Evidence Based Medicine – it was a good idea

25th April 2022

[Until it died]

Once upon a time I was a member of the General Practitioners Committee. A sub-committee of the British Medical Association that represents GPs. This was during a time when the Quality and Outcomes Framework (QOF) system was being rolled out. There is hardly anyone working in the NHS, including almost all hospital doctors, who has any idea what QOF is. But GPs [Family physicians] sure as hell do.

I donned my armour and battled against it, in a purely Don Quixote style. I was aware that I was tilting at windmills, but I felt the need to do something, however unlikely I was to succeed. This stance did offer the advantage that I could then say two things that really irritate other people. First ‘It wasn’t my fault.’ Even worse ‘I told you so.’

Ah yes, what on earth is he talking about this time? What is this QOF thingy, you ask? And what has it to do with evidence-based medicine? Well, you could say that QOF represents the inevitable end-point of evidence-based medicine. The crowning glory of a system designed to remove uncertainty from clinical practice. Replace it with carefully crafted treatment algorithms, based on the best possible evidence.

To explain in a little more detail. QOF itself is a system whereby GPs can earn points for reaching various targets. They are then paid money for each point gained. How much money? You can skip the next bit, but it makes me laugh. It is but the tip of a mighty iceberg of complexity. A system that makes filling in a tax return look like light-hearted fun.

‘To work out your actual QOF value for your practice, you need to divide your population by 8,479 to derive a factor and multiply this to the QOF point value to derive the actual QOF value for your practice.

For example, if your practice has 4000 patients.

4000/8479 = 0.4717537

0.4717537 x £187.74 = £88.57 per QOF point.’

At present it is possible to achieve a maximum of 567 points (last time I looked). This equates to an income of roughly fifty thousand pounds, for a practice of four thousand patients. If, that is, you achieve all the points on offer. Which is tricky.

What sort of activity earns points? Well, take diabetes as an example. You start by establishing, and maintaining, a register of all patients, aged seventeen or over, with diabetes. The register must also specify the type of diabetes – where a diagnosis has been confirmed.

You may think this all sounds perfectly reasonable, but then ask yourself why does it need to be done? In the UK, all GPs use computer systems. If someone has diabetes, this will be known. It will be on screen. It’s not as if the GP is going to be taken by surprise to learn that the patient has diabetes when they carry out an audit.

In short, an up-to-date list makes no difference to their management. Nor are you going to suddenly stumble across more patients with diabetes simply by the magical act of creating a list.

No, the reason why a list must be created is that you can gain points for such things as lowering the blood pressure to a ‘target’ level in the approved percentage of patients. Or driving the cholesterol level down below the ‘target level’, or getting the blood sugar (HbA1c) level below the ‘target’ level in the approved percentage of patients.

In short, for QOF to work, the GP needs to create database after database of different diseases. Then carry out audit … after audit. What a great use of clinical time it all is. Appointment after appointment filled with patients called in to have their annual blood pressure check, which just sneaks in just below target level – every single time.

For the pharmaceutical companies this is manna from heaven. Every patient with diabetes logged and audited. Every one driven to reach a ‘target’. A target that will inevitably require medication. Medication that the pharmaceutical company just, ahem, happens to have developed. Medication where they just, ahem, happen to have done all the clinical trials.

In addition to QOF, you also need to link everything into NICE guidelines. NICE stands for ‘The National Institute for Health and Care Excellence’. They produce magnificent ‘evidence based’ medical guidelines on such matters as the management of low back pain, or treatment of high blood pressure. Amongst a multitude of other things.

Some of these guideline documents are, literally, hundreds of pages long. But if you do not follow them then you are in trouble. You could find yourself struck off the medical register.

If you add NICE to QOF, what do you get?

What you get are extraordinarily rigid pathways, and algorithms, for treating patients. Soviet style central planning at its finest. Everything commanded from on high, everything measured, everything inspected. All five-year plans in place …comrade.

At this point you may well ask, why the need for highly trained clinicians? Disease X requires treatment Y, at dose Z, to achieve the desired outcome. Anyone sitting in front of a computer can do this. It requires no knowledge of why you are doing any of it.

Equally, it requires zero understanding of the complex relationship between various physiological systems, or the specific medical needs of a patient either. What if the patient has three different diseases, where you must balance one system against another? What if no-one has ever studied the use, benefit, or harms, of four different drugs given at the same time? How do you balance one set of guidelines against another?

Leaving such issues to one side, depending on your philosophy of life, you may believe this is all a fantastic idea. Repeatable and reliable treatment protocols replacing potentially flawed clinical judgement. Factory worker vs. skilled artisan. Ford vs Rolls Royce.  In general, we know who usually wins this one. Command and control vs. individual decision making. No contest.

However, if the medical authorities decide, as they have done, to go down the bureaucratic ‘command and control’ model – based on the best evidence available – then there is a critical thing. It is the absolute requirement to be certain that the evidence you use is of the highest quality. Untouched by bias … if not, your house of algorithms simply collapses.

So, how reliable is the evidence base? Here is what Richard Horton (editor of The Lancet) stated a few years ago in an article ‘Has science “taken a turn towards darkness”?

“The case against science,” wrote Richard Horton, editor of the medical journal the Lancet, “is straightforward: much of the scientific literature, perhaps half, may simply be untrue.”1

A while back I wrote a book called Doctoring Data, in which I tried to help people understand the many, many, ways in which the data from major clinical trials are manipulated and biased. How they are carefully designed to obtain only the desired results. I also attempted to clarify the endless data manipulations used to report the results themselves.

If I had to sum up the overall message of the book, it is that we are all, essentially, bunny rabbits caught in the headlights of an onrushing car. The onrushing car, in this case, being pharmaceutical company profits.

More recently the BMJ published an article entitled ‘The illusion of evidence-based medicine.’ 2

It begins, thus:

‘The advent of evidence-based medicine was a paradigm shift intended to provide a solid scientific foundation for medicine. The validity of this new paradigm, however, depends on reliable data from clinical trials, most of which are conducted by the pharmaceutical industry and reported in the names of senior academics. The release into the public domain of previously confidential pharmaceutical industry documents has given the medical community valuable insight into the degree to which industry sponsored clinical trials are misrepresented. Until this problem is corrected, evidence-based medicine will remain an illusion.’

It goes on to say:

‘Regulators receive funding from industry and use industry funded and performed trials to approve drugs, without in most cases seeing the raw data. What confidence do we have in a system in which drug companies are permitted to “mark their own homework” rather than having their products tested by independent experts as part of a public regulatory system? Unconcerned governments and captured regulators are unlikely to initiate necessary change to remove research from industry altogether and clean up publishing models that depend on reprint revenue, advertising, and sponsorship revenue.’

I have been saying this, or something pretty much like this, for years. As have many other voices … howling in the wilderness. Has anything changed? Well, yes, it has changed. It has all got considerably worse.

For example, much of the recent research done during the COVID19 pandemic was almost laughably biased and dreadful. Anything that could make a pharmaceutical company money was promoted ruthlessly – did someone say remdesivir. Anything where no little money could be made was slammed though the floor. Did someone say hydroxychloroquine?

As for the vaccine trials themselves. Let us draw a discrete veil over those …vague approximations to science.

What we currently have is a crisis in evidence-based medicine. The evidence that we use is, at best flawed and incomplete. At worst, just plain wrong. Yet, this is this evidence used to create the NICE guidelines and drive the QOF targets.

Any wonder so many GPs are completely fed up. It is not the only reason, but it is a major reason. ‘You trained me for ten years, now I cannot even make a bloody clinical decision. What is the point?’ A GP colleague calls it ‘monkey medicine.’ In that a well-trained monkey could do it.

When QOF was first being heavily promoted as the glorious future of primary care, I made a prediction. I predicted that life expectancy of the elderly (where most of the QOF points aggregate) would gently start to fall. This would happen because everyone was going to be monitored and measured. Then treated with drug after flawed ‘evidence-based ‘drug.

Two problems. First, this would inevitably drive polypharmacy [many different drugs prescribed simultaneously], and the evidence for this is overwhelming, and clear. Here is a short section from a paper examining the increasing use of multiple medications. ‘Medication usage change in older people (65+) in England over 20 years: findings from CFAS I and CFAS II.’

‘The number of people taking five or more items quadrupled from 12 to 49%, while the proportion of people who did not take any medication has decreased from around 1 in 5 to 1 in 13.’3

Polypharmacy is, in of itself, potentially dangerous, in that all the different drugs can start interacting with each other in unexpected and, often, damaging ways. Many studies have demonstrated this unequivocally. 4

These inherent problems with polypharmacy are, of course, made far worse by being driven by biased evidence. It does not take a genius to add two and two in order to predict that, in this situation, life expectancy may well go down, rather than up.

Biased evidence base + polypharmacy = increased morbidity and mortality

In support of this, here is an analysis from Imperial College London entitled ‘Life expectancy declining in many English communities even before pandemic.’

‘A substantial number of English communities experienced a decline in life expectancy from 2010-2019, Imperial College London researchers have found … For such declines to be seen in ‘normal times’ before the pandemic is alarming.’’ 5

Cause and effect? This cannot be said for certain – rather too many variables flying about. I know what I think.

However, one thing you can certainly argue is the following. If the evidence we now use to audit and treat everyone, using QOF, was of unbiased high quality, then you should expect to see some improvement in life expectancy.

But that is not what happened. What happened, was a fall. Not a huge, oh my God fall, but a fall, nonetheless. Has anyone pointed to QOF, and NICE, and the endless proliferation of guidelines as potential factors? You already know the answer to that one. Not a chance.

Whilst other countries do not have QOF, or NICE, the relentless march of evidence-based guidelines, and the subsequent clinical algorithms that they are based on, has become a world-wide phenomenon. The US, too, is seeing a fall in life expectancy.

At one time, long ago, I was a great believer in evidence-based medicine. It seemed like a good idea at the time. I now recognise that I was hopelessly naïve. First, as a student of history, I should have known that centralised command and control systems always end in disaster.

