Posted by: Nicholas Swetenham | July 31, 2009

Migrating to

Dear readers,

For Science, Biomedicine and Science in Politics relate posts, please subscribe to:

Blue Genes

Blue Genes Feed

Colin and I are posting there regularly.

Faced with the inability of fitting two blogs into an already packed schedule, and no longer being BMA representative for students at Cambridge University Medical School, I have decided that I will no longer be posting anything new to DFTF for the foreseeable future, if at all.

Thanks for reading, and I hope to see you on Blue Genes!


Posted by: colinhockings | June 8, 2009

Now with twice as much boffin goodness

Colin Hockings

Hello everyone, my name is Colin Hockings. Nico and I are graduating in the next few weeks and have decided to join forces.

We will have some quite different experiences in the next few years:  I’m the scientist,  he’s the medical student. For this reason we’re going to set up a new blog, all nicely professionally hosted, discussing  good science, bad science, and science in the media.

Over the next few months we will build up this new blog,  featuring posts from both of us as well as guest contributors: clever people that are going into science, journalism, and  medicine.

What makes us special? Firstly we have a very international background – englandfrancegermanyluxembourgaustraliasweden, not necessarily in that order. Nico will be reporting from London and Colin from Frankfurt. Secondly, we’re graduating in three weeks and will be entering the big bad worlds of science and medicine in the early days of this blog. Together, that means that we’ll have a fascinating perspective that I doubt you’ll find anywhere else.

With these bold words, I’ll leave you with a request: we’re currently working on creating a name that will best characterise our work. We welcome any suggestions!

Watch this space. We will be unveiling the new blog soon!

Posted by: Nicholas Swetenham | April 28, 2009

Swine flu: less reliable, but interesting links

Some other links for interest that are based on new media or social media – less reliable.

A world map of all the confirmed and suspected cases on Google can be found here:

Google Maps – H1N1 Swine Flu

A Flu Wiki has been created:

Flu Wiki

I also recommend the following infectious disease & public health blogs on Scienceblogs for some interesting commentary:

Effect Measure


Posted by: Nicholas Swetenham | April 27, 2009

Swine flu: reliable, up-to-date information

Influenza A virus (CDC)

Influenza A virus (CDC)

Governmental and inter-governmental agencies with reliable info:

World Health Organization – latest swine flu news.

Health Protection Agency – the source for UK info: some for everyone, some for health professionals.

Department of Health – the UK’s governmental branch for health

Center for Disease Control –  the US equivalent of the HPA. Twitter username: CDCEmergency.

NHS Choices – Information on infection control measure for the general public

Guidance for doctors by doctors:

BMA – the British Medical Association’s list of resources

Posted by: Nicholas Swetenham | April 27, 2009

Swine flu: an insight into crowd psychology

A pig - CC Yftach Herzog

A pig - CC Yftach Herzog

How have social media responded?

Who knew that swine flu could also infect Twitter? Yet this is what appears to have happened in the last 24 hours, with thousands of Twitter users turning to their favorite service to query each other about this nascent and potentially lethal threat as well as to share news and latest developments from Mexico, Texas, Kansas and New York (you can check most recent Twitter updates on the subject by searching for “swine flu” and “#swineflu”).


The author of the article above argues that twitter is actually full of misinformation and scare-mongering. However, I disagree. As I tracked the #swineflu channel on twitter trends, the number of posters urging people to use reliable sources increased. There were plenty of randoms making inappropriate jokes or grabs for attention, of course. Then,  as Sunday afternoon rolled on, something strange happened: the appearance of dedicated swine flu twitters. H1N1swineflu, influezame, swineflualerts, and Gripe_porcina, to name but a few. They are now posting high-quality, real-time updates, as is the CDC which makes the twitter stream highly informative. So I am no longer particularly worried that people are being overly panicked by twitter.

Interestingly, some people were discussing political implications: some users were blaming illegal immigrants (while of course legal migrants on airplanes are the real danger), and others were pointing that many US States don’t have paid sick days, and that this might encourage reckless behaviour in a pandemic.

