Today, Philosophical Transactions of the Royal Society B has published a paper I co-wrote with the Chief Medical Officer and some public health colleagues on antimicrobial resistance policy. The abstract says:

Antibiotics underpin all of modern medicine, from routine major surgery through to caesarean sections and modern cancer therapies. These drugs have revolutionized how we practice medicine, but we are in a constant evolutionary battle to evade microbial resistance and this has become a major global public health problem. We have overused and misused these essential medicines both in the human and animal health sectors and this threatens the effectiveness of antimicrobials for future generations. We can only address the threat of anti-microbial resistance (AMR) through international collaboration across human and animal health sectors integrating social, economic and behavioural factors.Our global organizations are rising to the challenge with the recent World Health Assembly resolution on AMR and development of the Global Action plan but we must act now to avoid a return to a pre-antibiotic era.

The paragraph which has received most attention – perhaps surprisingly in a paper which predicts that more people will be dying of AMR than cancer and diabetes combined within decades – is one on food prices:

Public support for action to tackle AMR is crucial, as many measures to mitigate the effects of resistance will incur substantial financial and societal costs, which will ultimately be borne by the public, both through taxation and,probably, through higher purchase costs of products whose manufacturing methods are altered. For example, a pricing paradox exists in farming whereby antibiotics, an increasingly scarce natural resource, cost less than implementation of more rigorous hygiene practices. Reversal of this paradox may lead to higher food prices. While these costs are undoubtedly lesser than the long-term cost of unmitigated antibiotic resistance, they are also more immediate and, superficially at least, discretionary.

Anyway, it’s all quite interesting stuff (though I guess I’m a bit biased). Read it here.

The BMA is asking members to sign a petition asking Government to repeal the Health and Social Care Act 2012. The leadership’s rationale is that the Act requires providers to compete, while the BMA believes that “collaboration and not competition is more likely to allow a greater integration of community and hospital services”.

I could not agree more: collaboration is more clearly in the interests of individual patients than competition, and collaboration seems at odds with competition. Yet I don’t think the BMA’s position should be to call solely for repeal of the Act: after all, the Act is not solely about competition. The legislation brought about many changes, some of which are working well.

For example, we are beginning to see the value of a new local authority perspective on influencing the wider determinants of health, as shown by the exemplary nominees for NICE’s local government public health award. This sort of progress can be found in many Local Authorities across England. To campaign for repeal of the Act is to surround this progress with a fog of uncertainty: repeal would reject this progress outright and move staff back into PCTs.

The Act limits the Secretary of State’s powers to intervene in the day-to-day running of the NHS. While the success of this has been questionable at best, we are beginning to see push-back against Government diktat. No one, except perhaps Lansley and Hunt, would argue that the NHS benefits from the Health Secretary holding operational control; yet repeal would reintroduce this.

The Act confers new responsibilities on NICE to support evidence-based social care. The Act provides the first (baby) steps towards regulation of healthcare support workers. The Act gives an unprecedented level of legislative support to research in the NHS. These may be small considerations in comparison to the problems of the Act, but outright repeal would (if I may mix metaphors) cast the baby and the bathwater both into uncertain territory.

How quickly the BMA seems to have forgotten the pain inflicted on our profession through restructure, job uncertainty, and redundancy. Excellent professionals left medicine — and especially public health — to pursue other careers, while others lived for years with the stress of the uncertainty of their positions. For the profession’s trade union to argue for yet another overnight reorganisation “so big, it can be seen from space” seems utterly perverse. Perhaps this is why, despite the BMA’s repeated urging, fewer than 4,000 people have signed the petition. Even if every signatory were a BMA member, this would represent less than 3% of the membership.

Repeal represents only a return to the past. It behoves professionals to put forward an alternative vision. For example, politicians refuse to discuss the threat to universal healthcare of having fewer taxpayers per patient as a result of an ageing population; yet the BMA is uniquely placed to devise a considered, collective, professional vision of the future of the NHS. To campaign only for repeal of what exists, and allow the next government propose and introduce yet another short-term model, seems to me to be a sure route to unhappiness.

