Corbyn is *dangerous* on health

Some two decades ago, in Sydney, Australia, I ran a campaign. Many of my friends who were living with HIV/Aids were living in dire poverty. One of my friends was surviving in part on what he could grow in his back garden. So myself and the founding Editor of Sydney's gay newspaper (who sadly died before the campaign wound down) started a campaign to draw attention to their plight and demand that people lobbying around HIV/Aids take the issue of poverty more seriously.

We were successful and I ended up getting an award. What we also got was a hell of a lot of grief from those running HIV/Aids lobbying because, to describe their comments broadly, we were distracting from the big picture. And that big picture was making sure that new drugs could get trialed quickly, that promising drugs were properly supported and that as many as possible could get into trials (this was a time when candidates would be excluded for reasons such as that they might get pregnant).

Although I'm proud of that campaign, looking back I'm not proud of how those leaders were portrayed. This was a time before HIV drugs that really worked became widely available. Some of the hopeful ones were prolonging lives but many, many people were still dying. I am not unusual in having 50 people, including many good friends, die. My generation of gay men fought like rats in a sack over how best to fight this. There were a couple of other policy ideas which I supported which I got seriously thrashed over, as well as my being involved in a clinical trial of herbal medicine.

When you're in that sack it can be hard to see any big picture, and this is what I and many others missed. What those leaders were doing was literally fighting for our lives and, in many cases, their own. Nothing could stand in the way of getting drugs out which could prolong or save people's lives, including theirs.

That job involved making compromises and it meant working with government and it meant working with the pharmaceutical companies. Yes, sometimes lobbying them including running campaigns on certain issues against them, but mostly it was about putting on a suit and tie and attending endless meetings and reviewing a vast amount of documents. Many of those activists ended up become so skilled they could probably have qualified as pharmacists.

Who would they have sat opposite? People like the Head of Policy and Government Relations (the former job of contender for Labour Party Leader Owen Smith MP) for a company like Pfizer. They would work with them and - I know this for a fact - most of the people sat opposite would work in good faith back with the activists.

Standing outside with a placard only got you so far. This is a hard lesson gay activists learned very early on over HIV/Aids. Knowing when to invade a Cathedral and when to sit on a Committee with so-called 'Big Pharma'. That was the sort of practicality required in order to save as many as could be saved.

Gobsmacking stupid Corbyn comments

Launching his bid to retain the Labour leadership, Corbyn said this week:

I hope Owen will fully agree with me that our NHS should be free at the point of use, should be run by publicly employed workers working for the NHS not for private contractors, and medical research shouldn’t be farmed out to big pharmaceutical companies like Pfizer and others but should be funded through the Medical Research Council.

Isabel Hardman of The Spectator explained that the reason he made this stupid comment was:

It plays into the suspicion of many of his supporters that big business is always bad and doesn’t help society, whether that be by employing a lot of people, or, in the case for big pharma, responding to demand for drugs by researching and producing drugs. Big pharma is one of those dirty bogeymen that it is easy to set up as The Enemy, without really thinking through what the implications of taking out that Enemy might be.

The Medical Research Council (MRC) last year spent £506 million on research grants. Pfizer spent $6.6 billion (£4.8 billion).  The world’s top 10 pharmaceutical companies between them spent just under £50 billion – 100 times as much as the MRC.

When I heard Corbyn's remarks I immediately thought of my dead friends and yelled very loudly on Twitter, for which I got a mostly positive response. How fucking dare he play politics with something as serious as this?

Let me just go back to what happened in Australia. Activists then would have positively wanted someone like an Owen Smith as the Head of Policy and Government Relations for a company like Pfizer. Anyone who thinks otherwise wasn't there and should just butt out.

Corbyn's policy suggestion would be an absolute disaster for health (not that he's ever going to be PM, of course). This should disqualify him but as Isabel suggested it's the opposite because his base has stupidly forgotten the lessons from something like HIV/Aids and prefer pious posturing to actual policies which help actual people. Anyone can dig up or even tell personal stories about some awful thing 'Big Pharma' has done. Harder is coming up with ways you can make sure those who produce most of the drugs that real people need do that essential job.

Instead we get jawdroppingly stupid memes like this circulating alongside endless crap - led by Corbyn, Diane Abbott et al - that working for drug companies means you can't be a socialist and that therefore disqualifies Smith.

Or ones like these that demonise pharmaceutical companies (none of the below is true):

 

A diluted scientific nerve

Corbyn is also a big, big fan of the con job known as homeopathy having signed a number of motions in Parliament backing it including one wanting NHS homeopathic hospitals and another which not only criticised the House of Commons' Science and Technology Committee investigation into homeopathy but, as the science writer Ben Goldacre puts it, its language included "vindictive" attacks on him including "ad homs against me personally."

Asked to defend his signature on one motion here is what Corbyn wrote:

Junior doctor: Corbyn "b******s"

During his reign Corbyn has been criticised for mouthing platitudes on health but failing to support his Shadow Health Minister, failing to support striking junior doctors and failing to stop his Shadow Chancellor from trying to corner health policy for himself.

Will Turner, a junior doctor picketing St Thomas' Hospital - just a few hundred yards from where Prime Ministers Questions was taking place in the Commons - criticised Corbyn for not mentioning their strike at PMQs.

Dr Turner said: "It should be big news. It should be talked about on the biggest platform of political discussion we have got. We are unsure of the Labour agenda. They seem to be very vocal about Jeremy Hunt, very vocally pro the NHS, but not very vocal about junior doctors.

"One hundred per cent, Corbyn should have raised it. They are the Labour movement, it's a huge mobilisation of a massive work force. It's a missed opportunity."

Mr Corbyn raised education, child poverty and the economy but did not criticise the Prime Minister over the Government’s handling of the strikes.

Joe Lipton, a 32-year-old junior doctor also picketing at St Thomas', said Mr Corbyn had disappointed him.

Dr Lipton, of Beckenham, south east London, said: "I don't feel surprised. It's a familiar sense of anger that this is slipping down the political and public agenda when all of us have so much strength of feeling. I'm disappointed there isn't a vocal opposing speaking on our behalf.

"Jeremy Corbyn has spoken about the NHS in general but it is the fact he hasn't raised it today in parliament, when we are on strike for a record 48 hours, that I am disappointed about."

A consultant, who refused to give his name, described the Labour leader's silence as "b******s".

(Source)

The shadow health secretary, Heidi Alexander, had to stage a physical sit-in outside Corbyn’s office in order to get a decision from him on Labour party policy on the NHS.

(Source)

Heidi Alexander, who quit as shadow health secretary last weekend, has criticised John McDonnell’s “totally unacceptable” conduct in setting up a team of NHS policy advisers without telling her.

The Guardian reported earlier on Thursday that McDonnell, the shadow chancellor, had secretly created a group of advisers, bypassing Labour’s usual policymaking processes, and that two of the advisers were or until recently had been members of other political parties. McDonnell’s involvement with the group was first disclosed by Health Policy Insight, an influential source of NHS analysis.

