Friday, October 12, 2007

Judicial wisdom from Britain

Following are the inaccuracies in Al Gore's "An Inconvenient Truth" as found by a British High Court judge:

The decision by the government to distribute Al Gore's film An Inconvenient Truth has been the subject of a legal action by New Party member Stewart Dimmock. Although a full ruling has yet to be given, the Court found that the film was misleading in 11 respects and that the Guidance Notes drafted by the Education Secretary's advisors served only to exacerbate the political propaganda in the film.

In order for the film to be shown, the Government must first amend their Guidance Notes to Teachers to make clear that 1.) The Film is a political work and promotes only one side of the argument. 2.) If teachers present the Film without making this plain they may be in breach of section 406 of the Education Act 1996 and guilty of political indoctrination. 3.) Eleven inaccuracies have to be specifically drawn to the attention of school children. The inaccuracies are:

The film claims that melting snows on Mount Kilimanjaro evidence global warming. The Government's expert was forced to concede that this is not correct.

The film suggests that evidence from ice cores proves that rising CO2 causes temperature increases over 650,000 years. The Court found that the film was misleading: over that period the rises in CO2 lagged behind the temperature rises by 800-2000 years.

The film uses emotive images of Hurricane Katrina and suggests that this has been caused by global warming. The Government's expert had to accept that it was "not possible" to attribute one-off events to global warming.

The film shows the drying up of Lake Chad and claims that this was caused by global warming. The Government's expert had to accept that this was not the case.

The film claims that a study showed that polar bears had drowned due to disappearing arctic ice. It turned out that Mr Gore had misread the study: in fact four polar bears drowned and this was because of a particularly violent storm.

The film threatens that global warming could stop the Gulf Stream throwing Europe into an ice age: the Claimant's evidence was that this was a scientific impossibility.

The film blames global warming for species losses including coral reef bleaching. The Government could not find any evidence to support this claim.

The film suggests that the Greenland ice covering could melt causing sea levels to rise dangerously. The evidence is that Greenland will not melt for millennia.

The film suggests that the Antarctic ice covering is melting, the evidence was that it is in fact increasing.

The film suggests that sea levels could rise by 7m causing the displacement of millions of people. In fact the evidence is that sea levels are expected to rise by about 40cm over the next hundred years and that there is no such threat of massive migration.

The film claims that rising sea levels has caused the evacuation of certain Pacific islands to New Zealand. The Government are unable to substantiate this and the Court observed that this appears to be a false claim.


Beware Muslim doctors

Some Muslim medical students are refusing to attend lectures or answer exam questions on alcohol-related or sexually transmitted diseases because they claim it offends their religious beliefs. Some trainee doctors say learning to treat the diseases conflicts with their faith, which states that Muslims should not drink alcohol and rejects sexual promiscuity. A small number of Muslim medical students have even refused to treat patients of the opposite sex. One male student was prepared to fail his final exams rather than carry out a basic examination of a female patient.

The religious objections by students have been confirmed by the British Medical Association (BMA) and General Medical Council (GMC), which both stressed that they did not approve of such actions.

It will intensify the debate sparked last week by the disclosure that Sainsbury's is permitting Muslim checkout operators to refuse to handle customers' alcohol purchases on religious grounds. It means other members of staff have to be called over to scan in wine and beer for them at the till.

Critics, including many Islamic scholars, see the concessions as a step too far, and say Muslims are reneging on their professional responsibilities.

This weekend, however, it emerged that Sainsbury's is also allowing its Muslim pharmacists to refuse to sell the morning-after pill to customers. At a Sainsbury's store in Nottingham, a pharmacist named Ahmed declined to provide the pill to a female reporter posing as a customer. A colleague explained to her that Ahmed did not sell the pill for "ethical reasons". Boots also permits pharmacists to refuse to sell the pill on ethical grounds.

The BMA said it had received reports of Muslim students who did not want to learn anything about alcohol or the effects of overconsumption. "They are so opposed to the consumption of it they don't want to learn anything about it," said a spokesman.