This happens, no matter how well intentioned it may have been to start with, and QOF was well intentioned. A crushing and inflexible bureaucracy will inexorably grow, and suffocate, and drain enthusiasm and energy from the workplace. The guidelines themselves would also, inevitably, end up as a Procrustean bed, upon which no patient can ever fit. So, you have to chop bits off, or stretch, as required.

Procrustes “the stretcher [who hammers out the metal]”, was a rogue smith and bandit from Attica who attacked people by stretching them or cutting off their legs, so as to force them to fit the size of an iron bed. [The process was always fatal].

In this case, the Procrustean bed has been further distorted by the fact that the evidence base itself rests of quicksand. It is a horribly biased mess. So, yes, evidence-based medicine was a good idea (sort of). It died long ago. R.I.P.

As an end-note, the impact of QOF was reviewed a few years ago. In 2017, to be precise. Nothing since that I am aware of. As the study concluded:

‘The lack of effect of the QOF on mortality is surprising, given that the indicators are based on high-quality evidence of effectiveness of interventions. Why this is the case is not clear… ‘6

Not clear… There are none so blind as those who have not eyes to see.

1: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60696-1/fulltext

2: https://www.bmj.com/content/376/bmj.o702

3: https://academic.oup.com/ageing/article/47/2/220/4237359

4: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02192-1#:~:text=Background,among%20older%20adults%20with%20polypharmacy.

5: https://www.imperial.ac.uk/news/231119/life-expectancy-declining-many-english-communities/

6: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647921/

182 thoughts on “Evidence Based Medicine – it was a good idea

  1. AhNotepad

    There is no need to worry, everything in the garden will be carefully tended and care exercised to ensure everything is at its best, by the regulatory authority and its experts, the MHRA. To see just how carefully they work, visit their board meeting https://youtu.be/V2YXWoChA4I. Unfortunately February is the latest posted, as we are only near the end of April, and March is not available.

    PS If anyone can translate their word-soup, can you post it somewhere?

    Reply
    1. David Bailey

      Wow I just dipped into that video – if I had watched it for 10 mins I’d have been asleep! It lasts over two hours, so I reckon it could be used for low level torture (guaranteed not to leave any incriminating evidence).

      Reply
      1. AhNotepad

        Conmen don’t give away that information, they appear honest. Have a look at the video, what’s your view?

        Reply
        1. alisonfletch

          I was reminded of a business meeting, which perhaps says it all.The chair seemed nervous at first but relaxed in to the role of refereeing the back slapping. (I looked him up. He worked/works in big pharma).You would not believe they were tallking about people’s lives. It could have been stocks of baked beans or cats eyes. If only!
          Reading between the gobbledygook, you can see that pharmaceuticals is big business and the MHRA is the British Govt’s entry in the drugs race. They proudly announced that they had authorised 210,000,000 doses of Covid 19 “vaccines”. Nothing about adverse reactions, of course. It was all about money. Interestingly they said the latest vaccine on the block (Novovax) is much more like a traditional vaccine which acknowledges that the mRNA ones aren’t.

          There was also talk of responding to future pandemics and approving therapeutics and vaccines quickly. Complete blanking of existing therapies for Covid 19! But also signs that future medical interventions may not come in a needle.They had the gall to say “Health and Safety” is paramount but they were only talking about their staff not the public. I could not have sat through that meeting without speaking up to say they should not approve unsafe medicines but of course I would not be invited back if I did so.

          I could not sit through more than about 50 minutes of the video beacause my blood pressure was going through the roof. One thing though that I noticed near the start was when they went round asking if anybody had any interests to declare, one man spoke up to say he hadn’t. He was something to do with AI. That is a clue to where we are going. His name was Haider Husain.

          “Biography
          Haider Husain is an experienced international healthcare IT business leader with a strong technology background and experience of partnership working, combined with his work as a Panel Chair for the British Standards Institute (BSI) and non-executive experience within the NHS.

          Haider is the Chief Operating Officer of an international healthcare technology consultancy called Healthinnova Limited, a Non-Executive Director of Milton Keynes University Hospital NHS Foundation Trust and is the Panel Chair for the Safe and Effective Use of AI in Healthcare at the British Standards Institute. Prior to this, Haider was the General Manager for Caradigm’s European population health management business and has worked for other international companies such as Microsoft, GE Healthcare and Logica”..

          Reply
          1. AhNotepad

            Alison, that’s a superb appraisal. I’m impressed you stuck it out for 50 minutes. I didn’t last that long as they never said anything with any substance. Have you looked at ukcolumn? Debi Evans there has written to June Raine several times asking very pointed questions. Guess how many answers were received.

    2. Paul

      I watched the one in April.
      It was a pointless exercise .
      Asked about vaccine damage payout ……
      Nothing was said

      Reply
      1. AhNotepad

        Paul, your watching it, even if it was a short while, was not a pointless exercise. Please keep looking, and everyone else look too. They are getting more frightened the more they see people are watching them. I think that is one reason for their word-soup statements, so people will find it difficult to pin anything else on them. That is not important, they are up to their necks in sh*t, and they know it. If things get worse, and more people wake up, they will never be free to go outside again, the fear will be too great. Nothing is likely to happen to them, but the fear will haunt them. What goes around, comes around.

        Reply
  2. David Grimes

    Thanks Malcolm. Clear and committed as usual. If you think the world is going mad you are proxy right. If you think things cannot get any worse, you are almost certainly wrong. But how ti stop it. Like you, I thought that clinical audit would be a good thing, but it has turned out to be a monster. Big and expensive departments looking at details of process (easy), not outcome (too difficult). Like your colleague, we are all made monkeys. I received a complaint (and GMC referral) as I had “missed” a diagnosis of cirrhpsis of the liver, whereas in r=eality I hd applied the diagnosis of alcoholic liver disease. I had “missed” the diagnosis in two patients of auto-immune liver disease, whereas I had used the more accurate terms chronic active hepatitis and primary biliary cirrhosis. The task was beyond the knowledge of the audit clerks, but they are more important than the hospital consultants. The GMC assessors were horrified and a hearing was not necessary. David Grimes

    Reply
    1. Dr. Malcolm Kendrick Post author

      I find the response of the GMC to unfounded complaints is normally. We did’t get you this time, but have no doubt we will…. in the end. Because we know that doctors are always guilty- of something terrible. I am always reminded of the child-catcher in Chitty-Chitty Bang-bang.

      Reply
      1. Robert Dyson

        It does seem that some are using it to target colleagues they don’t get on with, possibly those who are more conscientious.

        Reply
    2. Robert Dyson

      Lovely to see you on here David! I too think things will get worse unless there is resistance and better education of the public, though I don’t know how to get people more sceptical. One on my mathematician friends was recently disagnosed with T2 diabetes. He told me: “I went to a course on diabetes, but it was at such a low level that it was unbelievable and prompted me to ask basic questions – questions that they couldn’t answer … You talk of too much cholesterol, what does it do and why does no-one ever seem to have not-enough?” I sent him some starters for research.

      Reply
    3. thecovidpilot

      Hello Dr. Grimes. Do you find that doctors are reluctant to treat patients with calcifediol, which can be obtained by mail order (at least in the US). Could you comment about reluctance to treat with calcifediol and why doctors ought not be reluctant?

      Reply
  3. Rosemary Wellman

    Thank you for sending me your email. I Thoroughly enjoyed it (perhaps not an appropriate word.As a mere elderly patient with lots of GP and hospital doctor experience for the usual selection of troubles, It seems that we have always been rather willing pawns in a pharma nightmare, (maybe brainwashed would be a good word here) to the point where I have dropped my poly meds where allowed, to follow my own rules, even during the covid nightmare, so far so good fingers crossed!!

    Reply
      1. Prudence Kitten

        I am 73 and cannot remember when I last consulted a GP. Maybe about 25 years, for ear-wax or such. Long before they moved the practice to a brand-new brick building (further away from us) with en-suite pharmacy.

        I do recall going there with my wife for something trivia. She was given a one-off prescription and had some difficulty in persuading the pharmacy people that she had no repeating prescriptions!

        Today we eat as healthily as we can, walk a few miles every day, get as much sunshine and sleep as possible… and are resolved to avoid organised “medicine” like the plague. (That cliche comes readily to the tongue, but on second thoughts it seems eerily apt).

        Reply
        1. Prudence Kitten

          By the way, I am deeply indebted to Dr Kendrick for correcting me recently when, over-impressed by “The Perfect Health Diet”, I said that one must balance protein, fat, and carbs.

          Dr Kendrick stated in terms that no human being needs any carbs. Since then I have read Dr Shawn Baker’s “The Carnivore Diet” and have started to eat very little except meat (and fish, dairy, and a few green veg). So far I have lost about 20 lb in two months and feel great. I am hopeful of getting down to my teenage weight without any health risk or the slightest hunger.

          Thanks, Dr Kendrick! If the total good that a person has done to other people in their lifetime were to be totted up, you would have a massive “plus” balance. Quite apart from the practical benefits, the psychological effect of knowing there are at least a few people on whom you can rely to tell the truth as they see it is enormous.

          Reply
          1. jeresavo1

            That indeed is a very satisfying thought and a great comfort – to me certainly, that I hav a source of honest scientific advice in these blogs. The biology or chemistry of LDP as outlined in “the clot thickens” is a go to area for me if I need a reference for what the statin marketing people & their downstream influenced subjects call “bad cholesterol”.
            Are we living in a time of absolute deceit ?

        2. sticky

          I too avoid organised medicine like the plague.

          The GP surgery that I used to attend, in a mid-terrace house, has since been moved into a large new ‘health centre’ nearby.

          I also discovered that the practice had been taken over by another one (Reach Healthcare) – based about four miles away – when I received a succession of letters from them, a few years after my last visit.

          They wanted me to arrange an appointment to have my medication reviewed, since I was apparently taking medication for high blood pressure.

          I received three letters like this from them over the course of several weeks, which I ignored, until I had the thought that maybe they had confused me with another patient with the same name as mine.

          I called them to let them know that I have never had high BP, nor, not surprisingly, have I ever taken medication for it. I suggested to the receptionist that, were they to have a patient with the same name, and on meds for high BP, she might wish to contact them urgently.

          I did, however, out of curiosity, take up their invitation, on turning 65, to attend for a AAA screening at a different location. It was 1.7 cm, which is good.

