Category Archives: media

Medical mistakes

Here’s another question of an order of magnitude… Daniel Ubani, a German ‘stand-in doctor’ who was over in the UK doing a shift as an on-call GP and gave a patient a fatal overdose of diamorphine (Guardian again). He gave the patient 10 times the amount – at first I wondered if he’d got millilitres and centilitres mixed up. However, you can now read the inquest material and it makes for interesting reading.

It seems that the mistake came when David Gray’s partner mentioned 100mg and 10mg, pethidine and diamorphine, in the same conversation. Having no pethidine, Ubani chose the diamorphine. Hearing 100mg, he chose the bigger vial. As diamorphine isn’t used in Germany he wouldn’t know the correct dose: he didn’t look at the instructions kept with the drugs, hence ‘manslaughter by gross negligence’. However, the death could have been prevented by proper induction. It seems that no-one showed Ubani round his equipment: he should have known that the 100mg vial was for palliative care and used in slow release with a syringe driver, as opposed to all at once.

At the inquest there was a some discussion about Ubani’s proficiency in understanding English. However, one of his employers said that his English was OK, and it seems unlikely that this was a huge factor. His unfamiliarity with NHS kit and procedures was more to blame. However, the papers seem to have decided that the black African with a German passport was an example of non-English speaking foreigners making a mess of things (see the Mirror). There’s a lot of blame on the profit making agencies too.

But, as noted in the report, this has happened before, and the month before the deaths NHS Cambridgeshire were discussing changing the boxes of drugs to avoid this:

“In attempting to relieve patients in acute pain, doctors in two different situations erroneously selected the 30mg diamorphine vial…and administrated the entire contents to their patients by injection.

“This six-fold overdose caused respiratory depression and collapse; the patients had to be admitted to hospital for resuscitation. If this is repeated and the patient not rescued in time, death could result.” (C4)

I don’t know if these doctors were the stereotyped foreign doctor, unable to speak English, or not. The lack of media interest suggests not as I’m sure a scandal would be being promoted as I write.

Indeed, focusing on this rare occurence misses the wider issues in ‘patient safety’. If society is fixated on this one fatal mistake, then it can ignore the fact that in 2007 there were ‘as many as 860,000 errors or near misses involving medicines’ in the NHS (Guardian). I’m sure that not all these mistakes were down to foreign doctors, but are down to normal human error, the kind of error that can often be avoided with the right systems in place, good management and so on. Dull (and expensive but that’s another story).

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An order of magnitude

We know many people are bad at maths. However, most mistakes are easily spotted through experience and common sense. But sometimes, common sense is lacking: here I’m talking about the Conservatives gaff on teenage pregnancy.

So first, the Conservatives. A few days ago they launched a document called Labour’s Two Nations, that was supposed to show how there is great inequality in Britain today (let’s ignore the fact that the rise in inequality happened in the 1980s). What they wanted to point out was that under-18 girls in the most deprived areas are three times more likely to become pregnant than in the least deprived areas (Guardian). It’s not clear what this means with regards to ‘most deprived’ and ‘areas’ – I think it’s top and bottom centiles and districts – and I’m sure I could find a more shocking figure if I chose a harsher definition of most and least deprived. The mistake they did make, though, was to divide 54 by 1000 and come up with 54% not 5.4%. That’s if they did a calculation: some social statistics come as ‘per 1000’ or ‘per 10,000’ and it’s important to notice this.

This matters for two reasons. First, because 54% v 18% is a big difference and much more significant than a difference between 5.4% and 1.8% (significant thought this is). Second, because anyone with any sense would realise that 54%, that is over half, is completely absurd.  Anywhere with 54% of its teenagers pregnant would have babies everywhere. Either the writer and editor just missed this, or they genuinely believed that there could be such a place and they are massively out of touch with normal life.

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Chinese whispers

While reading my local paper online, I came across a contribution from the public that complained that Muslims in the UK are given latitude to act differently to the rest of the people, showing that Muslim lobby groups have the government in their pocket. Combined with the Islamophobia that is prevalent now, it feeds into the idea that a different group is somehow taking over. And as ever, the full story is ignored for the game of Chinese whispers that is our media machine.

