Dr Will Welfare

Covid PCR tests: at least 43,000 in UK may have had false negatives | Coronavirus | The Guardian

What a great name for a public health doc?

Dr Will Welfare, the public health incident director at UKHSA, said: “There is no evidence of any faults with LFD or PCR test kits themselves and the public should remain confident in using them and in other laboratory services currently provided.”

The west is the author of its own weakness

The west is the author of its own weakness | Financial Times

What Trump understood, as did populists elsewhere, is that the voters’ respect for established politics is rooted in a bargain. Public faith in democracy — in the rule of law and the institutions of the state — rests on a perception that the system at least nods towards fairness. There have been reforms to that end since the crash, but little to suggest they are enough.

There was nothing wrong with the ambition of the post cold war optimists. It remains hard to see how the world can work without liberal democracy and a rules-based international system. What the optimists missed then, and the China watchers overlook now, is the hollowing out of trust in democracy at home. Of course, China is a potential threat. A second presidential term for Trump would be a much more dangerous one.

It may be that history will conclude that the excessive optimism of the 1990s is being mirrored today by too much pessimism. That’s a judgment I intend to leave to others. For a political commentator, 25 years in the same slot is long enough. So this is my last column. I will continue to write from time to time as an FT contributing editor, but otherwise intend to go in search of a better understanding of, well, history.

Philip Stephens

Twin miseries

It was not deliberate policy; it simply seemed to be only men who applied, usually refugees from the twin miseries of academia: low salaries and high tables.

The Fear Index. Robert Harris

Line manager

Every time I hear the term line-manager used by or about an academic, retirement gets a day closer.

I once wrote.

Business has always hated competition

Full quote:

Business has always hated competition. The City of London, home to our banking sector, was founded on the trade guilds which policed quality but whose hidden agenda was to fix prices.

Sounds familiar.

Paul Lewis in the FT

Shurely shum mishtake

by reestheskin on 29/09/2021

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From today’s FT online. A moment’s hesitation. Who is this fed guy?

Voting for Turkeys

The Government is telling the world that it is fighting night and day to save Christmas, in September. Don’t you find that the fight to save Christmas starts earlier every year? I know I do. But what message does that send? Things are so bad, putting a turkey on the table in three months time, is now top of the government’s agenda.

Jonty’s jottings, Jonty Bloom

The Lie of Nation Building

The Lie of Nation Building | by Fintan O’Toole | The New York Review of Books

Fintan O’Toole in fine form.

The great question of America’s twenty-year war in Afghanistan was not whether the Afghans were fit for democracy. It was whether democratic values were strong enough in the US to be projected onto a traumatized society seven thousand miles away. Those values include the accountability of the people in power, the consistent and universal application of human rights, a clear understanding of what policies are trying to achieve, the prevention of corrupt financial influence over political decisions, and the fundamental truthfulness of public utterances. In the first two decades of the twenty-first century, the American republic was fighting, and often losing, a domestic battle to uphold those values for its own citizens.

Critics of the war argued that the US could not create a polity in its own image on the far side of the world. The tragic truth is that in many ways it did exactly that.

The easiest way to cope with the reality that the longest war in US history (longer than World War I, World War II, and Vietnam put together) has ended in defeat and an ignominious and deadly evacuation is to fall back on the belief that the Afghans were never capable of creating or sustaining a modern nation-state. The US, after all, spent $143 billion on “nation building” in Afghanistan. Adjusted for inflation, that is more than it spent on the Marshall Plan to rebuild Western Europe after World War II. Why did it not achieve similar results? The problem, it is comforting to conclude, must lie with the Afghans themselves: too backward, too poor, too inextricably entangled in medieval tribalism and obscurantist religion. [emphasis added]

Worth reading in full.

The next five years will be worse

The next five years will be worse for English universities than the past five years have been. And the five after that could be worse still.

Alison Wolf writing in 2015. And don’t think this is all to do with Covid.

Can higher education’s golden age of plenty continue? | Times Higher Education (THE)

School’s out for summer

by reestheskin on 28/06/2021

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Things will be even quieter here than usual. Summer is here, and I have some long form writing to do. Take a break.

Good teaching

by reestheskin on 27/06/2021

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A comment on this article on the WONKHE site. Scale matters, but not in the way that the C-suite want.

It has been salutary being an insider-academic doing visit days. It has confirmed my long held view that one of the most important things for a would be student is to get on a smallish course irrespective of subject wherein they will be personally known and recognized by their lecturers, not just an allocated ‘tutor’ or ‘supervisor’.

