We are developing the social individualist meta-context for the future. From the very serious to the extremely frivolous... lets see what is on the mind of the Samizdata people.

Samizdata, derived from Samizdat /n. - a system of clandestine publication of banned literature in the USSR [Russ.,= self-publishing house]

The strange mental softness around the NHS

UK Prime Minister and Conservative Party leader Boris Johnson has made much of how he would shower “our wonderful National Health Service” with money (from we lucky taxpayers and future generations, no doubt) in this election campaign. Cynics will say that he probably does not mean it all that much but such statements are the price one must pay for persuading wavering Labour voters into switching from the Red to the Blue team, etc.

But I wonder. There does seem to be a deeply rooted attachment to the NHS that goes beyond all logic and reason. A service created in the late 1940s, run as a monopoly (private healthcare in the UK is relatively small versus the NHS), paid for out of tax and delivered free at the point of use. Result: its services must be rationed. Some of its actions are pretty good, some far less so. I got treated for water on the knee last year and was dealt with reasonably well, although the diagnoses given were so wide and contradictory that in the end I learned more by surfing the internet and talking to some medically savvy friends. Many people’s experiences with NHS treatment vary from excellent to terrible. It does certain things very well, but in my view is poor at area such as tracking patients after their initial encounters to make sure they are keeping on a regime, etc. I think that the UK could and should move towards private healthcare provision for the bulk of the population, via a mix of healthcare accounts that one builds up over time (people will tend to draw from these funds more as they enter middle age), insurance (for large, catastrophic spending) and some public provision for those in serious poverty. The Soviet model that we operate under seems not just anachronistic, but dangerously resistant to innovation and change. (James Bartholomew had good thoughts on the NHS in this article.)

And yet the NHS is, as former UK finance minister Nigel Lawson once said, rather like a state religion, such as the Church of England. Criticise it at one’s peril. The other day on Facebook an acquaintance of mine, a senior nurse on a good salary, bleated about the hours she has to work. I pointed out that as a small business owner I have put in 60-plus hours a week, but accepted that as part of my choice to work in this way. The meltdown, and the sarcasm, that I received from this person’s friends was something to behold.

The NHS is, like the BBC, one of those institutions that seems to defy all logic, no matter what it does and how ropey its output is.

Universal healthcare vs the rights of doctors and nurses

So it wasn’t George Bernard Shaw after all.

It wasn’t him in the funny story about the dinner party, I mean, the one where a man teasingly asks the woman seated next to him, “Would you sleep with me for a million pounds?” Laughing, she answers, “You bet!” “All right,” he says, “How about for five pounds?” Now she is outraged and says sharply, “What do you take me for?” He replies, “We have already established that. All we are doing now is haggling over the price.”

*

“Bristol Southmead Hospital: Racist patients could have treatment withdrawn”, reports the BBC.

North Bristol Trust (NBT) launched its Red Card to Racism campaign after staff reported an increase of abuse from patients and visitors at the city’s Southmead Hospital.

The abusive behaviour covers racist or sexist language, gestures or behaviour.

Trust chief executive Andrea Young said they wanted staff to “challenge and report it”.

Under the scheme, any patient abusing staff would be challenged and warned, leading to a “sports-style disciplinary yellow card” followed by a final red card in which treatment would be “withdrawn as soon as is safe”.

and

Ms Young said: “We’re sending a strong signal that any racism or discrimination is completely unacceptable – we want staff to challenge and report it and we want everyone to know that it will have consequences.”

Although I am not an adherent of the worship of the National Health Service that has replaced Anglicanism as the British English state religion, I can understand what people like about the NHS. Its founding principles were that its services should be comprehensive, universal and free at the point of delivery. I think the experience of other countries shows that there are many other healthcare systems that would work better overall, but it is a genuine advantage to the UK system that when a British person falls ill they do not have to even think about where and how they will get treatment, or how they will pay for it. It’s universal.

Or it used to be. Bristol Southmead Hospital has changed all that.