          I have since received requests to make appointments for ‘health checks’ and covid ‘vaccinations’, which have, you might guess, been ignored. (They certainly aren’t living up to their name, where I am concerned).

          (In the ‘vaccine’ letter they said that they had tried unsuccessfully to contact me by telephone, and asked me to provide them with an updated telephone number. Well, I have had the same landline number since I moved here 31 years ago, and had provided this when I registered with Dr Rahman, presumably not long after that. Needless to say, I haven’t let them know it again).

          Reply
  4. John

    So, so true. And explains daft things like why I was told I needed to have a lung function test over the phone(???) as I used to smoke 35 years ago. No mention of the fact I have always had asthma. And why it’s impossible to book an appointment at a time to suit the patient with a doctor of your choice. And why GPs lose interest in those who are obviously not OK, but don’t have a points-generating disease (thyroid problems, for example). Why spend money on training doctors if they can’t make clinical judgements? Oh, wait, we aren’t doing it any more – we are getting nurses to do the doctors’ work and possibly importing doctors. Ah, well.

    Reply
    1. 186no

      May I recommend you scope the NICE guidelines for lowering Cholesterol to a specific, pan population numerical value, and follow the line of crumbs to the original study used – at least in part – to “underwrite” their “policy recommendations” for treatment, and precisely who were the major funding sources. That will give you the answer…..and I think referenced by Dr K in “TGCC”?
      There are precedents for this adoption of metrics from the private profit driven sector all over the place.You may recall the change instigated by the DHSS (now effectively DWP) for the method of assessment of incapacity; this started – originally – in the late 1980’s and was imported from the US which came to be known as the “Work Capacity Assessment” ; introduced ATOS to the UK, a massive increase in DHSS/DWP Tribunals because of very very dubious tactics used by some ( I stress “some”) medics and Solicitors who jumped on the money bandwagon set up by various government departments – the intent was to drive down the Social Security budget and part of this was to deny claimants the right to have their medical advisers intercede on their behalf ( a precis of a highly complex process I readily admit) . This was essentially the work of a major US multinational and latterly its UK subsidiary; high level personnel from said UK subsid were involved at the highest level of policy making from day1 and Lab/Tory/LibDem Tory administrations are all involved. (Golly me , a private sector profit machine manipulating the direction of travel of policy that benefits them over the interests of the PBI – surely not?)

      Reply
      1. Robert Dyson

        The thing about that serum cholesterol is that a measurement is made at one point of time and regarded as the permanent level whereas it fluctuates just like blood pressure. Even were it desirable to reduce it one would need to take several samples over a few days.

        Reply
          1. sticky

            I’ve got a copy of a ‘meme’ – too much hassle to post it here – which shows a (masked) woman standing with two (unmasked) Amish men in a rural setting.
            “Why isn’t covid affecting you people?” she’s asking.
            “We don’t have tv” replies one of the men.

        1. Jackie Hewitt

          Ever since I read The Great Cholesterol Con I don’t even think about my cholesterol levels one little bit.

          Reply
    2. David

      I don’t think so. NICE, as originally conceived as the National Institute for Clinical Excellence, was supposed to evaluate treatments for cost effectiveness, just because a pill works and is safe does not mean it is cost effective. Big Pharma hated it and eventually, through the granting of exemptions for emotive diseases (cancer, for one) effectively destroyed it.

      Reply
  5. Stephen Moorhouse

    It’s as if these systems were designed to be co-opted for nefarious purposes. And that is why they were introduced in the first place. They centralize power and finally make it so you are effectively unable to disagree with the mandates in anyway that doesn’t serve the controlling party’s interests.

    “But, I don’t think we should give patient pharma bio engineered crocodile baths!”

    “Sorry, this mega organisation of checks an balances massively infiltrated by ex-cocodrilluscorp members says you don’t have any evidence for that and should be banned from ever practicing medicine again.”

    Reply
    1. 186no

      How spookily coincidental; my post at 9.57am is all about a proven criminal US entity – very large – who with their UK subsidiary have successfully framed UK Government policy for years (albeit the vast and prolonged outrage at these tactics in action, having filled a lot of MPs mailbags for years, has served to change the policy at the margins I believe); part of their M.O. has to my certain knowledge ( and maybe still is ) is to target people with ME and CFS – I think it sage to say “they” consider these ailments as “made up” – and other ailments broadly under the banner of “mental heath”. Their corporate “playbook” – some of which I have had personal exposure – will surprise no one familiar with “Doctoring Data” and Robert Kennedy Jnrs recent work.

      Reply
  6. John Archibald

    Very depressing reading but convincing in his usual long-winded way.

    I am being prescribed 8 different medicines at present. Four of them are to deal with my latest MG flare-up, so at least I should be able get those down to one if and when I get back into remission. This does not include supplements like vit C and D.

    xxx

    Sent from John’s ipad pro

    >

    Reply
  7. Joshu's Dog

    Interesting stuff. QOF et al may be similar to the mediocrity of Soviet style central planning, but I seem to remember the Tory and New Labour governments who implemented it imagining they were solving a crisis in a “moribund public sector” by introducing a “greed is good” principle. Clearly all they did was to undermine professionalism to the benefit of corporations, while allocating hush money to GPs.

    Reply
    1. Dr. Malcolm Kendrick Post author

      They thought the only reason why anyone will do anything is for money. Scotland, of course, has given up on QOF. There have been attemtps to get it abolished in England and Wales – so far no luck. The problem is – do GPs just stop doing all this stuff. Or, do they carry on doing it – but not get paid for it. Or…what? GPs understandably fear that QOF work has become ‘standard’ practice that they will be contracted to do, without getting the additional funding needed. It has all become very political.

      Reply
      1. Robert Dyson

        You can see that doing things for money is what Blair & Cameron etc did/do. They naturally assume everyone is like them. That’s another reason that Jeremy Cobyn could not possibly be allowed to become PM, he doesn’t things for money, he was not in the club, could not be bought.

        Reply
    2. Prudence Kitten

      Yes. It’s fascinating, for those with a cynical sense of humour, to see how governments manage to combine parts of public and private and somehow create something worse than the worst of either.

      Just as – to take one random example out of scores – we all use exactly the same gas and electricity supplied by exactly the same networks, but there are scores of companies competing to get paid for it. As if you shopped at a supermarket and found, when you went to the checkout, that there were 68 of them all charging different prices for everything. And guaranteed to change their charges between the time you join a given queue and the time when you are given your bill.

      Reply
  8. childofthesixtiesblog

    Good morning Doctor

    I’m typing this on train in Holland travelling to the airport to return to U.K.

    Whilst I am in no way asking for or snuffling about for truffles of medical advice, I am rather anxious as to what I should believe when I’m being given advice by my own GP and how to interpret what I am being gently nudged towards.

    I’m a (just) 58 year old white male and I’m in reasonable rude health (I’ve been in Holland to take part in a couple of running races for example). “So what?” I hear the repost…

    My cholesterol is at 7.5 and I am politely but firmly refusing to even entertain the kind Doctor’s insistent attempts at every opportunity to get me to take statins after I have assiduously read all your books and many other articles about cholesterol and the misguided attempts at reducing it so such a low point that it satisfies “results”.

    All my other functional results are there or thereabouts. Perhaps my resting heart rate of 48 is a tad alarming for those who are not runners, but in general I’m in pretty decent nick.

    In short, I am sure that my GP has my best interests at heart and genuinely wants me to continue in as good health as I can maintain for as long as possible, but both my late parents were very polypharmic and their demise was long and slow and unpleasant and I am determined to avoid a repeat.

    So at what point do I give up on the “health” service as a peddler of unnecessary medication based on deeply flawed research funded by pharmaceutical companies ? You’ve literally changed my life with your books.

    I guess in one question I am now aware of what to avoid as far as pharmaceuticals are concerned, but what is the alternative path?

    Yours sincerely

    Andrew Steel.

    Reply
    1. HerIndoors

      The alternative is the alternative medicine route. Homeopathy, medical herbalism, acupuncture, chiropractic, aromatherapy, reflexology, orthomolecular medicine, nutrition, holistic dentistry or go further as these are all ultimately energy medicine and use Radionics, Rife, Spooky2, Spirit Release… the list is long and healthy. Seek out the good practitioners, you will wonder why you ever went to a less than mediocre GP.

      Reply
    2. Marion

      Hello,
      I think the best advice is to eat low carb, high fat (animal fat and olive oil – not vegetable oil as it’s very bad for humans). Don’t carb-load as some athletes do. Lots of high strength vit D3 and K2 – see Dr Kendrick’s previous posts on vit D. Also magnesium, vit c and zinc, perhaps. Avoid doctors, apart from Dr Kendrick. Accidents happen, of course, especially to those who take part on strenuous sports, but what we put in our mouths is of upmost importance….read Dr Knedrick’s latest book on heart disease, also Dr Jason Fung on diabetes and the benefits of fasting and low carb diets.

      Reply
    3. David Bailey

      childofthesixtiesblog,

      From personal experience don’t take statins – but you know about that. Also, if you get anything skeletal – arthritis in the joints, sciatica, etc or anything involving ‘untreatable’ chronic pain – find an acupuncture practitioner (preferably one recommended by someone else) I have had good results, so has my partner, and one other person I know who took my advice.

      I’d never have discovered this if it were not for the delays in the NHS, even before COVID.

      Reply
      1. Sasha

        I would like to add that acupuncture treats not just pain. It can lower or raise blood pressure, reduce or increase appetite, make you somnolent or energized, lower blood sugar or elevate it, treat amenorrhea or menorrhagia. The trick is to find an experienced practitioner who works from the first principles of Traditional Chinese Medicine. For acupuncture it’s the laws of yinyang and wuxing.

        Reply
    4. spamhelper

      You might be interested in Dave Feldman’s Cholesterol Code.

      https://cholesterolcode.com/

      I am the same age as you and also an athlete, and my cholesterol went up when a) I switched to a low carb diet and b) I started doing a lot more zone 2 running, which I do fasted.

      My GP is unhappy with my current cholesterol levels, despite the fact that I previously at quite a bit of sugar for my training and a lot of other refined carbs. And I was pretty obviously becoming insulin resistance, but my GP only looks at HbA1c because reasons.