In my personal, and anecdotal, admittedly, experience, of family members, and of teaching undergrads this has determined more than anything how well students do, in terms of academic performance and personal development. It is not wholly related to RG vs post-92 either. The latter seem to do really well, if the cohort is small.

The Long Now

Which living thing is the best ‘mascot’ for long-term thinking? – The Long-termist’s Field Guide

Richard Fisher:

Perhaps the most famous one is about the oaks of New College, Oxford. The tale goes that, sometime in the 1800s, officials realised they needed replacement beams for their main hall. To their surprise, they discovered that the college’s founders had planted a grove of oaks in the 1300s to supply the job. The story is often told to illustrate the virtues of long-term planning – even the former British Prime Minister David Cameron recounted it once during a Tory party conference speech. However, it is apocryphal. “I am amazed that this myth still continues: long-term tenacity if not long-term thinking,” the college archivist Jennifer Thorp once told me.

Such a shame. I always loved the story.

A university is a gym not a hotel

(source ?)

Regulatory subventions

Pluralistic: 02 Jun 2021 – Pluralistic: Daily links from Cory Doctorow

Uber’s main project has always been regulatory, not technological: that’s why it funneled hundreds of millions of dollars into passing California’s Proposition 22, a law that legalized worker misclassification and banned unionization.

The irony? Uber is a “bezzle” – JK Galbraith’s name for “the magic interval when a confidence trickster knows he has the money he has appropriated but the victim does not yet understand that he has lost it.” Uber is a scam and it will never be profitable.

I give you the tea bag and Tractatus!

A century ago Ludwig Wittgenstein changed philosophy for ever | The Economist

Of all the innovations that sprang from the trenches of the first world war—the zip, the tea bag, the tank—the “Tractatus Logico-Philosophicus” must be among the most elegant and humane.

That the book ever made it into print was miraculous. Before the war, as a student at Cambridge, Wittgenstein’s talent was clear to his contemporaries, who begged him to put his many thoughts into writing. He refused, fearing that an imperfect work of philosophy was worthless. His mentor, Bertrand Russell, made a habit of taking notes when the two spoke, lest his protégé’s genius be lost to memory. Wittgenstein himself had other preoccupations, principally suicide.

 Now I don’t have to feel so guilty

Letter: Socialist historian foresaw Covid work habits in 1967 | Financial Times

Anyone who has read the socialist historian EP Thompson’s article “Time, Work-Discipline and Industrial Capitalism”, written in 1967 and collected in Customs in Common in 1993, will recognise his account of pre-industrial work habits in Pilita Clark’s article about modern workers’ reluctance to engage on Mondays (Business Life, May 17).

Thompson identifies a work pattern composed of “alternate bouts of intense labour and of idleness, wherever men were in control of their own working lives”. He remarks that the “pattern persists among some self-employed — artists, writers, small farmers, and perhaps also with students — today [1967], and provokes the question whether it is not a natural human work-rhythm”.

Michael Williams, Letchworth Garden City, Hertfordshire, UK.

Arithmetic matters

Summer reading 2021 | Science

From a review of “The Ascent of Information” by Caleb Scharf.

Every cat GIF shared on social media, credit card swiped, video watched on a streaming platform, and website visited add more data to the mind-bending 2.5 quintillion bytes of information that humans produce every single day. All of that information has a cost: Data centers alone consume about 47 billion watts, equivalent to the resting metabolism of more than a tenth of all the humans on the planet.

Scharf begins by invoking William Shakespeare, whose legacy permeates the public consciousness more than four centuries after his death, to show just how powerful the dataome can be. On the basis of the average physical weight of one of his plays, “it is possible that altogether the simple act of human arms raising and lowering copies of Shakespeare’s writings has expended over 4 trillion joules of energy,” he writes. These calculations do not even account for the energy expended as the neurons in our brains fire to make sense of the Bard’s language.

Better not a “mere snip” at £6m a litre

Thoroughbred horses are increasingly inbred | The Economist

Superstar sires “cover”, as horsey types call mating, over 200 mares per year, up from 40 in Northern Dancer’s day.

At first, horse breeders did not consider inbreeding a problem. On the contrary: horses, like maidens, were better when purer. Within a century of the arrival of those three stallions, it was decided that the job of perfecting the horse had been done so well that the stud book was closed to new entrants. Aristocrats policed the parentage of their horses, listing their dams and sires in Weatherbys stud book. In 1826 Burke’s Peerage appeared, allowing aristocrats to do much the same for themselves. Francis Galton, the father of eugenics, recommended that “no time ought to be lost” in instituting a human equivalent to the stud book, to record not class, but fitness and form.