In a series of tweets on Thursday, Alexander said: “John McDonnell invited NHS campaigners to a meeting in the Commons but didn’t invite me. I challenged him about it. I was then invited and I was shouted at by some of the attendees.”

After that meeting on 13 April, she said, “John McDonnell then invited them to form an advisory group (again not telling me). I found out about this, said it was totally unacceptable and it must not be an advisory group.”

(Source)

If it isn't clear by now that Jeremy Corbyn on health is not just incompetent but positively dangerous then I don't know what evidence will convince. But then the Dear Leader has made clear he's not a huge fan of 'evidence based' solutions now hasn't he?



======


MRC/drug research info via Ross Clark.

Corbyn screengrab credit @twlldun

UK medical research funding breakdown image via @josephclift

Thanks to Glyn for prodding me into writing this.

The death of satire – an important appeal

This is a repost from Steve Walker's SKWAWKBOX

As 38 Degrees and other campaign groups have highlighted, the government’s “Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Bill” threatens (among many other bad things) to make it practically impossible to expose government lies and misdeeds in the run-up to an election, not to mention hamstringing the main form of organised representation left to ordinary people, by inflicting yet another evisceration on unions.

If the letter of the law is applied, even satire, as a tool of highlighting the absurdity of government attitude and policy, could be prosecutable if it can be considered as attempting to influence people’s voting intentions. This move by the government will effectively make dissent illegal – and has been condemned even by Conservative blogs such as The Spectator.

But while stifling dissent by members of the public, it would be incredibly naive to think that this bill will prevent the main reason given for its introduction – the influence of lobbyists. Big Corporate will still spend huge sums influencing politicians – effectively buying policy.

The death of satire and the continuing, even growing, influence of wealthy companies and individuals on government policy – that’s our future if this bill is rammed through Parliament, as seems likely.

So, while satire is still legal, film-maker and SKWAWKBOX reader Jon LeBrocq, whose excellent guest post ‘Love letters to a Tory MP‘ can be found here, has decided to use it to highlight the real problem – and hopefully to raise funds to promote awareness of it even further.

In a stroke of genius, John has launched a satirical – yet deadly serious – crowdfunding appeal to raise funds to buy back some government policy.

After all, buying back what should be ours in the first place is hardly without precedent – only this month, £53 million of public money was spent to ‘buy back’ a privately-run NHS surgical centre because of several avoidable deaths (strangely without the media fanfare that accompanies fictional avoidable deaths in proper NHS hospitals).

The satirical appeal to buy the government’s interest in our wellbeing, which should have been ours all along, is a crucial means of raising awareness of what’s being done by this robber-government as it exploits a corrupt politics. Its nominal aim, to raise £100,000 to buy some policy, echoes the infamous offer that £100k is a ‘premier league’ donation that will guarantee serious attention from the PM.


You can visit it here – and I encourage you to do so. It’s a humourous moment that will bring a bitter-sweet smile to your face – with a deadly serious message that needs to be spread.

And if you can afford to chip in a few quid, please do. Any money that is raised will go toward continuing and enlarging the satire – for example by making a film on the appeal that should go viral to the embarrassment of this government and any corrupt or venal politician.

Related articles

• Alert! Conservative Government wants to make People Power Illegal.
• The new Lobbying Bill will criminalise even basic campaigning by Trade Unions

No, Guardian, we can't have nice things

Oh, the irony.

In the Guardian Polly Toynbee argues for the new NHS database of patient records and the scheme whereby researchers can make us of it. (Toynbee is the Guardian's doyenne.)

She patiently explains that it will use anonymised data and people can opt out and there are layers of privacy protections. Any fears about privacy are overblown and we already see benefits such as identifying possible new cancer drugs.

The fear is that patients will be identified, losing control of their records and trust in their GPs. But the protections are many and thorough: patients records transmitted to the Health and Social Care Information Centre are fed through an automated anonymiser. The information commissioner has strict oversight over each stage. The Royal College of GPs and the British Medical Association back the project.

Is there any risk? Yes, some rogue researcher always might – with difficulty – trace back to the probable patient. But that's only the same risk as with previous use of patient data. Next week's leaflets and posters will tell patients they can refuse to let their records be used: under the present system 750,000 patients do opt out.

She rails against other newspapers for their 'scare tactics' that the data will leak and could be sold.

From the comments below her piece, which are already overwhelmingly negative:

I find it a tad difficult to believe, given the current access, scope, range, and sheer computing power that GCHQ posses that however the data is anonymised, it almost most certainly begins life as extremely personalised and private, is attached to a name and to an nhs number and GCHQ should it decide to, would be capable of digging down to the individual.

As I pointed out in my article about the Guardian's promotion of Glenn Greenwald's linkbait, hysterical, debunked 'revelations':

Once you get people to distrust government in one policy area it is so much easier to turn them off in another - like healthcare or economic stimulation. This lets in corporate control which those banging on about the evil government have either shown little or no interest in (see the stupid pat response I just dealt with [corporations don't arrest or murder people]) or have cloaked, bait-and-switch style, their real positions [namely, libertarian, pro-corporate].

Et, voila. We can't have an obvious good from Big Data because 'government is evil!'

Nothing, no level of accountability or democratic oversight, nothing will ever be good enough. People want the whole thing torn down, even in the socially positive situation Toynbee highlights.

But it is difficult impossible to explain how the left would manage policing and security, let alone how we would reform them, when the atmosphere is dominated by falsehoods and lies. How can you reform something which is thought to be terminally broken and which people are being led to believe cannot be managed by the people - us - through a democratic system?

And, of course, no one is pointing out or railing against very similar use of corporate metadata, which has the same technical ability to breach privacy, by health care researchers.

I wrote that:

No one has polled this in the UK but I would be shocked if Greenwald's work has not impacted trust in government here as well. At least in the US there are some voices challenging the falsehoods, in the UK who is doing this?

To be fair it hasn't just been the Guardian doing this but for a leftie Guardianista who sees the good government can do to be seemingly ignorant of her own newspapers' role in destroying that trust is beyond ironic.

Postscript 2: You could make it up

↑ This didn't happen

A last return to the subject of Stafford Hospital and not the statistics, this time, but the human face.

Steve Walker, whose coverage I have been covering, has secured a heart-rending interview with some of the nurses. The people made out in the same media who have played loose with numbers to be witches and evil. The people banned from speaking.

They explain how the level of care was tied to the removal of resources, not human behaviour, their behaviour. The vicious media campaign has devastated them:

Several of the nurses told me of their frustration at the media’s acceptance of the claims by campaign group Cure the NHS (‘Cure’) that nobody from the hospital had apologised to them for the poor care they felt their relatives had received. Two nurses told me that they had apologised in person to Cure leaders – even though they were apologising for something beyond their ability to prevent – and had been thanked for doing so.

One nurse told me of a day that she had worked an extra 12-hour shift at the hospital because there was no one else available to provide cover. As she left the ward, exhausted, at the end of a shift she wasn’t obliged to do, she saw that someone had scrawled on the notice board,

ALL A&E NURSES ARE BITCHES!