Posted by: Nicholas Swetenham | April 26, 2009

This house would selectively legalise heroin – carried


Bayer brand Heroin, in the old days

That was the topic of the Thursday April 23 main debate at the Cambridge Union Society, Cambridge’s prestigious student debating society. The speakers in Proposition were:

KATE McKENZIE, mother of a girl living with heroin addiction who featured on television.

FRANCIS WILKINSON, former Chief Constable of Gwent Police.

DANNY KUSHLICK, founder of Transform Drug Policy Foundation, a pro-legalisation advocacy group.

The speakers in Opposition were:

PROFESSOR NEIL McKEGANEY, former White House advisor on cannabis.

KATHY GYNGELL, chair of the Prisons and Addiction Forum at the Centre for Policy Studies, a conservative-leaning think tank.

RICHARD LAU, Union debater, ranked 11th in the world for British Parliamentary style debating.

Of course, prescribing heroin must be only one tool in a panoply of the weapons of public health. Support for addicts is even more important. Everyone agreed on that premise. The debate centred on whether it would be a useful addition to add prescription heroin for addicts to those tools. It could be used as part of a long-term treatment scheme to get people off heroin, or used for people who have tried and failed many times to detox despite their best efforts.

The debate was defined by the proposition as centering around prescribing heroin on the NHS (for those readers not familiar, that means giving it for free at the taxpayer’s expense). After the debate, attendees voted on the motion by walking through the appropriate door (Ayes, Noes, Abstentions). The Ayes carried the motion by a large majority. I made a floor speech, which I have (approximately) reconstructed from my notes below:

Nicholas Swetenham, Churchill College.

Ladies and gentleman, I am a medical student. I also have the pleasure of representing our twelve-hundred and fifty medical students at the British Medical Association. I would like to respond to the speakers in opposition.

Doctors prescribe drugs that can cause harm, as most can, if necessary. Doctors have a duty to intervene to protect the public, if necessary. And doctors put aside their prejudices to protect their patients’ health by whatever means necessary.

We are taught to use only those treatments that work. And whatever the good old boys sat around the table at the Royal College may think, I can assure you that a young generation of medical students that is willing to adopt evidence-base practices is coming. Heroin prescription works in all those countries that use it. I urge you to support this motion. Thank you.

The reference to the RCGP is a response to this press release from 2002 which was quoted by Professor McKeganey. I am unconvinced by its arguments: that heroin has a low Therapeutic Index (so does methadone) and that it is more expensive (if we mass-produced it it wouldn’t be). When I talk about countries that use it, I am thinking of Sweden and Switzerland. Switzerland, under its system of direct democracy, they recently approved a referendum to make it permanent:

Final results from the national referendum showed 68% of voters supported the plan.

The scheme, allowing addicts to inject the drug under medical supervision at a clinic, began in Zurich 14 years ago before spreading across the country.

But in another referendum vote, 63% of voters rejected the decriminalisation of cannabis.BBC

This Times of London piece discusses the costs of the scheme vs. the costs of the drug scene in the UK. The scheme still has its opponents but heroin addiction and its human, social and financial cost has dropped dramatically in Switzerland.

Posted by: Nicholas Swetenham | April 22, 2009

Coke for tummy-ache – fact or fiction?


On the BBC today:

The National Institute for Health and Clinical Excellence said it was a myth that sugary drinks could help ease bouts of gastroenteritis.


Oral rehydration salts (ORS) are definitely the best solution for a dehydrated child. But for one with a minor tummy ache, surely a sweet drink might make them feel better? Perhaps a small amount could be used to wash out the taste of ORS, which is not that great (but not that bad either).

Posted by: Nicholas Swetenham | April 16, 2009

Who wants home births?