The specific claim is that ‘Ed Balls has made it legal to smack children in muslim schools’, and this something that can’t be done elsewhere. As ever, the object of the attack is the Labour government, who are seen to be ‘bending over backwards’ to incorporate minority viewpoints (usually accompanied by the claim that they rely on minority votes).

Reading this, I thought ‘this seems unlikely to be true’. Making opt-outs from laws on ‘community’ grounds, whether religion/ethnicity or anything else is fraught with danger, and the government would avoid it at all costs. And, of course, it isn’t true. The truth behind this story is that staff in schools haven’t been allowed to use physical punishment children since 1999 (for England and Wales) and in state schools this happened earlier. However, parents aren’t banned from smacking their children (unless it is ‘cruel and degrading’), and thus anyone standing in for parents (in loco parentis) isn’t banned either. The only people banned are teachers in schools. And to define a school, the government chose to define them as establishments where kids go for 12.5 hours or more. Therefore, football or gymnastics coaches, sunday school teachers, music tutors, home schooling tutors, scout masters, parents’ friends and family, and anyone who is asked by a parent to look after children is allowed to smack. The BBC have posted a good history of the law, and point out that:

‘Some MPs have proposed a new clause for an education Bill currently before Parliament… meaning that only a person with actual parental responsibility for a child could continue to justify battery of that child as “reasonable chastisement”.’

So how did this claim about muslim schools come about? First Ann Cryer, MP asked a question in parliament about ‘teachers in madrassahs or in other religious schools’ (Hansard, BBC). Ed Balls pointed out that ‘there is not one rule for a child in a madrassah and another for a child in a school or in any other circumstance’ but didn’t promise to do something about part-time settings, presumably knowing that it would be a step towards a ban on smacking by parents too.

Next, and because of the simplification required for the headline and first two or three sentences in news pieces (see Wikipedia for a good explanation – I think this is a Nut Graph(!)) the story became:

‘Under existing law, teachers at state and private schools are banned from smacking children but their counterparts in faith schools are not.’ (Keighley News)

This claim is a lie, and is only explained properly at the middle of the piece.  But this sentence gets repeated:

‘A loophole in the law means that while teachers in state and private schools are banned from smacking children, their counterparts in faith schools are not.’ (Guardian)

This is so close that in an academic context could be considered plagiarism, unless citing the source. Again, explaining the actual law comes later.

But that dig at journalism is a digression. Now we have the idea that all faith schools are exempt (due to simplifying the story), and that it’s got something to do with Islam. Then politicians get back in on the act with the Lib Dem spokesman saying “The government needs to legislate to protect children – not leave an opt-out simply because it fears some ethnic or religious backlash.” (Guardian).

So instead of a bigger story about the fact that piano teachers are still allowed to rap children’s fingers with a ruler, Koran and Bible classes can enforce rote learning with similar methods, and parents, friends, family and babysitters are allowed to smack children in their care, we end up with the false claim that teachers in Muslim schools can smack and other teachers can’t. Is that right? No. Is it true. No again.

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Prejudice and equalities

Yesterday’s UK papers have been covering a spat between Philip Davies, a Tory MP, and Trevor Philips, the head of the UK ‘equalities’ body (see the Guardian, the Times). I do support the work of the Equality and Human Rights Commission, but Trevor Philips doesn’t do the cause any favours in some of his answers to the MP’s letters.

The Tory MP is a mischief maker with too much time on his hands. He’s written lots of letters about ‘political correctness gone mad’ that fit into a Daily Mail view of the world. In this view, anything and everything is done for the benefit of ‘minorities’ and that would include ‘wimmin’, gay people, ethnic minorities, and anyone different to the norm. This argument takes in the myths about banning golliwogs and Christmas in schools.

Part of the problem comes in the name of the body. The word ‘equality’ means different things to different people, and political philosophers have used up much paper and ink working out what equality, justice, and the ‘good society’ should be. Particularly in the literature on multiculturalism, there’s the big question of group and cultural differentiation and rights. In essence, should people be treated differently just because of their (assumed) membership of a group, and the further (assumed) differences in needs and capabilities. This raises questions of the form ‘should women have separate sports sessions, as they may be put off by the presence of men?’ or ‘how far should employers adapt their working hours for those who need time off for religious reasons?’. Treating everyone the same isn’t equality, as people have different needs and capabilities (see Amartya Sen on capabilities), but treating people differently merely on the basis of group membership can create new injustices (see Sen again in Identity and Violence).