The GMC said it had received requests for guidance over whether students could "omit parts of the medical curriculum and yet still be allowed to graduate". Professor Peter Rubin, chairman of the GMC's education committee, said: "Examples have included a refusal to see patients who are affected by diseases caused by alcohol or sexual activity, or a refusal to examine patients of a particular gender." He added that "prejudicing treatment on the grounds of patients' gender or their responsibility for their condition would run counter to the most basic principles of ethical medical practice".

Shazia Ovaisi, a GP in north London, said one of her male Muslim contemporaries at medical school failed to complete his training because he refused to examine a woman patient as part of his final exams. "He was academically gifted, one of the best students, but gradually he got in with certain Islamic groups and started to become more radical," said Ovaisi. "You could see there was a change in his personality as time went by. During the final exams he was supposed to treat a female patient in hospital. He refused to do it, even though it would have been a very basic examination, nothing intrusive. "But he refused and as a result he failed his exams. I was quite shocked and disappointed about it because I don't see there being anything in our religion that prohibits us from examining male and female patients."

Both the Muslim Council of Britain and Muslim Doctors and Dentist Association said they were aware of students opting out but did not support them. Dr Abdul Majid Katme, of the Islamic Medical Association, said: "To learn about alcohol, to learn about sexually transmitted disease, to learn about abortion, it gives us more evidence to campaign against it. There is a difference between learning and practising. "It is obligatory for Muslim doctors and students to learn about everything. The prophet said, `Learn about witchcraft, but don't practise it'."


NHS superbug negligence kills 90

At least 90 patients died and more than 1,100 became infected as hospital managers failed to control the worst outbreaks ever recorded of the super-bug clostridium difficile, a report states today. Inadequate staffing levels, dirty wards and too much focus on cost-cutting and government targets contributed to two serious outbreaks of C difficile in as many years at Maidstone and Tunbridge Wells NHS Trust, an investigation by the Healthcare Commission found. The Health and Safety Executive and Kent Police are now considering the possibility of criminal charges being brought against the trust or its executives.

The commission found "significant failings" in infection control at three hospitals run by the trust between April 2004 and September last year, including unwashed bedpans, a lack of isolation units, beds being spaced far less than the recommended 3.6 metres apart to stop the spread of infection and nurses telling some patients with diarrhoea to "go in their beds". Pictures taken as recently as February disclosed continuing hygiene concerns. Rose Gibb, the chief executive of the trust, left her job on Friday by mutual agreement with the board.

The failure to contain and treat infections at all levels contributed to 1,176 patients being infected with the bug at Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital, Kent, the watchdog said. A total of 345 patients died while infected with the bacterium between April 2004 and September 2006, 21 died as a direct result of infection and for 69 patients it was probably the main cause of death, it added. In addition, C difficile could also be considered a "contributing factor" in as many as 241 of the deaths, although the report said that patients, many of them elderly or frail, may well have died of other causes if they had not acquired the infection. The trust had previously told the Healthcare Commission there had been "no deaths that were definitely caused by C diff" between April 2004 and March 2006.

The first big outbreak was between October and December 2005 but, despite the number of infected patients quickly doubling to 150, the trust did not identify the outbreak. The second significant outbreak was between April and September 2006, in which 258 patients were affected, and was recognised as serious by the trust. But despite these problems, the trust declared itself compliant with national government standards for hygiene and infection in May 2006.

At the time of the outbreaks the trust was carrying out a programme to save 40 million pounds over three years in the face of huge debts. At the end of 2003, the trust had an accumulated deficit of 17.6 million. Last year, it reported a deficit of 4.5 million.

The commission said that there was evidence patients had been moved between several wards, increasing the chance of spreading infection. It said this was partly due to concerns over hitting the Government's targets on waiting times for treatment in A&E.

Anna Walker, the chief executive of the commission, said that the lack of infection control at the trust had been "unacceptable" but that conditions had improved as a result of monitoring by the commission. Improvements included increasing the space between beds, appointing a new director of infection prevention and control and implementing a policy on the use of antibiotics which are known to help C difficile thrive.