      I’m fair confident that the changes in my LDL are only due to my fat metabolism being a lot higher.

      Reply
    5. jill4535

      I am reading Dangerous Doses, a true story of cops, counterfeiters and the contamination of America’s drug supply by Katherine Eban. I am 75. No meds.

      Reply
    6. Robert M.

      Hey, remember the Pareto principle (80/20). Only 80% of modern medicine is bullshit, 20% of it is valuable and substantive . . . “Don’t throw the baby out with the bath water.”

      Reply
    7. Eggs ‘n beer

      Andrew, my questions would be, are you sick? Do you feel ill? Do you have any symptoms? If not, why are you seeing your GP?

      From a child of the fifties, BP 113/76, resting pulse 60 but I’m no runner, cholesterol 5.2 down from 6.5 after I switched to a bacon and egg diet. Only seeing my GP for my ten year check up and a prostate issue. No meds.

      Reply
  9. 186no

    Thanks Dr K; scarily relevant to me atm. A recent trip to be examined by a ANP (who was encouragingly non QOF orientated and listened to me at length) threatened to go down the tubes when my BP was taken to check “my levels” only to be abandoned when it was revealed the Omicron was wildly variable and not to be relied upon – a leitmotif if ever there was one. As with other very current revelations illuminating the endemic world class “crassocracy” of western governments ( arming or not arming Ukraine, funding Putin via buying Siberian gas and oil), I am not surprised to read about the patient care hating QOF regime; it does underline my not so knee jerk response ” where do I go for medical advice ” or , as I am doing atm, wait for my grumbling appendix to give out and get immediate treatment as a consequence….Russian roulette I think.

    Reply
  10. jeanirvin

    As a retired teacher OFSTED inspections come to mind. Huge files of paperwork to be evaluated and short classroom observations!

    Reply
    1. Steff

      Spot on, OFSTED inspectors should have been made to demonstrate how they themselves would improve on the lesson they had just observed.

      Reply
  11. Ian Roselman

    So glad I stopped taking regular prescribed medication (including statins) years ago. I don’t know many people my age (74) who are not on a regular cocktail of drugs for something or other. Not because they are sick, just to meet targets.

    Reply
    1. David L

      And how do you discuss this matter with loved ones on a lot of medications? I’m sure the responses would be emotional, shouted, and my opinions would have no value to them as my lack of medical qualifications would render anything I say as a conspiracy theory.
      A big thank you to Dr Kendrick as my GP actually agrees with him and encouraged me (“I’m not allowed to tell you…”) to stop the statins many years ago in spite of high ldl and family history of cardiac disease.

      Reply
    2. Maire Lenagh

      I’m 70 and have not used any standard medications for the last 50 years as an adult. I feel very fortunate to have escaped some of the horror stories one hears!

      Reply
    3. Alec Evans

      Here in France we are very lucky to have found a British GP who “escaped” from the NHS a couple of years ago, apparently for similar reasons. She is loving the life here – even does house calls…
      She has reduced my wife’s meds from 6 to 2 – a lowish-dose BP med and a precautionary anticoagulant in case her AF recurs – with beneficial effects.
      I registered with her and she was happy to go along with my “if it ain’t broke, don’t fix it” philosophy – still no meds at 72.

      Reply
  12. Robert Dyson

    If you add the WHO pandemic treaty to NICE and QOF, what do you get? I feel ill even thinking about it, pass the smelling salts.

    Reply
  13. Joan Donaldson

    I always love when your most wise words pop into my inbox. They should be mandated reading!! Thankyou, Thankyou, Thankyou

    Reply
  14. ellifeld

    From what I’ve read one of the goals of the WEF is to have people constantly monitored 24/7 for everything under the sun, BP, cholesterol, sugar, etc. It will be run by artificial intelligence. Medicine will be ‘free’ but mandatory. The future of medicine looks grim to me.

    Reply
    1. Prudence Kitten

      It makes perfectly good sense if you realise that the fundamental goal is to maximise profits for Big Pharma, Big Medicine, Insurance – and, of course, government.

      Reply
  15. Hamish Soutar

    Incisive and revealing as usual. Thank you.

    For the last 10 years of her life, I looked after my mother. She was on a huge cocktail of prescription meds. Which I steadily stopped. Her GP (since retired) asked if she was still on one med, expressed gratitude that she wasn’t, and said with hindsight he should never have prescribed it in the first place. Is this QOF business part of the reason the elderly just get put on more and more meds, and rarely taken off them?

    Reply
  16. thecovidpilot

    I am of the peculiar philosophy that all regulations, laws, ordinances, etc. should have a word limit. So, once the limit is reached, in order to add new rules, some old ones must be abolished. You can see that this would set a limit on bureaucracy and the power of lobbyists.

    I’m also a proponent of jury nullification.

    Reply
        1. AhNotepad

          If juries only knew it, that’s what they could do in te UK too. The jury can consider the evidence pertaining to the accused, they can also consider the quality of the law being prosecuted.

          Reply
  17. Simon Derricutt

    This method works pretty well for machines such as cars or computers. Use the standard diagnostic device, and it tells you what is wrong and what needs to be done to return the machine to standard operation. It does however fail if there’s an intermittent connection, or a failure that the diagnostic process hasn’t foreseen and thus doesn’t have the correct fix for. In that case, you either need to scrap the machine or go outside the standard diagnostics using someone who has deeper knowledge.

    For people, there’s no standardised manual, so the failures of the standardised diagnostic procedures imply either a poor quality of life or a funeral. Over time, this might lead to a situation where the remaining people do respond well to the standardised treatments, but since a lot of the patients will be beyond reproductive age then the genetic variations that were a problem will remain a problem.

    It seems to me that medical interventions are always going to be “best guess” as to whether a treatment is an advantage or not, and even the best doctor can’t be certain that the treatment is beneficial except by looking at the results and using their accumulated knowledge for that patient.

    It’s hard to argue against a system that is specified to force doctors to use the best treatments and practices that the experts agree on, and to meet targets on quality of care and health indicators of their patient-base. It’s after all for The Greater Good…. However, the people in charge of setting those targets may be wrong, and then we’ll get problems and, because everyone has the same problems, we won’t see them as problems but as just what always happens. We need the diversity of opinions so that we can see when one opinion produces a better outcome than another.

    We’ve seen what happens when the people in charge decide that vaccination is the only allowable fix to a pandemic problem.

    Reply
  18. Barbara

    As I am a humble retired nurse( not that humble) this absolutely horrifies me. I trained not quite with Florence but in the days when we were required to understand the import of drug interactions. I have in recent years monitored my 95 year old mother in law’s polypharmacy and have twice intervened when I found contraindications to them being taken together. This is madness!

    Reply
  19. Anne Blore

    I remember being puzzled by a comment Bill Gates made in an interview, where he said that by 2025, doctors would be no more than glorified car mechanics. Now I understand.

    Reply
    1. Prudence Kitten

      As usual, what Bill Gates said was utterly wrong-headed. People are more complicated than glorified cars.

      Having studied and written about software for 40 years, I am perhaps better placed than most to know that Gates has acquired a reputation for brilliance and sagacity that is completely undeserved. An early dropout from university – because he was impatient to start raking in cash – Gates has never distinguished himself in any way except as an unscrupulous businessman. There he does excel.

      Reply
        1. Prudence Kitten

          I have never seen any evidence that Gates has particular skill as a programmer, and the very idea of software engineering on a large scale seems to have eluded him. He has acquired a huge reputation as a “guru” in the way that such reputations are built up nowadays: he’s stinking rich, and almost everyone uses Microsoft software, therefore he must be brilliant.

          His role at Microsoft was never as a software creator or architect. Rather, he did business deals – helped by his parents and other well-placed individuals who were able to get IBM (Normally very hard-nosed) to make Microsoft the sole provider of software for the IBM PC back in 1980.

          Reply
          1. sticky

            He’s just a clever marketeer, in effect, by providing something easily-produced that ‘everybody needs’, and selling hundreds of millions/billions of copies of it.
            In his view, ‘vaccines’ are just the same: set the terrain (everybody ‘needs’/must have it) and sell billions of copies of it.
            He may not be the producer, but is intimately involved in the scam, and is raking in huge amounts.

  20. Patricia Brown

    I can’t even get my husband’s private GP to agree to have a review done of his 10 prescription medicines (18 separate doses daily) on the grounds that he doesn’t know a clinical pharmacologist – forget the individual consultants involved – they don’t seem to believe in adverse reactions or interactions.

    Some of these products my husband has been taking for 15 to 20 years without asking any questions or reading the patient pack insert, never mind the longer Summary of Product Characteristics, despite being a pharmacist and a Cambridge chemistry PhD.

    My private GP has access to a hospital based clinical pharmacologist but I’m not sure how “free” (under protocols which also apparently apply to private practice) he is to tell my my by now not entirely compos mentis husband to kick over the traces for some of these substances – not all, that would be unrealistic, but still…

    Thank you for what you are doing and have done.

    Reply
  21. Marcia T

    So very happy that you’re still writing columns like this: in my attempts to explain to others (friends, family, anyone who’ll listen) some of my medical (or let’s-stay-away-from-medical) decisions, I usually fail miserably – and then go looking for your appropriate column to send along. This one’s a gem – as usual. Thanks!!

    Reply
  22. dearieme

    “multiply this to the QOF point value”: so this was written by someone so ill-educated that he thought one “multiplied to” rather than “multiplied by”. Or, perhaps, who didn’t know that a x b = b x a.

    Has it come to this? Someone had been found who is even less numerate than your average doc. Envy of the World.

    Reply
  23. klbosse88

    Great Read !! I personally do not trust the Medical Entity … I am 81 years old and I am through
    with the Cardiologist and Primary Care Physicians. Their answer to obvious reported mistakes is ” He is just following protocol”. I am through with “Protocol”.

    Reply
  24. DAVID MACPHAIL

    When lab data began to be digitized and made available online I quickly saw where this was headed; algorythms that analyze lab results and generate a treatment protocol mandated by a commitee (acting on behalf of the pharmaceutical industry).