There was a sense of helplessness to put forward a counter-view, as all staff had been banned by the new chief executive from making any positive statements or responses on the grounds that it would be ‘insensitive to the families’. Yet when staff appealed to him to stop people from coming into the Accident and Emergency unit and abusing staff, he told them,

I can’t do that.

Staff are still banned from speaking out, especially to the press. But there was no such restraint in the opposite direction. One nurse was spat upon in the street several times, while others were called murderers as they walked with their young children. As I heard these stories, the outrage I felt was barely mirrored in the faces of those telling them. Instead there were red eyes, and tears – a sense of hurt and grief more than resentment.

These were not hard-hearted harpies, but kindly, capable women treated like monsters for circumstances outside their control. One told me:

They said everyone was responsible – but it wasn’t true. There was a lack of resources, a lack of numbers, a lack of even the right forms – how can we be responsible for that?

They did complain, and report, and use procedure, but this is a typical experience:

I blew the whistle about something. The next thing, I was ‘named and shamed’ in a staff meeting, with minutes and everything. I rang the NMC (Nursing and Midwifery Council) and the RCN in flood of tears and was told:

“You can fight it – but it’s Stafford. You won’t get anywhere.”

They feel betrayed. Says Walker:

The public’s anger has been directed at the wrong people – and we shouldn’t forgive the misdirection either.

• Stafford nurses speak out

Postscript: You could make it up

Somewhat of a validation for my post on how media reports about '1200 deaths' at Stafford Hospital was pulled out of someone's ass thin air. It's Paul Taylor in the august London Review of Books on 'Rigging the Death Rate'.

Taylor, a reader in health informatics at University College London, in a lengthy piece, pretty much demolishes the basis for those media reports and their source, one Professor Jarman. In fact, in an extremely detailed exposition on measuring stuff in health care, he comes back to the points raised by Steve Walker, the blogger on which my post was based and who has been battling away, somewhat on his lonesome, against the use of Jarman's mishandled (to be generous) data by those who wish the NHS ill.

On the controversial source of info in the NHS which we're talking about, here's something I did not know:

The coding, however, is notoriously prone to error (last year’s HES [Health Survey For England] summary statistics record, for instance, that of the 785,263 in-patient episodes coded under Obstetrics, 16,992 were recorded for male patients) and the system wasn’t designed to measure the quality of care, only the quantity.

The basis of Jarman's business (DFI) is something called the 'Good Hospital Guide', which is entirely based on ...

League tables – applied to surgeons, hospitals or schools – do not give the person reading them any sense of how much variation would be expected for a given sample size and instead impose a rank that the data may not support. There were good reasons for a hospital to regard a poor placing in DFI’s tables as merely an irritating bit of bad publicity.

As Walker and some others have noted, the recording of data isn't the problem, it's how it gets used:

Governments and regulators tend to make drastic interventions with the worst-performing institutions in mind, but the more effective strategy is probably to aim at improving average hospitals, since the ideas developed along the way will work almost anywhere. Lilford and Mohammed [Birmingham University critics of DFI] so criticised the use of the HSMR [Hospital Standardised Mortality Ratio] to measure quality of care. The HSMR shares the weaknesses of the HES data on which it based, but Lilford and Mohammed had a more fundamental criticism: mortality is unlikely to be a good measure of how good care is in a hospital. Typically, 98 per cent of in-patients survive their visit, so nearly all the data about what happens in a given hospital are ignored if we concentrate on mortality rates. Not only that, but of the 2 per cent who don’t survive, only a few will have died an ‘avoidable’ death, and it is only those deaths that can be used to measure the quality of care.

Was Stafford 'broken' because of useless nurses, as you may have heard in the MailExpressTelegraphSun, or ...

The chart above shows the distribution of waiting times in A&E in Stafford Hospital. There is an extraordinary peak at 3 hours 50 minutes: patients were being admitted in a hurry to avoid breaking government targets for a maximum of four-hour waits in A&E. That the system encouraged such sleight of hand is unsurprising – the data from many other hospitals would show a similar peak – but the problem at Stafford was that the care in A&E was poor. It was chronically understaffed, initial assessments were carried out by receptionists with no medical training, and essential equipment – cardiac monitors, for example – were missing or broken. Many patients admitted just before the deadline were sent to units where the care was even worse, some of them to an unstaffed ‘clinical decisions unit’, others to the so-called emergency assessment unit (EAU), a large ward described by the Healthcare Commission as poorly designed, busy, noisy, ‘chaotic’. Nurses in the EAU were inadequately trained and it was common for a patient’s condition to deteriorate unnoticed or for necessary medication not to be provided.

After running through the similarities uncovered in a report on a past case of poor care at another hospital with the Mid Staffs report (staff/patient ratios, inadequacy of systems for reporting incidents, whistleblower victimisation, disinterested senior management in which consultants weren't involved), Taylor turns to the latest idea from the No. 10 brains trust, the ‘friends and family’ test:

Given what we’ve learned about how managers respond to targets, it would be surprising if trusts weren’t already looking for wards or services which, given some extra attention, might yield more than their fair share of grateful respondents. If the test worked, it might help identify hospitals where nursing is poor, but it will be of less help in cases where patients are treated with a combination of kindness and technical incompetence – as at Bristol – or, as with Harold Shipman’s patients, ostensible kindness but actual malice. Just as important, most NHS scandals have affected patients who aren’t likely to voice their complaints, aren’t in a position to make choices and who often don’t have friends or family to speak up for them.

Here's Taylor's concluding point, a sad but true one given the investment much of the media and a certain political party have made in misusing data:

A different approach is used in Australia. Queensland Health was the subject of two public inquiries in 2005 over its employment of a surgeon who became known to journalists as Dr Death. In response, it has adopted an approach which bears some similarities to the work of DFI: data are obtained from hospitals across the state and actual outcomes compared with expected outcomes in order to generate alerts. The focus is on performance over time rather than on a single number and, more important, the data are used differently. A broader range of outcomes is considered, not just mortality, and because it was argued that the threshold should be set very low, many hospitals are flagged so that investigations become a normal part of an institution’s commitment to safety. So long as NHS trusts that have a high HSMR continue to be named in the papers and the statistical concept of ‘avoidable death’ is interpreted as providing grounds for criminal prosecution, the argument for a similar system won’t be made here, let alone won, any time soon.

Walker has just reported on how Mid-Staffs is demonstrably improving, yet is being threatened with closure -- for blatantly political reasons. The proposal is to give £30m to a nearby hospital, and close Stafford. As opposed to:

Save £53m over 5 years in order to keep a hospital that serves around 300,000 people and which has been adjudged by the Care Quality Commission (CQC) as ‘meeting all the essential standards of quality and safety‘.

You could make it up

In today's collective strop by the newspapers about regulation there's one theme, a supposed threat to investigative reporting. One story being pointed at as potentially being threatened by 'government control of the press' is the 'scandal' of hundreds of 'avoidable deaths' at Stafford hospital.

