MacDoctor

The Blanket man is dead. Ben Hana, AKA the Blanket Man, died in Wellington Hospital yesterday, age 54. Apparently, Wellington mourns his passing

The MacDoctor generally takes a benign view of hobos. Although they provide the streets with some distressing sights and odours, they are generally harmless and cause little trouble. But the MacDoctor does not subscribe to the school of thought that describes the Blanket man as an “icon” or a “character” or even a “celebrity”. The MacDoctor has no praises for this man, only pity.

The MacDoctor also does not subscribe to the bleeding heart school of thought where the Blanket Man’s condition is all the fault of society. Ben Hana could have accessed plenty of help had he wished – alcohol and drug rehab, WINZ, counseling, and several newspapers willing to publish his story and support his journey back up the social ladder. He chose not to avail himself of any of this.

His death should not be a rallying cry for more funding for homeless people, nor an excuse for mawkish sentimentality. His death is the sad result of alcoholism, drug abuse and the complete abandonment of all self-respect. We should not be dressing his passing in pretty colours, for the truth of it is ugly. We should not be celebrating this man’s life but weeping over the terrible waste of it.

100 years ago this year the Titanic struck and iceberg and, despite the claims for her being unsinkable, sank in arctic waters taking 1517 souls with her. In an uncanny (but fortunately less deadly) replay, the Italian cruise ship Costa Concordia struck a reef and sank, listing sharply to one side. Although the passengers are likening the scenes inside to the scene inside Titanic when she sank, I suspect that the scenes were more likely reminiscent of that much older movie The Poseidon Adventure. Titanic was only briefly vertical just before sinking, but Costa Concordia has been at a 45 degree (or greater) list since half an hour or so after the accident. The other difference between Titanic and Costa Concordia is that the former did not slam into a well marked reef. Have they no navigators aboard modern ships or are they all travelling on GPS autopilots?

The MacDoctor’s sympathies go out to the survivors and the families of those who did not survive. However, he can’t help noticing that there are plenty of ironic parallels between this shipwreck and the shipwreck of the downgraded european economies. Including the GPS autopilot.

Additional

Seems that Emmerson sees the parallels too…

This is the face of Carl Drewer, former white supremacist and general all-around bad boy.

Carl is having the “skinhead” tattoo he had put on in prison removed by laser treatment courtesy of the kind donations of the public and Radio DJ Simon Barnett. This is not the good part of the story.

This is:

“He said each treatment cost about $160, so he would have money donated towards his tattoo removal left over [from the $3,000 that has been donated].

“Drewett said he would like to donate it to someone else in the same situation or a charity.

““That’s obviously why people give it to me, it’s for a cause so it can stay like that.

““I think it’d be wrong of me to keep it for personal reasons.” [emphasis mine]”

Spam Journalism: The spurious use of sensational headlines to add spice to an otherwise pointless article. 

And in the quest for ever more sensational headline, MacDoctor brings you the original spam – food.

Tasty foods linked to addiction

“Sugar and fat produce changes in the brain which resemble the effects of addictive drugs, a Waikato University scientist says.”

but wait, there’s more..

““We don’t want to send the message that if you’re eating a sandwich, that you’re consuming a drug. However palatable, high-sugar foods very often increase activity of the same brain circuits that are involved in the creation of the addictive state.

““So we believe this addictive-like behaviour stems from the effect that nutrients, in particular sugar and to some extent fat, have on the same set of brain areas that drive addiction.””

Of course, almost anything that stimulates the pleasure centres in the brain can be addictive. so this piece of research is unlikely to be telling anything we didn’t know. On the other hand, we can be sure that it is not telling us that tasty foods have any link with addiction beyond the fact that they are pleasurable.

A researcher into the benefits of resveratrol, the ingredient in red wine that is thought to have cardiovascular benefits, has been found to be falsifying his results. Dr. Dipak Das is alleged to have fabricated, falsified and manipulated data for several minor published studies of the substance.

This is a little weird in itself because there is no need to falsify data for resveratrol. There are plenty of studies that indicate its benefits, so there is none of the pressure that comes from wanting to justify a new drug. One presumes that Das falsified his data just because he was too lazy to redo his experiment (or perhaps even do it at all).

This sort of behaviour is not merely a nuisance and an embarassment. In the eyes of the public, it throws all of the research on resveratrol into doubt. Hence the rather terse assessment from another researcher:

“But Dr Nir Barzilai, whose research team conducts resveratrol research at the Albert Einstein College of Medicine in New York, told The Associated Press that Das is not a major figure in the field.

“The new allegations will not make a material difference to resveratrol research, which is being conducted extensively around the world with encouraging results from many labs, Barzilai said.”

