A case for legalising illegal drugs?

Small things matter. Think about the way many people economise with water and electricity – not leaving the tap on when brushing their teeth; not filling the kettle with more water than is needed for that cup of tea. OK, so it’s a very small difference in the scale of things, but it could never be called insignificant.

The same is true for the casual purchase of small quantities of illegal drugs for personal use.

So what is the problem here? Well, who will deny that the illegal drug industry has brought vast wealth to some of the most vicious criminals on this planet.  And in their wake are the broken lives of men, women and children. Usually the most vulnerable in society, either through deprivation, poverty or sheer stupidity. The illicit drugs industry has been a direct contributing factor to the driving of people, including countless children, into prostitution and worse.

So each spliff you buy along the road contributes in a small, but never insignificant, way to driving these unfortunate people to ruin and death. If you so indulge yourself then you are complicit in these crimes.

My own view? Well, I think we should at least listen to the arguments for legalising the lot. Make it available from discreet licensed outlets. Even if taxed sufficiently to fund treatment of the health problems that would result from drug usage for some, it would still surely be a lot cheaper than what a street criminal would charge. Of course such a move should be combined with a health education programme to encourage people not to use the stuff, but sadly too many people seem quite impervious to the influence of good advice – after all, they still smoke, they still eat too much and they still don’t exercise. My own belief is that those wider lifestyle issues will continue to have a far greater impact of the health of the nation than the availability of de-criminalised drugs.

The abortion act of 1967 pretty well put paid to the back street abortionist who killed so many women. I’d like to see the same done to the drug barons and their miserable acolytes on the street corners.

Chuggers

The headline in today’s ‘Times’ concerns the aggressive behaviour of some charities toward donors and those perceived as potential donors, and so I thought I might share some of my own views.

I have always given to charities, but I am selective on the matter of to whom and what I will give. I have a favourite to which I give regularly – a care home for elderly people run by an order of nuns. The fact that I have no religious faith does not matter here – I think they do a good job with love and care. I get a very courteous greetings card at Christmas and almost always put a cheque in the post to them, for which I am graciously thanked and told that prayers are offered for me. Bless them. And if I sell one of the oil paintings I do from time to time I don’t take money, but ask the person who is buying the painting to contribute instead to this good cause. That way I don’t get into complicated tax wrangling. And if a young person is helping to pack bags at the supermarket checkout I like to ask all about what they are collecting for, and as well as dropping a pound into the bucket I congratulate them and wish them well. I just admire them, and they are always courteous and never pushy.

I will give to medical charities, but again to those less ‘popular’ with the sympathetic (and sentimental) public, and in particular to such as Alzheimer’s and mental health issues. The Salvation Army does good work, but as a non-believer I know that they are convinced that I am destined for Hell, being the sort of sect they are. I do forgive them for that though.

But I do find being approached by ‘chuggers’ in the street, a common enough occurrence, annoying. And it’s not a one off donation they want, I am told, but a commitment to more regular giving. I have no problem dealing with such: a charming young man or woman approaches me with an opening gambit along the lines of ‘may I have a minute of your time?’ to which I reply, politely, ‘no you may not’ and walk by. I don’t make an excuse. Why should I?

The charities I do favour are those that help the seriously marginalised and underprivileged – such as the elderly as I have mentioned, and the addicted and the homeless. The ‘Cinderella’ groups. I am less enamoured of most of the children’s charities – which may shock some of you – and animal charities. For if children are being neglected or ill treated it is simply a national disgrace and it is our government that should be addressing that, and imposing taxes to fund it. And so far as animals are concerned, the main problems seems to be that there are just too many of them. People who mistreat animals should be up in front of the courts. And if people can’t afford vetinary care for their pets, then they shouldn’t have pets. No-one has a ‘right’ to own an animal. I don’t have a pet because I know too well that to care for one properly demands huge commitment and not a little sacrifice. Instead I feed my garden birds who seem very appreciative, not only of the food I put out but also of the fact that there will not be a feline on the prowl in my back yard. Those are seen off with a gentle squirt from a hose pipe. Actually I like cats for their beauty, but not for their destruction or defaecating on my grass. So off they go.