What's funny about the press using this example to make their argument is that their Stafford reporting has, universally, from the BBC all the way to the Daily Star, been terrible, shockingly terrible.

The number of 'avoidable deaths' - the figure commonly reported is 1200 - is completely made-up. Any reporter doing their, you know, job could figure it out.

Blogger Steve Walker explains at length how '1200 deaths' was pulled out of someone's ass thin air and how its basis is undermined by just a cursory understanding of statistics. Here's a key passage:

As I explained in my post on the real story of Mid Staffs, Prof Jarman’s HSMR (hospital standardised mortality ratio) system rates English hospitals according to where they sit according to the average death rate for the nation. A hospital hitting exactly the average rate would receive a ‘score’ of 100. A hospital doing better than average would have an HSMR below 100, and one doing worse would be over 100.

So far, so clear – I hope. But here’s the key fact: every year, the system is ‘rebased‘ – the averages are re-measured and ’100′ is re-calibrated to the new average.

This leads to 3 key problems:

1. Because of how averages work, unless by some miracle every single hospital in the country got exactly the same score, you will always have some hospitals above 100 and some below. This does not mean the ‘extra’ deaths in those hospitals were avoidable – it just means that somebody has to be above the line because it’s an average.
2. Because the ’100-line’ moves every year, a hospital can maintain exactly the same standard in one year as it achieved in the previous year – and yet can score below 100 one year and above 100 the next. The performance of the hospital did not get worse. The line just moved. It’s not only wrong but ridiculous to extrapolate ‘extra’ or ‘avoidable’ deaths from a position above or below a line that moves every year.
3. Leading on from number 2 – and it’s impossible to overstate this – there is no ‘standard’ rate of deaths from a particular illness. No expert clinicians are sitting down together and saying ‘Yes, we agree that out of every 100 patients with an intracranial bleed, this many are going to die’. No. All that happens is that the average for the previous year becomes the re-calibrated ‘expected death’ figure for the following year. This means that HSMRs are measuring the success/failure in achieving/beating/failing to bear a target that moves every year – and has no basis in clinical expertise. It’s just a number.

In his testimony to the Francis inquiry, Prof Jarman claimed that he had to present the figures this way because the English are ‘simple-minded‘ – but in doing so he has committed a fundamental error of logic worthy of a simpleton.

These fundamental logical errors mean that even if everything else was perfect, HSMR scores over 100 cannot be used to calculate avoidable deaths.

Walker explains how behind the media's scary headlines lies 'rubbish in, rubbish out'. The data wasn't being properly recorded at the hospital and the woman brought in to fix that, who he has met, wasn't allowed to give evidence or speak to the media.

That women's work on correcting the errors produced the exact opposite outcome to the screaming headlines:

When Ms Kirkbright arrived at Mid Staffs, she carried out a re-coding exercise on past deaths. This re-coding corrected the absent Z51.5 code and used the case notes to add in the co-morbidities (what is known in the jargon as ‘depth of coding’) that was missing. This brought down Mid Staffs’ HSMR to 88 – well below the national average death rate.

Further:

HSMRs are a statistical device. If you want to be sure whether deaths were avoidable or not, you need to look in detail at the case notes for each patient. The doctor in charge of the Independent Case Note Review (INCR) was asked by the inquiry how many ‘excess’ deaths he had discovered among all of the cases for which families asked for a review. His answer was telling – but has been almost completely ignored:

    Perhaps one such death.

And further, Walker reports evidence that hospitals are gaming this bonkers system because of funding pressures - to increase their incomes.

Plus Walker gives examples of how reporting on supposed bad treatment of patients at the hospital could simply not be true.

The man behind the headlines, Professor Sir Brian Jarman, has a clear conflict of interest. He is financed by a company which sells services that allow NHS Trusts to use and monitor HSMRs. That has not been reported.

What is also not being reported is that the entire system is based on the most ridiculous way of recording and therefore supposedly monitoring morbidity rates.

HSMRs are based on ‘first diagnosis’.

If a patient arrives unconscious and the ambulance driver reports ‘He fainted’, fainting would be the first diagnosis. If that patient is then discovered to have had a serious stroke and dies, that death will be recorded against ‘fainting’ – a condition with a very low death-rate – resulting in an inflated HSMR.

There is no recording of post mortum results. The system is utterly broken. You couldn't make it up!

It's plain once you read Walker, or the handful of other bloggers, or this lonesome letter to The Guardian, or Computer Weekly, all similarly demolishing the media's reporting, that the headlines about '1200 avoidable deaths' aren't wrong because the media are all idiots, they are the result of an agenda. A stealth-privatisation, anti-National Health Service agenda.

Says Walker:

The threat is serious, because a lot of people will believe what’s being said and written just because it’s in the media and has apparent statistical/scientific support. Very few will look beyond the soundbites to see whether they stand up to scrutiny.

So please, if you’ve read this article and agree with its premise, spread the word. We need good information out there to counteract the absolute tripe that’s being force-fed to the British public.

Happy to oblige

• Here's a postscript

Swineflu: NHS #fail

Not only do we have a crashing website. Not only do we have a phone line four months late. We also have an #fail for how most people will seek information about swineflu online - search.



Mate Jack reports that he is #1 in Google result for 'have I got cold or swine flu'. Although the NHS is advertising on this search this isn't good enough because click through on text ads is very low.

NHS is #5 'natural' result - below my 'fold' on this search. They must also be optimising their site to appear at #1 in such results. But they have not.

Not. Good. Enough.

Either NHS online fixes this - quick, Google indexes pretty damn quickly - or they hire someone who can. Thousands, if not millions, of Brits will be looking for swine flu advice online via search NOW. If this is what they will see the NHS is #fail-ing them.

Only tactical votes for Labour

On his blog today Alastair Campbell makes the correct point that Labour has done well with the NHS. Speaking in Hull for Mental Health Week, he reports how this was pointed out to him by a woman from the NHS.

But a far better answer came from the woman from the NHS who spoke after me and who could not have been clearer that the government had delivered huge extra resources for the NHS, and the NHS staff were making that money work to deliver real improvements. And as she spoke, I thought what a crazy world we live in - that Labour promised to 'save the NHS', has done so, with enormous consequences for people's lives and livelihoods, and there is a risk of the country voting in extremists and opportunists because Gordon is copping it for every MPs' expenses claim.

I agree, and Cameron will slash services. However, this is what I said to him in response:

I know all this Alastair - I'm culturally Labour. But like a lot of gays in the US are getting with Obama, as an advocate for gay asylum seekers I can't get past what monstrous policies Labour has overseen regarding them. When you know the personal situations it's nigh impossible. Plus I can see the Tories being *better on this issue! Truly.

I understand politically why this has happened - why, in general, the Home Office has been left to deal so badly with the whole issue of asylum - but this just makes it worse and really is an utter betrayal of Labour's core values. Miliband is right now, like the USA, completely ignoring /denying the pogrom of Iraqi LGBT! Plus LGBT Labour have just ignored asylum, only now taking any interest.

