A friend (you know who you are) informed me that the Economist magazine was "getting better", for example it had a lead story denouncing government debt. Of course this was the government debt that the Economist had urged government to take on (to bail out banks and other corporations and then to "stimulate the economy"), but it was good that it was denouncing the debt.

So I decided to give the Economist a chance and read their article ("editorial") on American health care. After drinking a bottle of cider to recover (what a nice new bottle shape Henry Westons have produced) these on my thoughts upon that article:

It starts with a lie - Barack Obama was elected in part because of his plans to "fix American health care".

In reality it was Hillary Clinton who stressed her health care plan during the Democrat primary campaign (Barack Obama just attacked her plan and made vague noises about his own). And during the general election campaign it was John McCain who came out with a specific health care plan, allowing people to buy health cover over State lines and switching the tax deductibility of buying health care cover from employers to individuals, whereas Barack Obama just (dishonestly) attacked the McCain plan and was vague about his own.

Barack Obama was elected President of the United States for several reasons (white guilt about mistreatment of black people, the total ideological devotion of the education system and the mainstream media, the insane judgement by John McCain to back the bank bailouts...), but stressing some specific plan to "fix American health care" was not one of them.

Still the Economist does not let the truth stand in the way of its articles, so it then outlines its position.

"Starting from scratch their would be a good case for a mostly publicly funded system" even for a magazine "as economically liberal as this one".

This is a standard Economist trick - propose some form of statism and defend it by saying even we, the free market ones (the European meaning of "economically liberal"), are in favour of this statism. Of course the Economist never actually produces any evidence that it is pro-free market - but it is at trick it has been using since Walter Bagehot (the second editor, the first editor actually was a free market man) so I suppose it is a lie hollowed by history.

However, we are not "starting from scratch" so the Economist reluctantly concedes that some little freedom (about half of American health care is already government funded and the rest is tied up in regulations - facts that the Economist avoids, see later) must remain for awhile - it suggests five years.

The first step, according to the Economist, must be to make everyone buy health cover by statute with the poor being subsidized by the government "as is done already in Massachusetts". That the Massachusetts "reform", introduced by Governor Romney, has turned out rather badly is a fact that the Economist article neglects to mention - even though the percentage of "uncovered" in Massachusetts was very low compared to other States so if this "reform" was going to work anywhere it would have worked in Massachusetts.

Of course, says the Economist, insurance companies must not be allowed to exploit government subsides for the poor. They must provide "affordable" plans (no prices are suggested - it is all left vague), and must not be allowed to exclude the old or the already sick from their plans.

In short - lower prices and covering high cost groups. As (contrary to the propaganda) American health insurance is already not a high profit margin industry, these "reforms" should be enough to bankrupt the insurance companies - even before the five year period comes to an end and the government plan the Economist suggests takes over.

However, just in case the private health companies are not bankrupted, the Economist also suggests that "anti trust" be introduced into the area. As the late Ayn Rand (and so many others) have pointed out, there are no clear principles (things that can be clearly defined in advance) in "anti trust" or "competition policy" in fact the whole thing is an excuse for arbitrary power for the government working with the politically connected. But the Economist either does not know, or does not care, about this point - and loves "anti trust".

Almost needless to say the Economist does not mean getting rid of regulation (such as the licensing regulations for doctors - exposed as a racket by Milton Friedman 60 years ago,. or the F.D.A. and its price inflating and new medical adavance preventing "health and safety" regulations). On the contrary the Economist means yet more regulations on top of all the ones that exist already.

Of course the Economist does not mention the real problems of American health care. Neither the ones I have mentioned already or the others. It does not mention how Medicare and Medicaid and SCHIP have vastly inflated prices (just as the subsidies for higher education have had the effect of inflating tuition fees over the decades) or how the vast web of Federal and State regulations prevent much of a real "market" in health care at all, or how American hospitals are forced to provide free ER cover in spite of the fact that an expensive (although terrible - rather like some British NHS hospitals in fact)) network of government "county hospitals" already exists, or... But of course it does not - because it wishes to add subsidy schemes and regulations, not get rid of them.

Lastly I must mention one other policy suggestion of the Economist.

It suggests abolishing the tax deductibility of employer health care provision - not to switch the tax deductibility to individuals to buy health cover themselves, but because the lower taxes "cost the government" lots of money (all money belongs to the government it seems - although it should kindly allow people to buy toys, not important things like health care).

This massive tax increase is something that even Barack Obama is wary about talking about (although it would only pay for a fraction of the costs of his plans), but have no fear the Economist will hold his hand - it is all about "The Renewal of America" to quote one of the most vile magazine front covers I have ever seen.

As for the Obama plan of one and half TRILLION Dollars (according the Congressional budget office in reality it will grow to far more than that, entitlement programs always do) that will only cover a fraction of the people he says it will. Well if the Economist is truly "economically liberal" it will help lead the fight against this evil - but judging by this article...

Of course it could be claimed that I am being unfair - that the American coverage of the Economist is the worst element in the magazine. Although I have not noticed the Economist denouncing the move to income support schemes and government health cover in India (in spite of the ever growing fiscal deficit) in India - or indeed in any country.

Be that as it may, it is the United States where the alternative of a free market current affairs magazine is most needed - an alternative to the statism of Time and Newsweek and the rest of the mainstream media. And the Economist utterly fails to provide this alternative.

So, friend (again you know who you are), do not ask me to give the Economist a chance again - to do so is not good for my liver.

All the existing [medical care] schemes, including the present American mixed corporatist/socialist model, represent a transfer from the young and healthy to the old and chronically sick (and to the medical cartel, of course). The way it's used in practice, the phrase "having health insurance" means having the right to place oneself on the receiving end of these transfers. No honest discussion of the situation is possible until the entirely false and misleading concept of "health insurance" is dropped.

- Commenter Ivan

Millions and millions of Americans support Obama's desire to even more massively intervene in the market for medical care than the US state already does. And of course Obama's moves are just the opening salvo in a desire to eventually end up with fully socialist healthcare, along the lines of Britain's ghastly National Health Service, which has intermittently tried to kill me over the years.

I have tried pointing Americans at the British example to show them what an appalling idea it is to have the state directing any industry, let alone medical care. But alas it is very hard to overcome that special kind of insular American optimism that does not think what happens in another advanced first world nation can teach them anything, because in the USA things will be different.

Well yes, it will be different... in that the control obsessed Obama's of this world will find new, innovative and oh so wholesome American ways to end up with a third rate health care system much like Britain has today.

This might be a good time for Americans to invest their money in Swiss medical clinics as I suspect in the coming years expatriated medical care will be a serious growth industry... plus it has the added benefit of getting your money out of the USA and US dollar.

"It is rare that governments successfully cut costs by first spending more money."

- Tyler Cowen. He was talking about Mr Obama's plans to socialise US medicine. I am sure that when the NHS was set up here in the UK, the advocates of said argued that it would "save" money in the long run. Meanwhile, here is some useful commentary from Arnold Kling.

Oh dear... seems the EU is being beastly to us again.

I wonder if I can buy brain futures or it is just pork bellies?

As here, for instance. Via Liberty Alone, I learn of a remarkable new recruit to the ranks of those who are panicking about the pandemic. Yes, it is none other than the US Libertarian Party. They have just issued a press release reprimanding the US state for not being statist enough about this medically trivial event, which is in any case only being plugged up in order to divert attention away from other governmental blunders and to excuse further governmental usurpations, despite all the blunders. Why can't they see that? Or don't they care about such things any more? One can imagine a true "pandemic" that really did need measures like draconian border controls to defend against it (sickness is the health of the state), but if this trivial flu variant is it, then, to put it mildly, an explanation to that effect should have been added.

The UK Libertarian Party should treat this pandemic pandering as an awful warning of what happens to small parties - parties "of principle" - who become gripped by the desire to pile up lots of mere votes, and who forget what they were started to accomplish. First they pick a regular politician to lead them, and he then picks more regular politicians to help him, and before you know it, they are behaving like regular politicians.

But it is more fundamental than that, I fear. Start a political party, and before you know it, it is behaving like a political party. LPUK beware.

One of the beauties of the blogs, I find, is that the link-rich medium enables you to fly off on all manner of tangents and think through issues that might otherwise not arise or come into one's head so fast. The recent posting on Samizdata about Ayn Rand - which seemed to trigger a rather bad-tempered and long comment thread - led me to a site put together by this fellow, who wrote a rather rude comment about Rand - nothing very new there - and I decided to take a look at his own blog. This is what I found. James Hooper is a socialist who once, apparently, was a "teenage libertarian". I guess one does not come across many libertarians who imbibed their Hayeks, Rands, or Rothbards and later decided that what the world really needed, in fact, was lots of collectivism, progressive taxes, and the rest of it. I suppose John Gray fits a similar path, although as Brian Micklethwait has noted, Gray is consistent in his pathological gloomsterism.

Anway, back to James Hooper. In his latest post, he writes this:

"Healthcare is an area where the market has proven utterly inadequate, indeed it’s hard to find any pure market approach outside of the Third World (company insurance is decided by CEO boards and unions, state insurance by governments), although I’d imagine that those who have died in America owing to lack of insurance didn’t rate the distinction that much."

Now it seems to me that there is something very wrong about this statement. Human beings require health care, just as they require food. Now, in the West, food is - mostly - produced by the free market, although as a libertarian I'd be the first to note that there is a lot of regulatory control over food production (ask any farmer, slaughterhouse owner, food retailer, etc) and a lot of subsidies, such as under the EU's Common Agricultural Policy. But by and large, the process by which we get our fruit, veg, meat and carbs is via capitalism. This seems to work tolerably well. It could work a heck of a lot better, of course, but in general, you don't see people, even the very poor, starving in the streets as happened under communism in Russia (1930s) or Mao's China (1950s, 60s), or see the sort of state-induced disasters in Zimbabwe, etc. So clearly, something as basic as food seems to work best when left to the market.

So what is so different about health care that it can only - according to various statists, including many right Tories - be provided by a mixture of private/public operations or even, only by state monopolies, such as the UK's National Health Service? For sure, some people, such as the very poor, will not be able to afford all the healthcare they want, but then the same issue applies to very poor people who cannot get all the food or housing that they want. Their problem is poverty, not something peculiar about food or housing. I understand that healthcare purchases tend to be less frequent than purchases of food; there may be inefficiencies or supply-demand issues that perhaps don't let a market in health care function as well as in say, baked beans. But even so, for a person to state as a bald fact that a market in health care does not work seems, well, to be a case of ideology trumping experience and elementary logic. This article by Ronald Bailey lays out a good argument for a free market in health.

Of course, if, like Marx, Mr Hooper believes that a socialist society will be based on the "From each according to his abilities, to each according to his needs", then that of course begs all kind of momentous questions of interest to defenders of liberty and prosperity. As I have pointed out before, if you say, for example, that I have a "right" to "free" healthcare, what that really means, in practice, is that I have a right to coerce someone who is able to work as a doctor/nurse/lab technician to give me what I want. In short, the Marxian "from each according to his abilities" presumably means that the state must have the power to decide what are the "abilities" that Johnathan Pearce, or James Hooper, etc, actually have, and then have the power to harness those abilities to fullfill the needs, as the state has defined them. In short, the Marxian formulation requires conscription of abilities.

There is a word for this state of affairs. It is called totalitarianism.

This story is bizarre: China is ordering folk to smoke to boost the economy? Maybe the Chinese authorities figure that with air pollution already so bad, what could be any worse?

It goes without saying that being a good liberal that I am, I consider it as outrageous for a government to encourage smoking as to use invasions of property rights and censorship of things like adverts to stop it. This sort of issue cuts both ways. What next: forcing folk to get hammered every evening?

What is the worst case scenario for swine flu cases in the United States? About 1,700.

This is not a pandemic, and the ballet of institutional panic in government combined irresponsible media coverage over the last few days has been instrumental in ticking public health as another area where contemporary alarmism, fanned by governments, signposts higher mortality when a crisis finally arrives.

Reported by Lucy Bannerman in today's Times:

Fire kills child, 3, and parents as police prevent neighbours from trying to rescue them

A pregnant woman, her husband and their three-year-old son were killed in a house fire early yesterday as police who arrived before the fire brigade prevented neighbours from trying to save them. The woman screamed: “Please save my kids” from a bedroom window and neighbours tried to help but were beaten back by flames and were told by police not to attempt a rescue.

By the time firefighters got into the house in Doncaster, Michelle Colly, 25, her husband, Mark, 29, and son, Louis, 3, were dead. Their daughter, Sophie, 5, was taken to hospital and believed to be critically ill.

Davey Davis, 38, a friend of the family, said: “It was the most harrowing thing I have ever witnessed. Michelle was at the bedroom window yelling, ‘Please save my kids’ and we wanted to help but the police were pushing us back and not allowing us near. We were willing to risk our lives to save those kiddies but the police wouldn’t let us.

“Tempers were running very high, particularly with the women who were there, but the police were just saying we have to wait for the fire brigade because of health and safety.

“There were four or five police officers. They were here before the fire brigade. We heard the sirens and we came across to help but they wouldn’t let us.

“I thought the police were there to protect lives. At one time they would have have gone inside themselves to try and rescue them.

“When a family is burning to death in front of your eyes, rules should go out of the window – especially with kids. Everybody wanted to try and help.”

In a previous post about loss of nerve in our public services I said, referring to instances in which firemen and policemen had "broken procedure" to save life, that despite their personal courage "institutional gutlessness surrounded them, was embarrassed by them, and will kill off their like eventually. Poisoned soil does not long give forth good fruit."

Seems like the poison has worked its way well in. Note: I do not know whether the Colly family could have been saved had the attempt been made while Mrs Colly was still alive to scream for someone to save her kids. A spokeswoman for the South Yorkshire Police said, “The senior officer in charge is confident we handled this incident as professionally as possible. In a situation like that you could end up with more deceased bodies than you had in the first place.”

One of the lesser known sights of London is the Watts Memorial in Postman's Park. I gather it featured in the film Closer, starring Natalie Portman and Jude Law. No, I am not being funny, suddenly veering off into a travelogue in the middle of a post about the deaths of a family. I wish there were something to laugh about. The memorial was set up by a Victorian artist, George Frederick Watts, to commemorate those who died saving others. It consists of hand made plaques each bearing the name of a person who sacrificed his or her life and a brief citation. Very quaint they are, with their crowded lettering with the extra-large initial capitals and little swirly plant motifs and curlicues in the corners. Even the names are quaint, laboriously given in full. Police Constables Percy Edwin Cook, Edward George Brown Greenoff, Harold Frank Ricketts and George Stephen Funnell are among them. I wonder what PC Percy Edwin Cook, for instance, who perished when he "Voluntarily descended high tension chamber at Kensington to rescue two workmen overcome by poisonous gas" would have made of his successors in the South Yorkshire force.

Perhaps the police spokeswoman was right. Perhaps if health and safety had been less comprehensively assured and the Colly incident handled rather less professionally, we would have ended up with more than the three "deceased bodies" - no, make that four, when you count the child expected to be born in two weeks - that we did end up with. Still, more than four dead bodies is quite a lot and quite unlikely, I cannot help thinking. And I also cannot help thinking that there is more to this than just counting the dead under different scenarios. If the critically injured five year old girl does survive she will be burdened by more than just the fact that her family died. She will eventually have to know that those who might have answered her mother's last desperate appeal were held back on grounds of "health and safety." Not theirs, obviously.

UPDATE: Other accounts give the spelling of the family name as "Colley". They confirm that the police actively prevented rescue attempts.

FURTHER UPDATE: There is a thoughtful discussion in the comments regarding several moral and practical questions, and whether the press accounts are to be trusted. Quite possibly not. Yet I must add that if the South Yorkshire police are trying to convince me that they are not abdicating responsibility in order to follow rote "health and safety" procedure (as commenter "sjv" put it), then best not claim, as they appeared to in the Mail report linked to in the word "other", that the reason they will not tell us exactly how long elapsed between the arrival of the police and the arrival of the firemen is "'data protection' rules."