Eugenics has fallen out of fashion. The horsey equivalent has not. Thoroughbreds can earn far more from propagating their race than from running races. At the National Stud, one commands a fee of £25,000 ($35,000) for a cover. Galileo, among the world’s finest stallions, is rumoured to command £600,000 a pop.

Such fees make the very best thoroughbred semen one of the world’s most expensive substances, at around £6m a litre.

Resilience and sustainability

Hack the Planet: Tega Brain on Leaks, Glitches, and Preposterous Futures

This quote is actually from an article about washing machines, water supplies and ‘wastage’. But it just reminds me of the technical and intellectual debt that is drowning health care and the NHS

That balancing act reminds me of something engineer and professor Deb Chachra wrote in one of her newsletters. She wrote, “Sustainability always looks like underutilization when compared to resource extraction.”

UK Universities and their dismal future

The Guardian view on funding universities: the market model isn’t working | Editorial | The Guardian

But perhaps the time has come for a deeper rethink. The marketisation of the higher education sector, through the loan system, successfully expanded access and fears of social exclusion were not borne out. But the numbers are not looking good, and there has also been a significant cultural cost. Universities, increasingly run as competing businesses by overpaid vice-chancellors and a coterie of financial managers, have lost touch with the collegiate ethos that used to inform campus life. Crude systems of measurement and monitoring have eroded trust and generated false incentives, leading, for example, to grade inflation. A drive to cut costs has targeted staff pay and pensions, and created a disillusioned underclass of pitifully rewarded young academics on insecure short-term contracts. Strike action, currently taking place at the universities of Leicester and Liverpool, has become commonplace.

Removing, or greatly reducing, upfront fees and recasting the direct funding relationship between government and universities could help address such problems. The market model pioneered 10 years ago has begun to look dated and unsustainable. New thinking is needed.

Yes, I know all of this. But solutions, please. And ones that can be defended and not crapped all-over in that place 400 miles south of me.

What do I need to know to pass the exam?

by reestheskin on 24/06/2021

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After thirty-five years of teaching medical students dermatology the 2021 GMC’s Medical Licensing Assessment (MLA) content map makes for dispiriting reading. The document states that it sets out the core knowledge expected of those entering UK practice. It doesn’t.

My complaint is not the self-serving wish of the specialist who feels that his subject deserves more attention — I would willingly remove much of what the GMC demand. Nor is it that the document elides basic clinical terminology such as acute and chronic (in dermatology, the term refers to morphology rather than just time). Nor, bizarrely, that it omits mention of those acute dermatoses with a case-fatality rate higher than that of stroke or myocardial infarction: bullous pemphigoid, pemphigus, and Stevens-Johnson syndrome/Toxic Epidermal Necrolysis are curiously absent. No, my frustrations lie with the fact that the approach taken by the GMC, whilst superficially attractive, reveals a lack of insight into, and, knowledge of medicine and expertise in medicine. The whole GMC perspective, based on a lack of domain expertise, is that somehow they can regulate anything. That somehow there is a formula for ‘how to regulate’. This week, medicine; next week, the Civil Aviation Authority. The world is not like that — well it shouldn’t be.

Making a diagnosis can be considered a categorisation task in which you not only need to know about the positive features of the index diagnosis, but also those features of differential diagnoses that are absent in the index case (for Sherlock Holmes aficionados, the latter correspond to the ‘curious incident of the dog in the night’ issue). It is this characteristic that underpins all the traditional ‘compare and contrast’ questions, or the hallowed ‘list the differentials, and then strike them off one-by-one’.

Take melanoma, which the MLA content guide includes. Melanoma diagnosis requires accounting for both positive and negative features. For the negative features, you have to know about the diagnostic features of the common differentials that are not found in melanomas. This entails knowing something about the differentials, and, as the saying goes, if you can’t name them, you can’t see them. A back of the envelope calculation: for every single case of melanoma there are a quarter of a million cases made up of five to ten diagnostic classes that are not melanomas. These include melanocytic nevi, solar lentigines, and seborrhoeic keratoses; these lesions are ubiquitous in any adult. But the MLA fails to mention them. What is a student to make of this? Do they need to learn about them or not? Or are they to be left with the impression that a pigmented lesion that has increased in size and changed colour is most likely a melanomas (answer:false).