As for mail from charities that comes through my door – in to the recycling it all goes (other than the Christmas card from the nuns). I just think it a dreadful waste of trees,

Walking the Dog

I like dogs – at a distance that is. They are beautiful (mostly) and joyful creatures. It’s a pleasure to see them out running after a pitched ball in our local park. Closer up they are too often less aesthetically pleasing. They piss against lamp posts, defaecate on the pavement and poke their noses up other dogs’ bottoms.

The dog mess nuisance is mostly less of a problem than it once was, dog owners having been educated to a degree to ‘bag and bin’ their dog waste. But it certainly remains a problem on our country lanes and footpaths. For a long time I have seen a tendency for dog walkers to gather up the mess, only to chuck the filled bag on to the pathway or into the bushes where it hangs to give the effect of a festooned devil’s Christmas tree.

But recently I have discovered that I am not the only one to find this behaviour particularly revolting. Along a couple of my favourite walks in Wiltshire someone has taken to pinning laminated notices on to gateposts. These read:

Dog Walkers!

Please bag up your shit and take it home with you!

Leaving it on the pathway or throwing it in the bushes

 is grossly offensive and a serious health hazard, particularly to children.

Now, I shall be curious to see whether these messages will have any effect. I am not optimistic, because it has always seemed to me that a minority of dog owners have a ‘to hell with everybody else’ attitude. You know the type – the ones who bleat at you ‘he won’t hurt you’ when their beloved mutt runs to you and jumps up, leaving dirty paw marks over your clean trousers.

We are, of course (or we are so often told) a nation of dog lovers. I’m not convinced. As a species, the domesticated dog has been bred into a diaspora of weird and wonderful shapes and sizes for the pleasure of his human masters and mistresses. Some are menacing, some passing strange. Some live simply wretched lives as a consequence of having been created as a sort of deliberately fashioned mutant. Their respiratory passages are contracted and convoluted so that ever breath is an effort; their joints are prone to dislocate; their eyelids so lax that the eyes have little or no protection from the elements and are a source of constant discomfort or pain.

The obsession with deformity in dogs is a left over, I guess, from Victorian or earlier times when attitudes towards animal suffering were rather, well, primitive. Indeed, times were when to see an animal being tortured was a popular public spectacle, and regrettably we seem not to have left that predilection entirely behind us. My point is that it cannot be disputed that dogs – and other animals - suffer because of what we require of them for our entertainment. And there are far too many of them, as is evidenced by the dogshit-on-public-pathways phenomenon.

Fibromyalgia – my experience as a doctor

I need to make it clear that I am not so unfortunate as to have been a sufferer from fibromyalgia. I am writing this more from the point of view of a doctor who has been involved in the care of people with the illness.

I worked as a full time GP in south east London from 1976 until 2006 when I retired from my practice. I then moved to the West County where I undertook part time locum work in both rural and urban settings until I reached the age of 65.

Curiously I cannot recall seeing a single case of fibromyalgia when I worked in London, nor talking with any patient who thought they might have the condition. I was nevertheless aware of it from my regular reading of medical journals. When I moved to Wiltshire I began to see cases quite regularly and quickly familiarised myself with current thought about the condition, and its treatment.

Casual enquiry among professional acquaintances as to why this geographical discrepancy might be resulted in the rather surprising answer that one of the local consultants in rheumatology had a particular interest in the disease. Patients were given the diagnosis and returned to their GP practices for further follow up. The GPs became aware of it and no doubt read further about the condition and picked up cases of their own. Curiously, these patients were then referred to the consultant for confirmation of the diagnosis. I say ‘curiously’ because the means by which a diagnosis is reach is partly a process of exclusion of other conditions, and then by a medical history and a standardised examination, all of which are well within the competence of a GP to carry out. No expensive or hazardous investigations are involved. And in most cases, once a diagnosis in given, the patients are referred back to the GP without further follow up from the specialist. Treatments offered are all available in a primary care setting. So it is not immediately clear why a specialist is involved at all, either with the diagnosis or management. It may be a matter of legitimacy – it is a life changing disease that usually runs a chronic course. Many sufferers are unable to work because of their symptoms and may have to be in receipt of benefits for many years. These are serious implications, and it may be speculated that the opinion of a specialist is needed to give weight to the diagnosis.