    The next step (and it only has to be implemented) is technology that tracks medication uptake. Non-compliant patients who attempt to make personal decisions on their health will face huge increases in health care premiums and even denial of coverage. The will be labelled liabilities to the health CARE system who cost society millions and scorned by the compliant

    COVID opened the door (and closed one) to online consults with doctors a patient has never seen and never will see. What’s next? AI doctors; images that look like doctors. No problem with Dr. Kendrick types. AI doctors will be programmed…….. by the pharmaceutical industry. Incentives? None needed. Big bonuses are in the works for pharma execs.

    Sent from my iPad

    >

    Reply
  25. jeresavo1

    Thanks Dr Kendrick – Much administration is now self serving – a bureaucracy loop feeding itself, a domain (a dominion) with a budget maximising drive hotwired in to its DNA. Am i alone in believing there is an untold benefit in human to human interactions.
    Human to human interactions thing of the past – where you can see the whites of the eye ?

    Reply
  26. Eric Stubbes

    Splendid article. The best from you.

    I am thinking of sending a copy to my G.P. I probably won’t, since he is obese and could have a heart attack while reading it.

    Best

    Eric ERIC STUBBES

    E.H. Stubbes ________________________________

    Reply
  27. Robert Malcolm Kay

    Gosh, hadn’t realised it was that bad. My wife and I are aged 68 and 70, and take no routine prescripion meds at all : we must be pr etty exceptional!

    Reply
    1. Neil

      Apparently 7% of over-65s don’t take any NHS medication. So we’re now in a small minority.

      Three people I know in the age range 68-74 have been in various ways ‘captured’ by the NHS system in the past two years. Its overriding motto now seems to be: ‘Say yes to drugs’.

      http://www.vaxcontrolgroup.com deserves support from people who decided to remain in the control group. If one believes the government – a big ‘if’ – apparently 8-9% in the age range 65-70 did so.

      Reply
    2. ShirkeyKate

      At ages 68 and 70 you are both young chicks! I can remember D-day (that was 1944) and I take no meds. Is this a competition?

      Reply
      1. Mr Chris

        Shirley Kate
        I can Romberg VJ Day, death of Stalin etc. I take no medicine but bags of supplements.see my doctor maybe twice three times a year.

        Reply
        1. ShirkeyKate

          Hi Mr Chris, yes, bags of supplements of course. And you see your doctor occasionally? In our practice they’re still hiding under their beds – from which hideout one of them phoned me during the first year of lockdown. On hearing my symptoms she prescribed metabolism-altering drugs, never having seen me at all. Needless to say I googled the stuff, decided the side effects were too scary and went back to the trusty vitamins. You take care now.

          Reply
    3. sticky

      My partner and I don’t take any prescription drugs either.
      Her daughter, aged 50, and double-jabbed, has just come down with C19. My partner was, understandably, worried about her since she is on her own, her husband working away during the week.
      I offered to run her up there (to Herts, about 100 miles away). Before we left, my partner asked me if I saw the irony of the situation.
      “What, you mean the fact that a 68-year-old who hasn’t had any ‘vaccinations’, nor C19, is taking his partner, a cancer survivor aged 75, who is triple-jabbed, with no C19 history, to look after her 50-y-o double-jabbed daughter with covid?” I suggested.
      “Yes, and the fact that I didn’t see her for 14 weeks when I was undergoing chemo.”
      I produced some Ivermectin and urged my partner to take it but, of course, she wouldn’t. I also said that she should offer it to her daughter, since it would probably clear it up in a few days but, of course, she won’t.
      She will be coming back on Saturday by train. I just hope that she manages to keep herself safe.

      Reply
  28. howie

    I am reminded of the great American financial system. where mortgages are bundled into stock portfolios. Ratings are made of the quality of these portfolios – from Junk – AAA. The expert agency’s trusted to make these judgements – such a s Moody’s and Standard & Poors compete with each other to get the work – the higher the ratings they give the more work they get. What could go wrong?
    Well, the Great Financial Crises of 2008-9 that hurt so many millions of people – since the agency’s were/are corrupted by that system. Junk was rated at AAA.
    As far as I know – no executives at these agency’s were fined – or spent time in jail – and that system of ratings as not changed despite what happened.

    Reply
  29. C Lewis

    Fascinating. Totally fascinating. It explains so much. I’m a 58 year old woman. 2 years ago I fell off a large horse, jumping a 3 foot jumper, at a cancer. I broke my wrist. In my total innocence I asked and got a DEXA scan. As a result I was told that I had ‘osteoporosis’. I was so shocked that I did a great deal of reading; everything I could find. You need to understand that I am a very little woman, always have been but I’m strong, fit and never had anything more than a cold in my life. I was only just into the ‘osteoporosis’ region of bone loss. Sight unseen by any doctor I was prescribed Alendronate. This stuff is so counter-intuitive. If you take it too long you get horizontal thigh bone fractures. Dentists will not do invasive dental work because of jaw bone damage. It stops you making new bone, you just keep all the old bone. How is that a good idea? I could go on and on about why I simply can’t see why this drug is helpful. To cut a long story short, I simply don’t believe there is anything wrong with my bones. I’m convinced that the system just gives everyone Alendronate, whether they need it or not, just is case it does them a bit of good. I am equally convinced that it will damage their bones and that it will all be exposed in court one day. What happened to doctors ‘doing no harm’? I thought they swore this at graduation!!

    Reply
  30. Bob Niland

    EBM: Eminence Based Medicine
    It hasn’t been Evidence Based Medicine for a very long time now.

    That’s why I personally don’t ever write about the late great EBM. I speak of outcomes instead.

    Reply
  31. andy

    I could not read much beyond my ‘blood pressure level’, but get the picture.
    But I got fine treatment this week and even a follow up appointment. It was caring, efficient and I trust the diagnosis..one that several years of my local NHS surgery hasnt given me, (it cant even give a diagnosis of a nasty possible skin cancer on my wife’s face following a telephone call plus photo of last week)
    I suggested, as I left the fine man who discussed my case and my questions, that they embark on knee replacements and a great deal more besides without further hesitation. Yes. Specsavers do the full opthalmicjob..

    Reply
  32. Trish C

    Hello Malcolm – I have just taken a peek at the BMJ article (reference 2) and this in your Rapid Response “Key opinion leaders become the members of the committees deciding on clinical guidelines, they become elected to roles of presidents of this, or that, society. They referee themselves, and inexplicably find themselves not guilty” is a situation of which I have personal experience, not in the area of medicine. Some years ago I was working for a “not for profit” organisation (an ironic title it turned out). I reported my “boss” for misappropriating funds. The executive board commissioned an inquiry into this, and guess who they appointed to do this? Yes, you guessed it – and surprise surprise he could find “no evidence of wrong doing”. The whole experience of trying to uncover the fraud this man was perpetrating against this organisation – a two year battle – was a salutary lesson in life. The truth is right down the ranks of importance when money and ego are involved.

    Reply
  33. Scott Robinson

    Dr. K. As a retired anesthesiologist. I have been in a unique position to discover the movement to “evidence based medicine.” I feel dismayed for primary care physicians who don’t have the luxury of observing their patients frequently enough to use their clinical expertise to adjust drug doses and regimens. Fortunately, I was able to observe and modify the effects of drugs I used on a minute to minute basis on a single patient at a time. As such, I was able to discern for myself which algorithms were effective, and which were not. In the US, at least reimbursement has not been tied to any kind of score, but it seems like it is moving in that direction. The pandemic has revealed organized medicine to be increasingly something I don’t recognize, and I’ve never been more disappointed in my profession.

    Scott Robinson, MD

    >

    Reply
  34. Mark Heneghan

    So much of QOF seems to be based on the idea that everything is preventable, and that all that is needed is to identify the ‘risk factors’, and then find a method of reducing these risk factors (and it’s always a drug) and the problem is solved! Never mind that association is not the same as causation, it made theoretical sense at a superficial level, and the justification for all the money that we (GPs) were being paid was the old chestnut that we would start to reap the benefits when all the strokes and heart disease were no longer happening, everybody healthier, and less work for us all. It hasn’t happened of course, and the standard explanation is not that the whole thing was a terrible idea, but that we haven’t been trying hard enough.
    I am reminded of the often quoted story about the NHS, that Aneurin Bevan believed that it could probably be dismantled about 5 years after its inception because by then the backlog of all accumulated illness in the UK would have been cleared. I think that the philosophy behind QOF was equally naive.

    Reply
  35. nestorseven

    EBM has been lost for the last 30-40 years. As a converted believer to “terrain” theory verses “germ” theory, the basis for most drugs and treatments is totally bogus because the sicknesses are bogus. Show me any virus that is evidence based (fully purified and detected without using a computer algorithm to guesstimate it) and 100% transferable from one human to another, with 100% proof of course.

    I have been using vits and mins, herbs and a healtheir diet to combat my heart problems. The cardio doc wants me on statins, blood thinners and stents…all which I flatly reject. The herbs are working just as well since my heart episode 9 months ago. Sorry, I just cannot trust the medical community even though there are probably some very good docs out there who put patients first instead of big pharma drugs.

    Reply
  36. Ruth Baills

    Sad state of affairs for our world. Seems we keep repeating the same mistakes. No wonder some leave mainstream medicine for other types of medicine. i.e. Holistic health etc.

    Reply
    1. Prudence Kitten

      They are not “mistakes”. They stem from different goals. The patient’s goal is to stay (or become) healthy. The industry’s objective is to maximise profits. The government’s objective is to minimise outlay.

      The doctor’s objective used to be (mostly) to heal patients or keep them healthy. Increasingly, doctors are being absorbed into the Borg and forced to adopt its values: profit and obedience.

      Reply
  37. Eggs ‘n beer

    Quality and Outcomes Framework? This scheme could only have been named, and developed, by management consultants. The very name reeks of appearance over substance. Of administration over efficiency. Of bureaucracy over productivity.

    I think it’s time to rename the NHS the National Sickness Service. Or maybe just the SS. You don’t treat health, you treat sickness. Although more and more the emphasis is on treating healthy people, who have ‘risk factors’, just in case they are susceptible to those factors and might get sick. Instead of trying to determine if the risk factor applies to the robust, totally healthy looking individual in front of you. Statins, BP medication, vaccines, blood thinners; whack ‘em in, just in case.

