1: Alan Bennett had open-heart surgery in Spring 2019 and the news completely passed me by.

2: A paucity of Papal patience provides problematic publicity for a Pontiff preaching peaceful pacifism to pious pilgrims.

3: Norovirus probably causes about two-thirds of care home outbreaks of gastrointestinal disease.

4: Fewer than 20% of schools in Texas teach children about safe sex. Texas is among the States with the highest teen pregnancy rate. Any connection is disputed by conservatives.

5: I’m reading Matt Haig’s Reasons to Stay Alive at the moment, and there’s a line advocating for greater ‘mood literacy’ which I found a rather lovely turn of phrase. It reminded me of this blog post advocating examination of one’s own response to the outside world to better understand one’s mood. Both taught me something about self-examination.

6: One of the room booking systems at work requires me to “invite” a given room to attend a meeting. I’ve now learned through bitter experience that rooms can decline invitations… which felt a little humiliating, even if it does open up a whole new seam of entertaining insults (e.g. “that meeting sounds so pointless that even the room declined the invitation”).

7: Populist ‘knee-jerk’ reactions in politics are commonly discussed and clearly dangerous. I’ve been reminded today by an article on the lack of legislation around in vitro fertilisation research in the USA that the opposite—a complete failure to react because issues are complex and divisive—can be just as dangerous.

8: Merely possessing a placebo analgesic, without even opening it, has been shown to reduce pain intensity.

9: The average age of a BBC One viewer is 61. If one considers that a problem, as the BBC seemigly does, then I suppose one might conclude that removing children’s programmes from the channel was not the right approach.

10: The Royal Botanic Garden Edinburgh is only a short walk from the city centre and is a great place for a winter stroll. The uphill walk back to the city centre is a touch more tiring.

11: Over the past decade, the proportion of the UK’s electricity generated from wind and solar power has increased from 2.4% to 20.5%. The proportion from coal has fallen from 31% to 2.9%. (As reported in Positive News, though the specific article isn’t online.)

12: Aspiring comedians often go on ‘introduction to stand up’ courses. I’d never thought about these sorts of courses existing, but of course they do.

13: More than half of Luxembourgers speak four languages. The best-selling newspapers in Luxembourg have articles in two languages. This makes me feel inadequate.

14: In the 1990s, John Major mooted renaming Heathrow airport after Churchill, while Lindsay Hoyle and William Hague fancied naming it after Diana.

15: I have long known the North East is an outlier for antibiotic prescribing in primary care, but hadn’t fully realised until a meeting today that the North East isn’t an outlier for antibiotic prescribing in secondary care.

16: I was surprised to read that a survey suggested that only one in three people on the UK knows the standard VAT rate is 20%, and one in ten knows the basic rate of national insurance is 12%. But then, on reflection, my own surprise surprised me, because I don’t really know how or why I know those figures myself. I’m sure there are plenty of similar figures on which I’d have no idea myself!

17: Since last September, Monday to Friday, the City of London Magistrates’ Court has been filled by Extinction Rebellion defendants from around the country.

18: The developers of Morecambe’s Central Retail Park have “put an extraordinary amount of effort into stylising the car park” including quirky themed artworks, sculpted steel waves and effigies of seabirds diving for fish.

19: In the US, a broadly similar amount is spent on treatment for back pain ($88bn) and treatment for cancer ($115bn).

20: Office for National Statistics Travel to Work Areas are an interesting way of dividing up the country.

21: Civil servants in China cannot ordinarily be dismissed. One wonders what Dominic Cummings makes of that.

22: Over 70% of 12- to 14-year-olds in China are short-sighted. The Communist Party has set targets for reducing that, leading to some slightly strange practices in schools, including compulsory twice-daily eye massages and dressings-down for those whose sight worsens over time.

23: It’s not a public health emergency of international concern.

24: Blinded trials are not always best. I remember having to write an essay or answer an exam question on this topic at some point in the past, but haven’t really thought critically about it in years.

25: The attendance fee for the 2020 World Economic Forum in Davos is 27,000CHF (£21,400). I will never complain about medical conference registration fees again!

26: Luxury branded homes—as in, “I live in a Bulgari residence” or “I’m in the Porsche apartments”—are now a thing. Is it possible that this is a global conspiracy to see how far the definition of “gauche” can be pushed?

27: “We fill our days with doing laundry, replacing our brake pads at the auto shop, or making a teeth-cleaning appointment with the dentist, in the expectation that everything will be fine. But it won’t. There will be a day that kills you or someone you love.”