The BMA should not call for repeal of the Act: this is opposition without a position. The BMA should identify the most insidious parts of the Act, and work tirelessly to scrap or rework them. But, more importantly, the BMA should thoughtfully advocate for the future health of the nation, not for a return to the systems of the past.

This week’s Pod Delusion is out now! In it, you can hear me wittering on about Captain Scarlet, and lots of really interesting stuff, too: an interview with the wonderful Gia Milinovich, the latest on the bizarre CBeebies Get Well Soon row, a bit of public health discussion of the census by Sean Davidson, and loads more good stuff besides. So why not make listening every week your new year resolution?

I’m afraid my inner pedant got the better of me and couldn’t overlook another correspondent’s loose grip on reality last week, resulting in another letter published in my hometown rag, the Southport Visiter. Sorry for the geekiness: if you find it frustrating when letters myopically concentrate on the specifics of claims while ignoring the bigger issues, it’s probably best if you don’t click through.

I’m on The Pod Delusion again this week, talking about something… esoteric. And a bit political. Why not have a listen?

I may or may not post an edited transcript on here at some point… I promised a while ago to make a point of doing so, but haven’t been great at keeping it up 😉

There’s a new episode of The Pod Delusion out today – and I feature in it, talking about assessment of junior doctors. It also features Richard Dawkins, which is quite exciting, and lots of other things too. You know you want to listen.

I’ve recorded a bit on IT in the NHS for this week’s Pod Delusion. Other topics covered include “The Big Freeze”, Google, and ITV’s regions – how can you resist?

I intend to try and remember to add a note here each time I contribute, given that this site was intended to bring all of my writing from all over the internet into one repository – even if that ideal has never really come to fruition.

Plus, I wanted an excuse to use this ‘Diary’ template which hasn’t seen service in some considerable time, but which I think is rather pretty. So there.

After holding my own in the non-aligned category of Iain Dale’s political blog rankings, I’m amused to see that overall I’ve dropped from being the 69th best political blog in the UK to, err, 198th. I guess you can’t win ’em all.

This week’s Gazette post was another eerily familiar one, though this one’s been reheated so many times now I fear it’s lost all nutritional value. Ah, well…

A kilogram © Robert Rathe - www.robertrathe.com

The lump of metal by which we define a kilogram has lost weight: It’s now 50μg lighter than it was when it was created, 118 years ago. We know this because other cylinders created at the same time are now heavier than it – but they are not the designated ‘official’ kilograms, so I guess, in a round about way, it’s now them that’s wrong.

This is one of those delicious stories which messes with my brain. It’s scientific, philosophical, and incredibly accessible. ‘Cool!’

So, if the official measure of a kilogram is now lighter, is it lighter, or is everything else heavier? And how heavy is it? Despite having lost 50μg, its mass must surely still be 1kg, as it is by definition 1kg. Indeed, if it had lost half it’s weight, or gained ten stone, it would still weigh 1kg.

And, even more intriguingly, this is a kilogram that’s been kept in a triple-locked safe – so how can it possibly have lost weight?

Richard Davis, who’s the bloke in charge of the lump of metal, says that nothing will change: A kilogram will still be a kilogram. But what does that mean? A kilogram is the mass of this lump of metal, which has changed, so how can the kilogram philosophically stay the same? Scientifically, we can say that a kilogram is the weight of the lump of metal plus 50μg, but that’s not very satisfying, because if the lump has fluctuated already, who’s to say it won’t again?

The sensible solution is to define a kilogram using some more scientific measure – a popular option is to define it by a number of atoms of a particular type, which would never fluctuate. Except that it might, as our understanding of physics increases.

It’s all a bit reminiscent of the problem of the 2p coin from last May, but maybe that’s just because I like this kind of story.

Anyway, I hope it makes you think.

Originally posted on Gazette Live

This week’s GazetteLive piece is The Hypocrisy of Guantánamo. The original, from more than two-and-a-half years ago, is here (or on page 164 of the book).