There is no stated national consensus that as a country we should substantially reduce overall masturbation, but such a reduction would benefit the health of many who wank – and those affected by passive wanking- the concept I invented a few sentences ago and am now treating as a genuine problem.

In 2006, 180,000 people died from pornographic-related causes. Wanking has a major impact on individual wanker's health: it causes cancers of the liver, bowel, breast, throat, mouth, larynx and oesophagus; it causes blindness, hairy palms, a pale pallor and insanity ...

Some point to the potential benefits of self-pleasuring, but these tend to be greatly overstated.

Despite its known harms, one-quarter of the adult population – about 10 million people – now wank above the recommended low-risk levels. I made this figure up but as the Chief Medical Officer I can cite myself because I am in a position of authority.

Here is a graph to illustrate how many people are killed by masturbation. It actually represents something completely different, possibly cat food sales, but I'm guessing that most of you are actually too stupid to actually look at the graph in any detail ...

- some Unenlightened Commentary sadly not actually supplied by Sir Liam Donaldson (with thanks to Obnoxio the Clown)

The blogger Slugger O'Toole expresses a very sensible view, in my opinion, about the recent case of a NHS nurse who was disciplined for offering to pray for a patient. I am all in favour of the separation of church and state, but then would reflect that this case shows just what happens when hospitals are part of the state and not part of the non-state sector, where they can be run by secular or religious groups without such issues arising. If a hospital is run by a church or has an endowment froma religiously-minded gazillionaire, and staff want to pray with its patients and the patients are okay with that, what exactly is the problem? Many UK hospitals, as their names often suggest - such as St Thomas's Hospital in London - were founded by churches and religious orders. For all that I am not a religious person, I can greatly admire the spirit of compassion that motivated many religious believers to work in or endow hospitals with funds. Many of Britain's greatest hospitals were started by churches and their history goes back hundreds of years.

This is wonderful, funny and true.

Via Radley Balko.

More support comes from the medical profession that regular, moderate intakes of red wine is good for health. (Via this blog).

This makes me happy.

Random link-chasing brought me here. "Leg-iron" writes:

I have a pack of tobacco with no hideous picture. Instead it has a phone number and the words:

Choose freedom. We'll help you get help to stop smoking.

Freedom? Really? That would be nice. I don't have the freedom to smoke in a bar, at a bus stop, bus station or on the open platform of a railway station.

There is more, please do read it. I should explain for foreign readers that British cigarette packets must by law bear an anti-smoking slogan such as "smoking kills" or "smoking causes impotence" and often, these days, a repulsive picture showing the bad consequences of smoking. I do not smoke so I do not often need to look at these pictures, but nothing about their appearance repels me as much as the fact that our laws force people to publish material designed to humiliate themselves. Truly, that does repel me. I neither like nor dislike cigarette manufacturers or those who work for them as a category, but when I imagine whichever bureaucrat thinks up these rotating slogans sneeringly transmitting the latest one to some servile flack in a cigarette company along with orders to start the print run - then I feel a faint echo of the shame someone living in Mao's China must have felt at the sight of a wretch bearing a placard saying "I am an enemy of the people."

I scrolled down Leg-iron's blog and found another good post on the same topic:

On the first one I bought was one of those pictures that are supposed to terrify us into stopping smoking. This one shows a pair of eighty-year-old hands with the slogan 'Smoking causes ageing of the skin'.

Interesting. I was under the impression that ageing was the main cause of ageing of the skin.

After ruminating on the lameness of these propaganda efforts, Leg-iron writes that it is almost

...as if ASH have realised that, should we all give up smoking, they'd have nobody left to torment and they'd all be out of a job.

ASH refers to a body called "Action on Smoking and Health." It is a fake charity - in fact, I learn, it is the original fake charity - receiving just 2% of its money from voluntary contributions. The rest of its money is paid to it by the government. It exists in order to allow the government (I should say "the State" since it has been the tool of several successive governments of both major parties) to pretend that when enacting new forms of repression it is merely responding to popular demand; in other words, it pretends to be servant the better to be master. There are many such. Some call themselves charities, others "NGOs". As the EU Serf asked years ago, "I always thought that NGO meant Non Governmental Organisation. How come any of them get money from the state?" Some are funded by the British government, some by the European Union, although trying to to establish the extent, if any, to which the former category is not a subset of the latter, would not be a good use of anyone's time.

Devil's Kitchen is sick of fake charities. He has put forward a modest proposal, and has registered the domain name http://fakecharities.org/ in order to put it into practice. His co-blogger, "The Filthy Smoker" wrote about the staggering dishonesty and corruption that the existence of these shills brought to a Department of Health "consultation process" here.

All these lies and deceptions spread out and reinforce each other - until we come to a stage where someone can force someone else to publish the words "choose freedom" and feel no shame.

I suppose it is a sign of advancing years, and having lost some close friends to cancer or having been scared by a close relative's condition that the notion of a cure for the gremlin should weigh on my mind a bit more than it used to. (You are definitely getting old, Ed). I cannot help noticing, when reading Instapundit as I do every day that Glenn Reynolds has been putting up regular links to the growing use of nanotechnology in delivering cancer-busting chemicals to the body with incredible accuracy. Here's another one. The more accurate the delivery of the drug, so the reasoning goes, the fewer the unpleasant side-effects associated with things like chemo treatments, and the greater chances of beating the cancer. The steady trickle of news items and articles has yet to become a flood, but I have this sense that the flood may be pretty close.

When I read Engines of Creation by Eric Drexler back whenever it was, the idea of tiny nanobots being used to treat cancer was, then, still on the edge of what folk thought might be possible. There is a way to go yet but it is a mark of how certain stories get below the radar of current events that nano-medicine has crept up on us so quickly, rather as the internet did about 20-odd years ago.

Faster please!

These pictures are pretty cleverly done. (Via Andy Ross).

We are sometimes told by its defenders that the National Health Service is the envy of the world. Well, I wonder if all those countries yearning for socialised medicine are dreaming of this?

I used to visit the South of France as a kid and one day, walking down the beach in St Tropez, yours truly, then a pretty wet-behind-the-ears lad from Suffolk, espied a whole row of lovely French women lying on the beach with nary a stitch on. Mon dieu! After my silly childish embarrassment wore off, I thought nothing of it after a while.

It appears that for health and fashion reason, though, that the lovelies of Europe are covering up. One of the main factors may be a concern about skin cancer. Also, I notice that in France, a lot of the men and women's skin gets very lined and aged if they sit out a lot in the sun, so for reasons of vanity or beauty - depending on your point of view - it makes sense to cover up. I have to watch it in the sun as I am pretty fair-skinned.

I did sort of half wonder whether any of this story from France has something to do with the large Muslim immigrant population in the South of France that takes a dim view of baring any female flesh at all. It does make one wonder. I hope not.

Last night, flicking through the TV channels after watching Andy Murray get pulverised by Nadal, the muscle-bound Spaniard, in the tennis, I watched in bemused fascination as ITV and the BBC both devoted quite a lot of air time to celebrating - that word was used repeatedly - the 60th anniversary of the National Health Service. There has even been a church service, attended by Prince Charles and the Prime Minister, Gordon Brown, to mark the anniversary of Britain's monopoly provider of health care, an essentially socialist creation that is hardly emulated anywhere else in the world, and for good reason. None of the major objections to health care that is provided via tax and distributed "free" at the point of use were mentioned. Last night's stories gave no balancing comments from skeptics or opponents of the NHS to counter the general feel-good presentations.

At the Institute of Economic Affairs, here is a rather more sober treatment of the NHS. As the US writer PJ O'Rourke once warned his countrymen about socialised medical care, if you think US private sector healthcare is expensive, just wait until it is "free".

Here is a great new book to cheer libertarians as we draw close to the sixtieth anniversary of the National Health Service. Written by the director of Nurses for Reform, Dr. Helen Evans, and published by the Institute of Economic Affairs, ‘Sixty Years On: Who Cares for the NHS?’ not only shows that the country’s top 100 health opinion formers no longer actually believe in nationalised healthcare but, gloriously, this book fundamentally challenges the medical monopoly inherent in all health systems around the world.

Citing a huge array of free marketeers the work is awash with glorious quotes like this one from David Friedman:

Both barbers and physicians are licensed; both professions have for decades used licensing to keep their numbers down and their salaries up. Government regulation of barbers makes haircuts more expensive; one result, presumably, is that we have fewer haircuts and longer hair. Government regulation of physicians makes medical care more expensive; one result, presumably, is that we have less medical care and shorter lives. Given the choice of deregulating one profession or the other, I would choose the physicians.

Quoting our own Brian Micklethwait we again read:

Far from being obvious to me that a truly free medical market would be disastrous, I believe on the contrary that such arrangements would be of huge benefit to mankind, and that the sooner medicine is done this way the better.

Things would not, inevitably, be perfect. Some fools would make crass blunders, by ignoring manifestly superior medical services for the most frivolous of reasons, and by patronising the most notoriously incompetent. Some such fools would perish from their foolishness. Others would merely be unlucky. No law can prevent either stupidity or bad luck, although the world is now filled with the particular stupidity which consists of refusing to face this truth, and with the many luckless victims of this stupidity.

Powerfully, he concludes:

Given that for most people the avoidance of suicide rather than suicide is the objective, a truly free medical market would enable them, for the first time ever, to purchase steadily improving medical advice and medical help, and at a steadily diminishing price.

One of the most pernicious restrictions on medicine imposed by the current medical regime is the restriction on advertising. In a free market rival medical procedures, rival medical 'philosophies', rival views on the relative importance of confidentiality, hygiene, speed of treatment, riskiness of treatment, and so forth, would all battle it out in the market place. 'Alternative' therapists would be allowed to prescribe potentially dangerous drugs, as only government favoured therapists may now. It would be up to the patients to pick therapists who seemed to know what they were doing and their look out if they chose badly. The already thriving medical periodical press would assist with voluminous comparative advice, praise and criticism.

In such a free market, any number of different medical styles could be practised, and patients would make their choices.

Evans’s book is a must read for libertarians. It is also a tonic for the period of NHS propaganda we will no doubt endure over the next couple of weeks.

Looking for a real boost in the morning? Someday you may be able to do better than coffee. According to New Scientist (via the Foresight Institute):

Human cells could have their metabolisms upgraded without altering their genes by inserting tiny plastic packages of enzymes, Swiss researchers have shown. They hope the technique could allow advanced cancer therapies, or even upgrade a person’s metabolism.

I can hardly begin to imagine the applications. With this technique you could correct chronic genetically caused disorders. It makes drugs old hat. You could boost athletic performance from inside the cell and really give the luddite sports crowd something to worry about.

Imagine the battlefield applications! It could keep the 21st century soldier alert despite little sleep; alive when injured; fed from sunlight or other external energy sources and performance enhanced when under threat.

Over at ConservativeHome there's a survey suggesting the social conservatives are doing the Guardian's work for it by trying to make one's position on abortion a party-political issue in Britain. The next generation of Conservative MPs support a lower time limit for abortions says an email questionnaire to 225 candidates, answered by just under half. I'm as irritated by this sort of spinning of some very doubtful evidence as I am by the contrary stuff - to the same effect - from the Guardian, which has recently started to suggest (as a measure of its desperation) that no-one who favours abortion choice should vote Conservative.

What really winds me up, though, is the mendacious presentation of their position by the proponents of this staged debate. The legal position of abortion in Britain is the sort of muddy compromise people with a clear ideas about the question are quite right to resent. But the approach of many abortion-banners (as they actually are) is anything but frank, and reminiscent of the step-by-step strategy of the anti-smoking lobby. For every principled (usually religiously principled) pro-lifer, there is someone who secretly shares their conviction, but makes the case for just a little cut in the time-limit now "because science tells us that babies of that age can now survive outside the womb".

It's nonsense. Without a lot of help a two-year-old can't survive outside the womb. And the prospect of those few born at the limit of current paediatric technology surviving uncrippled to live a normal life is tiny even with a massive input of medical and nursing resources. But worse, it is mendacious nonsense - they don't care about "viability" in the slightest. What they want is a plausible excuse to cut the availability of abortion just a bit.

So I have a test to flush them out. It is provided by that ghastly muddy compromise. Britain doesn't in law permit women to choose abortion, unlike most rich countries. It is an extraordinary construct of bureaucratic paternalism.

What British (mainland) law does is to permit pregnant women to petition doctors to give them permission to abort on the grounds that it will be bad for their well-being to carry the baby to term. With two doctors assenting to this opinion in writing (that is, as the doctors' professional opinion - the woman's view doesn't matter in law), you may have an abortion. Where the 'time-limit' comes in is that those two doctors can only approve an abortion to preserving the patient's social or mental well-being before a certain point. After that terminations may only occur where there is a substantial risk to life or health, or in cases of severe foetal abnormality.

So in practice, in the UK you have a choice only if you approach the right doctor armed with the right argument. A naive or poorly educated, woman who seeks help from her GP when the GP happens to oppose abortion, or who mistakenly calls a pro-life charity canvassing itself as offering help to the unexpectedly pregnant (as opposed to one of the pro-choice groups who do the same thing) may never find out how to get an abortion, or at least not until it is too late. The late abortions themselves aren't occuring as a lifestyle choice - which is another mendacious narrative element in the pseudo-debate.

My test is this: Next time anyone says they want the time-limit for abortion cut to because "science shows" the baby can survive outside the womb after X weeks. Say, "And of course you support changing the law to allow abortion on demand before that date, don't you?" Then watch them flounder.

I am interested in this story as I am one of many people for whom the hopefully sunnier weather of summer is accompanied by the irritation of hayfever. I do not suffer from it as badly as when I was a child but it is still unpleasant sometimes. I once played in a cricket match and my symptoms - streaming eyes and sneezing - got so bad that I could hardly continue to play the game.

Anyway, it may be soon be possible to significantly nail the problem with a vaccine.

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 policemen 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.

The CNE Health blog reports that Pfizer is to take UK's National Institute for Clinical Excellence (NICE) to court because of its refusal to allow tax money to be spent on its new drug for Alzheimer's disease. In a perfect system, NICE would not exist. But given our socialist healthcare system, I do not really like the idea of companies like Pfizer expecting that taxpayers must cough up the cash regardless of whether a treatment offers value for money. And to be fair, under a social insurance system or other private system, insurance companies would still make NICE-type decisions about whether something delivers value.

Meanwhile, Pfizer continues to lobby for taxpayers to pay more for pharmaceuticals by arguing for the end of the free trade in pharmaceuticals in Europe.

Take my advice, never trust a politician. When a politician tells you they are going to look after your child’s education, it's perhaps time to go private - or even to home educate. When a politician tells you they are going to ban guns – expect vast increases in gun crime. When a politician tells you they are going to ban dangerous drugs – watch out for your community being awash with these substances. My heart sinks when politicians get involved in anything. Invariably, they promise the earth, coercively tax you out of your hard earned money, and then they deliver bugger all when you really need the service.

- Helen Evans in the Nurses for Reform blog today (I thought it might liven up)

I particularly like it when blogging is being done, or is about to be done, by people whom I know quite well. And my friend Helen Evans has just this very day started a blog about nursing, called the Nurses For Reform blog.

That said, the prose style so far is rather corporate and armour-plated for my taste. However, despite the rather baffling word "contestability" - which is presumably some kind of Blairite code-word, for something or other - I think it is reasonably clear what is intended by the following:

NFR rejects bland egalitarianism in favour of contestability. Above all else we believe that greater partnership with the private sector is to be actively welcomed and that this sector’s contributions are good news for patients and healthcare professionals alike.