I could go on about how easily this policy by North Bristol NHS Trust could be abused, could lead to tragedy. A story by Jack Montgomery at Breitbart UK did just that. But in a sense all that is just haggling over details: once it is established that the NHS is no longer universal, what is the point of it?

The National Health Service was meant to be like the justice system: no one can ever lose the protection of the laws, not proven criminals, not actual racists, and certainly not some shabby old man who has been waiting in Casualty for five hours and can’t stop himself blurting out some non-PC word because he is in pain.

On the other hand, in other contexts I have argued that state systems should drop their obsession with universality. When I was a teacher I saw how one feral child in a class in a state school could ruin the education of thirty other children. For a mess of perverse reasons the policy of putting them in “sin bins” was never applied wholeheartedly, and there are some children so monstrous that even the other denizens of the reformatory should be spared their company. Not to mention the teachers, many of whom quit the profession rather than having to face one more day trying to control these thugs. Whenever it was suggested that the state should simply cease the attempt to educate such children someone would wail, “We can’t just abandon them”. “We can and we should,” I would say. “If they make themselves so unpleasant that no one wants to teach them, no one should have to.”

So don’t those arguments also apply to NHS staff members and patients who find themselves cheek by jowl with some aggressive bigot spewing out obscenities? In this case I am not talking about people who are unjustly deemed to be racists or sexists (real though I think the threat of this happening is), I am talking about truly nasty people. I said one of the best aspects of state healthcare was that it is available to all. But my own words regarding state education, also meant to be available to all, come back to haunt me: if some people make themselves so unpleasant that no one wants to cure them, surely no one should have to.

What do you think?

The Anti-Saloon League is back

“Prohibition showed bans can be good for us”, writes David Aaronovitch in the Times. Unironically. He means it. He thinks Prohibition was good and wants it back. I suppose it was ever thus; it is like the way that when the people who remember the last banking crash die the banks start crazy lending again.

Mr Aaronovitch writes,

Your mental charge sheet against prohibition may well include the accusation that it didn’t get rid of drinking but sent it underground; that the resulting appetite for “bootlegged” liquor led to the rise of organised criminal syndicates, Al Capone, the mob and the St Valentine’s Day massacre; that it helped to make corrupt hypocrites out of public servants; that the rich were able to indulge while the poor were criminalised.

Why yes, it does.

And after just a few years the Americans saw what a disaster it was and repealed it. It may not improve your view of it to know that the Ku Klux Klan were very much in favour of prohibition.

That does not surprise me.

Strangely though, the one question that almost no one seems to ask of this epic public health measure is whether or not it actually improved public health. Yet it doesn’t take much digging into the available statistics to discover that it did — quite a lot, in fact.

Excessive alcohol consumption is linked to all kinds of adverse health conditions. The most obvious is alcoholic cirrhosis (or scarring) of the liver. In 1911 the death rate for cirrhosis among American men was nearly 30 per 100,000. By 1929 that had been reduced by more than 30 per cent. Registered admissions to mental hospitals for psychosis linked to alcohol more than halved. Even by 1933, when Volstead was revoked, alcohol consumption had gone down by a third since pre-prohibition. Whatever Mark Twain may have written, prohibition saved many, many lives.

The commenters made several good points to contradict that assertion. Some pointed out that in the same period alcohol consumption also went down other countries, including the UK, where alcohol continued to be legal. Bryan Dale said, “If prohibition reduced alcohol consumption by a third that can hardly be called a success. It was supposed to eliminate it entirely after all. With 2/3 as much alcohol being illegally consumed as had been done legally before prohibition, the impact on respect for the law must have been dreadful.” Others described well-stocked drinks cabinets in modern Saudi Arabia, or the way that the type of alcohol consumed shifts from beer to spirits when it must be sold and transported illegally.

I expect readers of this site can supply many other historical and factual arguments. All I will say is that there is a void at the heart of the passage I quoted above. Mr Aaronovitch never even questions the assumption that it is for him and people like him to decide what other human beings may or may not put in their own bodies.

