh green salad".
And Satan presented Blue Cheese dressing and garlic croutons on the side.
And Man and Woman unfastened their belts following the repast.

God then said, "I have sent you healthy vegetables and olive oil in which to cook them".
And Satan brought forth deep fried coconut king prawns, butter-dipped lobster chunks and chicken fried steak, so big it needed its own platter.
And Man's cholesterol went through the roof.

Then God brought forth the potato, naturally low in fat and brimming with potassium and good nutrition.
Then Satan peeled off the healthy skin and sliced the starchy centre into chips and deep fried them in animal fats adding copious quantities of salt.
And Man put on more pounds.

God then brought forth running shoes so that his Children might lose those extra pounds.
And Satan came forth with cable T.V. with remote control so Man would not have to toil changing the channels.
And Man and Woman laughed and cried before the flickering light and started wearing stretch jogging suits.

Then God gave lean beef so that Man might consume fewer calories and still satisfy his appetite.
And Satan created McDonalds and the 99p double cheeseburger.
Then Satan said, "You want fries with that?" and Man replied, "Yes, and super size 'em".
And Satan said, "It is good."

And Man and Woman went into cardiac arrest.
God sighed. And created quadruple by-pass surgery.
And then Satan chuckled, and created the National Health Service.

Some people get disgusted - I guess it is the 'yuck!' factor - at the idea that a person can sell his or her own kidney for money, for example. We seem to live in an era of warped values about the donation and use of human body parts, as this article in Reason makes clear. It appears that in some jurisdictions, just about everyone is allowed to make money from the business of using human tissue and bone for medical purposes - except the people from whom the tissue and bone is taken (I think we can take it as read at a liberal blog like this that killing people for their body parts is wrong).

Virginia Postrel, the US-based writer, underwent surgery to give one of her own kidneys to a friend and made sure said friend is alive today (what a great woman Virginia is). As a classical free marketeer, Postrel does not understand why it is so terrible that such acts should be done for financial gain. She has a long and typically thoughtful piece on the subject here. She responds to those who fear that poor or gullible people might be led into selling their body parts out of financial desperation, but that is an argument about curbing poverty, not reducing human freedom. Ultimately, I own my body, and not the state, not the rest of the UK population, not Tony Blair, not god or the Great Cheese Monster in the sky. Of course, a "market in organs" may attract shysters and unscrupulous doctors, but as the Reason article I alluded to makes clear, there are plenty of shysters in the system now.

Of course, in a country like Britain where a lot of the population drink like fish, it is debatable whether anyone would want to buy our kidneys, or even take them for free.

There is a class of drugs called 'cognitive enhancers' that could potentially raise the intelligence, skills and productivity of users. Pharmocological enhancement is an anticipated bonus of the information revolution, and has been welcomed by many in the transhumanist community. These issues are now cognitive blips on the unenhanced specialist offices that civil services establish to monitor that horrible outcome of progress known as the Future.

When governments begin to understand that people could use a new set of drugs for improvement, they grasp for an improper P word, Prohibition. Their Puritanical wish to maintain a level playing field between themselves and the Populace demands that these substances be controlled, classified, prescribed, monitored and hopefully banned. Enhancement is a dirty word, but if these drugs have to be accepted, then they will make sure that we will use them on their terms:

Foresight, a Government think-tank, believes that "cognitive enhancers" could be "as common as coffee" within a couple of decades to help a person think faster, relax and sleep more efficiently....

The Department of Health has become so concerned about these drugs that it has asked the Academy of Medical Sciences (AMS) to assess the potential impact of the substances, some of which are licensed in Britain to treat narcolepsy or acute tiredness.

They are already being bought illegally over the internet in the US by people who think they will enhance their performance in the classroom and in the office.

Government attention in these drugs is unwelcome, since the report of Foresight or the Academy of Medical Sciences speculate about social problems as an excuse for regulation. One argument raised is that the pharmaceutical industry could abandon research into mental health and switch to 'cognitive enhancers' because of greater demand.