    Does anyone know if we have an equivalent of QOF in Australia? I think I detected signs of it a few years back with my GP when she started hinting about my cholesterol level. She knows the chances of my taking drugs for that are like lining up the pigs ready for takeoff, yet there was the nudge. Does she get paid for putting a tick in the “Recommended Statins for High Cholesterol” box? Interestingly she has stayed well out of the Covid dempanic, refusing to test for it, administer vaccines or issue vaccine exemptions. Maybe we can have a chat over a bottle of red or two if the hysteria ever dies down.

    Reply
  38. Binra (@onemindinmany)

    Robotic ‘protections’ usurp & undermine life support.
    Digitisation to generate a systemic surveillance & control system turns meaningful relationships & experiences into coded control under centrally defined quantified ‘values’

    Reply
    1. alisonfletch

      Good to hear from you, Binra. I can’t go on Twitter anymore because I mentioned ivermectin! The BBC Disinformation Unit didn’t like that nor my mentioning free speech. I always liked your Tweets. Maybe I’ll be able to get back on now Elon Musk is head boy.

      Reply
  39. Richard Chadwick

    Great Post, really hits the nail on the head.
    Immediately after reading it I logged on to medpagetoday.com and learned that the FDA just expanded use of remdesivir to COVID patients as young as 28 days (provided they weigh at least 3 kg)
    It just keeps getting worse.

    Reply
  40. sticky

    centralised command and control systems always end in disaster

    An encouraging aphorism also for within a global context.

    Reply
  41. Leila

    Thank you Dr Kendrick. They were pushing evidence based medicine when I graduated as a physio in 2009 in NZ. Basically the only thing that had enough evidence was apparently exercises prescription, so we learnt all these techniques and skills only to be told to give out exercise and everything else didn’t have enough evidence behind it

    Reply
  42. Jeremy May

    One problem is people believe what their doc or HCP tells them. You go in with a worrying ache and a few minutes later you’re cured. All you have to do is march your prescription to the chemist. Suddenly light of heart, soon to be mended.
    In my case, T2 diabetes. Answer from nurse, Metformin and a statin immediately – which I didn’t.

    The other day I was called a very unpleasant name on an internet forum. It was a ‘debate’ on statins. I referenced an article by Dr Sebastian Rushworth (‘What Defines a Good Drug?’) where he states that the NNT (Number Needed to Treat) for statins is 40. In other words, 40 people have to take a statin before one person may see any benefit. (Ignoring the fact that some of the 39 may experience adverse effects).
    On the forum I pointed out that actual evidence for the benefits of statins was minimal and getting more minimal. (Here I referenced Dr. K.). Also, the prescription of billions of the things was perhaps profit-based.
    But one (of a number) of my debate opponents believed both ‘historical data’ and his HCP and took a statin regularly, despite having perfect health. ‘It’s a preventative thing’, he said. His comments on other topics showed him to be an informed, bright person, but on this subject he had a bit of a blind spot. His reasoning why Statins NNT of 40 is unimportant is ………

    “But if you get 4,000,000 people on statins, that’s 100,000 events prevented, including a fair number of preventable fatalities and more people transformed into invalids. Since Statins are cheap and, for most people, the risk of side effects is low, it’s a sensible thing to do, both from the health service’s point of view and the individuals.”

    People believe this stuff. The ‘rigid pathways and algorithms for treating patients’, based on QOF and NICE, is horrifying to learn about. It’s taking the human being out of the equation, doctor and patient.

    Reply
  43. Ruth Baills

    Today I saw my newly acquired GP. When I say new, she just spent 4 years in the hospital system as an intern and now she is new to the medical practice as a registra. I am new to the area here in Queensland Australia, so I get the new person on the block. Anyway I avoided blood tests for 2 years due to COVID. So today: Total Cholesterol: 6.4mmol/L; Triglycerides: 0.9 mmol/L; LDL (calculated) 2.17 mmol/L; Non-HDL cholesterol: 4.23 mmol/L; Total/HDL ratio (Australian cardiovascular risk calculator) 2.9. She informed me that I am 10% risk od developing heart disease in next 5 years. Aren’t I lucky. Perhaps not. Not consideration of all the things our Dr Malcolm Kendrick writes about in his very informative book. “The Clot Thickens”

    Reply
    1. An Italian Australian at the tropics

      If your GP was able to predict your risk of a cardiac event by your cholesterol level alone, find another GP.

      By the way, it seems that this forum has more Queeslanders than Scots! Aren’t we lucky bastards, living in paradise? 🙂

      Reply
      1. Eggs ‘n beer

        Riskeeeee! Scotland is a great place to visit. But Queensland’s a great place to live.

        Ruth, if my GP said I had a 10% chance of developing heart disease in 5 years, I’d want to know:

        a) why don’t I already have heart disease if my cholesterol is so high (ho, hi ho, it’s off to stats we go), and

        b) what can we do to determine if I’m part of the 10%. i.e. why will 90% not get it. Gimme the science. Do the 10% have high blood sugar levels? Exercise regularly? Are vegans? Go on holiday to Scotland?

        However, she’s a smart cookie so she won’t give me the opportunity of asking.

        Reply
      2. Ruth Baills

        Systolic blood pressure, cholesterol, age, sex. She used “the Australian cardiovascular risk calculator” you can find it on line. Interesting 🤓.

        Reply
        1. An Italian Australian at the tropics

          Talking about cholesterol here, as per previous comment, I really would like to see the science behind it as a risk factor, I haven’t seen any, yet.

          Whatever says the Australian government, I couldn’t care less, I usually don’t listen to the Official Health Experts and when I do, I act the opposite of what they say, I find it to be a good strategy in the long term.

          Reply
          1. Ruth Baills

            Like your strategy. My GP of 30 years said to me she won’t take statins unless she had a heart attack. I told my current GP not interested in taking statins and not provided to have any benefit for older woman and have been known to induce type 2 diabetes. I am not certain this young woman will hang around in a cold climate winter in Toowoomba and surrounded can be very cold at times. She ailes from Malaysia originally.

  44. Ivan M. Paton

    Hi Dr. Kendrick – It’s great to see you posting on a blog where your community of followers can come and comment, interact, and also share your GREAT ARTICLES on social media.
    And wonderful that you have toughened up, sucked up your frustrations – which reflect all of ours – and are back to the regular fight and turning up on the page. THANK YOU! Your voice adds to the chorus of scientists and doctors that believe in evidence based medicine. And even though we have been through dark days, and there may be more ahead, this movement has gained so much momentum that there is nothing that will stop those fighting back against the attempt to impose totaliarianism on the world through public health dictatorship. All of which has been given to us by the CCP-WEF alliance’s public-private partnershjps in the global health vaccine industrial complex and all their corrupt political puppets dancing to the tunes of C19-mania.

    Reply
  45. Stan Calderwood

    Perhaps it is time that regulatory bodies were reviewed, taking info consideration Boeing and the FAA?
    A

    Reply
    1. Prudence Kitten

      Aaaaaaaargh! Then you would need more review bodies to review the review bodies that supervise the review bodies…

      That way madness lies.

      May I submit that the whole concept is fundamentally wrong? Instead of trying to enforce goodness through bureaucracy, we should go back to the original system (or rather non-system) of educating and training experts and then trusting their judgment. Together with a culture that encourages free, open communication and debate about everything.

      Today we are going in exactly the wrong direction.

      Reply
        1. Jimmy C

          Reminds me of the idea of “pre-existing” conditions. You can’t have a pre-existing condition — it either exists or it does not. If it exists it cannot pre-exist. If it does not exist, there is no logical way of stating it does. It is a useless prefix. So if any insurance company asks if you have pre-existing conditions then you are correct in saying “no” — if they ask about underlying conditions or existing conditions, that’s a different story.

          And of course there are no pre-meetings. There are meetings. Only.

          Reply
      1. Prudence Kitten

        As the Tao Te Ching has it,

        “When the great Way is lost
        There is ‘benevolence and rectitude’.
        When cleverness appears
        There is ‘great ritual’.
        When the family is not harmonious,
        There is ‘filial piety’.
        When the state is in chaos
        There are ‘loyal’ ministers”.

        and:

        “The highest virtue doesn’t practise virtue
        That’s why it is virtuous.
        The lowest virtue is always ‘virtuous’
        That’s why it has no virtue.
        The highest virtue is inaction
        But nothing is left undone.
        The lowest virtue is action
        But things are always left undone.
        Benevolence is acting
        But without ulterior motives.
        Rectitude is acting
        But with ulterior motives.
        Those steeped in the rites act,
        And when no one responds,
        They roll up their sleeves
        And resort to threats.
        So when the Way was lost
        There was ‘virtue’.
        When virtue was lost
        There was benevolence.
        When benevolence was lost
        There was rectitude.
        When rectitude was lost
        There were the rites”.

        The NHS has reached the stage of “rites”.

        Reply
          1. Prudence Kitten

            Bearing in mind that the original text is Chinese and about 2,500 years old… I understand “rectitude” to be a kind of legalistic following of rules. Best is when people act according to their nature, which according to Lao-Tze is not violent and selfish but friendly and cooperative. If you lose that wholly natural, instinctive cooperation, you fall back on morality and formal religion; failing that you have to depend on laws; and then you are in deep trouble, because all laws have exceptions and loopholes. It has been said in China, Rome, and the present day that the more laws a country has, the more crime there will be.

            Thus the NHS appears in the light of a huge organisation that has striven energetically to suppress people’s natural sympathy and cooperation, replacing it with a myriad laws, rules, and regulations – even “guidelines” that are not laws but which are nonetheless binding.

          2. Prudence Kitten

            For an extremely accessible explanation of Taoism from a Western point of view, I recommend Alan Watts’ book “Tao: The Watercourse Way”. YouTube also has many of his lectures, free of charge.