I suspect Dr. Barzilai realises that Das’ antics have made it just that little bit harder to get funding for resveratrol research. If it is any consolation, the MacDoctor still thinks the stuff is great and will be having a glass of red wine with his meal tonight. His heart is good…

The stoush between Ports of Auckland and the Maritime union appears to be heating up. Len Brown has at last showed up and planted himself down firmly on the side of PoAL, which is as it should be. It would have been utterly bizarre for the Mayor to side with the union against a business owned by the council. Not that Mr. Brown is incapable of such weirdness, but it is good to see he has restrained himself on this occasion.

The MacDoctor has read much on this issue and he thinks that there is nothing unusual happening. Blogs neatly divide in predictable party lines. The Right appear to be concentrating on the overpaid, lazy stevedores and their greedy attitudes, which is rather unfair considering the few stevedores the MacDoctor has met work long, hard hours. The Left are emphasising safety and family life while spitting their usual venom at the rich (some, of which, is being sprayed on Len Brown for being a “scab”). The venom rather undermines the rest of their message of sweetness and the light of reason.

The Media appear to be doing what they do best – drawing out a story as long as possible with as little effort. Reprinting press releases for the most part. Not one has found out what the average dockworkers salary is, or how many hours he actually works. No-one has asked how MUNZ measures productivity and how PoAL measures it – The MacDoctor is betting they have two very different ideas as to what the word means. He suspects MUNZ will be talking containers per day and PoAL will be quoting $ per container.

It is clear to the MacDoctor that the dispute is not about money – PoAL is being generous in their offer and MUNZ is actually offering to take less. It is also not really about safety, though MUNZ would have us believe it is. PoAL are happy for stevedores to take long breaks – just between shortened shifts, at their own expense. The dispute is not even about lifestyle because, frankly, shift-work is lousy, no matter how you cut it (the MacDoctor has done plenty of it).  Flexibility in rosters can cut both ways – it can free you to be able to work in ways that suit your lifestyle more, rather than less. Of course, it is not the one-size-fits-all solution beloved of unions.

In the end, this is not even about job security and hours as the protracted nature of the dispute has chased away large customers and lay-offs have become inevitable.

This industrial action is about what all long industrial actions are about.

Control.

Is PoAL controlled by the shareholders and the board, or is it controlled by the union? That is what the fight is about. The lives of the stevedores involved are a secondary consideration, as are the customers and the business of the port. Even less of a consideration are the ratepayers who will wind up all paying higher rates should PoAL be permanently damaged by this squabble.

The MacDoctor is not sure who will win this one, but he is sure of one thing. The time for a peaceable settlement is long gone. This one will get bloody (hopefully metaphorically speaking).

The Rena has finally actually split in two after several weeks of being reported by the media as “splitting”. Apart from the temporary sudden increase in debris from the ship, this may actually be a good thing, in the long run. The MacDoctor has been told that it may be possible to float the back half off the reef and ground it on the shore, making removal of those containers considerably easier. It may also be that the front portion of the ship will be more stable without the more mobile back half dragging on it. Preferring optimism to the relentless negativity of the press, the MacDoctor hopes this is an accurate assessment. He would be interested in hearing the opinions of the salvors on this.

Regardless of the outcome, he wishes to offer his congratulations to the salvors who have done a sterling job so far, in very difficult circumstances. Without their efforts, there would not have been room for optimism of any description.

Additional:

On the other hand, it could just sink.

I have been meaning to blog about this article in Stuff on Electroconvulsive Therapy. As with almost every media article I have every seen on the subject, this one is thoroughly biased against ECT. It is as if journalists cannot resist dredging up the checkered and lurid past of ECT and presenting current ECT practice in the same light. I note that the stories of the two people in the article, one intensely negative and one lukewarm positive, are both taken from elderly people who had their ECT decades ago. The first before I was born, in the early fifties, and the second in the early nineties. I would not have been difficult to interview someone who had had ECT in the past couple of years, but this would not be in keeping with the meme of evil psychiatrists and their dark practices.

Modern ECT is performed under general anaesthetic with a dose of muscle relaxant on board. The patient is asleep the entire procedure and the muscle relaxant ensures that the electrically-induced convulsive episode in the brain does not cause convulsion of muscles in the body. The electrical dose is now carefully measured and is far lower than the doses used in the 1950s. Some ECT is now done with electrodes implanted into specific areas of the brain, which further reduces the electrical dose and enhances the effect. These electrodes are removed after the session (in case anyone thinks this may be a re-run of Michael Crichton’s Terminal Man). There is also an increasing tendency to use magnetic, rather than electrical stimulation which may reduce the transient amnesia often caused by ECT. These latter two techniques are still somewhat experimental, but there is a wealth of evidence[1] that ECT in its current form is a valid and useful technique in the treatment of a number of disorders, notably refractory and severe depression.