I'm sure there are other previously loyal people who feel betrayed and it isn't good enough to just keep saying NHS! NHS! NHS! - it's marginalising and sending people (like me) to the back of the bus.

Locally I will (tactically) vote LibDem, in the Euros I will vote Green.

[I do know that others will have their reasons. These are mine]

• You can leave Jacqui Smith a goodbye note here www.dearjacqui.co.uk

Scrapbook clips catch up

I've been repeatably hearing a bizarre (to my ears) ad running on the Olbermann netcast - Kraft 'natural, 2% milk' cheese with ... drumroll ... "no added growth hormone". Only in America?

I shouldn't mock. We have crap food here too. But something called Velveeta, which "doesn't need to be refrigerated after opening"???

Google has launched a Elections Video Search gadget which use speech recognition.

Using the gadget you can search not only the titles and descriptions of the videos, but also their spoken content. Additionally, since speech recognition tells us exactly when words are spoken in the video, you can jump right to the most relevant parts of the videos you find.

+ Google kills the Google bomb :{

Hah (sorry, shouldn't laugh).

A disgruntled city computer engineer has virtually commandeered San Francisco's new multimillion-dollar computer network, altering it to deny access to top administrators even as he sits in jail on $5 million bail.

US 'Department of Homeland Security' is seriously suggesting that airline passengers wear 'security bracelets' which would deliver taser-like shocks if they 'fail to comply' - seriously.

Here's another shock horror story in 'the war against tourism':

And it wasn't enough for another woman to show TSA agents nipple rings that set off a metal detector. The agents forced her to take them out.

Mandi Hamlin said, "I had to get pliers and pull it apart."

In Chicago, people like Robert Perry are subjected to exhaustive security checks. He was patted down, his wheel chair was examined and his hands were swabbed, all in public view in a see-through room at the security checkpoint. Perry, 71, is not alone

"It's humiliation," Perry said.

Perry was also taken to a see-through room by a TSA agent when his artificial knee set off the metal detector.

"He yelled at me to get the belt off. 'I told you to get the belt off.' So I took the belt off. He ran his hands down over and pulled the pants down, they went down around my ankle," Perry said.

At that point, Perry was standing in his underwear in public view. He asked to see a supervisor. That made things worse.

Tracey Ullman has a great character, Chanel Monticello, taking da piss outta this shit.

Delightful story about how Karl Rove, aka 'Bush's brain', threatened a webbie:

If he does not "'take the fall' for election fraud in Ohio".

No wonder they're losing online, who'd want to work for them?

Computing magazine had a good-news story about the NHS IT project - the biggest non-military IT project in the world - focusing on Homerton Hospital. All great, practical, working properly, stuff. Pity that a/ it's not easily found on the web and b/ Labour is making nothing of it.

eGov: New figures from NWEGG shows that:

A ‘self-serviced’ web transaction is 24 times less costly than a telephone transaction and 46 times less costly than a face - to - face transaction.

According to the Daily Mail (FCS):

Ministers had so far failed to put sex education on a statutory footing in the national curriculum.

AND

Attempts to search for advice on school computers were often frustrated by filters which block sites containing sexual words.

New York Times piece on the challenges of being a Tekkie in Kenya:

Consider Wilfred Mworia, a 22-year-old engineering student and freelance code writer in Nairobi, Kenya. In the four weeks leading up to Apple’s much-anticipated release of a new iPhone on July 11, Mr. Mworia created an application for the phone that shows where events in Nairobi are happening and allows people to add details about them.

Mr. Mworia’s desire to develop an application for the iPhone is not unusual: many designers around the world are writing programs for the device. But his location posed some daunting obstacles: the iPhone doesn’t work in Nairobi, and Mr. Mworia doesn’t even own one. He wrote his program on an iPhone simulator.

Here's good CRM for you. From an email:

We couldn't help but notice that it's been a while since you've visited Current.com, and it's bumming us out.

If you have a moment, we'd love to hear from you about your experience on Current.com, what did or didn’t work for you, and how we could make things more enticing for you in the future.

Lincolnshire is truly pioneering with eGov. Apart from the ads they are:

As part of their “Accessibility tested by humans” strategy, Lincolnshire’s website will be tested every 3 months by a panel of disabled users with disabilities ranging from cerebral palsy through to dyslexia. Results will then be published on Lincolnshire’s website for anyone to see.

I completely agree with this more 'social' attitude to accessibility.

Here's Whitehall's approach:

The draft had threatened to switch off non-compliant websites altogether, warning: "websites which fail to meet the mandated level of conformance shall be subject to the withdrawal process for .gov.uk domain names". The final guidance issues a similar warning, but using the softer formula 'may be at risk' instead of 'shall be subject to': "Government website owners are reminded to follow the conditions of use for a .gov.uk name (Registering .gov.uk domain names (TG114)). Websites which fail to meet the .gov.uk accessibility requirements may be at risk of having their domain name withdrawn".

Monbiot point:

A few weeks ago the writer Mark Lynas found a counter-intuitive revelation buried in the small print of an ICM survey. The number of people in social classes D and E who thought the government should prioritise the environment over the economy was higher (56%) than the proportion in classes A and B (47%). It is counter-intuitive only because a vast and well-funded denial industry has spent years persuading us that environmentalism is a middle-class caprice

How guardian.co.uk stays atop the pile:

In the past two months, we have started to combine search engine optimisation - talking to the news desk on the paper about SEO-friendly headlines and underlining SEO with our subs desk [on the website] - with our marketing and pay-per-click activity. If you do two to three small things at one time that can be very significant.

Etre (newsletter only) had a great post about 'cognitive illusions', relating this to usability. Citing Bruce Tognazzi from 1989 it notes that:

1) Users consistently report that using the keyboard is faster than using the mouse.

2) The stopwatch consistently proves that using the mouse is faster than using the keyboard.

This illusion reveals a much more important learning: Users' perception of reality and reality itself are not the same thing - which means that you should always verify their claims through research. You should also take pains to validate your own intuitions, because even when you're certain of something, you can still be very wrong.

Etre's blog had an interesting post about a new ATM interface for Wells Fargo. ATMs are thirty years old - proving that usability is an ongoing and never-ending process.

Dave Briggs is running an event in Peterborough relating the ReadWriteWeb to the needs of local government. Check it out.

Featuring case studies from both local and central government, practical exercises to learn more about how social media could be used within a local authority context and plenty of time for networking and chats over coffee.

eGov AU on why UK lgov sites are better than Australian ones. Unfortunately he cites Redbridge :{

Information ain't free. After a long break with no email, I had a notification about a citation of that suicide and the internet BMJ article (which I went to work on). But of course I couldn't read it because JAMA's medical research is behind a paywall.

That's cleared some clips :}

Just this to add - from the online journo Michael J Totten: The Truth About Russia in Georgia:

He raised his hand as if to say stop.

“That was the formal start of the war,” he said. “Because of the peace agreement they had, nobody was allowed to have guns bigger than 80mm. Okay, so that's the formal start of the war. It wasn't the attack on Tskhinvali. Now stop me.”