All of the evidence indicates that civil servants, politicians, and public sector professionals would not benefit from 'cognitive enhancers', since their increased intelligence would be expressed in greater fiscal and regulatory complexity. These classes should be prohibited from employing cognitive enhancement.

As if the threat of being bullied and labelled a fattie is not enough, there is now the risk that the state and its agents will take a child into care if that child is deemed "obese". Over the last few days, the press has carried reports of how a young boy, weighing in at a powerful 14-stone (196 lbs/ 89 kg), narrowly avoided such a fate.

My first instinctive belief is that the state has no business telling us about what should be the shape of our butts. In the case of children, responsibility lies with the parents, and there has to be real and sustained proof of neglect and abuse to trigger any form of intervention. In nearly all cases, my view is that the "cure" of taking an "obese" child into care will far worse than the supposed problem. Yes, extreme obesity, as measured in terms of excess fat vis a vis overall body shape, is not something to laugh at or dismiss. Although I have been lucky and born with a slim physique, I still try to build on that good fortune by keeping fit. There's no doubt that many people in Britain are unhealthily overweight. Lack of exercise, sedentary lifestyles and the demise of hard, physical labour all have an effect. But while I would encourage folk to look after themselves, ultimately, what people choose to do with their lives is their business, not mine. In the case of this youngster, realising that he is overweight should be incentive enough to do something about it. His parents may not be the brightest lights in the harbour, but from what I have read, they plainly adore their son, although they probably could exert rather a stricter control over his diet.

As we have also found in so many cases, paternalistic state actions often start to "protect the kids" and end up spreading towards adults as well. I hope this young man learns to take pride in his own health and can look back in future to this time in his life as one where he learned to control his appetite and also realise how dangerous the state has become. There are plenty worse things than having a large tummy, that is for sure.

If water were not so obviously essential, I wonder if it would now be even allowed:

If you drink too much water, eventually the kidneys will not be able to work fast enough to remove sufficient amounts from the body, so the blood becomes more dilute with low salt concentrations. "If you drink too much water it lowers the concentration of salt in your blood so that it is lower than the concentration of salt in cells," says Professor Robert Forrest, a consultant in clinical chemistry and forensic toxicology at the Royal Hallamshire Hospital in Sheffield.

Professor Forrest continues:

"When the brain swells, it is inside a bony box so has nowhere to go," he says. "The pressure increases in the skull and you may get a headache. As the brain is squeezed it compresses vital regions regulating functions such as breathing."

Eventually these functions will be impaired and you are likely to stop breathing and die. Warning signs included confusion and headaches.

No sniggering. This is exactly what happened to a Californian lady after she had taken part in a water drinking contest (a sport which should obviously be banned forthwith).

A government task force is clearly needed to keep a constant eye on the water threat. Once that happens, health warnings on water bottles are only a matter of time. "Water can seriously damage your kidneys", and so on. "Big Water" will be accused of peddling scaremongering stories about the alleged need for water, and the alleged benefits of water, and even nonsense about how, if you don't regularly wash with it, that might be a danger to your health.

Some time ago, I recall someone translating "water" into "hydrogen oxide" or "oxygen di-hydride" or some such thing, and listing all the dangers of this profoundly dangerous fluid, such as the definite danger of contracting cancer if you drank, say, forty gallons of the stuff at one sitting, and quite a few safety nazis fell for it. Well, now such anti-water campaigners have some hard evidence to work with.

Professor Aziz Sheikh has called for the National Health Service to provide separate (privileged?) services for Muslims to take account of their religious requirements. The Professor is of Muslim orientation and has written an article for the British Journal of Medicine, giving reasons for his argument:

Writing in the British Medical Journal, he said the NHS should record patients’ religion as well as their ethnic grouping. “It is absurd that we do not, for example, know the perinatal mortality or smoking prevalence among Muslims,” he said. Male infant circumcision should be available throughout the NHS, he added. Although some NHS trusts do offer circumcision, most parents are forced into the poorly regulated private sector, he said.

