Quality charter

I have just reviewed our quality charter, which was drawn up nearly a decade ago.

I am pleased to say that only one thing  has changed substantially in all those years - the address. Memo to me - change it, ASAP!

To be frank - one other item may have changed. The charter states we do not sell items - it is strictly correct, we do not currently sell directly but we do subscribe to a number of affiliate schemes, which we believe offer appropriate goods; and we do support some local historians who sell their own books. We are also considering selling second-hand books. But that is a story for another time.

Free services

Our web-site manager is at Glastonbury and the rest of us are concentrating on a major new contract. So apologies that free news feeds are not currently running on their normal daily basis.

All contracted services continue as normal - and in fact are being stepped up.

Normal service will resume after Glastonbury (we hope).

Fattism or fatism?

A new word surfaced today - fatism. Or is it fattism?

The authors of the word spelt it as above: fatism. We think that would be pronounced fay-tism when they really want a word pronounced fat-tism. In those circumstances English convention is to double the last consonant. For instance "ratting" not "rating" means chasing rats, "matting" not "mating" means making mats and you are "hatted" not "hated" if you wear a hat. That gives us "fattism".

In case you're in any doubt, it means prejudice against overweight people. Here's the story.

Curiously in the age of tweeting, English is becoming more like German with more and more portfolio words emerging. Does it matter? Probably not but we're resisting some of them - like "underway" and "healthcare". We'll generally write "under way" and "health care".

Citizen news editors?

We've had it in mind for some time - they talk about citizen journalists but what about citizen news editors? The news feels instant these days but much of it takes time to prepare, especially if it's to have any depth and balance. A news editor's job involves selecting the stories worth working on .

Yesterday seemed the ideal chance to invite the e-world into our virtual newsroom - to help us to select the stories to write up.

There was a flurry of press releases during the morning, some for instant release, some with embargoes attached. There were all on different topics. Quite a few were government announcements - maybe we should just have planned a single story headed "government announcements". By mid-morning it was clear we were in a news fog and that choices would have to be made about the most significant news. What better solution than to ask potential readers?

We'd led in the early morning with some big stories on children getting the wrong drug doses, on maternity service problems and on a new meningitis vaccine - and also of course on Haiti. We were not behind with the news but we now found ourselves with many story proposals to sift.

So using the blog and using Twitter we rushed to implement the half-formed plan. The initial story-list had about 16 stories on it. We could not give details of embargoed stories but indicated the topics. What visitors did not know was that some topics included several possible stories - see today's big roll-up on pregnancy and diet.

We invited the world at large to be citizen news editors and help us to decide the most important stories, before we wrote them - even before we did any more work on them in some cases.

Here was how the day worked out, with regular updates on Twitter:

• at 1pm we announced the poll and within minutes we'd added a 17th story to the story list;
• several people retweeted the announcement (thanks for the RTs!);
• by 3pm we reported there were enough votes for us to identify a couple of stories for extra work;
• by 5pm we reported the exercise had prompted some people to send us extra material. We added one more topic on GP issues;
• at 6pm we added two more topics on heart care and health-funding.
• At midnight we closed and deleted the poll.
• By 2am some of the selected stories we appearing on our newsfeeds.

The results? In fact, not a large number of votes after the initial flurry. Surprisingly a very small proportion of those who clicked through seem to have voted. I'd like to know if votes weren't being recorded and if there is a problem with the polling gadget on blogger.

Four topics came out level-pegging - medical training, alcohol policy, transplants and psychiatric drugs. We have written up the first three and they can be found on our news feeds. Given the nature of the news, we might not have done alcohol policy and transplants. But we have - and Britain's new alcohol policy is now today's lead item on Englemed and also at doctors.net.uk.

The vote did not dictate everything we did

Why did visitors not vote? It would be interesting to know. There may have been too many topics and they may not have been specific enough.

An exercise which involved a smaller number of very specific stories might attract votes. It would also be a problem. One result would be to tip off our competitors about stories we are working on. It would also mean we could not highlight embargoed reports - and there were plenty of those. We're not ready for that yet.

Could this be done routinely? Probably not. But we'll certainly attempt it again sometime when circumstances seem right. Yesterday it was worth doing - it helped us to see through a great fog of news, much of it with potential and much of it half-formed.

