Saturday, June 30, 2012

Time to Decriminalise Drug Addiction?

Just the word ‘addict’ is enough to conjure up a negative impression in many people’s minds. Precede it with the words ‘book’, ‘telly’, or ‘exercise’ and it softens the perception. However, try ‘drug’ or ‘alcohol’ instead and the negativism drops off the chart. In western society, drug addicts are often perceived to be amongst the worst members of society, with alcoholics not that far behind. For many people, the concept invokes images of seedy squats, down-and-outs, crime, prostitution, discarded needles, HIV, hepatitis, wasted lives, early deaths…the list is endlessly dismal. Such people are perceived by many to be untrustworthy as employees and undesirable as neighbours.

However, what if your neighbour happened to be the author Jack London, famous for his books ‘The Call of the Wild’ and ‘White Fang’, who rewarded each 500 words written with an alcoholic drink; or the writer Robert Louis Stevenson (of Jekyll and Hyde fame), addicted to hashish, opium and cocaine, and who thought wine was ‘bottled poetry’? Alternatively, consider the poet Dylan Thomas, the mind behind such invocative poetry as ‘Do not go gentle into that good night’, and who rather pertinently said that ‘an alcoholic is someone you don’t like, who drinks as much as you do’. Then there was Aldous Huxley, the author of the classic ‘The Doors of Perception’, which was written whilst under the influence of the psychotropic drug mescaline. The list is endless, and includes the likes of poets and writers such as Thomas de Quincey, Lord Byron, Percy Bysshe Shelley, John Keats, Charles Dickens, Edgar Allen Poe, Samuel Taylor Coleridge, and Sir Arthur Conan Doyle, all of whom were addicted to the opium and alcohol mixture known as laudanum.

Now, not for one moment do I want anyone to believe that I am condoning the misuse of drugs and alcohol. Many of the aforementioned famous personalities died of illness brought on by addiction. My point is to illustrate that our perception of whether or not the addiction is generally acceptable depends on whom the person is, and how they deal with their addiction. For example, the controlled use of alcohol is accepted by most people in our society; being drunk in the city centre on a Saturday night is not acceptable to most. With some notable exceptions (such as the late Amy Winehouse), what also differentiates the acceptable from the unacceptable is the availability of money. Drugs tend to be expensive; mainly because of their illicit status. This in turn fuels the negative spiral of people turning to crime and dropping out of acceptable society to fuel their addiction. To compound the issue, in many areas the most successful rehabilitation centres are only available to the wealthy.

Drug addiction, as anthropological research has shown, has always been with us. It is equally true to say that it will never disappear, and it is not just a problem associated with the young. According to some studies, illicit drug use in those over 50 years has increased by a factor of ten since the mid-1990s. In London, for example, one in ten over-sixties regularly uses cannabis. Other drugs featured in these studies of the older population include cocaine, ecstasy, LSD, amphetamines, and tranquilisers.

Additionally, throughout the world the criminalisation of drugs is causing hardship in, and destruction of, whole countries; many of which are in South America. As a result, global initiatives are now taking place to consider drug policy reform. There is a very rational, public health argument for decriminalising drugs, and substituting litigation with appropriately resourced treatment for addicts. Increasingly, doctors are calling for evidence-based policies in respect to drugs. The evidence in respect to the potential health-gains for society is out there; we now all need to suppress our prejudices and encourage our politicians to effectively engage in this important debate.

(First published in the Scunthorpe Telegraph, Thursday, 31st May 2012)

Tuesday, June 26, 2012

Time for More Compassion

All professional bodies have codes of conduct, expounding the ethical principles that underpin the manner in which its members are expected to act. For doctors, the code comes in the guise of a document called Good Medical Practice, published by the General Medical Council (GMC). Likewise, the House of Commons produces a guidance code for Members of Parliament, Funeral Directors have theirs, and the Press Complaints Commission operates a Code of Practice for newspapers. In Addis Ababa, Ethiopia, where the World Congress on Public Health recently took place, there was a publically displayed list of Principles of Ethical Public Service, listing integrity, loyalty, transparency, confidentiality, honesty, accountability, serving the public interest, exercising legitimate authority, impartiality, respect for law, responsiveness and leadership as pre-requisites for service. In America there is even a Code of Practice for Columnists. The interesting thing is that nowhere in these documents appears the word ‘compassion’.

The Oxford English Dictionary defines compassion as ‘sympathetic pity and concern for the sufferings or misfortunes of others’. In turn, ‘sympathy’ is the feeling of pity and concern for the affected person or people; it is showing that one understands their plight.

However, Kamran Abbasi, editor of the Journal of the Royal Society of Medicine, recently expressed the opinion that ‘compassion isn’t even a dirty word in the NHS…with clinicians too preoccupied with targets, efficiency drives, and restructuring to care for their patients’ (JRSM 105, p. 93).

Yet, according to a survey by the GMC, compassion, kindness and empathy are qualities which people feel are important and should be portrayed by doctors. Why then, do so many codes of practice leave out such important values? Is it that you can train people to act with all the principles expounded in the Addis Ababa example above, but cannot enforce a quality that comes from deep within one’s own personality?