28: “To err is manatee. A manatee might mistake a swimmer’s long hair for shoal grass and start munching away, oblivious to the attached figure. To err is baby elephant, tripping over her trunk. To err is egg-eater and moonrat and turnstone and spaghetti eel, and whales, who eat sweatpants.“

29: Pulmonary tuberculosis can be detected in babies by doing PCR tests on faecal specimens. Sensitivity of the test varies according to the exact methods used, and this is an active area of research.

30: It’s a public health emergency of international concern.

31: The TV series Love Island has an unexpectedly innovative business model which involves selling items seen on the show via the app which viewers download to vote for contestants.

This morning, I was sent a list of seven papers in medical journals by a colleague. The titles looked intriguing, and I wanted to read further.

I have access to various journals via a number of means: the NHS provides me with access to a given selection via Athens, comprising about 1,500 journals; I personally pay the RSM to give me access to another 1,000 or so; and my BMA membership allows me to access perhaps 100 others. Clearly, the numbers are too large for me to retain details of which portal gives me access to which journal.

So, having found a given article, I then have to cycle through the three access methods, generally in the order outlined above, to find which works. That’s three sets of logins to three different sites (neither the BMA nor the RSM allows direct login from journals’ own sites). This is maddeningly frustrating, especially when I’m trying to glance through seven articles. Accessing each article can take, perhaps, five or ten minutes, which is sheer lunacy. I often don’t have that kind of time.

Now, let me share with you the process for just a couple of the seven papers I happened to be accessing this morning.

First was the Journal of Medical Ethics. I stuck the article title into Google (1 click). The second result was on a bmj.com domain. I often read things in JME, so I knew that I could access this via the BMJ domain with my NHS password. So I clicked the link (2 clicks), and ended up on the abstract page. I hunted for the “Full Text” link, which took me (3 clicks) to a login page. I clicked the “Login via Athens” button (4 clicks), which took me to an institutional login page. I clicked the “Login via Athens” link on this page (5 clicks), entered my username and password, and got redirected (6 clicks) back to the full article.

I make that six clicks and one login to get from my email to the article, for something I know how to access. Clearly, no-one in the field has heard of the three click rule.

Second on the list was a 2011 article from the Journal of the National Cancer Institute. Again, I copied and pasted the title into Google (1 click). The top result was from Oxford Journals, taking me to the abstract page (2 clicks). I clicked the “Full Text” link (3 clicks) to be taken to a log-in page. I clicked “Login via Athens” (4 clicks), and then “Sign in via Athens” (5 clicks) on the resulting page. I entered my NHS Athens details (6 clicks), and got redirected back to the journal’s login page, with no explanation as to why. Out of confusion, I clicked “Login via Athens” again (7 clicks), then “Sign in via Athens” (8 clicks), and again got redirected to the login page with no explanation as to why.

I assumed (correctly) that the NHS doesn’t pay for access to this journal. So I accessed the RSM website (9 clicks), and clicked “Library” (10 clicks), then “E-journals collection” (11 clicks). I logged in (12 clicks), and searched for “National Cancer Institute” (13 clicks). No results.

So I accessed the BMA website (14 clicks) and logged in (15 clicks). I went to “Library Services” (16 clicks), chose “E-resources” (17 clicks), and “Login now” under e-journals (18 clicks), despite having already logged on earlier. This gave a list of journals, on which JNCI didn’t feature.

At this point, I gave up. I could’ve requested the article from the BMJ or the RSM for a couple of quid, or emailed round to see if anyone else had access (e.g. via a university). But for an article I’m browsing for interest and to casually increase my own knowledge, it’s not worth the hassle or cost.

So now, I’m left more ignorant than I need be because of incompetence (the system is crazy), stinginess (my employer isn’t paying for access), and a touch of defeatism.

I struggle to see how conducting research and then hiding it from people is ethical – isn’t that precisely what skeptics constantly berate Big Pharma for doing? Granted, there’s are important ethical and practical differences between non-publication and sticking an article behind a crazily high pay-wall, but I’m sure there’s an extent to which people on the ground are less informed than would ideally be the case because of this broken system.

Why can’t somebody (perhaps the UK Access Management Federation) compile a composite list of journals I have from various sources, and provide some kind of auto-login toolbar or cookie that gets me straight from the abstract page to the full-text page without the faff, or morosely reports my lack of paid access if none of my providers subscribe?

And why can’t journals like PLoS and BMJ Open have more sensible publication fees for individual authors who, for want of a better metaphor, don’t want to hide their light under a bushel? Funded research should factor in the cost of publication in such journals into it’s funding; un-funded research should be admitted for a nominal fee (or, preferably, nothing).

Anyway, it strikes me that the whole system is pretty crazy – something I’ve thought frankly since I started reading medical journals almost a decade ago. And I needed a cathartic rant. Thanks for reading it.