          3. Sasha

            In my opinion, translations of these texts should be done by people who can read Classical Chinese. Otherwise, problems quickly start accumulating…

          4. Prudence Kitten

            Sasha, I quite agree that bad translations can make a mockery out of any great writing – especially poetry. Here are the translator’s details. https://www.poetryintranslation.com/Admin/Bio.php

            I am familiar with several translations of the Tao Te Ching, although I am utterly ignorant of Chinese. This one looks consistent with the gist of the work as I understand it; I chose it merely because it was conveniently available online.

          5. Sasha

            Yes, I think there might be a shortage of translators from Classical Chinese, especially ones that combine technical skills with personal experiences of such practices that lead to creation of works like Dao De Jing. I don’t read Chinese, neither Classical nor modern, so this is my superficial impression from the outside.

  46. thecovidpilot

    In the US, the American Hospital Association is fighting against doctors’ freedom to prescribe as they see fit, which means no HCQ or IVM for you. The AHA and AMA have become very oppressive as are the various state licensing boards and their lackeys.

    Reply
  47. Sasha

    Thank you, what a great post. Bureaucracy meets corruption and greed, meets the science of medicine while everyone forgets that medicine is also an art…

    Reply
  48. cavenewt

    Excellent, as always. Thank you. And so refreshing to have it pointed out that things started going downhill well before Covid.

    Reply
  49. Martin Back

    When doctors are constrained to use a narrow range of approved medications, the signatures of the bureaucrats who do the approving become a valuable commodity, and they become prime targets for the corrupting influence of Big Pharma.

    In fact, come to think of it, if you believe you have a superior medication for some malady, how do you get your medication on the list? And will the authorities be sued if they want to take older medications off the list, not because they are dangerous or ineffective, but because something allegedly better has come along?

    Reply
  50. rtj1211

    I must say, Dr Kendrick, that I have been proposing for several years the replacement of the NHS with the National Healthy Living Service. Of course, an NHS per se will need to remain, because no matter how well intentioned healthy living aspirations might be, there are going to sick people.

    But the principle is fairly simple: people should be supported in living healthy lives, not forced to work in psychopathic power environments where they fall into ill health and despair, then have ‘medical professionals’ try and force drugs into them.

    My principles for ‘healthy living’ are pretty simple:

    1. Healthy exercise – this is of course age-related and related to the type of physiology someone is endowed with.
    2. Healthy eating – diet is of course a huge contributory factor toward all kinds of disease and, whilst healthy diets will not eliminate everything, they will certainly support the retention of a vigorous and healthy immune system. Healthy eating should consider how to maintain a healthy digestive tract, since health of gut flora is also important for health and vigour in general.
    3. Healthy emotional, spiritual and sexual relationships – we are a social species, not designed to live as Trappist Monks. No more need be said.

    Having fed two over 85s of generally good health (one died aged 95), I have come to the conclusion that ‘A fresh soup a day helps keep Covid away’ (for those non-UK readers and those under 40, Mars Corporation had the advertising slogan ‘A Mars a day helps you work, rest and play’ in the 1970s (it helped your teeth to rot and make people unhealthy and obese, but there we are). I have made fresh vegetable soups made mainly from home-grown ‘organic’ vegetables throughout the year and 200ml a day guarantees a daily intake of really good food. Particularly when the very elderly start to find chewing more of a challenge, liquid soup intake is the single biggest guarantor of healthy eating for them, particularly if you add fresh fruit like grapes, raspberries, strawberries along with stewed apple, rhubarb etc.

    Healthy exercise means not causing injury, not overexerting so much that the immune system becomes compromised, whilst ensuring that healthy replacement of gaseous mixtures in the lungs takes place, heart muscles are stimulated appropriately and, for many, swinging an axe to break wood has many benefits in terms of stimulating the body – you would never get a GP diagnosing ‘go and chop wood for 20 minutes 5 times a week’ to cure fungal infections of the skin, but I can attest personally that that works 100%.

    My cynical view of the pharmaceutical industry is that it needs to create a world of sick people to make profits, so it conspires with other people to make the world an intrinsically unhealthy place.

    It promotes conflicts, wars, depression, anxiety, anger, frustration, aggression, impotence. You name it, they want to create it so they can treat it.

    I want a world where the majority are healthy 99% of the time, some unfortunates need medical treatment and most money is invested in proactive prevention and picking up of early, non-serious symptoms so that major medical interventions are hardly ever needed.

    It’s a nirvana for sure: but I know that it’s possible.

    The real question is what you do about those individuals whose life meaning is solely linked to imposing order on others from above.

    They would absolutely hate my kind of world and would no doubt brutally try and prevent it from happening.

    Reply
      1. Jimmy C

        Thank you for yours! As usual you make a whole load of sense. Wish more physicians were like yourself, and more pharmacists/clinicians had a similar perspective to that of the Graedons (The People’s Pharmacy)

        One point that often fails to come up is the NNT value for all these chronic prescription medications — in other words the reciprocal of the absolute risk reduction (rather than the relative risk reduction so often quoted by companies pitching their products). Statins, for example, having an NNT (number needed to treat) of about 100 for five years to prevent one CVD incident — this means, of course, that if you treat 10 million people you can state you could prevent 100,000 heart attacks or strokes (notwithstanding any other malaise the darned things cause). Similar stuff comes up for BP meds for those with mild HT but whose physicians are hell-bent on treating biomarkers, less root causes, simply to meet artificial quotas.

        It seems that all patients should be provided with NNT values for any chronic drugs to help them and their physicians make informed choices — and that patients should be encouraged to demand them at the point of care. Otherwise so many will head down the path of prescription cascades, polypharmacy, and frailty they need not travel. This, as much as anything, is a chronic pandemic/epidemic that is the scourge of medical practice in so many nations.

        Reply
    1. Steve

      Many moons ago, when I was an apprentice and later an undergraduate the ethos was, explicitly, ‘a healthy mind in a healthy body’. Exercise/sport was considered an essential part of work and education. Many large enterprises had sports facilities, sports days and their own sports teams. Lunchtimes at work always saw groups of workers get together for a kick about or impromptu cricket/rounders. What happened ? Since the 70s and 80s we’ve morphed into sick minds in sick bodies. Is this progress .

      Reply
      1. Prudence Kitten

        Sometimes it does seem as if everything is being done to make people unhealthy. Lousy food – or “food-like substances” – manufactured at the lowest cost, and pumped full of grains, sugar, and unhealthy oils. Longer and longer work hours, forcing employees to sit for far too long. Lengthy commutes, extending the torment. Electronic gadgets – including TV – encouraging shorter hours of sleep, and those less wholesome. And we are warned to shelter from the slightest ray of sunlight, lest it burn away our skin and tissues and give us cancer. All of this with more and more stress.

        Reply
    2. Jeremy May

      Somebody heard you Mr rtj1211.
      Your post sent a shockwave through the ‘Unhealthy Alliance’. Within hours of your excellent post, two subjects of interest popped up on my news feed. (Feed, huh, there’s that word again.)

      First in The Guardian a sorry tale about Kellogg’s challenging the Governments initiative to restrict the overt promotion of HFSS products (HFSS = High in Fat, Salt and Sugar). One of Kellogg’s arguments, and I quote here from the article……
      “Kellogg’s argues the rules fail to take into account the fact that 92% of people eat cereal with milk or yoghurt, which changes the nutritional profile of its products and means they would not be classified as junk food.”

      Second, doctors may be struck off of spreading ‘fake news’. For expounding the unhealthy aspects of consuming hazardous breakfast cereals perhaps?
      Our good Dr K has already written on the subject of back in February (Vaccination – silencing doctors in the UK). A scary tale.

      I only touched on these two stories because both were part-hidden behind paywalls. As I already subscribe to Cycling for Porkers and Woodchoppers Weekly, there’s only so far my budget will stretch (like my elasticated trousers).

      Should I volunteer as a Corporal in your health army Mr rtj1211, the forces against us will be mighty indeed. On a global level, vested interests in the pharmaceutical and food production industries invest zillions to keep us unhealthy.
      On a local level my friend recently moaned bitterly that his new freezer was not fit for purpose – he couldn’t close the door on an ultra-large pizza without taking it out of the box.

      I applaud you. Good luck.

      Reply
  51. Tish

    You are integrity personified and I wish there were more like you. Shocking to think what most people seem to be like. I have more respect for many other groups of animals. We are not top of the animal hierarchy whatever we like to think.

    Reply
  52. Tish

    ‘but then ask yourself why does it need to be done?’

    Exactly.
    I worked happily with children in the NHS until we were told that every month we had to write an updated report on every child on our list and send it to everyone who had any dealings with the child. Prior to this I only wrote reports when I had something to say that was worth saying and my efforts were appreciated. But once everyone became flooded with reports that they had no time to read, important information that you wanted to convey got lost in the deluge. This was of no benefit to the children or their families. And more erosion of professional autonomy and work time.

    Reply
  53. Tish

    Then my newly employed boss was trained to insist that where a school (education) could be persuaded to cough up money to pay for my NHS visit to a child, that child had to be seen by me whether he or she needed my help or not. So I resigned.

    The nonsense affects so much of the NHS. Invasive and crippling and lowering morale everywhere.

    Reply
  54. Vivien Stratton

    Another stonking essay …. May I send it to my Andrew Murrison, my MP, who is/was a GP – even if he screws up his ears and eyes, at least I know he has received it ….

    Very best wishes for all your succinct writings ….

    Vivien Stratton RSHom
    homeopathy@vivienstratton.co.uk
    vshomeopathy.co.uk
    +44 (0) 7768 448 522

    Reply
  55. Tim Fallon

    My wife, and I had been with the same GP practice for eighteen years or so, we had no problems with them.
    We both had an invite to come to the surgery for some nutritious and delicous warp speed magic sauce, we politely declined. We are both is an age bracket that has close to zero risk from the disease and it was already clear that these jabs were anything but safe,on top of that we had both already had covid if you believe the dodgey PCR test.
    A month or two later we had a second letter offering us the same, again we politely declined.
    Our next letter was one from the surgery telling us to sling our hook as we were no longer welcome there, the excuse was we were outisde their boundary so they were not obliged to serve us.
    Obvioulsy they were angry that they weren’t making any money out of vaccinting us.