That suggests to me something quite like free market medicine, and of course I am totally for that. This next bit is definitely about free market medicine:

NFR believes in fundamental change. It believes that only by putting patients and consumers interests first will healthcare improve. It is only when healthcare is opened up to real consumers and trusted brands that nurses will find themselves working in a sustainable environment and with the incentives, resources and encouragement to deliver a responsive, popular and truly high quality service.

This says stuff I agree with, but in the manner of a corporate mission statement, and I loath and detest nearly every corporate mission statement that I have ever encountered.

Wouldn't it be fun one day to read one of these things starting with something like: "We believe only in superficial change. Fundamentally, things should stay pretty much as they are." And how about someone just occasionally admitting that he aims to supply an "unresponsive, unpopular" product or service? Many splendid tradespersons do just that and are richly rewarded.

However, since this is a corporate mission statement, I really ought not to carp. And since this is medicine and nursing care in Britain that is being talked about, well, I admit it, I do believe in "fundamental change". Nor can I reasonably object to the ambition that nurses should work, if at all possible, in a "sustainable environment", nor to them delivering a "responsive, popular and truly high quality service".

To be more serious, I have quite often heard Helen Evans say, in the plainest of English, that one of the many problems of Britain's National Health Service is that its nurses do not now have a proper career path in front of them. As soon as they get really good at their job, they tend to leave. The NHS has lost many of what would now be its NCOs, so to speak, good and experienced senior nurses being to hospitals what good and experienced sergeants are to armies. And where have they all gone? To get married, or to the private sector.

When the postings at this new blog get more specific and personal, as I am sure many of them will, I will surely read them with interest and pleasure. There will be more links from here to there in the future, I promise you.

I came out of hospital yesterday. La Belle Dame is in America making money (one of us has to) so Dave picked me up and steered me home. I live quite close to the Chelsea & Westminster and needed some air to clear my head so we walked back. I felt surprisingly well considering I have been under a general anaesthetic and had quite a few squishy bits from inside lopped off me. In fact I felt amazingly well.

The journey back home was interesting. The colours were so very bright and someone seems to have turned up the contrast. Sometimes when I looked closely as the things written on the back of people's tee-shirts whilst walking down King's Road, the words seemed to suddenly zoom away from me towards some vanishing point.

Getting home and having a nice shower was a transcendent experience but the thing that really kept me captivated was the way the water fell down, coming from hundreds of feet above my head and travelling downwards towards the gleaming ceramic floor perhaps three yards below. I could feel the vibration of the water spiralling down the plughole and the strange flute-like sound it made.

I looked forward to getting some good food as being chopped up had not dented my appetite and the hospital food was moderately dreadful. When it came time to eat, for some reason Dave would not let me near the hot stove. The smell of bacon was almost erotic.

Dave and I work together and I had been struck by some really good creative ideas whilst pacing back and forth in the ward the night before last, waiting for the frigging painkillers to actually do something. The ideas kept pouring out of me and Dave just absorbed them like the 185 IQ colossus he is. For a while at least.

But then I noticed that I was having to force the ideas out through clenched teeth and they kept bouncing off Dave's head rather than going in. To make matters worse although the bacon surrendered to me willingly, the sausages were staring at me with ill concealed contempt. I stabbed a couple to death as punishment and gave the rest to Dave.

Today I find the internet in front of me and deep throbbing pains from within. Be prepared from some bad tempered blogging over the next few days when I can drag my fingers to the mouse. Tramadol, Co-Codamol and Diclofenac are pallid impostors. Sister Morphine is a fickle lover and she would not come home with me.

The threats to liberty in Britain are too numerous to keep track of. Thanks to Josie Appleton on Spiked! for this, which I had entirely missed before now:

The Safeguarding Vulnerable Groups Bill, due to return to the House of Commons next week, will mean that 9.5million adults - one third of the adult working population - will be subject to ongoing criminal checks.

It is a House of Lords Bill, but has Government backing.

The Bill would create an Independent Barring Board (IBB), which would maintain "barred lists" preventing listed individuals from engaging in "regulated activities". "In respect of an individual who is included in a barred list, IBB must keep other information of such description as is prescribed." [cl.2(5)]

As the Bill was originally presented, you would have no right to damages if you were mistakenly or maliciously included in a barred list, and nor would anyone else. And the IBB would have been an absolute finder of fact, with appeal allowed only on a point of law. So among the things the IBB would have been independent of is responsibility for its actions.

Now things are slightly better, but there's a cunning pseudo-compromise. You can sue. And you can now appeal the facts. But the criteria applied in the application of policy to an individual case - the core of what the IBB would do - is expressly (with a shade of Guantanamo) deemed not to be a matter of law or fact, and are therefore not to be subject to examination by the courts [cl.4(3)].

The schedule of "regulated activity" is 5 pages long in the printed copy. So you'll have to look it up yourselves if you are interested.

The practical effect? Well, as an example, as I understand it, if the Bill were currently law, I would be committing a criminal offence in paying someone I trust to look after my elderly mother, who is currently convalescing from an operation, without both of us being made subject to official monitoring first.

Once it is in force, if you wish to be self sufficient - even if you don't value your privacy, and are confident that theree's nothing about you to which an official could possibly have objected in the past, and that you might not be confused with anyone else - you'll need to know if a family member is going to be ill in sufficient time to fill in all the forms and wait for them to be processed. Better leave it to the state - which is of course always perfect.

The obesity crisis, epidemic, or whatever (is fatness contagious?) continues to keep the chattering classes busy. In the Daily Telegraph today, Andrew O'Hagan, of whom I was blissfully unaware until about a month ago when he sprung to the defence of Mel Gibson after he made his anti-Jewish rant, argues for stuff like taxing "junk food" and encouraging a whole cultural battle to get the moronic lower orders off their dietary habits. It is an article reeking of disdain for vast swathes of the UK population. Perhaps it is deserved. Many Britons are disgusting people, I suppose, but being the wild-eyed libertarian that I am, do not consider it my business to nag them into eating better by a mixture of state exhortation, punitive taxes and compulsory five-mile runs.

I am not entirely sure what to make of Mr O'Hagan, or indeed the decision of the right-leaning Telegraph to hire him. I thought his article on Gibson was a terrible piece, both patronising towards Jews, other groups, and offensive but perhaps a one-off lapse, one which might not be repeated. But pretty much everything he has written since seems to be entirely lacking in humour, grace or wit. I fear that paper is in one of its down-cycles. O'Hagan may perhaps fit in nicely into the modern Conservative Party.

For a related article on obesity, diet and the nanny state, read this by Jacob Sullum.

Scientists have observed that smoking pot may stave off Alzheimer's Disease. Hmm. I am not a medical expert, but this is not the first time that people have claimed medicinal benefits for smoking this substance. There appears to be quite a steady drumbeat of support for the idea that marihuana may beneficial and that some of the scare stories are just that - scares. Of course, there are certain downsides to a "spot of blow": such as a desire to suddenly consume the entire contents of one's fridge (I speak from
experience over several years' ago).

The War on Drugs is a disaster on many levels. Besides the encouragement to organised crime, the corruption of the legal system, and the obvious assaults on individual liberty, one of the stupidest aspects of said war has been the way in which substances like pot, which might have useful properties in dealing with certain conditions, are ruled off-limits by the law. It is high time ('scuse the pun), that the law was changed.

Remember, when was the last time you heard of a bunch of young British youths getting into a fight because of lighting up a large bong as opposed to being blind drunk?

Last month, it was this:

A report published by the government predicts more than 12m adults and one million children will be obese by 2010 if nothing is done.

And this month, there is this:

Culture Secretary Tessa Jowell has called for "stick-thin" models to be banned from the catwalks during London Fashion Week...

Ms Jowell said "stick-thin" models pressurised girls to starve themselves.

Damn these wretched sheep! Can they not get anything right? One minute, they are stuffing their ovine faces with calories and the next minute they are starving themselves. Have they no pity for the suffering of the Nagging Classes?

That the BBC can earnestly report, almost simultaneously, two flagrantly contradictory agenda-driven hysterias is symptomatic of the fact that we have too many paid worriers with too little to worry about.

I am sure that ours is not the first civilisation to undergo spasms of a sociological St. Vitus' Dance nor will it be the last. But have there ever been so many popular hobgoblins surrounding the subject of food and eating? Could it have something to do with the fact that ours is possibly the first (or maybe second) generation that is more than one rainy season away from famine? Is it all just a part of the struggle to find a cultural narrative within which to fit this apparently easy abundance?

Who can say? But the sheep will graze on regardless.

This seems like a good idea

The Financial Services Authority (FSA) is to hold a six-week exercise to test the resilience of the UK's financial institutions to an avian flu pandemic.

Starting on 13 October, some 60 banks, insurance firms and other financial businesses will take part.

The exercise will look at a number of factors including how firms could cope with a greatly reduced workforce

Yes, I know that we free market purists might argue as to why we need a big regulator like Britain's FSA to set this up, but even in the absence of such a body, smart businesses would be looking to stress-test their systems against a potential serious problem like avian flu. And it is serious. Naysayers may jest about how much effort was expended on the Y2K technology issue (remember that?) but I am encouraged that these sorts of issues are taken seriously. The health of the London-centred financial system is critical, not just to the British economy, but to the wider trading system as well.

Tyler Cowen, hardly a scaremonger, has thoughts about possible preparations that should be taken.

The journey from environmentalism to sanity may not be so far after all:

The World Health Organization (WHO) has reversed a 30-year policy by endorsing the use of DDT for malaria control.

The chemical is sprayed inside houses to kill malaria-carrying mosquitoes.

And about bloody time too! The prohibition of DTT was a product of wrong-headed, fashionable green dogma and Lord only knows how many people in the developing world have paid for it with their lives. Just how many neural transmitters do you have shut down in order to hand-wring about poverty and premature death in the developing world while simultaneously campaigning against everything and anything that stands a chance of tackling them?

I sincerely hope that the greenslimers are seething with thwarted rage. In fact, I hope their blood boils until they have a collective stroke. I wish a pox on them (before they unleash a pox on the rest of us).

London calling! London calling! Reports are coming in of growing resistance to the brutal occupation of the Food Nazis:

Pupils at a South Yorkshire school are being fed fish and chips through the gates by parents who say the canteen is not providing what their children want...

The move is being seen as a backlash against TV chef Jamie Oliver's campaign for healthy school dinners..

"We aim to provide good quality food which is within government healthy eating guidelines and helps the children's learning in the afternoon "...

"The food that these parents are handing out is not part of a healthy eating diet and on top of that I have to question the morality of delivering it from the grounds of a cemetery."

Smuggling food into prisoners is a time-honoured practice but I have to admit that the cemetery angle is cool. They may need to start digging tunnels though.

Hopefully, this is a 'line in the sand'; a message from the public to the ruling class paternalists and busybodies that their food fascism is an intervention too far.

British government scientists claim that Britain faces a growing crisis of obesity. And of course such predictions, which carry all the usual credibility of such things, are accompanied by calls on the powers-that-be to "do something" about it, including the likes of bans on advertising for sinful foods, funding for sports and so on.

First point: even our waistlines are expanding, is it any of the state's business? At present, one might argue that because we have socialised medicine in the form of the National Health Service, taxpayers, both slim, chubby and positively enormous, have to pay for the consequences of bad health habits. So the neo-puritans will argue for controls on how we all live to reduce the tax cost of bad habits, which is an example of what economists might call a 'negative externality'. Surely though, the approach that would encourage good habits and treat citizens like adults is one based on private medical insurance. If people want to cut their insurance premiums, then they will have a strong market-driven incentive to do so. In a private sector model, there may be much more encouragement from health providers to get in shape and give up the triple cheeseburgers. Of course, there will always be feckless people who do not give a damn and end up demanding some kind of handout when things go wrong, but I do not see why the liberties of the majority of us should be tossed away to deal with people who are too weak willed or plain stupid to act differently. In any event, I imagine that as in the days before the NHS came along, there will be health care available for those who cannot afford it - as James Bartholomew pointed out in his book - provided through charitable means. I actually think that a charity which supports doctors might, for example, insist that if a poor person wants to get medical care for his or her obesity-related problems, then as part of any treatment, that person has to do something about their problem.

Such an approach may, at first sight, appear to be 'unaring' or harsh, but I think there is no greater respect that one can give to one's fellows than to accord them the ability to act like adults.

Goodness, all this venting has made me hungry. Anyway, as I head towards the kitchen, may I recommend this collection of articles by Reason magazine on the obesity issue.

Bon appetit!

The British Medical Association's response to a proposal by the British government to allow optometrists more leeway to prescribe medication for eye problems.

"In order to safeguard patient care, the BMA's ophthalmic committee can only envisage extremely limited opportunities for optometrists to make therapeutic interventions."

I wonder whose interests are really being 'safeguarded' here.

It seems there is a shortage of certain drugs in Britain's National Health Service.

Joe Fortescue from Alfreton, Derbyshire wants the government to provide more diamorphine, which has been in short supply since 2004. He said his 49-year-old ex-wife from Nottingham was screaming in pain in the days before her death because it was not available.

Horrendous. We are not talking about sophisticated and costly cutting edge drugs here, just a strong painkiller. As someone personally currently gobbling none-too-effective codeine painkillers every four hours after a close encounter with the NHS yesterday, dare I say I 'feel the pain' of those relying on the NHS in their time of need.

Perhaps the ex-husband of the hapless woman who died in agony for want of the correct drugs should have just scored some himself, available to anyone driving slowly with their windows open in the crappier parts of most large British towns and cities. Diamorphine is essentially just heroin after all and needless to say the 'free market' in heroin has no difficulty supplying public demand. Only the state could be inept enough to be unable to find heroin for a dying woman.

Truly the state is not your friend.

The NHS is now being instructed to turn its back on 'alternative' treatments such as homeopathy. This is a very good beginning... now all we need is for it to turn its back on non-alternative treatments too and Britain can start to allow a First World healthcare system to develop.

I recently had a very interesting chat with my good friend, Steve Edwards, who is currently without his own blog - although probably not for much longer. He is a regular at libertarian.org.au, however. In the course of our conversation, he informed me that HIV risk-of-transmission rates are not nearly as high as I previously thought. Consider this - for every 10 000 exposures to an HIV-infected source, it is estimated 5 will contract HIV via insertive penile-vaginal intercourse. 10 will contract HIV via receptive penile-vaginal intercourse. These figures assume no use of a condom. Click the link for the risk via other routes of exposure.

This got us both thinking about the HIV/AIDS epidemic epicentre of Sub-Saharan Africa. Given the very low rate of HIV transmission through sexual intercourse, is it really feasible that a country like Botswana has an infection rate of 30%+? If the ratio mentioned above is correct, an African male with an average number of vaginal sexual encounters can have unprotected sex with only HIV positive partners for a lifetime and still stand a reasonable chance of not contracting the virus. How could a virus that difficult to catch spread through a population so comprehensively?

I am not saying that HIV/AIDS is not an enormous problem in Africa - of course it is. And I do not discount the anecdotal evidence of health professionals who report a multitude of AIDS orphans and hospitals groaning with AIDS-riddled patients. I am sure this is the case, however from the limited perspective of a person's experiences, how could they possibly tell if this casualty rate represents 30% of a population of several million or 3%? 10% or 1%? Sick people do tend to cluster in hospitals, and health professionals go where the need is great. Given this working environment for doctors and nurses treating HIV in Africa, they could be forgiven for believing an inflated number. Conversely, if a foreign doctor spent a month in the wealthier parts of Nairobi, they would probably report to the folks back home that they saw no signs of HIV/AIDS at all.