Tonight's story list - quick poll!

We've had a large number of announcements about all sorts of topics today.

So here's your chance to help us decide the priorities for our news feeds and writers. Use our poll on the left to tell us which you think are likely to be the most important. You can cast multiple votes but please don't vote for more than half a dozen.

Don't forget we've already reported some of the stories you may see as headlines today - such as the drug errors that endanger child patients, maternity crisis in Milton Keynes.

Some of the stories on our story-list are embargoed until midnight - so we can only publish scanty details.

The poll will end at midnight, today Tuesday, GMT.

1/ NHS Constitution comes into law
2/ Protection for vulnerable adults
3/ New organ donation drive in Scotland
4/ Government drive against health inequality
5/ Regulation of medical education and training
6/ Psychiatric drug collaboration launch
7/ Personalised care plans announced for cancer survivors


The following topics are likely to be the subject of embargoed press releases about new research findings:
8/ cervical cancer
9/ smoking
10/ pregnancy
11/ nursing practice
12/ heart diagnosis
13/ fall prevention
14/ Benefits of the apple


Some more stories breaking today:
15/ Fitness criteria for assisted reproduction treatment
16/ UK drive announced against alcohol abuse


Slots reserved for more breaking news today
17/ Embargoed story on GP issues
18/ Embargoed story on heart patient care
19/ Embargoed story on health funding
20/


If you know of other news we should be looking at for our newsfeeds tomorrow, use the comment option.

* Poll now closed

Santa Claus row - we warned you!

No sooner had we commented on the somewhat po-faced responses to the medical oddities in the annual Christmas edition of the British Medical Journal, than events took an even odder turn.

An unfortunate Australian doctor called Nathan Grills was forced to defend himself against the might of the world's media for criticising Santa Claus for being too fat. We understand that editorials were written in newspapers around the world ; some of the more savage picked on the Australians for not having a "proper Christmas" - as their Christmas is celebrated at the blazing height of summer.

Speaking to the Australian Associated Press Dr Grills rushed out an explanation.


"Most of my 'Santa - A public health pariah?' article was meant to be tongue-in-cheek... It's a Christmas spoof," he explained, using a word of one syllable.

He went on: "I hoped to spread a bit of Christmas cheer, but with a tinge of seriousness to provoke a bit of healthy Christmas dinner table conversation."

Finally he stated: "To clarify, I am not a Santa researcher. The article was written in my spare time for a bit of comic relief."

This was our original report on Dr Grill's comments. But, note, we also managed to find some experts in Sweden who shared Dr Grills' purported concerns about Santa's health; and not only does Sweden still have  a proper winter, it also  contains Lapland, which claims to be the home of Santa, so they should know what they are talking about.

May we wish all our readers a very merry, happy and joyful Christmas and a prosperous New Year.

Keeping up appearances...

It was only meant to be a bit of Christmas jollity. Instead everyone has gone very po-faced about some research suggesting you may well be as young as you look.

Here's our report: Appearances may be deceptive. This report makes it clear the article is in the Christmas issue of the British Medical Journal. While not exactly a spoof issue, it is notorious for publishing odd findings and curiosities. Not to be taken too seriously.

Apparently other media took the report seriously and missed the point. Most serious of all was this very detailed report in The Guardian headed Look Young, Live Longer.

This prompted a long ripost from the NHS Choices "health news unspun" pages here. NHS Choices almost gets round to the point that smoking, for instance, is notorious for ageing the skin. If you smoke, you look older and you reduce your life expectancy.

Frankly anybody should be able to read the basic details of this report and spot that it is very, very limited in what it says. All the researchers found is that identical twins aged 70 may show their biological age in their appearance. So it is purely about the environment and the lifestyle of people with identical genes.

In reality, we know we pass judgements on people's ages using all sorts of uncontrollable factors, which may well result from genes - for instance, hair loss, grey hair and even bone structure. The BMJ study says nothing about such things.

Sometimes the NHS Choices analyses are well worth reading. On this occasion it has missed the point.

For the BMJ Christmas issue is always a cocktail of unbelievable reports and unsustainable headlines. It's a chance to read, enjoy, chuckle for a moment and learn a little bit of scepticism about far-flung conclusions.

