The link between the two articles in this 2D is health and economics. It’s a reasonably weak link, granted… but it’s a link nonetheless!

The first article I’d like to recommend is this long and thoughtful interview with Bill Gates by Ezra Klein of the Washington Post, which carries the arresting title “death is something we really understand extremely well”. He talks through some of the financial decisions his Foundation makes, and the economics of disease eradication. I found it quite fascinating.

The second article is really rather different. For Priceonomics, Alex Mayyasi gives a history and economics lesson to explain why articles in scientific journals are, more often than not, behind a paywall. He argues, too, that the system needs to move on and develop in the 21st century. As someone who spends a disproportionate amount of time whining about medical journals and their paywalls, I found this detailed blog post very interesting and informative.

2D posts appear on alternate Wednesdays. For 2D, I pick two interesting articles that look at an issue from two different – though not necessarily opposing – perspectives. I hope you enjoy them! The picture at the top of this post was uploaded to Flickr by Howard Lake, and has been modified and used under Creative Commons licence.

Regular readers will know I’m a fan of infographics, and I thought this was was particularly powerful (though clearly more “graphic” than “info” – what’s with that 50% reduction “graph”?). Still, it’s a powerful message – 100,000 new donors needed in the next few weeks. Sign up to give blood today.

I’m celebrating tonight, as this letter arrived today to inform me that I’ve passed my Part B exam, and so earned membership of the Faculty of Public Health.

This is both scary and exciting on a couple of fronts: firstly, I’ve passed all the exams I need to pass to become a consultant in public health; secondly, for the first time since I was nine years old (the current age of my oldest nephew), I’ve no exams planned in the next twelve months. Or at all, for that matter.

It surely won’t be long until I end up like this:

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I’m now officially a flu-fighting super-doc, and hope that all of my clinical colleagues are similarly brilliant!

The evidence is clear: in randomised trials, care facilities with high uptake of flu vaccine amongst staff have been consistently shown to have significantly lower levels of flu-like illness and mortality. In the 2010/11 flu season, the UK saw 2,200 ITU admissions with flu, mostly in under-65s.

So do your bit, and get your jab!

As a public health doctor, I was very pleased to see the Stoptober team out in force when I popped to the supermarket today. I wish anyone taking part every strength and every success!

If you smoke but haven’t yet signed up, there’s still time to get involved: sign up at the Stoptober website.

If you don’t smoke: good for you!

These are all practice OSPHE stations that I’m using to help prepare for my MFPH Part B exam. I put them in coloured folders to make them more fun. It wasn’t a terribly successful strategy.

When coming to post this, I’ve realised that I forgot to post a photo yesterday, so I’ll do two tomorrow to make up for it! Sorry!

This is the Hownsgill Viaduct. It’s 55m high, and a little over 200m long. It used to carry the Stanhope & Tyne Railway, but these days carries only the C2C cycle route. Construction was completed in 1858 to Sir Thomas Bouch’s design.

Bouch would later go on to design the Tay Bridge, which collapsed in use. Seventy-five people were killed, and Bouch’s reputation and career were left in tatters. Whilst the Hownsgill Viaduct is still standing, its fate has become almost as grim: it’s one of the UK’s suicide hotspots. In 2011, there was a death every two weeks. In response, Durham County Council is arranging the construction of a 3m high steel tube and cable fence.

Suicide barriers are a knotty public health issue: whilst they seem logically sound, it’s difficult to come up with strong evidence of their effectiveness. The most famous study in this area (and one which came up in my Part A MFPH, as it happens) is of the Bloor Street Viaduct in Toronto – where, actually, fewer suicides occurred each year than at Hownsgill. The study suggests that whilst the Luminous Veil barrier prevented suicides from the viaduct itself, it had no impact on the suicide rate as a whole. Of course, study design is a huge problem in this field, but it remains the case that no published study has shown a reduction in the overall suicide rate as a result of the erection of a barrier.

I guess the only thing we know for certain is that suicide is better tackled through comprehensive and wide-ranging suicide prevention programmes rather than through barriers alone. Psychiatry services often suffer when healthcare resources are tight; yet the biggest cause of death in British men under the age of 35 is suicide. Let’s hope that the vital work of mental health teams isn’t dismissed by anyone as “easy pickings” in the ongoing recession.

It’s Annual Review of Competence Progression (ARCP) time for most medical trainees at this time of year. This is where a panel reviews how we’re doing, and how our training is progressing. Most trainees these days have e-portfolios to collect evidence for these annual reviews, but in Public Health in the Northern Deanery, we still use paper… which requires literally hundreds of physical signatures from supervisors, and other numbers from other people, which can make co-ordination something of a challenge!

This picture shows my portfolio carefully balanced on top of my car, as I prepared to hand it in to the Deanery’s office. I’m glad to finally have it finished for another year!

I’ve spent some time today reading Balance’s stuff about responsible marketing of alcohol… then was forced to walk through my local Tesco’s makeshift aisle of discounted alcohol in order to get into the store. Hint: this doesn’t tally with Balance’s idea of best practice.

I don’t often venture into Tesco, but I had some bedding to return today, so popped along. The customer service was truly awful.

The customer before me didn’t speak great English, and had a coupon that had been refused at the checkout. The *two* customer service assistants adopted the Basil Fawlty method of communication, almost shouting at the lady that the terms and conditions on the voucher excluded e-topups. The customer’s protestations were met with increasingly loud insistence, until one of the assistants had the inspired idea of actually reading the terms and conditions. The customer had been right: e-topups were not excluded.

As the customer left, the assistants started a frankly racist conversation about the preceding customer, before one beckoned me over with a wave. I asked to return the bedding, and the assistant continued her conversation, directing only three words at me: “receipt”, “clubcard”, and “card”. They were quite literally the only three words she said to me throughout the encounter. She didn’t greet me, she didn’t ask why I was returning the bedding, she didn’t say goodbye, and she certainly didn’t thank me; her rudely continued conversation with her colleague did provide a live demonstration of parochial bigoted opinions that was deeply disrespectful to the previous customer.

Tesco’s problems, it seems, run deep.

It’s my first public health on call tonight: nervously waiting for the phone to ring! It’s about 20 months since I did my last hospital on call, so I’m no longer used to being at the mercy of the phone, but I’m sure I’ll get used to it fairly quickly!