It is of little surprise that the article goes on to quote Professor John Read who considers ECT to be “dangerous and ineffective”. Little surprise because Dr Read is the author of a recent review paper[2] that came to the conclusion that ECT was no better than placebo. This paper has recently been criticised in the latest issue of International Review of Psychiatry[3] for its excessive reliance on several small randomised controlled trials which compared ECT to placebo and found no difference, and his limited, qualitative method of review.

The paper was also co-authored with Dr. Richard Bentnall whose books Madness Explained and Doctoring the Mind are heavily weighted against the medical model of psychiatry. I have not read the first book, but the latter I found to be  full of psychiatry’s most abject failures while being remarkably free of its successes. I particularly liked the somewhat paranoid feel to the chapter on drug companies. Apparently we have all been duped as to the effectiveness of psychotropic drugs. As a prescriber of said drugs, it is remarkable how stupid I feel not noticing that they don’t work (yes, this is sarcasm).

The irony is that a very recent Cochrane review meta-analysis, that can be found online here, has found only limited evidence that Cognitive Behavioural Therapy itself is effective in treating depression. I have found CBT to be very useful for my patients, so I treat this paper a little skeptically as well.

Psychologists and psychiatrists have been at loggerheads over the treatment of mental illness/behavioural problems for a century and I don’t see it resolving very soon. Unfortunately, the danger of strong anti-medical stances like Dr Read’s is that patients read books like the above and articles such as the one discussed and then decide to stop their medication in an unsupervised fashion, with disastrous results. Of course, Dr Read would dispute this, as he does not think psychotrophic medication works. Yet, I have had two patients die in exactly this way (stopped meds because they heard that they don’t work) in the past 18 months.

As a GP, I long ago adopted the attitude of “whatever works” in trying to help my patients with mental health issues. I regularly prescribe psychotrophic medication and regularly refer to an excellent therapist, often both at the same time. For patients who are clearly severely mentally ill (manic, psychotic, delusional or suicidal), I always refer directly to our mental health unit. Some of these patients may well get ECT (though I can’t recall any), as this is done in Waitemata. I have no preference about this one way or the other. All that really matters is that my patients get better. I sometimes think that academics lose sight of that.

References

1. Carney, S., Cowen, P., Geddes, J., Goodwin, G., Rogers, R., Dearness, K., et al. Efficacy and safety of electroconvulsive therapy in depressive disorders: A systematic review and meta-analysis. Lancet, 2003:361, 799–808.

2. Read, J.  Bentall, R. The effectiveness of electroconvulsive therapy: A literature review. Epidemiologia e Psichiatria Sociale, 2010: 19, 333–347.

3. Allan CL, Ebmeier KP. The Use of ECT and MST in treating depression. International Review of Psychiatry Oct 2011, Vol. 23, No. 5: 400–412

Apologies to Matt Harding whose body I have stolen (because only Matt can dance like Matt… )

The latest round in the arguments against partial sales of assets is the treasury report from Ernst and Young which apparently says that these assets are performing well when compared to similar assets in the private sector. I confess to viewing that piece of information a little dubiously when the same annual Crown monitoring report (PDF found here) says that Mighty River Power (said to be the first company on the block) lost 20,000 customers in the 2010/11 fiscal year. That does not sound like a great performance to me. Plenty of room for improvement, I would have thought.

Still, be that as it may, in my simplistic economic world, I tend to look only at the cash figures involved. To me, those are the only figures that truly matter and there are only two of them. The first is the amount of actual cash paid to the government in the fiscal year – not the capital gains or retained earnings – just the cash. That figure is $95 million. 49% of that is $46.5 million. That is how much money the government loses each year by selling MRP.

The second figure is how much it would cost to keep. The independent valuation for MRP is $3,631 million. 49% of that is $1,779 million. Assuming the government could borrow at a mere 5% (English was borrowing extra last year because he could get a rate a little over 5%, so this is conservative), the interest on borrowing this amount is $89 million. This figure is bigger than 46.5 million, so it is worth selling Mighty River Power.

This is very “rough and ready”, of course. The government may get more or less money for its 49% shareholding. The actual loss of income from the sale is less because this money will now be going to others as taxable income and therefore some of it will return to government coffers as income tax. Actual cash from shares may be more or less than this depending on how Mighty River does with more private input.

All of this financial consideration is probably irrelevant anyway. National want to sell down these assets because they (correctly in my opinion) see no reason why a government should be dabbling in electricity generation. Labour hate the sales because they think government should be the be-all-and-end-all of everything. They like to call these assets “strategic”. This is code for “we don’t trust the market”.

You could call Ports of Auckland a strategic asset for Auckland. Look what the (local) government has achieved with that. I suspect their inability to stand up to a strong union will cost rate-payers dearly. Does anyone think for a moment that Labour would not find itself in a similar position eventually with State Owned Enterprises?