Of course, the work of the EHRC is informed by the historical injustices of the UK. So our history of colonialism and inability to welcome or assimilate newcomers leads to problems with regards to race. Moving from a patriarchal society means that gender issues are important, and so on. However, the EHRC also suffers from its own history. It was formed by the bringing together of a number of bodies that did similar work (the Commission for Racial Equality, the Disability Rights Commission, the Equal Opportunities Commission) but only on one inequality each. There was hope for ‘joined up thinking’ whereby the way that individuals’ multiple identities combine to form injustice could be addressed. Furthermore, other injustices could be addressed.

I was actually a researcher on a small study that informed the creation of the body, Melanie Howard and Sue Tibballs’  Talking Equality (2003). I remember that the interviews and focus groups added a further source of inequality that got lost from the agenda: class. Indeed, if we added class to the mix it would help with some of the other injustices. It is surely more just (in terms of numbers), and so a higher priority and more likely to be supported by the public, to argue for equal pay for female cleaners than to examine the numbers of women in boardrooms. Similarly, addressing literacy problems across the board, and especially in white and Asian working class families, should be more important than BME business initiatives.

To go back to Trevor, and what I think he’s missing in his replies to the MP, just addressing the five or six ‘inequalities’ identified so far doesn’t bring justice. I know he was probably bored of the correspondence by this point but this exchange is particularly problematic:

Should anti-discrimination laws ought to be extended “to cover bald people (and perhaps fat people and short people)”?

“The answer to your question is no.”

Now I haven’t read anything about bald or short people, but there’s plenty of literature on discrimination or prejudice against fat people. Trevor Philips should have said that the body works to eradicate prejudice wherever it is found, and that if a group or type of people is found to be unjustly discriminated against then measures could be needed, perhaps laws, perhaps not. He’s fallen into a trap: he didn’t want to play into the anti-PC brigade (imagine the Daily Mail headlines re. short people), but instead he’s telling us that only some groups deserve protection, so we can have Daily Mail headlines saying that the body only protects ‘minorities’, so can be cut by a Tory government. A broader support for human rights and tackling discrimination is more likely to be achieved if it isn’t about sectional interests, or the different, but is for everyone and is promoted as being for everyone.

P.S. If you think that other, less talked about, prejudices are never as serious as racism, remember that one young woman was recently murdered for being a goth.

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Say something often enough…

and people will believe it. Today I was annoyed with the repeated claim that a lesser crime such as fraud or avoiding tax on cigarettes funds a greater crime such as terrorism, drug dealing or people trafficking (National Fraud Authority).

This has been around for a while. I remember ads in London advising people not to buy counterfeit DVD’s in the pub as it would fund drug dealing, and this time it’s scam websites (see the Guardian).

The websites are thought to have generated millions of pounds for organised criminal gangs, which could then be used to fund other illicit activities, the Metropolitan Police’s Central e-crime unit (PCeU) said.

Now excuse me if I’m wrong, but those other illicit activities such as drug dealing and people trafficking (but not terrorism) tend to be quite profitable themselves. Given the risks involved I don’t see why an organised crime gang would take the money from credit card scams and invest it in loss-making drug and trafficking ventures. They don’t really need to be cross-subsidising unprofitable parts of the business. Drug dealers tend to make money and can use their previous profits to buy more product (see the Wire). People traffickers take the money up front, so they’d never be in a position to risk their own money.

Of course, a start-up drug dealing operation might need some capital, but setting up a fraud operation probably needs just as much. And perhaps credit card fraud can help with laundering, although I don’t see how. It’s more likely that the kind of gangs that are breaking the law and risking punishment are willing to diversify into other risky – in terms of punishment – businesses.

It would make sense to concentrate on the terrorism angle. After all, terrorists need money, and will use illegal means to get it. This part of the argument makes sense and should appeal to almost everybody.

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Lightbulbs

Much of the UK media, and most of the people here to be fair, love to knock the EU. Perhaps this is sometimes justified, but many stories are exaggerated or re-spun to give it the greatest anti-EU, faceless bureaucrats* theme in order to allow us the feeling of righteous anger. Don’t ya just love it.

