benl

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About benl

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  • Birthday 04/16/1989

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  1. When I listened to his speech I thought the underlying argument was the abuse of science, selecting only papers (namely Freemantle et al.) that supported his viewpoint and negating those that said anything to the contrary. This undermines scientific principles and he attributes it to the 'post-truth' state of the world. I think he is reasonably well qualified to make those points being a world-leading scientist. SH even attacks the NHS saying there is a need for 7-day services, but the changes to be made should be based on a body of evidence, not just single studies. Again, I think these are fair points, it's only more political when he says the extension of services must be resourced. From friends who have worked at Addenbrooke's SH has been a patient advocate to improve services. He's seen his fair share of healthcare and I guess this also makes him more qualified than most to comment. JH position is a poison chalice. The NHS probably is underfunded relative to expectations but no one has the hunger to challenge the latter part. He's unpopular but if he's replaced it will look like a victory to the BMA and look like the Conservative Party are acknowledging they disagree with his decisions. Short of an economic catastrophe, I don't think any party would truly dismantle the NHS, it would be political suicide, though the river does erode the mountain.
  2. There is actually evidence that we're living longer, but more recently the rate has slowed (http://www.instituteofhealthequity.org/about-our-work/marmot-indicators-release-2017). The increase in life expectancy has been attributed to declines in smoking and cardiovascular disease. I think there is a risk of those in manual occupations being unfairly punished with rising life expectancies as social inequalities grow. My other concern would be if retirement ages increase, does it not make it harder for the younger generations to find work? Just because people retire later doesn't mean there are more jobs, just that people stay in their jobs for longer.
  3. You really would hope that someone in seemingly knowledgeable position wouldn't be stupid enough to use his/her own name and address when posting a class B drug.
  4. I'm not quite sure I understand your first argument. I accept that we're talking about the simplified version of prevention and causation etc rather than the hyper correct epidemiological terminology. That said, I think you could argue that physical activity prevents such illnesses by reducing the overall risk/odds ratio of developing the conditions listed. The subsequent consequence of lower odds is that fewer would develop the disease of interest calculable by the population attributable fraction. I'm sure the number needed to treat at a certain threshold is high but on a population level this will still result in large benefits. I completely agree that you can't do double blind trials in public health, but you can perform randomised control trials which equally distributes confounding factors. Many of the papers listed in the Canadian review were randomised. I'd say you can never really prove a concept like this but I'd say it meets many of the Bradford Hill criteria. I think what they are addressing here is physical activity, not exercise (which has to be planned and structured). Overall, I think behaviour change is poorly understood and is typically expensive (also not my area of expertise so willing to be corrected). Nudges do work and several people may well have changed their actions after simply reading this thread, though they were likely quite motivated prior. Public health always feels a bit patronising, like your mum telling you to take your coat, because it addresses a problem before it happens or impacts on liberties. That said, nobody likes being told that their ill health is their fault, we'd all happily adopt the sick role and then complain about waiting times and costs. I agree on the assertion of health inequalities. Maybe the DOI would be better using their resources to actually assess the health impact of their major projects. This really didn't seem to be considered with the prom, perhaps the island's largest recreational facility (my objections still aren't as strong as some of my family members, we all know who I mean). Removing parking spaces definitely helps, but I can already imagine the threads on here. PS sorry to all of you who bothered to read this and don't really care.
  5. I agree, yes. I know it's frustrating but isn't this the type of thing that's worth submitting to the consultation? I mean for safety, maybe someone has a suggestion for improving legislation that encourages cycling safety (I await the response, make cyclists pay insurance). As with the others, yes the weather is fecking horrible and cycling/walking is never going to be favourable. Lack of routing can surely be addressed in the consultation, surely if enough people favour certain routes etc it would show where to focus resources. It might even identify the need for a new crossing or something relatively cheap (though I'm sure the DOI will find a way to make this cost £1million and take 6,852 weeks). Isn't there a tax rebate scheme now with cycling? So it does look like there doing something, even if it's just making people angry enough to think about it.
  6. OK, before I start, I'll put my cards on the table, I work for a university research group and most of our work is on the consequences of physical exercise on health and well-being. That doesn't mean I'm an advocate of everything, but I see and even produce some research on this topic. I don't really know if I can counter your point on the narrative, but this consultation, if done properly, should elicit the barriers people have to exercise to see what the government can do to reduce them. I'd guess it's more about small substitutions, you know, walking into the town centre if you live a couple of miles away etc. Public health is always a battle as the benefits are always seen as intangible. Remeber the uproar about seatbelts. Emerging evidence is showing that providing information isn't enough to encourage healthy behaviours. Perhaps the best summary of the benefits of physical exercise is in "A systematic review of the evidence for Canada’s Physical Activity Guidelines for Adults". The review shows a cumulative benefit in exercise and activity with an optimum of about 30 minutes per day. There are reductions in seven major illnesses including type 2 diabetes and cancer. Most health outcomes are down to diet and physical activity - really basic things. Genetic elements only account for about 30% (yes there is always going to be a debate about attributable fractions). Preventing these things takes more strain off the health service and increases the quality of your years of life far greater than quantity. Also, fewer cars means less wear on the roads and the tax implications. I also read a post saying we're not living longer... we are. The rate has slowed, likely due to social pressures and recession but, we are still gaining a good couple of minutes for every hour of life. We see more reporting of younger people dying due to reporting bias. Death is a little bit of Poisson regression, random events occurring at a fixed rate. Summary: exercise does work, it's cheaper to prevent than treat, everyone hates public health and probably me.