Samizdata quote of the day

These people who live a vigorous life to 70, 80, 90 years of age—when I look at what those people “do,” almost all of it is what I classify as play. It’s not meaningful work. They’re riding motorcycles; they’re hiking. Which can all have value—don’t get me wrong. But if it’s the main thing in your life? Ummm, that’s not probably a meaningful life.

— Ezekiel Emanuel, chair of the University of Pennsylvania’s department of medical ethics and health policy and “a chief architect of Obamacare”.

Expelled from his profession, financially ruined, officially deemed to be a a sexual abuser

So what did the perp actually do?

Dental Hygienist Loses License, Labeled Sex Offender For Sleeping With Client – His Wife

Note that Alexandru Tanase’s story involves that modern equivalent of the Roman delator, the Facebook nark:

After one of the treatments, his wife, Sandi Mullins, posted a picture with Tanase. The former dental hygienist wrote on Facebook that in the “summer of 2016, a complaint was filed with the CDHO by a former friend and Facebook acquaintance of my wife’s, who saw a photo my wife posted, saying how happy she was with her dentist and what an amazing dental hygienist she had.”

That Which Shall Not Be Named

It waits. It hungers. In its tenebrous embrace all memories, all identities, all names are lost. What was once known becomes unknown.

And a jolly good thing too, that’s what I say.

The Scottish government’s creepy Named Person Scheme has been fed to Azathoth, the BBC reports.

An earlier post of mine called “Sixty pages” described one father’s experience of the pilot scheme:

The surviving extracts appeared to indicate that the minutiae of his family life had been recorded in painstaking detail for almost two years, under a Named Person scheme which has been introduced in his part of the country ahead of its final roll-out across all of Scotland in August. A separate note made by the Named Person charged with keeping an eye on the academic’s two little boys was concerned with nappy rash.

Rob Fisher also wrote about it here: What the GIRFEC?

We have always been at war with Vapasia

India bans e-cigarettes as global vaping backlash grows

India has announced a ban on electronic cigarettes, as a backlash gathers pace worldwide about a technology promoted as less harmful than smoking tobacco.

[…]

“The decision was made keeping in mind the impact that e-cigarettes have on the youth of today,” India’s finance minister, Nirmala Sitharaman, told reporters in the capital, New Delhi.

[…]

The government said it would advance tobacco control efforts and contribute to a reduction in tobacco usage. Punishments include up to a year in prison.

[…]

According to the World Health Organization, India is the world’s second-largest consumer of traditional tobacco products, which are not covered by the new ban, killing nearly 900,000 people every year.

[…]

India is also the world’s third-largest producer of tobacco, the WHO says, and tobacco farmers are an important vote bank for political parties.

Keeping the poor from wealth and the sick from health

“Bulgarian authorities bust gang suspected of illegal organ trading”, reports the Chinese state news agency Xinhua.

Bulgarian law enforcement authorities have dismantled a four-member organized criminal group suspected of illegal human organs trading, an official said here on Friday.

Two of the gang members were arrested on Tuesday evening when they were trying to leave the country at the Kapitan Andreevo checkpoint on the border with Turkey, and the other two were detained later, Siyka Mileva, a spokesperson for the Specialized Prosecutor’s Office, said at a press conference.

The evidence gathered so far indicates that the gang has been active since Feb. 2019, recruiting donors and recipients of kidneys, and transporting them to a clinic in Turkey where transplantations were performed, Mileva said.

All the criminals, donors and recipients are Bulgarian citizens, she said.

The recipients paid the gang between 50,000 euros and 100,000 euros (55,500 to 111,000 U.S. dollars) for a kidney, of which from 5,000 euros to 7,000 euros were paid to the donors, and the surgery cost between 20,000 euros and 25,000 euros, Mileva said.

The donors were of low social status, she added.

Thanks to the splendid work of the Bulgarian authorities their low social status will now be lower still, as in “criminal”. The people who needed the kidneys will have their status changed from “sick” to “sick and in jail”.