    Hippocrtic oath 2022 – ‘First do no harm – to your bank balance’

    Reply
    1. Eggs ‘n beer

      Our GP has gone the opposite way. Whilst she obviously complies with all the regulations, her surgery will not vaccinate you, test you or provide exemption certificates. (Giving an exemption certificate in Oz is like painting a huge target on yourself for AHPRA). She’s seen what happened to our daughter after dose 1, and presumably many others. While I won’t embarrass her by asking why at an official visit, when we catch up for drinkies at Xmas I’ll see if she opens up a bit.

      Reply
  56. MalcolmC

    Hmmm, they make economic targets. so then of course people go “too far” in order to meet the targets. No surprise there.

    It seems to me this is the wrong way round. Instead of mandating (supposedly) similar treatment to everyone with a given condition, the BMA/GPC/whoever should be encouraging slightly _different_ treatments and studying the outcomes to find out what works and what doesn’t.

    Obviously the financial incentives should be reduced (removed?) so that they don’t distort the treatments given.

    Reply
    1. Dr. Malcolm Kendrick Post author

      The BMA/GPC has no influence on what is, and what is not, prescribed. The MHRA approved drugs for use in England and Wales. They are then put on the formulary. NICE has morphed into the body that set treatment guidelines. NHS England/Wales and the Clinical Commissioning Groups can drive prescribing in different directions – to an extent. I agree that financial incentives should be removed. QOF is part of the General Medical Services agrrement, that is overseen by NHS England.

      Reply
  57. johnsymes

    When I started as a hospital doctor over 35 years ago, guidelines, protocols, EBM were unknown. Like MK I supported the ideas of EBM, and in principle, I still do. Of course medicine must be evidence based, otherwise why not use astrology or voodoo. Evidence can come from many sources, and is there is generally a hierarchy of value,with one person’s anecdote having the scientific status of gossip, consensus opinions, observational studies and RCTs being higher up the chain. All types of evidence need to be analysed for bias.

    There is a place for guidelines and protocols. Generally they are mostly useful in very rare conditions that practitioners may encounter only once or twice, very complex conditions, or where it is important to work together with others and everything is done exactly right, e.g. CPR. It is not realistic to expect individuals to be able to read all the emerging evidence in their speciality. I think it was in Ben Goldacre’s book that I read that a GP would need to read for 26 houris per day to keep up with all new relevant information. Pharmaceutical companies have leapt in to provide succinct educational material, totally unbiased of course!!! There are some organisations that can provide some unbiased reviews, e.g. CEBM in Oxford, Cochrane databases etc. Some are better than others.

    MK is right. We hospital doctors knew nothing of QOFs., but there has been an explosion of guidelines protocols etc. that are beginning to encompass the whole of medical practice. Partly this is out own fault. Doctors are generally fairly self important and any new field tends to open up new empires for self aggrandisement. Some like nothing better to grab a clipboard and check list and run around checking up on everybody else. It is evident that protocols etc. are taking the place of thought in some doctors, coupled with the background fear that if anything goes wrong, and the protocol has not been followed, then immediately you are first in the firing line.

    Reply
    1. Eggs ‘n beer

      “It is not realistic to expect individuals to be able to read all the emerging evidence in their speciality.”

      I totally disagree. That’s a cop out phrase for fraudulent, lazy people with a sense of entitlement.

      Fraudulent because I’m paying them $400 per hour or more for their specialty opinion, and they don’t know their specialty. Lazy because they can’t be bothered, and entitled because they consider themselves deserving of respect and obedience by virtue of their position.

      If I’m paying that much I expect them, if not to know everything, then to at least be aware of current topics. And if they don’t, then to admit it (hahaha) and suggest seeing someone else. They aren’t GPs, the GP has referred me to them already.

      Reply
      1. Dr. Malcolm Kendrick Post author

        It is impossible to read even one percent of published trials. I read more than anyone I know but fall way behind. I did a quick pubmed search using a few keywords and got over two million papers in the seconds. It is an issue in itself.

        Reply
        1. Eggs ‘n beer

          I realise that, but I’m not suggesting that a specialist, a professed expert, reads every paper. Impossible! But they should be able to read every paper in their specialty, otherwise they can’t be considered an expert. If they find that they can’t keep up perhaps they need to narrow their area, which again can become an issue.

          Take the Covid thing as an example. How can the experts, the CMOS, CHOs advising govts not have read the clinical trials of the vaccines? Yet despite the official trials, published by Pfizer, AZ and the CDC which showed how bad the vaccines are, they went ahead with the advice to double, treble etc jab people. I’m just baffled. The only explanations are that they are fraudulent, lazy and/or criminally inclined.

          Reply
          1. Prudence Kitten

            Eggs, you have put your finger on one of the worst problems today. Namely the tendency for individual professionals to delegate their responsibilities to official bodies, which cannot be trusted to act ethically.

          2. johnsymes

            I suggest you distinguish between those chiselling away at the coal face and those climbing the slippery pole of political advancement.
            Are more thoughtful contribution would have been to point out that hospital specialists face similar but slightly different pressures than GPs
            Firstly, advances in hospital specialities are not that common, and specialists will know about them (unless absolute charlatans). New developments are always accompanied by strong financial and commercial pressures to get them adopted. There will be early adopters, either because of direct financial benefits, advancing their reputations or just because that is the way they are. It is not always in the patient’s interest to have new treatments. The earlier type of hip joint replacements seem to last longer with a lower failure rate than the newer types, especially the metal on metal replacements.

            Secondly, how to sort the wheat from the chaff. There have been many discussions estimating that possibly one half of published biomedical literature is wrong. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572812/
            https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60696-1/fulltext
            There are about 30,000 medical journals published worldwide. Trying find the nuggets of truth here is not something that can be easily done on top of a full time clinical practice.

          3. An Italian Australian at the Tropics

            I believe that’s a very optimistic estimate, in the fields of nutrition for example the vast majority of papers are blatant frauds, and nothing makes me think that it could be better in other departments, especially if there is even more money involved.

            I often say to friends and acquaintances, bring me a PubMed article and I’ll find another one with diametrically opposed conclusions.

          4. Tish

            Prudence :
            Yes, and I believe there is more than delegation afoot. Malleable, ignorant and vain people are surely going to be cannon fodder if there were to be any future retribution following these new world order attempts. The cowardly rich instigators are using them like puppets, ones that are probably too wrapped up in their new self-importance to realise it. I’m seeing potential fodder among the so-called experts, and people like Matt Hancock and some new knights of the realm, along with many prominent political spokeswomen and men and some of those in the media. Just look at the backgrounds of many of the silly vain people who think they are valued for their sense or charisma. Thugs are even being used to do the dirty work at protests.

            A big thank you to AhNotepad for drawing our attention to the wonderful work by the hardworking people at ukcolumn.org. They are heroic.

  58. Jennie Williams

    Dear Malcolm,

    I have been following your writing with much gratitude for about a year now and have been so grateful for your taking the time and effort to share your knowledge and understanding, which totally accords with mine.

    I gave up on registering with a GP after our retirement move to Manchester nearly 7 years ago and have looked after my own health with the support initially of functional medicine and the support of others in that field.

    I am wondering if you are still practising and whether you would consider taking me on as a new patient, privately if necessary? I live in South Manchester and would be more than happy to travel to Macclesfield on the very odd occasion I might need to ask you something! I sort of think I probably need a GP but didn’t think someone like you existed that has the wealth of experience I am looking for.

    In hope…

    Jennie Williams

    Reply
  59. Eggs ‘n beer

    How can I distinguish between two aspects I am unaware of? We’re approaching the specialist as a customer. They don’t seem to wear labels identifying themselves as slimy political gits as opposed to someone who actually cares. We’ve got pretty good at it now, we only waste our $400 once before dumping them, we thought they were just lazy incompetent arrogant pricks rather than politically motivated. As it actually takes effort to climb that slippery pole, I suppose we should adjust that description to leave ‘lazy’ out of it.

    The most recent case in point. My daughter developed POTS after dose 1 of Pfizer. She and her husband did heaps of research into POTS, POTS after vaccine, mechanisms by which POTS may develop with or without vaccines, etc. etc. and found a paper, published in a neurological magazine i.e. not a pre-print, linking a mechanism by which the vaccine could trigger POTS. Which they took to a specialist. Who said “I don’t read articles from THAT publication. Your condition has nothing to do with the vaccine. You do appear to have POTS. Here are prescriptions for some tests we must do to confirm it. $400 please.”

    Needless to say he’s obviously a political animal. Not remotely interested in his patient. Contrasting starkly with a GP who did a two hour consult for $350, covering many aspects of her symptoms including diet and extensive, very extensive, previous history and came up with mitigation procedures (which work) immediately in addition to further tests, agreed that it was vaccine related and gave her an exemption from requiring the second jab. This GP is a POTS specialist, however, as his wife had developed it fifteen years earlier. He is passionate about it. He’s da man!

    Reply
  60. jeresavo1

    Matt Hancock’s equivalent in northern irelan was of course Robin Swann, Northern Ireland’s Health Minister, who dubbed Van Morrison “dangerous” for daring to air his views on the pandemic policies of the government.
    Now the outspoken godfather of Celtic Soul answers back on his new single. What will the 77th Brigade make of it all? I’d say we’re about to find out.
    To quote one of the commenters under the YouTube video:

    “In times of mass deception, telling the truth is truly revolutionary. Very few entertainment celebrities tell the truth. Van puts to shame those celebrities who know the truth but do not speak it for fear of being cancelled.”

    Reply
  61. Eric

    So how do you handle this in your practice, Malcolm? Can you afford to ignore these KPIs and guidelines? I’d think that it takes a full time medical assistant to do all this bookkeeping, and all that for a maximum of GBP 50K gain. So ignoring it, saving the salary of the assistent and the mental contortions around all these rules might make sense economically.

    Reply
  62. sticky

    Dr Tess Lawrie, Neil Oliver, Del Bigtree and others have organised an international conference to look at ways out of the situation that we have been facing for the last 2+ years.

    This is taking place in Bath next weekend: https://betterwayconference.org/, and tickets are available to the public.

    Dr Kendrick, I stopped getting email notifications from your blog about two weeks ago. Is this you, or the 77th?

    Reply

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