Recently I heard a piece on ‘Does 75 per cent of UK law come from Brussels?’ on Radio 4’s More or Less. Of course, this is very difficult if not impossible to answer reasonably. We could count the number of laws, the words used, or try to estimate each laws influence on people’s lives. As Tim Harford said, 40 laws on the regulation of car wheel sizes will be less important than a single law restricting the right to a trial by jury.

Often, though, the EU laws and regulations are misrepresented to the point of outright lie, and this is especially true where some people can make money out of the misinformation. Let’s take the humble lightbulb as an example. The news seems to be that incandescent bulbs are being banned, we’re all being forced to use the mini flourescent ones, so the EU is evil and we need to stock up now.

THE old-fashioned 100-watt incandescent lightbulb is to be phased out across the EU.

Countries will have to use energy-efficient compact fluorescent lamps instead. They use up to 80 per cent less electricity than standard bulbs and could cut a home’s annual energy bill by up to £37.

Experts say they will also help reduce carbon levels, curbing climate change. But some campaigners claim energy-saving bulbs may trigger migraines and worsen skin conditions. (The Sun)

I suppose the first line is true, but given that they’ve started with 100w bulbs I find this amusing, because I don’t think they get used much anyway. Most light fittings only take bulbs up to 60w, and we’ve got two years of 60w normal bulbs anyway. So there’s no need to panic… ‘Congratulations to anyone who can find 60 or 100W bulbs to hoard’ (contributer to BBC).

However, it’s the second line that is completely untrue. Old-style incandescent (i.e. a glowing filament) are going, but newer style incandescent lamps are perfectly fine (see  the EU document). So all the complaints about not being able to use dimmer switches, slow start-up times, or having a different quality of light are from people who misunderstand the law. Greenpeace would like to see these banned too, but given that the new bulbs can have a B or C rating, that won’t happen.

So given that we’ve got a little while of old-style bulbs yet, that we aren’t being forced to use the compact flourescents, and that the EU is encouraging new-style incandescents anyway, it seems this story is mainly being written in the dark.

—–

*Indeed, I’ve always loved the ‘faceless bureaucrat’ argument as it seems to be made by people who don’t understand how democracies work. Yes, the EU commission (bureaucrats) write the EU laws, and then the Parliament (an elected body) and the Council (the EU heads of state) have to pass them. But these laws can also be requested by the Parliament or the Council. And this is also how the UK system works… it’s the civil servants that write the laws as politicians don’t have time for the details. As far as I can tell, the usual is that a government policy commitment is given to civil servants to create green papers, white papers, and laws, and the ministers and eventually parliament sign them off (see this, or even Yes, Minister!). On occasion, for example where the police request new powers to deal with a particular problem, the initiative starts with the civil servants too. This looks much the same to me.

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Laziest journalism?

Today I noticed lots of flying ants in my garden, so looked them up to see how they work. I remembered there was a bit of a panic recently in Glasgow and Edinburgh when they were around, so I knew what they were, but didn’t know why they swarm as they do.

The wikipedia article was most useful:

In most species, the male ants also fly alongside them, although they are smaller and less noticeable… The queens fly for a while – sometimes being dispersed very long distances, and sometimes going only a few meters – then mate, and drop to the ground where they lose their wings, and attempt to start a colony[1]… The mass of flying insects often attracts the attention of predators such as birds, and it is common to see flocks of feeding birds gorging on the readily available food… This phenomenon occurs in many colonies simultaneously when the local weather conditions are appropriate, to reduce the effectiveness of predation and to ensure that the queens and males from different colonies stand a chance of meeting and interbreeding.

However, I’m sure that the journalist who wrote about the ants for the Bucks Herald found it more useful:

Wednesday saw millions of the insects crawl up from out of the ground to follow their larger, more noticable queens…the queens fly for a while – sometimes being dispersed very long distances, and sometimes going only a few metres – before mating and dropping to the ground where they lose their wings, and attempt to start a colony… The mass of flying insects often attracts the attention of predators such as birds, and it is common to see flocks of feeding birds gorging on the readily available food. The annual phenomenon occurs in many colonies simultaneously when the local weather conditions are appropriate as they were with temperattures (sic) hitting as high as 27 degrees in the Vale today.

Does this count as plagiarism?

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