  7. Don't you think it would be interesting to get a copy of the correspondence where they determine a request vexatious? I think that might cause a few red faces.
  8. Should companies such as Manx Gas be expected to contribute to these schemes to reduce the cost? If they can't reliably know where their pipes/infrastructure is and this adds to the overall time and cost of the project should they not be culpable? Perhaps I'm unrealistic and uninformed. Surely they also benefit as they can do work whilst the scheme is ongoing to update their own infrastructure at a lower cost too (granted it prevents the digging up and destruction of a freshly resurfaced road too)?
  9. I'm not sure what state it is they are kept in? I think it's sad you've never seen the benefits programmes such as they can offer, perhaps volunteer and open your mind? Everyone can make a valuable contribution to society, and people with mental ill-health are included in that. There is evidence to suggest the less people with serious mental health conditions are excluded from society, the lower their care needs are. Shunning people doesn't work, giving them purpose through schemes such as this can improve lives. On a side note, have a look at the Global Burden of Disease report, it shows that nearly half is attributable to mental ill-health with only a fraction of the money spent on physical health (even though separating the two is often artificial). My only fear with these project is capital expenditure doesn't always equate to care, yes they have a new building but are they proposing better or new services with it?
  10. As a genuine question, how much damage was done by closing Glenside and how much pressure has this placed on the rest of the system? Whilst I suspect it wasn't up to modern standards it seemed to be closed without any sort of strategic plan and in the years since there has been a lot of talk about the lack of social care/residential facilities. If it was a cock-up how has the minister who recommended its closure escaped repercussions? I'm pretty naive when it comes to what is expected in terms of legal requirements, but surely something OK is better than an abject shortage?
  11. Does anyone know if this figure includes the 'Meals-on-Wheels' service, as I think they are made in the hospital kitchens? If so, perhaps the loss is partly cost of the service? That said they could even up the prices of the vending machines in the hospital, it's pretty cheap for the NHS.
  12. Admin is a bit of a nightmare in every hospital, but Noble's does need to modernise. Discharge summaries are really in need of change to free up admin time but I think they are sorting these. The whole modernisation of IT systems that Quayle has overseen is pretty commendable IMHO. The IOM Govt has a pretty hard job with health and controlling spending. I think less is spent less per head on the IOM than in the UK but it's hard to separate the figures and with overspends etc. The other challenge on the Island is the demographic, it's 90,000 and very top heavy and so the spend will be disproportionate to the UK. Then there is the isolation, lack of on-site specialists (no friends to ask when the proverbial hits the fan) and covering 24 hour rotas. Change in the NHS is hard and changing a process takes on average 3 years. The Isle of Man has the potential to be nimble in this. I think online service could improve a lot and publishing transparent data re waiting times, incidents and infection rates would be a cheap and reasonable push for change. I wonder what other people think, crowd sourcing positive solutions might be a way forward as would frank discussions about what the island can afford. In positive news, locate.im is pushing some figures, as part of nursing recruitment which would suggest life expectancy is one of the best in the world. Whilst this could be trickery with stats, it could equally prove that current achievements with the health service are spot on?
  13. Declaring my interest, I am a doctor but not a BMA member. With regards to the BMA leak I doubt many are that surprised. They were whatsapp messages and if you don't think the UK govt have something similar between themselves I'd be surprised. I think the tactics stated were already visible maximum impact with minimal damage - junior doctors aren't essential for a few days during working hours. Pay is an issue, not because of the overall lack of it, but the relative decrease over the years with pay freezes and shift of fees and training costs. No doctor can realistically say they struggle to pay basic bills if they live sensibly. The slap in the face of being told it was a pay rise when in reality it was a complex cut also really pissed people off. Morale in junior doctors is pretty low at the minute (not helped by the BMA campaign) and pay I think is seen as the only thing that will change. There are so many gaps in rotas you end up picking up crap from sub optimal care. I think replacement of doctors duties in some areas is feasible and realistic. It is a waste of resources for doctors to take blood or be a glorified scribe for their boss whilst being not always dealing with the nicest colleagues. I'd happily take a cut in exchange for fewer hours. We should be careful what we wish for in the NHS because if you take away control of the markets you will end up where demand and shortage drives up wages - look at locum fees. Still, I'm grateful for what I get to do, it is a privilege, just wish the politics side of it was less of a thing.
  14. I'm not an expert on the consultant contract, but I'm certain they don't get paid this figure which is spurious. RogerMexico linked to the salary but this cost will cover pension contributions, national insurance contributions, some continued professional development and the expense of hiring a locum to cover annual leave. There is also the cost of college membership, GMC registration, exams and indemnity cover. The cost of training has now been shifted onto graduates, new doctors in the UK carry around £90k of debt. Doctors do earn well over the national average but I think this figure is quite misleading, for any job the cost is above that of the salary alone. The NHS works to the UK's advantage of restricting free market economics with labour, effectively one large employer, don't like it look else where for work! It is down to society to determine the worth of doctors (though doctors can be manipulative and have a powerful trade union). Perhaps a more interesting question would be the economic benefit of a consultant (would be almost impossible to calculate) but does the average benefit in health and therefore productivity exceed their cost? If you asked how much an MHK costs after considering pensions, salary, travel and expenses I'd estimate the figure exceeds £100k I don't think anyone can say they do private work for moral gain (unless you donate profits of said work or it is charitable). The hours are outside of the contracted NHS (annual leave/time off) and it does have unintended benefits to the NHS. The rich pay twice and some money goes toward hospital service, NHS waiting lists get shorter, and you maximise use of resources i.e. one constant works 120% of expected hours.
  15. The Swedes have a pretty interesting view on road accidents called Vision Zero. They say we should anticipate that all people make mistakes and it is for the system to accommodate and minimise the consequences of it. The idea is now that it should now be almost impossible to suffer serious injury in a modern car on Swedish Roads. Their fatality rate is 87% lower than the Manx figures. Unlikely with Manx geography but interesting.