Water Birth

Water Birth

The Department of Health has promised that all women in the UK would have the choice between home and hospital birth. Enter this Dutch Study. It is a retrospective study comparing various outcomes, comprising most Dutch women in midwife-led care 2000-2006. Obstetrician-led care is excluded (it’s not clear whether this is because obstetricians deal with mostly high-risk mothers).

Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births

Conclusion: This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.


And, just for kicks, here is an older North Ameican study in the BMJ on the same topic. I read about this story yesterday. But I didn’t blog about it because, as it turns out, it wasn’t yet published on the BJOG website, so for all I could tell, the media were prattling on about an imaginary study.

A pretty balanced report on the BBC:

Home births ‘as safe as hospital’

Research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

Home births have long been debated amid concerns about their safety.

UK obstetricians welcomed the study – published in the journal BJOG – but said it may not apply universally.


Also covered in the Times and Telegraph.

The RCOG/RCM joint guidance on this topic:

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.1-3

Melanie Reid argues in the Time that, in fact, most reserved tea-sipping pinky-extending British mothers will have no interest in this possibility; we’re not like the sandal-wearing hippies in the Netherlands:

When a pregnant woman announces that she intends to have her baby at home, surrounded by friends and family, I always have an irresistible impulse to glance down and check if she’s wearing sandals. She usually is. Disgraceful stereotyping it may be, but it is impossible to deny that home births are the preserve of homely, principled types who may then go on to breastfeed their child until it goes to secondary school.


That said, home births are not all sunshine and rainbows. NHS Blog Doctor likes to report on the dangers of home births. I wonder what he will have to say on this study which will be used for years to come by proponents of home birth as an evidence base for generalising the practice.

Posted by: Nicholas Swetenham | April 15, 2009

More on the Horse Boy story – NY times

Some people may not agree with the New York Times’ political stances (liberal, and generally pro-Democrat, in American terminology). I have come to realise, however, that American newspapers report on health science reasonably well as a whole (perhaps because their consumers are quite savvy?) and the NY Times is one of the best for science reporting. Their ‘Well’ blog features opinions

In today’s New York Times, reporter Motoko Rich writes about a new book, “The Horse Boy,” that chronicles a father’s trip to Mongolia to ride horses and visit shamans as part of an effort to heal his son’s autism. Ms. Rich asked several top autism experts whether the book offers important insights or false hope for families coping with autism. Here’s what they said:

NY Times

Commentary from some big names, including Cambridge’s very own Simon Baron-Cohen, and many other clinicians/scientists/advocates with varied but balanced opinions. Top notch.

Posted by: Nicholas Swetenham | April 2, 2009

Junior doctors salary increase – 1.5%



The Doctors’ and Dentists’ Review Body has recommended a 1.5% salary increas for junior doctors, which the government has accepted. Other NHS employees get 2% under a 3-year agreement (BBC) except servicemen (2.8%) and MPs get 2.3% although ministers, David Cameron and Nick Clegg refused the pay rise (Guardian).

Please follow this link for more information from the BMA. Hamish Meldrum, Chair of BMA Council, said:

“Doctors will be disappointed at this award. They will feel that the DDRB appears to have capitulated to government pressure. Whilst we appreciate that tough decisions have to be taken during this period of economic difficulty, holding back on doctors’ pay is not the answer.”

Student debt has also been covered by the Evening Standard:

Tom Foley, a 27-year-old trainee doctor and BMA spokesman on medical student finance, said: “As unemployment rises and economic problems increase it is likely that lower income families will have less money to spend helping their children through medical school. Students are also finding it more difficult to get study loans from banks -something that I could not have got through university without – and may find it increasingly challenging to get part-time work or work in term breaks as everyone scrambles for a limited number of vacancies.”

Evening Standard

The BMA is opposed to the lifting of the fee cap. There is however a glimmer regarding student loans. Tom Foley, Chair of the Student Finance Subcommittee, told me:

The interest rate on student loans is actually based on the RPI, which is now at 0%. If it stays at 0 next month, it will be locked in as the rate for the entire 12 months from Sept 09 to Sept 10. So for that period, student loans will be interest free!

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