I do not doubt that there is a large amount of research that has gone into producing the figures commonly cited when detailing the scope of the HIV outbreak in Africa. I would, however, ask sceptics to ponder the beneficiaries of an inflated threat of this disease. The NGOs, university teams and (most) African governments are in accord regarding the magnitude of the AIDS threat. To use the old saying; well - they would be, wouldn't they? This issue is a magnet for foreign aid and grant money. After all, African despots need to keep their wives in the style they've become accustomed to. Not to mention one's stooges who require regular buying off. NGOs need to run their fleets of SUVs, hold their conferences in five star hotels and generously employ their "support staff". University professors need grants to carry out their research. I should not forget the UN - regarding that sprawling organisation's potential conflicts of interest, the mind boggles. These people all have a stake in talking up the HIV/AIDS problem. These are also the people who provide us with data concerning HIV rates in Africa.

I am not a scientist, and I have no specific expertise in this field. I could be omitting important variables that make the scale of the HIV/AIDS problem in Africa that we're told about more tenable. However, when considering the far lower than popularly believed HIV contraction rates, I smell a rat. What makes me even more suspicious is the fact that the beneficiaries of an overinflated HIV threat in Africa appear to be African governments, NGOs and foreign researchers. Even in rich nations, resources are scarce. We need accurate information to distribute them in optimal fashion. Please set me straight if I am wrong to question, but are we being lied to about the scope of the HIV/AIDS problem in Africa?

Life is far more fun when you have a really good book on the go, and the only thing wrong with mine just now is that it weighs too much to be lugged about comfortably on my pedestrian journeyings around London. It is The Lives & Times of the Great Composers by Michael Steen. For me, this book is perfect. I know what most of the music that the great composers composed sounds like. But I am enjoying hugely learning more about the circumstances in which this wonderful music was composed and first listened to.

After an Italian prelude, the first big name composer Steen deals with is Handel, the German who ended up living in London for most of his life.

Handel's London was an exciting place (p. 39 of my unwieldy paperback):

The year before Handel arrived, Sir Christopher Wren's St Paul's Cathedral had been completed at a cost of £1,167,474 paid for largely by the import duty on coal. Sir Isaac Newton, the great scientist was still at work. London, with its sounds of wheels rumbling on cobbles and cries from the street vendors, was well into a century of commercial and cultural prosperity: the country's population grew by 71 per cent over the century; its merchant fleet more than doubled in tonnage between 1702 and 1776.

London, in other words, then as now, was making lots of progress. Perhaps because music itself can be such an otherworldy thing, even when composed by such a worldly figure as the energetically entrepreneurial Handel, Steen chooses in this book to emphasise the material aspect of things when describing the world in which this music was created.

The kind of people who enjoy the fruits of material progress, but who enjoy them more than they think about how they were first devised and are now cultivated, often dismiss progress as a small thing, perhaps because they dislike the kind of people who are needed to make it, and the methods they must be allowed to use. (Basically: commerce. And insofar as "public spending" is involved, someone has to make that money first before it can be spent.) Such people should ponder pieces of writing such as what Michael Steen says next about Handel's London:

Behind its superficial prosperity and elegance, London was overcrowded, squalid and full of beggars. People had fleas, lice and few teeth. Most people defecated in nooks and crannies, or used public lavatories built over rivers such as the Fleet. For the more refined, with a small fee, the 'human lavatory' would provide a pail and extend its large cape as a screen. Lavatory paper did not exist, the alternatives ranged from a sponge on a stick in a container of salt water, to stones, shells and bunches of herbs.

Delightful.

But the most chilling observation Steen makes about the trials and tribulations of material life in the early eighteenth century - instead of the early twenty-first, say – is this, a couple of paragraphs later:

The political outlook was uncertain.

So? When was it not? But now, hear the reason:

Queen Anne, who was in her late 40s, had borne seventeen children; mostly still-born, none had survived.

Let an anti-progress person of now read that, and then try telling us that material progress of is no great importance, or of no "spiritual" significance, that it is merely a matter of brute, animal comfort. The Queen of England, no less - who presumably enjoyed, if that is the word, the very best medical attention then available - scored zero out of seventeen in the deadly game of childbirth and child-rearing; which meant that there was no obvious royal heir, which meant that the political outlook was uncertain. Poor, poor woman.

Later (p. 54), Michael Steen throws light on another kind of material progress, of a sort that is far more widely and deliberately scorned than progress in things like plumbing or medicine (which is often merely forgotten about), namely cosmetics. Steen has this to tell us about the way that the sort of women Handel often had dealings with - such as the highly paid and outrageously indulged and pampered opera singers whom he supplied tunes for, the crazy rock stars of their day – tried to beautify themselves:

Their faces were painted with compounds of white lead, rice and flour, with washes of quicksilver boiled in water with bismuth.

Suddenly, the progress made in female adornment, which has put incomparably more convenient and healthy – to say nothing of far more visually appealing - methods of adornment into the hands of any modern woman with a few quid to spare who wants them, appears almost as impressive as progress in plumbing, medicine, nutrition, travel, civil engineering, electronic entertainment, or even the wondrous progress that was about to be made in the two centuries after Handel, in music.

Many moral questions are tricky, requiring complex theories and difficult judgements... but many more moral issues are really very simple when you look at them clearly. Manditory mass medication is one of those simple issues. I am as keen as anyone else to not see epidemics of infectious disease and in the case of such, I take the view that it is rather like why you have states to fight against foreign armies: a collective threat to everyone can sometimes only be faced by a government acting collectively. However very few things fall into this category, but infectious disease is one which indeed does - a collective threat that can only be defeated collectively. So yes, I am all for property rights but that does not include having a malarial breeding swamp on your property next to mine or infecting everyone's water supply with some nasty bug.

Birth defects on the other hand, are not a 'collective threat' and so taking folic acid to avoid certain birth defects is the responsibility of anyone who does things likely to get them pregnant. So when Max Pemperton writes an article in the Telegraph opposing government plans to force bakers to add folic acid to bread, you would think I would be supportive of him, right? Well no.

In his article Folic acid is not the best thing since sliced bread he goes into a great song and dance about the pros and cons to various groups in the population of adding folic acid and whilst he does talk about civil liberties, he is mostly just making a utilitarian argument of net-benefit. He ends with saying "It's certainly a complex moral dilemma"... and that completely fogs the issue.

No, it is actually a very simply moral dilemma: does anyone have the right to alter my body chemistry to benefit other people when my body chemistry poses no threat to anyone else (unlike if I have smallpox, for example). The question (does the state have this right?) and the answer (no) are not complex at all. If women want to avoid neural tube defects in their children, they should take folic acid. Making me take it as well will not help and is none of anyone elses damn business.

Few things are as impermanent as medical theories of 'what is best', so the utilitarian argument is utterly irrelevant. As it happens I take folic acid pills for a medical condition so I have nothing against the stuff myself but that does not change the fact the state has NO moral right to medicate me in such a way and anyone who trusts the state to pick 'what is best' for your health and make it a force backed law really needs to take a look at the state's history of screw-ups and ask themselves is this is an institution which should have the right to mess with your personal body chemistry.

Fans of the great Stanley Kubrick satire, Dr Strangelove, will struggle to suppress a wry smile over this story:

Fluoride in drinking water - long controversial in the United States when it is deliberately added to strengthen teeth - can damage bones and teeth, and federal standards fail to guard against this, the National Academy of Sciences reported on Wednesday.

The vast majority of Americans - including those whose water supply has fluoride added -- drink water that is well below the limit for fluoride levels set by the U.S. Environmental Protection Agency (EPA)

Maybe all that stuff about flouride in the water being a crazy Commie plot may not have been so nuts after all. On the other hand...

This story about advances in creation of artificial limbs and muscles caught my attention:

Scientists have developed artificial, super-strength muscles which are powered by alcohol and hydrogen. And they could eventually be used to make more advanced prosthetic limbs, say researchers at University of Texas.

Writing in Science, they say these artificial muscles are 100 times more powerful than the body's own. They said they could even be used in "exoskeletons" to give superhuman strength to certain professions such as firefighters, soldiers and astronauts.

As we ponder the flow of day-to-day news, it is easy to overlook the tremendous advances going on in fields like this. As the article mentions, applications of such medical technologies apply not just to repairing existing injuries or coping with the terrible effects of losing a limb (a sobering reality for victims of terror, car accidents, conflicts, etc), but even for perfectly healthy people looking to augment their physical strength.

The story demonstrates how blurred the boundaries now are between medical technologies that can be used to repair or heal injuries and those used to make what we have picked up in Darwin's great lottery draw even better. The genetic fatalists will decry all this for tampering with God's Will or whatever, but I don't see any difference between this and say, laser surgery for the eye, or technologies to make it possible to vastly increase our hearing strength, or enhance our cognitive capacity, and so forth.

Mind you, it makes me wonder how this technology, if it really works, is going to affect sport. At the moment the sporting authorities controlling events like the Tour de France cycling event, say, or the Olympic Games, treat any form of human augmentation or performance enhancement as off-limits. I guess so long as participants agree in advance not to use such techniques, then they cannot complain if they are caught breaking the rules. But in some occupations like those mentioned in the story, such as astronauts experiencing the effects of zero-gravity environments, this sort of stuff might be a basic necessity rather than a luxury.

Meanwhile, here is an interesting story about nanotech and possible cures for blindness. And I can recommend this book by Ronald Bailey.

Makes a change from writing about Tony Blair, anyway.

Exhibit A from the United States. That 100 pattie burger looks tasty...

(Spotted on Marginal Revolution)

Exhibit B from the United Kingdom - wait a few seconds to be diverted.

Both sites for the epicureans amongst us, most certainly.

I have come across a press release from Britain's National Health Service. The NHS is currently trying to prevent obese people from having hip replacement operations as they do not "deserve" to have such treatment, despite the little matter of their having been taxpayers like the rest of us.

"The NHS, like any proud creation of a socialist, inclusive Britain, has to operate under certain priorities. Indeed its founder, the great Soviet leader Nye Bevan, stated that socialism is about priorities. Well, there is no place and certainly no priority to treat people, who, by laziness, sloth and lack of intelligence, choose to make themselves ill or incapacitated. In fact ill people are a positive nuisance. It is the fit, able-bodied and alert people of Britain who deserve to be treated by the Greatest Health Service Devised by Mankind. No more obese people. No more smokers. No more drinkers. No more red meat eaters and chocolate fans. Such habits have no place in a socialist Britain. Let such vile habits wither away."

I am still trying to vouch for the authenticity of this release. Looks plausible to me.

As Christmas is almost upon us, it is a pleasure to read a nice article by a doughty basher of nanny-state puritanism, Jacob Sullum. Sullum states what many of us probably instinctively know to be true - a bit of what you fancy is good for you. Dark chocolate (yeh!), red wine (yeh again!) and even red meat (thrice yeh!).

So in the interests of good health, I am now eyeing a bottle of fine Rhone red wine sitting on the rack in the kitchen.

I have long gotten a laugh from Dilbert, the socially inept engineer comic created by Scott Adams. Usually, Dilbert is harmless, but occasionally he causes real damage. Last Sunday's cartoon, which features Dilbert's mother in an excessive shopping adventure that ends with organ harvesting struck me as rather amusing, but according to Scott Adams' blog, dozens of people failed to see the humour in it:

Recently I killed thousands more people. I don�t have exact numbers yet. The problem stems from my comic that ran on 11-20-05, implying that retail stores might harvest organs from bad customers and sell them on eBay. I�ve received dozens of letters (long ones!) from very angry people who assure me that the Dilbert comic will reduce the number of organ donors. The concern is that people will think their parts will end up on eBay and so they won�t be inspired to donate.

This would only have an impact on exceptionally dumb potential organ donors. But as you know, that�s a large block of the general population. Now I have to wonder how many people are smart enough to read an entire Dilbert comic and still dumb enough to think that the first person on the scene of an accident might be there just to harvest organs for eBay. It can�t be more than 1%. Let�s see, we estimate 150 million people read Dilbert, so 1% would be 1.5 million. And only 10% of them might have donated an organ anyway, so I�m probably killing 150,000 people.

It�s times like this when �oops� doesn�t seem sufficient.

I bet you did not know that cartoonists could be so dangerous. If you ever meet Scott Adams, approach with extreme caution.

One of the concerns appearing on the radar is the impact of a flu pandemic upon Africa, where a rudimentary infrastructure for health is combined with the largest number of individuals with HIV and AIDs. A common mistake is to view this latter group as the most vulnerable to a flu pandemic, with a potentially catastrophic death rate.

Recent comments by Dr. Robert Webster, at an avian-influenza conference, organised by the Council for Foreign Relations, in New York, theorised that HIV positive patients and those suffering from cancer could act as incubators for the virus, leading to more virulent strains. However, there is evidence to support the view that immunologically compromised individuals will not facilitate the spread of the pandemic:

Stephen Wolinsky, chief of the infectious diseases division at the Feinberg School of Medicine, concurred that prolonged shedding of the virus was a definite problem but referred to a study published earlier this week that stated that immunodeficiency may in fact be a benefit in the face of avian influenza.

The study, published in the journal Respiratory Research, indicated that the young and healthy may be those most seriously affected by avian influenza, as the body's immuno-response was to produce a storm of cytokines that can lead to respiratory difficulties.

Wolinsky opined that, for Africa, the lack of access to doctors and hospitals may prove to be a greater concern in the fight against avian influenza than the continent's HIV/AIDS epidemic.

This region has been identified as a potential outbreak region for the pandemic. Farming practices that bring farmers into close proximity with poultry, are compounded by non-existent public health schemes and a large proportion of the population suffering from ill-health and malnutrition.

The H5N1 virus overstimulates the immune system, and many of its powerful effects are caused by what medical expert call a "cytokine storm", after the immune molecules excited by the disease.

It was the cytokine storm that overwhelmed so many victims of the 1918 flu pandemic. Aids patients may be spared that fate.

But equally possible, with their immune defences down, they could succumb easily to the disease.

"In that situation," said Laurie Garrett, "vast populations of HIV positive people could be obliterated by the pandemic flu."

Laurie Garrett, senior fellow for global health at the Council of Foreign Relations, was identifying the worst case scenario.

Alexia Harriton, an Australian woman who is deaf, blind, physically and mentally disabled and requires round-the-clock care, is suing a doctor for allowing her to be born, with the full support by her mother. Never mind that rubella during pregnancy does not guarentee what happened to Ms. Harriton.

I have a better idea. If she is competent to sue the doctor, she is competent to tell the people giving her round-the-clock medical care to get lost and let nature take its course. Hell, she could tell one of them to leave a nice sharp knife or a cup of water and a bottle of sleeping pills within reach if she wants to expedite things and if she cannot manage that, well seeing as how her mother is so supportive...

Why should a doctor be liable for an 'act of God'? So he did not diagnose how thing would shake out correctly. Too bad, no one is perfect.

Seems to me that Alexia Harriton and her mother were born moral and emotional cripples too. Nature dealt them a seriously crap hand and that is truly tragic but it is no one's fault. It happens. Deal with it, but please, deal with it yourself. Think I am being a little harsh? Well I do not think so and I have my reasons.

A study claims that the long-term effects of smoking tobacco can impair mental functions. My goodness, what other horrors can the dreaded weed be held responsible for? I don't smoke and dislike the pong of cigarette smoke in my clothes after visiting a pub, but is there no limit to the ways in which our blessed medical profession want to condemn smoking? The claim rings false to me (I am not a scientist mind so if this can be verified in a peer-reviewed journal, I'll stand corrected). There have been lots of brainy smokers over the years, surely.

I wonder how many members of Mensa have been smokers?

Just as the NHS is the darling of the British people, it will come as no surprise that its failures are increasingly covered by the tabloids, who have found that the crisis in health provision is a concern to those who have to rely on the state through no fault of their own. High taxes and expensive private health care denies choice to the majority of the population.

One of the latest (and incredible) stories to emerge is a lack of mops in Victoria Infirmary in Glasgow:

PATIENTS spent two days in "grotty" wards - after a hospital ran out of mops.

Cleaners at the Victoria Infirmary in Glasgow were left stunned after bosses told them of the shortage. And it took two working days for the hospital to replace all the mops.