Second, the guide essentially provides a list of nouns, with little in the way of modifiers. Students should know about ‘acute rashes’ and ‘chronic rashes‘ — terms I should say that jar on the ear of any domain expert — but which conditions are we talking about, and exactly what about each of these conditions should students know?

In some domains of knowledge it is indeed possible to define an ability or skill succinctly. For instance, in mathematics, you might want students to be able to solve first-order differential equations. The competence is simply stated, and the examiner can choose from an almost infinite number of permutations. If we were to think about this in information theory terms, we would say we can highly compress in a faithful (lossless) way what we want students to know. But medicine is not like this.

Take psoriasis as another example from the MLA. Once we move beyond expecting students to know how to spell the word watch what happens as you try to define all those features of psoriasis you wish them to know about. By the time you have you finished listing what exactly you want a student to know, you have essentially written the textbook chapter. We are unable to match the clever data compression algorithms that generate MP3 formats or photograph compressions. Medical texts do indeed contain lots of annoying details — no E=MC2 for us — but it is these details that constitute domain expertise. But we can all agree, that we can alter the chapter length as an explicit function of what we want students to know.

Once you move to a national syllabus (and for tests of professional competence, I am a fan) you need to replace what you have lost; namely, the far more explicit ‘local’ guides such as ‘read my lecture notes’ or ‘use this book but skip chapters x, y and z’ that students could once rely on. The most interesting question is whether this is now better done at the level of the individual medical school or, as for many non-medical professional qualifications, at the national level.

Finally, many year ago, Michael Power, in his book, The Audit Society: Rituals of Verification demolished the sort of thinking that characterises the whole GMC mindset. As the BMJ once said, there is little in British medicine that the GMC cannot make worse. Pity the poor students.

The philosopher Stuart Hampshire served in British military intelligence during the Second World War. When we were colleagues at Princeton he told me about the following incident, which must have taken place shortly a)er the Normandy landings. The French Resistance had captured an important collaborator, who was thought to have information that would be useful to the Allies. Hampshire was sent to interrogate him. When he arrived, the head of the Resistance unit told Hampshire he could question the man, but that when he was through they were going to shoot him: that’s what they always did with these people. He then le) Hampshire alone with the prisoner. The man said immediately that he would tell Hampshire nothing unless Hampshire guaranteed he would be turned over to the British. Hampshire replied that he could not give such a guarantee. So the man told him nothing before he was shot by the French.

Another philosopher, when I told him this story, commented drily that what it showed was that Hampshire was a very poor choice for the assignment.

LRB Vol. 43 No. 11 · 3 June 2021, Types of Intuition, by Thomas Nagel.

Innovation, and rule breaking

by reestheskin on 23/06/2021

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How ‘creative destruction’ drives innovation and prosperity | Financial Times

From time to time, I vow not to read any more comments on the FT website. Trolls aside, I clearly live in a different universe. But then I return. It is indeed a signal-noise problem, but one in which the weighting has to be such that the fresh shoots are not overlooked. I know nothing about Paul A Myers, and I assume he lives in the US, but over the years you he has given me pause for thought on many occasions. One recent example below.

Comment from Paul A Myers

Science-based innovation largely comes out of the base of 90 research universities. One can risk an over-generalization and say there are no “universities” in a non-constitutional democratic country, or authoritarian regime. Engineering institutes maybe, but not research universities. Research is serendipity and quirky; engineering is regular and reliable. Engineering loves rules; research loves breaking them. The two fields are similar but worship at different altars.

This contrast is also true of medicine and science. Medicine is regulated to hell and back — badly, often — but I like my planes that way too. But, in John Naughton’s words, if you want great research, buy Aeron chairs, and hide the costs off the balance sheet lest the accountants start discounting all the possible futures.

Keyboard warriors and the reverse Voltaire

We are living through a time of online outrage and increasing irrationalism, and the combination has not been a happy one for public discussion. Generally, shallow emotion seems to be in the driving seat for many keyboard warriors: not the slow burn of genuine anger that fuels the prolonged, difficult pursuit of a worthwhile goal, but rather a feel-good performative outrage whose main expression is typing furious snark onto a computer screen before switching over to Netflix. [emphasis added]

Material Girls, by Kathleen Stock.

And applicable to a lot more than the topic of her excellent book. Sometimes, it takes a philosopher to spell out exactly what people are saying. She also introduced me to the reverse Voltaire from Mary Leng

I agree with what you have to say, but will fight to the death to prevent you from saying it.