I first heard this story on the radio. Unfortunately I cannot remember which station I was listening to, but I do remember that the report specifically said that all the participants, including the would-be donors, were willing participants in the exchange of kidneys for money. Both sides were better off in their own judgement; the poor wealthier, the sick healthier. This evil had to be stopped.

Discussion point: compulsory vaccination

Stop return of measles by making MMR jab compulsory, say GPs.

The Guardian headline makes it sound as if all GPs (General Practitioners) have said this. In fact only four named doctors are quoted, and when one reads the article the “compulsory” of the headline is not fully justified, but I think most GPs would agree with the government moving from a “nudger” to a shover on this issue.

The MMR jab should be compulsory for children before they are allowed to start primary school to stop the resurgence of measles and mumps, leading GPs are demanding.

Schools should ask all parents to prove their four- or five-year-old has had their two recommended doses of the vaccine before they can attend, they say in a letter to ministers seen by the Guardian.

They want school entry procedures toughened so that the only exceptions made to the new rule would be for children whose parents have registered a conscientious objection to the measles, mumps and rubella vaccine or those whose health means they cannot have it.

The four London GPs, who include a former government adviser on health policy, have urged the health secretary, Matt Hancock, and the education secretary, Gavin Williamson, to embrace the proposed change in policy.

Many a libertarian shuffles their feet when questions of herd immunity come up. The ghost of Typhoid Mary laughs. What do you think?

If it saves just one life…

We have to do it, right? Politico reports,

Some U.K. lawmakers think they’ve found a way to reduce British smoking deaths: Brexit.

Large numbers of British cigarette smokers will switch to vaping once the U.K. leaves the bloc, they argue, if looser British tobacco laws replace tighter EU limits on nicotine advertising and packaging.

Ultra-processed food

The BBC reports that ultra-processed food has been linked by scientific studies to early death.

Then come “ultra-processed foods”, which have been through more substantial industrial processing and often have long ingredient lists on the packet, including added preservatives, sweeteners or colour enhancers.

If a product contains more than five ingredients, it is probably ultra-processed, says Prof Maira Bes-Rastrollo, of the University of Navarra, citing a maxim.

This sounds quite vague. My problem with “processed food” as a concept, is that industrial processes involving food include things like mixing two ingredients together in a large vat. Surely if there is a problem it is to do with the content of the food. Something harmful is present, or something beneficial is missing. If so, tell me what that is, there is no need to be vague about it.

→ Continue reading: Ultra-processed food

This is not yesterday’s post about the NHS killing several hundred people

Today’s post about the NHS killing several hundred people is quite different from yesterday’s and should not be confused with it. They have nothing in common except both being about times when the NHS killed several hundred people.

The Guardian reports,

Fresh criminal inquiry launched over Gosport hospital deaths

Police have launched a fresh inquiry into how 450 patients died over 14 years after being given dangerously high doses of painkillers at an NHS hospital that showed “a disregard for human life”.

Relatives of the victims hope the investigation – the fourth into one of the biggest scandals in NHS history – will finally lead to criminal charges being brought against staff involved in administering the drugs unnecessarily.

An independent inquiry last year into events at Gosport War Memorial hospital in Hampshire found 456 patients had their lives shortened as a result of being given opioids without medical reason between 1987 and 2001. Their deaths are the focus of the new police investigation.

Another 200 people “probably” received excessive doses of painkillers at the hospital between 1989 and 2000, it added.

However the Guardian does not report a little detail that the Times does:

A hospital doctor faces a new police investigation into the deaths of 456 patients who were given “dangerous” levels of powerful painkillers.

Last year an official inquiry concluded that Jane Barton, who was known as Dr Opiate, headed an “institutionalised regime” of prescribing the drugs without medical justification at Gosport War Memorial Hospital.

Patients considered a “nuisance” were allegedly given drugs on syringe drivers filled with opiates which killed them within days of their arrival at the hospital in Hampshire.

(An earlier post on Gosport can be found here: “If a nurse didn’t like you, you were a goner”.)