A source at the closure-threatened hospital said: "We knew things were bad here but this takes the biscuit. Cleaners went to work on Wednesday and were told there were no mops and nothing could be done about it

Only scenes such as these could be caused by a state monopoly of health:

After replacement mops arrived on Thursday, a source revealed that hospital staff celebrated.

The insider revealed: "People were dancing around the boxes, singing and chanting, 'We have mops.' " The source added: "No wonder our hospitals are riddled with MRSA superbugs and such like if they can't get something as simple as this right."

Only the NHS could ration health and mops!

"Organic farming has been put forward as one of the major pillars of a new, more-sustainable human society that would be "kinder to the earth". Unfortunately, organic farming cannot deliver on that promise. In fact, organic farming is an imminent danger to the world's wildlife and hazard to the health of its own consumers."

Dennis Avery, quoted in Fearing Food, (page 3) by Roger Bate and Julian Morris.

Something for George Moonbat to ponder, I reckon.

The pharmaceutical industry has been running an ad campaign in the United States saying that reimportation of drugs from Canada were allowed, those drugs might be counterfeit, unregulated and unsafe. This is simple propaganda and nothing more.

Pfizer's Chief Executive Officer Dr Hank McKinnell has come out and contradicted his industry's advertising. On page 69 of his new book, he says that: "Drugs from Canadian pharmacies are as safe as drugs from pharmacies in the United States." Pfizer vice-president Dr Peter Rost says that drug company lobbyists "know full well" that drug reimportation has "been done safely and cost-effectively... in Europe, for over twenty years... The German Federal Health Ministry has verified that not one single confirmed case of a counterfeit medicine has ever come through the parallel trade chain. The UK regulatory authority has described the level of pharmaceutical counterfeiting as 'virtually undetectable'."

They were not speaking on behalf of their employer.

Dr Rost's view is confirmed by Donald MacArthur of the European Association of Euro-Pharmaceutical Companies who in November 2003 testified at a US Senate committee. MacArthur said: "As far as can be ascertained there has never been a single, proven case of a counterfeit medicine leaving the parallel trade supply chain in Europe. Certainly, none has been reported in the two largest markets for incoming parallel trade - the UK and Germany; in the case of the latter, the government has recently verified this fact".

In the US, where reimportation is illegal, counterfeiting is on the rise. The ban on reimportation has led many people who cannot afford the cost of drugs from their local pharmacy to use online shops they have never heard of to illegally get cheap drugs. Some of these websites, which are marketed through spam e-mail, claim to be in Canada but are based in developing countries and fail to deliver anything or supply counterfeit drugs.

If the US wants to fight counterfeit drugs, it should follow the European model and let legitimate, properly-regulated businesses, which consumers can trust, safely and securely reimport pharmaceuticals. That way, the drugs get imported from legitimate wholesalers in Canada and Europe. Contrary to claims of pharma's lobbyists, it is America's ban on reimportation that promotes counterfeiting. The US government should adopt free trade in pharmaceuticals not just to reduce prices but to reduce counterfeiting, too.

Crossposted from the Globalisation Institute Blog.

Last summer, I went on very public record with my opinon that the überhyped and screechingly hysterical 'obesity epidemic' was nothing but a crock of shit, cooked up (in this country at least) by grasping public sector vested interests and amplified by their MSM handmaidens.

While I will continue to do whatever is in my power to undermine this whole wicked, mendacious plot over here, I am pleased to note that there is also some serious fightback going on over on the gun-toting side of the Atlantic:

One would be forgiven for thinking CDC stands for Center for Damage Control. Just a year after its widely-publicized and exceedingly controversial announcement that excess weight kills 400,000 Americans annually, the agency is rumbling, bumbling, stumbling toward an explanation for a new study that says the real figure is just 26,000.

Unfortunately, trial lawyers who see dollar signs where the rest of us see dinner have seized on the CDC's 400,000 deaths number to justify their frivolous crusades.

Now word comes from experts within the CDC that excess weight is about one-fifteenth as dangerous as previously thought, and has a lower death toll than diseases like septicemia and nephritis. Each death is of course tragic. But has anyone heard of the septicemia "epidemic" or the nephritis "tsunami"?

It's said that a lie can travel halfway round the world while the truth is putting on its shoes. Well, the truth about obesity is finally lacing up. And that's bad news for trial lawyers pursuing obesity lawsuits against food and beverage companies as well as the self-appointed diet dictators seeking extra taxes on foods they don't like.

Not that that will stop them, mind. Truth has little currency when compared to the value of a well-forged career-path or the tantalising lure of brimming public coffers. (By the way, the link above is to the website of an American organisation called the 'Center for Consumer Freedom'. Not only do they appear to be on the side of the Angels but their website looks like an excellent activist resource that is well worth a bookmark).

Still, the backlash has to begin somewhere, somehow and debunking the fraudulently inflated statistics is an important part of that process. However, it is equally important to maintain the principle that, even if all the har'em-scar'em statistics were true (which they clearly are not) then the responsibility for and solution to the problem of obesity lies with the obese themselves and not with judicial system or the apparatus of tax-collection.

Story here that says that far from being a bad thing, sitting outside in the sun for at least 15 minutes a day is good for you, latest medical findings suggest. It certainly is a bit of a change from the period, I well recall, in the 1990s, when it appeared to be the case that any exposure to sun was fraught with danger as a result of the supposed hole in the ozone layer. I recall the constant worries, fuelled in the press and elsewhere, about skin cancer and the dangers of overdoing the sunshine.

Sometimes you have to just laugh. Of course being exposed to the sun is good for you in moderation! Mankind was not meant to sit indoors or conceal every aspect of the body all the time. Anyone I know who spends the vast majority of his or her time indoors looks, well, unwell, in my opinion. I always make the effort to break out of my office at lunchtime to get what passes for sunshine in this damp country of ours. It is not rocket science.

Coming next: medical experts reveal that regular exercise, eating vegetables and playing sports can do you some good.

The steady advances in cloning technology holds a great deal of hope the future of the species and the news from Korea and Britain has been pretty damn encouraging over the last few years. It now looks like we could be on the brink of being able to mass produce stem cells and that, boys and girls, could be the gateway to a new era of medical possibilities.

�This is really the destruction of the National Health Service."

- Professor Vincent Marks of the University of Surrey on the Today programme this morning discussing the modest government announcement to allow more private involvement in the National Health Service.

It takes some nerve to announce this on the day of a General Election. Mind you, I doubt very much that it would at all influence the outcome:

Patients should be refused treatment because of their age in some cases, government advisers have proposed.

Where age can affect the benefits or risks of treatment, discrimination is appropriate, the National Institute for Health and Clinical Excellence said.

Charities representing older people said the recommendations were outrageous and sent out mixed messages.

Wrong. The message is quite clear and will gradually become more acceptable. Within five years, people over 75 will be offered euthanasia when they get sick. Within 10 years it will be mandatory.

The fine U.S. blogger and libertarian scholar, Tyler Cowen, who's blog Marginal Revolution is well worth a visit (as if I did not have enough things to read, aarrgghh, Ed) has started a specialist blog devoted to tracking developments and medical research surrounding avian flu. Tyler is clearly worried about the spread of new and more powerful viruses and the threat this poses to the health to millions of people around the world.

Rather interesting, I think, that the Internet, which helps to spread ideas with the speed of a virus, is now spawning blogs which are devoted to actual, existing viruses.

Terri Schiavo died this morning.

I hope that her husband and family can find some peace, if not with each other, than at least within themselves.

Now that the emotional flash point of the debate is gone, I hope that we can have a more considered policy discussion over who should make medical decisions for non-decisional patients, and under what restrictions.

Nobody is willing to take the position (at least in public) that a person should not be able to refuse medical care in person, on their own behalf. However, many of those now engaged in the struggle over end-of-life health care are, wittingly or not, arguing that some health care decisions should be removed from private hands and made by the state.

The current baseline rule is that your personal autonomy with respect to consenting to or refusing to consent to medical care is pretty much absolute (I am discussing medical care, not mental health care, which operates in a parallel universe on these issues). I note that there are some second-order restrictions on what kind of care is actually available to you, arising from various licensing and regulatory regimes, but leave those aside for now. You can refuse any and all kinds of care, ranging from the most extreme life support to the most mundane blood transfusion, and people do all the time, even when the refusal puts their life at risk.

Things get more complicated when you are unable to decide for yourself (or, what amounts to the same thing, unable to communicate your decision). Someone has to decide what care you will be given. Your ability to make such decisions in advance will, sooner or later, be outrun by the unforeseeable complexities and irreducible detail of your medical care. If nothing else, someone will have to interpret your written instructions and apply them to the messy clinical realities. At the end of the day, if you are not "decisional" you will have a surrogate decision-maker. That decision-maker will either be a private individual or the state.

The current system very rarely results in the state directly taking custody of a medical patient who is not decisional, and is very heavily biased toward leaving health care decisions in private hands, with a fairly limited "reserved" power in the state to hear disputes about who the private decision-maker should be. So far, so good.

Although reasonable people can disagree on whether, for example, Michael Schiavo should be Terri Schiavo's surrogate or one of her parents should be, this dispute is over the proper issue of which private party should make decisions. It is very difficult, I think, to argue that this issue hasn't been fairly and adequately processed by the courts.

However, we are seeing increasing pressure to restrict the decisions that the surrogate can make. This is where it gets tricky, because legal restrictions on the decisions that a private decision-maker can make mean that the state is making that decision. If there is a law on the books that prohibits your surrogate from consenting to experimental treatments, then the state is making the decision that you will not receive that treatment. If there is a law on the books that prohibits your surrogate from withdrawing a feeding tube, then the state is making the decision that you will be fed through a feeding tube.

The current mantra that "if there is any doubt, err on the side of life" is a TV-friendly sound-bite in the service of expanding the control that the state has over your medical care, because this "principle" removes from your surrogate the ability to make health care decisions, and is functionally equivalent to the state ordering that medical care be provided regardless of your wishes. For your own good, of course.

Similarly, the endless agitation for more appeals amounts to agitation for more state review and oversight of a nominally private decision. For your own good, naturally.

In short, to the extent any coherent public policy is being advanced by the people who want the feeding tube re-inserted into Ms. Schiavo, it is a public policy that shrinks the decision-making powers of private decision-makers, and necessarily transfers those decisions from private hands to those of the state.

The over-riding principle that is cited in favor of this transfer of power to the state is the protection of life. However, the protection of life is not an absolute trump card; indeed, when it comes to medical care, personal autonomy overrides protection of life; otherwise, the law would require that life-saving health care be provided to you over your objections.

Nobody is willing to take that step, so advocates for the transfer of power to the state are left in the position of arguing that some decisions that you can make for yourself should never be made by your surrogate, but should be made by the state instead. Those are the only two choices on offer - either the state makes decisions about your end-of-life medical care by prohibiting your surrogate from deciding, or your surrogate decision-maker does.

I think you know where my instincts are when faced with a choice between preserving the private sphere and expanding state control.

On The Voice of Reason (slogan: "A penny saved is a government oversight"), there is a pretty clear headed little essay of what I think is most the reasonable position on this absurdly emotive case.

For an excellent overview of the Schiavo case, written by someone with a better work ethic than me (she links to her sources, I just kind of remember their gist), go to Majikthise.

Out of the morass of purely case-specific issues in this case, perhaps the most legitimate policy argument raised by the Schiavo trainwreck has to do with the withdrawal of food and water.

Let's be clear on Schiavo's condition and treatment here: she is being fed and hydrated through a tube in her stomach. She is not feeding herself, and is presumably not capable of taking food and water orally, or the tube would never have been inserted. This kind of feeding and hydration is just as much a medical treatment as having a glucose or saline IV inserted into your arm.

No one attempts to deny that Terri (or anyone else) would be permitted to refuse this treatment for themselves; a law mandating that you receive a given medical treatment against your will would be widely regarded as an abomination.

Similarly, no one seems to be seriously arguing that if Terri were on a ventilator or some other form of artificial "life support", that her guardian should be permitted to withdraw the life support, even though there is no written evidence of what Terri's wishes were in that regard.

This leaves many of the folks who are now arguing for federal intervention into Terri Schiavo's medical treatment in the rather uncomfortable position admitting that (a) she could refuse to consent to being fed through a tube in her stomach, and (b) that her guardian could withdraw other forms of life support, but nonetheless that (c) her guardian cannot refuse consent to her being fed through a tube in her stomach.

Thus, the policy question being posed by this case seems to be whether a surrogate decisionmaker should be compelled by law to "consent" to their ward being fed through a tube in her stomach, unless he can produce written evidence that is what the patient would have wanted.

The case against such a legal mandate boils down to the argument that denying the right to consent or refuse consent to the surrogate is the same as denying it to the patient herself. Of course, the surrogate is not, in fact, the patient, and there may be legitimate boundaries placed on the decisions the guardian can make on behalf of their ward. The question is whether withdrawal of nutrition and hydration is outside of those boundaries, and if so why.

The case for a legal mandate that nutrition and hydration be given over the objections of the legal guardian rests comes down to the argument that, where there is any doubt as to what the patient would want, we should err on the side of keeping them alive. This argument, however, founders on a couple of points. Logically, it cannot be limited to nutrition and hydration, and thus requires that we keep all life support, no matter how extraordinary, in place. Further, it begs the question of how much certainty is enough. Even where a written living will exists, the question can be raised about whether the patient changed her mind.

Because we cold-hearted libertarians care about such things, Terri Schiavo's care is being paid for by taxpayer money through the Medicaid program. Even though her parents have noisily pledged to take all financial responsibility for her care, they have not yet done so, even though the trust fund established out of the proceeds of her malpractice case to pay for her care is nearly exhausted. The annual cost is probably around $80,000 per year.

Various precincts of the US body politic are obsessed with Terri Schiavo, a young woman who has been at the center of an ongoing familial, legal, and now, sadly, political dogfight.

In very broad terms, Terri Schiavo is unable to make decisions for herself. She is apparently brain damaged, and has been in some degree of coma or "persistent vegetative state" for years. Her husband wants to withdraw artificial life support and let nature take its course. Her parents want her kept on life support indefinitely in the hopes that some day she will make some degree of recovery. As ever, you can find a medical expert to present just about any side of this that you want. This situation is, sadly, all too common.

The uproar around Terri Schiavo illustrates rather nicely the key distinction between libertarians and, well, everyone else. For libertarians, the critical question is "who decides?", based on their belief that you should be able to make your own decisions in life. Most other folks, it seems, don't care "who decides" nearly as much as they care about "what decision is made," and particularly, "whatever decision is made, it damn will better be one I approve of."

In Terri's case, this means that all sorts of folks who you think would know better than to invite the state to participate in medical decision-making are doing exactly that, because Terri's husband has made a decision that they do not approve of.

So, not only have we been treated the spectacle of the Governor of Florida, Jeb Bush, trying to elbow his way to Terri's bedside so he can dictate what care she will receive, we also have various Florida legislators trying to insert the State of Florida into the mix. Now the US Congress, apparently not satisfied with embarrassing itself* in its ongoing investigation into steroid use in major league baseball, is preparing to abuse its subpoena power to block the decision made by Terri's husband.

A fundamental principle of health care law, and one dear to the hearts of libertarians, is that you must give informed consent to any treatment before it is administered to you (with an exception in cases of emergency when you are unable to communicate, in which case the caregivers are allowed to assume you want life-saving treatment). A doctor who treats you without your consent has committed assault and battery. It is your right to refuse any treatment at all, even if it will mean your death, and so long as you are a competent adult no court or legislature can intervene to force treatment on you.

When the patient is not a decisional adult, someone who will make decisions on their behalf must be located. You can appoint your own surrogate decision-maker, via a health care power of attorney (which I strongly recommend). Some states have lists of "deemed" surrogate decision-makers on the statute books, such as spouses, parents, siblings, etc., in rank order so everyone knows who has authority in a given case. As a last resort, a court will appoint a guardian.