Alcohol and healthy diets - what's the story?

We've been harping on about the so-called Mediterranean diet for some time. Much of the recent research on this has come from Spain, where researchers seem to have decided to define the southern European diet as an intrinsically healthy one ie one involving vegetables, nuts, fish and minimal animal fat.. According to this story, the Mediterranean countries only eat small amounts of meat and drink in great moderation. I find this hard to believe.

So today's report from Spain is gratifying. It does not exactly say that the Spanish are heavy drinkers but still quite healthy - but that is the implication. For the report says that the more a Spanish man drinks, the healthier his heart. As an aside, the researchers add that Spanish men  drink quite a lot and indeed the country's vineyards and granaries make it the world's third largest producer of alcohol.

There will be a lot of criticism of the findings. The definition of health is quite narrow - heart disease. What about the other problems alcohol may cause, including liver disease and stroke?

I think there's a more interesting question. Is the finding unique to Spain and similar countries? Is there something about Spain that means drinking is linked to better health. Now the researchers tried their best to disentangle drink from other factors but I wonder if they succeeded.

For instance, in a country that takes its alcohol with its meals, good drinking may be linked to good eating. And whereas in the UK, a good meal probably involves steak, chips and a sugary, fat-laden dessert, in Spain it may involve a menu that's a great deal healthier. In northern Europe also, heavy drinking is associated with the ubiquitous beer belly as drinkers also tend to pile on fat. It seems unbelievable that the obesity that many heavy drinkers suffer from does not also lead to heart disease.

So this is yet another plea for some research on the real diets of the southern European countries. These are diets rich in wine, olive oil and yes also vegetables, fruit, nuts and quite a lot of fish. Let's not pretend the Mediterran lifestyle is entirely healthy. But it may offer some clues as to how to enjoy alcohol better.

Folic acid and pregnancy

All women who are considering having a baby are encouraged to take folic acid. Some countries include the vitamin with their flour - to ensure all women get it.

The reason is that it has a dramatic impact in preventing the disability spina bifida and a range of conditions called neural tube defects.

So today's report linking it to the development of asthma in children is potentially alarming - as it might deter women from taking this important vitamin.

The Australian researchers stress their findings only apply to the taking of the vitamin in late pregnancy. To prevent spina bifida, it needs to be taken before conception or in early pregnancy.

However it does raise questions about adding folic acid to flour - as it might lead to women being over-exposed in late pregnancy.

The Englemed report allows you to link through to the original article.

We've seen some criticism of the research which says the following:
it was conducted by postal survey;
only 76 per cent of women took part.

If that was so, it would make it dangerously flawed as the increase in asthma risk is only about 23 per cent.

However those criticisms only apply to the final stage of the research, when the children were aged five. And no link with asthma was established at this age.

Most of the research was, in fact, done by research nurses who conducted interviews with the women. When the children were aged three, the women were interviewed again and this is the age at which the link with asthma was found. At this point 88 per cent of the original sample were taking part, just four percentage points fewer than the 92 per cent who successfully gave birth.

The numbers involved - just over 500 families - are not enormous so the findings have to be treated with caution. It does not seem they can be dismissed out of hand.

Asthma is quite a common condition in young children and a small increase could affect quite a few children. Ironically, folic acid fortification of flour was introduced in Australia after this research was done.

It will be interesting to see what other analysts make of this and what further research is done. For, yet again, it is thought-provoking research that raises some tricky issues.

Patient views

We've now created a list on the left-hand side for patient and family blogs. Let us know if you have a blog you'd like to be considered for inclusion. We're looking for blogs that are interesting, yes, that share good news and bad alike, yes, and also demonstrate a healthy scepticism about what's in the news and what's pushed at you as cures, treatments and explanations.

That genetic cure for eye-sight

The remarkable story about how doctors have used genetic treatment to restore sight to children came with a great many resources.

This is a graphic that explains the treatment.

And here's another viewing of thevideo of the child demonstrating that he can now find his way round an obstacle course. The following text explains what is happening on the two videos, which were shot three months after treatment: Video 1 shows the child traversing the obstacle course with his left (injected) eye patched. He has difficulty seeing the course and it takes him a long time to complete the test. Video 2, captured within 10 minutes of Video 1, shows the same child traversing a reconfigured obstacle course with right (uninjected) eye patched, using his injected eye for navigation. He has no difficulty completing the test accurately.:



Our news report here

Sympathy for the aggregators?