"What happened to the patients at this trust was a tragedy," Ms Walker said. "This report fully exposes the reasons for that tragedy, so that the same mistakes are never made again." She called for the NHS to treat C difficile as an illness rather than just an added complication.

Health Protection Agency figures showed that rates of C difficile are now lower than the NHS average last year. A spokeswoman for the Health and Safety Executive said that it was working with Kent Police to consider the report.

Patients were treated on open wards instead of in isolation. A former children's ward was being used for adults. It contained an uncleaned shower, one wash basin for 12 beds and beds placed only 30cm (less than a foot) apart. A shortage of nurses contributed to the spread of infection "because they were too rushed to undertake hand hygiene, empty and clean commodes, clean mattresses and equipment properly" and wear aprons and gloves. High bed occupancy - over 90 per cent at Maidstone and the Kent and Sussex - led to less time for cleaning. Staff used alcohol wipes, which are ineffective against C. Diff spores, to clean commodes instead of soap and water. Old commodes were used despite the trust agreeing to replace them and setting aside 250,000 pounds to do so


Political stupidity about superbug prevention

Government plans for tackling superbugs, such as MRSA, have been condemned by a leading medical journal for not being based on scientific fact. The Lancet said there was little evidence to support hospital "deep cleans" or short-sleeves for medical staff as recently proposed. Instead of "pandering to populism" politicians should listen to the evidence, the editorial said.

The government said the plans were part of a wide range of preventive measures. On Sunday, Prime Minister Gordon Brown announced plans to "deep clean" hospitals ward-by-ward over the next year to return hospitals to the state they were in when they were built. His comments followed proposals from Health Secretary Alan Johnson for a new dress code for NHS staff which would advise against long-sleeved coats and ties for doctors as they can become contaminated.

But The Lancet said a government working group had found no conclusive evidence that uniforms or other work clothes posed a significant hazard in terms of spreading infection. And the focus should be on disinfection of high-touch surfaces rather than deep-cleaning wards to get rid of visible dirt, the journal said.

The editorial said: "Brown also plans to double the number of hospital matrons, to check on ward cleaning, and accost doctors wearing long sleeves. "They would be better employed making sure doctors, nurses and visitors wash their hands properly, the proven way to stop hospital acquired infections," the editorial stated.

Professor Richard James, director of the Centre for Healthcare Associated Infections at the University of Nottingham agreed the evidence on transmission of infection from clothing such as long sleeves was not clear but short sleeves may encourage staff to wash their hands properly. He added: "The main route of transmission of MRSA is person-to-person contact and this will be affected little by deep cleaning.

"In contrast, Clostridium difficile is transmitted by contact with faecal contamination so it may be more effective here." He said in addition to hand washing, other useful strategies would be screening patients for MRSA on admission, regular use of hydrogen peroxide vapour generators to kill bugs in the hospital environment and educating patients and visitors on ways they can reduce risk.

Chief Nursing Officer, Professor Christine Beasley said there was no single solution and the new proposals were part of a wider set of measures to reduce hospital-acquired infections. She agreed that there was no evidence that uniforms themselves pose a significant risk of transmitting infections but said long sleeves and watches "get in the way of washing and decontaminating the hands, wrists and forearms". "Clean and tidy hospitals and staff are very important to patients," she said. "We make no apology for asking hospitals to take every reasonable measure to reduce infection and increase patient confidence that this is an issue the NHS is taking seriously."

Dr Mark Enright, an expert in molecular epidemiology at Imperial College, London said deep cleaning would be a waste of resources and an inconvenience to patients and staff. "MRSA is a major problem in the UK because it is present, mostly unknowingly, in patients and staff. "Interrupting the chain of transmission from these people to new hosts should be the main focus of infection control, not attempts at the sterilisation of floors and windows."


Cheap trainer shoes as good as (or better than) expensive ones

RUNNERS who buy expensive training shoes in the belief they are less likely to cause injury are deluding themselves, according to a new study. Researchers in Scotland tested running shoes, made by three manufacturers, that fell into three price bands - low (40-45 pounds or $90-$102), medium (60-65 pounds) and high (70-75 pounds).