The whole process is focused on the proper issue of identifying "who will decide." Once the decision-maker is identified/appointed, they stand in the shoes of the patient. The state retains (or should retain) only the most limited role, to ensure that the decision-maker does not abuse their power. Clearly, the decision to withdraw life support is a decision that Terri Schiavo could make for herself. Indeed, my wife has told me that if she were in Terri's position, that is exactly what she would want. Her husband's decision to make it in her stead is by no means an abuse of his power as her surrogate decision-maker - such decisions are made routinely, every single day, across the country by people charged with the heavy burden of making health care decisions for someone else.

What we have in the Schaivo case, then, is the legally appointed and recognized decision-maker making a choice that is well within his purview. Multiple court reviews have concluded that he is the right person to make the call, and his decision should be honored. To this libertarian, that is the end of the matter, because the very essence of being a libertarian is respecting the decisions of others even when you might decide otherwise. To a broad spectrum of conservatives, however, the fact that medical decision-making should be private is of no concern when the decisions made are decisions they disagree with.

*While at the gym yesterday, I caught a few minutes of the steroid hearings. It was painfully embarassing to see the solons of American governance earnestly seeking noted idiot Jose Canseco's advice on public policy. A quick survey of the fellows in the locker room revealed that this latest Congressional exercise in nannying competent adults and chasing headlines is not being well-received by the public. The universal sentiment was, "Don't they have anything better to do?"

Stephen Pollard, a former member of Britain's Young Conservatives who is now a New Labour guru, has an article in the Times called: My easy ride in the Senate seat.

Life after his easy ride is getting a little more tricky, with a savaging from Global Growth, the free-market NGO.

The Centers for Disease Control released new life expectancy figures for the USA today. Average life expectancy is up to 77.6 years, up three tenths in a mere two years. Also remarkable is the rapidly closing gap between the life expectancies of men and women. It was a 7.8 year gap in 1978 and is now down to 5.3 years.

When I was in my twenties I told friends my life's goal was to go downhill skiing on Ganymede at age 120. If the technological exponential keeps going as I expect -- and I am 'lucky' enough not to draw the Ace of Spades -- I might just do it.

See you on the slopes!

For more information, see Space.com's Live Science article.

Leon Trotsky's views on the role of arts were well known. He argued that art in all its forms existed to convey political messages to the masses and that any other use of the arts was bourgeois nonsense. The idea that it was acceptable for the arts exist to express the personal views of some artist or to simply 'entertain' in a non-political sense (not that anything is really non-political to a statist) was just preposterous to Trotsky. Thus if the state wished to advocate or depreciate something, it was the role of the arts to assist with that process. A modern day example of this would be, say, the relentless demonization of smoking.

Which brings us to the views of the Orwellian sounding Centre for Tobacco Control. This group of lobbyists is infuriated that their calls for smoking to be censored by the British Board of Film Classification (who were once simply known as the Film Censors) has been rejected.

The board's cautious mention of smoking for the first time falls far short of demands that smoking scenes, particularly in any film likely to be seen by children, should be banned in Britain and consigned to the cutting room floor. Professor Gerard Hastings, director of cancer research at the UK's Centre for Tobacco Control, said: "If the BBFC doesn't accept its moral responsibility, it might as well pack up and go home."

And so we discover that this lobby thinks is the 'moral responsibility' of the state to impose standards on entertainment to make them more in accordance with the wishes of our technocratic betters (them, of course). Not only do they wish to make it as difficult as possible for you to make your own non-coerced choices as to what stresses and chemicals you expose your body to, they wish to prevent you seeing images which do not conform to the message they wish to indoctrinate you with. I would be curious to know if Professor Hastings also supports forcing people to take favoured chemicals?

Remember this?

The sun's rays, which are called ultraviolet A and ultraviolet B rays (UVA and UVB rays) damage your skin. This leads to early wrinkles, skin cancer and other skin problems.

Being in the sun often over time, even if you don't burn, can lead to skin cancer. A tan is the body's desperate attempt to protect itself from the sun's harmful rays.

Well, forget that. Now learn this:

Sunshine might stop certain cancers from growing, including skin cancers, according to two new studies.

One found it helped beat the deadly skin cancer malignant melanoma. The other found the sun helped with non-Hodgkin lymphoma.

Tobacco is also known to prevent cancer. So get out that sunbed and a packet of cigarettes now. It's for your own good.

One of the unspoken benefits of globalisation is the use that professionals make of the new instruments and techniques that are publicised over the internet or through the wider dissemination of networks to newly emerging economies, such as India. However, as one example demonstrates, medical professionals in India read or learn about new developments from the West in their specialism but are unable to apply them because they are too expensive or the instruments cannot be imported or the patients are not rich enough to afford them. This is providing a spur to entrepreneurial and philanthropic activity.

Narayana Hrudayalaya is a medical foundation established in India by Mother Teresa's cardiologist, Davi Prasad Shetty. Acknowledging the dilemma faced by all professionals in poorer countries, Shetty aimed to pioneer low-cost cardiac surgery that would prove affordable, with charitable supplements and insurance for even the Bengali peasantry and textile workers inhabiting the countryside around Kolkata.

In an interview with New Scientist, Shetty understood that governments and international bureaucracies were a hindrance, not a benefit.

If there is one organisation that can be squarely blamed it is the WHO. Headquartered in Geneva, separated from reality, it runs its global activities with help from government representatives who are mostly bureaucrats. In the countries I travel to, bureaucrats are a class of people who are experts in nothing but authorities on everything. They are not best-suited to guide planning at the WHO. One of the WHO declarations was "Health for all by 2000". How can a global body make that kind of statement when a country like Zambia does not have an echo-Doppler, without which you cannot detect any heart problem, or when one cannot find a single functioning ECG machine in many African countries?

Apart from the WHO, I have stopped blaming the politicians and bureaucrats. We are better placed to bring about changes by being outsiders, not by being a part of the system. All that the government can do is to stop being an obstacle. If it decides to be a bystander, things will fall in place. My belief is that within ten years, the government healthcare systems in all Third World countries will fold up. The government will not be able to pay even salaries, never mind offering healthcare. In that situation, organisations like ours should come forward to take over and manage it in a professional manner.

Whilst Shetty describes himself as a social worker as a libertarian, he has recognised that governments cannot provide the resources to meet his objectives and that it is best if they stand aside or collapse. When the state is no longer a factor, the economics or healthcare starts to add up.

Yes, it's very different. In Western hospitals, about 60 per cent of the revenue is spent on salaries, while in government hospitals in India, 90 per cent goes on salaries. By contrast, in our hospital only 12 to 13 per cent is spent on salaries. That doesn't mean our doctors are being exploited. Since their output is ten times more, unit operating costs are very low. To earn a given salary in another hospital, a doctor would have to perform one operation a day. With us he might have to operate on five patients. We also work with zero inventory, so the burden lies with the supplier. And since we are the largest consumers of medical disposables, we procure them at a discount of 30 to 35 per cent.

Increasingly, for the pragmatists of the world, freedom provides the answers that the state is unable to.

Peter Cuthbertson has some pretty clear views about those who would control us for 'our own good'

Any Brit who turns their television on to ITV or Channels 4 or 5 now will sooner or later see a vile new National Health Service advertisement, funded by their own tax money. Showing a young man running around bars and shopping centres spraying foul smells into the air and onto the clothes of others, it literally urges people that just as they would not tolerate anyone who does that, they should fight against the freedom of smokers to light up in bars and pubs. An obvious prelude to the government's campaign to stop restauranteurs and landlords from allowing smoking on their own property, it is no doubt hoped the advertisement will edge public opinion in the nannying direction.

It is difficult to fathom the petty, narrow mind of the sort of otherwise unemployable bureaucrat who came up with this one. But one comes to understand the idea of people feeling aliens in their own country when one sees such things. What a profoundly un-British little broadcast it was. What a sickening way to impose the morality of the elite's stateless global citizen onto a country whose famous tolerance and fair-mindedness is probably what left-liberal nannies feel necessitates such propaganda - sorry, such a campaign of public education - in the first place. One can only hope enough independently-minded people are emboldened by such spiteful nonsense to take stands on behalf of smoking, one of the few remaining mass activities that genuinely is not in some way anti-social, in an age where it seems few Britons can enjoy themselves in a group without being obnoxious to others.

Somehow worse than this, however, one sees explicit use of taxpayers' money to campaign for one side on politically controversial areas, over behaviour that is perfectly legal and normal. This is a precedent that should worry everybody.

In any reporting on a quasi-tyranny, the state's control and use of the media is usually cited to show that a country cannot be a genuine liberal democracy. Chile's slide into dictatorship in the early 1970s is exemplified by Salvador Allende's decision to eliminate criticism of his regime by nationalising the press. Today's Russia is now widely described with the euphemism 'managed democracy' to a considerable degree because so much of its television is under state control: the elections themselves are free, but the state-run television stations campaigned strongly for Vladimir Putin in advance of last March's Presidential election.

It's because the use by the state of the media to advertise its own virtues and ideals is so symbolic of a wider lack of freedom that it is such a good indicator of the health of a society. The state is effectively limitless in its power to take by taxation anything people earn and produce. When it also feels free to use that money to take political stands, often stands opposed by the very people who pay these taxes, that is a signal of an overmighty government, wherever it exists.

When the state, as distinct from any political party, takes on the role of encouraging people to have the correct views and oppose the right habits, the liberty of everyone is made immediately more precarious. There is a very great supply of petty nannies with a favoured cause, and altogether more dangerous authoritarians and social engineeers with their own pet projects, who would love to get their hands on the power the NHS is now abusing. Rest assured, they will find ways of doing so if the precedent now being set is not reversed.

As the unrelieved gloom surrounding freedom in the UK becomes too much to bear, here is a recommendation for all of those who wish to celebrate the diversity of snackdom before the health fascists force us all to eat lentils and turnips.

Visit snackspot and track down all of those arcane foods such as Gummi Zone Gummi Pizza before they are banned by the edict of Nanny Blair.

According to Dutch health investigators, going to church can cause lung cancer and other respiratory problems, because of the carcinogenic effects of candles and incense. Dr Theo de Kok, says that it is "very worrying". With Christmas approaching, levels of pollutants would be expected to rise.

The solution is obvious. The European Union must immediately ban church-going for all children, impose a tax on adult church-goers, put health warning signs on the outside of all churches and copies of the Bible.

Oh, and ban Christmas.

Obviously, the EU must also impose diplomatic and economic sanctions on any country that does not comply with this (the USA).

In dreaming up appropriate health warnings for church-going, I like the following:

God kills!
Do not worship God in the presence of children
and cutest of all:
God can seriously damage your unborn child

Last month a British panel of the Great and Good issued a thumpingly big report on the state of Britain's pensions system covering both the private and state networks of provision. In short, the report said that we are living longer, have fewer children, and hence pensions systems which were constructed in the middle of the last century are buckling under the strain. It is all now a fairly familiar story and likely to prove one of the most ticklish political domestic issues in Europe and north America for the next few years.

But consider this - if we are living longer and able to live healthier lives for longer, and this is causing certain strains to emerge in pension provision, then how do the doomongers square that with the claim that we face all manner of threats to our health? One can barely open the pages of a newspaper or turn on the television without being regaled about all the horrible risks out there, obesity being the latest issue, but by no means the last.

Well, for all our supposed problems, something wonderful has happened to the health of most people in modern industrial nations these past few decades. (Clues: modern medicine, drugs, decline of heavy manual labour, greater awareness of healthy diet, dangers of tobacco, etc). I appreciate that stating such a thing in today's culture of gloom is unfashionable, even reckless, but there it is.

Business enterprises are often attacked for selling people 'junk food' and not telling them about the health benefits of vegetables.

Well recently ASDA (the British arm of Walmart) labelled its vegetables, explaining that people who eat certain types of vegetable have a lower chance of developing certain forms of cancer.

ASDA was promptly prosecuted and punished. It seems that 'making health claims' is not legal in Britain.

Oh well, back to selling junk. The state is not your friend.

Via Catallarchy, here is something you do not hear every day from a legislator:

Folks have got to take personal responsibility for their actions.

So said Michigan Representative David Palsrok, sponsor of a bill signed into law today in that state by Democratic Governor Jennifer Granholm - a law which bans people suing food companies and restaurants for 'making' them fat.

And here is another quotation from the same article which is not quite as much of a shocker:

The Legislature and society should focus on preventing the sale of fatty, sugar-laden products in our nations [sic] schools or requiring that fast food manufacturers provide nutritional information on the food they sell.

Says who? The Michigan Trial Lawyers' Association, of course.

BBC Radio Four (indeed any part of the B.B.C.) is not where one would expect to find support for liberty, but a few a days ago I heard, on the Radio 4 Today Program, a report on medical care.

According to the report private hospitals in India (including in Calcutta) offer British people medical care at least as good as that provided by the NHS, and in wonderful conditions (marble floors, everything clean rather than the dirt, and decay one finds in British government hospitals - thousands of people die every year in Britain from infections they pick up whilst in government hospitals) and at a small fraction of the cost of the (highly regulated) British private hospitals.

The Labour MP Frank Field (a man known for his honesty - hard to believe in a politician, but it is true in his case) came on to the program and claimed that a constituent of his was being left to go blind by the NHS, people are normally left to rot for long periods of time by the government medical service, but his sight was saved by sending him to an Indian hospital.

The price of his medical care (not including the cost of flying to India, I admit) was £50 - in Britain the medical care would have cost (according to Mr Field) £3000.

So the choices were - go to a highly regulated British private hospital (if you happen to have £3000), rely on government medical care (and go blind), or go overseas.

Being a Labour MP Mr Field wanted the NHS to pay to send people to private hospitals in India (they put administrative barriers in the way of this ["it is too far"] - although they are willing to spend far more money sending people to European hospitals), but this was the closest I have ever come to hearing both the BBC and a Labour MP condemn statism in health care.

Discussing nationalised healthcare with those of a leftist frame of mind, it occurs to me that one is put at a disadvantage in attempting to demonstrate the merits of a private healthcare system if one restricts the options to a public health system versus private health system. This tends to conflate the separate benefits a private system would provide. Nationalised healthcare systems are wasteful and ruinously expensive but there are actually two separate phenomena contributing to this.

1. Any business which is run by the government will have priorities unrelated to those of the customers of that business and will tend to provide the product or service it wants to provide, in the quantities it wants to produce as opposed to providing the product according to the customer's demand. This leads inexorably to unsatisfied customers, gluts, rationing and shortages.
2. 'Free' healthcare is a problem similar to the tragedy of the commons. If there is no cost to be borne by availing of 'free' healthcare, there is no corrective against frivolous use of this service. The phenomena of bored pensioners visiting the doctor for a chat is solely that of a system where that doctor's time is paid by the taxpayer and not the loquacious geriatric. Hypochondria, held in check by a pay-as-you-go system is positively rewarded by free healthcare.

One is further disadvantaged by conflating nationalised health with redistributionism per se. Thus, if the matter for discussion is simply nationalised health versus private, one must not only convince the sceptic of the benefits of the market but also to abandon a, perhaps cherished, redistributionist outlook. Yet, it is not necessary to do so if these issues are separated. In agreeing to set aside the issue of redistribution in the first place it ought to be possible to agree with the leftist interlocutor that the government does a lousy job of running the health system. An ardent supporter of cradle to grave healthcare, if intellectually honest, may be persuaded to concede that, so long as the government still pays for it, healthcare would be better provided by the private sector. If this step is accepted, such an intellectually honest leftist might also note the role of incentives when healthcare is provided on a no-cost basis. In an alternative system, an individual might be provided with health vouchers or subsidised insurance, perhaps a no claims bonus might apply or a policy excess. In such a system, the government still picks up the tab but there is at least some incentive for the user to modify his consumption.