The UK-based news aggregator NewsNow has published a defence of its place on the web in the face of threats of action from established media.

Interestingly when we published a draft manifesto for e-journalism a few weeks ago we put up for discussion two propositions on this issue as we did not think they should be included. (And in spite of quite a lot of interest, nobody has commented! :-;)

These were that:
a) RSS feeds should only contain original writing.
b) Journalists should withdraw cooperation from news aggregators that carry advertising.

This is in effect what is now being considered by major news organisations, along with some potential legal action, placing the business of organisations such as NewsNow in peril.

You must expect us to have mixed feelings on this. These people do get a free ride on the back of working journalists and have certainly made life difficult for us in past years. However they can also perform a useful function, providing a more efficient service than search engines to enable the browser to scan what's going on in the news.

Unlike search engines, aggregators have been able to market specialist RSS feeds to websites - ensuring that none of the fees paid reach the originators of news. Some have very, very aggressive marketing campaigns.

However as a news provider you don't have to participate - and it is true most news organisations have chosen to use aggegation-friendly formats. Until a couple of years ago we did not participate and used a very simple technique to prevent aggregation. That is to keep multiple stories on a single page - ensuring there is no unique URL per story. Now we have changed our format and some of our content can be aggregated.

Any website owner who thinks they are getting the full range of our output by using a third-party aggregator is simply misguided. The news feeds on this site are deliberately selective - interesting and varied, I hope, but selective. In contrast, aggregated RSS feeds tend to be repetitive and lack depth. A typical feed will contain no more than one or two stories, recycled in different formats by different media - with limited or no access to anything that happened as recently as one or two days previously. It sometimes beggars belief that people actually pay for these.

So, at the end, we left just one provision about aggregators in the draft manifesto.

It was this:
12/ News aggregation organisations should be subject to specific monitoring by regulatory authorities for monopolistic power.

No prizes for guessing that we had Google News in mind.

But should propositions a) and b) also be included?

That drifting Mediterranean diet

Normally we grab hungrily at stories about the so-called Mediterranean diet. Yesterday we chose to ignore one, which has seized the attention of the world's media.

This was the story that the Mediterranean diet can help relieve depression, from research published by a Spanish team in the Archives of General Psychiatry. The nature of journal, part of the American Medical Association group, probably helped stir interest.

There has been a great deal of analysis of the "Mediterranean diet" recently, mostly originating from Spanish researchers. Here is another recent one. It's all interesting material and is not to be dismissed - as it links a good healthy diet to all sorts of benefits. In this instance we noted the funding source:  The Spanish Government Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias and the Navarra Regional Government project.

This is how the "Mediterranean diet" was defined for the research: high ratio of monounsaturated fatty acids to saturated fatty acids; moderate intake of alcohol and dairy products; low intake of meat; and high intake of legumes, fruit and nuts, cereals, vegetables and fish. A shorter version stated it was "rich in vegetables, fruits, nuts, whole grains and fish."

I've comment on this drift in definition before. It's increasingly looking as if the Mediterrranean diet is being defined by researchers as a standard "healthy" diet - low in meat and saturated fat and containing only moderate alcohol - rather than as a diet that is recognisably Mediterranean. It creates a circular argument - study a diet known to be "healthy", prove it is "healthy" and link it to a specific region of the world.

Surely the true Mediterranean diet is certainly rich in grain, fruits and vegetable - but specifically it contains large amounts of olive oil, olives and wine. If my memory serves me correctly, this was the kind of diet studied in the original research that defined this diet many years ago. As for the meat content, yes, coastal communities tend to eat fish but do they not raise sheep and goats in the mountains? Choose your dish, Greek moussaka, Italian spaghetti bolognese - it's made with mince from meat.

Arch Gen Psychiatry. 2009;66[10]:1090-1098
Here's our newsfeed on diet and nutrition in health.

A tough week for health reporting

Two news stories this week in Britain have stirred up some old controversies about the quality and merits of popular reporting on medical matters.

The tragic death of a 14-year-old girl after receiving the new cervical cancer vaccine stirred up all sorts of issues.