After masking the manufacturer's logo and other tags with tape, the scientists slipped a thin pressure plate, shaped like an insole, into the shoes. The device, called a Pedar, measured the pressure at three points on the sole of the foot: under the heel, across the forefoot and under the big toe. The goal was to get an idea of the effectiveness of the cushioning that manufacturers add to the shoe to dampen the shockwave to the foot. Thus, the higher the pressure, the greater the force that is transmitted to the runner when his or her foot makes contact with the ground.

They then asked 43 young male volunteers to put on the shoes and walk along a 20m walkway in the lab. The volunteers each wore a small backpack which held a box that picked up data signals from the pressure gauge. Nine volunteers then wore the shoes as they ran on a treadmill, to see if this made any difference in sole pressures as compared to walking.

"Plantar pressure was lower overall in low- and medium-cost shoes than in high-cost shoes,'' says their paper, which appears in the British Journal of Sports Medicine. "This may suggest that less expensive running shoes not only provide as much protection from impact forces as expensive running shoes, but that in actual fact they may also provide more.''

The volunteers were also asked to assess the masked shoes for comfort. But their preferences were subjective and bore no relation to the distribution of plantar pressure or the cost of the shoe, the investigators found.

Running is a high-impact activity. With every footfall, a middle-distance runner experiences an impact equal to 2.5 times body weight - and this force increases with speed and fatigue. The impact transmits shock waves that are transmitted by the bones of the foot to the rest of the body, with the potential to cause knee damage, shin splints, muscle tears, Achilles tendonitis and other injuries.

Athletic footwear can reduce the impact by a third through good cushioning, as compared to the impact from walking barefoot, according to the study headed by Rami Abboud of the Institute of Motion Analysis Research at Ninewells Hospital and Medical School, Dundee.


More irresponsible statin evangelism

No mention of their often disastrous effect on quality of life -- which is WHY alleged "former" takers are focused on. It takes a lot for most people to continue with them. This is obviously such a careless study (see the rubrics and italics below) that I am not even going to bother looking at the abstract

People who take cholesterol-lowering drugs are protected from heart disease and premature death years after they stop taking them, a major study has shown. New research into statins - the world's biggest-selling medication - offers dramatic evidence of their long-lasting ability to halt and even reverse the progression of heart disease. The study, involving 6,500 men, found that those who took statins were still showing benefits of the drugs ten years after they had finished taking them. The chances of suffering a fatal heart attack over the period dropped by more than 25 per cent, the scientists found, while there was no evidence of unexpected side-effects. This remarkable result will increase pressure on GPs to prescribe statins to an even greater number of middle-aged people with raised cholesterol levels.

Professor Stuart Cobbe, of the University of Glasgow, the leading cardiologist on the study, said that he had been extremely surprised. "The benefit appeared to extend to at least ten years after the original trial," he said. The findings do not suggest that people on statins should give up; rather it is better to continue taking them. But even those who do give up continue to enjoy a benefit, Professor Cobbe said.

The results, published in The New England Journal of Medicine, come three months after a government adviser suggested statins should be offered to all men over 50 and women over 60 as an effective "shortcut" to prevent heart disease. Statins are currently taken daily by an estimated three million Britons to tackle high chloresterol. Heart disease is Britain's biggest killer, accounting for one in three deaths. The annual cost to the economy is about œ26 billion a year, the bulk of which is treatment costs.

Professor Chris Packard, a co-author of the study, said: "The impact of the statin treatment appeared to persist long after the active phase of the trial. This suggests that the drugs have lasting beneficial effects on the artery wall, possibly by stabilising plaques that might be about to rupture and cause an heart attack." Breakaway plaques can cause attacks by blocking the blood vessels and starving the heart of blood. Statins appear to stabilise the lining of the blood vessels, as well as damping down inflammation.