By separating the issues it may be possible to reach wider agreement on privatising health than would be possible with the issues lumped together. It is probably worth adopting such an incrementalist approach in lieu of the 'greedy' approach of the absolutist. For most of the issues which concern libertarians, a step in the right direction is not only useful in getting closer to one's goal, it may also offer a noticeable improvement in its own right.

Whenever we touch on the issue of state controlled health system versus private healthcare, we get a smattering of outraged readers who cannot understand why we attack that venerable (in their eyes, not ours) dinosaur, the NHS. It's free and for everybody they screech, you heartless capitalists... would you let your parents/grandparents/children die without treatment and care, if they couldn't afford to go private?!.

The fact is that those I care about are more likely to be in need of treatment and care, as a result of coming into contact with the NHS. I want them to stay away from the NHS, and the government to give them back their money taken to support the giant leech known as national healthcare.

Many people are now frightened that they could pick up a dangerous infection if they go into hospital. It is hardly surprising. More and more of us know someone who has been infected with the superbug, MRSA (methicillin resistant Staphylococcus aureus). Marjorie Evans has been infected with it on eight occasions at the same hospital in Swansea. Now wheelchair-bound as a result, she says: "I'd rather go abroad and trust foreigners."

As James Bartholomew writes in the Telegraph opinion section one is vastly safer in a private hospital and the danger of getting MRSA is a risk affecting patients of the NHS.

The NHS both is the most state-controlled hospital system in the advanced world and has the worst record in Europe. At a practical level, it is because of things like ministers driving hospitals at full capacity to reduce waiting lists, with the result that patients with MRSA cannot always be isolated.

But at a more profound level, the MRSA crisis is because the NHS is a state monopoly. Ministers are always making hospitals respond to the latest newspaper headlines rather than doing what is best in the overall interest of patients; hospital workers - like many employees of state industries - are demoralised and their pay rates are unresponsive, thus causing the local shortages. The state has also closed too many hospitals. The list of ways in which it has increased the risk is endless.

This is a result of the fundamental dynamics (or statics) of the public sector, not any lack of funding. There is no legitimate role for the state in healthcare, education and many other sectors that it appropriated for perpetration of what is so misleading called 'public services'.

The dynamics of the private sector, meanwhile, are simpler and more effective. If you don't treat your customers well, you go out of business.

Indeed, unless you take their money first and then help yourself to it...

This used to be the state of Britain in the 1970s; a reference to the relative economic decline that accompanied the imperial scuttle. Now, we should use the term in another sense: the transition of the National Health Service from modernity to the Middle Ages.

If you enter a National Health Service hospital, there is a high risk of contracting an infection caused by a dugs resistant bacteria called MRSA (methicillin-resistant Staphylococcus aureus), which the tabloids have dubbed "superbug". There are numerous stories of patients, who have no choice but to use state provision, due to its monopolistic powers, and have contracted this infection as a consequence. There is one poor unfortunate who has been MRSA positive eight times.

A grandmother who has contracted the MRSA superbug eight times is refusing to return to hospital for a vital operation.

Doctors warned Marjorie Evans, 69, she could die or be bedridden for the rest of her life if she is hit by the infection again. She plans to travel abroad for her hip replacement rather than trust a British hospital. Mrs Evans has caught MRSA during inpatient stays at Morriston Hospital in Swansea since 1992.

One of the major causes of these infections is the inability of NHS hospitals to maintain minimum levels of cleanliness, such as insisting all visitors wash their hands. Once drugs-resistant bacteria have taken hold, they are difficult to eradicate. However, there is an alternative, the private sector:

BMI Healthcare is one of the biggest private hospital groups in the UK, with 47 hospitals. During the course of a year, the group has a quarter of a million in-patients and three-quarters of a million out-patient visits. How many patients in BMI hospitals have acquired MRSA in the blood? None. In fact, over the years, the company has "never" had such a case.

If you do come to Britain, avoid the NHS. For if they do manage to kill you, a task they achieve with ease, you may still not be given last rites as the religious affiliation of your dying husk cannot be disclosed under the Data Protection Act.

The Hospital Chaplaincies Council has criticised several NHS Trusts for their "hysterical" refusal to disclose the religious backgrounds of their patients. The trusts claim that such information is "too sensitive" to share with chaplains.

Candida Moss, writing in the Spectator, suggests that 'presumed consent' ought to apply for donating organs. On the basis that my comments my not appear in the magazine, here's what I wrote:

Presumed consent is not consent. If it were, then minors or people suffering from dementia might not enjoy the protection from sexual assault that they do at present. Sexual predators could no doubt claim "presumed consent" for their crimes.

There is a difference between medical expedience and morality. There can be no doubt that there would be enormous medical benefits from performing vivisection on human beings, instead of on animals: dosages, differences in metabolic rates etc. would be far easier to calculate.

Rightly, we abhor this and consider controvertial using the results of Nazi experiments on Jews, because it can be considered the partial condoning of horrific actions.

Is it Candida Moss's wish that the state (probably at EU level) ought to nationalize our bodies and redistribute organs according to need? At least Gordon Brown only wants my money.

I might add that the issue of designer babies giving their own consent to being used as experimental animals is another current topic. It seems pretty sick to me.

Some time ago President Bush offered 15 billion dollars of American taxpayers money for 'the fight against AIDS' in various nations.

Yesterday the Secretary General of the UN denounced the United States for not spending enough money. Now this anger could be dismissed as the Secretary General being upset that so much of the money was going to be spent 'direct' in the nations concerned rather than put through the UN (where the Secretary General's son and his friends could steal some of the money), however this does not explain all the anger directed against the United States at the AIDS conference in Bangkok.

I think the explanation for the anger is very simple - people are never grateful for loot.

Everyone knows that President Bush is not giving his own money when he hands out the 15 billion dollars (assuming that Congress goes along with this idea), he is just taking (by the threat of violence) money from the taxpayers and dishing it out.

Why should anyone be grateful to him? He is not making a sacrifice; he is just handing out the money of the taxpayers. Why should he give 15 billion dollars to the third world, why not 50 billion or 500 hundred billion? It is not costing him anything.

So the various political activists feel no reason to thank President Bush.

It is the old story of 'conservatives' and government spending. No matter how much they spend the activists will always think they can get more money from the 'progressive' politicians and so will shout and scream and stamp their feet.

I am going to have to find some new term to adequately describe the condition of ignorance that renders its sufferers unable to comprehend the inevitable truth that state-control means political control.

A shining example of this tragically far-too-common form of myopia can be found in one of today's letters to the UK Times [note: link may not work for non-UK readers]:

Sir, Once again the NHS is set fair to become the filling in the Labour and Conservative policy sandwiches, and yet neither party recognises that the biggest problem besetting the service is the very political control each espouses.

Health, like broadcasting, is too important to be the political football of major parties during the first skirmishes of an impending general election. The NHS needs a charter, it needs sensitive management, it needs to value and cherish its long-suffering staff and, above all, it needs to be isolated from the political process.

The man who wrote this letter is a doctor and is, therefore, unlikely to be either dim-witted or uneducated. Yet, he passionately demands (and no doubt expects) a government-run health service that is somehow 'isolated from the political process'.

I have penned a letter of response to the Times pointing out that the only way to get politics out of healthcare is to de-nationalise it and allow provision to be bought and sold on the free market. However, I do not expect the editors of the Times will be inclined to publicise such heretical and 'extreme' views.

The great canard of the collectivists holds that a free-market in healthcare will assuredly result in healthcare providers hungrily pursuing maximum profits while abandoning the poor, the elderly and the vulnerable to a wretched and untreated fate.

So often and so passionately has this big lie been repeated that it is now accepted by most people in this country as an incontrovertibe truth. Nationalised healthcare, they say, puts people's needs at the top of the agenda where there is no room for ugly money-grubbing.

Only they forgot about ugly bed-grubbing:

A nurse has been jailed for five years for trying to kill two elderly patients at a Cheshire hospital.

Barbara Salisbury, 47, was found guilty of trying to kill them to free up more beds at Leighton Hospital, in Crewe.

Rationed resources require desperate measures. In fact, and given the governmental obsession with reducing waiting times for hospital treatment, I am a little surprised that the Department of Health has not pinned a medal on this woman.

When she finally emerges from her time in stir, Ms Salisbury may well find herself being offered a job back in the NHS as a senior consultant.

It is strangely comforting to see that the 'class war' instincts of old Labour are not entirely dead yet:

John Reid, the Health Secretary, yesterday dismissed the demand for a blanket ban on smoking as "an obsession of the learned middle class".

Speaking at a Labour Party event, he said he was reluctant to use compulsion to outlaw something that was a source of pleasure, particularly to working class people.

That Mr. Reid has to fight the corner of working-class people at a Labour Party event speaks volumes about the evolutionary path of the modern left.

Earlier, Mr Reid expressed his views even more bluntly when he took part in a round-table discussion with some of those invited to contribute to the consultation.

Told that they were discussing a smoking ban, Mr Reid said: "Let me play devil's advocate. What enjoyment does a 21-year-old mother of three living on a sink estate get? The only enjoyment sometimes they get is having a cigarette."

One participant objected quite strongly, telling Mr Reid her mother died of lung cancer.

But Mr Reid, a former chain smoker who has now given up, said it was best to provide people with information and let them decide what to do for themselves.

Now, perhaps, Mr. Reid can take the next logical step and denounce the levels of tax that working people have to pony up in order to enjoy their smoking habit. Then the bien-pensant can safely re-classify him as a 'right-winger'.

Compared to the length of time it took to hike up the taxes on tobacco, alcohol and petroleum, the great 'junk food' shakedown has been completed in remarkably quick time. HMG is clearly honing its modus operandi down to a fine art: [note: link to UK Times may not be available to readers based outside the UK]

BRITAIN�S biggest food companies are to be told by the government to pay an �anti-obesity� levy to fund new sports centres or face punitive laws restricting advertising, marketing and labelling.

Firms such as McDonald�s, Walkers and Cadbury Schweppes are to be asked to contribute tens of millions of pounds towards the sports facilities. The government is set to provide £1m for the scheme for every £3m pledged by the food industry. It will be used to build sports centres, gyms, football pitches and tennis courts.

The food industry confirmed this weekend that it was preparing to co-operate with ministers and could provide hundreds of millions of pounds to fend off regulation.

Of course, I knew this was coming but not even I was prepared for the ugly truth to be revealed quite this rapidly. The Treasury must be desperate for the cash.

Yes, it really was only a few short weeks ago that I noticed the wave of 'shock, horror' articles about an 'obesity crisis' ripple right through the Fourth Estate like an electro-magnetic pulse. From out of the blue, every single news organ in the land was suddenly brimming with distraught editorials about how fat all 'our children' were becoming and what could be done about it. Some blamed the food industry, some blamed the public, some blamed advertising, some blamed George Bush, everyone blamed 'rampant capitalism' (as if we have even a faint prospect of such a thing) and former Tory cabinet minister, Norman Tebbit, brought a twitch to everyone's jowls by blaming it on homosexuals.

It all felt far too co-ordinated to be either genuine or the mere manifestation of some form of mass hysteria. In fact, it was neither. It was a deliberate, well-planned and professionally executed 'softening up' operation designed to smooth the political path for the pay-off of a 'junk food' levy.

There is no 'obesity crisis'. It is, and always has been, a fictional hobgoblin to be exploited for maximum fiscal effect and now that endgame has been achieved, press coverage of the 'obesity crisis will suddenly vanish as quickly and mysteriously as it appeared. Job done (at least until such time as an increase in the tax is required).

But even if 'our children' were as dumpy as has been so mischieviously claimed, they are going to get thinner now for sure. The tax on the profits of food producers will be passed onto consumers who will now have to pay significantly higher prices for their weekly shopping. As with all such extortions, it is those on fixed or low incomes who will be hit the hardest.

Nor are they to be compensated by the appearance of any brand, spanking new sports facilities which, I predict, will never materialise. A few crumbs of the cash will go to the appointment of some Real Sports Advisers as a Potemkin show, but the lion's share of the money will simply be poured into the great, sucking black-hole of the public sector and lost. That is how it goes in Britain.

So now that our wonderful, caring government has finally solved the 'obesity crisis', all that remains is for us to speculate as to what private sector industry is next on the list for a shakedown. At a rough guess, I'd say telecommunications. There is an awful lot of money sloshing around in that sector right now and that makes it a very tempting target. I do not yet know what pretext will be employed but I am in no doubt whatsoever that it will somehow involve 'our children'.

Growing up in the 1970's I recall being rather spooked by dire warnings of an impending ice age and the threat that I would spend my adult life shivering in a cave. Some twenty years later that apocalypse vision had been melted clean away by the dire (and considerably shriller) warnings about global warming and, according to everyone who is anyone, I now face the threat of spending what remains of my adult life sizzling like a sausage.

Two decades in which to manage a complete polar reversal in doomsday-scenario is pretty good going but it pales into 'also-ran' status by an eerily similar polar switch in the rather more mundane field of eating disorders.

This is from the BBC website in July 1998:

Doctors have hit out at the media and advertisers for encouraging anorexia by portraying skinny supermodels as the beauty ideal instead of 'more buxom wenches'.

The British Medical Association's annual conference in Cardiff voted overwhelmingly for a motion condemning the media obsession with ultra thin supermodels.

Dr Muriel Broome, a former director of public health, said "the constant image of very thin models" encouraged girls to develop eating disorders. "We urge the media to be more responsible and show more buxom wenches," she said.

I know not whether Dr Broome's advice was acted upon, but I am now informed that we have, indeed, taken on the mantle of buxomness with some considerable gusto. From the BBC website today:

Improving children's eating habits is the key to tackling an obesity "timebomb", MPs have warned.

The Commons Health Select Committee attacks the government, food industry and advertisers for failing to act to stop rising levels of obesity.

From 'ultra-thin models' to 'obesity timebombs' in the space of slightly over half-a-decade. Now I am no statistician but I think even I am qualified to regard that as a quite remarkable national metamorphosis.

Nor are these select MPs (who clearly have nothing better to do) speaking out in some frolic of their own. The media that only five years ago was, apparently, inciting and encouraging starvation and skeletal thinness is now tripping over itself in scolding us for being too fat!

From today's Telegraph:

The food industry should be given three years to end the "cynical" promotion of high-fat, high-sugar food aimed at children, MPs say today.

In a scathing report they criticise high-profile advertising campaigns that use sports stars and celebrities to sell chocolate and crisps and call for a voluntary ban on television food advertisements aimed at children. If the industry fails to act the Government should step in, they say.

And from today's Independent:

Britain's "devastating" epidemic of obesity could threaten the very existence of the NHS, a report warns today.

So it's not all bad news then. And (as if they were going to miss out on all the fun) from today's Guardian:

It should not be a surprise that we have become gripped by an obesity crisis. After all, the warning signs have been there for some time. Lifestyles have become more sedentary. We have become more attached to our cars. Life is also faster; there is less time to prepare food and eat. More parents are working and have less time to cook for, and with, their children. Meanwhile, the food industry has become hyper-competitive and, in the battle for market share, children have become fair game.

This last article is the most significant because it is not from any of the Guardian's usual columnists (although it is written in the same hectoring politburo party line style) but from a certain John Krebs who, we are informed, is:

...chairman of the Food Standards Agency.

So clearly his opinions are above and beyond the febrile scribblings of the average hack. This article is an ex cathedra statement of intent.

Those companies that fail to respond with healthier products will, like the dinosaurs, be doomed to extinction.

For once, a reliable prediction. Reliable because it is self-fulfilling. What he means is that suppliers who do not toe the Food Kommisars line on acceptable products will be actively driven into extinction by the said Food Kommisar and his obedient minions.

I must say that I am rather glad that Mr Krebs has come out and laid it on the line because otherwise there are some unwordly people who might be fooled into believing that this tsunami of propoganda in the press is merely a coincidence or, worse, a reflection of concern about a genuine problem. It is further proof of the axiom that one must never underestimate or dismiss the power of vested interest.