So it wasn't long before the critics emerged from the woodwork and accused the media of getting everything wrong or pursuing private agendas (yes, sometimes some newspapers do have their own agendas). Here is a report from The Guardian criticising the reporting of the death of a 14-year-old girl after receiving the HPV vaccine.

A second story has also upset quite a few people - because it implied that households with parents who work full time weren't looking after their children properly. We tucked the report away as four paragraphs in the middle of a round up of child health here. Instinctively, we felt it raised all sorts of social issues rather than establishing any direct health links between parents working and their children's lifestyles. Some British newspapers made a big thing of it and upset many of their readers. Here is blogger Jayne Howarth, (who occasionally writes for Englemed)  letting rip at the research.

The problem with these controversies is it begins to sound as if  some people think these stories should not be reported. For when they are reported, there is always scope for misunderstanding and distortion of facts, on the part of headline writers and editors as well as readers.

I'm not sure that the critics of the reporting of the cervical cancer vaccine story really get the problem. It appears, according to statements released yesterday, that the teenager had an underlying and hidden medical condition - it emerges today it was a cancer in the area of the heart.  Nobody yet knows whether the vaccine - or the shock of vaccination - triggered her collapse. The vaccine is being offered to every teenage girl in the country - so if it is going to cause fatal reactions to hidden "underlying medical conditions", that surely seems a legitimate question of public policy.  And it is a real concern for parents, unless they can be reassured their child does not have "hidden" conditions that won't also cause a big reaction.

The story about working parents is more problematic. Instinctively, it seemed a story that needed treating with caution. Usually in these instances, you can spot the flaw quickly - not many people in the study, other factors, eg smoking, not properly accounted for, dodgy source.  In this instance the number of children involved was quite large, about 12,500 and the source reputable - but it felt as if the phrase "working parents" stood for a load of other issues. Instead we focused on a story from Sweden, published in the same journal, the Journal of Epidemiology and Community Health, about pecking order in the playground. And we took pains the highlight the main query about that particular study - it was from Sweden, which may well not be like other countries.

The NHS Choices analysis of the working parents story was particularly interesting and detailed. It seems to boil down to how the findings are interpreted.

Sometime ago I blogged about some guidelines for assessing medical stories. Dr Alicia White apparently provides analysis for NHS Choices and has published her own guidelines for "reading" medical news, which expand on the theme, stressing, for instance, the difference between studies involving humans and those involving laboratory animals.

In our last posting, about the new world of news reporting on the web, we suggested that writers start learning to show greater respect for the intelligence and education level of their readers.

The problem with debunking all medical reports and all scary headlines is that it gives out a rather old-fashioned and patronising message - that only the experts can make sense of the evidence. That's not the world we live in now - the public is thirsty for information and doesn't always trust 'experts', knowing they are not always right. Sometimes it is true people flit - or tweet - from headline to headline. But if they are interested in a topic, they will dig deep, checking sources and challenging conclusions.

Both readers and writers need to understand one simple thing about medical news: it is that very, very few individual pieces of research change understanding of health and medicine.

Those that do, tend to involve very large numbers of people  - hundreds of thousands. Good doctors and the public health specialists who assess evidence pull together and assess large numbers of pieces of research. Sometimes they are slow to do so and sometimes they get it wrong. Look how long it took for all the problems with hormone replacement therapy to emerge. And how long it took for British government scientists to put a stop to cattle being fed the brains of other cattle. And I'm still not convinced (and here) that British medicine isn't over-reliant on drugs to treat blood pressure when overwhelming evidence from the USA and elsewhere suggests that fitness and good diet can be effective.

So it's no wonder that the public want faster information and they want a chance to decide for themselves. From a reporting point of view, the most helpful medical organisations are those that get in fast with response and explanation. Full praise here to the British Heart Foundation who were quick to challenge a study that could have been read as disputing that eating fish is good for the heart. Report here. But it didn't happen in the case of the Coventry death - and public statements continue to be erratic and poorly sourced.

Another study involved 39,000 people in 29 Asian countries and we blogged on it a few months ago. And it reached the curious and surprising conclusion that those who "trust" the media are the healthiest. A rogue study? Perhaps.Or perhaps an argument for more rather than less health reporting.