The original trial, the West of Scotland Coronary Prevention Study (Woscops), was launched between 1989 and 1991. More than 6,500 men aged between 45 and 64 who had not had a heart attack but had elevated cholesterol levels were recruited and divided into two groups. Half were given pravastatin and the other half a placebo. They were followed up for five years, until May 1995. The results showed that the risks of death from heart disease, or of suffering a heart attack, were significantly reduced in the statin users. The new study follows up the same men for another ten years. It compares heart attack and death rates in the original statin group against the original placebo group. Since the trial, both groups have changed. The statin group have tended to give up taking the tablets, while many of those in the placebo group have started to take them. No account was taken of these changes [Thus rendering the implications of the results completely indeterminate. Perhaps the group given a statin placebo have been so disillusioned by "their" statins that moved on to more harmful "natural" remedies], and a simple comparison was made of the 15-year experience of the original statin group against the original placbo group.

Professor Ian Ford, lead author of the study, said: "Remarkably, five years of treatment with a statin resulted in 27 per cent fewer nonfatal heart attacks or deaths due to heart disease over the period of 15 years. There was a significant 12 per cent reduction in deaths over the entire period, with deaths due to heart disease reduced by 22 per cent." The gap between the groups narrowed after the trial ended, and their use of statins tended to converge. But up to the end of the 15-year period, the original statin group did better than the original placebo group, showing a persistence of the effect. [Or showing that most high-risk people end up taking statins for a while; some sooner, some later. And maybe those given it when younger tend to tolerate it better. It is all pure speculation]

Professor Ford said: "The results of the follow-up provide strong support for the safety of five years of statin use. "When fatal and nonfatal heart disease events were studied it was found that, despite the fact that most of the participants were not treated with a statin after the first five years of the trial, there was evidence of the group originally receiving the statin continuing to be at lower risk of having a heart disease event."

Statin prescriptions have risen by 150 per cent in England in the past five years. The trial raises the question of whether they should be given to an even wider group, including younger people in whom heart disease has yet to get a start.


Jagger has more sense than the historians

SCHOOLS should teach proper history, not pop music, Mick Jagger has suggested, after discovering that the Rolling Stones are a topic on the British high school syllabus. Still rolling at 64, Jagger was responding to a Bristol teacher who asked how best to present the cultural importance of the Rolling Stones to a class of eager history students. Despite being the subject of numerous academic works, Jagger said it was only rock 'n' roll and the Stones' importance in the grand scheme of things may have been overstated.

In a BBC News website question-and-answer session, Alison McClean wrote: "I am currently teaching my Year 11 students about the impact of the Rolling Stones in preparation for their GCSE history coursework on Britain in the 1960s. How does Mick feel about being part of the history curriculum and, if he was sitting the exam himself, how would he describe the Stones' impact on Britain?"

Jagger, who passed O-level history at Dartford Grammar School in 1959, was less than impressed. "I suppose pop music was very important in the 1960s, it became perhaps too important. It was one of the things in popular culture," he said. "Alison, I'm sure you're teaching it as part of the whole popular culture movement. I'm sure it's brilliantly accurate - or perhaps not because if you look up a lot of it, it's nonsense."

He was speaking as a concerned parent. "I have a daughter who's doing GCSEs at the moment," he said. "She hasn't got me in her syllabus. She's much more traditional. It's more the cause of World War I, that sort of thing." The best he could say for lessons in dad's role in the 60s cultural revolution was that "it was an interesting historical tipping point".

Jagger benefited from a traditional schooling at Dartford, where Latin was obligatory, masters donned gowns and pupils wore a cap at all times with a regulation blazer with gold trim. His first report in June 1955 placed him 15th out of 30 pupils. His form master, Dick Allen, wrote that he had made "a good start". His academic performance went into steep decline after he discovered "music and girls". Contemporaries recall a lecture young Jagger gave to the school's historical society on the blues.

The high-point of his Dartford career came when the emerging rebel led a protest against the quality of school dinners, which resulted in the dismissal of a kitchen supervisor. "It was probably the greatest contribution to the school I ever made," Jagger said in 2000, before returning to open a performing arts centre in his name. He gained seven O levels and two A levels in June 1961, and won a place at the London School of Economics.


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