Which experts?

by reestheskin on 16/06/2021

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The following is from Pulse, a magazine that is aimed at GPs. My point is not so much about the specifics but a more general point.

Headache, runny nose and sore throat top three symptoms of Delta variant, says researcher – Pulse Today

Professor Spector said cases were rising exponentially and people who have only had one vaccine dose should not be complacent.

The UK really does now have a problem and we’ll probably be seeing, in a week, 20,000 cases and by 21st June well in excess of that number,’ he said. ‘Most of these infections are occurring in unvaccinated people. We’re only seeing slight increases in the vaccinated group and most of those in the single vaccinated group,’ he said.

He goes on to say:

Covid is also acting differently now. Its more like a bad cold in this younger population and people don’t realise that and it hasn’t come across in any of the government information.This means that people might think they’ve got some sort of seasonal cold and they still go out to parties and might spread around to six other people and we think this is fuelling a lot of the problem.

He added:

The number one symptom is headache, followed by runny nose, sore throat and fever. Not the old classic symptoms. We don’t see loss of smell in the top ten any more, this variant seems to be working slightly differently.

He advised people:

who were feeling unwell to stay at home for a few days, use lateral flow tests with a confirmation PCR test if they get a positive result.

Now comes the boilerplate Orwellian response from the Department of Health and Social Care

[A] spokesperson said: ‘Everyone in England, regardless of whether they are showing symptoms, can now access rapid testing twice a week for free, in line with clinical guidance.

Experts keep the symptoms of Covid-19 under constant review and anyone experiencing the key symptoms – a high temperature, a new continuous cough, or a loss or change to sense of smell or taste – should get a PCR test as soon as possible and immediately self-isolate along with their household.’ [emphasis added]

Two points:

  1. The spokesperson, as usual, is not named nor are the credentials of this person available. How are we to assess their competence or reliability? At least you can look Prof Spector up and check out his work.
  2. Following on from the first point, which experts are we talking about? Most expertise, we know, is not within the Dept of Health. One of the most interesting features of the pandemic has been the recognition that the government nor the state (including the Dept of Health) have a monopoly on knowledge. Of course, we know they will seek to conceal and dissemble for political reasons. But the fact remains that many people now appreciate that knowledge is diffused more widely within society. David King and his alternative SAGE group have played an important role — beyond just Covid.

Why don’t we produce enough doctors?

by reestheskin on 15/06/2021

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The following excerpts are from a letter in the FT from Professor Rachel Jenkins from Kings College, London.

Letter: West’s wooing of medical staff weakens pandemic response | Financial Times

An effective pandemic response capability requires such a framework to give legal bite to the 2010 WHO code of practice on how health personnel are recruited globally — something with which rich countries, especially the UK, have singularly failed to comply.

The code recommends that member states discourage active recruitment from so-called low and middle income countries facing critical shortages of health workers; that they never recruit from the 57 poorest countries and create their own sustainable workforce through workforce planning, education, training and retention strategies.

The OECD club of rich nations recently reported that the number of migrant doctors and nurses from low and middle income countries working in OECD member states had increased by 60 per cent over the last 20 years. This trend has been further exacerbated by the pandemic, as rich countries have deliberately loosened their health worker recruitment requirements.

The UK’s long standing failure to train adequate numbers of medical students and to show global leadership in reversing this enormous subsidy of skilled health workers from poor countries to rich countries is not only a national disgrace.

I have thought about this issue for years. Thought might not be the right word, however, as I have never worked out the ‘why’ of what is going on. I do not know the correct figure, but from memory perhaps 40% of UK practising doctors trained overseas. Why? A few thoughts.

  1. People argue that it is extremely expensive to train doctors. I do not find this a convincing argument. First, I do not believe the government’s figures which are top-down flows, rather than costs identifiable at the coal-face. Second, even if I did believe the government’s figures, a crucial question remains: does it need to be this expensive? I don’t think it does. Of course, that the argument is mistaken, doesn’t mean that it cannot be widely quoted or used for political purposes.
  2. The more doctors you have, the higher health care expenditure will be. I suspect that is something to this argument, and it will appeal to chancellors. But of course, the issue is not that we cap doctor numbers, but that we don’t train enough to begin with. Still, I wouldn’t dismiss this line of thinking out of hand.
  3. I don’t think you can predict how many doctors you need. Not just for the future, but for any time-point. Sorry. But of course you can make mistakes of varying size and direction.
  4. Pace the late Henry Miller, I would encourage medical graduates to look at the possibilities of working outwith the UK. Some might like it.
  5. I wonder why people think this whole topic has anything to do with the government. They may be the problem rather than the solution. Besides, if we gave the ‘tuition’ money directly to the students, it might be spent more prudently.