“Okay,” I said. “All the reports I've read say Saakashvili started the war.”

“I'm not yet on the 7th,” he said. “I'm on the 6th.”

“Okay,” I said. He had given this explanation to reporters before, and he knew exactly what I was thinking.

“Saakashvili is accused of starting this war on the 7th,” he said.

“Right,” I said. “But that sounds like complete bs to me if what you say is true.”

Thomas Goltz nodded.

NHS website - how much?!

I don't know what the NHS website costs but given their IT expenditure is in the multi-billions you would expect it's a lot. Maybe it's actually minimal. I don't know if this has bothered the Public Accounts Committee.

What I do know is that it appears to not contain any information about medical/doctor's certificates - those things which come in various flavours and require a visit to the GP. Definitely not 'a page' which contains 'the official info'.

Here's what happens when you type in 'certificates'.



Nowt of any use to anyone.

Actually another thing that happens is that a list of suggestions pop-up which are all about types of illness - obviously the site is geared around 'prevention'. This is pretty damn obvious from the homepage as well, as it yells 'FIVE A DAY MEALS ' at you.

The actual reason I was looking for 'certificates' was to provide information to people who needed to know something about the different types of them and what they meant. Y'know 'joined up government', 'do it online' and all that.

Plus it was people who were online anyway - looking at something I was attempting to link from - and in the particular case probably hadn't much clue about the way the system works. So, yes, talking to someone like a GP would help them but aren't we supposed to be saving government's money by doing more of the info provision online?

A fair bit of what the rest of government does is linked in some way to 'health'. Is this a case of dem silos? I would note that in my egov networking NHS people seem to be strangely absent ...

Postscript: turns out that info on medical certificates is on the DVLA website. Makes sense? Not.

Scrapbook clips catch up

Quickie job this week ;]

Will highlight a comment left with Off with the pixies from Dan McQuillan.

As the guy with the job of delivering the UK Catalyst Awards, I'd of course prefer to take more optimistic view.

But I agree that the critical thing is to move from excited blah blah to real impact. I'm trying to bring to catalyst as much grit as I can from my experience in co-founding social innovation camp.

We'll have to wait and see whether catalyst phase two can produce the kind of mentoring, incubating and financing that will deliver dynamic social startups.

Gerry McGovern, always worth reading, has started a series on What is the role of government on the Web?

For the government to truly serve its customers on the Web it needs to address the following issues:
1. Get away from a technology obsession
2. Manage customer top tasks, not government websites
3. Get politicians off government websites
4. Stop government vanity publishing
5. Develop a government archive

Federal Times has a very interesting piece on Gov’t. 2.0: Wikis, blogs and more - use in the US government.

The blog is a bold move for TSA [Transportation Security Administration | U.S. Department of Homeland Security] because it fully embraces public comments on what the agency is doing wrong, said Stephen Goldsmith, director of Harvard University’s Innovations in American Government program.

“They’re going to insult you whether you have a blog or not,” Goldsmith said. “You might as well learn from what they’re saying.”

Using discussion boards and e-mails, [Environment Protection Agency] EPA’s new social Web site, called National Dialogue on Access to Environmental Information, has pulled comments from across government and the country to help [EPA’s chief information officer, Molly] O’Neill as she fashions a new information-sharing policy.

Since O’Neill came on board last year, EPA has embarked on four such projects that integrate blogs, wikis, discussion boards and other social networking Web tools, which are collectively referred to as Web 2.0, into EPA’s business.

“The technology is not complicated, it’s just a different way of doing business. And getting people to do business in a different way is culture change and that’s a challenge,” O’Neill said.

New Canadian survey on the public's attitudes to use of web 2.0 in government.

When asked to consider specific ways that government might use social media, the respondents showed strongest support for:

1. Websites where government scientists or experts could answer the public’s questions
2. Websites that would allow Canadians to express their views on different issues
3. Audio tours or pod casts of historical and natural sites across Canada that could be downloaded.

Jakob Nielsen updates his guidance on Writing Style for Print vs. Web

Summary: Linear vs. non-linear. Author-driven vs. reader-driven. Storytelling vs. ruthless pursuit of actionable content. Anecdotal examples vs. comprehensive data. Sentences vs. fragments.

We should accept that the Web is too fast-paced for big-picture learning. No problem; we have other media, and each has its strengths. At the same time, the Web is perfect for narrow, just-in-time learning of information nuggets — so long as the learner already has the conceptual framework in place to make sense of the facts.

For example, I dated "learning around the campfire" to 32,000 years ago to coincide with the emergence of high culture and the Cro-Magnons. Not that the Neanderthals didn't have campfires — they simply didn't have the cultural depth of modern humans, so I don't think their storytelling was equal to my seminars. So, did I actually remember that Cro-Magnon culture started 32,000 years ago with the Lascaux cave paintings? No, I looked that little fact up online.

Now where do you think this clip is from?

More than 10 new e-Government services will be launched in the next six months, while more than 15 e-Government services will come online within two years, Secretary for Commerce & Economic Development Frederick Ma says.

He told the Legislative Council today the e-Government services include the transport information system and the electronic health record system.

The bureau will also launch a geographical user interface to help users locate information and implement a unified identity management framework to verify their identity and safeguard their personal data.

A pilot scheme in forming district cyber centres will be conducted to provide hardware and technical support for children in low-income families and needy residents to access online resources.

Mr Ma added all Government bureaux and departments have revamped their websites to comply with Internet accessibility standards stated in the internal guidelines for information dissemination since 2003.

An inter-departmental committee regularly reviews the guidelines and released the latest version early this year.

Guessed? Hong Kong.

Facebook over? Only in Islington says Rory Cellan-Jones on BBC/dot.life

The social networking scene is settling down into separate camps. The very young are with Bebo. The music crowd are still on MySpace. The obsessive technophiles are on Twitter - latest Tweet from one sad West Coast blogger: "I have 3,500 unanswered direct messages. Please do not send more." But the mass of students and young professionals seem to be gravitating towards Facebook.

Is the Daily Mail editing the government too?

"In the same way that there are standards that are essential to broadcasting, in this converging world I believe there should be a set of standards online".

That's culture secretary, Andy Burnham. Sweetheart, talk to some Aussies about the 'issues' of going down this road. Pa-leaze!

Worth a read on cyber-censorship is Seth Finkelsten.

Also worth pointing out that repeated testing has shown the failures of censorware (filters), including one done earlier this year for San Jose libraries, plus, of course, that anyone can find out how to Bypass Internet Censorship.

House of Lords two-up now on the Commons as they launch a YouTube Channel.

The five videos aim to explain the "role, impact and relevance" of the House of Lords and "reach out to young people and other audiences who may not be involved in politics or well informed about the role of parliament".

Wired's Thomas Goetz makes a great point about Obama's FightTheSmears.com.