Of course, there is a lot that remains unknown about the condition, and treatments may sometimes be disappointingly ineffective. For this reason there is general agreement that much more research into the condition is required. Such research is usually carried out in specialist units. But I myself do not recall that any of my patients had been invited to participate in a clinical trial of any sort.

There is still a great deal that needs to be learned about fibromyalgia in terms of its cause, the nature of its pathology and best management of the condition. On the assumption that it is a real entity and one disease it simply cannot be that it is not within the scope of scientific investigation to answer these questions. 

Ghosts, Haunted Houses and the Supernatural

In the south east of Ireland, on a flat peninsula that thrusts out into the Celtic Sea, a fine house – a mansion indeed – stands dramatically and alone. It can be seen from upwards of twenty miles away. It has quite a history, including an association with the British Royal Family in the latter part of the 19th century. Like so many fine old houses in Ireland it has fallen into disrepair as so many did when English rule ended. For a while it was occupied by an order of nuns. When they moved out it was sold and for a brief time it became a hotel. Then towards the end of the 20^th century it was left unoccupied and at the mercy of thieves and vandals – and the elements which can be fiercely destructive there.

In the end it was sold on – to become a tourist attraction of a rather dubious brand: visitors are encouraged to come to experience ‘the most haunted house in Ireland’ and even to stay the night in its bleak, empty rooms.

It is, of course, yet another example of the sad phenomenon of the foolish and gullible being relieved of their money. Anyone with intelligence and discernment knows that all ghost stories are pure myth – concocted nonsense created with the cynical intention of achieving power over the credulous either with the intention of scaring people away from somewhere where the public are unwelcome, or conversely to attract them, usually with the intention – as in this instance – of making a profit out of them.

The house remains a virtual wreck. The upper floors are apparently so unsafe that they are ‘out of bounds’ to visitors. One has to give credit to the ingenuity of its owners. What else could have been done with this once fine old house other than to demolish it?

So, what is the particular myth in this case that successfully attracts so many visitors with nothing better to do? Well, it was put about that at a particular house party the Devil appeared, and when identified for what he was he made a quick exit through the ceiling, leaving a hole. And in a country where belief in the supernatural is still – tragically – very much ongoing – there is no shortage of people prepared to be gulled by this sort of nonsense. An no doubt many of them will move on next to one of the many sites where the Virgin Mary – or another of the Roman Catholic pantheon -  is said to have made an appearance, to salve and soothe themselves after having had the pants near scared off them.

Yet one should not make light of them and the thought of them being hoodwinked. Some people are actually quite seriously damaged by such experiences, and in particular the vulnerable and suggestible. I am not aware the proprietors take any serious steps to identify those who could be so harmed and deny them entry. Worse – small children are among the visitors, although I daresay there is an age limit imposed.

ME/CFS Chronic Fatigue, Fibromyalgia – experiences with GPs

A little over four years ago I had some thought-provoking comments on this blog from an ME/CFS sufferer. My post concerned speculation on ME/CFS from the perspective of the GP. The respondent who commented said: ‘If doctors would at least show some signs of empathy’. And I think that a very important message is contained in those few words. I am quite sure, too, that this plea would be one made by the majority, if not all, sufferers from the condition.

Since I wrote that piece (‘What do doctors think of ME/Chronic fatigue?’ 11^th March 2011) I have moved on. What I mean is, I have moved on four years into my retirement from general practice. And I have become a patient. I am not so unfortunate as to suffer from CFS, but I have experienced similar frustration to that complained of by those who are sufferers when they try in vain to get their GPs to take them seriously.

I am particularly concerned at the changes I have seen in family medicine – changes that were already creeping in during my final years as a GP. The sort of personal life-long care offered by perhaps the majority of GPs when I started in practice over 40 years ago is now a rarity, and actually looks set to die out completely. Doctors are under huge pressure and are highly regulated. I am sure that many who read this will be all too familiar with the consultation where the doctor barely looks at you, and instead taps data into her computer – data that she is obliged to gather for the purposes revealing prescribing patterns, the prevalence and incidence of this disease or that, and for her own appraisal and five yearly revalidation. Hardly a situation that favours the development of empathy as my correspondent so urgently wished for.