No mothers’ milk here

Nestlé document says majority of its food portfolio is unhealthy | Financial Times

Nestlé document says majority of its food portfolio is unhealthy

An internal company presentation acknowledges more than 60% of products do not meet ‘recognised definition of health’.

No surprises here, then.

Body lice

by reestheskin on 14/06/2021

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It is one of dermatology’s tedious and fun facts that, in contradistinction to say scabies or head lice, you treat body lice by treating not the patient (directly) but the clothing. The pharmacological agent is a washing machine. But the excerpt quoted below tells you something wonderful about science: you get things out that you never expected. Spontaneous generation — not in the real world — but in the world of ideas. Well, almost.

How clothing and climate change kickstarted agriculture | Aeon Essays

Scientific efforts to shed light on the prehistory of clothes have received an unexpected boost from another line of research, the study of clothing lice, or body lice. These blood-sucking insects make their home mainly on clothes and they evolved from head lice when people began to use clothes on a regular basis. Research teams in Germany and the United States analysed the genomes of head and clothing lice to estimate when the clothing parasites split from the head ones. One advantage of the lice research is that the results are independent from other sources of evidence about the origin of clothes, such as archaeology and palaeoclimatology. The German team, led by Mark Stoneking at the Max Planck Institute for Evolutionary Anthropology, came up with a date of 70,000 years ago, revised to 100,000 years ago, early in the last ice age. The US team led by David Reed at the University of Florida reported a similar date of around 80,000 years ago, and maybe as early as 170,000 years ago during the previous ice age. These findings from the lice research suggest that our habit of wearing clothes was established quite late in hominin evolution.

Gödel

Journey to the Edge of Reason by Stephen Budiansky — ruthless logic | Financial Times

Ever since I read of how Gödel’s work has rendered decades of work by Bertrand Russell and others void, Gödel has fascinated me. Not that I can follow the raw proofs. But his work speaks of a wonderful Platonic world that is hard not to fall in love with. Two quotes: the first is new to me, the second, sadly not.

Einstein sponsored his US citizenship, which Gödel almost torpedoed by telling the judge that he had found a logical inconsistency in the constitution that would allow a person to establish a dictatorship in America.

His end, when it came, was tragic. His paranoia grew and he became convinced that his food was being poisoned. When this had happened earlier in his life, his wife had managed to taste test and spoon feed him to health but this time she too was ill and in January 1978, he died in hospital, curled into a foetal position and weighing only 65 pounds.

Questionable blood

by reestheskin on 07/06/2021

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Infected blood scandal: government knew of contaminated plasma ‘long before it admitted it’ | Contaminated blood scandal | The Guardian

From the Guardian.

Among the victims of the contaminated blood scandal, which is the subject of a public inquiry, were 1,240 British haemophilia patients, most of whom have since died. They were infected with HIV in the 1980s through an untreated blood product known as Factor VIII.

In 1983, Ken Clarke, then a health minister, denied any threat was posed by Factor VIII. In one instance, on 14 November 1983, he told parliament: “There is no conclusive evidence that Aids is transmitted by blood products.”

However, documents discovered at the national archives by Jason Evans, whose father died after receiving contaminated blood and who founded the Factor 8 campaign, paint a contrasting picture.

In a letter dated 4 May 1983, Hugh Rossi, then a minister in the Department of Health and Social Security (DHSS), told a constituent: “It is an extremely worrying situation, particularly as I read in the weekend press that the disease is now being transmitted by blood plasma which has been imported from the United States.”

(HIV screening for all blood donated in the UK only began on 14 October 1985.)

Rossi’s letter was considered damaging enough for the government to seek to prevent its release in 1990 during legal action over the scandal, by which time Clarke was health secretary.

In another letter uncovered by Evans, dated 22 March 1990, a Department of Health official wrote to government lawyers saying it wanted to withhold Rossi’s letter, despite admitting the legal basis for doing so was “questionable”.

Clarke has a legal background. There is a large logical gap between between denying ‘any threat’ and the statement that there is ‘no conclusive evidence’. The Department of Health would be better named the Department without Integrity. Recent events suggest things are no better now. It didn’t all start with Johnson.