By putting their own website out there front-and-center, and then getting everybody to link to it (starting with all the media covering the launch of the site), the result will be to drive fightthesmears.com towards the top of a Google search on, say, "obama muslim" or "michelle obama whitey". Ideally, if enough of the pro-Obama network links to fightthesmears.com, it'll drive the sites that peddle in the rumor-mongering, which are now the first results on said searches, off the top of the results list. Ideal long term result: any curious low-information voter who eventually bothers to google these pesky rumors will immediately be led to the debunking rather than the rumor.

And this is coming over here too. The disgusting Melanie Philips repeats the dirt for The Spectator.

Eric Schmidt thinks Google should extend a helping hand to 'old media'. He "hopes its recently acquired advertising service DoubleClick will aid newspapers as they struggle to corral more online revenue".

Bob Ostertag has some warnings about Obama's Internet Money Machine and the Future.

Yes, this is a wonderful thing that the Internet has democratized political financing in an unprecedented way. What is even better, the fact that the progressive guy figured out the new money regime first may catapult him from freshman senator to the White House, opening one of the most exciting chapters in American political history.

But it is not insignificant that in the process, vast sums of money are flooding into the political arena.

Worth something in twenty years will be ... McCain condoms! (Barack ones too).

Christopher Ciccone, brother to Madonna Ritchie (nee Ciccone), is writing a book. Met them both (if by meet you can count 'hello, this is ...' 'hello, goodbye') in my gossip column days. Some daft queen thought she'd enjoy a tacky drag troupe and being showered by glitter at a not-that-glamorous 'do' and birthday bash for Chris by the harbour in Sydney. As I recall, they didn't enjoy Oz very much .. wonder if that'll make his book ... ?

Quote of the week from GC Weekly:

Earls Court, location of this week's GC 2008 Expo, was replete with [sic] beautiful people and futuristic technology.

The fact that the venue was also hosting Graduate Fashion Week and a Doctor Who exhibition may have contributed in some small way to these qualities. But you could not beat Kable's conference when it came to threatening behaviour from chairpeople.

Brian Derry of Assist said he would expel people from the session he chaired if they violated the no-mobile policy - dancing to the tunes of their ringtones. Alternatively, they could pay £10 to the charity of his choice.

Mark Logsdon of Barclays, speaking at a session on security, revealed that his organisation charges £50 for rogue mobile vocalisations. But after adjusting for banking salaries, that works out around a hafpenny.

It might not have been appropriate for Dave Mitchell of BT, chairing a session on the NHS National Programme for IT, to have punished the use of telephones. But he did threaten a collective punishment for the audience, if it failed to show suitable interest: a video nasty on the auditorium's big screen.

Luckily, Mitchell decided it was necessary to deploy a video of former National Programme guvnor Richard Granger on his holidays. The threat was enough.

Postscript 2: Search and suicide

Now have a research author response: see below.

The responses on the British Medical Journal (BMJ) website are mounting up to the 'search and suicide' research they published and which I dissembled.

I mentioned before how a Japanese researcher responded about how they are using the web to directly intervene - Outreach in the Real World - here's a bit more detail. (NB: The BMJ may force you to sign up to view these responses in full).

Not only are online approaches expanding, but outreach-based interventions in the real world are expanding as well. The "Guidelines for Response to Advance Suicide Warning Cases on the Internet," released in October 2005, includes a statement that Internet community organizations can disclose the content of private communications to a third party in emergency situations. As a result, the National Public Safety Commission in Japan reported that among 121 cases of suicide warning on the Internet in 2007, the police identified 105 individuals based on provider information. Of these, 72 cases were intervened by police and other aid measures, while the remaining 33 cases were determined as pranks. Sixteen cases could not be identified because of access from unspecified terminals, such as Internet cafes.

I have absolutely zero problem with this - it's about saving life in the final analysis, not privacy. I can't see why the NHS cannot negotiate similar protocols in the UK. The model is there to learn from. Is that happening? I very much doubt it.

Other BMJ responses are mainly from Hong Kong researchers, but all give a very different take on where research should happen.

'Suicide and internet use levels-- the evidence is lacking', for example, says "the evidence for an association between internet use levels per se and suicide ideation are scant .. it is practically impossible to differentiate visitors drawn by morbid curiosity, boredom, transient dysphoric mood or even academic interest from those with actual suicidal intent, caution should be exercised in interpreting their results."

Another, 'Positive and negative influences of the Internet on suicide', says "the Internet may have beneficial effects on suicide and to better understand the phenomenon both positive and negative influences of the Internet on suicide should be considered." These researchers say that "suicide prevention and intervention can be provided through the Internet for those who have suicidal ideation and visit those sites".

Especially if you use the web to put your positive services in the middle, as the Japanese appear to have learnt.

An American researcher says, "we suggest further studies to be conducted by Biddle and her colleagues comparing the actual traffic to both pro-suicide and suicide prevention websites and focusing future studies on the actual online behaviors of suicidal individuals."

Too right. "Actual online behaviors" being a crucial element to any research around search.

It's very noticeable that there aren't any responses from the UK - how does Biddle et al's research get funded I wonder and why are these other countries seemingly looking at far better and more productive avenues vs. suicide and the web than the sort of web-bashing, headline-grabbing rubbish we're churning out?

NB: I have received no response to email from either the researchers ('Biddle et al') or the charity Sane, which was quoted by the BBC. Help is obviously not wanted as they know it all. Neither, it must be said, have I had much response from search industry bodies and media I contacted. As I have said numerous times before, the industry is lousy at PR. They will wait until regulatory bodies and ill-informed politicians start proposing draconian and irrational legislation before they start dealing with their social impact.

May 5th addition: research author response

Lead author David Gunnell, Professor of Epidemiology Department of Social Medicine, University of Bristol, has responded to my critique amongst others on the BMJ's website. I will note that I wrote to Gunnell and he didn't reply. This is relevant in the context of this response.

We are pleased to see the interest and broad range of views provoked by our paper. There appears to be consensus amongst correspondents about the potential of the Internet both to provide help and to cause harm. Several correspondents have helpfully highlighted additional approaches to altering the results of Internet searching in favour of minimising risk to individuals experiencing serious suicidal thoughts and planning suicide.

Some contributors (Grohol, Canning, Fu, Knight) express surprise at our focus on methods of suicide.

Not me, wasn't expressed by me.

Furthermore Fu points out that some suicidal web-users may have already decided on their method of suicide and be searching for technical information about its implementation. We agree. However, as we explained in the opening paragraph of our paper, we focused on methods of suicide (rather than Internet resources for suicide in general) because research evidence suggests that one of the strongest media influences on suicidal behaviour concerns its affect on the choice of suicide method used.[2,3] Choice of method, in turn, influences the likelihood that a suicidal act will result in death,[4] and so may have an impact on suicide rates. We assumed that some Internet influences on suicide are likely to be similar to those of other media such as TV and newspaper reporting. In keeping with this Fu highlights the possible role of the Internet in relation to the spread of carbon monoxide poisoning as a method of suicide in Hong Kong. Thus we chose the search terms likely to be used by individuals with serious suicidal thoughts who are planning their suicide attempt. We felt it important that organisations offering support to suicidal individuals should endeavour to ensure their sites occur high up on the list of 'hits' retrieved by searches making inquiries about suicide methods.