The Food Standards Agency was set up at the tail end of the 1990's as a response to the BSE crisis. Such was the trauma of the 'mad cow disease' outbreak that all food suddenly became suspect and 'da gubbament' had to do something. The something they did was the same thing they always do: they set up another government agency to 'restore public confidence in the food we eat'.

When I first heard of the FSA, I predicted (yes, we can all play that game) that this would spell trouble. And this is why it pays to be cynic because I was right. The BSE crisis has long-since slipped into history and there are no mad cows roaming the quiet countryside anymore (or, at least, the fear of them has been played out). So do we still need a lavishly-funded, well-staffed FSA? Of course we do because food is dangerous once again.

Take careful note because if this is not a text-book case of bureaucratic empire-building, well then, I don't know what is. And if those press articles have not been drafted (or, at the very least approved) by apparatchicks in the FSA then I will eat my hat (fried in butter!).

There is no 'obesity timebomb' in this country or any other country and the only thing that needs to be put on a strict diet is our bloated, grasping, greedy, flatulent public sector. Starve them down to the bone, I say. Make them anorexic. Then we can all get on with enjoying our lives and the fruits of our labours without being nagged into an early grave.

It is official: food is the new enemy of the international left.

While the crashers were doing their stuff on the neatly-manicured lawns of Geneva, dark plots were being hatched inside the gleaming towers:

All 192 countries in the World Health Organisation have tentatively agreed to an unprecedented policy on diet and health to tackle global obesity.

Did that include the Ethiopeans?

The voluntary plan was hammered out at talks in Geneva in the face of stiff opposition from lobbies such as the sugar-producing nations.

We are privileged indeed to witness the birth of a brand, new imaginary straw-man. Ladies and gentlemen, making its debut on the world stage, but soon to making regular appearances in the columns of every angry, left-wing polemicist in every media venue on earth, please give a warm welcome to..... "the Sugar Lobby" (boo, hiss). Stand right here in the spotlight, Sugar Lobby, and take your place among right-wingers, big tobacco, industrialists, zionists, gun manufacturers, motorists and George Bush.

Nearly one in six people worldwide is now considered overweight.

Amazing is it not? Seems like only five minutes ago that the battlecry of the social-working class was "feed the starving". Now, in the blink of an eye, they have changed it to "starve the fed". Astonishing stuff!

The BBC's Imogen Foulkes in Geneva says this is the first ever attempt to regulate the world's eating habits.

And we all know that it will not be the last.

Dr Kaare Norum, a Norwegian obesity expert who advised the WHO on the development of the plan, said the agreement was a victory for public health.

DR. NORUM: "I have been studying obese people for many, many years and the incontrovertible data I have collected as a result leads me to conclude that these people are very fat".

WHO: "You are obviously an expert. Come join our committee".

Honestly, the whole article sounds as if it has been lifted from an old issue of Pravda. Mind you, it comes courtesy of the Beeb.

So be warned you choca-holics and doughnut-dunkers: your stodgy, sticky delights are on the hit list. Lock them away in secret bunkers while you still can.

The May 1 issue of New Scientist contains an item 'Why our fears about fat are misplaced' written by Paul Campos, a Professor of Law from the University of Colorado. We have often stated our belief fat is the new job frontier for government bureaucracy and Professor Campos seems to agree with us. He states unequivocally that no research directly links fat to shorter lifespans. Sedentery lifestyles and other factors, yes. Fat alone? No. In his own words:

Ultimately the current panic over increasing body mass has little to do with science, and everything to do with cultural and political factors that distort scientific enquiry. Among those factors are greed (consensus panels put together by organizations such as WHO that have declared obesity a major health crisis are often made up entirely of doctors who run diet clinics), and cultural anxieties about social overconsumption in general.

He notes that in one recent study:

It added up to just one extra death per 10,000 "overweight" women per year. The authors still treated the findings as strong evidence of a causal relationship between weight and cancer

Professor Campos also has a book on the subject, The Obesity Myth.

Like a lot of folk who spend much of their time working in an office in Central London, I try to grab what exercise I can by going to a gym. I have been visiting one of these places in London for about eight years, and, gratifyingly, my once pencil-thin physique has acquired a bit more muscle. (I have a long way to go, mind, not that I remotely want to look like the Governor of California). I have also acquired other benefits, such as being able to sleep much better, better chance of avoiding injuries in everyday life, and a better pallor... The benefits have not gone unremarked by my girlfriend, either.

Gymnasiums are now a major business. Their success in the West speaks of an ever-expanding desire on our part to live the healthy life and do something direct about it. I find it amusing that at a time when we are constantly told by our masters that we need new laws, taxes and the like to avoid obesity and other problems, that more folk than ever before are getting off their backsides and working out. Screw the nanny state, put on some gym shoes! It is a rather encouraging sign that the spirit of self-help, at least when it comes to developing a flat stomach or a nice torso, is well alive.

The gym culture also I think shows just how secular British society has become. If you lack faith in an afterlife, and want to squeeze the most out of life on this Earth, then get fit! Also, if you do not believe that pride is a sin, as I do not, then there is nothing wrong in doing one's best to look good and feel physically on top of the world, and enjoy that fact.

Dave Barry links to this:

Phil Henry said he went to Helen Ellis Hospital in Tarpon Springs and was admitted for abdominal pain. A few days into his stay, his I-V malfunctioned causing his right arm to swell.

"On Tuesday night my right arm started hurting. I rung for a nurse. I didn't get anyone and my arm got swollen up about the size of two golf balls and started bleeding," Henry said.

After ringing for a nurse several times, he decided to take matters into his own hands.

"I took my urinal can and threw it out in the hallway, still got nobody. I hollered two or three times. Nobody came so I picked up the telephone and dialed 911."

He said he told the dispatcher his name, where he was and described the problem with the I-V.

He then asked the dispatcher to call the hospital.

"Then I got a nurse. After that they took good care of me."

Warning to British people: Do not try this with the NHS.

Tony Blair's 10 Downing Street web site is claiming that some spurious target or other, for the National Health Service to recruit an extra 2,000 General Practitioners, has almost been reached. That is, according to some figures produced, and I use the word advisedly, by the UK government's Department of Health.

However, I have just watched a hilarious piece on Channel4's News programme where the Royal College of General Practitioners challenged how these good news figures had actually been arrived at? I felt like phoning the programme up and telling its producer about a civil service game called Hard Target, which involves a pack of marked cards, a set of rusty darts, and a small bag of pistachio nuts. But I relented and listened on.

With an increasing number of GP surgeries refusing new patients and an increasing shortage of GPs around the country, for instance in Barnsley, as mentioned by Channel4 tonight, and even in relatively well-funded towns in Scotland, the Royal College puts the alleged increase in GPs at something more like 200, rather than 2,000, and if you take into account the increasing number of GP retirements and the increase in part-time GP working, the full-time figure actually shrinks, in real world terms, to something more like 26.

So, well worth increasing the spend on the NHS then, to nearly one hundred billion pounds, from about sixty billion. I know that's almost £1.54 billion pounds per extra GP, but hey, is it really possible for us heartless libertarians to put a monetary price on the sanctity of human life and its guardians in the general practitioner service? Shame on us.

Which leaves me in a dilemma? Do I believe the UK government figures or do I believe the ones from the Royal College of General Practitioners set at about 1% of the government's own claims? It is a toughie, I will admit, but you know me. I always believe everything the government says on principle. For where would civilisation be if we ever lost trust in the government?

I am an Aardvark.

As someone often accused of never having one word for a subject, where three hundred and fifty seven will do, I am afraid the following act of collectivized lunacy has simply left me stumped. Gazumped. And just plain flummoxed.

A National Health Service surgeon, from the Queen's Medical Centre in Nottingham, has been suspended on full pay, for a week now, in a row over whether he took too many croutons to go with his lunchtime soup.

No, I am really not making this up.

I particularly like the comment from some idiot going under the name of Lord Warner:

I am reliably informed that there will be no detriment to patients, because the work that that doctor was due to perform will be covered by his colleagues

Tell you what, to save NHS costs let's sack every surgeon in the entire country except one, who can cover all the rest. There will be no detriment to patients, obviously. We just better make sure we have a fleet of helicopters ready to whizz him about the country and a good supply of amphetamine pills to keep him awake.

Like I said, words fail me. Just pick your own croutons from the following word soup and gently flavour with Basil:

Parasites. Fools. Cretins. Croutons. Bananas. Idiots. The sooner the NHS is privatized the better. Monkey nuts. Lickspittles. Guardian-reading Enemy Class. Arse. Feck. And of course. Drink. Lots and Lots of Drink.

I particularly like Monkey nuts.

That's it, I've had enough. I just could not believe my ears, last night, listening to some po-voiced BBC reporter agreeing with some equally pompous do-gooding UK doctor that British people simply cannot be trusted to look after their own health. They also agreed that Wanless Chinder's HM Treasury proposal, to introduce yet more tax-funded social engineering into British health care, was a desperately needed breath of fresh air.

Jesus H. Christ. Just when will you people get it? When will you get it into your thick skulls that it is your damned social engineering policies, over the last sixty years, which have created all of your alleged problems in the first place? When you take away people's responsibilities for their own health care, by providing them with an MRSA-infested paid-for-by-everybody-else National Health Service, the obvious response is for many of them to start abusing their own bodies, or at the very least to start taking less care of themselves. Why? Because someone else will be forced to pick up the pieces afterwards, that's why. So what the hell, let's eat another cream cake, let's drink another bottle of whisky. Because the NHS will pay for any liposuction I may need, afterwards, and the NHS will always supply me with a new liver, should I need one. And if they refuse to, then I'll sue them for a loss of human dignity.

Take, for instance, asthma patients who smoke. I came across many of these, as a medical student, when I worked in the Northern General Hospital, in Sheffield. So why do they smoke when this lands them in an oxygen tent manned by a medical student making a mess of their right-arm, in his pitiful attempts to take blood samples from them every morning? Because the NHS supplies all of the Ventolin Inhalers they may need, supplies all of the incompetent medical students they may need, and supplies all of the sick notes and hospital beds they may need, to help their damaged lungs recover from their stupid and continuing nicotinic self-abuse. Some of them were even happy to be there, to spend a few weeks away from home, relaxing, getting paid on the medical sick note, watching television all day, and chatting to nurses and medical students. Oh yes, and when well enough, slipping outside for a quick smoke.

Would they abuse their bodies as much, smoking with asthma, if they had to supply their own wages insurance, had to pay the full cost for their own Ventolin supplies, and had to pay for their own hospital treatment insurance, to pick up the pieces, at a special ten times rate for asthmatics testing nicotine-positive on their blood samples? Of course they wouldn't. And will more social engineering and more extravagant government targets make them quit smoking? Are you kidding me? They're in hospital, facing death through smoking, right in the face. And a subsidy on Kumquats funded by a tax on chocolate Kit-Kats is going to make them give up? Beam me up, Nanny. Even an outright ban on smoking would only stop them for a few weeks, until the rapidly expanding tobacco and chocolate black markets got them hooked back in again.

When nanny supplies a comfortable cot and a bottle of warm milk, baby is just going to lie there lapping it up, even if it begins a process of artery clogging. And by the way, just what divine right is it you possess anyway to stick your noses into their lives, even if they did choose to be so stupid? I suppose, you might say, because Joe Taxpayer is forced to fund the NHS, so Joe Taxpayer, in the form of your good selves, has the right to make people obey health diktats. I have a better solution. Let's get rid of the filthy disgusting chippy-staffed NHS, instead, problem solved. And let's not forget the sheer hypocrisy of your leading priests, as they genuflect at the font of the God of Society.

You've got lardy High Priest Gordon Brown, whose fat jowls are now dropping well below his tailored shirt collars, and the even fatter and the even lardier Head Whipping Boy John Prescott, whose broad face is the very road map which highlights the dangers of personal over consumption.

And then, of course, there's Social Engineer-in-Chief and Lord High Defender of the Faith, Anthony Charles Lynton Blair, a coffee-abusing man who can only carry out his job because there's a team of heart specialists waiting 24 hours a day at the Nomenklatura Hospital, in Chelsea, waiting for him to collapse again through overwork, so they can re-start his heart. I assisted in such procedures, in the Rotherham General hospital. But despite what Blair's aides have reported, even when such heart restart procedures are scheduled, they are never routine. Stopping and re-starting someone's heart, to get it into the correct sinus rhythm, is not something you do either lightly or while scoffing a Kit-Kat. It is always dangerous and it is sometimes lethal. Everyone around the table, especially the man with the shock paddles, gets a big hit of adrenaline when the capacitors charge up. Many people die in hospitals. But it's not every day you get to personally perform the action which kills them, especially when it is the bare chest of a British Prime Minister in front of you, all smothered in conductive K-Y Jelly.

But yet we all have to take lessons on health from this workaholic man, who is driving himself into an early grave through endless political briefs and night-time flights, because he is Social Engineering Superman. Despite heart restarts, which are nature's way of telling you to stop politicking and to start gardening, he still knows better than the rest of us as to how we should look after our own health. He even has the right, apparently, to force us how to look after our own health, through taxation and social engineering, because assorted health fascist Guardianistas, who make their obscene gravy-train living from the health-and-welfare monster that is the British state, say that he has this right, as they float around in a comfortable tax-funded sea of their own, smoking cannabis, drinking Chardonnay, and engaging in dubious STD-inducing night-time practices of sexual self discovery.

Well, good luck to you in your private lives. But if you do it, why can't anyone else? Your stupid social engineering, your filthy hospitals, and your unbelievable waste in the NHS, make me, and everyone else, sick. We will all be a damn sight better off, if we simply got rid of all you social engineers, and all of your terrible self-defeating Nanny State works, which make everything worse rather than better. Do you never learn anything? Sixty years of continuing NHS failure and your benighted solution is yet more of the same. It is simply unbelievable. It is time this ratchet was broken.

It seems Gordon Brown's favourite useful idiot, Derek Wanless, has been at it again. The much-criticised former banker, who disastrously turned the giant NatWest bank into a tiddler taken over by the Royal Bank of Scotland, has taken a second lump of taxpayer cash from HM Treasury, to produce a second report telling them, once again, what they wanted to hear in the first place.

This follows his previous report, also commissioned by HM Treasury, which told them National Insurance payroll taxes should be raised to increase government spending on the NHS. Which duly happened, straight after the last General Election.

Dilbert Derek's latest report tells us essentially that the government should do more to look after the health of its citizens. In much the same way, of course, that pig farmers should look after the health of their pigs. Welcome to the farm, citizens.

What this will undoubtedly turn into is a righteous claim, as predicted by our very own Mr David Carr, that HM Treasury should, unwillingly, and after due consideration, raise our taxes again. For our own good. Bless them.

Who cares what the actual tax will be? A fat tax, a hat tax, a stick it up your jumper tax, don't worry, they'll think of something. So my hot gambling tip of the day, if you've got any money left after this year's January self-assessment tax deadline, is to put your loot down on 'More Taxes Soon', in the five o'clock at HM Treasury. This may be your last chance to ever have any spare money, so enjoy it while it lasts. Get a McDonalds with your winnings. Don't worry. They won't mind. They just want your money.

Back in November 2003, I predicted that the end result of the anti-junk-food campaign would be 'sin taxes':

Then on to Step 5: the levying of 'sin taxes' on hamburgers to 'encourage a change of behaviour'. The money raised then pays for a lot more Food Standards Agents.

I hope I will be forgiven for this brief episode of smugness because, not only has my prediction come to pass, but it has come to pass rather more rapidly than even I had anticipated:

A Downing Street-based policy unit has proposed a plan to place a "fat tax" on junk food in an attempt to tackle the rising incidence of heart disease.

According to The Times, the Prime Minister's Strategy Unit raised the prospe