Aziz Sheikh is conflating two issues here: matters of health provision and providing specialised services for particular communities. Whilst there may be problems amongst Muslim communities in terms of infant mortality and chronic illness, it is unclear why their status as Muslims should predispose them to these. Indeed, habits of smoking, an inability to speak English in the United Kingdom as an immigrant and living in relative poverty are better indicators for life expectancy and health. Therefore, these arguments may demonstrate that Muslims suffer from these problems, but that the causes are not specific to Muslims in particular, but are generally prevalent amongst the poor and immigrant communities.

It is not absurd that we do not gather statistics on the basis of faith, as faith is not a primary indicator for health, unlike social class, education or the country of origin for your family. Aziz Sheikh has cited this argument to add ballast to his call for discrimination in favour of Muslims on the NHS. This points the article away from a public health agenda towards a medical version of the 'identity politics' that has hindered the effectiveness of other governmental institutions.

The NHS should be more accommodating to the religious needs of Muslims. Many Muslims would prefer to see a same-sex doctor for reasons of modesty, but this was often not possible, despite the increasing number of female doctors in the NHS. More information about drug ingredients should also be available to allow Muslim patients to avoid porcine and alcohol-derived drugs.

If a patient who is Muslim wishes to receive treatment that is compatible with his religious inclinations, the National Health Service is unlikely to meet their requirements. The rationing of healthcare is resolved in a mediocrity of outcomes based upon the equality of all - though contact with NHS personnel or class will often result in a better quality of care.

Aziz Sheikh's call for services in line with the Muslim faith could be interpreted as the natural demands of a community that has found its feet and started to request personalised treatment, in line with the oft-quoted rise of consumer expectations in health. Some could also see this as the further development of separatism within the Muslim community, demanding special treatment for itself.

The common factor is the state monopoly in health. It encourages communal responses to health issues, allowing professional leaders to make calls for particular treatment, with the corresponding balkanisation and backlash that we would expect from those who perceive that they have been missed out in any sharing of the tax spoils. Hence, the unedifying advance of 'white welfarism' in the leafy suburbs.

This would not be reported if health was a choice of individuals purchasing their requirements in a free market. The particular institutions would cater for those who wished to apply these requirements, and one would expect multi-faith alliances to obtain the critical mass that health provision often requires.

The problem is not Islam, it is the National Health Service.

It is a reflexive tic among libertarian types to describe Britain's NHS as 'Stalinist', in reference to its vast monolithic structure and institutional preference for central state planning. Now some indications that the parallels run a little deeper.

The Department of Health's first reaction to the campaign for people to opt out of the "Spine" medical records database, that I mentioned a couple of days ago, is not to attack it as 'irresponsible' as I was expecting. It is to demand that doctors report any patients who try to the authorities. "Let us deal with them," it appears to be saying.

The Guardian reported yesterday:

The Department of Health provoked uproar among doctors yesterday by asking GPs in England to send in correspondence from objectors who do not want their confidential medical records placed on the Spine, a national NHS database.

Sir Liam Donaldson, the chief medical officer, said letters from patients who want to keep their private medical details out of the government's reach should be sent to Patricia Hewitt, the health secretary, for "full consideration".

You will recall that such suggested letters were personal communications with doctors, asking them personally to do something: to code patients records so that they would not be uploaded to the Spine. That's something that can only (as I understand it) be done locally. "Consideration" by the Secretary of State defeats it.

It also seems to me that it would be a fundamental breach of confidentiality, and if the letter were posted, possibly a criminal offence contrary to the Postal Services Act 2000, for the letter to be forwarded to the Secretary of State without patient consent.

But neither law nor morals may stand in the way of the great plan.

...

BBC Radio 4 had another example this evening. Its File on 4 programme considered endemic MRSA and other antibiotic resistant bacteria in NHS hospitals. It interviewed a couple of epidemiological specialists who said with the current control regime slow progress was to be expected and the government target of 50% reduction in MRSA infections by 2008 is unrealistic. Andy Burnham MP, usually characterised as one of the brightest and best of the Primrose Hill group of New Labour heirs presumptive, was asked to comment. He said the complacency and defeatism of the clinical scientists was unacceptable: there was a target and the Health Service would meet it.