The Dalai Lama, the Tibetan Buddhist spiritual leader, recently wrote on the social network site Twitter (@DalaiLama) that ‘even our personal virtues, such as patience and our sense of ethics, are all developed in dependence upon others’. He said ‘fear, hatred, and suspicion narrow your mind - compassion opens it’. In his view, ‘once you realize that compassion is useful, that it is something really worthwhile, you immediately develop a willingness to cultivate it’.

To those who are religious and profess their faith in their daily lives and actions, the concept of compassion is real and becomes second nature. Many would agree that compassion helps in effectively communicating with others. Such action can also be self-rewarding for, again in the words of the Dalai Lama, ‘if you become more concerned for the welfare of others, you will experience a sense of calm, inner strength and self-confidence’.

Of course, self-reward is not principally what serving humankind is all about. However, nobody should object to a free dose of the ‘feel-good factor’, and if it means that the behaviour that earned the reward is more likely to be repeated, then who should complain about that? The sad part about all this is that ‘tender loving care’ or TLC as it was often known, is no longer seen as an appropriate form of treatment on its own. Indeed, it is often completely lacking, even when every other treatment has been exhausted.

Even in the 21st century, nobody has all the answers, and there is no cure for all ills. Compassion is often the most valuable tool left in the armoury and it should be deployed more frequently and effectively by all healthcare workers. It is also a tool that should be honestly wielded by everyone in public service (politicians take note), and indeed, by all of us in our daily interactions with each other. That said, it is not something that can be learned or fabricated; it needs to be felt. The starting point is to search deep inside oneself, find that hidden quality, and then bring it to the surface. The entire world would be a better place if we all put compassion into it.

First published in the Scunthorpe Telegraph, Thursday, 24th May 2012.

Saturday, June 16, 2012

Wednesday, June 13, 2012

Beware a Secretary of State Bearing Gifts

Today, I would like to remind you of a tale from Greek mythology. It concerns the city of Troy; a city that did in fact exist and whose ruins can still be seen today in northwest Turkey. Troy was the centre of the Trojan Wars, which occurred somewhere between 1200 to 1400 B.C. About that time, the ruling Royal family of Troy was King Priam and Queen Hecuba, and they had a beautiful daughter called Cassandra. Unfortunately for her, Cassandra had the power of foresight. I say ‘unfortunately’, as on many occasions nobody was prepared to believe her. One of her disregarded prophesies was the destruction of the city of Troy; something which indeed took place (remember the story of the Trojan Horse?). In modern times, the term ‘Cassandra Syndrome’ is used to describe the malady affecting those who disbelieve predictions of doom until the events actually occur.    

Now, on no account am I suggesting that I can be compared with an attractive lady of royal parentage. However, I do feel that I am one of a growing band of doctors who have the power of prophesy (solely, it must be said, in relation to the future of the NHS) but have up to now been largely ignored. I can almost hear you yawn at this stage, and I appreciate that it may be a little tedious, but I make no apologies for returning again to the subject of the new Health & Social Care Act. Please read on, because I have a job for you all to undertake.

The fact is that, although the Act has been passed by Parliament, the detail has still to be implemented. In this respect, we can all be influential and potentially alter the destructive power of this Trojan Horse that now stands at the gates of the NHS.

There are two major issues for us. The first is to save the ‘National’ in the NHS. In an attempt to form a shared vision of the future of the NHS, the Royal College of General Practitioners (RCGP) is trying to encourage the adoption of a set of ten ‘core values’, against which the Act will be implemented. These values are: greater involvement of GPs in shaping NHS care, a UK-wide agreement on free NHS services, integration of health and social care, reduced bureaucracy and increased efficiency, patient empowerment, respect for patients’ beliefs and valuing diversity, patient involvement in shaping NHS services, encouraging innovation, promotion of public health, and cutting inequalities.

The second major issue stems from one of these values; that is the need for a national approach to public health. Under the new Act, public health services are moving from the umbrella of the NHS to the local councils. With no disrespect to my local authority colleagues, there is a widespread concern that councils are ill-prepared for this change, especially at times of epidemics. Already, we have seen a diminution of national advertising campaigns (last year’s influenza vaccine campaign suffered as a result, and we had a higher death rate from influenza than most other European countries). The fear is that, with more decisions of this nature being taken locally, will the public be as well informed of major health risks as in previous years? Sometimes, national leadership is the most effect way to get a message across.

So, your task, readers one and all, is to join me, along with my colleagues at the RCGP, and start to question how the Act is being implemented. Talk to your doctors, question your MPs, attend local council meetings, get involved with patient participation groups, write letters to the newspapers; in essence, take control of the future of your NHS. Please do not become victims of the Cassandra Syndrome. The Secretary of State for Health has delivered a modern day Trojan Horse to the doors of the NHS; don’t accept it as the gift he likes to pretend it is. Look to see what lies beneath and neutralise its threat now before it is too late and the NHS becomes your Troy.

(First published in the Scunthorpe Telegraph, Thursday 26th April 2012)

Watching with John Henry Newman

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