But they didn't focus on methods. The search terms they chose, which they didn't explain the genesis of in detail, barely included specific methods - Fu's point. If, as there is strong evidence of, people take clues from media reporting - 'copycats' - then surely it would help to look at what methods are shown/described in reporting and take cues from there? This they didn't do. And it's difficult to make recommendations - especially such dramatic ones as they did - when the initial sources "terms likely to be used by individuals with serious suicidal thoughts who are planning their suicide attempt" are so apparently weak.

We agree with Grohol and other correspondents that additional aspects of the Internet in relation to preventing and provoking suicide are worthy of academic study. Indeed this is something we wish to pursue. However, we felt in an area about which much is conjectured, but little empirical data exist, a focussed inquiry into one relevant aspect was appropriate.

In which case they picked the wrong area. Surely going to source - what is known about how suicidal people connect to information and then act on that information, taking cues from well-developed experiences like the Japanese - would be a more productive avenue. For example, what is the role of UK social networks? Where is research lacking on the actual connections prior to suicides? The assumption here was 'search engines' - and everything flowed from those assumptions. Again and again, the main issue here is researchers who aren't webbies, don't understand how the web works, make assumptions, don't talk to the right experts, then leap off with claims which are - plainly - false and suggest solutions they are not qualified to suggest and lead people down more false trails.

In a single brief research paper it would not have been possible to cover the range of aspects suggested by Grohol. We disagree with Grohol's suggestion that we painted a pessimistic picture.

Talk to the PR, what headlines have they generated? How helpful are those headlines? It is highly irresponsible for such researchers to step back here and say 'we're not responsible'.

We described a number of beneficial aspects of the Internet - highlighting advice and information sites. Indeed we report that 13% of our hits were for sites offering support or information about suicide and 12% discouraged suicide. We also highlight that in England, whilst use of the Internet has increased in recent years, rates of suicide have declined. Thus harmful impacts of the Internet on individual acts of suicide are either being offset by beneficial effects or the impact of other suicide prevention activities.

Yes, they mentioned this. But it wasn't their headline. As I showed, searches for 'suicide' appear to be going down. But this wasn't their headline or reported anywhere at all in the subsequent headlines generated from the cues they gave reporters (i.e. the press release). Look at it this way, if the media is a causal factor the researchers just failed to get the media to report the existence of suicide help and to only focus on the existence of harmful websites.

Some of the assertions made by Canning are incorrect. The sites we reviewed were restricted to the first 10 results for each search. The searches 'methods of suicide' and 'suicide methods', which, like most users, we carried out without the quotation marks, do, in fact, yield different sites.

Ok, point taken. Search engines are improving. Though results are barely different. What else makes up "some .. are incorrect".

The interview data we used to inform our search strategy referred to interviews that were conducted with people who had survived nearly fatal suicide attempts. Two of the twelve individuals we have interviewed to date used the Internet to research their methods and indicated the terms they used. We can think of few better methods of identifying search terms than from such individuals.

This detail wasn't in the paper. Two individuals? And remembering terms they used? On this headlines around the world was built? If you want 'better methods', look to the Japanese. It is actually possible to backtrack from the machine they used and find exactly what they searched on. Security services and police do this sort of thing all the time. Further, Gunnell's response doesn't take on board my point that existing industry methods will tell you what terms are most searched on. They couldn't think of methods because they didn't think to ask experts in that field.

Canning makes some good points regarding the relative use of different search engines. We agree, weighting our findings according to site use may have been more informative.

No, not doing it completely undermines the credibility of the numbers reported. Especially the headline numbers cited at the top of the paper.

We did report that searches of Google, the most frequently used search engine, retrieved the highest number of pro-suicide hits and so weighting our findings by site would be unlikely to substantially alter out findings. Canning also provides a series of useful suggestions regarding strategies for reducing the accessibility of pro-suicide sites and working with the Search Engines themselves.

Why do I have 'useful suggestions'? Because I work in the web area. These researchers don't. They couldn't 'think of few better methods' because they didn't 'think' to collaborate with people such as myself or - actually - true experts who do this sort of thing for a living.

The influence of the Internet upon an individual's risk of suicide and upon population suicide rates is currently uncertain. Our study has shed some light on one aspect of the Internet. Further research is needed to ensure there is a more evidence-based debate on the Public Health impact of the Internet on suicide.

But the paper still stands and the publicity is out there. Is this response letter going to do anything about that? Are the researchers going to take their public responsibility seriously?

This is not an academic question. Decision makers are, unfortunately, far more likely to listen to people like Gunnell than people like me. Gunnell does not indicate here that they have learnt from the reaction that further research must happen by drawing on collaborations with industry and experts in the web field.

This is defensive. This is about covering their academic asses. How does this approach help us actually deal with doing the right sort of research which will lead to the right sort of solutions and actually help those they claim to want to help?

References
1. Biddle L, Donovan J, Hawton K, Kapur N, Gunnell D. Suicide and the Internet: BMJ 2008; 336:800-802
2. Hawton K, Williams K. Influences of the media on suicide. BMJ 2002; 325:1374-1375
3. Schmidtke A, Hafner H. The Werther effect after television films: new evidence for an old hypothesis. Psychol Med 1988;18:665-676.
4. Miller M, Azrael D, Hemenway D. The epidemiology of case fatality rates for suicide in the Northeast. Ann Emerg Med 2004;43:723-730

NB: this response was published in full the next day by the BMJ.

~~~~~~

One thing which I did notice on returning to the BMJ's website to look at responses is that they are carrying a blog by a breast cancer victim which appears to be doing it's job - explaining day-to-day reality to practitioners.

I really appreciate the way you are looking at things.Your blog is an eye opener. As a practising physician, it has changed my outlook towards my patients and their illnesses.

Or sortof a blog, posts form part of a category called 'From the other side', which isn't flagged at their top level navigation (and NB again, probably behind a firewall).

It's by Anna Donald.

I should introduce myself before launching into a blog which I hope is not too depressing: living in the shadow of death. This is my starting point, as I was diagnosed with metastatic breast cancer (I lit up “like a Christmas tree” on the scans) in February 2007. It was not a complete surprise - I’d had primary breast cancer - not terribly high risk - in 2003. But disappointing that so much treatment hadn’t cured it.

I hope to write about things that may interest doctors, other health workers and policy makers about what it’s like to have life threatening disease; to be on the other side of the doctor-patient divide, and to experience 21st century health care for a chronic disease (Sydney’s hospitals are pretty similar to Britain’s), from a quality-of-care perspective.

One commentator puts the value of Anna having a voice in a nutshell:

There is a tremendous amount that we can learn from you as you write to us about your experience and insights. We all have challenges which can bring us to a brink (physically, emotionally, spiritually), and it is encouraging and healing to share thoughts and experiences. This can help us to gain empathy and become better health advocates, personally (for others and for ourselves) and professionally