You may be of the opinion that GPs don’t know how lucky they are. Well, in that case, why is the NHS experiencing such a haemorrhage of GPS who have been trained at such expense? I am in regular communication with many of them, and a pretty miserable bunch they are, by and large.

I have been on medication for a chronic condition for a number of years now. It is monitored entirely by nurses at my GP practice. None of the doctors there has the faintest idea who I am. Were I to develop new symptoms that might indicate something seriously wrong I would expect to be put through a raft of tests initially, possibly without an in-depth medical history or clinical examination. On attending for follow-up I would probably see a different doctor entirely and perhaps yet another doctor on the next occasion. And were I to question such management I would be ‘reassured’ that this is now standard practice and all the doctors were equally competent. But where is the ‘empathy’?

I would have thought – and please correct me if you think I am wrong – that many of you who are sufferers from ME/CFS will be all too familiar with this. You attend with mystifying and frightening symptoms, and are you listened to? Is your fear and confusion acknowledged? Does the doctor turn away from the monitor and focus his entire attention upon you? Well, I would hope so. But I would bet my boots that this is not the common experience.

And what happens when the raft of blood and other tests all come back negative? What then? Are you dismissed? Or are you referred to a clinic with a two year wait? And if the tests do show something, how can you or how can your doctor know that the abnormality has any relevance at all to the symptoms you are experiencing? Disturbed kidney or thyroid function, or a degree of anaemia showing up does not necessarily have anything to do with the symptoms you initially took to your doctor. OK – so all the focus will go on the results of the tests and the diagnoses that transpire but it doesn’t mean that when these are attended to you will be all bright eyed and bushy tailed again. What it does mean is that the doctor is distracted from your original presentation (perhaps only too pleased to be) and it will be pushed aside.

When I was a GP trainer – supervising young doctors entering general practice – I required all my trainees to justify every test they ordered and to tell me what they were suspecting and what they expected each and every test to reveal. I daresay that if I, as a patient, asked my doctor why she was ordering this test or that I would be regarded as something of a nuisance at best.

No. Too many doctors do not have the time to listen. And I have every sympathy with them. Demand has rocketed, as have expectations. My own view is that this is largely the result of meddling by politicians and misinformation put about by the press.

There is a regrettable tendency, too, for doctors to say or at least to imply that the condition won’t kill you and there is no treatment they can offer for it, so there is no point in coming back. And if there was one, I would say to that ‘then God help you’.

On Faith, Prayer and Religious Belief

When I was a small child I said my prayers by the bedside at night because – well, because it was what the children of middle class English families did. My prayers were not answered, and I know now why this was. But not then, as God was a ‘given’. Expressing doubt in his existence was unwise in the extreme, particularly at the Anglican institutions where I was sent to school.

The experience of a boarding preparatory school in the 1950s at the age of seven – one year after the sudden death of my mother – was a sombre one to say the least. One lived constantly with a certain level of fear: of punishment, of bullying and something we did not then understand of the predilections of some of the masters. Prayer seemed the only option through which one might possibly obtain relief, and I prayed nightly and at length. Not that my mother might somehow be restored – I knew enough them to realise that that was never to be an option – but to be allowed simply to go home. Each morning I awaited the summons to be told that my father had telephoned to say that he had changed his mind and wanted me back to continue my education at a local day school. It never came. Hope faded, and the intense grief faded into a bearable numbness that became in the end, a part of life. Now it could be said that since even then, though I did not know it, since I was not possessed of any sincere religious belief then how could I expect an answer to a prayer? And this was the sort of neat non-answer one came to expect from the ‘genuine’ religious.

It is the same with suffering in general. Why does God allow such suffering in the world? is the perpetually repeated question. Because suffering is a necessary experience, we are told. It strengthens us, makes us holy. And we are privileged to suffer because in so doing we join Jesus in His suffering. And why are some people so wicked, so cruel to their fellow men and women? Because God gave us free will, we are told – some of us chose to live principled and ethical lives (those of faith, of course) while others – usually not believers – will become thieves and murderers. What a cheap cop out! What utter boloney!

Well, I am glad that I live in the real world now, because it is a beautiful and often joyous place, a place of limitless wonder. And when the realisation came that I had no religious faith and in fact never had any, the sense of release and relief was profound indeed. Pity I wasted all those hours on my knees when I could have been out running in the meadows.